Sometimes there isn’t any help.
The past few months have been busy with helping one of our favorite clients move. We set up a new blog for BeverlyTaylorJDL at worpress. Beverly just turned 86. We are going through everything she wants to have preserved and getting prices for things that will be sold to free up some space.
Peter is also moving, back to New Hampshire. He is recovering from knee surgery and can now live independently. We’ll be helping him pack up over the Labor Day holiday.
We’ve arranged for White Glove Consulting to help Arnold get the social services he needs, after a year of rejections and setbacks.
It’s great when you can help someone and accomplish what you set out to do. But sometimes, you just have to recognize that nothing more can be done. Issues related to mental health are something we’ve only dealt with in regards to seniors, dementia, Alzheimer’s, hoarding and personality changes. For the past few months, we’ve been helping a younger patient find health services. She came to us complaining of chronic fatigue and insomnia. As usual, we started with getting a medical clearance. Then, we arranged for a psycho-social exam for housing. We’ve gained an appreciation of the adult home business. They are truly dedicated people. The psychological assessment opened up a new diagnosis that changed our approach entirely. We were able to find many services that would have helped the patient. However, in our journey with her we found that she had a history of resistance to care and substance abuse. She was also under the influence of people who enabled her behavior.
After discussions with the psychiatrists, attorneys, the Department of Health, Abuse Victim Advocates and Mental Health Specialists we decided to end her services. This was a very difficult decision and one that included her family. They assured us that many had tried to help, but it was time to throw in the towel. The family will now move towards appointing a legal guardian. I’ve been told that we did help in many ways, just maybe not in the way we hoped.
Unexpected Illness & End of Life Planning
If you follow Caryn on LinkedIn, Facebook or Twitter, you probably have read about the client who was diagnosed with a benign meningioma. She was 77 years young and enjoying her retirement from the local University. Her children and grandchildren all lived with her in the home her late husband had purchased when he returned from the war.
Her youngest daughter had inherited her husband’s diabetes and recently she required a lot of medical care. The daughter was still working, but had used up all her FMLA and was hoping to get disability soon. The family had already used all their credit paying for these medical bills.
Then, one day Mom fell down and couldn’t get up. At the hospital, they found the tumor, but it was considered inoperable because the patient had many other health complications. I got the call for help when Mom’s Medicare was almost set to run out. The discharge planner at the hospital was pressuring the family to apply for Medicaid and move their mother to a nursing home. Mom was very upset about the idea and became very loud about her feelings. As happens, the doctors put her attitude down to dementia.
I met with the son and the daughter who was sick herself, but was the one everyone counted on to understand all the issues since she worked in health care too. Mom was suffering from many symptoms of the meningioma, physical and mental. To make matters worse, Mom’s social security check wasn’t in her account. I suggested they check with the discharge planner, and sure enough her check had been diverted to a rehab facility she was in briefly during this event.
The first steps I suggested, was for the sister to get the doctors to give the dementia diagnosis in writing. Then someone needed to go to the social security office and be made the payee. They also needed to arrange for a Power of Attorney and Health Care Agent. All the while, the hospital staff kept changing the plan from Mom going to a rehab, going to a psychiatric adult home and going in for more tests. Mom was now on a respirator, so she couldn’t express her wishes.
At this point, I suggested that the family ask the doctors about hospice care. It took the hospital another two weeks, while they did more tests before they arranged for the transfer to a hospice facility. As if that wasn’t enough, the family dog died at home. Mom was at the hospice for another week, when she passed peacefully with her whole family around her. The house was safe and her assets intact since hospice is covered by Medicare.
Now, this should have been a satisfactory ending to the story, but what happened next is why this story is about the need for preplanning. As far as anyone knew, Mom had never made out a will. The children thought she had some kind of life insurance policy, but no one could find it. The funeral parlor accepted a deposit and said they would take assignment of the insurance policy for the rest. The son called me just as the wake was about to begin. They couldn’t find the policy and her employer didn’t have any record of one. He couldn’t find any of the paperwork about the house either. The funeral parlor stopped the service and offered the family a lesser costing arrangement and the family made do with that.
Now, they have to go to the probate court to appoint an administrator, which will probably be the sister. She will have to research all of Mom’s assets including finding the deed and her creditors before she can distribute the estate. The family doesn’t have any access to Mom’s accounts, and their credit is all gone, so they can’t hire an attorney for help.
This story could have been so different if there was just a little preplanning. Mom, knowing she had three children who lived in her house with their children could have made a simple will. She could have appointed one of the children as her Health Care Agent, so they could have avoided the unnecessary medical treatment and bills. They could have made sure her final wishes were followed in regard to her funeral and spent the time mourning her now, instead of scrambling for paperwork. I can only imagine that Mom has her dog in her lap and is shaking her head for not doing that planning.
Hoarders
I have an unusual amount of new clients who could be considered hoarders. Here is an article about this condition and the senior population.
http://www.aarp.org/health/conditions-treatments/info-02-2011/the_hoarders_among_us.1.html
New impact study shows how Republican plan effects patients.
District by District Impact of Republican Medicare Plan and Medicaid Cuts.
Rep. Henry A. Waxman, Ranking Member of the Energy and Commerce Committee, and Rep. Frank Pallone, Jr., Ranking Member of the Health Subcommittee, have released new analyses detailing the impact of the Republican Medicare and Medicaid proposals on each congressional district.
Click here to view the full text of the letter sent by Reps. Waxman and Pallone to their colleagues to assist them in understanding the ramifications of the Republican Medicare and Medicaid proposals.
Will Affordable Care Act make Health Insurance Affordable?
Jonathan Gruber and Ian Perry
Abstract: Using a budget-based approach to measuring affordability, this issue brief explores whether the subsidies available through the Affordable Care Act are enough to make health insurance affordable for low-income families. Drawing from the Consumer Expenditure Survey, the authors assess how much “room” people have in their budget, after paying for other necessities, to pay for health care needs. The results show that an overwhelming majority of households have room in their budgets for the necessities, health insurance premiums, and moderate levels of out-of-pocket costs established by the Affordable Care Act. Fewer than 10 percent of families above the federal poverty level do not have the resources to pay for premiums and typical out-of-pocket costs, even with the subsidies provided by the health reform law. Affordability remains a concern for some families with high out-of-pocket spending, suggesting that this is the major risk to insurance affordability. FROM THE COMMONWEALTH FUND
GOVERNOR CUOMO ANNOUNCES ON-TIME PASSAGE OF HISTORIC, TRANSFORMATIONAL 2011-12 NEW YORK STATE BUDGET
Redesigning Medicaid and Health Care
Total Medicaid spending including federal, state and local spending of $52.6 billion represents a decrease of $337 million, or minus 1 percent. Future growth in Medicaid will be limited to the 10-year rolling average of the Medical CPI, currently 4 percent. As with education, the budget includes a two-year appropriation.
The budget includes a cap of $15.3 billion on Department of Health Medicaid state expenditures, which represent the largest and one of the fastest growing component of state spending.
The budget process brought together health care providers, labor, government and other Medicaid stakeholders to form Governor Cuomo’s Medicaid Redesign Team (MRT). Tasked with identifying ways to provide critical health care services at lower costs and control unsustainable growth, the MRT recommended a series of proposals to fundamentally restructure and reform New York extensive Medicaid program.
Overall, the budget implements a majority of the MRT recommendations. The budget reflects $2.3 billion in spending reductions supplemented by $425 million in lower-than-expected expenditures to achieve the Governor’s original savings target of $2.85 billion.
The budget implements significant reforms including a major expansion of patient-centered medical homes, better control of home health care services, and care management for individuals with complex and continuing health care needs. New models of integrated care, such as Accountable Care Organizations, will help assure long-term control of health care spending.
Savings will be assured by an overall spending cap, enabling the Commissioner of Health to make additional savings actions during the year, if necessary. Here is the briefing book by subject.
http://publications.budget.state.ny.us/eBudget1112/fy1112littlebook/index.html
Health Commissioner Endorses New Federal Model to Help Elderly, Disabled New Yorkers to Remain in Their Homes
“Allowing disabled and elderly New Yorkers additional options to stay in their homes is consistent with Governor Cuomo’s goals,” Commissioner Shah said. “This new federal opportunity will help New York reform its Medicaid program while at the same time empower elderly and disabled individuals to stay in their own homes.”
The Community First Choice Option would provide a 6 percent enhanced federal payment under Medicaid for certain types of home and community-based attendant services and supports. The program must be offered throughout the state in the most integrated setting appropriate to individuals’ needs.
Dr. Shah said Governor Andrew M. Cuomo has asked him to take all necessary steps to prepare New York to make use of the new care option. Action will include establishing a development and implementation council, whose membership must consist primarily of elderly and disabled individuals and their representatives.
“Patient-centered and patient-directed care needs flexibility to work, which Community First Choice will help provide,” Dr. Shah said. “This is an opportunity to rethink the way New York supports its elderly and disabled populations. We look forward to implementing this new concept.”
The Community First Choice option expands on New York’s current consumer directed personal assistance program (CDPAP), in which Medicaid patients are supported in their desire to live in their community by specifying the types of care and support they require.
Governor Cuomo has directed Commissioner Shah to take all necessary steps to prepare New York to make use of the new care option. Action will include establishing a development and implementation council, whose membership must consist primarily of elderly and disabled individuals, and their representatives.
The Community First Choice Option is an important part of the Affordable Care Act. The Centers for Medicaid and Medicare Services (CMS) recently published in the Federal Register proposed regulations that would implement this part of the federal health reform.
Public comment on the proposed regulations is due to CMS by April 26. This new guidance provides additional clarity on the federal option, which will help patients make the transition from institutional to home or community-based living. Enhanced federal Medicaid payments will be made for certain supports, including the set-up costs for independent living, such as rent and utility deposits, first month’s rent and utilities, bedding and basic kitchen supplies. States looking to implement the program will have to establish a quality assurance system that includes consumer feedback.
The Community First Choice option expands on New York’s current consumer-directed personal assistance program (CDPAP), in which Medicaid patients are supported in their desire to live in their community by specifying the types of care and support they require.
Dr. Shah will coordinate New York State’s comments on the draft federal regulations and accept nominations to serve on the development and implementation council.
Meaningful Use helps doctors manage practice
Caryn attended a training session cohosted by IPRO and e-MDs. A NY e-Health Collaborative representative discussed the benefits of using the services of a Regional Extension Center. e-MDs demonstrated how their integrated EMR/PM, called Solution Series, gives reports that show how close a practice meets meaningful use benchmarks. The information is used to report directly to Medicare, but is also helpful to pinpoint where the practice is falling short and who in the organization needs more training to meet practice protocols.
Don’t let the guardian ship sale away with your $
http://myelderadvocate.typepad.com/blog/2011/01/son-imprisons-dad-then-steals-his-money.html
Jack Halpern hits in the the head with this blog spot.
AGINGICON.COM
Have you lived a life of accomplishment, doing what fulfills
you? Have you reached an age where things are harder to do?
Are you a leader and you know that you cannot do it alone?
Then, you are an Aging Icon.
My name is Caryn Isaacs.
Having been at the helm of developing hundreds of healthcare
businesses and running several multi-million-dollar companies,
my journey includes pioneering a physician-owned HMO and
active engagement in Healthcare Reform.
As a Patient Advocate, my company, GetHealthHelp, LLC,
specializes in crafting solutions that enable Aging Icons to
continue pursuing their passions.
An example is a 98-year-old author, playwriter and poet who is
suffering from fibromyalgia and thought that all her work
would be forgotten. I found a way for her legacy to continue by
publishing them as books and now working on having them
made into films.
If this sounds like something of interest, let’s meet to talk
further.
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