Senior couple one with brain tumor and another a heart patient. IKOR® helped them and their children sort through various care options. Through a thorough medical,social,environmental assessment IKOR® provided 2 options for the couple to live independetly with all the desired facilities with 24 hours nursing facility from IKOR® . The solution saved the family over $6,000.00 a month in costs.
Issues and Challenges
Mr. and Mrs. G are 72 and 70 respectfully. Mrs. G was diagnosed with a brain tumor and underwent brain surgery 30 years ago, which left her fully paralyzed on the right side. Her husband and children had been her primary care givers from that time on. Mr. G was an active executive until his retirement 3 years ago. Soon after his retirement, Mr. G began to experience cardiac and vascular difficulties. These medical conditions resulted in the need for numerous medications and subsequent surgery.
Following Mr. G's surgery, the couple was placed in a skilled care facility at the doctor's request for the purpose of rehabilitation for Mr. G, and because Mrs. G could not care for herself. Mrs. G's children, now grown and with careers and families of their own, did not have the time to provide care within their homes. The children ultimately searched independently for what they thought was the most appropriate placement. The children spent several weeks before finding the current facility.
IKOR® was engaged by 2 of the 4 adult children, who lived nearby. The children had been informed by the skilled care facility that their Father was no longer appropriate for the facility as he had greatly improved. The facility had recommended that the Father be moved to an assisted living center owned by the same company some distance away.
The children were concerned about the move. They were uncertain that the move was necessary and they were concerned about the effect of separating their parents. The children had also indicated that they were financially at a maximum with the current living arrangement, and were concerned they could not meet new and unexpected costs. At the time of IKOR® 's intervention, Mr. And Mrs. G were spending over $10,000.00 a month to live in the skilled care facility. The family was resigned to total Medicaid dependence as an inevitable conclusion when the money and assets ran out.
IKOR® Approach
IKOR® enters a situation such as this knowing that the business realities of facilities for the elderly may intrude on the care needs of the patients concerned. The facility had several monetary issues they were addressing. The family was completely unaware of these issues. Based upon the current criteria for Medicaid admission, Mr. G would bring the facility the lowest level of reimbursement possible. If the facility moved Mr. G to their own assisted living center, they would continue to receive the families full private pay reimbursement while at the same time filling Mr. G's skilled care bed with a patient who could provide the facility with the maximum Medicaid reimbursement.
An IKOR® care manager met with the family, and assessed both parents in their skilled care room. Mr. and Mrs. G were adamant about remaining together as they had been for over the last 46 years. Mr. G was so adamant about remaining together that he had hidden his full capabilities from the staff.
They discussed their wishes and hopes regarding a new environment. Among those wishes was that they could live in an apartment style home instead of one small room. They wished for cable television so they could watch their favorite programs, and they wished for choices when they had their meals. Their children had one specific request; that the facility be near a full medical center to address any potential crisis for the Father.
They were both mentally and socially active people, and they were currently living in an environment where they were unchallenged both physically and mentally. The IKOR® assessment clearly showed that Mr. G was mentally and physically far more independent than warranted a skilled care level. Mr. G was assessed by the IKOR® RN to be appropriate for an assisted living level. Mrs. G, although needing clearly more assistance than her husband was in many respects beyond skilled care as well. Mrs. G's capabilities placed her somewhere within the void between assisted living and skilled care.
The IKOR® determination was that assisted living with limited additional care was the best response to the needs of both individuals.
Case Outcome
IKOR® successfully found and recommended 2 possible facilities. Both were able to meet all the clients' desired objectives. Mr. and Mrs. G could have a 1-bedroom apartment living environment with cable television and a full kitchen where Mr. G could keep his favorite snacks. The couple could have the option either to take their meals in their apartment, or to eat in the restaurant style environment, personally selecting what they would eat. Mr. and Mrs. G would have the opportunity to participate in activities both inside and outside of the facility. Both options were geographically situated within an easy driving distance from the nearby children and within a mile of a full medical center. In both options IKOR® assured 24 hour nursing service and more than 4 hours of direct care for Mrs. G everyday.
IKOR® Quality Care Management presented a plan meeting all of the requested options and all of the identified needs. This solution also saved the family over $6,000.00 a month in costs.
