It’s complicated. Coming up with the right placement options when you loved one needs more help, and it’s important to get it right. The big challenge in evaluating placement alternatives is that most of you come to this decision point with a blank slate. You or your loved one may require support in a manner never needed before. Independence and living at home is either unwise or impossible. When that happens, where do you turn?
Often, the need for change follows a hospitalization. When a hospital stay is the precipitating event, the discharge planner or case manager employed by the hospital is there to assist. Please re-read that sentence. Focus on the word assist. Hospital employees are there to provide information and assist. They are not the decision maker. You are.
Hold on to this reality: you are the consumer, the customer. Think about it. Did you let your realtor select your home? Does the salesperson pick your next pair of shoes? The same applies in the field of healthcare. You are still the decision maker when it comes to placement alternatives.
Of course, finances and function are vital in the evaluation of which alternative is best. There is a limited period of time that medical insurance will cover all or part of the cost of care. This is referred to as the Acute Care stage. It makes financial sense to take advantage of any acute care eligible payments first before you begin paying out of pocket.
If you or your loved one has Medicare coverage, then many of the acute care options depend on a “qualified hospital stay.” The current criteria to qualify for other Medicare paid services is an inpatient hospital stay of three days or more. If this sounds straight-forward, it’s not. The hospital decides if the patient is being treated as an inpatient or if they are simply there for an observation stay. Be sure to ask the question: Is this a qualifying Medicare stay?
In both Age Your Way (Chapter 17) and in The Blueprint to Age Your Way, there are tables to serve as a reference in considering your options. These tables compare the nine supported living options.
Along with these tables, there is also a program you need to be aware of. It’s called Bundled Payments. The full name is Bundled Payments for Care Improvement or BPCI.
Under bundled payments, providers of health care services enter into an agreement with CMS (Centers for Medicare & Medicaid Services). Their payment is tied to a multitude of services during a patient’s episode of care. The providers are incentivized to save money and coordinate care.
Whereas the stated goal is higher quality and more coordinated care at a lower cost, this can dramatically differ from what you see described in your Medicare explanation book and on the Medicare website. For example, your Medicare benefit shows a skilled nursing stay following a qualified hospital stay may last up to 100 days when you meet the skilled care need. That may not be the case when your care need falls under a Bundled Payment. This can be very upsetting.
Alternatives to care will continue evolving in both available options and payment. When you simply cannot figure out which way to turn, you may benefit from hiring an independent Case Manager or Care Manager to assist. The best way to find someone to work directly for you is to search the national website: www.aginglifecare.org. This is where you can find aging life care professionals by entering the desired state and zip code.
As I said at the start, it’s complicated. You need an advocate whose only motivation is to meet your needs.
Do you have questions about this confusing issue? Post them in the comments or on my Facebook page.
The Blueprint to Age Your Way is now available for pre-order on Amazon.
