Bruce was shocked, but he soon realized that his father had not been managing any of the couple’s finances. “We discovered that my dad hadn’t been paying my mother’s Medicare premiums since May 2010, and the medical bills were piling up,” Bruce said.

It can be difficult to choose the right medicare plan for you and your loved ones

By Ross Blair

The 43 million caregivers in the U.S. — people who provide unpaid care to family members or friends age 50 and older — are overworked and need help. Here’s why:

26 million of these caregivers hold down fulltime jobs and care of the older person in their spare time.
27 million of them also manage the older person’s finances, which includes helping them decipher their Medicare options.

With five parts to Medicare; 10 different Supplement plans: a multitude of Part C (Advantage) options, from drug coverage to networks to out-of-pocket limits; and increasing prescription drug costs, navigating the Medicare maze is a daunting task to an overburdened caregiver.

The Caregiver Medicare tips below offer help. They were developed by Ross Blair, CEO of Plan Prescriber, a provider of comparison tools and educational materials for Medicare-related insurance products. These tips answer common questions and help caregivers choose the Medicare plan that meets both the health and financial needs of their loved one.

1. Manage Timelines Effectively: Medicare eligibility begins for U.S. citizens and legal residents when they turn 65. A person has a seven-month initial enrollment period that begins three months before their birthday month and ends three months after. During this initial enrollment period, a person can enroll in Original Medicare (Parts A&B), a prescription drug plan (Medicare Part D) or a Medicare Advantage plan.

If you want to enroll in a medigap (Medicare supplement insurance) policy, the open-enrollment period starts the first month the person is both 65 and enrolled in Part B, and lasts for 6 months. During that 6-month medigap enrollment period, a person has a guaranteed right to buy any medigap policy sold in their state.

2. Avoid Late Enrollment: Those who enroll late in Original Medicare (Parts A & B) or a Medicare prescription drug plan (Part D) can incur permanent late penalties. Anyone who isn’t working, doesn’t have insurance from an employer or lives abroad should plan to enroll in Medicare at age 65.

People on Medicare who have a gap in their creditable prescription drug coverage for more than 63 continuous days will also have to pay a late-enrollment penalty for their prescription drug benefit (Medicare Part D).

3. Don’t Expect a Notification: If the person you’re caring for began receiving their Social Security benefits before age 65, they don’t have to apply for Original Medicare when they turn 65.  But, nobody else should expect to receive a notice from Medicare when they turn 65. Medicare puts the responsibility on the individual senior to begin the enrollment process.

4. Know Your Loved One’s Prescription Drugs: Compile a list of the future Medicare beneficiary’s current prescription drugs: names, dosages and required frequency of use. Then use the prescription drug plan comparison tool at PlanPrescriber.com to:

- Find out if the drugs on your list are generic or available in generic form. If a generic drug is available, ask the Medicare beneficiary’s primary doctor if it makes sense to switch from a to a lower-cost generic alternative.

5. Obtain Consent: If you are a caregiver for your parents and are meeting with their doctor to discuss their health and treatment plan without them, make sure your parents sign a consent form so their doctor will be able to legally discuss their medical and coverage needs with you.

6. Take Care of Yourself: Preserving your own health is just as important as caring for someone else’s. Take control of your own life by balancing caregiving with personal needs. Take time to nurture your interests and tend to your health. Know the Caregiver’s bill of rights.

7. Beware of Fraud: Identify and report any Medicare fraud, abuse or scams. To be on the lookout, carefully review the ‘Explanation of Benefits’ statements received for all regular Medicare and Part D services. Review bills from all providers to make sure you are paying for only the services or equipment the Medicare beneficiary received. Be careful about giving out any personal information (your own or your loved one’s) to individuals or organizations. There is a helpful section on fraud and specific tips to avoid fraud at www.Medicare.gov.

8. Don’t Overlook Legal Matters: At a certain point, it may be advisable for your loved one to grant you or another family member a Durable Power of Attorney that includes the ability to make decisions relating to your loved one’s healthcare. Discuss who will take on this important responsibility and if there are specific medical preferences or directives that your loved one has requested. You don’t want to make these types of decisions in the middle of a health crisis. Also, make sure your loved one has a Living Will or Advanced Healthcare Directive.

9. See if You Qualify for Financial Assistance: If you provide unpaid care for a family member or friend, it might be possible for you to get a small but regular payment for your work. If the person you’re caring for is eligible for Medicaid, a program called “Cash and Counseling” might be available in your state. Call Medicaid or visit http://www.cms.gov/home/medicaid.asp to find out.

The same holds true if the person you are caring for has long-term care insurance that includes home care coverage. Call the insurer to ask about this benefit and any possible restrictions.

Additional Resources
You may be able to get Extra Help to pay for your or your loved one’s prescription drug premiums and costs. For more information on Extra Help, you can contact:

- PlanPrescriber.com at 800-404-6968

- Medicare at 1-800-MEDICARE (1800-633-4227). TTY users should call 1-877-486-2048, 24-hours-a-day/ 7-days-a-week;

- Social Security at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call 1-800-325-0778;

- Your Medicaid Office

In general, beneficiaries must use network pharmacies to access their prescription drug benefit, except in non-routine circumstances, and quantity limitations and restrictions may apply.

The Centers for Medicare and Medicaid Services (CMS) has neither reviewed nor endorsed the information provided in this press release.

“I kept making strikes that day,” he said with a laugh. “I went over and showed her and her friend how to score for two strikes in a row.”

Eventually they were put on the same summer league team while Kay became Hal’s personal cheering section as he umpired for baseball games.

And ever since, it has been an uphill ride for the Elys with three children and five grandchildren and five great-grandchildren.

For the couple, retirement could not have come sooner. While he worked as an accountant and she a retirement plan specialist, they looked forward to the extra time they could spend on their favorite activities.

The Elys knew, however, that they would need some help along the way. As they evaluated the different housing options in the SourceBook, they noticed an ad for Senior Supportive Services, Inc.

“It sounded too good to be true,” said Hal. “But we found they really could offer us all the assistance we needed.”

For the past three years, Michael Mastroieni and Jeanette Mastroieni-Cave have helped the couple with their retirement funds, long-term care insurance and income taxes while enabling them to navigate the Medicare system. They were also able to offer expertise on various surrounding retirement communities when the Elys were planning to move.

“They had a lot of experience with different communities and made several suggestions to us,” said Hal. “They’re terrific, very much people-oriented and efficient in what they do.”

With their worries behind them, the Elys are busier than ever. Enjoying the scenic views of their new home, Tel Hai Retirement Community, they are devoting their time to their favorite pastimes: music and baseball. The couple sings in the choir and Kay, who plays the French horn, has started a band within their community. Hal, who helped start the Norristown Community Chorale, works with staff to put on various musical programs while singing for chapel services and at baseball games.

And of course they make sure to spend time with Michael and Jeanette, two individuals they cannot thank enough for helping them find a home and solve their financial questions.

“They are much more like personal friends than associates or advisors,” said Hal. “Or I should say very helpful friends.”

Dr. Bill Thomas argues that this archetype is severely flawed. Joining a strong support network and becoming interdependent, he says, will help seniors live longer, healthier lives and is the answer to the impending eldercare crisis.

“We all have to accept the idea that aging is developmental. We have to understand that people grow old-and that growth is an important part of the process,” says Thomas. An international authority on geriatric medicine and eldercare, Dr. Thomas founded The Eden Alternative, a non-profit organization committed to improving the care received in institutional facilities. The Eden Alternative was born of necessity.

Thomas recalls, “My wife, Jude, and I were working in a nursing home in the early 1990s. Our first-hand experience led to the reform strategy that is the heart of the Eden Alternative.” Years later, Thomas took the strategy one step further. He explains, “We thought, ‘what if we could build a facility from the ground up, instead of trying to work with what was in place?’”

Dr. Thomas started over. He created a new model for nursing homes, and with a team of experts, prepared to build his village. Their efforts resulted in the Green House Project, a philosophy for designing, constructing, and operating long-term care facilities that is a dramatic departure from current standards.

Facility size, interior design and layout, staffing patterns, and the methods for delivering skilled services were all altered in the Green House plans. Homes will be much smaller than the average nursing home, housing only 15-20 residents, and will be more user friendly for both residents and staff members. Green Houses will be licensed as nursing homes, so that residents can receive care regardless of their physical condition, and services will be covered by Medicare.

The Green House Project even redefined staffing procedures for long-term care facilities. Green House staff members are trained shabazi, professionals who work to enhance the lives of the elders they serve. Thomas points out, “Our Shabazim are unique. They are trained in nursing, housekeeping, culinary arts, shared decision making, and teamwork.”

Dr. Thomas goes on to explain how the Green House Project did away with the departmental model so prevalent in nursing homes, in favor of an environment that fosters team work. “There is no boss or administrator in a Green House. R.N.s visit with patients on a regular basis to meet their medical needs, but the Shabazim take care of creating and maintaining a healthy ‘rhythm of daily life.’ They work as a team, and they feel like a team, and they really know the residents,” he says.

The pilot Green House was opened in Tupelo, MS in 2003. The home, called Green Houses at Traceway, has been deemed a success by its residents, staff members, and by industry professionals. Rosalie Kane, of the University of Minnesota, did a two year study on the Green House. Thomas notes, “Her evaluation showed better clinical outcomes, better staff and elder satisfaction, and proved that the Green Houses were financially viable, that they can be operated with the same amount it takes to run a nursing home in Mississippi.”

The positive outcome of the study led to the decision of the Robert Wood Johnson Foundation to provide an endowment for the program. The ten million dollar grant will result in the creation of Green Houses in all fifty states.

“America is loaded with nursing homes that are aging faster than the people in them. We have to decide whether or not we are going to rebuild them-or if we are going to choose to build something different in their place,” Thomas says. He feels confident that America is prepared for a change. He states, “I’ll make a bold prediction: Someday America will have 100,000 Green Houses, and there will be one million Shabazim.”

Not satisfied to focus only on seniors in need of high levels of assistance, Dr. Thomas has recently shifted his attention to active adults and independent seniors. He is attempting to create the interdependent environment fostered in Green Houses in communities that are mixed-use and made up of mixed-age residents. He calls these communities EldershiresT. EldershireT communities promote the idea that health and well-being are tied closely to the nature and quality of the community that surrounds us. Better communities are the surest path to a better quality of life.

EldershireT is based loosely on the Danish concept of co-housing. In the 1950s, the Danish government began to construct co-housing communities, developments of small homes built close together with several common areas among them. These planned communities foster connections among neighbors and offer distinct environmental and social benefits. In recent years, co-housing developments have begun to catch on in America.

Playing off the uniqueness and success of co-housing communities, Dr. Thomas and his team began planning EldershireT communities. EldershiresT are unique in their “focus on the value and worth of aging citizens as an important building block of a healthy community,” according to Thomas. He continues, “So much of what we hear about aging revolves around how awful it is and how terribly expensive it can be. We are saying that aging is an importation cornerstone of any community and that elders are a vital resource.” Dr. Thomas and his wife are in the process of planning the pilot community in Upstate New York.

The inspiration for EldershireT was to create a viable alternative to what Dr. Thomas terms the “aging in place paradigm.” He explains, “Today, aging in place is the Holy Grail; it is perfection. Seniors strive to remain independent in their own homes even if it means being lonely, isolated, or possibly in danger.”

Anything less than living independently, he says, “is seen as a defeat.” While remaining in a long-time home or a familiar environment is the first choice for most seniors, it may be a choice that is detrimental to their health-and the health of their communities. “Where do you think the term ‘shut-in’ came from?,” asks Thomas.

Isolated seniors are robbed of the opportunity to contribute to their community, and their communities, likewise, are denied their knowledge and expertise. EldershireT communities will tap into this resource by allowing seniors to “age in community,” instead of aging in place.

Dr. Thomas firmly believes that living in a supportive community can give individuals the opportunity to remain involved, engaged, and most importantly, interdependent. He concludes, “The number one reason people end up in long-term care facilities is social, not medical. I would argue that every nursing home resident in America has an exact clinical double living at home. It is the social network they have in place, whether that is children, friends, or an entire community, that allows them to live at home.”

If Dr. Thomas’s EldershiresT come to fruition individuals will age in communities and receive necessary support from their friends and neighbors. If care needs become great, residents will turn to home health providers, but until then, they will take care of their own-regardless of their age. They will be caregivers, and they will receive care. They will be comfortable in their dependence on each other. They will grow old, and they will continue to grow. They will be a village.

Dr. Thomas is the author of two books, the critically-acclaimed, What are Old People For? How Elders Will Save the World, and the soon to be released, In the Arms of Elders.

According to a study conducted by Harris Interactive, 37% of Americans aged 62-75 ranked fear of fraud ahead of concern for health crises and terrorism. An estimated five to ten percent of all health care expenses are due to health care fraud. Medicare alone lost more than $16 billion to fraud, abuse, and errors in 2004.

Health care fraud is an intentional deception which often results in an unauthorized Medicare or Medicaid benefit. Providers engaging in fraud will frequently bill for services or supplies that are not provided.

Any practice that is inconsistent with sound medical or business practices is considered abuse. Charging excessive amounts for services, filing claims for unnecessary services, or billing improperly are all incidents of abuse.

SMP is combating these abuses by enlisting the assistance of trained volunteers to work with beneficiaries to prevent, discover, and end fraud. The heart of the SMP program is education. Beneficiaries receive essential information about the prevalence of fraud and abuse and how to stop it.

Nationwide, SMP has over 45,000 trained volunteers and counselors. The program has already reached more than 1.8 million seniors in their communities and has played a role in the recovery or savings of over $103 million.

On the local level, the Virginia Association of Area Agencies on Aging (V4A) administers the SMP program. The association spearheads state-wide SMP outreach initiatives and utilizes the network of 24 Area Agencies on Aging to distribute educational information throughout the state. During a six month period in 2005, the V4A held over 370 educational events throughout the state, reaching nearly 15,000 beneficiaries.

This important effort not only helps seniors avoid losing money or benefits, but it also helps them to avoid the potential illnesses, injuries, and frustrations that can result from working with dishonest providers or utilizing bad equipment. In order to spot fraud and abuse before it occurs, consumers must be vigilant and informed.

Knowing what to look for and how to report suspected violations is the first step toward ending the abuses that are damaging our health care system. Informed consumers are a powerful defense against unnecessary spending and unscrupulous providers.

Medicare or Medicaid beneficiaries who suspect that they have been the victim of fraud or abuse should call 1-800-938-8885 (in Virginia only).

What to look for in a Nursing Care Facility
Before choosing a facility, contact the long-term Care Ombudsman Program of your Area Agency on Aging. Ombudsman programs promote the highest quality of life and care for residents of nursing facilities and can help families and staff with inquiries and complaints.

Tell the ombudsman which facilities you are considering and request any information they have about the facility. Visit prospective facilities at different times of day. Talk with residents and staff members. Be persistent about getting your questions answered.

Entering and Adjusting to Nursing Home Life
Although some people enter a nursing home temporarily for a short-term stay, it is still a sad day for most people and sad feelings are normal. Reassurance from family and friends that love and contact will be maintained can ease the transition. In addition, there are steps to take that may help lessen the trauma of the change:

–Talk about the admission in advance
–Visit the home with the prospective resident beforehand, if possible
–Involve the prospective resident as much as possible in the decision-making
–Describe the home in detail before moving there
–Decide together what items to bring to the nursing home
–Get to know the administration of the nursing home
–Maintain contact with the resident after admission
–Maintain contact with the home after admission
–On the day of admission, be available the entire day to help settle the resident and provide emotional support.

Paying for a Nursing Care Facility
Medicare, Medicaid, private insurance, and personal assets are all used under various circumstances to pay for services in a nursing care facility. If a facility is not certified by Medicare and Medicaid, the care will have to be paid for entirely with personal funds.

In general, Medicare pays for skilled nursing care following hospitalization for the same illness or condition at 100% of the cost for days 1 – 20. However, on days 21 – 100 the Medicare subscriber is responsible for a co-pay. Medicaid, a government program for the indigent, covers nursing home care for individuals who meet strict medical and financial eligibility requirements. Some long-term care insurance pays for nursing home care; insurance payments are usually a fixed amount for a specified number of qualified days. On the subject of buying long-term health care insurance, the National Council on Aging can be helpful, providing practical, objective information on what to look for. Call 1-800-373-4906 and request the “Long-Term Care Insurance” booklet. The cost for the booklet is $14.95 for non-members. Information is also available online: www.ncoa.org.

The “Consumer’s Guide to Nursing Home Contracts,” published by Legal Services of Northern Virginia, Inc., provides additional information and advice on paying for nursing care services. Below is an excerpt from the guide.

What is the Basic Daily Rate?
The basic daily rate is the standard charge the nursing home bills to all residents, which covers the fundamental services every resident receives, including rent for the room, housekeeping, meals, and general nursing care.

It is important to understand all the services and amenities that are not included in the basic daily rate. The fees and charges for “supplemental services” often increase the expense of the nursing home bill dramatically, to the surprise and dismay of the recipient of the bill. Often services expected to be included in the basic daily rate, such as extra nursing services, pharmaceutical needs, and telephone services are extra charges.

Does the basic daily rate include all the nursing care I will need? Probably not. The basic daily rate includes “basic” or “general” nursing services. What is provided with basic or general nursing care may vary from nursing home to nursing home.

But the basic daily rate often does not include many common nursing services. Physical therapy, glucose monitoring, incontinent care, hand or tube feeding, etc. might each involve extra fees. In addition, prescription and non-prescription medicines are not included in the basic daily rate.

How can I avoid being surprised by added costs?
To understand which additional services (and additional costs) a resident will require, the first place to look is the Resident Assessment. This assessment is required by law and analyzes what kind of nursing and other care the resident needs. For example, if the new resident is incontinent, the assessment should indicate this fact.

To get an accurate assessment of the costs, make sure you understand what is covered by the basic daily rate. Then, ask the nursing home representative to discuss the resident assessment and to explain to you what additional nursing and services, beyond what is covered by the basic daily rate, are necessary. The nursing home should give you an itemized list of supplemental services and the costs above the basic daily rate.

Also, decide what additional amenities you want (telephone, beauty care, etc.) and add these costs in. Request an estimate of the total bill. You should have this estimate long before the end of the first month, so that you know exactly what to expect.

Since paying for care in a nursing care facility can be both expensive and confusing, it is a good idea to contact your local department of social services or Area Agency on Aging for more information.

Evaluating Nursing Homes

Use this checklist to judge and compare the nursing homes you call and/or visit.

– Is the facility accepting new patients?
– Does the facility offer skilled nursing care?
– Is the facility Medicare-certified and/or Medicaid-certified?
– Are the home and its current administrator licensed?
– What type of education and training do staff members have? How many Registered Nurses (RNs) and Certified Nursing Assistants (CNAs) are on staff?
– Are background checks conducted on all staff members?
– Is there a care plan developed for every resident?
– Are care plans reviewed and updated by providers and family members?
– Is the interaction between residents and staff members warm and respectful?
– Are public areas and resident rooms clean and comfortable?
– Are there a variety of activities available for residents?
– What is the staff to patient ratio at night and on weekends?
– Do staff members respond to residents requests for assistance promptly?
– Are there enough staff members available to assist residents during meals?
– Does the food in the dining room look and smell appealing?
– Are there handrails in hallways and grab bars in bathrooms?
– Are exits clearly marked?
– Is the facility outfitted with smoke detectors and sprinklers?

Adapted from Medicare’s Nursing Home checklist. For more information, see www.medicare.gov.

Medical supplies and equipment fall into two major categories: medical supplies and durable medical equipment. Medical supplies generally refers to products that are used to make patients more comfortable and need to be replenished on a regular basis. Durable medical equipment includes items that are long-lasting and are generally one-time purchases. Medical supplies and durable medical equipment can be used together or separately to help elderly and disabled individuals maintain their independence and mobility.

Medical Supplies
Medical supply products help individuals cope with and manage the symptoms of illness or old age. Products include specially adapted socks and stockings, protective undergarments, skin care products, cushions and positioners, and many other helpful items. A wide variety of daily living aids are also available to help individuals who need assistance with bathing, dressing, or taking medication. Home health monitors let patients track everything from blood pressure to heart rate. Specialized in-home tests also allow patients to track their blood sugar and cholesterol levels.

Durable Medical Equipment
Durable medical equipment includes items that help elderly or disabled individuals maintain mobility and/or receive necessary care in the comfort of their homes. These products are designed to help those who need extra assistance performing the tasks of daily living. Durable medical equipment products can be broken into two major categories: mobility products and care assistance products.

Mobility products include a wide range of highly advanced equipment to help individuals get around. From Scooters to canes, products are available for every mobility need.

Scooters are available in a range of styles and feature various options to meet individualized needs. Many individuals find outdoor mobility challenging and are searching for a personal mobility vehicle that can help them continue to participate in activities they enjoy. Others need more comprehensive daily assistance. Today’s wide range of scooters are more maneuverable, lighter, and more durable than their older counterparts and can be customized to fit every lifestyle-from that of the active outdoorsman to the individual with decreased mobility who wants to remain independent.

Lift chairs are another popular mobility product. They look like standard recliners but provide assistance with moving from a sitting to a standing position. Most chairs provide settings that allow users to move comfortably and easily from lying, to sitting, to standing.

Stair lifts complete the motorized mobility offerings that are available to help today’s seniors. Stair lifts allow individuals to move from one level of their home to another with ease, eliminating the sometimes dangerous and difficult task of climbing and descending stairs. Stair lifts help seniors avoid becoming confined to a single level of their multi-story home. Advanced technology makes modern stair lifts smaller, quieter, and more attractive.

A wide array of wheelchairs, walkers, and canes are also available to help those with mobility assistance needs. Technology has dramatically increased the range of options available and the quality of mobility products, from the high-tech wheelchair to the low-tech but highly durable cane. As mobility technology has enhanced, seniors have found it increasingly easier to remain independent, even as their abilities change, and continue participating in the activities they enjoy.

Care assistance products include hospital-style beds, equipment to help with transferring, specially formulated mattresses that help reduce pressure, respiratory equipment, bathroom safety aids, and other equipment that promotes safety and wellness. All of these products are especially important for individuals who wish to remain in the home environment during an illness or convalescence. Durable medical equipment can also make the caregivers job easier by providing them with professional grade products to help meet their caregiving responsibilities.

Paying for Medical Supplies and Equipment
Medicare helps pay the costs for durable medical equipment. According to Medicare, in order to be covered, “items must be reusable, such as walkers, wheelchairs, or hospital beds.” Durable medical equipment for home health services is paid for under both Medicare Part B and Part A. Medicare coverage varies, and some equipment must be rented, while other equipment must be purchased. Durable medical equipment regional carriers can provide more specific information on coverage by Medicare.

Coverage by private insurance for durable medical equipment will vary greatly depending on the company and the specific policy. Coverage for medical supplies by both Medicare and private insurance will depend on the products required, specific medical needs, and doctors’ recommendations.

Finding a Medical Supplies and Equipment Provider
Medical supplies and equipment providers can offer a single solution product or multiple products to meet a range of needs. Before purchasing from a medical supplies and equipment provider, individuals should be comfortable with the professionalism and reliability of the company. Request specific information about costs and product delivery time frames. Consumers should also be aware of any warranties that cover maintenance, repair, or replacement of durable goods.

Finding a reliable provider is an important decision. The products that these providers deliver can lead to important and positive changes in the lifestyles of individuals with increased health care needs, decreased mobility, or who simply want to maintain or increase their level of independence.

A patient and family may turn to hospice care when the goals of patient care have switched from curing to comforting. Any individual of any age with any diagnosis of a terminal disease may turn to hospice.

Receiving hospice services
Reimbursement sources, such as Medicare, Medicaid, or private insurance, generally require a prognosis of six months or less for services to be covered. In addition to traditional medical hospices, there is also a non-medical hospice program in Montgomery County that offers practical and emotional support for patients with a year’s prognosis or less who may choose to continue their curative treatments.

Hospice is unique in that care and support are provided to the entire family, not just the patient. A team of skilled professionals and volunteers work to serve the special needs of the individual patient and family. Choice is at the center of the hospice approach – a person faced with a life-limiting illness is encouraged to remain independent and in control of his or her life.

Hospice care is usually provided in the patient’s home or the home of a loved one. Many hospice patients live out their lives in the comfort of familiar daily routines, surrounded by their treasured possessions and their friends and families. However, hospice services may be provided in long-term care facilities or in-patient hospice residential settings.

Choosing a hospice provider
Once you have decided that Hospice is the right care option for you or your loved one, there are a number of issues to address before choosing a specific program or provider. The best way to find a quality hospice provider is through a recommendation from a friend, family member, or health care professional-such as a social worker or hospital discharge planner.

While deciding on the program that is right for your family, look into any accreditations, certifications, or licensures that the program has received. JCAHO (Joint Commission on Accreditation of Healthcare Organizations) is a not-for-profit organization that provides accreditation for health care organizations and programs. You can contact them at 630-792-5000 or www.jcaho.org for more information about specific programs.

Whether or not the program is Medicare certified is also important. Programs certified by Medicare have met certain minimum requirements for operation. According to Caring Connections, a consumer education program provided by the National Hospice and Palliative Care Organization (NHPCO), “More than 90% of hospices in the United States are certified by Medicare. Medicare defines a set of hospice core services, which means that hospices are required to provide these set of services to each person they serve, regardless of the person’s insurance.” If your state has licensure requirements, inquire to ensure that the provider has met all those requirements.

After establishing that an agency meets certain minimum requirements, request that they send you any brochures or written materials; specifically request information on services, costs, payment procedures, and liability insurance coverage. Ask if the provider can supply references from professionals in your community. Before arranging for services or signing a contract with any specific provider, you may want to consider the questions in the box above.

Services provided by hospices
Hospice team members focus primarily on managing the patient’s pain and symptoms. Medication, medical supplies, and equipment are all provided to make the patient more comfortable. Other services, such as speech and physical therapy, are available should they become necessary. If managing pain and symptoms in the home environment becomes impossible, hospice providers can offer short-term inpatient care.

Hospice providers also teach family members how to properly care for the patient. Additionally, information and support is available to help patients and families deal with the emotional, psychosocial, and spiritual aspects of dying. Surviving family members and friends will receive bereavement care and counseling from the hospice professionals.

Paying for hospice care
Most hospice services are fully or partially covered by Medicare, Medicaid, private insurers, or prepaid health plans. The non-medical Hospice services available in Montgomery County are offered free of charge and are delivered by a staff of trained volunteers. For traditional Hospice services, financial assistance is available for those unable to pay for care.

NHPCO notes that, “Eighty percent of people who use hospice care are over the age of 65, and are thus entitled to the services offered by the Medicare Hospice Benefit. This benefit covers virtually all aspects of hospice care with little out-of-pocket expense to the patient or family.” In order to receive the Medicare Hospice Benefit, patients must be eligible for Medicare Part A, have a terminal disease or condition with a less than six months prognosis, sign a document certifying that they are choosing hospice care instead of routine Medicare benefits for their illness. Patients may only receive covered benefits from a Medicare-approved hospice program. In addition to Medicare’s coverage, hospice services are also generally covered by Medicaid or private insurers.

For more information, see Caring Connections website at www.caringinfo.org or the American Cancer Society’s information on hospice care at www.cancer.org.

*Eligibility*
There are several criteria that must be met before a consumer is eligible for a reverse mortgage. Potential borrowers must be 62 years of age or older and live in their own home. Borrowers must also own their homes outright or have significant equity in their homes. Individuals with remaining balances on a first or second mortgage may be eligible for a reverse mortgage, but those mortgages will have to be paid off with the proceeds from the loan first. Single-family homes, manufactured homes, condominiums, and townhomes are all eligible properties.

There are no income, credit, or employment requirements to qualify for a reverse mortgage. The amount a borrower receives is dependent on age, interest rates, and the overall value of their home. Older borrowers will generally receive more than younger borrowers and home values are a major factor in determining the payout amount of the loan.

Borrowers are required to meet with a reverse mortgage counselor before obtaining a loan. Counselors are independent professionals who provide education about the mortgages and can suggest other alternatives. For a list of counseling agencies approved by the U.S. Department of Housing and Urban Development, visit www.hud.gov or call (800) 569-4287.

*Payment Options*
Once a borrower has obtained a reverse mortgage, there are several payment options available to them. A lump sum payment gives borrowers the total amount of the loan in a single payment. Fixed monthly payments allow loan recipients to receive payments for a set time period varying from several months to up to life. A line of credit lets borrowers utilize funds from the loan at any time. According to the National Reverse Mortgage Lenders Association (NRMLA), “The most popular [payment] option-chosen by more than 60 percent of borrowers-is the line of credit.” The flexibility provided by a line of credit is the primary reason for its popularity.

*Using the Funds*
The proceeds from a reverse mortgage can generally be used in any way that the borrower desires. Borrowers frequently use the money to fund home repairs or modifications that will make aging in place easier and more comfortable. They may also opt to use the proceeds from the loan to cover rising health care or prescription drug costs. Obtaining money to pay off property tax bills and existing debts are also reasons that borrowers cite for seeking a reverse mortgage. Other consumers are looking for additional funds to enhance their lifestyles. This type of borrower may use the funds from a reverse mortgage to take vacations or purchase luxury items.

*Paying Back the Loan*
A reverse mortgage is due only when the last remaining borrower moves from the home, dies, or sells the home. Loans are repaid through the sale of the home. Therefore, the amount a borrower owes can never exceed the value of their home. Reverse mortgages have no affect on other assets and any debt associated with the loan cannot pass on to the borrower’s estate. Also, the NRMLA points out that if a home is sold and “the sales proceeds exceed the amount owed on the reverse mortgage, the excess money goes to . . . [the] estate.”

*Popularity of Reverse Mortgages*
Reverse Mortgages have grown dramatically in popularity in recent years. The escalating cost of living, combined with the desire of seniors to remain in their own homes for as long as possible, has led to an unprecedented increase in the amount of loans. The NRMLA notes that in 2004 “lenders originated a record 37,829 HECM loans . . . a 109 percent increase over the 18,079 loans closed the previous year.” NRMLA credits this tremendous growth to increased understanding of the consumer protection features that are inherent in reverse mortgages. Such features included standard and capped interest rates, independent counseling, no prepayment penalty, and asset protection, among others.

In the past, reverse mortgages have been misunderstood and have faced many misconceptions. As more seniors receive accurate information, the loans continue to grow in popularity. Reverse mortgages are not the financial solution to every problem, and they are certainly not right for everyone. However, for seniors who wish to remain in their own homes for as long as possible, they are an important option that should be considered.

For more information, visit the National Reverse Mortgage Lenders Association’s (NRMLA) website at www.reversemortgage.org or the U.S. Department of Housing and Urban Development’s website at www.hud.gov.

*Quick Facts about Reverse Mortgages:*

Types: Home Equity Conversion Mortgage (HECM) – This federally-insured private loan program is administered by the Department of Housing and Urban Development (HUD). Like all reverse mortgages, this loan requires that the borrower be 62 years of age or older and own their home or have significant equity in their home. Loan applicants must currently live in the home. Additionally, individuals must complete free mortgage counseling from HUD-approved counseling sources.

Single-purpose reverse mortgages-Provide borrowers with smaller loan amounts to pay for express costs. These mortgages are generally offered by state or local government agencies for a specific reason. Often these loans are used to pay for repairs or home modifications, allowing seniors to remain in their homes. They also may be offered to help pay property taxes. They are not available in all areas; check with your local Office on Aging about loan availability.

Proprietary reverse mortgages-Generally the type of loan individuals are referring to when they mention reverse mortgages. These reverse mortgages are not federally insured and are offered by banks, mortgage companies, and other private lenders. Mortgages are backed by the companies that develop them. Although proprietary reverse mortgages are generally more expensive than the other types, there are no restrictions on how the money can be used. Loan advances are generally available to quickly provide borrowers with much needed funds.

*General Features of all Reverse Mortgages:*
Social Security and Medicare benefits are generally not affected by reverse mortgages. Seniors should consult with a benefits advisor in order to ensure that there will be no change in their benefit status.
Homeowners retain the title to their homes until they die, permanently move from the home, sell the home, or reach the end of their loan period. This is beneficial for seniors because a move is considered permanent only after 12 consecutive months out of the home. Seniors could therefore live in an assisted living or nursing facility for recovery or rehabilitation and return to their homes without affecting their loan.
Reverse mortgages are rising-debt loans. The interest is added to the principal loan balance each month. Therefore, the amount that the loan recipient owes increases significantly with time.
At the end of a reverse mortgage term or when the homeowner dies or moves, there will be little or no equity left in the home. There are fewer assets for the homeowner and his or her heirs.
Lenders can determine which fees will be charged and the rates for those fees. Fees include origination fees, closing costs, and servicing fees.
Interest on reverse mortgages is not deductible on income tax returns until the loan is paid off in part or whole.
Homeowners are still responsible for taxes, insurance, utilities, maintenance, and other housing expenses.

Information adapted from the Federal Trade Commission’s consumer article, “Reverse Mortgages: Proceed with Care.”

For more information, please visit this helpful website: http://www.homeownersinsurance.org/additional-resources/how-reverse-mortgages-work/.

Bucks County is located in Southeastern Pennsylvania and is only 30 minutes outside of Philadelphia. New York City and Washington, D.C. are both only a short drive away. The County encompasses six hundred square miles and is home to nearly 600,000 residents. It can be divided into three, unique regions: The Lakes Region (Upper County), The Cultural Region (Central County), and The Heritage Region (Lower County).

The Lakes Region
Probably the County’s most scenic, The Lakes Region boasts covered bridges, wildlife, wildflowers, and of course, lakes. Despite the fact that they are still in use today, the Region’s covered bridges conjure images of a bygone era. The Loux Covered Bridge and the Cabin Run Covered Bridge are two of the most famous and are both located in a small, scenic valley.

The beautiful countryside is replete with parks and nature centers. Nockamixon State Park is the region’s largest park at 5,283 acres and is centered around the 1,450-acre Lake Nockamixon. Park areas are generally open from sunrise to sunset and a variety of outdoor activities are available throughout the year.

The Cultural Region
The Cultural Region is both centrally located and of vital importance to the Bucks County lifestyle. The county seat, Doylestown, is chief among the Region’s attractions and is home to stately mansions and local museums, as well as a variety of shopping and dining choices. The Bucks County Historical Society operates the Mercer Museum, which houses a large collection of early American artifacts, and Fonthill Museum, an American castle featuring original, handcrafted tiles.

In nearby New Hope, residents and visitors alike stroll through the historic streets, visiting antique shops and the over 200 arts and crafts galleries. After a day of shopping, a ride on the New Hope & Ivyland Railroad offers a distinctive way to see the surrounding countryside.

Heritage Region
A prime example of how the past and the present merge in Bucks County, the Heritage Region includes attractions ranging from the Washington Crossing Historic Park to the Philadelphia Park Racetrack.

On December 25, 1776, General George Washington and his struggling forces crossed the Delaware River to attack the British in Trenton, NJ. This march and the ensuing victory proved to be a turning point in the American Revolution. The Washington Crossing Historic Park commemorates this profound event. The 500-acre park also includes the 19th century village of Taylorsville and a large wildflower preserve.

In Bristol Borough, the historic homes that line the Delaware River are juxtaposed to the bustling shopping district along Mill Street. At Silver Lake Park & Nature Center, located near Bristol, every day provides new opportunities to enjoy the 468 acres of playgrounds, picnic areas, and trails.

Home to the annual Pennsylvania Derby, Philadelphia Park Racetrack in Bensalem hosts live Thoroughbred racing year round. A seasonal, outdoor picnic grove provides the perfect place for a cookout before the races.

A Senior-friendly Region
Whether they recently relocated or are long-time residents, Bucks County seniors enjoy a wealth of programs, services, and retirement living options. County officials and area professionals have developed new and innovative programs to meet the changing needs of the senior population.

The Bucks County Area Agency on Aging provides programs to help seniors and their families, including: 13 local Senior Community Centers, the Retired and Senior Volunteer Program, Senior Employment Service, and various care and housing options.

In addition to the services offered by the Area Agency on Aging and other local organizations, there is an array of retirement communities in the area that offer a full range of amenities and care options. Senior-serving professionals are also available to help with everything from moving and downsizing to administering a care plan. Seniors in Bucks County can fully enjoy all that the present (and the past) has to offer, while knowing that their future is secure.

Bucks County, PA

Local Resources

APPRISE Insurance Counseling
Offers free insurance counseling to Pennsylvanians over age 60. Trained volunteers can answer questions about Medicare and provide objective information about health insurance concerns.
Phone: 215-348-0510
Website: www.buckscounty.org/seniors/area_agency_aging/apprise.html

Bucks County Community College Zoomers Program
Provides courses for Baby Boomers on the go (Zoomers). Courses range from book groups and lecture series to computer courses and craft workshops. Classes are offered on the Upper County Campus and the Newton Campus, as well as in other community locations.
Phone: 215-968-8000
Website: www.bucks.edu/lifelong_learning/55plus.html

Bucks County Transport
Provides subsidized transportation for older persons. Qualified applicants can receive transportation to and from senior centers, medical facilities, human services agencies, libraries, and stores.
Phone: 215-249-9626; 215-794-8360; 215-741-0866
Website: www.buckscounty.org/seniors/area_agency_aging/transportation.html

CaregiverPA
Offers county specific information about resources for older adults and their family members throughout Pennsylvania. Website features searchable resource directory for seniors, as well as a list of resources for caregivers and a frequently asked questions section.
Website: caregiverpa.psu.edu/

The Center for Advocacy for the Rights and Interests of the Elderly (CARIE)
Works to improve the quality of life for vulnerable older people. Non-profit organization is based in Philadelphia and offers CARIE LINE, a telephone resource, and a variety of other programs and services. Staff members can assist older people and their caregivers with assessing needs, identifying resources, and resolving elder care issues.
Phone: 215-545-5728
Website: www.carie.org/

Children of Aging Parents (CAPS)
Assists the nation’s nearly 54 million caregivers of the elderly and chronically ill by providing information, referrals, and support. This non-profit organization also works to increase public awareness about the importance of maintaining the health of family caregivers in order to ensure quality care to the elderly population.
Phone: 1-800-227-7294
Website: www.caps4caregivers.org/

PrimeTime Health Program
Covers a wide range of health related topics that are especially important for older adults. Program goal is to help older adults remain healthy, active, and independent by offering activities that are fun and informative. Topics include: healthy cooking, weight resistance training, how to talk openly with your doctor, and many others.
Phone: 215-348-0510, ext. 1248
Website: www.buckscounty.org/seniors/area_agency_aging/health_programs.html

Retired and Senior Volunteer Program (RSVP)
Gives adults age 55 and over the opportunity to volunteer in positions that address educational, public safety, environmental, health and nutrition, economic development, or other human services needs. Over 800 County RSVP volunteers provide more than 175,000 hours of service each year.
Phone: 215-340-1210; 215-949-5800
Website: www.buckscounty.org/seniors/area_agency_aging/rsvp.html

Senior Community Centers
Offer a wide range of recreational and educational programs. Thirteen centers are located throughout Bucks County. Centers help seniors maintain their independence can provide referrals for needed community resources. Most centers serve a hot, nutritious meal daily.

Bensalem 215-638-7720
Bristol Township 215-785-6322
Central Bucks 215-348-0565
Eastern Upper Bucks 610-847-8178
Falls Township 215-547-6563
Lower Bucks 215-788-9238
Middletown 215-945-2920
Morrisville 215-295-0567
Neshaminy 215-355-6967
Northampton Township 215-357-8199
Pennridge 215-257-9692
Upper Bucks 215-536-3066
Benjamin H. Wilson 215-672-8380

Senior Employment Service
Helps individuals age 55+ obtain part-time and full-time employment. Applicants must register with SES. There is no fee to either the employee or the employer. Individuals with limited income may also be eligible for additional job placement assistance through the Title V program.
Phone: 215-348-0510
Website: www.buckscounty.org/seniors/area_agency_aging/senior_employment.html