Options for Support

As a Veteran you have choices for your in-home care needs.  In-home care could help you with mobility, hygiene, bathing, dressing, grooming, and other needs. Choosing the right program to administer your care may make all the difference in terms of whether you are able to continue age in place and remain in your home. There are several Agencies throughout Southeast Alaska that offer a Personal Care Assistance program for Veterans such as Center for Community, Community Connections, and Cornerstone Home Health.  There is different service model option offered by Southeast Alaska Independent Living (SAIL). Here are the differences between the programs to help you make an informed decision about which type of care you might prefer.

 

Southeast Alaska Independent Living (SAIL) – Veteran-Directed Care VOICE	Agency-Based Care – HHA: Center for Community, Compass, Community Connections, and Cornerstone Home Care
●   Based on your physician’s assessment of your needs, you are given a monthly “budget” from the VA to pay for personal care, in-home support and other goods and services not covered by your VA benefit that you need. Your designated SAIL advocate will help you design a budget and submit it to the VA for approval.	●   Based on your physician’s assessment of your needs, an agency-based program will receive authorization from the VA to provide a specified number of hours to provide you with personal care and or respite care.
●   You may appoint a designee (such as your spouse, grown child or friend) to manage your budget from the VA if you feel you are not able to manage your own care.	●   an agency will work with you or your Power of Attorney to schedule your approved hours to meet your needs.
●   You (or your designee) hire, train and dismiss your workers	●   an agency provides trained caregivers and manages all aspects of their employment.
●   You (or your designee) hire whomever you would like to provide your care (including your spouse, children, grandchildren, neighbors and friends). Anyone, other than your designee, who is eligible to work in AK, can work for you.	●   An agency hires employees who provide you care; they are not able to hire your family members to provide your care. However, they strive to match you with care providers you are happy with.
●   You (or your designee) sign your workers timesheets and submit them to be paid	●   You sign your workers timesheets, and an agency submits them to be paid
●   Your workers can perform whatever tasks you mutually agree upon based on your initial assessment which measures your Activities of Daily Living needs	●   Your workers can perform many tasks related to your independent living.   The tasks you receive are approved by the VA.
●   You (or your designee) should hire back-up employees to provide care for you in the event that your worker(s) are sick or on vacation	●   an agency arranges for staff to provide your services.
●   You may use any amount of your budget from the VA for other pre-approved expenses such as home or vehicle modifications and other approved expenses related to your in-home care that are not already covered by the VA. ●   Also, your VA health insurance typically covers durable medical equipment, catheter supplies, incontinence supplies, bedside commodes, lifts, etc. with a prescription from your doctor	●   Your VA health insurance typically covers durable medical equipment, catheter supplies, incontinence supplies, bedside commodes, lifts, etc. with a prescription from your doctor

Services:​

• Create your own Spending plan​
• Choose where, when, and how your services are provided​
• Hire and choose how much you plan to pay your staff​
• Save funds in your budget for equipment, home, or vehicle modifications ​

Process:​

• Contact SAIL ​
• Brochure, DD214, VA POA​

Eligibility Process:

• • • Enrolled in VA Healthcare​
    • Be able to self-direct care or assign someone you trust to direct care​
    • Medical eligibility as determined by the Alaska VA

Links:

• Southeast Alaska Independent Living (SAIL)
• Center for Community
• Community Connections
• Cornerstone Home Care

Indian Health Services that support the regional tribal health clinics do not pay for in-home services, assisted living placement, or skilled nursing/long-term care placement.  Payment for these services need to be planned through other resources such as Medicare, Medicaid, private insurance, or privately paid.  Most village tribal offices provide support for emergency needs or other social services to assist you until alternative benefits or options may be available to help you long–term.  Each community differs widely.​ Check your community for Tribal Services in the Elder Directory.​

Ketchikan Indian Community (KIC) Elder Services offers in-home supports, transportation, and meal services within the city limits of Ketchikan, Alaska.

SEARHC Patient Benefits provides individual assistance for your benefit needs as well as has information about Tribally Sponsored Health Insurance and other financial assistance available.

Adult Day Centers offer a daily outing for individuals who need to have light supervision for their safety.  Services often include lunch time meal, snacks, social activities, possible medication reminders and light Personal Care maintenance.  The staff and environment often cater to those who are suffering from Dementia or other cognitive impairments. Services are covered through a Medicaid Wavier, grants, private insurance, private pay, or a combination of funding.  Some programs offer transportation to and from the program.  These services can provide a well needed break for a primary home/family caregiver while providing a healthy safe environment for the participant.  Most programs offer support Monday to Friday from about 8:30AM to 4PM. 

Regional Programs 

Juneau                Catholic Community Services Bridge Adult Day Program

Ketchikan             Rendezvous Senior Day Center

Petersburg           SEARHC Petersburg Medical Center Cedar Social Club Adult Day Program (Facebook)

Assisted Living facilities provide 24-hour care in a homelike setting for elders and/or persons with mental health, developmental, or physical disabilities who need aid with their activities of daily living such as showering, dressing, and eating.  Facility size and some annuities vary upon location.  Many of the Assisted Living Facilities in Alaska are privately owned.  The Pioneer Home system is owned and operated by the State of Alaska and offers Assisted Living level of care. Most of the Assisted Living Facilities are in the Anchorage, Alaska area.  Planning ahead is important if you believe that your needs may reach the level for Assisted Living Placement.

The Pioneer Home system offers two waiting lists.  One, known as the Inactive Waiting List, is for those who plan to enter the Pioneer Home at some time in the future and the other, Active Waiting List, is for those with an immediate desire to move into the facility within 30 days.  The waiting list is free to sign up on.  Once an application is received your name and application date are recorded.  If you choose to move to the Active Waiting List, your application date determines your placement on the Active List.  The older the application date the higher you fall on the Active Waiting List (the oldest application is #1 on the Active Waiting List).   They require all applicants to be Alaska residents over the age of 65 years.

State of Alaska, Department of Family and Community Services, Division of Alaska Pioneer Homes

Medicaid Wavier will pay the Cost of Care to a facility for an individual needing Assisted Living placement.  The participant is required to pay a portion to the facility for monthly rent.

For an individual who needs immediate Assisted Living facility placement but is pending a Medicaid Wavier, The State of Alaska Department of Health Division of Senior and Disabilities Services provides the General Relief Program that assists with the cost of placement for an interim period.  The individual is still required to pay a portion of their monthly income to the facility with this funding.

State of Alaska, Department of Health, Division of Senior and Disabilities Services, General Relief Program

Looking for an Assisting Living Home Facility?  The State of Alaska, Department of Health, Division of Health Care Services, Assisted Living Licensing Unit provides a monthly updated list of statewide facilities.

Current Licensed Facilities

If you have improved while residing in a facility and desire to seek community placement, the State of Alaska, Department of Health, Division of Senior and Disabilities Services offers a program to assist with the cost associated for moving out of a Skilled Nursing, Long-Term Care, or Assisted Living Facility.

Nursing Facility Transition/Assisted Living Transition Program 

Skilled Nursing Facilities provide the highest level of care to an individual outside a hospital setting, known as sub-acute care.  The primary focus initially in a Skilled Nursing facility is rehabilitation care through skilled therapies.  Theses therapies include nursing (medication/wound care etc.), physical, occupational, and speech therapy.  Rehabilitative care is covered by Medicare if the individual had a three-day qualifying hospital stay prior to needing to be moved to a skilled nursing facility.  The belief at the time of admission is that the individual will be able and willing to work towards goals, if at any time this is not the case the status of the individual can be moved from Rehabilitative to Long-Term Care.  This means that Medicare stops paying for the services and an alternative option is required for payment.  In most cases, Medicaid is the primary funding source.  Often individuals will pay privately to spend down their assets on their care needs while pending approval by Medicaid.   In the case of a 75-100% service-connected veteran, the VA would cover the costs for a qualified placement.  There are not alternative payment options through grants or programs to cover the costs of Skilled Nursing facility care. Medicare will cover skilled nursing rehabilitative care up to a maximum of 100 days.

The State of Alaska, Department of Health, Division of Senior and Disabilities Services does offer a program to assist with the cost associated for moving out of a Skilled Nursing, Long-Term Care, or Assisted Living Facility.

Nursing Facility Transition/Assisted Living Transition Program 

Long-Term Care Insurance is a specific type of insurance coverage that covers the expenses for skilled nursing placement, hospice home care, and in-home care services.  Some policies will cover Assisted Living placement.  Most policies go into effect following a 90-day grace period for the first day that you enter a skilled nursing facility for rehabilitative care.  Often the insurance provider will require that you pay for the first 90 days of care.  Note that Skilled Nursing/Rehabilitative care are covered expenses under Medicare for up to 100 days.  You or your representative will need to contact the long-term care provider upon entry into a skilled nursing facility.  The insurance provider will likely request to conduct a physical and cognitive assessment to determine eligibility to activate the policy.

Long-Term Care insurance policies vary greatly.  Many have financial caps for the costs associated with the care that you may need.  The policy coverage will often not cover all the expenses that are accrued through the course of care needed.  Medicaid or other secondary insurance coverage may be required depending on the level of care and support you need ongoing.

Long Term Care policies have variable costs.  They tend to have lower premium costs, if established prior to retirement age.  Some employers offer the Long-Term Care insurance as a supplement to health insurance.

Links:

For State of Alaska Employees, Long-Term Care Policy

For Federal Employee, Long-Term Care

AARP Long-Term Care options

Articles:

Making Sense of Your Long-Term Insurance (aarp.org)

7 Ways to Pay for Care Without Long-Term Care Insurance (aarp.org)

 

Most in-home care and social service agencies offer a private pay option for support.  If looking for personal care utilizing an agency has its advantages in that the caregiver has been vetted, may have previous experience and knowledge, background checked, and the agency provides advocacy and oversight as your care needs may change.  Rates will vary and some programs offer sliding scales for fees.  Most programs offer support during the day and not overnight.

Alternatives are building your support as needed through hiring professional services such as a private cleaner, gardener, ordering home delivered groceries, establishing Meals on Wheels through your local Senior Center or an Alert One lifeline service.  Some individuals choose to develop a plan with friends and neighbors.  When planning in-home care, it is important to keep a schedule to know when supports are coming to assist in the home.  Managing a scheduling app or utilizing even a wall calendar may help keep you care team organized.  If you choose to privately hire utilizing a contract with your caregiver could help with a clear expectation for your daily needs.

Caregiver and Family Contract

Carezone This worry-free app lets you store and manage important documents in one secure place. You can upload files. You can even scan pill bottles with your smartphone’s camera to create a detailed list of medications and dosages. There is a shareable calendar with automatic reminders.  There is to-do section where you can coordinate care with friends and family members. Available for free at the App Store and Google Play.

AARP Caregiving   This caregiver app provides information and resources on how to effectively care for the aging.  Keep track of medications, appointments, and communicate with family members and other caregivers. It features a help center where caregivers can find quick answers to urgent or commonly asked questions with answers from AARP professionals. Available for free at the App Store and Google Play.