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Activities of Daily Living (ADL's)
People who are healthy tend to take most of the simple activities that they perform each day for granted. But for a disabled and/or older person, performing these activities may present a real challenge. Bathing, dressing, getting in and out of bed or chair, walking, going to the toilet and even eating can all become a problem. Many seniors who require help with such activities are largely independent, requiring help with one or two ADL's. In such cases, intermittent help from a family member or friend may be all that is needed. However, in many cases, particularly when needs are more extensive and/or the importance of scheduling these activities is critical, informal care arrangements may not be adequate.
Adult and Social Day Care Facilities
Adult Day Care facilities are designed for adults who have a need for significant medical attention and supervision but who do not require institutionalization in a nursing home. There are a limited number of such facilities in New York City. Where available, Adult Day Care centers are typically utilized for between 3 and 12 hours per day, up to 7 days per week. Social Day Care facilities are meant for adults who have no significant medical needs, but who may benefit from socialization opportunities and need supervision throughout the day. By visiting a social day care facility, the senior has companionship and supervision during the day. Our new VNS CHOICE Adult Day and Community Services Center in Woodside, Queens is both an Adult Day Care and Social Day Care facility.
Certified Home Health Agencies (CHHA's)
New York State licenses two types of organizations that provide home health care: Certified Home Health Agencies or CHHA's and Licensed Home Care Services Agencies or LHCSA's. Only the employees of such agencies are permitted to provide hands-on care to patients, from help with bathing to the administration of medications.
Home Health Aides
Home health aides are certified by the New York State Department of Health. They receive careful training in such areas as working with immobile patients, monitoring a patient's temperature, pulse rate and preventing infections. They may not give medications (they can count out and place medications in a patient's hand, but they are not permitted by law to place a medication in a patient's mouth.) They can also help with such household activities as shopping and laundry.
Instrumental Activities of Daily Living (IADL's)
Instrumental activities of daily living are considered those which are less basic than ADL's. They need to be performed, but scheduling may not be as critical. IADL's include such activities as shopping, paying bills, cleaning, doing the laundry and snow removal. Many more seniors require, or simply prefer, assistance with IADL's than with ADL's. Some seniors may merely want someone to escort them when they are shopping and help them avoid any situations that might cause them to fall. Other seniors may have become forgetful and welcome assistance with their bill paying and medical appointments. Still others who have become weakened by illness, may require assistance with many IADL's as well as one or more ADL's. The good news is that whatever the need, there are workers and programs to provide appropriate support.
Licensed Home Care Services Agencies (LHCSA's)
New York State licenses two types of organizations that provide home health care: Certified Home Health Agencies or CHHA's and Licensed Home Care Services Agencies or LHCSA's. Only the employees of such agencies are permitted to provide hands-on care to patients, from help with bathing to the administration of medications.
The "Lombardi" Program
The Lombardi Program, which is also known as the Long-Term Home Health Care or the Nursing Home Without Walls program, was designed to provide care in the home for those who are qualified to enter a nursing home but who have lesser care needs and prefer to remain in their homes. In addition to receiving home nursing care, Lombardi participants receive assistance from home health aides and are often provided with social day care, home delivered meals and transportation to and from medical appointments.
Managed Long Term Care Program
The Managed Long Term Care program was created in 1997 specifically for seniors who were physically qualified to enter a nursing home but who preferred to remain in their own homes. Under this program, members are eligible for all of the care that is available under the Lombardi program, but can also receive a wide range of additional services. VNS CHOICE is an example of a Managed Long Term Care Program.
Meals on Wheels
Meals on Wheels programs were developed to meet the needs of people who are largely homebound. Under these programs, nutritious hot meals are delivered to patients for a nominal fee. For many people who are homebound, these meal deliveries provide not only the nutrition they need, but also the only human contact he or she may have that day.
Medicaid
Medicaid is a program funded jointly by the Federal and State (and in some cases, city) governments. In New York, it is administered by New York State. People of all ages whose income and assets fall below a specified level can qualify for Medicaid coverage. Medicaid provides comprehensive medical coverage for all of its recipients but because many health care providers do not accept Medicaid, access to medical care is often limited. For adults over the age of 65, the picture is somewhat different. These adults are generally covered by Medicare, and the vast majority of health care providers accept Medicare. Those who accept Medicare often also accept Medicaid for their older patients. In these cases, Medicaid provides coverage that fills the gaps in Medicare, while Medicare continues to provide basis medical care benefits.
For older adults who qualify for Medicaid there are many other available services. Programs such as Managed Long Term Care (VNS CHOICE) and Long Term Home Health Care provide comprehensive home care for those who are covered by Medicaid. There are essentially two levels of Medicaid eligibility. One is for community-based care and the other is nursing home care. In order to qualify for Medicaid in New York State in 2004, an individual senior's adjusted income cannot exceed $659 ($950 for a family) per month.
Income is adjusted by deducting certain "allowable" expenses from it. Perhaps the most significant adjustment is one for specific kinds of "medical" expenses. For example, if someone spends $1,000 per month on medical expenses like home health care, and that person has an income of $1,600 per month, he or she has an adjusted income of $600. Consequently, such a person may qualify for Medicaid, even though his or her unadjusted income significantly exceeds the Medicaid maximum of $659 per month.
There is also a limit on the assets one may possess and still qualify for Medicaid. Assets one may not exceed $3,950 for an individual ($5,700 for a family) excluding the value of the person's primary residence, an automobile and a $1,500 burial fund. A spouse's assets may or may not be considered, depending on the circumstances. Only assets that exist on the day a Medicaid application is filled out are considered when one is applying for community-based programs. When applying for nursing home coverage, assets owned within the 36 month period prior to applying for coverage affect eligibility.
Medicare
Medicare is a national health insurance program designed primarily for seniors. Medicare is provided by the Federal government and virtually every permanent resident of the United States who is 65 or over is eligible for Medicare - even non-citizens. There are two parts to Medicare, Part A and Part B. Part A pays for hospitalizations and for limited home and nursing home care. Part B pays for physicians, lab tests and outpatient hospital care. There is a premium associated with each program. Part A premiums are waived for those who have fulfilled certain eligibility requirements (most permanent residents who have worked steadily in the United States, and their spouses). Part B premiums ($66.60 per month in 2004) must be paid by anyone who wishes to be covered under that portion of the Medicare program.
While Medicare covers the majority of most hospital and physician expenses, it also expects beneficiaries (Medicare's term for those it covers) to pay for a share of these expenses. For example, the annual deductible for hospitalizations in 2004 is $876, and Medicare beneficiaries have a $100 deductible for physician expenses as well as a 20% co-pay for all such expenses.
Contrary to popular belief, Medicare also does not pay for any drugs provided on an outpatient basis. For instance, Medicare covers the first 20 days in a nursing home (if it follows a hospital stay), requires beneficiaries to pay $97 per day for the next 80 days and does not cover days beyond 100. There is limited coverage for home health care visits (which can only be delivered by a nursing organization approved by Medicare - called a Certified Home Health Agency or CHHA - such as the Visiting Nurse Service of New York). CHHA's can provide "medical home health services" such as intravenous drugs, artificial feeding and hydration, oxygen therapy, nursing visits for wound care, injections, catheterization, colostomy care, administering oral medications, skilled therapy and some services of a home health aide.
Nurses
Nurses are licensed by the State of New York. There are two types of licensed nurses. Registered Nurses (RNs) provide such services as developing a plan of care with the patient's doctor and in consultation with the patient and his or her family, administering medications (orally, by injection or intravenously), and educating the patient or family on self-care methods. Licensed practical nurses may provide most of the care that a registered nurse does, but they may not perform some of the consultative services that registered nurses provide, such as developing a plan of care.
Nurse Practitioners
Nurse practitioners are nurses who have undergone extensive advanced training after becoming nurses. Nurse practitioners are licensed to perform many of the activities that only doctors have traditionally performed, such as diagnosing illnesses and prescribing medications. Nurse practitioners are more restricted in their practices than doctors. For example, a nurse practitioner cannot perform surgery.
Nutritional Therapist
Nutritional therapists focus on assuring that patients adopt short and long term diets that will maximize their health given the physical and medical condition(s) they have.
Occupational Therapist
Occupational therapists work with patients to help them regain the skills they need to function in their day-to-day activities. For instance, an occupational therapist might teach a stroke patient how to dress, or recommend a grab bar for the bathtub of a person who is becoming somewhat unsteady while bathing.
PERS
PERS (Personal Emergency Response System) is a device that's worn as either a bracelet or necklace. If you need help, you simply press a button on the PERS device and a central emergency station is instantly signaled by phone. The emergency station promptly communicates with you via a special wide area speaker-phone that is usually included with the PERS device. After the emergency station learns the nature of the emergency, a call is made (in accordance with pre-arranged instructions) to the appropriate person or persons 911, for instance, or a neighbor or family member.
Personal Care Workers/Home Attendants
Personal care workers (called home attendants in New York City) are specially certified under New York State law. The scope of their services is essentially limited to providing assistance with ADL's and IADL's, but they cannot perform the health care functions that a home health aide can (such as taking a patient's temperature). However, for people who simply need general (rather than medical) assistance, home attendants perform a valuable service.
Physical Therapist
Physical therapists help restore strength, flexibility, coordination and general function of patients who have been disabled by an accident or illness.
Rehabilitation Therapists
Rehabilitation Therapists are very important to the home health care team because they provide restorative treatments for patients following an accident, illness or surgery.
Respite Services
A number of facilities and community-based organizations offer respite programs. These programs are designed to provide relief to family caregivers who attend to the day-to-day needs of a sick or frail person. The respite period can be for a few hours, for a day, or even longer, depending on the program. Many families find that occasional respites are just what they need to relax and enjoy a break in their day-to-day care giving responsibilities. Subject to certain requirements, Medicare will pay for up to 80 hours of respite services per year.
Social Workers
Social workers are specialists (in the context of home care work) in helping people cope with the medical, functional, emotional, psychological, family relationship, environmental and financial challenges of living in their own homes. They are trained in counseling and in how to access community services, whether those services are provided directly by the government, or by community organizations.
Speech Therapist or Speech Language Pathologist
Speech Therapists or Speech Language Pathologists help patients regain their ability to produce and understand speech as well as facilitate communication skills.
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