People often confuse Medicaid for Medicare, another popular government-sponsored program. However, these programs are very different in what they are designed to do. Medicare is the national health care assistance program provided by the federal government.
Its function is to make sure that affordable home health care is available to all seniors and disabled people younger than 65. On the other hand, Medicaid is a program run by the individual states, along with some federal assistance, and it varies considerably from one state to another. One of Medicaid’s main function is to provide assistance to those who have very few possessions and assets. One of those areas that many people need assistance with is health care, and so Medicaid picks up the tab for assisted care costs that many seniors simply cannot pay for on their own. Medicaid is a wonderful provision to make sure that those with few means receive the care they need even when they cannot afford to pay for it themselves.
Only problem is that Medicaid does have its limitations, and one area that is draining Medicaid of its precious resources is long-term care. In fact, based to the Centers for Medicare and Medicaid Services, in 2001, Medicaid paid for almost 40% of the annual long-term care bill in this country.
So what is long-term care according to the definition put forth by Medicaid? It is generally custodial care that is provided when a person needs assistance for activities of daily living, which includes bathing, eating, dressing, continence, toileting and transferring.
Skilled care on the other hand, which is paid for to some extent by Medicare, is for situations in which you are expected to get better as a result of the care. It is often referred to as short-term rehab, and includes changing dressings, IVs administering medications, and physical and speech therapies. Once a patient’s progress stops, the skilled care reverts to custodial care. Medicare will not pay for long-term care if it is not accompanied by the need for skilled care, and so the problem falls on Medicaid to pay for the ongoing costs of custodial care.
Although Medicaid will pay for long-term care, there are severe restrictions on the qualifications for assistance.
First and foremost, Medicaid is a program designed to help those who are impoverished. In order to qualify for long-term care assistance through Medicaid, a person who must spend practically all of his own possessions before Medicaid will begin picking the tab. Medicaid, in general, is not set up to provide care in a home setting.
Usually the care must be provided within a residential facility, meaning that a person has to give up much of his independence in order to qualify. Remember that much of the individual’s ability to control the kind of care recieved is also forgotten or lost because the state will determine where and how the care is administered since it is paying for the care.
The skyrocketing costs of long-term care are placing many state Medicaid programs under extreme pressure, and much needs to be done to help make sure that this vital program for those who have few means will be able to continue to serve those who need it most. As a result, both state and federal governments are encouraging most Americans to take the responsibility for their own future long-term care needs. Getting more information on the important issues surrounding long-term care and how it affects us all is a good place to start.
Senior care which is often referred to as elder care or long term care, covers a broad area of services. Although it is always believed that elder care only serves those who require skilled nursing care, there are now several choices that now exist for various types of care services due to the varied demographics of aging today. Senior care begins when previously independent individuals are no longer able to perform life’s daily routine activities. For many recipients, the process evolves into different types of care as mental and physical capacities decline. A typical elder care cycle often includes the following: Custodial care, which includes assistance with activities of daily living such as grocery shopping, bathing or driving. Skilled care, in either a nursing facility or at home, often including rehabilitation after surgery or illness.Care for cognitive impairments such as Alzheimer’s or other forms of dementia; and Palliative care for individuals who can no longer benefit from regular medical treatment.
For those not familiar with the term, advance care planning means making decisions about the care you would want to receive should you become unable to speak for yourself. These are your decisions to make and they are based on your personal values and preferences. One of the good things about advance care planning involves communicating your wishes to loved ones and health care providers to comfort them and guide them if something should happen to you. Making an advance directive is an important part of advance care planning. Advance directives are legal documents that offer directions for your health care should you become unable to speak for yourself. A living will, on type of advance directive, provides directions to health care providers on the treatment you would want (and would not want) if you are faced with an end-of-life situation. A health care power of attorney or durable power of attorney is another type of advance directive that appoints a person of your choice to speak on your behalf, should you become unable to do so. State-specific advance directives, brochures about advance directives and other information about advance care planning can be found at www.nhpco.org.
Daily oral and dental care is essential for all of us, and especially when the mouth area is affected by therapy. Take in mind that chemotherapy for tumors in any part of the body can still affect the mouth,(whereas radiation therapy affects the mouth only when applied directly). Brushing and flossing natural teeth should be brushed daily (and preferably after each meal, large or small) with the use of a soft-bristle toothbrush. A small amount of toothpaste is useful when brushing, excessive amounts do not make up for inadequate brushing and flossing. Flossing is an effective way to clean between the teeth, but your doctor may decide that it would be too irritating for your gums. Ask his or her advice also about massaging the gums and tongue, another element in mouth care.
Inadequate oral hygiene leads to bad breath, gum irritation , pyorrhea and tooth decay. Since the effects of tumor therapy can limit the extent of your mouth care, it is even very important to take good care of this area before the therapy starts. Denture Care Dentures, like natural teeth, should be cleaned at least once a day. Brush inside and out with a denture brush, no toothpaste is necessary. Do this over a sink or bowl containing a few inches of water -if the dentures are dropped, then they’re less likely to be damaged.If you are in home health care, then you can have your caregiver help you. After brushing, you can soak the dentures in water, or in a commercial denture cleaner if you wish, however, always remember that soaking does not take the place of the thorough brushing. With the dentures removed, vigorously rinse your mouth with water or, again, a commercial mouth rinse. These simple procedures, when done daily after every meal or snack, will keep your mouth in the best possible health. Mouth Sores Some types of therapy, problem is, it causes mouth sores and irritated gums (mucositis), and measures beyond simple home care hygiene may be needed. Once you have mouth sores, stay away from irritating or spicey foods. Eat a bland, soft diet. Remove your dentures until the sores heal. Rinse four times daily with a 3% hydrogen peroxide solution diluted to half strength with water.
If you think this solution is too irritating to your mouth, continue diluting the solution until it no longer has this effect. You may also try a commercial mouthwash (such as Cepacol®). If your gums bleed very easily or are tender, use swabs, Toothettes®, or a damp cloth to clean your teeth and gums. Other non-irritating appliances are also available commercially. Dry Mouth If dry mouth is a problem, your doctor may suggest an artificial “saliva” (such as Zero-lube®, or Saliva-aid®) but these products are not always successful. Another solution may be a saliva stimulant (such as Pilocarpine®). A simple and often effective remedy for dry-mouth is frequent rinses with water and sucking on ice chips. Sugarless tart candies or chewing gum may also help. The problem should not be ignored; keeping your mouth moist is essential both to oral care and to comfort if you are in homecare.
This article, written by Jill Gilbert, originally appeared as “Grieving Takes its Course” in McKnight’s Long Term Care News June 2008 edition. For this month, we will continue our discussion with Joyce Ebmeier of Tabitha Health Care Services. A 25-year veteran of the nursing home industry, Ebmeier talked about the great social benefits of the Green House and a phenomenon she calls the “Green House Creep,” explaining how the model of senior care is leading to positive change at Tabitha’s 205-bed traditional nursing home, affectionately known as “the mothership.”
Mary’s story
To many, the social benefits of a Green House are undeniable. Living in a smaller community operating under its own set of rules makes for a happy household. When Mary, one of the first elders to move into the Green House, celebrated her 101st birthday, the staff asked her what she wanted. Ebmeier sounds wistful when she recalls, “Mary and her daughter sitting on the porch enjoying a margarita and a cigarette.” This year on her birthday, everyone gathered on the porch and had margaritas to honor her memory.
b. Community before business.
It always is painful to lose someone you love, but Ebmeier says in the Green House it is “that intense and more. [Death] impacts the dynamics acutely.” After the first death in the Green House, Tabitha staff acted to fill the spot. The senior care residents and staff of the Green House pushed back, saying they “had not grieved enough yet” they needed more time.
Tabitha’s administration agreed, writing a policy for the Green House, outlining the steps to be taken when an elder died, in order to allow time for everyone to grieve properly. Collaborative change. Tabitha’s administration have worked with the community to develop guidelines and a timeframe that worked. Ebmeier describes the policy as “an opportunity to honor that member of the household.” After the initial grieving period, staff members and residents will welcome the newest member to the Green House. The outcome has had a profound effect on the mothership as well. Its staff and residents quickly developed their own policy so that they, too, could grieve for neighbors and friends who had died.
Most of us have already heard about the recent news of swine flu, but have you thought about what it means for the seniors in your life, your aging parents or you as a caregiver? To date, almost all cases in the North America have been mild. Just yesterday, President Obama released this official statement: “We are closely monitoring the emerging cases of swine flu in the United States. This is obviously the cause for concern and requires a heightened state of alert, but it’s not a cause for alarm.
However, according to the World Health Organization, the number of confirmed cases of swine flu worldwide increased to 236 on Thursday; this is a substantial increase from the previous day’s total of 147. [spin]Anyone with an aging parent or a senior in their life, including all certified senior care managers, should be concerned about the recent swine flu pandemic and the potential risks for seniors. This group is at particular risk due to difficulties recovering if exposed. It is very important to ensure that all home health care aides are educated about swine flu Prevention Guidelines as prescribed by the CDC Center for Disease Control(CDC). Obtaining relevant information from all active caregivers, including recent travels and experienced flu symptoms, is a key component of prevention.
There are steps that professional and family caregivers as well as the community at large can take to decrease exposure and combat symptoms of swine flu. The Center for Disease Control is constantly updating their site, but the current guidelines and information about swine flu for caregivers is as follows: Swine flu’s symptoms resemble those of seasonal flu; fever, sore throat, cough, congestion, chills, headache, body aches and fatigue. Some patients also report diarrhea and vomiting. If you have symptoms, see your doctor or visit a community clinic. A medical provider’s diagnosis is important and prescription antiviral drugs are most effective when taken within 48 hours of the appearance of symptoms. If you are ill, avoid travel and do not go to work or school. Wash your hands often with soap and warm water for at least 20 seconds or use alcohol-based cleaners and hand sanitizers. Remember to cover your nose and mouth with a tissue when you cough or sneeze, and then discard the tissue.
Or if necessary, use your upper sleeve; not your hands. If you’re healthy, wash your hands often and avoid ill people. The flu’s incubation period is 24 to 48 hours. Make certain to follow any new developments regarding public health advice, such as avoiding crowds. Develop an emergency plan with the senior care caregivers. Your plan should include maintaining a supply of food, medicines, facemasks, alcohol-based hand rubs and other essentials.
A major fear people have of dying is that they’ll be in pain. Hospice eases that fear by providing palliative care with an emphasis on pain control. The main objective is to relieve symptoms that interfere with one’s quality of life. Hospice manages emotional and spiritual pain in addition to physical pain. By using a combination of medications, counseling and therapy, hospice care has a very high success rate of easing a patient’s pain. Some families worry about their loved ones being so drugged that they are unable to communicate or are unaware of what’s happening. Although this can happen, it’s rare. Fortunately, hospice nurses are capable of providing strong medications and high dosages that will provide comfort without impairing the patient’s alertness.
Hospice supports the Pain Care Bill of Rights, which states that as a person with pain, you have a right to:
Have your report of pain taken seriously and to be treated with dignity and respect by nurses, doctors, pharmacists and other health professionals.
Have your pain thoroughly assessed and promptly treated.
Be informed by your health care provider about what may be causing your pain, possible treatments, and the benefits, risks, and cost of each.
Participate actively in decisions about how to manage your pain.
Have your pain reassessed regularly and your treatment adjusted if your pain hasn’t been eased.
Be referred to a pain specialist if your pain persists.
Get clear and prompt answers to your questions, take time to make decisions, and refuse a particular type of treatment if you choose. CCRCs are living communities for seniors. Most have three levels of residence: independent living, assisted living and skilled nursing. Each of the level of residence is tied to the level of care that the resident might require. The primary concept behind a CCRC is that it offers a wider spectrum of assisted care, so that once a senior moves into the community, he or she will be able to receive the appropriate care as his or her needs change.
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