Our experts help with your frequently asked eldercare questions. With the holidays coming up this is an especially timely topic: handling holiday (and other) visits when your loved one lives in a nursing home.

Can I take my loved one out of his/her nursing home for an outing or holiday visit?

Yes, residents of nursing homes can definitely leave the nursing home for outings and visits with family. Of course, the nursing home is regulated tightly and residents are considered to be under medical care while there, so it is necessary to follow certain procedures.

You should talk to your loved one’s nursing staff about outings, to ensure the person’s safety and well-being. The staff can also prepare you for what might be needed during the trip, such as equipment and care needs. If you have not personally taken care of your loved one alone in some time, it is important to understand their needs before planning a nursing home outing.

Typically, you will need to “sign out” a nursing home resident and talk to the care staff about the plan and timing of the visit. It is important to let them know the intended length of the visit and keep in touch if anything changes, so they can plan accordingly. There are also financial implications for overnight/longer visits.

Florida Medicaid Rules for Holding Nursing Home Beds

In addition to whether or not you can leave a nursing home and what type of visits are advisable, costs are an important factor to consider. If a resident leaves a nursing home overnight, they (or some payment source such as Medicaid) would need to continue to pay the cost to hold their spot. For a private pay resident, monthly payment would simply be as usual and then the bed would be held (for longer stays away from the nursing home–even hospital stays, the resident/family would have to determine if they wish to pay to hold the bed).

This is known as a “bed hold” in Medicaid terminology and the policies vary by state. For what is known as “therapeutic leave”, Medicaid in Florida pays the nursing facility to reserve a resident’s bed a maximum of 16 days per fiscal year (July 1-June 30). Therapeutic leave means the resident leaves the facility to go to a family-type setting (not another nursing home or hospital). Each night away counts as one day.

However, the nursing home must have at least 95% of its Medicaid-eligible beds filled in order to bill the state for bed hold days (presumably, if not, there would be sufficient open beds for the person to return). If a resident exceeds the yearly allowed days, the resident or family could also pay privately to hold the bed. If they do not wish to do so, the nursing home may discharge the person but must readmit them in the 1st available Medicaid semi-private bed (of course, it does not have to be the same room as before).

The nursing home should provide this policy in writing, at admission and again when you go on any therapeutic leave. For a complete list of Medicaid bed hold policies by state click here (check with your state to see if the policies have changed since this was updated).

Medicare Skilled Nursing Coverage and Leaving the Nursing Home

Medicare only covers short-term skilled nursing care, so this isn’t an issue for most nursing home residents. However, if you are in a skilled nursing facility receiving treatment under Medicare and wish to leave to visit loved ones for the holidays, can you?

Despite what you are sometimes told, Medicare does not necessarily consider a family visit to mean you don’t need skilled care. You can be gone during the day (attending an outing, but back by midnight that day) and the facility can still bill Medicare for the day. If you stay away overnight, the facility typically can’t bill Medicare for that day. You can talk to the facility about their bed hold policy, and you may be able to privately pay to hold the bed if you wish.

Remember, however, that missing out on therapy services, in particular, may slow your recovery process and you may benefit less from your time in the skilled nursing facility. It is best to discuss your needs and scheduling of any visits with your care team.

The Logistics of a Nursing Home Outing

We have many clients who we arrange regular outings for, often with the help of a nursing assistant. We would never want our clients to feel that the nursing home is like a prison, but we also want to make arrangements to make any visit safe and comfortable.

Talk with care staff about the details beforehand and consider whether some assistance might be needed. You can arrange special transportation or an aide to go along with the person, to assist with transferring, going to the bathroom and other needs that may arise.

Our senior caregivers have shared tips and information about traveling with someone with dementia and they offer senior concierge services to plan events/outings and escort the person (even on long-distance trips to visit family).

We can also help with creative ideas for making the holidays special for your loved one residing in a nursing home or assisted living. Contact us for ideas or help with nursing home visits, concierge services, patient advocacy and more.

Also, don’t forget to check out our Senior Gift Guide!

Our Medicare advocates are here to help you understand Medicare as we’re in the midst of the Medicare 2016 open enrollment decision making. Today, we’ll answer some FAQs about Medicare, such as “What is Medicare going to cost me in 2016?” and “What is Medicare going to cover in 2016?” and “Will I be subject to a big Medicare Part B increase?”. We also help you find a broad range of information, such as “What is Medicare?” and “What is Medicaid?” and when you need to sign up and take certain steps.

What is Medicare going to cost me in 2016?

All of the numbers are not out yet, but sign up for our newsletter to get all the details as soon as they come out! We do know what Medicare Part D’s maximum deductible will increase from $320 to $360. Of course, this is only the maximum limit placed on the plans. Your drug plan may have no deductible at all and can range up to $360 (however, a Kaiser Family Foundation issue brief revealed that 2/3 of all Part D plans will have deductibles and a growing share will have the maximum deductible in 2016).

Part D plan premiums vary widely (as do the associated costs for covered medications) so it is important to analyze the best plan for your current situation during open enrollment. For 2016, the chart below details the income-adjusted premiums for Part D. In other words, if you are looking at a particular Part D plan and your income is more than $85,000 (or $170,000 for joint filers)–based on your 2014 return–you will need to add the extra cost to this premium to get your true monthly cost.

The average Part D premium is projected to increase by 13% from 2015 to 2016 ($36.68 to $41.46). Even if a number of beneficiaries switch/are reassigned to lower-premium plans, the average increase is likely to be the largest since 2009 (Kaiser Family Foundation).

Most of the other Medicare costs will likely stay similar to 2015. However, a big area of concern for some Medicare recipients is the potential 52% hike in their Medicare B premium if they are not protected by the “hold harmless” rule.

What is Medicare “hold harmless” and will I be subject to a large Part B premium increase in 2016?

Social Security benefits will not get a COLA (Cost of Living Adjustment) next year, which means that most Social Security recipients who are also Medicare beneficiaries will not see an increase in their Part B premium ($104.90–stable since 2013) under Medicare’s “hold harmless” provision. But this “hold harmless” rule doesn’t apply to about 30% of beneficiaries: those who are not yet receiving Social Security, new Medicare beneficiaries, individuals earning more than $85,000 a year (or $170,000 for joint filers), and Medicare/Medicaid “dual eligibles” (though for dual eligibles, the burden will fall mostly to the state Medicaid programs).

Unless Congress or the administration make some modifications, these Medicare beneficiaries will generally be facing a Medicare B premium of $159.30, with higher income retirees paying as much as $509.80/month.  The Part B deductible for these beneficiaries would rise to $223 next year (from $147 in 2015). This is due to the fact that premiums must cover cost increases within the Medicare program, and since about 70% of people are protected by the hold harmless rule this puts a large share of cost on the remainder.

What is Medicare open enrollment, when is it and what to I need to do?

Medicare open enrollment is your chance to switch Medicare D plans for 2016 (and switch to/from Medicare Advantage). Read more about Medicare open enrollment 2016 and what you need to do during this period (October 15th-December 7th). If you need help with this process or initial Medicare enrollment, our Medicare advocates can assist with our Medicare Analysis Package.

Find out more about Medicare and Medicaid at:

Aging Wisely’s Medicare Fact Sheet (2015 version), includes all the basic facts about Medicare and key dates

Medicare.gov: get your Medicare 2016 handbook, compare plans, find out what Medicare covers and more

Medicare Interactive answers questions about Medicare rights and benefits, run by the Medicare Rights Center.

What is Medicare? What is Medicaid? Who Pays? by EasyLiving’s senior care experts, with links to fact sheets about Medicare’s coverage of home health care and other resources

Contact our healthcare advocates  for any questions about Medicare, Medicaid, other benefits and your health needs. We do not sell insurance or any products, so our opinions are based on our experiences helping many families and our analysis of what’s best for you!

What is Sundowners Syndrome?

Sundowners describes the phenomena of irritability and other symptoms that occur in the late afternoon and evening in people with Alzheimer’s disease and other forms of dementia. The symptoms a person “sundowning” may experience include restlessness and wandering, agitation, delusions, increased confusion and more.

Many dementia symptoms are simply exacerbated during this period of the day, or your loved one may almost seem like a whole different person when the evening hours hit.

Scientists aren’t sure what causes Sundowners Syndrome. It is likely related to the fading light and perhaps the disturbed sleep cycles and body rythyms caused by dementia. I have always thought that our circadian rythyms and lifelong patterns may play a big role (i.e. this is the time of day when we usually expect transition…leaving work, family arriving home from school/work, preparing for dinner, relaxation, bed). Many times the people sundowning seem to be anticipating that something is supposed to happen, that they should be going somewhere or want to “go home”.

Sundowning can indicate that the person is worn out, in some discomfort, or feeling hungry or thirsty at this point in the day. The person may also be sensing the caregiver’s own frustration or exhaustion at the end of a long day.

How can I manage my loved one’s Sundowners?

• Plan. Anticipate that this can be a tough time of day and schedule accordingly. Don’t plan outings or other activities which might be difficult during this period. Be prepared to provide closer attention and learn ways to redirect your loved one (enlist extra help if needed).
• Prevent. Try to ensure your loved one gets plenty of rest, food and drink. Watch for subtle signs of pain or discomfort. Regularly help him/her to the bathroom. Make sure the temperature is comfortable.
• Soothe. Use soothing music or other activities to create a sense of calm. Find out what works best for your loved one.
• Adjust lighting. Turn on good quality lighting as daylight fades. Consider closing curtains to reduce shadows.
• Provide a safe environment/outlet for pacing and wandering. If your loved one is prone to pacing, you may want to plan walks in a safe area during this time or create a space where he/she can walk around without wandering away.
• Check out our Dementia Symptoms slide show, with practical suggestions for help with wandering and other behavioral symptoms.
• Talk to your doctor about the sundowners symptoms your loved one is experiencing. Sometimes medications can help, or the doctor may need to adjust current medications or address sleep issues.

Contact our eldercare team about dementia caregiver support and resources, dementia home care or respite care and more. For more sundowners, dementia and eldercare resources, sign up to get our free monthly tips.

The Medicare open enrollment period for 2016 Medicare plans will be from October 15th to December 7th, 2015.

What can I do during Medicare Open Enrollment 2016?

• You can switch your Medicare D prescription drug plan for 2016.
• You can switch from regular Medicare to a Medicare Advantage plan.
• You can choose to leave a Medicare Advantage plan and re-enroll in regular Medicare with a stand-alone Part D prescription drug plan.
• You SHOULD review your plan options even if you are happy with your current Medicare plan. Plans will make changes for 2016 and some may go away all together. Your medical needs may have changed as well. Many seniors could be saving money with a different plan for 2016. Get help with an unbiased Medicare plan review (whether currently enrolled or planning as a newly eligible). We can help you with Medicare open enrollment 2016 or enrollment/changes at other times, as well as with healthcare advocacy issues.
• Changes made during the Medicare open enrollment 2016 period will go into effect January 1, 2016.

What other times can I enroll or make changes to my Medicare plan?

• Everyone has an initial open enrollment period when they first become eligible for Medicare. This is a 7-month period (the month of eligibility and the three months before and after).
• You can make changes at other times for specified reasons (special enrollment periods).
• Five-star enrollment period: If a five-star rated plan (Medicare Advantage, Medicare Cost Plan or Medicare D Prescription Drug Plan) is available in your area, you have a one time opportunity each year (at any point during the plan year) to switch to any five-star plan (or between five-star plans if more than one is available). *Medicare rates plans on various factors, with a five-star rating being the highest possible rating. These are updated each fall for the plans available the following year.
• There’s a yearly Medicare Advantage disenrollment period, that specifically allows those in a Medicare Advantage plan to switch back to regular Medicare. This runs each year from January 1st to February 14th. This is only applicable for those currently enrolled in Medicare Advantage (so, in other words, those people have two chances to switch back to regular Medicare…during the upcoming Medicare open enrollment 2016 period and again from January 1st-February 14th).

Check out our Medicare Fact Sheet 2015 with more information and costs. Though most of this information will remain the same for 2016, the costs will change. Sign up for our Aging Wisely newsletter to get your copy of the Medicare Fact Sheet 2016 as soon as it’s available!