Seniorcare Options & Entitlements
How to Select a Nursing Home
A nursing home is a facility for persons needing skilled nursing services under a physician's direction and of the type and complexity not requiring hospitalization. Well-run and properly designed and staffed nursing facilities will provide a pleasant, clean, mentally-stimulating environment; careful attention to the nutritional needs of residents; a competent plan for controlling infectious diseases; rehabilitation services; and recreational activities.
Seek referrals from your physician or pharmacist. Visit several nursing homes before choosing and look in a community familiar to your loved one and/or close enough for you to visit regularly. Look for one that best fits their personality and needs. Check Health Department reports, which are on file and should be readily available to you at all nursing homes.
The following are some of the indicators of the nursing home's ability to provide the special care and commitment seniors require and your loved one deserves. Observe whether the staff is friendly and courteous. Is the facility clean and odor-free? Are rooms neat and well kept? Are the residents, themselves, well-groomed and active? What is the pace of activity? If it looks hurried and helter-skelter, that may be a signal of understaffing.
Assisted Living Services for Seniors
Assisted living services can be provided to seniors in two ways...in an assisted living residence or at home. Since there is no established standard for services provided in an assisted living facility, you will have to compare to determine the scope and level of services appropriate for your needs or those of your loved one.
Generally, assisted living facilities provide rooms, meals, supervision and assistance with the personal care, bathing, medications, and housekeeping needs of those elderly who cannot live alone in their homes but for whom nursing home care is not necessary. Some assisted living facilities offer a range of private or shared apartments. The scope, length and frequency of services available will vary, sometimes greatly, from place to place. These services may be charged for on an item-by-item or all-inclusive basis.
When deciding which facility is best for you, the specialized experience and skill level of the staff is of critical importance. Determine whether the staff is in-house or contracted for from outside. How many meals per day are provided? Is medical assistance available around the clock or only part of the day? Look for comprehensive recreation, nutrition and wellness programs.
Assisted living services can also be contracted for at home. These range from health services to rehabilitative therapies to personal assistance with meal preparation, bathing, dressing, transportation and housekeeping. Be sure to select a reputable, dependable provider experienced with the frailty of seniors and offering a broad scope of specialized services, since the unique needs of the elderly can change rapidly.
After a lifetime of work and raising a family, many seniors choose to compliment their retirement by trading the burden and responsibilities of home ownership or living alone for the carefree lifestyle, comforts and companionship of a retirement community.
Retirement communities provide a wide range of accommodations, conveniences and amenities which might otherwise be unavailable or difficult to access and enjoy. They allow for independent living while providing a wide range of services, including prepared meals, housekeeping, security, transportation, and a calendar of social events and recreational activities.
All retirement communities are not created equal, so compare carefully. Some offer the convenience and benefits of on-site health and assisted living services. Consider the facility's reputation and the experience of staff. Are services provided around the clock or just part time? Can meals be prepared to your individual diet? What is the scope and frequency of housekeeping and linen services? And if proximity to family is one of your criteria for selection, is the facility part of a network that may enable you to reside closer to your loved ones if your family moves?
Finally, ask the people who live in the places you are considering. After all your considerations, some of the best evidence that a retirement community is all that it appears or promises to be may be found by asking those who have already gone through the selection process.
Home Care for Seniors
Home care is a form of health and personal care delivered directly in the home. Services are provided to recovering, disabled or chronically ill persons requiring monitoring, treatment or assistance with daily activities of living. Care may be intermittent or long term.
Choosing the appropriate home care agency will depend on the type of care required and any restrictions imposed by the resources that will pay for them...such as Medicare, Medicaid, private supplemental insurance or personal funds.
Home care is usually a team effort involving professionals, such as registered nurses and therapists; technicians and aides, such as certified nursing assistants and homemakers; and volunteers, such as family members or friends.
A specific plan of care should be designed beforehand for each individual by a physician and/or social worker in concert with the team of people who will carry it out. Discharge planners can arrange for home care services for you after a hospital or nursing home stay. By law, the hospital or nursing home is required to present you a choice of agencies and make arrangements for any you may have pre-selected.
Quality of leadership, reputation, level of specialization or experience with seniors, and caliber of personnel should be your major considerations in selecting the right home care agency for you. Are they certified by Medicare? Are they licensed? How does the agency choose and train its staff? Ask for references and follow up on them. Investing the time to choose a quality home care agency at the outset will help insure a happy outcome.
Rehabilitation Services for Seniors
After an illness, injury or operation, some form of rehabilitation may be prescribed by your physician. For seniors, these rehabilitation therapies typically fall into the categories of physical therapy, occupational therapy and speech therapy.
The goal of physical therapy, or PT, is to restore the function, range of motion and ultimate use of a limb or other body part. Occupational therapy, or OT, is concerned with restoring one's ability to work and perform essential tasks, such as caring for oneself and maximizing independency. These therapies are sometimes performed together, relying on the therapeutic properties of exercise, cold, heat, and massage to improve circulation, strengthen muscles, and train or retrain an individual to perform the activities of daily living.
Speech therapies, often prescribed after a stroke, are designed to overcome defects and disorders of the voice and of written communication. Each of these rehabilitative therapies should be performed by trained, licensed professionals experienced with the fragile nature and specialized needs of seniors.
What is Medicare?
Medicare is a federal health insurance program that helps seniors pay for medical care. You become eligible on the first day of the month in which you turn 65. However, if you are disabled or suffer from kidney disease, you may become eligible before age 65. If you are already retired and getting Social Security, you will automatically get a Medicare card in the mail when you turn 65. Otherwise, you must file an application for coverage during an initial enrollment period, which starts 3 months before your birth month and ends 3 months after. If you don't enroll at that time, you must wait for the general enrollment period held the first 3 months of each calendar year.
Like most other insurance programs, Medicare does not pay the entire bill when you receive medical care. It has deductibles and co-insurance provisions that require you to pay part of the costs yourself and there are a number of medical services it does not cover.
Medicare divides all medical care into two parts, referred to as Part A and Part B, which you can enroll for separately or together. Part A helps pay for inpatient care in a hospital or skilled nursing home, home health care and hospice care. Most people don't have to pay premiums for Part A of Medicare. Part B, which everyone must pay monthly premiums for, is medical insurance that covers doctors' services in and out of the hospital, outpatient hospital services, medical equipment and various other medical services and supplies.
What is Medicaid?
Medicaid is the popular term for Medical Assistance, also referred to as Title 19 of the Social Security Act. Administered by the state, Medicaid is jointly funded by the federal and state governments and pays for the medical care of low-income people with limited resources.
Subject to broad federal guidelines, the state determines the benefits that will be provided, eligibility, rates of payment and methods of administering the program. Medicaid payments are made only to health care providers and subject to established limits that may change as Congress considers future alterations to Medicaid coverage. Currently, people eligible for Medicaid pay no premiums or co-insurance.
In a nursing home, while Medicaid pays for everything from medication, lab and physician services to eyeglasses, dentures and room and board, most recipients are required to make a contribution from their income. Medicaid also covers less intensive but widely needed long-term nursing care, which Medicare rejects as custodial. In the community, it covers doctor's services, medications, and select in-home health care services. It does not cover personal needs such as clothing, barbers, beauticians, and nursing home bed reservations.
Eligibility standards allow an individual, couple or family to keep a small amount of income and resources while receiving Medicaid benefits. To find out if you qualify, simply contact the Department of Human Services office in your community.
What is Medigap Insurance?
Medigap is a term used to describe private health insurance designed to supplement or fill the gaps after Medicare has paid its share of medical bills. A supplemental insurance policy can help pay deductibles, co-payments and services beyond the scope of Medicare. Such policies are available from many different insurance companies. One policy should satisfy all your needs although coverage varies from plan to plan. One of the most familiar plans is Blue Cross 65.
You should begin your consideration of Medigap insurance by understanding Medicare. The more familiar you are with what it covers, the easier it will be to evaluate the benefits of supplementing it. If you are eligible for Medical Assistance, the medical care program for low-income people with limited resources, you don't need a Medigap policy. However, changes being considered by Congress for Medical Assistance may limit coverage in the future. You may also find that you can convert private insurance through your former employer into a supplemental policy after retirement.
If you choose to buy a Medigap plan, be aware of pre-existing condition provisions and select a company that is financially stable and licensed in Rhode Island. In that way, if you have a problem, the Department of Business Regulation can intervene on your behalf. The Department of Elderly Affairs publishes a free guide containing price information about Medigap policies available in Rhode Island. Federal law allows a 30-day "free look" at such policies. If you return it within that time, your money must be refunded.
Long-term Care Insurance
Medicaid has traditionally served as the safety net for families facing the expense of nursing home care. Concerns that changes in Medicaid rules may reduce levels of coverage and limit eligibility have many seniors seeking precautions such as private long-term care insurance. The cost of these policies is relatively high at age 65.
As a general rule, consumer advocates recommend paying no more than 5 to 7 percent of your income on long-term care premiums. If you wait until you're sick or very old, it is too late. Older folks diagnosed with Alzheimer's or some other disabling condition will be rejected and even healthy people in their 70's could face very high premiums. Premiums drop significantly if you are younger. If you can't afford a good policy, advocates suggest not to bother. You must be sure you can afford the payments over the long haul.
It is essential to have inflation protection on such policies, since you may not use it for several decades. Although insurers promote lifetime coverage, realistically most seniors probably won't need more than a few years. Choose your insurance company carefully. Some agents represent only one company and some may represent many. Compare the underwriting procedures, claims payment histories and other vital information of several companies before deciding. You can check any company's rating on financial stability and ability to pay claims through rating services such as Standard & Poorsďż˝. Finally, get a copy of the policy contract, not just an outline, and make sure you understand every word.
How to establish a Living Will
Many experts advise people, especially seniors, to prepare "advance directives" to control the type of medical treatment they desire if they are unable to speak for themselves. This is simply a plan for your health care if you are unable to communicate.
Rhode Island has two types of "advance directives". The first type, commonly known as Durable Power of Attorney for Health Care, allows any Rhode Islander over the age of 18 to appoint an agent or advocate to make health care decisions on the person's behalf, if the need arises. A specific form must be completed to convey Durable Power of Attorney to someone.
The second type, called a Living Will, enables a person to make decisions ahead of time instead of appointing someone and putting any burden of decision on them. To establish a Living Will, you must complete a form instructing physicians of your desire to withhold or stop life-sustaining medical procedures in the event you develop a terminal condition and cannot communicate your exact wishes at the time.
It is recommended that anyone who is generally concerned with their health care prepare an advance directive. Although no specific form is required for a Living Will, general forms for such a purpose are available by calling or visiting the Department of Elderly Affairs. These directives can be revoked at any time by simply telling your physician not to follow them.
Government Services for Seniors
There are numerous government agencies that provide services to seniors. The Rhode Island Department of Elderly Affairs provides supportive programs and information about many of them, as well as assistance with problems related to aging.
The DEA, as it is called, provides information and referrals to help seniors meet medical and prescription needs, as well as counseling in obtaining assistance for legal, employment, tax and health insurance matters. It investigates complaints of elderly abuse and neglect and coordinates appropriate protective services. It issues senior citizen ID cards as proof of identification for check cashing and banking transactions.
The DEA maintains information on services that offer Alzheimer's care, adult day care, and geriatric assessment. The department also provides speakers to discuss topics of interest to senior groups and organizations.
Another government agency, the RI Department of Health, can provide you with information on the home health agencies, skilled nursing homes, and assisted living facilities that it licenses. It also operates a Hotline to answer your questions about nutrition, as does the URI College of Pharmacy to answer your questions regarding the medications you are taking.
Your local Social Security office oversees Medicare enrollment and is the main source of information on coverage.
The RI Department of Human Services provides eligibility evaluation and information on Medicaid reimbursement and long-term care assistance. Questions regarding health benefits for senior veterans should be directed to the VA or Veterans Affairs office.
Important Telephone Numbers
RI Department of Health
Three Capitol Hill, Providence, RI
General info 277-2231
Assisted Living info 277-2566
Nursing Home info 277-2566
Nutrition Hotline, Mon, Wed, Fri, 8am - 1pm, 1-800-624-2700
RI Dept of Human Services
600 New London Ave., Cranston, RI
General Info 464-3361
Long-term Care Assistance 464-5182
RI Department of Elderly Affairs
160 Pine Street, Downtown, Providence
General Info 277-2880 or toll free 1-800-322-2880
Medigap & Long-Term Care Insurance (same as above)
URI Medication Hotline
Typically open Mon., Wed., & Fri. 8am-Noon or you can leave your name and they will call you back.