Family Care Management During the COVID-19 Crisis

Managing a loved one’s care during these unprecedented times might call for non-traditional forms of communication, and self-education about recent changes in the law.

If a loved one lives in a residential care facility, whether it be assisted living, memory care or a group home, you may be the person on whom they rely to manage their care. Difficult enough in the best of situations, managing someone else’s care has taken on unprecedented challenges since the start of the  COVID-19 pandemic.

Government stay-at-home orders and residential care facilities’ prudent measures preventing visitors cause feelings of isolation for both the residents and their loved ones who are unable to see them. Worse, the inability to visit also interferes with family members’ ability to supervise their loved ones’ care, because it is often the family member who is the first to observe changes in the resident’s condition that need attention.

If you are in that situation, here are some tips for communicating with the resident and the facility and being alert to heightened needs for care.

Virtual Visits. If your loved one is able to manage a smart phone, you may be able to “visit” via Facetime or other video meeting options. If your loved one can’t manage the phone, you can ask a staff member to assist with a video call every few days.

While connecting in this way may not be ideal, it can be invaluable for you and them. Even someone with dementia may recognize a familiar voice or be uplifted by the video visitor’s smiling face or laughing grandchildren. Equally important, you may be able to get immediate feedback on at least some changes, such as apparent weight loss, skin conditions, or an unusual mood or affect.

Remote Care Plan Meetings. Residential facilities are required to have regular care plan meetings for each resident, and you can ask to attend by phone or video conference. You can also ask that a meeting be scheduled so that you can continue to make sure that the facility is aware of the resident’s specific needs, and that there is a plan in place to meet them. For example, if the resident requires hands-on assistance with showers twice a week, it is important that is still taking place, even while the staff takes extra precautions with masks, gowns and gloves.

New Rules. You should not assume that management and caregivers at your loved one’s residential care facility are fully aware of the many rapid changes in laws and regulations that affect Medicare beneficiaries during the COVID-19 crisis. While the staff at many facilities are amazingly on top of things, we are finding that to be more the exception than the rule, especially with the rules changing so frequently. As a result, you may know more about certain issues than the facility’s management, and you should not be shy about asserting your knowledge.

While the financial stimulus and loan provisions of the CARES Act have gotten the most publicity, some of its other, less-publicized provisions have a direct impact on  patient care. For example:

  • The CARES Act includes provisions that prevent pharmacies from (a) providing less than a 90-day supply of prescription medications if the patient requests more than the usual 30-day prescription or (b) requiring prior approval from the doctor to renew a prescription.
  • According to guidance issued by the Centers for Medicare and Medicaid just last week, insurance companies offering Medicare Part D and Medicare Advantage Plans are instructed to relax cost-sharing requirements and to “show flexibility” before canceling a policy , if premiums are late or unpaid during the COVID-19 crisis, .
  • If someone suffers a health crisis during this time, such as a stroke or major injury, Medicare has suspended the requirement that someone be admitted to the hospital for at least three days before Medicare will cover the cost of inpatient skilled care or rehabilitation. If, for example, your loved one has suffered a fall resulting in a broken bone, you may want to advocate that they be admitted directly into the rehab facility from the Emergency Room, both to start rehabilitation as soon as possible, and to avoid staying in a location where there is high potential exposure to the virus.

If the new changes have not been implemented in a facility, or if staff appears to be unaware of them, it may fall on you to educate them.

Extra Help. this may be a critical time to seek professional help, even if it is only temporary, and especially if direct contact with your loved one’s facility and caregivers is not an option. For example, geriatric care managers or visiting medical practices employ nurses and other medical professionals who can visit residents of care facilities and advocate on their behalf.

Medicare Patients Can Now Appeal “Observation Status”

Last week, Justice in Aging and the Center for Medicare Advocacy successfully won a ruling from a federal judge that Medicare patients who have been denied coverage in nursing facilities because they were under “observation status” in the hospital, rather than having been admitted, can appeal that classification.  A successful outcome would allow them to potentially receive reimbursement from Medicare for the uncovered nursing facility charges they had incurred.

if a patient is receiving outpatient observation services for more than 24 hours, hospitals are now required to provide a Medicare Outpatient Observation Notice (MOON) to advise that the person is an outpatient in a hospital or critical access hospital.  The MOON also describes how this may affect what the patient will pay while in the hospital, and for care   after leaving the hospital. However, the MOON is a relatively recent development, so patients previously had no way of knowing their treatment status while in the hospital, or on discharge.   Now, this important decision will allow thousands of Medicare beneficiaries who were denied coverage for nursing home stays to appeal changes in their status to “observation” going back to 2009.  And in the present time, patients can demand to know whether they are being treated as inpatients, or under observation status, so they can take appropriate action in real time.

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