Tag Archives: Nursing home

And You Thought “Mooning” Went Out With Hot Rods…………

In the beginning of 2017, Medicare implemented the new Medicare Outpatient Observation Notice which seems to have the same effect as the old ‘mooning’ we think about from American Grafitti.

You see, MOONing in Medicare (sounds like a love song from Cole Porter, doesn’t it?) means that within 36 hours of entering a hospital, if you will not be admitted, but only kept under  “observation,” they must inform you with a written explanation.  This is the form, if you’d like to see it!

MOON FORM

The problem with this form is the unintended consequences it might have for you, if you are on Medicare, or your loved one, if you are a caregiver for someone who is on Medicare.

If a patient is placed under observation, typically in the Emergency Room, and is never formally “admitted” to the hospital, Part A hospitalization of Medicare does not pay. In other words, you are paying as an outpatient.  For a quick trip to the ER (is there such a thing?) that’s no big deal. After all, the Part A deductible is $1340.00 so you may not even spend that much if you’re only there a few hours.

However, if you are there a few days, and you stay on observation, it is likely that you will start racking up fairly high medical costs with co-pays for every service you are getting. Not to mention any drugs, that likely will not be covered by your Part D while you are in the hospital. It’s complicated, scary and could be costly.

The worst result could be that you are sent to rehabilitation, and because you never met the “admitted to the hospital for 3 days” requirement to have Medicare pay for at least 20 days in that rehabilitation center, you are now responsible for a significant bill coming out of that rehabilitation center. This has happened to people to the tune of thousands of dollars.

So what can you do?

This advice comes directly from this AARP article, which oddly was written before MOON became a regulation and before the MOON form existed. So I have added two of my own suggestions at the end:

Medicare: Inpatient or Outpatient?

  • Ask about your status each day you are in the hospital, as it can be changed (from inpatient to observation, or vice versa) at any time.
  • Ask the hospital doctor to reconsider your case or refer it to the hospital committee that decides status.
  • Ask your own doctor whether observation status is justified. If not, ask him or her to call the hospital to explain the medical reasons why you should be admitted as an inpatient.
  • If, after discharge, you need rehab or other kinds of continuing care but learn that Medicare won’t cover your stay in a skilled nursing facility, ask your doctor whether you qualify for similar care at home through Medicare’s home health care benefit, or for Medicare-covered care in a rehabilitation hospital.
  • If you go to a skilled nursing facility and have to pay for it yourself, you can try formally appealing Medicare’s decision. When you receive your quarterly Medicare Summary Notice, make a copy and highlight the facility’s charge. Send this to the address provided on the notice with a letter saying you want to appeal Medicare’s decision of noncoverage on the basis that you should have been classified as an inpatient during your hospital stay and not placed under observation. If this is denied, you can go to a higher level of appeal, following instructions on the denial letter.

Additionally,

  •         You can refuse to sign the form. All that does is make the hospital sign it, and make them a bit testy. But it signifies that you do not accept this and hopefully is evidence on Appeal that you were trying to fight the observation status.
  • You can take your patient home. I am not recommending this, especially if the whole reason you are fighting ‘observation status’ is because your patient is very sick and you are certain they will end up in the hospital, a rehab center, or a skilled nursing facility after this event. But one of the problems with Medicare is that they penalize hospitals for re-admissions. So discussing the possibility that you might take your loved one home, that might force a re-admission, may move them to admit your loved one.

Sometimes this feels like the “Art of War,” when dealing with healthcare issues. Being forewarned is being forearmed, as they say. Seems like anything is better than being MOONED!

“You Just have to Laugh…..”

©2018 Cathy Sikorski

You might be a Caregiver….Part One

Just as I was sitting down to bring you the next installment of caregiving comedy, my computer decided the last laugh would be on me. Done, died, dead. With no warning, no goodbyes, no fond farewells, just dead.

These two weeks provided lots of time to come up with all the joys that caregivers experience. So in a huge nod to Jeff Foxworthy, I bring you the first installment of:

“You might be a Caregiver……”

  1. If you know Medicare’s phone number and website without Googling….You might be a Caregiver….
  2. If your search for an Assisted Living Community for your Mom starts to look like a nice vacation spot for you and your spouse….You might be a Caregiver
  3. If you cancel your dentist appointment to attend Ice Cream Social Wednesday at your Dad’s nursing home, because you want the ice cream….You might be a Caregiver
  4. If you know your parents’ Medicare number, AARP number, United Healthcare number but not your own cell phone number…You might be a Caregiver
  5. If you feel the need to correct WebMD about all the missed additional symptoms of a urinary tract infection….You might be a Caregiver
  6. If your iPhone calendar has words on it like ‘catheters’, ‘hearing aid’, ‘urologist’, or ‘dentures’…..You might be a Caregiver
  7. If going to the Emergency Room is like Cheers where they know your first name and how you take your coffee…..You might be a Caregiver
  8. If you took the black Sharpie to your husband’s underwear to mark it for the wash instead of your Mom’s for the nursing home…..You might be a Caregiver
  9. If you’ve had more knock-down, drag-out fights with Insurance Companies, Hospitals and Doctor’s office than Muhammad Ali…..You might be a Caregiver
  10. If everyone around you thinks you are speaking in tongues because you are constantly saying, PT, OT, UTI, or DME….You might be a Caregiver

And this is only the beginning, my friends. After all, this is a new computer, so there’s lots of room for humor here now!

“You Just have to Laugh……”

©Cathy Sikorski 2016

A Caregiver Confesses…………

Not every day in a caregiver’s life is worthy of a pat on the back. Last week the visiting nurse called me with her weekiy update:

“Hi Cathy, all is well with your brother-in-law,but I’m calling today as his advocate.”

Uh-oh. What does that mean? Immediately, my hackles go up. I don’t actually know what hackles are, if I have them or when they go up and down. But I do know that some red flag is waving behind my eyeballs, and I have become defensive before she even says her next sentence. And here’s why. I am his advocate. Not you. First, I am a professional advocate. Second, I am the one who goes to bat for him almost on a  daily basis. And third, if you are telling me you are advocating for him to me….that must mean you are about to tell me what I’m doing wrong.

“Okay,” I say calmly, “what’s up?”

“Since you’ve put him back on bed rest, he is frustrated and really angry. He doesn’t want to be in bed most of the day. He needs to be in his wheelchair and out and about with his friends. He needs to go to the dining room for every meal and have that independence.”

And here’s where I’m not so happy with myself….but this is only the first part of my confession.

“Let me tell you something (not a good way to start an open-minded conversation). He  just returned home from 10 months in and out of the hospital with 6 of those months straight in a nursing home.In just four days after being home, he began to have bed sores again and problems with open wounds. I feel pretty certain that he does not want to go back to either of those places and so since I know that bed rest was the only solution, I instituted that. Within 10 days of you seeing him, those wounds have significantly healed and he is almost able to return to his normal routine.”

“Well,” she replied, “I’m sure that’s what he needs.”

“I am not trying to make his life harder. Quite the contrary. But I will be sure and let him know that you have advocated for him.”

“Okay, thanks and Happy Thanksgiving!” she said as she got off the phone at breakneck speed.

The Thanksgiving remark sort of slapped me back to reality as well. I was feeling less grateful for her help and more needy of explaining my part in this Passion Play.

And then I misbehaved.

I went over to my brother-in-law’s apartment to discuss his advocate. I waited until the next day, so I could explain to him that I’m not a monster, I’m not insensitive to the fact that lying in bed most of the day is boring, not fun and makes for a long day. I only have his best interests at heart, and I don’t want him to end up back in any place but his home, where he is as happy as he can be.

When I arrived, he was watching TV in his chair.

“Hey,” I said, “your nurse tells me your mad at me.”

“Yeah,” he said, “I don’t want to be in bed so much. ”

And this is where all my sensitivity training, my caregiver’s heart and I’m pretty sure my 26 years as a Mom comes in to soothe and explain how all my hard work for him is truly in his own best interests, that I love him and want him to be healthy and safe and happy and that sometimes that road is a little bumpy.

“Get over it, ” I said.

I thought he would just have to laugh…..and guess what…he actually did………

©Cathy Sikorski

 

 

A discussion with John Hancock……

One day a letter came from John Hancock (not the real one, I’m pretty sure he died a while ago) stating that my brother-in-law had a small long term care insurance policy in effect left over from his employment.

Every little bit helps.

So I called John Hancock to see how we could begin using the benefits, as he clearly qualifies based on the policy I had them send to me for review.

“Hello? I would like to file a claim for long term care benefits.”

“Ok, I need to ask a few questions,” said the nice polite young lady from John Hancock.

“Who are you?” she asked.

“I am his sister-in-law and his Power of Attorney.”

“Well, ok, you need to send us a copy of the POA.”

“Yes, I can do that, in the meantime can you send me the application for benefits.”

“Yes, I will send it to his address.”

At that point, I noticed that they had the wrong zip code for his address.

“I see you have the correct street address, but the wrong zip code. Can you correct that before you send it?”

“Oh, no, I’m sorry, I can’t change anything of his until you send me the POA.”

“But if you send it out, it will go to the wrong place.”

“Oh, yes, I see that. Well, would you like me to send the documents to your address?”

I pause for just a nano second, because experience has told me not to interrupt the ridiculous if it is in my favor.

“Yeah, sure, send it directly to me.”

I gave her my address.

“Now will you be filing that within one week?” she asked me.

“Well, he’s in the hospital for a few days, and may go to a nursing home for rehab or he may come directly  home and rehab there, ” I told her.

“Oh, well then you have to call back and request the forms after he gets home.”

“But it’s long term care insurance,” I said, “either way he will be under long term care.”

“I’m sorry, but I can’t send the forms until he’s home.”

“So,” I say through tears…..of laughter, “you can’t send the forms for long term care until he’s home and not in long term care. And then you can send it to my address until I get you  a copy of the POA to correct his address.”

“Yes!” she says brightly, that’s exactly correct!”080

You just have to Laugh…..”

Cathy Sikorski

No matter where I go….

So I volunteered to be on an advisory board for a Catholic elementary school. I know, I know, REALLY? You need to do more volunteer work? But my really good friend, the principal of the school asked, and whenever she asks me to do something I say yes and have regrets later. But THIS time, I figured it’s about little kids, no elders, no Medicare, no Social Security, no nursing homes. Yay….little kids.

The parish priest leads the first meeting, and after we open with a prayer (and boy do I need all the prayers I can get), he tells this quick story.

“So, I’m a power of attorney for one of our parishioners who is 90 years old.”

Oh MY GOD (i’m thinking) REALLY, SERIOUSLY, THIS CANNOT BE HOW THIS MEETING STARTS.

“AND,” says Father, ” he was rushed to the hospital a few days ago, so of course, the hospital called me right away.  I went over there to make sure everything was fine, and they were going to keep him for a few days and then send him to rehab to one of two possible facilities.”

So I’m thinking: okay, he probably had some problem getting him in to the facility that he wanted. Or the elder parishioner had some unexpected medical condition. Nothing new here. And, by the way, I have not yet confessed to this group what my background is.

Father continues:

“The dear man is in the hospital for three days, and I’m waiting for a call because they have told me that he will likely be moved today or tomorrow. So I’m sort of hanging around, trying to stay close to home in case they call or need me for anything. Finally at 2:30 in the afternoon the nurse contacts me and says:

“Hello, Father?”

“Yes? I have been waiting for your call.”

” Well, I guess we should have called you sooner, like BEFORE we released your parishioner from the hospital.”

“REALEASED HIM???!!!! WHERE DID HE GO? He’s 90! He doesn’t drive and I’m the only one who transports him. WHERE IS HE?????

“Oh, he was transported by ambulance to a rehab center.”

“WHICH ONE…. where did you send him?????”

Poor 90 year-old guy, when he got there, he had no idea where he was, why he was there and what was going on. NOT BECAUSE HE HAS DEMENTIA…..he doesn’t……BECAUSE NO ONE TOLD HIM OR HIS CAREGIVERS.

Yup, true story (and I asked Father if I could put it in my blog and he gave me his blessing …and said yes, too)

You just have to laugh…….

Cathy Sikorski

A Waitress Contributes

So my girlfriend and I go out for lunch.  I ask my friend how her elderly parents are doing, on the other side of the state, and she relates how they are in the midst of considering assisted living. So we go back and forth for a few minutes talking about the possibilities, and what I know both in my experience with caregiving and with Elder Law. The waitress stops by to take our order and says,

“Hi ladies! I don’t mean to intrude but I heard your conversation and wanted to tell you about my  dad.”

“Sure, I said. What’s going on with him?”

“Well, he’s in a rehab center now, but we just moved him from the county home to a private facility for which he is paying $6500.00 a month. He doesn’t know that but we decided to put him there because he is getting excellent care.”

“Why did he leave the county home?” , I asked her.

“Well, his insurance and the medical team there said that he has reached a point, medically where he was good enough to go home. And basically, we moved him directly from the county home to hospice care.”

” Wait, WHAT? I’m sorry. What is your name?” I asked her.

“It’s Donna.”

“Donna, I am so happy to meet you. I know how hard it is to be a caregiver. So let me get this straight. Your Dad is allegedly so healthy, that he no longer needs to be in the county nursing facility. But the minute you moved him to the new facility, that facility put him in the hospice program, which means your Dad is seriously ill. ”

“And”, said this hard working, generous soul of a woman, “my Dad is a veteran and served during the war. But he is not entitled to veteran’s benefits because he has too much in assets. So, we will blow through his money, if we have to. We will make sure he gets the absolute best of care, until the money runs out, or gets as close as we need to get him veteran’s benefits.”

I happen to be going to a seminar this week that addresses this exact problem. So if I find out anything to help her, I will seek her out and tell her. But even though the veteran’s issue may be true. The thing that really frosts me…the thing that can’t possibly make any sense…is that how can the county home and the insurance company look at this sick elderly man, a veteran for crying out loud, and say: “Sure, he’s ready to go home!” And so the family, who KNOW their Dad and know that he needs a truly high level of good care,  place him in an excellent facility, and are instantly told to put him in hospice care. Do these people not know what the word, hospice, means. It means this person is really, really, really sick….and NEEDS care.

Not really a laughing matter, but absurdity abounds in this caregiving world. Thanks, Donna, for allowing me to post  your story! I’m still looking for anything that might help you.

Cathy Sikorski

A case for joint bank accounts

I may have sealed my own fate by allowing myself to be a lawyer and a caregiver. People really like that stuff. One way or another, they are going to find a use for me. My sister is now in the process of settling her aunt’s estate and she needs a lawyer who understands estates and the legal ramifications of former caregiving. She took care of this Aunt for many years. Both because she’s her Aunt and because the Aunt successfully alienated every single person in her life. My sister is now left with a miniscule estate to administer to pay back the state where her aunt had nursing home assistance and get all her other bills taken care of. Sounds easy, right? Nope, this Aunt left “everything” to my sister AND four other nieces and nephews in a foreign country. Swell. Thanks. Because NOW, rather than wrap this up easily, which a joint bank account would have accomplished, it will require a small mountain of paper work to satisfy the bank, and the state, that no one is getting anything except those who are owed. But Aunt pain-in-the- neck didn’t want a joint bank account, which of course, is absolutely her right. But oh the trouble that now creates.  And of course, corresponding with those in the foreign country that they are getting nothing and would they please acknowledge that so that we can all go on with our lives. Hmmmm.  Wonder how that will work out?