Lancaster Physician Fall 2019 - 30

L A N C A S T E R M E D I C A L S O C I E T Y.O R G

Patient Advocacy

be provided in the home, an assisted living
facility (ALF) is an option to consider. ALFs
are licensed by state governments through
the Centers for Medicare and Medicaid
Services but are not licensed by the federal
government. Therefore, the services provided
and quality controls vary by state. ALFs
generally offer a social model of care (not
a medical one) and provide residents with
support staff to assist with meals, medication
management, transportation, and social services. They also offer minor assistance with
activities of daily living such as dressing and
bathing. ALFs range from smaller home-like
environments to larger accommodations.
Most older adults must pay out-of-pocket
to live in an ALF (about $43,000 per year
on average), although some states now may
pay costs through Medicaid.

Simply put, older adults must often begin
to consider moving from the home if modifications and services available in this setting
are unable to adequately manage an individual's daily or instrumental activities of living
(e.g., bathing, toileting, meal preparation,
medication management), ensure his or her
safety, and preserve quality of life. In everyday
life, this may manifest as new or suddenly
worsening health issues due to mismanaging
medications, weight loss due to inability to
prepare meals or navigate grocery shopping,
and costly financial mistakes due to unpaid
bills or excessive spending. For older adults
facing these challenges and decisions, there
are a number of factors to consider.
First, it is important to understand and
determine the level of care needed. This
determination is often made based on
feedback from your health care provider as
well as through consultation with staff of a
care facility or community social workers
and rehabilitation therapists. Broadly, there
are two venues of care to consider: skilled
nursing facilities and assisted living facilities.

Nursing homes provide skilled care to
people who cannot be cared for at home
and need 24-hour nursing care. Skilled care
includes nursing or rehabilitation services to
manage, observe, or assess an individual's
care. The Nursing Home Compare tool available on medicare.gov allows individuals and
families to search for and compare nursing
homes certified by Medicare and Medicaid.
The tool encompasses over 15,000 nursing
homes around the country (note: facilities
not certified by Medicare and Medicaid are
not included). The website contains information regarding the quality of resident care,
safety ratings, staffing, and services provided
(e.g., physical and occupational therapy,
wound care, and intravenous therapies).
Long-term or custodial nursing care can
be quite costly. It's often paid out-of-pocket (averaging about $82,000 per year), in
conjunction with long-term care insurance
or by enrolling in Medicaid.
Alternatively, when an individual does
not need the round-the-clock skilled nursing and medical care that a nursing home
provides but needs more assistance than can

LANCASTER

PHYSICIAN

Finally, when facing a major change in life
such as moving from home, a critical part of
the process is ensuring you have completed
advance directives. These are legal documents
that allow you to write down your wishes for
future health care ahead of time. Advance
directives go into effect only when you lose
the ability to make decisions for yourself.
The two most common types of advance
directives include a living will and health
care power of attorney.
A living will allows you to document your
wishes regarding life-sustaining treatments
desired if you become terminally ill and are
no longer able to make decisions for yourself.
Some examples of life-sustaining treatment
include CPR, mechanical ventilation for
breathing, dialysis, or artificial feeding.
A health care power of attorney is a document that allows you to choose a surrogate
decision maker (i.e., the agent of your health
care power of attorney) to make your medical decisions if you lose the ability to make
them for yourself. It is best to discuss with
your surrogate ahead of time the types of
treatments you would or would not want
in specific situations, and the document
often includes stipulations about the types
of decisions an agent can make. The health
care power of attorney document is often
times different from a durable or financial
power of attorney document.

http://www.medicare.gov

Lancaster Physician Fall 2019

Table of Contents for the Digital Edition of Lancaster Physician Fall 2019