Health Insurance

The father of a dear friend of mine, Carol, died a few month ago. Last Friday night at our synagogue, she stood up to speak Kaddish, which was the communal prayer for the deceased, and I was taken aback by my visceral reaction at seeing my friend stand and speak those ancient words. The reality of her loss and her vulnerability, as well as my own, struck me full force. In that moment, I realized anew that what had happened to her will happen to me and to those I love. Loss is an intrinsic part of our lives. Each change of our loved ones along the way, illness, a change in mental capacity, a lessened ability to take care of oneself, is a loss to be acknowledged. When senior care managers are called in, the immediate work is to assess any immediate needs and set the necessary services into place. A sensitive care manager also assists the older person and their families and friends in acknowledging and also examine what the changes in their lives means to each one of them, and how they can best manage those changes. Senior care caregiving can raise some difficult questions.

Being aware of the following concerns can help you when the time comes:

Physical: am I physically able to care for my loved one? What sort of help can I give? When is it time to hire outside help?

Emotional: what emotions does this bring up for me? Do I need help in acknowledging the difficult (negative) emotions? Where should I turn to? S

Spiritual: what is the meaning of life? Does it mean something different to me now that my loved one is at the end of life? What will happen to me as I age?

Caregivers will benefit by addressing the physical, emotional and spiritual concerns of their own lives when helping their loved ones, as well as practical considerations such as the significant time commitment that homecare caregiving requires. A care manager can be available to discuss these concerns. She can sensitively demonstrate that grieving and working through loss is a lifelong task, not one that is simply relegated to after a physical death. Awareness of the small and not-so-small losses during our lives, and grieving those losses as they occur, makes for a fuller and richer life. If we open ourselves to the difficult and painful moments in our lives, we are then free to truly experience moments of pure joy and happiness as well.

This article, written by Jill Gilbert, originally appeared as “Assembling a Cast of Stars” in McKnight’s Long Term Care News October 2007 edition. There is actually no magic formula in making or creating your own dream team. But after talking with Jim Lee, administrator of Nineteenth Avenue Healthcare Facility in San Francisco, we learned some tried and true tactics that every facility can employ and you don’t need to break the bank to do them, either. It starts with hiring. We all know that due diligence always pays off when recruiting and doing background checks on potential employees, but Lee also values nontraditional assessments. One innovative example: He assembles a panel of residents and nursing homes staff to meet with job candidates so both sides can check and determine whether the candidate would fit with the culture and nature of the facility. Lee describes hiring as “very much a two-way process.” Also take note that support is also a two way street as Lee takes a humble approach to management. One way he does this is by turning the organization chart upside down. The top tier is the CNAs, dietary staff and homecare keepers, who Lee says have “the most opportunity to make a difference in the quality of (the residents’) lives.”

{In turn, it is management’s duty to ensure employees~In turn, it is the management’s obligation to make sure that the employees} have the best training and support to do their jobs optimally. This happy symbiosis fosters loyalty. Nineteenth Avenue boasts one CNA who has been on the job for 37 years, and there are lots of employees whose tenure ranges from 17 to 30 years. Social events are an excellent way to pay thanks to your staff. Not only does Nineteenth Avenue celebrate birthdays, company anniversaries and cultural holidays, but each monthly meeting concludes with a drawing for small cash prizes. Staffers who haven’t called in sick that month are eligible to win. In addition to the drawing, he spends less than $100 each month to buy small gifts for all attendees. The bottom line: Even small thank-you’s can be powerful.

If you get sick and your regular health insurance can’t cover your expenses, what should you do? Below are three good options along with some pointers and explanations. If any of these types of supplemental policies have had positive (or negative) effects for you and your loved ones, we’d love to hear your story. Snapshot: Long-term Disability Insurance (LTDI) is for individuals who are working and younger than 65. Some financial planners propose that LTDI is your best bet because it will protect your income if you are unable to work for a period of time. LTDI is also sometimes referred to as income protection insurance.

With this type of policy, you will be unable to do your normal occupational duties in your work environment. These policies are created for people who are actively working;although those in risky jobs may find that they are undesirable to insurance companies. If a covered disability occurs, then a specified monthly benefit is paid to you for a finite period of time (typically no more than two years).

Snapshot: long term care Insurance (LTCI) should be purchased in your fifties or once retirement is already possible it’ll pay out a monthly benefit for the type of care your policy allows. LTCI is geared toward the senior market. There are actually three types of policies: each of which is based on where benefits will be paid: either in a facility, at home or both. This type of insurance stems from the idea that as you age you may need assistance with anything from the activities of daily living (e.g., dressing or bathing) to skilled nursing care, and that in-home caregivers and care facilities are not affordable for many of us. Furthermore, many worry about draining their personal financial resources, resulting in an inability to leave an inheritance for their loved ones, or even support themselves at all.

For more information on when to buy LTCI, check out Is Long-term Care Insurance Worth It? Snapshot: Critical care insurance pays a single huge amount and then terminates, but your particular life-threatening condition must be enumerated in your policy. With critical care insurance, you are also paid a large amount after you have been diagnosed with a critical illness. The idea is that auxiliary expenses tend to pile up when diagnosis occurs, even if a person is insured in adult day care.

With a critical care insurance plan, the beneficiary can decide where his/her benefits will do the most good, whether it goes toward skilled nursing in home health care, or lost wages for family caregivers, or other expenses of daily living that are difficult to meet when one is financially disabled. As the policy only pays once, it has some advantages and disadvantages; while you are responsible for managing the funds sufficiently, then a big payment can ensure that debt isn’t allowed to accrue.

Long-term care insurance (LTCI) policies are very different from most other kinds of insurance. As a result, even the foundational features of these policies require taking some time to understand before making your final decision. But what about all the other options and features that are not built into the policy and require you to pay extra to get them? In my opinion, LTCI policies are best kept simple. If you have already done researching on setting up the foundational features of the policy, you have already done 90% of the work in most cases. Remember that it is always a good idea to find out more about those other options once you feel that you can afford to spend more on your care, but you should also examine whether they are truly going to be cost-effective in your case. A good way to accomplish this is to narrow down your selection to the two to three carriers that you feel most comfortable with and get quotes on a straightforward policy setup with no extras or options added.

Next thing to do is to add on the choices that you are interested in one at a time and then get a new quote. This will tell you exactly how much extra you can expect to pay for these options. Once you have those figures it’s much easier to decide if the options you are considering are really worth pursuing further. Here is a list of some of the most popular options in LTCI or Long Term Care insurance policies:

1. Return of Premium - This option allows you to receive back some or all of the premiums that you pay into the policy if you either decide to cancel the policy or if you die without using all of your benefits. {This is often a very expensive option~Be careful as this option is very expensive}.

2. Survivorship - The benefits of this option can vary from carrier to carrier, but typically it says that if the policy premiums have been paid for a specified period of time, often ten years, and one spouse dies, the surviving spouse’s policy is considered paid up with no further premiums required.

3. Restoration of Benefits - This provision restores all of the benefits paid out for care if a policyholder fully recovers and does not suffer a relapse for a specified period of time (usually six months).

4. Waiver of Home Health Care Elimination Period - This option reduces the elimination period (the amount of days that you pay for your own care before the insurance company starts to pay) to zero. This only means that it starts to pay from the very first day of services made if the care is recieved at home. There are other options that can be considered when shopping for LTCI too, but in my own experience, the most common problem is getting bogged down in these extra features that do not really impact the quality of your future care nearly as much as the foundational features.

This is one reason why getting an experienced and knowledgable agent help you with the process can often reduce much of the confusion surrounding these options so that you can select the policy and features that suit you best.

Private insurance companies sell LTCI policies to offset the costs of long-term care. LTCI, like all insurance policies, requires premiums to help recipients avoid paying large sums later on in the event of an illness or a catastrophic event. Premiums are based on the individual’s age at the time of purchase and are usually locked in for the life of the policy. LTCI covers the following, depending on the policy you choose:

Care in a skilled nursing facility

Care in an assisted living facility

Home health care

Adult day care

Buying a LTCI policy gives the policy holder to select from the many options, such as the amount of the daily benefit, the number of years the policy will pay benefits, and, once the applicant qualifies for a policy, the number of days or months before the policy will begin paying benefits. It is imperative to evaluate policies with scrutiny in order to see which one offers the benefits that you are looking for with a premium that fits your budget. Policies differ in their benefits, contract conditions, deductibles and premiums.

It is also a matter of great importance to take into account the rising expense of home care. Be sure the LTCI policy gives inflation protection for benefits to increase as health care costs continue to rise. Policies are generally labeled according to the place in which benefits are paid. Remember that home care only policies only pay for care at home and in an adult day care or adult day health care facilities. Make sure the policy includes both types of day care. Facility-only policies pay for care in a skilled nursing facility and in an assisted living facility. Comprehensive policies pay for care in a skilled nursing facility, assisted living facility, adult day care or adult day health care facility, and at home. Since the LTCI claims are always paid within many years after the purchase of the policy, it is imperative to check the following: Financial strength of the company. The industry’s major rating services are A.M. Best , Duff and Phelps, Moody’s, Standard and Poor’s and Weiss Ratings . Reputation and claims-paying history of the company.

You can contact the State Insurance Department for more information on specific private insurance companies. Click here for listings information for each state’s insurance information. Applicant must be healthy at the time of application Each insurance company has individual requirements and/or limitations Not sure when is the right time to buy an LTCI policy? Or how to assess what you will need from a policy? Visit our Expert Column on Financing Long Term Care to find out more.

Hospice services are available twenty-four hours a day, seven days a week. There is always a nurse on call at night and on weekends. The nurse will then visit a patient as often and as long as necessary to make sure that there is quality care. Because of this wonderful service, many people are under the impression that hospice care is expensive, and yet they believe that they cannot afford such a treatment. However Medicare, Medicaid and private insurance companies cover hospice care and services. This will include, but is not limited to, medications, nursing care, home health aides, social services and medical supplies. In 1983, Congress established the Medicare Hospice Benefit, covered under Medicare Part A, to ensure that all beneficiaries could receive high-quality end-of-life senior care. In order to receive the Medicare Hospice Benefit, the patient must meet three key criteria.

First, the patient’s doctor must certify, within his or her best clinical judegement, that the patient should be terminally ill with a life expectancy of six months or less. If the patient lives longer than six months, he or she can continue to receive hospice care as long as the doctor re-certifies that the patient is terminal and with declining health. The second key criterion is that the patient is willing to receive comfort care instead of curative treatments for their illness. For example, a patient could not be getting chemotherapy to cure their illness and be getting hospice care simultaneously. Hospice is intended to be used once a curative treatment is no longer a choice. Finally, the patient needs to enroll in a Medicare-approved hospice program. This should be one of the first questions you ask in determining which hospice agency to use. More than 90% of hospices in the United States are certified by Medicare.

Congregate care is the same as to independent living. Residents of congregate care live independently, for the most part. This type of housing environment is usually offered at least one communal meal per day, and it’s common for services and activities to be offered to residents. Independent living, on the other hand, typically offers only living quarters and limited services.

Based on an evolutionart standpoint, our bodies are made for short bursts of stress, just like running from a dangerous situations, like a forest fire. But today’s world is one of constant low-level stress. For most caregivers, high amounts of stress levels are continual. And frankly, the human body isn’t made to withstand such constant wear and tear. Therefore,most family caregivers cannot put aside strong feelings that is associated with caregiving, which can run the gamut from devotion to guilt, to see the importance of avoiding the problem of caregiver burnout.

I cannot stress this enough: as a senior care caregiver, you are only as good as the care you can provide. Oftentimes this is based on factors outside your control. You will get tired. You will get frustrated. You will need help. You’re allowed to have these thoughts and feelings. So how do you know when passing frustration has fizzled into a burnout situation? Well, early signs are similar to depression in that assisted care caregivers can vacillate between anger, anxiety, sadness and irritability. Feelings of exhaustion, both physically and emotionally, along with changes in weight are also hallmarks. Keep in mind that a depressed mind can make for a depressed immune system; getting sick often could be another warning sign. Additionally, perhaps the greatest irony of care giving is that the caregiver’s health concerns are often not looked into, because the caregiver isn’t the one who is “sick” or “needs help”.

Many family caregivers are reluctant to “take up time” for their own doctor visits. If these symptoms starts to grow more frequently or intensely, then it is time to seek help. Again and again I urge caregivers to make certain they are taking care of themselves, because even though it is good to place someone else needs above yours, it is not always feasible or right. In parent-child relationships, the adult children will often feel that they must look after the parent, in order to return the favor of having raised by their parents, even they are unqualified or ill-equipped to do so. These are all honorable ideas, however, reality is that care giving situations;just like raising a child;requires a village. If you want to provide good long-term care then you need to get hooked in with family, friends and outside resources. You can be the primary caregiver and still not be there every minute of the day. Spread out responsibilities.

On the Gilbert Guide web site alone, we offer dozens of solutions and ideas to help family caregivers, including coping strategies, online resources, and information on topics such as Alzheimer’s and dementia care, and how to effectively advocate as a caregiver. There are also support groups that provide family caregivers a place where they can discuss their feelings openly, can help monitor the effectiveness of coping strategies, and let caregivers know they are not alone. But one of the simplest solutions to avoiding caregiver burnout is this; keep your sense of humor and look for the small joys that can come your way throughout the day.

Here at Gilbert Guide, we are constantly urging family caregivers to seek respite so that when they are “on-duty” they can provide the best home health care to their loved one. One of the toughest jobs we can think of is taking care of an aging loved one, which is why each of our Guides has sections on Caregiver Support, Counseling and Support Groups and Crisis Lines. But just like what one of our readers recently pointed out, what resources are available for the professional caregiver, especially those who provide live-in senior care and assume a huge amount of responsibility? The reader also asked if there was forum in which to discuss wages and other issues in regard to providing professional home health care. Her opinions have brought up a point which was recently talked on Medical News Today that reports for caregivers are some of the lowest in the country. And how this fact coupled with the aging population of baby boomers could spell trouble for the industry if it is unable to keep up the supply with the demand.

To be honest, we are not so sure as to how to help her out, so we would like you to weigh-in, please tell us if you know which of the organizations, including anything from advocacy to support groups, you have found useful. Have you had any luck with contacting the National Organization for Homecare and Hospice to see what they recommend? Which direction were you pointed in, and most importantly, do you feel like your opinions are being heard?

Board and care homes are residences for seniors who require some care or help with the activities of daily living (ADLs or IADLs). These are smaller scale assisted living facilities, usually having a resident capacity of no more than fourteen. Licensing requirements vary by state, some states require that board and care homes carry the same license as assisted living facilities

CCRCS are actually living communities for seniors. Most have three levels of residence: assisted living, independent living and skilled nursing. Each level of residence is tied to the level of care that the resident requires. The primary concept behind a CCRC is that it offers a wider spectrum of care,~The most primary concept behind a CCRC is that it gives a wider spectrum of care so that once a senior moves into the community, he or she will be able to receive the appropriate care as his or her needs change. Many CCRCs support aging in place. Searc Gilbert Guide’s CCRC listings along with more information about what CCRCs offer.

When Should You Consider Buying Long-Term Care Insurance?

The short answer to this question is: the month before you need to make a claim! But since none of us have a crystal ball to tell us when we will be having a stroke or heart attack, or be diagnosed with a debilitating disease such as Parkinson’s, multiple sclerosis or Alzheimer’s, we simply can’t rely on waiting till the last minute to buy long-term care insurance. The basic truth is that anyone, regardless of age, can have an unexpected accident or a change in their health that they could not possibly have foreseen that wll require long term care. A couple of well-known examples of such a situation are Christopher Reeve and Michael J. Fox.

The problem nowadays is that most people think that long term care insurance is mainly for older folk. But that is simply not the case. In fact, almost 40% of those receiving long term care are younger than 65 years of age! This surprising statistic testifies to the unpredictability of such a need arising at almost any age. So, I suggest that the best age to purchase LTCI is at the earliest age that you:

1. Can comfortably afford the premium.

2. Have enough income and/or assets to protect that it justifies the cost of the policy.

one more reason for getting long-term care insurance earlier in life is that the premiums are much less and you will most likely easily qualify for coverage, perhaps even at a preferred rate that will save you considerable amounts of money throughout the life of the policy. The only problem is that as we age, most people stand a higher risk of developing health conditions that could cause them to become uninsurable at some point, or at least substantially drive up the cost of a good long-term care insurance policy. My recommendation is to avoid these problems by investing in LTCI at a relatively early age if you can. And since the cost of long-term care is not covered by medical health insurance, it only makes sense to protect your assets against one of the most devastating threats to your personal finances. Then, in most cases, the earlier you get coverage for long-term care, the better.

One rule that I always adhere is that I don’t discuss politics and religion unless I am with my close friends and relatives, it’s just too easy to cross the line from thought-provoking to offensive, especially for someone who’s as outspoken and opinionated as I am. After reading a recent article on President Bush’s 2.9 trillion spending plan for 2008, however, I felt that I need to break my rule. President Bush recently went before Congress, controlled by the Democratic Party for the first time in his presidency, and proposed a 2.9 trillion budget that will entirely cut down 70 billion in funding from Medicare and Medicaid over the next 5 years, while increasing military spending and without affecting first-term tax cuts. While the proposed time frame happens to be in line with Democratic goals, there seems to be some dissonance in terms of federal priorities. If you are in a higher income beneficiary you could expect to pay much higher long term care insurance premiums and more for drug coverage.

Another component of the plan, according to the New York Times: ” freezing Medicare payments to home health care agencies and reducing inflation allowance paid to hospitals, nursing homes and other providers. ” Considering Congress, bad response to be president’s proposal from last year which suggested smaller Medicare reductions, it’s unlikely this plan will be accepted as is. Whether you bat for the left or the right, though, there’s no denying that the rapid increase in the retirement-age population puts a lot of pressure on the federal budget. Remember that entitlement for the older Americans come from income taxes on people of working age. It takes five working Americans to support one senior citizen’s entitlements. How would, or should, the government respond if Social Security trustees have projected accurately, and by 2030 there are only three workers for every adult older than 65?

It is entirely possible for Medicare, Medicaid and Social Security to consume federal spending. Are there options that don’t involve spending cuts or tax increases? How and where should we conserve to avoid a fiscal crisis without stripping Americans of the care to which they’re entitled?