Peninsula Daily News Column 9-19-2013 "'ObamaCare' becomes real in 12 days"

          …once more, with feeling…

ObamaCare!

          I’m sorry if that once derisive/now descriptive term offends some of us, but it is the term that rings the most bells with most of us. If you prefer “Affordable Care Act,” “ACA,” “Health Benefits Exchange,” “HBE” or the “health insurance mandate,” feel free to substitute your preferred preference, but here’s this week’s “bottom-line:” 13 days from today, this whole thing becomes…real.

          That means that, 13 days from today (October 1, 2013), people with no health insurance (or crappy health insurance) will be able to get health insurance. That means that, for many of us, we’ll be able to get healthcare for ourselves and our families. Think about that; so, instead of just rolling the dice, hoping for the best or being known on a first-name-basis by our local ER room, we could actually have health insurance.

          Now, does having health insurance absolutely guarantee that you’ll be able to find a doctor or clinic who will welcome in you and yours with open arms? No – This is Earth: Nothing guarantees anybody anything, but having health insurance will sure-as-heck help you when you’re looking, because something is almost always better than nothing.

          So, on October 1^st, the Washington Health Plan Finder will be operational. The “Health Plan Finder” is a webs site (“portal”) where you will be able to “shop” for health insurance. That means that you will be able to put in some info about you and yours and it will tell you what you might be eligible for in terms of Medicaid or a “Qualified Health Plan.” IF Medicaid, it will help you apply for same. IF a “QHP” (I know, but I’m getting tired of typing “Qualified Health Plan”), it will tell you whether you’re eligible for a subsidy, how much and what QHP’s are available to you, depending upon where you live, tra la.

          THEN, you’ll be able to decide (if you’re ready to decide) about which plan, what level (bronze/silver/gold) AND actually purchase or commit, right then and there.

          STOP! If you re-read, like I just did, those last two paragraphs above, you might be thinking, “WOW! That’s a lot to understand and decide!” Yes, it is, which doesn’t mean you’re stupid – It means you’re smart, because you’re thinking.

          And if you’ve never had health insurance before, so you’re new to things like “copays” and “deductibles” and blah blah, then this could all be a bit overwhelming. Don’t beat yourself up, because we ALL had to learn it somewhere, sometime, so just take a breath and trust that you’ll “get it” – And you will.

          So, IF you have a computer, and IF you have internet access and IF you just can’t wait to get this going (and, by the way, I’m not being completely sarcastic, because there are plenty of us with families who are VERY anxious!), you can go to www.wahealthplanfinder.org now and mess around with the “calculator,” to see if you and yours might be eligible for subsidies and get in the ballpark. Can you do the whole shebang, like actually shop and enroll? No, but you can begin to get a “feel” and begin to know what your “ballpark” might look like.

          STOP! (…again…) Do we all have to jump in the middle of this on Tuesday, October 1^st? No. “Open enrollment” will run through March 31^st of next year, but if we want health insurance coverage to be effective on New Year’s Day (January 1, 2014), then we need to get this done by December 31, because that will (a) get us health insurance, and (b) avoid any possibility of any “penalties.”

          Now, stop stopping and tell the truth: Some of us, if we’ve even made it this far through this column, are feeling overwhelmed. We may not have a computer or we may not have internet access or we may not feel like we understand any of this **** and we’re feeling scared/nervous/anxious and STUPID! “What if I get on that web site and don’t understand something and freeze-up and don’t know what to do and…or…??”

          “What if?” Nothing, that’s what. Nothing bad will happen, except that you won’t be able to accomplish what you’d hoped to accomplish, so there will be a number of folks, like us, who will be able to help walk you through this, IF you want help.

          Somebody somewhere decided to call us “In-Person Assisters” (…sigh…Well, Lord KNOWS, I’ve been called worse), but it isn’t necessary that you remember that. It is necessary that you remember that there are folks who can and will help you. You can call any of the numbers at the end of this column, you can get help through the Jefferson County Health Department, or through Jefferson Healthcare, or through Olympic Medical Center, or through Planned Parenthood or through VIMO (Volunteers in medicine of the Olympics) or through Forks Community Hospital. (Note: There will be a “town hall” meeting on all of this in Forks, next Monday, September 23^rd, from 7:00 to 8:30 p.m. at the Forks Elks Lodge, free).

          “In-person assisters,” like us, will not try to sell you anything. We won’t tell you which plans to buy or not buy, or what you “should” do. We will help you navigate this thing (if you want help), help you understand what you’re looking at and help you understand what decisions you need to make and what those decisions will mean – Beyond that, it’s your call, because it’s your life. And you won’t have to decide everything at one time, unless you’re ready.

          Sometimes, if you’re me (and most of you aren’t), it’s a bit of a relief to stop talking about something and just get on with it!

          Let’s get on with it.

           



Peninsula Daily News Column 9-12-2013 "Even more ‘Obamacare” information"

ObamaCare!

          Yes, here we go again. Here we go again, because even if those of us who boast “Elder status” are already enmeshed in Medicare (or whatever) and don’t have to deal with this, we have kids and grandkids and nephews and nieces and friends who do (or should), and it’s still our job to show them the way, so quit yawning and sighing and PAY ATTENTION!

          This is about people who don’t have health insurance getting health insurance. Health insurance pays (to one degree or another) for healthcare, so let’s talk about what healthcare this health insurance is going to cover.

          Some of us have heard about “bronze plans” or “gold plans” or whatever – What’s that about? Well, these are just “levels” of insurance, measured by the dollar-amount of coverage that a plan will pay, so bronze = 60%, silver = 70%, gold = 80% and platinum = 90%; thus, if you go to a doctor for a covered service, a “silver plan” will pay (more or less) 70% of that bill, get it?

          There will not be any platinum plans in Washington in 2014 – I don’t know why.

          Let’s backup and begin to put this together. Last week I went on about levels of “help” that will be available to purchase this health insurance. The first level of “help” was (Is!) Medicaid. Medicaid is Medicaid is Medicaid; in other words, Medicaid covers what it covers (and doesn’t cover what it doesn’t cover), and that’s that for that – You don’t need to decide anything.

          The next level(s) of “help” is through tax subsidies – Coming back to you? OK, so what these tax subsidies subsidize (or don’t subsidize, if your income is above the levels I assaulted us all with last week) are the purchase of “qualified health plans,” which means health insurance plans that have been reviewed up one side and down the other by the Washington Health Benefits Exchange, holding hands with the Washington Office of the Insurance Commissioner.

          Said plans had to meet all kinds of conditions and eliminate the dreaded “fine print” and what-not. They also have to provide (at a minimum – by law) “10 Essential Benefits,” so this where we STOP thinking about money and mandates and penalties and politics and START thinking about what helps people we love. These 10 benefits are:

1.     Ambulatory patient services – Going to the doctor or clinic or whatever – NOT in the hospital!

2.     Emergency care

3.     Hospitalization

4.     Maternity and “newborn” care – Think about that, Mr.

5.     Mental health and substance about services – Think about that.

6.     Prescription drugs

7.     Rehabilitative and habilitative services and devices – Something very bad happened, so now you have to relearn how to do things (e.g. walking, etc). “Habilitative” means services that help you to keep the skills/abilities you’ve got or actually increase them.

8.     Lab services – Tests, etc.

9.     Preventive and “wellness” services – Including regular physicals, immunizations, managing “chronic conditions,” etc

10. Pediatric services for kids under 19 – There will be add-ons for dental and vision, too.

OK? So, the “bronzes” and the “silvers” and the “golds” ALL have to offer at least these benefits, and will generally pay 60%/70%/80% of their costs – Coming together?

For those of you who are new to the netherworld of health insurance, almost NO health insurance pays 100% of almost anything – No health insurance pays 0% of everything.

This is still a few weeks away (October 1^st is “go live”), so we’ll talk more about the “how” and “who can help,” so just try to let this all sink-in; for now, consider this: Most of us have car insurance, hoping that we’ll never need to use it; personally, I’d rather have it and not need it than need it and not have it.



Peninsula Daily News Column 9-5-2013 "It's time to 'get' Obamacare"

ObamaCare!

          Don’t panic. Yes, I did start a column on this same subject in this same way a couple of weeks ago; Yes, this is a different column, so – No! You haven’t “lost it” (at least, as far as I know).

          The object of the game here is to e-a-s-e our way into this thing, rather like sticking one-toe-at-a-time into the very cold water, so grit your teeth and go boldly.

          What we’re talking about here is the health insurance “mandate” that kicks-in on January 1, 2014. IF you are on Medicare, or Medicaid, or Tri-Care or VA or already have health insurance through your employer that is fairly decent or what-not, you already have health insurance, so will not be required to go get health insurance, so none of this will apply to you; HOWEVER, if you happen to know, like or love anyone who doesn’t have any of these, the “mandate” will apply to them, so cut this out and tape it to their toilet, or any other equally popular site in said insuranceless person’s abode.

          A lot of people are pretty focused on “THE PENALTY,” and Yes: There is a penalty. What many of us have heard is that for 2014, the penalty is $95.00, so many of the “young invincibles” (who are young, but NOT “invincible”) are expected to say, “Well, that’s cheaper than buying health insurance, so forget it.”

          OK, but here’s the rest of that sentence: The penalty is $95.00 per adult, plus $47.50 per child, up to a maximum of $285.00 per family OR 1% of income; potentially, that “1%of income” could be considerably more than $95 AND said Young Invincible could walk away with health insurance.

          By the way, in 2015, THE PENALTY jumps to $325 per adult, maxing-out at $975 per family or 2% of income, then jumps again in 2016, so we might as well start figuring this out now. Those of us who are neither “young” nor deluded into thinking that we’re invincible, and who don’t have health insurance will be subject to this same penalty, so don’t write this off as the exclusive problem of clueless, 27-year-old males.

          That’s the “stick” – What’s the “carrot?” Well, for many uninsured folks, there will be help paying for this new thing called “health insurance;” specifically, Medicaid (NOT Medicare – Medicaid) will expand. What that means is that folks whose budgets are pretty darned tight could get insurance for free. For instance:

          If the household is 1 person (just you), and your income is at or below $15, 856, you’re probably eligible for this “new version” of Medicaid. I purposely say “new version,” because even if you’ve applied for Medicaid before and got turned down, this is a NEW critter, so you’re starting over.

          If the household is 2, the income cut-off is $21,404. If there are 3 of you, annual income at or below $26,951 gets you into Medicaid and for 4 of you, $32,499 ($2,708/month) – It goes on, but this is getting boring, and I’m sure you’ve got the drift by now.

          I know what some of you are thinking. You’re thinking, “Oh, PIFFLE! That kid of mine makes just slightly over those amounts!” OK, try this:

          The next level of “help” is through tax credits, that could be applied to the health insurance premiums or taxes or whatever is best. These, too, are “tiered,” and we could get lost in a visual blizzard of numbers here, so allow me to cut to the “high end:” If you’re alone, and you’re income is $44,680 or less, you could get some help. If there are two of you, think $60,520, and for a family of four, think $92,200.

          Being the omniscient column-producer that I am, I know what some of you are thinking now – You’re thinking, “REALLY? (That could really help!).” Others are thinking, “REALLY? (That’s an abomination!).”

          I’m thinking, “Yes, REALLY” – And this is another one of those junctures where this whole conversation could get very political, and I have no intention of getting “political,” because that’s not my job. This is the law, and the law is in effect; thus, my job (OUR job) is to help people get to where they need or want to go. Do I think this will help some people? Yes. Do I think this is a perfect law? No. Do I think it’s time to stop beating it to death and get on with it? YES!

          Look, there are many of us who haven’t been able to afford (or get) health insurance, so what happens is that many of us can’t get healthcare because we don’t have health insurance, so we do without; THEN, we get sicker (or the family does) and we end up in the ER room and…Right: The circle goes ‘round, and people suffer, so let’s get on with this.

          This whole thing begins on October 1^st, so we still have a little while to try to “get it.” We, and plenty of other good folks in our communities, will be available to help – For free! – If you need it or want it, so for now, just try to understand the “big picture,” and think: Think about you, and the people you love and the people you know, who are going to be needing to navigate this, because once again, my friends, there will be absolutely nothing “blissful” about ignorance.



Peninsula Daily News Column 8-29-2013 "Caregiving often improvised, imperfect"

          Here’s something I said in a column a few weeks ago:

          “The people who know the MOST about ‘long-term care’ are caregivers – People who took care of people who needed to be taken care of, whether they liked it or not. Most of us have been, are or will be ‘caregivers’, or we’ve at least been close enough to it to see it…” The point being that we could learn a lot about this “long-term care thing” (most of which is provided at home) by just learning from that experience.

          While I still believe that to be absolutely true, I must also accept responsibility for the fact that I probably caused a lot of past and present caregivers to have a gastric event: “WHAT?! I didn’t have the remotest idea what I was doing, and I still don’t! I’m making it up as I go along! And it sure would’ve been nice if someone had come along and sent me to Caregiver Boot Camp, cuz I’ve screwed-up so much stuff, it’s scary! Did you hear me, Harvey? – I’m making it up as I go along!!!!!”

          Here’ something that one of you said back:

          “Dear Mark Harvey:

          I read your column regularly and for the first time feel that I have something to say.  I agree totally with long-term care being an imperfect art.  You can compare it to being a parent.  My mother-in-law, a very wise lady, once said it was a good thing god didn’t let us know what it was like to be a parent until it was too late. 

My daughter called me when her first child was about 2 years old and said she had figured out something that day. She had always thought I had all the answers and was always there with the solution to every problem and it was that day with her own child that she realized that I had been making it all up as I went along.  I told her of course…this is what every parent does.  No books or lectures or college courses can truly prepare us for parenting.  Same with taking care of our aged parents.  No two cases are the same and no two days are the same.  There are no rules (other than the law and morals) or timetables for us to follow.  Things happen as they happen.  You simply make it up as you go along. 

I care for my 87 year old mother who has an inoperable disintegrated hip.  She is in a lot of pain but still manages to live in an apartment in an assisted living facility.  It still gives her some semblance of independence and me a little freedom.  I am her legs and entertainment.  Still I sometimes feel like my life has been taken over but then I realize it is as it should be and it could be worse.  I can take a vacation when I need to and her mind is still very sharp.  But when I get frustrated with something I have to do or something she has done I immediately call my daughter and apologize for what she has coming.  We have a good laugh and it relieves the situation. 

Thank you for your wise words and all you do to help everyone.  I know you have done this for many years and have much education for your job but I am sure that there are times you ‘just make it up as you go along’.”

Oh, Dear Reader, you have NO idea! – And that’s probably just as well – But I thank you for jumping in.

There are, I suppose, some of us who will resent the comparison of raising kids to caring for Elders, seeing it as disrespectful, but I don’t think that was the writer’s point. I think her point was (and is) that in both of those rather tricky undertakings, we become whatever (and whoever) we need to be at that given moment in order to “handle” what needs to be handled, and then we worry – We worry that we didn’t get it right/do it right/say it right, and that we should have done better.

Maybe – Depending upon what “right” is…

So we think we should learn more, read more, listen more, ask more questions – And we should! – We can always get better and do better, and those of us who are doing this “long-term care” thing ought to be trying to do better ALL THE TIME!

But when that next thing comes up – In the next moment! – And we don’t have time to read something or call somebody or go to some web site, what do we do? Right: The best we can.

Here’s what I can tell you about doing the best we can: If it’s done with caring, respect and a modicum of common sense and intelligence, it will usually be just fine. I’m not talking about cruelty or abuse or raging irresponsibility – I’m talking about where most of us are, most of the time: Trying very hard to do the right thing while we beat ourselves up for not doing the “right” thing.

Try hard. Think. Do better. Learn.

Care.

And remember that imperfection is allowed.



Peninsula Daily News Column 8-22-2013 "Aging is not the problem; society’s opinion of it is"

          A few weeks back, I succumbed to my periodic need to clamor up on a soapbox and clamor; in this particular instance, I clamored about the fact that “we” are not a “problem;” more specifically, that “aging” isn’t a “problem” that needs to be “solved.”

          I managed to overstate the obvious by pointing out that aging is a natural part of this thing we call “life,” so why are we made to feel guilty or “less than,” simply because we haven’t died according to an outdated, actuarial schedule? – Then, feeling sated for the moment, I moved on.

          But some of you have actually considered my clamoring, so allow me to share parts of a letter I received, severely edited to avoid any possibility of identifying the writer, who isn’t a “problem:”

          “I just finished reading your article…I am so-o-o glad I am not a ‘problem’, no matter how many people seem to find older people just that…

          I am a 77-year-old widow (mother of one…who certainly does consider me a ‘problem’. I have worked since the age of 12 in business fields and hospitals…have no diseases, take no medications…

          I have never felt I was a ‘problem’ or ‘abnormal’, although periodically have been condemned for receiving civil service retirement…, on social security and receiving 2 survivor benefits from my late husband of 50 years and taking jobs away from unemployed locals, etc, etc, not to mention comments---‘At YOUR AGE you should get some hobbies and stay at home or travel, although volunteering is acceptable AT YOUR AGE…’

          Your article says it all, Mr. Harvey…especially if you aren’t dead, ‘aging’ is a universal experience, so why do we need to ‘solve’ a universal experience? WHAT AN ENLIGHTENED POINT OF VIEW – although marketing it to the public is a different matter entirely – good luck with that…

          The common view of the public seems to be OLD PEOPLE ARE PROBLEMS, CURSES AND SOCIETAL LIABILITIES – and we are stuffed into OLD PEOPLE categories, no matter if we are still productive and viable or not.

          I endorse the idea that old age is a ‘blessing’, an opportunity and an inherent phase of this funny thing called ’life’, and for one, plan to and do ‘run with it and learn from it’, and avoid and definitely not listen to those putting down older people.

          You’re the greatest, Mr. Harvey – keep up the good work and keep your lovely articles coming – I enjoy them immensely…”

          You’ll notice I didn’t edit out the “You’re the greatest, Mr. Harvey” part.

          I thank this good lady for taking the time to write and give us all a little something to think about – I’ve read her letter several times and am still thinking about it. Here’s one thing I think:

          “Aging” really is NOT the problem. The “problem” is that we’ve allowed our society and our culture to evolve into such a stupor that we can’t recognize an asset when we see one! In my humble, soapbox-inclined opinion, we (the collective “we”) need to back WAY up, until we can see this “aging thing” in some perspective, and realize that we’re not talking about “them” – We’re talking about “us.”

          Elders are an unmined resource on an increasingly over-mined planet, and we might want to figure that out pretty soon – Since when did society and humanity not need all the help it could get? Most folks want to contribute and can, if allowed to – If allowed to step out of a box that they never chose to step into and remain cogs in the wheel that they’ve been cogs in, all of their lives.

          That we’ve been cogs in, all of our lives.

          And those of us who choose to act like “old people,” probably deserve what we get.

         



Peninsula Daily News Column 8-15-2013 "Face 'Obamacare' with equanimity"

ObamaCare!

          Yes, I am trying to get your attention.

          Most of us see “ObamaCare” and we have a reaction. The reaction can range from, “Hallelujah! This is a good step in the right direction and will probably do me and/or mine some good,” to “This is terrible! BAD for America, BAD for me and it shouldn’t be happening!” As is almost always the case, most of us fall somewhere in-between.

          But whatever you think of it – Whatever I think of it! – It is going to happen; so, since I’m about the fine art of “What is” (as opposed to “What Isn’t” or “What Should Be” or What-Not), let’s talk about this for a minute.

          A few of us may actually be able to recall 6-7 years back, when Medicare Part D was about to roll-out (roll over us?), and there were similar, widely divergent reactions to it; actually, there still are and so be it – But the fact remains the fact: It is happening, so attempting to ignore it is rather like standing in the railroad tracks and saying, “I don’t like freight trains so, therefore, there’s no freight train coming at me.”

          Right: Doesn’t work; at least, not very well for very long.

          So, back to it, “ObamaCare:” What most of us mean when we say that word now is the implementation of the health insurance mandate – YOU HAVE TO GET HEALTH INSURANCE, OR ELSE! Well, yeah, OK.

          Others of us think in terms of the “Health Benefits Exchange,” which “goes live” on October 1^st of this very year; well, yeah, OK.

          Others of us just get a headache and try not to think about it at all, because it’s yet another thing we’ll be required to NOT understand, but have to do anyway – Well, yeah, OK!

          Let’s try this. Let’s all stop thinking whatever it is that we’ve been thinking and try thinking about this:

          Yes, there is a health insurance mandate (YOU HAVE TO GET HEALTH INSURANCE!) that kicks-in on January 1, 2014, more-or-less, mostly, depending…Basically, it says that if you don’t have health insurance, you have to get it. Stop here:

          If you are on Medicare, you have health insurance, so this has absolutely nothing to do with you.

          NOTE: The already-confusing will be made more-confusing by the unfortunate fact that “open enrollment” for “ObamaCare” will run from October 1, 2013, through March 31, 2014, while the usual Medicare Part D/Advantage Plan “open enrollment” will run (as usual) from October 15, 2013, through December 7, 2013, so we’ll be hearing about both at the same time and thinking, “WHAT?!” So, allow me to knowingly repeat myself:

          If you are on Medicare, you have health insurance, so this has absolutely nothing to do with you.

          OK? Now, if you have TriCare or VA or fair-to-decent health insurance through your employer (or whatever), then you have health insurance, so this has absolutely nothing to do with you; in other words, if you have health insurance, you don’t need to get health insurance.

Now, it’s true, that if you have “minimal” (meaning, “pretty crappy”) health insurance, you may have to get better health insurance, but for most of us, we will not be forced to go get something that we already have.

Comforting? I thought so.

Now, the “Health Benefits Exchange” is the “thing” (entity, agency, bureaucracy, etc) that ObamaCare invents in every state to be the “marketplace” for finding said health insurance; in Washington, the Health Benefits Exchange is called the “Washington Health Benefits Exchange” – Catchy, huh?

And the Washington Health Benefits Exchange is in the process of inventing the “Washington HealthPlanFinder,” which is a web site we can go to, put in some info about ourselves and find out what the best deals for health insurance for ourselves and our families might be, and whether we might be able to get some help paying for it; THEN, if so inclined, we could enroll in said health insurance plan right then, from right there – But we won’t have to. We will be allowed to think about it.

Occasionally, thinking-about-it is good.

You cannot do this now, because it doesn’t work yet, and YES: We’ll be talking a lot more about all of this, and YES: We will be glad to help you do this (for free) when it’s time to do it, if you want or need help.

If you are on Medicare, you have health insurance, so this has absolutely nothing to do with you. YES, I do know that I already said that – Twice! – But that doesn’t mean that you heard it.

So, what about the “OR ELSE” part? The “you-HAVE-to-get-health-insurance” part? Well, yeah, OK: This is a “mandate,” so if this applies to you and you don’t do it, you could get slammed with a tax penalty OR a penalty of up to about 1% of your income, whichever is greater. What is also true is that there are a whole lot of details that we just don’t have yet (after all, it’s only early August), so try to relax. If you can’t relax, call any of the numbers at the end of this column and we’ll try to help you relax and/or tell you what we know, but remember that there is a whole lot of stuff that nobody knows – Yet.

I personally know a number of folks who will be considerably better off because of all this. I can also imagine that there might be some folks who won’t be (or won’t feel like they are), but I also have to remember that I don’t know what I don’t know.

There’s nothing any of us need to do right now, except for those of us who are eager to do all kinds of research on the subject – And if that’s you, have at it! For the rest of us? Try to relax, and remember that if it looks like a freight train and sounds like a freight train, it’s probably a freight train.



Peninsula Daily News Column 8-8-2013 "Long-term caregiving an imperfect act"

          Long-term care; providing care, long-term – It makes a little more sense if you say it that way: Providing care, long-term.

          And since this has turned into quite the conversation, let’s converse! Last week, I said:

          “The people who know the MOST about ‘long-term care’ are caregivers – People who took care of people who needed to be taken care of, whether they liked it or not. Most of us have been, are or will be ‘caregivers’, or we’ve at least been close enough to it to see it…” The point being that we could learn a lot about this “long-term care thing” (most of which is provided at home) by just learning from that experience.

          While I still believe that to be absolutely true, I must also accept responsibility for the fact that I probably caused a lot of past and present caregivers to have a gastric event: “WHAT?! I didn’t have the remotest idea what I was doing, and I still don’t! I’m making it up as I go along! And it sure would’ve been nice if someone had come along and sent me to Caregiver Boot Camp, cuz I’ve screwed-up so much stuff, it’s scary! Did you hear me, Harvey? – I’m making it up as I go along!!!!!”

          I know. You’re replaying, in your heads, the times that you almost dropped him or you messed-up the meds or you knew what the doctor said, but not what he meant, or didn’t know that you couldn’t do that without this document or JUST WANTED TO KILL HER!!!!!!!!! Or, or or…

          And every day, there’s something new that you didn’t know, but feel like you should have known. Or you were just going so fast, that you didn’t realize that if you did this, then that would happen! And you beat yourself up about your hopeless stupidity and raging incompetence, then I come along and say, “Learn from these people” – WHAT?!

          I know, because here’s something I know: Caregiving is not a perfect science; well, unless you’re a “pro” and you do this for a living in a perfect institution and are trained to the hilt and supported by nurses and everything goes perfectly everyday and no other caregivers ever get sick and don’t show up and there are never any surprises and…You know what that sounds like? Yeah, so do I…

          …and that’s not where most long-term care “happens.”

          Most long-term care happens in imperfect homes, where imperfect people are trying to provide perfect care to imperfect people who need perfect care on an imperfect planet, so my prediction is that things will go perfectly imperfectly, and it’s scary-as-Hell if you’re the caregiver; yet, this is what most of us say we want?? Care at home?? Are we stupid??

          Maybe, but more likely, we’re just human – And imperfection is all we’ve ever known.

          Our lives, from Day 1, have been all about imperfection – That’s what gives it its color, its flavor – Its memories and its laughter – And the stories that end with “…THAT was close!”

          Yeah, it was.

          If we all held hands and toured 100 different homes (apartments, mobiles, yurts, whatever) to view and evaluate the “delivery of long-term care,” what we’d see is 100 different ways of doing it. If we were smart, we’d make some notes about some of the incredibly creative things we saw – And we’d probably be appalled by some of the things we saw! – And in some of those appalling yurts, we’d see care receivers who were perfectly happy…

          …well, OK: IMperfectly happy; because caregiving – LONG-TERM CARE – Is not a perfect science.

          And my point is…?

          Simply that, should you ever need long-term care, it isn’t going to be perfect; thus, our trying to prepare for long-term care isn’t going to be perfect, either – There is no “right way.”

          There never is.

          Look around, learn, think, read, ask questions, imagine strategies, play “what if” and prepare the best you can, but don’t spend your time wasting your time living in fear of tomorrow – What are you going to do? Be scared-to-death to get up and get cabbage for munchies for fear of falling? Rent a room at the hospital? Wall your daughter into her bedroom, so she’ll be there to take care of you? Rent an apartment over a pharmacy?

          Come on! No, you’re not! And neither am I. What we are going to do is the same thing that most of us have always done: The best we can.

          The best we can to learn, think and prepare, while understanding that tea leaves and tarot cards won’t show us what we think we want to know: Tomorrow. We think we want to know how the story is going to end.

          …but we really don’t; because if we did…?

          What would have been the point of the story?



Peninsula Daily News Column 8-1-2013 "Learn about dementia the easy way"

          If your life is touched, in any way, by Alzheimer’s (or any form of dementia, for that matter, but we’ll just say “Alzheimer’s”), here are two things I know to be true:

1.     You HATE that disease with a passion that you didn’t know you had in you! And…

2.     …you know a lot about it – You don’t think you do, but you do.

So, #1: Some of you are thinking, “…as opposed to all of the diseases what we like…??” No, but Alzheimer’s is slow, deceptive, cruel, unpredictable and robs us of the one thing that we valued the most: The person we love. The person we love slowly slips away and is replaced by…somebody else – Somebody else that we didn’t know, but now have to come to know, with little bursts of that other person who we did know, so sometimes we end up thinking, “Who are you?”

Then, we hate ourselves for thinking that.

#2? Well, the most common scenario for a lot of us is being the caregiver for the person with Alzheimer’s; we could be friends, extended family, professionals, or even the person themselves, but the one we see the most and know the best is the “caregiver” scenario.

Most caregivers for people with Alzheimer’s make it up as they go along. We do that because we don’t know what else to do. Most of us have read books and web sites and talked to pro’s and listened to others and read and read and read and…But, moment-to-moment, we make it up as we go along, because our “moment-to-moment” isn’t in anybody’s book.

Sometimes we screw it up, and we beat ourselves up: “I should have known better!” “I should have seen that coming!” “I should have known that!” “Why didn’t I think of that??”

But, we learn – Usually, the hard way.

We learn what works (today), and we learn what doesn’t. We learn (sometimes) about stuff that’s out there that can help us, and we learn about what we wish was out there, but isn’t.

But, we learn.

So, now, I want you to put yet another thing on your plate that can’t possibly hold another thing: I want you to show up at the Sequim Senior Activity Center (Yes, the “senior center”) at 1:30 next Tuesday (August 6). I want you to do that because the Western and Central Washington State Chapter of the Alzheimer’s Association is going to put on a “town hall meeting.”

The point of said town hall meeting that won’t be at the town hall is to hear from you about what ought to be in the “National Alzheimer’s Plan” (Yes, the Feds may actually be getting around to this) AND the Washington State Plan for same, because if you don’t tell them, then what will happen is that people who don’t know as much about it as you do will just make it up as they go along…

…and most of us know how that goes.

There will be a panel. The panel will get us up to speed about what’s happening on the topic, and provide some expertise to answer some questions, and talk a bit about an initiative in Washington to improve health care for folks who are on both Medicare and Medicaid (“dual-eligibles”), but the main thing is to hear from you.

I’m told that I will be there to “moderate;” interestingly, I’m not at all sure what “moderate” means, unless I’m to forestall us from breaking into spontaneous line-dancing (which might, actually, not be a bad idea), but I don’t really care, because it’s going to give me an opportunity to learn a lot from you.

You don’t have to walk-in with the Great-Solution-for-Alzheimer’s-in-the-Western-Hemisphere (unless you have one); you just need to be able to tell us what would help – What would have helped – Or, what didn’t help. Or what failed. Or what went wrong. Or what worked wonderfully!

Or what would help you to put one foot in front of the other, tomorrow.

I know that you don’t have time for this. And I know that you’re probably thinking that by the time anybody gets around to actually implementing an “Alzheimer’s Plan,” it could well be too late to do you any good – You may be right – I don’t know.

What I do know is that if we don’t share what we’ve learned the “hard way,” then everyone else who becomes forced to walk in our shoes will also be forced to learn it all, all over again – The hard way.

Please don’t do that.

Just sigh, roll your eyes, and mutter under your breath, “Oh, sure, why not? I’ve certainly got nothing better to do…” Then, show up at the Sequim Senior Center at 1:30 on August 6^th and learn something.

And SAY something!

And don’t fret, because I don’t know how to “line-dance,” either, so we’ll all just make it up as we go along!

The hard way.



Peninsula Daily News Column 7-25-2013 "Get smart on long-term care"

          Good Day! And welcome to yet another day of not being dead!

          Odd way to begin a column, think you? Well, consider the source, but my excuse for today is that we appear to have struck a collective nerve by swerving into the nether world of “long-term care.”

          My original intention was simply to provide a modicum of information regarding payment for LONG-term care in a skilled nursing facility, but it seems that this something that a lot of us have on our minds, and good for us! Historically, the “problem” I encountered most often was that folks had no idea what “long-term” care even meant, or thought that it was strictly a synonym for “nursing home care,” so we were always beginning at the beginning in the midst of a crisis.

          Pat yourselves on the back! (OK, that’s enough)

          Let’s hit “pause” for a moment and be sure that we’re all talking about the same thing: When I say “long-term care,” I mean that somebody is going to need some level of “care” for a very long time, or permanently – That could mean everything from an occasional ride to a doctor appointment and maybe a little help keeping the prescriptions straight, to 24/7 care in a nursing home – But, the fact is, most of the time it means something in-between.

          The vast majority of us will NOT end up in nursing homes! True, we may need to be in one for “x” amount of time while we recover or rehab-back from this-or-that medical event, but on a permanent basis? No; besides, more and more “long-term care” can be provided (and IS provided!) right there at home. So, smart people start looking around at “home” to see if the only bathroom is UPstairs, etc – Or, they start considering what they could do to prevent the likelihood of falling over, because falls put more of us in conditions and places where we don’t want to be than Alzheimer’s ever has!

          But smart people will also figure out that “long-term care” can be pricey, wherever you are! (…unless, of course, you happen to have an unlimited cadre’ of family and friends who are ready, willing and oh-so-enthusiastic about the prospect of spending significant chunks of their lives taking care of you…hmm…)

          So, smart people will begin to realize that what they don’t know can hurt them; so, Smart People try this: Go to http://longtermcare.gov/ and just cruise around – Take your time – Just figuring out the right questions to ask is a HUGE step forward!

          Do I think this is the “perfect” web site on the subject? No. I think it tends to push long-term care insurance, which certainly can be a great answer for some folks in some circumstances, but hopelessly unaffordable for others. I also think it tends to be a little “fear based,” and I don’t happen to think that most of us think well when we’re scared, but I do think it does a good job of laying out things to think about, possible strategies, etc – In other words, I think it does a good job of helping us to understand the right questions, including the right questions to ask ourselves.

          So, go ahead – Go to http://longtermcare.gov/ and just look around and make some notes. Some of those notes will be questions, because smart people have questions, so e-mail them to me or call any of the numbers at the end of this column and ask your questions – Ask as many as you want and keep asking them until you understand the answers. Do NOT rely on what you heard at the coffee shop this morning or from your brother-in-law in Biloxi, because bad info is often worse than NO info.

          Now, do me a favor and back-up, mentally, because here’s another thing that Smart People know: Life is meant to be lived – And loved. Laugh! Celebrate this crazy thing called “life!” Enjoy it! Do things that make you feel good about you! Planning for the future is smart, but losing “today” out of fear about “tomorrow” is just…A waste.

          One last thought for today, then I’ll leave you to your own, web-based devices: The people who know the MOST about “long-term care” are caregivers – People who took care of people who needed to be taken care of, whether they liked it or not. Most of us have been, are or will be “caregivers,” or we’ve at least been close enough to it to see it.

          Most of us have learned (or will learn) a great deal from that experience; now, reverse the roles: If it were you who needed to be taken care of, how would you want things to be different? What would you done differently? How would you have planned differently? How would you have acted differently?

          That, my friends, is how Smart People get smarter.



Peninsula Daily News Column 7-18-2013 "‘Road to Medicaid’ not that bumpy"

          A couple of weeks ago, for a couple of weeks, I went on about paying for long-term care – In a nursing facility. It might be worth noting that there are also Medicaid-related programs for helping folks to receive “long-term care” at home, depending upon need, finances, etc, but we won’t go there today – It’s just too nice out.

          Anyway, where we landed on all that was that, for a lot of us who might be struggling to figure out how to pay for nursing home care, where we’re going to land is Medicaid (not Medicare – Medicaid), and that can scare-the-heck out of some folks.

          There is any number of reasons why intelligent people might be scared of Medicaid. There are things like “estate recovery” (“The State will take the house!” – M-a-y-b-e…) and assets and transferring assets and and and…All or some of which are, generally, over-blown or misunderstood; but, again, I’m not going to suck us all into that right now.

          The FIRST thing that scares most people is something like, “…OMG! The PAPERWORK!” The second thing is usually something like having to deal with bureaucracies and bureaucrats and State agencies and Federal agencies and the “Mind Police” and flying monkeys and…WAIT A MINUTE!

          I’ve never lied to you before and I’m certainly not going to start now – There is certainly paperwork/forms associated with getting someone qualified for Medicaid, but it often looks like more than it is – AND, a lot of that paperwork has been pretty severely simplified over the last 15 years, so those of us who have been dealing with this kind of thing since the demise of 8-track tapes need to get an updated view of reality; however, it can still be…daunting.

          Here’s something we all need to remember: Lots of people have done this, and lots of people are doing it – Today, so it is doable. One of the things that helps it to be “doable” is help; so, one thing you can do is call any of the numbers at the end of this column and decent people will help you, for free.

          It is also true that plenty of folks get qualified for Medicaid all by themselves. The way they do that is to get the forms, sit down calmly, do the best they can at completing said forms, then being honest and forthcoming with the folks at DSHS (Department of Social & Health Services), and things usually go quite well, but this is where some of us explode into the “flying monkey” paranoia: “Those nasty bureaucrats don’t care about me/us, and they’re going to be rude and nosey and everything will be horrible!”

          Not true. Check out this e-mail from a reader:

“Reading this…beginning essay on long-term care expenses, I wished to add a ‘good experience’ story to your file.  Mother had been in long-term nursing care for many years (living longer than usual for dementia patients) and savings was running out, even at the extremely low (but with loving care) rate (southern Idaho).  (Staff) sent me over to the social services, giving me name of man to work with.  I was doing this on a visit from my home on the Washington Peninsula, so had to get as much done as possible in short time.  He couldn't have been more helpful.  Gave me the large stack of paperwork, explained how it worked, discussed the timelines, answered all questions, and, as the home head had, kept reassuring me that there wouldn't be a problem.  Then he gave me phone numbers in Washington to call if ran into problems that needed face-to-face help.

As it happened, I'd just begun digging up information and filling out papers when Mom died, with three months payments still in her bank account, so didn't need to continue.  However, for all the problems one hears about re: uncaring and arrogant staff, I've nothing but praise for my experiences.  (Suppose small town in rural state helped?) 

Thank you for your continued informative, easy to follow, interesting articles.  At 73, know sooner or later, will be needing that extra information, even if I'm doing fine on my own 2.3 acres for now.  (We rural Idaho gals have been known to take over working ranches at ages weaker beings are checking into assisted care homes. :-)  Great genetic inheritances!)”

Sounds to me like, at 73, she’s getting warmed up!

And Yes: The experience she describes did take place in southern Idaho, but after 26 years in this business, I can tell you that the vast majority of people you will encounter on the “Road to Medicaid” (sans Hope and Crosby) will be good, decent people who genuinely want to help you “get there, from here.” What we need to remember is that those good folks have a job to do – Jobs that we expect them to do! – So, we need to hold up our end, with honest, civil interactions, and respond when we need to respond, and we’ll be pleasantly surprised by pleasant surprises.

Again, free help is always here, so don’t feel like you’re out on a limb by yourself – You’re not – But it really isn’t as insurmountable as you might have been led to believe, so if you’re in this situation (or close to it), stay calm and optimistic. You can do this.

We can do this.