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With people living longer and health care costs escalating, it’s likely that you’re going to have elderly clients who cannot take care of their daily needs, such as bathing and dressing, but who don’t need the kind of medical care they would receive in a hospital, rehabilitation facility, or skilled nursing facility.
The bottom line is, people are living longer and are likely to need some type of custodial services. They may be disabled after a stroke, suffer from a chronic condition such as congestive heart failure, or have Alzheimer’s. These patients don’t need to be hospitalized or receive skilled care. But they do need help with bathing, dressing, feeding, and transportation.
"Any case manager, other than those in a workers compensation environment, is likely to encounter patients who need long term care," says B.K. Kizziar, RNC, CCM, CLP, owner of B.K. & Associates, a Southlake, TX, case management consulting firm.
Medicare and commercial insurers have strict limits on necessity and time frames for skilled nursing care. Few Medicare supplement policies cover custodial-type care.
Long-term care insurance policies often pay for the types of services that elderly patients need. These policies may include home health benefits, assisted living benefits, adult day care — "everything you can imagine," Kizziar says. "Case managers are going to see more and more people who have purchased long-term care policies."
That’s why case managers should become familiar with long-term care policies, what they cover, and what options they provide, she adds. "When an elderly patient becomes a client, case managers should ask if [he or she has] a long-term care policy. Family members may or may not know about the policy, and if they do know, they aren’t likely to know what it covers," Kizziar says.
Treat it like a regular health care policy and ask clients to bring in the book so you can determine what their benefits are and what they can do.
"It gives the case manager an opportunity for a more comprehensive plan of care. They can address the custodial issues as well as the needs for skilled care," Kizziar says.
Armed with this information, you can help your clients and their family members come up with the most cost-effective way to meet their needs for care.
"Knowing what the elderly person has available in terms of health care benefits, whether it’s private insurance, Medicare, Medicaid, and how the benefits work is the most important part of managing care for the elderly," she adds.
But managing care for your elderly clients doesn’t stop there.
Case managers also must be aware of community resources in the event that an elderly client doesn’t have a long-term care policy. "Case managers need to be aware of what unique services are available in their community, including transportation and services for care," Kizziar says.
Look at family resources, such as how much time family members have to help with the patient’s care.
Ask the patient about organizations they belong to that may be helpful. For instance, the patient’s church family may be able to help.
Look for community resources that may be available, such as Meals on Wheels, volunteer groups that visit the elderly, and organizations that provide transportation to and from medical appointments. They may be able to provide the kind of care your patients need part of the time, allowing the family members to pitch in when they aren’t at work.
Adult day care is an affordable alternative to in-home custodial care for some families who may want to help care for their elderly parent but who have jobs and families of their own. "For family members who are willing to help but who have obligations of their own, adult day care is something that has been wonderful," she adds.
The programs also are covered by many long-term care policies, often on a sliding scale for payments. "Most of them will work with the family on the type of reimbursement they are able to make," Kizziar says.
Some tips for helping your clients choose adult day care:
Make sure the programs meet the requirements of the state, whether it’s certification or licensing.
Check out the type of staff and the ratio of patients to staff. If the program is for Alzheimer’s patients, make sure the staff is sufficiently skilled to give the patients the attention they need.
Look at the types of activities that are offered during the day. Choose a program that has controlled activities and outings.
"You certainly don’t want a bunch of patients sitting around doing nothing," she says.
Look for a program that encourages family participation and volunteerism.
"If the family can come to lunch one day a week or volunteer a few hours a week, they can see what goes on and are more likely to get a good idea of how the patients are treated. It gives them an idea of whether the staff are capable of handling the patient population," Kizziar says.