What Are IADLs or the Instrumental Activities of Daily Living?

IADLs or the Instrument Activities of Daily Living are more complex than the Activities of Daily Living (ADLs) needed for basic unassisted living and go a long way in improving the quality of life in elders.

Definition of Instrumental Activities of Daily Living (IADLs)

The Instrumental Activities of Daily Living (IADLs or the Instrumental ADLs) are the activities performed by an individual on a day to day basis that are not essential to basic self-care and independent living, but add quality to the way of life. These activities are not indispensable to a person’s survival and fundamental functioning, but they do let someone live independently in society and function well as a self-reliant individual.

The repeated failure of a person in performing IADLs is usually a precursor to assisted living (at least in part) be it home care or the admission of the person to an assisted living and care facility.

Examples of IADLs

IADLs are more complex tasks of unassisted living and being able to do them can add to a person’s quality of life immeasurably. Simple examples of IADL include:

  • Being able to do housework and prepare your meals.
  • Taking your prescribed medicines and keep a track of your physician visits.
  • Managing your money – be it ATM withdrawals, writing checks and keeping a track of income and expenditure.
  • Doing your own shopping – be it groceries, clothing or anything else you need.
  • Using the telephone and computer as a means of communication – be it for calls or emails…
  • Managing transportation – be it driving, or hiring cabs or taking the public transport.
  • Managing your household in its entirety – including pet care if you have any pets.
  • Any and all extracurricular activities – be it maintaining a hobby or socializing with friends, family and peers.

A simpler way to refer to IADLs is by remembering the mnemonic SHAFT – Shopping, Housekeeping (or housework), Accounting (or managing money), Food preparation and Telephone/Transportation… A full list of IADLs is available here.

Are IADLs essential for living unassisted?

Think of it this way – while things like being able to bathe, walk, go to the bathroom, eat and take adequate rest are the activities “essential” for the survival of a person– IADLs are activities that are not necessary for survival but do aid a person in living life to the best. The very definition of Instrumental Activities of Daily Living is that these are the things help an individual flourish as a person in the community, and be completely self-reliant in his or her care and health.

For a person to fail in doing the IADLs does not necessarily translate into needing assisted living, rather – he or she may need some help to perform these tasks every now and then; so it’s time for friends, family and paid care to pitch in as and when needed. It can also be taken as an indication to get a full check-up done for that person, so that any and all medical needs can be taken care of.

What is the difference between ADLs and IADLs?

A frequently asked question is the difference between Activities of Daily Living vs. Instrumental Activities of Daily Living. ADLs are essential to unassisted survival. A mnemonic that can be used to typically define ADLs is DEATH: Dressing (the ability to wear clothes in an acceptable fashion), Eating (feeding self so as to be in perfect health), Ambulation (walking, sitting and then standing up, getting in and out of vehicles), Toilet (ability to use the facilities and & wipe/wash self without help) and Hygiene (bathing to maintain proper hygiene). If a person fails to perform one or more of these activities, then his or her ability to live independently and without care has diminished considerably. This person may need long-term assisted living immediately.

What do failing IADLs indicate?

The inability of an individual to perform IADLs can indicate declining health, be it physical or mental. Factors that can affect a person and render them unable to perform these everyday tasks can be many – from general old age and senility to mental fog brought on by medications and/or a failing brain, and of course an increasing downfall in chronic illness or disability. IADLs need to be taken as a frontier; if a person is repeatedly failing to do them, it’s an indication to get help. Here’s an IADL test scale to check scores in case you have concerns about a friend or family.

How to handle someone with IADL dependence?

Frankly, it’s difficult to walk up to someone – be it your own parents – and tell them that they haven’t been managing their lives properly be it financially, socially or even personally. They may view it as an unwelcome intrusion into their way of living or their independence. When it comes to senior care, it’s difficult for the parent to accept this role reversal – for the children to become the caregivers and the parents to become the dependents.

To handle IADL dependency, reach out for professional help in the form of doctors and psychiatrists. What seniors may feel uncomfortable or even embarrassed about discussing with the children, they can freely talk about with their medical caregivers and between the trio – the individual needing help, the family and the medical professional – a solution can be worked out to the best benefit of the person in question.

 

What is a Medicaid Waiver? Your Guide to Medicaid Home and Community Based Services

What is a Medicaid waiver, anyway? Let us help you discover what you need to know about Medicaid waivers and how to access home and community based services.

A Definition of Medicaid Waivers

A Medicaid waiver is a provision in Medicaid law which allows the federal government to waive rules that usually apply to the Medicaid program. The intention is to allow individual states to accomplish certain goals, such as reducing costs, expanding coverage or improving care for certain target groups.

Thanks to these waivers, states can provide services to their residents that wouldn’t usually be covered by Medicaid. For instance, in-home care for people who would otherwise have to go into long-term institutional care.

What Are the Different Types of Medicaid Waiver?

There are three types of Medicaid waiver, all of which have different purposes.

  • HCBS waiver: Also known as a Section 1915(c) waiver, this kind of waiver is designed to allow states to provide home and community based services (HCBS) to people in need of long-term care. This means they can stay in their own home or a community setting (such as a relative’s home or a supported living community) instead of going into a nursing facility.
  • Freedom of choice waiver: A Section 1915(b), or “freedom of choice,” waiver lets states provide care via managed care delivery systems, thus limiting the individual’s ability to choose their own providers.
  • Research and demonstration waiver: Otherwise referred to as a Section 1115 waiver, this lets states test out new approaches to delivering Medicaid care and financing.

We’re going to be focusing on HCBS waivers and how they can help people get better and more appropriate long-term care.

What Care is Provided Under an HCBS Waiver Program?

As outlined above, the purpose of an HCBS waiver is to let states provide care to certain individuals in the community, rather than putting them into institutional care.

Those who are accepted into their state’s HCBS waiver program will receive a range of medical and non-medical care, which can vary depending on the individual’s needs and situation, as well as state guidelines. This may include:

  • Personal care services and supervision, at home or in an assisted living facility
  • A home health aide
  • Nursing
  • Chore and homemaking services, such as shopping, laundry and cleaning
  • Hot meal delivery services
  • Respite care to relieve a primary caregiver
  • Home and/or vehicle modifications, such as ramps and safety rails, to increase independence
  • Access to senior centers or adult group day care
  • Transport to and from non-emergency medical appointments

Who is Eligible for an HCBS Waiver Program?

The good news is that all states have some type of HCBS waiver program but, unfortunately, not everybody is eligible.

Each state has its own programs, but most states offer HCBS waivers to elderly people (aged 65 or over), physically disabled people, adults and children with developmental disabilities, medically fragile people (who require life support or other extensive medical equipment) and adults with traumatic brain injuries.

Even so, not everybody within these groups is automatically eligible for Medicaid waiver programs; they must also require a certain level of care. Usually the individual needs to meet medical criteria that would require them to be in nursing home or other institution if they didn’t receive in-home or community care.

Plus, there are financial criteria to meet. While states don’t have to require the individual to be in regular receipt of Medicaid, many do. And in those states that don’t, there are still caps on how much someone can be earning and have in savings/financial assets to qualify for an HCBS program.

Benefits of Medicaid Waivers

For those who are a part of an HBCS program, the main benefit is they get to stay in their own home or community, instead of being sent to a care institution.

According to the American Association of Retired Persons, almost 90 percent of over 65s say they want to stay in their own homes for as long as possible as they age, so this is clearly something that’s important to the majority.

The federal government isn’t complaining, either, because the cost of care in the home or an assisted living facility is cheaper than a nursing home place – often by up to 50 percent.

Problems Associated with Medicaid Waivers

Medicaid waivers aren’t considered an entitlement. Whereas someone in need of nursing home care would be automatically entitled to a place in an institution, the HCBS waiver program is deemed a privilege rather than a right. As such, most people spend several years on a waiting list before they receive care.

While a lot of help is available, some responsibility often falls to family members when an individual receives care in their own home. So, if the individual has no willing or able family, there may be some shortfalls in their care.

There can also be a lack of appropriately trained and qualified caregivers available, especially in rural areas.

How Do You Apply for a Medicaid Waiver Program?

First thing’s first: if you want to apply for a Medicaid HCBS waiver program, you need to contact your state’s Medicaid agency.

You’ll then be given information on how to submit an official application – a process which differs from state to state.

Skilled Nursing Facilities Definition

Skilled nursing facilities are establishments for the elderly or disabled who needs tender loving care. They provide a home for the elderly when they need around the clock care by skilled nurses. The skilled nursing facilities also provide therapy and rehabilitation for the disabled. This helps the elderly and disabled live more comfortable lives. Skilled nursing facilities provide twenty-four hour, seven days a week expert care for those in need of constant care. This type of facility is for those who need short or long term care. These facilities offer help for a loved one when they have a temporary or permanent health issue, and they are not able to get the kind of care they need at home. A skilled nursing facility is good for the very sick, or for those who need to recover from a serious accident or surgery. They may need specialized therapy that they could get in this type of facility. The skilled nursing facilities will give them medical treatment that their doctor prescribes, as well as help them with their physical needs like taking a bath, eating, and even walking. This facility is a home away from home, where you get expert nursing care.

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Skilled Care Definition

Skilled care is a type of intermediate care in which the patient or resident needs more assistance than usual, generally from licensed nursing personnel and certified nursing assistants. This care is not the same as long-term care in which a resident may not need the services of a licensed nurse on a daily basis. The resident/patient does need longer-term care than what the acute care hospital services can provide. Reasons may include long-term IV therapy, IV line access and care, chemotherapy, physical therapy, long-term wound care rehabilitation, respiratory treatments, nutritional therapy with feeding tubes, and continuous positive motion machines to exercise limbs in which prosthetic joints have been inserted. According to Medicare, there are a certain number of allowable “skilled care” days in each billing year that are covered. Skilled care can be offered in a wide variety of facilities, such as a “skilled” unit in an acute care hospital, a LTAC (Long-Term Acute Care) rehab unit or hospital, and sometimes at the patient’s own home provided for by Home Health nursing staff. The term refers to the level of care a patient needs and not the facility in which it is provided, acute care being the highest level, skilled care at the intermediate level and chronic care or long-term care being the lowest level of care.

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Progressive Neurological Condition Definition

Progressive neurological disorders are conditions that get worse as time goes on. These types of illnesses usually impact the person for their entire life. Types of diseases include Parkinson’s disease, multiply sclerosis, and motor neuron disease. In geriatrics the most common form of a progressive disease is Alzheimer’s. The main culprits for degenerating disease can be defective brain cells. The conditions can sometimes be genetic. The use of illegal substances and alcohol can also damage brain cells, as well as toxic or chemical environments. Once brain cells have been damaged they cannot be repaired.

When the need for assisted living is necessary there are many facilities well trained in providing care for those suffering from progressive neurological disorders. Since damaged brain cells are permanent an experienced facility will concentrate on creating a comfortable environment for the patient. Treating the patients conditions are done best by helping to relieve and reduce the severity of symptoms.

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Palliative Care Definition

Palliative care is a special type of care offered to patients who are at the end of their lives. The most common type of palliative care is Hospice. Hospice care takes place in a person’s home rather than in the hospital.

Hospice does not focus on treating the medical problem an individual suffers from. Instead, palliative care is given. This means that the hospice nurse is there to lend support to the patient and family and to manage the pain and other symptoms that are affecting the patient. The goal of the hospice nurse is to make the patient as comfortable as possible during their last days of life. There are many other professions involved with hospice to provide patients with the best care and concern at the end of their lives.

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Program of All Inclusive Care for the Elderly (PACE) Definition

Program of All Inclusive Care for the Elderly or PACE is a therapeutic program which offers individual support to people enrolled with the idea of enabling them to live independently in their communities. The requirements for PACE are simple, a person of ages fifty-five or older, is located within an area supported by the program, meet the state’s nursing facility level care after a screening and be able to live safely in a community. The service offers transportation to the care center three times a week where individuals meet with doctors, nurses and other health care professionals to help with their needs.

If medication is suggested by a health care professional the cost is covered under the PACE program. Payment for the program is monthly per person and remains the same price throughout the entirety of the contract year. As well as monthly payment, a premium may be required, which is dependent on qualification for Medicaid and Medicare.

The overall goal of the program is to enable elderly individuals to remain living within their community for the longest time possible without being brought into assisted living homes. The program is open ended and those enrolled in it may leave at any time and resume their prior Medicaid or Medicare program.

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Medicare Supplemental Insurance Definition

Medicare supplemental insurance is a government-funded insurance program designed for people 65 years and older or for people who are disabled. Also called medigap there are five parts to this insurance: basic, part A, part B, part C and part D. Basic Medicare insurance covers the basics, so there are some things the insurance will not cover. It will not cover any kind of in-home, assisting or nursing home care nor will it cover certain illnesses. It will cover some prescription medication but it will not cover all of it. Part A covers hospital care. It pays for a semi-private room, food, tests and doctors’ fees too. This may or may not cost anything. To get the other three will cost extra. They require paying for deductibles, enrollment fees every month and co-insurance payments. Plan B covers outpatient care. It covers doctors and therapy including purchasing canes, walkers, scooters, wheelchairs, and limbs. Plan C covers HMO, PPO and other organization related to it. Plan D covers prescription drugs. Depending on the insurance plan picking any one of these four will have the person covered pay the deductible and Medicare paying the rest OR Medicare will pay for all of it.

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Medicare Savings Program Definition

A Medicare savings program is a special program offered through Medicaid to help pay for a patient’s Medicare premiums. These programs are typically based on income levels and help to cover both medical costs and prescription drugs. Medicare savings programs will typically cover part B Medicare premiums and also helps with other out-of-pocket expenses. There are four types of Medicare savings programs that one might qualify for. These are Qualified Medicare Beneficiary or QMB, Specified Low-Income Medicare Beneficiary, or SLMB, Qualified Individual, or QI and Qualified Disabled and Working Individual, or QDWI. In order to qualify for any of these Medicare savings programs, the patient must meet certain income and asset requirements. These requirements will determine which of the four types of programs the patient will be eligible for.

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Medicaid Spend Down Definition

Medicaid spend down is a type of deductible. When you receive Medicaid coverage, your income and other assets will be evaluated to determine the amount of coverage you will be qualified for. In some cases, you will be assigned a spend down amount. This means simply that you will need to pay this amount of money out of pocket before you will have Medicaid coverage for your prescriptions and other medical care. This is not a yearly amount that must be met, but a monthly payment. Many people think in terms of the typical insurance coverage that carries a yearly family deductible or personal deductible that, once met, does not need to be reached again until the following year. However, with Medicaid, the spend down amount, or deductible amount, must be met every month before the coverage is available.

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