Helping elderly deal with costs of long-term care
Use ingenuity to find community services
When elderly people need long-term care for themselves or their loved ones, they often experience "sticker shock" when they find out the cost.
Many senior citizens believe that all benefits are free for the elderly, points out Carole Stolte, RN, MA, CCM, CRC, CDMS, CPC, director of Maturity Concepts: Care Management & Consulting in Towson, MD.
"It’s a reality check for them to find out that you do have to pay a hefty price," Stolte says.
The largest payer for long-term care is Medicaid fee-for-service. Most of this is for people who started out paying out-of-pocket expenses until they depleted their assets so they qualified for Medicaid, adds Elizabeth Bodie Gross, FNP, MBA, CCM, director of Lutheran Home Health Services in Arlington Heights, IL.
Medicare pays very little. Long-term care insurance pays 5% to 7%.
"A lot of people have some means to live in their homes, but their chances of outliving their resources are quite high," Gross says.
Dealing with people who are paying for their own care is quite different from dealing with an insurance company that determines what is going to happen, she adds.
"It is incumbent on case managers to know how to manipulate the system to meet the needs of the population," she says.
Case managers who deal with the elderly must know about more than just nursing care. They must be informed about all the resources available in their community so they can help families find the best solution for their elderly member, Stolte points out.
"When we have someone call us with an inquiry, we should do everything we can to give them access to free resources. If they can do that, they can save their resources for when they really need it," she says.
Case management for the elderly means knowing how to maximize benefits, whether they are free, discounted, or full pay, and how to put it all into a plan that is appropriate for the client.
To do this, case managers have to understand financing and be extremely flexible, Gross adds.
"You have to understand where the money is coming from to make it work and how to stretch it as far as it can be stretched to provide quality of care and not to have overlap," Gross adds.
Most of the time, case managers who deal with long-term care issues will be working for someone who is paying out of pocket.
"If you are working with a senior population, you have to know a lot of things so you’re not spending your time looking up services. Experience-based practice comes through experience of working with different providers so you have this knowledge," Gross says.
The majority of people do not go into a retirement community. They remain in their homes.
Case managers need to know how to get needed services into the home, and what quality markers to use to determine whether caregivers are doing what they are supposed to do.
Case managers need to know about programs that help the elderly stay in their homes, such as fee-for-service home health, Medicare home health, and Medicaid home health that may be available because of state waiver programs, Gross says.
If you don’t feel you have the ability to do the research necessary to determine the pros and cons of different resources, contact a national organization for assistance. Your local council on the aging or case management professional society may be able to help. The National Association of Professional Geriatric Care Managers in Tucson, AZ, also can provide resources.
This is where your expertise provides invaluable help to the family.
"I can provide information in less than an hour that the family would have to research for 20 to 30 hours," Gross says.
When elderly people need long-term care for themselves or their loved ones, they often experience sticker shock when they find out the cost.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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