2019-2020 Health Care Guide

S ENIOR R ESOURCES' 2019/2020 Health CareGuide for Older Adults Counties Served: Milwaukee Ozaukee Washington Waukesha Comprehensive Information On: • Adult Day Services • Care Coordination • Home Care/Non-Medical • Home Health • Home Medical Equipment • Hospice • Hospitals • Skilled Nursing Facilities

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Compliments of:

Visit us online: www.seniorresourcesonline.com Senior Resources, Inc. • P.O. Box 285 Germantown, WI 53022-0285

A N I NTRODuCTION AND O vERvIEW Of ThE D IRECTORy Milwaukee County listings show the area of Milwaukee where a facility is located. Please refer to the Milwaukee County map on page 3 for a geo- graphic breakdown. Information was obtained from returned question- naires and phone calls to N EED A DDITIONAl C OPIES ? Individuals –We do provide these directories to profes- sionals to give out to the community. If you can’t find a copy or want a copy of any of our other directo- ries, please call or e-mail us. We do ask for a $3 donation if possible to help cover our shipping costs. If you are looking for Wisconsin based services in

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Professionals – Senior Resources’ Directories are provided free to profession- als. These directories can be given out to older adults and family members to assist them in locating appropriate services. If you are a professional working with older adults and need additional copies, please call or e-mail us and we will be happy to get you additional copies. elcome to the nineteenth edition of Senior Resources’ Health Care Guide for Older Adults . This directory was developed to assist older adults and their families locate appropriate health care options in Milwaukee, Ozaukee, Washington and Waukesha counties. This directory is broken down into eight main sections. Each section begins with a narrative describing the ser- vice offered followed by a comprehensive listing of providers in that section.

facilities listed in this directo- ry. Every effort was made to verify the accuracy of this data. Inclusion in this direc- tory does not constitute a rec- ommendation. Senior Resources is not responsible for inaccuracies in this direc- tory. We hope this information is helpful to you. This directo- ry will be updated and pub- lished annually. We would appreciate any comments or suggestions regarding this directory. Please call 262-253-0901. areas where we do not print a directory, please check out our comprehensive website of Services for Older Adults in the state of Wisconsin at www.seniorresourcesonline.com. Senior Resources, Inc. PO Box 285 Germantown, WI 53022 262-253-0901 info@seniorresourcesonline.com

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2019

T ABLE OF C ONTENTS

S E N I O R

R E S O U R C E S

A BOUT T HE D IRECTORY

A DULT D AY S ERVICES pg 24 • Early Memory Loss Programs . . . . . . . . . . . . . . . . . . . . . . .26 • Milwaukee County . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28 • Ozaukee County . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31 • Washington County . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31 • Waukesha County . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31 • Introduction and Overview . . . . . . . . . . . . . . . . . . . . . . . . . . .1 • Obtaining Additional Copies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 • Map of Milwaukee County . . . . . . . . . . . . . . . . . . . . . . . . . . .3 • Informational Phone Numbers . . . . . . . . . . . . . . . . . . . . . . . .4 • Overview of the Medicare Program. . . . . . . . . . . . . . . . . . . .6 • Overview of the Medicaid Program . . . . . . . . . . . . . . . . . . . .7 • Family Care & Family Care Partnership . . . . . . . . . . . . . . . .8 • What Is An ADRC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10 • Emergency In-Home Pendants Do Save Lives . . . . . . . . . .12 • Responsible Planning for Long Term Care Needs . . . . . . .14 • How to Pay for Long Term Care? . . . . . . . . . . . . . . . . . . . .16 • On-Site Medical Care - The Doctor Is In! . . . . . . . . . . . . . .18 • Questions To Ask Before Moving or Downsizing . . . . . . . . .20 • How Home Rehab Services Help Return Patients To Functional Wellness . . . . . . . . . . . . . . . . . . . . .22 • Provider Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .44 H OME M EDICAL E QUIPMENT pg 48 • Provider Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50 H OME C ARE / N ON -M EDICAL pg 52 • Provider Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .56 C ARE C OORDINATION pg 42

GARy KNIPPEN President

JOE lAuERMAN Production Coordinator seniorresources@wi.rr.com

Senior Resources, Inc. P.O. Box 285 Germantown, WI 53022-0285 (262)-253-0901 info@seniorresources online.com

Find us on the Web: www.seniorresourcesonline.com

Note: Every effort was made to verify the accuracy of the information contained in this directory. This information is provided with the under- standing that the consumer will contact providers to obtain information them- selves prior to making a final decision regarding services. Advertisements do not con- stitute endorsement by Senior Resources, Inc. All rights reserved. The con- tents of this publication may not be reproduced without written consent of the publisher.

H OME H EALTH S ERVICES pg 82

• Provider Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .84

H OSPICE pg 94

• Provider Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .96

H OSPITALS pg 110

S KILLED N URSING F ACILITIES pg 124 • How to Choose a Rehabilitation Provider . . . . . . . . . . . . .112 • Milwaukee County . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .114 • Ozaukee County . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .119 • Washington County . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .120 • Waukesha County . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .120 • Short Term Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .126 • Changing Nature of Skilled Nursing Care . . . . . . . . . . . . .128 • Milwaukee County . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .130 • Ozaukee County . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .147 • Washington County . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .149 • Waukesha County . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .150

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NEW WEBSITE ARRIVING 2019!!

M AP O f M IlWAuKEE C OuNTy • broken out by area

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2019

Information and Referral Services Information and referral ser- vices are agencies that provide options for seniors in the com- munity. Multiple listings and referral phone numbers for senior services are available through these agencies.

Alzheimer’s Assistance Alzheimer's Association 800-272-3900 Alzheimer’s Disease Education and Referral Center 800-438-4380 Benefit Specialist Benefit Specialists assist older persons with their private and governmental benefits, such as private insurance or Medicare. Specialists are employed by each county aging unit to pro- vide accurate and current infor- mation regarding available ben- efits. Milwaukee 414-278-1222 Ozaukee 262-284-8120 Washington 262-335-4497 Waukesha 262-548-7848 Title 19 Title 19, or medical assistance, is available to persons who are eligible for Supplemental Security Income (SSI) and to people age 65 or older who are medically needy individuals, who are below established poverty levels after deducting medical expenses. Wisconsin automatically places an individ- ual on Title 19 if they receive SSI.

I NfORMATIONAl P hONE N uMBERS

Aging & Disability Resource Center

National Eldercare Locator 1-800-677-1116

These offices provide informa- tion and services to the elderly. These offices are excellent sources of information. Milwaukee County Aging Resource Center 1220 W. vilet, Ste 300 Milwaukee, WI 53205 414-289-6874 Ozaukee County Aging and Disability Resource Center 121 West Main Street Port Washington, WI 53074 262-284-8120 Washington County Aging and Disability Resource Center 333 East Washington Street Suite 1000 West Bend, WI 53095 262-335-4497

Milwaukee County Aging Resource Center 414-289-6874 Ozaukee County Aging & Disability Resource Center 262-284-8120 Washington County Aging & Disability Resource Center 262-335-4497 Waukesha County Aging & Disability Resource Center 262-548-7848

Waukesha County Aging and Disability Resource Center

Milwaukee 888-947-6583

514 Riverview Drive Waukesha, WI 53188 262-548-7848

Ozaukee , Washington & Waukesha Counties 888-446-1239

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CASH In Balance, LLC Daily Money Management For Individuals

Catherine A. Schramka Heidemann Phone: 414.217.4510 catherine@cashinbalance.com Insured & Bonded • Free Initial Consultation Member of American Association of Daily Money Managers www.cashinbalance.com •Maintaining financial files for your CPA/tax accountant, financial advisor, or attorney CASH In Balance, LLC provides assistance with your day-to-day transactions to give you control over your finances. We come to you. Our personal financial services include the following and are tailored to meet your needs: •Opening and organizing mail •Paying bills by preparing checks •Balancing/reconciling checkbooks

SOUTH CENTRAL DIRECTORY

NOW ACCEPTING ADS!

Online: www.seniorresourcesonline.com Email: info@seniorresourcesonline.com Mail: P.O. Box 2 8 5 Germantown, WI 5 3 0 2 2

Tel: 2 6 2 -2 5 3 -0 9 0 1 Fax: 2 6 2 -2 5 3 -0 9 0 3

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to need "skilled nursing" care to con- tinue on Medicare benefits. Once a person reaches their "maximal poten- tial", Medicare benefits end. This can happen anytime after the first 20 days. • Medicare Part A provides no cover- age beyond 100 days Is Home Health Care covered under Medicare? Yes, Medicare pays 100% for all covered and medically necessary home health services under Part A (or Part B if beneficiary does not have Part A) as long as the beneficiary continues to meet the coverage requirements. Medicare will pay for an unlimited number of visits during an unlimited period, as long as it is med- ically necessary and coverage require- ments are met. It is the intent of home health visits under Part A to deliver skilled medical attention to home- bound patients. Home health care is not available for chronic illness or to help with Activities of Daily Living (ADL's). Requirements include: • Home Health Care Agency must be Medicare certified. • Patient must be under a doctor's care and the doctor must authorize med- ical treatment. • Patient must be in need of skilled care . Hospice care is a service provided to termi- nally ill persons with a life expectancy of six months or less. Medicare defines a hospice as a public agency or a private organization whose primary role is to provide pain relief and symptom management to terminally ill patients. This benefit does not generally cover inpatient room or board charges. Medicare requirements include: • Doctor certification that patient is ter- minally ill and has a life expectancy of less that 6 months • A Medicare-certified hospice pro- gram must provide care Medicare pays 100% of most covered ser- vices. Medicare pays for up to two 90-day periods, one 30-day period, and a fourth unlimited extension period. The beneficiary pays a small co-insurance fee only for outpa- tient drugs and inpatient respite care. For more information on Medicare, please visit www.medicare.gov. Article submitted by Barbara Horstmeyer, Benefit Specialist, Senior Planning Group. 1-866-670-0888

O vERvIEW Of ThE M EDICARE P ROGRAM Part A because they or a spouse paid Medicare taxes while they were work- ing. Some seniors, such as those who have not completed the mandatory num- ber of working quarters for Social Security benefits, enroll on a voluntary, premium-paying basis. Medicare Part A begins when someone enters a hospital. Medicare Part A has hospital deductibles. • First 60 days, Medicare pays all but $1,364 • Days 61 to 90, Medicare pays all but $341/day • Days 91 to 150, Medicare pays all but $682/day • Beyond 150 days, Medicare pays nothing Remember, Medicare is a health insur- ance program aimed at covering acute health care costs such as hospitalization (Part A) and periodic doctor visits (Part B). It does not cover most nursing home fees, nor does it offer extensive home health care for the chronic ills often experiences with age. What does Medicare cover for nursing home care? Very little! Medicare Part A helps pay for inpatient skilled nursing care in a Medicare participating skilled nursing facility (SNF) or rehabilitation service facility following a 3 day hospi- tal stay if a person's condition requires skilled nursing services or rehabilitation services such as Physical Therapy (PT), Occupational Therapy (OT), and Speech Pathology (SP). Doesn't everyone get 100 days cover- age in a SNF? No. Medicare will pay up to 100 days. • Days 1-20, Medicare Part A pays 100% • Days 21 - 100, Medicare pays all but the daily co-insurance amount that is the patient's responsibility. The 2019 coinsurance amount is $170.50 per day. After the first 20 days, a person must be making "reasonable, measurable progress" in their rehabilitation, or continue

edicare is a National Health Insurance Program administered by the Health Care Financing Administration (HCFA). Benefits are for: People 65 years of and older. Some people with disabilities under age 65. People with End Stage Renal Disease (permanent kidney failure requiring dial- ysis or a transplant) Medicare has Two Parts: Part A (Hospital Insurance) Part B (Medical Insurance) Medicare Part B covers physician ser- vices, outpatient hospital care, ambu- lance services, prosthetic devices, med- ical equipment, and supplies. You pay the Medicare Part B premium of $135.50 per month for single individuals with an income of $85,000 and a married couple with less than $170,000 (2019 rate). • Single with income greater than $85,000 and less than $107,000 or married with income greater than $170,000 and less than $214,000 - $189.60 monthly Part B Premium • Single with income greater than $107,000 and less than $133,500 or married with income greater than $214,000 and less than $267,000 - $270.90 monthly Part B Premium • Single with income greater than $133,500 and less than $160,000 or married with income greater than $267,000 and less than $320,000 - $352.20 monthly Part B Premium • Single with income greater than $160,000 and less than $500,000 or married with income over $320,000 and less than $750,000 - $433.40 monthly Part B Premium Part A (Hospital Insurance) Medicare Part A primarily provides cover- age for inpatient hospital care. It also provides hospice care. Limited coverage is provided for skilled nursing home and home health. No coverage is provided for assisted living. Most seniors become eligible for Part A coverage when they reach age 65 and become entitled to Social Security retire- ment benefits. They do not have to pay a monthly payment called a premium for

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O vERvIEW Of ThE M EDICAID P ROGRAM

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his article focuses on the Medicaid program as it applies to elderly and disabled individuals. There are three common names for one program. 1. Medical assistance 2. Medicaid 3. Title 19 Medicaid is a welfare program jointly funded between the Federal and State government. It is designed to assist in paying for skilled nursing facility expenses and many other medical expenses for individuals who have minimal assets and inadequate income to pay for these expenses. The individual is normally responsible to pay for all of his/her own long term care expenses: generally, if the cost of this care exceeds the individual's income and the individual is asset- qualified, Medicaid supplements the individual's own payment. Within the Federal guidelines, each state is able to establish their own eli- gibility standards, determine the type, amount and duration of services, set the rate for payment of services, and administer their own program. This article will outline the eligibility requirements for Wisconsin as of 2019. A single adult qualifies if they meet the following criteria: The applicant can't retain more than $2,000 plus exempt assets 1. Home : Homestead property is exempt regardless of the value if the applicant intends to return home, or if a disabled child is liv- ing in it. 2. Car : One automobile per house- hold is excluded regardless of the value if it is used for transporta- tion of the eligible individual or couple or a member of the eligi- ble individual's or couple's

couple's household. 2. IRA of the community spouse How much money may a couple "Shelter"? The Spousal Impoverishment Act passed by the U.S. Congress in 1988 and the Omnibus Budget Reconciliation Act of 1993 (OBRA'93) provides the legal means for anyone to shelter assets and qualify for financial assistance through an entitlement program. This act protects married individuals from depleting their assets due to an extended nursing home stay. If the couple's combined assets are: $0 - $50,000 the "community spouse" may keep ALL $50,001 - $100,000 "community spouse" may keep .....$50,000+$2,000 $100,001 - $252,840 "community spouse" may keep .....HALF+$2,000 $252,841 + "community spouse" may keep ....$126,420 plus $2,000 for a total of $128,420 These figures are adjusted annually for inflation. Note: This article provides a limited space for information regarding Medicaid Eligibility. There are oppor- tunities for married couples to protect more that the above figures. Attorney Ryan Zenk offers free consults or call for your free booklet on "What is Spousal Impoverishment?" please call 262-670-8888 or 1 (866) 670-0888. For more information, please visit the Wisconsin Medicaid webpage. Article submitted by Barbara Horstmeyer, Benefit Specialist, Senior Planning Group . 1-866-670-0888

household. 3. Life Insurance : Life insur- ance is exempt if the face value of all policies is less than $1,500. If the face value exceeds $1,500, full cash value counts towards resource limit. Term insurance has no cash value and is excluded from countable assets. 4. Household goods and per- sonal effects : Generally no inquiry unless reason to sus- pect unusual value. 5. Pre-paid funeral arrange- ments : Each fiscal group member may have one or more irrevocable burial trusts, of which the total face value may not exceed $4,500. Any principal amount over $4,500 is a countable asset. Although Wisconsin law allows $3,000 to be irrevocable, Wisconsin’s Medicaid state plan allows an additional $1,500 to be con- sidered as though it were irrev- ocable by law for these burial trusts. This is why $4,500 is allowed. Married couples can own exempt assets listed above plus: 1. One automobile per household is excluded regardless of the value if it is used for trans- portation of the eligible indi- vidual or couple or a member of the eligible individual's or

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f AMIly C ARE AND f AMIly C ARE P ARTNERShIP reach your personal goals because they are relationships built on trust, kindness and caring – that results in better quality care for you. Once your Natural Supports are in place, other services can be added if they support your personal goals. Family Care Partnership Members of family Care Partnership benefit from the same long-term care as family Care, while also receiving all- inclusive health care from a network of physicians. linking these services together makes family Care Partnership both convenient and effective. your Care Team is not only involved in helping you meet your long- term care needs, but your health care needs as well. That makes your Care Plan even more comprehensive. To be eligible for family Care, you must: •Be at least 18 years old •live in a county where family Care is offered •Meet financial and func- tionality requirements •Be eligible for Medicaid To be eligible for family Care Partnership, you must meet all

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of the family Care requirements listed above, plus: •If you are eligible for Medicare, you must enroll in, and remain enrolled in, all parts of Medicare for which you are eligible (Part A, Part B, and/or Part D) Enrollment into the family Care program is conducted through your county’s Aging and Disability Resource Center (ADRC). for more information about eligibility or to enroll, call your local ADRC below: Milwaukee County ARC 414-289-6874 Milwaukee County DRC 414-289-6660 Ozaukee County ADRC 262-238-8120 Washington County ADRC 262-335-4497 Waukesha County ADRC 262-548-7848 Article provided by Community Care Inc. 866-992-6600 www.communitycareinc.org

amily Care and family Care Partnership are two pro- grams that provide seniors and adults with disabilities with the long-term care supports they need to live independently. family Care helps individuals like you live in your own home and in your community. family Care Partnership does that too, while also providing and coordi- nating all-inclusive health care for members. here’s a quick description of each program. Family Care family Care provides long-term care supports to meet your spe- cific needs as determined by you and your Care Team. Once enrolled, you’re assigned a dedi- cated Care Team, including a registered nurse and care manag- er, who will work with you and your family to make sure you receive the care and support you need to reach your personal goals. The result is a Care Plan, personalized to you, that is reviewed regularly by you and your Care Team, and is adjusted as your needs change. Care Plans begin with Natural Supports. Natural Supports are the people who are a part of your life and provide help and support without pay. Natural Supports are the best way to

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Choosing Self-Direction in Long-Term Care ?

A TTORNEY J OANNE L EIFHEIT • Medicaid Analysis and Veterans Benefits • Special Needs Trusts and Asset Protection

• Powers of Attorney • Disability Planning • Probate

• Estate Planning • Elder Law Issues • Wills & Trusts • Guardianships

CHOOSE

N27 W23953 Paul Road, Suite 107 Pewaukee, WI 53072 (262) 347-2820

tmgwisconsin.com

F or information on S enior S ervices in Wisconsin, visit our website www.seniorresourcesonline.com Located one mile north of the Machine Shed Restaurant Check our website for upcoming dates to our complimentary monthly educational estate planning & Medicaid workshop! www.LawOfficeofJL.com

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WhAT IS AN ADRC?

he place for information and assistance! Aging and Disability Resource Centers (ADRCs) are the first place to go to get accurate, unbi- ased information on all aspects of life related to aging or living with a disability. ADRCs are friendly, welcoming places where anyone - individuals, concerned families or friends, or professionals working with issues related to aging or dis- abilities - can go for information tailored to their situation. The ADRC provides information on broad range of programs and ser- vices, helps people understand the various long term care options available to them, helps people apply for programs and benefits, and serves as the access point for publicly-funded long term care. These services can be provided at the ADRC, via telephone, or through a home visit, whichever is more convenient to the individ- ual seeking help. ADRCs are available in all Wisconsin counties. To find an ADRC go to http://www.dhs.wisconsin.gov /lTCare/adrc/index.htm SERVICES PROVIDED BY THE ADRC Information and Assistance: • Information about local ser- vices and resource • Assistance in finding ser- vices to match your needs o housekeeping and chore services o health (healthy lifestyles, manage- ment of chronic condi- tions, dementia, etc)

Benefit Counseling: • Benefit specialists provide information and advocacy about government and other benefits that you may be entitled to receive, such as Medicare, Medicaid, Social Security, Disability, low income housing, etc. Access to Funding for Long Term Care: • The ADRC can determine if you will be eligible for public funding for your long term care. • The ADRC can explain the program choices you have that will provide your long term care. These programs include family Care, IRIS and in some areas Partnership and PACE. Health and Wellness: • ADRC can connect you to wellness programs to help keep you healthy and inde- pendent, such as Stepping On falls prevention, living with Chronic conditions and others.

o Transportation o Nutrition, home delivered meals o housing, including senior and low income housing o Assisted living, nursing homes and other long term care facilities o financial assistance linkages o legal issues (guardianship, power of attorney, client rights advoca- cy) o Abuse, neglect and financial exploita- tion o Adaptive equipment choices you have when making decisions about where to live, what kind of help you need, where to receive that care and help, and how to pay for it. • One-on-one consultation to help you think through the pros and cons of the various options in light of your situation, values, resources and prefer- ences. Long Term Care Options Counseling: • Information about the

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CUSTOM LONG-TERM CARE PLANS DEVELOPED WITH YOU, FOR YOU

Toll Free 1-877-489-3814 www.mychoicefamilycare.org

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2019

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E MERGENCy I N -h OME P ENDANTS D O S AvE l IvES neck or on a wrist band. That sends a radio signal to the console at the telephone, which then automatically dials the phone. The remote dialer can be programmed to call any number the user specifies. Most people choose to have the unit dial a remote moni- toring center, which will then determine the nature of the emergency and contact the appropriate responder (fami- ly or neighbor or emergency responders). If the PERS wearer does not respond to the monitoring center, or if the monitoring center can't determine the exact nature of the emer- gency, they will most typical- ly contact emergency respon- ders and stay on the line until help arrives. Before you commit to using a particular emergency response system, you will want answers to the follow- ing questions: 1. Is monitoring available

around the clock, 365 days a year? 2. What training do response center employees receive? 3. how does the monitoring center test that the unit is working properly? 4. Can you keep and use the same system if your elder moves? 5. how easy is the unit to set up? What are the most common reasons for "mal- functions?" 6. Can you test the unit in your elder's home to be sure it works from every point in the home before you commit to renting, leasing or purchasing? What is the return policy? help keep yourself or your loved one safe in their home. Don’t wait for a crisis to hap- pen—be proactive to help pre- vent such a situation. PERS units can cost as little as just over $1 per day so take some time and help protect the ones you love. This article was submitted by William Horstmeyer, founding owner of Secure At Home, a local company based in Brookfield. Call for a free, no cost, no obligation demonstration of how Secure At Home can provide you with peace- of-mind. Toll Free at (866) 670- 0888 or www.secureathomellc.com

ave you always said that a Personal Emergency Response unit (PERS) isn’t for you? Do you tell your children that you won’t fall or do you try explaining that wearing that necklace just isn’t for you? Think again! Each year, one in every three adults age 65 and older falls. Among those, falls are the leading cause of injury death. And for every hour a senior lies on the floor they will mostly likely have to remain in rehabilitation for one week. By having a PERS unit in your home you are greatly decreas- ing your odds of injury death. These emergency systems are not for everyone. A senior who will benefit from a PERS unit must be able to understand what the unit is for, what con- stitutes an emergency, and be able to remember what to do with the "hElP" button in an emergency. There are three components to a personal emergency response system: A small transmitter (the "hElP" button), a commu- nications console connected to the user's telephone, and a remote monitoring center. When the person using the system needs help, he or she presses the "hElP" button, typically worn around the

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R ESPONSIBlE P lANNING fOR l ONG T ERM C ARE N EEDS Medicaid and Medicare for benefits if and when they require expensive care, no amount of government-sponsored education or tax breaks will change the underlying behavior. My message to you is to pre-plan, save, invest or insure for long-term care. Do not get caught up in denial which holds one back from pre-planning for long- term care needs. Remember, by pre- planning for your long-term care needs, you are actually giving your self more options when care is needed. Planning ahead gives you a voice after you are incapacitated and allows a choice in the type of care that you receive. By failing to pre-plan, you are putting a burden on your family, limiting the type of care you receive, and potentially putting your “nest egg” at risk in the process. By pre-planning, we also fulfill our responsibilities as citizens. The best way not to become poor is to take the risk of long-term care seriously and make sure you have adequate protection for you and your family. How can we pre-plan? If you are between the ages of 55-70, seriously evaluate the possibility of long-term care insurance. Long-term care insur- ance is not appropriate for everyone. Never buy from someone who tries to rush you into a decision after only one meeting. Always work with a Long-term care specialist who represents several

ost Americans want to be good providers for their families and good citi- zens. Both responsibilities require fore- thought, vigilance and planning. Today, the least expected and most daunting chal- lenge for our country and ourselves is to provide competent, humane and loving long-term care for our elders . . . and ulti- mately, for ourselves. Yet, we are unpre- pared--as individuals and as a country--for this responsibility. Few older Americans, and fewer-still baby boomers, have private long-term care insurance to help with the catastrophic cost of long-term care for chronic illness. Consequently, most people end up in nursing homes on public welfare when they need professional care instead of pay- ing privately for help in their own homes or assisted living. Why does this remain true even as the age wave begins to crest and threatens to crash upon us? For 38 years, our government has tried to provide long-term care services through Medicaid and Medicare. This effort, while well intentioned, has never provided ade- quate care to enough people in the most desirable settings. But it has, unintention- ally, de-sensitized us to the risk and cost of long-term care. Today, the government- financed, welfare-based, nursing-home- oriented system is falling apart, character- ized by limited access, poor care, and widespread bankruptcies. The government needs to act quickly to educate the public about the necessity to plan early and save, invest or insure fully for long-term care. Will it? We will prob- ably see measures of this kind passed by Congress and signed by the President sometime in the near future. This will help, but will not alone solve the problem. As long as most people continue to ignore the risk of long-term care, avoid the pre- miums for private insurance, and rely on

companies rated in one of the top two cat- egories by at least two rating services. This way you can compare prices and fea- tures to determine which is best for you. Remember, long-term care insurance is necessary to insure that any transfer of money can take place outside of the 60- month lookback. The law’s have changed on divestments and gifting as of 2/8/06. I recommend that every senior take a per- sonal inventory. This should include a health history, legal inventory, income inventory, asset inventory and insurance inventory. For example, your legal inven- tory should have advanced directives. You need to have a Health Care Power of Attorney, Durable Power of Attorney and a Will in place. You should be investigating the use of a quitclaim deed to protect your “cottage up north” or your homestead. You also need to take an inventory of your investments. I often find that older seniors loose track of “all their holdings”. My emotional inventory usually encour- ages clients to “pre-plan” for their funeral arrangements using irrevocable burial trusts. Insurance inventory forces us to re-evaluate our life insurance policies, disability policies, long term care insur- ance and Medicare supplements. Income inventory allows us to evaluate total income, and income after the death of a spouse. An inventory of assets is of great importance when evaluating asset preser- vation, asset transfer, and gifting. Remember, the decisions you make today are the decisions that you and your fami- lies will have to live with tomorrow. Please call 1-(866) 670-0888 for a free consultation. Article submitted by Barbara Horstmeyer, President, Senior Planning Group, www.seniorplanninginc.com

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an insured to undergo under- writing to qualify. Any agent you work with should be able to explain the differences or choose another agent. lastly, one may qualify for gov- ernment benefits if a qualifying veteran (or spouse of a veteran) or if he/she meets the income/asset test of family Care (assisted living facilities) or Medicaid (skilled nursing facilities). To qualify for family Care or Medicaid one generally must have $2,000.00 or less in countable assets and income less than the cost of care. Many facilities do not accept family Care or Medicaid. furthermore, many accepting family Care require a private pay period prior to allowing one to go on family Care. It is very important that any plan implemented, to qualify one for family Care or Medicaid, take into considera- tion the care plan, all options available to pay for the care and a strategic plan to minimize taxes, legal, administrative expenses, and opportunities to prevent impoverishment in any or all of these goals. The finan- cial, tax, legal, and care plans must all work together to maxi- mize the results. W. Ryan Zenk, JD, CFP ® Elder Law Center of Wi, LLC 125 N. Executive Dr., Ste 210 Brookfield, WI 53005 262-812-6262 www.eldercarecenterofwisconsin.com

hOW TO PAy fOR lONG TERM CARE? The second option, long term care insurance, has changed drastically over the past sev- eral years. Many carriers no longer offer long term care insurance because the product was underpriced and carriers lost large sums of monies. It is still available from some carriers including newer options. One such option is a type of life insurance policy that pays a benefit if needed for care and pays a death ben- efit if never or only partially used for care. One good thing about these policies is the insurance company does not keep the money, either the client receives monies for care expense or it goes to his/her beneficiaries as a death bene- fit. These types of policies typically require prepayment of the premium over one to seven years. After this, no additional premiums are ever paid. Other policies (partner- ship policies) allow an indi- vidual to protect assets equal to the benefit of the policy. for example, a policy with $200,000.00 benefit allows the family to protect $200,000.00 of assets. Still others are the traditional annual pay policies with a set benefit. These are the traditional use it or lose it policies. All of these require

he cost of long term care is very expensive. It can range from hundreds to tens of thou- sands of dollars per month. Many studies indicate the odds of a 65 years old needing long term care, at some point, is over 50%. So how can one pay for it? The answer is there are 3 ways to pay for long term care. first, one can pay with one’s own assets until either broke or deceased. Second, one can use long term care insurance if one was smart enough or fortunate enough to obtain such insur- ance while he/she was insur- able. Third, one may qualify for governmental assistance through the veteran’s Administration, family Care or Medicaid. let’s look at each option further. Private pay will require assets be liquidated (or already liquid i.e. cash) and a check written to caregivers typically on a month- ly basis. The liquidation of assets such as IRAs or appreci- ated assets may be a taxable event though typically the tax liability is completely or mostly offset by the medical deduction generated by spending on care costs. Paying privately will reduce and may eliminate any inheritance for family or chari- ties. Worse yet, this may cause an individual to go broke while alive or a healthy spouse to become impoverished. Are there ways to prevent spousal impoverishment – yes with proper planning this can be pre- vented.

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O N - SITE M EDICAl C ARE – T hE D OCTOR IS IN ! side effects and interactions, which may be difficult for the patient to manage alone. On-site primary care allows for a complete review of the patient’s ongoing plan of care thereby reducing risks from medications, and improving understanding of the full picture of the patient’s health status. On-site primary care visits from a medical provider help establish a more per- sonal doctor-patient relation- ship. Seeing patients at their place of residence allows the provider to work with the on-site care team to monitor medications more closely, evaluate living space for possible safety issues, and get a better sense of how the patient is doing in general. Care team collaboration with other on-site service partners such as home care and hos- pice staff also allows for bet- ter communication and effi- ciencies in care for these patients.

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n-site medical care is designed to meet the unique and growing needs of patients living in residential care com- munities. Residents of care communities more often than not, have complex chronic conditions, memory issues, and multiple medications requiring close oversight by a physician care team. By using a collabora- tive, team-based, on-site, med- ical care program, it is possible to reduce the need for emer- gency room visits and trips to the hospital which leads to sig- nificant improvement in the overall care of the patient and peace of mind for their fami- lies. for those with loved ones in residential care communities, it can be a daunting challenge to transport them to a clinic setting for regular office visits. If there are complex care needs, multiple specialty visits can add to this burden. It is not unusual for patients in res- idential care communities to experience fragmented care with lack of overall care plan oversight. If multiple doctors are involved trying to manage a variety of chronic issues, this can result in a number of pre- scriptions, all with different

Those who reside in residen- tial communities deserve com- passionate medical care, social and psychological support, and awareness of their wishes. On-site providers have found that getting to know the patient at home, on a regular basis, helps accomplish this goal, and has an enormous positive impact on the well- being of the patient.

Article Submitted By: Bluestone Physician Services

Online: www.seniorresourcesonline.com Email: info@seniorresourcesonline.com Mail: P.O. Box 2 8 5 Germantown, WI 5 3 0 2 2

Tel: 2 6 2 -2 5 3 -0 9 0 1 Fax: 2 6 2 -2 5 3 -0 9 0 3

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EXPERT CARE. MORE CONVENIENCE.

Bluestone’s specialized teams provide our unique model of care to patients in senior living communities. Regularly scheduled visits and close collaboration with patients, families and community staff lead to better care for those with chronic conditions. BluestoneMD.com • 262.354.3744

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N27 W23953 Paul Road, Suite 107 Pewaukee, WI 53072 Located one mile north of the Machine Shed Restaurant Check our website for upcoming dates to our complimentary monthly educational estate planning & Medicaid workshop! www.LawOfficeofJL.com

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Q uESTIONS T O A SK B EfORE M OvING O R D OWNSIzING · Are you afraid when the doorbell rings unexpect- edly? · Are you afraid of being alone or getting sick with no one to help? · Do you refuse to go out in inclement weather? · Is the neighborhood get- ting too noisy? · Is the neighborhood get- ting too busy? · Do you need more interesting activities to fill your time? · Do you feel the need to be around people your own age? · have you been ill and are having difficulty get- ting back into your for- mer routines? Being ill can zap our energies and make it difficult to get back to the way things were. · Are you ill and finding it difficult to cope with everything else? · Would you like to be in a more secure environ- ment? · have you recently lost a spouse and are finding it difficult to function

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without the extra sup- port?

oving or downsizing can be emotional and stress- ful. If you are unsure of whether or not you should move, read the following questions and ponder your answers. The thoughts they provoke should help point you in the right direction. IN WhICh Of ThE fOl- lOWING AREAS ARE yOu hAvING DIffICulTy? · Do you hesitate about going out to do necessary errands? · Do you refuse to leave the house for social activities? · Is it difficult to take a shower or bath? · Are you getting everyday tasks done to your satis- faction? · Is it painful to go up and down stairs? · Do you dread the thought of extra tasks; yard work, shoveling, mowing the lawn? · Are weekly tasks becom- ing overwhelming; changing beds, washing floors, vacuuming…? · Do you remember to take your medication? Do you find yourself wondering whether or not you have taken your medica- tion? · Are you preparing healthy and appetizing meals?

If you answered yes to most of the above questions, then you probably need to be thinking about a more secure environment. Everyone has the right to feel comfortable where they live. If you answered no to most of the questions, then you should be able to stay where you are. Of course, that choice is up to you. There might be other reasons com- pelling you to move, or you might find that a different lifestyle would suit you bet- ter. If you decide to stay, getting extra assistance may be the solution to minor problems. Remember that it’s easier to move when you’re healthy and able to make your own choices about your new home. We wish you the best with the decisions you are about to undertake, whether it be staying put or moving.

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h OW h OME R EhAB S ERvICES h ElP R ETuRN P ATIENTS TO f uNCTIONAl W EllNESS

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touch the surface of the true picture of the client’s func- tion. using a battery of tests, the rehabilitation professional can identify limitations as well as refer to baseline measurements of function. The “why” behind the poor balance, dizziness and other deficits drives the chosen interventions—it is the hall- mark of how a tailored plan of care is developed. House Calls and Rehabilitation As a patient moves through the health care continuum after a surgical procedure, he or she will come to a point where a decision needs to be made: to use traditional homecare ser- vices or outpatient services. homecare services tend to focus on recovery to a point where the client is no longer homebound, as well as clinical needs. homecare services allow for physical therapy, occu- pational therapy, speech

language pathology and nursing care. Outpatient ther- apy allows for physical thera- py, occupational therapy and speech language pathology services, but does not offer the services of a nurse. Outpatient services focus on higher-level functional goals and go beyond the homecare goals of medical stability while focusing on overcom- ing being homebound. Some practices have chosen to provide outpatient services as a house call. This way, the clinician can evaluate a client’s ability to transfer to standing from their favorite chair, climb the stairs to their second-floor bedroom, step down the curb to enter their garage, and even walk on the grass outside to get to their outdoor patio where their grandchildren gather every Sunday for a barbecue—all things that a traditional clinic setting does not allow. A house call care delivery model may have advantages over the traditional clinic- based rehabilitative services.

ollowing an orthopedic surgery, physical and occupa- tional therapy services typi- cally will begin while a per- son is still in the hospital and will continue until their func- tional ability is restored. Physical therapy helps a per- son reduce pain, regain strength, increase range of motion, improve balance and reduce the effort needed to access the community. Occupational therapy helps people regain the ability to care for themselves, care for the people that depend on them and to care for their home. The Rehabilitation Process The first step to a successful recovery of function is for a thorough assessment to be completed by the rehabilita- tion professional. The focus of this assessment is on the patient’s prior level of func- tion, current level of function and the mutually agreed upon outcomes within the plan of care. A comprehen- sive assessment looks at more than just range of motion and strength; those things only

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According to a 2006 article published in the Journal of the American Geriatrics Society, older adults who received physical therapy ser- vices at home reported improvements in their quality of life, a decrease in their per- ception of functional difficul- ties, and an increase in their confidence level. Even more astounding is that these reported gains remained pre- sent up to six months after therapy services concluded. While physical therapy works on regaining overall function, occupational therapy (OT)

focuses on the finer details of daily functioning. Occupational therapists are the troubleshooters of the rehabilitation process; they make the impossible possible through the use of adaptive equipment, home modifica- tions and functional strength- ening. When occupational therapists complete evalua- tions, they ask the questions, “What do you want to be able to do? What is important to you?” The occupational therapist starts to identify where the client wants to go and starts to make a plan on how to get there, in the com-

fort of the home. Together, client and OT work on opening medication bottles and making a checklist for setting up the weekly pill organizer; fastening buttons and zippers; or teach- ing a client how to use tools such as a dressing stick or a reacher. Being able to complete one’s own self-care tasks is key for successfully aging in place. Dr. Tim Fox, PT, DPT, GCS, is the founder and CEO of Fox Rehab, a primarily clinician owned and operated professional private practice of physical, occu- pational and speech therapists.

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