Archive for the ‘ Medicare ’ Category

In-home care services












Caring for our loved ones when they have a chronic condition, when they require extra attention as a result of advanced aging or when a family caregiver needs respite can lead us to consider hiring home care help. How do we select home care help and make sure that our loved ones will continue to receive compassionate, respectful and appropriate care?

Carol Marak, an older adult and family caregiver advocate, shares some tips to help families find and select competent and supportive home care.

Thank you, Carol, for your great tips!



How to Select Home Care Help

Adult children and seniors must learn how to read the ratings of home care agencies prior to hiring a home helper.

The CMS, Centers for Medicare and Medicaid Services, created the Five-Star Quality Rating System to guide consumers when comparing and selecting a home care agency.

Most states do not require home care agencies to have a license or to receive certification. But if a home care agency offers home health, like nursing care, then the company must follow applicable laws, regulations, and state compliance issues.

Even though you’re hiring for in-home care and not home health care, CMS suggests that consumers should follow the same requirements and ask questions designed for the Five-Star Quality Rating System. Learn how Medicare measures the quality of data. 


Check the Qualifications of the Caregiver Agency

Here’s a list of the questions to ask a home care agency when you are ready to hire a professional caregiver.

1.  Does the agency have a state license? If one exists, request to read and review it.

2.  Does Medicare approve and certify the home care firm? Remember, only home health care agencies, the ones offering nursing care, will receive Medicare certification.

3.  How does the care company hire and screen the staff?

4.  Ask for client references. Ask for a list of physicians, discharge planners, and geriatric care managers who have worked with the agency.

5.  Ask health care professionals, family members and friends for professional caregiving recommendations.

6.  How does the care company train the caregivers?

7.  Does the agency staff receive continuing education? If so, what kind of training?

8.  Are the staff supervised? By whom?

9.  What factors evaluate the home care helper?

10.  What is the improvement program?

11.  Do the agency’s employees seem friendly and helpful? Make sure you feel comfortable with the agency’s representatives.


Caregiver Training










Questions to Ask about the Caregiver

1.  Does the caregiver/home helper have a proper attitude?

2.  Is the home help aide friendly?

3.  Are you comfortable with the caregiver?

4.  Is the care aide certified?

5.  Is the caregiver insured?

6.  Does the assistant receive ongoing training? If so, what kind and what topics?

7.  Does the helper receive continuing education?


Types of Services Given by a Home Care Company

1.  Will you receive a written care plan before service begins? Make sure the doctor gets involved.

2.  Obtain a copy of the patient’s bill of rights.

3.  Will a nutritionist, dietitian, counselor, therapist or another specialist be referred if needed?

4.  How does the care provider include your family members and health care providers?

5.  Are limits set on the types of tasks performed?

6.  When will service be provided? Is care available round-the-clock, when needed?

7.  What procedures are in place for emergencies?

8.  How are problems addressed and resolved?

9.  Whom can you contact with requests, questions or complaints?

10.  When can services begin?

After you hire a home care company, stay on top of the services they give and monitor closely. If concerned, discuss it immediately with the agency or home health aide.


About the author

Carol Marak is a contributor for the senior living and health care market. She advocates older adults and family caregivers by writing on tough topics like chronic issues, senior care and housing. Find her work at and and contact Carol on LinkedIn and


When the clock is ticking away and your list of tasks has barely shortened despite the fact that you’ve actually checked several of them off… Or when a particular job has taken much longer than expected and left you with no time to take care of the rest… it may be time to consider hiring some caregiving help.

Stephanie Lynch, from How Much Is It, provides some useful cost-cutting tips for us to consider as we look into the possibility of hiring a caregiver.

Thank you, Stephanie, for contributing this article!



Caregiver Costs:  Factors to Consider

Hiring a new caregiver is no easy task.  This person or company is going to be responsible for one of your loved ones.  He or she is going to provide 24/7 support when you’re not around.  So if you’re thinking about hiring one, you may be wondering what the costs are.

To help break things down, let’s explore what caregivers can do, the ways to pay and what the factors are.


Factors That Affect The Price

With any service, there are going to be a lot of factors that can affect the price.  Caregiving will be no exception.  Some of the major factors that increase the price tag can include your geographical location, what kind of accommodations are required and the hours that person has to work.

When all of these factors come into play, most caregivers will make anywhere from as little as $500 to as much as $3,000 per week.  While this range can be large, let’s explain some scenarios.

Scenario #1:  Let’s say that you need a caregiver to come in for eight hours every day of the week to bathe, do some light chores and make sure everything is in order.  If this caregiver were to make $15 per hour, he or she would make close to $900 per week.

Scneario #2:  Let’s take the same scenario mentioned above, but let’s say that the same person has to stay 24/7 — basically a live-in caregiver.  Taking the same exact salary of $15 per hour, the costs can come close to $2,500 per week.  So as you can see, when the caregiver has to live in with the resident, the costs can get extremely close to that $3,000 range.

When hiring a caregiver, it can either be done via two common ways:  either by an individual or by a company.  Most companies will charge more than $20 per hour and usually pay their workers around $10 per hour.  If you were to hire an individual, most experienced caregivers will command an average of $15 to $30 per hour.  Again, this will depend on the factors mentioned above.


What Will They Do?

The word “care” is within the word caregiver for a reason.  Aside from caring for your loved one, caregivers are also expected to do the following:

– Housekeeping and smaller repairs

– Transportation to doctor’s appointments, activities, etc.

– Preparing meals

– Making sure medication is taken

– Daily activities such as bathing, dressing, brushing teeth, etc.

TIP:  All caregivers will have their own pricing structure.  Before hiring any caregiver, always make sure that you know what they are going to be able to do for you.  Some caregivers will strictly work within the home, while others will be able to drive to appointments and so forth.


How to Save

The prices above are high enough to scare anyone away!  If you’re still focused on a caregiver, but want to save money, here are some things to consider:

Negotiate:  See if you can lower the price.  In return, the caregiver may state that he or she won’t do certain chores.  This may be worth it.

Don’t Overpay:  Always make sure that you get at least five to ten quotes before proceeding.  NEVER settle on the first person you come across.  That extra $5 per hour can make a huge difference.

Discounts:  Many caregivers and companies will provide discounts to those who pay cash up front.  If you can afford it, explore your cash discount options.

Explore Discounts:  Check with local senior centers that offer free subsidies to those who qualify.


Ways to Pay

If you can’t set aside time to take care of someone, you may be exploring options if you can’t afford the cash payments.  Thankfully, there are some ways to pay:

Medicare:  Medicare will reimburse up to 100 days at a nursing home.  However, it won’t cover long-term needs.

Long-term Insurance:  If your loved one has a long-term insurance policy — which is possible — be sure to check with the company.  Every insurance company will vary with their regulations and payments.  If you’re just preparing for the future, it isn’t too late to consider this type of policy.

Veteran’s Aid:  War veterans are able to tap into a plan known as the “Veteran’s Aid and Attendance” benefit.  This benefit will provide assistance to private caregivers.

Medicaid:  Unlike Medicare, Medicaid can provide low-income seniors with long-term care assistance.  Every state will have different qualifications.  Refer to your local state for Medicaid requirements.



About the author

Stephanie Lynch is from How Much Is It — a collection of more than 3,500 cost helping guides.  So if you want to find more cost helping guides, such as this one, be sure to bookmark her resource!


Welcome to FIRE IN THE HOUSE! – a reality show that takes an inside look at life with CRPS.  Complex Regional Pain Syndrome is a dysfunction of the central nervous system.  Its cause is unknown.  There is no cure as of yet. Treatments are inconsistently successful.  It causes nerves to become hypersensitive to the environment, overreacting to stimuli by perceiving extraordinary pain or misinterpreted sensations.  At times and as CRPS progresses, it can lead to permanent damage to skin, bones, muscles and even internal organs.  As a result, mobility becomes difficult or limited, and severe pain can spread to other parts of the body. [CRPS Fact Sheet, NINDS]

Symptoms of CRPS include:

  • intense burning pain that worsens or spreads
  • profuse sweating
  • skin changes – color, dryness, temperature, texture
  • thickened nails
  • limited mobility due to stiffness or pain

Some people experience flare-ups that subside in time. Others, like my husband, get flare-ups that remain and become the “new normal” level of pain.


Why should people watch this show?  Because with awareness, they can learn the early symptoms and try to find a treatment that works.  Some research states that early diagnosis and treatment increase the chance of stopping CRPS’s progression.  Through awareness, we also hope that researchers and those who fund research will take an interest in finding a cure for this crippling form of endless torture.

Getting an inside look at living with CRPS can round out the “invisible” aspect of this painful disease.  Some people, including doctors and family members, don’t believe patients really experience the inordinate level of pain that they say they have.  “It’s all in your head” or “You’re exaggerating!” they are told.  Often, patients look fine until the pain makes them cringe in agony or physical changes become obvious.  These can be skin peeling, reddening or turning purple-gray; swelling or spasms taking place.

This reality show would expose yet another “invisible” side effect of CRPS: depression.  Many CRPS patients consider suicide as a preferable alternative to spending the rest of their life in unspeakable pain.

You won’t want to miss FIRE IN THE HOUSE!




PATIENT – in this case, my husband is the star of the show.  A kind and quiet man with a brilliant mind, a PhD in Economics.  He is homebound, suffers from brain fog, which makes him forgetful and unfocused.  The intolerable pain keeps him at home, for vibrations intensify his pain and walking 10 feet is exhausting.

DOCTOR – makes house calls and monitors his vital signs, medications and mental well-being.

NEUROLOGIST – oversees his medications and is ever-vigilant for new research that may help relieve the pain.

OXYGEN PROVIDER – supplies the oxygen machine that helps treat sleep apnea.

OCCASIONAL MEDICAL STAFF – they make house calls to do blood work, take X-rays, perform oxygen testing or whatever else the doctors order.

PHARMACIST – fills meds monthly and resolves any insurance coverage issues that sporadically arise.

MEDICARE & BLUE MEDICARE Rx – provide health insurance and cover doctors and meds every month. They are amazing and have provided the care that my husband needs in a professional, timely and compassionate manner.  The system has worked for us!

SOCIAL SECURITY – provides benefits upon disability and has been efficient and professional. We are grateful.

CAREGIVER / WIFE / EVENT PLANNER – I oversee my husband’s care, schedule appointments, pick up meds, resolve any and all issues regarding insurance, keep house and advocate for him.

DAUGHTER – Senior in high school, amazing person, crushed to see her father suffer so much and sad that he can no longer attend her theater performances or award ceremonies for her academic recognition.  Notices other friends have fathers present at events…



A recliner in a home in the suburbs with a huge window to catch the sunrise.

(Because hubby’s feet must be elevated at all times due to very poor circulation, a recliner lets him rest comfortably with his feet up.)



SOCIAL SECURITY DISABILITY BENEFITS APPROVAL – filling out forms, explaining in detail the disability and why it keeps my husband from working.  (Thankfully, approved!)  A saga in itself!

COPING WITH PAIN LIKE NO OTHER – what do you do when the pain doesn’t end but only gets worse?

PREDICTABLE UNPREDICTABILITY – just like change is the only constant, CRPS presents all sorts of “symptoms” that come and go at random.  These include inability to focus, not knowing what day it is, idiopathic fevers, aches, itching, weakness, peaches tasting like garlic, foods tasting fishy / offensive, muscle cramps, intense pressure, feeling like bones are being bent / crushed…

DISABILITY STEALS YOUR DREAMS – accepting disability is difficult but necessary.  We have adjusted our plans and dreams.

CREATING A NEW LIFE – out with the old, in with the new!  Exploring ways to make things work now.  Finding ways to cope and making the best of the situation.

LOVE LOVE LOVE – we are blessed to have it!  Life is about people – let’s be kind to each other.  Let us not just talk about love and charity; let them be evident in our actions!



New caregiving links below have info on finding home care, hospice, reminders to take medications on time and even a mobility device that lets paraplegics walk despite atrophied legs!


OnTimeRx   –  reminders to take your medications on time

Depend One   –  personal medical alert system

ReWalk     –  mobility device for paraplegics

Sensory Swim    –  special needs swim lessons

Enabled Kids    –  enabling children with neurological disorders

Mountain West Chiropractic    –  chiropractic care to restore health

Hospice Palliative Care Ontario    –  info on hospice palliative care in Ontario

Practical Assisted Living Solutions    –  modular home additions for seniors or handicapped persons

AVM Survivors    –  support & community for AVM survivors

Rare Genomics Institute    –  funding research of rare diseases

Fight Conquer Cure    –  Cancer Research Fund for adolescents & young adults

Cancer Center    –  patient-centered cancer treatment

Medicare Wire    –  Medicare news, blogs, benefits



Passing along lots of useful links that can help your caregiving!  Please browse the lists below and visit the websites to find plenty of good resources, tips and inspiration to make your day more manageable.



Inspire – online health & wellness communities for patients & caregivers

Groups@Care – join / form groups with similar interests

Caregiver Stress – caregiving topics, expert advice, self-care

Laughing with Mary Maxwell – humor, quick wit about life

Mary Ann Liebert Publishers – information on science, technology, medicine

Arleen Alleman – author, fiction




aQuire Training Solutions – online training courses, Alz & memory care training courses

Wheelmap – map of wheelchair accessibility around the world

Care Conscious – Educating, preparing family caregivers




Rankings & Research – rates hospitals, nursing homes, health plans, diets, doctors – national clearinghouse

Home Care Generations – home care help in Phoenix, AZ

Golden Touch Caregivers – non-medical home care

Ethos – coordination, delivery of home & community-based care

Visiting Nurse Service of NY – home health care services in NY

Brooke’s Home Care – non-medical home care; Ontario, Canada

Community Connections TimeBank – share talents to help others, get favor back in return, free

Easier Living – medical products, services for home, tips

The Easier Living Blog – help manage day to day

Elders Resource LLC – help with Medicare, locating benefits, filling out forms

CarePlanners – navigate healthcare system, coordinating care for self & family; understand Medicare, insurance, diagnosis

Chamber of Hope – free Oxygen (mHBOT) for sick children, Tampa Bay, FL

AAHCP – directory of doctors who make house calls


Medicare Proposals an Improvement?

Medicare has been a highly debated topic during the last year, mainly in the search for ways to cut government costs in order to balance the federal budget.  While I’m not particularly politically inclined, discussions about altering Social Security or Medicare get my full attention since my husband enrolled in them as a result of his disability.  Medicare is his only health insurance policy, as no one else would cover his illness thanks to the pre-existing condition exclusion that remains in place for adults until 2014.  At least President Obama’s Healthcare Reform changed that right away for beneficiaries under 18 years of age.  The rest of us will have to accept the lack of coverage for a couple more years.

Considered “almost sacred,” according to some reporters, Medicare or Social Security are not usually probable candidates for much tampering.  So last year, efforts by some politicians to revamp Medicare in order to bring the federal budget back down to Earth raised a lot of political temperatures.  By mid-December, a reworked proposal containing parts of earlier efforts was laid on the table for discussion.  Let’s see if this version fixes the budget.  What I’d like to know is will it make Medicare better?

If anyone is going to restructure or “fix” Medicare, I would hope that it would be an earnest effort to improve it, not to be used as a stepping stone with an ulterior financial motive.  Too many beneficiaries rely on it for their healthcare and financial security.  What recourse would they have without it or with reduced coverage?

I have to say that our experience with both Social Security and Medicare has been excellent.  Although we have heard stories to the contrary, each agency has taken care of our family’s benefits with utmost professionalism and efficiency.  The only thing that we would suggest is to do away with that “Donut Hole,” but President Obama has already taken care of that!

Remember that you have a voice in choosing a representative who will look out for your best interests: VOTE!


GOP Medicare Proposal Doesn’t Work Like Members of Congress’s Health Care as Republicans Claim

The Inherent Flaws in Medicare Premium Support

Democrat Ron Wyden and Republican Paul Ryan Propose Overhaul of Medicare

What is the Donut Hole?

The President’s Budget for Fiscal 2012



Obama Administration Announces $749 Million to Fund Housing for Very Low-Income Seniors and Persons with Disabilities

“The U.S. Department of Housing and Urban Development (HUD) is providing $749 million in housing assistance grants to help nonprofit organizations deliver accessible housing, rental assistance and supportive services for the elderly and persons with disabilities. HUD’s Sections 202 and 811 Supportive Housing programs will kick start construction or major rehabilitation on housing developments in 41 states and Puerto Rico. Find out about rental assistance by contacting your local HUD office.”  Read more

Housing Vouchers and Public Housing tweets about benefits and housing every Monday



Social Security Launches New Spanish Online Services at:    Seguro Social

“Michael J. Astrue, Commissioner of Social Security, announced that the agency’s most popular online services, the applications for retirement and Medicare and for Extra Help with Medicare prescription drug costs, are now available in Spanish.  The new online services are available at, the robust Spanish version of Social Security’s award winning website,”

Seguro Social




Low-Cost Broadband and Computers for Students and Families

By: Josh Gottheimer and Jordan Usdan, Chairman’s Office

November 10, 2011


FCC Chairman Genachowski announced in Washington, DC an effort to bring broadband and computers to low-income families through a new non-profit initiative called “Connect to Compete.”

This project will begin in selected cities in the spring of 2012 and spread to the entire country by September 2012.  Read more


November for me is a month of giving thanks.  One day is not enough to call to mind all our blessings – friends, family, good neighbors, good times, home, comforts, freedom, opportunity, happiness, good health…  This year, I have added 2 more: House Call Doctors and Encompass Home Health.  My husband’s list of things for which to be grateful has been shortened by one: his good health is gone.  And yet, both of us realize that he could be worse.  CRPS has left him homebound and unable to continue his trips to his doctors’ offices, which prompted me to find medical care at home.

Dr. Jaynes from House Call Doctors

Dr. Jaynes from House Call Doctors checks on my husband at home!

House Call Doctors are just that: doctors who visit patients in their home.  After contacting them to find out about their services, all they needed was my go-ahead to begin visits.  They took my husband’s insurance information, verified it, informed me of payment arrangements and we were set.  My husband happens to have Medicare, but House Call Doctors also accepts private insurance and offers self-pay programs for patients without insurance.  I scheduled an appointment for the following week and looked forward to our first house call – so simple!

RN Cindy from Encompass Home Health

RN Cindy from Encompass Home Health monitors my husband at home!

Two doctors have visited my husband and both have been professional, compassionate and personable.  Armed with smart phones, they can access the patient’s medical records as needed.  They also issue orders for the appropriate medical services when additional tests or procedures are needed at home.  X-rays, blood work and oxygen have all been done or administered here.  Between doctor’s visits, nurses from Encompass Home Health have assessed or checked on my husband and advised him on nutrition, caring for his delicate skin and other medical concerns.  They have been courteous, respectful, knowledgeable, supportive and ever so nice!  It’s wonderful to see such team work!  I am touched by everyone’s interest in taking good care of my husband and for a change, I can step back and let them do the caregiving (for a little bit)!

If you know someone who is too unwell to travel to receive medical care, House Call Doctors or Encompass Home Health may be what you need.



House Call Doctors

Encompass Home Health


Long-term health care dropped

Obama drops long-term health care program

From Scott Poerry, CNN Senior Producer

Friday, October 14, 2011


Health and Human Services Secretary Kathleen Sebelius canceled the Community Living Assistance Services and Support [CLASS] Act after searching for 19 months for a way to fiscally maintain it.

She wrote in a letter to Congress, “Despite our best analytical efforts, I do not see a viable path forward for CLASS implementation at this time.”

Long-term care encompasses a broad range of services, including personal or home health aides, assisted living accommodations and nursing homes.  To determine what type of service is needed, it’s necessary to look at the present needs of the care recipient and to consider things like:

  • medical or physical assistance needed
  • affordability
  • what is available nearby
  • how does the caree or family like those facilities
  • is this facility good
  • how does this facility compare with others

Fortunately, Medicare offers a service that compares all of its approved facilities:


US Administration on Aging also has a service to help find facilities:


Certainly not a popular topic, especially among younger adults, long-term care is an important subject to discuss early on.  Once an illness or disability hits, it is much harder to address, as the need to find proper care is more urgent.  Long-term care insurance companies cover nursing homes and other services, but do check into their coverage of pre-existing or future conditions.  Consider also their cost.

Compare Cost of Care Across the US

Medicaid and Medicare have limited coverage for long-term care, usually only after an injury and if medically necessary.  Medicare will not cover non-medical services.

Personally, I am saddened to hear that the CLASS Act was dropped.  While I understand that it is not financially viable now, I hope that Health and Human Services continues to explore ways to make it so.  It is a service that would well serve many ill, disabled or elderly persons who have little choice but to pay high premiums to private carriers or to go without.  It would be great if both our government AND insurance companies offered an option to address care in the advanced stages of many conditions or in our own autumn years.  You just cannot predict what lies ahead sometimes.  We definitely never saw my husband’s disability coming.



Long-term care: Early planning pays off

The National Long-Term Care Ombudsman Resource Center is a federal government website that provides information on disability-related laws, benefits, programs and services.  Its aim is to connect people with disabilities, their family, caregivers, Veterans, employers, service providers and others with needed resources in order to ensure their participation in the workplace and in the community.

Many people have pre-existing conditions, which health insurance carriers often do not cover for the initial 6 months or longer under a new policy.  A Pre-Existing Condition Insurance Plan (PCIP) addresses this issue.



YouTube Video About Pre-Existing Condition Insurance Plan (PCIP)

“This video from the Centers for Medicare & Medicaid Services presents an overview of the PCIP online application, information about what to expect, and what information you should have on hand when you are ready to apply online. PCIP makes health insurance available to people who have had a problem getting insurance due to a pre-existing condition. Find out if there’s a PCIP in available in your state.”

This information was recently added to

To learn more visit Finding Health Care