Health Care for Older Adults

1. Health Care for Older Adults Pat Mezinskis April, 2008

2. Health Insurance for Older Adults • Older Americans Act of 1965: made funds available for the elderly • Social Security Act of 1935: amended in 1965 to provide Medicare and Medicaid

3. Medicare (Title XVIII) • Federal health insurance program established for those over 65 • Today it also includes some people with disabling diseases such as End Stage Renal Disease

4. Medicare (Title XVIII) • Payment is based on DRGs which is a prospective method of deciding costs rather than a retrospective method

5. Medicare (traditional) • Part A: funded through SS payroll taxes • Covers: • hospital services • blood transfusions • SNF (3 months or less) • home health care • hospice care • inpatient psychiatric care

6. Medicare (traditional) • Part B: monthly premiums $93.50 for 2007 • Covers: • MD/nurse practitioner services • outpatient services • emergency services • PT/OT/ST • outpatient psychiatric services

7. Medicare (traditional) • Part B • Covers: • lab fees • ambulance • inpatient drugs

8. Medicare (traditional) • Part B • Now covers some preventive services: mammography, prostate screening, glaucoma screening, bone density measurements, diabetes ed., colorectal cancer screening, pap smears, some vaccinations

9. Medicare Home Care Benefit • Provides acute or restorative skilled nursing care • Intermittent or short-term basis • For homebound patients under care of a physician

10. Medicare • Not covered: • Long-term nursing home care • Routine physicals • Dental care • Eye exams, glasses • Hearing exams, hearing aids

11. Managed Medicare • Part C- “Medicare Advantage” • Must provide all that Medicare does • Provides preventive care

12. Medicare • Part D • 2006-NEW • Prescription Drug Benefit • Optional

13. Medicaid (Title XIX) • Assistance for the poor, uninsured • “Means” tested- must be indigent to qualify • Assets and income must not exceed your state’s defined poverty level • Look-back period currently 3 years

14. Medicaid • Covers: • Inpatient and outpatient hospital care • Lab and x-ray services • Physician services • Skilled nursing home care

15. Other Programs • Ohio • Passport • Elderly Services Program (ESP) • Supplemental • Medigap • LTC insurance

16. Cost of Health Care Home Care- $15-30/hour Home Nursing Care- $35-75/hour Adult Day Service-$40-100/day Assisted Living-$125-200/day Nursing Home Care-$150-250/day

17. Health Care Levels • Independent Living • Assisted Living • Skilled Nursing Care • Traditional nursing home • Eden Alternative • Green Houses • Dementia Care or Memory Unit

18. Health Care Regulations • Nursing homes-licensed • Medicare/Medicaid facilities-licensed and certified • Highly regulated industry • Only so many beds available in state

19. Housing Options • Life Care or Continuing Care Retirement Communities (CCRC) • Foster Care • Homesharing • Assisted Living Facility • Co Housing

20. Community Resources • Senior Centers • Adult Day Care • Respite Care • Hospice • Meals-on-Wheels