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Last Modified 07/22/04

Fall 2008 NWKAAA CARE Newsletter

Key Words:  Consistency and Timeliness

Two words come to mind after speaking with the CARE team in Topeka – CONSISTENCY and TIMELINESS.  In order to compile accurate statistics about levels of care and community service needs, we all must be using the same criteria of evaluation. There have been several trainers throughout the existence of the CARE program, therefore, it is important to rely on the information contained in the manual for the consistent “official word.”

Coding can be interpreted differently depending on personal biases and backgrounds.  Please consult your manual or CARE Coordinator if a situation arises that makes you wonder how a customer’s activity should be coded.

Timeliness is essential to the CARE program.  Assessments must be faxed to the CARE Coordinator within one working day.  That does not mean one working day after all of the referrals have been made; it means one working day after the assessment was dated.  If there is a need for an exception, please contact the CARE Coordinator.

It does not matter if the client has determined where they are planning to go after the CARE assessment has been completed.  Please write “unknown” in the blank for the name of the nursing facility and indicate “has not make final LTC decision” on the certificate.  If there is a question about which nursing facility (if considering more than one) the client will go to, place all of the potential names in the comments section.

It may be beneficial to call the Area Agency on Aging to make sure they successfully received the CARE assessment you faxed before you file it away.  We tried emailing “I got it’s” last year and received more “unable to deliver” messages than we did successes.  Phone calls will allow us to give you immediate feedback about the success of your fax and ask any follow-up questions we have while the client’s situation is still fresh in your mind.

Nursing facilities may want to call the Area Agency on Aging to check on CARE for each resident they admit so there is definitely a copy of the assessment on file.  That will prevent any billing issues or noncompliance with PASRR.

If you have any questions, please call us at the Area Agency on Aging at 1-800-432-7422. 

Medicare Part D – Open Enrollment

November 15 to December 31

Call NWKAAA at 1-800-432-7422 or (785) 628-8205 for help evaluating your prescription drug plan needs.

Clock Draw Measures Executive Memory Function and Visuospatial Abilities

“Why do I have to do this?”  “I feel like I’m a first-grader.”  These comments often arise when we’re asking a client to complete the clock draw portion of the CARE assessment.

Families often wonder what this test is supposed to indicate about their loved one.  The CARE manual states on page 17 (revised 5/1/06) that “Executive memory function and visuospatial abilities are usually the first noticeable areas affected in Alzheimer’s disease and other dementias, often before other types of memory impairment are easily discernable.  The person’s ability to make judgments about his/her personal care or direct others in providing care may be compromised.”

“Executive function is an interrelated set of abilities that includes the ability to:

• Form concepts,

• Self-monitor, and

•  Plan and execute detailed activities.”

“Impairments in executive function may make instrumental activities beyond the person’s capacity, even if memory impairment is mild.  Types of IADLs affected include:

• Driving,

• Money management,

• Shopping, and

• Medication management.”

It is important to remember that even if an individual has impairments, such as blindness or paralysis, that prevents the use of the clock draw test, it will be necessary to proceed with other aspects of the cognitive assessment.  We would code someone with one of these impairments as (9) “Unable to test” and put a note in the comments section about the impairment.

Please encourage families to be supportive of their loved ones during this assessment.  It is not our intention to upset the client or allow their families to ridicule the accuracy of the clock draw.

There are many sites online that describe studies that were conducted to determine the value of clock drawing in identifying executive cognitive dysfunction.  Curious clients or assessors can use Google, keywords “clock draw cognition test” to find more information.

Discontinuation of CARE/Van service

HAYS, Kansas (August 10, 2008).  CARE/Van, an Intercity Bus service operated since 1996 by Developmental Services of Northwest Kansas, Inc., was discontinued July 1 due to the lack of a local funding source.

The service has been operated via a grant from the Kansas Department of Transportation.  The grant has covered 50 percent of the operational expenses.  The capital expense of a vehicle is also part of the grant with 80 percent paid via federal funding.

The Office of Public Transportation has stated that they are willing to consider approving this grant if a local funding source can be secured.

Ron Straight, transportation manager at DSNWK, has overseen this project and is the individual to contact if an organization or individual wishes to fund CARE/Van.

For more information, please contact Ron Straight at 1-785-621-2078.

Fall Trainings Successful

The final group of scheduled trainings were held September 11, 16, 17 and 18.  Six new assessors were trained in Hays.  Updates were held in Goodland, Oakley and Osborne, featuring speakers from the Senior Companion Program, Regional Prevention Center, Northwest Kansas Technical College Respiratory Therapy department and Home Buddy.

Thanks to all who attended – you are what makes the CARE program so successful!  If you missed these dates and would like to schedule a training at your facility, please give us a call at 1-800-432-7422.

Independent and Agency Assessors must return fuel receipt to be reimbursed at the increased rate

Fuel prices vary drastically throughout our service area.  In order to fairly reimburse independent and agency assessors for out-of-town assessments we must require that a fuel receipt is submitted along with the voucher.  Please refer to the sliding scale to determine how CARE assessors will be reimbursed for mileage.

Assessments submitted without a fuel receipt will be reimbursed at $0.36 per mile.

Ethics Training Held

The staff of NWKAAA attended an Ethics in Community Based Services training sponsored by the Kansas Area Agencies on Aging Association.  Presenter Ron Denney helped those in attendance develop customer service skills in addition to addressing ethical principles, professional standards and cultural competence and their application in delivering home and community-based services.

Several aspects of the presentation apply directly to CARE assessors.  It’s always important to put clients first.  Clients have the rights to dignity and choice regarding their care – assessors must remember to respect their clients’ wishes.  Some clients have hectic schedules; it is necessary to adapt your schedule to fit the needs of the client and their family.

Utilize the available resources to help you complete the CARE assessment timely, accurately and professionally.  We are happy to help you or your client navigate any long-term care mazes you encounter.  Discussing unusual situations with someone can make the best solution more visible – please call us!

Recording comments on the assessment will help you out of situations when judgment is in question.  Please remember to include comments on all of your assessments.

Several assessors are packing the CARE assessment with clients as they leave for the nursing facility in an envelope marked “nursing facility.”  Unless the client has specifically stated that they want the nursing facility to receive a copy of the entire assessment (and you have documented the request in the comments section) you may only send a copy of the CARE certificate to the nursing facility.  The goldenrod copies of the CARE forms are the property of the client.

Finally, please remember to help the client understand what they are signing.  If you do not believe they understand what they are signing, please find another individual with the power to help make decisions to sign the form.  This applies to the CARE consent to release information and CARE certificate.

If you have any questions about the dilemmas faced by CARE assessors or with to discuss a specific situation, please call our office at 1-800-432-7422.

A CARE Assessment Is Based On…

An average day

In their normal living environment

Within the last month, or last limiting event if sooner

**Their personal wishes that are not founded with ability is not fact.

Focus on Client’s Choice

The CARE assessment includes a question regarding “Customer’s Choice for Long Term Care” on it.  That said, especially in a hospital setting, if the customer (or their legal representative) requests that a CARE assessment be completed, it is the CARE assessor’s job to complete it.  The customer is allowed to make the choice to try to enter a nursing facility if they desire.  It is not up to the doctor or CARE assessor to determine if a CARE assessment should be completed if the client requests it and is considering nursing facility placement.  After all, the CARE assessment is valid for one year.

The doctor may not authorize a nursing facility stay.  The nursing facility may not accept the client.  However, if it is the client’s choice to evaluate their long term care options during the CARE process, it is our duty to assist them as much as possible.

If you have a client requesting a CARE assessment and it is not in the client’s best interests to enter a nursing facility, it is then our opportunity to help them realize that some of the referrals we offer may be a better option.

Please remember to let the client know the PASRR (Kansas PASRR is the CARE assessment) is REQUIRED for admittance to a Medicaid-certified nursing facility or long term care unit.

If you have any questions, please give us a call at 1-800-432-7422.

Medicaid News

The Kansas Health Policy Authority will begin issuing plastic identification cards to more than 275,000 Medicaid beneficiaries.  The new cards replace the paper identification cards that used to be mailed to beneficiaries each month.  “This should make for a more streamlined, more efficient system,” said health policy authority Deputy Director Andy Allison.  The cards include a magnetic swipe strip designed to give health care providers instant computer access to a beneficiary’s eligibility status.

Officials said the new system is expected to lower the state’s administrative costs by  about $500,000 annually.  Beneficiaries are scheduled to receive their new cards on or soon after September 2.

**Taken from an August 25^th article by Dave Ranney, KHI News Service

Protect Yourself from Uncomfortable Situations

During the update trainings, we found that several assessors have been placed in uncomfortable situations with clients.  There will probably be times for each assessor when something “just doesn’t feel right.”  Think proactively – enlist the help of others to avoid a potentially dangerous situation.  It may be beneficial to work with the client and their contact person together, bring along a police officer or conduct the assessment at a public place (in the case of mental illness, the mental health center may be appropriate).  If you have a question about who an appropriate witness may be, please call the Area Agency on Aging at 1-800-432-7422.

Good Advice on Stress Management

A lecturer, when explaining stress management to an audience raised a glass or water and asked, “How heavy is this glass of water?”

Answers called out ranged from 8-20 ounces.

The lecturer replied, “The absolute weight doesn’t matter.  It depends on how long you try to hold it.  If I hold it for a minute, that’s not a problem.  If I hold it for an hour, I’ll have an ache in my right arm.  If I hold it for a day, you’ll have to call an ambulance.  In each case, it’s the same weight, but the longer I hold it, the heavier it becomes.”

He continued, “And that’s the way it is with stress management.  If we carry our burdens all the time, sooner or later, as the burden becomes increasingly heavy, we won’t be able to carry on.  As with the glass of water, you have to put it down for a while and reset before holding it again.  When we’re refreshed, we can carry on with the burden.  So, before you return home tonight, put the burden of work/life down.  Don’t carry it home.  You can pick it up tomorrow.  Whatever burdens you’re carrying now, let them down for a moment if you can.  Relax; pick them up later after you’ve rested.  Life is short.  Enjoy!”

Many of our CARE clients feel like the lecturer described (although the length of time is quite different) and we’re their “ambulance.”  One of the best things we can do as CARE assessors is reassure the client, their caregiver and family that their feelings are normal and to be expected.

The NWKAAA Family Caregiver Support Program is here to help!  A monthly newsletter is available.  To be included on the mailing list, please call the Area Agency on Aging at 1-800-432-7422.

NEW CMS INITIATIVE HELPS TO ASSIST AND IDENTIFY INDIVIDUALS WHO CARE FOR MEDICARE BENEFICIARIES AS CAREGIVERS

ASK MEDICARE PROVIDES ONLINE INFORMATION, TOOLS AND MATERIALS FOR CAREGIVERS

The Centers for Medicare & Medicaid Services (CMS) today launched Ask Medicare, a new initiative to help family caregivers – those who are family members or friends who help people with Medicare – access and use valuable healthcare information, services and resources.

More then 44 million Americans, more than one in five adults, provide care to a loved one, friend or neighbor, valued in economic terms at $350 billion annually, according to a recent report by AARP.  The new initiative will provide a one-stop Web page for caregivers (www.medicare.gov/caregivers) that provides easy access to useful information about Medicare and other essential resources to help with caregiving.

“Caregivers are often overwhelmed and as part of this new education effort called Ask Medicare will be a single, go-to place for help and information,” said Kerry Weems, CMS acting administrator.  “There is a genuine need for credible and easy to use information that provides answers to a wide range of questions toward helping beneficiaries make better use of Medicare.  The Ask Medicare Web site was designed with family caregivers in mind.”

The CMS, part of the U.S. Department of Health and Human Services (HHS), launched the new caregiver initiative through a live Webcast hosted by Acting Administrator Weems.  During the live online forum, national partner organizations, including HHS’ Administration on Aging, AARP, and the National Alliance for Caregiving, joined CMS in answering questions from caregivers.

Information to Help You Care for Others

Most caregivers do not think of or identify themselves as caregivers; yet, so many of the resources available to them use that term.  “If a person helping someone on Medicare does not relate to the term ‘caregiver,’ they may miss a lot of resources,” said Weems.

Many family caregivers see their roles of providing help or service to someone they care about as simply “the right thing to do” because the person is a family member or friend.   Family caregivers provide help that includes:

• Buying groceries;

• Picking up prescriptions;

• Taking someone to the doctor;

• Helping an elderly parent navigate benefits and plan for the future;

• Looking after someone with a disease or disability; or

• Caring for a parent in their home.

The Ask Medicare Web site will provide links to key partner organizations that assist caregivers and beneficiaries, and present personal stories from caregivers in the community.  Support information and tools to help caregivers address common problems will be available.  As part of the initiative, CMS will launch an e-newsletter for caregivers that will deliver information into subscribers’ email boxes.

“Through Ask Medicare and the new e-newsletter, CMS will help provide more information to caregivers, helping to streamline caring for Medicare beneficiaries and ultimately improve their quality of life and that of their loved ones,” said Weems. 

For more information about Medicare’s new caregiver initiative, please visit: www.medicare.gov/caregivers

Press release:  Thursday, September 18, 2008

Contact:  CMS Office of Public Affairs 202-690-6145

Kansas Mission of Mercy 2009

FREE Dental Clinic

February 20 and 21, 2009  

Manhattan, Kansas

United States National Guard Armory,

located just east of Manhattan on U.S. Highway 24

No Eligibility or Income Requirements  

No Appointments – First Come, First Served

Serving Children and Adults

Services include fillings, cleaning, extractions.

Doors open at 5:30 am

For updated information, continue to check the following website:

http://kdcf.blogspot.com

Veterans News   

Hello, my name is Eric Rohleder and I am a Veterans Service Representative for the Kansas Commission on Veterans’ Affairs.  I serve thousands of veterans and their family members in the counties of Barton, Ellis, Graham, Norton, Osborne, Phillips, Rooks, Rush, Russell, Smith and Trego in Northwest Kansas.  My primary focus is to assist the veteran or surviving family member when applying for benefits from the Department of Veterans Affairs.  Below, I will explain some of the more common benefits that I deal with on a regular basis.  

Who is eligible?  A person may be eligible for VA benefits if they are:

• a veteran,

• a veteran’s dependent,

• a surviving spouse, child or parent of a deceased veteran,

• an active duty military service member, or

• a member of the Reserves or National Guard.

Compensation – The disability compensation program provides financial assistance to veterans with service-connected disabilities to compensate them for the loss of, or reduction in earning power resulting from comparable injuries and disease in civil life.  Disability compensation payments vary in amount, depending on the impairment of earning capacity suffered by the veteran. 

The degree is assessed in multiples of 10, from 10 percent to 100 percent, with special statutory rates for such disabilities as blindness and loss of use of limbs.  According to the Department of Veterans Affairs, to support a claim for service connection, the evidence must show three things.

1.                  That the veteran had an injury in military service, or a disease that began in or was made worse during military service, or there was an event in service that caused an injury or disease. 

2.                  That the veteran must have a current physical or mental disability shown by medical evidence. 

3.                  There has to be a relationship between a veteran’s disability and an injury, disease, or event in the military service.

Pension – There are several different types of pensions that are available to the veteran and family members, all of which are awarded based on income and net worth as well as the veterans wartime service to the country.

I will begin by describing the Non-Service Connected Disability Pension.  This type of pension is the Department of Veterans Affairs benefits program that provides financial support to wartime veterans having limited income.  The amount payable under this program depends on the type and amount of income the veteran and family members receive from other sources.  Monthly payments are made to bring the veteran’s total annual income (including other retirement and social security income) to an established support level.  One thing to keep in mind is that unreimbursed medical expenses may reduce countable income.  If eligible, the VA pays the difference between a recipient’s countable family income and the annual income limit set by law for his or her status.  The difference is generally paid in 12 equal monthly installments.  The current maximum annual pension rate under this program for a veteran alone is $11,181.00 and a veteran with one dependent is $14,643.00.  If the veteran is homebound or in a nursing home the maximum annual pension rates will usually increase.

Another common type of pension is the death pension.  This is a benefit paid to eligible dependents of deceased wartime veterans.  Eligible dependants may qualify for a death pension if the deceased veteran was discharged from service under other than dishonorable conditions and he or she served 90 days or more active service with at least one day during wartime and the dependent is the surviving spouse (spouse must not have remarried).  The dependant’s countable income must be below an annual limit set by law.  These limits are currently set at $7,498.00 for the surviving spouse alone and $9,818.00 for a surviving spouse with one dependent child.

As you can see, there are many factors that the VA uses when adjudicating a claim from a veteran or surviving spouse.  My recommendation to you is to refer them to my office or the nearest veteran services representative for assistance. 

It is our duty, and above all, our pleasure to help the veterans and family members when applying for VA benefits.  I only scratched the surface in these few paragraphs when it comes to benefits.  Hopefully I answered some questions, and if not, please feel free to contact me at 785-625-8532. I look forward to presenting future articles on the ever changing world of VA benefits.