Tuesday, October 27, 2015

Medicaid Jargon Made Easier

Let's face it.  Learning the complexities of Medicaid is tough.  If your parent is running out of money, you'll need to know the meaning of the following words.

A little introduction.  To be eligible for Medicaid, your aging parent has to qualify two ways:  first, financially, and second, medically.  Each state has its own program.  The basic rules are similar, but dollar amounts on income and assets can vary. 

Most people these days in Washington State are applying for a Medicaid-waiver program called COPES (Community Options Program Entry System) which offers people care in their homes, in assisted living communities and in adult family homes.  Traditional Medicaid refers to care offered in a skilled nursing facility. 

Step One:  Financial Qualification--words you'll need to know:

1.  Income cap--this is the limit on monthly income your parent can have and still qualify for COPES.  In Washington State, the income cap is currently $ 6381.  If your parent seeking COPES help is married, his or her income in their own name cannot exceed this amount. 

2.  Asset cap--in Washington State, and in many states, the limit for resources (assets, property and savings) is $2000 for a single person.  In the case of a married couple in which one spouse applies for COPES, they can have $56.726. 

3.  Exempt resources--These are resources that don't count toward the $2000 limit.  They can include a home (under certain conditions including when one spouse continues to live there when the other goes on COPES), household goods and personal affects, some real estate contracts, a car, life insurance with a face value of $1,500 or less, most burial plots and prepaid burial plans.

Step Two:  Eligibility Due to a Need for Help with Activities of Daily Living--more words

1.  Comprehensive Assessment--a social worker will assess your parent's needs for help with such things as eating, bathing, transfer (e.g. moving from a bed to a chair), bed mobility (positioning), locomotion (walking and moving around), using the toilet and medication management.  A person can run out of money and still not qualify for Medicaid if he or she is still independent or needs very little help.

2.  Award letter--This letter is the official approval for COPES help.

3.  Reimbursement rate--If your parent is applying for care in an assisted living community or adult family home, DSHS will set a daily rate that the State will pay for your parent's care.

4.  Participation--This is the amount your parent will pay toward the cost of the care.  Generally, a person "contributes" his income toward the care, minus a small amount for personal expenses.

Much of the above is excerpted from a publication of Columbia Legal Services, Questions and Answers on the COPES PROGRAM.

Tuesday, October 13, 2015

Book Review: 'Activities to Do With Your Parent Who Has Alzheimer's Dementia'

Judith A. Levy is an occupational therapist.  For more than 40 years she has worked in geriatric care centers, hospitals and home-care programs.  She has helped people of all ages get well.

 In 2013 she wrote a book, with another audience in mind:  children of people with dementia.  At the time Judith had been caring for her 97-year-old mother for nine  years.  Clinical knowledge was one thing.  Having the responsibility of another life--that if her parent--was quite another.

"I cannot go home at the end of the day and leave it all behind.  Now I am the child, and this is my parent.  I'm no longer the professional.  I have no choice but to adjust to the changes."

Judith's book,  'Activities to Do With Your Parent Who Has Alzheimer's Dementia,'  has simple, meaningful activities that will stimulate the long-term memory and bring enjoyment to you and your parent. 

Some principles for doing activities with someone with dementia:

1.  Morning works best.  People with dementia are mentally sharper then.  As the day goes on and draws nearer to dusk, "sundowning" occurs, bringing with it increased confusion and agitation.

2.  If the activity produces frustration, stop and move onto another one.

3.  Do all the tasks at the same place each time.  Choose a well lit table; make sure your parent's chair is comfortable.  Spread out any "props" and clear the tabletop of other objects.

The 57 activities are presented in alphabetic order and include:
  • The Alphabet--Using colored alphabet letters, sort the letters by color and count each group to see which color has the most letters.  Other ideas:  "The letter A is yellow; can you find it?"  "Tell me a word starting with the letter A."  And of course, sing the Alphabet Song.
  • Baking--It's structured, sequential, time limited and satisfying.  Baking can get your parent to talk about favorite foods, childhood holidays and an event in the past at which a special food was served.  Depending on your parent's ability, he or she can help assemble ingredients, stir the batter, and wait for the timer to go off.  Baking and decorating cupcakes are especially fun.
  • Crossword Puzzles--Books in the grocery store have puzzles that may be doable if you work together.  You can give clues that will help him or her succeed.
A great book, with practical activities and conversation starters.


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