Christopher Williams, Senior Solutions

The words “long term care” usually bring to mind images of nursing homes and elderly people living in them who can no longer care for themselves. In truth, long-term care (LTC) comes in many different forms, is provided in many different settings, and can refer to people of all ages.

In 2008, the average annual cost of a stay in a private room in a nursing home was more than $76,000. A stay in an assisted living facility was $35,628. Yet the majority of long-term care services aren’t paid for at all. They are provided by 52 million unpaid caregivers – primarily family members and friends of those needing the care.

According to the Alliance for Health Reform, two-thirds of Americans age 65 will need some type of long term care in their lifetimes. For those who do not have family members to provide it, or those who do not want to be a burden financially (or emotionally) on their relatives, the out-of-pocket cost can be substantial. These costs vary widely from region to region, ranging from $25 per day to $500 per day, with the highest rates in the Northeast, Texas, and Florida. The average cost of a nursing home here in Florida is near $140 per day.  With the average stay in a LTC facility being two and a half years, that adds up to $127,700.

The question that needs to be addressed is whether someone has enough income or assets to handle these costs over time.  Typically, a senior’s income will not cover the costs, but their savings may be enough to handle the expenses. Unfortunately, however, there is no way for anyone to estimate the total of their future LTC expenses.

In making these decisions, one should consider all of the options. Many elderly people who do not have the assets to sustain the high costs of LTC may eventually qualify for Medicaid assistance. In order to qualify, though, they will have to spend down their own assets first before Medicaid steps in. Medicaid accounts for 49% of the total spending towards LTC in America. Another option is to purchase a Long Term Care insurance policy. These policies can be expensive, with costs varying greatly depending on the age and medical history of the insured. But the cost of these polices pale in comparison to the out-of-pocket potential of using one’s own assets. Before making any decision, it is a good idea to sit with a state licensed insurance agent to estimate the cost of a policy. This may be the agent who sold you your life or auto policy, or you may need to find a specialist. Either way, be sure the person fully understands your needs and is active enough to be selling at least a dozen policies a year.

In 1987, the Robert Wood Johnson Foundation initiated the Program to Promote Long-Term Care Insurance for the Elderly. This program is available in eighteen states, including Florida. The program involves a partnership between Medicaid and private LTC insurance.  It allows nursing home patients with state-approved long-term care insurance policies to be eligible for Medicaid with substantially higher levels of assets than are normally allowed. This would permit them to receive nursing care but still have enough to live on and to bequeath to their children.

Whatever decision you make, you may want to make it sooner rather than waiting. The cost of an insurance policy is partly based on age, but you will also want to make arrangements with friends or family members should you choose to “self-insure” or to receive care from a relative. It’s never easy to discuss or think about, but definitely needs to be addressed before it’s too late.

The operators of three separate assisted living facilities in Florida have been arrested, all on charges of operating without licenses. One of the arrests was in Volusia County, the others in Duval County.

In Volusia, officers from the state’s Medicaid Fraud Control Unit arrested Marjorie Nelson, owner and operator of Helping Hands Manor I and II in Edgewater. According to the Attorney General’s office, Nelson told investigators she had not licensed the second location because upgrading the septic system and fire suppression systems would cost too much. Those upgrades were necessary to qualify for a license. Nelson is charged with operating an unlicensed assisted living facility, a third-degree felony. If convicted, she faces up to five years in prison and a $5,000 fine.

In Duval County, officers arrested Tommy Teague and Roberto Gallegos on charges of operating an unlicensed facility at 2198 Mossbrook Court in Jacksonville. Teague and Gallegos face third-degree felony charges and could each face up to five years in prison if convicted.

At the third facility, Medicaid fraud investigators determined through a routine spot-check that Torina Brooks had exceeded the capacity of her licensed facility, Pauline’s House in Jacksonville. Brooks placed the extra clients in an unlicensed facility across the street and requested Medicaid reimbursement for their care. She faces one count of operating and/or maintaining an assisted living facility without a license, one count of Medicaid fraud and one count of grand theft, all third-degree felonies, and could face up to 15 years if convicted of all charges.

To legally and properly operate an assisted living facility in the state of Florida, there are various administrative and operational requirements which must be met. These include licensing procedures, staffing requirements, compliance with county health and local fire authority regulations and the safe management of medication by trained staff personnel.

For a searchable database of licensed assisted living facilities throughout Florida, visit Florida Senior Living Advisor. Licensing status can change, so be sure to ask for proof of licensure when visiting a facility. For more information on the Florida’s licensing process for senior living facilities, visit the Florida Agency for Health Care Administration (AHCA).

The nationally renowned advocacy group, Americas Watchdog, has created the Nursing Home Complaint Center to draw attention to senior citizens suffering wrongful death, abuse and neglect. America’s Watchdog describes itself as a “National Advocacy Group for Consumer Protection and Corporate Fair Play.” It’s the same group that has been helping to lead the charge against allegedly toxic Chinese drywall. They have also received attention for their Mortgage Inspection Service, intended to keep consumers from being cheated or overcharged when they finance or refinance their home.

According to America’s Watchdog,”once our legal team is in place, the Nursing Home Complaint Center will focus weekly press releases on elder abuse, Medicare or Medicaid fraud, Class Actions, or Wage and Hour investigations.”

They are interested in the following issues:

• Nursing homes not providing patients with minimum time per day.
• Nursing homes over billing Medicare for testing that was never done.
• Nursing homes not changing patients for a 24 hour period of time. (the patient then gets septic infections and then they often die)
• Nursing-home care firms that, instead of sending an actual nurse, send a undocumented worker to spend the day with the patient.
• Nursing homes not paying overtime to their employees, or abiding by fair labor laws.
• Possible class issues related to standard of care, drug costs, testing schemes, etc.

I will be interested to see what develops from this group. Unfortunately, I suspect they won’t have any trouble finding complaints against nursing homes to try to splash all over the evening news. Certainly there are many wonderful nursing homes throughout Florida and the entire country that are providing quality care and service to patients. But I also think that in many of these facilities, employees are overworked, underpaid and not monitored closely enough. Maybe just the creation of this complaint center will be enough to get some nursing homes to pay closer attention to safety, quality and customer service.

We’ll see. I’ll report back as I learn of updates from America’s Watchdog.

If you are trying to select a Florida nursing home for yourself or a loved one, here is an information-packed website that you will want to check out – www.medicare.gov/NHcompare/Home.asp

This is the federal government’s Medicare website. One of the most useful tools they provide is their Nursing Home Compare database. This tool has a Five-Star Quality Rating System about every Medicare and Medicaid-certified nursing home in Florida and throughout the country. There are 677 Florida nursing homes in the database.

Here is a description of the rating system for nursing homes from the website:
The Five-Star Quality Rating System helps consumers, their families, and caregivers compare nursing homes more easily and to help identify areas about which you may want to ask questions.

The Nursing Home Compare Web site now features a quality rating system that gives each nursing home a rating of between 1 and 5 stars.  Nursing homes with 5 stars are considered to have much above average quality and nursing homes with 1 star are considered to have quality much below average.  There is one Overall 5-star rating for each nursing home, and a separate rating for each of the following three sources of information:

Health Inspections – The health inspection rating contains information from the last 3 years of onsite inspections, including both standard surveys and any complaint surveys.  This information is gathered by individuals who go onsite to the nursing home and follow a specific process to determine the extent to which a nursing home has met Medicare’s minimum quality requirements.  The most recent survey findings are weighted more than the prior two years.  More than 200,000 onsite reviews are used in the health inspection scoring nationally.

Staffing – The staffing rating has information about the number of hours of care on average provided to each resident each day by nursing staff.  This rating considers differences in the level of need of care of residents in different nursing homes.  For example, a nursing home with residents who had more severe needs would be expected to have more nursing staff than a nursing home where the resident needs were not as high.

Quality Measures (QMs) – The quality measure rating has information on 10 different physical and clinical measures for nursing home residents – for example, the prevalence of pressure sores or changes to resident’s mobility.  This information is collected by the nursing home for all residents.  The QMs offer information about how well nursing homes are caring for their residents’ physical and clinical needs.  More than 12 million assessments of the conditions of nursing home residents are used in the Five-Star rating system.

On the Web site people will be able to arrange the order of the nursing homes according to any of the three aspects above, as well as an overall quality rating based on those three sources of information.