Nursing home care for seniors has been the solution turned to by Medicare and Medicaid insurance for the last 70 years. However, a few states are finally making strides forward in developing new managed care solutions for senior care.
As seniors begin Medicare insurance at age 65, they discover that Medicare does not pay for ongoing long-term care needs, but only for short-term stays in a nursing home. Medicaid, for very low-income seniors, does pay for ongoing nursing home stays. However, seniors on Medicaid are limited to the nursing homes accepting Medicaid for payment, with available beds. Notice that the term “beds” is used, rather than rooms, as many times the senior will be sharing a room with one or two others when living at a nursing home reimbursed by Medicaid.
Nursing home care can cost as much as $350 per day. Medicaid daily payments for nursing home care vary in each state as the program combines state and federal funds. Review the Medicaid financial qualifications in your state as you plan ahead for care needs. You may also view Caregiverlist’s nursing home directory to find the daily costs and ratings of nursing homes in your area along with Medicare and Medicaid payment acceptance.
“Managed Care”, a new model of senior care where the same medical and social services received in a nursing home are now delivered in a day care setting, is beginning to expand into more and more states. Managed care can replace the nursing home care model, especially when a senior still has an active spouse living at home.
Teams of doctors, social workers, physical and occupational therapists visit the adult day-care centers and in their homes. New York state plans to shift as many as 80,000 people who need more than 120 days of Medicaid-reimbursed long-term care services into managed care models.
Geriatric Care Manager Charlotte Bishop has been a leader in geriatric care for more than a decade and is founder of Creative Case Management. Her company’s certified professionals are geriatric care advocates and counselors to seniors and she sees a new focus on wellness and health instead of reactive care.
“We are at an exciting intersection of needs identification and evolution of services for our aging population. The traditional models of either family/home care or nursing home enrollment for an elderly individual are becoming less of an all or nothing experience,” says Ms. Bishop. “With the expanding awareness of needs of the elderly and the financial implications for the individual, their family and society, creative use of funding resources is essential. Medicaid has traditionally been viewed as a safety net for many seniors when their personal funds and resources have been exhausted.”
New York City’s Archdiocese for the Catholic Church recently announced the opening of a 250-patient program at Saint Vincent de Paul Catholic Healthcare Center in the South Bronx. The new adult day-care center, known by the acronym PACE (Program of All-Inclusive Care for the Elderly), provides almost all the services of a nursing home, including social activities.
Ms. Bishop sees the nursing home population being transformed as more PACE programs open their doors. “The options offered by the PACE program for Adult Day Care and Managed Care will allow individuals the opportunity to benefit from timely and appropriate health care coordinated by professionals whose charter is focused on wellness and health maintenance rather than reactive and fee-for-service health services which operate on a more emergent care basis and offer fewer options. The nursing home experience will then be reserved for those for whom it is more medically-appropriate and in need of the services. The public funds represented by Medicaid will be spent in a more cost-effective manner with potentially better outcomes, because there is greater coordination of services being provided and oversight of the programs involved,” says Ms. Bishop.
Learn about senior care programs in your area through your local Area Agency on Aging which you can find in Caregiverlist’s “By-State” services directory. Compare nursing home costs and ratings and find nursing homes accepting Medicare and Medicaid insurance as payment in our nursing home directory.
About Charlotte Bishop:
C. Charlotte Bishop, MS, CRC, CCM, CDMS, LCPC, GCM is a Geriatric Care Manager and president and founder of Creative Case Management, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago. You may reach her at: firstname.lastname@example.org .”
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