|
Table
Of Contents
Quality
Health Care - The Variations
Health
Care: How to Measure Quality
How
To Assess Health Plans - Questions To Ask
Choosing
A Doctor
Choosing
Treatments
Choosing
A Hospital
Choosing
Long Term Care
"Long-term
care" means helping people of any age with their medical
needs or daily activities over a long period of time. Long-term
care can be provided at home, in the community, or in various
types of facilities.
This
section deals mainly with older people who need long-term care.
However, the information also may be useful for younger people
with disabilities or illnesses that require long-term care.
When
you look for long-term care, it is important to remember that
quality varies from one place or caregiver to another.
It
is also important to think about long-term care before a crisis
occurs. Making long-term care decisions can be hard even when
planned well in advance.
Research
shows that to make the best choices, you need to think about:
-
What your options are.
-
Whether they meet your or your family member’s needs (physical,
medical, emotional, financial, etc.).
-
How to find the highest quality care.
Types
of Long-Term Care
Research
shows that many people do not know about or understand long-term
care options. Following are brief descriptions of the major
types of long-term care: Home care can be given in your own
home by family members, friends, volunteers, and/or paid professionals.
This type of care can range from help with shopping to nursing
care. Some short-term, skilled home care (provided by a nurse
or therapist) is covered by Medicare and is called "home
health care."
Another
type of care that can be given at home is hospice care for terminally
ill people. Community services are support services that can
include adult day care, meal programs, senior centers, transportation,
and other services. These can help people who are cared for
at home—and their families. For example, adult day care services
provide a variety of health, social, and related support services
in a protective setting during the day. This can help adults
with impairments— such as Alzheimer’s disease—continue to live
in the community. And it can give family or friend caregivers
a needed "break."
Look
for long-term care that:
- Has
been found by State agencies, accreditors, or others to provide
quality care.
-
Has the services you need.
-
Has staff that meet your needs.
-
Meets your budget.
Supportive
housing programs offer low-cost housing to older people with
low to moderate incomes. The Federal Department of Housing and
Urban Development (HUD) and State or local governments often
develop such housing programs. A number of these facilities
offer help with meals and tasks such as housekeeping, shopping,
and laundry. Residents generally live in their own apartments.
Assisted
living provides 24-hour supervision, assistance, meals, and
health care services in a home-like setting. Services include
help with eating, bathing, dressing, toileting, taking medicine,
transportation, laundry, and housekeeping.
Social
and recreational activities also are provided.
Continuing
care retirement communities (CCRCs) provide a full range of
services and care based on what each resident needs over time.
Care usually is provided in one of three main stages: independent
living, assisted living, and skilled nursing.
Nursing
homes offer care to people who cannot be cared for at home or
in the community. They provide skilled nursing care, rehabilitation
services, meals, activities, help with daily living, and supervision.
Many nursing homes also offer temporary or periodic care. This
can be instead of hospital care, after hospital care, or to
give family or friend caregivers some time off ("respite
care").
Another
type of long-term care takes place in home-like settings called
Intermediate Care Facilities for the Mentally Retarded. They
provide a wide variety of services to mentally retarded and
developmentally disabled people from youth to old age. Services
include treatment to help residents become as independent as
possible, as well as health care services.
You
can learn about long-term care options in your area by contacting:
The
Eldercare Locator (1-800-677-1116, weekdays, 9.00 a.m. to 8.00
p.m., EST). This service can refer you to your Area Agency on
Aging.
Area
Agencies on Aging provide information on a wide variety of community-based
services. Examples are meals, home care, adult day care, transportation,
housing, home repair, and legal services.
Your
State or local Long-Term Care Ombudsman (call the Eldercare
Locator for the number). Ombudsmen visit nursing homes and other
longterm care facilities to check on and resolve complaints,
protect residents’ rights, and give emotional support to lonely
older people. A call to your area Ombudsman can give you information
on:
- The
most recent State survey (inspection) report of the facility.
- The
number of outstanding complaints.
- The
number and nature of complaints lodged in the last year.
- The
results of recent complaint investigations.
http://www.medicare.gov/nhcompare/home.asp—a
Web site created by the Health Care Financing Administration,
which runs Medicare and Medicaid. This site helps you locate
nursing homes in your area. It also has inspection records for
nursing homes that receive Medicare or Medicaid funds.
There
are three important questions to ask yourself when deciding
about long-term care for yourself or a loved one:
1.
What kind of services do I need?
2.
How will I pay for these services?
3.
How can I choose the best quality services?
What
kind of services do I need?
Think
of long-term care as a menu of services. A person may need only
one or a few kinds of services. Or, several kinds may be needed
over the course of a person’s older years.
How
will I pay for these services?
Long-term
care can be very expensive. In general, health plans and programs
do not routinely cover long-term care at home or in nursing
homes. Here is some general information about long-term care
coverage:
Medicare
is the Federal health insurance program for people age 65 and
older and for some disabled younger people. Medicare generally
does not pay for long-term help with daily activities. Medicare
pays for very limited skilled nursing home care after a hospital
stay. If you need skilled care in your home for the treatment
of an illness or injury, and you meet certain conditions, Medicare
will pay for some of the costs of nursing care, home health
aide services, and different types of therapy.
Medicaid
is a Federal-State program that pays for health services and
long-term care for lowincome people of any age. The exact rules
for who is covered vary by State. Medicaid covers nursing home
care for people who are eligible. In some States, Medicaid also
pays for some home and community services.
Private
Insurance. Medicare beneficiaries may supplement their policy
with insurance purchased from private organizations. Most of
these policies—often called Medigap insurance or by a similar
name— will help pay for some skilled care, but only when that
care is covered by Medicare. Medigap is not long-term care insurance.
Commercial
insurers offer private policies called long-term care insurance.
These policies may cover services such as care at home, in adult
day care, in assisted living facilities, and in nursing homes.
But plans vary widely. If you have such a policy, ask your insurer
what it covers. If you think you may need long-term care insurance,
start shopping while you are relatively young and healthy, and
shop carefully.
Personal
Resources. You may need to use resources such as savings or
life insurance to pay for long-term care. Most people who enter
nursing homes begin by paying out of their own pockets. As their
personal resources are spent, many people who stay in nursing
homes for a long time eventually become eligible for Medicaid.
Your
State Health Insurance Program (SHIP) can give you general information
about Medicare, Medicaid, managed care plans, and the types
of health insurance that can supplement Medicare, including
Medigap and long-term care insurance. Counselors also can help
you with questions about your medical bills, insurance claims,
and related matters. These services are free. To find the phone
number of the SHIP office in your State, call the Medicare Hotline
at 1-800-633-4227. Or, look at the consumer Web site for MPedicare
services, http://www.medicare.gov.
How
can I choose the best quality services?
Here
are some tips for choosing the kinds of long-term care people
most often use: home care (including home health care) and nursing
homes.
Home
Care
In
many States, home care agencies must be licensed. Check with
your State health department to see if your State requires it.
If so, be wary if an agency is not licensed.
Ask
if the agency is certified by Medicare. Medicare inspects home
health care agencies to assure they meet certain Federal health
and safety requirements. Medicare will pay for services only
if the agency is Medicareapproved and if the services are covered
by Medicare.
If
the home health care agency is certified by Medicare, you can
review its survey report. Call the Medicare Hotline at 1-800-633-4227
and ask to be referred to the Home Health Hotline for your State.
You can request a copy of the report from that hotline.
Find
out if the agency has been accredited (awarded a "seal
of approval") by a group such as the Joint Commission on
Accreditation of Healthcare Organizations (630-792-5800); http://www.jcaho.org)
or the Community Health Accreditation Program (1-800-669-1656;
http://www.chapinc.org).
Contact
your State or local consumer affairs office to see if any complaints
have been filed against a home care agency. Also ask about the
outcome of any complaint investigations.
Whether
you work with an agency or hire someone yourself, carefully
check the backgrounds of the people who will be coming into
your home. Ask for references who have worked with the agency
or person. Call them, and ask about their experiences. Would
they use the agency or person again?
Does
the home care worker have the necessary skills and training
for your needs? Ask to see training certificates. Make sure
the worker knows how to safely assist and care for patients.
Does
the agency have supervisors who check on the quality of care
its workers provide?
How
does the agency follow up on and resolve complaints?
Nursing
Home Care
All
nursing homes that participate in Medicare or Medicaid are visited
about once a year by a team of trained inspectors. They check
the home and the care provided and prepare a survey report.
You have a right to review the report, which must be posted
in the nursing home. Speak to the nursing home administrator
to learn more about any problems that appear on the report.
Ask if the problems have been corrected.
Call
your State or local Long-Term Care Ombudsman. Ombudsmen visit
nursing homes on a regular basis and know about each nursing
home in their area. You can ask about the latest survey report
and about complaints that have been filed. You can also ask
what to look for when visiting local nursing homes.
Compare
the inspection records of your top choices by visiting the "Nursing
Home Compare" Web site: http://www.medicare.gov/nhcompare/home.asp.
Some
nursing homes have been accredited by a national group such
as the Joint Commission on Accreditation of Healthcare Organizations
(630-792-5800). It may be helpful to find out if the home participates
in this voluntary process and to learn the results.
Location
is very important. Is the nursing home close enough so that
family and friends can visit? Close enough for the resident’s
personal doctor to visit?
The
most important step is to visit—more than once—and look around.
Go at different times of the day—for example, first thing in
the morning and at mealtimes.
-
Do
residents seem to enjoy meals? Is there help for those who
cannot eat on their own? If possible, eat a meal at the
facility.
-
Is
the home clean and free of odors? Is it pleasant?
-
Are
residents clean, well groomed, and dressed appropriately
for the season and time of day? Are they involved in activities?
-
Are
staff friendly, helpful, and respectful?
-
Talk
to staff, residents, and families to find out what they
think of the facility.
-
Ask
to see the area where physical therapy and other rehabilitation
services are provided.
-
Is
the nursing home experienced with special needs—for example,
problems with swallowing?
-
Who
provides the medical care?
-
Which
hospital(s) does the nursing home use?
|
