FAQs - Elder Care
What is the difference bewteen Medicare and Medicaid?
Medicare and Medicaid are two different government-run health coverage programs.
Medicare is a federal program that provides health coverage for people age 65 or older, or people who have certain disabilities, regardless of income.
There are 4 different parts to Medicare:
Part A - Hospital Insurance
Coverage for in-patient care in a hospital or skilled nursing facility (not custodial or long term care), hospice care, or home health care. If you or your spouse paid Medicare taxes while working, you will not pay a monthly premium for Part A.
Part B - Medical Insurance
Coverage for services from doctors and other health care providers, outpatient care, home health care, durable medical equipment, and some preventative services. Most people will pay a monthly premium for Part B.
Part C - Advantage Plan
Advantage Plans are run by Medicare-approved private insurance companies for individuals eligible for or enrolled in both Medicare Parts A and Part B. Medicare Advantage plans are HMOs, PPOs, or Private Fee-for-Service plans (PFFS).
Part D - Prescription Drug Coverage
This plan provides outpatient prescription drug coverage. Plans are offered by insurance companies and other private companies. Upon enrollment there is a monthly premium, a yearly deductible, and a co-payment.
Medicaid is a joint state and federal program that provides health coverage for people with low incomes and limited resources. To be eligible you must either be 65 years of age or older, blind, or permanently disabled.
*For more information on Medicaid or to see if you are eligible, please contact the SHIP Office (State Health Insurance assistance Program) at 1-866-516-3051.
What housing options are available for my older loved one(s)?
There are 4 main TYPES of senior housing:
Independent Living - To be eligible for Independing Living a person must be able to maintain his or her own living area and attend to personal care needs such as cooking, cleaning, laundry, personal grooming and managing medication. Independent living is paid for my private funds or HUD subsidies, if eligible.
Assisted Care Facility - A state certified live-in facility that provides basic assistance with self-care tasks such as bathing, dressing, grooming, meals, leisure activities and reminders for medication. Assisted Care Living is paid for by private funds or Long Term Care Insurance (check your policy carefully).
Personal Care Facility - A state licensed facility that offers the same basic assistance with self-care tasks as an Assisted Care Facility - bathing, dressing, grooming, meals, and leisure activities. However Personal Care Facilities are able to dispense medication. Personal Care Facility is paid for by private funds.
Long Term Skilled Care Facility - This type of facility is licensed by the state and provides 24-hour medical care for those needing skilled or intermediate nursing care. They are required to comply with rigid standards enforced by regular facility inspectors and extensive evaluations. Long Term Skilled Care Facilities are paid for by private funds, Medicaid, or Long Term Care Insurance.
Each of the four main senior housing categories offers different levels of care and support to residents. Some also offer specific services such as Memory Care, or short term Respite Care. Some facilities offer several levels of care (e.g., assisted living and personal care facility), creating a continuum of care service known as a CCRC - Continuing Care Retirement Communities. This service allows you to receive one level of care when you first become a resident and move into other types of care, if needed as you age.
*This information is applicable in Kentucky. For searches in other states, please contact that state's Nursing Home Ombudsman for clarification. Other states will have similar categories by may refer to each category differently.
What should I look for when visiting a senior residential facility?
THERE IS A LOT TO LOOK FOR!
Your first impression walking in should be one that makes you feel comfortable and secure....go with your instinct.
Is the community clean and well maintained?
Is the staff licensed or certified? What training does the staff receive on a yearly basis?
How are the meals served? Is there assigned seating or can residents choose where to sit? Is there a dietician on staff? How are the menus planned? Are special diets offered?
Are the handrails on the walls? Are there grab bars in each of the bathrooms?
Is there enough light in the hallways and rooms for the residents to see and feel comfortable?
Does the staff respond quickly to call lights?
Is there a resident council?
What is the pay structure for care and services?
Are there activities or other residential events that encourage a sense of community?
Ask to meet some of the management team and pertinent staff members. What is their experience and skill level? Do they seem interested and involved?
And finally, always visit more than one place! Each facility has its own unique atmosphere and culture; you want to make sure that your loved one will 'fit in'. Spend time looking around. If able, visit during different times of the day to observe how care, activities, and meals are handled. If possible, share a meal with another resident.