Question:  My mother is currently in skilled nursing following a recent hospitalization after a fall.  She has Alzheimer’s Disease and I don’t feel that we can care for her at home after her discharge.  Will Medicare cover the cost of her care in an Alzheimer’s care facility?

Unfortunately, the answer to that question is NO.

Medicare will cover up to 100 days of nursing home care after a 3 day INPATIENT** stay at a hospital and then it becomes the duty of the care recipient or the family to pay.  (If the patient is discharged home from the nursing home and waits a 3 month period of time, and THEN is readmitted to the hospital, another 100 days of nursing care is covered.)

** Whenever your aging loved one is admitted to the hospital, make sure that they are admitted as an inpatient, not on observation and that they stay a whole 3 days or the nursing home care will not be covered.  Ask to have the social worker speak with you in order to determine that this is carried out correctly.

They are 4other ways that care in a memory care facility might be covered:

1.  Long Term Care Insurance will cover a certain percentage of daily memory care.  (It may be too late to utilize this option for your loved one but consider purchasing  it for yourself, as it becomes much more expensive as your age increases.)

2. Medicare Supplemental Insurance (sometimes called Medi-Gap) will help to pay for skilled nursing care but only when it is covered by Medicare.

3.  Medicaid may cover memory care but what is covered and the ability to qualify for Medicaid varies from state to state.  Check with an experienced elderlaw attorney to determine qualifications.  You should begin planning for this option long before your loved one needs to use it.

4.  If your loved one served in the military, there may be some coverage available, but this option is iffy at best and often difficult to access.

by Shelley Webb and Tonia Boterf

Tonia Boterf is a licensed clinical social worker.  Several of her e-books (and her brand new print book) can be found on our website under products.

One of the first things that must be considered about assisted living is its cost.  Two times in the last month, friends of mine have mentioned that “when the time comes”, they’ll simply move to assisted living rather than burden their children.  But assisted living can cost anywhere from $2500.00 a month for a very basic dwelling to more than $7000.00 a month depending upon the amenities available there and upon the medical needs of the resident.   Both of my friends were very surprised to hear this. 

But when examing these numbers, one must also be aware of the costs of living at home.  By comparing the costs of  home maintenance, insurances, utilities, food, property taxes, possibly a mortage and maybe a gardener and/or housekeeper, one might find that assisted living is less expensive than remaining in the home.  Most assisted living facilities have free transportation so there may not be a need to maintain an automobile either, which would be an additional savings.

If you feel that your parent or parents may be struggling to maintain their home or that they may not be safe there anymore, one way to begin the discussion about transitioning to assisted living is to watch television together and comment on news stories or programs  relating to the difficulties of aging.  Ask how they are doing in relation to the situation you see on television.  Is Mom managing the grocery shopping and cooking without difficulty?  Can Dad still mow the lawn?  Are there small things that can be done to make their life easier or are they at the point where assisted living might actually be a more joyful experience?

Point out the positive aspects of  assisted living…nutritious meals are available; there are crafts and games in which to participate; there are often off-campus field trips;  housekeeping is included; the lawn is always mowed and there are lots of social opportunities.

If they happen to have any friends or other relatives who have moved to assisted living, ask how they are doing.  They may have somepositive or negative experiences which you can explore more thoroughly.  Offer to take them there to visit these friends so that they can get a feel for the surroundings and what is available to them.

Many of our aging loved ones are not aware of the differences between assisted living and nursing homes and therefore may have an unnecessary negative opinion of them.  They may also be embarrassed to discuss the fact that they feel they may be ready for some help with their activities of daily living.

Assisted living is not for everyone, but it’s good to have the discussion early so that everyone will be on the same page when the time comes to make a decision about some different living arrangements.

Dementia Patients Victims of Slippery Prank

(08-03) 18:48 PDT UKIAH — Six employees of a Ukiah nursing home coated dementia patients with ointment as a prank, leaving them slippery for workers on the next shift, authorities said Tuesday.

The employees, after a probe by the state Bureau of Elder Abuse, were charged last week by Mendocino County District Attorney Meredith Lintott with four misdemeanor counts, including elder abuse.

The workers allegedly put ointment on the patients at the Valley View Skilled Nursing Facility from “head to foot,” said the office of Attorney General Jerry Brown. Because of their condition, the patients were unable to object.

“As part of a cruel and shocking prank, these caregivers abused defenseless elders,” Brown said in a written statement.

Charges were filed against Jenny Bido, 26; Christina Guerrero, 30; Jared Buckley, 29; Jennifer Burton, 33; Kathleen Phillips, 23; and Monica Smith, 51.

Bail was set at $7,500 each. The six workers were also fired.

E-mail Jill Tucker at jtucker@sfchronicle.com.

This article appeared on page C – 3 of the San Francisco Chronicle

I originally purchased this book thinking it was a resource for caregivers on keeping an aging parent out of a nursing home for as long as possible. I soon found out that it was much more.

Having been a registered nurse for almost 30 years and a caregiver for my father who lived with me in my home for 4 years before he passed away, it was my goal to keep my father out of a nursing home. I’ve done clinical practice in several of these homes as part of my training (I apologize to all nursing homes who do their best to provide great care within their limited budgets) but I am not a fan of them!

Not only does Dr. Fisher explain how suddenly a crisis can occur that places a parent or aging spouse into a nursing home, but he also provides wonderful information for those of us in our mid-life years on how we can better avoid ending up in one ourselves.

He discusses the importance of maintaining our independence by taking care of our bodies and also discusses systems which should be put into place as soon as possible (durable powers of attorney for health care, trusts, wills and long-term care insurance).

This is a great book for everyone, not just for those who are caring for aging relatives.

Usually, the care provided is as good as it can be given the circumstances, but sometimes the care is less than adequate or can even be full of neglect and abuse.  When we see signs of possible neglect or abuse, we wonder how we can deal with it and not create a bad relationship with the staff of the facility thereby subjecting our loved one to even more punishment. 

If the abuse is blatant, it’s an easy call……..get the loved one out of the facility and have charges filed.  But when you simply have a suspicion, a niggling fear that something is not quite right, it’s hard to know what to do.

That is the time to call in a long-term care ombudsman.

A long-term care ombudsman is an official advocate for residents of long-term care facilities.  Under the Federal Older Americans Act, every state must have an ombudsman program.  This program consists of both volunteer and paid members.

Their goals are to provide information on how to find a facility that provides quality long-term care, to assist with complaints and resolve problems in such facilities, to educate both consumers and long-term care providers on patient’s rights, legislative policy, and ways that families and providers can work together.  They also provide community involvement through their volunteer programs. 

When working with patients or patient’s family member regarding a complaint, all information is kept confidential, unless the patient or family requests otherwise.

Problems that they address are violations of resident’s rights or dignity, physical, verbal or mental abuse, deprivation of services or poor quality of care (for example, lack of hygenic care, not turning the resident to prevent bedsores, etc.), unreasonable confinement, improper transfer or discharge of patient (when money runs out, etc.), and use of chemical or physical restraints that are in appropriate.

According to The National Long Term Care Ombudsman Resource Center, the rights of long-term care residents are as follows:

• The right of citizenship. Nursing home residents do not lose any of their rights of citizenship, including the right to vote, to religious freedom and to associate with whom they choose.
• The right to dignity. Residents of nursing homes are honored guests and have the right to be so treated.
• The right to privacy. Nursing home residents have the right to privacy whenever possible, including the right to privacy with their spouse, the right to have their medical and personal records treated in confidence, and the right to private, uncensored communication.
• The right to personal property. Nursing home residents have the right to possess and use personal property and to manage their financial affairs.
• The right to information. Nursing home residents have the right to information, including the regulations of the home and the costs for services rendered. They also have the right to participate in decisions about any treatment, including the right to refuse treatment.
• The right of freedom. Nursing home residents have the right to be free from mental or physical abuse and from physical or chemical restraint unless ordered by their physician.
• The right to care. Residents have the right to equal care, treatment and services provided by the facility without discrimination.
• The right of residence. Nursing home residents have the right to live at the home unless they violate publicized regulations. They may not be discharged without timely and proper notification to both the resident and the family or guardian.
• The right of expression. Nursing home residents have the right to exercise their rights, including the right to file complaints and grievances without fear or reprisal.

If you feel that your loved one has been denied any of these rights in the facility in which they are residing, don’t hesitate to contact a long-term care ombudsman in your state.  Call 1-800-300-6222 or check The National Long Term Care Ombudsman Resource Center to find resources in your state.