This website, LTCInfo, identifies resources that provide useful information on Long Term Care (LTC) to those who are planning for or seeking Long Term Care sevices for themselves or for family members or friends.
Traditional healthcare deals with the prevention, diagnosis and treatment of medical conditions. Long Term Care (LTC) deals with your health as well as personal care needs, such as bathing and eating, over a long period when you cannot fully handle them yourself. LTC is not a subject most people think about or plan for until there is an imminent need for it. The options, resources, and costs are quite varied. When the need for LTC arises for yourself or for a member of your family or a close friend, the task of finding a suitable location and services that are affordable can be taxing. This task becomes particularly difficult when it falls (sometimes without warning) on a family member or friend, who does not live closeby and is not very familiar with the area where the person needing the LTC wants to live.
There are numerous government, non-profit, and commercial websites that deal with various aspects of LTC. The information available on the internet is so vast that it is not very easy to navigate through the websites or even locate the right ones. This website is not intended as another website to cover the same topics available elsewhere. Rather, this site is intended as a road map to help people quickly access resources with information relevant to topics they need to know and understand by directing them to organizations that provide generally free help and to sources of information that exist on other websites.
The aspects or topics of LTC that one may wish to explore are listed on the right with links directly to relevant external website pages that discuss the topic; thus, hopefully, saving the effort to navigate those websites. Those websites are provided by governements and non-commercial organizations listed below.
1. LongTermCare.gov (LTCgov) - Department of Human and Health Services of the federal government
2. Medicare.gov (Medicare)- Center for Medicare and Medicaid of the federal government
3. Own Your Future (OYF)- A Partnership between the Texas government agencies and the LTC insurance companies
4. DSHS/ALTSA - Aging and Long-Term Support Administration of the Washington state Department of Social and Health Services
5. OAAA (O3A) - Olympic Area Agency on Aging, the regional office of the AAA, established under the federal Older American Act of 1973
6. Benefits.va.gov (VA benefits)- Department of Veterans Affairs benefits website of the federal government
7. Washington LawHelp (Lawhelp) "is a guide to free civil legal services for low-income persons and seniors in Washington" state.
There are also several commercial websites that provide information and placement to persons looking for help to locate LTC facilities.
Well before one needs LTC due to incapacitation or terminal illness, it is wise to have in place legal documents such as Advance Medical DIrective, Durable Power of Attorney etc. Often the person who needs LTC is already in a state that he/she cannot make rational decisions. A family member or a friend often needs to step in to help.These documents help ensure that your wishes are followed if you are unable to make decisions for yourself. These documents are defined and the need for them explained in Lawhelp. Free blank documents are also included. These documents have to be executed when one is of sound mind. It may be too late when they are needed. In the absence of these documents it may be necessary to go to court to set up a guardianship that could be quite expensive. You should consult your Elder Law attorney for preparing the documents. O3A offers a free 30 minute consultation service with local attorneys.
Long Term Care Basics
LTC deals not only with traditional healthcare for illnesses and ailments, but also with personal care for help with activities of daily living. The basics of LTC including what it covers, who needs it, the types of care etc. are explained at a general level in LTCgov. They are also described in OYF. More specific details are addressed under other topics listed on the right.
Assessment of Care Level
An assessment of the level of necessary LTC help is neded to determine the type of LTC resources required. Free help with this assessment is available from O3A under their Family Caregiver Resource Coordinators..If financial help from Medicaid is applied for, the DSHS may conduct an assessment to determine the level of help needed. Help for preparing and understanding this assessment tool is available here.
Home based care
Most adults prefer to stay at home even when they need assistance. "Home" can be the home of the person in need of assistance or a family member or relative. (If you are covered by Medicare, see under Medicare for Home Health Service).
The home should be safe, functional, and comfortable for the person receiving care as well as the caregivers. O3A may be able to advise and to a limited extent financially help minor modifications to the home.
If the assessment of LTC needs indicates that care can be provided at home, various available options to provide the care are described in DSHS/ALTSA. O3A can also provide various kinds of support including caregiver training to unpaid family caregivers.
A number of commercial care giving agencies that provide vatious types of care workers are available locally. O3A uses a Home Care Referral Registry "to match needs of Washington State residents who receive publicly funded long term in-home care with pre-screened and pre-qualified in-home care workers". O3A also has a free helpful booklet called "How to Hire In-home Help".
Hiring a care worker through an agency may cost about $20/hour (in 2016) or more. Private care workers may cost less but you may have to consider household employee tax rules.
Facility based care
There are basically three types of facilities that provide different levels of LTC.
Adult Family Home (AFH)
Assisted Living Facility (ALF)
Skilled Nursing Home (SNF)
These are licensed and described by DSHS. SNFs are also subject to federal regulations and inspections. The persons receiving care in these facilities are considered "residents". The Nursing Home Reform Act enacted in 1987 assured fundamental rights to the residents. In 1995 Washington state extended these rights to all the above facilities. These rights are explained here. The LTC Ombudman Program was established by the Older American Act to "address complaints and advocate for improvements in the long-term care system". The O3A administers this program in Clallam and Jefferson counties with a team of volunteers who visit the facilities regularly. They can be reached at 800/801-0070. If a resident has an unresolved issue with his/her care, the Ombudsman for the facility should be contacted. If the issue cannot be resolved, the resident or family can file a complaint with the Complaint Resolution Unit (800/562-6078) of the DSHS.
Resources for Information on these facilities and how to choose one are described below.
Adult Family Homes (AFH) are operated by private individuals in residential neighborhoods. They can provide care for 2 to 6 residents. The owner and caregivers are licensed after undergoing DSHS training and passing a test. The legal requirements for AFH are described here. The DSHS brochure Choosing Care in an Adult Family Home or Boarding Home provides information on choosing care in an AFH.
The cost of care in an AFH may cost $3500 per month (in 2016) or more depending upon additional specific services. Financial help from Medicaid may be available for low-income residents (see Medicare and Medicaid).
A list of local AFHs is attached here.
Assisted Living Facilities (ALF) provide care for more than six residents. The legal requirements of services to be provided by an ALF are specified here. The ALFs provide home-like accomodation and provide various levels of personal care and medication requirements. They do not provide any skilled nursing services. The DSHS brochure Choosing Care in an Adult Family Home or Boarding Home provides information on choosing care in an ALF.
Some ALFs serve only residents with dementia. Some have separate sections for them.
Cost in ALFs may be $3000/month (in 2016) or more depending upon the size of the accomodation space and additional services that are needed. Financial help from Medicaid may be available for low-income residents (see Medicare and Medicaid).
A list of local ALFs is attached here. The facilities should be contacted to get details on current costs and conditions of acceptance of Medicaid.
Skilled Nuring Homes (SNF) provide a range of services from 24-hour personal and nursing care, physical and occupational therapies, organized activities, nutrition management, laundry etc. Licensed nurses and Certified Nursing Assistants (CNAs) are on duty round the clock. The federal Center for Medicare and Medicaid Services (CMS) has oversight in the state licensing of the SNFs.
Cost in a SNF may be $275 a day (in 2016) or more depending on required additional personal services. Financial help from Medicaid may be available for low-income residents (see Medicare and Medicaid)
A list of local SNFs are listed here. A comparison of SNFs in the area can be found on the Medicare site by entering the zipcode. The Wasington DSHS inspects the SNFs periodically. The reports can be seen by entering the zipcode.
Hospice Care is a concept of care to provide comfort rather than cure for persons and their families facing life-limiting illnesses. It is administered at home or at a facility by a team including a physician, nurses, social worker, nursing assitant and clergy as explained in the website of the Department of Health and Human Services. Hospice service is covered by Medicare as explained in the booklet Medicare Hospice Benefits. There are two Hospice facilities in Clallam and Jefferson counties..
Assured Hospice (360/582-3796), certified by Medicare and Medicaid. Medicare and many private insurers cover the cost. Service is provided in both Clallam and Jefferson counties.
Volunteer Hospice not certified by Medicare provides free service in most of Clallam county.
Dementia and Alzheimer's Disease Care
Taking care of persons with dementia such as Alzheimer's disease (memory care) requires special knowledge and skill. The non-profit organization Helpguide has useful information on this subject.
Memory care can be at home or usually at an Assisted Living facility (see Facility Based Care)..
Veterans Long Term Care
The US Department of Veterans Affairs has three different programs related to LTC for eligible veterans:
Geriatrics and Extended Care
Aid and Attendance
State Veterans Home
Geriatrics and Extended Care is part of the VA Health Benefits. In addition to the traditional health benefits, this program serves elderly veterans who have complex needs with Adult Day Care, Hospice Service and Respite Care as explained here. Please note that Adult Day Care for veterans is not available in Clallam or Jefferson counties.The veteran must be enrolled in the VA Health Benefits program. The eligibility requirements to enroll in this program and help with enrolling are described here. Enrollment is based on a priority scheme and may be limited by available funds. If you were not eligible before, you can apply again if conditions have changed. The social worker in the VA Medical Clinic where you are enrolled can help you with the enrollment. The clinic in Port Angeles, WA can be reached at 360/565-7420.
Aid and Attendance is a monetary benefit of enhanced pension for veterans who need the aid of another person or is housebound. This benefit including how to apply is explained in the VA website. This benefit is also available to survivors of the veteran. The eligibility to apply for this benefit is explained by the VeteranAid Organization. Veteran Service Organizations such as VFW and American Legion can help you with the application for this benefit. VA does not pay for custodial care (room and board) at an AFH or ALF (see Facility based care). VA may pay for LTC at a community SNF if the LTC need is service related above a certain percentage. Check with the social worker in the VA Medical Clinic in Port Angeles, WA (360/565-7420) if youi qualify..
State Veterans Homes are operated by the Washington State Department of Veterans Affairs (DVA) They are similar to community based Skilled Nursing Homes and are Medicare and Medicaid approved. The closest one to the Olympic Peninsula is located at Restil near Port Orchard. Certain veterans are eligible for LTC at these facilities. The eligibility requirements and application procedures are provided in the DVA website. There is usually a long waiting list to be admitted to these facilities.
More information on the above VA benefits and free help with applying for them are available at the Northwest Veterans Resource Center in Port Angeles, Wa. Phone 360/797-1791.
Medicare and Medicaid
Medicare does not provide any personal care services except under limited conditions. If you are sent to a Skilled Nursing Home (SNF) for rehabilitation and therapy, Medicare will pay for some of the costs for a protracted period as fully explained in Medicare. Please note that to be eligible for this service, one must have been "admitted" in a hospital for 3 days. Being in the hospital for "observation" does not qualify for this service..
O3A operates a free program called Statewide Health Insurance Benefits Advisors (SHIBA) sponsored by the state Office of the Insurance Commissioner. SHIBA can help you with questions and issues about Medicare and Medicaid benefits.
Medicare also provides Home Health Service when you are homebound and require part time skilled nursing services or therapy. The eligibility and cost of this service is fully explained in the Medicare booklet, Medicare and Home Healthcare.
Medicaid, administered by the DSHS, will pay for medical and personal care services at home or at facilities for residents who are functionally and financially eligible. The Home and Community Based Service is covered by the Community Options Program Entry System (COPES). The functional and financial requirements for eligibility for this assistance is explained in the pamphlet Q&A on the COPES Program. The eligibility requirements for financial assistance in a Nursing Home (SNF) is explained in the pamphlet Q&A on Medicaid for Nursing Home Residents.
Long Term Care insurance is sold by insurance companies. Like any other insurance, it is purchased when there is no immediate need for it. LTC Insurance is explained here. The older you are, the higher the premium. The benefits are paid under specific conditions. The different policies and the cost must be carefully investigated before purchasing one. Some guidance on shopping and buying LTC insurance can be found here. When you can receive benefits from LTC insurance depends on two main factors specified in the insurance policy: Benefit Triger and Elimination Period. These are defined here.:
Elder Abuse Protection
There are state laws to protect abuse of vulnerable adults. The types and signs of abuse are described in the DSHS/ALTSA website as well as how and to whom to report suspected abuse. Reporting by staff of LTC facilities is mandatory.
Transportation is available locally with Clallam Paratransit service (360/452-4511). Eligibility to use this service and how to apply are described in their website. Jefferson Transit (360-385-3020) provides bus transportation in Jefferson County. Dial-a-Ride (Para Transit) service is available under their ADA Policy for qualified persons who cannot ride a bus. An explanation of this service can be seen by clicking (as directed on the web page) to view the ADA Policy and scrolling down to item 16.
Library Service is available from the North Olympic Library System. Books and DVDs are delivered and picked up for homebound or persons at LTC facilities periodically by the staff or volunteers.
In Jefferson county ECHHO (Ecumenical Christian Helping Hands Organization) provides volunteer services to help the elderly and disabled persons with transportation for medical appointments, household chores, loans of medical equipment etc. (360) 379-3246)