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.

Nursing Homes – Often the End Game

I am confident most of you heard the news about the eight seniors who died from overheating.  They were all in a licensed “nursing home” in Hollywood Hills.   ‘Nursing Home’ is a euphemism for a home for seniors who are at the poverty level and qualify for medicaid.

Nursing homes are like every other industry — they have to make money to survive.  In the case of nursing homes they’re paid by the state medicaid fund and it’s per pa

The nursing home visit

tient.  This fund is made up of state and federal dollars.  Obama Care expanded medicaid in the states who took the federal dollars but Florida is not one of them.

Bottom line, these are not the luxurious environments for either staff or residents.  In my parents case, Mom had been in a lovely residential facility where she was one of three or four people.  Her Long Term Care Insurance paid for it.  She outlived her two year policy and we had to place her in a Nursing Home.  It was our only realistic option as Mom’s care in an Alzheimer’s facility would be close to $7000,00 a month.  Mom and Dad couldn’t afford it and neither could the children.

In pursuit of the best we could find, I  went to several nursing homes and learned more than I needed to know.  All these homes are very austere and it’s a shock!  Bare floors, usually

formica, and waiting rooms with plastic chairs.  Almost all the receptionists were behind a barrier — some better designed than others.

The patient population is made up of mostly Alzheimers and Dementia sufferers.  All the residents are in a wheel chair, a portable bed or never moved from their beds.

Another surprise, the aides often use pulleys attached to patients to change their clothes, move them to the shower or simply change their diapers.  Depending on the home, these medical aides must change and clean about 19 patients each.  Some work in tandem others work solo — it all depends on the chore.

Further, most patients are only bathed twice a week, maximum three times a week.  During one of these showers their hair is washed.  Bottom line, it’s not how we envision our last days, weeks, months or years of life.

On the good side, the ‘better nursing homes’ have excellent care.  They hire a team of Geriatric Doctors that include Psychiatrists.  These Geriatric groups come to the Nursing Home through a PPO and the doctors physically visit once a month.  There is usually a Podiatrist group that also visits once a month (Medicare pays for podiatry services) and a dentist who comes once a quarter. The day to day care is with the Registered Nurses (RNs), Licensed Professional Nurses (LPNs), physical therapists and medical technicians.  They also have a contracted Hospice service.

Here are some tips when you need to look for a nursing home:

What is the turn-over rate of its employees

Needless to say, the less turnover the better the place.  If the staff is not leaving then something is going well — usually their paid above average wages

Is there a hair salon

If there is a hair salon then there’s a market for it.  This means the residents take pride in how they look.  People who take pride in themselves care about their environment.

Is it clean

As we all know, cleanliness is godliness

Is there a smell

Again, if it smells that means it’s really not clean – no matter how good it looks

Is there a smile on the faces of the staff

A smiling staff means a happy staff

Again, hopefully it doesn’t come to this but if it does, know how to choose the best one.

Tough Love – Parenting Your Parents

It’s not easy to parent your parents — it’s not a pleasant role — it means Mom, Dad or both are getting weaker and none of us want to admit the role reversal has begun.

When I consult with clients I hear time and time again — Mom doesn’t want to leave her home, Dad is not going to allow any one else to pay his bills,  There is no need to force anyone — the name of the game is to persuade in an assertive, caring and respectful manner.  For their sakes and yours, embrace the role!

After Mother’s decline into Alzhiemers, my brother and I were thrown into the role reversal with little or no direction.  Here’s what we learned:

Accept Your Role. No one else can do it with your love so embrace it and consider it an honor.  But for them, you wouldn’t’t be here.

Be Assertive.  Yes, at times you will have to tell Mom or Dad (or both) what to do.  Of course Mom doesn’t’t want to move from her home — you have to tell her (gently and politely) that she must.  You explain the reasons, answer her questions and, as she did with you, persuade her that “this’ is the best way.

Pay Attention to the Basics.  Are your parents showering regularly?  Are they having regular meals?  Are they taking their medication on a timely basis?  If not, see above — it’s time to be assertive and decide how best to move them forward.

Insist.  Or, if you prefer, be firm.  When your parents resist keeping on insisting.  “Dad, we have to do this, we’ve gone over it a million times – let’s not fight about it.”  Again, no yelling or shoving – just gently insist.

Prepare all the financial and legal documents.  Taking the helm of your parent’s finances is a daunting but necessary task.  Make yourself, or your sibling, a signer on their checking accounts then have them sign a Power of Attorney for both financial and medical decisions. This must be done before they lose their mental capacity.  If you don’t do this it will be much more difficult and costly when they lose their ability to make decisions.

At the end of the day, here is what you have to remember – when it comes to parenting your parents you have three choices:

  • You care for your parents yourself
  • You hire someone to care for your parents
  • You allow them to enter a Medicaid facility

These alternatives all have pluses and minuses.  Most of the decisions are based on finances and nothing and no-one is perfect so after you’ve been assertive, and insistent forgive yourself – your parents did!

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.

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.

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!