Elder Care Home Health Blog » Home Health Care

Long Term Care Insurance – Elimination Periods

admin — Fri, 03 Feb 2012 12:00:53 +0000

We Urge You to Look at Your LTC Policy Before You Need It and Check about Elimination Periods and Your Daily Benefit.

Many of our clients at Boca Home Care Services, Inc. have Long Term Care Insurance. They use their policy when personal care and household assistance following a fall, accident, illness or surgery is needed. The client may be returning home from a hospitalization or Rehab stay, compounding a stressful and busy time of coordinating care while recuperating.

It’s not unusual for people to forget that the policy they purchased has an “Elimination Period” which likely lowered their premium payments. However it means home care coverage does not begin right away, but after the “Elimination Period” is met. Let’s face it, few people remember the terms of their insurance policies. As time goes by, details fade. It’s an expensive “surprise” through which time you must pay out of pocket for the care you need. Insult to injury, usually the most help is needed at the start of care.

“Elimination Periods” can be a few days, a few weeks or even a few months. If you require live-in or substantial care, the costs can be thousands of dollars – you didn’t expect to pay.

Boca Home Care Services, urges you to familiarize yourself with your Long Term Care Policy BEFORE you need to use it. Call your agent or the company and review the terms of your coverage. If your policy has an “Elimination Period”, plan accordingly. Suggestions include: setting funds aside to cover the period you would have to pay out of pocket expenses for your care, put together a plan with family, neighbors and friends of who can help with which tasks. If some people can do the shopping, bring in cooked dishes, and take you to appointments, then you may need a Home Health Aide just for personal care such as bathing, dressing, respite time and laundry. In this way, you may be able to manage with only the minimum hours from an Aide. Research which food stores, restaurants and pharmacies deliver in your neighborhood.

Lastly, some policies will count days in a Rehabilitation facility and Medicare home health visits (Boca Home Care) towards the “Elimination Period”. Explore these possibilities with your insurer. Ask what paperwork is required to have these Rehab and Medicare visits count

How to limit Alzheimer’s wandering

admin — Wed, 01 Feb 2012 12:00:53 +0000

By Elizabeth Cohen, Senior Medical Correspondent/updated 11:34 AM EST, Thu November 10, 2011

A hallmark feature for some people with Alzheimer’s Disease is wandering which is scary for the caregiver and potentially very dangerous. Here are some tips and things to look out for should your loved one be a wanderer with dementia.

Tips to prevent or tract people who have Alheimer's Disease and wander.

People with Alzheimer’s and other forms of dementia often leave clues that they’re about to wander.

(CNN) — It was early evening when Lee Ferrero got in his car to make the trip home from a meeting for work. He’d done the trip many times over the years, and he looked forward to the drive.

Several hours later he found himself in open farmland in unfamiliar territory. He pulled over, brought out a book of maps, and realized he’d driven two hours past the turnoff to his home in Los Osos, California.

“It was terrifying,” he remembers now. “I thought, I didn’t mean to come here. How did this happen? I just zoned out.”

But he wasn’t just zoning out. A visit to the Mayo Clinic in Scottsdale, Arizona, showed Ferrero was in the beginning stages of Alzheimer’s disease, a form of dementia.

“That car ride was a real wake-up call,” he says.

After his trip to Mayo, Ferrero’s wife insisted he get a professional driving evaluation to make sure he was safe to drive. His driving was fine — the only problem was that he might wander off again down the road.

It has been five years since that fateful car trip. The disease forced Ferrero, an Air Force veteran, to retire from his position as president and CEO of the Private Industry Council of San Luis Obispo County. Now 64, he doesn’t want to sit home all the time, and still drives and walks around.

To decrease the chance he’ll wander again, Ferrero writes down exactly where he’s going so he can refer to it later, and he wears an ID bracelet with a 24-hour emergency response number. He hasn’t had another wandering incident, but knows he might at some point as his disease progresses.

“I forget things I never used to forget and I know it’s only going to get worse,” he says.

November is National Alzheimer’s Disease Awareness Month and Family Caregiver Month. About 60% of the nation’s 5 million Alzheimer’s patients will wander, according to Beth Kallmyer, senior director of constituent services at the Alzheimer’s Association.

“This is such a big worry for families,” she says. “We tell them their loved ones can wander off at any time, even when you just go into the kitchen for a minute to start dinner.”

Kallmyer advises families that there’s no way to keep an eye on someone 24-7, but that there are some steps they can take to decrease the chances their loved one will wander.

1. Keep wandering top of mind

Sometimes families are surprised when their loved one wanders. Lawrence Schonfeld, an Alzheimer’s expert, has noticed sometimes families forget that wandering is a huge risk because they’re so overwhelmed with other aspects of Alzheimer’s disease.

That can be a fatal mistake.

“Families are worried their loved one will leave the stove on in the kitchen, or they’re annoyed when their loved one asks the same question over and over again,” he says. “Wandering isn’t always their major concern.”

2. Pick up on the red flags of wandering

Wandering can happen at any time, but it’s more likely in certain situations, such as when someone with dementia is in unfamiliar surroundings.

People with Alzheimer’s and other forms of dementia often leave clues that they’re about to wander. If your loved one says, “It’s time to go to work,” she might truly be headed out the door in a few minutes. “I want to go home” might mean he’s about to go in search of his childhood home, and you have to stop him.

3. Distract them

Don’t say “Dad, you haven’t worked in 30 years,” or “Mom, you’re already at home.” Reasoning won’t work. Instead, distract.

“If they say they want to go to work, tell them ‘OK let’s go see if we can find your shoes,’” Schonfeld suggests. “By the time they get their shoes on they’ll have forgotten about going to work.”

4. Block (or disguise) the exits

For safety reasons, you should never lock or trap a person with dementia in a home alone. If someone is there with them you can block the doors. There also are screens you can buy that look like, say, library books, so your loved one won’t realize it’s in front of a door. You can also put a lock toward the bottom of the door; Kallmyer says people with dementia won’t think to look for a lock in such an unusual place.

Another idea: Put a mirror or a stop sign on the door, or you can try putting a dark rug in front of the door. People with late-stage dementia might think it’s a hole and won’t go near it.

5. Label your rooms

Sometimes people with dementia will go wandering off in search of the bathroom or a glass of water and get distracted and actually leave the house. The Mayo Clinic suggests putting a picture of a toilet on the door to the bathroom or food on the door to the kitchen, so they can more easily find what they need.

6. Keep them busy

“Sometimes people wander out of boredom, or because no one’s paying attention to them,” Kallmyer says. “Spending a lot of time watching TV isn’t good. Have them wash dishes with you, or fold clothes.”

You can also enroll your loved one in an adult day care program so they’ll have interesting activities. Seniorresource.com and Eldercare Locator have search tools for finding a program near you.

7. Take a walk

“Have them take a walk or exercise with you,” Schonfeld suggests. “They may be so tired afterwards they’ll want to sit for a while.” Even if they’re not tired, the social engagement of the walk might be enough to keep them from wandering in search of company.

8. Provide safe wandering

Create a path through the rooms of your house as a place for your loved one to wander, or a circular trail through a fenced backyard, the Mayo Clinic advises.

GPS shoes track dementia patients

9. Consider technology

Some devices alert you if a door is open in the house. Others tell you if your loved one has wandered beyond a certain area. You can even attach a GPS to your loved one and then go online to find him on a map; the GPS might be on a bracelet or in a shoe.

The Alzheimer’s Association has an overview of electronic devices that can help keep track of Alzheimer’s patients, and the association also has information about the ComfortZone and other safety products it sells. American Health Assistance Fund has a partial listing of companies that sell safety products. These devices can be expensive and some have a monthly service fee.

10. Find the right facility

Many families aren’t sure they can safely keep their loved one with dementia at home. The Alzheimer’s Association has a guide to determining what kind of care you need, and a guide for finding nursing homes and assisted living facilities.

Schonfeld recommends you check out a facility to see whether it has any complaints against it, especially those that involve wandering. The National Long-Term Care Ombudsman Resource Center has a list of state ombudsmans’ offices, which can help you find the complaints.

Be sure to ask the right questions.

“Is the door monitored, either electronically or by staff?” Schonfeld says. “Do they have electronic devices to keep track of people who wander? And ask about their strategy for what they do if someone does wander off.”

Aaron Cooper and John Bonifield contributed to this report.

Read more: http://www.cnn.com/2011/11/10/health/alzheimers-lost-empowered-patient/index.html?hpt=hp_bn10

Navigating Senior Care Services – A Guide to Acronyms:

admin — Mon, 30 Jan 2012 12:00:10 +0000

It is so difficult to understand people when they speak in letters rather than words. The medical profession and governmental organizations in particular seem to have their own language comprised of acronyms. This can be immensely frustrating to us civilians. Here is a guide to acronyms most having to do with Senior Care Services, Home Care, and some medical terms.

Acronyms and Abbreviations:

AAA: Area Agency on Aging

ABT: Arterial Blood Pressure

AC: Before meals

ADA: Americans with Disabilities Act

ADC: Adult Day Care

ADHC: Adult Day Health Care (see ADC)

ADL’S: Activities of Daily Living (& see IADL)

AHCD: Advanced Health Care Directive

APS: Adult Protective Services

B&C: Board & Care Facility

CNA: Certified Nurses Assistant

Cap Dec: Capacity Declaration for Exclusive Informed Medical Consent

CCRC: Continuing Care Retirement Facility

CFAR: Center for Aging Resources

CFP: Certified Financial Planner

CFAR: Center for Aging Resources

CM: Care Manager or Case Manager

CSA: Certified Senior Adviser

COE: Conservator of the Estate

COP: Conservator of the Person

CONS: Conservatorship

C’TOR: Conservator

C’TEE: Conservatee

DAC: Disabled Adult Child Benefits or/ Disabled Adult Child

DD: Developmentally Disabled

DHS: Department of Health Services

DP: Discharge Planner

DPOAHC: Durable Power of Attorney for Health Care

DSM: Diagnostic & Statistical Manual of Mental Disorders

DSS: Department of Social Services

ESC: Eldercare Services Co-ordinator

FC: Family Caregiver

FID: Fiduciary

GAL: Guardian ad Litem

GCM: Geriatric case manager

HHA: Home Health Agency

HICAP: Health Insurance Couseling & Advocacy Program

HIPAA: Health Insurance Portability & Accountability Act

HMO: Health Management Organization

IADL: Independent Activities of Daily Living (& see ADL)

ICF: Intermediate Care Facility

ICU: Intensive Care Unit

IMCU: Intermediate Medical Care Unit

IPU: Inpatient Unit

LC: Limited Conservatorship

PPN: Licensed Practical Nurse

LPS: Lanterman-Petris Short – Mental Health Conservatorship

LVN: Licensed Vocational Nurse

MICU: Medical Intensive Care Unit

MMMNA: Minimum monthly maintenance need allowance

MMSE: Mini Mental Status Exam

NAPO: National Assn of Professional Organizers

NGA: National Guardians Association

OPG: Office of Public Guardian

PA: Physicians Assistant

PCP: Primary Care Physician

PF: Professional Fiduciary

PFAC: Professional Fiduciaries Assn of California

PDN: Private Duty Nurse

PDR: Physician’s Deck Reference

PHI: Personal Health Information

PICU: Pulmonary Intensive Care Unit

PPF: Professional Private Fiduciary

POA: Power of Attorney

P.O.L.S.T.: Physicians Order for Life-Sustaining Treatment

PT: Physical Therapy

RW: Respite Worker

RCF: Residential Care Facility

RCFE: Residential care facility for the Elderly

RCU: Respiratory Care Unit

RN: Registered Nurse

RNA: Registered nursing assistant or Rehabilitation Nursing Assistant

ROM: Range of motion

SCU: Special Care Unit

SDRC: San Diego Regional Center

SLMB: Special Low-income Medicare beneficiary

SNF: Skilled nursing facility

SNT: Special Needs Trust

SS: Social Security

SSA: Social Security Administration

SSI: Supplemental Security Income

SSDI: Social Security Disability Insurance

SSP: State Supplemental Payment – augments SSI

T’tee: Trustee

USPHA: United States Public Health Admin

VA: Veterans Affairs

W&I: Welfare and Institutions Code

Read more: http://www.elder-care-services.com/blog/2011/11/06/Navigating-Senior-Care-Services-Part-1.aspx

Private vs. Licensed Home Care

admin — Fri, 27 Jan 2012 15:45:47 +0000

Once the decision is reached to that a home health aide or caregiver is needed one has to decide whether to hire privately or go with a licensed company. There is a lot more to consider than price so you must know your responsibilities as an employer or as a client. Also, Long Term Care insurance may come into play.

A cautionary tale learned the hard way. Every now and then a client decides that they will hire someone privately who someone in their building used. It is cheaper after all-although as the employer of the privately hired aide, you are legally responsible to pay Social Security and other Federal taxes- remember “NannyGate”?

Last week, a client did just that, they decided they wanted to save their insurance, hired someone referred to them and discontinued service. Two days later Boca Home Care Services received a call from the hospital from this client. Her new aide whom she hired on her own didn’t stay with her or come when called so the client attempted getting to the bathroom on her own, fell, is severely bruised along her left side. Thankfully, nothing was broken, but her spirit.

Of course this scenario can happen with the best of care however, the client had no recourse. She couldn’t call the office and ask for a new caregiver. No one could speak to the aide and set a higher standard. The client learned the hard way, she was on her own. We were back on service in the hospital that day. Even though her LTC insurance doesn’t cover in the hospital, she wanted one on one help in the morning to start her day.

There are tangible, important advantages to hiring a caregiver through a licensed company. You have back up in case the caregiver cannot work or they change schedules. The aides are screened and credentialed. There is accountability and transparency. When you or a loved one is incapacitated these things are worth the cost.

Top 5 Regrets of the Dying

admin — Wed, 25 Jan 2012 15:00:07 +0000

Posted: 1/21/12 06:12 PM ET/Bronnie Ware is a writer and songwriter from Australia.

A Hospice care worker relates her findings culled from many patients over time. Ms. Ware has consolidated the top five regrets her patients communicated to her. Some are typical, wihshing they worked less and others are very poignant about wishing they had chosen to be happier. Overall, it is our relationships which matter most to us inour last weeks and days.

Ms. Ware worked in palliative care for many years. Her patients were those who had gone home to die. She spent the last 3 to 12 weeks of their lives with them.

Every single patient found their peace before they departed though, every one of them. She reports being amazed at the capacity for growth and change a person has at the end of their life.

Here are the five regrets or things they would have done differently, the common themes as told to Ms. Ware by her patients.

1. I wish I’d had the courage to live a life true to myself, not the life others expected of me.

This was the most common regret of all. Most people had not realized even a half of their dreams and knew that it was due to choices they had made, or not made.

It is so crucial to realize and live some of your dreams while you still have your health and strength. Once illness and weakness take over your body, it is usually much harder or not possible to do so.

2. I wish I didn’t work so hard.

Every male patient stated this regret. The fact that they missed much of their children’s formative years loomed large. Many women cited it also though most were from an older generation and were homemakers.

Many, though not all are our choices on how we wish to live and compete with neighbors. How we value our time, what we must do without if we choose to value time over objects.

3. I wish I’d had the courage to express my feelings.

Many of her patients said they suppressed their feelings in order not to rock the boat and they wish they had been more honest. Some felt this suppression ate them up inside and may have led to their illness.

It is hard to be honest with people but by doing so, it can deepen a relationship or end one that was either negative or superficial.

4. I wish I had stayed in touch with my friends.

Ms. Ware found that “Everyone misses their friends when they are dying. But when you are faced with your approaching death, the physical details of life fall away.”

We all lead busy lives and live far away from one another in some cases, therefore friendships slip away. At the end of life, people want to get their finances and business in order. The thing is, by then they are usually too weak to do so and it falls to others to do. It is our relationships and loves that matter at the end of our life. The loves, the friends are what count most. The nurturing of these relationships can only be done before one is too ill or weak to d

5. I wish that I had let myself be happier.

This is a surprisingly common one. Many of her patients only realized that “happiness” is a choice once they were at the end of their life. Fear of change, falling into the familiar and comfortable or just plain old patterns make it harder for us to realize this.

When you are on your deathbed, what others think of you is a long way from your mind. How wonderful to be able to let go and smile again, long before you are dying. Her patients said they wished they had laughed more, longer and could be silly more.

This post was originally published on Inspiration and Chai.

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