Run It By Tamara

by Tamara Jacobson, Compassionate Care Referral Service

QJanuary produced many desperate calls for help in finding care for those seniors with various forms of Dementia; almost 75% of my calls had to do with the subject. Most did not have the funds for Long Term Care where the average cost, by my estimate, is around $5000$7000 per month for those with Memory Care needs. Where to go, what to do?

AAbout five years ago, I saw a crisis for affordable care developing. My first recollection was some local Assisted Living Communities, that took mainly Medicaid as payment, closed down. Why?

There is something so encouraging and comforting just sharing our concerns with one another. I look forward to hearing from you!

— Tamara Jacobson

If you would like to submit a question and ‘Run IT By Tamara’ regarding senior care issues, please email: CCRS@netscape.com or call 208-660-9982

I discovered that Idaho’s reimbursement rate for those on Medicaid for Long Term Care was not keeping pace with the expenses for the facilities to provide that level of care. Once a person is on Medicaid, the State determines that individual’s care level, from an assessment by their own nurse, and comes up with a daily rate for care. Add on a set amount for room and board and this totals, in a very simplified example, what the facility receives for payment, after insurance and Medicare is funded.

With the Pandemic challenges, the cost of food and paying staff, coupled with the shortage of workers, many facilities determined they were unable to accept Medicaid as payment. They tell me, they would receive approximately half of what a private pay person would be charged.

Those Long Term Care Facilities that will accept Medicaid, require two to three years private pay initially. After this set period of time, they will then keep the senior as a resident on Medicaid. I find this scenario only works if, for example, there is a house to sell to provide those years of funding.

A few will take Medicaid as payment up front but require the family to pay a supplement: the difference of what Medicaid brings in and what private pay would total, if they are given a private room. My experience is that only about one in seven families are able to afford this option.

As a side note, Medicaid originally assumed two persons to a room in Assisted Living. The minimum size of room for two persons is dictated by the State Of Idaho and most of the newer facilities did not build them to this specification although they do exist. A senior couple who both need care are easier to place if they are willing to share!

Any Alternatives?

A personal approach to evaluating senior care choices to fit your needs and budget. NO FEES. NO PRESSURE. Tamara

In Home Care is a vital service for many, but for those Seniors who cannot afford the rising costs of private pay, few companies will take Medicaid clients. Again, because of low reimbursement rates from the State.

Area Agency on Aging of North Idaho (AAANI) does have some respite programs which reimburse caregivers for caring for a loved one when the main caregiver needs a break. The key is already knowing

by Jan Noyes, Associate Ombudsman Area Agency on Aging of North Idaho

someone who could do the caregiving during the respite due to Caregiver shortages. Contact AAANI for details.

I find limited facilities in smaller towns outside Kootenai County still take Medicaid if something comes open and they don’t have too many residents on the program at once. Timing seems to be everything, so it is good to get on some lists.

Some have opted to cross the state line and get on the Washington State Medicaid program.

Skilled Nursing Facilities do take Medicaid once in a while for long term care, mainly because they are federally inspected and deal with both Medicare and Medicaid. I have found more reluctance to taking on those with Memory Loss and they explain this is due to shortages of caregivers.

Veterans or surviving spouses who qualify for Aid and Attendance benefits, which supplements their income for assistance for Activities of daily living (ADL’s), have a better chance of finding and affording Long Term Care. Adult day care or In home care can come under the Veterans benefits as well.

Future Change? What can be done?

The State of Idaho is keeping pace with increasing reimbursement rates for Medicaid for senior care needs. They have increased those rates some with a dementia diagnosis, but I have been told it is not enough.

Perhaps, state tax incentives for those facilities that do take on some folks with Medicaid as payment may be an answer. Other states have county tax subsidized care facilities for those on Medicaid, but that would affect Idaho voters’ taxes. Find a way to increase the number of Certified Family Homes (1-4 residents) specializing in Dementia care, and again make it attractive and rewarding for those homes to do so.

Families are talking more about taking on the responsibility for caring for a loved one. I have worked with families who have put together caregivers with friends and family to cover needed bases. Adding an ADU or addition onto their home, when feasible, has worked in some situations.

Puzzles on pages 38-39