Every year about three million older adults are hospitalized. What happens next? Often we are sent to brief “rehab” in a nursing home. If we have spent at least three nights in the hospital, Medicare pays without a copay for up to 20 days; with a copay for an additional 80.
But can our bodies really be rehabilitated? About a quarter of us wind up being rehospitalized. About 10% of us move into long-term care, eventually on Medicaid. (96% of Texans exhaust their funds within six months of entering a nursing home). The majority of us find that we now need substantial help with one or more of the activities of daily living. We may need help bathing or dressing and grooming. We may need help using the toilet or find it safer to wear Depends at night than to risk another fall. We may need help moving around or start wearing a fall alert. We may need help getting sufficient nutrition and hydration. Our long-term trajectory is unknown.
Although Medicare regulations allow for up to 28 hours per week of home health care for people who need a visiting nurse, physical or speech and language therapist, adding needed visits by an occupational therapist and certified nurse’s assistant (CNA), the Medicare payment plan does not. People typically receive about six hours per week: a weekly nurse’s visit, two visits by a therapist and three by a CNA, perhaps to help them bathe. It can be a challenge to find a home health agency which will accept Medicare: in some areas, it pays less than market rates. It can be a challenge to keep home health care going month after month: the new payment plan focuses on acute, not chronic, care.
This means that many of us are rehospitalized, decline faster than need be, or wind up in a nursing home. Doctors may frame the conversation by saying, “I worry that it may take many months for you the regain your independence or that you may need live-in-assistance to return home safely.” They may say, “Best case, you go to a nursing home for rehabilitation and return home independently in a few weeks. Worst case, you end up returning to the hospital, your recovery may be slower, and returning home independently may not be possible.” While we may recover better at home, getting the help to do so will be a challenge.
We may not have family who can provide live-in assistance.
Even if we do, they need support and assistance.
Every veteran, regardless of when he or she served, should enroll at the VA. This will open the door to the VA Program of General Caregiver Support, including respite care (www.caregiver.va.gov 855-260-3274) and to the VA Geriatric and Extended Care Aid Program, which will train and hire family or friends or others to provide up to 20 hours home health care per week. One contractor with the program, operating in Texas and 21 other states, is the Care Planning Institute (877-487- 8166).
Veterans who were on active duty for at least 90 days, at least one of which was during a time of war (though not necessarily in country) may also qualify for VA Aid & Attendance, sometimes called “Improved Pension.” This will provide a dollar amount for home health care, in most cases cover assisted living, and, if the veteran does not elect a VA nursing home, pay for a private nursing facility or, with Medicaid, increase the monthly personal needs allowance from $60 to $150. Applications can now be filed online at www.va.gov/disability/file-disability-claim-form-21-526ez/introduction.
All Texans may be eligible for Medicaid waivers which provide home health care. The most generous of these, Star Plus, provides 30-50 hours per week of homemaker and home health care for Texans who would otherwise be in a nursing home and who qualify financially. Under the Money Follows the Person initiative, people can transition home from a nursing home using Star Plus (888-337-6377).
Elder law attorney, Terry Garrett, is a member of the National Academy of Elder Law Attorneys and is an Approved Guardianship Attorney. She assists people in elder law, estate and special needs planning, guardianship and settling estates. She graduated with honors from Cornell University. She was on the Dean’s List at Wharton Business School. She earned her J.D. at Columbia Law School, receiving the Parker Award and a Mellon Fellowship.
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