What is Medicare and what does it cover?

Medicare is a federal health insurance program that has limitations when it comes to paying for skilled, or long-term care in a care center.  (Medicare does not cover living costs in an assisted living).  Medicare has multiple parts:

Part A:  Hospital Insurance: helps pay the cost of an inpatient hospital stay.  Under certain conditions, Part A helps pay for inpatient care in a 'skilled' nursing facility, hospital related home healthcare, and Hospice care.

Part B:  Helps pay for necessary doctor's services, outpatient hospital services, home healthcare, and some preventative services.

Part D:  Helps pay for your drug coverage.  

2.

What is Medicaid and what does it cover?

Medicaid is a health care program for low income persons, financed by Federal and State governments.  Benefits cover both institutional and outpatient services.  Medicaid will pay for skilled, and long-term nursing home care for as long as the individual meets the level of care needs.  Medicaid is accepted in both our care center, and our assisted living (via the Assisted Living Waiver Program), provided an individual qualifies.  

If the application is approved, or an individual is enrolled, the resident will contribute most of their monthly income, and the balance is paid via Medicaid.

3.

What is 'Patient Liability'?

Patient liability is the individual's financial obligation toward the Medicaid cost of care.  The nursing home, and/or assisted living is notified (via the State) of the amount to bill the resident, any changes to the amount thereafter, and any retroactive adjustments.  We do not have jursidication to change it without official notification from the State, or a governing entity.  

4.

What is MyCare Ohio?

In 2012, Ohio became the third state to receive federal approval to coordinate benefts for residents whom are covered under both Medicare and Medicaid, or whom will one day qualify for both benefits.  The result is MyCare Ohio, which uses a managed care approach to better connect services in each program.  In 2014, MyCare Ohio was launched in Cuyahoga County, and the process began for nursing homes, and assisted livings to learn, and adapt to the new system(s).  

Joshua Tree Senior Living is contracted with each of the three MyCare Ohio providers, which are: Buckeye, CareSource and United Healthcare.

5.

How will MyCare Ohio affect my stay in a nursing home, or an assisted living?

To date, there is still a lot of unknowns regarding MyCare Ohio, as far as our role in the process.  What we can promise you is that we are educating ourselves on the processes, and pre-certifications that may be needed depending on the Managed Care entity the resident chose, or which may have been chosen on their behalf.  

In short, we are hopeful that our current, and future residents will be unaffected by this new program, as far as assessments, admissions, re-admissions, level of care changes, and/or allowed benefits during their stay with us!

6.

What does respite care mean?

Respite care means a 'short-term' stay  A person can come to our facilities (based upon availability), and pay a daily rate for services rendered.  

The reasons for these stays vary, but examples may be:  seeing if the resident is comfortable, feels save, and/or will transition well into our facilities for a short length of time before deciding if they will be long term.  Or, if a family is taking a vacation, and would feel better if we cared for their loved one in their absence, etc.  

7.

You advertise you are a 'continuum of care' campus.  What does that mean?

In short, the nursing home and assisted living work hand-in-hand, and always prioritize each other's residents accordingly.  Transitions from the assisted living to the nursing home, or from the nursing home to the assisted living can, and often do happen.  Whether a resident's health has declined to the point they are no longer safe in an assisted living, or a resident's health has improved, and although they are not safe in their home, they are no longer in need of the nursing home setting; we work as one unit to help the resident, and/or their families out.  

This is a wonderful benefit to offer the community!

8.

You mention 'level of care' in many responses.  Please define what that means.

Although our nursing home, and assisted living can provide a lot of specialized services, there are sometimes areas where a resident's level of care exceeds our capacity. Those conditions vary, but an example may be behavorial issues that may cause harm to the resident in our setting, or to the other resident's in our setting.  

9.

How do I decide which nursing home to choose for placement?

Choosing a nursing home that provides the kind of care and enviroment that meets the individual's physical, social, emotional and spiritual needs will signficantly help the person make the adjustment to the new surroundings.  If possible, it is important to keep the person as much of a part of the decision-making process.

 Primary factors affecting the choice of a nursing home are, and should be:

• Type of care required.
• Financial resources available (What insurances are accepted?  What is the cost if we need to pay privately, and what is included in that per day rate?  What are our choices if the resident runs out of money?)
• Location, and size of facility.
• How the nursing home compares to other's in the area.  (please see our 'helpful links' section for more information).

We know this transition may be difficult for the resident, or those making the decision, but we firmly believe in keeping their needs a priority, and will be honest with you if we feel we cannot meet their needs accordingly.

Always tour the facilities before you make a choice!

10.

How do I decide which Assisted Living to choose for placement?

Choosing an Assisted Living can be difficult, as there are so many possibilities in our area.  Ultimately, you want the Assisted Living to meet the individual's physical, social, emotional and spiritual needs.  We strongly urge the individual to be a part of the process, which will ease their transition from the community to the Assisted Living.  

Primary factors affecting the choice of an Assisted Living are, or should be:

• Level of care needs for the individual, and how they can be accommodated accordingly.
• Size, and location of the facility.  Too big?  Too small?  
• What forms of payment are accepted, or in the event the resident runs out of funds, does the facility accept the Assisted Living Waiver residents.  Furthermore, what are the facilities stipulations/limitations regarding the 'spend down' of the individual.  Do they need to pay privately for 6-months, an entire year, etc?
• What amentities are included in the basic rent package, versus what additional items will be billed seperately?
• How the assisted living compares to other's in the area.

We know the transition may be difficult for the resident, or those making the decision, but we firmly believe in keeping their needs a priority, and will be honest with you if we feel we cannot meet their needs accordingly.

Always tour the facilities before you make a choice!