senior
care
resource
center
Are you a
senior or
family
member
searching
for Home or facility senior care
options in Volusia County Florida?
This page is intended to help with Deltona, Orange City, Deland, Debary,
Daytona, New Smyrna, Port Orange Ormond and other county cities for senior
assistance programs.
What do
you need
to know? ElderAssistance
of
America
was born
from
experiencing
the
challenges
personally
and
hopefully
our
lessons
can help
you. Use these geriatric care resources below to help you in
understanding the different option you might have to help your loved one.
We do try to keep our information up to date but things do change
sometimes. Our recommendation is that this be a start for you but to
always obtain the information directly from the agency in question.
Please call us if you have any questions and we will be glad to help any
way we can.
-
Assisted
Living
Facilities:
Provides
housing,
meals
and
some
personal
services
for
residents.
Residents
have to
meet
certain
functional
criteria
and
must be
ambulatory
and
able to
perform
daily
living
activities
like
eating
and
able to
care
for
basic
bodily
functions.
Bed
ridden
residents
are not
accepted.
Medicaid
will
pay for
such a
facility
if both
the
resident
and
facility
are
eligible.
-
Adult
Day
Care:
These
are
less
than 24
hour
care
facilities.
They
offer
therapeutic
programs
impaired
adults.
These
centers
offer
many
activities
such as
exercise,
education,
health
screening
and
behavior
modification.
These
centers
also
serve
as a
reprieve
to the
primary
caregivers.
These
programs
may be
covered
by
Medicaid.
-
Adult
Family
-
Care
Homes:
These
family-type
living
arrangements
provide
a
private
home
for up
to 5
aged or
disabled
people
(not
related).
The
owner
lives
with
the
residents.
The
residents
must
not be
bed
ridden
and are
subject
to
other
criteria
as
described
in
Florida
law.
Adult
family
care
homes
are for
residents
that do
not
require
more
care
than
can be
provided
by the
owners.
In some
cases
Medicaid
will
pay if
both
the
resident
and the
AFCH
are
eligible
-
Home
Care:
Private
Duty
Home
Care
companies
are
governed
by the
State
of
Florida
and
offer
services
for
seniors
in the
home
setting.
The
types
of
services
depend
on the
licensure
of the
company.
There
are
three
different
types
of
licensed
agencies;
Homemaker
companion
which
can
provide
all
services
accept
for
hands
on care
(usually
a
necessity
for bed
bound
patients),
Nurse
registries
and
Home
Care
Agencies
can
provide
all
services
plus
hands
on care
with
the
appropriate
caregivers
but
usually
cost a
little
bit
more
per
hour.
Private
home
care is
usually
not
covered
by
Medicaid
or
Insurance
unless
the
patient
has
long
term
care
insurance
or is
part of
the
nursing
home
diversion
program
under
DCF and
Medicaid.
-
Hospice:
Hospice
is a
program
that
coordinates
professional
services
including
nutritional
counseling,
pastoral
services,
social
work,
and
many
other
services
for the
terminally
ill.
These
services
can be
provided
at the
hospital,
hospice
facility
or the
patient's
residence.
Medicare
or
Medicaid
will
pay for
these
services
if the
patient
is
eligible.
For
more
long
term
care
information
contact
AHCA
(888)
419-3456
or visit
their
website
http://www.floridahealthstat.com/
or visit
these
additional
links:
top of
page
Senior
Care
costs are
all over
the
board.
It just
depends
on what
level of
care you
or you
loved one
needs.
Most
seniors
choose
want to
keep
their
independence
and stay
at home.
Others
choose to
go to
assisted
living
and some
seniors
will
require
the care
of a full
time
nurse
generally
associated
with a
nursing
home.
Home Care
services
usually
range
from
$14/hr to
$20/hr
for CNA's
or HHA's
which are
the
primary
home care
clinicians.
Assisted
Living
usually
ranges
from
$1500/month
to well
over
$5000/month
depending
on care
and the
quality
of the
facility.
From our
experience
here in
Florida
we seem
to see
most
often an
average
cost of
about
$2500 per
month for
assisted
living in
Florida.
Please
call your
local
facilities
to
determine
exact
costs.
top of
page
Medicare
will pay
for short
term
assistance
in the
home if
the
beneficerary
is
considered
to be
"homebound"
see
"how to
qualify
for
Medicare
Home
Care".
There are
also
options
for
government
assisted
private
home care
and
assisted
living
under the
Medicaid
waiver
Nursing
Home
Diversion
Program,
however
you must
qualify
for
Medicaid
so
generally
speaking,
beneficeraries
who
cannot
qualify
for
Medicaid
must seek
out an
assisted
living
facility
or
private
home care
company
such as
EderAssistance
of
America
for
private
pay care
until
they
would
qualify
for
Medicaid.
In
addition,
there are
limitations
to the
available
companies
under the
medicaid
programs.
Not all
company's
accept
the
Medicaid
waiver
programs.
The
patient
and their
family
will
usually
only have
very few
options
for care
relative
to the
amount of
facilities
and home
care
agencies
available.
top of
page
under
construction
top of
page
Information
derived
from dcf
and does
not
guarantee
coverage
Medicaid
for
Aged
or
Disabled |
The
State of
Florida
has
several
programs
designed
to
provide
Medicaid
to low
income
individuals
who are
either
aged (65
or older)
or
disabled.
This is
referred
to as SSI-Related
Medicaid.
Florida
residents
who are
eligible
for
Supplemental
Security
Income
from the
Social
Security
Administration
are
automatically
eligible
for basic
Medicaid
coverage.
There is
no need
to file a
separate
ACCESS
Florida
application
unless
nursing
home
services
are
needed.
Individuals
may apply
for full
Medicaid
coverage
and other
services
using the
online
ACCESS
Florida
Application
and
submitting
it
electronically.
If long
term care
services
in a
nursing
home or
community
setting
are
needed,
the
individual
must
check the
box for
HCBS/Waivers
or
Nursing
Home on
the
Benefit
Information
screen.
HCBS/Waiver
programs
provide
in-home
or
assisted
living
services
that help
prevent
institutionalization.
Medicare
Savings
Programs
(Medicare
Buy-In)
were
created
to help
Medicare
beneficiaries
with
limited
finances
pay their
Medicare
premiums,
and in
some
instances,
deductibles
and
co-payments.
Medicare
Buy-In
provides
different
levels of
savings
depending
on the
amount of
an
individual
or
couple’s
income.
Individuals
may apply
exclusively
for
Medicare
Buy-In by
completing
a
Medicaid/Medicare
Buy-In
Application.
The
completed
form must
be
printed
and
mailed or
faxed to
a local
Customer
Service
Center.
Individuals
eligible
for full
Medicaid
or a
Medicare
Savings
Program
are
automatically
enrolled
in Social
Security’s
Extra
Help with
Part D
(Low
Income
Subsidy)
benefit
for the
remainder
of the
year. An
individual
may also
apply
directly
with
Social
Security
for the
Medicare
Extra
Help
Program.
More
information
about
Medicaid
programs
for aged
or
disabled
individuals
is
available
in the
SSI-Related
Fact
Sheets.
Income
and asset
limits
for
Medicaid
for aged
or
disabled
individuals
may be
found on
the
SSI-Related
Programs
Financial
Eligibility
Standards.
Important
information
for
individuals
seeking
Medicaid
to cover
long term
care
services
in a
nursing
home or
community
setting
is
available
in the
Qualified
Income
Trust
Fact
Sheet.
Prescription
Help
for
Those
Who
Are
Not
Eligible
for
Full
Medicaid |
Individuals
who are
not
eligible
for full
Medicaid
may
receive
help with
the cost
of
prescription
drugs
through
the
Florida
Discount
Drug Card
Program.
Individuals
that are
not
eligible
for
Medicaid
because
their
income or
assets
exceed
the
Medicaid
program
limits
may
qualify
for the
Medically
Needy
program.
Individuals
enrolled
in
Medically
Needy
must
incur a
certain
amount of
medical
bills
each
month
before
Medicaid
can be
approved.
This is
referred
to as a
"share of
cost" and
it varies
depending
on the
household's
size and
income.
Once an
individual
incurs
enough
medical
bills to
meet the
share of
cost for
the
month,
the
individual
should
contact
DCF to
complete
bill
tracking
and
approve
Medicaid
for the
remainder
of the
month.
Information
about
this
program
can be
found in
the
Medically
Needy
Brochure.
For
information
about
other
ACCESS
Florida
programs,
visit
Temporary
Cash
Assistance
and
Food
Stamps.
top of
page
under
construction
top of
page
under
construction
top of
page
Medicare
information.
Medicare
Coverage
Who
qualifies
for
Medicare
benefits?
-
Individuals
65
years
of age
or
older
-
Individuals
under
65 with
permanent
kidney
failure
(beginning
three
months
after
dialysis
begins),
or
-
Individuals
under
65,
permanently
disabled
and
entitled
to
Social
Security
benefits
(beginning
24
months
after
the
start
of
disability
benefits)
The
Different
Benefits
of
Traditional
Medicare
-
Medicare
Part A
benefits
cover
hospital
stays,
home
health
care
and
hospice
services
-
Medicare
Part B
benefits
cover
physician
visits,
laboratory
tests,
ambulance
services
and
home
medical
equipment
-
While
oftentimes
you do
not
have to
pay a
monthly
fee to
have
Part A
benefits,
the
Part B
program
requires
a
monthly
premium
to stay
enrolled.
In 2007
that
premium
will
range
between
$93.50-161.40
per
month
depending
on your
income.
Typically,
this
amount
will be
taken
from
your
Social
Security
check.
What Can
You
Expect to
Pay?
-
Every
year,
in
addition
to your
monthly
premium,
you
will
have to
pay the
first
$131 of
covered
expenses
out of
pocket
and
then 20
percent
of all
approved
charges
if the
provider
agrees
to
accept
Medicare
payments.
-
Unfortunately,
your
medical
equipment
provider
cannot
automatically
waive
this 20
percent
or your
deductible
without
suffering
penalties
from
Medicare.
They
must
attempt
to
collect
the
coinsurance
and
deductible
if they
are not
covered
by
another
insurance
plan;
however,
certain
exceptions
can be
made if
you
suffer
from
qualifying
financial
hardships.
- If
you
have a
supplemental
insurance
policy,
that
plan
may
pick up
this
portion
of your
responsibility
after
your
supplemental
plan’s
deductible
has
been
satisfied.
- If
your
medical
equipment
provider
does
not
accept
assignment
with
Medicare
you may
be
asked
to pay
the
full
price
up
front,
but
they
will
file a
claim
on your
behalf
to
Medicare.
In
turn,
Medicare
will
process
the
claim
and
mail
you a
check
to
cover a
portion
of your
expenses
if the
charges
are
approved.
Other
possible
costs:
-
Medicare
will
pay
only
for
items
that
meet
your
basic
needs
as
prescribed
by a
physician.
Oftentimes
you
will
find
that
your
provider
offers
a wide
selection
of
products
that
vary
slightly
in
appearance
or
features.
You may
decide
that
you
prefer
the
products
that
offer
these
additional
features.
Your
provider
should
give
you the
option
to pay
a
little
extra
money
to get
a
product
that
you
really
want.
- To
take
advantage
of this
opportunity,
a new
form
has
been
approved
by the
Centers
for
Medicare
and
Medicaid
Services
(CMS)
that
allows
patients
to
upgrade
to a
piece
of
equipment
that
they
like
better
than
other
standard
options
prescribed
by
their
physician.
- The
Advance
Beneficiary
Notice,
or ABN,
must
detail
how the
products
differ,
and
requires
a
signature
to
indicate
that
you
agree
to pay
the
difference
in the
retail
costs
between
two
similar
items.
Your
provider
will
typically
accept
assignment
on the
standard
product
and
apply
that
cost
toward
the
purchase
of the
fancier
item,
thus
requiring
less
money
out of
your
pocket.
Purpose
of ABN
- The
Advance
Beneficiary
Notice
also
will be
used to
notify
you
ahead
of time
that
Medicare
will
probably
not pay
for a
certain
item or
service
in a
specific
situation,
even if
Medicare
might
pay
under
different
circumstances.
The
form
should
be
detailed
enough
that
you
understand
why
Medicare
will
not pay
for the
item
you are
requesting.
- The
purpose
of the
form is
to
allow
you to
make an
informed
decision
about
whether
or not
to
receive
the
item or
service
knowing
that
you may
have
additional
out-of-pocket
expenses.
Durable
Medical
Equipment
(DME)
Defined
- In
order
for any
item to
be
covered
under
Medicare,
it
typically
has to
meet
the
test of
durability.
Medicare
will
pay for
medical
equipment
when
the
item:
-
Withstands
repeated
use
(excludes
many
disposable
items
such
as
underpads)
-
Is
used
for a
medical
purpose
(meaning
there
is a
condition
which
the
item
will
improve)
-
Is
useless
in
the
absence
of
illness
or
injury
(thus
excluding
any
item
preventive
in
nature
such
as
bathroom
safety
items
used
to
prevent
injuries)
-
Used
in
the
home
(which
excludes
all
items
that
are
needed
only
when
leaving
the
confines
of
the
home
setting)
Understanding
Assignment
(a
claim-by-claim
contract)
-
When a
provider
accepts
assignment,
they
are
agreeing
to
accept
Medicare’s
approved
amount
as
payment
in
full.
- You
will be
responsible
for 20
percent
of that
approved
amount.
This is
called
your
coinsurance.
- You
also
will be
responsible
for the
annual
deductible,
which
is
$131.00
for
2007.
- If
a
provider
does
not
accept
assignment
with
Medicare,
you
will be
responsible
for
paying
the
full
amount
upfront.
The
provider
will
still
file a
claim
on your
behalf
and any
reimbursement
made by
Medicare
will be
paid to
you
directly.
(Providers
must
still
notify
you in
advance,
using
the
Advance
Beneficiary
Notice,
if they
do not
believe
Medicare
will
pay for
your
claim.)
Mandatory
Submission
of Claims
-
Every
provider
is
required
to
submit
a claim
for
covered
services
within
one
year
from
the
date of
service
The role
of the
physician
with
respect
to home
medical
equipment:
-
Every
item
billed
to
Medicare
requires
a
physician’s
order
or a
special
form
called
a
Certificate
of
Medical
Necessity
(CMN),
and
sometimes
additional
documentation
will be
required.
-
Nurse
Practitioners,
Physician
Assistants,
Interns,
Residents
and
Clinical
Nurse
Specialists
can
also
order
medical
equipment
and
sign
CMNs
when
they
are
treating
a
patient.
- All
physicians'
have
the
right
to
refuse
to
complete
documentation
for
equipment
they
did not
order,
so make
sure
you
consult
with
your
physician
before
requesting
an
item.
Prescriptions
Before
Delivery:
- For
some
items,
Medicare
requires
your
provider
to have
completed
documentation
(which
is more
than
just a
call-in
order
or a
prescription
from
your
doctor)
before
they
can
deliver
these
items
to you:
-
Decubitus
care
(wheelchair
cushions
and
pressure-relieving
surfaces
placed
on a
hospital
bed)
-
Seat
lift
mechanisms
-
TENS
Units
(for
pain
management)
-
Power
Operated
Vehicles/Scooters
-
Electric
Wheelchairs
-
Negative
Pressure
Wound
Therapy
How does
Medicare
pay for
and allow
you to
use the
equipment?
-
Typically
there
are
three
ways
Medicare
will
pay for
a
covered
item:
-
They
will
purchase
it
outright,
then
the
equipment
belongs
to
you,
-
They
will
rent
it
continuously
until
it is
no
longer
needed,
or
-
They
will
consider
it a
“capped”
rental
in
which
Medicare
will
rent
the
item
for a
total
of 13
months
and
consider
the
item
purchased
after
having
made
13
payments.
-
Medicare
will
not
allow
you
to
purchase
these
items
outright
(even
if
you
think
you
will
need
it
for
a
long
period
of
time).
-
This
is
to
allow
you
to
spread
out
your
coinsurance
instead
of
paying
in
one
lump
sum.
-
It
also
protects
the
Medicare
program
from
paying
too
much
should
your
needs
change
earlier
than
expected.
-
After
an item
has
been
purchased
for you
(either
outright
or
after
13
payments),
you
will be
responsible
for
calling
your
provider
anytime
that
item
needs
to be
serviced
or
repaired.
When
necessary,
Medicare
will
pay for
a
portion
of
repairs,
labor,
replacement
parts
and for
temporary
loaner
equipment
to use
during
the
time
your
product
is in
for
servicing.
All of
this is
contingent
on the
fact
that
you
still
need
the
item at
the
time of
repair
and
continue
to meet
Medicare’s
coverage
criteria
for the
item
being
repaired
top of
page
Information
based on
CMS
national
coverage
determination.
This
information
is a
guide
only and
in no way
guarantee's
coverage.
Florida
Medicaid
Policies
may be
different.
Many
health
care
treatments
that used
to be
done only
in a
hospital
can now
be done
in your
home.
Health
care
given in
the home
is
usually
less
expensive,
more
convenient,
and just
as
effective
as care
you get
in a
hospital
or
skilled
nursing
facility.
If you
are
eligible,
Medicare
pays for
you to
get
certain
health
care
services
in your
home.
This is
known as
the
Medicare
home
health
benefit.
If you
get your
Medicare
benefits
through a
Medicare
HealthPlan,
other
than the
Original
Medicare
Plan,
check
your
plan’s
membership
materials
and call
the plan
for
details
about how
the plan
provides
your
Medicare-covered
home
health
benefits.
What are
Medicare's
Home
Health
Services?
Medicare
beneficiaries
can
receive
health
care
services
in the
home.
Home
health
services
can
include:
-
Skilled
nursing
(including
planning
and
monitoring
your
care)
-
Physical
Therapy
-
Occupational
Therapy
-
Speech
Therapy
-
Home
Health
Aides
(Including
assistance
with
care
such as
bathing,
dressing,
grooming,
changing
bed
linens,
feeding,
toileting,
transfers,
ambulation,
simple
dressing
changes,
range
of
motion
exercises
and
other
routine
therapy
and, in
some
instance,
personal
laundry
and
light
meal
preparation.
-
Medical
Social
Services
(such
as
social
workers)
-
Medical
Supplies
(including
durable
medical
equipment)
Who is
Eligible
to
Receive
Home
Health
Services?
If you
have
Medicare,
you can
use your
home
health
benefits
if you
meet all
the
following
conditions:
1.
Your
doctor
must
decide
that you
need
medical
care at
home, and
make a
plan for
this
care.
2. You
must need
one or
more of
the
following:
-
Intermittent
skilled
nursing
care
-
Physical
therapy
-
Speech-language
pathology
services
-
Continued
occupational
therapy
Skilled
nursing
includes
non only
"hands-on"
treatment,
but
observation
of your
changing
condition.
There is
no
requirement
that your
condition
must
improve.
Intermittent
can mean
skilled
nursing
case as
infrequently
as once
every 62
days.
Some
people
can need
a nurse
less than
once
every 62
days and
still
receive
home
health
aide
services,
as long
As they
have a
regular
and
predictable
need for
a nurse.
For
instance,
you may
need a
nurse to
assist
you in
administering
B12
injections
once
every 90
days.
3.
The home
health
agency
caring
for you
must be
approved
by the
Medicare
Program
(Medicare-certified).
4. You
must be
homebound
or
normally
unable to
leave
home
unassisted.
To be
homebound
means
that
leaving
home
takes
considerable
and
taxing
effort. A
person
may leave
home for
medical
treatment
or short,
infrequent
absences
for
non-medical
reasons,
such as a
trip to
attend
religious
services.
You can
still get
home
health
care if
you
attend
adult day
care.
Eligibility
is also
based on
the
amount of
services
you need
If you
meet the
conditions
above,
Medicare
pays for
your
covered
home
health
services
for as
long as
you are
eligible
and your
doctor
says you
need
them.
However,
the
skilled
nursing
care and
home
health
aide
services
are only
covered
on a
part-time
or
"intermittent"
basis.
This
means
there are
limits on
the
number of
hours per
day or
days per
week that
you can
get
skilled
nursing
or home
health
aide
services.
Usually
not
daily.
How Do I
Get Home
Health
Services?
If your
think you
may be
eligible
for home
health
benefits,
ask your
physician
to
develop a
plan of
care for
you. If
you are
hospitalized,
you may
aks the
hospital
discharge
planner
to set up
these
services
for you.
You can
also ask
a nurse
from a
home
health
provider
to
evaluate
your need
for home
care
services
and to
develop a
plan of
care. In
a managed
care
plan, you
must get
prior
approval
for an
evaluation.
The nurse
will
visit
your
home,
develop a
plan of
care, and
submit
her plan
to your
physician
for final
approval.
You must
get home
health
care
services
from a
provider
that is
Medicare-certified
or
selected
by your
managed
care
plan.*
Even if
you have
a
chronic,
terminal,
and/or
degenerative
condition,
home
health
coverage
may be
available
to you.
For
example,
you may
need
skilled
nursing
or
therapy
services
to
prevent
or slow
further
deterioration
or to
preserve
current
capabilities.
*Contact
ElderAssistance
of
America
at
386-774-9090
with your
prescription
and we
can help
in
finding
you a
home
health
company
in
Volusia
County.
Back to
top
How Much
Will I
have to
Pay for
Home
Health
Services?
Unlike
other
Medicare
services,
Medicare
home
health
benefits
require
no
co-payment
or
deductible
amounts.
There is
an
exception
for
durable
medical
equipment
where you
musty pay
a 20%
co-payment.
Back to
top
How Long
Am I
Entitled
to Home
Health
Services?
You can
receive
home
health
services
for as
long as
you
continue
to meet
the
coverage
criteria.
You can
receive a
combination
of home
health
services
for up to
seven
days per
week and
up to 28
hours per
week as
long as
the need
for these
services
is
documented
by the
home
health
provider.
In
addition,
you can
receive
up to 35
hours per
week of
daily
services
as long
as the
need for
these
services
is for a
finite
period of
time. A
terminal
condition,
for
example,
might
allow you
to
qualify
for these
increased
hours.
Back to
top
What
Types of
Home
Health
Services
Are
Available?
Some
examples
of home
health
services
covered
by
Medicare
are:
You
have
hypertension
and
suffer
from
dizziness
and
weakness.
Your
doctor
is
concerned
that
your
blood
pressure
is too
low and
has
stopped
your
hypertension
medication.
Home
health
coverage
will
allow a
nurse
to
observe
and
monitor
your
blood
pressure
until
it
remains
stable
and in
a safe
range.
You
were
recently
diagnosed
as a
diabetic.
You
need a
skilled
nurse
to
teach
you to
self
inject,
to
manage
your
insulin,
to
understand
the
signs
and
symptoms
of
insulin
shock,
and how
to
respond
to
emergencies.
The
teaching
services
would
be
covered
as a
home
health
benefit.
You
recently
broke a
leg
bone
which
has not
healed
and is
unstable.
You
need
regular
exercise
to
maintain
function
until
the
bone
heals.
A
physical
therapist
visits
to make
sure
that
your
leg is
properly
aligned
during
your
maintenance
exercises.
Medicare
will
cover
the
therapist's
services.
You
have
Alzheimer's
disease
and get
confused
about
whether
you
took
your
medications
and how
much
you are
supposed
to
take.
Medicare
will
cover a
nurse
to come
to your
home to
assess
your
medical
symptoms
for
medication
compliance
, and
to
ensure
that
your
overall
care
plan is
adequate.
You
have
multiple
sclerosis
and
require
regular
exercise
so that
your
condition
does
not
deteriorate.
Medicare
will
cover a
physical
therapist
to come
to your
home
and
ensure
that
your
exercise
program
remains
appropriate.
Although
you are
homebound,
your
managed
care
plan
requires
you to
obtain
your
physical
therapy
at
their
outpatient
facility.
You
also
require
a nurse
to come
to your
home to
change
your
catheter
once a
month
and the
daily
assistance
of a
home
health
aide
with
bathing
and
dressing.
Because
you
leave
home
for a
medical
service,
the
managed
care
plan
will
cover
the
nursing
and
home
health
aide
visits
in your
home.
These are
just a
few
examples
of the
types of
services
you can
get if
you are
determined
eligible
for
Medicare's
home
health
benefit.
Remember,
Medicare
will also
cover
home
health
aides or
social
workers
if
Medicare
is
covering
a nurse
or
therapist.
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FL
32720
Telephone: 386-738-0498
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