The Expected is Still Unexpected

On July 28th, at 1:00 am in the morning my phone rang, it was the hospice nurse informing me that Mom had died at 12:28 a

Mom and her skydiving team – Frances, Jeff and Elizabeth

And yes, our hospice nurse had prepared us for this  . . . he said as nicely as he could that she was “leaving”, that “it was time”  . . . using gentle words to describe death.  Still, when the call came early Friday morning I wasn’t’t “prepared.”  Why?  Because no one ever is.

As you know if you’ve been reading my columns, the family had done all we could to prepare for death.  So the lesson learned was PREPLAN.  My brother and I had  hired a funeral home which allowed us to make our father the focus of our lives in the the immediate days after his partner of 63 years died. He insisted on seeing her one last time, my brother called the funeral home and they prepared her for Dad’s visit.  My father insisted on a small, familial memorial service — not a problem, we focused on the service and the reception after.  Caterers were hired, programs were printed and music abounded.

And yes, all this costs money but there was no “guilt money”.  We knew what we could spend and had done all the budgeting when hiring our funeral home.  In fact, we told the director that when Dad dies he wants his ashes placed in a military cemetery in Ft. Worth, TX – next to one of his best friends, our cousin General Akin,  “so they can pal around.”  The funeral home takes care of that, as well.

So, yes it all worked to our benefit.  Mom was cremated, some of her ashes placed in the ground at the nearby churchyard and the rest to be mixed with Dad’s when we take them to their final resting place.  What doesn’t go away, nor should it, is the grief.  it comes in waves.  At the service when I spoke I didn’t shed a tear.  Two days later, telling a ‘stranger’ the story, my eyes welled with tears.

Grief counselors tell you this is what happens.  I was shocked at myself, I knew Mom was close to death but when the finality happens it hits hard!  We even had time for last rites, last songs, last moments  . . . but death is final and no amount of preparation prepares you for it.

Revel in the memories, think of the good times and admire your loved ones for all they accomplished  . . . including you!  Yes, they do live on in our hearts.

Observations After a Disaster

If you haven’t seen the video of the residents of a nursing home in Houston, Texas sitting in waist high water simply search “video of seniors in waist high water” in your browser.   School children were evacuated, families were evacuated and who was left behind  . . . seniors.  Two weeks later, in the aftermath of Irma, 14 seniors die from overheating in a Broward County Nursing Home.

If these seniors had been children, the outcry would have been much louder and punishment swifter.  An excellent example is the most recent earthquake in Mexico.  The school that fell down on top of 24 children and four adults had rescuers there in minutes with TV crews transmitting  the entire search for more than three days.  I fear that would not be the case if this had been a home where senior citizens lived.

It is this dichotomy that led me and my partners to found Parent Your Parents (PYP)(parentyourparents.com).  How could anyone allow their “charge” to drown or die from overheating.   Yes, these Assisted Living Centers and Medicaid funded nursing homes are negligent but isn’t that also the case for the families who left them there?  Would they have ever done that to their children??

There is no criticism here — simply a look in the mirror.  If your parents or grandparents are in one of these homes today the chances are EXCELLENT that you will be as well. Yes, we can buy Long Term Care Insurance  but today’s policies don’t cover you for the duration of your life.  We are living longer and unless you have a minimum of $5 million there is a very good chance you will use all your money in the last five years of your life for healthcare.

As a child of an aging parent or loved one there comes a time and you must take charge.  It isn’t easy and it wasn’t easy for them when you were a cute kid begging for a kitty and they said no.  But, if it’s time – face it .

First, honestly asses where they are mentally and physically.  Discuss options with your siblings and present a united front — just like your parents did when you were a child.  You must have a Living Will, you must have a Power of Attorney – one for finance, one for medical.  You must go to the doctor with them and make certain they are receiving the best medical care.  The   doctors MUST know that you are on top of their health.   (Remember, I fired my parents doctor, see Article 2 – How to Get the Best Care Through Medicare),

Secondly — ask them what insurance they have  . . . is it life insurance, supplemental health insurance, burial policy, Long Term Care —- and, the most difficult question — what is their financial status?   None of this is easy but none of it takes financial acuity — it takes emotion, love, tenderness and hand holding.  Remember when you were a kid and your parents took you through some of life’s trials with the same skills?

Disasters like Irma, Maria and earthquakes bring out the best and the worst.  Now is the time to be the best.

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.

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.