COVID-19 Testing available for Medicare beneficiaries

Medicare Part B generally covers medically necessary outpatient testing for beneficiaries. CMS has recently advised that if testing is ordered by the patient’s physician and the test is performed on or after February 4, 2020, it will be a covered service under Medicare Part B. Read more here.

The Centers for Medicare and Medicaid Services is issuing fact sheets and alerts that address corona virus-related concerns raised by Medicare beneficiaries as well as health care providers. Some of them are: guidance to home health care providers — anyone who hires a home care provider might want to study this and share it with their employee — expanded tele-health services to enable people to contact professionals for advice by phone; and specific guidance for specific health care settings such as nursing homes or dialysis centers. 

The Center for Medicare Advocacy (CMA) is an excellent source for updates about Medicare and for advocacy on legal problems with Medicare coverage that are encountered by enrollees. Another great source of help can be found at your local SHIP office — the State Health Insurance Assistance Program (SHIP).

Call us for help with your elder care law problems …… 732-382-6070

Behavioral Therapy Techniques Show Promise for Alzheimers’ Patients

If you are caring for a person with Alzheimers’ dementia, you are probably seeing a number of behavioral changes that are difficult to understand and challenging to respond to. These are sometimes called “neuropsychiatric symptoms,” and they span the spectrum from apathy and depression to wandering, disinhibition, irritable verbal onslaughts, agitated pacing, and hallucinations. Physicians sometimes have success in managing these symptoms by prescribing  medications to address anxiety, restlessness/agitation or psychosis. Studies are ongoing and there’s an excellent article about them by Jeffrey L. Cummings, M.D. in the Spring, 2016 issue of  AFA Care Quarterly.

Non-pharmacologic  interventions are the province of behavioral therapy. Caregivers can learn what triggers an agitated response and can avoid those triggers; they can learn to engage the patient in activities which increase socialization and stimulation while avoiding an increase in the patient’s confusion or distress. Each patient is of course unique, and a caregiver would be wise to keep notes of behavioral changes, stimuli and triggers, as well as what responses seem effective and which just made things worse. This is crucial information for the physician, as well as for other people who will be caring for the individual.

If your loved one needs to be placed in a nursing home, a full medical report is requested and it is important to discuss these behavioral issues as you work with the staff to develop the individualized care plan. The Nursing Home Resident’s Bill of Rights and federal Medicare and Medicaid laws require a skilled nursing facility to “provide services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident, in accordance with a written plan of care.” See 42 USC 1395i-3(b). It has to be an individualized plan. You will be helping the staff to do the best job for your loved one if you share with them what you know about him or her.

We advocate for nursing home residents in care planning meetings. For elder care advice and representation, call us at … 732-382-6070

Baby Boomers looking ahead: long term care insurance or Medicaid?

There’s no doubt about it, long-term care insurance is expensive, and the premiums can be steep if you wait until after age 70 to first buy a policy. Some companies have gotten approvals for big premium increases on old policies. The marketplace has shrunk as companies have left the business, and some companies create bureaucratic barriers to paying claims. However, there’s also no doubt that nursing home care is expensive — in New Jersey it is not uncommon for the monthly costs to hit $12,000 to $14,000 a month. Hiring a live-in to help you at your home can cost $6,000 a month.  If there’s no money and no insurance, then Medicaid is the only source of payment.

The Baby Boomers and those starting to plan their retirement years have to think way ahead, as life expectancy is lengthening and therefore the statistical risk of needing long-term care in one’s 80’s is real. The Boston College Center for Retirement Research has interesting articles and useful statustics on this subject.   http://crr.bc.edu/briefs/long-term-care-how-big-a-risk/ Their recent research shows that more people are trending towards waiting to see what happens, and then embarking on a Medicaid spend-down plan, rather than purchasing long-term care insurance. The benefit is the savings in premium dollars, of course. The downside is that the state Medicaid program may only provide a complicated or inadequate home health aide program for people residing outside of nursing homes.

As I see it, the main benefit of long-term care insurance is the way it helps people age in place at home. To remain in the home in a “naturally occurring retirement community (NORC)”, a person needs to plan out their need for hands-on assistance, transportation, medical services, grocery shopping & food preparation, and attending social & cultural events,  If you have the means, insuring for long term care costs can make a big difference in how quickly you can get your home care started and in the administrative process that’s involved after that. Policies frequently  have a 90-day waiting period. This means that once you require hands-on home health care because you’ve become dependent in two or more of the Activities of Daily Living (ADL’s), you need to cover the cost of that care during the waiting period. Depending on the circumstances, this may not be a big financial burden, because many patients are tending to their own needs at home and it isn’t until they are hospitalized due to illness or injury that they begin to have care in the home. For those patients, they may receive skilled care or “rehab” during this initial waiting period, paid for by Medicare part A or their Medicare Choice plan.

For those without such insurance, the only way to obtain in-home care is to pay for it privately or apply for Medicaid when the assets are below the required level ($2,000 in available assets; the home is not counted; there can also be a share of assets reserved for the spouse). The application is filed after the applicant’s assets reach this level, and then the long wait begins , as the application is being processed.  However, New Jersey’s MLTSS Home and Community Based Services programs  have been undergoing a massive reorganization since 2013 with an apparent shortage of staff to fully and swiftly implement the program. Everyone hopes that the snags will be worked out soon. The law requires that the county welfare agency notify the applicant within 90 days if there is a reason the application can’t be approved. This is often the opening volley in a protracted experience. So based on past experience, I think that it is still likely to take a very long time for  the county welfare agencies to process and approve the many home care applications they receive under MLTSS.

Careful planning can prevent a crisis and improve your ability to direct the course of your care plan.

Call us about planning for a good old age… 732-382-6070

 

National Panel Encourages Greater Use of Palliative Care at End of Life

Today it was reported that a nonpartisan 21-member committee appointed by the federal Institute of Medicine, which is the independent research arm of the National Academy of Sciences, has issued the results of its investigation into the way the United States’ health care system including Medicare deal with the delivery of treatment at end of life. Their 507-page report is called “Dying in America,” and you can read the report or the abstract at http://www.iom.edu/Reports/2014/Dying-In-America-Improving-Quality-and-Honoring-Individual-Preferences-Near-the-End-of-Life.aspx.  Along with recommendations to improve physician-patient consultation on end of life care, they urge Congress to begin looking at ways in which greater Medicare resources could be put towards home health care.

I wrote about this subject in my post on September 5th. There is a tremendous need to educate families and patients about the nature of palliative comfort care (hospice services) at the point in time that continuing treatment of chronic debilitating illness will be of minimal benefit and could cause further misery or suffering. It’s not merely an issue of saving health care resources & outlays — though that will be a likely result. I believe that it is really about enabling patients to come to terms with the declining trajectory of their illness and with their inevitable death so that they can stay comfortably outside the hospital and enjoy what time they have left. Practical, realistic conversations with physicians about the palliative or hospice care options at an earlier point in time  would be beneficial to patients who can no longer recover from debilitating chronic illnesses.

The NY Times article is at http://www.nytimes.com/2014/09/18/science/end-of-life-care-needs-sweeping-overhaul-panel-says.html

For advice on preparation and interpretation of “living wills” and advance directives , and planning for long term care, call 732-382-6070

Schedule a Family Meeting before Leaving Rehab

If you have assisted a family member through a course of subacute rehabilitation (up to 100 days under Medicare Part A following a hospitalization), you are no doubt familiar with the process of the “family meeting.” This is a meeting at the facility attended by the members of the patient’s treatment team — the head of nursing, dietary, recreation, physical therapy, occupational therapy, speech therapy, and even the physician — where the patient and their family advocate discuss the goals that are in place for the patient, the progress being made, and the patient’s ongoing “skilled needs.” These meetings take place every few weeks during the skilled care/rehabilitation process.

Then there comes the day that the patient is advised that s/he will be discharged. Decisions have to be made quickly — is the patient staying in the facility for long term care? Is the patient going back to the community? If the patient is returning to the community, there may be a myriad of issues to address. Sometimes patients have multiple needs — the house may be inaccessible; they may need a companion in the home; they may be unable to prepare their own meals; they may have ongoing clinical problems that need specialized nursing attention; they may have behavioral disorders related to dementia which require special handling. Each patient has unique needs, and they may not be as capable as they were before this latest medical crisis.

When you are coordinating the discharge, the facility’s treatment team can be an invaluable source of information and suggestions.   Since home health aides for the basic activities of daily living (ADL’s) often must be hired privately — as generally the cost cannot be billed to Medicare —  family caregivers may be inclined to set up an informal casual volunteer arrangement rather than bring in many hours of professional hired help. However, the team at the facility may have an objective viewpoint on what is actually needed for a safe and successful return home, and this can be very useful to the family.

What are the questions to ask? Not just “can he come home?” Patients can usually go home if the proper supports are in place. You need to go well beyond the equipment that may be needed. Instead, try these concrete questions: 1.What do your aides have to do for him every day, starting when he wakes up? 2. Does he need physical assistance with showering, or just a shower stool to sit on and someone standing by? 3. Do you recommend that he have someone next to him while he is walking around? 4. Can he move his wheelchair around by himself? 5. Are there any special dietary issues we need to know about? 6. Does he get out of bed at night and try to walk around, or does he sleep through the night? 7. Do you think he needs to have an aide in the house throughout the night? 8. Does he ask for assistance, or just wait until someone comes in and asks him a question? 9. Does he eat his meal without someone assisting or prompting?  10. Do you have any thoughts on whether he can safely be left alone in the house?

Careful planning can prevent a crisis. Take advantage of the skills and knowledge of the rehab team to help you prepare for a good transition home.

 Contact us for legal advice and advocacy on a wide array of elder care issues, including participation in family meetings … (732) 382-6070 http://www.finkrosner.com/contact.html