Continuum of care

Continuum of Care

Home Health is designed to meet the needs of patients who are recovering from an illness or who have a chronic medical condition that requires the care of a nurse and/or a physical, occupational, or speech therapist. Diagnostic testing, wound care, therapy, and skilled nursing are Home Health Services. In most cases, Home Health patients are homebound. Home Health is generally a short-term service, designed to meet the needs of patients who have suffered an acute illness or injury or who have newly diagnosed health problems. Home Health patients covered by Medicare must be recertified by the physician every two months.

Home Health providers may also offer Home Health aides to provide additional services for clients on a short-term basis. Aides can provide supportive services, bathing and meal preparation, for example, that help ensure that the client is able to remain in his or her home.
Home Health may be funded by insurance companies, private payers, VA, Workers’ Compensation, Medicare, and Medicaid. Some long term care policies cover Home Health.
Home Health agencies in Georgia must have a Certificate of Need and a License from the Office of Regulatory Services.
Home Health agencies do not generally provide around-the-clock care.
A full list of Home Health Providers in Georgia and survey data appear on the Department of Human Resources website, www.ors.dhr.georgia.gov.
A Checklist for Choosing a Community Provider can help you know what questions to ask.

Private Home Care or Private Duty
Private Home Care providers may provide companions, personal care aides, and nurses to clients who require supportive services.

Companions: In Georgia, companions or sitters employed by a Private Home Care agency may provide light housekeeping, run errands, prepare meals, and monitor safety, but they may not perform hands-on care.
Personal Care Aide/Assistants: Most care delivered by Private Home Care agencies is provided by Personal Care Assistants, who may or may not be certified. Agencies are required to credential aides. Aides may provide companion services, personal care, and homemaker and errand services.
Skilled Nursing: Skilled nursing can also be provided by Private Home Care LPNs and RNs, if the agency is licensed to provide this service.
Private Home Care is primarily a private pay service, but some long-term care insurance will cover this level of care when provided through an agency. Other payers include Medicaid for persons enrolled in certain programs, including the Community Care Service Provider program (CCSP), SOURCE, the Independent Care Waiver Program (ICWP), and others. Some people with Workers’ Compensation injuries may qualify for Private Home Care. The Veterans Administration, www.va.gov, also offers limited personal care assistance. The Administration on Aging through the Area Agencies on Aging also makes some funds available to help offset the cost of care for a limited number of eligible people.
A full list of home care providers by community appears on the Department of Human Resources website at www.ors.dhr.georgia.gov.
A checklist for Choosing a Community Service Provider can help you know what questions to ask.

Chore and Homemaker Services
Some companies offer chore and homemaker services, though many families may privately employ or contract with individuals who can perform these duties.

In some instances, these services may be provided by Home Health or Private Home Care agencies as part of the overall care plan for the client.
Most chore and homemaker services are arranged by clients and families and are paid for privately. The Administration on Aging does have some funds to offset the costs for a very limited number of eligible people. The Area Agency on Aging has information about such services.
Housekeeping service agencies do not have to be licensed in Georgia, but customers may wish to check references and determine if the agency has insurance and a means of conducting employee and contractor background checks and drug screens.
If such services are offered by a Private Home Care agency, the agency must be licensed and use qualified staff.

A Checklist for Choosing a Community Service Provider can help you know what questions to ask.

Family Caregivers
The Rosalynn Carter Institute for Caregiving, www.rosalynncarter.org, is an excellent resource for family caregivers.

Same support organizations, like the Alzheimer’s Association, www.alz.org, do have limited funding for Respite Care (jump within this article) for family caregivers.
Medicaid programs, including SOURCE and the Community Care Service Provider programs, provide some funding for short-term Respite Care, when that care fosters continued community residence.
Area Agencies on Aging (jump within this article) can provide contact information for caregivers who need respite.
Support groups can also offer an opportunity to share experiences with other caregivers. Caregiver support groups include the following:

Family Caregiver Alliance – www.caregiver.org
National Alliance for Caregiving – www.caregiving.org
National Family Caregivers Association – www.nfcacares.org

Adult Day Services in Georgia

Adult Day Care
Although defined differently by different providers and different states, in many cases adult day care provides a basic level of support to older and disabled adults.

Services may include watchful oversight, meals, activities, and, in some cases, personal care, often called support for Activities of Daily Living.
Adult Day Care is generally paid for privately, but some areas of the state have centers that offer sliding scale payment and assistance with funding. Some centers are supported by Alzheimer’s organizations, other support groups, and church or civic groups.
Adult day care programs may be episodic and may be offered anywhere from a church to an Assisted Living facility.
The Administration on Aging provides some funding to Area Agencies on Aging for Respite Care at day care centers to give caregivers a break.

A Checklist for Choosing a Community Service Provider can help you know what questions to ask.

Adult Day Health
In Georgia, Adult Day Health includes all of the above services of Adult Day Care, along with nursing care.

Adult Day Health in most instances offers the same level of care that a Nursing Center might offer, that is, nursing, therapy, and activities, as well as personal care (bathing, grooming, toileting, etc.)
In Georgia, the rate of pay for Adult Day Health may be based on the level of services required.
Adult Day Health may be paid for by private payers, long term care insurance, and some Medicaid programs, including the Community Care Service Provider and SOURCE programs. Some Veterans Administration offices also provide funding for Adult Day Health programs.

General information about Adult Day Health programs may be available by calling your local Area Agency on Aging office. A Checklist for Choosing a Community Service Provider can help you know what questions to ask

Assisted Living

In Georgia, Assisted Living homes may be referred to as Personal Care Homes, Alternative Living, or Assisted Living. Assisted Living facilities must be licensed in Georgia. In general, they provide supportive living services, including personal care, often referred to as support for Activities of Daily Living. Nursing care is generally limited to oversight of services.

Most Assisted Living is funded by private pay.
While Medicaid does not currently pay for room and board at Assisted Living facilities, some people may be eligible for a personal care support allowance, which may make such care possible.
A full list of licensed Assisted Living Facilities appears on the Georgia Department of Human Resources website, www.ors.dhr.georgia.gov.

A Checklist for Choosing an Assisted Living Facility may help you know what questions to ask.

Nursing Centers / Skilled Nursing Facilities

Nursing Centers provide around-the-clock care to long-term and short-term care patients with an interdisciplinary team approach, including direct care givers, nurses, physical, occupational, and speech therapists, registered dietitians, and pharmacy consultants, with oversight by a Medical Director. Social service and activity programs are an integral part of care, and housekeeping and laundry services are available to all residents.

Nursing Centers are increasingly used for short-term rehabilitation following an acute illness, but these facilities also provide long-term care.
In Georgia, most Nursing Center stays are funded by Medicaid, although traditional Medicare will cover up to 100 days of skilled care in Medicare-certified facilities. Some Nursing Centers have contracts with the Veterans Administration and accept VA patients. There are also some facilities dedicated to the long-term care of veterans. Long-term care insurance may also cover a Nursing Center stay. Potential residents who have Medicare Advantage Plans should check with their plans to determine benefits, since each plan is different. Some short-term rehab stays are funded by insurance companies.
Some Nursing Centers specialize in an intermediate level of care for persons with mental health or developmental disability issues.
Hospice services are available in some Nursing Centers, but Hospice does not cover the costs of room and board.
A complete list of Nursing Centers and survey results for each can be found at www.ors.dhr.georgia.gov.
A Checklist for Choosing a Skilled Nursing Center may help you know what questions to ask.

Other good resources for Nursing Center information are the Georgia Heath Care Association at www.ghca.info and the American Association of Homes and Services for the Aging at www.aahsa.org. The government’s Medicare website, www.medicare.gov, also has much information about selecting a Nursing Center.

Respite Care

Respite Care is designed to give caregivers a break from their normal responsibilities. Care may be provided in the home by personal support aides or companions, at Adult Day Health Centers, and in some Assisted Living Facilities and Nursing Centers.

Most Respite Care is paid for privately.
Medicaid will pay for respite in-home or out-of-home if the provider has the appropriate Medicaid credentials and the person receiving the service is a member of one of the Medicaid programs that provides such services. VA also makes some respite funds available, as do some support groups like the Alzheimer’s Association. Some Area Agencies on Aging also have limited funds available to support Respite Care.
If the person who requires the care needs nursing, including medication administration, then you will need to look for a higher level of care than many respite agencies provide.

A Checklist for Choosing a Community Services Provider may help you know what questions to ask about Respite Care.

Independent Living

While there could be many definitions for Independent Living, in most cases, residents of a defined “neighborhood” pay a fee for access to certain services, which may or may not include security, meals or restaurant dining, housekeeping and laundry. Generally speaking, most people who reside in Independent Living Communities remain able to function on their own but enjoy the security of the neighborhood or campus.

Independent Living is nearly always privately funded.
The concept of “catered living” is relatively new. It refers to living independently while having access to a “concierge” who can make arrangements for needed services. Package arrangements may be purchased at a flat rate or services may be purchased from an “a la carte” menu at a somewhat higher rate. This concept is designed to appeal to higher income seniors.
Continuing Care Retirement Communities (CCRCs) often have an Independent Living Component.
Some government programs provide Case Management services for people who live in subsidized housing to help them access needed services. This is sometimes called “supported housing.”
Section 8, a federally-funded housing assistance program, provides vouchers to qualified low-income people who need rental assistance. This program is designed to foster independent living for those with incomes below 50% of their area’s median income. It is administered by the U.S. Department of Housing and Urban Development. The HUD website, www.hud.gov, provides information about properties that are available for rent or purchase and instructions on applying for vouchers.

Case Management / Care Management

Case Management services are those that help people navigate the system of health and social services.

Medicaid funds several types of Care Management services, including programs for mental health and mental retardation, programs for the elderly and disabled, and programs for children.
Recipients of some Medicaid Case Management services may have access to a variety of home and community services, which include meals, personal care, skilled care, adult day health, Assisted Living, and Respite Care.
The Community Care Service Provider Program is a Medicaid waiver program operated out of the Department of Human Resources. Recipients who have income above the SSI level may qualify for Medicaid services by paying for a portion of the services they receive. CCSP recipients must have a chronic disease and be eligible for Nursing Center placement to qualify for services. The Area Agency on Aging in your area accepts referrals for the Community Care Program.
The SOURCE program is a state plan service for Medicaid recipients on SSI who have chronic diseases and are at risk of Nursing Center placement. SOURCE’s hallmarks are physician involvement and intensive Case Management.

Disease Management

While Disease Management has traditionally been the function of the primary care provider, the health care system is increasingly seeing additional oversight for Disease Management provided by qualified nurses and other care providers. Many insurance companies, including managed care organizations, use Disease Management to help control the costs of the care for which they are paying and to improve the outcomes for the patient. Disease managers track utilization of health care services and medications, confer with primary care providers when there is a question about orders, and follow-up with patients to ensure that everyone is working together to control the chronic disease process.

In Georgia, SOURCE includes a Disease Management component in which the case manager works with the physician to ensure that evidence-based best practices are followed and with the client on self-management goals established by the primary care provider.
Georgia also has a contractor that provides Disease Management services to Medicaid-only (no Medicare coverage) recipients who are not covered by another program. Additional information about the state’s Disease Management program for the aged, blind, and disabled population is available though the Department of Community Health at www.dch.georgia.gov.
Recent growth in Medicare managed care provides another layer of Disease Management to dual eligible (Medicare-Medicaid) people.

For additional information about Disease Management options, you may call the Agency on Aging in your area.

Legal Services for Older Georgians

Legal Services are provided to elderly and disabled persons through the Area Agencies on Aging. According to the Department of Human Resources website, the Georgia Legal Services Program can provide the following services:

Document preparation (i.e., living wills, durable powers of attorney for health care, financial powers of attorney, etc.);
Legal information;
Legal counseling ;
Case representation; and
Legal education sessions to help older Georgians prevent more costly, time-consuming legal problems.”
Some funding may be provided through the Administration on Aging, but most Legal Services are privately funded. For further information about help with Legal Services, you may call the main office of the Georgia Legal Services Program at 1-800-498-9469 or the Pro Bono Project of the State Bar of Georgia at 1-800-334-6835. The Department of Human Resources website, www.dhr.georgia.gov, also has helpful information on legal assistance for older adults.

Financial Services

Some companies provide bill-paying and other Financial Services to clients.

Many CPA and bookkeeping companies provide this service for their elderly and/or disabled clients who are not able to manage their financial matters. Be sure that the agency is reputable and is bonded. Get references from others before turning over finances to an agency.
While most Financial Services are provided by family members, some are paid for privately. Private Home Care companies may offer bill-paying services if a special request is made by the client. The agency should be bonded or have theft insurance. It will also be important to have someone review the financial activities to make sure that the assistant is competent and honest.

Friendly Visitor and Telephone Checks

Some volunteer organizations, churches, and civic groups host organize “Friendly Visitor” or “telephone check-ins” for older adults and disabled persons. Chambers of Commerce, area ministerial associations, church senior groups, local senior services programs, or the Area Agency on Aging may provide contact information about available services. These services are generally provided by volunteers without charge.

Emergency Response Systems

Elderly and disabled persons who live alone or who have no one who can provide urgent care during certain hours of the day or night may appreciate the security of an Emergency Response or Medical Monitoring System. These systems are most often paid for privately, but some Medicaid waiver programs and SOURCE may make these available to their members, sometimes for a cost share.

Emergency response systems require a phone line. They will not work if the phone is in use.
The client pushes a button, which summons an operator who will direct the appropriate helper—a relative or neighbor, firefighter, ambulance, or law enforcement-- to the client’s home.
Good ERS companies update client information regularly and check to ensure that equipment is working.
ERS systems can reduce death and disability because help can be summoned rapidly.

A Checklist for Choosing a Community Service Provider may help you know what questions to ask about Emergency Response Systems.

Hospice

Hospice programs are designed to provide palliative or comfort care to persons who are at the end of life. Generally speaking, Hospice candidates are those who physicians believe have six months or fewer to live.

Hospice can be paid for by insurance, Veteran’s benefits, Medicare, Medicaid, or private payers.
Hospice is available in the community, in Nursing Centers, and in special inpatient Hospice units. Some Hospices also provide Respite Care when family caregivers need a break from their duties.
Hospice does not pay for room and board. It does pay for the full-range of nursing and aide services and for medical supplies and medications and treatments that are related to the terminal illness. Social services and the care of a chaplain and volunteers are also part of most Hospice programs.
Hospices are licensed in Georgia. A full list of Georgia Hospice organizations may be found on the Department of Human Resources website, www.ors.dhr.georgia.gov.
Several Hospice programs serve most counties in Georgia.

For general information about Hospice programs, you may call the Georgia Hospice and Palliative Care Organization at 1-877-924-6073 or refer to www.hospicefoundation.org. A Checklist for Choosing a Community Service Provider offers may provide help in knowing what questions to ask when you are selecting a Hospice agency.

Therapy

Therapy is a vital part of returning to good health and an improved quality of life. All Medicare-certified Nursing Centers offer Therapy, and Therapy is also available on an outpatient basis at independent agencies, hospitals, and from Home Health providers.

Types of Therapy
There are three general types of Therapy: physical, occupational, and speech-language pathology. For a person who has suffered a major stroke, all three specialties might be involved in helping the person maximize function, but for someone with a broken bone, only one type of Therapy might be involved. Physician’s orders are required for Therapy.

Physical therapists work with the large muscle groups to help increase mobility.
Occupational therapists concentrate on small muscle groups to help patients regain function.
Speech-language pathologists help people with speech issues and swallowing problems.

Understanding Therapy treatments
Medicare rules require that Therapy stop when the person is no longer making progress. When this happens, follow-up care can be provided in Nursing Centers by nurses and nursing assistants to ensure that function is maximized.

Payment for Therapy
Therapy can be paid for in the following ways:

Medicare will pay for a limited amount of Therapy, based on the annual Therapy cap established for that therapeutic discipline.
In outpatient settings for Medicaid-only patients, Medicaid will pay for Therapy services.
VA and private insurance will cover the cost of Therapy, but advance approval must be obtained.
Workers’ compensation insurance will generally cover Therapy related to the on-the-job injury.

Medication Management

For many older adults, medication management can be challenging. The first rule is to ensure that the primary care provider is aware of all medications, including those prescribed by other doctors. Compounding the difficulty of sorting out prescriptions and the cost is the implementation of Part D, which provides some cost savings for prescription drugs to Medicare recipients in certain income brackets.

Management of medication has become somewhat easier thanks to creative forms of packaging, which take the guesswork out of what to take when. Ask your pharmacist about options for packaging.
For people who have difficulty managing their medications, help may be available through Private Home Care agencies. Nurses can set up pill boxes on a regular basis and monitor the client’s ability to take medicine correctly. The cost of this care is inexpensive when one considers the cost of a dangerous drug interaction. Private Home Care can be paid for privately or through certain Medicaid programs, including Community Care and SOURCE)
Pharmacists can also be consulted to learn about drug interactions, including interactions from over-the-counter medicines and herbal supplements.
Contrary to what most people think, drug and alcohol abuse are common among the elderly, especially those who are isolated. Go to www.samhsa.gov for information about misuse of prescription drugs.

The website, www.ahrq.gov/consumer, has a video called “Tips for Taking Medicines Safely” as well as general information about medication management, prescription drug safety issues, and Part D. Medicare also provides prescription drug information at www.medicare.gov/AssistancePrograms/home.asp. The American Society of Consultant Pharmacists has an excellent, reader-friendly consumer section that provides much information on medication safety at http://www.ascp.com/consumers/tips/. Elder Care Pharmacy, www.eldercarepharmacy.org, also has helpful information.

Area Agencies on Aging: Contact Information

Northwest Georgia

800-759-2963 or 1-800-759-2963
Counties served: Bartow, Catoosa, Chattooga, Dade, Fannin, Floyd, Gilmer, Gordon, Murray, Paulding, Pickens, Polk, Walker, Whitfield

Legacy Link/Georgia Mountains

770-538-2650 or 1-800-845-5465
Counties served: Banks, Dawson, Forsyth, Franklin, Habersham, Hall, Hart, Lumpkin, Rabun, Stephens, Towns, Union, White

Atlanta Regional Commission

404-463-3333
Counties served: Cherokee, Clayton, Cobb, Dekalb, Douglas, Fayette, Fulton, Gwinnett, Henry, Rockdale

Southern Crescent

706-675-6721 or 1-866-854-5652
Counties served: Butts, Carroll, Coweta, Heard, Lamar, Meriwether, Pike, Spalding, Troup, Upson

Northeast Georgia

706-369-5650 or 1-800-474-7540
Counties served: Barrow, Clarke, Elbert, Greene, Jackson, Jasper, Madison, Morgan, Newton, Oconee, Oglethorpe, Walton

Lower Chattahoochee

706-256-2910 or 1-800-249-7468
Counties served: Chattahoochee, Clay, Crisp, Dooley, Harris, Macon, Marion, Muscogee, Quitman, Randolph, Schley, Stewart, Sumter, Talbot,
Taylor Webster

Middle Georgia

478-751-6489 or 1-888-548-1456
Counties served: Baldwin, Bibb, Crawford, Houston, Jones, Monroe, Peach, Pulaski, Putnam, Twiggs. Wilkinson

Central Savannah River

706-210-2029 or 1-888-922-4464
Counties served: Burke, Columbia, Glascock, Hancock, Jefferson, Jenkins, Lincoln, McDuffie, Richmond, Screven, Taliaferro, Warren, Washington, Wilkes

Heart of Georgia/Altamaha

1-888-367-9913
Counties served: Appling, Bleckley, Candler, Dodge, Emanual, Evans, Jeff Davis, Johnson, Laurens, Montgomery, Tattnall, Telfair, Toombs, Treutlen, Wayne, Wheeler, Wilcox

Southwest Georgia

229-432-1131 or 1-800-282-6612
Counties served: Baker, Calhoun, Colquitt, Decatur, Dougherty, Early, Grady, Lee, Miller, Mitchell, Seminole, Terrell, Thomas, Worth

Southeast Georgia

912-287-5888 or 1-888-732-4464
Counties served: Atkinson, Bacon, Ben Hill, Berrien, Brantley, Brooks, Charlton, Clinch, Coffee, Cook, Echols, Irwin, Lanier, Lowndes, Pierce, Tift, Turner, Ware

Coastal Georgia

912-264-7363 ext. 226 or 1-800-580-6860
Counties served: Bryan, Bulloch, Camden, Chatham, Effingham, Glynn, Liberty, Long, McIntosh

Home Delivered Meals/Congregate Meals

Many Georgians are able to remain in their homes, thanks to Home Delivered Meals. Congregate meals are also served at most county Senior Citizen Programs, but services are limited to the center’s capacity.

Home Delivered Meals may be arranged through multiple resources, but the first stop should be the local Senior Center or the Area Agency on Aging in your area for information about enrollment. A list of Senior Center meal programs is available at http://www.mealcall.org/meals-on-wheels/ga/index.htm.
Home Delivered Meals may be available to persons who need the service and are enrolled in the Community Care Service Provider or SOURCE programs. Most Home Delivered Meals programs will deliver to homebound self-pay clients, but for those who cannot pay the full cost of the meals, United Way, www.unitedway.org, and some private fund-raising resources help support these programs.
Meals come in a variety of formats, from hot to shelf-stable to frozen.

For more information about meal delivery or congregate meals in your area, call your local Senior Center or the Area Agency on Aging serving your home county. A Checklist for Choosing a Community Service Provider offers a helpful list of questions to ask.

Transportation

Being able to run errands, meet with friends, or go to church and social events are integral parts of most people’s lives. When a person is no longer able to drive, reliable transportation is a key factor in continuing community residence.

In more urban areas, many people count on taxis and buses, including special buses for people who have physical handicaps.
In Georgia, all Medicaid recipients have access to transportation to medical appointments, but a three-day notice is generally required unless the appointment is considered urgent.
The Department of Human Resources operates some van transport for people who participate in DHR programs and senior centers. In some areas, this service may be available to other area residents.
Some Georgia cities and counties participate in a Department of Transportation program that provides routine transport by appointment to elders and disabled people. This service does allow pick-up for non-medical appointments.
Most Private Home Care Agencies provide an errand service, but few companies allow the client to ride in the car with the caregiver.

Most Area Agencies on Aging can provide information about transportation resources in your community.

End of Life Care

The act of preparing an advance directive can be an act of consideration for worried loved ones facing difficult decisions. Knowing the type of care one would want when dying and what one would choose following death can remove the burden of decision-making from grieving family members.

Advance Directives
There are three important documents that individuals may wish to complete to provide guidance to physicians and family members about their decisions concerning end-of-life care.

Living Wills provide directions to medical professionals on the type of care a person would choose.

The best Living Wills are those that provide specific instructions for care, including whether the person would choose antibiotic care, hydration, or nutrition when he or she is terminally ill with no hope of recovery.
Directions on post-death care are also helpful, to include funeral and burial wishes and organ donation.

A Durable Power of Attorney for Health Care (DPAHC) is a document that allows a person to appoint someone (or more than one person) to speak on behalf of him or her if he or she is unable to speak.

Some experts recommend that a succession of persons be appointed as agents, in the event the first person is unable to serve. Others recommend appointing only one person to avoid conflicts, but many people choose several family members as co-agents. These are personal decisions and depend on each individual’s situation.
The person appointing an agent also has an obligation to discuss his or her wishes with the appointed agent or agents. The DPAHC is especially important for those without anyone authorized in Georgia law to speak for the person.
While a parent or a child or other close relatives may be able to discuss health care preferences with a doctor or other provider, a close friend or a niece or nephew would not be considered a person who can legally make a decision without a DPAHC.

A Do Not Resuscitate Order is intended to prevent medical professionals from performing cardiopulmonary resuscitation on a patient when such an action would have no meaningful or lasting benefit to the patient. For example, if a person is actively dying and CPR would not benefit the patient, then a DNR would be in effect.

Such an order would not be carried out for a person who, for example, had an accident or injury or heart attack, but who was otherwise healthy.
A doctor’s order is required for completion of a DNR. It is important to note that most CPR is futile.
Special rules apply for physician signatures for patients in Nursing Centers.
Keep in mind, too, that copies of Advance Directives must be available to health are providers if they are to be honored.

Georgia has recently combined all three documents into one easy-to-understand and complete Advance Directive available at http://www.gabar.org./public/docs/Form_GeorgiaAdvanceDirectiveforHealthCare.DOC.

Funerals, Burial, and Cremation

While many Americans choose traditional burial, Americans are increasingly choosing cremation for their remains. Part of the reason is cost. Funerals often cost $10,000 or more, and cremation services may be purchased for less than $1000. “Funerals: A Consumer Guide,” a publication of the General Services Administration, is available at http://www.pueblo.gsa.gov.

Veterans and their immediate family members may be buried in a national cemetery and provided a marker at no cost to the family.
Discussing funerals with your family prior to death helps family members honor your wishes.

Additional information is available at the Cremation Association of North America, www.cremationassociation.org and at Funeral Consumers Alliance, www.funerals.org.