Frail older adults can stay at home with LIFE program's help

Articles, Care Management Services, Elder Law

Frail older adults can stay at home with LIFE program’s help

August 8, 2014
Marshall Parker & Weber

Numerous studies reflect that a large majority of older adults want to continue to live at home for as long as possible.

But “aging in place” can become difficult if we begin to suffer functional and cognitive losses and are no longer able to live fully independently. The burdens placed on our family caregivers can become overwhelming.

In recent years, the expansion of community-based and home care support services has allowed many seniors who would have otherwise been required to move to a nursing home to remain at home. This article is intended to alert readers to the existing of one such program that has benefited a number of my clients and their families. It is a program that I think is underappreciated.

The LIFE program provides health-care and supportive services for older persons who are certified to need a nursing home level of care but are able to live safely at home with the program’s support. If you have limited financial resources and your income is within 300 percent of the Federal Benefit Rate ($2,163 in 2014) your participation in the LIFE program may be fully covered by a combination of Medicaid and Medicare. (And private payment may be an option for those who do not qualify for those programs).

On a national level, this wonderful but underutilized program is referred to as PACE (Program of All-inclusive Care for the Elderly). The name was changed in Pennsylvania to avoid confusion with our state pharmaceutical assistance program. The Pennsylvania program is generally referred to as LIFE (Living Independently For Elders).

The LIFE program brings together all the medical and social services needed to provide community-based care for seniors who are frail enough to meet the Medicaid standards for nursing-home care. The program is designed to meet all of its participants health related needs. You are generally provided with transportation to and from your home to an adult day health center where you can participate in activities and medical appointments. However, services may also be given in your home, a hospital, or a long term care facility where necessary.

Because the LIFE interdisciplinary health care team authorizes and coordinates all your health care services, the program becomes a one-stop alternative that simplifies your access to health care. And increased coordination of your care can result in improved quality of that care.

The Balanced Budget Act of 1997 established the PACE model as a permanent provider type under both the Medicare and Medicaid programs. Most LIFE participants are eligible to receive services under both Medicare and Medicaid. The joint funding sources may be sufficient to provide total care for dually eligible beneficiaries.

Like another home care alternative – the Aging Waiver Program, LIFE serves individuals who are 60 years of age or older, who would otherwise qualify clinically to be in a nursing facility, but who choose instead to remain in their homes with the support of LIFE program services. (The age threshold for LIFE can be reduced to age 55 depending on the program). Clinical eligibility for participation in LIFE programs is determined through an assessment done by the local Area Agency on Aging, in cooperation with the individual’s personal physician.

To qualify for Medicaid payment for LIFE services, the individual’s available income and available resources must be at or below 300% of the federal benefit rate. The available resource ceiling is $8,000. Limited “spend down” is available since the LIFE program rules do allow individuals with income in excess of the ceiling to qualify for partial Medicaid funding by paying a monthly share of the cost of LIFE services, with Medicaid paying the monthly remainder. If an individual wishes to pay privately for participation in the LIFE program, his/her monthly premium is equal to that amount that would otherwise be paid by Medicaid.

Enrollment is voluntary. Once enrolled, PACE becomes the sole source of all Medicare and Medicaid covered services, as well as other medical, social, or rehabilitation services required by the enrollee. If an enrollee requires placement in a nursing home, the LIFE provider is responsible for the cost of care. An enrollee’s needs are determined by PACE’s team of care providers, which includes primary care physicians, nurses, therapists, social workers, personal care attendants, dieticans, and drivers.

With capitation plans like PACE, providers receive a flat monthly fee in return for covering the entire spectrum of care for enrollees from acute to long-term. The payment does not vary no matter how many services are provided. This provides a strong incentive for the LIFE program to keep its participants healthy.

Pennsylvania has one the most vigorous PACE programs in the country. People can thrive under the program. But many seniors are unaware of or don’t understand the value of the LIFE alternative. And, depending on where you live, it may not be an option for you. As of July 2014, LIFE is available in many but not all geographic areas of Pennsylvania. A list of areas and providers is available on the PA Department of Public Welfare website: https://tinyurl.com/mgs33q8. For your ease of reference I’ve reproduced the list below.

National information about PACE and a list of programs in each state is available on the Pace4You website at https://tinyurl.com/nlxxlgp.

Here is a list of the 23 LIFE programs currently operating in Pennsylvania:

Albright LIFE Williamsport

901 Memorial Avenue

Williamsport, PA 17701

Ph: 570-322-5433

If you are currently in crisis, click here to request expedited assistance.

If you are currently in crisis, click here to request expedited assistance.

If you are currently in crisis, click here to request expedited assistance.

Frail older adults can stay at home with LIFE program’s help

Share this Article:

Contact us for an Initial Consultation.

Call (800) 401-4552 or

Williamsport, PA

Jersey Shore, PA

Plains, PA

Connect with Marshall, Parker & Weber

Copyright © 2015 - 2023 Marshall, Parker & Weber LLC

Legal

Copyright © 2015 - 2023 Marshall, Parker & Weber LLC | Legal