Tag: Medicaid

Hospice Care Availability

Hospice care is accessible to anyone, regardless of what type of insurance or financial resources the patient is using. Home hospice care is cheaper than care in hospitals or nursing homes. This is because affordable technology is used which can easily be monitored and facilitated even by family and friends. For most occasions, the cost of hospice care is fully paid by the Medicare Hospice Benefit. Through the Medicare Hospice Benefit, the patient will be given a daily allowance and pays all medical services, medical equipment, medications, as well as treatments and supplies.

There are other health insurance companies who offer hospice care and services. Medicaid also offers the same services like other private insurance companies. You can check the insurance plan you have regarding the insurance benefits, requirements and deductibles. For those who are not covered by Medicare, Medicaid or other private insurance companies, they can avail of free hospice services through the donations and contributions from a community or a foundation. There are also programs who only charge a minimum hospice cost if the patient has a low income

Hospice benefits are provided on a per day (per diem) basis to the hospice provider. The hospice benefit is very helpful for those under its care since it covers all services, medications and equipment related to the person’s needs. The patient and his family can save a lot.  Medicare offers hospice consultation for those who want to know about the details of their hospice care, it’s a one-time consultation only. Ask someone who knows about hospice care, specifically those who are connected with health insurance companies. You may even discuss your options with their director for clarifications.

Assisted Living Centers and Families

Many families do not learn about the costs of long-term care until the crisis hits and many get the sort of rude awakening that people who underwent this experience felt, said Jon Howell, president and CEO of the Georgia Health Care Association, an industry group that represents assisted living centers, nursing homes and companies that coordinate home care across the state. Seventy percent of individuals now turning 65 will need long-term care at some point during their lives. Only a fraction of those who will need proper care have long-term care insurance, which can pay for services at home or in an elderly care facility or assisted living centers.

Such plans grew in popularity during the 90’s, but sales have dropped recently as some insurance providers exited the market and many of the remaining insurance providers have hit policyholders with steep premium increases. When speaking to civic groups, Howell said, he shares lots of key facts that catch individuals off guard, including: Medicare covers elderly care facility care after a hospitalization, but at day 21, a co-pay requirement kicks in that could cost up to $12,000 over the next 80 days of care. To qualify for State Medicaid programs, residents must effectively impoverish themselves, spending all but $2,000 of their non-exempt resources and also using all but $50 of their monthly Social Security checks to pay for their care.

Medicaid pays an average of $158 a day in Georgia for elderly care facility care; private pay prices are higher. Medicaid doesn’t cover assisted living, only nursing home care. After a resident’s death, State Medicaid programs can take the resident’s house equity and other resources in an estate to cover the price of care paid by the government, although there are protections for surviving spouses. The requirements represent a harsh reality for many once solidly middle-class individuals, individuals who have spent a lifetime working toward financial security, who find they have no option other than switching to State Medicaid programs to cover nursing home bills.

Nursing Homes Quality

Ohio tax payers are paying large numbers to nursing homes that don’t succeed to fulfill minimum state specifications for looking after their citizens, falling short of a bar many say is too low. Even three nursing homes on a government watch list for high numbers of inadequacies over long periods, two in Cincinnati and one in Youngstown, met Ohio’s quality measures, which give a passing quality even if a service flunks 75% of state specifications. In all, $12.7 million was invested to take good care of sufferers living in nursing homes that did not achieve at least five of 20 measures for great quality care, according to research for the financial year that ended June 30 from the Ohio Department of Medicaid. Still, less than 1% fell short of that standard, only nine of the 926 nursing homes. One has since closed. None is in central Ohio.

“We’ve got some good signs, but the floor is so low everybody can fulfill those,” said Robert Applebaum, home of the Ohio Long-term Care Research Project at Miami University. He also served on the advisory board that released suggestions to congress for enhancing care. “We need to do a better job of getting rid of bad-quality homes, but we also need to do a better job of reimbursing the high-quality homes.”

Medicaid, which provides coverage of health to poor and impaired Ohioans, will pay for approximately 70% of nursing-home care in the state. On average, the federal-state program includes about 58,200 long-term-care citizens. Last year, in an effort to improve institutional care, the state started demanding features to fulfill at least five of 20 high quality measures to earn a full State Medicaid programs payment, which earnings $165 a day per person. The measures include giving citizens meal options, enabling them to choose when they get up and go to bed and the opportunity to customize their bedrooms. The nine nursing homes unable to fulfill the mark lost 10% of the payment, or nearly $16.50 of the per-resident daily subsidy. Those funds are to be allocated to the more than 900 facilities meeting the standard.

Assisted Living Centers Competition

Despite the state’s aging population, the common age of Ohio nursing-home citizens has decreased from 83.1 years to 77.3 in less than two years, according to a state-commissioned report. Several reasons underlie the pattern. On one hand, far more senior Ohioans who would have been in assisted living centers 20 years ago are in their own homes today, thanks to the state’s focus on less-expensive home-health services. Among Ohioans, at least 60 years of age who need help looking after for themselves, 55% obtained proper care in a seniors care facility this year compared with 91% in 1993. And the state now is based far less on nursing-home care than in the 90’s, when Ohio had one of the highest rates of nursing-home use and its State Medicaid programs per-capita nursing-home expenses were among the biggest in the country.

Ohio’s rate has enhanced from 47th among states, to 24th, said Bob Applebaum, director of the Ohio Long-term Care Research Project at Miami University’s Scripps Gerontology Center. “It symbolizes an amazing success tale for the state,” he said. But a malfunction in the state’s healthcare system also is a factor in the lower regular age of nursing-home citizens, Applebaum said. The number of nursing-home citizens younger than 60 more than tripled between 1994 and 2012, from 4% to 12.7%. And 1 in 6 State Medicaid enrollees residing in assisted living centers was younger than 60 this year. That is an increase of 26% from 1997 and coincided with an 11% drop in the number of State Medicaid programs enrollees older than 60 in assisted living centers.

In the spring of 2012, there were 8,723 State Medicaid program enrollees younger than 60 in assisted living centers. Of them, 18.5% needed no assistance with “activities of daily living” such as showering, putting on clothes, eating and self care. Competition from assisted-living centers and home-health organizations also has forced assisted living facilities to keep prices down, Applebaum said. Ohio has kept speed with its growing inhabitants of elderly citizens with serious problems, but that growth is expected to speed up over the next 25 years, increasing in size.

Financial Considerations for Assisted Living Centers

Assisted living is an alternative living arrangement for senior citizens requiring moderate care, including help with activities like eating, getting dressed, bathing, and using the bathroom as opposed to the more intensive care provided in nursing homes. This type of care serves as an intermediate between in home care for the elderly and the elder care provided by a nursing home. Facilities for this type of living may be in connection with retirement communities, nursing homes, home medical care agencies, or complexes for senior citizens, or they may be separate facilities. This type of elder care is known by many names, such as residential care, board and care, congregate care, and personal care.

Another aspect of assisted living centers to think about is cost. Assisted living is generally less expensive than elderly care service, but more expensive the in house care for the elderly. The usual range is anywhere from $10,000 per year to over $50,000 per year, so it is important to know what you can afford and how much each service costs. Another thing to know is that there may be fees not included in the basic rate. It will be helpful to figure out how much extra you will have to pay to live in a certain house. Insurance may help cover some of these expenses, but usually, charges are covered primarily by the elderly people who decide to live in these homes or family members responsible for them. Some assisted living centers also offer financial assistance programs, which you may want to inquire about.

Medicare does not cover the expenses of these homes or the senior care provided there. Medicaid is the joint federal and state program that helps elderly people and people with disabilities pay for medical care when they are unable to afford it. It may cover the service component of assisted living in certain states. It is important to consider the different options in elder care. If cost is a concern, it may be helpful to consider in house care. This type of senior care may provide sufficient care for your needs in the comfort of your own house. If the degree of senior care provided by in house care or an assisted living service does not meet your needs, consider an elderly care service or nursing home.

Realities in Assisted Living Centers

Assisted living centers are places where people, who are less than independent but not in need of full time care, are provided with guidance or support in the activities of daily life. It is a proper care option typically employed by the elderly who do not require the 24-hour health care typical of an elderly care facility. It gives seniors help in housing, support services and health care, on a needed basis. The setting is similar to a person’s own home; however, assistance is provided in the form of meals, housekeeping, entertainment and other lifestyle support. The senior gets the security of having assistance when needed and residing in a structured environment, while maintaining an overall stage of independence. Options include staying in a separate apartment or condominium type residing quarters, or if more assistance is required, staying in a dormitory. The stage of interaction with staff varies, depending on the stage of need.

One of the major drawbacks for those seeking assisted living is the cost. The median monthly cost for assisted living is $2,575. While this may be comparable to assisted living centers prices, covering the expenses is much more difficult. Medicare A and B, the traditional sources of funding for a senior’s care, do not offer comprehensive protection for long term, ongoing care in an assisted living center. Medicare A, which pays for hospital coverage for seniors, may provide partial coverage for care in an assisted living center for rehabilitation following hospitalization, but will only last up to 100 days. Coverage will decrease throughout the 100 days. Medicare B, which covers physician care, will not provide any coverage for assisted living expenses separate from treatment by a doctor. Private insurance is the most effective way to pay for assisted living care.

Medicaid, a state and federal program which provides health care for low income individuals, may cover some assisted living expenses. However, the availability of State Medicaid programs coverage will vary by state, and likely will be decreasing coverage rather than expanding in the coming years. In contrast, traditional assisted living centers are covered by Insurance coverage if the senior stays in Insurance covered certified house after a qualified hospital stay (at least three days).

Nursing Home Inspections

In reaction to a Freedom of Information Act demand by ProPublica, the government has launched unredacted write-ups of issues discovered during nursing home examinations around the country. We’re making them available these days for anyone who wants to obtain the complete editions. For several weeks now, ProPublica has made redacted editions of this same information available in an easily retrievable format in our Nursing Home Inspect device. These editions, which are posted on the U.S. Centers for Medicare and Medicaid Services website, Nursing Home Inspect, sometimes empty out patients’ age groups, health circumstances, schedules and recommended medicines.

The organization has said the redactions are designed to balance individual comfort issues with the need to notify customers about the quality of care. ProPublica asked for the unredacted reviews because they are public records and because the included information can make them more useful. For example, prescribed information in the unredacted write-ups can help recognize situations in which sufferers obtained medicines such as antipsychotics that are risky for those with dementia.

Sufferers and workers are not determined in either the redacted or unredacted reviews. Nursing Home Inspect allows patients and their loved ones to recognize nursing homes in their states and recognize those with serious inadequacies and charges in the last three years. The entire national collection of reviews, record more than 267,000 inadequacies in nursing homes nationwide, is retrievable by keyword and key phrase. At this point, Nursing Home Inspect is constantly on the link to only the redacted examination reviews. To search through the unredacted editions, you’ll have to obtain them and use a program like Microsoft Excel or a text manager that enables you to search for keywords and phrases.

Trends in Hospitals for 2013

Hospitals & Health Networks together with the American Hospital Association released a 2013 environmental check, a comprehensive review of the health care field that recognizes market forces likely to impact the field. The report identified 10 key themes which are generally not new to health care, but jointly indicate the industry’s sweeping changes. They are:

Information technology and e-health, such as ICD-10 execution, mobile health, big data, details exchange, and EHRs

  • Insurance and coverage, such as State Medicaid programs spending and registration growth, consumer-driven health plans, and Medical health insurance costsPolitical issues, such as the decrease of Medical health insurance company rates, the Supreme Court ruling State Medicaid programs expansion unconstitutional, and the decrease of federal support for hospital State Medicaid programs and Medical health insurance programsProvider organizations and doctors, such as the increase of retail treatment centers, the creation of a culture of performance quality and responsibility, and the need for hospitals to operate more leanly
  • Quality and individual safety, such as penalizations for low quality analytics, cost benefits opportunities in supply-sensitive care, care synchronization during hospital-to-home changes, and concern that public reports fairly and perfectly reflect hospital performance
  • Science and technological innovation, such as the capability to build and enhance virtual company networks, the use of mobile phones and tablets, the growth of e-visits, and the facilitation of hospital care through wireless technology
  • Human resources, such as trust between doctors and hospitals, demand for highly trained individual capital, and shortages of primary care physician
  • Consumers and census, along with a development of adult and weight problems in children, an increase in serious conditions, middle-agers working past the age of 65, and families providing the majority of proper care to the elderly
  • Economy and finance, along with a negative outlook for the charitable health care sector, a growth of hospital mergers and products, and $200 billion dollars of annual waste in health care