Elder care is a family matter--an important, appropriate part of any family's agenda. Problems your elderly loved one may be having may become apparent during your holiday visit. Read this article for guidance in having a successful family meeting.
http://insight.regencyhospice.com/pub.1/issue.947/
December 18, 2009
Holidaze--Challenges and Joys
Click on the link below to view the video
http://gracefulaging.com/2009/12/16/holidaze-challenges-and-joys-part-2/
http://gracefulaging.com/2009/12/16/holidaze-challenges-and-joys-part-2/
10 Tips to Help Seniors Enjoy the Holidays
Ensure happier holidays for seniors with special needs or health issues by reading this article.
http://seniorliving.about.com/od/grandparents/a/happy_holidays.htm
http://seniorliving.about.com/od/grandparents/a/happy_holidays.htm
November 5, 2009
What questions should a person ask when hiring a Professional Geriatric Care Manager?
*What are your professional credentials?
A care manager should have at least a Bachelor’s degree in a health-related area and/or be a licensed nurse. Certification as a case manager is preferred, as well.
*Are you a member of the National Association of Professional Geriatric Care Managers (NAPGCM)? If not, why not?
Members of the NAPGCM must have set education, credentials, certification, and experience. This should be your starting point for selecting a Professional Geriatric Care Manager (PGCM). There are individuals without appropriate knowledge, skill, and experience calling themselves care managers or "coaches" . The State of Michigan does not require licensure or certification so it is especially important to choose well.
*How many years have you been practicing professional geriatric care management?
One cannot be a member of the NAPGCM unless he/she has at least two years of supervised experience in the field of gerontology. Needs of older adults and their families are very complex and professional experience is important. Typically, the more experience in direct geriatric care management the better.
*Are there other care managers to serve as back-up when the assigned care manager is away or unavailable? If so, how many hours does this person work with you weekly or monthly in order to be knowledgeable regarding your clients?
Many care managers practice solo. Older adults need consistent support at unexpected times. If you want and/or need 24/7 assistance, it is important the care management company has more than one care manager or that the "solo" care manager has made arrangements for coverage by a well-informed and experienced colleague when he/she is not available.
*Are you available after hours and on weekends?
Older adults need consistent support and at unexpected times. High quality PGCMs, or their knowledgeable and experienced counterparts, are available to their clients and their families 24/7, 7 days a week.
*What are your fees?
Fees for services should be provided in a written agreement before service begins and be as specific as possible, so there is clarity for all involved.
*Are you licensed in your profession?
The PGCM should be licensed, if required, in his/her area of expertise.
*How do you involve the family in your care of the older adult?
While the primary client is the older adult, all others affected by his/her care needs should considered as part of the client system. Most older adults will give the PGCM permission to consult with their families, so it is important the PGCM value this relationship and be willing and able to address any problems or conflicts which are present.
*Are you affiliated with any other elder care service or company?
The PGCM should provide full disclosure regarding business, professional, or personal relationships he/she has with each recommended business, agency, or institution.
*What do you consider your area(s) of specialty or interest?
PGCMs may choose to specialize in certain client populations or services. Do any of these interests or specialties apply to your loved one?
A care manager should have at least a Bachelor’s degree in a health-related area and/or be a licensed nurse. Certification as a case manager is preferred, as well.
*Are you a member of the National Association of Professional Geriatric Care Managers (NAPGCM)? If not, why not?
Members of the NAPGCM must have set education, credentials, certification, and experience. This should be your starting point for selecting a Professional Geriatric Care Manager (PGCM). There are individuals without appropriate knowledge, skill, and experience calling themselves care managers or "coaches" . The State of Michigan does not require licensure or certification so it is especially important to choose well.
*How many years have you been practicing professional geriatric care management?
One cannot be a member of the NAPGCM unless he/she has at least two years of supervised experience in the field of gerontology. Needs of older adults and their families are very complex and professional experience is important. Typically, the more experience in direct geriatric care management the better.
*Are there other care managers to serve as back-up when the assigned care manager is away or unavailable? If so, how many hours does this person work with you weekly or monthly in order to be knowledgeable regarding your clients?
Many care managers practice solo. Older adults need consistent support at unexpected times. If you want and/or need 24/7 assistance, it is important the care management company has more than one care manager or that the "solo" care manager has made arrangements for coverage by a well-informed and experienced colleague when he/she is not available.
*Are you available after hours and on weekends?
Older adults need consistent support and at unexpected times. High quality PGCMs, or their knowledgeable and experienced counterparts, are available to their clients and their families 24/7, 7 days a week.
*What are your fees?
Fees for services should be provided in a written agreement before service begins and be as specific as possible, so there is clarity for all involved.
*Are you licensed in your profession?
The PGCM should be licensed, if required, in his/her area of expertise.
*How do you involve the family in your care of the older adult?
While the primary client is the older adult, all others affected by his/her care needs should considered as part of the client system. Most older adults will give the PGCM permission to consult with their families, so it is important the PGCM value this relationship and be willing and able to address any problems or conflicts which are present.
*Are you affiliated with any other elder care service or company?
The PGCM should provide full disclosure regarding business, professional, or personal relationships he/she has with each recommended business, agency, or institution.
*What do you consider your area(s) of specialty or interest?
PGCMs may choose to specialize in certain client populations or services. Do any of these interests or specialties apply to your loved one?
November 2, 2009
What are the top 10 signs of quality services of
Professional Geriatric Care Management?
*Accepts the older adult as the primary client but considers all others affected by his her/her care needs as part of the client system.
The PGCM’s goal is to arrive at a solution that allows maximum decision-making autonomy for the person receiving care and for the other persons involved with or affected by these care needs.
*Fosters self-determination on the part of the older adult to live in accordance with her/her personal values and goals whenever possible.
The PGCM must attempt to involve the older person, to the greatest extent possible, in decisions that impact his/her life regardless of the determination of competence. If the PGCM should see that the older person is not competent in decision-making, then the PGCM should see that all decisions are made by the person(s) with the legal authority to do so.
*Respects the older person’s right to privacy, and when applicable, that of the client system.
The PCGM should consider all information in the client’s files confidential. The PGCM has good reason to waive confidentiality if he/she believes circumstances are life threatening or the law requires the reporting of suspected abuse or neglect.
*Demonstrates a genuine caring and non-judgmental approach toward the older person and the entire client system.
It is through the therapeutic relationship that help and/or emotional support will be received by the older adult and or the client system.
*Acts in a manner that ensures his/her own integrity as well as the integrity of the client system.
The PCGM would make a report to the appropriate authority if there is a circumstance where the integrity and safety of the older person is at risk, e.g. abuse, neglect, or self-neglect. The PGCM can appropriately refuse to accept a new case or continue in a case in which he/she believes that remaining in the situation would require compromising his/her own values, beliefs, or standards.
*Avoids exploitation of the relationship with the older person and/or the client system for personal gain.
The PGCM should avoid an inappropriate personal relationship with the older person and/or the client system that may impair their impartial judgment or lead to exploitation. The best interests of the client are always the focus of the PGCM.
*Strives to provide quality care using a flexible care plan developed in conjunction with the older person and/or client system.
A plan of care with recommendations, goals, and appropriate interventions must be flexible enough to deal with the older person’s changing status. The overall goal is to strive to assist the older person to attain the highest level of health and quality of life that is possible within his/her particular set of circumstances.
*States all fees for service in written form and discusses with the person accepting responsibility for payment prior to the initiation of services.
Fees should be charged for services rendered and presented in a clearly itemized statement. If unable to pay for care management services, the older person and/or client system should be referred to publicly supported agencies that can provide the necessary services. The PGCM does not support fee splitting or receiving referral fees from anyone providing services to the older client.
*If accepting a fiduciary responsibility the PGCM acts only within his/her knowledge and capabilities and avoids any activities that might suggest a conflict of interest.
Strict guidelines should be followed if the PGCM if in the role of "pay agent". Records of all transactions should be kept current in a format recognized by generally accepted accounting practices and should be open to inspection by appropriate parties.
*Participates in continuing education programs to enhance professional growth and development.
All PGCMs should remain current in best practices and domains pertinent to the discipline of professional geriatric care management.
*Defines his/her role clearly to other professionals.
The PGCM should act only in the roles for which he/she has appropriate skills, knowledge, and training, He/she should recommend consultations with specialists as needed.
Parts excerpted from "Standards of Practice", NAPGCM 2009 Directory of Members
Parts excerpted from "Standards of Practice", NAPGCM 2009 Directory of Members
September 14, 2009
Program Affiliations and Publications
Program Affiliations and Publications
of Serving Seniors, Inc.
Program Affiliations
Serving Seniors, Inc. is a member of "The Wraparound Program" and it's "Community Collaborative Team". The Wraparound Program consists of geriatric evaluation centers, home care agencies, social workers, and other dementia care consultants.
The "Community Collaborative Team" assists with issues surrounding dementia and offers support to caregivers of those with dementia. The ultimate goal of this program is to help those with dementia remain in their homes while also providing support and assistance to the caregiver. This program offers the following: 24/7 hotline service, support groups, care consultations, educational workshops, and respite care.
See these Recent Publications by Diane Hischke, President/Serving Seniors, Inc.
"Successful Communication", The American Senior Gazette - Vol. 10, No. 1, 2010
"Choosing the right Geriatric Care Manager is a family affair", The American Senior Gazette - Vol 5, No.1, 2009
of Serving Seniors, Inc.
Program Affiliations
Serving Seniors, Inc. is a member of "The Wraparound Program" and it's "Community Collaborative Team". The Wraparound Program consists of geriatric evaluation centers, home care agencies, social workers, and other dementia care consultants.
The "Community Collaborative Team" assists with issues surrounding dementia and offers support to caregivers of those with dementia. The ultimate goal of this program is to help those with dementia remain in their homes while also providing support and assistance to the caregiver. This program offers the following: 24/7 hotline service, support groups, care consultations, educational workshops, and respite care.
See these Recent Publications by Diane Hischke, President/Serving Seniors, Inc.
"Successful Communication", The American Senior Gazette - Vol. 10, No. 1, 2010
"Choosing the right Geriatric Care Manager is a family affair", The American Senior Gazette - Vol 5, No.1, 2009
September 3, 2009
Checklist: Can Mom or Dad Still Live at Home?
As people age, they can develop difficulties performing everyday activities. But when is there cause for concern? When should services be considered, and when are those services no longer enough?
This checklist can help families determine what resources might be appropriate now and help prepare for the future. For further help, consult a physician, geriatric-care manager, county social service department of other professionals.
What Help is Needed?
For each task below, check the one description that best fits the situation of the person you are concerned about. Add the numbers to get a score. Then find the recommendation for that score in the accompanying guide.
Maintain Home/Lawn:
Does Housekeeping/Laundry:
Recognizes Strangers:
Handling Emergencies:
Driving:
Social Activities:
Managing Finances:
Getting Groceries:
Preparing Meals:
Eating:
Recognizing Surroundings:
Keeping Appointments:
Following Directions:
Wandering:
Personal Care:
Dressing:
Bathing:
Continence:
Gait:
Transferring:
Medical/Rehab Therapy:
Medications:
Scoring the Evaluation – What Kind of Help is Needed?
Score 21-30
People with this score function independently. There may be no need for services now, but start exploring options. Make sure that legal and financial plans are in place. Consider which level of care family members would be able or willing to give, as needs change.
Some Tips:
Talk as a family with your older relatives about medical, financial and legal arrangements and personal preferences. Encourage them to fill out a health care directive (living will) and to write a will, or to review existing documents.
Help older adults do as much as possible for themselves, and recognize your own limitations. That can help them remain more vigorous and alert and help you avoid caregiver burnout.
Find out about community resources. Keep a file of articles and advertisements for services. Tour senior housing and assisted living apartments in the area.
Complete a home safety evaluation to minimize the risk of falls and to improve safety.
Review this assessment regularly to track changes.
Score 31-50
People with this score may be unable to complete some important daily activities with out help. Consider several options:
Community based services include a broad spectrum of help. Evaluate whether some of them are practical and affordable. Some seniors qualify for economic assistance through a county social service office. For safety, it may be more difficult for people with memory loss to continue to live at home.
As needs increase, costs of services may exceed similar services in residential care homes of assisted living apartments.
Adult day care provides structured activities and meals. Some offer health services and transportation. Most can be attended full or part time.
Companion programs provide in-home visitors who can help with shopping, meals, housekeeping and companionship. They do not provide medical care and usually do not give personal care such as bathing or dressing. Twenty-four hour care can run upwards of $250 per day.
Home health care provides medical care in the house. Services may be provided by a nurse, occupational, speech or physical therapist, 24-hour security and on site staff. Residents may choose to eat in a common dining room.
Residential care/memory loss homes are similar to assisted living, and are designed for people with Alzheimer’s or other memory impairing illnesses.
Score 51-66
People with this score are unable to care for themselves and have health problems. Some may need rehabilitation and may be able to return home.
Nursing homes provide complete personal and medical care for people who are unable to manage independently. That can include short term rehabilitative services as well as long term care for very frail people.
Residential care/memory loss homes are designed for people with Alzheimer’s or other memory loss conditions. They can work well for people who need supervision but do not need intensive medical care.
24 hour home health services are available to very frail people who prefer to remain at home and receive 24-hour care from a home health agency. This will cost much more then nursing home care. Hospice services include medical and social programs for terminally ill people and their families.
This assessment form was developed by Carla MacGregor, a Minneapolis social worker who operated Transitions, Inc., a private geriatric case management firm. She produced it for Care Providers of Minnesota, a nursing home trade association.
This is a tool to begin the care planning process but, it is not to be used in place of a comprehensive assessment from a geriatric specialist, which may take into account additional factors. This is not meant to diagnose or treat.
This checklist can help families determine what resources might be appropriate now and help prepare for the future. For further help, consult a physician, geriatric-care manager, county social service department of other professionals.
What Help is Needed?
For each task below, check the one description that best fits the situation of the person you are concerned about. Add the numbers to get a score. Then find the recommendation for that score in the accompanying guide.
Maintain Home/Lawn:
- Without assistance (1)
- With some assistance (2)
- Needs total assistance (3)
- Lives in apartment or other maintained housing (1)
Does Housekeeping/Laundry:
- Without help (1)
- With some help or reminding (2)
- Needs total assistance (3)
- Hires outside agency (1)
Recognizes Strangers:
- Able to recognize strangers and seek help (1)
- Unable to recognize strangers or seek help (2)
Handling Emergencies:
- Independently able to get emergency help (1)
- Needs guidance and instruction (2)
- Unable to get emergency help (3)
Driving:
- Drives or is able to use public transportation (1)
- Doesn’t drive or needs help with transportation (2)
- Needs special van for transport (3)
Social Activities:
- Independently arranges and attends social activities (1)
- Needs help making social arrangements and getting transportation (2)
- Unable to participate in social activities with out direct help (3)
Managing Finances:
- Independently manages finances (1)
- Needs some help (reminding, writing out checks, reviewing mail) (2)
- Unable to manage finances (3)
Getting Groceries:
- Able to get or arrange for groceries (1)
- Needs Help (2)
- Unable to get groceries (3)
Preparing Meals:
- Prepares meals without assistance (1)
- Needs help (2)
- Unable to prepare meals (3)
Eating:
- Feeds self without help (1)
- Needs supervision or reminders (2)
- Unable to feed self (3)
Recognizing Surroundings:
- Always alert and oriented to date, time and place (1)
- Intermittently confused about time and place (2)
- Consistently confused about time and place (3)
Keeping Appointments:
- Able to set and keep appointments (1)
- Needs reminding (2)
- Needs help to set appointments (3)
Following Directions:
- Able to understand and follow directions (1)
- Needs to check directions several times before understanding (2)
- Unable to follow directions even with supervision (3)
Wandering:
- Does not wander (1)
- Wanders or has gotten lost (3)
Personal Care:
- Independently manages hygiene, brushing teeth, nail care, shaving, hair care (1)
- Needs reminders to maintain grooming and appearance (2)
- Needs help to complete grooming (3)
Dressing:
- Gets dressed independently (1)
- Needs reminders to choose clothing and dress (2)
- Needs help to dress (3)
Bathing:
- Independently bathes or showers (1)
- Needs standby help or supervision (2)
- Needs help to bathe (3)
Continence:
- Continent of bowel and bladder, or use of incontinence products independently (1)
- Needs reminding to use toilet, or help using incontinence products (2)
- Unable to use toilet independently (3)
Gait:
- Walks or moves independently (with or without cane, walker or wheelchair) with no falling (1)
- Has unsteady gait and has fallen in past 6 months (2)
- Needs help to walk or maneuver wheelchair (3)
Transferring:
- Independently transfers to bed, chair or toilet (1)
- Needs help to transfer (3)
Medical/Rehab Therapy:
- No need for medical or rehabilitative therapy (1)
- Has medical needs or therapies and manages them independently (1)
- Needs intermittent help managing medical needs (2)
- Needs medical monitoring (3)
Medications:
- Needs no help identifying and taking medications (1)
- Needs help or reminders to take medications (2)
- Unable to manage medications (3)
Scoring the Evaluation – What Kind of Help is Needed?
Score 21-30
People with this score function independently. There may be no need for services now, but start exploring options. Make sure that legal and financial plans are in place. Consider which level of care family members would be able or willing to give, as needs change.
Some Tips:
Talk as a family with your older relatives about medical, financial and legal arrangements and personal preferences. Encourage them to fill out a health care directive (living will) and to write a will, or to review existing documents.
Help older adults do as much as possible for themselves, and recognize your own limitations. That can help them remain more vigorous and alert and help you avoid caregiver burnout.
Find out about community resources. Keep a file of articles and advertisements for services. Tour senior housing and assisted living apartments in the area.
Complete a home safety evaluation to minimize the risk of falls and to improve safety.
Review this assessment regularly to track changes.
Score 31-50
People with this score may be unable to complete some important daily activities with out help. Consider several options:
Community based services include a broad spectrum of help. Evaluate whether some of them are practical and affordable. Some seniors qualify for economic assistance through a county social service office. For safety, it may be more difficult for people with memory loss to continue to live at home.
As needs increase, costs of services may exceed similar services in residential care homes of assisted living apartments.
Adult day care provides structured activities and meals. Some offer health services and transportation. Most can be attended full or part time.
Companion programs provide in-home visitors who can help with shopping, meals, housekeeping and companionship. They do not provide medical care and usually do not give personal care such as bathing or dressing. Twenty-four hour care can run upwards of $250 per day.
Home health care provides medical care in the house. Services may be provided by a nurse, occupational, speech or physical therapist, 24-hour security and on site staff. Residents may choose to eat in a common dining room.
Residential care/memory loss homes are similar to assisted living, and are designed for people with Alzheimer’s or other memory impairing illnesses.
Score 51-66
People with this score are unable to care for themselves and have health problems. Some may need rehabilitation and may be able to return home.
Nursing homes provide complete personal and medical care for people who are unable to manage independently. That can include short term rehabilitative services as well as long term care for very frail people.
Residential care/memory loss homes are designed for people with Alzheimer’s or other memory loss conditions. They can work well for people who need supervision but do not need intensive medical care.
24 hour home health services are available to very frail people who prefer to remain at home and receive 24-hour care from a home health agency. This will cost much more then nursing home care. Hospice services include medical and social programs for terminally ill people and their families.
This assessment form was developed by Carla MacGregor, a Minneapolis social worker who operated Transitions, Inc., a private geriatric case management firm. She produced it for Care Providers of Minnesota, a nursing home trade association.
This is a tool to begin the care planning process but, it is not to be used in place of a comprehensive assessment from a geriatric specialist, which may take into account additional factors. This is not meant to diagnose or treat.
August 31, 2009
Planning to Leave a Hospital, Nursing Home or Other Health Care Setting?
Please click on the link below for an informative checklist for patients and caregivers preparing to leave a hospital, nursing home or other health care setting.
Planning for Your Discharge Checklist
Planning for Your Discharge Checklist
Little-Known Government Program Pays the Cost of Elder Care
WHAT IF 33% OF ALL SENIORS IN THIS COUNTRY could receive up to $1,949 a month in additional income from the government to help cover their elder care costs? THEY CAN!
Under the right circumstances, a little-known federal program will pay additional income to cover long term care costs for at least 1/3 of all US senior households -- that's how many war veterans or their surviving spouses there are in this country. But the provisions of this program are such a well-kept secret that only 4.7% of US seniors are actually receiving the benefit. The great news about this program is the Department of Veterans Affairs will pay you to hire your family, friends or just about anyone to take care of you (Caregiving spouses can't be paid under this program). The program is called "Veterans Pension."
Most people who have heard about Pension know that it will cover the costs of assisted living and, in some cases, cover nursing home costs as well. But the majority of those receiving long term care in this country are in their homes. Estimates are that approximately 70% to 80% of all long term care is being provided in the home. All of the information available about Pension overlooks the fact that this benefit can also be used to pay for home care.
It also comes as a surprise to most people that the Department of Veterans Affairs will allow veterans' households to include the annual cost of paying any person such as family members, friends or hired help for care when calculating the Pension benefit. This annual cost is deducted from household income and used to calculate a lower "countable income" which in turn enables families to receive this disability income from VA. Even though VA claims the benefit is for low income families, because of the special provision in the regulations -- allowing for deduction for care costs -- households earning between $3,000 to $6,000 a month or more can still qualify for Pension under the right conditions.
This extra income can be a welcome benefit for families struggling to provide eldercare for loved ones at home. Under the right circumstances, this annualized medical expense for the cost of family members, friends or any other person providing care, could create an additional household income of up to $1,056 a month for a single surviving spouse of a veteran, up to $1,644 a month for a single veteran or up to $1,949 a month for a couple.
If the disabled care recipient has been rated "housebound" or in need of "aid and attendance" by VA, all fees paid to an in-home attendant will be allowed as long as the attendant provides some medical or nursing services for the disabled person. The attendant does not have to be a licensed health professional. There is also no need to distinguish between medical and nonmedical services -- all are deductible.
For a disabled person who has been rated "in need of aid and attendance" or "housebound", a family member will be considered an in-home attendant, but that family member has to be paid for services duly rendered. There is potential for fraud here where a family member may move into the home and ostensibly receive payment as a caregiver but not actually provide the level of care paid for. Documentation for this care must be provided to VA, and it is reasonable for VA to question whether the services being purchased from a family member living in the household are legitimate. Such arrangements should be extensively documented and completely arm's-length.
The care arrangements and payment for home care must be made prior to application and there must be evidence that this care is needed on an ongoing and regular basis. We recommend a formal care contract and weekly invoice billing for services. Money must exchange hands and federal law requires employment taxes must be withheld and there must be evidence of this. All of this documentation must be provided as proof to VA when making application for the pension benefit. Costs for these services must be unreimbursed; meaning these costs are not paid by insurance, by contributions from the family or from other sources. VA will allow, however, family caregivers being paid by their loved ones, to turn around and pay the household bills for their loved ones to help defray the cost of the care.
Due to the need for a rating, documentation for annualizing care costs and the extensive proof needed to show the caregiver is indeed an employee of the care recipient, most people should not try this on their own. An expert in this area should be sought to help with the application in order to avoid lengthy delays in awarding a benefit or a possible denial of benefits. For a list of individuals or companies in your area who understand how to get this benefit go tohttp://www.longtermcarelink.net/ref_veterans_consultants.htm
Under the right circumstances, a little-known federal program will pay additional income to cover long term care costs for at least 1/3 of all US senior households -- that's how many war veterans or their surviving spouses there are in this country. But the provisions of this program are such a well-kept secret that only 4.7% of US seniors are actually receiving the benefit. The great news about this program is the Department of Veterans Affairs will pay you to hire your family, friends or just about anyone to take care of you (Caregiving spouses can't be paid under this program). The program is called "Veterans Pension."
Most people who have heard about Pension know that it will cover the costs of assisted living and, in some cases, cover nursing home costs as well. But the majority of those receiving long term care in this country are in their homes. Estimates are that approximately 70% to 80% of all long term care is being provided in the home. All of the information available about Pension overlooks the fact that this benefit can also be used to pay for home care.
It also comes as a surprise to most people that the Department of Veterans Affairs will allow veterans' households to include the annual cost of paying any person such as family members, friends or hired help for care when calculating the Pension benefit. This annual cost is deducted from household income and used to calculate a lower "countable income" which in turn enables families to receive this disability income from VA. Even though VA claims the benefit is for low income families, because of the special provision in the regulations -- allowing for deduction for care costs -- households earning between $3,000 to $6,000 a month or more can still qualify for Pension under the right conditions.
This extra income can be a welcome benefit for families struggling to provide eldercare for loved ones at home. Under the right circumstances, this annualized medical expense for the cost of family members, friends or any other person providing care, could create an additional household income of up to $1,056 a month for a single surviving spouse of a veteran, up to $1,644 a month for a single veteran or up to $1,949 a month for a couple.
If the disabled care recipient has been rated "housebound" or in need of "aid and attendance" by VA, all fees paid to an in-home attendant will be allowed as long as the attendant provides some medical or nursing services for the disabled person. The attendant does not have to be a licensed health professional. There is also no need to distinguish between medical and nonmedical services -- all are deductible.
For a disabled person who has been rated "in need of aid and attendance" or "housebound", a family member will be considered an in-home attendant, but that family member has to be paid for services duly rendered. There is potential for fraud here where a family member may move into the home and ostensibly receive payment as a caregiver but not actually provide the level of care paid for. Documentation for this care must be provided to VA, and it is reasonable for VA to question whether the services being purchased from a family member living in the household are legitimate. Such arrangements should be extensively documented and completely arm's-length.
The care arrangements and payment for home care must be made prior to application and there must be evidence that this care is needed on an ongoing and regular basis. We recommend a formal care contract and weekly invoice billing for services. Money must exchange hands and federal law requires employment taxes must be withheld and there must be evidence of this. All of this documentation must be provided as proof to VA when making application for the pension benefit. Costs for these services must be unreimbursed; meaning these costs are not paid by insurance, by contributions from the family or from other sources. VA will allow, however, family caregivers being paid by their loved ones, to turn around and pay the household bills for their loved ones to help defray the cost of the care.
Due to the need for a rating, documentation for annualizing care costs and the extensive proof needed to show the caregiver is indeed an employee of the care recipient, most people should not try this on their own. An expert in this area should be sought to help with the application in order to avoid lengthy delays in awarding a benefit or a possible denial of benefits. For a list of individuals or companies in your area who understand how to get this benefit go tohttp://www.longtermcarelink.net/ref_veterans_consultants.htm
Cost Saving Examples After Hiring a Professional Geriatric Care Manager
A professional geriatric care manager (PGCM) can help families realize cost savings, but the biggest advantage is the emotional peace of mind knowing that a relative or loved one is being cared for with the most appropriate level of care as recommended by the PGCM.
Regarding the average savings from hiring a GCM, The National Association of Professional Geriatric Care Managers (NAPGCM) does not generate projectable data across the country. Every case is unique. What we can tell you are areas that have resulted in savings when a professional geriatric care manager is in the picture. Here are some of those that we often see:
1. Saving in care costs – Recommending live-in care when appropriate in place of (more expensive) shift care. Recommending free or low-cost products and services that may be available in local communities. Understanding today’s medical system can save clients money while ensuring the appropriate level of care.
2. Making the most of insurance – Ensuring that secondary insurance had been given and billed for medical bills coming to a senior's home. Avoiding paying unnecessary bills. Realizing benefits from public programs including those from Veterans Administration (VA) benefits and from programs like Medicare and Medicaid. Helping clients enroll in the most appropriate Medicare Part D (pharmacy benefit) plans for their state (and there are many in each state from which to choose).
3. Avoiding expensive duplication – Ensuring that seniors aren't paying for duplicative insurance, aren't donating repetitively to a charity (when the senior forgets they just donated last week or last month), or aren't buying duplicative clothing or food when the senior forgets what they already have in the home.
4. Saving in travel expenses – Supervising care including medical appointments, operations of in home staff can postpone expensive travel to a relative.
5. Avoiding lost wages – Monitoring caregiving. Some adult children take leave from work after vacations have been exhausted, to check on Mom or Dad. A PGCM can be the person on site to monitor the caregiving level.
6. Saving in household expenses – Identifying cost saving programs. Utility companies or other providers offer discount programs for seniors. PGCMs are aware of these programs and can recommend and sign up these services for the loved one.
7. Making better financial decisions – Encouraging clients to speak with financial planners about whether annuities are really good investment choices, especially when clients in their 80's can't access their funds without large withdrawal penalties. Curtailing compulsive spending from shopping on line or on TV.
8. Discovering assets the loved one might not have realized existed in the home. For instance, when a house is cleaned and put in order, often hidden money and valuables are found.
9. Savings in time and efficiency – While information is available (and NAPGCM recommends that consumers educate themselves), a PGCM is experienced in the wide range of resources available and can do the job in half (or less than half) the time.
Other Scenarios
1. Correct coding/insurance – When an elder had a terrible accident, was in a coma, hospitalized and then transferred to a rehabilitation hospital, her elder husband was overwhelmed with her care. She was transferred to a skilled nursing facility (SNF) near only child. The PGCM was hired when the decision was made to transfer her for long term care near her husband. Upon admission to the SNF, the son had signed a private pay agreement for following her Medicare days. He was eventually presented with a bill for $15,000 and the promise of future bills. After the PGCM discovered they had counted her rehab hospital days as SNF days (even though they had, of course, received referral from hospital), she urged the son not to pay the bill, which was clearly in error. Though receiving a couple of pretty threatening calls from the SNF wondering why I was giving such advice, the PGCM was right and the family did not pay. Also, this was accomplished without an attorney.
2. Telling families of the benefits from the VA system. Saved one son $1,600 per month (he was paying out of this money before VA). Also, VA provides free hearing aids and other services to veterans.
3. Recommending most cost effective level of care. Spouse who had her husband in a nursing home plus 24-7 care. Moved him to a small residential family home owned by a nurse. Cut the costs to the family in half. Wife didn’t know he could be at a lower level of care.
4. Helping families chose the most cost effective care plan (caregivers, agencies, care management)
5. Helping families advocate for lost dentures and/or glasses in skilled nursing facilities. Ombudsman comes into to play and it is the facilities responsibility to replace them.
6. Helping families with supplies – like incontinent supplies – finding sources on-line at less the drug store costs with free delivery.
7. Advocating for more time in acute care or skilled care by pointing out new diagnosis that give clients more days of care.
8. Telling families about free items – like hearing enhanced phones or other communication devices for the telephone company.
9. Helping spouse understand that Medicaid will pay for skilled nursing – they don’t have to sell the farm. But, they do need to qualify. Advising working with an Elder Law attorney to help.
10. Telling families about free services that are location specific. We have a hospital that has a volunteer helping/companion service and another small city that provides free shoppers for seniors.
11. Understanding that “Meals on Wheels” can often be free or donation only.
12. Getting clients “transportation” systems that are either a van with low costs or taxi scripts.
13. Signing clients up for low cost rates at the gas & electric company.
The rates are typically $300 - $800 for an initial assessment and $80 - $200 per hour depending on the region.
To find a PGCM in your area, visit www.caremanager.org for a searchable database by zip code or state.
Regarding the average savings from hiring a GCM, The National Association of Professional Geriatric Care Managers (NAPGCM) does not generate projectable data across the country. Every case is unique. What we can tell you are areas that have resulted in savings when a professional geriatric care manager is in the picture. Here are some of those that we often see:
1. Saving in care costs – Recommending live-in care when appropriate in place of (more expensive) shift care. Recommending free or low-cost products and services that may be available in local communities. Understanding today’s medical system can save clients money while ensuring the appropriate level of care.
2. Making the most of insurance – Ensuring that secondary insurance had been given and billed for medical bills coming to a senior's home. Avoiding paying unnecessary bills. Realizing benefits from public programs including those from Veterans Administration (VA) benefits and from programs like Medicare and Medicaid. Helping clients enroll in the most appropriate Medicare Part D (pharmacy benefit) plans for their state (and there are many in each state from which to choose).
3. Avoiding expensive duplication – Ensuring that seniors aren't paying for duplicative insurance, aren't donating repetitively to a charity (when the senior forgets they just donated last week or last month), or aren't buying duplicative clothing or food when the senior forgets what they already have in the home.
4. Saving in travel expenses – Supervising care including medical appointments, operations of in home staff can postpone expensive travel to a relative.
5. Avoiding lost wages – Monitoring caregiving. Some adult children take leave from work after vacations have been exhausted, to check on Mom or Dad. A PGCM can be the person on site to monitor the caregiving level.
6. Saving in household expenses – Identifying cost saving programs. Utility companies or other providers offer discount programs for seniors. PGCMs are aware of these programs and can recommend and sign up these services for the loved one.
7. Making better financial decisions – Encouraging clients to speak with financial planners about whether annuities are really good investment choices, especially when clients in their 80's can't access their funds without large withdrawal penalties. Curtailing compulsive spending from shopping on line or on TV.
8. Discovering assets the loved one might not have realized existed in the home. For instance, when a house is cleaned and put in order, often hidden money and valuables are found.
9. Savings in time and efficiency – While information is available (and NAPGCM recommends that consumers educate themselves), a PGCM is experienced in the wide range of resources available and can do the job in half (or less than half) the time.
Other Scenarios
1. Correct coding/insurance – When an elder had a terrible accident, was in a coma, hospitalized and then transferred to a rehabilitation hospital, her elder husband was overwhelmed with her care. She was transferred to a skilled nursing facility (SNF) near only child. The PGCM was hired when the decision was made to transfer her for long term care near her husband. Upon admission to the SNF, the son had signed a private pay agreement for following her Medicare days. He was eventually presented with a bill for $15,000 and the promise of future bills. After the PGCM discovered they had counted her rehab hospital days as SNF days (even though they had, of course, received referral from hospital), she urged the son not to pay the bill, which was clearly in error. Though receiving a couple of pretty threatening calls from the SNF wondering why I was giving such advice, the PGCM was right and the family did not pay. Also, this was accomplished without an attorney.
2. Telling families of the benefits from the VA system. Saved one son $1,600 per month (he was paying out of this money before VA). Also, VA provides free hearing aids and other services to veterans.
3. Recommending most cost effective level of care. Spouse who had her husband in a nursing home plus 24-7 care. Moved him to a small residential family home owned by a nurse. Cut the costs to the family in half. Wife didn’t know he could be at a lower level of care.
4. Helping families chose the most cost effective care plan (caregivers, agencies, care management)
5. Helping families advocate for lost dentures and/or glasses in skilled nursing facilities. Ombudsman comes into to play and it is the facilities responsibility to replace them.
6. Helping families with supplies – like incontinent supplies – finding sources on-line at less the drug store costs with free delivery.
7. Advocating for more time in acute care or skilled care by pointing out new diagnosis that give clients more days of care.
8. Telling families about free items – like hearing enhanced phones or other communication devices for the telephone company.
9. Helping spouse understand that Medicaid will pay for skilled nursing – they don’t have to sell the farm. But, they do need to qualify. Advising working with an Elder Law attorney to help.
10. Telling families about free services that are location specific. We have a hospital that has a volunteer helping/companion service and another small city that provides free shoppers for seniors.
11. Understanding that “Meals on Wheels” can often be free or donation only.
12. Getting clients “transportation” systems that are either a van with low costs or taxi scripts.
13. Signing clients up for low cost rates at the gas & electric company.
The rates are typically $300 - $800 for an initial assessment and $80 - $200 per hour depending on the region.
To find a PGCM in your area, visit www.caremanager.org for a searchable database by zip code or state.
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