Care for Low Income Elders in Alaska

First, let me say that the State of Alaska has provided many opportunities for my mother as a lower income elder.  Overall, it has been done with relative ease.  So, I am not criticizing what is in place for elders. What is daunting is negotiating a clear path through the information, or lack thereof, to find what can be done for a loved one in need. 

Levels of Care in Assisting for Elders

As I mentioned in my previous post, the State of Alaska will only provide assistance to low income elders that meet a set of physical criteria.  One program, Medicaid, covers the cost of medical care and will provide PCA services.  The second program is the Medicaid Waiver Program and it covers the cost of medical care and either increased in-home and daily care services or assisted living support.  Before those programs are required, Adult Day Care can fill the need well.

Adult Day Care - FRA provides adult day care and pro-rates the cost of care based on the elder's income.  They care for elders in many stages of physical need.  When my mother first started attending, she was in complete control of her physical condition, but not her mental acuity.  The Day Care Center provided physical and mental stimulation in addition to ensuring her safety.  It provides an environment where they won't wander and won't harm themselves attempting to cook or do other things that used to be easy for them.

Medicaid - Based on the advice of my mother's care coordinator at the time, we applied only for Medicaid at the onset.  Her care coordinator was not sure she met all the criteria for Medicaid Waiver and once rejected by the program, you can not be assessed again for six months.  

After her assessment, Mom was accepted into the Medicaid program and was provided with a plan of care.  Her initial assessment provided Personal Care Attendant services for 20.5 hours per week.  That is roughly three hours for 3 days and then 5.5 hours over the weekend since the PCA care can not exceed 3 hours/day.  This worked for her simply because we used part of the funds we placed in trust to pay for her daily care at FRA.  In this way, we ensured she was not at home alone without stimulation or support.

Medicaid Waiver - In late August we went through a second assessment to qualify her for the Medicaid Waiver Program.  The income levels for this program are several hundred dollars higher and is based on the criteria I mentioned previously.  Mom qualified due to her physical limitations regarding her need for oxygen, administration of medications, and personal hygiene.  Financially, she qualified because her income is well below the criteria for this advanced stage of care. 

If the senior continues to live at home, this program will pay Medicaid as before plus

• hourly care, such as FRA 
• personal care attendant services
• respite care attendant services
• 14 days of daily respite where the elder can be housed temporarily in an assisted living home to provide relief for family.

If the senior exercises the option to receive care in an assisted living home, the state will pay for the 24/7 cost of care at the facility and the elder will pay all but $100 of their personal income for room and board.  That $100 is all that is allotted for personal needs.

What I Would Do Differently

If I had understood the criteria for admission into the Medicaid Waiver Program, I would have applied for that sooner.  At the time we qualified Mom for Medicaid, she was already exhibiting the conditions which ultimately qualified her for the Medicaid Waiver Program.  Had she been in that program earlier, she would have made the transition to an assisted living home while still able to adjust to the stage.  We have recently become concerned that it is too late for that step.  Yet her needs, physical condition, and mental frame of mind may be beyond the type of client that is best served at FRA.  She may be falling into a between state where her needs are not well met under any circumstance.