Choosing long-term care is a very important decision. You should plan and think about long-term care before you need care or before a crisis occurs. Planning ahead allows you the time to talk with your doctor about your health and any problems you may be experiencing. It is also very important to talk with your family about the kind of long-term care services you think you might need someday, how much they would cost, and how you would pay for them. The best time to talk about long-term care is before you need services.
These guidelines will provide you and your family members with a variety of resources to aid you in making your long-term care decisions.
Long-term care is a variety of services and support to meet health or personal care needs over an extended period of time. Most long-term care includes non-skilled personal care assistance, such as help performing everyday activities of daily living (ADL), which are:
The goal of long-term care services is to help you maximize your independence and functioning at a time when you are unable to be fully independent.
Long-term care is needed when you have a chronic illness or disability that causes you to need assistance with ADL. Your illness or disability could include a problem with memory loss, confusion or disorientation. This is called Cognitive Impairment and can result from conditions such as Alzheimer’s disease.
This year, about 9 million Americans over the age of 65 will need long-term care services. By 2020, that number will increase to 12 million. While most people who need long-term care are age 65 or older, a person can need long-term care services at any age. Forty percent of people currently receiving long-term care are adults 18 to 64 years old.
When choosing a long-term care facility, you should consider the following:
The type of care or services needed will be dependent upon a number of factors. There are many different types of long-term care facilities. Long-term care can take place at home, in senior centers, at community centers, in an assisted living facility or special retirement communities, as well as in nursing homes. Long-term care service is not only nursing home care. Consider the following when making your decision:
The cost of long-term care services vary greatly depending on the type and amount of care you need, the provider you use, and where you live. For example, many care facilities charge extra for services provided beyond the basic room and board charge, although some may have all inclusive fees. Home health and home care services are usually provided in two-to-four-hour blocks of time referred to as visits. An evening, weekend or holiday visit may cost more than a weekday visit. Some community programs such as adult day service programs, are provided at a per day rate, and rates may differ based on the type and variety of programs and services offered.
When searching for any long-term care facility, ensuring that the highest quality of care is rendered is a top priority. In addition to looking up the quality ratings about a facility, rely on your own instincts. Taking a tour of the facility and talking to people who actually provide the services can be helpful in helping you make your decision.
Most people find it more comfortable to be around people of similar demographics, the same age and with similar medical conditions. During your planning research for a long-term care facility remember to find out information about the residents who reside in the facility.
Many long-term care facilities have a waiting list for taking in new clients or residents. An essential question to ask when comparing long-term care facilities is when care can begin. This is especially important if you need to find a facility immediately.
Adult Day Care offers health care and support during the day to older adults with multiple, chronic conditions in a safe comfortable setting. Adult Day Care provides daytime supervision and a variety of social and support services to people 18 and older with physical or emotional disabilities. In Georgia, Adult Day Care centers are not licensed or regulated. However, those that participate in programs with federal or state funding must meet minimum standards.
A Dialysis Center furnishes at least one specific End Stage Renal Disease (ESRD) service (i.e. transplantation services, dialysis services, and self-dialysis and home dialysis training). ESRD is the stage of renal impairment that appears irreversible and permanent, and requires a regular course of dialysis or kidney transplant to maintain life.
A Personal Care Home is any dwelling that provides or arranges for the provision of housing, food service, and one or more personal services for two or more adults who are not related to the owner or administrator by blood or marriage. Personal services include but are not limited to individual assistance with and supervision of self-administered medications and essential activities or daily living such as eating, bathing, grooming, dressing and toileting.
Nursing Homes provide care to people who cannot be cared for in their home or in their community. Nursing Homes generally provide skilled nursing care, rehabilitation services, meals, activities, help with daily living and supervision. Many nursing homes also offer what is known as respite care. Respite care is temporary or periodic care instead of hospital care, after hospital care, or to give family or friend caregivers some time off.
Home Health Care can be given in your own home by family members, friends, volunteers, and/or paid professionals. Home health care covers a number of services and therapies, including skilled nursing care, speech, physical and occupational therapy; medical social services and home health aide assistance. Some short-term, skilled home care (provided by a nurse or therapist) is covered by Medicare and is called home health care.
Hospice Facilities offer health and personal care services to patients who are terminally ill. Hospice care can be provided in freestanding hospice centers, hospitals, personal home, nursing homes and other long-term care facilities. Hospice programs usually include nursing; physical and occupational therapy; speech language therapy; medical social services; home health aids; medical supplies and appliances; drugs; physician services; short-term inpatient care; and psychological, spiritual and nutritional counseling.
Medicare pays for long-term care if you require skilled services or recuperative care for a short period of time. Medicare does not pay for non-skilled assistance with activities of daily living.
Medicaid is the joint federal and state program that pays for the largest share of long-term care services, if you meet financial and functional criteria.
Medicaid pays for the largest share of long-term care services, if you meet financial and functional criteria. Most often, eligibility is based on your income and personal resources. Most of your health care costs are covered if you have Medicaid. The best source for information is the state Medicaid office or an attorney. In some states, people with Medicaid may get coverage for nursing home care, home care and outpatient prescription drugs that are not covered by Medicare. For more information on Medicaid, please log onto dch.georgia.gov. Other federal programs such as the Older Americans Act and Veterans Affairs pay for some long-term care services for specific populations and in specific circumstances.
| Georgia | Average Daily Nursing Home Rate: Private | Average Daily Nursing Home Rate: Semi-Private | Average Monthly Rate: Assisted Living Facility | Average Hourly Rate: Home Health Aide | Average Hourly Rate: Homemaker Services | Average Daily Rate: Adult Day Services |
|---|---|---|---|---|---|---|
| Atlanta | $173.00 | $162.00 | $2,495.00 | $43.00 | $17.00 | $43.00 |
| Rest of State | $143.00 | $135.00 | $2,184.00 | $40.00 | $16.00 | $56.00 |
| State Average | $158.00 | $149.00 | $2,340.00 | $42.00 | $17.00 | $50.00 |
| Source: U.S. Department of Health and Human Services 2008 Cost of Care Survey, March 2008 | ||||||
| Long-Term Care Service | Medicare | Private Medigap Insurance | Medicaid | Private Pay | ||
|---|---|---|---|---|---|---|
| Nursing Home Care | Pays in full for days 0-20 if you are in a Skilled Nursing Facility following a recent hospital stay. If your need for skilled care continues, may pay for days 21 through 100 after you pay a $128/day co-payment. | May cover the $128/day copayment if your nursing home stay meets all other Medicare requirements. | May pay for care in a Medicaid-certified nursing home if you meet functional and financial eligibility criteria. | If you need only personal or supervisory care in a nursing home and/or have not had a prior hospital stay, or if you choose a nursing home that does not participate in Medicaid or is not Medicare-certified. | ||
| Assisted Living Facility (and similar facility options) | Does Not Pay. | Does Not Pay. | In some states, may pay care-related costs, but not room and board. | You pay your own except as noted under Medicaid if eligible. | ||
| Continuing Care Retirement Community | Does Not Pay. | Does Not Pay. | Does Not Pay. | You pay your own. | ||
| Adult Day Services | Not covered. | Not Covered. | Varies by state, financial and functional eligibility required. | You pay on you rown [except as noted under Medicaid if eligible]. | ||
| Home Health Care | Limited to reasonable, necessary part-time or intermittent skilled nursing care and home health aide services, and some therapies that are ordered by your doctor and provided by Medicare-certified home health agency. Does not pay for on-going personal care or custodial care needs only (help with activities of daily living). | Not Covered. | Pay for, but states have option to limit some services, such as therapy. | You pay on your own for personal or custodial care, except as noted under Medicaid, if you are eligible. | ||
| Source: U.S. Department of Health and Human Services 2008 Cost of Care Survey, March 2008 | ||||||
A private insurance policy can help pay for many types of long-term care, including both skilled and non-skilled care. Long-term care insurance coverage can vary widely. Some policies may cover only nursing home care. Others may include coverage for a whole range of services like care in an adult day care center, assisted living, medical equipment, and formal and informal home care.
Long-term care insurance premiums vary, depending on your age and health status when you buy the long-term care insurance policy and how much coverage you want. Additionally, you must be in generally good health to pass underwriting when purchasing a policy. For this reason, it may be better to buy long-term care insurance at a younger age when premiums are lower. If this is done, a periodic review is advised to make sure your policy covers your current and future long-term care needs. Talk about this with a family member, insurance agent or financial advisor to learn what is best for you.
You can use your savings or other personal resources to pay for long-term care. This is also called self-insuring. Some personal resources may include money in a checking or savings account, stocks, bonds, investments, life insurance policies, pensions and income. Your family may also want to give you money towards your long-term care needs. If you choose this option, you should plan ahead before you need long-term care. Make sure you think about all your future health care needs and costs.
Some insurance companies offer payment options in which premiums are paid for a limited period of time, rather than over the life of the policy. Rather than paying premiums as long as the policy stays in force, payments are made for a predetermined number of years or up to a certain age. Common examples are:
You can use cash, certificates of deposit (CD), annuities or other resources to buy a limited pay/long-term care policy. For example, if you purchase a policy that offers a single-premium payment, you are guaranteed that there won’t be any additional premium charges. The policy includes a set amount of money for your long-term care needs. The longer you have the policy and don’t file a claim, the more money you will have for your future long-term care needs. These policies also pay a death benefit to your heirs (family or friends).
A life settlement means you can sell your life insurance for the present value of the policy. This is usually done when the original reason why you bought your life insurance policy no longer exists. For example, if you have a life insurance policy and you get divorced, you may be able to sell the life insurance policy for present value. The money from the sale can be used to pay for your long-term care needs.
To be eligible for this, you can not be ill and must be over age 70 (for females) or over age 74 (for males). In some situations, a life settlement can be made at a younger age.
If you are terminally ill or chronically ill, you might be able to sell your life insurance policy to another person (a third party). You usually have to sell your life insurance policy for a lower amount of the full face value. The amount that is paid is usually based on the remaining life expectancy of the insured (you). The death benefit usually ranges from 50 percent to 80 percent. When you die, the third party will get the full death benefit.
Before making a final decision to make a viatical settlement to pay for your long-term care needs, you may want to contact your State Attorney General Office at (404) 656-3300 or your State Department of Insurance at (404) 656-2085.
An Accelerated Death Benefit (ADB) is a benefit that can be added to your life insurance policy. It can provide cash advances against your death benefit while you are still alive. You can use this benefit if you have a terminal illness, need nursing home care permanently, or can’t perform activities of daily living for yourself. Some examples of activities of daily living include eating, bathing, dressing and using the bathroom. There might be spending limits (caps) on ADB policies. You may want to review before getting an ADB policy.
A reverse mortgage is a special type of home loan that lets a homeowner convert a portion of the equity in his or her home into cash. The equity built up over years of home mortgage payments can be paid to you. But unlike a traditional home equity loan or second mortgage, no repayment is required until the borrower(s) no longer uses the home as their principal residence. The U.S. Department of Housing and Urban Development’s (HUD) reverse mortgage provides these benefits and it is federally-insured. To obtain a HUD-insured reverse mortgage you must be 62 years of age or older; own your home outright, or have a low mortgage balance that can be paid off at the closing with proceeds from the reverse loan; and you must live in the home.
For more information about a reverse mortgage, visit the U.S. Department of Housing and Urban Development’s Web site at www.hud.gov.
The Department of Veterans Affairs (VA) may provide long-term care for service-related disabilities or for certain eligible veterans. There may be a waiting list for VA nursing homes. The VA also provides some at-home care.
Managed care organizations (MCO) and other group health plans sometimes include coverage for home care services. MCOs contracting with Medicare must provide the full range of Medicare-covered home health services available in a particular geographic area. Medicare beneficiaries who are enrolled with an MCO may elect their hospice benefit from the hospice of their choice. These organizations only pay for services that are pre-approved.
On a cost-shared basis CHAMPUS covers skilled nursing care and other professional medical home care services for dependents of active military personnel and military retirees and their dependents and survivors. CHAMPUS offers a comprehensive hospice benefit to its terminally ill beneficiaries, which covers nursing, social work and counseling services, therapies, personal care, medications, and medical supplies and equipment.
Any individual requiring medically necessary home care services as a result of injury on the job is eligible to receive coverage through workers’ compensation.
If you have been referred for nursing home or other institutional care, but could stay in your home or in the community with special services, you may be eligible for home and community-based services through one of Georgia’s Medicaid long-term care programs.
These services are called waiver programs, because the Centers for Medicare & Medicaid Services (CMS) allows states to waive certain Medicaid requirements and pay for home and community-based services as an alternative to institutions, such as nursing homes or hospitals for people with mental retardation or Intermediate Care Facility for the Mentally Retarded (ICF-MRs).
If you are interested in a waiver program, call (404) 656-6862 or log onto dch.georgia.gov for a booklet of available Home and Community-Based Service Programs.
You can use the “Search For Care” application on the georgiahealthinfo.gov Web site to find long-term care in your area.
Last time you visited your aunt, she had bruises and you wondered how they got there. Perhaps you suspect your elderly neighbor isn't caring for himself the way he used to. It could be elder abuse. What should you look for, and what can you do?
Elder and disabled adult abuse occurs when someone intentionally causes harm or puts at risk of harm to an older or disabled adult. Neglect occurs when someone intentionally or unknowingly withholds basic necessities or care. Self-neglect refers to a person’s inability to provide care and support to himself or herself. Elder and disabled adult abuse can take several forms, including:
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If you are concerned an older adult might be abused, knowing the signs and symptoms of abuse can help. Changes in an older person’s behavior or emotional state may suggest a problem. Examples to look for are agitation, apathy, withdrawal, fear or anxiety, comments about being mistreated, or the refusal of the caregiver to allow you to visit the older person alone.
Some indicators of abuse, neglect and exploitation include:
Physical Abuse:
Emotional Abuse:
Sexual Abuse:
Financial Abuse or Exploitation:
Neglect:
Self-Neglect:
Note: ANYONE can and should report suspected abuse.
Many people are required by Georgia law to report when they suspect abuse, neglect or exploitation. Mandated reporters must make a report when they have a reasonable cause to believe that a disabled or elder adult has had an injury or injuries inflicted upon them, other than by accidental means, or has been neglected or exploited. Mandated reporters who do not fulfill their obligation to report may be charged with a misdemeanor. Georgia law lists mandated reporters in Code Section 30-5-8 for alleged victims who live in the community; and in Code Section 31-8-80 for alleged victims who are in a long-term care facility. All other parties are encouraged to make reports if they believe that abuse, neglect or exploitation has occurred.
The following are mandated reporters:
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Anyone who makes a report of fraud, testifies in any judicial proceeding, assists protective services, or participates in a required investigation is immune from any civil or criminal liability as a result of such report, testimony, or participation, unless such person acted in bad faith or with a malicious purpose, or was a party to such crime or fraud.
If you suspect abuse, you can do something about it. First, recognize the signs. Then, report the situation so it can be investigated. The problem can not be solved until it is reported.
Any Setting
If immediate, serious risk, call the Police (911).
Community Setting
If the suspected abuse, neglect or exploitation occurs in a person’s home or other community setting then contact the Division of Aging Services’ Adult Protective Services Central Intake in Metropolitan Atlanta at (404) 657-5250 or outside of Atlanta at (888) 774-0152. Your report is confidential.
Long-Term Care Facility or residence including Nursing Facility, Personal Care Home (including assisted living) and Community Living Arrangement.
The Office of Regulatory Services is responsible for investigating reports in these facilities. Call (404) 657-5726, (404) 657-5728 or the toll free number (800) 878-6442.
Long-Term Care Ombudsman
If you or someone you know needs an advocate in any of the long-term care facilities then contact the local Long-Term Care Ombudsman who is authorized to advocate for residents in long-term care. To find your local long-term care ombudsman, call your Area Agency on Aging (the number is in your blue pages of any telephone directory) or call the Office of State Long-term Care Ombudsman at (404) 463-8383 or (888) 454-5826.
All services listed above are free of charge regardless of income.
Making a decision to select long-term care for yourself or a loved one often involves numerous and sometimes difficult issues. There are decisions to make about the choice of long-term care setting, financing that choice, possible treatment options, surrogate decision makers and end-of-life decisions. It may be easier to make some of these decisions after becoming more informed about options and available choices. To assist in this effort, some information on various topics is provided to guide the thought process, raise possible questions or clarify considerations on the issue of long-term care. This material is meant to be educational information only. For your specific fact situation, you may consider consulting a legal representative for legal advice.
You may be asked if you have completed a health care advance directive. The law states that a person must be informed of the right to complete an advance directive for health care before being admitted to a care facility or hospital. A health care advance directive is a written document that states how you want medical decisions to be made if you can not make decisions for yourself.
The Living Will and Durable Power of Attorney for Health Care were formerly the instruments used as health care advance directives are no longer options in Georgia. As of July 1, 2007, Georgia law authorized the execution of a single form of health care advance directive, the Georgia Advance Directive for Health Care. Any validly executed Living Will created between March 28, 1986 and June 30, 2007 will remain valid until it is revoked. Any validly executed Durable Power of Attorney for Health Care created before June 30, 2007 will remain valid until it is revoked.
To know if your current Living Will and/or Durable Power of Attorney for Health Care is valid, find a copy of the old code sections to confirm the witnessing requirements or consult an attorney who can compare it with the law in effect prior to July 1, 2007.
The Georgia Advance Directive for Health Care is an attempt to combine the best features of the Living Will and Durable Power of Attorney for Health Care into one written document. An effort has also been made to make the execution (signing and witnessing) of this document easier and more convenient. The effect of this new document still does not constitute suicide, physician assisted suicide, homicide or euthanasia. Completing one has no effect on insurance, annuities or anything else contingent on the life or death of the person making the advance directive (hereafter, “the declarant”). For more information about Georgia advance directives for health care contact the Georgia Department of Human Resources, Division of Aging Services (866) 55AGING or (404) 657-5319.
If you do not have a health care advance directive and need help preparing one, or need more information, talk to a social worker, discharge planner, your doctor or the nursing home staff. You can call your local Area Agency on Aging to find out if your state has any legal services that help with preparing these forms.
You may want to open an account managed by the nursing home. You can deposit money into the account for personal use. Check with the nursing home to see how they manage these accounts. You may only have access to the account at certain times. View the Nursing Home Resident Rights document for information about your rights and protections regarding money.
With a Durable Power of Attorney for Finances you are able to name another person who would make your financial decisions if you were to become incapacitated and unable to make your own decisions.
If you do not have a Durable Power of Attorney for Finances, and you become incapacitated, your relatives would have to go through the court and ask a judge to assign someone to handle your finances. This could be a long process. When writing your Durable Power of Attorney for Finances, remember that you can specify how much authority your representative will have.
For people seeking admission to a nursing home, the nursing home must provide (orally and in writing) and prominently display written information about how to apply for and use Medicare and Medicaid benefits. They must also provide information on how to receive refunds for previous payments covered by such benefits.
Advance directive for health care is a written document which combines provisions of a Living Will and a Durable Power of Attorney for Health Care.
Attending physician means the physician who has primary responsibility at the time of reference for the treatment and care of the declarant.
Declarant means a person who has executed an advance directive for health care authorized by Chapter 32 of Title 31 of the Official Code of Georgia Annotated.
Durable power of attorney for health care means a written document voluntarily executed by an individual creating a health care agency in accordance with Chapter 36 of Title 31 of the Official Code of Georgia Annotated as such chapter existed on and before June 30, 2007.
Health care means any care, treatment, service, or procedure to maintain, diagnose, treat, or provide for a declarant´s physical or mental health or personal care.
Health care agent means a person appointed by a declarant to act for and on behalf of the declarant to make decisions related to consent, refusal or withdrawal of any type of health care decisions related to autopsy, anatomical gifts and final disposition of a declarant´s body when a declarant is unable or chooses not to make health care decisions for himself or herself.
Health care facility means a hospital, skilled nursing facility, hospice, institution, home, residential or nursing facility, treatment facility, and any other facility or service which has a valid permit or provisional permit issued under Chapter 7 of title 31 or which is licensed, accredited, or approved under the laws of any state, and includes hospitals operated by the U.S. government or by any state or subdivision thereof.
Health care provider means the attending physician and any other person administering health care to the declarant at the time of reference who is licensed, certified or otherwise authorized or permitted by law to administer health care in the ordinary course of business or the practice of a profession, including any person employed by or acting for any such authorized person.
Life-sustaining procedures means medications, machines, or other medical procedures or interventions which, when appropriately could in reasonable medical judgment keep the declarant alive but cannot cure the declarant. The term does not include the provision of nourishment or hydration or the administration of medication to alleviate pain or the performance of any medical procedure deemed necessary to alleviate pain.
Living will means a written document voluntarily executed by an individual directing the withholding or withdrawal of life-sustaining procedures when an individual is in a terminal condition, coma, or persistent vegetative state in accordance with Chapter 32, as such chapter existed on and before June 30, 2007.
Physician means a person lawfully licensed in this state to practice medicine.
Terminal condition means an incurable or irreversible condition which would result in the declarant´s death in a relatively short period of time.
Confused by all the jargon? We have provided a handy glossary to help you have a clearer understanding of long-term care.
