1. Programs Under the Older
Americans Act

There are a variety of services funded by the
Older Americans Act which are available in
each community through the Area Agency on
Aging. These services, which are available to
all older persons, include information and
referral, homemaker/home health-aides,
transportation, congregate and home delivered
meals, chore and other supportive services.
Contributions are encouraged; however, there
is no fee for services under Older Americans
Act programs. The types of services available
vary in each community based upon the needs
and resources of a given locality. Contact the
Area Agency on Aging for information about
obtaining these services.*

FINANCES

to file a claim at least three months before
becoming eligible for benefits. Spouses and
widows/widowers may be eligible for special
benefits, including death benefits. Individuals
who are disabled before 65 may apply for
Social Security disability benefits.

Older persons may have their Social
Security checks sent directly to their bank by
the United States Government. This prevents
lost or stolen checks and eliminates a trip to
the bank to deposit the check. Contact your
local Social Security Office for information
about direct deposit and ask your bank about
this service.

A. Part A-Hospital Insurance-Medicare
Part A helps pay the cost of inpatient hospital
care. In some instances, and under certain
conditions, Part A helps pay for inpatient care
in a skilled nursing facility, home health care
and hospice care.

Older persons and their families need to
be knowledgeable about Medicare coverage.
Detailed information about Medicare benefits,
including a number of pamphlets explaining
coverage can be obtained from the local Social
Security Office.

It is important that older persons and their
families understand patients' rights under
Medicare. Written material describing these
rights should be provided to patients upon
admission to a hospital. This is especially true
since the number of days in the hospital paid
for by Medicare is governed by a system
based upon patient diagnosis and medical
necessity for hospital care. Once it has been
determined that it is no longer medically
necessary for the older person to remain in
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the hospital, the physician will start the
discharge process.

If the older person or the family disagrees
with the decision to discharge the patient, the
decision may be appealed. To initiate an ap-
peal, the State's Peer Review Organization
(PRO) must be contacted by the patient or the
family. Each hospital has the name, address
and telephone number for the PRO responsible
for overseeing hospital inpatient services. In-
formation about how to contact the PRO is
available from the hospital administrator's of-
fice, social services or business office staff.
The patient or family can obtain information
about implementing appeal procedures from
the PRO and should ask about time limits
governing these procedures.

B. Part B-Medical Insurance-Part B helps
pay for medically necessary doctors' services,
outpatient hospital services and some other
medical services. Enrollees must pay a
monthly premium for Part B. Inquire at your
local Social Security office for more
information.

Medicare will pay for many health care
services but not all of them. Medicare does
not cover custodial care or care that is not
determined to be reasonable and necessary for
the diagnosis or treatment of an illness or
injury. In some instances, Medicare may pay
for certain psychiatric services. Individuals
should check with the local Social Security of-

Medicaid is a health care program for low in-
come persons cooperatively financed by
Federal and State governments. Administered
by States, the program provides for medical
services to eligible individuals. Benefits cover
both institutional and outpatient services.
However, the types of services covered may
differ from State to State. For example, some
States may provide psychiatric services for
persons over 65. Each State has a set of
criteria that establishes eligibility for services
under this program.

Further information about the Medicaid
Program is available at the local county
welfare, health or social service departments
or the Area Agency on Aging.*

6. Other Types of Public Supported
Programs

Other sources of public support include food
stamps, Veteran's benefits, housing assistance

and low income energy assistance for eligible
older persons.

Veterans, their widows or widowers, or
parents of veterans with limited income may
be eligible for benefits. Contact the local
Veterans Administration for the details.

Older persons must apply in order to par-
ticipate in any of the programs described
above.

7. Private Resources

Families need to determine whether an older
person has accumulated private resources
which can be used to help pay for the cost of
care. These resources may include retirement
plans, long term care insurance, equity in a
home, Certificates of Deposit (CDs) and In-
dividual Retirement Accounts (IRAs) as well
as assistance from family members.

8. Home Equity Conversion

Home equity conversion is a program which
enables the owner to utilize the equity in a
home for purchase of needed services. Some
banks participate in this type of program and
will arrange to free up these often overlooked
resources to help cover the costs of services
needed by the older person."

*See page 37 for the telephone number of the
agency to help you.

Health Services

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HEALTH

1. Health/Medical Services

Good health care is a very important factor in
remaining as independent as possible. Health
care, diagnostic and medical services can be
obtained through a private physician. When
necessary, the family physician can make
referrals to a specialist, a hospital or other
health services. In some communities doctors
will make house calls.

Another approach to receiving health care
and medical services is through membership
in a Health Maintenance Organization (HMO)
Contrary to a fee-for-services approach,
HMOs provide care for a predetermined,
fixed fee. The patient has a physician who
provides and monitors care and, through the
HMO, arranges for any additional health care,
diagnostic and/or medical services that may be
needed. A patient enrolled in an HMO plan
must use the doctors and health care facilities
covered by the HMO plan or must pay for
medical services received outside the plan.
Neither the HMO nor Medicare will pay the
cost of services rendered by other physicians
or facilities except in an emergency situation.

Other types of health care services that
many communities offer include educational
programs about good health habits, physical
fitness, proper nutrition, screening programs
for cancer, high blood pressure, diabetes,
dental, vision and hearing problems, reha-
bilitation
programs, and programs that monitor
the status of chronic physical conditions.

Older persons and their families need to take
an active role in selecting the most suitable
facility and service to meet the needs of the
older persons.

2. Health/Psychiatric Services
Good mental health is an important factor in
remaining independent for as long as possible.
Mental health care and diagnostic services
may be obtained through private means such
as psychiatrists and psychotherapists. Other
mental health professionals, such as psychi-
atric nurses and social workers provide help
with emotional problems. Services may also
be obtained through the local Community
Mental Health Center, psychiatric hospitals,
and at some community hospitals.*
3. Hospital/Emergency Services
Many older persons, at some point in time,
may require acute care services such as hospi-
talization and/or emergency medical services.
Physical and mental health services are usually
obtained through the family physician or the
Health Maintenance Organization. If a physi-
cian is not available, the patient may be taken
to the emergency room of the local hospital.
Ambulance services are available in most
communities if the patient cannot be taken to
an emergency room by any other means.

HEALTH

Soon after a person is admitted to a
hospital, the patient and family should be con-
tacted by the discharge planner or social
worker. If such contact is not made, inquiries
should be made about discharge planning.
Plans for the care of the patient, after
discharge from the hospital, should be made
as early as possible. Older patients and their
families should be knowledgeable about Medi-
care coverage of hospital costs and patients'
rights under Medicare. More detailed informa-
tion about Medicare benefits and patients'
rights is provided in the Finances section
under Medicare. (See page 2.)*

*See page 37 for the telephone number of the agency to help you.

physical and emotional supports that are
needed. However, in some cases when family
supports are either not available or needs ex-
ceed what families can provide, it becomes
necessary for the older person to move into a
nursing home.

Different nursing homes offer different
levels of care. The types of nursing homes
include:

A. A Skilled Nursing Facility (SNF)-is
a nursing home which provides 24 hour-a-day
nursing services for a person who has serious
health care needs but does not require the in-
tense level of care provided in a hospital.
Rehabilitation services may also be provided.
Many of these facilities are Federally cer-
tified, which means they may participate in
the Medicare or Medicaid programs.
B. An Intermediate Care Facility
(ICF) is also a nursing home which is
generally Federally certified in order to par-
ticipate in the Medicaid program. It provides
less extensive health care than a SNF. Nurs-
ing and rehabilitation services are provided in
some of these facilities, but not on a 24 hour-
a-day basis. These homes are designed for
persons who can no longer live alone but need
a minimum of medical supervision or assis-
tance and help with personal and/or social

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The first consideration in selecting a nurs-
ing home is to ensure that the facility can pro-
vide the type of care needed. Questions about
what care may be needed should be discussed
with the older person's physician. co

The second prime factor is a frank analy-
sis of the older person's financial status.
There should be a complete inventory of
available resources. This includes: source and
level of income, property, savings accounts,
stocks and bonds, veteran's benefits, pension
provisions, insurance benefits and any family
assistance available. If the older person can
not afford to pay for nursing home care,
hospital or local social services departments
will provide information about eligibility re-
quirements and procedures for applying for
assistance from publicly financed programs. If
an older person is unable to pay for nursing
home care, the choice of a nursing home is
limited to a facility which accepts Medicaid
and has an opening.

The third factor is to decide on the best
geographic location. The best choice is a
facility which is most convenient to family
and friends.

Many older persons and their families delay
or avoid discussions and decisions about nurs-
ing home placement until failing health forces
an immediate decision. If immediate help is
needed in locating a nursing home or deter-
mining the quality of care provided in a par-
ticular facility, contact the Area Agency on
Aging for assistance. Additional valuable in-
formation can be obtained through consultation
with the physician, hospital discharge planner,
State or local Nursing Home Ombudsman,
local Social Security office, clergy and
families of other nursing home residents.

Emergency placement in a nursing home
is necessary in some instances if an older per-
son is required to transfer from the hospital to
a nursing home on short notice. Even under
these circumstances, appropriate timing and
arrangements for this transfer should be
discussed with the physician and hospital
personnel.

Even though the need for nursing home
placement is urgent, it is still essential to con-
sider the type of care needed, the finances

available and the convenience of the facility's
location.

E. Nursing Home Ombudsman-The
best way for families to assure quality care
for an elderly relative in a nursing home is
for family members and friends to continue to
be involved with the older person through fre-
quent visiting and good communication with
the nursing home staff. If a question or prob-
lem arises regarding care of the nursing home
resident, the first step in resolving the issue is
to talk to the nursing staff or the social
worker. If the issue continues to be of con-
cern, the next step is to talk to the nursing
home administrator. If these steps do not
resolve the issue, the resident and/or the fam-
ily may want to contact the Nursing Home
Ombudsman who serves the community. The
Ombudsman works with nursing home resi-
dents and families to negotiate a satisfactory
resolution to questions and/or problems which
have surfaced.

All States and many local communities
have an Ombudsman who is responsible for
investigating and resolving complaints made
by or on behalf of residents in long term care
facilities. The Ombudsman monitors the im-
plementation of Federal, State and local laws
governing long term care facilities. In many

*See page 37 for the telephone number of the agency to help you.

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COMMUNITY SERVICES