Health Insurance

For seniors who are living on their own, mental health is always dependent on their capacity for self awareness and also their own willingness to seek appropriate senior care. For those living in nursing homes or other long-term care facilities, the situation is a little more tenuous. As the numbers show, depressive and behavioral disorders are prevalent in these settings. In addition to the usual stressful work associated with aging, such as loss of loved ones, physical deterioration, and fears related to death, seniors in long-term care facilities often struggle with increased isolation and debilitating physical ailments, which can always reproduce latent mental issues. Since residents of senior facilities are often in poor health and have decreased cognitive functioning, it’s not always easy to evaluate and treat these individuals.

How Medicare Helps Seniors with Depression

The Nursing Home Reform Act of 1987 have announced screenings for mental illness and the reduced use of chemical and physical restraints. As part of the Omnibus Budget Reconciliation Act (OBRA), this law mandated some pivotal changes in nursing home care, giving importance to the quality of life. In 1990, Congress responded by revising the Medicare laws, specifying the beneficiaries will recieve mental health care, should it be needed. Unfortunately, Medicare does not cover blanket screening procedures. This makes it impossible to discover hidden symptoms that residents sometimes hide to avoid stress and shame. In 2002, however, Medicare recognized the value of psychological services coinciding with the management of medical conditions. I translate this as such: Once you are already physically very ill, then your mental health is very important. If depression or mental illness is detected, and a doctor refers the resident to a psychiatrist, Then Medicare will take care of 50 percent of the approved amount. This is a hefty co-payment, especially in relation to the 80 percent Medicare covers for doctor’s office visits. I think it’s safe to say navigating through the Medicare system can be a little confusing.

Treating Depression in Long-term Care Facilities

A lot of organizations have risen to bridge the gap between mental health and long term care. VeriCare, for example, partners with skilled nursing and other residential facilities to make programs which are tailored to their resident’s needs. This company, founded shortly after the Nursing Home Reform Act, improves compliance with OBRA standards and provides behavioral and mental health services which is unavailable when it comes to most long term care settings. In searching for a nursing home facility, a process in which Gilbert Guide simplifies, it may be wiser to ask as to what mental health systems may have in place. With over 50 percent of nursing home residents exhibiting signs of depression and under 5 percent of those individuals receiving treatment, it’s crucial to plan ahead. I certainly wouldn’t choose a home for my grandmother if her physical health might be jeopardized. I’m even more hesitant to choose a place that doesn’t recognize her mental well being as equally important.

There are lots of caregivers who are placed in a role in which they are unprepared. Meeting with medical professionals can be intimidating, as we are living in a society that thinks doctors in white coats are seen beyond reproach and are sometimes unapproachable. But as all family caregivers know, it is their job to ensure that the family member’s needs are seen to, that person depends on their advocacy. Patients and senior care caregivers often feel that physicians and medical professionals are too busy to “hear” their concerns. Below are a few tips to make sure you get the most out of your doctor’s visits.

Before Your Appointment - Remember to be prepared and have detailed and important information for your doctor. For example, ” My father hasn’t been feeling well ” is not as easy for a doctor to assess as ” my father has had a fever for two days that was over 100°F. He also has had tingling sensations in his left leg for four hours. “

Always keep a list of all health concerns and then put them in order of importance. This list will help you bring up any home care issues, and keep both you and your physician focused on what matters to you.

During Your Appointment - Pay attention. The likelihood that you will retain everything that the doctor explains to you, especially if it isn’t good news, is slim. Help yourself recall the information your physician tells you by using the 3 R’s: record, write or rope in a relative or friend. Take notes during the conversation or directly after, when information is fresh in your mind. Taking a small tape or digital recorder with you can also be helpful. Having another set of ears listening may also help you decipher the full meaning of the information later on. Ask for clarification when a term or concept doesn’t make sense to you.

Specialists sometimes use a lot of medical jargon. Make sure you are effectively communicating. Doctors often are very busy people. Listen to what they are saying. Don’t waste anyone’s time, including your own, by rambling on in conversation. Make certain they know your feelings, a doctor can only guess until you say something. Both doctors and caregivers are in the business of helping people. Go in prepared to make sure you get the most out of the experience, and keep in mind that you came to provide long term care to another person.

In previous blog articles I have discussed the long-term care insurance partnership program that almost two thirds of the states have already put in place or are in the process of approving for their residents. This program is designed to encourage the purchase of LTCI by consumers so that the state can reduce its liability for paying for long term care costs in the near future. This is vital if current state Medicaid programs are going to remain solvent. The advantage to customers is that the state acts as the safety net for all of them in case their care exceeds the benefits of their LTCI policy, and they are guaranteed that long-term care costs will not be allowed to completely wipe out all of their assets. The question is what identifies a policy as being partnership qualified? There are several qualifications that were outlined in the federal Deficit Reduction Act of 2005, including the need to be federally tax-qualified and to contain the consumer protection provisions of the NAIC LTC Model Act and Model Regulation.

Majority of the policies sold today already have those provisions. However, there is one requirement that contributes more than almost any other to qualifying a LTCI policy for the partnership program. It needs to have the age-appropriate inflation protection benefit. These requirements are as follows: Those age 60 or younger must have ” compound annual inflation protection. ” Those at least 61 but younger than 76 must have ” some level of inflation protection. ” Those by the age of 76 or older must be offered an inflation protection option but they are not required to purchase that option. Why is inflation protection given such prominence in partnership-qualified policies? The answer is that if partnership-qualified policies don’t have inflation protection, the purpose of a partnership program may be defeated. This is because the whole point of the partnership program is to help relieve the financial burden of long-term care costs from the state Medicaid systems.

If a consumer buys a LTCI policy but does not allow it to keep pace with the rising costs of assisted care, the insufficient benefits will most likely to force the policyholder to turn to Medicaid anyway. With very few assets left, the state will have to pick up the rest of the bill for this individual and the original intent of the program is defeated. A very important lesson that can be learned is that inflation protection is a vital component of any LTCI policy;whether partnership-qualified or not.

For most of us, life is one juggling act where family, home, work and play are a few of the many things that we try to balance. But what if you could get some of these pieces to fall into sync with each other? A number of recent articles I have read pointed out how Vermont seems to be doing exactly this for its citizens. In 2005 the state known for its maple syrup, Ben & Jerry’s and forward thinking began to implement Care for Choices, a new plan for Medicaid-eligible seniors who need assistance. The choice in this case is twofold: the elder can stay at home and the assistance is given by a family member, friend or neighbor who is paid by the state to provide homecare care for the individual. (In the past I have written articles as to how the internet can help in managing family caregiver duties. In this case it’s the state, at least in Vermont, that is offering its own helping hand by paying family senior care caregivers whose finances or time is strained when trying to balance both work and family.) So why is Vermont doing this anyway? Well, the reasoning is fairly simple; the state simply needs to be proactive. According to the May update from the Vermont Department of Disabilities, Aging & Independent Living, ” the state’s fastest growing age group is…65 to 74, [which is] projected to grow 62% during the period 2005–2015. ” The report stated that in 1996, Vermont spent 88% of its public long term care dollars on nursing homes facility care leaving 12% for home and community-based services.

Today, the figures are 68% and 32% respectively, giving Vermonters greater choice in their long term care options. And it isn’t just Vermonters who benefit, the state does too, withe caregivers being paid an hourly rate about $10, with an eight-hour day costing $80, whereas skilled nursing facilities cost the state on average about $122 a day. But there are still a few unanswered questions, is this keeping those seniors who do not require skilled care out of nursing facilities? Even worse yet, keeping those who need skilled care inside their homes with caregivers not able to provide them with all the care they needed? How many people not requiring skilled care have been made to move into a facility preemptively? And will this really make a financial difference to the state? These are the types of queries that only time will be able to answer. What we do know so far is that the numbers of seniors who are eligible for Medicaid in skilled nursing facilities has dipped and rates of homecare have increased since the Care for Choices plan first came into action. And every person’s scenario will be different. However, in my opinion, every time the state steps in to ensure that a senior’s needs and desires are met should be applauded. I’m sure many Vermonters welcome the opportunity to aid seniors with household chores, getting dressed or even rides to a doctor’s appointment. Knowing that the state will compensate you for your work could take financial pressure off of many family caregivers. And whether this proves the best option for a particular person comes down to personality, compatibility and needs;similar to the process of choosing the right facility for yourself or a loved one. And no one can argue that choosing is better than being told.

No one likes to pay insurance premiums of any kind and long-term care insurance is no exception. We pay these premiums because the alternative leaves our retirement income and investment assets exposed to high risk if long-term care becomes necessary and, of course, we have to pay for the care ourselves. It is no secret that the cost of nursing facility care can quickly drain a retirement nest egg and force a retiree into financial ruin. By getting a long term care insurance or LTCI, a policyholder is accepting a small loss each year in the form of premiums paid. This small loss helps making sure that he or she will not be wiped out financially by unmanageable long-term care costs in the future. People who are unfamiliar with long-term care insurance often wonder how long the premiums will need to be paid. The answer is that there are three choices for the premium payment period usually offered by insurance carriers.

The most popular choice so far is a “lifetime” payment period that requires the payment of premiums until death or until the policy is activated. There are people who oppose to paying these premiums for a long time. In response to that objection I usually ask prospective clients to consider other forms of insurance that they most likely own. For instance, would they expect to only pay premiums for health or major medical insurance for a short time, or do they plan on paying those premiums for life? Wouldn’t they expect to pay auto insurance premiums for as long as they drive? Isn’t it reasonable to pay homeowners insurance premiums for as long as they own a home? As long as the financial risk is present, the payment of insurance premiums is prudent. Since the risk of needing long-term care is present for as long as we live, the premiums for long-term care insurance can be expected for the remainder of our life.

The second and third options for payment of long-term care premiums allow the policyholder to condense all of those expected premium payments into a shorter time period. For those under fifty-five years of age, a “pay to age sixty-five” option may make sense. For others a “ten-year pay” option may be a good choice. Because the expected premium payments over a lifetime are simply condensed into a shorter time frame, the cost of these premiums is much higher. So therefore, these choices usually makes sense for policy holders who can take advantage of tax deductions that help them reduce the overall cost of their long-term care insurance..

A level of frustration is inherent in Alzheimer’s and dementia , not just for the person who has it, but also for that person’s caregiver(s). Until recently, caregivers were advised to “correct” a dementia patient in regard to actions not considered “normal”. Today a gentler approach has superseded this wisdom. For example, a dementia care patient, forgetting that he is retired, may begin to dress for work. So nowadays, caregivers are always told to ” go along ” with the patient’s sake, help them pick out a tie or what-have-you, and then slowly move the discussion to other matters until the fact that he must go to work slips his mind. I have one friend who is a licensed CNA, and an in-home caregiver with over a decade’s worth of experience providing long-term care to dementia patients.

Rita’s voice appeals its rythmic Irish phrasing and accent, her laughter and graying red curls burst forth from her small frame in spurts of abundance. I had the chance to talk to her about her own personal care philosophy. When I mentioned the above situation, she responded, “You have to let them get dressed for work. You have to let me them go through their moments.” Her philosophy is definitively one of diversion, but she says she came across this naturally, and told me, “The man I look after now is a person. There are times when he’s going through something or having a moment, but he’s always a person.” She then stressed the importance of eye contact as she finds dementia patients are ” in their own world and they are clinging onto ideas, it is often hard to distract them from that so you need to make sure they really see you.” She went on to explain, ” It can be difficult because they are so strong-willed.” I asked how her patient was that evening. She said, ” He is absolutely wonderful. I’m holding hands with him right now,” and I could hear her mouth breaking into a smile even over the phone line. This vacillating between great joy and stress seems par for the course for many homecare aides. Caregiving is truly an interdisciplinary field where science, the mind and the heart have to combine for any real success to occur.

Rita’s patient is medicated and his aides overlap at different points in the day to help him with walking. One aide walks in front of his walker and the other on the back. Once during this exercise, a family member was talking about an issue in the family business, and although normally the man would be completely engulfed in the act of walking, he exclaimed in a jovial manner, ” Well, it’s my dough anyways! ” to everyone’s amusement. I also asked Rita how she deals with a job that can be rewarding, but can sometimes be quite tiresome, both physically and emotionally. She mentioned attending social events, in her opinion, nothing relieves stress as much as a good party with friends. She also made mention that even her patient was able to attend the odd family occasion, but big crowds stress him as do unfamiliar faces. I inquired as to whether he remembered her, after all, she works there five days a week. ” Oh now, I began working here too late. He doesn’t know my name, but, you know what, he is always happy to see me and calls me a nice lady. “

There are actually so many opinions about LTCI or long term care insurance which are mainly based on anecdotal evidence. Once a year, the American Association for Long-Term Care Insurance publishes a LTCI Sourcebook that cuts through the fog of opinion by helping to establish the facts. The 2009 version of this publication just became available and here are some of the results of the data gathered from a large sampling of the leading long-term care insurers for those who only have a single long-term care insurance policy:

The number of claimants and policyholders paid in claims: 8.25 million Americans currently have long-term care insurance and last year 8.5 billion dollars were paid in claims to 180,000 policyholders.

Age of claimants: Of the new claims opened during 2008, 61% of claimants were age eighty or older, 30% were between seventy and seventy-nine and only 9% were under the age of seventy.

Sales by issue age: It was found that 24% of long-term care insurance buyers were between the age of forty-five and fifty-four. 53% were between fifty-five and sixty-four. 15% were between the age of sixty-five and seventy-four.

Sales by daily benefit amount: Only 6% have bought policies with a daily benefit between $50 and $99, while 31.5% were between $100 and $149, 35% were between $150 and $199, and 27% bought more than $200.

Sales by elimination period: The overwhelming favorite elimination period chosen was ninety days, with almost 83% of buyers choosing it.

Sales with the use of benefit period: Benefit period choices by long-term care insurance consumers were as follows: 2 years, 7%; 3 years, 30%; 4 years, 15%; 5 years, 24%; 6–10 years, 11%; and Lifetime/Unlimited, 13%.

Sales by benefit increase mode: 40% chose 5% compound interest, 16% chose simple interest, 13% chose a Future Purchase Option, 7% chose CPI (consumer price index), 14% chose none, and 10% chose other forms of inflation protection benefits.

Care settings paid for: 42% of long-term care insurance claims paid were to policyholders receiving home care, 30.5% to those in a nursing home, and 27.5% to those in an assisted living facility.

There are still many other interesting facts that was revealed by this important gathering of data that I will include in the next articles. The information presented here should be helpful to anyone who is seriously considering the purchase of long-term care insurance.

On a clear Monday morning, the New York Times ran a good story about Medicare Advantage Plans. Medicare Advantage Plans are a type of home health care plan sold by private insurance companies. These plans are actually associated with Medicare. It seems that seniors across the country have been duped into signing away their Medicare benefits by enrolling in a Medicare Advantage Plan. In some cases, the seniors didn’t understand how the Medicare Advantage Plans worked, and in others, they didn’t even know that the insurance agents had signed them up for the plan. The insurance companies that sell these plans have been accused of several bad practices, including:

There are deceptive marketing strategies that do not make a clear distinction between Medicare and Medicare Advantage Targeting of uninformed seniors in low-income areas by pushy agents with hard-sell techniques, Outsourcing customer service to overseas call centers, whose employees have substandard knowledge of the complex Medicare system, Insurance agencies such as Medicare Advantage Plans undergo greater scrutiny than they have in the past;and it seems to be helping at least a little. Kerry N. Weems, the acting administrator of the Centers for Medicare and Medicaid Services, says, “There are substantially fewer violations, and those violations are of substantially lower severity than in previous marketing periods.”

It is true that Medicare Advantage programs can help some customers to finance their senior care, but these plans are not for everyone. There are factors to consider before signing up for any type of Medicare Advantage Plan. Here, a few of the most essential issues: Make sure your doctor(s) and local hospital are within the insurance company’s network of providers. Medigap policies become null and void once you are enrolled in a Medicare Advantage Plan. If you already have a Medigap policy, cancel it once coverage begins with a Medicare Advantage Plan to avoid paying twice.

Some Medicare Advantage plans vary greatly. You are giving up all rights to your existing Medicare policy, so pick a plan that will meet your future senior care needs as well as your current ones. Always read the fine print. This is an important decision, don’t rush it! We live in a society where the buyer must beware. Call your parents tonight! Make sure that they know about the issues concerning Medicare Advantage. That phone call could be the one thing that saves them from making, or worse yet, being pushed into a decision that isn’t right for them. You don’t even want to think about the alternative!

A close family friend recently phoned me to ask, “So I am thinking about long-term care insurance, what exactly should I be looking for and where do I start? ” And my answer was, ” Are you confused?” “Yes.” “Well, that’s how most people start.” We both laughed, but the point remains that picking a long-term care insurance plan can be very confusing. Some of the other postings on this particular subject I have covered the benefits of buying a policy especially in the early years of retirement. But what should you be looking at when you are shopping around for an LTCI policy? and how do the policies actually work?

1. Check out what will be covered. LTCI policies vary and may cover home health care, homecare, adult day care (and health care), assisted living, skilled nursing care, hospice care or some combination of these, but one must look closely and see what is being covered. Your best bet is to get a policy which covers most, if not all, of these possibilities.

2. How benefits will be paid out. Most of the policies pay by a daily benefit. Sometimes the daily benefit is calculated using a monthly average. This is an advantage when working with nurses, aides or homecare might work sporadic hours if, for example, a family caregiver is available. Secondly, benefits are paid on either an indemnity or reimbursement plan. So benefits are either a lump sum payment regardless of what the charge is OR (in the case of reimbursement) the insurance carrier will only pay the actual charges for care even if the charge is lower than the maximum daily. There are times when the unused funds are carried over.

3. When your coverage will begin. Many policies spell out how many activities of daily living (like dressing or bathing) you must need assistance with before your coverage begins. There is also a waiting period, which usually runs from 0-90 days, but sometimes is longer. So you need to consider what you can afford to cover before your benefits kick in.

4. How long will your benefits last. How long do your benefits need to last;a few years? 10 years? Although this is somewhat of an unknown, you need to take into consideration if you are predisposed to a chronic illness and what kind of funds you may have at your disposal.

5. What will your benefits be “worth” once they are paid out to you. Not only should you look at how they are paid out but what is exactly paid out in regard to inflation. Many policies offer some sort of inflation protection. Considering long-term health care costs only seem to be rising, this protection translates into having a financial cushion protecting your assets.

6. Which resources can help you make the best decision. There are three resources you need to use to make the best decision: ratings companies, a reliable agent and yourself. Always make sure that you select a company which has been in business and is highly rated by A.M. Best, Moody;s, Standard & Poor;s, or Weiss. Looking for professional assistance with long-term care insurance and which policy might meet your needs? Get a free long-term care insurance consultation and quote. Finding an agent is tricky. Many people are “referred” by carriers or internet searches. This is akin to mushroom-picking by memory, it is not in your best interest. Look for an agent that sells a variety of products, but specializes in LTCI.

Also, if the agent’s commission rates are standardized, then it is not financially gainful for him or her to up-sell you. And although most of these decisions can and should be aided by professionals, it is always your job to be vigilant. Use common sense along with the help of professionals. It can be hard to determine what your long term care needs are. A good place to start is by looking at what many consider the baseline;that is, what the federal government offers to its employees via the Federal Long-Term Care Insurance Program.

All of us have that relative who always has a checklist of what needs to be done in case of an accident or crisis. And although we might mock them, many are happy to know what needs to be done and how they can pitch in. In my previous articles, I have talked about how important it is for both the family and professional caregivers to make sure they are taking care of themselves. Also, a new product, which is Lotsa Helping Hands website, is streamlining the process for family caregivers by allowing 1 person to organize a circle of up to 100 loved ones who can look at a list of tasks and volunteer to do them. Many baby boomers are facing the prospect of how to do senior care for aging parents.

For people whose old parents need help with activities of daily living (e.g., buying groceries, preparing meals or maintaining the household) this website can be very useful in helping establish a network where everyone can volunteer for “assignments” so that, for example, the groceries are not bought two times in a day or so everyone doesn’t visit Granny on Sunday, leaving her alone the rest of the week. The family members of the senior might also find this helpful in getting someone to stop by and “check in” on their loved one. Has the senior dressed properly for the day? Does he or she need breakfast to be made for them? Scheduling tasks is also made easier with Lotsa Helping Hands, another person can pick up the dinner shift and help with bathing. This type of coordination can augment the service provided by homecare agencies, particularly if the aides are only on duty for a few hours every day.

Perhaps best of all, the service is free and the website is fairly intuitive. The process takes less time than a phone call on the volunteer side, but the administrator (e.g., you) has to be fairly on-task with what needs doing. A calendar shows whether help is needed or if all needs are met on a particular day. You can even scroll ahead and offer specific services. I think this is a brilliant concept, I mean, how many times have you wanted to help someone, but just were unsure of what to do? Also, most families have members with more free time than others.

We often don’t phone relatives for help as we figure they are probably “just too busy” and that someone else will take care of it. However, giving everyone a chance to know what is needed and what they can do is not just democratic, it is downright helpful, and as senior care caregivers isn’t that the point? As always I look forward to your comments and would love to know more if anyone has used the service and found other glowing points or even something that could be better in regard to this fantastic new resource