1. Demystifying Long-Term Care: Understanding Your Options

2. Overview Aging in Place: Options to Stay at Home Facility Based Care Residential, Assisted living, skilled nursing, and continuing care retirement communities How to Choose The Inspection process, Where to Begin, Factors to Consider, Tips for Touring, Admissions Contract, and Decision Time

3. Long-Term Care Most people will need some form of long-term care services and supports at some point in their lives. 70% of those reaching age 65 will need long-term care before end of life. o Average length of care is 3.5 years.

4. Aging in Place: Options to Stay at Home

5. In-Home Services In-home assistance with a variety of needs: Homemaker/chore Personal care Skilled nursing care

6. In-Home Services Payment Sources Private funds Long-term care insurance Veteran’s benefits Medicare Medicaid

7. Medicare and In-Home Services Doctor must establish and review regularly a plan of care certifying that you need one or more of the following: Intermittent skilled nursing care; physical therapy; speech-language pathology services; or continued occupational therapy You must be considered homebound Custodial care is not covered unless receiving skilled care

8. Medicaid and In-Home Services In-home assistance available to those who are: 63 years of age or older Eligible for Medicaid Monthly income at or below current limit of $1,281 Consumer-directed services Pays a caregiver who is chosen by the recipient of care

9. Adult Day Care Provides health, social, and recreational activities in a supportive setting for those with functional and/or cognitive impairments that do not require 24-hour care May also offer services evenings and weekends Medicaid may assist in covering costs; Medicare will not

10. Respite Care Provides short-term breaks to family members or caregivers Can be provided in-home Long-term care facilities Medicaid may cover services; Medicare will not Caregiver support services through Area Agency on Aging

11. Senior Centers Offer educational, recreational, and health programs, among other services Serve meals on site or through Meals on Wheels to homebound seniors No charge but given the opportunity to contribute

12. Hospice Program of care and support for people who are terminally ill Helps them to live comfortably Focus is on comfort, not on curing an illness Care is given for the “whole person” Also provides support for caregivers Typically provided in-home, but can be provided in long-term care community Services covered under Medicare and Medicaid

13. Facility-based Care

14. Levels of Care Residential Care Facility I or II Assisted Living Facility I or II Skilled Nursing Facility Continuing Care Retirement Community (CCRC)

15. Residential Care Facility I or II Provides 24-hour care for those needing room, board, and protective oversight, which can include distribution or administration of medications Requires that residents make a pathway to safety Unassisted evacuation in under 5 minutes Option II may provide some assistance with personal care

16. Residential Care Facility I or II Cost of care: $1,000-$3,000 per month Payment sources include: Personal income and savings Cash grant program o Financial assistance of $156-$292/month available if individual meets Medicaid asset requirements (<$999.99/month)

17. Assisted Living Facility I or II Provides 24-hour care for those needing room and board, and includes assistance with personal cares, protective oversight, and medication management Option I requires that residents make a pathway to safety Option II may accept residents who cannot make pathway to safety and offers option to age in place

18. Assisted Living Facility I or II Cost of care: $3,000-$5000 per month Payment sources include: Personal income and savings Medicaid Cash grant program Veterans’ benefits Long-term care insurance

19. Skilled Nursing Facility Provides 24-hour accommodation, board, custodial care, skilled nursing care and treatment Skilled nursing includes physical, occupational or speech therapy and services such as wound care or IV therapy

20. Skilled Nursing Facility Cost of care: $5,000 to $12,000 per month Payment sources include: Personal income and assets Long-term care or other private insurance Medicare Medicaid

21. Payment Sources: Medicare Must have qualifying 3-day hospital stay within last 30 days and require skilled care Will only cover up to 100 days of care Pays 100% for days 1-20 Pays 80% for days 21-100

22. Payment Sources: Medicaid Provides health insurance for low-income seniors Administered through the Family Support Division under the Department of Social Services Known as Vendor Medicaid for those in long-term care communities Pays for cost of care minus resident’s monthly income

23. Payment Sources: Medicaid To qualify for Medicaid, an individual must: Be residing in a certified Medicaid bed in a licensed nursing facility Meet standards for medical disability in federal and state law Have countable assets of less than $999.99

24. Payment Sources: Medicaid Countable assets Any asset that can be liquefied for a cash value o Cash, stocks, or bonds o Real property other than primary residence o IRAs or 401K plans o Cash surrender value of insurance policies

25. Payment Sources: Medicaid Protected assets Primary residence One automobile Personal property, such as furniture and jewelry $1,500 cash surrender value of life insurance policy Money placed in an irrevocable pre-paid burial contract

26. Payment Sources: Medicaid Transferring assets 5 year look back period o Any transfer to someone other than a spouse may incur a penalty

27. Payment Sources: Medicaid Division of Assets Countable assets gathered and divided in two o Community spouse keeps one half o Other half must be spent down to $999.99 Allows community spouse to keep his/her share Intended to prevent community spouse from becoming impoverished as a result of caring for the nursing home spouse

28. Continuing Care Retirement Communities Offer different levels of care on one campus Residents move from one level to another based on needs Generally require large entry fee and may charge monthly fees

29. How to Choose a Long Term Care Community

30. How to choose The Inspection Process Where to Begin Factors to Consider The Tour The Admission’s Contract

31. The Inspection Process DHSS inspects residential care and assisted living CMS contracts with DHSS to conduct federal certification survey in federally licensed facilities DHSS also investigates complaints about facilities and resident abuse or neglect Law requires that DHSS inspect facilities twice in a fiscal year (July 1 – June 30); federal survey required every 9 to 15 months for Medicare and/or Medicaid-certified facilities

32. The Inspection Process Before inspection, DHSS survey team reviews compliance history and complaint investigations Visits are unannounced and evaluate resident quality of care and quality of life; environmental services; dietary services; and fire safety Inspection process involves observations; interviews with residents, residents’ family members and facility staff; and record review of documentation

33. The Inspection Process Inspectors may cite facility with one or more deficiencies if not in compliance with federal and/or state regulations Federal deficiency is assigned a scope (i.e. how many residents affected) and severity (i.e. level of harm) State deficiencies are classified as Class I, II, or III, with I being the most severe

34. The Inspection Process DHSS sends Statement of Deficiencies (SOD) to non-compliant facilities describing violations Facility administrators prepare written Plan of Correction (POC) detailing how and when they will correct cited deficiencies; DHSS must approve POC DHSS may conduct up to two revisits to ensure corrections are implemented; state and CMS may impose penalties if deficiencies are not corrected

35. Consider These Factors… Financial need—What is affordable? Medical need—Can medical needs be met? Physical environment Social need—Are there benefits of certain options? Family support o Caregiver stress

36. Where to Begin Call VOYCE to consider the Consumer Resource Guide and Directory and speaking with VOYCEconnect Choose 3-5 facilities to focus on Call to long-term care community to discuss your financial and medical needs and placement arrangements

37. The Tour: A Few Tips Take a relative or friend if possible Try not to visit more than a few facilities in one day During initial visit discuss specific items such as: Cost Extra services not covered under basic cost Facility policies, such as staff to resident ratio, advanced directives, use of restraints, and bed hold policy

38. The Tour: A Few Tips During your tour, observe the following: Is the environment comfortable and homelike? Are there any offensive odors? Are the residents well groomed? Are the residents all gathered in one area? Are the residents comfortable around staff? Is there respect between staff and residents? What is the noise level like?

39. The Tour: A Few Tips Ask to see the latest state survey results on your visit or access the results online at http://health.mo.gov/safety/showmelongtermcare Details violations/deficiencies for which the community has been cited After the initial visit, plan on going back one or two more times, unannounced at different times than original visit

40. Decision Time Gather all of your information from inspections, tours, interviews, websites Sit down with your loved ones to go over each facility Make the decision based on what you feel would be the best for you Remember that if you are unhappy with the long- term care community, there is always the option to relocate

41. The Admissions Contract Be sure to read and understand what you are signing. “Responsible party” o Community cannot require third party payment Arbitration provision o Signing forfeits right to go to court to resolve disputes

42. VOYCEconnect Please call for assistance with your long-term care needs. Katelyn Eichorst, BSW VOYCEconnect Coordinator 314-919-2403 keichorst@voycestl.org