Enhanced Case Management/Case Management
Case Management services are those that help people navigate the system of health and social services.
- Medicaid funds several types of Care Management services, including programs for mental health and mental retardation, programs for the elderly and disabled, and programs for children.
- Recipients of some Medicaid Case Management services may have access to a variety of home and community services, which include meals, personal care, skilled care, adult day health, Assisted Living, and Respite Care.
- The SOURCE program is a state plan service for Medicaid recipients on SSI who have chronic diseases and are at risk of Nursing Center placement. SOURCE’s hallmarks are physician involvement and intensive Case Management. More information about SOURCE is available by calling 1-888-762-2420.
- The Community Care Service Provider Program is a Medicaid waiver program operated out of the Department of Human Resources. Recipients who have income above the SSI level may qualify for Medicaid services by paying for a portion of the services they receive. CCSP recipients must have a chronic disease and be eligible for nursing center placement to qualify for services. The Area Agency on Aging in your area accepts referrals for the Community Care Program.
Emergency Response Systems
Elderly and disabled persons who live alone or who have no one who can provide urgent care during certain hours of the day or night may appreciate the security of an Emergency Response Monitoring System. This system is often paid for privately, but SOURCE and some Medicaid waiver programs make this available to their members if needed.
- Emergency response systems require a phone line.
- The client pushes a button, which summons an operator who will direct the appropriate helper—a relative or neighbor, firefighter, ambulance, or law enforcement—to the client’s home.
- Quality ERS companies update client information regularly and check to ensure that equipment is working.
- ERS systems can reduce death and disability because help can be summoned rapidly.
For general information about Emergency Response Systems, call 1-800-922-5487. A Checklist for Choosing a Community Service Provider may help you know what questions to ask about Emergency Response Systems.
Private Home Care or Private Duty
Private Home Care providers may provide companions, personal care aides, and nurses to clients who require supportive services.
Companions: In Georgia, companions or sitters employed by a Private Home Care agency may provide light housekeeping, run errands, prepare meals, and monitor safety, but they may not perform hands-on care.
Personal Care Aide/Assistants: Most care delivered by Private Home Care agencies is provided by Personal Care Assistants, who may or may not be certified. Agencies are required to credential aides. Aides may provide companion services, personal care, and homemaker and errand services.
Chore and Custodial Services: Some Private Home Care agencies offer chore and homemaker services. These services may be provided by Private Home Care agencies as part of the overall care plan for the client. If such services are offered by a Private Home Care agency, the agency must be licensed and use qualified staff.
Skilled Nursing: Skilled nursing can also be provided by Private Home Care LPNs and RNs, if the agency is licensed to provide this service.
Medication Management: The first rule is to ensure that the primary care provider is aware of all medications. For people who have difficulty managing their medications, help may be available through Private Home Care agencies. Nurses can set up pill boxes on a regular basis and monitor the client’s ability to take medicine correctly.
Respite Care: Respite Care is designed to give caregivers a break from their normal responsibilities. Care may be provided in the home by personal support aides or companions, at Adult Day Health Centers, and in some Assisted Living Facilities and Nursing Centers.
General information about the range of services provided by Private Home Care providers is available at 1-866-269-0174. A Checklist for Choosing a Community Service Provider can help you know what questions to ask.
Home Health
Home Health is designed to meet the needs of patients who are recovering from an illness or who have a chronic medical condition that requires the care of a nurse and/or a physical, occupational, or speech therapist. Diagnostic testing, wound care, therapy, and skilled nursing are Home Health Services. In most cases, Home Health patients are homebound. Home Health is generally a short-term service, designed to meet the needs of patients who have suffered an acute illness or injury or who have newly diagnosed health problems. Home Health patients covered by Medicare must be recertified by the physician every two months.
- Home Health providers may also offer Home Health aides to provide additional services for clients on a short-term basis. Aides can provide supportive services, bathing and meal preparation, for example, that help ensure that the client is able to remain in his or her home.
- Home Health may be funded by insurance companies, private payers, VA, Workers’ Compensation, Medicare, and Medicaid. Some long term care policies cover Home Health.
- Home Health agencies in Georgia must have a Certificate of Need and a License from the Office of Regulatory Services.
- Home Health agencies do not generally provide around-the-clock care.
A Checklist for Choosing a Community Provider (link to 064) can help you know what questions to ask.
Adult Day Services in Georgia
Adult Day Care
Although defined differently by different providers and different states, in many cases adult day care provides a basic level of support to older and disabled adults.
- Services may include watchful oversight, meals, activities, and, in some cases, personal care, often called support for Activities of Daily Living.
- Adult day care programs may be episodic and may be offered anywhere from a church to an Assisted Living facility.
A Checklist for Choosing a Community Service Provider can help you know what questions to ask.
Adult Day Health
In Georgia, Adult Day Health includes all of the above services of Adult Day Care, along with nursing care.
- Adult Day Health in most instances offers the same level of care that a Nursing Center might offer, that is, nursing, therapy, and activities, as well as personal care (bathing, grooming, toileting, etc.)
Home Delivered Meals/Congregate Meals
Many Georgians are able to remain in their homes, thanks to Home Delivered Meals. Congregate meals are also served at most county Senior Citizen Programs, but services are limited to the center’s capacity.
- Home Delivered Meals may be arranged through multiple resources, but the first stop should be the local Senior Center or your Area Agency on Aging for information about enrollment.
- Home Delivered Meals may be available to persons who need the service and are enrolled in SOURCE or the Community Care Service Provider. Additionally, most Home Delivered Meals programs will deliver to homebound self-pay clients.
- Meals come in a variety of formats, from hot to shelf-stable to frozen.
Transportation
Being able to run errands, meet with friends, or go to church and social events are integral parts of most people’s lives. When a person is no longer able to drive, reliable transportation is a key factor in continuing community residence.
In Georgia, all Medicaid recipients have access to transportation to medical appointments, but a three-day notice is generally required unless the appointment is considered urgent. The Department of Human Resources operates some van transport for people who participate in DHR programs and senior centers.
Assisted Living
- In Georgia, Assisted Living Homes may be referred to as Personal Care Homes, Alternative Living, or Assisted Living. Assisted Living facilities must be licensed in Georgia. In general, they provide supportive living services, including personal care, often referred to as support for Activities of Daily Living.
Independent Living
While there could be many definitions for Independent Living, in most cases, residents of a defined “neighborhood” pay a fee for access to certain services, which may or may not include security, meals or restaurant dining, housekeeping and laundry. Generally speaking, most people who reside in Independent Living Communities remain able to function on their own but enjoy the security of the neighborhood or campus.
- Independent Living is nearly always privately funded.
- Some government programs provide Case Management services for people who live in subsidized housing to help them access needed services. This is sometimes called “supported housing.”
Hospice
Hospice programs are designed to provide palliative or comfort care to persons who are at the end of life. Hospice can be paid for by insurance, Veteran’s benefits, Medicare, Medicaid, or private payers.
- Hospice is available in the community, in Nursing Centers and in special inpatient Hospice units. Some Hospices also provide Respite Care when family caregivers need a break from their duties.
- Hospice does not pay for room and board. It does pay for the full-range of nursing and aide services and for medical supplies and medications and treatments that are related to the terminal illness. Social services and the care of a chaplain and volunteers are also part of most Hospice programs.
The Checklist for Choosing a Community Service Provider may provide help in knowing what questions to ask when you are selecting a Hospice agency.
Therapy
Therapy is a vital part of returning to good health and an improved quality of life. All Medicare-certified Nursing Centers offer Therapy, and Therapy is also available on an outpatient basis at independent agencies, hospitals, and from Home Health providers.
Types of Therapy
There are three general types of Therapy: physical, occupational, and speech-language pathology. For a person who has suffered a major stroke, all three specialties might be involved in helping the person maximize function, but for someone with a broken bone, only one type of Therapy might be involved. Physician’s orders are required for Therapy.
Understanding Therapy treatments
Medicare rules require that Therapy stop when the person is no longer making progress. When this happens, follow-up care can be provided in Nursing Centers by nurses and nursing assistants to ensure that function is maximized.
Payment for Therapy
Therapy can be paid for in the following ways:
- Medicare will pay for a limited amount of Therapy, based on the annual Therapy cap established for that therapeutic discipline.
- In outpatient settings for Medicaid-only patients, Medicaid will pay for Therapy services.
- VA and private insurance will cover the cost of Therapy, but advance approval must be obtained.
- Workers’ compensation insurance will generally cover Therapy related to the on-the-job injury.
Nursing Centers/Skilled Nursing Facilities
Nursing Centers provide around-the-clock care to long-term and short-term care patients with an interdisciplinary team approach, including direct care givers, nurses, physical, occupational, and speech therapists, registered dietitians, and pharmacy consultants, with oversight by a Medical Director. Social service and activity programs are an integral part of care, and housekeeping and laundry services are available to all residents.
- Nursing Centers are increasingly used for short-term rehabilitation following an acute illness, but these facilities also provide long-term care.
- In Georgia, most Nursing Center stays are funded by Medicaid, although traditional Medicare will cover up to 100 days of skilled care in Medicare-certified facilities. Some Nursing Centers have contracts with the Veterans Administration and accept VA patients. There are also some facilities dedicated to the long-term care of veterans. Long-term care insurance may also cover a Nursing Center stay. Potential residents who have Medicare Advantage Plans should check with their plans to determine benefits, since each plan is different. Some short-term rehab stays are funded by insurance companies.
- Some Nursing Centers specialize in an intermediate level of care for persons with mental health or developmental disability issues.
- Hospice services are available in some Nursing Centers, but Hospice does not cover the costs of room and board.
- A complete list of Nursing Centers and survey results for each can be found at http://ors.dhr.georgia.gov.
- A Checklist for Choosing a Skilled Nursing Center may help you know what questions to ask.
Good resources for Nursing Center information are the Georgia Heath Care Association at www.ghca.info and the American Association of Homes and Services for the Aging at www.aahsa.org. The government’s Medicare website, www.medicare.gov, also has much information about selecting a Nursing Center.
Legal Services for Older Georgians
- Legal Services are provided to elderly and disabled persons through the Georgia Legal Services. For further information about help with Legal Services, you may call the main office of the Georgia Legal Services Program at 1-800-498-9469 or the Pro Bono Project of the State Bar of Georgia at 1-800-334-6835. The Department of Human Resources website, www.dhr.georgia.gov, also has helpful information on legal assistance for older adults.
The act of preparing an advance directive can be an act of consideration for worried loved ones facing difficult decisions. Knowing the type of care one would want when dying and what one would choose following death can remove the burden of decision-making from grieving family members.
PATIENT SELF-DETERMINATION ACT
The "Patient Self-Determination Act" of 1990 is a federal law that went into effect on December 1, 1991. The legislation was created to ensure the legal right of each competent adult, 18 years and older, to make his/her own medical decisions. The act mandates Medicare and Medicaid certified nursing facilities, as well as other agencies, to give patients information about their right to make decisions concerning medical care including the right to accept or refuse medical or surgical treatment and the right to complete advance directives.
In order to make informed decisions, patients are entitled to adequate information about their condition, treatment alternatives, likely risks and benefits of the alternatives, and possible consequences.
ADVANCE DIRECTIVES
Advance Directives are written documents that are set up in advance in case a person is unable to communicate his or her desires about medical treatment. These are documents that state your choices about medical treatment and/or name someone to make choices about medical treatment for you, if you become unable to make decisions. Advance directives only come into effect when the individual is unable to make medical decisions on their own. The intent of the advance directives provisions is to enhance an adult individual’s control over medical treatment decisions. Whether you choose to execute an advance directive is a personal matter and will never be a condition of whether you receive services from a health care provider.
There are two primary purposes of advance directives that are recognized in Georgia:
1) A document which appoints a health care agent, and
2) A document that directs treatment preferences when a person is in a terminal condition or state of permanent unconsciousness
The Advance Directive for Health Care form provides a document that allows one or both of these purposes for advance directives to be completed on one form.
HEALTH CARE AGENT
A person can appoint a “health care agent” to act for and on their behalf to make decisions related to consent, refusal or withdrawal of any type of health care when the person is unable or chooses not to make health care decisions for him or herself. You should sit down with this agent and discuss your views; thus, giving your health care agent instructions or guidelines, you want them to follow.
As long as you are competent and able to communicate, you make your own decisions. Your health care agent is involved only when and if it is determined that you are unable to understand or communicate your decisions. You can make changes in or revoke or cancel the document at any time.
In Georgia, the current statutory form is the Advance Directive for Health Care and Part One of this form allows a person to appoint a health care agent and back-up agents. Other forms of advance directives for health care that substantially comply with this form may be used. If a person has completed a validly executed Durable Power of Attorney for Health Care on or before June 30, 2007, this advance directive document will remain valid unless you decide to revoke it.
Another type of advance directive is a document that directs treatment preferences when and only when a person is in a terminal condition or state of permanent unconsciousness. One of the two conditions would have to be established by having two physicians personally examine and certify in writing that the condition exists. Statements about the withholding and withdrawal of life support as well as statements concerning whether the individual would want nourishment or hydration may be declared. The withholding or withdrawal of certain medical procedures does not include the administration of medication to alleviate pain or the performance of any medical procedure deemed necessary to alleviate pain.
In Georgia, the Treatment Preferences section of the Advance Directive for Health Care form allows you to state your treatment preferences if you have a terminal condition or if you are in a state of permanent unconsciousness. Other forms of advance directives for health care that substantially comply with this form may be used. If a person has completed a validly executed Living Will on or before June 30, 2007, this advance directive document will remain valid unless you decide to revoke it.
These documents can be changed or revoked at anytime. If you choose to complete the new Advance Directive for Health Care, it will replace any other advance directive form that is currently in place.
Georgia has recently updated previous Advanced Directive documents into one easy-to-understand and complete Advance Directive Form.
Funerals, Burial, and Cremation
“Funerals: A Consumer Guide,” a publication of the General Services Administration, is available at http://www.pueblo.gsa.gov.
- Discussing funerals with your family prior to death helps family members honor your wishes.
Additional information is available at Funeral Consumers Alliance, www.funerals.org and the Cremation Association of North America, www.cremationassociation.org.