the language of long-term care

Further complicating matters is that long-term and end-of-life care have languages of their own: To figure out what you're doing, you need understand the difference between rehab and a nursing home, and how palliative care is different from hospice.

Any long-term care journey, whether it's your own or that of someone you love, is arduous in its own way. To aid a tiny bit in the process, I've compiled a list of some of the key terminology related to long-term care.

Types of Care

"Rehab": A generic name for rehabilitation therapy to help patients recover from a serious illness, injury, or surgery. Medicare covers, in full, the first 20 days of rehab care in a qualified facility following a qualifying hospital stay (defined as three days in a row in the hospital as an inpatient). For days 21-100 (again, following release from a qualifying hospital stay), you must pay a copayment (often covered by a supplemental health-insurance policy) while Medicare covers the remainder of the cost. For days 101 and beyond, Medicare does not cover the costs of rehab care. Patients receive rehab therapy in two main settings: acute inpatient rehabilitation facilities or skilled nursing facilities.

Activities of Daily Living: Basic activities that are used to measure a disabled or elderly individual's level of functioning. The key ADLs are bathing, dressing, eating, ambulating/transferring (moving from place to place, or from standing position to chair), grooming, and toileting. Activities of daily living are metrics used within the healthcare system, but families can also think about them when calibrating how much care their loved ones need.

Instrumental Activities of Daily Living: More complex self-care tasks, including shopping and meal prep, navigating transportation systems, and personal financial management. Slips in IADLs are usually the first signals that an elderly parent or loved one needs more help.

Skilled Nursing Facility (sometimes called a SNF or "Sniff"): A type of facility that provides skilled nursing care, usually medical care and/or rehabilitation services. Such rehab care is covered, in whole or in part, by Medicare for up to 100 days. Some skilled nursing facilities do double-duty, providing short-term rehab for patients who have had a qualifying hospital stay while also serving as long-term residential facilities.

Nursing Home: A facility that helps individuals with the activities of daily living, including eating, bathing, and getting dressed. Nursing homes are also likely to coordinate and/or provide medical care for individuals who need it, but their central focus is to help residents with their daily lives. In contrast to care provided in a skilled nursing facility to people who have had a qualifying hospital stay, nursing-home care (sometimes called "custodial care") is not covered by Medicare. Instead, costs are covered out of pocket, by long-term care insurance (for those who have such policies), or Medicaid for individuals with limited assets.

Assisted Living Facility: A type of facility geared toward people who need assistance with ADLs and IADLs but who do not need the type of extensive care provided in a nursing home. Most assisted living facilities, like nursing homes, help patients coordinate medical care, but providing medical care to sick individuals is not the central focus. Many ALFs now have locked "memory care" units geared toward people with Alzheimer's disease or dementia. As with nursing homes, stays in ALFs are not covered by Medicare; instead, such care is covered out of pocket, by long-term care insurance (for those who have it), or Medicaid.

Independent Living Facility: A type of facility geared toward individuals who can live independently and do not need assistance with activities of daily living, but want access to assistance to certain services such as meals and transportation. As with assisted living facilities, stays in independent living facilities are not covered by Medicare.

Adult Day Services: Services, including social activities and assistance with activities of daily living, provided during the day to individuals who otherwise reside at home. Approximately half of the individuals who take part in adult day services have some form of dementia, according to the National Adult Day Services Association; thus, adult day services frequently focus on cognitive stimulation and memory training. Medicare may cover adult day services in certain limited instances, but generally does not.

Hospice Care: Care provided to individuals at the end of their lives; the focus is on keeping the patient comfortable rather than extending life. Such care may be provided at home, in the hospital, or in a skilled nursing facility. Hospice care is covered by Medicare if your doctor and the hospice director certify that you're terminally ill and have less than six months to live. To be covered by Medicare, hospice care cannot be delivered in conjunction with any curative treatment. This document provides more details on the interaction between hospice and Medicare.

Insurance 

Long-Term Care Insurance Covers long-term care, including custodial/personal care not covered by Medicare. Depending on the policy, the type of care covered may be delivered in a facility, at home, or through adult day-care services. Owing to insurers' negative claims experiences (people who have purchased the policies tend to use them and don't let them lapse), many insured individuals have confronted huge premium spikes in recent years; other insurers have gotten out of the long-term care business altogether.

Elimination Period: Similar to a deductible for other types of insurance, this is the amount of time during which one must pay long-term care costs out of pocket before insurance kicks in. The longer the elimination period, the lower the premiums will be.

Medicaid Eligibility

Exempt (or Noncountable) Assets: Assets that can be owned by the institutionalized person without affecting Medicaid eligibility. Specific parameters depend on the state where you live, but exempt assets typically include $2,000 in cash, a vehicle, personal belongings, and household goods. In most states, a primary residence is also considered an exempt asset, even if an individual ends up moving into a nursing home, so long as a spouse or child lives there. The individual's equity in the home cannot exceed certain limits; for 2017, it's $560,000 in most states.

Lookback Period: The five-year period prior to an individual's application for Medicaid benefits. If assets were transferred to children or any other individuals during this five-year period, it will trigger a period of ineligibility for Medicaid benefits. The length of the penalty period is calculated by dividing the amount of the transfer by the average monthly nursing-home costs in the region or state where the individual resides. The goal of this provision is to keep otherwise-wealthy individuals from transferring assets to qualify for long-term care coverage under Medicaid.

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75 statistics about long-term care

the best advice I ever received was...

nobody else knows what they are doing either

-- Eva Gutierrez, Quora

Jerry Lewis

LAS VEGAS >> Jerry Lewis, the manic, rubber-faced showman who jumped and hollered to fame in a lucrative partnership with Dean Martin, settled down to become a self-conscious screen auteur and found an even greater following as the tireless, teary host of the annual muscular dystrophy telethons, has died. He was 91.

Publicist Candi Cazau says Lewis died this morning of natural causes at age 91 in Las Vegas with his family by his side.

Lewis’ career spanned the history of show business in the 20th century, beginning in his parents’ vaudeville act at the age of 5. He was just 20 when his pairing with Martin made them international stars. He went on to make such favorites as “The Bellboy” and “The Nutty Professor,” was featured in Martin Scorsese’s “The King of Comedy” and appeared as himself in Billy Crystal’s “Mr. Saturday Night.”

In the 1990s, he scored a stage comeback as the devil in the Broadway revival of “Damn Yankees.” And after a 20-year break from making movies, Lewis returned as the star of the independent drama “Max Rose,” released in 2016.

In his 80s, he was still traveling the world, working on a stage version of “The Nutty Professor.” He was so active he would sometimes forget the basics, like eating, his associates would recall. In 2012, Lewis missed an awards ceremony thrown by his beloved Friars Club because his blood sugar dropped from lack of food and he had to spend the night in the hospital.

In his 90s, he was still performing standup shows.

A major influence on Jim Carrey and other slapstick performers, Lewis also was known as the ringmaster of the Labor Day Muscular Dystrophy Association, joking and reminiscing and introducing guests, sharing stories about ailing kids and concluding with his personal anthem, the ballad “You’ll Never Walk Alone.” From the 1960s onward, the telethons raised some $1.5 billion, including more than $60 million in 2009. He announced in 2011 that he would step down as host, but would remain chairman of the association he joined some 60 years ago.

Lewis had teamed up with Martin after World War II, and their radio and stage antics delighted audiences, although not immediately. Their debut, in 1946 at Atlantic City’s 500 Club, was a bust. Warned by owner “Skinny” D’Amato that they might be fired, Martin and Lewis tossed the script and improvised their way into history. New York columnists Walter Winchell and Ed Sullivan came to the club and raved over the sexy singer and the berserk clown.

Lewis described their fledgling act in his 1982 autobiography, “Jerry Lewis in Person”: “We juggle and drop a few dishes and try a few handstands. I conduct the three-piece band with one of my shoes, burn their music, jump offstage, run around the tables, sit down with the customers and spill things while Dean keeps singing.”

Hollywood producer Hal Wallis saw them at New York’s Copacabana and signed them to a film contract. Martin and Lewis first appeared in supporting roles in “My Friend Irma” and “My Friend Irma Goes West.” Then they began a hit series of starring vehicles, including “At War With the Army,” ”That’s My Boy” and “Artists and Models.”

But in the mid-1950s, their partnership began to wear. Lewis longed for more than laughs. Martin had tired of playing straight man and of Lewis’ attempts to add Chaplinesque pathos. He also wearied of the pace of films, television, nightclub and theater appearances, benefits and publicity junkets on which Lewis thrived. The rift became increasingly public as the two camps sparred verbally.
“I knew we were in trouble the day someone gave Jerry a book about Charlie Chaplin,” Martin cracked.

On July 24, 1956, Martin and Lewis closed shop, at the Copa, and remained estranged for years. Martin, who died in 1995, did make a dramatic, surprise appearance on Lewis’ telethon in 1976 (a reunion brokered by mutual pal Frank Sinatra), and director Peter Bogdonavich nearly persuaded them to appear in a film together as former colleagues who no longer speak to each other. After Martin’s death, Lewis said the two had again become friendly during his former partner’s final years and he would repeatedly express his admiration for Martin above all others.

toss that sponge

Stop. Drop the sponge and step away from the microwave.

That squishy cleaning apparatus is a microscopic universe, teeming with countless bacteria. Some people may think that microwaving a sponge kills its tiny residents, but they are only partly right. It may nuke the weak ones, but the strongest, smelliest and potentially pathogenic bacteria will survive.

Then, they will reproduce and occupy the vacant real estate of the dead. And your sponge will just be stinkier and nastier and you may come to regret having not just tossed it, suggests a study published last month in Scientific Reports.

The thrifty among us may try to clean a sponge that starts to stink, but it’s probably time to let it go. Disinfecting it, as many have tried, does not necessarily work. You can microwave a sponge, throw it in the laundry or dishwasher, douse it in vinegar or other cleansing solutions or even cook it in a pot. But the researchers discovered more of the potentially pathogenic bacteria, like Moraxella osloensis, on the sponges collected from people who said they routinely disinfected them.

“When people at home try to clean their sponges, they make it worse,” Dr. Egert said — similar to how people can encourage antibiotic resistant bacteria if they don’t follow the doctor’s orders. He says if you can’t clean it perfectly, it may be best to replace it with a new one every week or so — especially “if it starts to move.”

Glen Campbell

Glen Campbell -- legendary country music singer best known for his 1975 hit, "Rhinestone Cowboy" -- has died after a long battle with Alzheimer's ... TMZ has learned.

Campbell died Tuesday around 10 AM in a Nashville facility for Alzheimer's patients ... according to a source close to his family.

The musician released more than 70 albums over a 50-year career, and had a series of hits in the '60s and '70s including "Gentle on My Mind," "Wichita Lineman," "Galveston," "Country Boy" and his best-selling single, "Rhinestone Cowboy."

Glen made history in 1967 by winning 4 Grammys in the country and pop categories, and took home CMA's Entertainer of the Year award in 1968.

Campbell was also an actor and TV host who starred in the variety show, "The Glen Campbell Goodtime Hour" on CBS from 1969-1972. The 2014 documentary "I'll Be Me" documented Glen's farewell tour and struggle with his Alzheimer's diagnosis.

He's survived by his wife, Kim Campbell, and 8 children. Kim's scheduled to speak at The Alzheimer's Alliance of Smith County luncheon in Tyler, Texas in November about the challenges faced by people living with the disease and their families.

Glen was 81.

RIP