health care system
...lth agency" (p. 5). This coverage must meet specific criteria, but it can be a relief to family members to know that their loved ones can be taken care of at home without worrying about the expenses. Unfortunately, if the care to be given within the home is termed "not medically necessary" the expense is not covered. This can include items such as meal and medication delivery, a percentage of necessary durable medical equipment, personal care and homemaker services. My employment within a home health care agency has allowed for review of services that are not covered by Medicare and/or private insurance. Health care services that are not included can become quite numerous. It is often difficult for family members to understand why specific services are not covered especially when they appear to be necessary for the care of the patient. These costs can add up quite quickly and the impact of the cost can become quite distressing for family members and patients on a limited budget. In these cases a Social Worker is usually provided to help the patient and family explore other avenues which may enable them to cover their health care costs. Assisted Living Assisted living is an arrangement to residents of a facility that enables them to complete certain daily activities while remaining independent. The services provided enable the resident to achieve maximum function of their activities of daily living. The services are unskilled and non-specialized personnel provide the activities essential to the care of the resident. These services help assist the aged, blind, disabled, and other functionally limited individuals with necessary daily activities which they require help with or are unable to perform on their own. An example of some of the services which may be available are light housekeeping, meal preparation, medication reminders and personal care. The personal care does not include specific health oriented services which would require the services of a certified or licensed professional. It is stated well in Aging "Although the level of services provided may vary, assisted living communities all share a common goal: e! nabling people to live as active and independent a life as possible" (p. 212). The goal of an assisted living facility is to have the residents feel independent within their own home. According to the article Assisted Living's Future In Michigan Debated "Assisted living facilities can offer consumers a great opportunity to get personalized care in a comfortable setting" (p. 2). Currently there is some controversy surrounding the different types of assisted living facilities. In Michigan facilities termed assisted living have no real legal meaning and are not required to be licensed under this name. According to the article Assisted Living's Future In Michigan Debated "Unlicensed facilities, unsubsidized care, untrained staff, and unmet promises make some places seem more like un-assisted living" (p. 1). Unfortunately many facilities are misleading as to what level of care they are providing. Both the government and national organizations are currently addressing this issue. My own experience with an assisted living facility has been quite good. Formerly my grandmother was a resident of an assisted living facility. The facility was specifically built for seniors and was that of an apartment like structure. The facility provided social and recreational activities on a continual basis. There was also transportation service available for residents who wished to use it. My grandmother thoroughly enjoyed living in an assisted living facility where she had the opportunity to make numerous friends, participate in activities and remain independent. Long Term Care Long-term care patients are categorized by having a chronic condition and/or disease. The long-term care facility can be either hospital-based or freestanding. It consists of an organized medical staff, which provides continuous nursing services under professional nurse direction. The patient's status is reviewed on a regular basis to determine if they meet criteria to remain at the facility. The long-term care facility is regulated by state licensure regulations, federal regulations and Joint Commission on Accreditation of Health Care Organizations (JCAHO). State licensure is mandatory, Federal regulation is only necessary if the facility participates with Medicare and Medicaid, and JCAHO standards are voluntary. Long term-care is very expensive and it often becomes a financial catastrophe for the elderly person and their family. Private insurance is unlikely to cover the full cost of care and Medicare only pays for a limited amount. The person usually must eliminate a substantial amount of their assets to become eligible for Medicaid which covers long term care. According to Growing Old In America "In order for elderly persons to qualify for nursing home care under Medicaid, they usually must reduce their personal financial status to the poverty level (p. 119-120). Regretfully, the cost is not the only disturbing factor of a long-term care facility. A family decision to place my grandfather who was suffering from Alzheimer's disease into a nursing home was a very difficult and emotional experience for everyone involved. Regular visits by all family members continually raised concerns about the quality of care that he was receiving. Staffing was also a concern for our family. It seemed there was not enough staff to meet the needs of the patients within the facility. Although licensing agencies regulated these aspects, this was not comforting to our concerns. Fortunately, we were able to move my grandfather to a different facility. The nursing home was newer and better staffed and all family members felt more comfortable about the care he was receiving. The experience of placing a loved one into a long term care facility is one I would prefer to not experience again. It is comforting to know that there are good facilities availab! le and caregivers that really care about the patient's needs. These aspects are very important for families to u...