Community Resources
for Boston Elders
Boston University Geriatric Services
Catherine Fabrizi, MSN, APRN, BC
Ellen Harrington, MSW, LICSW
Patricia Kimball,RN, MS, BC
Maureen Russell, RN, MPH, BC
Purpose and Objectives
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Identify the community resource providers that
oversee homecare and home health care in the
Boston area.
Assist patients in accessing home services.
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Describe basic Medicare and MassHealth
eligibility and coverage.
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Discuss various housing options available to
seniors in Boston and understand the eligibility
requirements as well as services provided
~ Home-Based Services
~ Benefits & Insurance
~ Housing
CASE 1 – 74 y.o. non-english speaking obese Haitian woman
 OA hips, knees, lumbar spine; HTN; urinary incontinence; h/o
falls
 lives alone, cluttered studio apt., BHA senior building w/ elevator
 difficulty ambulating d/t pain
 cruises around apt. instead of using cane/walker; has w/c but
cannot self propel
 depressed
 needs assist with ADLs and IADLs
 limited family support
 medicare and mass health (medicaid)
What service plan would you design to help maximize function, minimize
pain, increase socialization and meet all ADL/IADL needs?
How will it get paid for?
Aging Services Access Points
“ASAP”
 3 “ASAPs” cover Boston geographic areas.
-Central Boston Elder Services (CBES)
-Boston Senior Home Care (BSHC)
-ETHOS (point of referral for adult protective services)
 Funded through the Executive Office of Elder Affairs
-100% state funded with some additional federal funds
 Offers a package of home care services
 Provides case management services
 Eligibility and cost based on income and need
 Anyone can refer by calling:
ELDER INFO (617) 292-6211
Services Provided by ASAPS
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Care Coordination
Personal Care
Homemaking
Grocery delivery
Laundry Service
Personal Emergency
Response System (PERS)
Adult Day Health
Home Delivered Meals
Nutrition supplements
Money management
Home safety equipment
Medical Transportation
Volunteers –medical escort
Caregiver Support /Respite
Criteria for “ASAP” Eligibility
1. Age 60 or >
(or under 60 if dx. of dementia & needs respite)
2. Functional impairment - ADL and IADL needs
3. Income
single person <$ 1732.00/month
couple <$ 2,450.00/month
4. Agrees to co-pays – ($7-$135.00/month)
MassHealth members financially eligible -no co-pays
5. Respite needs – income exemptions may apply
ASAP SERVICE PLAN
(EXAMPLE- $230.00/month)
 Personal Emergency Response System
 Home Delivered Meals (20/month)
 Homemaking, 3 hours q 2 weeks
$30
$95
$105
Service plans are individualized based on CM assessment of
functional impairment level. Service packages are provided thru
various programs within the ASAP based on need/income and even
living situation (ie. GAFC in senior buildings, respite for caregivers)
Certified Home Health Agency
(“VNA”)
Standard Services
 Skilled Nursing
 Physical Therapy
 Occupational Therapy
 Home Health Aides
Other Contracted Services
 Medical Social Work
 Speech Therapy
 Nutritionist
 Community Resource Specialist
Criteria for CHHA Eligibility
 Skilled nursing or physical therapy need
-cannot refer just for nutrition, speech, OT or SW
 Insurance
 MD/NP orders
 Short term / intermittent monitoring / therapy needs
 60 day certification period
Payment Sources for
Certified Home Health Agency Services
• MEDICARE A
• Covers100% of skilled care provided by RN/PT/OT/ST/SW
as long as pt meets skilled level of care.
• MASSHEALTH (MEDICAID)
• Covers 100% all services if medically necessary
• PRIVATE PAY
• Patient may have out of pocket expenses if care not qualified
as skilled or if there is no secondary insurance
• COMMERCIAL
• Coverage depending on individual plans
MassHealth
And I thought there were only two kinds !
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Thirteen programs offered in Massachusetts
Mass Health Standard:
• age 65+ and income less </= to 100% federal
poverty level ($8,960)
• assets of less than $2,000/ind., $3,000/couple
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SSI Recipients –automatically eligible
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Former SSI recipients ages 65+ same as above
Benefits/Covered Services
MassHealth Standard
 Inpatient Hospital
Services
 Outpatient Services
 Medical Services
 For 65+ entitled to
Medicare A, Division of
Medical Assistance will
also pay for the cost of
the Medicare A&B
premiums as well as
deductibles and
coinsurance amounts
 Medical equipment and
supplies
 Transportation Services
 Adult Day Health
 Foster Care
Adult Day Health Centers
Medical Model
Supervised setting for qualified elders with skilled needs to receive medical,
nursing, social and nutritional services such as:
-health screening/monitoring,
-teaching
-counseling
-medication assistance/monitoring
-rehabilitative therapies.
Mission: keep elder in the community by
providing structure & social stimulation thru
recreational & cultural activities as well as
providing respite, support, counseling for
caregivers.
•May be covered by mahealth, ASAP, SCO, some LTC ins. or private pay (NOT
COVERED BY MEDICARE)
ADH Programs in Boston Area
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Ellis Memorial (Southend)
Alianza (Roxbury)
Cape Verdian (Dorchester)
Laboure (South Boston)
Golden Age Center (Chinatown)
Rogerson (Roslindale)
Rogerson (Brookline)
Rogerson (at Egleston)
Kit Clark (Codman Square)
Kit Clark (Fields Corner)
Greater Boston Guild for the Blind (JP)
Cooperative Elders (Milton)
May Institute (geri-psych)
Volunteer Programs
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Little Brothers Friends of the Elderly
MatchUp Interfaith Volunteers
Kit Clark Senior Services
ASAPs
Congregations
Commission for the Blind
Case 2 - 82 y.o woman s/p CHF exacerbation and pelvic fx now
being d/c’d from rehab.
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HTN; AFIB; OA; COPD; mild dementia
lives alone, senior building
new functional/cognitive decline: needs assist with ADLs/IADLs
involved daughter but cannot provide 24hr care; assists with $,
shopping, errands etc.
 caregiver stress- daughter cares for grandkids too
 daughter wants pt to consider alt. living but pt wants to go home
 medicare managed care thru TUFTs
What is necessary for a safe d/c plan that maximizes
function and ensures safety? How will it be paid for?
Medicare
 Medicare is a federal health insurance
program
 Eligibility:
65 years of age, or certain individuals
with disabilities under 65 and any person
with kidney failure on dialysis.
 Program overseen by CMMS
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(Centers for Medicare and Medicaid Services)
 PPOs and HMOs
Medicare Part A
Medicare A Covers
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inpatient hospital care
some skilled nursing facility care
hospice care
certified home health agency
Medicare Part B
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enrollee must be eligible for part A
enrollee must apply –it is not automatic
monthly premium required
covers most physician/NP outpatient care;
diagnostic x-rays and lab tests, outpatient
therapy, some durable medical equipment
and flu/pneumonia vaccines
Medicare D
Housing Options
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Public (BHA) senior buildings
Privately owned and managed senior buildings
Private home
Supportive Housing
Ana Bissonette House
 Congregate Living
Tuttle House
 Assisted Living
 Group homes
 Group adult foster care
Roxbury Community Adult Foster Care Program
 Continuing Care Retirement Community
Lasalle Village - Newton
 Rest Homes
Mount Pleasant and Hale House
 Nursing Home
What is public housing?
 Public housing provides safe and affordable rental housing
for eligible low-income families, the elderly, certain veterans
and people with disabilities whose income does not exceed
80% of the area median income.
 People who live in public housing are expected to pay 30%
of their household income towards rent.
 Median income of Boston residents: $38,691
 Eligibility- Family of 1: $16,000 annual income
 Family of 2: $18,300
1701 Washington Street
Boston Housing Authority
Eligibility for Elderly Housing
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Age 62 or older
Rent is 1/3 of income
All utilities included except cable and phone
Waiting period for prime locations is 2+ years. Some up to 5 years
Priority is homelessness:
• Residing in shelter
• On the street
• Evicted from residence deemed not fit for human habitation
• Eviction papers with specific date of eviction
• Waiting for public housing can be 3-6 months
Ruggles Assisted Living
Assisted Living
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Provides housing, meals and personal care services to adults
ALs do not provide medical or nursing services
Not designed for individuals that need serious medical care
Intended for adults that need help with ADLs/ IADLs
AL provides comfort of 24-hour security and assistance
Costs range from $3,000 a month and upwards
Individuals may receive subsidies, permitting low-income
individuals to afford the monthly rate
 Residences have single and shared apartments with efficiency
kitchens lacking oven space, but stove tops and microwaves.
 Some assisted living facilities have specialized dementia
programs
Note:
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Resident Care Director is usually an RN, but not permitted
hands on nursing care as most people think but rather to
supervise the aides
Standish Village at Lower Mills
Other Programs for Elders
 Program of All Inclusive Care for Elders
(PACE)
 Senior Care Options (SCO)
 Personal Care Attendant (PCA)
-Toward Independent Living and Learning (TILL)
-United Cerebral Palsy (UCP)
PACE
Program of All-inclusive Care for the Elderly
(AKA: ESP -Elder Service Plan)
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PACE is a fully capitated medicare and medicaid
managed care program which serves frail
individuals age 55 and over who meet NH clinical
criteria and who are able to remain in the
community with supports
2.
PACE sites utilize an interdisciplinary team of
clinicians in an expanded adult day health model to
provide and manage all health, medical and social
service needs.
Senior Care Options (SCO)
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SCO is another fully capitated medicare and medicaid managed care
program that is offered to eligible MassHealth members age 65 and
over at all levels of need, both community and institutional settings
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SCO organizations establish large provider networks which coordinate
and deliver all acute, primary care, LTC, mental health services to
enrollees with a geriatric model of care.
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SCO provides flexible funding vehicle to manage the delivery of all
components of enrolled seniors medicare and medicaid covered
services
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Promotes improved access for enrolled seniors to the most appropriate
and necessary services
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Provides enrolled elders with access to healthcare, triage, and advice
24 hours a day, 7 days a week
PCA Programs
(personal care attendant)
PCA services are for those who need daily assistance in meeting personal care
needs. With PCA help a person can live independently in their home.
PCA
-assists with ADLs & IADLs
-assists with health related functions - delegated by consumer under the
direction of a licensed health care professional (i.e. catheter care, home glucose
monitoring)
PCA programs are consumer driven and managed by consumer
Eligibility
1. Medicaid subscriber
2. Medical necessity
3. Person must be able to make decisions about his/her own care or have a
responsible party who can make those decisions
4. MD must order the services
PCA Programs in the Boston Area
 Toward Independent Living and Learning (TILL)
 United Cerebral Palsy (UCP)
 ASAPs
 Boston Center for Independent Living (BCIL)
Other Resources
 Elder Law Attorney
 Boston Elder Legal
Services
 Financial Advisors
 Guardianship
Programs
 Money Management
 Adult Protective
Services / Elders At
Risk
 Private Care
Managers
 Transportation
-Senior Shuttle
-The RIDE
WHEN IN DOUBT CALL:
ELDER INFO
617-292-6211
OR
ElderINFO.org
CASE 1
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Mrs. T is a 74 y.o. non-english speaking obese Haitian woman with OA
of hips, knees and lumbar spine; HTN; urinary urge incontinence and
h/o falls followed by Geriatrics Home Care Team. She lives alone in a
cluttered studio apartment in a Boston Housing Authority (BHA) senior
elevator building. While she transfers independently using walker or
quad cane she has difficulty ambulating alone d/t chronic back/hip/knee
pain. Usually she “cruises around apt”. She limits going out b/o pain
and ambulation difficulties thus is becoming isolated and depressed.
Mrs T. has a standard manual wheelchair which she does not use
because she is unable to self-propel. In addition to impaired mobility,
she needs help with most ADL’s and IADLs d/t OA and related chronic
pain. She has 1 son who visits on weekends. But no other supports.
She has medicare and mass health (medicaid).
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What service plan would you design to help maximize function,
minimize pain, increase socialization and meet all ADL/IADL needs?
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How will it get paid for?
Case 2
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Ms. S is an 82 y.o woman with HTN, Afib, CHF, OA, COPD and mild cognitive
impairment who lives alone in a south end senior building. Her daughter who
lives nearby is very involved. She assists with IADLs but she cannot provide 24
hr care or assist with daily ADLs b/o providing child care for 2 grandchildren while
her daughter works. Ms. S was recently hospitalized with a fall d/t CHF
exacerbation after forgetting to take her lasix for few days and is now returning
home from a short rehab stay. She has a healed pelvic fracture and is walking
short distances with a walker but needs assist with bathing, dressing and
grooming. She cannot stand long enough to cook meals or clean. She has
medicare managed insurance thru Tufts. Prior to hospitalization pt was
independent with ADLs and had a HM 1 day/wk for cleaning/laundry. And she
was attending the lunch program in the building daily. Daughter took pt shopping
on weekends and assisted with banking/finances. Given Ms. S’s recent
functional and cognitive decline daughter is worried about her ability to live alone
and would like to consider alternative living options but Ms S is adamant about
going home.
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You are involved in planning Ms. S’s discharge from rehab – what care plan
would you design to maximize function; ensure supervision and safety?
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Who would you involve in the discharge planning?
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How will services be paid for?
Case 3
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Mrs C is an 92 y.o. woman with HTN, DM, hypothyroidism, COPD, mild cognitive
impairment and depression who was referred to geriatrics from her PCP b/o
difficulty getting to appts. Pt suffered a stroke over 1 year ago and has made
remarkable progress with PT, OT, speech therapy. She is able transfer safely with
1 person assist and walk short distances. She spends most of they day in her
w/c. She is occasionally incontinent but it is more related to functional impairment
and urgency. She can feed self soft foods but does not take in enough calories by
mouth so tube feedings continue. Until now she has had a HHA 3 days/week for
1 hr each to assist with bathing. Her son Thomas is the primary caregiver who
manages meds, feedings, personal care when no HHA and all IADLs. He never
leaves her alone d/t safety concerns. While his sister visits weekly for 1-2 hrs she
does not help with ADLs. Thomas has missed his own medical appts b/o not
wanting to leave pt alone. Mrs C has medicare and medicaid. She is on15
medications requiring copays. She will be losing the HHA now that the CHHA will
be terminating therapies. A referral was made to the area ASAP but the CM could
only offer PC/HM 1-2 hrs daily.
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On your initial assessment you identify major caregiver stress and you are
concerned about pt’s son neglecting his own health. While the other case studies
examples demonstrate services options which will aid the pt and decrease stress
on caregivers there are other programs which provide additional support to pts
who require a lot of care and are nursing home eligible but want to remain living at
home.
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What services would help this patient remain safely living at home and decrease
caregiver stress?