Caregiver Hints

Medicare Advantage plans have come on the scene within the last 2-3 years to help deal with the immense overhead of Medicare billing in the US, at least as I understand it. My past experience with Medicare is that they were often backlogged, meaning slow to pay bills, and dealing with them to resolve billing issues was often an exercise in frustration. Some medical offices would even refuse to bill Medicare, leaving the patient to do this, because the cost of delayed payments and dealing with them was too costly for smaller offices. In other cases, the offices would send the benefit claims, but require up-front payment of bills, and then instruct Medicare to send you (the patient or bill payer) a check for the amount covered. Larger medical facilities usually don’t have a problem, but if there is a dispute, the patient generally has to call the Medicare offices to resolve it. There are a number of Pros and Cons to these plans, so generally you will have to review the issues and see what decision is best for you. Unfortunately, in my opinion, this is not as simple as you might hope.

Blue Cross/Blue Shield (or in my case Blue Cross of California) was one of the first companies to instate a Medicare Advantage (or replacement) policy*. When first introducing the policy, Blue Cross set up seminars that people could attend free of charge, to get an explanation of the policy benefits, and to ask questions. Representatives would also help you fill out forms and get additional information. As far as I know, they are still doing this, so best to check out their website at http://bluecross.com/ or check your local area for an office you can call for more information. At the time I was investigating (about 2 years ago), they were not offering the Medicare Advantage plans in all states.

The policy in California was called Freedom Blue, and for $7 per month, you could get a full coverage PPO style health plan. This made it a very affordable plan for older people who do not have health plan coverage through their spouse or former workplace. Another option was that you could have your plan premiums automatically deducted from your Social Security payments, meaning one less bill to worry about.

One of the distinct downsides of these plans, that I have found, is that many medical facilities are not aware of these plans or how they work. On several occasions, in spite of my instructions to the contrary, facilities would bill directly to Medicare (which would say they are not handling the patient) and then turn around and bill us for the full amount with a note saying that Medicare denied charges. I would then have to call them back and explain the whole thing again, and even then, some places would continue getting it wrong. It was quite a headache at times. Hopefully this will get better in the future, but keep this in mind if your state or area has just begun accepting this kind of plan.

In the case of Blue Cross, they will explain that this particular plan is a low-cost solution that is best for people who are still in relatively good health that are seeing doctors only occasionally for checkups. In my Mother’s case, it might not have been optimal since she was dealing with Diabetes, and a number of other health problems. We had tried it in an attempt to circumvent other problems we were having dealing with Medicare and her primary physician.

You will have to explore these options for yourself at length, but I would say that it is best designed for people who need some medical and prescription help, but are still doing well, and are active, but don’t have any regular health coverage.

(*information about insurance companies and their policies are not endorsements, but are simply accounts of my experience. I recommend you check several different policies and companies before making a choice.)

Dementia is the progressive decline in cognitive function due to damage or disease in the brain beyond what might be expected from normal aging. Particularly affected areas may be memory, attention, language, and problem solving. (from Wikipedia)

Full entry on Dementia is here.

In the past, this condition was referred to as “senility” or “being senile”. I’m not certain, but I believe that the term senile began to have a derogatory connotation. To say someone was “senile” was associated with loosing one’s faculties and being forgetful. I remember this term is use as I was growing up. I believe the term “dementia” started as an academic or medical term for this, but seems to be gaining more popular usage in recent years.

My first introduction of the term came a few years ago with the diagnosis of my Mother’s mental state after a series of hospital stays. Also, it is very common for Assisted Living communities, or facilities, to perform mental acuity tests to determine what level of assistance the residence needs.

Diagnosis of dementia can be a sign of other health ailments, so it is best to consult a doctor about additional testing. In the case of my Mother, she had diabetes and during cases of low blood sugar, she would exhibit symptoms of disorientation and some memory loss. In her case, while this did amplify the problem, she also had regular dementia caused by micro-vascular strokes, a minor form of stroke that often has no outward symptoms, but over time can degenerate the brain’s function. Dementia, high blood pressure, or micro-strokes can be a sign of things to come, most likely more severe strokes which lead to paralysis and decrease in brain and body functions. This was the diagnosis for my Mom and the more severe stroking compounded with her other health problems was more than her body could take. Regular doctor visits are the best way to handle this, but be prepared that preventative measures may or may not be effective. This can be the toughest time during the care of an ailing family member because there seems to be little that you can do.

I will cover more of this in another posting.

NOTE: You should keep in mind that if someone is diagnosed with dementia, you may no longer be able to authorize a Power of Attorney or Will, since most legal entities will no longer allow individuals to sign such documents if there is evidence that they are not fit to make that decision. If you suspect that a family member is developing any impairment, or if your family has a history of mental disease, get this sort of paperwork done EARLY.

A living will is a document which defines someone’s wishes as to whether or not to be kept on artificial life support. These documents can also appoint someone to make important health care decisions on that person’s behalf in case they are unable to do so.

A living will is not a replacement for a Power of Attorney. The living will only gives the hospital or care facility permission to take directives, from the person appointed in the living will, regarding health decisions. It does not cover any legal territory. In most cases a spouse or parent is allowed to make these directives without such a document, but it is best to consult with a lawyer regarding the details of your particular situation.

A living will may be useful if you happen to live far away from a parent and are receiving assistance from another non-immediate family member or friend whom you trust and may need to make quick medical decisions if you are unavailable.

Here is an article from USA Today which discusses this issue…

Living will laws, alone, can’t prevent end-of-life disputes

This is perhaps the most important legal document you will have to deal with next to a person’s will. For anyone who is about to begin the journey of caring for an aging parent or loved one, you will find that if this is not taken care of early enough, it will make the tasks of managing the person’s care and finances incredibly difficult.

For anyone who is facing the onset of dementia or Alzheimer’s in a parent, it will be really important to have a POA prepared and dealt with BEFORE the person is deemed unfit to authorize such a document.

I narrowly missed having my Mother officially diagnosed with dementia before getting this paperwork processed. To have a doctor officially make this diagnosis before your parent can make this decision, will make the ability to get legal approval to manage their assets extremely difficult.

I will be talking more about this with some details in the future. I only stumbled upon this fact accidentally and if I hadn’t found out until later, I would have had even more stress that I already had. You are going to need to find good legal advice to take on the variety of issues you will come across to care for a family member. The more prepared you are the better!