week 4 Nursing aging

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Chapter 7

Economic and Legal Issues

Social Security
Designed as a pay-as-you-go system
An age entitlement program
Age of eligibility has increased over time
Supplemental security income
Provides stipends to low income people who are aged 65 years or older, blind, or disabled
Social Security income is not adequate
Private investments
Pensions

Late Life Income

To be eligible for Medicare, one must be eligible for Social Security
Only covers select services and requires that they are medically necessary
Costs are covered by a employer and employee tax of 2.9% and by the beneficiary in the form of premiums, deductibles, and co-pays

Medicare

Offers acute care or short-term rehabilitative care
Free to those who receive Social Security
Provides insurance regardless of financial status
A person is automatically enrolled on the first of the month of his or her 65th birthday
Deductible and co-payments under Part A vary by setting and can be quite high

Medicare Part A

A person eligible for Part A must apply for Part B in the 6 months surrounding his or her 65th birthday or wait until the next open enrollment
Choose either (the “Original”) Medicare Part B or an alternative plan available in his or her area
Original is a traditional fee-for-service arrangement
Patient is responsible for a monthly premium (usually deducted directly from the monthly Social Security check), an annual deductible, and co-pays

Medicare Part B

Offers Medicare Advantage Plans similar to an HMO or PPO
Replaces both Medicare Part A and Medicare Part B
Co-pays and deductibles, if any, vary considerably, and extra premiums may be required for added services
Several new programs alternatives to Medicare Part C, such as Private Fee-For-Service Medical Savings Accounts

Medicare Part C

Person pays a monthly premium and in exchange all of the co-pays and deductibles not covered by the “primary insurance” (e.g., Medicare) are paid
Some are part of a person’s retirement benefit or available to members of organizations such as AARP

Supplemental Insurance

Program funded jointly by federal government and state government
State determines eligibility, types, and extent of services to be covered; sets the payment rates to providers; and administers its own programs
States pay about 40% of the costs with the federal government paying the rest
Provides care for those with low incomes
Covers more services than Medicare

Medicaid

Veterans Administration (VA) system is a model for the continuity of care in various care provider systems
Active duty and retired military members and their dependents are eligible
VA hospitals have restrictions; the problem has to be service related
Financial support, “Aid and Attendance Pension,” is provided

Care for Veterans

TRICARE health care program
Health care insurance program provided by the Department of Defense for eligible beneficiaries
Requires the person to enroll in both Medicare Part A and Part B and pay the premiums for Part B
As a Medigap policy, Tricare for Life covers expenses not covered by Medicare
Long-term care insurance

Other Veterans
Administration Services

Which part of Medicare helps cover some skilled nursing facility care, hospice care, and home health care under certain conditions?

Part A

Part B

Part C

Part D

Question

A—Medicare Part A covers acute hospital care, short-term acute rehabilitative care, and costs associated with hospice and home health care under certain circumstances.

Answer

Financial issues
Health care decisions
Consent to treatments
Capacity

Legal Issues in Gerontological Nursing

Ability to understand a problem, the risks and benefits of a decision, the alternative options, and the consequences of the decision
Range of tasks, from handling finances and daily business, to taking care of self and making medical decisions
Only the courts can declare the person “incapacitated

Capacity

Powers of attorney
Conservatorship
Guardianship

Advanced Care Planning

Legal document that gives a designated person the power to act on the behalf of a person
Two types of power of attorney (POA) documents
General POA

Usually has the right to make financial decisions, pay bills, and so on in defined circumstances but not necessarily to make decisions related to health care

Durable POA

Can make health-related decisions for persons when they are unable to do so themselves

Power of Attorney

Individuals, agencies, or corporations that have been appointed by the court to have care, custody, and control of a disabled person to manage his or her financial responsibilities
Guardian is a person appointed to be responsible for another person
Conservator is a person specifically appointed to control the finances of the person

Guardians and Conservators

Nursing roles include
Helping older patients deal with financial issues
Using their expert advocacy and negotiation skills
The nurse may be the first to notice the subtle changes indicating a potential change in capacity
Obligation to work with the applicable statutes of his or her state, province, or country

Implications for Gerontological Nursing and Healthy

Who can be the POA for an older adult?

Anyone

Attorney

Blood relative

Anyone except a blood relative

Question

A—Although it usually is a friend or family member, a person can designate any another person to act on his or her behalf.

Answer