703-329-0900

Hospitalization, Skilled Nursing and Medicare

Recently, in one 48-hour period, I received similar questions from caregivers. These caregivers were not related, and they did not know one another. Each was the adult child whose parent was about to be discharged from a skilled nursing facility. Though they were very informed and had been through the hospital to skilled nursing to home process before, they were each a little unsure about their options, and wanted to be sure they did right by their parent. Their questions had to do with skilled nursing facilities, Medicare, covered days, and finally home health care options. It led me to lay out some of the information so that others could benefit. Below are the 2017 Medicare hospital and skilled nursing facility benefits. This information does not cover every aspect of the subject, but it is a start.

Medicare Part A Hospital Expenses*

Member Deductibles:

Members will have a $1316 deductible per benefit period. A benefit period starts the day you are admitted to a hospital or skilled nursing facility, and ends after you have not been in the hospital or SNF for 60 consecutive days.

Member Co-payments:

  • $0/day for days 1-60
  • $329/day for days 61-90 in hospital per benefit period.
  • $658/day for days 91-150 in hospital per benefit period (Lifetime Reserve Days).
  • No coverage after day 150 in hospital (or day 90 if Lifetime Reserve Days previously used).

Skilled Nursing Facility Expenses*

  • Full coverage of expenses in skilled nursing facility for days 1-20 when this follows a 3-day hospitalization during each benefit period.
  • $164.50/day for days 21-100 in a skilled nursing facility during each benefit period.
  • No coverage after day 100 in skilled nursing facility during each benefit period.

*Hospital and Skilled Nursing Facility daily co-pays may be covered by your Medigap policy or other commercial secondary insurance coverage.

 

 

 

Visiting Mom During the Holidays and Something is Not Right

The holiday season is here, and you may have visited, or will be visiting an elderly loved one. Are things different than the last visit? Are you seeing things that don’t seem right?  How do you know if something is wrong?  Below are some areas to consider (note feminine emphasis for ease of writing, but also applicable to elder males):

Personal Hygiene – Does she shower less frequently, wear dirty clothes, or have neglected teeth? Are there any injuries that you can see? Is there a urine smell? Was she always fastidious about her wardrobe, and now is dressing in a less put together way?

Forgetfulness  – Have you seen stacks of unopened mail or newspapers, unpaid bills, unfilled prescriptions or missed appointment slips? Letters from credit card companies with reminders to pay or late payment charges can be a sign.

Behavior – Does she repeat questions? Can she carry on an extended conversation? Does she refuse any suggestion or does she just agree with everything said? Does she retain what was said? Are there any apparent mood swings? Is she unusually loud or quiet? Is she angry?

Relationships – Do friends call? Have relationships changed in such a way that friends and neighbors have expressed concerns? Has she quit socializing or participating?

Medication and Health Management – Can she take medications without supervision? What are the medications? Who goes to the doctor with her? Is she going to the doctor at all?  Does she refuse to go?

Eating Habits – Does the refrigerator contain adequate food? Is there any spoiled food present? Have her eating habits changed? Any unexplained weight loss? Has she missed meals or have a lack of appetite?

Shopping or buying things – Do you see evidence of excessive shopping or ordering? Is the mail full of charitable letters, a sign that she is giving money to anyone who asks?  Is she having difficulty making change or writing checks?

Home Maintenance – Is it in disrepair? Is dust accumulating where (at one time) she was a great housekeeper? Is trash accumulating?

Kathleen S. Allen, LCSW, C-ASWCM, is a Geriatric Care Manager and Elder Care Consultant in Northern Virginia. She works with seniors and their families to help guide them through the challenges of aging and caregiving.

 

This article was first published in December 2011, and has been revised for this posting.

Enrolling in Medicare with an Employer Health Plan – Who Pays First?

Recently, I received the following question from a reader:

“I have health insurance through my employer, my husband is self-employed. Will my insurance still be the primary insurance when my husband turns 65 and applies for Medicare?”

Suspecting this could be a complicated question, I went to the medicare.gov website to research the answer. Not too much longer I believe I found the answer in their publication CMS #02179, dated August 2015, “Your Guide to Who Pays First.”

In both the chart that starts on page 6, and in the text on page 12, they refer to such a scenario, answering that when one is 65 or older and covered by a group health plan of either oneself or one’s spouse, and the employer has 20 or more employees, the group health plan pays first, and Medicare second. When the employer has less than 20 employees, then Medicare would be the first payor.

This publication is worth a look because there are many more scenarios to consider. It is available for download on the medicare.gov website here. If you prefer to someone directly, call 1-855-798-2627.

 

What Would You Do?

This is a question I hear fairly frequently. Family caregivers come to me looking for solutions to their caregiving challenges, and often this question surfaces. “If this were you, what would you do?”

Recently, I was reminded of this question after attending a one day conference with Teepa Snow, a national expert in communicating with those with dementia and Alzheimer’s. It was a day I will not soon forget. She was engaging, interesting, entertaining, and so very informative. I could not get over how many notes I took, as she showed the large audience many techniques in having a successful communication with their dementia and Alzheimer’s patients or family members.

So, if someone came to me looking to understand how to communicate with their loved one who has Alzheimer’s, I would share what I know, and I would also recommend they look online for Teepa Snow. She is the most informative expert I know of in this area of Alzheimer’s.

Here is a link to her website. Be sure to check it out.

Medicare Announces Year 2016 Part B Premiums

This week, the Centers for Medicare and Medicaid announced the year 2016 Medicare Part B premiums. Much discussion and lobbying preceded the announcement, mostly due to the threat of large increases and a lack of a Social Security Cost of Living Adjustment. In the end, some premium amounts changed, while others did not.

 

Click here for the chart, and then find your income level on the 2016 chart to determine your premium amount for 2016.

 

Additionally, the annual deductible for Part B is rising, from $147 per year to $166.

This Veterans Day is November 11, 2015

A very Happy Veterans Day to our veterans. Thank you for all you have done for our freedoms. We frequently hear about all the challenges Veterans Affairs face in assisting veterans with their needs. But today I want to call attention to an interesting program for veterans that has recently received national media attention.

Shakespeare for Veterans?

Yes, Shakespeare for veterans. Recently, ABC News reported on a Milwaukee program for veterans called “Feast of Crispian,” a reference to a Henry V pre-battle speech. In this acting program, veterans work with area actors in scenes of heavy conflict from Shakespearean plays. The aim of this free program is to help former service members work on addiction and reintegration issues, mental health problems and post-traumatic stress disorder.

The project director of the program states that Shakespearean plays work well because the language of Shakespeare “holds big emotion.” Nancy Smith-Watson says the language “elicits it, but it also holds it, the metaphor just enables a lot of emotion to be put on them.” The acting, she says, helps veterans access bottled up emotions by using Shakespeare’s words, which breaks down walls and builds confidence. Participants are encouraged to be as angry or sad as they want. One participant, a 25-year-old Army veteran credits the program for allowing him to open up and be himself. He has also remained sober and free of drugs and alcohol for six months.

The program started in 2013, and to date has had 300 veterans participate.

 

 

 

September is World Alzheimer’s Month

Each September, the Alzheimer’s Disease International releases a report of the status of Alzheimer’s Disease throughout the world. This year, their report was entitled “The Global Impact of Dementia.” In it, they document the global prevalence, incidence, cost and trends of dementia in the world today. Some interesting facts include:

  • In 2015, there are estimated to be 46.8 million people worldwide who are living with dementia.
  • This number is expected to double every 20 years, and will reach 131.5 million in 2050.
  • Throughout the world, there is estimated to be one new case of dementia every 3.2 seconds, or 9.9 million news cases.
  • Of the number of new cases of dementia:
    • 4.9 million are in Asia
    • 2.5 million are in Europe
    • 1.7 million are in the Americas
    • 0.8 million are in Africa.
  • The global cost of dementia care is $818 billion in 2015, and will reach $2 trillion by 2030.
  • Global dementia care, if it were a country, would be the 18th largest economy in the world.

These are pretty grim statistics, especially in light of the fact that there is no effective treatment, no cure, and no proven way to prevent Alzheimer’s or dementia. However, if you are inclined to take part in the fight against Alzheimer’s or dementia, there are studies you can volunteer for. Even if you do not have a personal or family history of these diseases, you may be needed in a study. If interested, contact the NIA’s Alzheimer’s Disease Education and Referral (ADEAR) Center at 1-800-438-4380 or visit www.nia.nih.gov/alzheimers/clinical-trials.

Northern Virginia Senior and Caregiver Resource

I’ve written about this before, but it bears repeating because the resource can be so valuable. When you have questions about resources for an elder, and no one to answer them, a good way to help your search is with the local Aging and Adult Services office in your county. They know the resources and criteria and are a great place to start when looking for options, public or private. Each county in Northern Virginia has such an office, and it is worth your while to keep their number. Here they are:

City of Alexandria

Senior Services of Alexandria

703-836-4414

Arlington County

Aging and Disability Services

703-228-1700

Fairfax County

Fairfax County Services for Older Adults

703-324-7948


Falls Church City

Adult and Aging Services

703-324-5411

or contact

Fairfax County Services for Older Adults

703-324-7948


Loudoun County

Aging Programs and Services

703-777-0257


Prince William County

Prince William County Area Agency on Aging

703-792-6374

Global Aging: A Little Look Around the World

Just out of curiosity, I recently sat down to do some research about how the world population is aging. I was interested in how other areas of the world are aging. Are the factors driving the aging population growth in the U.S. true in other countries as well? Here is a little bit of what I found.

 

There are excellent resources through the United Nations Population Division. As recently as late 2014, they published updated statistics that tell the global aging story. It was all very interesting.

 

For instance, during the years 2005 – 2010, the rate of death of persons 65 years and older was 50% per 100 total deaths. This was a significant change from the period 1950 – 1955. During that five year period, the rate of death among persons 65 and older was 22% per 100 deaths (all ages).

 

On first glance these numbers might seem incorrect, but there is a logical explanation. The increase in older age deaths was due to the reduction of child-age deaths, which had a worldwide reduction of 26%. There were some exceptions though – the least developed countries, where the percentage of mid-age deaths increased from 34% in 1950 – 1955, to 40% in 2005 – 2010.

 

The percentage of old-age deaths differs considerably from the countries with the highest percentage, to those with the lowest percentage: The three highest were Italy (86%), Sweden (86%) and Greece (85%). The three lowest were the Democratic Republic of the Congo (13%), Chad (12%), and Angola (11%). This again would be explained by longevity in the population in countries like Italy, Sweden and Greece.

 

Globally, the percentage of the population aged 60 years or over increased from 8.6% in 1980 to 12% in 2014. This group is projected to continue to rise, reaching 21% in 2050.