SOUTHERN MAINE LONG TERM CARE GROUP MEETING

 

MINUTES

 

                                                           July 26 2006

 

                                                      2:00 PM – 4:00 PM

 

Introductions: Debbie DiDominicus, SMAA; Vivien Eisenhart, SMAA; Amy Hatch, SMAA;; Robyn Berry, Alzheimer’s Association; Kate Dulac, SMAA;  Dianne Fazio, Home Instead Care; Katharyn Ledoux, Kindred Healthcare;  Michelle Matt, Goodall Hospital; Margaret Meyers, SMAA; Terry Roy, Goodwill Bayside Neuro Rehab;  Michelle Matt, Goodall Hospital; Ann Neelon, Maine Medical Center; Susan Rosenbaum, Home Health; Perry Blass, Living Innovations; Kathleen

Candage, In Home Senior Care; Margy Gambell, Home Instead Care; Corinne Gilmore, Casco Bay Homecare; Polly Miller, Maine Ambulance; Liz Paige, Foster Grandparent Program Family/Friends; Melissa Picoraro, SMAA; Suzanne Plourde, Kindred Healthcare; Robin Snowden, New England Emergency Response Systems; Jennifer Theberge, Living Innovations.

 

UPDATES:

 

Michelle Matt, Goodall Hospital, is selling cookbooks as a fundraiser for the area SALT for $8.00.  

 

PRESENTATION:  Susan Lutton, Attorney with Maine’s Legal Services for the Elderly on Immigration/Citizenship and Estate Recovery.

 

IMMIGRATION/CITIZENSHIP

 

The Deficit Reduction Act of 2005 requires that, as of July 1, 2006, actual documentary evidence must be provided before Medicaid eligibility can be granted or renewed.  Once this has been proven, documents need not be provided again unless later evidence raises questions.

 

  • Two weeks ago the Federal Government issued a statement that seniors and people with Medicaid/SSI have already made documentation and therefore are automatically approved.

 

There are four Tiers which the government accepts as proof of citizenship:

 

  1. Tier I proves citizenship and identity.   A person needs a certificate of citizenship

      which would include the following:

 

 

 

 

 

·        A U S Passport

·        A Certificate of Naturalization (DHHS Forms N-550 or N-570)

·        A Certificate of U S Citizenship (DHHS Forms N-560 or N-561)

 

Acceptable secondary documentation to verify proof of citizenship (an identity document is also required)

 

      2, 3, 4 Tiers – verify proof only of citizenship:

 

·        Passport, Birth Certificate, Proof of birth abroad of a U S Citizen

·        U S Citizen I D card

·        American Indian Card issued by Department of Homeland Security with classification of “KIC” which was issued by DHS to identify U S citizen members of the Texas Band of Kickapoos living near the U S/Mexican border

·        Adoption decree

·        Extract of U S hospital record of birth established at the time of the person’s birth and was created at least 5 years before the initial application date and indicates a U S place of birth

·        Federal or State census record showing U S citizenship or a U S place of birth

·        Institutional admission papers from a nursing home, skilled nursing care facility or other institution and was created at least 5 years before the initial application date and indicates a U S place of birth

·        Medical (clinic, doctor, or hospital)

·        Written Affidavit

·        Other written documents created at least 5 years before the application for Medicaid.  These documents are Seneca Indian tribal census record, Bureau of Indian Affairs tribal census records of the Navaho Indians, U S State Vital Statistics official notification of birth registration

·        Written Affidavit – these may be used only in rate circumstances when the State cannot secure evidence of citizenship from another listing.

 

Acceptable documentation to verify proof of identity

           

·        Current state driver’s license with individual’s picture

·        Certificate of Indian Blood or other U S American Indian/Alaska Native tribal document

·        School identification card with photograph of individual

·        U S Military card or draft record

·        Identification card issued by the Federal, State or local government with the same information included on driver’s license

 

 

 

·        Military dependent’s identification card

·        Native American Tribal document

·        U S Coast Guard Merchant Mariner card

·        Data matches with other agencies can be used to verify identify such as those with Federal or State governmental, public assistance, law enforcement, or corrections agencies, at the State’s option.  Such agencies may include food stamps, child support, corrections, including juvenile detentions, motor vehicle, or child protective services

 

Estate Recovery Law

 

Here are some important facts about Estate Recovery and MaineCare:

 

·        The Estate Recovery Program allows DHHS to recover the cost of a MaineCare recipient’s care from his or her estate in some situations.

·        The DHHS won’t recover any money for expenses for health care benefits you received before you turned 55 (with only two exceptions)

·        The Estate Recovery Program in Maine allows the state to recover its costs only after the MaineCare/Medicaid recipient has passed away.  The state cannot take your property or put a lien on it while you are alive.  Even after your death, the state cannot simply step in and take your property.  There are certain legal procedures that must be followed and many restrictions apply

·        After a death, in certain circumstances, DHHS may try to recover the amount of MaineCare/Medicaid assistance you received from your probate estate as follows:

 

55 or older or receiving MaineCare/Medicaid; or

You have received MaineCare/Medicaid even though you could have had your costs paid for by long term care insurance in connection with certain assets that DHHS disregard

DHHS discovers that you had assets during the time you received MaineCare/Medicaid that actually made you ineligible.

 

Estate Recovery does not apply to the following benefits:

 

·        Low Cost Drug Program

·        Maine Rx Plus

·        Qualified Medicare Beneficiary Program (QMB), the Specified Low Income Medicare Beneficiary Program (SLMB), and other programs that help Medicare beneficiaries pay their out of pocket costs

 

 

 

 

When you die most property you owned at the time of your death becomes the property of your probate estate.  This may include your savings, personal property (such as a car or household items) and your home or other real property.  DHHS can make a claim against your estate to pay back whatever MaineCare paid for your health care. The property in your estate may be sold to pay DHHS back.  There are some very important exceptions.  Sometimes Estate Recovery does not apply at all and sometimes property is completely protected.  The exceptions for others living in the house are as follows:

 

·        A surviving spouse

·        A surviving child under the age of 21

·        A surviving adult child who is blind or permanently or totally disabled

 

Even when these dependents die, DHHS will not pursue claims against their estate for your MaineCare/Medicaid expenses (unless they die within four months of your death)

 

Jointly owned real estate is excluded.  If someone else’s name is on the deed that property will not be affected.  Transferring property at less than fair market value or simply adding someone to your deed could make you ineligible for nursing home or other long term care through MaineCare. 

 

Your estate, or a portion of it, may also be protected if DHHS’s actions will create an undue hardship for someone who survives you.  For example, if the survivor’s income or asset level for the year would fall below 180% of the current federal poverty level without your estate or if the survivor has low-income and your estate includes real property which is his or her primary income producing  resource.  Another reason would be if the survivor took care of you for at least two years and can show that the care provided allowed you to stay at home, she or he may also be eligible for a Hardship Waiver.  The Hardship Waiver must be made within six months of your death, or within 30 days from the notice of DHHS’s claim against your estate, whichever is later.

 

Debbie thanked Susan for a very informative talk.

 

SECOND PRESENTATION:  MAINE MEDICAL CENTER – Bonnie Smith, Director of Care Coordination and Cindy Tack, Director of Social Work.

 

On any given day the statistics show that there are roughly 487 patients at Maine Medical Center.  Maine Medical Center is normally a 600 bed hospital.  However some beds are not considered “true” beds.  When the census gets up over 500 patients, additional attention is on the care coordinators to enlist the support of community providers to seek appropriate alternative placements.

 

 

 

 

 

 

There are 31,000 patients in house and 500,000 outpatients in a given year.  A lot of patients are uninsured or on Medicare.  The Emergency Room sees about 51,000 patients a year.  There are 24,000 surgeries a year and 2,400 births a year.

 

Maine Medical Center is rated very high and the nursing staff just received magnum status which means it is the highest rate of accreditation a hospital can get. 

 

  • Bonnie Smith, Care Coordinator talked about the barriers for good discharge planning.  She emphasized how important it is to have the correct information on a patient and their living arrangements before they are admitted.  There are times when a patient enters the hospital for hip replacement, has the surgery, and is released to their home.  Then the hospital learns that the patient is living on the third floor and has some problems.  .It is this type of thing where there needs to be better communication between the patient, family, physician, and hospital.  

 

  • Emergency Admission and waiting in emergency can be very fast paced.  It is important to have Medical cards available.  It can be a very scary place for the elderly especially when the physician has told the patient to go the emergency.  Some believe their physician will meet them at Emergency which is often not the case.  When the patient gets to Emergency, no one has contacted Admitting and they are unaware of the person’s arrival.  The Care Coordinator tries to be there to oversee and make sure everything is in place before the person is discharged from Emergency.  

 

  • Another problem area is a person coming in for scheduled surgery could be bumped because of an emergency admission.  The patient bumped or delayed admission for a few days can experience a negative start to their eventual hospital stay.  

 

  • The technology in the hospital can be frightening to an older person .  

 

  • In addition having multiple caregivers can be of concern as well.  It is possible for a patient to get three different nurses if they are in the hospital for three or four days. 

 

  • If a patient is stable and no longer in need of acute care, they are discharged and can go home often within 23 hours.  It is hard for the patient to understand this quick turnaround.  They can express upset about going home when they still don’t feel well enough to go home.  One of the programs being discussed now is talking with the patient and their families before the patient is admitted to the hospital.

 

  • There is not enough access to services and also not enough services for the Medicare patient.  It is very important the patient gets the services they need after leaving the hospital.

 

 

Discussion

 

Question:  How do we know what medications are needed?  Sometimes the doctor will change the medications the patient is receiving.

 

There is usually a three day supply of medications given to the patient on leaving the hospital. 

 

Question:  Is it possible to invite the community into the hospital to share in the planning for the eventual discharge?   Also what if a person is not considered to need “acute care” but is a repeat patient to the hospital.  What are the criteria for a patient going home in a timely manner?

 

There needs to be a strong collaboration working for a common goal for those who do not have access to services.  It is important to have meshing of the Social Worker and the Care Coordinator using great team work and having great communication and making sure that there are services for the patient when they return home and checking up to make sure things are going well.

 

Question: Are there volunteers in the hospital to be with an older person?  An example would be of patients sometimes not getting the attention they need in the emergency room. 

 

There are volunteers in the emergency department but there is not 24/7 coverage.  The volunteers are there to talk to the family and make rounds to talk to patients. There are 18 beds in the emergency room and sometimes a patient will be in the hallway for a period of time.  The emergency staff is aware of the problem and that there is lack of staffing.

 

Debbie thanked Bonnie and Cindy for their wonderful presentation.

 

Meeting adjourned.

 

The next meeting will be held on Wednesday, September 27, 2006 - 2:00pm – 4:00pm

 

Respectfully submitted

Vivien Eisenhart