Boring But Useful: Medicare/Medicaid – They Sound Alike But Are Very Different

BORING BUT USEFUL:

MEDICARE – MEDICAID — THEY SOUND ALIKE BUT ARE VERY DIFFERENT

Many of us think if we’re eligible for Medicare then we’re also eligible for Medicaid — although very few of us understand the difference.  I am going to attempt to explain that difference without putting you to sleep.

MEDICARE: Medicare is a federally funded insurance program for “seniors.”  It is available to all US citizens and green card holders from the age of 65 and higher.  There are two parts:  Part A (Hospital Coverage) and Part B (Medical Insurance).  If you choose a simple ‘medicare’ then you also have to choose doctors and hospitals that accept medicare.  (Please see my article, “Choosing Good Care Within the Medicare System”).   In 2017 the Part B premium average is $134 but if you have a higher income it can go as high as $600.00/month.   If you live on or close to your social security income it’s $109.00 on average.

For hospital insurance you usually pay a deductible — this can go into the thousands which is why many people choose to have a “supplemental” plan.  These plans are run by insurance companies and often are free — which is an HMO.  As you know, we at Parenting Your Parents, recommend PPO plans which is an out of pocket cost.

MEDICAID:  Medicaid is a state administered program with some funds coming from state taxes and other funds coming from federal Medicaid grants given to needy states.  (In other words, the poorer the state the more federal funds.)  The benefits are intended for low-income patients who cannot otherwise afford medical assistance.  To be eligible for Medicaid, you must meet a mandatory list of standards that are partially enforced by the federal government.

Again you must be a US Citizen or Green Card holder to be eligible.  For the purposes of seniors, they must be in a nursing home facility or receive “home or community-based care.”  Bottom line, a senior cannot have assets or income over the poverty level if they want to qualify for medicaid.

Here is the kicker – qualifying for Medicaid triggers a five year look back to ascertain that you (the senior or the child) have not recently transferred a home, bank account, and/or other assets  to avoid paying for nursing home care.  And this is the tricky part — when do you begin the asset transfer to children, a trust, and/or a power of attorney.  And that is where Parenting Your Parents is a resource.

This is a very tough subject.  In our experience  parents don’t want to give up control and the kids are the prime suspects, i.e. “they want to take our money away and use it for vacations!”  For the kids the hardest part is that one parent is going to go into a nursing home and you have to be prepared (unless you have more that $10 million in assets).

Bottom line — ask yourself — do you want these homes to get your money or do you want the money used for the greater good — whatever that might be.  Once that question is answered, you can move forward in either direction  . . . protecting your assets now or letting fate take her course.

Monitoring the Monitors – Assisted Living Centers

A visit with Dad at his Assisted Living Center

That dreaded phone call — the one where you don’t know the person at the other end of the line and he or she says, “we’re calling about your Mother.” In this case, Mother, suffering from dementia, had pulled the fire alarm and the locks on the “locked facility” had released. She walked out onto a busy street in Atlanta, GA and tried to flag down a car and escape. Luckily, a concerned motorist called the Police who called the facility. They walked two blocks and found my mother. Until that moment no one knew she was missing. That was a wake-up call.

Dementia does not mean stupid — it simply means that the mind is forgetting. Mother, a summa cum laude graduate of American University, wanted out! She took a look at her surroundings, saw the fire alarm and pulled the lever. The problem, as you can see, is that her “protectors” are not as smart. Needless to say, we moved her out and found another place for her to live. That was three years ago. Today, she has forgotten how to walk, cannot move her wheelchair and is no longer a flight risk.

If one of your family has dementia/alzhiemers it is incumbent upon you to visit the facility regularly — this alerts the staff and the person receives better care. It’s the old axiom — the squeaky wheel gets the oil. Mother is now in a Medicaid nursing home and we are more vigilant than ever. The stories we hear of horrible abuse might be rare and extreme but they’re true.  I check her legs, arms, feet, cut her nails and toenails because no one else does. Mom always has new scratches and I ask about each and every one. She can barely communicate so she is at the mercy of those who attend her.

Inform the nursing home of any issues verbally and follow up with a written document. I always email what I stated verbally.

Dad is in an assisted living facility. He has his wits about him and can communicate his needs to the staff. Still, we’ve had to watch the little things — are they washing his clothes on time, changing his sheets weekly, doing the deep cleans in his room and treating him with respect. As Dad has aged he has also lost motor skills, he is a fall risk and weaker – hence the heightened vigilance. If your parents live together this becomes much easier. They watch out for each other. However, this is an exception, not the rule.

In conclusion, the workers at these facilities care about their residents but are human. It really becomes an issue of time. In a nursing home each attendant has 16 to19 patients a day to bathe, dress and feed. The private-pay locations are more vigilant than the Medicaid nursing homes BUT they also have more employees and better paid employees. I do my best to be “understanding” but, at the end of the day, it’s my Mother and Father and no one messes with them!

The Airport Wheelchair – How to Navigate the System

THE AIRPORT WHEELCHAIR – HOW TO NAVIGATE THE SYSTEM

The other day, while running in Crandon Park, I came across my friend, Lilian, whose elderly Mom is in pretty good health.  Every year she and her Mother go to Santa Fe, New Mexico for mother-daughter time.  This means, she, like me, needs to utilize the wheelchair services provided at airports.  We’re both experts on the do’s and don’t’s and have compared notes.  So, although I’m writing the column, Lilian is a great source of research.  She, like many of us, is living it.

Eulan the wheelchair provider at Miami International Airport, has no competition — this means they don’t have to try  . . . and it shows.  When Dad first needed a wheelchair, I used to drop him off at Door #3, walk him in and sit him down in the wheelchair area.  I’d make sure his name was in the book with his flight time.  Then I would leave.  Big mistake — basically,  wheelchair dependent travelers are at the mercy of strangers.  It’s as if they are cows in a pen being led to slaughter.  OK, I exaggerate . . . but only a little!  Too many times,  a person is forgotten and are raced to the gate in a cart.  Think of how stressed you are when you might miss your flight and double that feeling for someone who has no control and elderly.

That’s not all, the Eulan workforce, i.e. the wheelchair drivers, are paid minimum wage and expect tips.  They don’t care about your family member, they want to transport as many people in the shortest amount of time and make money.  I remember one particular scene I created when the wheelchair driver left my father alone to retrieve other passengers from other TERMINALS (not gates)  to place them all in one cart!  This means Dad is sitting in a chair for 20 to 30 minutes.  Luckily, I was with him and that didn’t’ happen. BUT, it does happen and it happens more than it should

This is the system and although I don’t like it we must live in it.  Here are my suggestions:

Ensure that you have $5.00 bills, $10.00 bills and $20.00 bills in your pocket/wallet;

Get a pass from the airline to escort your loved on to his or her gate;

If you’re a member of the American Express Centurion Lounge or an airline club, have the wheelchair take your loved one there by wheelchair then arrange for a guest services cart to take him or her to the Gate at an appropriate time — these clubs specialize in customer service.  Whoever the driver is give him $10.00.

If you’re not a member of a club then escort the wheelchair and the attendant to the gate and tip the attendant well.  (I do it on length of transport – the more distant the gate the larger the tip with Gate 60 being $20.00.) Give your family member the $5.00 bill and tell the attendant that it’s for him after he takes the family member to the door of the airplane.  This is a little extra security — it mightn’t always work but it usually does.

For connecting flights in other airports stay with your family member.  They will take them off the plane and leave them in the wait area to go get more folks off the plane.  That’s when you pull out the $5.00 and tell them you have a connecting flight and need them now — ask them to call a peer to retrieve the other passengers.  When you arrive at the gate — another tip.

Yes, it costs money but its the best way to work within the system and have peace of mind.  If you have other suggestions please let me know.  If you can’t don’t have time to do this for your family members, call us at Parenting Your Parents — yes, a little more expensive but you still have peace of mind!

The Big Event – Travel Plans with Aging Parents

This occasion has been in the making for over a year . . . family is coming together and it’s a happy, happy occasion. The entire time your parents have been part of the plans . . . where they will sit, what they will wear . . . And now, it’s a month away and Mom is unable to travel because of her dementia and Dad a little weaker from a hospital stay. Often the kids make the decision — they cannot come. But wait, why not??

Again, we as the children have to ask the question, is it because we don’t want to be bothered or is it because Dad simply cannot handle the travel? Our company says: ask Dad! If he says yes, here are a few suggestions:

You want to avoid having your parent travel alone. We say, hire a traveling babysitter. Depending on your parents health, the person can be hired for both or one.

Why a babysitter? First, the airport mania is overwhelming. There are wheelchairs available but someone must supervise the attendant. I’ve seen seniors left by themselves while the attendant goes to pick up more passengers to fill up a terminal bus. That is not how my parent is going to be treated and nor should yours.

Secondly, the airplane ride. Will they need help getting to the restroom? Are they in an aisle seat where it’s easy to get up and down? What about getting those headphones in the ears so the show can be watched?

Thirdly, landing. Yes, the airline will have the wheelchair waiting but it’s a strange airport with all the chaos of any large meeting space. The babysitter adds calm to the chaos and supervision to the wheelchair attendants.

Lastly, the party! No one family member wants to go to take Dad to his room and skip the rest of the party. Nor is it fair to have a family member in charge of dinner, getting the elderly to their table . . . etc. Think of how much you’ve already spent on this party. What’s a few more dollars if it means your parents/grandparents can be in the photo? The memories last you a lifetime.

So yes, there are options. The babysitter costs money but helps to prevent resentment. At Parenting Your Parents that’s what we do — make certain that your family event is a family event with minimum trauma.

The Search Begins – First Steps for Choosing An Assisted Living Center

You walk into the lobby and take a deep breath. How did you get here? Why is this necessary? How did my very competent ‘elders’ all of a sudden need assistance living? Other questions pop into your head, will they be happy here? Will they be fed well? Will they like the people here? Whether you’re 40 years old or 80 years old — these are real moments. Change is coming and it seems to be screaming down the train track right at you. Do you jump or simply lie down? Before you decide ask:

  1. Do the elders want to live near family or friends? If both are in the same location the question is moot. Otherwise, this question comes first. It’s not about YOU as the child it’s about your parent’s quality of life. We all think Mom and Dad should be close to us, family, but that’s not necessarily what THEY want. If they have a life in a separate location and want to stay, keep them there. Today, with UBER and LYFT the ability to drive is not a necessity.
  2. What is your budget for a senior care center? Certainly this makes a small difference in the food or housing (food and maintenance are fairly comparable) but the big difference is location. You ask yourself — how long will it take to get them to their synagogue or church? How far is it to their favorite restaurant? What other bills will need to be paid?
  3. How much money is there? Can Mom and Dad afford this on their own or are will the kids have to assist financially? What other sources of monies can be tapped? Are there VA benefits? Widow/widower benefits? Can social security disability come into play?
  4. Can this facility be trusted? We’ve all heard those horror stories of badly treated seniors and none of us want that happening to our parents. There are many resources and most of them are online. You can look up assisted living centers and many will pop up — most with ratings right next to the name. There is also AARP ratings, YELP ratings and Facebook.

Bottom line: You will have to do some searching — online and in person Peace of mind is what you want in any location. As the children you want your parents well treated — as the residents you, too, want options in food, activities and people. The most important aspect of this is that you and your parents feel comfortable and secure.

Our company, Parenting Your Parents takes no fees from assisted living centers. Our concern is you and we want the option of defending you against them — which can sometimes happen.

The Emotional Toll

NOTHING prepares you for your parents aging. Our company can assist with the financial scams and pitfalls but you’re the one who has to watch Mom, Dad, Grandma or Grandad age and weaken. It’s heart wrenching! I write this column as a daughter who has a demented mother (87) and a weakened , non-driving father (93).

Mother is in a nursing home. This nursing home has an excellent reputation and a low employee turn over rate but it’s still one of those places where the halls are filled with moaning people in wheelchairs or portable beds.

This home charges close to $7000.00 a month but accepts medicaid. This means we had to impoverish Mom. By “impoverish” I mean I had to do the paperwork to make her medicaid eligible. We now pay a little over $700.00 a month. I do not have the words to detail the pain . . .humiliation that I felt in using my legal education to make my mother poor enough so she could live with other poor people in her old age. This is not what she wanted nor is it what we wanted. However, Dad is lucid, Mother is not — we couldn’t afford both and neither could they.

Each time I visit Mom I cut her nails, take off the old nail polish, pay for a weekly hairdresser. rub Lubriderm on her skin and place vaseline on her lips. It kills me to leave her although I know in five minutes she won’t remember I was there.. But, there is a silver lining, Mom and I were oil and water as I grew up. We simply didn’t get along. Today however, it gives me great joy to minister unto her — to do little things that allow her to feel special and loved. She always has tears in her eyes when I say goodby and so do I BUT (and this is important) I know when she dies I’ll have done all I can. For that I’m grateful.

I am a “Daddy’s Girl” so watching him weaken is difficult. On one hand I’m so grateful that he has a quality of life that allows him to live alone in an assisted living facility but I still have to cut his nails, hire a barber, and cajole him to use his walker. I accompany him to the 3:30pm weekly Happy Hour when I’m in town but I see his failure to thrive. Who can blame him? He lives in place with lots of old people all of whom are simply trying to get through the day. I know Dad is ready to leave us — I don’t want him to but I know he’s tired of growing old.

And let me end this column by stating that as hard as it has been for me I am once removed. My father chose to live in Atlanta where my brother and his family reside and Matt has had to deal with the day to day. Matt is more stoic but he’s also the baby of the family — and this is a true role reversal for him. He does a phenomenal job and I’m grateful.

To make it a bit more personal I’ve added a photo of Mom and Dad before dementia took hold and we had to take over.

mom and dad
H. Frances Reaves’ Mother and Father

Hospital to Rehab – The Great Medicare Scam

 

 

You have phones in hospitals — don’t be afraid to use them.

This is one of my all time favorites — the “Hospital to Rehab” scam. Here’s how it works:

A medicare, assisted living center client needs to go to the hospital . . . usually dehydration, a urinary tract infection or some “non-death” reason. The person is transported to a hospital ER and the battery of tests begins. (For purposes of this hypothetical it’s the second time the patient has come to the ER because to get paid the hospital MUST admit them.)

The elderly patient becomes totally disoriented (happens 90% of the time in the over 80 crowd — only 80% in the over 75 crowd!). Think about it, strangers come in at all hours of the day and night, sticking needles in your arm, taking blood pressure and sleep is constantly interrupted. Time is indistinguishable. Once again, the elderly have no control and in many cases become combative because they don’t want to be there and no one explains what is going on. Medication is given to calm them down — the heavy sedative. Usually security is in the room to assist. Imagine how it must feel to be held down and given a shot. It gets better — the patient becomes woozier — powerful sedatives plus loss of control . . .

Next step, an alarm is added in case you get out of bed (like to go to the bathroom) so this very loud noise adds to the alarm and loss of control. Bottom line, you end up laying in bed, woozy, scared and not understanding who you are or where you are. Then — boom — the diagnosis, a UTI! OK, one day of treatment (antibiotics) and you can go home! NOT SO FAST! You’re weak, you need physical therapy, the drugs are not through your body . . . a myriad of excuses as to why you must go to rehab.

[An aside here, once the insurance company approves physical therapy they will pay for ALOT of sessions. Hence, these rehab centers love physical therapy patients. Most of them are also medicaid nursing homes.]

Oops — Bad news —- you can be discharged on Saturday but the rehab doesn’t take transfers on the week-end because they don’t pay people to do the paperwork on Saturday and Sunday. Now we offer to pay for a private physical therapist to come to the assisted living center and work with the patient in his/her home. Nope — can’t do that either because the hospital will only discharge you Against Medical Advice (AMA). Medicare doesn’t’ pay AMA claims.

Bottom line, the elderly patient has to stay in the hospital for two extra unnecessary days before rehab will admit him. There is a five day minimum and now a UTI is a 13 day hospital stay! Who wouldn’t be stark raving mad!?!

Hospitals – How to Manage Your Loved One’s Care in the Hospital

HOSPITALS — once synonymous with a place to go when you’re REALLY sick is now the last place you want to be unless it’s prescheduled surgery with a doctor you trust. If you’re elderly and/or on Medicare you are treated as a money machine — not a person.

Here’s how it works . . . depending on how sick you are is how quickly you’re seen. If you have an HMO or PPO assigned to your Medicare plan then everything is a predetermined price. If you only have a medicare card then the patient becomes an ATM. This means that the nurses and techs will run as many tests as reasonably possible (that insurance will pay). The Doctor will review the chart for a “diagnosis” which, in my experience, is usually “inconclusive.”

The first time you go to the ER they will probably let you go home after the inconclusive tests BUT should you go back within 72 hours the hospital will admit you. This is because the insurance companies won’t pay for a second ER visit without a diagnosis and admittance.

Now, here’s what is very important — you cannot let your elderly Mom, Dad and/or relative stay in the Emergency Room by themselves. Here’s why — the administration will have them sign consent forms for numerous tests that do nothing except take up time. Secondly, the treat them horribly! Here is my story:

I took my 90+ Dad to his HMO doc. He was having balance issues with other symptoms that portend a stroke. We rush to the ER and sit in highly uncomfortable chairs with all types of sick people. After approximately 2 hours they call Dad into a “room.” The medical techs hook him up to a glucose drip and leave the room. For the next 3 hours he is taken from one machine to another for test after test. Because my Father is elderly he meekly goes where he’s told. At the end of this interminable afternoon we receive an “inconclusive diagnosis” and he is allowed to go home.

Two nights later the same symptoms occur — my brother calls 911 and Dad is whisked off to the hospital. I get home in time to follow the ambulance to the same hospital where we’d spent the afternoon. I stay with my Father — they finally move him to an ER room and begin to do THE EXACT SAME TESTS they do 48 hours earlier. I question every one. It is now 1 am in the morning — I find blankets and sleep on the floor next to Dad’s bed because they are going admit him. Remember, if they don’t admit him the hospital won’t be paid. In every case, with every test, the results were the same as the ones 48 hours earlier BUT now the diagnosis is not inconclusive . . . it’s we need more tests and observation. After two days they allowed him to leave with the diagnosis of dehydration! (You knew that if you read my last column.)

Bottom line, if you have an elderly parent or grandparent do not trust the hospital. When either of my parents stay in the hospital overnight we hire a “babysitter”. Yes, it costs money but your loved one doesn’t wake up to an empty room trying to figure out where he or she is. Further, I check the chart constantly to see what is written by the medical professionals.

Next week: From Hospitals to Rehab — another money machine created by insurance companies.

The Long Term Care Insurance Dilemma

Long Term Care Insurance (LTC) is, without a doubt, the most complicated to collect. This is intentional — they do not want to give up any of the money you have been paying them for the past 20 or 30 years.

First, the company hopes you die before you collect. Often the children don’t know their parents have the policy and find it in their belongings after death. The other big mistake is that the seniors or their children call the company assuming there will be assistance . The companies have a name for this group: customer service (an oxymoron). No one in customer service has your best interests at heart. Every person you deal with will give you a different answer and, remember, this is after 45 minutes (minimum) of holding.

Here’s how it works, the parent must have lost 2 of the 7 Adult Daily Living (ADL) activities (place a link listing ADLs). 2 that are common are loss of balance and incontinence. At this point, you call, state you’re unable to perform 2 ADLs and the company will open a claim. Next you have to prove your claim which means that a “nice person” (NOT) from the insurance company comes to ask you questions and asses whether you “really need” LTC. If you’re denied there is an appeal process and it’s cumbersome. If you are approved there is a 90 to 100 day waiting period in which the family has to pay for the treatment. The insurance company will never reimburse you for this and it is not cheap.

You’ve now done the “waiting” period . . . in so doing you have wasted hours finding a care provider, documenting the care and overseeing who they sent. Now, it’s time to collect! Well, LTC doesn’t’ pay until after the treatment is rendered — so the waiting period is actually 130 days (131 if it’s the wrong month). Then there are all the reasons they cannot send you the payment and, no, they don’t accept emails, only regular mail or fax. Every phone call is sent to Bangladesh or the Philippines where the English is difficult to understand and on and on and on. The most appalling part is when they quit paying without notice because they miscounted the days or money or . . . does it matter??? Our company has collected monies for our clients from these insurance companies because of this error — in one case $15,000.

Bottom line – LTC is a must but like every insurance company it must be monitored! These companies do not care about old people or sick people, they care about the bottom line.

And now . . . onto emergency rooms and hospitals.

Choosing Good Care Within the Medicare System

When I think of an insurance scams I think of companies who profess to assist in “sex addiction” (whose not addicted to sex?), eating disorders (really — Karen Carpenter still died and Oprah is still overweight) or exhaustion (who isn’t?) But, now that I work with families in assisting their elderly parents/grandparents I find the true insurance scam is against seniors.

First, medicare supplement insurance companies — and, some are the largest insurance companies in the United States. I have a client couple, the Smiths. Mr. & Mrs. Smith have two very different needs as seniors. Mrs. Smith has dementia and lives in a nursing home. Mr. Smith, the elder of the two, lives in an assisted living center. When I met them they had the same doctor and the same medicare supplement plan. The physician who cared for them through their plan would speak loudly to Mrs. Smith and give her more medication to subdue her. If Mr. Smith had an ailment that she couldn’t’t check off in the supplement insurance form he was sent to the emergency room for diagnosis. In one three day period, Mr. Smith went to the emergency room twice (Not the “nice” advertised ER —the one for medicaid and medicare recipients). After they second stay they kept him overnight (it’s the only way medicare will pay for the second ER visit) and diagnosed him with . . . ready for it . . . dehydration. Because insurance companies need to make money from medicare they find the least competent doctors, who in turn check as many boxes as possible to refer out to other medical practitioners so everyone makes more money.

My first recommendation was to have two separate policies and pay the $25.00 a month for a PPO. The health care improved but the insurance company did not. As part of our services we monitor the monthly billing. To date, we have had to call the insurance company more often than not for over-billing or wrongful billing.

Bottom line, you cannot expect an elderly person to actually understand insurance bills. Besides a “bill” in which money is owed there are also the more confusing documents titled, “This Is Not A Bill.” The insurance companies actually make millions from wrongful billing because who has the time to decipher the bill? Or to call and hold a minimum of 45 minutes with “customer service”(an oxymoron). Then when the representative speaks he/she does not know the answer which means you hold and hold and hold to speak to the supervisor who’s not available so can you hold . . .

My way of thinking is that maybe it’s easier to call yourself a sex addict, a food addict or exhausted — at least those companies know which box to check and someone makes money! Our seniors, who have added value to our country and society, certainly aren’t getting their fair share. And, if you think these insurance companies are bad . . . wait until we discuss the Long Term Care Insurance Scam!