Quick Basics of Medicare & Medicaid...
Here are the most fundamental general differences between Medicare and Medicaid:
*Medicare in an insurance program; Medicaid is a welfare program.
*Medicare coverage extends pretty much automatically to everyone age 65 or older; Medicaid is available only to those who qualify and apply.
*Eligibility for Medicare does not depend on how much assets or income a person has; eligibility for Medicaid is “means-tested,” and depends directly on those things.
*Medicare is strictly a federal program and the rules are the same everywhere in the United States: Medicaid is a combined federal and state program, and the rules vary from state to state.
*There are also some important fundamental differences between the two programs with regard to the coverage each may provide for nursing home costs. The most important of those differences are as follows:
Medicare pays only for “skilled care”; Medicaid also pays for “custodial care”.
Medicare pays only for short-term care; Medicaid pays for long-term care.
Medicare requires a prior hospital stay; Medicaid does not.
(See these definitions below on this page)
Traditional Medicare -- Medicare Part A (hospital insurance) and Medicare Part B (medical insurance)-- provide the same coverage wherever you are in the United States. If you have this traditional Medicare coverage and you move to another state, you do not have to do anything to keep up your coverage. However, if you also have Medigap private insurance as a supplement to Medicare coverage.
Get an attorney to make sure your assets are protected
Before applying for government benefits and utilizing govenment benefits, savvy people will consult with an experienced attorney to make sure their assets are protected. for example:
Protecting your Home from Michigan Estate Recovery
The State of Michigan passed the Estate Recovery law as of July 1, 2011. Estate Recovery allows DHS to attach a lien to a Medicaid applicant’s home to recover whatever the state paid out in benefits, once the Medicaid applicant passes away. There are a few ways to avoid estate recovery in Michigan, including through the use of a Lifetime Protection Trust or through the use of a Legacy Deed. It’s important to work with a Michigan Certified Elder Law Attorney to protect the family home from Medicaid Estate Recovery.
New nursing home focus on certain Ailments & health conditions.
Upon searching for a nursing home you may want to seek out a facility that has health care specialties. A new approach is for nursing homes to specialize in specific ailments. One home might be best equipped to care for patients with Alzheimer’s disease, ALS (Lou Gehrig’s disease). Some companies are launching care facilities that offer unassisted living, assisted living and nursing home arrangements in one complex and the person can get all of their care at the same location. The goal: Keep a person in one location throughout his or her later years. This helps financially and creates consistency of care.
Nursing homes have strict government requirements.
Provide 24-hour access to a skilled nursing staff, and make sure all medical treatment is supervised by a physician. The regulations also require facilities to provide “services to attain or maintain the highest practicable physical, mental and psychosocial well-being” of each resident. Patients often have multiple medical conditions, also can require assistance with daily activities such as bathing and dressing. In 2015, nursing home staff spent a national average of 4.1 hours attending to each resident per day.
Ask detailed questions...
Who works for the company, if the company ever operated under a different name, where are their headquarters are located (and direct phone number), how they screen employees, their code of standards and compliance (find out how you check their compliance), check licenses and names, and always have your attorney review the living contract. *Sometimes contracts will have items that are not compliant by law and can be to your disadvantage. Talk with the other residents and their family/visitors and get an unbiased opinion and tips about the facility and staff. Have a meal and judge the food taste the quality.
Check to see what the plan is if there is an emergency, fire, or disaster. How much food and water do they have? Are exists well marked? Do they have an alternative number if their phone service has issues or goes down temporarily? Who are all of the point people that handle these situations? Also make observations as well. For example, do you see fire extinguishers easily accessible throughout the facility, well marked exits with wheel chair ramps, etc.
Nursing home checklist
Is there a waiting list?
What is the ratio of staff to residents? Will this ratio remain or change?
Is the nursing home Medicare certified?
Is the nursing home Medicaid certified?
Have they ever had a different name (name change?)
Has their license (or certifications) ever been revoked? Ask for this in writing.
Are staff members friendly and helpful?
How does the resident get to their doctor’s appointment?
Are there units or programs for special needs such as Alzheimers or Diabetis?
Are residents nursing home rules posted?
Are residents rights posted?
What is the nursing home discharge policy?
Do the staff members knock before entering a resident’s room?
Are the doors shut when the staff members dress and bathe a resident?
Is the facility an easy place for family and friends to visit?
Do the residents well groomed, bathed and look well?
Do the staff members respond quickly to calls for help?
How does the resident call for help?
Do residents have the same caregivers on a daily basis?
Are residents bathed and well groomed?
Do hallways have handrails?
Can you visit the resident after hours (impromptu without giving the nursing home a notice that you are coming?) to check on things?
Are there healthy snacks for the residents throughout the day?
Is physical therapy available and how long are the programs? Are they ongoing?
Does the nursing home provide outdoor areas for residents and staff to get a - Does the nursing home provide outdoor areas for residents?
Do residents have choices about daily routines, such as when to go to bed, when to get up, when to bathe, or when to eat?
Is the facility homey, pleasant looking, clean, smell well?
Can they bring their belongings and use their own furniture in the room?
If you decide to have a shared room - Do you or the resident have a choice of roommates (& vice versa)?
What type of gatherings do they have? Culturally, religious, creative/crafts, exercise, learning new things, games, social outings (how many staff members accompany them?
Nursing home terminology that is important to know.
Assisted living facilities (ALFs) are lower-cost alternatives to nursing homes for people who are largely able to take care of themselves. ALFs do provide some help with daily activities and a range of amenities, but they don’t typically provide medical assistance.
Skilled nursing facility is the official term for a nursing home that meets the requirements to be eligible for Medicare and Medicaid payments. Nursing care must be available 24 hours a day (including a full-time registered nurse) and a doctor must supervise medical care and record the treatment that each resident receives.
Activities of daily living (ADLs) Tasks a person must be able to do unassisted in order to live independently. The core activities include eating, bathing, dressing, going for walks, using the bathroom, “transferring” (getting out of bed or up from a chair, for example) and manuvering from one room to another. A nursing home will ask new residents how many ADLs they need assistance with.
Registered nurses (RNs) usually hold either an associate degree or a bachelor’s degree in nursing, have passed the exam given by the National Council of State Boards of Nursing and also have passed all of the state’s licensing requirements. RNs are widely considered to be key components in the quality of care at a nursing home.
Memory-care living facilities are retirement communities or nursing homes for people with Alzheimer’s or other memory-related diseases.
Home-and-community-based services are programs that provide needed ongoing care to patients in their own community and/or community, rather than in an institutional setting. These options typically appeal to people who prefer to stay in their home as long as possible and need help with only a few of their daily activities and that are semi-independant.
Continuing care retirement communities offer independent living, assisted living and nursing home care on one campus, so residents don’t have to move as their needs change. (As previously mentioned), this is a popular choice among many due to not having to re-home/relocate the person due to mental and physical disruption or stress of an unfamiliar place, staff and facility is already familiar with the person and vice-versa, financial savings of not having to move, new right facility may not have vacancies and record transfers.
62% of Medicaid spending on nursing homes.
55 billion dollars from Medicaid goes to nursing home aid.
1.3 million American seniors now live in nursing homes.
70% of seniors rely on Medicaid to pay the bill, which means they are low-income or have otherwise spent down their assets.
There are almost 17,000 nursing homes in our country; most of them are for-profit businesses and the facilities are part of a chain of nursing homes.
It is possible for patients to get Medicare coverage in their first months at a facility.
Each state is required by federal law to have a long-term care ombudsman, who serves as an advocate for people in nursing homes and their families. The office of the ombudsman reviews complaints and other concerns about nursing homes, with the goal of fixing problems. Much of the information these offices gather is available on their websites in reports and other documents. To find the ombudsman for your region, go to the website of the National Consumer Voice. See Michigan Umbudsmens
*Always keep an eye on your loved one in any nursing home, make impromptu visits at different hours unannounced. Always check for cleanliness, check their laundry for proper cleaning, check for bedsores (sign of neglect and must be treated right aware), check for bruising and the overall well being of your loved one. With nursing home populations increasing proper management can become a challenge for some facilities.
Elder abuse occurs without the elderly persons’ knowledge in a high percentage of elder abuse cases involving financial abuse. Elder care facility residents have also reported financial abuse in the form of coercion to revise wills, deeds, or trusts to compensate caregivers, loss or theft of personal property, and compulsion to withdraw cash from bank accounts or to take loans for proceeds that are made by caregivers. If you suspect any type of abuse, whether it is physical, neglect, (get a doctor’s diagnosis right away), or financial; call us for a free consultation and Knappmann Law can answer any question you may have.
Between 1999 and 2001, almost one-third of all nursing home facilities were cited for violations of federal standards that could cause harm, or that did harm elderly residents of those facilities.
*****Elderly Abuse from caretakers exists in forms of physical, neglect, verbal, financial. Always keep a close eye on your loved one and check them for sores, cuts, stage 1 bed sores (must be treated right away by a physician), bruises, signs of hydration, and eating a well balanced diet, room and facility cleanliness, and laundry. unfortunately one aid can care for up to 30 people in some facilities. Nursing home ratios of staff member to patient range greatly. Ask what these ratios are and if they will remain the same in the future. If you suspect abuse feel free to contact us at Knappmann Law for a free consultation.
A great resource for nursing home information and complaints is the state Umbudsmen. This government position is to be a voice from the public who serves as an advocate for people in nursing homes and their families. The umbudsmen not only takes down complaints, but listens and solves problems that arise in any nursing home in that state & region. See who your umbudsman is in your state & region by clicking on the National Consumers Voice.
Nursing Home Planning
Nursing home monthly cost in Michigan can be 10,000 per month. With value of the dollar decreasing drives up the cost of living, peoples savings and retirement can become a challenge to a family's financial future and living budget. Medicaid, Medicare and VA Aid & Attendance benefits can pay for part of this cost (if you qualify), but yet many families can not afford the remainder balance that is left over to be paid. Supplemental insurance is essential. This is when two related factors play a key role to our client's advantage at Knappamann Law, time and planning. The sooner you plan, the more affordable services and facilities can become and your family can immediately get peace of mind to your loved one's well being.
Government programs as Medicare & Medicaid are a good start to begin coverage on necessary care, they don't always pay for everything (please laws change throughout the years). It may be necessary to supplement aid with an additional insurance programs to help offset what the government programs do not cover. This is considered supplemental insurance there are many varieties of this to choose.
Medigap or Supplement Insurance:
It covers most of the Medicare deductibles and co-payment amounts that the insured would otherwise be required to pay out-of-pocket. The extent to which it does so depends on which plan the insured chooses. Plans are identified alphabetically, with coverage increasing by letter of the alphabet (an “A” plan would provide the least coverage). Not all plans are available in all states.
A Medicare supplement policy under Plan F or above covers the co-payment amount for days 21 through 100 of a nursing home stay covered by Medicare. Thus, for someone who was eligible for the maximum 100 “Medicare days” in 2012, such a plan would provide a nursing home benefit of $11,560.00 which the insured would otherwise have had to pay personally.
The limit on Medicare supplement coverage is easy to understand. If Medicare coverage does not apply, then neither does Medicare supplement coverage. Thus, if rehab or other skilled care ends after, say, 28 days, then Medicare supplement coverage ends, just as Medicare coverage does. And a Medicare supplement policy never provides coverage beyond the first 100 days of a nursing home stay.
In some instances, people who want to avoid the extra expense of a Medicare supplement insurance policy elect a Medicare “Part C” plan, sometimes otherwise known as a “Medicare Complete” or “Medicare Advantage” plan. Such a plan is an HMO (or similar structure) that a Medicare-eligible person can elect in lieu of the coverage they would otherwise have under Medicare Parts A and B. Depending on what plan is chosen, there may or may not be a premium in addition to the Medicare Part B premium that is automatically deducted from Social Security payments. Because these plans vary in terms of what they cover, someone who is enrolled in one needs to ask specifically what nursing home coverage is provided. It is not safe to assume that these plans will cover the days 21-100 deductible in the same way that a typical Medicare supplement policy. Generally speaking, you get what you pay for.