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Providing management and coordination of personal, financial, legal, and health insurance matters
| July 2009 - Issue 12: Finding Aides for Loved Ones
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In This Issue:
1. Finding Aides for Loved Ones
2. Rebecca R. Eddy & Gideon Y. Schein in the Public
3. Previous Newsletters Archived on Our Website
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Finding Aides for Loved Ones
Discovering that a family member, friend or client needs
assistance is hard enough, but convincing your senior that he/she needs help at home, and then finding the right help is a whole other challenge.
In our ongoing effort to educate ourselves about the choices available to our clients, we have spent the last few months getting to know local Home
Health Aide agencies and learning about the different structures. The process has reinforced our belief that a call to a Geriatric Care Manager
(GCM) should be the first step. Geriatric Care Managers will assess a client's health and the living situation, make recommendations about a
client's need for aides, and the number of hours of assistance required. GCMs will supervise the process of hiring aides using their own
resources, a registry, or an agency, and then monitor the care provided by the aides. Even with the hired know-how of a GCM, it is helpful to
have some information regarding a senior's options for finding and paying for aides. Medicare and supplemental insurance cover a limited number
of Home Health Aide hours, acute care nursing visits, and limited physical, speech and occupational therapy. Once that turns into long-term
care, Medicare and supplemental insurance do not cover any of the personnel costs. One should not rely on Medicare for long-term personal care
(Home Health Aide) needs.
What are the Senior's Financial Resources?
One of the first questions to ask in considering a senior's home health aide choices is what financial resources are available. Some of the
payment options include:
• Private Pay - the client has
the funds to pay for care for
an indefinite amount
of time.
• Long Term Care (LTC) Insurance - the client bought LTC insurance prior to an illness
and is now able
to use the insurance to pay for care. The policy needs to be reviewed carefully to ascertain how much money is available on a daily basis and for
how
long, how many days the client has to wait before drawing on the insurance, and what services it covers.
• NYS Partnership Long Term Care Insurance - the client bought this form of LTC
insurance (or a similar
one in another state). It is a mix of private insurance and Medicaid support that allows the senior to keep more of his/her assets once he/she has
used up his/her allocated amount of long-term care insurance and becomes Medicaid eligible. The same review of the policy as outlined above is
needed.
• Medicaid - depending on the
state in which a senior lives
and
even the county
within the state, a senior may be able to qualify for Medicaid. New York State (and especially New York City) provides a very generous home
care
benefit under its Medicaid program. Middle class seniors who do not have LTC insurance, or the resources to pay for long term health care
themselves, should see an elder law attorney to discuss how to best plan ahead for assistance. In New York, there are legal ways of
transferring
assets and becoming eligible for this benefit. The work done with an elder law attorney would make a person Medicaid eligible, should the day
arrive when they need the services. The seemingly large payment to an elder law attorney is a wise investment for the future.
What are the Senior's Choices For Hiring Aides?
There are various ways to hire aides:
• Privately Hired Aides - These
can come through a variety of
channels
Registry: The client pays the registry a fee and the
agency provides aides to be
interviewed
by the senior or his/her representatives. Once aides have been hired, it is the client's responsibility to pay the aides and handle payroll
taxes and statutory benefits (this can be done by a payroll firm or a payroll accountant).
Referrals from Geriatric Care Manager - The aides are ones that the GCM has worked with
personally
and feels good referring. The same payroll issues exist.
Referrals from Friends, Family and Acquaintances - The aide may not be certified as a
home health
aide but may be very capable. Again, the same payroll issues exist. There could be a considerable cost benefit to hiring privately;
however, if things don't work out, there is not an Agency to fall back on or hold accountable.
• Home Health Aide Agencies -
The agency recruits aides,
provides training and supervision, selects the appropriate aides for the client, pays
the aides, and generally bills the client on a weekly basis. Agencies vary in terms of licensing and skill levels of aides. Long Term Care insurance
and Medicaid have specific requirements for the aides and the agencies providing aides, so it is important to know the difference.
Certified Home Health Agencies - Certified home health agencies (CHHAs) are certified by
the New
York State Department of Health and are qualified to participate in Medicare and Medicaid. CHHAs must provide, at a minimum, the following
services which are of a preventative, therapeutic, rehabilitative, health guidance and/or support nature to persons at home: nursing services, home
health aide services, medical supplies, and equipment/appliances suitable for home use. In addition, at least one of the following services
must
be provided by a CHHA: physical therapy, occupational therapy, nutritional services, speech/language pathology, or social work services.
Licensed Home Care Services/Agencies - Licensed home care services/agencies (LHCSAs) are
voluntary,
non-profit or proprietary organizations granted a license from the New York State Department of Health to provide, either directly or through a
contract, at least one of the following services: nursing (e.g. blood pressure monitoring, medication coordination), home health care, or personal
care (e.g. bathing, dressing, housekeeping). LHCSAs are regulated by the New York State Department of Health. Reimbursement is usually
through private pay, Long Term Care Insurance, or contractual Medicaid/Medicare arrangements through a County, CHHA or Long Term Health Care
Program.
Companion Services - Companion Services provide a quality alternative to nursing homes
and costly
private duty nurses with affordable live-in or hourly companion or homemaker care. They handle the daily tasks of meal preparation, light
housekeeping, transportation to appointments, companionship, medication reminders, and much more.
How Many Hours of Help Can a Senior Receive?
The amount of hours aides will assist a senior depends on what resources the senior has. For private pay, the senior and his/her family decide
what is needed and ask what the agency can provide; for those with LTC insurance, the number of hours will depend on the allotted amount of daily
money to be distributed by the company; if a senior is Medicaid eligible the hours will be determined by Medicaid. Some of the options for
coverage are:
• 4 to 5 hours minimum per day for as many days a week as is decided to
assist with
personal care, cooking, light cleaning, shopping, laundry, companionship, a walk
• Two aides each doing 12-hour shifts
• 24-hour live-in aides, which is usually cheaper than two 12-hour shifts
because
the aide is not paid for 8 to 12 hours of assumed free time/sleep. It requires that the client sleep most of the night and calls for the aide
infrequently.
• It is rare that the agency can provide an aide to help for 2 hours in
the morning
and 2 hours in the evening, which is often all that is needed. The loss of other clients due to wasted time traveling makes this prohibitive
in
most cases, but it is worth asking.
Team Building
We have given you a very brief overview of what is involved in hiring home health aides. It is intended to provide a basic vocabulary and
understanding so you will be able to speak comfortably with the team of professionals we recommend you use in helping the seniors in your life.
To learn more about potential team members, refer to our Newsletter Issue No. 3, from June 12, 2008 entitled Aging in Place takes a Team.
Resources
Long Term Care Costs - Find the Cost of Care in Your Area provided by The Federal Long Term Care Insurance
Program - you can put in
your State and City, adjust the number of hours an aide would work each day and how many days a week. This site also gives a glossary of
terms.
Caring.com: Helping
You
Help Your Parents
Medicaid in
New York State
National
Association of
Professional Geriatric Care Managers
MSN Money: "The Basics - Prepare for the Unthinkable: Long-Term Care" by Terry Savage
New
York State
Partnership
for Long-Term Care
AARP Financial: Retirement Income Quick Check Calculator
Thank you to Allen Rosen of YAI Home Health Services for reviewing this article for
accuracy.
Rebecca R. Eddy & Gideon Y. Schein in the Public
August 27th - Rebecca and Gideon to address the residents of The Hallmark of
Battery Park City at the weekly
Wellness Seminars series. The topic being presented is "10 Mistakes to Avoid: Make Your Senior Years Easier."
September 16th - Gideon and Rebecca to address the Health Care Professional's
Breakfast at the Isabella Geriatric Center - "Help Your Senior Clients: Ten Mistakes Your Clients Can Avoid." To attend, kindly RSVP by
Wednesday, September 9 to (212) 342.9538 - aguerrero@isabella.org, or (212) 342.9224 - mpacheco@isabella.org. 9am, 515 Audubon Avenue - Larson
Library, New York, NY 10040.
October 1st - Gideon and Rebecca to speak at Health Fair 10am-2pm,
Main Building at Isabella Geriatric Center - 515 Audubon Avenue, New York,
NY 10040.
November 5th - Rebecca and Patricia Mulvey of Jewish Home Lifecare to speak to
Health Leaders of New York
(HLNY) - www.hlny.org on "The Team Approach to Elder Care: From Home to
Institution and
Home Again."
Rebecca and Gideon are available to speak to groups on a variety of topics related to seniors and their families. Please
contact our office to discuss possible presentations.
Previous
Newsletters Archived on our Website
Our previous newsletters are archived on our
website at http://www.eddyandschein.com/newsletters.php
At any time, from our home page, you can click on the
"View Archives" link situated below the subscription sign up space.
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If you found our newsletter informational or
useful, please scroll back to the top of the page and click on the link send this to a friend - to send it to anyone else
who would benefit
from it!
Please feel free to contact us and take
advantage of our free telephone consultation. We would be happy to talk
to you about how we can provide Life Keeping, Not Just Bookkeeping®.
Sincerely,
Copyright, July 2009, Eddy & Schein, Inc.
About Us
Partners
Rebecca R. Eddy and Gideon Y. Schein, both MBAs and certified
Professional Daily Money Managers, have a primary focus on the needs of
an aging population:
• Seniors
who need help in organizing and streamlining tasks such as expense and
revenue tracking, bill paying, health insurance claims management, or
providing regularly required information to accountants and lawyers.
• Seniors who may or may
not have an estate plan in place, but need to catalog assets and
personal effects and coordinate and track philanthropic activity.
To learn more about us, check out the May 2008 issue of Kiplinger's Retirement
Report. It describes the services of daily money managers and quotes one of our clients.
Our Promise
Eddy
& Schein In-Home Administrators for Seniors® is dedicated to making
life easier when it comes to managing seniors' personal administrative
matters. From simply gathering and paying bills each month to
performing a complete review of seniors' financial and personal
affairs, we provide exactly the help needed. Working with Eddy & Schein, clients are given private, one-on-one attention at home. Together, we'll develop a plan to address our clients' specific needs. And of course, privacy is strictly guaranteed.
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