Hospice care focuses on quality and comfort of life

Published in Church Health by Dr. Susan Nelson
Hospice is a word that some people are afraid of.

For some, it conjures the image of a patient who has “given up” on medical treatment. Others may worry that they won’t get the medical care they need once in hospice.

However, hospice care doesn’t mean all medical treatment stops. It just means you and your family have decided to focus on what makes your life more comfortable, rather than continue to seek treatment for a disease that has no cure. Hospice care is 100% covered by Medicare, and 15% of hospice patients survive more than 6 months and actually get better for a time.

Over the years, I’ve had many patients in hospice care, and almost every one of them – and their families – told me they wished they had started it sooner. Hospice helps patients and families prepare for death in a dignified way that focuses on the quality and comfort of life that remains.

Rather than being a “last resort”, I think hospice offers patients and families the chance to be at home, together during this important time in life’s journey.

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Helping Veterans age well after military service

Published in Military Times by Sherman Gillums Jr. and Andrew Greene

When you think of hearing aids, canes, knee pain, memory issues, and heart problems, you might envision a grandparent or elderly person. But these indicators of aging may also describe a military veteran in their late 30s or early 40s who served on numerous deployments, worked on a flight line, or parachuted from aircraft for a living.

While new military inductees are typically some of the healthiest people in our society, many find themselves anything but healthy by the time they end their careers. In fact, many find themselves coping with an accelerated aging process that combines natural aging with the service-related wear and tear on their bodies and minds.

There has always been a national interest in ensuring that veterans receive retirement benefits for serving their country. What hasn’t been emphasized are the specific challenges veterans face as they age. A 2019 study, published in the International Journal of Environmental Research and Public Health, found that Persian Gulf War veterans suffered chronic conditions — such as high blood pressure, heart attacks, diabetes, stroke, and arthritis — about 10 years sooner than non-veterans the same age. This results in lower quality of life, higher mortality rates, and shorter life expectancies, especially for women veterans.

Compared to the overall population, veterans are more likely to be male, older, retired, widowed, educated, and living in the South, according to a report prepared by the LTSS Center in Boston. They also are more likely to report fair or poor health, limitations with activities of daily living, obesity, depression, and chronic conditions. This is despite the fact that there are not stark differences in financial wealth, and veterans pay less out-of-pocket for health care than civilians.

This raises the question: What is the best way to serve aging veterans who report a higher number of health and daily living issues during a greater portion of their lives than civilians?

To answer this, American Veterans (AMVETS) and the National Council on Aging (NCOA) are partnering to understand the specific needs of the nation’s 12.4 million veterans aged 65-plus and ensure that those who served have as fair a shot at aging well as those they defended. The partnership builds on two successful efforts: AMVETS’s HEAL Program and NCOA’s Aging Mastery Program® (AMP).
HEAL — which stands for healthcare, evaluation, advocacy, and legislation — encompasses all necessary steps to intervene directly on behalf of veterans, service members, families, and caregivers to reduce veteran unemployment, homelessness, and hopelessness, particularly for those who are at the highest risk of suicide.

The suicide rate among middle-aged and older veterans remains high, with approximately 65 percent of all veterans who died by suicide being aged 50-plus. Currently, the program has assisted over 600 veterans and families in crisis, with zero suicides following intervention, primarily by coordinating access to care and assisting with VA benefits. AMP helps older adults build their own playbook for aging well. Nearly 25,000 people have taken part either through classes in their community or by using the at-home Aging Mastery Starter Kit. Participants in AMP classes have achieved meaningful, measurable, and enduring changes in their health, finances, life enrichment, and advance care planning. The classes also serve as a gateway to encourage and lead older adults to participate in other community offerings.

An understanding of the aging process — both as a matter of acceleration among younger veterans and ways to make aging more of a comfort than a hardship — is essential to promoting good quality of life for those who served. The AMVETS and NCOA partnership will promote timely access to care and benefits for veterans with unique needs, along with customizable programs that support positive aging.
In addition to active support with obtaining VA benefits, veterans will have access to educational materials through Aging Mastery Starter Kits if they don’t live near an in-person class, are physically or socially isolated, or are caregivers. And with accredited representation and support from AMVETS, AMP will add a session on helping veterans coordinate their veterans benefits with Medicare.
From the time we’re born, we are educated and trained for the next phase of life. There is elementary school, high school, college, and military training. But there is no boot camp for aging. Veterans’ needs are unique, and the AMVETS-NCOA partnership provides a model for helping them age well.

Sherman Gillums Jr., chief advocacy officer, AMVETS, and Andrew Greene, managing director, Aging Mastery Program, National Council on Aging.

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Asset Expert Explains What Long-Term Insurance Covers

Published in SmartAsset by Ashley Chorpenning

While Medicare and Medicaid both help aging adults afford some of their medical expenses, they may not cover the cost of an extended illness or disability. That’s where long-term care insurance comes into play. Long-term care insurance helps policyholders pay for their long-term care needs such as nursing home care. We’ll explain what long-term care insurance covers and whether or not such coverage is something you or your loved ones should consider.

Long-Term Care Insurance Explained
Long-term care insurance helps individuals pay for a variety of services. Most of these services do not include medical care. Coverage may include the cost of staying in a nursing home or assisted living facility, adult day care or in-home care. This includes nursing care, physical, occupational or speech therapy and help with day to day activities.

A long-term care insurance policy pays for the cost of care due to a chronic illness, a disability, or injury. It also provides an individual with the assistance they may require as a result of the general effects of aging. Primarily, though, long-term care insurance is designed to help pay for the costs of custodial and personal care, versus strictly medical care.

When You Should Consider Long-Term Care Insurance
During the financial planning process, it’s important to consider long-term care costs. This is important if you are close to retirement age. Unfortunately, if you wait too long to purchase coverage, it may be too late. Many applicants may not qualify if they already have a chronic illness or disability.

According to the U.S. Department of Health and Human Services, an adult turning 65 has a 70% chance of needing some form of long-term care. While only one-third of retirees may never need long-term care coverage, 20% may need it for five years or longer. With a private nursing home room averaging about $7,698 per month, long-term care could end up being a huge financial burden for you and your family.
Most health insurance policies won’t cover long-term care costs. Additionally, if you’re counting on Medicare to assist you with these extra expenses, you may be out of luck. Medicare doesn’t cover long-term care or custodial care. Most nursing homes classify under the custodial care category. This classification of care includes the supervision of your daily tasks.

So, if you don’t have long-term care insurance, you’re on the hook for these expenses.
However, it’s possible to get help through Medicaid for low income families. But keep in mind, you may only receive coverage after you deplete your life savings. Just know that Medicare may cover short-term nursing care or hospice care, but little of the long-term care in between.

What Does Long Term Care Insurance Cover
So what does long term care insurance cover, Well, since the majority of long-term care policies are comprehensive policies, they may cover at-home care, adult day care, assisted living facilities (resident care or alternative care), and nursing home care. At home, long-term care may cover the cost of professional nursing care, occupational therapy, or rehabilitation. This may also include assistance with daily tasks, including bathing or brushing teeth.

Additionally, long-term care coverage can cover short-term hospice care for individuals who are terminally ill. The objective of hospice care is to help with pain management and provide emotional and physical support for all parties involved. Most policies allow beneficiaries to obtain care at a hospice facility, nursing home, or in the comfort of their own home. However, most hospice care is not considered long-term care and may receive coverage through Medicare.

Also, long-term care insurance can help cover the costs of respite care or temporary care. These policy extensions provide time off to those who care for an individual on a regular basis. Usually, respite care provides compensation to caregivers for 14 to 21 days a year. This care can take place at a nursing home, adult daytime care facility, or at home

What Long-Term Care Doesn’t Cover
If you have a pre-existing medical condition, you may not be eligible for long-term care during the exclusion period. The exclusion period can last for several months after your initial purchase of the policy. Also, if a family member provides in-home care, your policy may not pay them for their services.
Keep in mind, long-term care coverage won’t cover medical care costs. Many of your medical costs will fall under your coverage plan if you’re eligible for Medicare.

Long-Term Care Insurance Costs
Some of the following factors may affect the cost of your long-term care policy:

1. The age of the policyholder.
2. The maximum amount the policy will pay per year.
3. The maximum number of days the policy will pay.
4. The lifetime maximum amount that the policy will pay
5. Any additional options or benefits you choose.

If you’re in poor health or you’re currently receiving long-term care, you may not qualify for a plan. However, it’s possible to qualify for a limited amount of coverage with a higher premium rate. Some group policies don’t even require underwriting.
According to the American Association for Long-Term Care Insurance (AALTCI), a couple in their mid-50s can purchase a new long-term care policy for around $3,000 a year. The combined benefit of this plan would be roughly $770,000. Keep in mind, some policies limit your payout period. These payout limitations may be two to five years, while other policies may offer a lifetime benefit. This is an important consideration when finding the right policy.

Bottom Line
While it’s highly likely that you may need some form of long-term care, it’s wise to consider how you will pay for this additional cost as you age. While a long-term care policy is a viable option, there are alternatives you can consider.

One viable choice would be to boost your retirement savings to help compensate for long-term care costs. Ultimately, it comes down to what level of risk you’re comfortable with and how well a long-term care policy fits into your bigger financial picture.

Retirement Tips
If you’re unsure what long-term care might mean to your retirement plans, consider consulting a financial advisor. Finding the right financial advisor that fits your needs doesn’t have to be hard. SmartAsset’s free tool matches you with financial advisors in your area in 5 minutes. If you’re ready to be matched with local advisors that will help you achieve your financial goals, get started now.

The looming costs of long-term care may have you thinking about how much money you’ll need for retirement. If you aren’t sure how much your 401(k) or Social Security will factor into the equation, SmartAsset’s retirement guide can help you sort out the details.

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Ask an Attorney: Understanding Medicare’s hospice benefit in cases of terminal illness

Published in The Middletown Press By Robert Scalise
Caring for a loved one during the final stages of life is difficult both physically and emotionally. Thankfully, Medicare can help ease the burden.

Medicare’s hospice benefit covers any care that is reasonable and necessary for easing the course of a terminal illness. It is one of Medicare’s most comprehensive benefits, and can be extremely helpful to both a terminally ill individual and his or her family, but it is little understood and underutilized. Understanding what is offered ahead of time may help Medicare beneficiaries and their families make the difficult decision to choose hospice if the time comes.

The focus of hospice is palliative care, which helps people who are terminally ill and their families maintain their quality of life. Palliative care addresses physical, intellectual, emotional, social and spiritual needs while supporting the terminally ill individual’s independence, access to information, and ability to make choices about health care.

To qualify for Medicare’s hospice benefit, a beneficiary must be entitled to Medicare Part A, and a doctor must certify that the beneficiary has a life expectancy of six months or less. If the beneficiary lives longer than six months, the doctor can continue to certify the patient for hospice care indefinitely.

The beneficiary must agree to give up any treatment to cure his or her illness and elect to receive only palliative care. This can seem overwhelming, but beneficiaries can also change their minds at any time. It’s possible to revoke the benefit and reelect it later, and to do so as often as needed.

Medicare will cover any care that is reasonable and necessary for easing the course of a terminal illness. Hospice nurses and doctors are on call 24 hours a day, seven days a week to give beneficiaries support and care when needed. Services are usually provided in the home. The Medicare hospice benefit offers:
• Physician and nurse practitioner services
• Nursing care
• Medical appliances and supplies
• Drugs for symptom management and pain relief
• Short-term inpatient and respite care
• Homemaker and home health aide services
• Counseling
• Social work services
• Spiritual care
• Volunteer participation
• Bereavement services

Services are considered appropriate if they are aimed at improving the beneficiary’s life and making him or her more comfortable.
Because the beneficiary is electing palliative care over treatment, there are things the hospice benefit will not cover:
• Treatment to cure the beneficiary’s illness
• Prescription drugs, other than those for symptom control or pain relief
• Care from a provider that wasn’t arranged by the hospice team, although the beneficiary can choose to have his or her regular doctor serve as the attending medical professional
• Room and board. If the beneficiary is in a nursing home, hospice will not pay for room and board costs. However, if the hospice team determines that the beneficiary needs short-term in-patient care or respite care services, Medicare will cover a stay in a facility.
• Care from a hospital, either inpatient or outpatient, or ambulance transportation, unless arranged by the hospice team. The beneficiary can use regular Medicare to pay for any treatment not related to the beneficiary’s terminal illness.

Medicare now has a hospice compare site that allows patients or their families to evaluate hospice providers according to several criteria. Visit the site at medicare.gov/hospicecompare.

To download Medicare’s booklet on the hospice benefit, go to medicare.gov.
Robert A. Scalise Jr. is a partner of Ericson, Scalise & Mangan, PC in New Britain. For information, visit esmlaw.com.

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VA launches mobile app to streamline veterans’ access to health records, resources

Published in Becker’s Healthcare by Jackie Drees
Department of Veterans Affairs released a new mobile application that aims to simplify veterans’ and caregivers’ access to healthcare information by storing it on a single platform.
Four things to know:
1. The new app, called Launchpad, organizes more than 20 VA health apps into five categories: health management, healthcare team communication, vital health information sharing, mental health improvement and quality of life improvement.
2. Users will be able to view and share their VA EHR data, schedule VA appointments and refill prescriptions, among other functions, on the app.
3. The app also includes free mental healthcare tools for individuals who are not enrolled in VA healthcare services.
4. Launchpad is available for download on Apple and Google devices.

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Are You One of the 40 Million Americans Who Are Taking Care of a Loved One? Here’s What You Need to Know

It isn’t easy, but it’s important
Published in thriveglobal.com by BJ Miller, MD and Shoshana Berger

All over this country there are people like you who are driving out of their way to pick up a prescription after work, using coffee breaks to visit someone and make him lunch, missing out on dates with friends in order to make sure someone is safe before they go to bed, or taking trips to the hospital.

We see you (we are you), and you are not alone. In the United States at any one time, 40 million adults are caregivers. You are more likely to be a woman — especially if you’re doing the difficult work of bathing and toileting — though the percentage of male caregivers is on the rise: in 2009, 34 percent of caregivers were men; as of 2017 that number was 40 percent. On average you provide more than twenty hours per week of care for four years. It’s a hard job, but when they look back on the experience most people say they wouldn’t trade it for the world.

Courtesy of Africa Studio / Shutterstock

But, as the airline industry reminds us: in order to help others, we need to put on our own oxygen masks first. We’ll go even further — since someone in a predicament is relying upon you: it’s selfish to not take care of yourself. Self-care is a muscle you need to learn to flex so it becomes part of your routine, instead of a rare treat. It means paying attention to yourself, even when the only thing you want to pay attention to is your beloved.

Here are some ways to care for yourself.
• Take time for yourself. Foster a contemplative practice of some sort. This means prayer, meditation, yoga, the gym, hiking, biking, dancing, gardening, writing. Find some way to connect with yourself, body as well as spirit.
• Share. Have a short call list of people who will listen, without judgment and talk about anything: colleague, spouse, friend, therapist. It doesn’t need to be a shrink, though they can be helpful, too. Venting over coffee with someone you trust might be enough. One way or another, unbottle yourself.
• Pace yourself. If your loved one is already in the late stages of illness, it’s likely a matter of a few weeks of serious effort. A sprint. If she seems to have months or years to live, you’re in for a marathon. Don’t make the mistake of trying to hold your breath until it’s all over.
• Distract yourself. Movies, golf, books, howling at the moon — whatever transports you for a bit. A glass or two of wine is not a bad idea, but be careful not to slide into coping mechanisms that will hurt you over time.
• Seek respite. For yourself. This might mean finding someone to take your place for a time, finding an adult day care program, or, if on hospice, arranging for your loved one to stay for a few nights in a hospice house or nursing home. Take small breaks as often as possible and longer breaks now and again.
• Watch your health. Be sure to factor in your own health and limitations. Do you need to see a doctor? Are you aching somewhere? Are you keeping current with your meds? Let an honest answer inform how you set up living arrangements for your loved one and when to seek home care or elect hospice.
• Recruit hospice and palliative care. It’s the explicit philosophy of both services to support caregivers. Yes, your own wellbeing is reason enough to invite hospice in.
• Find other people in a similar situation. Just as there are support group for patients with different illnesses, there are support groups for different types of caregivers. Are you the husband of a patient with Alzheimer’s? The daughter of someone with ALS? There’s a group for you. Conduct an online search for “caregiver support” + “(type of illness)” to find those resources.
• Reach out to friends. They probably don’t know how to help you and will be so grateful if you can simply tell them what you need. You can even prompt them: Help me think about anything other than illness.
• Engage HR. Make sure to check with your HR department about whether you qualify for, and how to best utilize, the Family and Medical Leave Act (FMLA). FMLA may not cover you if you work for a smaller business, but you should definitely inquire. FMLA protection or not, if you have a good and trusting relationship with your boss be sure to talk to her about your situation; often enough, there are creative ways to make it all work for everyone.

Taking care of someone requires taking care of yourself; you two are directly and intimately linked. Try to remember the gifts of caregiving: purpose, perspective, love. They won’t always make the toil pleasant, but they will help you keep your sanity. You are engaged in some of the most important and under-appreciated work there is. For all that gets sacrificed to make room for caregiving, many come to feel that the world they entered is more true and rewarding than the one they left behind. Hard and painful though these days can be, someday you might look back and miss them.

From The Beginner’s Guide to the End: Practical Advice for Living Life and Facing Death by BJ Miller, MD and Shoshana Berger.

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How to Make My Uncle Comfortable in Hospice Care?

Published in Collegian by Jacob Maslow
My uncle has a terminal disease, and after years of fighting, he has been given just a few months to live. He is going to be put in hospice care at-home, and I would like to make him as comfortable as possible. Do you have any recommendations on what I can do to make sure his last days are comfortable?

Hospice doesn’t mean that your loved one will be gone in a month or two. In general, hospice means that a patient will live for six months or less. But we’ve all heard stories of a person living for much longer than their doctors suggest. Doctors often underestimate the time a person has left to live, and if the person lives longer, no one generally complains.

The goal will be to keep your loved one comfortable.

Hospice care will help with pain management, and this is best left to the professionals. Hospice caregivers will come to the home and ensure that your loved one is giving the best pain medication and following their treatment plans. But you can help in other ways. As a person becomes weaker, they’ll have trouble with everyday tasks, even including eating and balancing. Independent living aids can help a lot.

“With independent living aids and other products including reachers, grab bars, eating utensils, thickening powder and more, you can make simple changes in your home that will make your loved ones feel safer, more independent and, most importantly, more at home,” explains AvaCare Medical.

Lack of preparation has been associated with:
• Anxiety
• Depression
• Grief

Discuss your uncle’s needs with his doctor. The doctor will be able to alert you of any items that you can purchase or have in the home that will best help your uncle.

Bed placement will be equally important. The bed, if your uncle is bed ridden, should be accessible by friends and family. Your uncle doesn’t want to be locked away in a room alone at all times. Family time, sharing memories and doing things will keep his spirits up.
If he is stable enough and can walk or be put in a wheelchair, bring him out to a ball game or to a restaurant.

Family time can lift a loved one’s spirits.

One of the things I remember my mother complaining about towards the end of her life was that she was so bored and wanted to do things. She was on oxygen, so she was slightly limited in her ability to go out for long periods of time.

Find activities to do with your uncle even if that means watching his favorite movies or going for a stroll around the neighborhood. If he is stuck in the home with nothing to do, depression will start to set in. Comfort is also important, and this means ambient lighting and soothing sounds. Try your best not to disturb your uncle, and also make it a point to keep the room at a temperature that is comfortable for him. He may have hot flashes, or medication can make him feel cold. Cater to these needs as best as you can.

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“Let me know if there is anything I can do”

Published by unknown hospice physician

“Let me know if I can do anything.” How many times have we uttered that sentence when a friend, distant relative or a colleague has informed us they have suffered a loss of a loved one? Don’t get me wrong, I’m sure most of us mean it and it seems like the right thing to say along with “I’m so sorry.” When I look back through my life, I can easily count how many times people have taken me up on my offer. As you’ve guessed, and I’m sure you can relate, it’s 0 number of times. In a time of loss and pain, people don’t want to ask others to go out of their way to help. They aren’t going to tell you they have no energy to cook, need help watching children, money to pay the bills or buy groceries. They won’t tell you they just need a hug and your gentle presence. We are afraid of impinging on people’s privacy and space. We don’t know what words to share or how to behave and in that uncertainty of what to do or say is where the subsequent isolation occurs for the one grieving. The isolation then leads to a sense of loneliness despite the rich number of friends and family willing to help but not knowing how.

Now that I’ve been through losing a close family member to cancer and experiencing the pain of grief, our family was grateful for people’s thoughts and prayers, however, we very much appreciated those friends who did simple things such as bring us a meal, watch our children (so we could have some quiet time) and checked in on us to see how we were doing. It was those who walked in our shoes through their own similar experiences who didn’t shy away, knew the right words to say and were insistent on being there for us in a tangible way. So what can you do if you haven’t walked in our shoes but want to be there for your friend, colleague or relative who’s lost a loved one?

Here are few suggestions which really helped our family.
1. Ask “How are you doing?” The question is open-ended enough that it allowed me to elaborate on the days I felt like talking or cut the conversation short on the days I didn’t. There were days I didn’t want to talk about my feelings, however, I felt more alienated by those who never asked. The common mistake most people make is to assume they will make the person more depressed by asking, hence, reminding them of their pain.
2. Bring a meal. Sounds simple enough, however, this was much appreciated on several occasions when there was no time or energy to feed my family. Close friends didn’t ask if they could bring us a meal, they just asked what time they should drop it off.
3. If there are small children in the family offer to watch them or pick them up from school. We were so grateful for those families who took our children for play dates or out to meals with their children. It gave us some down time to let us be present with each other and our feelings.
4. Consider gift cards. This is helpful whether there are financial constraints or not. If there are financial constraints, I think it’s harder for people to accept cash, therefore, a gift card to a local grocery store or department store will be appreciated. On the other hand, we were given gift cards to local restaurants, which as stated above, allowed us to spend more time with family than worrying about cooking and cleaning.
5. As a follow-up to #1. We noticed immense support initially, however, it began to dwindle as the months went on which is understandable, however, those that have walked in the same shoes have continued to check in with us and see how we are doing. Nothing too intrusive but that great open ended question of “How are you doing?”

This is a short list but nevertheless a few suggestions that pulled me through some of the darkest times during the grieving process. For those that have gone through losing a loved one, what to do for a friend feels more natural, however, I hope this blog post will help others who genuinely want to help but don’t know how. It would be great to hear more suggestions from those who have experienced support from others so that I can expand this list.

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Financial Assistance for Assisted Living in Texas

The following post contains helpful resource information from assistedliving.org/Texas

 

STAR+PLUS
STAR+PLUS is a multifaceted program which provides reimbursement for people seeking assisted living. The STAR+PLUS Home- and Community-Based Waiver is a part of the program that helps seniors who are assessed as nursing home-eligible continue receiving their Medicaid benefits without being institutionalized. Eligible applicants are reimbursed for services that promote independence, such as assistance with personal grooming tasks, basic mobility, and caregiver respite. Services may be provided by direct care aides at an assisted living facility or by home health contractors.

Who is Eligible?
The STAR+PLUS program has absorbed many Texas Medicaid plans and services, so understanding whether you qualify can be difficult. This is due to the many caveats that may apply if you are eligible for multiple state programs under the STAR+PLUS umbrella, or for other programs like Supplemental Security Income. Eligibility requirements are listed on the Texas Health and Human Serviceswebsite, though understanding what you may qualify for is likely to require the assistance of a dedicated case worker.

Eligible applicants are people who need an institutional level of care and qualify for Medicaid. Medicaid applicants over 65 should have a maximum income of $2,250 and countable assets of no more than $2,000, though eligibility criteria varies with marital status, level of assistance needed, and other factors.

How to Apply
This waiver is a non-entitlement program, which means that it can only support a limited number of active participants. Applying for the waiver is likely to result in one’s name being added to a waiting list for enrollment, so it is advised that interested parties sign up as far in advance as possible. Applicants are encouraged to seek qualified counseling to help them navigate the enrollment process and eligibility requirements of STAR+PLUS. To begin the application process, contact The Office of the Ombudsman at (866) 566-8989, or consult the Texas Area Agencies on Aging by calling (800) 252-9240. Find your local Area Agency on Aging by consulting the directory in this guide.

The Community First Choice (CFC) Program
The Community First Choice program is a lot like the STAR+PLUS HCBS waiver in what it offers, except that CFC is a Medicaid entitlement program, meaning there are no maximum recipient caps and no waiting lists for enrollment. Community First Choice offers Medicaid reimbursement to low-income assisted living residents for the provision of assistance with activities of daily living, such as personal grooming tasks, mobility, and basic house chores. People already enrolled to receive other Medicaid waiver services may elect to switch to the Community First Choice Program.
Services provided under the CFC Program may include:
• Personal assistance with activities of daily living
• Skills education for self-care and independent living
• Emergency response services
• Training for support staff management
• Consumer-directed service options

Who is Eligible?
Applicants for the Community First Choice program must qualify for Medicaid and must be assessed by a physician as nursing home-eligible. Coverage of personal care services through this program is provided based on an assessment of which services an individual requires.

How to Apply
Interested parties can apply online at YourTexasBenefits.com, or call 2-1-1 for guidance and consultation. Your local Area Agency on Aging can also help with Medicaid and non-Medicaid applications. To initiate an assessment and determine your eligibility, consult the directory in this guide to find a nearby Area Agency on Aging.

PACE
Serving the cities of El Paso, Amarillo, and Lubbock, PACE is the Texas branch of the national Program for All-Inclusive Care for the Elderly. It is a Medicaid-administered program intended to provide total coverage of all medical and personal care needs for especially frail seniors, helping them to avoid institutionalization. This program reimburses for a broad array of services that may be provided by assisted living facility staff or home health contractors.
PACE provides these services:
• Personal care services and home healthcare
• Adult day healthcare
• Medical care
• Coverage for all necessary prescription drugs
• Hospital and nursing home care when necessary
• Social services
• Caregiver respite

Who is Eligible?
• Individuals aged 55 and older who are nursing home-eligible
• People who live in an area covered by PACE services
• Those who can live safely at home or in an assisted living community
Private payment is accepted for individuals not receiving Medicare or Medicaid and fees for these participants will not exceed average costs for nursing home care in Texas. However, space in the program is limited, and preference is given to applicants who have greater medical and financial needs. Most recipients of PACE are dually eligible for both Medicaid and Medicare. All applicants must have family or caregivers who can provide limited support during short intervals of respite.

How to Apply
To find out if you’re eligible and to learn about what PACE offers, contact your local HHS office by dialing 2-1-1, or 7-1-1 for the hearing impaired. You can also consult your local Area Agency on Aging for more details and application assistance. Find your local Area Agency on Aging by searching the directory included in this guide.

More Ways to Finance Assisted Living
Some additional ways to finance assisted living costs include:

Free Assisted Living Resources in Texas
Texas is home to hundreds of nonprofits and government resource providers that assisted living residents can look to for added support. Some of these organizations, like the Area Agencies on Aging, operate in every state across the country, while others are dedicated only to specific regions in the state of Texas. All of these services are free to use. However, some organizations listed here may have income and health-related requirements intended to preserve resources for those who are most in need.

The Aging & Disability Resource Center
This center was opened by the HHS as part of the national No Wrong Door initiative, and it is intended to streamline public access to resources and information concerning long-term services and supports. The Aging & Disability Resource Center helps to reduce confusion and facilitate access to care for long-term care recipients in all 254 counties of Texas. Contact them by calling (855) YES-ADRC, or (855) 937-2372. Find out more online by visiting hhs.texas.gov.

The Long-Term Care Ombudsman Program
Most states have a Long-Term Care Ombudsman program which organizes volunteers to act as advocates for recipients of LTC benefits. Ombudsmen periodically visit residents of ALFs and nursing homes to verify the quality of their care and environment, field complaints and concerns, help them protect their rights, and keep them in touch with the service providers and authorities they may rely on. The services of ombudsmen are always free and confidential, and their organizations avoid conflicts of interest by remaining unaffiliated with service providers and government agencies. The Texas LTC Ombudsman program can be reached via e-mail at ltc.ombudsman@hhsc.state.tx.us and toll-free at (800) 252-2412.

211 Texas
The Texas Health and Human Services Commission provides 211 Texas as an anonymous social service hotline with 25 information centers across the state. They are available to take calls 24/7, and can help citizens understand and gain information on any programs administered by Health and Human Services, which includes long-term care facilities like assisted living and other supports for seniors.
Reach 211 Texas by simply dialing 2-1-1, or visit them online at 211Texas.org.

Area Agencies on Aging
The AAA is a national, federally funded organization. It acts as a central agency, unifying hundreds of community outreach programs and supports for citizens over 60 years of age. Texas hosts 27 Area Agencies on Aging, making this a convenient resource for people in all regions of the state.

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Arrangements to Make When You or a Loved One Has Terminal Illness

If you or a loved one has been diagnosed with a terminal illness, you are likely to be flooded with emotion and may be unsure of the next step to take. It’s overwhelming to receive such life-changing news. Take the time you need to digest and process this information, then begin to prepare for the next steps. There are practical arrangements that need to be made to help make the coming days easier. Let’s discuss a few important arrangements to take care of that can benefit not only you but also your surviving loved ones.

Determine Plan of Care
When you have received the terminal diagnosis, one area to consider is your plan of care. First, talk to your doctor regarding available treatments and whether they are in your best interest. They may not save your life, but they may extend it. You also want to consider whether you would like to receive palliative care. According to Verywell Health, palliative care can begin at diagnosis, unlike hospice, and will help improve your quality of life and ease your symptoms. Patients receiving palliative care often live longer, experiencing relief from ailments and discomforts. Research which company you would like to receive care from and discuss the anticipated timeline of care with your doctor and loved ones.

Get Legal Matters in Order
In addition to making important medical decisions, it is also beneficial to get your legal matters in order. Most people are familiar with a traditional will, detailing the recipients of your estate and possessions. According to CNBC, there are other documents that you should draw up in order to ensure your wishes are respected. A living will is an important document, as it will direct your loved ones about which medical treatments you want, relieving them of the burden to decide. You can dictate what life-saving measures you are comfortable with and whether you would like to donate your organs. You need to assign both medical and financial powers of attorney to make decisions on your behalf for when you are no longer able to make them. The goal is to have all your legal documents fulfilled to make things easier on your loved ones.

Ensure Financial Security
Your legal documents help determine financial distribution, but it’s also helpful to secure proper insurance to cover expenses rather than relying on your personal finances. Burial insurance, for example, can be purchased to pay for funeral expenses (funeral home services, casket, gravestone, transportation, etc.) and any remaining medical or legal bills. The average cost of a funeral is over $11,000, and with proper insurance, you will be saving your family a large financial burden. Hopefully, you have already outlined detailed funeral instructions in your will if you have any funeral or burial preferences.

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Check Off the Bucket List
With all documents in order, the last arrangement to be made is to enjoy your final days. Choosing to enjoy life rather than embracing death. Make your dream bucket list and enlist your friends and family in helping you check it off. Swim with dolphins. Attend the concert of your favorite band. If you dream of travel, plan a trip to your favorite destination. Studies have shown that travel is very beneficial for those diagnosed with a terminal illness. Touring new cities can result in deep spiritual meaning in addition to boosting self-confidence.

When you receive a terminal diagnosis, determine your plan of care, ensure your legal documents are in order, purchase burial insurance, and create a bucket list. Spend as much time with loved ones as you can and gain peace knowing that you have lived a life full of love.

 

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