AGING ICON

What are your options when you run out of money?

“My mom is running out of money in the assisted living, hospital or rehab, so she will have to go on Medicaid and live in a nursing home.”  I have heard  these words so many times, I can’t count them.

On most of these occasions, my role is to help the family make the decision to accept hospice for their loved one because they have waited so long, hoping the patient was going to get well and go home.  But recently, I found a large gap between what the system has to offer in between independent living and the nursing home.  A lot has to do with licensing and advertising.

In this case, the client was suffering from moderate dementia, she used a walker but had no other medical complications. Her heart was healthy and she didn’t have diabetes or COPD. She was living in a private residence for seniors, but not a licensed assisted living according to state law and therefore not covered by Medicaid. However, everyone assumed that because the residence offered room and board and everyone there used either a walker or a wheelchair, that this was an Assisted Living Facility.  In fact, they were advertised on many web sites under the heading Assisted Living Facility. I don’t think this was the fault of the residence. There is simply no distinction on these websites between those that qualify for Medicaid and those that are private. It is up to the family to shop around.

The cost of the stay at most private residences is about $5000 a month, including assistance from a licensed home care agency that provided help with bathing, dressing and medication. Sometimes the bill can be as much as $7000 including Cable TV and other utility bills and personal services such as hair cuts and toe nail clipping. If the patient does not have diabetes, toe nail clipping is not covered under Medicare.

I was called in to help with the Medicaid application, pending the move from the independent residence to the nursing home. The financial paperwork had been with the nursing home for months.  Since the nursing home accepted that I would be able to help the patient qualify for Medicaid, we were asked to speak to the admissions nurse to get a move in date. That’s when we found out that the patient did not medically qualify for admission to the nursing home, as she was able to perform most physical activities of daily living with a minimum of supervision. Even though she was not mentally able to live on her own, dementia is not considered a reason to confine a patient to a nursing home level of care.  We realized that it would even be cruel to condemn the woman to a life of laying in bed or sitting in a wheelchair, just because her memory wasn’t what it used to be.

Now, here is where the gap in the system showed itself. No one could point me to where the client could find the level of care she needed that would be covered by Medicaid. The nursing home staff suggested someone might be able to take her into their home.  Since the woman did not have any family, I was pointed to unlicensed homeowners who will take a persons social security check in exchange for room and board. I couldn’t accept that in all good conscience, so I pulled out my trusty SUN-B Directory. There I found Fred Altman, who I remembered is like a real estate agent for senior residences. He said there was only one place in about a 50 mile radius that would be appropriate.

As it turns out, the facility is licensed as an Adult Home and so can accept Medicaid, when the resident is in need of a higher level of assistance with activities of daily living, but not ready for a nursing home. The kicker here is that since the facility is set up to treat people requiring this higher level of care, many services that this client needs are included in the basic rent.  Medication Management, assistance with bathing and dressing, making sure the resident gets to meals and activities are all covered. For this client, it meant that she would not even need to qualify for Medicaid as she had sufficient income to pay for her monthly expenses.

This was a very good ending to a story that could have gone another way. The person could have been made homeless without the intervention of the people at the original Senior Residence, who called the alarm early enough for something to be done. The woman could have been pushed into an inappropriate setting if the Nursing Home hadn’t been ethical about her qualifications.  Or the Adult Home could have been full, as I am sure they will be soon, as more and more people live longer, but just need a little help.

by Caryn Isaacs, Patient Advocate http://gethealthhelp.com

Resources: Senior Umbrella Network of Brooklyn http://sunb.org ;

Fred Altman, http://www.ElderCareAdviceInc.com;

August 17, 2012 Posted by Aging Icon | Uncategorized | Leave a comment

I usually don’t copy, but this is a must read article!

Where ‘Socialized Medicine’ Has a U.S. Foothold
By UWE E. REINHARDT

Doug Mills/The New York Times The Olympics’ opening ceremony included a tribute to Britain’s National Health Service, which American critics often depict as a failure of “socialized medicine.”

Uwe E. Reinhardt is an economics professor at Princeton. He has some financial interests in the health care field.

Last Friday’s exuberant celebration of Britain’s National Health Service during the opening ceremony for the 2012 Olympics, directed by the Oscar-winning filmmaker Danny Boyle, got me thinking about American attitudes about socialized medicine.

Today’s Economist
Perspectives from expert contributors.
As might be expected, the event elicited a few tut-tuts from Conservative members of Parliament, and more stern rebukes from the commentariat in the United States, most vehemently by Rush Limbaugh.

Bashing the N.H.S. has become a favorite ritual during any debate on health care reform on this side of the Atlantic. As the disgraceful treatment of Dr. Donald Berwick, former administrator of the Centers for Medicare and Medicare Services, illustrates, any American remarking positively on the N.H.S. runs the risk of being declared unfit to serve in government and vehemently attacked in the blogosphere.

The most humorous illustration of American N.H.S.-bashing was supplied during the heated health reform discussions in 2009 by Investor’s Business Daily. In an editorial, the paper asserted, “People such as scientist Stephen Hawking wouldn’t have a chance in the U.K., where the National Health Service would say the quality of life of this brilliant man, because of his physical handicaps, is essentially worthless.”

Dr. Hawking, who has lived and worked in Britain all of his life, responded: “I wouldn’t be here today if it were not for the N.H.S. I have received a large amount of high-quality treatment without which I would not have survived.”

Eventually, Prof. Ara Darzi, a former minister of health, head of surgery at Imperial College in London and Britain’s ambassador for health and life sciences, and Tom Kibasi of McKinsey & Company, an honorary lecturer at Imperial College, gently lectured American readers on this amusing episode and on the actual modus operandi of the N.H.S. The episode also opened a lively and sometimes bemused blog traffic in Britain.

Although I personally have never advocated adopting an N.H.S.-style approach to health reform in the United States, I have been puzzled for decades by the almost instinctive habit among many Americans of incessantly running down every other country’s approach to health care and health insurance.

Is this habit born of the deep-seated insecurity that might naturally arise from the cognitive dissonance of boasting “ours is the best health system in the world,” all the while beholding daily the travails and hand-wringing over the sometimes glaring shortcomings of the American health care system?

I have found that one effective way I can stop N.H.S.-bashing dead in its track is to ask bashers this simple question: “Why don’t you like my son?” I posed that question to a congressman who had berated “socialized medicine” during a hearing on health insurance reform at which I testified.

In response to the stunned look this question invariably elicits, I go on: ”You see, our son is a retired captain of the U.S. Marine Corps. He is an American veteran. Remarkably, Americans of all political stripes have long reserved for our veterans the purest form of socialized medicine, the vast health system operated by the U.S. Department of Veterans Affairs (generally known as the V.A. health system). If socialized medicine is as bad as so many on this side of the Atlantic claim, why have both political parties ruling this land deemed socialized medicine the best health system for military veterans? Or do they just not care about them?”

I must note that there is a widespread confusion in this country over the terms “social health insurance” and “socialized medicine.”

Among policy wonks, “social health insurance” is understood to be health insurance to which the individual makes contributions on the basis of ability to pay, rather than on the basis of health status. Such a system can be coupled, and often is, with purely private health care delivery systems, including for-profit enterprises. Canada, Taiwan, Japan, South Korea, Germany, the Netherlands and Switzerland come to mind.

Socialized medicine refers to systems that couple social health insurance with government-owned and operated health care facilities, such as Britain’s N.H.S. or the Hong Kong Hospital Authority, a still-appreciated legacy of British colonialism. Socialized medicine also typified the health systems operated by the former socialist countries in the Soviet orbit. Evidently, the V.A. health system perfectly fits the definition of socialized medicine.

Occasionally one does come across an American politician who mutters something about privatizing the V.A. health system. I doubt this idea would have much political traction, either as part of a party’s platform or in the presidential candidates’ campaign repertoire.

In fact, I would dare presidential candidates professing a distaste for socialized medicine to call openly for abolition of the V.A. health system in favor of a purely privatized system – e.g., a defined contribution system such as that advocated for Medicare by Representative Paul D. Ryan, Republican of Wisconsin and chairman of the House Budget Committee.

So far I have not received a satisfactory answer from detractors of “socialized medicine” to my question of why we have the V.A. health system when socialized medicine putatively is so evil. Perhaps some commentators on this blog will enlighten me.

Before responding, however, readers might consider these readings, which can be found in an Internet search on “V.A. Health Care and Quality”: a book by Phillip Longman, “The Best Care Anywhere: Why V.A. Health Care Is Better Than Yours”; an article on V.A. health care in the American Medical Association’s amednews.com, and, finally, from the Rand Corporation’s nationally recognized team of experts on the quality of health care in the United States this eye-opening report.

August 5, 2012 Posted by Aging Icon | Uncategorized | Leave a comment