Monthly Archives

December 2015

Who Receives Skilled Nursing Care and Where in Rhode Island?

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Skilled Nursing Care Demographics in Rhode Island

Nearly 8,000 people reside in Rhode Island’s 84 nursing homes and skilled nursing care facilities at any single point in time.

They are mostly independent facilities (60.7%), although a large minority belong to a multi-facility organization (39.3%). Nearly eight in 10 (78.6%) RI nursing homes are for-profit.

Residents are predominantly female (72.1%) and non-Hispanic white (93.4%).

More than half (55.5%) are aged 75 or older.

In 2012, RI nursing home costs averaged $8,517 per month for a shared room and $9,277 per month for a private room. Source: Rhode Island Journal of Medicine: The Nuts and Bolts of Long-Term Care in Rhode Island: Demographics, Services and Costs (March 2015)

WHAT ABOUT BEING ABLE TO RECEIVE CARE AT HOME UNDER THE MEDICAID WAIVER PROGRAM?

Rhode Island has a program called SSI Enhanced Assisted Living Program that provides up to approximately $1,200 / month to be put toward the cost of assisted living. However, this is not a Medicaid program. RI does have a Medicaid program called RIte @ Home which offers 24/7 personal care in a residential environment but not in assisted living communities. Finally, the state’s Home and Community Care Medicaid Waiver also covers assisted living.

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Nursing Home Demographics

Elderly Rhode Island residents can receive a variety of care services and support through the Home and Community Care Program. This program is intended as an alternative to nursing homes.  The services are provided to individuals living at home or “in the community”. By the rules of the program, “in the community” includes assisted living residences. The benefits of the program are designed to support individuals at home. This program provides adult day care, in-home care, meal delivery services and medical alert services.

This program is under the jurisdiction of the Rhode Island Division of Elderly Affairs and is funded through a combination of state and federal monies.

Want to learn more about how nursing home skilled nursing and the Waiver Program may impact you and your family? Contact our office for a free consultation.

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How Do People Pay For Nursing Home Care In Rhode Island?

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What do you mean my health insurance does not pay for nursing home care?

There are 3 major ways on how people pay for nursing home care in Rhode Island:

First is by accessing and using an earlier purchased long-term-care insurance policy. Unfortunately, very few people have them as they are for many people cost prohibitive.

The second way is by private pay, which means you write a check directly to the nursing home from your life savings to pay for the room and board to live there. Per the Rhode Island Department of Human Services, the average cost per month for skilled nursing home care in Rhode Island is $9,113.

The third way to pay for nursing care is to qualify for Medicaid coverage under the Medicaid program. By qualifying for Medicaid, an individual will not be required to spend their life savings on skilled nursing care.

Unfortunately, medical insurance does not pay for long term care. Most plans will only pay a portion of the first 100 days of skilled care. After the 100 days is used, individuals will need be responsible for paying for their own room and board – their medical insurance will continue to pay for doctor visits and prescriptions, but individuals will need to pay for the bed, meals and roof over their head in nursing home.

How do I qualify for Medicaid?

Qualifying for Medicaid is like filing a very complicated tax return over a series of years. For a person to take advantage of the tax rules the taxpayer needs to make decisions as to their assets and income, perhaps transferring assets or claiming some while using others. So too is it with qualifying for Medicaid. As a CPA helps with a Tax Return, and Elder Law Attorney helps with understanding and advising as to what needs to be done to qualify for Medicaid. It is a lengthy process that for it to be optimized requires 5 years!

Want to learn how to qualify for Medicaid? Contact our office and schedule a no-cost meeting!Nursing Home Image

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One Quarter of America’s Caregivers Are Millennials

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Who are the caregivers looking over our loved ones?

Caring for older relatives is usually a task associated with Baby Boomers, the 50- and 60-somethings who find their aging parents need assistance. But almost a quarter of the adults who take care of older people — on top of their regular jobs and responsibilities — are between the ages of 18 and 34, according to research by the AARP Policy Institute and the National Alliance for Caregiving.

As millions of Americans are expected to live longer than they used to — often losing the ability to do so independently — their families and communities are grappling with how best way to take care of them. Kaiser Health News focused on the problem in a Dec. 2 webinar with advocates and policymakers. About 40 million Americans considered themselves caregivers in 2013, according to an AARP report, said Susan Reinhard, senior vice president at the AARP and one of the webinar’s panelists. Those people are typically women, and their median age is 49. The work they do caring for older relatives — usually parents and grandparents — was estimated that same year to be worth about $470 billion.Caregiver

The study underlines the importance of having a plan in place.

As we live longer lives, it is up to each person to ensure they have
a plan on how they will handle those years. Discussions need to include topics of domicile, care givers, support with daily activities of living, financial and medical.

Need to start your conversation? Contact us to schedule a meeting.

Source: Kaiser Health News

 

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Leaving Nursing Home During Medicare-Covered Stay

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LEAVING NURSING HOME WHILE STILL BEING TREATED – IS IT POSSIBLE?

Nursing home residents often want to participate in holiday gatherings but may worry they will lose Medicare coverage if they leave the facility to do so. Residents and their families and friends can put their minds at ease. According to Medicare law, nursing home residents may leave their facility for family events without losing their Medicare coverage.leaving hospital

However, depending on the length of their absence, beneficiaries may be charged a “bed hold” fee by their skilled nursing facility (SNF). The Medicare Benefit Policy Manual recognizes that although most beneficiaries are unable to leave their facility, “an outside pass or short leave of absence for the purpose of attending a special religious service, holiday meal, family occasion, going on a car ride, or for a trial visit home, is not, by itself evidence that the individual no longer needs to be in a SNF for the receipt of required skilled care…Decisions in these cases should be based on information reflecting the care needed and received by the patient while in the SNF and on the arrangements needed for the provision, if any, of this care during any absences.”

Source: Center for Medicare Advocacy

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Couples Fight More About Finances as Retirement Draws Closer

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Couples Fight More About Finances before Retirement – No Duh?!

Interesting article about the stress retirement and finances can put on couples.  It is CRITICAL that couples put together a PLAN that address their concerns with specific details to protect and preserve their finances and assets.  We are happy to meet with you to discuss how we can protect your assets and take the stress out of retirement.

http://www.nbcnews.com/business/retirement/couples-fight-more-about-finances-retirement-draws-closer-n473551?utm_source=PBN+Master+List+-+All+Subscribers&utm_campaign=ea799b1b17-2015_1204_call12_3_2015&utm_medium=email&utm_term=0_0e86591c9b-ea799b1b17-29917329

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There is an old adage: A FAILURE TO PLAN IS A PLAN TO FAIL.

This is true with most aspects of life but most especially with finances. Too often people wait too long to face the economic realities of retirement. The thought being I will just earn as much as I can during my working days and hope it holds me is simply not enough. People do not need to live in the dark or in fear. Meeting with a financial planner who can model out your lifestyle and the costs associates with it will be helpful in determining if you need to make adjustments.

The other aspect of finances is seeking to protect them. If you learned that you would need to spend over $109,000 per year on a spouse and their care in 3 years, would you do anything different today? The answer to that is a most definite YES. Should one of you require skilled care, it costs over $109,000 per year and is not covered by insurance, thus a plan for that expense is critical for the healthy spouses financial future.

Want to discuss your plan? Contact us for a free consultation.

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What is the Medicaid Global Waiver?

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What is the Medicaid Global Waiver?

The Medicaid Global Waiver is an agreement with the federal government about how Medicaid money is spent. Medicaid, a program that funds health services for qualified elderly, disabled, children, and families, is paid for by both the federal and state governments. Under this new agreement, the federal government will relax its Medicaid rules to allow Rhode Island to spend federal Medicaid money on a broader range of services through streamlined administrative processes that would not have been possible without the Medicaid Global Waiver.

Why the Waiver program?

The significance of this is intended to provide greater flexibility to provide services to needy Rhode Island residents in a lower cost setting. Allowing for state provided services in home with the hope of providing better care for the individual and greater savings to the taxpayer.

Want to learn how to qualify for Medicaid benefits? Contact our office for a free consultation.rhode_island_medicaid_waiver

Global Waiver Questions & Answers

What is the Medicaid Global Waiver?

The Medicaid Global Waiver is an agreement with the federal government about how Medicaid money is spent. Medicaid, a program that funds health services for qualified elderly, disabled, children, and families, is paid for by both the federal and state governments. Under this new agreement, the federal government will relax its Medicaid rules to allow Rhode Island to spend federal Medicaid money on a broader range of services through streamlined administrative processes that would not have been possible without the Medicaid Global Waiver.

 

  • Why does Rhode Island need this waiver?

Under the current system, federal rules governing how Medicaid money can be spent do not allow for the healthcare innovations Rhode Island envisions. The Global Waiver will facilitate increased consumer responsibility and choice, more emphasis on prevention and wellness, greater reliance on home and community based care as opposed to institutional care, and simplified administration of the Medicaid dollars.

 

Along with improved health care the waiver is needed to ensure that Medicaid programs remain affordable. Medicaid spending accounts for 25% of the state budget and is growing at a rate of 7% a year. With state revenue only growing at a 1.8% rate, it is easy to see that Medicaid spending is outpacing our ability to pay. That means that without changing the way we provide and pay for Medicaid services, those services are in danger of being lost. By receiving this Global Medicaid Waiver, Rhode Island will be able to preserve and improve services while keeping them affordable.

 

  • What if the recession worsens and more and more people become eligible? Will RI run out of money?

The secondary purpose of the Global Waiver is to make Medicaid programs more affordable. So, the expectation is that RI will be saving money and, ultimately, be able to serve more people. In other words, RI will better handle an influx of people into Medicaid programs through the Global Waiver than under the existing system. Although the Global Waiver has planned for many contingencies, if unforeseen and emergent conditions arise that make the Global Waiver unworkable, the State may suspend or terminate the Global Waiver.

 

  • Will people who now receive Medicaid-funded services lose them?

No. The State of Rhode Island is bound to follow the eligibility rules that were in place as of November 1, 2008. These eligibility rules cannot be easily changed; any changes must be approved by the state legislature and the federal government.

  • Will the Governor unilaterally change eligibility for certain populations?

The Governor cannot act alone without public input and legislative approval.

 

  • Will people in nursing homes be forced to leave?

No. Anyone who is in a nursing home and continues to need a nursing home can stay in the nursing home. With this new waiver, the goal is that people will not be forced to go into nursing homes because they lack choices. The Global Waiver will enable the State of Rhode Island to develop options for people so that more can stay in their homes with the proper supports if they so choose. Under the old Medicaid rules, this was not possible; now, Medicaid money will pay for more home and community-based care options.

 

  • Will the global waiver offer protection from a waiting list for seniors currently eligible for nursing home services?

There is no waiting list now for nursing homes and no waiting list is anticipated under the waiver. Anyone who needs nursing home level of care will receive it.

 

  • How will this relate to residents in assisted living that are currently on an existing waiver now?

Residents in assisted living can remain in assisted living if they so choose. Under the current system, there are limited assisted living slots. Because the Global Medicaid Waiver merges all waivers, it will open up the number of assisted living slots. In addition, the “selected contracting provision” in the Global Medicaid Waiver has the potential of paying certain kinds of assisted living differently, further opening more assisted living beds.

 

  • What is the timetable for these programs?

The Medicaid system as we know it has grown over the last forty years. Reforming that system and making it more affordable will not happen overnight; that will take a few years. The first order of business is legislative approval. After that, the Assessment Team will be assembled and new levels of care will be drafted so that Assessment Services will be operating by July 1. In the meantime, departments will be working with providers to offer more home and community based services.

 

  • Will there be public hearings?

Yes. This is really a community effort and the input of the public will be sought – as it has been – in addition to the legislative hearings.

 

  • Does the waiver conflict with any state laws?

No. The waiver must conform to all state and federal laws. Changes in the Medicaid program cannot be made without public notice and legislative approval.

 

  • How many different waiting lists will there be?

There are already waiting lists for some Medicaid-funded services. That will not change initially, but the goal of the Medicaid reforms made possible by the Global Waiver is to eliminate waiting lists.

 

  • Who will decide whether or not a person requires nursing home or residential care?

There are already state regulations that dictate whether or not a person requires residential care. The new Global Waiver will make two differences. First of all, there will now be more alternatives to residential care so that even if a person requires a high level of care, it may be possible for him/her to receive that care in the home and community. Secondly, an assessment team of medical and social service professionals will be created that will now include the individual and family in the decision-making so that all the options can be studied and the best one chosen.

 

  • What happens if a person or family disagrees with the assessment team’s decision about what kind of care is recommended and would be paid for?

People will be able to appeal any decision to an independent board.

 

  • What criteria are used to decide if a person needs residential care?

People are assessed for their skilled needs or their ability to perform what are called, Adult Daily Living Skills. If they require extensive or total dependence they are eligible for nursing home care. Now, with the Global Waiver, more supports will be created that will assist people with these Daily Living Skills in their home or in less restrictive settings.

 

  • If more than one person in the family qualifies for Medicaid help is there a preference given to keep them in their homes?

The advantage of the Global Waiver is that families can be assessed as a unit and not according to separate programs. Standards will be set for these sorts of situations, but the family will also be able to weigh in on the decision.

 

  • Are there any built-in preferences in this system? (Who gets help first?)

Priority is based on medical necessity; those in need of the highest level of care get priority.

 

  • We’ve heard that you’re considering a proposal for the Alliance for Better Long Term Care to send staff into nursing homes to identify candidates for return to the community and do assessments. Is that so, and what can you share with us about that?

The Alliance for Better Long Term Care has been contracted to bring good news to people in nursing homes who might want to live in their own homes or more independently. No one who is in a nursing home will be asked or forced to leave. However, those who want and are able to leave nursing homes due to new home and community based options may do so if they so choose.

 

  • Isn’t there a nursing shortage in RI? Where will all these home care professionals come from?

Now that money is available for a different range of services, agencies and companies will make the commitment to expanding services and staff. With new opportunities created, smart companies will move toward training and recruitment to take advantage of the Global Waiver.

 

  • What kinds of home and community based services are envisioned by this Global Waiver?

They would include: housekeeping, nutrition, nursing care, medication management, financial management, medical transportation, physical and occupational therapy, day care, home companions, coordinated medical care, assisted living and other non-institutional living arrangements.

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