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Questions About Senior Living
Senior Resource Center
Do you have a question concerning a health or aging related issue?
The Senior Resource Center is Lutheran Senior Life's comprehensive reference service for seniors and their families who have questions about retirement living, senior care and many other related topics.
A telephone call to the Senior Resource Center connects you directly to our staff of senior care professionals who are ready to answer your questions and provide you with the information you need about senior living.
The Senior Resource Center is a free service that allows you to call our toll-free line with your questions. Our experienced staff of senior care professionals can assist you on a wide range of topics, including:
• Safety concerns
• Consumer protection information
• Legal and ethical issues
• Life transitions/housing
• Alzheimer's Disease
• Financial issues
• Long-term care and in-home care
• Medicare and Medicaid
• Social Security
• Socializing/community activities/leisure
• Weight maintenance and exercise
• Health related issues
• General aging questions
Frequently Asked Questions about Senior Living
1. What is Long Term Care?
Long term care in Pennsylvania is a continuum of services that can be provided in a variety of settings to individuals with physical or mental impairments who have lost the ability to function independently. These settings include nursing facilities, personal care homes, domiciliary care residences and in-home services for individuals that reside in private homes in the community. Services may include assistance with activities of daily living such as dressing and bathing, medication management, and other medical and non-medical care. Services may be provided by family and friends in combination with professional health care workers and community and church organizations.
2. What is skilled nursing care?
Skilled care is professionally supervised nursing and rehabilitative care and other related medical and health services. Skilled nursing care is provided for individuals who require 24-hour nursing care, which can only be met in a nursing facility on an inpatient basis because of illness, injury or disability.
3. How do I find the best nursing home in my area?
When considering nursing home placement, planning ahead may help individuals gain more control during a very stressful period. The Centers for Medicare & Medicaid Services (CMS) provides online tools and publications to help individuals make informed choices when selecting long term care providers including nursing homes. The "Guide to Choosing a Nursing Home" and Nursing Home Compare may be helpful during this process.
The Pennsylvania Department of Aging also has a Nursing Home Checklist that may also provide assistance.
4. How do I pay for nursing home care?
There are three ways to pay for care in a nursing facility: (1) Medicare or private insurances; (2) Private pay resources; and (3) Medical Assistance. Medicare or other private insurances can only be used as a source of payment for skilled nursing care. Eligibility requirements are strictly defined by the health plan and will not cover intermediate or personal care. Therefore, most insurances, including Medicare, will only pay for short-term care in a skilled nursing facility. Private pay resources will then need to used, but costs can be offset by having long term care insurance policies. When assets drop below a certain level as determined by the state Department of Public Welfare, then the nursing home stay will be covered by Medicaid.
5. What is the difference between Medicare and Medicaid?
Title XVIII of the Social Security Act is commonly known as Medicare. Medicare is a federal program that provides insurance benefits for people over the age of 65 and for people with disabilities who are under the age of 65. Medicare Part A covers hospital, skilled nursing care, home health, and hospice services. Medicare Part B (for which a monthly premium must be paid) covers physician, other medical and preventive services.
Medicaid was authorized as a joint federal and state program under Title XIX of the Social Security Act in 1965. The program supplies health care coverage to low-income, aged and disabled individuals and relies on states to set eligibility limits and, as such, there is a wide variation in Medicaid benefits from state to state. Individuals must meet state eligibility requirements based on income and financial resources to qualify for assistance. Individuals who have both Medicare and Medicaid are considered "dual-eligible."
APPRISE, an insurance counseling program designed to help Pennsylvanians age 60 and over with health insurance questions and concerns, may also be helpful.
6. What is Medicare's new Prescription Drug Benefit?
Medicare Part D is the new Prescription Drug Benefit being offered to all Medicare beneficiaries starting January 2006. This is a voluntary benefit. Each Medicare Approved Prescription Drug Plan will differ in terms of premiums and cost sharing, drugs covered, and pharmacy network. There are a variety of options so beneficiaries will have to thoroughly compare Medicare Prescription Drug Plans to determine which plan best meets their needs should they decide to enroll.
The initial enrollment period is from November 15, 2005 and May 15, 2006. If enrolled by December 31, 2005 coverage will begin on January 1, 2006. Beneficiaries need to know that if they are eligible to enroll in a Medicare Prescription Drug Plan and do not do so between November 15, 2005 and May 15, 2006, they may face increased premiums when they subsequently join a Medicare Prescription Drug Plan. If a beneficiary already has prescription drug coverage that is as good as or better than Medicare's plan, they may choose not to enroll. Special rules also apply to those beneficiaries that also have Medicaid.
The APPRISE program is also a good resource to help with understanding and making decisions about this new benefit.
7. Are there alternatives to nursing home placement?
Yes. Most people want to remain in their home for as long as possible. Sometimes when it is no longer safe and the individual can no longer have their needs met at home, a nursing home or other type of long term care placement may be considered. However, Pennsylvania does offer alternatives to nursing home placement. LIFE (Living Independence for the Elderly) programs and PDA Waiver Programs can help individuals that meet the requirements for nursing home care remain in their own homes by bringing the services needed to them. Although nursing home placement may be unavoidable, home and community-based services may be an option for some people.
8. What is meant by continuing care communities or CCRC?
Continuing care communities are facilities licensed and regulated by the Pennsylvania Insurance Department. Continuing care communities typically offer an independent lifestyle as resident’s age. In some cases, assisted living and nursing home facilities may be a part of the property or campus. These communities offer a comprehensive package of services adapted to suit individual needs, abilities and preferences. Overall, the fees paid by residents of CCRCs cover residential accommodations and may also include utilities, meals, housekeeping, outside maintenance, linens, major appliance repair and security services. Additional fees may apply for other services and amenities.
9. As a caregiver, what are some important things that I need to know?
Care giving is not easy. The caregiver role can be very rewarding yet comes with many challenges. Having access to information, skill development and emotional tools is necessary to provide balanced and confident care for as long as possible.
Other tips for caregivers:
- Be alert to caregiver stress and burnout.
- Arrange for respite care and take regular breaks.
- Investigate and use local, state and federal resources.
- Take time for self care, relaxing and your own pleasure.
- Go to the movies or take a walk.
- Find support wherever you can.
- Join a support group.
- Most importantly, don't be afraid to ask for help.
Caregiver PA can provide additional resources for caregivers in Pennsylvania.
10. What is an Advance Directive?
Advance directives describe two types of legal documents that enable an individual to plan for and communicate their wishes for medical care in the event they become unable to do so. In Pennsylvania, two types are specifically authorized: (1) A living will allows you to document the types of life-sustaining treatment that you want or do not want and would apply only when your condition or illness is terminal or you are permanently unconscious. (2) A durable power of attorney for health care allows you to appoint a person you trust as your health care agent (or surrogate decision maker), who is authorized to make medical decisions on your behalf. It is wise to consult with your doctor and tell close family members and other health care providers about your wishes and give them copies of these documents.
11. What is Hospice Care?
Hospice care is designed to provide comfort and support to individuals and their families when a terminal illness no longer responds in a meaningful way to cure-oriented treatments. The goal of hospice care is to improve the individual's remaining days by offering comfort and respect. Hospice staff and volunteers offer a specialized knowledge of end-of-life care including issues such as pain management. In addition to hospice care being provided in private homes, hospice can also be provided in hospitals, nursing homes, other long-term care facilities and freestanding hospice facilities. Services are covered by Medicare, Medicaid, most private insurance plans, HMO’s and other managed care organizations after meeting certain criteria. For additional information and resources, visit the Hospice Foundation of America website.
12. What is Home Care?
Home care includes a wide range of health and social services. These services are delivered at home to recovering, disabled or chronically ill people in need of medical treatment, rehabilitation and/or assistance with activities of daily living. Medicare and other health plans may help pay for home care. If an individual is homebound (cannot leave home without assistance), under a physician's care or requires skilled nursing or rehabilitative services, they may be eligible for services provided by a Medicare-certified home health agency on an intermittent basis.
Individuals can also elect to privately pay for other services provided in the home such as private duty nursing, meal preparation, medication reminders, companionship, laundry, light house keeping and errands and shopping. For your protection, it is important to ask care providers if they are bonded and insured.
Community agencies such as the Area Agency on Aging may also be able to provide home assistance for reduced fees.
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