Blog

What Level of Care is Best for My Loved One or Me?

As people reach retirement age, they may also encounter lifestyle changes and increased risks for serious medical conditions. Determining what retirement solutions (including everything from healthcare plans to living arrangements) will meet a person’s future needs can be challenging and stressful for everyone.

When choosing a plan for retirement that’s right for you, it’s important to consider not only your current needs but also to try to foresee issues that may arise in the future. For example, you may need assistance with physical needs that are part of your daily routine. This can range from cooking and cleaning to shopping and dressing, among many others.

Sudden medical conditions – such as stroke, heart attack or a progressive condition – should also be accounted for in the planning. This is especially true for those that hinder physical and cognitive abilities; such is the case for those with diseases such as Multiple Sclerosis or Alzheimer’s. In these situations, it is often recommended to pre-plan to hire a Home Healthcare Aide (HHA) or Personal Care Aide (PCA).

As a person ages, their social surroundings may also change as they might not have access to public or self-transportation that will enable them to visit with friends and family members. Some seniors will seek exposure to additional social settings to avoid becoming housebound or isolated.

For those who do not need constant supervision but want to live in a social community of seniors while receiving help with day-to-day tasks, an assisted living service may be ideal. Most typically set up with apartment-style housing or in a large home with individual bedrooms, assisted living residents are encouraged to act independently. Services available at these locations include food prep assistance, housekeeping, planned social and physical activities, multiple levels of care and full-time staff available to meet additional needs.

Individuals with high-level personal and medical care needs should opt instead for a nursing home, which can provide full-time care and address all lifestyle changes. These facilities usually serve residents who need to rely on staff for most basic needs, including bathing, toilet, dressing and eating. These facilities feature licensed medical professionals on premises who can provide individualized medical care as well as high levels of safety features, including access ramps, oxygen tanks, hospital beds and nurse pagers. To keep residents active, nursing homes also offer peer and interest-oriented activities

If you are looking to secure a home healthcare aide or need assistance determining which assisted living facility or nursing home is ideal for you or a loved one, P & P Medicaid has a full staff of professionals who can help you in your search, council you on the ideal type of care and guide you through each step of the process.

P & P Medicaid also offers a range of geriatric care management services to help individuals and their families make decisions about and supervise their long-term care needs. For more information regarding this, or any of our services please, contact us at 516-541-4770 or by email at paul@ppmedicaid.com.

How Medicaid Programs are Combating Antibiotic-Resistant Bacteria

Antibiotic resistance is a growing cause of concern in the United States and is attributed to the misuse of antibiotics. To address this, the Centers of Disease Control (CDC) has enacted the Get Smart campaign for Medicaid programs in all states, including New York, to ensure that antibiotics are administered only when they are absolutely necessary and used as prescribed. This program will not only combat levels of antibiotic-resistant bacteria, which are fueled by ineffective antibiotic treatments, but also improve the well being of all Medicaid patients.

According to 2013 Medicaid claims data, 55 percent of provider visits across 11 New York counties resulted in antibiotics being prescribed for upper respiratory conditions despite that the drugs are considered to be ineffective against such viral diseases. Some providers had attributed the high prescription rate to the pressure placed on them by their patients who would in turn deliver poor satisfaction reviews if denied the medication.

The New York Department of Health (DOH) collaborated with the CDC to address the issue by educating the Medicaid providers on illness circumstances in which antibiotics do not have to be prescribed. Antibiotics are inefficient as treatment in instances of cold and runny nose, bronchitis or chest colds (in otherwise healthy adults and children), flu, sore throat (except strep) and fluid in the middle ear (otitis media with effusion).

New York Medicaid’s efforts follow the White House’s action plan to combat antibiotic-resistant bacteria. The CDC estimates that drug-resistant bacteria cause two million illnesses and approximately 23,000 deaths each year in the United States alone.

According to E Medicine Health, aside from the antibiotics not helping patients with viruses feel better, cure the illness or prevent others from catching the infection, they may also cause side effects such as nausea, diarrhea, stomach pain, allergic reactions or swelling of the large intestine or colon.

Medicaid is a federally-funded program run by the state and the county, which provides medical insurance and long-term care for middle-to low-income persons, including the elderly and disabled. P&P Medicaid Consulting Inc., specializes in preparing applications for Medicaid eligibility, guiding you through the document-acquiring process and will appear on your behalf at all interviews with the Department of Social Services (Medicaid).

If you are interested in learning more about applying for Medicaid or any of our addition services, call (516) 541-4770 or visit www.ppmedicaid.com.

Long Island Resident Caring for Others? Don’t Forget to Care for Yourself, Too

Caring for a loved one can be rewarding, but also comes with difficulty. The changes in the family dynamic, mounting finances from medical care, household disruption, all piled on top of your already hectic workload can contribute to a caregiver’s high stress level that can eventually lead to burnout.

caregiver-main

The stress and burnout can be particularly damaging to caregivers’ health due to its consistency over a long period of time. Often, people care for their loved ones for years or even decades. Without ample support, the surmounting stress can attribute to various physical and emotional complications, ranging from insomnia to heart disease.

According to Help Guide Organization, the common signs and symptoms of caregiver’s stress are anxiety, irritability, depression, fatigue, insomnia, snapping at people due to minor nuisances, new or worsening health conditions, difficulty concentrating, increased feelings of resentment, overeating, substance abuse, neglecting responsibilities and straying from leisure activities.

Caregiver burnout can attribute to decreased energy, low-level immune response to colds and flu, chronic fatigue, neglecting personal needs due to lack of interest or a busy schedule, inability to relax even with available support and reoccurring feelings of helplessness or hopelessness.

According to AARP, one of the first steps to managing caregiver stress is to tend to your personal needs first. This means eating nutritious meals, avoiding stress-driven urges like overindulging in food or finding comfort in alcohol or drug dependency. Make sure you find time to exercise and schedule regular medical check-ups. You should also set aside 30 minutes everyday to meditate, listen to music or do something you enjoy to keep you energized and motivated.

Seek additional assistance. Unless you are the next Clark Kent, you do not posses the powers to be everywhere and do everything at once by yourself. Sit down and write out responsibilities to delegate to friends and relatives, or look into geriatric care management to coordinate all aspects of your loved one’s care. Spreading the responsibility is the only way to ensure that you and your loved one are getting the optimal care and support you both need.

Finally, it’s important to manage your feelings and stay positive. Bottling up your emotions can take a significant toll your physical and mental well-being. Talk to your friends, family members or coworkers who are in similar situations, seek out a professional counselor or join a caregiver support group. Do your best to avoid negativity by not dwelling on what you can’t do, recognize how much good you are doing and focus on the rewards that come with caring for someone you love.

P&P representatives are available to assist caregivers secure the geriatric care services and home healthcare aides to assist you with care for your loved ones. For more information about these or our other services, please contact us at 516-541-4770 or by email.

Long Island Medicaid Reborn During Its Golden Anniversary

In the midst of Medicaid reaching its 50-year milestone in July, New York is hosting its own renaissance for the federal-state health insurance program. Transformation ignited in 2011 when Governor Andrew Cuomo created a Medicaid Redesign Team and began passing policies to slow annual spending growth.

Why was Medicaid chosen as the golden goose? According to 2006 New York State Spending Budget, Medicaid accounts for 37 percent of the overall budge at a whopping $57 billion. Under Cuomo, New York has a plan to invest $9 billion to implement a Medicare rebirth in the form of its Delivery System Reform Incentive Payment program.

New York aims to utilize the Delivery System Reform Incentive Payment program to spend less by delivering more care to Medicaid patients outside the hospital, keeping expensive emergency room costs down. The goal stands at a 25 percent reduction in avoidable hospital use over five years.

Major reforms will change the way healthcare providers are paid. According to the Centers for Medicare and Medicaid services (CMS), instead of being paid based on the number of services or tests conducted, Medicaid healthcare professionals will increasingly be paid based on the quality of work they do and how well it helps their patients.

Additionally, New York will implement 25 new delivery networks called preforming provider system (PPS) to coordinate Medicaid patient care. This system targets the issue that enrollees are going to multiple doctors and receiving duplicate or ineffective treatment.

Why Do I Need a Geriatric Care Manager?

Geriatric care managers are social workers, psychologists, gerontologists and nurses who specialize in senior care issues. They are trained to assess, plan, coordinate, monitor and provide services for the elderly and their families. They offer necessary hands-on guidance and services, while allowing family members to provide quality time and emotional support that would otherwise be limited if the family was the sole caregiver.

Geriatric care managers take into consideration a client’s mental and physical health, financial resources and personal preferences. They are a knowledgeable guide that determines a senior’s needs and provides a personalized type, level and source of housing and care best-suited to help meet those needs. While transitions in care and housing can often be difficult and overwhelming for the elderly, the geriatric care managers oversee the situation and work to relieve the hurt feelings and anger that come with losing independence.

Families should consider hiring a geriatric care manager when the senior reaches a point of transition. This can be anything from hiring a home care worker, moving the senior into or between senior living options, and even during a hospital stay to prepare for the patient’s discharge.

There are many reasons to consider hiring a geriatric care provider, as when a loved one develops a loss of function, whether physically or mentally, for which the patient will require assistance. One may seek out additional assistance for when an older family member reaches a need for a higher level of caregiving or there is uncertainty regarding a senior’s living arrangement or health needs. If a senior is not functioning at his or her best, or is thought to be at risk in the current living situation, a geriatric care manager can step in to address the concerns of the senior and their family.

What Does Medicaid Cover?

Medicaid is a joint federal and state program that helps with medical costs for most retired and disabled people living with limited resources. Medicaid offers benefits not normally covered by Medicare, such as nursing home; personal care; laboratory tests and x-rays; care at federally qualified health centers (FQHC); and ambulatory, inpatient and outpatient hospital services.

States may also provide optional services, with additional matching of funds from the federal government. The most common of the 34 approved optional Medicaid services are intermediate care facilities for the mentally handicapped; home- and community-based care to certain individuals with chronic impairments; and rehabilitation and physical therapy. Prescription medications, prosthetic devices and eyeglasses, as well as the medical services necessary to acquire these, are covered under Medicaid in most states. Clinical, diagnostic and transportation services are also frequently reimbursed.

Each state sets its own Medicaid eligibility guidelines. New York expanded its Medicaid coverage to low-income adults under the age of 65 who do not yet have Medicare, such as people on Social Security Disability. Those who did not qualify for Medicaid in the past are urged to reapply under the new expansion Medicaid rules. There are many services available under the program for families with young children, including pediatric care, vaccines and early intervention.

According to the NY Department of Health, the chart below depicts the income ratio necessary to qualify for Medicaid and the amount of benefit you might receive.

Medicare

Is the Affordable Care Act the New Medicaid/Medicare?

Wilbur J. Cohen, U.S. Secretary of Health, Education and Welfare under President Lyndon B. Johnson, created the United States Medicare and Medicaid programs in the 1960s.  Inspired by the success New Deal at the end of the Great Depression, Cohen aimed to provide “relief, recovery and reform” to older and low-income Americans who could not afford coverage in the competitive commercial market.

It’s hard to believe President Johnson could have imagined such success for the Medicare and Medicaid programs when he signed them into law in July 1965. At that time, his main objective was simply to provide “the miracle of healing to the old and to the poor.”

While Medicaid is a federally funded program, it is controlled by local governments in each state and county. If one is eligible, based on age and disability, several applications and an evaluation of a person’s income and resource restrictions must be coordinated to determine to what degree Medicaid will to help pay for all medical expenses. Medicare offers many similar services as Medicaid, but it is available only to people over age 65, or younger if they are found to be certified disabled, who have worked and paid into the U.S. Social Security system.

Today, at the 50 year anniversary of the two programs, the nation still relies on that legislation. In fact, the Obama administration continues to make improvements to both platforms, in addition to using them as a basis for the Affordable Care Act, referred to by many as “Obamacare.” Like Medicare and Medicaid, the Affordable Care Act offers a combination of federal and private healthcare coverage. Unlike its predecessors, the program is open to all Americans, rather than just the elderly or those with limited incomes.

First enacted in March 2010, Obamacare’s original provisions led many insurers to forecast a decline in enrollment due to an increase in out-of-pocket expenses. Under pressure from the Obama administration’s Affordable Care Act, however, Congress reduced payments to Medicare Advantage. The legislation stated that beginning in 2014, Medicare Advantage plans could not spend more than 15 percent of Medicare payment on administrative or insurance costs. This could result in a reduction of individual member plan cost by up to $1,000 without reduction of benefits. Since this legislation was passed, member enrollment unexpectedly increased from 11 million in 2010 to 16.6 million in 2015.

Today, under Obamacare, more than half of the states’ governments have expanded Medicaid eligibility. Overall health insurance enrollment has soared thanks to government subsidies to private insurers who are now providing and coordinating almost 80 percent of new beneficiaries. Additionally, over 30 percent of the 55 million Medicare beneficiaries and more than half the 66 million Medicaid beneficiaries are now in privatized health care plans. White House officials are hopeful that Obama’s healthcare program will one day garner the standing and popularity of Medicare and Medicaid.

 

George H.W. Bush’s Recent Fall Brings Attention to Senior Safety

After a fall Wednesday at his summer home in Kennebunkport, Maine, resulted in a broken neck bone, former President George H. W.  Bush remains hospitalized. Bush is expected to make a full recovery, but his accident is fodder for senior safety concerns; neck injuries from falls by seniors can be debilitating and sometimes fatal.

According to reports about the accident, the injury is not life-threatening. The nation’s 41st president suffered a break in his C2 vertebrae, which, luckily for him, is away from the spinal cord and not in a crucial zone of the neck. Bush will, however, have to wear a neck brace, which will add to the limitations brought on by Parkinson’s disease which already leaves him wheelchair-bound.

Yet despite struggling with Parkinson’s, the former president is known for his health and fitness, having celebrated his 90th birthday by skydiving. For his age, this is the biggest contributing factor to his unusual recovery.

“It is a significant injury, but right now the [former] President is in excellent shape, and we would anticipate that he would make a full recovery,” Dr. William D’Angelo, his attending physician at Maine Medical Center in Portland.

For seniors concerned about their fall potential, follow these steps to ensure the safest, healthiest lifestyle:

  • Fall-proof your house: remove rugs and clutter, put in railings, and be sure to have adequate lighting especially over steps and staircases
  • Strengthen your bones: 1,000 mg of calcium is recommended each day to build strong bones for men and women over age 50
  • Soak up the sun: adults should consume 600 IU of vitamin D each day
  • Stay active: seniors who walk regularly have healthier hearts and stronger muscles than those who don’t
  • Get tested: adults age 65 and older should undergo regular bone-density screenings for osteoporosis; since some treatments are available it is best to catch this disease at the start

Study finds rise in medication use by those newly covered by Medicaid

According to a report by the IMS Institute for Healthcare Informatics, people newly covered by Medicaid in 2014 have caused a significant increase in prescription drug use. For instance, states that have expanded Medicaid programs saw a 25.4 percent increase in prescriptions over the past year. In states that chose not to expand their Medicaid programs, prescription drug use only increased by 2.8 percent.

The report sheds light on how consumers used their insurance in 2014, after millions of Americans gained coverage from the Affordable Care Act. This health care law expanded Medicaid eligibility in many states and set up marketplaces for consumers to shop for insurance. To learn more about U.S. medicine use and spending in 2014, click here.

Dutch nursing home offers free housing to college students

Humanitas Retirement Home in the Netherlands allows college students to live rent-free as part of a program aimed at suppressing the negative side effects of aging. In exchange for their own apartments, students are required to spend at least 30 hours per month with the nursing home’s residents.

So far, six students from local universities in Amsterdam live among the 160 senior citizens at Humanitas. The students volunteer their time by teaching computer classes and preparing meals, while also engaging in conversations and attending birthday parties. They are allowed to come and go as they please, as long as they do not disturb the senior citizens.

Studies have shown that seniors who are surrounded by others live longer and healthier lives. Social interactions also help to ward off the loneliness and isolation the elderly may feel while living in a nursing home. According to Humanitas CEO Gea Sijpkes, “The students bring the outside world in.”