Welcome to the Light Keepers podcast. I'm Clayton
Vandiver, your Light Keeper, with a show dedicated
to everyone who wants to get the most quality
out of life that they can. My co -host, as always,
Charlene, our very own licensed clinical social
worker, certified in the state of Florida, joins
the conversation this week about the population
who thinks that they're covered, and they might
not be. We'll have that and a whole lot more
on this episode of the Light Keepers Podcast.
And before we start, please leave your questions
or comments below. We always love to hear from
you. Questions this week will be answered during
our next show that appears online every Wednesday
evening at 7 p .m. Eastern. The Light Keepers
podcast is an exclusive production of A Guiding
Light. We'll tell you more about A Guiding Light
at the end of the podcast, but we don't have
much time, so let's get right into this week's
conversation, Charlene, about people who think
that they're covered. but they're not necessarily.
What do we mean by that? So what we mean by that
is that a lot of times people think that Medicare
will cover everything. And sadly, that is not
true. As someone who has worked in the hospital
setting, in the hospice setting, it can become
a very difficult conversation when I... am talking
with someone who finds himself in a situation
where they're needing long -term care placement.
For those that may not know the lingo, that means
a nursing home. Oh, yeah. Nursing home placement.
And nursing homes differ from ALFs and ILFs,
or do they not? I'm a little confused about that.
So an assisted care facility. or an uh long -term
care facility so here's your different levels
of care okay okay and These can be a little confusing
to someone who's not familiar with them. So you
have your independent living. Right. These are
for individuals who are still capable of taking
care of themselves. Right. They're still ambulatory.
They get around. They go shopping a couple times
a week. Go out to dinner with the family. Exactly.
A lot of times you'll hear these places referred
to as senior living communities. Okay. All right.
This is someone who can still live in their own
home without any assistance. Okay. Okay. Then
you have your assisted living facilities, your
ALFs. Okay. Okay. These are facilities for people
who can do most things on their own, but they're
starting to need a little bit of help. You know,
maybe they can't cook for themselves anymore.
Maybe they can't do the housework. Well, I've
seen some of the meals in the assisted living
facilities that I've visited, and they really
lay out a beautiful spread. They make wonderful
meals, many of them, most of them. Most of them
are really good. In order to be able to go into
an assisted living facility, you have to be able
to do some things for yourself. Like, for example,
you have to be able to ambulate. You have to
be able to move around on your own. You have
to at least be able to transfer, and that means
you have to be able to go from one sitting position
to a different. like you have to be able to go
from a wheelchair to a bed. Oh, okay, or just
get from point A to point B kind of on your own.
Exactly. So assisted living facilities do have
minimum requirements that someone has to be able
to do. Now, assisted living facilities are not
paid for by Medicare. Those are private pay.
That's an important point to understand. Very
important point. Who pays for these? Is your
skilled nursing facility. Okay. Your long -term
care facility, your nursing home. Okay. So that's
where we were going was the nursing home when
I got distracted by all those other facilities.
And nursing homes, skilled nursing facilities,
these are where people go who need rehab. If
they're not strong enough to go back home, if
they need some physical therapy. So they have
a few extra features, maybe a few therapists,
physical therapists, more of a nursing staff.
Exactly. But if you are someone who can't go
home, if you are not able to be cared for at
home, maybe you don't have any family. Maybe
your family is not physically able for whatever
reason. If you are not able to be taken care
of at home and you're not capable of taking care
of yourself, then a skilled nursing facility
is where you would need to go. And where the
conversation can become difficult, and I've actually
had this conversation with an older gentleman
who became very distraught when he found out
that the Medicare that he's been paying into
his entire life does not pay for skilled nursing.
So he assumed that it did and that he was covered
and good to go right there. And see, and it gets
complicated. It gets complicated for people because
Medicare does pay for skilled nursing if it's
short -term for rehab. Oh. But they do not pay
if it is where you're living. So they don't exactly
make it easy to follow because some conditions
follow this and some conditions follow that.
Let me ask you. How do you find out? Let me ask
you. Would your insurance pay for physical therapy?
You know, I honestly don't even know. Yes, your
insurance would pay for physical therapy. So
the standard employer's insurance covers for
physical therapy. If the doctor prescribes it,
it'll pay for it. Okay. Would your medical insurance
pay your mortgage? I would assume not unless
there's the difference. There's probably not.
But there's the difference. Medicare is for medical
and they're not going to pay for you to live
somewhere. They're not going to pay your rent.
They're not going to pay your mortgage. So they're
not going to pay for your skilled nursing stay.
So a good standard to sort of understand it by
is if it's purely medical, like a hospital where
you're going to get treatment. they're very likely
to cover that. Your insurance is very unlikely
to cover it if it's just a place to live. Exactly.
That provides your meals. Now, does that change
if it's an assisted living facility that has
a memory care unit, for instance, where someone
with dementia or Alzheimer's would be receiving
more specialized care, but they're also living
there? So memory care units are usually found
at skilled nursing facilities, and they're very
specialized units where they have special safety
features in place. Most of them are locked down
units, which means once you go in, you can't
get out without being buzzed out. You have some
key that will let you out, and that's for the
safety of the residents to keep them from wandering.
And anyone who's ever worked in the news, as
I have, and has seen a silver alert come across
when someone is like a funny quick story, I've
got to tell you this anecdote. I've got to share
this with our listeners and viewers. I'm editing
the morning news many years ago, and I'm seeing
a feed that came over CBS. from the Carolinas
and I'm seeing my cousin. And I said to our producer,
I leaned out of the edit bay and I said, this
is my cousin. He's on this story. And he ran
over and said, what's the story? I said, well,
it's a silver alert. And oh my Lord, it's my
own uncle. My own uncle had driven the mile to
church on Sunday. And here it was Monday and
he hadn't been heard from and he never arrived
to church. Well, he was found, thankfully, alive,
well, everything was okay. Two states over, because
he got to driving, and then things didn't look
familiar to him. And so he kept driving. Because
he thought to himself he was able to thankfully
tell us after this all happened. He kept thinking
to himself, nothing looks familiar, and I'm confused.
And if I stop and ask for help, they're going
to come and they're going to take my driver's
license from me. So, of course, when he was found
two states over, having slept in his car several
times when he got tired along the way, they took
his driver's license away from him. Rightfully
so, unfortunately. But it was a real awakening
to me to realize that here I am editing a news
story about my uncle, my cousin. All of this
had happened. It was almost too close to bear
because it was family. And unfortunately, that
can happen. So those assisted living facilities
that have memory care units are so important
and they do such a wonderful job. The lockdown
does not mean it's like a prison. they make it
as much like home as possible. They help you
decorate usually. They bring things from home
and they make it look as much like the familiar
environment that you know so that your loved
one will feel very much in a place that looks
familiar, that they know. In a place that feels
safe because that's critical to controlling the
behavioral issues that can sometimes come with
memory care. Right. Yeah. It's a tough time in
life. It's a tough condition. And it's one you
hear so much about. And we have the amber alerts
or silver alerts both come over our phones quite
often these days. And, you know, maybe that's
a topic for another day where we can tell our
listeners and our viewers about how to recognize
when someone... might be struggling with some
memory care issues because people who do have
memory care issues they develop crutches that
can make it look like they're managing perfectly
fine when really they're struggling and they
may not realize and the family may not realize
and so That can be an issue. And, you know, this
is something we've had personal experience with
family members where the doctor was telling us
they're perfectly fine and we were going, no,
something's off. The doctor only sees them once,
twice a year. For a few minutes, we see them
every day. It's lengthy. We see them when they
sundown. That's a different thing we'll talk
about at some point, I'm sure. Because sundowning
is weird for the caregiver. That, hey, they're
fine, they're fine, they're fine. And then somebody
flips the switch. And the sun begins to go down.
It's later in the day. Their energy levels become
lower. And just as a preview of that show that
we'll do, all of a sudden you've got the lovely
little Dr. Jekyll followed by Mr. Hyde. And that's
exactly it. That's exactly it. But to get to
answering your question, even the memory care
units, be they at assisted living or skilled
nursing facilities, are not covered by Medicare.
They're not covered by Medicare. Really? Really.
Wow. So to get back to where we were when we
started all this, we kind of went off on a tangent.
Good information. Great stuff. But we were really
looking at the population who thinks that they're
covered, but they're not. So anyone who is on
Medicare, who's been paying into it their entire
lives, a lot of these people go into their golden
years thinking that whatever they need is going
to be covered. And truth of the matter is, that's
not true. And that can be a rude awakening for
some people. The gentleman that I was talking
about that I had this conversation with actually
became quite belligerent when he found out that
what he had saved to leave to his family, he
was not going to be able to leave to them because
it was now going to cost that for him to be able
to receive the care that he needed. Oh, wow.
That could be a very... It was very upsetting,
not just to him, but to the entire family. I
mean, and it really does put our seniors in a
delicate position because here you have someone
who is on a fixed income. You know, they're only
getting a certain amount each month. And now
you're looking at a facility that is going to
cost thousands of dollars a month. And you have
most of the time. You have a spouse who's going
to be at home with all the same expenses, but
now with half the income and the added expense
of that facility. Of course, of course. And that's
important to, it's one of the topics, one of
the things, one of the very purposes of this
show is to allow people to live. More in control
of their destiny, more in control of their resources,
of their life, of their medical choices. To be
able to prepare, to plan. To be aware, to know
these situations are possible would have saved
that family and that particular patient a lot
of shock at the moment. Absolutely. When they're
already not doing well, not feeling well, and
all of a sudden they realize. Now everything
I ever saved for, everything I paid into Medicare
isn't going to pay for what I have to have done
here. Correct. And I'll tell you, Medicare is
a whole other topic that we're going to talk
about at some other point. And we've run out
of time. We're going to have to push this off
until another show. But I wanted to ask specifically,
when people, a community center or a church has
a... a gathering and passes out the five wishes
and has everyone fill it out and then everyone
goes home all happy thinking, yeah, I've taken
care of all my paperwork. Is that really the
case? Not all the time. Not all the time. So
we're going to talk about that in an upcoming
episode. So stay with us. Is there anything you'd
like to follow up with here to top off this particular
show? Yes. So there are things out there called
long -term care policies. that can be bought
that will help offset the cost of care if a facility
is needed there's the added benefit here that
long -term care policies can also pay for care
in the home so it might help people remain in
the home longer and maybe avoid those facilities
and something to think about you know you could
need a long -term care policy uh well one of
the i've talked about this actually done lectures
on this before that When you can afford a long
-term care policy, you're generally young and
you're generally not thinking about it. By the
time you're old enough that it enters your mind
and you need a long -term care policy, you're
already too old for it to be affordable. And
they get very expensive, the older you get, because
you require more care. But the important point
that I've always made in those lectures, you
can need long -term care at any age. Absolutely.
I've known 20 -year -olds, unfortunately, involved
in bad accidents who are then made necessary
for long -term care their entire lives. Correct.
And long -term care may not necessarily mean
end of life. No, not at all. It just means a
situation where your care is going to be prolonged.
And it's going to take place where most recovery
is weeks, months. Long -term care means you're
looking at years. Or potentially could need services
and procedures and regular maintenance that family
members are neither trained nor sometimes even
willing to provide for you because it's way out
of their wheelhouse. So it's something that,
again, we're going to talk about in the future.
We've got a lot of great topics to tell you about.
And again, going into these situations with that
knowledge is what this show is all about. because
you can live a better quality of life and make
better decisions. So we've run out of time. We're
way over time. And I appreciate you being here.
Of course, it's all a highly personal choice.
No conversation that we have on the Light Keepers
podcast should ever take the place of your own
medical care team or other professional advisor
who should always be consulted by you. for your
specific situational needs. And it's always good
to be willing to talk about quality of life because
every single one of us will face some of these
issues some of the time. Either not prepared
at all... We're very well prepared indeed from
joining us here on the Light Keepers podcast
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