Michigan Long Term Care Conference March 23, 2006

Choosing from the Array of Long-Term Care Supports and Services

Long-Term Care Supports and Services

• Long-Term Care Supports and Services are available from a number of agencies including Private-for-Profit, Private-Not-For-Profit, Hospital-based, and local government-based organizations

Institutional-Based Long-Term Care Services are provided by:

Private Nursing Facilities County Medical Care Facilities Homes for the Aged Licensed Adult Foster Care Homes Non-licensed Assisted Living Facilities

The most common types of agencies providing community-based long-term care services include:

Community Action Agencies County Commissions on Aging Local Departments of Human Services Private Home Care Agencies Other community agencies and

businesses

Long-Term Care Services can be classified in the following types:

Institutional Care ServicesAccess ServicesCommunity-Based ServiceIn-Home ServicesResidential (i.e. group homes)

Institutional Care Services include: Nursing Homes

• Private For-Profit• Private Non-Profit• County Medical Care Facilities

Licensed Adult Foster Care

Licensed Homes for the Aged

Traumatic Brain Injury Facilities

Access Services consist of:

Information and Referral Services Area Agencies on Aging

2-1-1 Call System Centers for Independent Living

Care Management Includes the MI Choice Waiver program

Outreach Programs

Transportation Services

Community-Based Services include

Adult Day Care Home Delivered Meals/Congregate Meal

Programs Transportation Counseling Medical Supplies/Equipment Environmental Modifications Legal Assistance LTC Ombudsman Program Elder Abuse & Education Programs Kinship Care Programs

In-Home Services consist of:

Personal and Attendant Care In-Home Respite Homemaker Aide Program Chore Services Private Duty Nursing Personal Emergency Response Systems Home Delivered Meals Home Injury Control Assistance Home Health Care Hospice Programs

How are these services and supports paid for?Home and Community-based services and institutional care supports are paid for through a variety of funding mechanisms, including:

Older Americans Act Medicare Medicaid Long-Term Care Insurance Private Pay Veteran’s Administration Private Insurance

How are LTC Resources Accessed?

Most LTC Programs have specific eligibility requirements – both medical and financial

Title III of the Older Americans Act: Older American Act resources require a

person to be at least 60 years of age or the spouse of someone age 60 or older

Some services have physical deficit requirements determined through an in-person assessment.

There are no financial eligibility requirements, however, there are priorities for those with the greatest economic and social need.

Title III resources funnel through the local Area Agency on Aging.

Some funds are contracted out to local organizations such as Community Action Agencies or Commissions on Aging who provide the services. The growing trend, however, is for consumers to choose services through a pool of providers.

Medicare

Must be age 65 or older or disabled and enrolled into the Medicare Program

Co-payment may be required for certain services or supports

Skilled nursing services require physician orders

Skilled Services are considered intermittent and are associated with rehabilitation

Institutional care is limited to a maximum number of days and contingent upon the need for “skilled” care and the potential for rehabilitation

Coverage for both nursing facilities and in-home is very limited and accounts for less than 5% of LTC costs.

Medicaid

Must be 65 or older, or blind or disabled Must meet financial eligibility tests

• These vary by county of the state and types of support (asset limitations are universal)

• Access to Medicaid resources requires the completion of a Medicaid application available at the local Department of Human Services Office (formerly FIA)

Some services and supports require prior authorization

Long-Term Care Insurance

There are many different products on the market today, each covering different types of services and supports

Most have physical limitation requirements Many follow Medicare guidelines for skilled

nursing Some policies only cover institutional care Policies usually have a maximum daily or

total benefit Consumer must pay policy premium

Private Pay

If the consumer can afford it, he/she can usually get whatever type of care desired

Private pay options include both institutional and community and in-home care

To access institutional care services and supports:

Nursing Facilities: must meet functional and financial eligibility requirements unless private pay

Assisted Living Facilities: not government subsidized – private pay only (may be in the future under the MI-Choice Program)

Homes for the Aged & Adult Foster Care: usually have physical limitations and meet financial eligibility criteria unless private pay

To access Community-Based LTC services and supports: MI Choice Waiver Program: must meet

functional and financial eligibility requirements the same as nursing facilities

DHS Home Help Program: must have functional limitations and meet financial eligibility requirements

Title III In-Home Services: must have functional limitations and age 60+

How To Get Information From Which To Make Long-Term Care Decisions and What To Do When You Get Stumped

The easiest way to get information regarding long-term care services and supports is to contact the local Area Agency on Aging regarding persons age 60 and over or the local Center for Independent Living

In the future there will be Single Points of Entry to provide information, assistance and supports to persons seeking long-term care, similar to a one-stop shop allowing easier access and information on the array of LTC supports.

ADVOCACY SERVICES

Michigan Long-Term Care Ombudsman Program (1-800-292-7852)

Michigan Protection and Advocacy (1-800-288-5923)