You should seek professional help to properly assess your needs and help you choose among the myriad of long term care options - especially if you wish to age in place. The likely fact that you haven’t been through this process before, coupled with the typical urgency that normally accompanies long term care placement decisions, dictates that you get help.

Your local Area Agency on Aging, ombudsman, private geriatric case manager, and hospital discharge planner are excellent resources to assist you in sorting through your options.

Your local AAA is the place to start; they have the greatest resources and expertise. Your local ombudsman can help you choose the best nursing home for your needs. Private geriatric care managers can be used to supplement the services provided by your local AAA. Hospital discharge planners are a short-term last resort option when you are being discharged from a hospital and you have not done advance planning.

All but hospital discharge planners offer care management to help you coordinate home care and other needed services where multiple services and agencies are involved.

AREA AGENCY ON AGING

Your local Area Agency on Aging (AAA) is the best place to begin.

AAAs were established under the Older Americans Act of 1973. Area Agencies on Aging provide information and referrals to help you find the services you need. The services offered by the various AAA offices differ, but all are great sources of information. Each offers care management to assist you in coordinating home care (sometimes for a fee), most act as the waiver agent for the MI Choice program, and all can help you locate senior subsidized housing. AAA management services are usually free or low cost for those who qualify. Eligibility for AAA assistance is based on the amount of help and care you need, not your income. Even if you are ineligible for care management services, the AAA should be able to direct you to other services that can help meet your needs.

Area Agencies on Aging fund local organizations to deliver personal care and homemaker services to older adults in need. Services are generally offered on a part-time basis, typically a few hours each week. The services are usually free or offered at very reduced costs, although donations are accepted. Waiting lists for AAA services are common.

The Michigan Department of Community Health (MDCH) Office of Services to the Aging sponsors an excellent Web site: http://www.miseniors.net
For assistance with ADLs see the DHS Web site: http://www.michigan.gov/dhs.
Call the Elder Care Locater at 1-800-677-1116 for AAAs across the country.
Here is a  list of the AAA offices in Michigan by county.

MICHIGAN LONG TERM CARE OMBUDSMAN PROGRAM

The Michigan long term care ombudsman program, administered in most districts in Michigan by Citizens for Better Care, advocates for residents of long term care facilities. They address complaints made by or on behalf of residents and work to help to resolve them. The ombudsman program helps consumers shop for long term care services by advising them on how to find, select and pay for care that meets their needs. Ombudsmen regularly visit nursing home facilities, and as a result are a very good source of general information. Although they don’t rank nursing homes, they can tell you the number and nature of the complaints they have received about a particular nursing home, and will steer you away from the bad ones. Long term care ombudsman services are confidential and free. Ombudsmen advocate, educate, provide practical information and give referrals. They also regulate licensed adult foster care homes (AFC) and homes for the aged.
Here is a list of Ombudsman services in Michigan.

The Citizens for Better Care Web site, http://www.cbcmi.org provides valuable information about nursing homes and advocacy in Michigan. Citizens for Better Care also publishes The Michigan Long Term Care Companion, a 387 page book that covers all aspects of obtaining quality long term care in Michigan which you can order for $25.00 by calling (313) 832-6387.

PRIVATE GERIATRIC CARE MANAGER

Geriatric care managers typically charge an up-front initial assessment fee and work by the hour thereafter to assist you in arranging and monitoring short or long term care (called case management). Typically, the process starts with an on-site assessment and evaluation visit to your home. Geriatric care managers typically have the hands-on experience to help you locate qualified home care, assisted living and nursing home providers in your area. Michigan does not currently regulate or license geriatric care managers, so it is important to ask for their educational background and experience (you’re looking for nursing, social work, and gerontology backgrounds), and get references (especially of clients they have served). Your local AAA office or hospital discharge planner can give you a list of the geriatric care managers in your area.

The National Association of Professional Geriatric Care Managers, (520) 881-8008, Fax (520) 325-7925 website: http://www.caremanager.org can help you identify qualified professional geriatric care managers in your area. Also visit http://www.careguide.com

HOSPITAL DISCHARGE PLANNER
Discharge planners are hospital employees who arrange hospital aftercare. They facilitate the hospital discharge process by identifying basic patient needs and arranging appropriate in-home, rehabilitative, or nursing home care. The role of the discharge planner has become more important as patients are being discharged “sicker and quicker.” Patients are often too sick to go home, but for insurance reimbursement purposes must leave the hospital (but see the three-day MPRO appeal process below).

Hospital discharge planners work for the hospital, and basically do what is best for their employer. Their principal duty is to discharge you as soon as possible. If you have good insurance, they may recommend their own nursing facility, and if you don’t, or if you have limited resources, they may recommend the first available facility irrespective of the quality of care. Hospital discharge planners have a heavy case load, and rarely have the time to work with you to arrange home care or adult day care. Contact your local AAA or private geriatric care manager if you believe you are not getting the service you require.

The best advice is to plan ahead. Don’t wait until you experience an illness or injury to begin looking at your alternatives. Hospital discharge planners don’t have the time or the incentive to create a plan that gives you the greatest autonomy; their job is to get you out of the hospital. If you want to age in place, you must plan for your own future.

If you believe you are being discharged from the hospital prematurely, you may use your appeal rights under Medicare to stay an extra three days – without paying for it. To do so, you must appeal your discharge by contacting the Michigan Peer Review Organization (MPRO) (free of charge) at 22670 Haggerty Rd., Suite 100, Farmington Hills, Michigan 48335-2611 (800) 365-5899 or Website: http://www.mpro.org by noon of the first working day after you receive what is called the Hospital-Issued Notice of Non-coverage (HINN). The MPRO is required to make a decision on your appeal by the end of the next business day. Even if the MPRO agrees with the hospital, you will not be responsible for hospital charges until noon of the day after you receive the MPRO’s decision. Thus, even in the worst case scenario, you have given yourself three extra days of covered hospital care to more thoroughly and thoughtfully examine your long term care options.

MEDICARE MEDICAID ASSISTANCE PROGRAM (MMAP)

MMAP is a free counseling service for Medicare/Medicaid beneficiaries and caregivers. By calling 1-800-803-7174, you will be automatically linked with a MMAP (pronounced “map”) counselor in your area who can help you understand doctor and hospital bills, Medicare and Medicaid eligibility and coverage, claims and appeals, as well as help you enroll in Medicare savings programs. They will review Medicare supplemental insurance needs, identify resources for prescription drug assistance, explore long-term care financing options including long-term care insurance, and identify and report Medicare/Medicaid fraud and abuse.

OTHER HELPFUL RESOURCES

See http://www.michigan.gov/ltc for information on long term care in Michigan including programs administered by the Department of Health Services (DHS). The site allows you to search for nursing homes in Michigan by county, city, or ZIP code.

The Michigan Department of Community Health (MDCH) Office of Services to the Aging sponsors an excellent Web site: http://www.miseniors.net that supplies information about services administered by the aging network and the MDCH. Under Resource Directory, you can search for services or agencies dealing with every imaginable long term care need.

See http://www.medicare.gov the official U.S. website for Medicare. Select “Long Term Care.” The website lists nursing homes by city and zip code and provides general information about every Medicare and Medicaid certified nursing home in the country including nursing home inspection results, the number of nursing home staff, and resident information. Their Web site also provides access to several interactive databases, which offer detailed comparison information on nursing homes, Medicare health care plans, and Medigap policies by State or ZIP Code.

http://www.AlternativesForSeniors.com publishes a free booklet outlining the various senior housing and services in Southeast Michigan. The publication describes the services available at various home care, adult day care, senior apartments, retirement communities, assisted living, Alzheimer’s/Dementia, and nursing centers in Southeast Michigan. 1-800-350-0770

The American Association of Homes and Services for the Aging (AAHSA) offers a series of free “Consumer Tips” on finding home and community services, assisted living facilities, nursing homes, and continuing care retirement communities by State or ZIP Code. See http://ww.aahsa.org (Select “Consumers”).