Monthly Archives: February 2014

Calling all Caregivers…..

Calling all Caregivers.....

Especially those in the Polar Vortex……even you and ALL of you deserve a rest.

You just have to Laugh…..and rest

Cathy Sikorski

When wine and wheelchairs don’t mix……

What do several rocket scientists, a computer nerd, a lawyer, a doctor, an industrial inventor a, a plumber and a nurse have in common? Let’s see………..

The day of the engagement party finally arrived. It was an unusually cool and delightful August evening. The bride-to-be was resplendent in an adorable white frock, the groom-to-be handsome and convivial with all the guests from young to old.  Because Uncle L was confined to a wheelchair from his MS, many things were put in place to make sure he could attend the party. He was an important part of the family and we all wanted him there, and he was game to go out and be with friends and family.

It was just lovely, We were really having a wonderful time. Uncle L had a nice Jack Daniels, his favorite adult beverage, and enjoyed several of the fancy hors d’oeuvres. When it came time for the buffet dinner, there weren’t enough clucking hens of mothers, nieces, sisters-in-law to fill his plate and keep his mustache clean. Of course, he was at the “cool table” where all the middle-aged people think they’re the coolest with lots of joking, insults and free flowing wine. Even Uncle L was not spared a joke or two…just like old times.

With so much taken away by that dastardly MS and the wheelchair, we all made allowances for Uncle L’s one vice-smoking. So after dinner, Uncle L wanted to go outside for a smoke. A couple of smoking cohorts joined him to proceed to the parking lot. No go. No, seriously, the wheelchair no go.

First they called me, the caregiver/lawyer. What did I do? I pushed the button that says “go.” That didn’t work. I thought about saying, “objection!” but was pretty sure that was a waste of time. Then we called over the rocket scientists and the computer guy. Hmmm, look at this, push that, fiddle here and there. Nope, nuthin’. The plumber, the nurse and the doctor wisely said, “well, we will all just have to push the chair.” This chair weighs a ton, even without a big guy in it.

So all the big guys got together pushed the chair to the transport, we got into three separate cars to meet at Uncle L’s home to get him back into his room in time for the  caregivers to get him to bed. We were a little late and God Bless these amazing caregivers who have never let us down at Chestnut Knoll at Home (I promised them I would give them a plug whenever I could as the minimum of thanks) who called me to find out where Uncle L was.

We get him and the super heavy chair out of the transport with lots of brawn and maneuvering, and they put him to bed.

The next morning I get a call from one of the lovely ladies of Chestnut Knoll at Home to tell me that I could call off the repairman I sent an emergency call to last night. She fixed the chair just by making sure the plug was connected in the back.

You just have to Laugh………

Cathy Sikorski

I still got it…..sort of…..

As I enter the stage of life called “aches and pains,” I am sometimes rewarded with a girlish moment.

I went to visit my mother-in-law in the assisted living facility shortly after we moved her in there. I tried especially hard to get her involved in activities that were age appropriate. She was, after all, 94 years old, so I didn’t think she needed to learn how to play bridge or try Zumba. But she could go to the sing-alongs, play bingo for 25 cents a game, and sit at the big puzzle table with other ladies and gents and gently touch the pieces while looking for their ideal slot.

So off we would go to the activity of the day. I didn’t mind playing bingo or helping with rudimentary crafts, And I loved ice cream sundae Wednesday. Yeah, that was pretty terrific. My mother-in-law loved that too. We shared a common appetite for a good sundae on Wednesday.

I would go two or three times a week, just to make sure she wasn’t sitting in her apartment sleeping while watching TV. My mother-in-law was a very social person. She was charming and enjoyed talking to people. The aides loved her because she was kind and she was interested in what you had to say. I wanted to encourage her to have places to go and people to talk with.

I became a ‘regular’. A certain contingent of the locals who engaged in the same activities were friendly and chatty with me on all my visits.

On some days, I might be dressed up, if I were going to or coming from a business meeting. It would be like CHEERS when I would go through the lobby, the activites room, the dining hall ,or down to the nurses station. People who lived there and worked there would say, “hey”, “hello”, “Hi Cathy, how are you?” Very pleasant ,indeed.

On this day, I was looking pretty spiffy, and went down to the mailboxes to check for my mother-in-law’s mail. As I exited the elevator, there was a gentlemen, who I didn’t know, walking slowly with a cane coming towards me with a small pile of mail in his hands.

“Hello,” I said.

“Hello,” he said.

I thought just in that moment I detected a little sparkle in his eye. Charming, I thought.

“Well,” I said, “I see my timing is perfect.”

I glanced down at the mail in his hands to indicate that I had come just in time to get today’s mail.

“Your timing is absolutely perfect, ” he said.

I swear to you, he looks me up and down, a smile of approval slowly spreads across his withered face and he said:

“Are YOU moving in here?”

I would have flicked my hair, but it’s short. I just gave him my best girlish laugh, shook my finger at him, and moved to the mailboxes.

You just have to Laugh…….

Cathy Sikorski

And the Winner is…………….

As every caregiver knows, I have been frustrated so often by insurance companies and physicians offices that I, well…started a blog.

If  you’ve read my : Never call an ambulance if  you’re old…..Part 2  and  Ambulance…”part trois”….., you know that one of Medicare‘s absurd rules is how to transport the infirm. They will pay for transport from facility to facility, but they will not pay for transport from your home to any medical appointment or hospital test (with certain exceptions). So, if you are completely wheel chair bound, like my brother-in-law, have no use of your legs, and your doctor orders a CAT Scan or MRI, or even the lowly X-ray, you:

A.  Can’t get there

B.  Can’t get ON the table when you get there

C.  Better have a bucket of cash stowed somewhere to pay for private transport

After days, weeks and months of figuring out the rules, and hacking at the system. I found that if my brother-in-law could be transported upright, so that he didn’t have to get out of the wheelchair, he would have to make all the arrangements with the ambulance company and pay for it himself.

If, however, he needed to get on to a medical table for any kind of test or examination AND the test or examination was at a hospital, then Medicare would pay for the ambulance and I would still have to make all the arrangements for transport.

This is how I found that out.

Medicare denied payment of a transport for a CAT scan. I followed all the rules, contacted all the right people. Got all the pre-certs, the approval numbers and the referrals. But since I had already scheduled the scan, I just used the information the insurance company gave me and had the test done.

Several weeks later, I get the denial for payment. I made a thousand phone calls, appealed the decision, twice, and was still denied as transport not an emergency or medically necessary.

Now I had to appeal to an Administrative Law Judge. This law degree I have and over 15 years of practice in Elder Law came in handy. I jump in with both feet and file the appeal. But because I’ve been around this block many times with many people, I know that a simple paper appeal will not work. Short of asking the ALJ to come to my brother-in-law’s apartment and see how the hired caregivers get him ready for the day, I’m pretty sure the information I would send would not shift the decision.

Yay….social media…..Yay….youtube.

I get up very early in the morning and with my brother-in-law’s approval, I take that amazing little iPhone I have and make a movie of the two caregivers dressing him, washing him, lifting him out of his bed and into his wheelchair, combing his hair,  helping him brush his teeth and shave, and giving him a nice pat on the head to have a good day.

I make a copy of the video, put it on a CD (yeah the Medicare appeal system isn’t that tech savvy that I could upload it), mail it to the judge, and wait.

Lo and behold after 3 hearing cancellations by the insurance company, I get a phone call from the judge’s office saying that the insurance company has decided to pay the claim and there would be no hearing.

I take a bow and accept my Oscar for best performance by  a caregiver.

You just have to Laugh……

Cathy Sikorski

Lions and tigers and Bear Hugs…Oh my……

Caregiver’s often feel like they have been cast in a Stephen King movie, and no one told them. A scare a day is not an unlikely scenario. One of our scares with my mother-in-law was when she got dramatically ill for unknown reasons. Even though in her 90’s, all her blood work, scans, and any test they could think of continued to come back negative. But she became pretty much unresponsive, landed in intensive care, and her body temp dropped to 90 degrees.

They put a huge piece of bubble wrap around her like a blanket and had a machine pumping hot air into the bubble wrap to try and get her temp to come up from it’s dangerously low hovering place.  They called this contraption, “the bear hug.” I kinda wanted to take one home. It looked so cozy and comfy and you could pop it for fun.

Even though Mom wasn’t really conversant, she would continuously shake her head back and forth and push “the bear hug” off of her and put her arm over top of the bubble wrap ,so that she wasn’t under the heat. Just like anyone would who was too warm under the covers. Whoever was visiting had to constantly put her back under the “bear hug” and hope for the best.

After the gazillion tests, the medical team decided that she was likely suffering from an infection that was coming from her toe. They discussed taking her toe, her foot, or even half her leg. I put my foot down (oh yeah, pun totally intended). I wanted to wait as long as possible before they would do anything like that. I just couldn’t see trying to train my mother-in-law how to walk or use a wheelchair with that kind of disability at her age.

The “bear hug” did it’s loving job, and she was moved out of ICU. Just as the doctor came in to look at the offending infected toe, it fell off right in his hand. Ack! Really, I was there with my teenage daughter. I wanted to yell, “cut!” to stop this horror film I was in, but I was afraid what they might do next.

So we were able to take Mom home in a few days, but she had to wear special surgical shoes to protect the injured foot until it healed. She was in assisted living. They would get her dressed and get her to meals. But as soon as she got back from breakfast, she would change out of those surgical shoes and into her sneakers.

This went on for a day or two and finally, I told the physical therapist to hide her shoes. Oh my God! My mother-in-law, the sweetest, kindest, gentlest soul went crazy looking for her shoes. She was absolutely convinced that my daughter was the culprit and I should  get her to confess and get those shoes back immediately. This was not completely unfounded as my daughter would occasionally take Grandma’s jewelry or refrigerator magnets as a joke when she was younger. But my daughter was 500 miles away in college, and there was no convincing Grandma that that made a bit of difference.

This battle went on for weeks, until the therapist gave the ok to return to real shoes. When the magic shoes finally reappeared, my mother-in-law said, “Well, finally your daughter has given me back my shoes!” Guess she felt like she was in a Stephen King movie.

You just have to Laugh…….

Cathy Sikorski

Um….yeah…..not paying that….

You think when your caregiving ends….well, your caregiving ends. But not so, intrepid caregivers. I’m now steeped in estate work and it, too has it’s unbelievable encounters. I have to call billing department after billing department to make certain that a bill is legitimate before I concede to pay. And each billing experience makes the last one look like child’s play.

Billing Experience Number One (really probably number 157)

“Hello? I have a billing question. Can you help me with that?”

“Sure.”

“What information do you need?”

” How about do you have a name and birthdate?”

“Why yes, yes I do.” And do I give her all the necessary information to retrieve the bill for my mother-in-law.

“My question is, this bill seems to have been processed by all her insurance carriers, and so there should be no balance due, and I know that she has also met her deductible.”

“Well, there is still a balance due after that.”

“No, I don’t think so. I’m pretty sure that according to the laws in Pennsylvania, if someone is on Medicare and they have a Medigap policy and both insurances have paid AND the patient has met their deductible that you must accept that as payment in full.”

“One moment, please.”

Oh boy, Muzak.

She returns pretty quickly, which in and of itself makes me happy.

“Well, ok, then. There is no balance due, but we didn’t have in our records that she was on Medicare.”

“Really? Because you just asked me to identify her by her birthdate, which is 1916, which makes her 97 years old AND you are showing on your bill that Medicare made a payment, just sayin’…”

“Well……”

And she hung up.

Billing Experience Number 2 (Actually not even 157, more like 210 by now)

“Hello. I have a billing question. Can you help me with that?”

” I will transfer you to billing.”

“Hello, I have a billing question. What information do you need?”

“Sorry ma’am this isn’t billing. Let me transfer you.”

“Hello, I have a billing question. What information do you  need?”

“Can you hold a moment?”

Of course, I don’t get to answer that question. I just get more Motley Crue Muzak.

“How can I help you?”

“I need to know if this bill for Aunt J is final?”

“Well, let me see…..hmmmm…..no, it looks like there is another bill with an additional balance.”

“Well, I’m sorry to tell you that there are no funds to pay this bill or any future bills. There will be no estate and the patient was visiting from Australia.”

“What? Australia? I don’t understand.”

Really? I’m thinking…..what’s not to understand. That seems pretty clear to me, but OK, I’ll just lather, rinse and repeat.

“Well, I’m sorry to tell you that there are no funds to pay this bill or any future bills. There will be no estate and the patient was visiting from Australia.”

“Um…ok…so could you send us a letter to that effect with a death certificate?”

“Sure. I would be delighted to do that.”

So far I’ve had to send that letter and death certificate 11 times. Do you think they would send me anything for free?

You just have to Laugh……

Cathy Sikorski