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If your loved one requires a Medicaid bed in the Chicago metropolitan area and the payor source is Public Aid Pending (PAP), you may be in for a difficult encounter. What do I mean by Public Aid Pending? It means that an individual needs the support of the Medicaid program (Federal system administered by each state that grants assistance for long term care to people who can’t pay privately.), but his/her application is in the process of being prepared. Or, the application has been prepared, filed, but isn’t approved with a case number. Due to the implementation of the SMART Act (Save Medicaid Access and Resources Together), Illinois is now one of the toughest states in which to obtain Medicaid.

Right now, the nursing homes aren’t too willing to accept residents who are in PAP status. That’s because if a resident enters in this status, the nursing home receives no reimbursement for their care until the case is approved and stamped with a number. In addition, it can take up to three months or longer to get an application approved. Plus, many of the nursing home representatives that I deal with are reporting that reimbursement from the state is currently nine months or more in arrears. In total, you may be looking at a year before a nursing home receives payment for a public aid resident. Therefore, most nursing homes are asking that a resident has at least one or two years of funds to pay privately before filing a Medicaid application.

Here are some issues I have encountered while searching for Medicaid beds for my clients. many of the nursing homes are simply not accepting anyone in Public Aid Pending status because their censuses already have too many residents applying or waiting for approval. Please don’t panic. You will find a bed for your loved one, but it may not necessarily be at your first choice of communities. If your loved one is currently at a nursing home for a Medicare stay (That is the federal program for short term rehabilitation at a long term care community.), and you know there is no way the senior can return home permanently, begin your application process immediately. Ask the Admissions Director if there is a Medicaid bed available so your loved one can transition from Medicare to Medicaid. If a bed will not be available, use your loved one’s remaining Medicare days as a bargaining tool with another community that might have a Medicaid bed available. That way, your loved one can transfer and their new home can be reimbursed by Medicare while you are filing the Medicaid application. The Admissions Directors are more likely to help you if they know the community is going to get some payment from Medicare while waiting for the Medicaid application to be approved. I will also note that many of the nursing homes want the prospective residents to use their, “financial specialist,” to file a Medicaid application, rather than using an alternative source. If the resident uses their resource, the home is assured of collecting as much private pay from the resident as possible.

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I have been receiving a fair number of requests to assist families with the placement of loved ones who have psychiatric issues. Many of them have had episodes with violent behaviors. Unfortunately, there are no easy solutions to these types of placement problems, and under no circumstances do these placements resemble a typical nursing home placement. A nursing home is simply not a dumping ground for a senior who exhibits psychiatric behaviors. If you call a nursing home to inquire about a bed for someone who has bipolar manic depression, schizophrenia, or Alzheimer’s disease with disruptive behavior disorder, it is likely the response you receive won’t be positive. That is because there is a real lack of Geriatric-Psychiatric (“Gero-psych”) care available for seniors around Cook, Du Page, Will, and Lake Counties in Illinois. For instance, there are only about 6 nursing homes in Du Page County that can handle psychiatric illness effectively. There are more in Cook County. Most nursing homes don’t have the staff with training to accommodate the one-on-one type of attention seniors with mental health issues require. They may be a danger to themselves and their fellow residents.

Here’s what you can expect if you enter the senior psychiatric arena in the Chicago metropolitan area:

1. Most of the homes that handle mental illnesses (Institutions for Mental Disease or IMDs) are at the intermediate care level. The residents are often ambulatory and many are not elderly. The residents need their medications administered to them and sometimes need help with some of their activities of daily living. Depending upon the seriousness of his or her mental condition, the resident may be allowed to check in and out of the facility on a daily basis. There is a lack of locked units that treat psychiatric illnesses that many seniors who wander require.

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As a senior living advisor, I recommend that my clients who are at the independent living or assisted living level take a trial stay at a long-term care community before they make a commitment to move in. This will allow a senior to sample the food, try the activities, socialize with potential fellow residents, and decide if they like congregate living.

Sometimes the communities will not allow a trial stay. At other times, it may be required that the senior stays for at least 30 days. Personally, I am in favor of the 30 day requirement, because a stay of two days or a week isn’t going to give the senior the ,”big picture,” of retirement community life.

A short stay or “respite” at a senior living community is normally treated like a regular admission. The senior may have to submit a medical history and physical form from their primary care doctor, along with the results of a TB test that is negative. This information ensures that a community can meet the resident’s medical needs. I recommend that my clients request the medical information several weeks prior to the anticipated admission. Collecting the information from a physician’s office can be extremely slow and often delays the admission process. Many physician’s will not complete the forms unless they have seen the patient recently. The homes also will not accept medical information that is too old.

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A recent article published in the Washington Post portrays a very biased picture of assisted living communities. The writer is a former Zen monk and journalist. I encourage you to read the article and take note of the facts that were left out of his side of the story.

The author writes the he, “decided,” to move out of his home at age 53 to an assisted living community because he had Parkinson’s disease. He neglects to mention the reason as to why he made the decision to move. Did he move because he wanted the socialization of being with other people? Was his condition becoming too complex to be handled at home? Were his funds being depleted? Could his caregiver have been experiencing “burn out?”

The article states that he knew his future fellow residents were going to be much older. Yet, he complained about watching his table mates, “waste away,” and die.

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There are approximately 44 million Americans who are caring for an elderly loved one. A recent article written by Terry Savage and published in the Chicago Sun Times cites that between one and two million people over the age of 65 have been abused by someone who cares for them. During the six years that I’ve owned my senior living advising business, I have never been witness to any suspected elder abuse until recently.

A respected colleague called me and said that a couple in their 80’s were in a very tenuous position, and asked if I would assess their situation with regard to recommending some senior living communities in the Du Page County area. When I called and spoke to one member of the couple, I was told that he and his wife weren’t interested in senior living communities, but would rather speak to someone who would help them integrate back into society via participation in activities at a senior center. He also expressed an interest in having a personal trainer come to the house and exercise with them. I told him I’d call back in several days with some contact information.

When I contacted him several days later with potential resources, his conversation with me headed in a drastically different direction. I felt that an onsite visit was in order, so I made an appointment with him.

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I have been hired to find an assisted living community with a memory care component for a client in southern Cook county or Will County in Illinois. Defined in general terms, assisted living with memory care is an extension of assisted living that caters to individuals with Alzheimer’s disease or other dementias. This form of care is a wonderful alternative for individuals who have dementia but are not yet ready for a nursing home. The communities with memory care provide the resident with heavy cueing to remind him or her to begin the activities. The staff is trained to handle the behaviors that often accompany the diseae. For example, activities are provided on a structured, 12-hour basis including the residents’ activities of daily living in order to keep them mentally stimulated and occupied.

During my research, I compared nine communities on the basis of cost, staffing, activities, living areas, and and the attitude of the person conducting the tour. Here is what I found in each catagory:

As far as what you can expect to pay for your loved one’s care at one of these communities, the cost for a studio will range from $4,500 to $6,800 per month depending upon whether the charges are on a tiered or package basis.

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There are many seniors who prefer to stay in the comfort of their own homes rather than move to a retirement community. Non-medical home care agencies will send a private caregiver to your loved one’s home to assist with activities of daily living (bathing, dressing,walking, transferring, toileting, eating), light housekeeping, running errands, companionship, and meal preparation etc. The process of choosing a non-medical home care agency needs to be performed with due diligence.

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During the past several years, we’ve observed the number of these non-medical home care services have increased drastically in the Chicago metro area. We have assessed many of them. They are not all created equal. The owners’ backgrounds and levels of expertise vary. Some are licensed by the state of Illinois and operating as home care agencies. Others may not be licensed an operating as independent contractors. In the latter case, hiring the nice lady from across the street places you in an employer/employee relationship. You will have no recourse but to assume liability when the independent contractor makes an error.

At Andrea Donovan Senior Living Advisors, we have a systematic approach to assist you with hiring a non-medical home care agency. The process begins by selecting several candidate agencies with the appropriate credentials, longevity, and experience in the industry. Then, we guide you through the rigorous interviewing process by questions that may not have dawned on you to ask. The answers will ultimately determine which agency is a good fit for you and/or your loved one.

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My friends and prospective clients who have parents who aren’t ready for senior housing placement often ask me questions about non-clinically licensed home health caregivers. The question I’m most often asked is, “Why can’t I just hire the nice lady from across the street to take care of Mom/Dad? It is much cheaper.” While I have seen that strategy work successfully for a lot of people, I do not make that recommendation to anyone.

If you are considering home health care for a loved one, the providing agency should be a member of the National Private Duty Association (NPDA). Without going into a lot of detail, agencies that are members of the NPDA in Illinois hold a license. They profess allegiance to a code of ethics. An NPDA-agency, in contrast to an independent contractor or staffing agency, is responsible among other things, for the screening, training, and background checks of staff members. If you choose to hire “the nice lady up the street,” you will be assuming all the responsibilities of an employer and may have no recourse if something goes wrong. What may appear as savings in the short-term may have long-term repercussions, as exemplified in this month’s real life story.

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Real-Life Story

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I recently worked with a family whose Dad contracted an infection in his foot. The infection lead to further complications coupled with the fact that he had mid-stage Alzheimer’s disease. He was using his Medicare days in a nursing home. His wife was very dissatisfied with the care he was receiving. When the family realized he probably wasn’t going to be able to return home, they hired me to find a better nursing home for him on a permanent basis.

1014575_war_veteran.jpgHis wife was in her 80’s and still working part-time. Monthly income was limited. When I sat down with the family to tell them the cost of his nursing home care would be in excess of $6,000 a month, tears began to flow from her eyes. Thank goodness this was a wonderful family. They insisted upon the best care for their father. The kids offered to chip in and pay for the best place possible. I suggested that they look into the VA Aid and Attendance benefit because their Dad was a World War II Veteran. Although the benefit isn’t huge, it lifted some of the financial burden from the kids, thus alleviating some personal and work-related stress.

Assistance may be available whether at home, in assisted living, or in a nursing home. There are specialists authorized to provide Veterans with assistance in filing a claim and interpreting the benefit. Please see the VA Aid and Attendance article or call me for details.

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The cost long term care can be exorbitant. Aside from the typical ways of paying for long-term care (private pay, long-term care insurance, Medicare, Medicaid; some of which may not apply to all of the above), there is a little known benefit provided by Department of Veterans Affairs. It is called the VA Aid and Attendance benefit. It can provide up to $1,056 to $1,949 per month to the Veteran and/or his or her surviving spouse if they qualify. Basic qualifications for the Veteran include:

  • Served at least one day during the War Time period
  • Served 90 consecutive days on active duty
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