Assisting the Senior in your life to prepare for Long Term Nursing Care/Living Assistance

“Stand Up for Seniors” seems to be a rallying phrase in 2023. But what does it mean? 

If you have a parent or loved one who needs assistance with activities of daily living or round-the-clock nursing care, you know better than anyone what all goes into "standing up" for them. Trying to advocate for their needs, managing the financial aspect of long-term care, and ensuring good quality care can be difficult especially when there is very little guidance available for a personal caregiver.

It's not as simple as being handed the dreaded nursing home list. You know the one- every doctor or hospital nowadays seems to have one of these contact sheets of skilled nursing facilities that they give to families when they want to discharge a patient who is deemed not sick enough to stay in the hospital but is not well enough to go home. Most people are under the impression that Medicare covers confined care stays and though it can cover some of the costs- it doesn’t take care of everything. And, it covers even less if it’s home health care.

The actuality is that Medicare pays up to 90 days of inpatient care, which resets if you have 60 days between incidents, and you have 60 lifetime reserve days.  That’s it!  And, it all has to be justified by doctors which means it can often work out to much less time in reality, not to mention it's not always “enough” when longer terms or permanent residency come into play. 

What initial roadblocks, might I run into as an advocate for my Senior?



Unfortunately, when advocating for our loved ones, we don’t get clued into the nuances of hospital discharge policies, confinement limitations, or care requirements until we are standing in the hallway talking to a case manager. Even then, the details of how the care will be covered (ie. the financial impact of care) aren't usually even discussed. 

Another reality check often hits when the patient arrives at the skilled nursing facility and you realize there’s a countdown clock on that stay, too. Medicare covers up to 100 days in a skilled nursing care facility, but only when deemed medically necessary.  The caseworker is likely to come looking for you on or before the 20^th day of confinement and will want you (the advocate) to make a discharge decision. That’s primarily because, after 20 days, Medicare will start charging a $200 copay per day.  If a Medicare patient has secondary coverage, such as a Medicare Advantage plan or a Long-Term Care policy, that might pick up the cost of the remaining 80 days of care, but it does not mean the doctors will deem it medically necessary to stay that long and it definitely doesn’t change things if a longer or more permanent stay is warranted due to living assistance support and not an actual medical need. 

How can I be proactive? Or the least, get on top of things quickly?

As you try to help advocate for your senior, it definitely important to have the number from the Medicare disclosure form the patient is given at admission- which should have a designated “quick appeal” contact. That way, if a longer stay is likely going to be needed you can jump on it well before the time of discharge.  You can also ask to speak to the hospital's/care facility's patient representative. If you need to take things further, you can pay out-of-pocket to hire an independent patient advocate but this can be extremely costly since most charge by the hour.

You can also buy some time going through a re-evaluation and working your way up the chain of command. Be mindful that you may eventually be on the hook for charges you weren’t expecting, which is another reason to stay in good communication with the facility. 

When it comes to longer-term care needs, not all Medicare-approved skilled nursing facilities are equal, and there could be some options available to you that aren’t on the official hospital list you’re given at discharge.  Many family members who are trying to advocate for their seniors, will check reviews online and ask around at the hospital or if they know people locally. If you want to dig further, you can check state websites for violations and complaints. If you can, always go check out the facilities in person though. It’s important to see with your own eyes how the care facility is managed and ask questions about safety protocols, visitation, etc. 

What does managing long-term care look like for the advocate?

Once you do choose a facility, keep an eye on your loved one once they are transferred there.  The inspection process shouldn’t stop once the patient moves in.  You'll want to stop by and check on things unannounced, on varying days of the week, and at random times. You can tell a lot on a single visit with your Senior, like how frequently someone checks in on them, cleanliness, toileting and hygiene routines, and nutrition protocols. Ask about their procedures to minimize a run of illness through the facility, not just Covid but the flu and/or other communicable diseases.  Lastly, it might also be a good idea to test how long it takes for nurses to respond to a call button; and frankly, it wouldn’t hurt to become friendly with, or at the least, get to know the staff caring for your Senior.  Little things like that can make the world of difference in their quality of life. 

What kind of financial planning support is there?

Often the most tedious aspects of advocating for a loved one’s long-term care needs are the finances.  There’s been talk in politics about shoring up the Social Security trust fund and securing Medicare and Medicaid funding. Those are big things that the government needs to do for sure, but every financial situation is different.   Preparing in advance for the cost of care can be essential. Some financial vehicles like long-term care insurance policies, indexed universal life insurance, and even annuities can help you and your loved one prepare for the future cost of care. 

At Summerlin Benefits Consulting we know that regardless of your Senior's circumstances, one thing is almost always the same. Along the way, someone is going to have to stand up for and advocate for them. This means not only helping them prepare but also ensuring they receive the care they need when the time comes. The Summerlin Benefits 2023 Caregiver’s Readiness Guide (available to all clients) is designed to help with the planning and many of our financial vehicles are designed to help with the cost. It’s just a matter of you and your Senior doing a little preparation before the need is imminent.

If you are someone who knows you may be a loved one’s advocate in the future, or if you are actively planning a loved one’s care right now, it’s a good time to ask for help.  At the least, we can present some options to help plan for the cost of future care now so that there's one less thing to worry about later.