It is unfortunate that many people who died in a hospital emergency room or who received heroic treatments to prolong life in a hospital or nursing home may have had the alternative of dying at home in familiar surroundings, with family or other loved ones at their side.
When someone is dying but there really is no hope for recovery, the family often calls 911 and starts a process which can result in great stress and great emotional discomfort. The loved one who is dying ends up in a hospital or nursing home in a strange environment, frightened and confused and tied to tubes and monitoring devices. This is not the ideal way in which to spend one's last hours on earth.
Attending to a dying loved one in the peace and quiet of the home with caring children and grandchildren surrounding the bed can be a spiritual experience for all involved. Hospice can allow this to happen. Memories of a loved one passing in peace can provide great comfort for family members in years to come.
When there is no longer hope for prolonging life, especially when this decision is made months in advance, hospice is a better alternative to other medical intervention.
Hospice is a form of medically supportive care for patients who are terminally ill. It allows for compassion and dignity in the process of dying. A commonly used definition for terminally ill patients is,
"patients who have a progressive, incurable illness that will end in death despite good treatment, and who are sick enough that you would not be surprised if they died within six months." A list of hospice providers can be found at http://www.longtermcarelink.net/a7hospicecare.htm
Hospice care is a valuable service and is generally underused except for terminal cancer patients. Most families wait too long to have their doctor prescribe hospice from Medicare. Many doctors or family don't often consider this care alternative for Alzheimer's, degenerative old age or other debilitating illnesses where a person is going downhill fast. They should.
Hospice involves a team approach using the following providers.
•Family caregivers;
•The patient' s personal physician;
•Hospice physician (or medical director);
•Nurses;
•Home health aides;
•Social workers;
•Clergy or other counselors;
•Trained volunteers; and
•Speech, physical, and occupational therapists, if needed.
The purpose of hospice is the following:
•Manages the patient's pain and symptoms;
•Assists the patient with the emotional and psychosocial and spiritual aspects of dying;
•Provides needed medications, medical supplies, and equipment;
•Coaches the family on how to care for the patient;
•Delivers special services like speech and physical therapy when needed;
•Makes short-term inpatient care available when pain or symptoms become too difficult to manage at home, or the caregiver needs respite time; and
•Provides bereavement care and counseling to surviving family and friends.
A person can receive hospice from Medicare if he or she is
•eligible for Medicare Part A (Hospital Insurance), and
•the doctor and the hospice medical director certify that the person is terminally ill and probably has less than six months to live, and
•the person or a family member signs a statement choosing hospice care instead of routine Medicare covered benefits for the terminal illness, and
•care is received from a Medicare-approved hospice program.
A person may continue to receive regular Medicare benefits from his or her customary doctors for conditions not related to the hospice condition.
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Monday, November 30, 2009
Wednesday, November 11, 2009
Veterans Long Term Care Benefits
The Department of Veterans Affairs provides three types of long term care benefits for veterans.
The first type is benefits provided to veterans who have service-connected disabilities.
These medically necessary services include home care, hospice, respite care, assisted living, domiciliary care, geriatric assessments and nursing home care. In order to receive the services, a veteran must be enrolled in VA's health care system. Veterans with service-connected disabilities have priority for health care enrollment acceptance.
Some of these services may be offered to veterans in the health care system who do not have service-connected disabilities but who may qualify because of low income or because they are receiving pension income from VA. These recipients may have to provide out-of-pocket co-pays or the services may only be available if the regional hospital has funds to cover them.
Currently, veterans desiring to join the health care system may be refused application because their income is too high or they do not qualify under other enrollment criteria. Increased demand in recent years for services and lack of congressional funding have forced VA to allow only certain classes of veterans to join the health care system.
The second type of benefit is state veterans homes.
The Veterans Administration in conjunction with the states helps build and support state veterans homes. Money is provided by the Federal Government to help with construction, and a subsidy of $67.71 a day is provided for each veteran using these nursing homes. These homes are generally available for any veteran and sometimes the nonveteran spouse and are run by the states, often with the help of contract management. There may be waiting lists in some states.
Most state homes offer nursing home care but some may offer assisted living, domiciliary (a form of supported independent living), and adult day care
State veterans homes are not free but are subsidized and the cost could be significantly less than a comparable facility in the private sector. Some of these homes can accept Medicaid payments. A complete list of state veterans homes can be found at http://www.longtermcarelink.net/ref_state_veterans_va_nursing_homes.htm
The third type of benefits for veterans is disability payments.
These include Compensation, Pension, survivors death benefits associated with compensation and Death Pension.
Compensation is designed to award the veteran a certain amount of monthly income to compensate for potential loss of income in the private sector due to a disability or injury or illness incurred in the service. In order to receive compensation a veteran has to have evidence of a service-connected disability. Most veterans who are receiving this benefit were awarded an amount based on a percentage of disability when they left the service.
However, some veterans may have record of being exposed to extreme cold, having an in-service non-disabling injury, having tropical diseases, tuberculosis or other incidents or exposures that at the time may not have caused any disability but years later have resulted in medical problems. In addition, some veterans may be receiving compensation but their condition has worsened and they may qualify for a a higher disability rating. Veterans mentioned above may qualify for a first-time benefit or receive an increase in compensation amount. Applications should be made to see if they can receive an award. There is no income or asset test for compensation and the benefit is nontaxable.
Pension is available to all active-duty veterans who served at least 90 days during a period of war. There is no need to have a service-connected disability to receive pension. To be eligible the applicant must be totally disabled if he or she is younger than 65. Proof of disability is not required for applicants age 65 or over. Apparently, being old is evidence in itself of disability.
The purpose of this benefit is to provide supplemental income to disabled or older veterans who have a low income. If the veterans income exceeds the pension amount then there is no award. However, income can be adjusted for unreimbursed medical expenses and this allows veterans with household income larger than the pension amount to qualify for a monthly benefit.
Compensation and pension claims are submitted on the same form and VA will consider paying either benefit. Generally, for applications associated with the cost of home care, assisted living or nursing home care, the pension benefit is a better option.
All active-duty veterans who served at least 90 days during a period of war are eligible for pension and additional disability allowances -- aid and attendance or housebound allowances. Surviving single spouses of these veterans are also eligible for lesser benefits and for the allowances.
Veterans' service would include World War II, the Korean Conflict, the Vietnam Conflict Period and the Gulf War conflict.
Pension can pay up to $1,800 a month to help offset the costs associated with home care, assisted living, nursing homes and other unreimbursed medical expenses. The amount of payment varies with the type of care, recipient income and the marital status of the recipient. There are income and asset tests to qualify.
VA claims this benefit is only for low income veterans but a quirk in the way the benefit is calculated for recurring medical expenses (long term care costs associated with home care, assisted living or nursing homes) could allow veteran households earning between $2,500 and $5,000 or more a month to qualify.
Estimates are that up to 30% of all Americans over the age of 65 might be eligible for a pension benefit under the right circumstances.
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The first type is benefits provided to veterans who have service-connected disabilities.
These medically necessary services include home care, hospice, respite care, assisted living, domiciliary care, geriatric assessments and nursing home care. In order to receive the services, a veteran must be enrolled in VA's health care system. Veterans with service-connected disabilities have priority for health care enrollment acceptance.
Some of these services may be offered to veterans in the health care system who do not have service-connected disabilities but who may qualify because of low income or because they are receiving pension income from VA. These recipients may have to provide out-of-pocket co-pays or the services may only be available if the regional hospital has funds to cover them.
Currently, veterans desiring to join the health care system may be refused application because their income is too high or they do not qualify under other enrollment criteria. Increased demand in recent years for services and lack of congressional funding have forced VA to allow only certain classes of veterans to join the health care system.
The second type of benefit is state veterans homes.
The Veterans Administration in conjunction with the states helps build and support state veterans homes. Money is provided by the Federal Government to help with construction, and a subsidy of $67.71 a day is provided for each veteran using these nursing homes. These homes are generally available for any veteran and sometimes the nonveteran spouse and are run by the states, often with the help of contract management. There may be waiting lists in some states.
Most state homes offer nursing home care but some may offer assisted living, domiciliary (a form of supported independent living), and adult day care
State veterans homes are not free but are subsidized and the cost could be significantly less than a comparable facility in the private sector. Some of these homes can accept Medicaid payments. A complete list of state veterans homes can be found at http://www.longtermcarelink.net/ref_state_veterans_va_nursing_homes.htm
The third type of benefits for veterans is disability payments.
These include Compensation, Pension, survivors death benefits associated with compensation and Death Pension.
Compensation is designed to award the veteran a certain amount of monthly income to compensate for potential loss of income in the private sector due to a disability or injury or illness incurred in the service. In order to receive compensation a veteran has to have evidence of a service-connected disability. Most veterans who are receiving this benefit were awarded an amount based on a percentage of disability when they left the service.
However, some veterans may have record of being exposed to extreme cold, having an in-service non-disabling injury, having tropical diseases, tuberculosis or other incidents or exposures that at the time may not have caused any disability but years later have resulted in medical problems. In addition, some veterans may be receiving compensation but their condition has worsened and they may qualify for a a higher disability rating. Veterans mentioned above may qualify for a first-time benefit or receive an increase in compensation amount. Applications should be made to see if they can receive an award. There is no income or asset test for compensation and the benefit is nontaxable.
Pension is available to all active-duty veterans who served at least 90 days during a period of war. There is no need to have a service-connected disability to receive pension. To be eligible the applicant must be totally disabled if he or she is younger than 65. Proof of disability is not required for applicants age 65 or over. Apparently, being old is evidence in itself of disability.
The purpose of this benefit is to provide supplemental income to disabled or older veterans who have a low income. If the veterans income exceeds the pension amount then there is no award. However, income can be adjusted for unreimbursed medical expenses and this allows veterans with household income larger than the pension amount to qualify for a monthly benefit.
Compensation and pension claims are submitted on the same form and VA will consider paying either benefit. Generally, for applications associated with the cost of home care, assisted living or nursing home care, the pension benefit is a better option.
All active-duty veterans who served at least 90 days during a period of war are eligible for pension and additional disability allowances -- aid and attendance or housebound allowances. Surviving single spouses of these veterans are also eligible for lesser benefits and for the allowances.
Veterans' service would include World War II, the Korean Conflict, the Vietnam Conflict Period and the Gulf War conflict.
Pension can pay up to $1,800 a month to help offset the costs associated with home care, assisted living, nursing homes and other unreimbursed medical expenses. The amount of payment varies with the type of care, recipient income and the marital status of the recipient. There are income and asset tests to qualify.
VA claims this benefit is only for low income veterans but a quirk in the way the benefit is calculated for recurring medical expenses (long term care costs associated with home care, assisted living or nursing homes) could allow veteran households earning between $2,500 and $5,000 or more a month to qualify.
Estimates are that up to 30% of all Americans over the age of 65 might be eligible for a pension benefit under the right circumstances.
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Wednesday, November 4, 2009
Hidden Government Program Pays the Cost of Home Care
What if 33% of all seniors in this country could receive up to $1,800 a month in additional income from the government to cover their long term care costs? They can! Under the right circumstances, a little-known federal program will pay additional income to cover long term care costs for at least 1/3 of all US senior households. But the provisions of this program are such a well-kept secret that only 4.6% of eligible seniors are actually receiving the benefit. The great news about this program is the government will pay you to hire your family, friends or just about anyone to take care of you. The program is called "VA Pension."
Only about 520,000 people are currently receiving Pension from the Veterans Benefits Administration and these are not all elderly. At the most, this number represents only about 4.6% of the eligible 11,400,000 senior households -- 33% of the US senior population. Based on the incidence of long term care in the elderly, about 22% of eligibles or about 2,500,000 people should be receiving pension. That's roughly five times more persons than are receiving it now.
Most people who have heard about Pension know that it will cover the costs of assisted living and, in some cases, cover nursing home costs as well. But the majority of those receiving long term care in this country are in their homes. Estimates are that approximately 70% to 80% of all long term care is being provided in the home. All of the information available about Pension overlooks the fact that this benefit could be used to pay for home care.
It also comes as a surprise to most people that VA will allow veterans’ households to include the annual cost of paying any person such as family members, friends or hired help for care when calculating the Pension benefit. This annual cost is deducted from household income and used to calculate a lower "countable income" which in turn enables families to receive this disability income from VA. Even though VA claims the benefit is for low income families, because of the deduction for care costs, households earning between $3,000 and $6,000 a month can still qualify for Pension.
This extra income can be a welcome benefit for families struggling to provide eldercare for loved ones at home. Under the right circumstances, this annualized medical expense for the cost of family members, friends or any other person providing care, could create an additional household income of up to $976 a month for a single surviving spouse of a veteran, up to $1,520 a month for a single veteran or up to $1,800 a month for a couple.
If the disabled care recipient has been rated "housebound" or in need of "aid and attendance" by VA, all fees paid to an in-home attendant will be allowed as long as the attendant provides some medical or nursing services for the disabled person. The attendant does not have to be a licensed health professional. There is also no need to distinguish between medical and nonmedical services -- all are deductible.
It is our understanding that a nonlicensed in-home attendant could be just about anyone receiving pay for providing services. This might be members of the family, friends, or someone hired to live in the home. Examples of medical or nursing services would be help with activities of daily living such as dressing, bathing, toileting, ambulating, feeding, diapering and so on. Other services might include medication reminders or supervision necessary to provide a protective environment for the care recipient -- in the case of dementia or Alzheimer's.
For a disabled person who has been rated, a family member will be considered an in-home attendant, but that family member has to be paid for services duly rendered. There is potential for fraud here where a family member may move into the home and ostensibly receive payment as a caregiver but not actually provide the level of care paid for. Documentation for this care must be provided to VA, and it is reasonable for VA to question whether the services being purchased from a family member living in the household are legitimate. Such arrangements should be extensively documented and completely arm's-length.
The care arrangements and payment for home care must be made prior to application and there must be evidence that this care is needed on an ongoing and regular basis. We recommend a formal care contract and weekly invoice billing for services. Money must exchange hands and there must be evidence of this. All of this documentation must be provided as proof to VA when making application for the pension benefit. Costs for these services must be unreimbursed; meaning these costs are not paid by insurance, by contributions from the family or from other sources.
The National Care Planning Council also has a book to help people understand how to obtain this benefit. The book is available to order online at http://www.longtermcarelink.net/a16veterans_books.htm
Information for this article came from the website -- www.veteransaidbenefit.org. This website is not sponsored by the government but the site is currently the only complete source for information on the Pension benefit other than VA.
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Only about 520,000 people are currently receiving Pension from the Veterans Benefits Administration and these are not all elderly. At the most, this number represents only about 4.6% of the eligible 11,400,000 senior households -- 33% of the US senior population. Based on the incidence of long term care in the elderly, about 22% of eligibles or about 2,500,000 people should be receiving pension. That's roughly five times more persons than are receiving it now.
Most people who have heard about Pension know that it will cover the costs of assisted living and, in some cases, cover nursing home costs as well. But the majority of those receiving long term care in this country are in their homes. Estimates are that approximately 70% to 80% of all long term care is being provided in the home. All of the information available about Pension overlooks the fact that this benefit could be used to pay for home care.
It also comes as a surprise to most people that VA will allow veterans’ households to include the annual cost of paying any person such as family members, friends or hired help for care when calculating the Pension benefit. This annual cost is deducted from household income and used to calculate a lower "countable income" which in turn enables families to receive this disability income from VA. Even though VA claims the benefit is for low income families, because of the deduction for care costs, households earning between $3,000 and $6,000 a month can still qualify for Pension.
This extra income can be a welcome benefit for families struggling to provide eldercare for loved ones at home. Under the right circumstances, this annualized medical expense for the cost of family members, friends or any other person providing care, could create an additional household income of up to $976 a month for a single surviving spouse of a veteran, up to $1,520 a month for a single veteran or up to $1,800 a month for a couple.
If the disabled care recipient has been rated "housebound" or in need of "aid and attendance" by VA, all fees paid to an in-home attendant will be allowed as long as the attendant provides some medical or nursing services for the disabled person. The attendant does not have to be a licensed health professional. There is also no need to distinguish between medical and nonmedical services -- all are deductible.
It is our understanding that a nonlicensed in-home attendant could be just about anyone receiving pay for providing services. This might be members of the family, friends, or someone hired to live in the home. Examples of medical or nursing services would be help with activities of daily living such as dressing, bathing, toileting, ambulating, feeding, diapering and so on. Other services might include medication reminders or supervision necessary to provide a protective environment for the care recipient -- in the case of dementia or Alzheimer's.
For a disabled person who has been rated, a family member will be considered an in-home attendant, but that family member has to be paid for services duly rendered. There is potential for fraud here where a family member may move into the home and ostensibly receive payment as a caregiver but not actually provide the level of care paid for. Documentation for this care must be provided to VA, and it is reasonable for VA to question whether the services being purchased from a family member living in the household are legitimate. Such arrangements should be extensively documented and completely arm's-length.
The care arrangements and payment for home care must be made prior to application and there must be evidence that this care is needed on an ongoing and regular basis. We recommend a formal care contract and weekly invoice billing for services. Money must exchange hands and there must be evidence of this. All of this documentation must be provided as proof to VA when making application for the pension benefit. Costs for these services must be unreimbursed; meaning these costs are not paid by insurance, by contributions from the family or from other sources.
The National Care Planning Council also has a book to help people understand how to obtain this benefit. The book is available to order online at http://www.longtermcarelink.net/a16veterans_books.htm
Information for this article came from the website -- www.veteransaidbenefit.org. This website is not sponsored by the government but the site is currently the only complete source for information on the Pension benefit other than VA.
http://www.reversemortgageloans-rates.com/
http://www.mireverse.com/
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