Peninsula Daily News Column 11-29-12 "Suit follows 'improvement standard'"

            Does it ever seem to you that we ought to get some manner of recognition for just “making it through?” I mean, we have, presumably, survived Thanksgiving (CONSUMER NOTE: If you can’t readily identify what that is behind the leftover cranberry sauce, you probably shouldn’t eat it) AND an election!

            Congratulations!

            Regardless of your reaction to the outcome of the election, most of us reasonably conclude that “ObamaCare” will lumber forward, and rightly so; thus, a reasonable question from Elders and/or Medicare beneficiaries is, “NOW, what do I have to do??”

            Answer: Nothing. For the foreseeable future, all you need to do is what you were already doing, which is to do your “due diligence” regarding your Part D and/or Advantage Plan, make a decision (or do nothing) and have that in a proverbial bag by midnight on December 7^th; other than that, put on your seatbelts and prepare for the December holidays.

            But while we were busy making ourselves nuts with the election, the Center for Medicare Advocacy (along with a number of other folks) sued CMS(Centers for Medicare & Medicaid Services) who runs, obviously, Medicare and won – Well, they’re winning, because a settlement has been filed in federal District Court and should be formally approved soon. And you would take off your HazMat suit and back away from the refrigerator for this little piece of news WHY?

            Here’s the deal: As way too many of us well know, for years and years Medicare has had an “improvement standard” that limited our access to Medicare-paid skilled nursing and therapy services (think, among other things, “Home Health”); in other words, when you stopped “improving,” services stopped.

            …hmm…So, if I had a condition that was stable, chronic, not improving or that required such services to just keep things from getting worse (“maintenance only”), I was out of luck. Here are two surprises:

1. A lot of us have conditions like that;
2. Said “improvement standard” isn’t in Medicare law!

It was just some rule or regulation or standard or whatever that got injected into the mix somewhere along the way and became gospel; thus, those of us who need such services to keep from getting worse (a reasonable goal, if you’re in that situation) will now have access to them.

Think about that, then say, “Wow!”

The true wonks among us may already have heard of this as the “Jimmo Settlement Agreement,” and if you want to learn a whole lot more about it, go to http://www.medicareadvocacy.org/hidden/highlight-improvment-standard/ and let it sink in. When the Court formally approves the Settlement, CMS will launch a big (I hope!) education campaign aimed at Medicare medical providers AND the rest of us, but the fact is that we could push this NOW – Take a look at the “Self-Help Packet” on that web site.

Will this only apply to certain diseases, diagnoses or conditions? No. It applies to any Medicare beneficiary who requires “skilled services” to keep from getting worse.

“Skilled services” – Does that mean “…only in a nursing home?” No, it could mean at home, outpatient OR in a skilled nursing facility.

Will this add to the number of days that Medicare will pay for in a nursing facility? Good question! No, because the famous “100 days” is specified in Medicare law, but it does change how you might qualify for same.

Won’t this just cost Medicare more and make this whole “healthcare thing” worse? Smart! Well, we shall see, but a study was done through the Veterans Administration model where people had access to services like this and it appeared that it actually cost less, because hospitalizations and nursing home costs went down! Why?

Well, because if we have access to what we need when and where we need it, we tend not to get worse and cost more – Makes sense, huh?

Well, the federal District Court certainly seems to think so.

This will all be unfolding in the next few months, so stay tuned; in the meantime, if you or yours are on Medicare and are denied skilled nursing and/or therapy services because you’re not “improving,” say “Jimmo Settlement” and argue about it, because allowing people to get worse doesn’t save anybody any money.

And remember that this is Medicare, so it’s national, so this is all just as true for Cousin Clem in Kansas City as it is for your sister in Sappho, OK?

“Improvement” can be a relative thing – This is an improvement.

Peninsula Daily News Column 11-22-12 "Thank you to weary, done-in caregivers"

            HAPPY THANKSGIVING!

            Do you s’pose that, just for today, we could lighten up a little bit? Call a time-out to the perpetual offense that we take, on a daily basis, to all those people who are wrong and rapidly leading us to the brink of global destruction? To all those liars and cheats and power-hungry, self-righteous greedy ne’er-do-wells who are leading the rest of us down the proverbial primrose path to poverty, servitude and sore-throats?

            I didn’t think so – OK, never mind.

            It is an interesting day, though, with all of the commercial images that are thrust upon us, from seemingly happy pilgrims in funny clothes gorging themselves to the Waltons (gorging themselves) to the paintings that were on the covers of Post magazines (if you have no idea what that was, never mind – If you have no idea what a magazine is, just GOOGLE it and trust me), but the theme is often the same: family and friends gathered about some manner of table, gorging themselves…

            …because if there’s anything that will make us grateful quickly, it’s FOOD! The more food, the more gratitude, so by the end of day we’re so grateful we’re comatose! – And already worrying about diets, which do not make us grateful, so…

            It’s an interesting day, but I have no intention of going on today about obesity – Gratitude is where we find it.

            And, indeed, today there are families plus friends plus neighbors plus spouses plus significant others plus kids-who-are-already-making-kids and dogs and whomever else celebrating and enjoying a lovely time with a lot of food – Good for you! Enjoy! Any Respite from the grief and worry of the “real world” is welcomed and deserved – And so has it always been.

            And I’m not going to go on about all of the tragedy and poverty and horror and hunger and loneliness in the world – Or next door; you know that as well as I do, but that doesn’t mean that you can NEVER just forget about it for a moment and enjoy yourself and the people you love, so let’s don’t worry about the bad guys or the good guys today – Tomorrow, despite our best efforts, will be here soon enough.

            So, for just a couple of more minutes, I want to talk to people who are taking care of somebody who needs to be taken care of, whether they like it or not – “Caregivers,” if we need a label – Because I know what today is.

            So do you.

            Today is a day that you get to do even MORE! Ta-Dah! Oh…goody.

            Today is a day when, on top of everything else you were already doing just to get him or her or them (and you) through the day – Any day! – You get to do even more! You get to do something that will make it feel like Thanksgiving, whatever that may be.

            Even if you’re taking care of someone who has no idea where they are, who they are or who you are, it just seems like you should.

            Even if you’re not really all that crazy about whoever it is you’re taking care of, and maybe never were, or barely even recognize them or aren’t really doing this whole “caregiving thing” out of some deep love or commitment, it just seems like you should.

            And even if you’ve already figured out that trying to do anything on top of just getting him, her and you through the day in more-or-less one piece is SO past stupid that you’ve been very carefully pretending that today is just another “…day in the neighborhood,” it just seems like you should, and you also know (just as well as I do) that before the day is over, you probably will.

            Softy.

            And it doesn’t matter what you try to do, whether it’s cook a special meal or have family over or try to take him or her somewhere else or just nuke a Cornish game hen and watch the “Wizard of Oz” (again) – Whatever it is, it’s going to mean that you have to do more.

            Like you weren’t doing enough.

            Oh…goody.

            Maybe we do this out of love – Or duty or honor or to “pay back” – Or just by default: There is no one else.

            Maybe being able to take care of him or her is the most wonderful gift we’ve ever been given! Maybe it’s not. Maybe it feels like a…sentence.

            Maybe it is.

            For many of us, though, we do this out of all of those reasons, but we only admit to some of them to certain people at certain times – “Truth,” sometimes, is a moving target.

            But we can’t think too much about it, because if we do, we might not be able to do anything! We’d paralyze ourselves with the prospect of tomorrow and tomorrow and tomorrow and “…I don’t have time for that because I have to get the meds down him RIGHT NOW!”

Or whatever.

And we know that, on some level, he or she knows what we’re doing and appreciates it – Understands the magnitude of the gift we’re giving, and loves us for it, but it would sure be nice to…hear it.

Faith, sometimes, is a moving target.

So, go ahead and do whatever you think you need to do to make today “special,” because you’re going to do it, anyway – Even if you had very carefully decided not to, you will: You’ll do something that you didn’t have time to do, and you may not even realize that you did it for a few more days – And when you do, you’ll say to yourself, “Am I NUTS?!”

Maybe sanity is a moving target, too – We seem to have a lot of those.

So tonight, when you’re very quietly stealing those few moments with a few leftovers and planning for tomorrow (because you are, and you and I both know it) and thinking that “Thanksgiving” just isn’t what it’s cracked-up to be, remember what that guy in the paper said – He said:

Thank you.

Peninsula Daily News Column 11-15-12 "Have a care to avoid hospital (again)"

            Let’s face it: When you’re sick and in the hospital, there’s nothing more annoying than a hospital full of sick people.

            Oh, sure, you probably get good care (especially locally!) by genuinely decent people who honestly do care, and you get to lay around a lot and most of the time (despite all the old jokes) the food is even pretty decent, but the fact is, you’re IN THE HOSPITAL!

            …and that’s usually not good.

            It’s not good because you’re sick: You feel anywhere from lousy-to-dreadful, you’re scared, you don’t know exactly what’s going to happen next or who’s going to make it happen to you or if it will hurt, you can’t account for all the weird sounds you hear (or don’t), you’re getting pretty tired of telling EVERYBODY your date of birth and maybe you’re worrying about how all this is going to get paid for and how the dog/cat/iguana are doing without you and just getting to the bathroom (or not!) is a major undertaking (OK, we won’t use the word “undertaking”) and you just want to GO HOME!

            GET ME OUT OF HERE!

            Another funny thing about sick people in hospitals is that there’s a reason we’re in the hospital, and that’s scary! We’re sick! We’re…scared.

            And if we have a spouse/family member/buddy/significant other who’s trying to take care of us, they’re feeling a lot of the same things PLUS listening to us casually whisper, every 11 seconds, “GET ME OUT OF HERE!”

            So, do you know what happens? Right: By the time it’s getting close to actually GETTING OUT OF HERE, we’re all so myopically focused on GETTING OUT OF HERE that we don’t hear what we’re being told to do once we finally do GET OUT OF HERE because we just want to GET OUT OF HERE! So, somebody gives us a handful of “discharge instructions” written in Martian and we smile and nod and thank everybody and then whisper sweetly and discreetly, to whoever it is that is trying to help us:

            GET ME OUT OF HERE!

            Do you know what happens then? Right: We go home, breathe a huge sigh of relief, inquire after the iguana, and go to sleep; then, what often happens, is that we get sick all over again (or sickER!) because we don’t know what-the-heck to do to take care of ourselves because all these papers are written in Martian and we didn’t really hear much of anything because all we could hear was the sound of our own minds (or voices!) saying, “GET ME OUT OF HERE!”

            And what often happens then is…Right: We end up back in a hospital full of sick people. Oops.

            And this is particularly likely to happen to those of us who have a chronic disease or condition, like heart failure or diabetes or COPD or pneumonia, etc. OOPS!

            So, what if you had somebody whose job it was to actually coach you through what to do when you got home? Who could actually understand those Martian instructions? Who could (and would!) help you figure out the difference between the prescriptions you were taking when you went in and the ones they sent you home with and the ones you’re supposed to be taking now? In other words, walk you through it? Yeah? And what if it didn’t cost you anything? YEAH?         

This coach could (and would!) help you figure out who you need to make an appointment with, and when, how to get there, what to say (and ask!) when you get there and how to keep track of what’s happening to you, the goal being to NOT end up back in the hospital, worrying about an iguana with abandonment issues. Really.

It’s called “Care Transitions,” if you care, but the idea is simply to help you, Patient, transition from this care setting (hospital) to that care setting (HOME!) so you can stay where you want to stay, which probably isn’t in the hospital.

Is this about money and healthcare costs and all that jazz? Sure! If you’re not bouncing in-and-out of said hospital every other day, it’ll save everybody money, so…OK! But that really isn’t the point if you’re you, is it? The point is to make it at home and have your life, right? So, you wouldn’t do this…why?

Right, so here’s what you (or your “person”) needs to do if you’re in the hospital or about to be or just got home and don’t read Martian: Call 417-7315 (Olympic Medical Home Health) or 452-3221 (Information & Assistance) and say, “Care transitions,” or something close to that, or just tell whoever answers the phone what’s going on – They’ll figure it out; OR, tell the folks who are caring for you in the hospital that you want to know about “Care transitions” – They’ll figure it out, too.

That’s all – The rest will happen TO you. What you’ll have to do is try to pay attention and tell the truth and be the best “patient” you can be, so you won’t have to keep being a “patient,” but don’t worry about that too much – These folks understand that you’re sick.

This works – I’ve seen it – And it doesn’t hurt or cost us anything, so why not?

The iguana will thank you.

Peninsula Daily News Column 11-8-12 "Open season starts for Tax-Aide help"

            Does it ever feel to you like the whole world is going to Heck in a hand basket (whatever a “hand basket” is – Or, for that matter, whatever “heck” is)?

            I know; me, too.

            As if Medicare’s “open enrollment” wasn’t enough to drive you back under the covers (we have four weeks from today!), it seems like all we hear about is what’s wrong, or who did what to who, or who is trying to do what to who, or greed, or lies or how the world is going to end soon or…You know. It’s all around us, all the time.

            And we begin to wonder, “What happened??” Oh, sure, we knew “Andy of Mayberry” was a TV show, but…GEEZ! There used to be simple, decent people around who behaved simply and decently, if a bit…oddly. What happened? It’s…scary.

            I’m not personally convinced that “it” is any worse than it ever was; it’s just that media make us privy to every bad, scary thing that happens in the world IMMEDIATELY! But if that’s all you hear all the time, you have to begin to wonder. It’s…scary.

            And in the face of all that sadness and horror, we feel helpless – Powerless; there’s nothing we can do. There’s nothing I can do.

            Yes, there is.

            Where I end up, when I get lost in all that fear and all those discouraging words, is realizing that I can’t fix all of “that” – But I can do a little something to make my little corner of this very strange world a little better, and so can you. Listen:

            This is the time of the year that TAX-AIDE is recruiting volunteers to help them help people who need help; yes, I know it’s “open enrollment” and I know the days are getting shorter and colder and I know that the holidays are coming and I don’t care. This is something that some of us can do to make our little corner of the world better, and it probably won’t be fun – Unless you think being showered with gratitude is “fun.”

            You’d have to show-up in Sequim for “new volunteer orientation classes” on December 4^th and 5^th, and then you’d have to study your little hearts out using IRS-provided materials and tax preparation software to learn how to electronically file tax returns. Sound fun so far? It gets better.

            Then, you’ll get to go back to Sequim on January 3^rd and 4^th for “review classes,” and then you’ll have to pass an IRS test at the “advanced” level (because it doesn’t help people to help them if you don’t know what you’re doing) AND sign a IRS “Standards of Conduct” document that says you’ll act like a good and decent human being- Andy would’ve been proud.

            THEN, you’ll get to work your tail off (metaphorically speaking) all through “tax season!” TAX-AIDE will ask you to work (oh, Yes Virginia – This IS “work!”) at least four hours per week, but they’ll need you more than that; well, I’ve never lied to you before…

            You do not have to be 65 or retired to do this; yes, TAX-AIDE is sponsored by AARP, but you don’t have to be a member or join-up or whatnot - TAX-AIDE serves all comers who are low-to-medium income. Period.

            In my never-ending quest to overstate the obvious, I’m forced to observe that not all of us are cut-out to prepare tax returns; OK, but that doesn’t mean that there isn’t something else you could do to help, right? I mean, they’ve got to have “coordinators” and publicity people and “facilitators” (think “crowd control,” or “hospitality”) and probably “grunts” and “techies” and who-knows what else! Are you willing to at least think about this?

            OK, here’s what you do: Contact AARP at www.aarp.org for an online application. No? OK, try this:

• In Port Angeles, contact Lois Bellamy at 457-1497 or lois_bellamy@mac.com ;
• In Jefferson County, contact David Self at 385-2617 or dcself@olypen.com ;
• In Sequim, it’s Gail Anundson at 582-1295, sequimgail@gmail.com ;
• …and in Forks/West End, try Corinne Spicer at 374-6332, forkstaxaide@hotmail.com .

These folks need to know who’s willing to help by December, so don’t think about this too long; besides, what’s to think about? You’re not going to be able to tear yourself away from the 119^th rerun of “It’s a Wonderful Life” long enough to learn the IRS tax code? Oh, come now!

Helping TAX-AIDE probably won’t save the world from Handbasket Land, but it will help people who want and need that help, so our little corner of the world will be a little better than it was, because of what you did.

And for most of us, my friends, that’s as good as it’s going to get.

Peninsula Daily News Column 11-1-12 "Special enrollment period starts December 8"

            HEADS UP! If you’re planning on attending the 6^th annual “Building Your Caregiver Tool Box” conference on Saturday, November 3^rd (the day after tomorrow), you need to know that it’s been moved to the Dungeness Valley Lutheran Church at 923 N. Sequim Avenue in (you guessed it) Sequim! Everything else is the same: 8:30 to 3:30, free lunches and snacks (free everything!), a chance to learn some stuff that folks like us could stand to learn and a whole bunch of people who are doing the same thing – Taking care of somebody who needs to be taken care of.

            See you there. Now:

My plan for today’s column had been to write about bed rails – Yes, “bed rails.”

            Everybody who works in a hospital or a skilled nursing facility or some such is thinking, “Right, bed rails. I get it.” You’re thinking, “Bed rails?!” Oh, yes I can…

            …and in the future I still may, just to prove to you that I can do it, but not today; no, today is going to be about Medicare (again) because, as per the bumper sticker that would probably make me rich, Medicare…happens.

            Here’s what’s happened this time: As just about everybody who is even distantly concerned with Medicare well knows, we are right in the middle of what most of us call “open enrollment” for Part D and Advantage Plans, so what happened? Well, some Part D, and Advantage Plans decided to leave certain areas, so won’t be around next year, and because they are private plans, they can do that.

            Oops! OUCH!

            So, that’s what we’re about today, and what I’m going to tell you here is Federal stuff – National stuff – So, if this happened to Cousin Clark in Kansas City this will apply to him too, OK? OK. So, if you’re Part D or Advantage Plan (most likely, the latter) is leaving your county in 2013, here’s what you’re looking at:

            In addition to the “open enrollment period” that we’re smack in the middle of, you will also have a “special” enrollment period that will run from December 8^th through February 28^th, 2013 to switch to a new Advantage or Part D plan; remember, this is ONLY if you’re Plan is leaving! – Not liking your current one, or finding a better deal or just being contrary doesn’t count – Your Plan has to be leaving; if they are, you’ve got until 2/28/13. Your new Plan’s effective date will depend upon when you actually enroll.

            IF the Plan that is rudely abandoning you is an Advantage Plan, you could decide to join a Medicare Supplement plan (aka MediGap, MedSupp). If you do that within 63 days after your current Advantage Plan terminates (probably December 31, 2012), the MediGap plan has to accept you WITHOUT A HEALTH SCREENING, which is also known as “guaranteed issue.”

            It’s OK to go back and read that again, because it took me several tries to write it. OK? That could be a very big deal for some folks.

            The “bad news” is that if you’re under 65 on disability, you’re still limited to the MediGaps that will “accept” you. I’m sorry – Really. I know this is a HUGE blow to some of you, and I wish I had a better answer.

            So, what if you’ve been lounging about in the Caribbean and don’t get around to switching to a new plan by December 7^th? Well, if you have LIS (“low income subsidy,” “extra help” – We’ve talked about this before), Medicare will automatically switch you to a new “benchmark” plan that will kick-in January 1^st, UNLESS you choose a new one by December 31^st (go ahead, read that again – It IS confusing). If you get “switched,” CMS (Centers for Medicare and Medicaid Services) will send you a blue letter (yes, BLUE) telling you what plan you’ve been switched TO…

            …but you still have until 2/28/13 to change that; besides, if you do have LIS, you can actually change anytime! Whew!

            Now, if you don’t have LIS and you were carousing in the Caribbean, Medicare will return you to “original” Medicare (meaning, Part A/Part B), with no other coverage, which means no “MediGap” – But you still have until 2/28/13 to do something.

            If any of this is happening to you or somebody you like, start working on this NOW! And, info on available plans for 2013 is up on www.medicare.gov now. Should you decide to move to a different Advantage Plan, be sure to check with your medical providers FIRST, to be sure that they accept that plan; otherwise…Oops!

            I know. If none of that made any sense at all, just call any of the numbers at the end of this column and decent people will help you – For free! – Without trying to sell you anything or make you feel like an idiot, because you’re not.

            No, you’re not; I know that this can all make you feel like you are, but you’re not – It IS unbelievably complicated! And I wish I could tell you when it was all going to start making sense, so regular people could actually understand it, but I can’t, because I don’t know.

            Nobody knows, so here’s the only thing you can do:

            The best you can.

            I’m serious: There’s no magic decoder ring or secret file or wonderful web site or exceptional salesperson or humanistic insurance company that can make this all be fine – And if anybody tells you that there is, they’re either lying to you or trying to sell you something.

            What there is is good people, who genuinely care and will try their best to help, but that’s as good as it’s going to get; in the end, it’s on you.

            It’s on us.

            Here’s what I can absolutely guarantee you: What will happen if you do absolutely nothing?

            Nothing good.