About Eldercare Agencies
There are basically four government organizations that furnish long term care services.
(1) Medicare, (2) Medicaid, (3) State aging services and area agencies on aging, and (4) Low income housing
Copayment and premium amounts for 2006:
- Part B premium .............. $88.50 per month.
- Inpatient hospital deductible.......$952.
- Inpatient hospital copay for days 61 - 90 ....... $238 per day.
- Hospital copayment for stays in excess of 90 ....... $476 per day.
- Skilled nursing facility copayment for days 21 - 100 .......$119 per day
Medicare pays for limited long term care:
- The full cost of 20 days of a nursing home after a three-day hospital stay and a skilled need. Copayment for days 21-100 of $119 per day and Medicare pays the rest. Average stay for Medicare nursing homes is about 23 days.
- Home care for skilled need for homebound patients. Authorized 60 days at a time. Average stay for home care is 41.5 days.
- Hospice covered for patients expected not to live beyond six months. Apply for hospice early; don't wait! Average stay for hospice is 49.9 days
For a single person receiving Medicaid nursing home care, all assets have to be spent down to less than $2,000. ($3,000 total if it's a couple both needing care) For most states there is no income test and after the asset spend down has occurred, and if the income is not sufficient to pay for care, Medicaid makes up the difference. For the states with an income test, if the income exceeds that level (usually 300% of SSI), Medicaid will not pay. However, a Miller Trust is normally used in this case to qualify for payment.
For couples, if one needs Medicaid, assets are combined whether they are in a trust or not. (Except for an irrevocable trust established at least five years prior to the need. Very few people have irrevocable trusts. Most of them have "living" or revocable trusts.) Assets are then split in half. The healthy spouse at home keeps his or her half and the other half belonging to the care recipient must be spent down to less than $2,000 before Medicaid will start paying. This spend down can be used for anything; it doesn't necessarily have to be spent on care: a trip around the world, buying a new car, fixing up the house and so on.
It after splitting the assets in half, each half is more than $99,540 in the year 2006, a healthy spouse at home can only keep that amount and the rest has to go to the care recipient for spend down. If total assets are less than $19,908, a healthy spouse keeps it all. In some states this minimum allowance is much higher and a healthy spouse can keep everything up to, as an example, $75,000.
Depending on state allowances, if a healthy spouse has less than the following income levels in 2006 -- $1,603.75 to $2,488.50 -- that spouse can take income from the spouse receiving care to bring his or her income up to the state allowable level. States use incomes between the minimum listed above and the maximum. It depends on the state.
Medicaid limits for 2006 SSI FBR, Resource Limits, 300% Cap, Break-Even Points, Spousal Impoverishment Standards Effective Date: January 1, 2006 Unless Otherwise Noted.
- CPI increase for 2005: 4.1 percent
SSI Resource Standard
- Individual: 2,000.00
- Couple: 3,000.00
Spousal Impoverishment Standards
- CPI increase since september 1988: 65.9 percent
- Min. CS monthly income allowance: 1,603.75 (effective 7/1/05)
- CS monthly housing allowance: 481.13 (effective 7/1/05)
- Max. CS monthly income allowance: 2,488.50
- Min. CS resource standard: 19,908.00
- Max. CS resource standard: 99,540.00
- Max. spousal share: 99,540.00
The National Aging Network
(Serves primarily low income or socially disadvantaged but some services are available to all)
The Older Americans Act of 1965 created a program to provide community aging services to Americans 60 years of age and older. Over the years, with numerous amendments, the focus of the act has been changing to provide more long-term care services and caregiver support to help individuals remain independent in their homes and avoid going into long-term care institutions. Programs created by the Older Americans Act are managed by the Department of Health and Human Services, Administration on Aging.
The Administration on Aging has guided the development of the national aging services network that today consists of 56 State units on aging, 655 area agencies on aging, almost 250 Tribal organizations, 29,000 community-based provider organizations, over 500,000 volunteers, and a wide variety of national non-profit organizations. This nationwide infrastructure currently provides a wide array of home and community-based services to over 8 million elderly individuals each year, which is 17 percent of all people aged 60 and older, including 3 million individuals who require intensive services and meet the functional requirements for nursing home care. It also provides direct services to over 600,000 informal caregivers each year, who are struggling to keep their loved ones at home. The national aging network is the largest long-term care provider network in the country.
Services are designed to support the elderly in the community and keep them out of nursing homes.
- Senior Centers
- Meals on Wheels
- Legal Assistance
- Health Insurance Counseling
- Congregate Meals
- National Family Caregivers
- Support Program Support For Grandparents Raising Children
- Health and Nutrition Counseling
- Caregiver Counseling
- Supportive Services
• Access Services , such as transportation, outreach, information and assistance, case management and so on
• In-Home Services , including homemaker and home health aides, chore and maintenance, supportive services for families of older individuals who have Alzheimer's disease and so on
• Community Services such as adult day care, senior centers, legal assistance, recreation and so on
Low Income Housing
Government subsidies and housing units are usually administered by city or county Housing Authorities. You can either call your local area agency on aging to find out about available housing and subsidies or dial 211 if that service is available in your area.
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