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Housing Options
In Home-Care Services
Health Care Terminology
Legal and Financial Terminology
Insurance Information
Housing Options:
Senior Apartments - housing designed or adapted, and maintained for
occupancy of elderly (usually over 62 years) and / or infirm persons. Handicap accessible,
one- level apartments, community lounge, increased security. Special social and health
related programs are often provided to meet the needs and interests of the residents. Some
offer a noon meal which can be purchased. No personal care is provided. Rent is often subsidized.
Adult Homes - Private and semi-private rooms with centralized dining,
housekeeping, laundry, and social programs plus supplementary personal care. Also
protective oversight including medication management (but not the medical or skilled
services of a nursing home.
- Adult Care Facilities - more than 4 residents.
- Family-type Homes - licensed by NYS Department of Social Services.
They provide the same types of services as adult homes but are run by private homeowners. They are
usually limited to four residents and are paid for privately.
Residential Health Care Facilities/Skilled Nursing Facility - Provides care for long term
chronically ill clients and rehabilitative clients whose primary needs involve relatively
complete assistance with activities of daily living (dressing, toileting and mobility) and
/ or essential skilled nursing care and medical supervision. Also available ombudsman and
hospice programs. Sometimes eligible for MC and MA reimbursement.
Life Care Community - provides a continuum of residential and health
care services. They allow residents to continue living in the same complex as their
housing and health care needs change. Life Care Communities usually offer apartments,
cottages, and group homes with a range of support options, as well as skilled nursing
facilities.
Out of Home Respite Care - provides housing, bathing, meal
preparation, housekeeping, medication administration, and possible recreation activities
for a short time while primary care providers are unable to care for them.
Assisted Living Program (ALP) - long term residential care, room, board,
housekeeping, laundry, personal care and supervision and provides or arranges for home health
services to five or more eligible adults unrelated to the operator. The Assisted Living Program (ALP)
providers must possess an operating certificate as an adult home or an enriched housing unit and must
be a Certified Home Health Agency (CHHA), Licensed Home Care Services Agency (LHCSA) or Long Term
Home Health Care Program (LTHHCP). Skilled nursing and therapies may only be provided by Certified
Home Health Agencies (CHHA) or Long Term Health Care Program (LTHHCP). These services can be paid for
by Medicaid (MA), Supplemental Security Income (SSI), or privately.
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In Home-Care Services:
Licensed Home Care Agencies (LHHCA) - offer one or more home care
services including all levels of nursing care, various therapies, home health aides and
personal care aides to the individuals who pay privately or who have insurance coverage.
Many agencies also contract with local social services departments to care for those
individuals with Medicaid coverage for personal care services.
Certified Home Health Care Agencies (CHHA) - meet both federal and
state regulations and provide part-time or intermittent health care and support services
to individuals who have intermittent and skilled health care needs for a short time. These
agencies provide nursing, home health aide services, and provide or arrange for
professional services including physical therapy, occupational therapy, and speech
therapy, as well as social work and nutrition services. In order to receive Medicare
benefit, the client must be confined to home, receiving services under a plan provided by
a physician, receiving skilled nursing on an intermittent basis and /or receiving
professional services on a continuing basis.
Long-Term Home Health Care Programs (LTHHCP) - also known as
"Nursing Home Without Walls" offer the health care and support services to the
disabled and people of any age who are ill, medically eligible for admission to a nursing
home, but would prefer to remain home. These programs provide full range of professional
and aide level health care services to clients over a long period of time. Currently the
client must be Medicaid eligible. Services provided include typical CHHA services as well
as medical social work, structural modifications, nutitional counseling.
Hospices - offer home and inpatient care for the terminally ill (with a
life expectancy of six months) and their families. The hospice goal is to ease symptoms
rather than treat the disease. Under the Hospice program, terminally ill clients and their
families receive physical, psychological, social and spiritual support and care.
Consumer Directed Personal Assistant Program - is a (client) driven personal
assistance service offered by Tompkins County's Medicaid program in conjunction with the
Finger Lakes Independence Center. The consumer will recruit, hire,
supervise, train, and dismiss aides they have chosen to work for them. The long term care case
manager will authorize the adequate amount of time for service.
Expanded In-home Services for the Elderly Program (EISEP) - provides
non-medical, in-home services and case management for people over 60 years old who can be
cared for safely at home. Services include bathing, dressing, cooking, shopping, laundry,
and housekeeping. Clients pay for services on a sliding fee scale. A grant from the Office
for the Aging will pay for those individuals whose income are approximately $1,000/month
or less as well as assist with the sliding scale amount. There is no fee for case
management.
Personal Care Program -
provides a variety of home care services to Medicaid clients. A physician must document medical
need of services. Case managers and/or nurses under a doctor's order coordinate in-home personal
care services to people who receive Medicaid. Services are provided regardless of age.
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Health Care Terminology:
Registered Nurse (RN) - licensed by the State of New York to do
specific medical care.
Licensed Practical Nurse (LPN) - licensed by the State of New York to
do a lower level of medical care.
Home Health Aide (HHA) - trained to provide medical-related services
and personal care such as taking vital signs and bathing /dressing a client.
Personal Care Aide (PCA) - provides personal care such as bathing,
grooming, and meal preparation.
Certified Nursed Aide (CNA) - trained to provide medical-related services
in a nursing home setting.
Homemaker - assists with home management activities, which have no
hands on contact with the client.
Companion - visits and may provide escorting, assistance with shopping
and running errands.
Respite Caregiver - visits while primary care giver is out of home or
doing another activity away from the client. Provides temporary primary care to rest/relax
primary care provider.
Activity of Daily Living skills (ADL'S) - represent the fundamentals
of personal care necessary to live independently such as bathing, toileting, grooming,
mobility, and assistance with feeding.
Instrumental Activities of Daily Living (IADL's) - these are the tasks in
the home which are not related to personal care, such as laundry, cleaning, shopping, and
personal finances.
Assessment - is an evaluation to look at the medical, social,
nutritional, and emotional needs of a person to determine if they are being adequately
met.
Case Management - is a service of client advocacy which includes,
assessment, care planning, service coordination, monitoring the safety and quality of services, and
the well being of the client.
Durable Medical Equipment - equipment rented or owned necessary for the
health maintenance of the client to remain at home safely. These goods are ordered by the
physician and are contingent upon the client remaining home.
Personal Emergency Response System (PERS) - is a communications system, which
links an individual with the county's emergency medical response system. Pressing a button
on the unit or pendent automatically dials emergency rescue. They are free to those with
Medicaid who qualify for the service, they can be rented on sliding scale
from the Office of the Aging or rented from a private provider.
Physical Therapy - A licensed professional whose job it is to detect,
assess, prevent, correct, alleviate, and limit physical disability and body malfunction.
Physical therapy can be for preventative and therapeutic purposes. This service must be
ordered by the physician; and may be provided in home or at an outpatient therapy facility.
Occupational Therapy - is defined as "e; the art and science of
directing man's participation in selected tasks to restore, reinforce, and enhance
performance, facilitate learning of those skills and functions essential for adaptation
and productivity to promote and maintain health". In other words Occupational Therapy
helps you do what you can do or could do better. After an injury or illness the therapist
develops a plan of care (which may include equipment) which will assist the client to regain
previous functions.
Respiratory Therapy - the technical specialty concerned with the
treatment, management and care of the patients with respiratory problems.
Speech Therapy - technical specialty concerned with assessment and
rehabilitation of persons with speech or language disorder as well as swallowing problems.
Alzheimer's Disease - is an irreversible senile dementia characterized
by intellectual deterioration, disorganization of the personality, and functional
disabilities in carrying out the tasks of daily living. This disease is definitively
diagnosed only after autopsy. There are only hypotheses on the cause of this disease.
Dementia - is an organic mental syndrome characterized by a general loss
of intellectual abilities involving impairment of memory, judgement, abstract thinking as
well as personality. There are several different causes for dementia, cause is determined
by a physician. There are types of dementia, which are reversible and others, which are
progressive.
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Legal and Financial Terminology:
Protective Services for Adults - protective services are provided to
adults over age 18 who, because of physical or mental impairment, are unable to manage
their own resources or protect themselves from neglect or hazardous situations, and have
no one able to help them. All referrals are confidential.
Guardianship - a court may appoint a guardian to manage property and/or
personal needs of an impaired adult at the request of that adult or another concerned
person. Once the court has appointed a person he/she is now called the guardian. A person need
not be mentally incapacitated for the court to appoint a guardian. The court will only appoint
a guardian when necessary. The court sets and defines the limits of the guardian's powers. The
guardian must submit a plan to the court to provide for the financial care of the client and their properties.
Power of Attorney (POA) - is a written contract in which you appoint
someone to act on your behalf to manage your affairs. When you sign a power of attorney,
you become the principal and the person you appoint to act as your agent is called the
attorney-in-fact. This does not mean you've given up your own rights to continue to handle
your own affairs. Many people choose to have the POA act on financial and business matters.
Representative Payee - The Social Security Administration will select a
person called a representative payee to receive benefits on behalf of a beneficiary who is
unable to manage his or her own benefits. A Rep-payee will be appointed for you if you are
found to be mentally incompetent or physically incapable of managing benefit payments. The
decision of competence is determined by a court or decided by the physician while
considering statements of relatives and friends.
Health Care Proxy - grants competent adults the right to appoint
someone they trust to make decisions about medical treatment on their behalf when they are
no longer able to make such decisions for themselves. The person appointed to make health
care decisions is known as the agent. An attorney is not needed to draw up the proxy. The
written document must be signed and dated by you and witnessed by to other adults. A copy
should be kept in your possession and with your doctor, attorney, and close relatives.
Your agent must make decisions in accordance with your wishes, religious and moral
beliefs. These wishes may be documented in the health care proxy.
Living Will - is a document in which an individual gives directions
about health care to be followed in the event the individual has a terminal illness and is
unable to provide further instructions.
Do Not Resuscitate Orders (DNR)- means when you are
unable to breath and your heart has stopped beating that you do not wish professional staff or
family to provide you with CPR. This means no one will try to breathe for you or pump on
your chest to get your heart to re-start. This order would be kept with your medical
record and should also be kept on your person at all times in order that it would be
followed.
Burial Funds - Are monies set a side to provide the funding for your
funeral. All of the arrangements, including which funeral home, casket and services you
wish can be set and paid for a head of time. Usually your family at the time of loss is
very relieved not to have to think about arrangements, the cost, and more importantly
knowing your wishes. Typically 4,000 dollars are set aside. If you are currently on
Medicaid your family will receive 1,500 dollars for arrangements.
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Insurance Information:
Medicaid - is the medical assistance program for low-income people of
all ages who are unable to pay for care and who meet eligibility guidelines. Federal,
state, and local funds finance it. Federal and state law sets the services that
Medicaid covers. Older adults are expected to use their Medicare, and private insurance
first and to use Medicaid only for expenses not covered, such as prolonged nursing home,
home health care and other exceptionally high medical costs not met by Medicare. For
guidelines check with the Department of Social Services.
Medicare - is the federal health insurance program for almost everyone
age 65 or older and certain disabled people under 65. It is run by the Health Care
Financing Administration of the U.S. Department of Health and Human Services. The Social
Security Administration offices across the country take applications for Medicare. There
are two parts to the Medicare program:
(Part A) Hospital Insurance - helps pay for
in-patient hospital care, in-patient in a skilled nursing facility, home care and hospice
care. Most people don't have to pay premiums.
(Part B) Medical Insurance - helps pay for
the doctor's services, outpatient hospital services, and durable medical equipment, etc.
Most people do have to pay a monthly premium.
Medicare Buy-in Program - Some lower income recipients can have their
Medicare premiums, deductibles and co-insurance paid for by the Medicaid program or the
Medicare Buy-in program.
Medigap - many companies
offer "Medigap" policies, which
cover costs not covered in the Medicare program.
Medigap policies are supplemental to
Medicare policies.
Elderly Pharmaceutical Insurance Coverage (EPIC) - is a drug insurance
program for N.Y. residents' age 65 or older. Annual income limitations are 17,500 dollars
or less (single) or 25,000 dollars or less (married). You are not eligible for EPIC if you
receive Medicaid benefits or if you are on a private insurance plan which has a better prescription
benefit.
Supplementary Security Income (SSI) - is a program administered by
Social Security which pays monthly checks to aged, blind, and disabled people, who have
limited resources, to assure a minimum income for eligible applicants.
Long Term Care Insurance - is a policy you buy to help pay some of the
costs of long term care. The covered services typically include home health care and
nursing home care. Policies may seem expensive but it can help in later years to maximize
your independence, increase your choices about care, protect your assets, and avoid
depending on your family and friends.
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