Dispatch from China by our mobile Director of Communications

With a long interest in eldercare, I’ve always taken note of the older people anywhere I travel. I try to learn and observe how elders are treated in different societies, as well as find out different nuances about how families and the country’s systems manage care for elders needing assistance.

Having lived in the People’s Republic of China for almost two years, I am slowly learning more about this culture and have tried to do a lot of reading to overcome some of my ignorance, and many misconceptions.  There is a lot about the “Eastern” versus “Western” perspectives that can make it a big gap to bridge.  For anyone interested in this subject, I highly recommend The Geography of Thought: How Asians and Westerners Think Differently…and Why by Richard Nisbett as a good primer (based in research).  Clearly, filial piety, group/relationship orientation and an intergenerational focus provide the framework for caregiving here.  Traditionally, this is a culture very based in familial responsibility and generations caring for one another, living together, etc.  Lessons from Confucianism, Buddhism and Taoism form much of the value system. Of course, China also has a unique historical and political history to contend with in terms of its system and norms.

Now, China (in so many ways) is struggling with a rapidly changing society and various repercussions.  The top one when it comes to eldercare being that (recurrent) theme of declining birth rates/availability of younger generation to help the older.  In China, this has presumably been exacerbated by the one child policy.  Additionally, as the population becomes rapidly wealthier and living conditions improve, life expectancy has increased.  The family structure of today is often called 4 to 1, i.e. four elders (two parents and two grandparents) for one adult child to care for.  In a culture where (despite my grade school idea of “communism”) there are few safety net supports, the burden of care typically is both physical/emotional and financial.  Additionally, there has been a mass migration of rural people to cities for work opportunities over the past few decades.  Many times elders remain in the villages, often with the grandchildren (at least until the parents can afford to bring them or they are old enough to go to school).  Now, many rural communities are home almost solely to older residents and these very young children.  Benefits such as schooling and healthcare are also tied to the residency system (hukou), adding challenges for the migrant worker families.

Many societies are struggling with providing for our elders under modern conditions, and we can learn a lot from each other’s problems and solutions.  China has recently seen the “import” of some western concepts of eldercare help, from a couple of international private duty home care companies starting services here to the first private assisted living facilities.  A subsidiary of Emeritus opened a facility in Shanghai last year, which I hope to tour at some point.  A care facility here has typically been seen as a last resort for the very poor, so this concept is a huge leap.  It sounds as if the companies have done their homework on trying to make some cultural adaptations.  However, I understand that the care facility is only operating at about 20% occupancy, so it is far from a wild success at this point.

Clearly more options are going to be necessary as things change.  There are not going to be easy answers for China or anybody else as we all work towards meeting the challenge of caring for our elders. There has been a lot of discussion about changes to the one child policy (there have always been some exceptions to this rule for rural families, ethnic minorities and those who can pay a penalty fee) and some adaptations have been made to attempt to alleviate the pressure of the “4 to 1” structure for two only children marrying. Interestingly, some research points to the fact that, policy or not, many young professionals no longer desire to have more than one child (as we are seeing in most European countries and Japan, where the population shifts have been dramatic).

Another aspect of eldercare that has continued to crystallize for me here is the challenge of long-distance caregiving. As the entire world becomes more mobile, more of us face this issue. The expat community in Shanghai is very large, estimated at about 200,000. I probably have at least one conversation each week with someone who is concerned about an aging parent at home. One friend has a daily check-in phone call with his parents and he and his wife make several trips back each year to handle appointments, check to see how things are going and make arrangements and plans. Another friend expressed her suspicions that Mom has a chronic illness and has not yet told the family. I personally had the experience a couple years ago, while living in Spain, of getting the phone call in which my Mom told me she had two brain tumors and would be going in for surgery within the month.

Fortunately, technology has made it easier for us to keep in touch and travel quickly and we can avail ourselves of many resources to assist. In the U.S., we’re fortunate to have a very strong geriatric care management profession, which is well-equipped to support long-distance caregivers with services like geriatric assessments for a clear picture and road map. Of course, what is available in each country varies in addition to the family’s personal and economic resources. Given that, I am hopeful however, that most of us can now access better information to understand options and we can share ideas and resources worldwide to help us all better care for those we love.

These are so many different cultural perspectives on eldercare and healthcare, as well as innovative ideas in different communities. I would also love to hear from you about your experiences (feel free to leave us a note or connect on social media). I look forward to sharing more about what I learn from my travels and research!

A little while ago, we introduced readers to the new Medicaid Managed Care program which is currently going statewide in Florida. You can read our post on Florida Medicaid Managed Care (SMMC: Statewide Medicaid Managed Care) to find out more about how this change affects current Medicaid recipients and others who may need Medicaid assistance for long-term care.

One important aspect of the managed care process is the assessment used to determine level of care and services. Medicaid eligibility has two pieces: the financial qualifications and “medical eligibility” or care-related qualifications (level of care). Medical qualification must meet federal guidelines, but is state-determined, so a person eligible in another state may not be eligible in Florida. The form used to gather assessment information to determine level of care is the 701B form. This form gathers comprehensive information on a number of areas about a client, attempting to provide a picture of his/her care needs and situational factors. Some of the most important aspects of the assessment in the level of care determination are these sections: mental health/behavior/cognition, nutrition, health conditions, specialized services and medications.

The determination relies on this information as well as that provided by the client’s physician. Therefore, it is vital that good information is provided. If a client and caregivers provide the “rosiest” picture of how things can be or gloss over potential problems, they may be doing themselves harm because the client really needs more than the assessor may understand. We find that for clients and families, the whole Medicaid eligibility process can be very confusing and many little things can go wrong along the way, whether it is missing a step, poor timing, inaccurate information given or not following through with various steps.

With SMMC, the assessment takes on additional importance. At one time, the eligibility process was mainly determining whether someone was eligible or not…typically for care in a long-term care nursing home. Today there are various options for where care might be provided. Under the managed care system, the providers will be looking to provide care in a way that is most cost-effective (and the program has always had a goal of attempting to provide care in the least restrictive environment, through sometimes options have been limited due to limited program funding for alternative care).

Under SMMC, each Medicaid recipient will be asked to choose a managed care plan to manage their care under Medicaid benefits. A plan representative meets with the recipient to determine a care plan. The client is supposed to have input in to this plan (including personal goals) and is entitled to have an advocate present. During this meeting, a care plan is developed outlining what services will be provided. This process is very important (and the care plan generally stays in effect for a year) in determining what care you will receive. Once again, the accuracy of the information given is essential and we believe that having an advocate there with you is also essential. There is a process to complain and make plan changes if you are not satisfied with the care being provided. It is also important to note that since the care is being managed by private companies, they create contractual relationships with care providers. So, Plan X may or may not contract with a specific Assisted Living Facility or home care provider. Therefore, there are many factors in play throughout the process. All of these factors can ultimately affect the care you are receiving.

Several Aging Wisely care managers have trained and become certified in the Florida Medicaid 701B assessment process. We can offer guidance through the Medicaid eligibility, enrollment and care planning process. We work with qualified elder law attorneys if you need help with financial qualification/Medicaid planning and we can coordinate the process for you to help you understand the various steps and get the optimal care situation for your circumstances. Give us a call today at 727-447-5845 to find out more about how we can help.

Aging Wisely, your advocate, with solutions when you need them: when you want to ensure optimal care for yourself or a loved one, have an experienced advocate by your side.

March 2014 is “Social Work Month”, the goal of which is to “help raise awareness about the American social work profession’s 116-year commitment to improving social conditions and quality of life opportunities for everyone.  Social workers across the globe believe that all people have dignity and deserve respect.” As the National Association of Social Work reflects, this month is a chance to “educate the public about how these values are essential to improving relationships within families, making social support systems more effective, and building stronger communities.”

Our care management team shares this commitment, and many of us come from a heritage of social work education and experience. Several of our team members have degrees in social work or related social sciences and have provided social work services in diverse settings such as hospitals, nursing homes, assisted living facilities, public organizations and non-profits. You can read all of our care managers’ bios on our Aging Wisely team page, to get a full picture of the team’s diverse and rich experience.

The social work profession has been around much longer than geriatric care management, with a heritage spreading back to the late 1800s when the profession was established to help immigrants and other vulnerable populations gain tools and skills to escape poverty. The National Association of Professional Geriatric Care Managers formed in 1985, but many of the initial members came from the social work profession. They did what social workers have always done; they sought to fill a need they saw in their communities to ensure that all people have that opportunity for dignity and respect. In this case, that population was elders (and their families) who needed advocacy to navigate multiple, often disconnected, systems.

Today we continue on with this work and proudly celebrate over 15 years of providing care management and patient advocacy at Aging Wisely. Our mission remains to “enable every individual we work with to live the most fulfilling life possible, with utmost dignity, focusing on their physical, mental, spiritual, family and financial well-being.” You can clearly see our social work heritage in the mission statement we work hard to carry out with all of our clients. We believe this holistic approach to our clients’ lives, with an emphasis on their familial and support systems, allows us to provide the best tools for achieving the most fulfilling life. While much of our work is in patient advocacy and medical situations, we know that many aspects of the person’s life are integrated with health and well-being. Without proper support, follow-up, the right resources and more, the best medical treatments only go so far.

Our holistic approach also encompasses partnering with a client care team. This team involves a wide array of professionals, including many social workers in various settings. Over the next month as we celebrate both Social Work Month and National Doctor’s Day, we will be talking more about the importance of that team support. By working together as professionals (particularly with the right coordination), we bring better results to our clients.

Want to learn more about working together with Aging Wisely? Give us a call at 727-447-5845 or contact us online.