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Question: When does Medicare pay for a nursing home?
Answer: Medicare will pay for a nursing home if you have been in the hospital for at least three days prior to discharge to the nursing home and you are in need of skilled nursing care. Medicare pays the full cost of the nursing home for the first 20 days and then all but $96.00 per day for day 21-100 for as long as you are determined to be in need of skilled care. If you have a medi-gap insurance such as Medex or AARP this insurance will pay the balance as long as Medicare is the primary payor. If at any time during the 100 days it is determined that you no longer meet the Medicare requirement for skilled care than you are responsible for the bill. Each HMO has their own criteria for skilled nursing coverage. Please check with your plan's benefit office for exact terms.

Question: What is the role of the social worker in a geriatric practice?
Answer: A geriatric social worker provides counseling, support and guidance to patients, families and caregivers around the social, psychological, environmental and care issues related to aging. Many older adults are faced with choices regarding home health care, relocation to retirement communities or nursing homes, or a move to the home of a relative. These decisions are both important and complex, and the social worker helps patients and families navigate this new territory.

Question: How will I know when my parents can't live alone any more?
Answer: Information and guidance are provided in the following areas: home health care, assisted living and continuing care retirement communities, nursing homes, medical and long term care insurance, evaluating resources, and management of care.

Through the combination of counseling and resource information, the primary goal is to provide patients and families with the tools and assistance to manage the many challenges of aging.

Question: How do I begin talking with my parents about moving out of their home into a community setting?
Answer: Before assuming that parents need to leave their home, it is important to sort out why you are recommending the move. Are they having difficulty maintaining their home, are they showing physical and psychological signs of struggling, has a neighbor called you with concerns? Is the need related to memory and behavior, or is the home structurally unsafe for frail individuals? Are you struggling with the long commute to their home on weekends? A clear understanding of the concern will guide the intervention. It is often helpful to seek consultation from health care professionals who can assist in the evaluation as well as join you in the discussion with your parents.

It's always helpful to outline the issues and consider the full range of options before making a final decision. For many older adults, housecleaning, food delivery and meal preparation service may make a dramatic difference in their capacity to remain at home. However, if your parent is at risk for wandering or unsafe behavior, alternate planning is certainly indicated.

It is frequently difficult for children to have conversations with their parents about these important issues. Too often, we wait until there's a crisis when decisions must be made quickly. If possible, start talking about their wishes and your concerns as soon as possible. It will then pave the way for decision making in the future.

Many older adults can be supported to live alone with intervention from family and hired assistance. However, if individuals are unable to manage medications and health care treatments, or if they are at risk for unsafe behaviors such as wandering and leaving the stove on due to memory impairment, a move to a supportive setting may be indicated. Similarly, if the design of a home is difficult to modify to accommodate a frail parent who has difficulty walking, that may be a consideration for relocation.

Consultation with a health care professional who can help you assess your parents' needs and consider all options for support may be helpful in making this important decision with your parents.