Thursday, December 19, 2013

Alternative Choices to Nursing Home for Alzheimer’s Patients

Nursing home might a best option for the patient, or it may be definitely not. Before starting the search for suitable accommodations, get familiarized with other alternatives to the nursing home dispatching. Discuss all the available approaches in the given situation and patient state with your family, your doctor or other health care provider, or a social worker for help deciding what kind of long-term care you need.

If you have limited income and resources, there may be state assistance programs that help cover some of your costs in some of the long-term care choices. Call your State Medical Assistance (Medicaid) office for additional information.

Community services

 A variety of community services might help with your personal care and activities, if these services aren’t covered by your health insurance. Some services, like volunteer groups that help with things like shopping or transportation, may be low cost or the group may ask for a voluntary donation. Some services may be available at varied costs, depending on where you live and the services you need.

Below is a list of home services and programs that are found in many communities:
* Adult day care
* Meal programs (like Meals-on-Wheels)
* Senior centers
* Friendly visitor programs
* Help with shopping and transportation
* Help with legal questions, bill paying, or other financial matters

For detailed information about available community services, call your local Area Agency on Aging, Aging and Disability Resource Center, or Center for Independent Living.

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Home Care

Depending on your needs, you may be able to get help with your personal care activities (such as laundry, shopping, cooking, and cleaning) at home from family members, friends, or volunteer groups. If you think you need home care, talk to your family to see if they can help with your care or help arrange for other care providers. There are also some home health care agencies that can help with nursing or attendant care in your home. If you’re eligible for Medicaid, personal care services in your home may be covered.

Not all in-home services are the same. Some in-home services provide non-medical help, such as assistance with daily living. Other in-home services involve medical care given by a licensed health professional, such as a nurse or physical therapist.

Common types of in-home services:
* Companion services: Help with supervision, recreational activities or visiting.
* Personal care services: Help with bathing, dressing, toileting, eating, exercising or other personal care.
* Homemaker services: Help with housekeeping, shopping or meal preparation.
* Skilled care: Help with wound care, injections, physical therapy and other medical needs by a licensed health professional. Often times, a home health care agency coordinates these types of skilled care services once they have been ordered by a physician.

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Accessory dwelling units (ADUs)

If you or a loved one owns a single-family home, adding an ADU to an existing home may help you keep your independence. An ADU, sometimes called an “in-law apartment,” an “accessory apartment,” or a “second unit,” is a second living space within a home or on a lot. It has a separate living and sleeping area, a place to cook, and a bathroom. Space such as an upper floor, basement, attic, or space over a garage may be turned into an ADU. Family members might be interested in living in an ADU in your home, or, you may want to build a separate living space at a family member’s home.

The common features of all accessory units are that they are self-contained (they provide complete living facilities for the use of one or more individuals, with permanent provisions for living, sleeping, eating, cooking, and sanitation) and subordinate to the existing dwelling. The approach used by most municipalities for accessory units is a zoning bylaw that permits the additional, but accessory unit, allowing certain improvements to be made to the existing dwelling. Restrictions that may be considered include whether the dwelling existed as of a certain date, the maximum allowed building and site modifications, the options for choosing inhabitants, whether the owner must occupy the main unit, and minimum lot sizes.

Check with your local zoning office to be sure ADUs are allowed in your area and find out if there are special rules. The cost for an ADU can vary widely depending on how big it is and how much it costs for building materials and workers.

Subsidized senior housing

There are state and Federal programs that help pay for housing for some older people with low to moderate incomes. Some of these housing programs also offer help with meals and other activities, such as housekeeping, shopping, and doing the laundry. Residents usually live in their own apartments within an apartment building. Rent payments are usually a percentage of your income (based on a sliding scale).

Board and care homes

Board and care homes are group living arrangements designed to meet the needs of people who can’t live independently but don’t need nursing home services. Most board and care homes provide help with some of the activities of daily living, such as bathing, dressing, and using the bathroom. Board and care homes are sometimes called “group homes.” Many of these homes aren’t paid for by Medicare or Medicaid. The monthly charge is usually a percentage of your income (based on a sliding scale) that covers the cost of rent, meals, and other basic shared services.

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Assisted living facilities

These facilities vary from state to state, but generally they provide help with activities of daily living, such as bathing, dressing, and using the bathroom. They may also help with care most people do themselves, like taking medicine or using eye drops, and additional services, like getting to appointments or preparing meals. Residents often live in their own room or apartment within a building or group of buildings and have some or all of their meals together. Social and recreational activities are usually provided. Some of these facilities have health services on site.

In most cases, assisted living residents pay a regular monthly rent and pay additional fees for the services they get. Assisted living facilities aren’t paid for by Medicare. The term “assisted living” may mean different things in different facilities within the same state. Not all assisted living facilities provide the same services. It’s important that you contact the facility and make sure they can meet your needs.

Continuing Care Retirement Communities (CCRCs)

CCRCs are retirement communities that offer more than one kind of housing and different levels of care. In the same community, there may be individual homes or apartments for residents who still live on their own, an assisted living facility for people who need some help with daily care, and a nursing home for those who require higher levels of care.

Residents move from one level to another based on their individual needs, but usually stay within the CCRC. If you’re considering a CCRC, be sure to check the quality information and inspection report (posted in the facility) of its nursing home. Your CCRC contract usually requires you to use the CCRC’s nursing home if you need nursing home care. Some CCRCs will only admit people into their nursing home if they are already living in another section of the retirement community.

Many CCRCs generally require a large payment before you move in (called an entry fee) and charge monthly fees. To find out if a CCRC is accredited and get advice on selecting this type of community from the Commission on Accreditation of Rehabilitation Facilities and the Continuing Care Accreditation Commission (CARF-CCAC), visit or call 1-202-587-5001. 

Hospice care

Hospice is a special way of caring for people who are terminally ill (expected to have 6 months or less to live) and for their families. Hospice care includes physical care and counseling. The goal of hospice is to provide comfort for terminal patients and their families, not to cure the illness.

If you qualify for hospice care and you choose hospice, you can get medical and support services, including nursing care, medical social services, doctor services, counseling, homemaker services, and other types of services. As part of hospice care, you will have a team of doctors, nurses, home health aides, social workers, counselors, and trained volunteers to help you and your family cope with your illness. In many cases, you and your family can stay together in your home.

Medicare covers hospice care if you qualify. Depending on your condition, you may get hospice care at home, in a hospice facility, hospital, or nursing home. Medicare doesn’t cover room and board if you get general hospice services while you’re a resident of a nursing home or a hospice’s residential facility. If you’re eligible, Medicaid may pay for some services that Medicare doesn’t cover, such as personal care assistance at home. Medicare doesn’t pay for 24-hour assistance if you get hospice services at home.

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Alzheimer’s Disease Special Care Communities (nursing home-based)

These facilities are characterized by high level of medical assistance, offering housing designed to accommodate the special needs of those with Alzheimer’s Disease. All support services are available, including 24 hour medical staff trained in understanding Alzheimer’s Disease and its progression. 
Residences are usually private or semi private rooms.  Payment is usually by private pay, Medicaid or Medicare.   

Respite care

Some nursing homes and hospice care facilities provide respite care. Respite care is a very short inpatient stay in a nursing home or hospice care facility for a hospice patient so that the usual caregiver can rest. Medicare covers inpatient respite care for up to 5 days if you’re getting covered hospice care services. Room and board are covered for inpatient respite care and during short-term hospital stays. If you’re eligible, Medicaid will pay for some of these services at home that aren’t covered by Medicare.

Respite care can provide the caregiver with:
* A chance to spend time with other friends and family, or to just relax
* Time to take care of errands such as shopping, exercising, getting a haircut or going to the doctor
* Comfort or peace of mind knowing that the person with dementia is spending time with another caring individual

The person with dementia is experiencing many changes and challenges, too, and may also need variety in his or her routine and social interactions. Respite care services can give the person with dementia an opportunity to:
* Interact with others having similar experiences
* Spend time in a safe, supportive environment
* Participate in enjoyable activities designed to match personal abilities and needs

Programs of All-inclusive Care for the Elderly (PACE)

PACE is a Medicare and Medicaid Program that manages all of the medical, social, and long-term care services for older people with multiple care needs. It allows people to remain in their homes and maintain their quality of life. PACE is available only in states that have chosen to offer it under Medicaid. The goal of PACE is to help people stay independent and living in their community as long as possible, while getting the high quality care they need.

To be eligible for PACE, you must meet the following conditions:
* Be 55 or older
* Live in the service area of a PACE program
* Be certified as eligible for nursing home care by the appropriate state agency
* Be able to live safely in the community

To find out if there is a PACE program in your area, visit or call your State Medical Assistance (Medicaid) office.

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Home and Community-Based Waiver Programs

If you’re already eligible for Medicaid (or, in some states, would be specifically eligible for Medicaid coverage for nursing home services), you may be able to get help with the costs of some home and community-based services, like homemaker services, personal care, and respite care. States have home and community-based waiver programs to help people keep their independence while getting the care they need outside of an inpatient facility.

Sources and Additional Information:
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