Thursday, October 08, 2009

Jumping the Hurdles of Health Care For the Elderly

Today, I share some of my learning experiences of the past few weeks in the hopes that you don't have to cross these hurdles someday with your aging relatives. You will have planned ahead.

1. The elderly are eligible for Medicare once they reach age 62. This coverage does NOT cover all medically related expenses. Oh, and if you receive Medicare and are offered the opportunity to go to a PPO or Managed Care Option? DO YOUR RESEARCH FIRST!

Some of the crappier companies will sway the elderly into signing up for their plans by inviting them to a free presentation, give them a meal and a couple of cheap items with the plan's name on it (like pens, credit card holders or refrigerator magnets) and the gullible will think "they are so NICE, they fed me, therefore they must care." No, they don't. Such is the case with my in laws. (They're sweet people, but savvy, they are not.)

A good rule of thumb: if it's a big name and you've heard of them before (United Healthcare, US Healthcare, Principal, etc), then they're backed by a large consumer base and offer good benefits. If it's a name you've never heard of before, for the love of all that is holy, do as much research as you can before signing up.

Don't be swayed by how low (or nonexistent) the premium is. Look at how much you'll shell out for prescriptions, how long they will cover rehabilitative nursing care, and out of network doctors or facilities.

2. Make a plan, have a plan and WORK the plan. What this means is BEFORE you get sick, have a living will, durable power of attorney, living trust, and all legal paperwork filed. It is a LOT cheaper for you when you're not scrambling around like a madman to get a guardianship because the patient is deemed not mentally competent. We're talking six thousand dollars cheaper.

Thankfully, we got a durable power of attorney, but on Monday morning, it really looked like we would be spending six grand to go to court for a guardianship.

3. Think about who is the best person to advocate on your behalf and ask them if they are willing to do this job before you're in a position that they are doing it. What this means is don't pick your daughter because she lives in the house with you, pick the person who gets stuff done. Pick the person who will breathe fire on the powers that be if they are not acting in your best interests. Pick the person who will work relentlessly on your behalf. Sometimes, this isn't a family member, but a good friend. Leave other people's feelings out of the decision-you have to pick the person who will do everything they can for YOU.

4. Make plans and prepare that you or your loved one WILL go into a nursing home and budget accordingly. No one wants to go that route, but having that fall back makes it easier to choose a placement. To not do so limits where someone can go if the worst happens and your parent/loved one can't walk, talk or otherwise care for themselves and you can't do it yourself.


5. Be prepared that you will have to be nasty to people to get things done properly.

6. Know that if your loved one is being released from care and you feel the situation is unsafe, you can appeal to Medicare AND refuse the release to home. If Medicare denies the appeal, the patient will be liable for hospital bills, but this is an avenue to use if someone lives alone and cannot care for themselves while you seek a suitable placement.

7. Nursing homes have waiting lists. Really good nursing homes won't even accept names, because their waiting lists are too long. Good ones are out there, but you will be doing a lot of leg work to ensure the one you choose is a good one. Never choose a nursing home sight unseen. Names are no indicator of how good the home will be.

8. You can apply for Medicaid to cover skilled nursing care, but it takes between 30 and 90 days to get a decision. Many nursing homes will take a patient in while awaiting approval and take the retroactive payment.

There are so many things we've learned, and several things have been accomplished, but I'm on hurdle two in the Elder Care 800m hurdles. We have a potential placement that both Jane and I liked. Now I have to fire Mom's lousy Medicare PPO, complete the Medicaid application, drop off a copy of the PoA to the hospital, drop off the letter to the lawyer modifying the PoA and do a few dozen other things before I can breathe.

Oh, and if you're a lying, crappy, hospital social worker? Know that I will call you on your lie and report you to the hospital administrator, the state Ombudsman and to HIPPA for violating their law. If you backpedal later, it won't change the fact that you violated the law and there were a few witnesses to this who can and will testify to what you said. And being sweet to me after I tell you off? That won't get you off the hook, either.

Once we get all that taken care of, we get to the matter of sorting and getting rid of all the stuff that has accumulated in the house that neither one of them will be taking with them. I guess it's a good thing I don't have a full time job, because it looks like this will be it for a while...




2 People talked back:

DoeWDW said...

I haven't been around as much as I'd like but just got caught up. Wow, you sure are dealing with a lot. You seem to be doing what you do well - learning at the speed of light, analyzing the options, and making logical decisions (even the hard ones that others are loathe to make).

There's a light at the end of this tunnel - hang in there!
- Doreen in PA

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