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.

What are the senior care options?

• 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:
 

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What are the senior care costs?

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.

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Will Medicare or insurance pay for private home care or assisted living?

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. 

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What do I need to do to become a power of attorney for my parents?

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How can I manage my parents' estate to qualify them for Florida Medicaid?

Information derived from dcf and does not guarantee coverage

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.

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.

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What should I look for in an Assisted Living Facility?

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What should I look for in a Home Care company?

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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?

1. 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.
2. 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

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How to qualify for Home Health?

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.

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)

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.

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. 

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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.

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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.

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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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Volusia County Assisted Living Facilities

Alliance Center for Healthcare
Deland, (386) 734-6401Alliance Community for Retirement, Inc
Deland, (386) 734-3481Almost Like Home
South Daytona, (386) 756-8042Americare Assisted Living
Deltona, (386) 789-8848The Andall-Forbes ALF
Deland, (386) 738-0025Azalea Manor
Port Orange, (386) 767-8968Bayside Care Center
Port Orange, (386) 761-9771Beach Manor, Inc
Daytona Beach, (386) 255-2389Bel-Aire House
Daytona Beach, (386) 677-6452Bethesda Manor
Ormond Beach, (386) 441-6045Better Living Care ALF, Inc
Edgewater, (386) 428-6977Bishop's Glen
Holly Hill, (386) 262-9000Canal View Rest Home
Port Orange, (386) 756-5516Church-Hill North ALF
Deland, (386) 738-0507The Cloisters
Deland, (386) 822-6900Coquina Place
Ormond Beach, (386) 677-0782The Cornerstone at the Groves
Port Orange, (386) 767-5858Country Club Retirement Center
New Smryna Beach, (386) 423-5725Country Manor Rest Home
Port Orange, (386) 761-7678Countryside Care Center
Port Orange, (386) 760-8033Countryside Lakes
Port Orange, (386) 756-3480Deerfoot Manor
Deland, (386) 734-3519Dee's Elderly Care Facility
Ormond Beach, (386) 672-5181Deland Retirement Home
Deland, (386) 736-0022Dixie Lodge
Deland, (386) 734-4830Dove Villas Cooperative Association, Inc
Daytona Beach, (386) 274-1155Edgewood Manor
Deland, (386) 736-6224Elm Tree Place
Daytona Beach, (386) 985-5231Fern View ACLF, Inc
Deleon Springs, (386) 985-2315Florida Lutheran Retirement Center
Deland, (386) 736-5800Florida Shores Elderly Care, Inc
Edgewater, (386) 428-5370Forest Lake Manor, Inc
Daytona Beach, (386) 760-7174Four Seasons Retirement Home
Deland, (386) 736-1402Garden in the Woods
Port Orange, (386) 788-8499Gardenview ALF
Port Orange, (386) 673-7444Golden Abbey
Daytona Beach, (386) 257-6924Golden Friends
Deltona, (386) 860-4080Golden Years Rmnt Home of New Smyrna
New Smyrna Beach, (386) 427-4266Good Shepards of Deland ACLF
Deland, (386) 734-9009The Good Shepards West
Deland, (386) 738-9986Great Oaks Hall
Deland, (386) 736-7756Green Acres Retirement Home
New Smyrna Beach, (386) 428-9396Halifax Manor
Daytona Beach, (386) 253-9636Harbor Oaks Elderly Care Home
Harbor Oaks, (386) 767-1613Hartland Manor
Deland, (386) 740-7446Heavenly Rest Home
Ormond Beach, (386) 676-2230Herald's Retirement Home
Daytona Beach, (386) 258-9921Hill Top Pines
Deltona, (386) 532-2588Holly Hill Care Center
Holly Hill, (386) 672-3906The Home Circle
Harbor Oaks, (386) 767-2412The Home Place
Orange City, (386) 775-4453Horizon Healthcare & Specialty Ctr
Daytona Beach, (386) 258-5544Huntington
Daytona Beach, (386) 255-6571Independence Court of Ormond Beach
Ormond Beach, (386) 673-5000Indigo Manor
Daytona Beach, (386) 257-4400The Islander
Deland, (386) 734-1379Jan's Elderly Care
Harbor Oaks, (386) 756-9581John Knox Village of Central Florida
Orange City, (386) 775-3840Jolanta's Elderly Care Center, Inc
Harbor Oaks, (386) 258-5673Just Like Home of Orange City
Orange City, (386) 966-3636Kozy Korner Elderly Care
Ormond Beach, (386) 677-0059Ladies Limited
Daytona Beach, (386) 257-5684Lakeside Lodge
Deland, (386) 736-7756Leisure Lodge
Deland, (386) 736-7756Linda's Quality Care
Holly Hill, (386) 252-4091Manila Home Care
Port Orange, (386) 760-0198Martins Rest Home
Holly Hill, (386) 255-2455Merrill Gardens at Orange City
Orange City, (386) 775-3561New Smyrna Retirement Center
New Smyrna Beach, (386) 427-2492Oak Manor Rest Home
Deland, (386) 736-7231Oak Manor Retirement Home, Inc
Deland, (386) 734-6974Oasis of Love Care Center
Holly Hill, (386) 252-3772Ocean View Manor
Daytona Beach, (386) 258-5116Olds Hall Good Samaritan Center
Daytona Beach, (386) 253-6791Open Arms, Inc
Port Orange, (386) 761-6268Ormond in the Pines
Ormond Beach, (386) 676-7463Our Open Arms, Inc
Daytona Beach, (386) 254-8686Paradise Manor
Daytona Beach, (386) 322-4222Pepper Hill Care Center
Port Orange, (386) 760-3557Peridot Place/ Forest Lake
Daytona Beach, (386) 760-7174Peridot Place / Independence Court
Ormond Beach, (386) 673-5000Pinecastle Retirement Center
Daytona Beach, (386) 253-8145Quinley Inn
Port Orange, (386) 322-9023Rainbow Assisted Living
Deltona, (386) 532-1859Rastelle Manor
Daytona Beach, (386) 252-2627Rebecca Manor Retirement Home
Daytona Beach, (386) 257-7781Rising Sun Manor
Holly Hill, (386) 253-0433Rose Manor, Inc
Deland, (386) 738-5982Savannah Place Care Center
Holly Hill, (386) 252-7082Shady Oaks Rest Home
Daytona Beach, (386) 252-3429The Shangri-La House
Daytona Beach, (386) 788-0462SJ Cerreta Corporation
Holly Hill, (386) 255-8690Southern Living Adult Care Facility
Edgewater, (386) 689-6050Sparrows at General Marshall
Ormond Beach, (386) 252-5331The Squirrel's Nest
Deland, (386) 943-9571Sterling House of Daytona Beach
Daytona Beach, (386) 238-3333Sterling House of Deland
Deland, (386) 736-8100Sterling House of Ormond Beach
Ormond Beach, (386) 672-8800Sterling House of Port Orange
Daytona Beach, (386) 304-3333Summers Rain Care Center
Holly Hill, (386) 615-0106Sunny Palms Assisted Living Facility
New Smyrna Beach, (386) 426-1433Sunshine Manor, Inc
Daytona Beach, (386) 257-2656Sunshine Manor South
Harbor Oaks, (386) 760-5026There's No Place Like Home
Debary, (386) 668-5950Tiffany on the River
New Smyrna Beach, (386) 423-1120Tomoka Loving Care
Ormond Beach, (386) 676-1138Triple Oaks
Port Orange, (386) 767-8825Valencia Care-N-Touch, Inc
Ormond Beach, (386) 677-4552Wellington Place of Ormond Beach
Ormond Beach, (386) 441-1771Woodland Towers
Deland, (386) 738-2700WORC Haven, Inc
Daytona Beach, (386) 274-4228

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Volusia County Nursing Homes

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Volusia County Financial Advocates

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