1. Continuum of care Jerry Kiesling, LCSW MU Adult Day Connection

2. When care needs rise, costs rise

3.  Skilled Home Health – You must be Home bound  Can be covered by Medicare or Health Insurance  Homemaker Chore – Help with a bath, cooking, cleaning, transportation, etc. (non medical services)  Respite care – in-home -  Housekeeping services - In-home care

4.  8-10 hours of care in a community setting. Has a nurse, staff that provides activities.  Persons with dementia many times attend this if they have a caregiver at home.  Ideal for working caregivers  Usually costs about half of Nursing Home Care  Delays entry into 24 hour care Adult Day Care

5.  Residential setting with assistance for housekeeping, laundry, medications, sometimes bathing.  Individuals entering assisted living must be able to find their path to safety in a fire drill.  Medicaid doesn’t cover Assisted Living.  Usually you will have a private room with your own bathroom. Assisted Living

6.  24 hour care for all Activities of Daily Living (ADLs).  Highest cost of all care.  Look at Medicare.gov for ratings of nursing facilities  Rates - $150.00 to $160.00 per day  Choose quality – look at how other individuals in the center are being cared for, what does the facility look like and smell like? Nursing Home

7.  Used when a person has 6 months or less to live.  Often thought of as end of life care for individuals with cancer.  Provides nurse visits, social work visits, chaplain visits.  Provides some medications and equipment to provide comfort.  Is only chosen by a patient when he/she doesn’t want invasive treatment or curative treatment. Hospice

8.  Short term (a few days)  You may be admitted for observation or fully admitted.  Observation is a period (up to 72 hours) where your physician may do testing and evaluate you to see what is causing the health concern.  A full admission is usually when your condition is being treated –surgery, IV Antibiotic intervention, etc. Hospital

9.  May be covered by Medicare or Health Insurance if you have been in the hospital as an inpatient for 3 days and need rehabilitation or a skilled service provided by a licensed nurse.  24 hour care and assistance with needs for safety, medication administration and personal care.  May need to pay privately or use Medicaid to cover these services. Skilled Nursing Facility

10.  Living Will – a written statement by an individual to withdraw or withhold medical procedures that merely prolong the dying process.  Durable Power of Attorney-  For Health Care – You appoint an agent to make decisions for you when you cannot.  Durable Power of Attorney for Finances – You appoint an agent to make financial decisions for you when you are unable to do so. Advance Directive

11.  Appointed by the court when someone is found to be incompetent (unable to be safe without someone to make decisions).  The guardian may be a family member or the Public Administrator.  The Guardian makes decisions to provide basic needs for the individual (food, shelter and medical care).  The guardian prepares a report for the court on the personal status of the ward. Guardianship

12.  Appointed by the court when someone is incompetent to manage their finances (may be the same person as the guardian).  Conservator must manage the financial resources of the protectee.  Conservators pay bill, receive public benefits, sell and buy real estate and personal posessions.  The conservator must be bonded and must complete an annual report with the court. Conservatorship

13.  Health Insurance administered by Centers for Medicare and Medicaid (CMS) to help pay medical costs for individuals age 65 or over and disabled individuals under 65.  Part A – Hospital Insurance – helps pay cost of hospitalization, rehab hospital, skilled nursing facility and skilled home health  Part B – Outpatient Medical Insurance – helps pay doctor visits, outpatient medical services, medical supplies and some preventive services  Part C-Advantage Plans (Managed care plans that take the place of traditional Medicare.  Part D – Prescription Drug Benefit – pays for much of the cost of medications. Medicare

14.  A joint federal-state program designed to pay some of the costs of health care for financially needy individuals.  You must qualify by being disabled or over 65 and have no more than $999.99 in non-exempt assets.  May pay for home and community based care or Nursing home care.  Missouri HealthNet often does an Estate Recovery after the covered individual dies. They may claim against the estate to recovery monies payed for care on behalf of the individual. Medicaid