Tag Archives: Assisted living

What those toddler tantrums were REALLY training you for……

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A friend of mine recently took a job at the Assisted Living facility where my mother-in-law spent her last few years. My friend will be a great asset to the Villa, and overall, it was a wonderful experience for us, eventually.

The first day, however, was like sending your first born to kindergarten. We had taken Mom to the facility to “check it out”, knowing full well we were already going to make it her home. ( I was going to say, “send her there” but even still those words sound so harsh….even though we KNEW it had to happen). And that tour was the disaster in my blog,  Who Knew Grandma Has Great Legs…

But we persisted with the move forward since we were still afraid that she might burn down her apartment building, or not have any nutrition but coffee for days at a time. So we brought her to our house for a long weekend, telling her that at the end of the weekend her furniture, clothing and personal items would be moved in to her new apartment and then she would move as well.

The first day of school arrives…I see her at my breakfast table having her coffee and tell her I’m going to the gym and when I get back we will shower and get ready to go.

“I’m not going. I’m not going,” she says while LITERALLY STAMPING HER FOOT LIKE A TWO-YEAR OLD! Now, my mother-in-law had an amazing sense of humor. And she is really kidding me, but I know there is a sense of panic there.

“Okay,” I say, “we’ll talk about that when I get back.”

“Don’t hurry back!” she yells after me.

As I’m working out at the gym, I realize that my best arsenal might be in remembering how I dealt with my toddlers. But I am really cognizant of respecting my mother-in-law here. We tried to include her in the process, but at 94, she wasn’t really all that interested in change.

When I return home from the gym, I hustle Mom into the shower, dress her in a darling little outfit and the protests begin:

“Why can’t I stay here and help you?” In support of that, she folded my laundry while I was at the gym, which she hasn’t done in about 5 years. Tricky little devil, this one.

“Well, Mom, because I have too many stairs, I’m not home all the time”…blah, blah blah

She is undaunted.

“Well, I can stay with  your mother. She has a big house. No one is there but her and she could use the company.”

Ugh. Remember when your little ones said “why, why, why” to everything? What did you do?

“No, Mom. Just no.”

“But…..” and she goes for it a few more times.

“No.” That’s all I say.

We get to her apartment and she is pleasantly surprised to see all her own things there set up much like her apartment that we moved her from. We go to the dining room and we let her order whatever she wants.

And this is where you know you’ve done the right thing.

She looks at her food and says:

“Who ordered this, it looks delicious!”

You just have to Laugh……………….

Cathy Sikorski

Never call an ambulance if you’re old…..Part 2

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I think I have spent about $5,000  ( at least in legal time and photocopying) trying  NOT to pay an ambulance bill. I began this tale as one of my first blogs, Do you really need an Ambulance? I think not. I related that my dear 95 year-old mother-in-law was found in pain in her assisted living facility, and the staff correctly called an ambulance. Her pain was evident, so even though she suffered from dementia, which was documented, the ambulance drivers decided to take her to the hospital.

For over a year now, I have been fighting with Medicare to pay this bill. I have told the Ambulance Company, I will not pay this bill, as there is no way my mother-in-law could have made the decision to go to the hospital, let alone  CALL for an ambulance. I do not wish to leave these hard working emergency first responders without pay. However, there has to be some manner in which they can support the patient when the first responders make a medical call, that requires an ambulance.

My mother-in-law does not drive. She has never driven. She has never had a car. In an assisted living facility, she has no transportation to go anywhere without it being directed by someone else. The facility is also doing the right thing by calling for an ambulance for a client who seems to need medical help.

Okay, so we’ve established that everyone who actually PARTICIPATED in this trip to the hospital made a rational and correct decision. The only people who don’t agree with this is Medicare and it’s not even Medicare. It’s a company called CMS, an independent contractor, who assesses whether the claim should be paid. So I send 22 pages of documentation with a letter of explanation telling this independent contractor why they should pay this bill.

The first denial is because this darling old lady really didn’t need to go to the hospital. They found nothing wrong with her and sent her home. Yep…..that’s absolutely true. But, I persist with an appeal.

The SECOND DENIAL is because I have NO AUTHORITY to appeal. I call to clarify this.

” If you would like to leave a message, please leave the appeal number, the claimant’s social security number, the date of service and the provider for which you are appealing. Please leave a phone number and we will return your call.”

YOU CANNOT TALK TO ANYONE…..EVER.

They do call me back, and I explain that I am holding in my hand the appointment of representative form that gives me authority to talk to them AND to APPEAL.

“O well, sometimes Medicare doesn’t send us all the paper work in the file so you need to send it to us again.”

I grind my teeth. Call the ambulance company AGAIN to reply to the bill they have sent ME again, and tell them I am still appealing.

The THIRD DENIAL comes because they still didn’t get my paper work. I call them again and they say….”oops”….and ask me to send it again. I ask the representative to explain to me how I will know if they get it…she says:

“Well you might get a notice that we received it…..wait, no, no I don’t think you will.”

Yesterday, I got the ambulance collection agency notice. They are going to sue my mother-in-law, which I kind of want to let them, because she died.

But I leave a message for the independent contractor, who calls me when I am in a meeting and can’t answer the phone. AND THE MESSAGE IS:

“This appeal was dismissed twice for failure to have the proper paper work to authorize you to appeal.”

I am not fing kidding. I’m not.

I was just going to pay the $797.20 bill. I mean they are just wearing me down to the nub. But I decided to give it one more try. I’m waiting for the return call.

To be continued……

And you really, really do…….

Just have to laugh….

Cathy Sikorski

A Waitress Contributes

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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