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A Changing Landscape for Memory Care

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There are many opportunities for specialized facilities offering memory care. The number of adults with cognitive impairments is increasing, but the number of caregivers is decreasing, which requires more innovative solutions. While some facilities are stand-alone solutions for memory care patients, others offer care integrated into existing assisted living or nursing home facilities.

Innovative Changes

Recent changes to memory care needs include inventive settings that are vastly different than existing dementia support floors and secure units. New care settings use the latest research and understanding of cognitive impairment to provide the best possible environment and services. There will be many more options to choose from in the near future. The small house model has become increasingly popular. It’s an intimate setting within existing nursing communities consisting of 10 enclosed, secure units designed for couples facing memory challenges. A small-scale affordable housing model, partially funded by the Department of Housing and Urban Development (HUD), is typically available to low-income seniors. Design elements include:

  • High visibility of features so patients can see the toilet from the bed, the kitchen from the living room, the activity space from the dining room, etc.
  • Discreet security measures like disguised doors to prevent exit-seeking behavior and decorative fencing to provide a secure environment.
  • Separate bedroom suites furnished with the patient’s own belongings.
  • Time-appropriate bright lighting during awake hours and dimmer lighting in the evening.
  • Accessible outdoor space to enjoy nature and walk and wander safely.

Those seniors who can afford private pay for their memory care can live in an assisted living facility designed like a neighborhood from an earlier time. Often, dementia patients readily recall memories from long ago, and these centers look like a community replete with porches, rocking chairs, carpet that mimics grass, and fiber optic ceilings that allows transitional lighting, creating a sense of the day and night sky. Other elements, like aromatherapy, calm residents or stimulate their appetite depending on the selection of oils integrated into the therapy. All these elements help reduce anger, anxiety, and depression, which are hallmarks of seniors who suffer from dementia illnesses.

Full Continuum Care with Geriatric Psychiatry

Memory care is improving to meet the increasing number of residents. Many facilities are tapping into the expertise of geriatric psychiatry. Geropsychiatry, psychogeriatrics, or psychiatry for older adults is a subspecialty of psychiatry dealing with the study, prevention, and treatment of mental disorders in seniors. This field of study can enhance a memory care facility and improve the problems of anger, depression, and anxiety with medical components that address dementia. The techniques use a person-centered approach that fosters autonomy, develops empathy with residents, and even focuses on humor to help alleviate stress and increase quality of life.

Certified Memory Care Professionals

Professional caregivers offer specialized care to patients with dementia. Formal memory care education will become a more commonplace accreditation as the number of patients increases. Rather than a certified nursing assistant (CNA), dementia patients will be tended to more frequently by certified dementia care nursing assistants (CDNAs). This change in credentialing is driven by rising consumer expectations and tighter regulations that govern memory care.

Slowing the Progression of Dementia

Dementia is more prevalent than ever before, and so is the understanding that the disease has a long preclinical phase. Intervention and healthy lifestyle modification can delay the clinical dementia phase. Physical activity, social engagement, and brain fitness through smart devices and computer applications are excellent cognitive compensation strategies that protect executive brain function, particularly in the preclinical phase of the disease. Cutting-edge technology can also help seniors compensate for memory loss, allowing them to remain at home longer. It also enables senior facility operators to refine their services with fewer staff.

Wearable cameras with artificial intelligence (AI) facial recognition capabilities can provide a patient with the name of the person approaching them. AI can also help a senior’s cognitive load, helping them stay informed regarding daily decisions. New software applications are making it easier for memory care patients to use video, audio, and sensory technologies that provide predictive analytics to caregivers to detect depression and receive alerts indicating a patient is having a bad day or at an increased risk of falling due to a change in gait.

Do you or your loved one have a plan in place in the event you become a memory care patient? Are you aware of the changing options available for living arrangements? Contact our Ruston, LA office by calling us at (318) 255-1760 today and schedule an appointment to discuss how we can help you with your planning.

A Nursing Home can be Covered by Medicaid

A Nursing Home can be Covered by Medicaid

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Remember Medicaid planning doesn’t simply mean meeting strict income and asset limits to qualify for long-term care insurance. You will also need to demonstrate you need the level of care typically provided in a nursing home setting. These health eligibility rules are valid if you apply for nursing home coverage. Or a Medicaid waiver program for coverage in your home. Each state has a level of care requirement. And its own criteria to determine if you meet the mandated level of care. It can get complicated because eligibility criteria are not always clear.

Determining the level of care necessity usually includes:

  • The need for two or more activities of daily living constitutes bathing, toileting, dressing, eating, and mobility.
  • You require frequent medical care, like IVs or other injections, medications, or other medical treatment.
  • You exhibit behavioral problems such as aggressiveness or wandering away from home.
  • Alzheimer’s disease or another form of dementia impairs your cognitive ability. Making decisions on your own is problematic and/or you cannot correctly process information.

The state evaluates the assessment of a Medicaid applicant and, in many cases, will require a doctor’s diagnosis. The assessment generally requires the applicant to answer a series of questions about their abilities to perform activities of daily living and any behavioral issues or cognitive problems. There are further questions regarding the applicant’s family and their ability to provide support.

Understanding Medical Services Covered by Medicare

Medicare still covers the medical services you may need beyond nursing care along with institutional Medicaid. If you need to see a specialist or go to a doctor’s office, Medicare pays first, and Medicaid will cover your remaining costs like copayments, coinsurances, and deductibles. When applying for institutional Medicaid, consider the following:

  • The program considers you and your spouse together when counting assets and income. Typically, you can set aside a certain amount of assets and income to protect your spouse’s standard of living. This spousal amount does not count when applying for Medicaid.
  • You will still be able to keep a small amount of income for your allowance even though you qualify. The amount varies by state, and your local Medicaid office can provide more information. The remainder of your income will pay the nursing home.
  • There is a look-back period of up to five years for institutional Medicaid in most states. When determining your eligibility, your state will count any assets you have transferred in the past five years. If Medicaid determines any transfers violate the Medicaid eligibility rules, you may be penalized. Medicaid may opt to pay only a portion of your nursing home stay or none at all.
  • Owning your own home affects Medicaid eligibility and coverage. An elder law attorney can characterize your specific circumstances and how the equity in your home may count as an asset. When long-term care is no longer necessary, or you are deceased, these assets may repay Medicaid for your care coverage.

Nursing Home and Assisted Living

Nursing home level of care, also known as nursing facility level of care (NFLOC), Is not an easily definable term as there is no formal federal definition. Each state has the task of defining the term, and rules are not always consistent from one state to the other. Generally, there are four areas of concern, though not every state considers all four; physical functional ability, medical needs/health issues, cognitive impairment, and behavioral problems.

For those families with a loved one who requires more care than they can provide at home but do not require a high enough level of care to qualify for nursing home admittance, there is an in-between care type typically provided in assisted living. However, Medicaid coverage of this type of assisted living is very limited in numbers.

Nursing homes are experiencing very limited capacity, and waitlists can be years. Medicaid is adapting to provide this coverage type in-home to those applicants who may meet NFLOC Medicaid eligibility requirements but not pose a danger to themselves or others in a home environment. Perhaps using this as a springboard as a potential nursing home residence is waitlisted for full-time care.

Getting Informed

Before applying to become eligible for Medicaid nursing home coverage, there is much to consider. Applications that are insufficient or incorrectly filed can create delays, and with limited space available, it can be several years on a waiting list before admittance can take place.

The need is more significant than ever before for long-term care in a nursing home. Meeting your state’s eligibility requirements can be a long and complex series of providing documents, answering questionnaires, having assessments and reviews, and filling out and filing forms. The scope of the project can be overwhelming. To get to your best outcome, don’t wait. Contact our Ruston, LA office today at (318) 255-1760. Proactive planning with an elder law attorney will help you understand and address all criteria you need to act on to succeed.

 

Playing the Blame Game with Nursing Homes and COVID-19 Deaths

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According to a report in the Minnesota Star Tribune, they account for more than 40 percent or approximately 45,500 of the US 115,000 COVID-19 deaths, even though nursing home residents are less than one percent of the total US population. Seema Verma, the administrator for the Centers for Medicare and Medicaid Services (CMS), asserts that nursing homes following federal infection control guidelines were largely able to contain the coronavirus.

Harvard researcher David Grabowski, a member of a nonpartisan commission, advising Congress about Medicare, states that “The federal government needs to own this issue,” about the need for federal efforts to routinely test nursing home staff and residents for COVID-19 and make more protective gear available. Grabowski agrees with other advocates for the elderly that the federal government has not provided consistent virus testing and sufficient protective equipment to nursing homes, its staff, and residents.

High Risk for Elderly Care During This Election Year

In this Presidential election year, the stakes could not be higher to garner support from older voters. Partisan overtones affect the discussion and subsequent policies to guide safer nursing home outcomes from the ravages of COVID-19. The blame game is on between political parties fighting for votes and states legally protecting health care workers and facilities from coronavirus lawsuits by residents or their families.

The Trump administration deflects accountability by criticizing nursing home facilities with low federal ratings for infection control and a handful of Democratic governors, New York in particular, who mandated that nursing homes accept recovering coronavirus patients. The number two House Republican, Steve Scalise of Louisiana, states that this NY policy, and other states with similar policies, “ended up being a death sentence.” Verma echoes the nursing homes with low federal rating criticism, saying CMS has data equating low safety ratings with outbreaks of COVID-19. Several academic researchers dispute this data citing their research has found no such link. Amid the finger-pointing, shamefully, more vulnerable senior nursing home residents are dying because of the coronavirus.

Nursing Home Concerns During Coronavirus

In agreement with other academic researchers, Harvard’s David Grabowski opined that neither state policies nor proverbial bad apples among nursing homes were responsible for driving the coronavirus outbreaks. The reason is simply because of the virus’s nature, which can spread via individuals displaying no symptoms and do not feel unwell. The illness’s very nature indicates it is already spread throughout communities. Without routine testing, nursing home staff can unknowingly bring COVID-19 into a facility where it then spreads easily among frail residents living in tight quarters. Ricardo Alonso-Zaldivar of the Associated Press quotes Grabowski, “The secret weapon behind COVID is that is spreads in the absence of any symptoms,” Grabowski told lawmakers at a recent briefing. “If COVID is in a community where staff lives, it is soon to be in the facility where they work.”

Advocacy group Justice in Aging’s long-term care expert Eric Carlson cites the lack of federal coordination as impeding the ability to identify people who are infected by and require care for the coronavirus. Other advocates agree that the White House directive for the testing of all residents and staff has had an uneven response, accounting for why some facilities suffer higher rates of infection than others. The Associated Press report from the end of May 2020 concurs with these opinions reporting “White House goal on testing nursing homes unmet.”

Meanwhile, at CMS, administrator Verma believes her agency has provided necessary safety guidelines, COVID-19 reporting requirements, and Medicare payment for testing residents since the outset of the virus. She continues that states have the money required from the federal government to support the nursing home staff’s testing. Let’s hope that is the case, as the nursing home industry reports one-time testing for every resident and staffer would cost 440 million dollars.

The coronavirus pandemic is not going to go away. New spikes of cases across the country are being reported and not even considered the “second wave” of infection that many experts anticipate. Third-ranking House Democrat Representative and chairman of a special panel on the coronavirus pandemic James Clyburn of South Carolina seems to match wisdom with temperance about the finger-pointing saying that the crisis in nursing homes should not be a partisan issue. Instead, stating, “Nursing home residents have died from the coronavirus in states governed by Republicans and Democrats, in big cities and in small towns, in rural and urban communities.” Capitol Hill law and policymakers seem to be very adept at identifying problems but slow in resolving them. In the meantime, our vulnerable senior nursing home population and their families are paying the price.

We help families with loved ones in a nursing home deal with a variety of issues. If you have a loved one in a nursing home, please don’t hesitate to reach out to see how we can help. Contact our office by calling us at (318) 255-1760 and schedule an appointment today.