Markenzie Jean-baptiste

4/25/2020

Part 1

In NYC, what options are available in each of these categories:

• Subsidized senior housing
• Assisted Living
• Skilled Nursing Facility

What are the criteria (physical/mental/financial) to get into these and find at least one or two specific ones in Manhattan for our patient.

Subsidized senior housing:

Low- income senior housing is available through 4 programs that are subsidized by the U.S. Department of Housing and Urban Development (HUD) and the federal government.

• Low-Income Housing Tax Credit properties:This is a program in which developers and investors get tax credits for renting low-or-fixed income rental housing. Many of these properties are operated as senior apartments or 55+ or 62+ communities.

• Section 202 Supportive Housing for the Elderly: Section 202 housing serves very low- income senior citizens. This includes the frail elderly who need help with IADL’s like cooking, cleaning, and transportation. This housing can be in the form of senior citizen homes or rent subsidized housing for residents.

• Public Housing: These are apartment complexes or high-rises operated by city or county public housing agencies for tenants that must be low income. The tenants pay about 30 percent of their income for rent and utilities. 31% of public housing tenants are elderly.
• Housing Choice Voucher Program (Section 8): This is a voucher program that helps low- income, elderly and disabled pay rent in privately owned market rate apartments. Tenants pay 30 % of monthly income for rent and utilities and the rest is paid with a voucher that makes up most of the difference in rent.

Requirements:

• Must be a senior citizen
• Qualify as elderly, disable or as a family
• May be disabled
• Must have a low annual income and minimal ownership of items of value- income is less than 80 to 50 percent of the median income in your county or city

Source:

1) https://www.assisted-living-directory.com/content/low-income-senior-housing/

2) https://www.after55.com/blog/how-find-low-income-senior-housing/

3) https://www.hud.gov/topics/rental_assistance/phprog

Assisted Living

NYC offers assisted living in the form of Adult Care Facilities (ACF) and Assisted Living Residences.

• Adult Care Facilities provide long-term, non-medical residential services to adults who are unable to live on their own due to physical, mental, or other limitations associated with age or other factors.

There are three types of Adult Care Facilities:

• Adult Homes (AH): provide long-term residential care, room, board, housekeeping, personal care, and supervision to five or more adults unrelated to the operator.
• Enriched Housing Programs (EHP): provide long-term residential care to five or more adults primarily persons sixty-five years of age or older, in community-integrated settings resembling independent housing units. The program provides or arranges for the provision of room, board, housekeeping, personal care, and supervision. No more than 25 percent of residents may be under 65 and all must be 55 or older.
• Residences for Adults: provide long-term residential care, room, board, housekeeping, case management, activities and supervision to five or more adults, unrelated to the operator, who are unable or substantially unable to live independently.

Requirements: In order to be eligible, residents must not require continual medical or nursing services provided in acute care hospitals, in-patient psychiatric facilities, skilled nursing homes, or other health related facilities. Adult Care Facilities are not licensed to provide for nursing or medical care. 

Adult Homes or Enriched Housing Program may offer services through an Assisted living Program:

• Assisted Living Program (ALP): provide services to elderly who are medically eligible for nursing home placement but in a less medically intensive, lower cost setting. The program provides personal care, room, board, housekeeping, supervision, home health aides, personal emergency response services, nursing, physical therapy, occupational therapy, speech therapy, medical supplies and equipment, adult day health care, home health services, and the case management services of a registered professional nurse.

Requirements:

NYC assisted living program has eligibility criteria related to the candidate’s age, functional ability, and financial situation.

Age – Applicants must be at least 21 years of age. There is no maximum age limitation.

Functional Ability – Applicants must be medically eligible for nursing home care but their functional ability cannot be so limiting that they require nursing home care around the clock. Must have a degree of self-mobility that will enable them to function in an assisted living environment.

Financial Requirements – Not a requirement but majority of participants receive Medicaid assistance. Monthly income for an individual applying for the ALP is limited to $1,477, and for a couple, with both spouses as applicants, is limited to $2,954. The value of the applicant’s non-exempt assets cannot exceed $15,750 for a single applicant and $23,100 for couples if both spouses are applying for benefits.

Source:

https://health.ny.gov/facilities/adult_care/intro.htm

https://aspe.hhs.gov/system/files/pdf/110561/15alcom-NY.pdf

https://www.payingforseniorcare.com/new-york/medicaid-waivers/assisted-living#Eligibility-Guidelines

Skilled Nursing Facility

• Nursing Homes focus on medical care on a higher level than assisted living facilities. The service includes nursing care, 24 hour supervision, three meals daily as a standard and assistance with activities of daily living. They also offer rehab services like physical, optional and speech therapy. People who are sixty-five (65) or older, disabled, or blind, can qualify for Medicaid that will cover a nursing home stay if they meet income and asset limits and if they need skilled nursing care.
• Skilled nursing facilities provide elderly patients who qualify, consistent presence of nurses or physicians and offer rehabilitation services such as occupational, physical and speech therapy. The care is customized to each patient. These patients typically require a lot of assistance, are often bed bound and may need the assistance of two individuals to move them. It is paid by Medicare for rehab services which are common upon discharge from a hospital for a patient in a recovery phase. SNF does not include long term care for stable or deteriorating patients.

Requirement:

A medical assessment must be performed by a registered nurse who has been certified to conduct the assessment in order to be admitted. The assessment is a two-step process and is specifically designed by NYS DOH to evaluate functional status and appropriateness for a nursing home. The assessment is valid for 30 days for individuals who are hospitalized and 90 days for individuals who are in any other setting, including their home.

 

Source: https://www.nia.nih.gov/health/residential-facilities-assisted-living-and-nursing-homes

https://www.nychealthandhospitals.org/services/long-term-care/

https://health.usnews.com/wellness/aging-well/articles/2018-10-30/whats-the-difference-between-types-of-long-term-care-facilities

https://agingwithfreedom.com/2015/06/09/skilled-nursing-facility/

Specific one in Manhattan for our patient

I was able to find a skilled nursing facility called Gouverneur Health. It is affiliated with the New York University School of Medicine and located at 227 Madison Street in Lower Manhattan. The facility offers comprehensive healthcare services, including outpatient, specialty, and skilled nursing care. I think this is a great one for our patient as she cannot fully manage her physical and mental conditions independently yet while she recovers. She will have access to many health care services on site to help her. I also like the amenities and therapeutic activities that are offered like restaurants, religion services, telephones at bed side and more.

Source:

https://www.nychealthandhospitals.org/gouverneur/services/long-term-skilled-nursing-care/

Part 2:

If she lived in an elevator building instead of a walk up, it’s possible that she could go home with a home health aide (depending on how much function she recovers).  What’s involved in setting up this service and who pays for it?  

After reviewing our patient’s history, assessment and plan, if she was able to recover more (has improved mobility and pain, corrected vision, improved mental status), it would be possible for her to go home with a home health aide.

To qualify for home health care:

• Our patient would need to be considered homebound based on the Centers for Medicare & Medicaid (CMS) criteria,
• Require skilled nursing care on a part-time or intermittent basis but NOT fulltime.
• She would need to be under the care of her doctor, who completes and documents an in-person visit with her either: three months before the start of home health care, or within one month after the home healthcare benefit has begun.
• She would need to receive home healthcare from a Medicare-approved home health agency. The home health care agency would coordinate the services ordered by her doctor.
• Medicare Part A(Hospital Insurance) and/or Medicare Part B(Medical Insurance) pays for it.

 

Source:

https://www.medicare.gov/coverage/home-health-services#1334