WNY Legal Services for the Elderly - What's New -> Other -> Tony's Top Ten Tips On Long Term Care

What's New -> Other -> Tony's Top Ten Tips On Long Term Care

TONY'S TOP TEN TIPS ON LONG TERM CARE

by Prof. Tony Szczygiel, SUNY at Buffalo Law School

1. Every individual has a unique set of health care needs and a unique way of meeting those needs.

Increasingly the responsibility for identifying the right care, and getting it, is on the individual. As an advocate/counselor you need to find out what that person needs and what is important to them. Each person has a different support system, different risk factors.

2. The "squeaky" patient gets the coverage .

Persistence will be rewarded when it comes to getting appropriate care, and having it paid for. Never accept a coverage denial without at least considering an appeal.

3. You have to know when to hold them, when to fold them and when to pass them to the player on your right .

Clients deserve the best advice possible in the confusing area of long term care. Be clear with them about what you know, and what you don't. Some "legal problems" can be resolved by non-lawyers - such as social workers, businesses that help file and follow through on medical claims etc. The client should consult with an attorney if they have a difficult or unfamiliar issue.

4. The best drug coverage may be different from your other medical coverage .

The new Medicare drug discount cards, the VA, your private insurance, EPIC or some free or discount drug programs from the drug manufacturers all are options for drug coverage. The drug discount cards include a waiver of the enrollment fee and a $600/year credit (for 2004 and 2005) for single individuals with income below $12,569 ($16,862 for a couple). For veterans, they need to register as a patient with the VA and establish a relationship with a VA physician. However, they can continue to see their regular doctor and use the VA just for prescription coverage.

5. Medicare can help cover nursing home care

Medicare can cover nursing home care - but it must be skilled care (most nursing home care is) provided after a minimum three day hospital stay. The first 100 days of care in a WNY nursing home can cost between $20,000 and $25,000. Medicare coverage will reduce your bill to about $8,000 for the first 100 days of care. Medicare nursing home benefits are exhausted after the100 days of coverage.

6. Medicare can cover a lot of home health care, for the "right" kind of patient .

Medicare covered home care must be provided through a certified Home Health Agency (CHHA). You must need either a) some recurring skilled nursing care, less than daily or b) skilled therapy services. You also must be "homebound" - meaning that it takes a considerable effort for you to leave home.

7. Medicare HMOs may not be the best coverage if you have chronic, long-term care needs.

Medicare HMOs operate on a budget set by Medicare. Expensive, potentially long-term care does not fit well in that budget. Consider your other options - and do it before you need the care. Medicare "locks-ins" limit your right to get out of a Medicare HMO.

8. Medicaid can cover most of the long term care costs for a married person with a "well" spouse in New York

The Medicaid "spousal budgeting" rules make nursing home care and the Long Term Home Health Care program affordable for most couples in New York - if only one member of the couple needs that care. The same care will cost more for singles, or if both members of the couple need care.

9. We have a lot of services available for individuals with long-term health care needs - but not always enough.

New York State, and Erie County, have a wide range of support services available for individuals with long-term health care needs. We have a range of housing options providing different levels of care. Meals on Wheels, Hospice Buffalo, several CHHAs to choose from, social day care programs and EISEP are just some of the many support services available. Despite this, you may have trouble finding the help you need at a price you can afford. A good place to start is the Erie County Department of Senior Services. Tel. # 858-8526.

10. Don't forget to get support for the caregivers.

Caring for some individuals with long term care needs can be very stressful. The caregiver must take care of herself. Asking for help may not be easy, but it will let her keep going longer.