Last week we moved my mother from assisted living to skilled care. The transition was seamless because she is in a facility that provides various levels of care, as needed. When selecting a care facility for your parent, a multi-level care facility that offers priority to those already in the system is crucial. Here are some other things to consider.
Medicare Confusion
Many people assume that Medicare covers all facility care for the elderly. This is not the case. If your parent is hospitalized for three days or more, not including time spent in the ER or the day of discharge, Medicare covers rehabilitative services at a care facility for twenty days at 100 percent. After twenty days, Medicare pays 80 percent of the bed fee and supplemental insurance the other 20 percent up to day 100. If you chose to place your parent in a facility as a lifestyle change, and your parent had the foresight to purchase long-term care insurance, now is the time to utilize it. If not, consider the cost before making the move. The out-of-pocket charges run between $3500-$6000 per month depending on level of care. If your parent isn't in a crisis situation, you may need to liquidate assets first.
Assisted Living
One issue to investigate is the size of the living quarters. Moving from a four-bedroom house to a space barely large enough for a bedroom and living area is not only dramatic but traumatic. Your parent needs at least some familiar things around for comfort.
When evaluating living arrangements that involve staff support, there are specific things to consider. First, determine if the services provided meet your parent’s needs. Assisted living in one facility may include bathing and laundry service, while in another, laundry service is not offered unless skilled care is utilized. In multi-care-level communities, look at a list of services provided at each care level. You are not likely to find a perfect fit, so prepare to make some compromises.
Investigate the number of patients or residents assigned to each staff member. But don’t be misled by numbers. Facilities readily offer figures based solely on employee and patient numbers. Management may be included in these figures, yet these employees may not actually provide hands-on care. Evaluate how long it takes to provide the services your parent needs and whether there is enough staff to do so.
Find out how many residents one staff member is responsible for bathing in a day or on a given shift, and what that staff member’s other duties include. The answers will let you know if the staff actually has enough time to do the job to meet your standards of care.
How does the training level of the staff change throughout the day? Not all staff members have the same training, certification, and abilities. Who is on duty, and when, can affect quality of care. If no registered nurse is on duty at night, can certain medications be given if they are needed?
Skilled Care
In a community setting, the skilled-care support needs to be investigated in the same manner as an assisted-living situation for patient/staff ratio and supervision. Patient/staff ratio and supervision are among Medicare’s qualifiers for facilities. Though your standards are likely higher, having Medicare approval is a starting point.
Another issue with skilled care is the use of doctors and hospitals. Some facilities require their patients to utilize a staff physician and services provided by specific hospitals. This may not work within your insurance guidelines.
Other things to consider when selecting a care facility:
Medication Management: Many facilities use their own pharmacies or have specific procedures in place for managing medications.
Bathing: Does this mean a once-a-week trip to a communal-style shower room down the hall or help several times a week in a bathroom adjacent to your parent's room? Bathing service schedules are common. Will Dad agree to having his shower at night rather than in the morning to fit the schedule?
Appointments and Transportation: Who makes appointments—you or someone at the facility? (Sometimes the transportation specialist makes the appointments to best accommodate the transport schedule). How far in advance does staff need to be notified of your parent’s appointment? Will you be required to meet your parent for the appointment or will a staff member be in the examining room and take notes?
Emergency Care:
· What steps are taken and who is available to handle emergency situations?
· Some facilities offer call buttons in assisted-living and skilled-care rooms. If so, who answers the calls, who responds, and what is the response time?
· Is there enough support staff to take over regular care of residents while emergency situations are handled?
· Falling is one of the most common accidents among the elderly. If a fall occurs (and it can happen even under the most watchful eye), what is the protocol?
· Is EMS called first to take your parent to the hospital? Or are you called first to make a decision based on staff members’ initial assessment?
Laundry:
· Will all of your parent’s laundry be done on site?
· Will linens be changed and washed as often as you want?
Understanding “Bed Hold” Fees
Many care facilities require a “bed hold” fee if your loved one is hospitalized. This is usually an out-of-pocket fee because insurance providers will not pay a per-day hospital charge and a care facility bed fee for the same dates of service. If you choose not to pay the fee to hold the bed at the care facility, most require you to clear out all personal items from the room, including furniture, by 5:00 p.m. the day your parent enters the hospital. And there is no guarantee a bed will be available for your parent at the same facility once he or she is released from the hospital.
Making the decision about whether to pay this fee is difficult because, more than likely, your parent is experiencing a health crisis, and your focus is on your parent’s condition. To aid your decision, ask the ER doctor about a projected course of treatment and an estimate of the days required for diagnostic testing. Also, check with the admissions coordinator at the care facility regarding bed availability. If eight beds are available and the projected stay in the hospital is five days, it may be best to release your parent’s bed at the care facility. Otherwise you may have to fork over roughly $1000 or more out-of-pocket. Conversely, if your parent’s projected stay in the hospital is 48 hours, it may be worth the $400 so you don’t have to remove everything from the room and have your parent return to a new room and roommate once released from the hospital.
Portions of this article excerpted from When Your Aging Parent Needs Care: Practical Help for This Season of Lifeby Candy Arrington and Kim Atchley (Harvest House Publishers). www.whenyouragingparentneedscare.com
