A Nest Plan

By Karen Minard #64779

Having a plan for your health care and housing is important, and this plan is best made, at least tentatively, before you must place the keys on that key hook. If the plan is not for yourself, maybe you need to help plan the care of one of your relatives.

Believe it or not, there is a sense of relief after one has dealt with the steps taken to create a will, power-of-attorney and medical directive. Relief, not just for yourself, but also for those you love who will be following your wishes.

This is not morbid but smart and is well worth the end result, knowing you are not leaving these important decisions in someone else’s lap, which can lead to family members feeling guilty and stressed. So why not look at the future personal care and housing options that are available and, at a minimum, inform yourself and then let the person of your choice know your desires.

It took my daughters several months before they would allow me to discuss my future plans. When they finally understood I was not planning my death but actually my future, it made the discussion so much easier for each of us. We can now focus on reality: me running all over creation in my RV and them with their jobs and family.

Certainly, your future plans may have to be flexible, but having a plan allows you to relax and focus your attention on your next road trip!

Now I am going to touch on the different types of care and housing options: how to choose one, what to look for in quality, facility staffing, checklists, finding in-home private care and other points. The Websites at the end of this article will guide you in your decision-making process.

Levels of Care
In facilities for retirement, assisted living and nursing homes, the care levels are independent, assisted and full care. Over time, if our health declines, we may need help in our personal care. There are several options from which to choose. The city where you reside will determine which options are available, so this is general.

Take into consideration that your financial standing will have a large bearing on what your decisions are. Do not depend on Medicare to pay for all your care needs. It will not. Ideally, you should at least have a secondary insurance policy, and you may want to consider a long-term care policy and a cancer-care policy.

• Independent Living: Living independently in your own home or RV is one option. You will want to look at your social and interpersonal needs and mobility restrictions closely, because you may find yourself more alone than you anticipated.

• Assisted Living: If you have assisted-living needs for personal care, hygiene or medication management and meals, etc., possibly your help may come from your family, or you may hire help. If ordered by a doctor, Medicare may temporarily pay for a portion of this.

One-of-a-kind CARE
I personally know of only one RV park that can provide a limited amount of personal care assistance. This is at Escapees headquarters, in Livingston, Texas. Adjoining the Escapees campground is the CARE facility, with its own campground and CARE Center, where meals, activities, socialization and transportation are part of the CARE program. Contact the CARE Center at 936-327-4256 or visit www.escapeescare.org. (If you know of any others, please notify me through Escapees magazine.)

If you are not on your own RV plot but are in an RV park, you must find out if there are any park restrictions related to the level of care you need that would allow you to stay there.

There are several other types of retirement options. Some facilities have “on campus” individual or duplex apartments with full kitchens and laundry units where you would live independently as required in the contract. You would usually be allowed your own furnishings. On occasion, if you need a meal brought to you, you may have to pay for this meal. You would drive yourself or may use the facility van service, if available. The van service provides transportation to and from various facility-planned activity and entertainment locations and may provide transportation to your personal desired locations, such as the doctor and grocery shopping, but you are usually on your own to plan your outside trips, and possibly at an extra fee.

If you became permanently dependent on others for your care needs, you would have to relocate or be moved to a higher level of care within the facility, if available, with increased fees. As mentioned, if your doctor orders temporary therapies or nursing visits, Medicare may pay a portion of it.

Some facilities on the same campus would have a large, multi-floor building with individual tenant rooms, usually with one to three inside rooms, for those folks who need some assistance with hygiene, dressing, mobility and/or meals, etc.

Only minimal assistance is provided under an assisted-living contract. You can usually bring some of your own furnishings. The facility would provide meals in a large hall or in the tenant’s room, or you can make use of the mini-kitchen.

Laundry service is provided and is usually only for linens. Some facilities will do your personal laundry, but you may have to pay extra.

Hired Help, Family Help or More
If your personal care needs become greater than assisted-living level, you must either hire help or get family help or be advanced to a higher care level, at the facility, if provided, or relocate, also with increased fees. Again, temporary doctor-ordered therapies may be paid by Medicare.

If this facility does not provide advancing care options on campus, including a nursing home, and you must relocate, your doctor may be able to help locate one; however, it is best if you do your own research and investigating. (Your doctor will usually advise you to look into the closest one he/she visits.) If you find one not in the area your doctor visits, with the quality and requirements you have, you can arrange for transportation to your physician, or you may want to change doctors.

A Neighborhood Home
Another assisted-living facility can be a personal home in a neighborhood, that is licensed to provide nursing care for usually six or less patients. Van transport to doctor appointments may or may not be provided. This type, however, will usually only accept assisted level people who can walk with a walker or need bathroom assistance. Some homes will not take those who are incontinent.

Also, if extra care from a visiting nurse, therapist, etc., is temporarily needed, it can be personally hired, or if ordered by a doctor, may be partially paid for by Medicare.

The Internet is full of information that can guide you in choosing everything from equipment, hired help, facilities and more. Inform yourself so you can create the kind of plan that will work for you. In a nutshell, here are a few things that are important to know:
1. Your anticipated level of care needs
2. Your mobility restrictions
3. Anticipated financial status
4. Interpersonal and social needs
5. Location where you want to live
6. Locations of hospitals for acute-care needs
7. Cost and hidden costs of the facility
8. Contract requirements and restrictions
9. Your rights as a patient; get a printed copy of it
10. Staffing-ratio-to-patient numbers, no more than 10 to an aide for minimal care, 8 or less for better-quality care
11. Are the aides certified or facility-instructed? Certified is best.
12. Is an RN or LVN available 24 hours a day (a must); how many per shift?
13. Is the facility licensed and accredited? A must.
14. Does the medical association or Better Business Bureau have any complaints or investigations listed against the facility?
15. Ombudsman available to help with patient rights and protections?
16. Facility cleanliness, odor, temperature of meals, frequency of linen changes, frequency of bath/shower given, activities available, double or single rooms, shared TV, time before call bell is answered, private bathroom and shower
17. Visit the facility unannounced; if you like it, make an appointment to get information, printed material and answers to your list of questions.
18. Transportation by facility available?
19. On- and off-campus activities and entertainment, costs
Full-care Facilities
Full-care facilities are nursing homes that provide total patient care. It can be a large facility with up to 100 or more patients. It can be connected to a hospital or a retirement facility or be free-standing.

The doctor usually visits the patient there, or sometimes the patient can be van-transported to the doctor’s office. If you qualify financially, Medicaid (welfare) will pay for your nursing-home stay. Medicare only pays the first 20 days if you were just released from at least a three-day hospital stay; you share payments after that, and at day 100 you pay everything while remaining in the nursing home.

Most RV parks, retirement and care facilities provide activities on and off campus. Whether you walk or need a walker or toilet facilities, you can participate in these activities barring illness or debilitation that would keep you from it.

Some nursing homes are considered rehabilitation facilities and provide physical and occupational and other therapies ordered by a doctor. Medicare will pay a portion of the fees for these therapies. The goal for patients in these rehab facilities is to get the patient back to as close to his/her previous level of function as possible so they can go home, home being wherever you were before needing a rehab facility. In any facility or your home, any needed medical equipment is either loaned by the facility, personally purchased and, if ordered by a doctor, may possibly be rented for you by Medicare.

For any of these living situations, the financial part of planning is vital. Retirement communities are privately paid and also have a contract. It is usually a large payment up front and with an additional monthly billing. Some allow you to pay up front for a future-use time. Be sure to understand the requirements and the contract for any additional or hidden expenses.

Medicare and Your Doctor
Medicare has strict criteria for qualifying for them to pay for your doctor-ordered care needs while in any living situation, and, as mentioned, it is for short term. Only your doctor can determine your need, and Medicare can determine if they will pay. Your doctor knows how to order the therapies or care so that Medicare will likely pay. If you have a secondary insurance policy or specialty policies, be sure you know exactly what they will cover before you purchase them or make care need commitments.

Flush, Help, Medicaid
In housing and personal-care needs, if you are flush, you pay, period. If you have insurance, then you have help. Medicaid (welfare) will only pay for your care if you have minimal available funds. Talk with your estate lawyer in planning your funds to stay with your family.

Depending on your finances, you may qualify for other government programs for assistance such as food stamps, “Meals on Wheels,” public transportation and low-income housing. Requirements change, as does the government, so I strongly encourage you to call Medicare and/or your state’s Medicaid office with all your financial and care need questions. You may also want to review the book, Medicare & You, sent to you by Medicare.

Obviously, as you do your research, visit facilities, talk to patients, their visitors and families and use the Internet, you will make your own additional list of questions. The Websites listed below are packed full of information. It is important to type the address exactly or, better yet, cut and paste it to your browser search area.

This is a huge topic with a lot of material. So, how about getting into a comfy chair, hitting the Internet, taking notes and then hitting the road for fun?

• Medicare: www.medicare.gov/NHCompare This is the Medicare site that will give you information on rating facilities, comparing them, how to make a complaint, choosing quality, how they should be staffed, guides and checklists to help choose one, state survey agency and tons more.
• Senior living options: helpguide.org/elder/senior–housing–residential–care–types.htm This site covers information about senior living options, personal and emotions points, help in assessing your needs and how to choose the type of housing and more.
• Checklists: www.caregiverslibrary.org/home.aspx. This site will help you determine your need and in finding qualified hired help, using checklists and forms and what to expect from hired help and much more. Look along the left column.
• Conditions and Fact Sheets: www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=407 This site will provide information on legal issues, health conditions, fact sheets, writing a job description for the hired help, pros and cons of using hired help.

Karen has been in nursing since 1969, with the last eight years as a travel contract RN across the country. Her areas of specialty are emergency room and telemetry. Karen lives full-time in her motorhome. Karen advises that nothing written is meant to diagnose, prescribe or take the place of seeing a physician. Portions of her articles have been previously published or will be published in other informational newsletters and publications.

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