Tag: Assisted Living

What is the California Department of Aging?

The California Department of Aging (CDA) is practically unheard of. I recently discovered it and knew immediately we would have to publish the information for our Beach Cities seniors. The Department administers programs that serve older adults, adults with disabilities, family caregivers, and residents in long-term care facilities throughout the State. These programs are funded through the federal Older Americans Act, the Older Californians Act, and through the Medi-Cal program.

To get things done, the CDA contracts with the network of Area Agencies on Aging (AAA), which are organized roughly along county lines. The local AAA directly manages services that provide meals; support for family members, and to generally promote healthy aging and community involvement. In this article we’ll focus on meals and family help, both of which are elements of “Aging At Home.”

“Meals On Wheels”

Here in Los Angeles County, seniors are eligible for home delivered meal service if they meet the following basic requirements. (For detail, see http://wdacs.lacounty.gov/ or call them at (213-738-4004.)

  • Persons 60 years of age or older who are homebound because of illness, incapacity, disability, or are otherwise isolated regardless of income level
  • Spouses and caregivers of eligible participants if it is beneficial to the participant
  • Persons with a disability who live at home with a participant

The Home-Delivered Meals Program also provides nutrition education, nutrition risk screening and nutrition counseling.

Being a senior citizen can be very challenging in our society. Even with family care givers, there can be a lot of questions, and a good deal of confusion. High on the priority list is finding ways so family members can help as much as possible.

Many times close relatives would be happy to stay home and help, but a formal job leaves no time to do so. The In-Home Supportive Services (IHSS) program is designed to provide training and income for a person who provides services to family members under the program.

Getting paid to take care of a family member

Are you caring for a senior member of the family? Or, are you a senior caring for a grandchild? Either way, you are performing a valuable service, and one you can be paid for! The California Department of Social Services (CDSS) can help you with qualifying for a paycheck in 90 days or less. The best part–it can be tax free income! The requirements:

  • Adult family members or other informal caregivers age 18 or older providing care to individuals age 60 or older
  • Adult family members or other informal caregivers age 18 or older providing care to individuals of any age with Alzheimer’s disease or related disorder with neurologic and organic brain dysfunction
  • Relatives, not parents, age 55 or older providing care to children under the age of 18
  • Relatives, including parents, age 55 or older providing care to individuals of any age with a disability

CDA also contracts with agencies that certify approximately 242 Adult Day Health Care Centers participating in the Medi-Cal Community Based Adult Services (CBAS) Program.

So every Californian has the opportunity to enjoy wellness, longevity and quality of life in strong healthy communities, CDA actively works to ensure:
– transportation,
– housing and accessibility
– wellness and nutrition,
– falls and injury prevention,
– dementia care.
For additional information, contact the CDA at https://www.aging.ca.gov/Programs_and_Services/ or you can locate the AAA in your area by selecting your county on the Find Services in My County page of this website.

Photo by CDC on Unsplash

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When Is Assisted Living “In-Home Health Care?”

Last year the Centers for Medicare & Medicaid Services (CMS) expanded how it defines many of the “primarily health-related” benefits that insurers are allowed to include in their Medicare Advantage (MA) policies. Air conditioners for people with asthma, healthy groceries, rides to medical appointments and home-delivered meals are among the new benefits now being considered for coverage by insurers. More importantly, insurers are now allowed to cover non-skilled in-home care starting this year.

Assisted living providers often provide this type of care, such as helping residents with bathing and dressing. Thus, the CMS change opened up the possibility that insurance dollars could start flowing to senior housing and care companies. Analysts already envision major MA insurers buying into senior housing companies to maximize profits.

Technically, the Assisted Living facility is your home,
so “home health care” benefits should apply.

Only a handful of insurance companies are offering any new benefits in 2019. Among them, Long Beach, California-based SCAN, announced its “Returning to Home” and “Home Advantage” offerings in mid-November. SCAN was able to quickly add new supplemental home care benefits because it has covered similar services in the past

To provide these benefits, SCAN already has contracts in place with home care agencies. According to SCAN executives, it’s possible SCAN would contract directly with an independent living or assisted living company if it has caregivers on staff, and residents signed up for these new plan offerings.

It’s possible a retiree will have health care
provided by a medical organization
owned by the insurer. Would that be
considered a conflict of interest?

Both SCAN and Anthem, another major player in the MA arena, have indicated they are open to contracting with senior living providers or otherwise forging partnerships with them. We can expect a variety of differing relationships between insurers and providers as best practices are devised.

As insurance companies create their benefits packages and consider potential senior living moves, some senior living providers are looking at ways to add MA policies to the 55+ living packages they offer.

Sunrise Senior Living has a newly established plan called Sunrise Advantage which is currently offered in four states (California is not included). The Sunrise plan replaces the insurance company that normally comes in between the health provider and Medicare. Physician referrals to Sunrise are up 300% since Sunrise Advantage launched, per Sunrise executives.

Should we allow the health industry,
providers or insurers, to engage in monopoly?

Senior living providers like Sunrise, who create their own plans can tap into the new supplemental benefits as well as more well-established options. The changes promise to add bottom-line value for the senior living business, while enhancing residents’ outcomes and reducing some of their expenses.

Many Medicare Advantage plans already offer some health benefits not covered by traditional Medicare, such as eyeglasses, hearing aids, dental care and gym memberships. The new rules, developed with industry input, expands that significantly to items and services not directly considered medical treatment.

CMS said the insurers will be permitted to provide care and devices that prevent or treat illness or injuries, compensate for physical impairments, address the psychological effects of illness or injuries, or reduce emergency medical care.

The changes were adopted late in 2018, so many insurers are still designing their modifications, and many changes will come in 2020. Some health insurance experts said additional benefits could include modifications in beneficiaries’ homes, such as installing grab bars in the bathroom, or aides to help with daily activities, including dressing, eating and other personal care needs.

Even though a physician’s order or prescription is not necessary, the new benefits must be “medically appropriate” and recommended by a licensed health care provider, according to the new rules.