Peninsula Daily News Column 1-31-2013 "Medicare game offers switch in plans until Valentine's Day"

          Sometimes, it’s hard to know which thing to apologize for: Should I apologize for not having called out some Medicare “stuff” sooner, or should I apologize for calling out some Medicare stuff?

          It probably doesn’t matter, so I apologize! – But you’ll note that doesn’t stop me…

          OK, here’s the deal: If you have a Medicare Advantage Plan, or an Advantage Plan that has a Part D “component” (which simply means an Advantage Plan that includes prescription drug coverage) you have until Valentine’s Day (which seems a cruel irony) to get out – IF you want to. “Get out” means that you can switch to “original” Medicare, which means Part A, Part B, a MediGAP plan (if you want one) and a Part D plan (if you want one).

          And we remember that a “Medigap” plan is a private plan that you can purchase to pay some part of what Parts A and B don’t pay, right? Good – I thought so.

          Let’s try this another way: If you have an Advantage Plan, you can switch to original Medicare, enroll in a Medigap plan and enroll in a Part D plan. You canNOT switch to a different Advantage Plan or an Advantage Plan with a Part D component – I don’t know why.

          If you have an Advantage Plan that has a part D component (known affectionately as a MAPD) you can switch to original Medicare, enroll in a Medigap plan and enroll in a Part D plan. You canNOT switch to a different MAPD plan or switch to a stand-alone Part D plan. I don’t know why, and seriously suspect that I don’t want to.

          If you want to do any of that, call the Plan directly to disenroll, call 1-800 MEDICARE to enroll or enroll in a Part D plan, which automatically disenrolls you from the Advantage Plan. Yes, a smart person would read that again – Slowly.

          If you’re perfectly happy with your Advantage Plan, don’t do anything and spend your time planning what to get someone special for Valentine’s Day, which could have a longer effect on your life than Medicare.

          If you decide to do something, and “something” includes a Medigap plan, remember that this is not “guaranteed issue,” which means that your Medigap plan-of-choice doesn’t have to accept you and could, thus, require you to complete a health questionnaire, which would then be scrutinized – At length; or, maybe, said Plan will smile sweetly and welcome you into the fold with open arms, as well as your premium check.

          Life is full of surprises.

          Medigap plans are “standardized,” meaning that all “A” plans cover the same stuff, all “F” plans cover the same stuff, etc. but their premiums could vary dramatically. Medigaps “travel,” which means that it doesn’t matter where in the good ole’ US of A you are, as long as you’re using a provider who accepts Medicare.

          See why I apologized?

          Care to have a little help with this? I get it: Call any of the numbers at the end of the column and decent people will help you, without trying to sell you anything.

          A couple of other Medicare “quickies” (an unfortunate choice of words, perhaps, but…):

*No, it isn’t you – Your Medicare “summary of benefits” (think “EOB”) has changed. It’s supposed to be simpler and actually include definitions, which could take some of the fun out of it -  at least the font will be larger;

*If you have a Part D and hit the “donut hole” this year, you’ll get a 21% discount on generics and a 52.5% discount on brand-name drugs, and…

*…our coinsurance for outpatient mental health treatment has actually decreased.

          If you’ve been at this “Medicare game” for a while, you’ll note that, with the exception of the “quickies” (sorry), nothing has really changed – It’s the same game that we’ve been playing for a while. I mention this because there is still a tremendous amount of fear and misunderstanding about what the “Affordable Care Act” (“ACA,” “ObamaCare,” whatever) will do/is doing to us Medicare-types – Answer: Not much.

          So we’ll have to find something else to be afraid of, like what will happen if we forget to remember Valentine’s Day; personally, I’ll choose Medicare any day.



Peninsula Daily News Column 1-24-2013 "Sometimes, nothing's all you can do"

          I thought we were done. I was wrong, which isn’t exactly uncharted territory for me.

          I thought I’d get off my preachy little high-horse about “negotiation” and “respect” and “safety,” so we could all move onto more universally entertaining topics, like “what’s new with Medicare today.”

          I was wrong. I’m not done because you’re not done. Here’s what I heard from a reader (who also happens to be a friend) who also happens to be a thoughtful, caring man:

          “…negotiations – empathy – negotiations – refusal – non-acceptance (of help) – Then what???...How does one cope with ‘that’ – Until acceptance of ‘recognition’ of ‘some changes happening’ is displayed, and (hopefully) then agrees to a visit to the Dr.??”

          Good question. I wish I had an equally good answer.

          In my experience, negotiation, respect, empathy and a willingness to take “baby steps” (a little help, then maybe a little more – You get it) works pretty well, most of the time, but not always – Because nothing is “always;” sometimes, you (me, whomever) can do everything “right,” and an elder just refuses to accept any help or “…visit the Dr….” or whatever.

          Maybe it’s fear – We’ve been there. Maybe it’s stubbornness. Maybe it’s saving-for-a-rainy-day, when it’s really just cheap. Maybe it’s ignorance. Maybe it’s denial (“I’m not old!”). Maybe it’s control or greed or…stupidity.

          Now, if it’s honestly dementia/memory loss or a diagnosable mental health condition, those are game-changers, and we’re in a whole, different ballpark, but often, it isn’t – It’s some combination of those things I listed above, but the question is still the question: What then??

          When we’ve done the best we can, and we’ve done the best we can to do it all “right” and we’ve continued to care and respect and help and try to keep the crises to a minimum and and and…Sometimes, here’s the only thing left to do:

          Nothing.

          Yes, I said, “Nothing.”

          What can we do? Force somebody to accept that help or go to that doctor? How? “Somebody should do something!” OK – Who? How? The fact is that, legally, failing mental “incapacitation,” they can do what they want which, sometimes, is nothing.

          So, what can we do? Right: Nothing. All we can do is accept that the situation is a trainwreck and the crisis will come – We can SEE it coming! – But there’s nothing we can do to stop it, and yelling and fighting and arguing and guilt-tripping and subtle intimidation won’t work – Don’t work.

          Sometimes, all we can do is accept that the trainwreck will happen.

          “Wait a minute, Harvey! You’re telling me to just say ‘oh, well’ and allow someone I care about to fail?! Or hurt themselves?! Or even, die?!”

          No, I’m not – Again, what do you s’pose I do all day long?? What I am telling you is that, sometimes, there’s just nothing more to be done, so all we can do is wait for the trainwreck.

          I’m telling you to never give up. I’m telling you to never allow the conflict between you to escalate to the point of alienation. I’m telling you to keep on “being there,” when you’re long-past wanting to have anything to do with it! I’m telling you to keep trying.

          I’m also telling you to accept the fact that each of us has a right to run our lives, no matter how poorly we do it, and no matter how obvious it may be to others that we’re about to crash, and if you care to stop and think about it, every single one of us can see ourselves in that scenario.

          Love is a funny thing. Love wants to protect and help and save. Love wants to…nurture. And love wants to stop the bad stuff and make it all better – But, sometimes, love isn’t enough.

          And, sometimes, love has to just wait in the wings, so it will be there later, when “it” happens.

          “Nothing” is the hardest thing there is to do.

          Long ago and far way, I listened to a loving, caring daughter try everything she could think of to convince her dad to come live with her and her family, who really wanted him to be there. He insisted on continuing – Alone – In the family tri-level, where he’d been for 40+ years and had fallen several times. The future looked, decidedly, bleak.

          “But, Dad,” she said, “…you could die there!”

          “That’s right,” Dad said. “Where do you want to die?”

          Sometimes, “nothing” is the hardest thing to do.



Peninsula Daily News Column 1-17-2013 "Help for elders an issue of safety vs. automony"

          I have a whole pile of swell ideas for newspaper columns – Articles, e-mails, stray thoughts, experiences, what-not – That call to me on a weekly basis; most of which could, conceivably, do some of us some good, or that  represent commitments made, or…Anyway, the point is that I make a genuine attempt to work through them.

          So here I am, just having spent several weeks on a soapbox about respect and dignity and negotiation and safety and what do I see in the PENINSULA DAILY NEWS a couple of weeks ago? An article from The New York Times, with a headline that proclaims, “Staying independent in your older years – It can be done – with some help.”

          That got my attention. The article points out some of the challenges that can accompany surviving past our historic shelf-lives: The costs and risks of finding competent and affordable in-home care, the limits of long-term care insurance, Medicaid, Medicare, challenges for families, blah blah; and, of course, we’re educated as to today’s statistics regarding how many of us are inconsiderately living past what age, tra la.

          In fairness, The New York Times article does extol the virtues of having our homes designed, re-designed, retrofitted, whatever, to accommodate us – Amen! And it does soften its reality-laden blows by referencing a nonprofit group of volunteers, called “Staying in Place,” who help those of us 50 or better to “…maintain active, independent, fulfilling lives in their own homes.” Great! Sadly, said volunteer group operates in Woodstock, New York; alas, several hundred thousand of us tried migrating to Woodstock back in the ‘60’s and while the experience was…memorable (for those of us who remember it), most of us would be loathe to repeat the experience of chanting “no rain” – In the rain.

          I quote The New York Times article: “…remaining in one’s own home indefinitely is not always the best choice, even if it is financially feasible. As life draws near a close, many older adults need more care that can be provided safely (emphasis mine) at home.”

          Really?!

          An accompanying article, also from The New York Times, shouted to us: “Knowing when home alone no longer possible,” and proceeded to list 21 situations, conditions or events that could “…help families determine when the time has come to move older relatives from their homes and into a more supportive environment…”

          How helpful.

          Again, in fairness (which I sometimes think is greatly over-rated), I wouldn’t argue the accuracy of any information presented in either article; and, clearly, both articles targeted “families,” meaning (I presume) anyone vaguely related to whichever elder might be in the family’s crosshairs today, and I’d certainly agree that there are “problems” associated with “not dying” – What do we suppose I’ve been going on about for the last 12+ years?

 Here’s my problem(s): (1) All of this helpful info was targeted, again, toward families – Like it was going around the elder; (2) elders read papers – I would have suspected that The New York Times would know that; so, elders read those same 21 “warning signs” that can “…help families determine when the time has come…” and do you know what some elders decide?

Right: They decide to keep secrets. They decide not to mention that this-or-that happened or that this-or-that is getting to be too much or they got confused about this-or-that or or or…sshhh, be quiet, because “…if I let them know that, they will determine that the time has come…sshhh…”

So nothing is said. The bad news, the fears, the scary things aren’t communicated, because we’re keeping secrets – Because we value our lives and our INDEPENDENCE and respect more than we value “safety.” …sshhh…

So we don’t take a little help – Make a few adjustments, cut a few corners, find a few different ways – That could make life a whole lot easier (and, probably, safer) because we don’t want it determined that the time has come.

And some of us, with a bit more…chutzpah, just get mad: “Oh, YEAH? Try it! I’ll do what I want, when I want, the way I want and if you try to mess with it, you’re going to pull back a stub!” (Or something even more colorful). We get mad, we get stubborn and we become even more entrenched, but the outcome is the same: No help.

I have no illusions about my ability to influence the editorial decisions of The New York Times, but I do hope to influence “families,” so one more time: Take the word “negotiation” and have it tattooed on your heart, then pray that the people who love you will do the same.

Do unto others…



Peninsula Daily News Column 1-10-13 "Brave the jaws of fear by seizing life"

            The new year still feels “new,” huh? – More or less. We’re hustling about, doing things or thinking about things that new years bring.

            And happily (for me!) one of the things that some of you are doing is writing this little column for me, which is deeply appreciated! Harken back to last Thursday, when a reader (well, OK – writer!) said:

            “Another concern (not mentioned in today's article, but many times before) which may lead the younger generation to feel it necessary to "help" is the possibility of Alzheimer's or some other form of dementia creeping unnoticed into our lives, and requiring intervention, in spite of our wishes.  This is a very scary possibility, and one that can't be ignored.  Already, "senior moments" are no longer as amusing as they used to be.  Instead, they are cause for evaluation, to be sure that we are still competent, still able to be in charge. What if there actually is a loss of ability to cope, and we are blindly (or willfully) acting as though nothing has changed?  That poses a real dilemma for our children.”

            There was a follow-up to that:

            “The issue of Alzheimer's/dementia is a huge one for me.  I have either known, or known about, a number of people who accomplished wonderful things during their active lives - professors, writers, doctors, relatives and friends.  As their dementia "progressed," their past achievements diminished in importance, and the focus of family ("caregivers") and friends shifted to the frustrations, and pity, caused by these once-admired persons' slide into becoming different persons - childlike, needy, angry, and lost.  When death came at last, the obituaries have often extolled their lifetime achievements, but for me the saddest part of those memorials is the frequent request for contributions to organizations supporting research into dementia.  Those requests tell a story of sadness and loss for everyone, patient and family alike.
              In the absence of a "cure" - which may never be found - I guess we do as best we can, remembering the loved one as he or she was in better times, and dealing with the new reality one day at a time.  I can't express how fervently I hope that dementia is not my fate.  I don't want to be an object of pity.”

            Ring a bell? As in, “Wow! Do I understand that! Me, too!”

            Me, too.

            Pretty much all of us who are old enough to care about Alzheimer’s/dementia, care deeply – And we could probably count on the fingers of one hand the things that scare us more – And that’s what I’d like to talk about, for just a moment: The fear.

            We all know what’s true: We know that, the older we get, the more often “senior moments” happen (sounds like a bumper sticker, huh?). We also know that, the older we get, the more statistically likely it is that we will “get” Alzheimer’s or some other form of dementia – But there are a couple of things we tend to forget, no pun intended.

            We tend to forget that it (Alzheimer’s) does NOT happen to everybody. We tend to forget that there is amazing research going on right now that is making slow-but-steady progress. Will there be a cure by Valentine’s Day? No, but there is progress.

            And we tend to forget that there are things we can do to help ourselves, and they are the same old, boring things that we hear all the time: Get some exercise – No, that doesn’t have to mean becoming a “fitness freak,” but it does mean move.

            Try to eat “right” – No, that doesn’t have to mean becoming a nutritional fanatic, but it does mean try – Do better than we’re doing.

            Try not to isolate ourselves – No, that doesn’t have to mean becoming a social butterfly with a calendar the size of the Port Townsend phone book, but it does mean interact – Have people in our lives and be a part of others’ lives.

            And use our minds for something more than just navigating the TV listings.

            You know the drill – We all do. And if we do all the “right things,” will Alzheimer’s dutifully avoid us and move on to the next poor schlock that didn’t do all the right things? Not necessarily, but it’s worth a shot, isn’t it?

            And here’s one last thing we can do to make this “getting older” thing better: We can decide NOT to be afraid.

            We can edge our way into this new year with a healthy dose of the same kind of courage that got us to here – Day-by-day, one crisis at a time – One opportunity at a time.

            We can refuse to be afraid. We can love and laugh and think and do and sing. We can try and fail and try again and screw-up and learn. We can stay on this ride until the end, or we can stand off to the side, scared-to-death that it will end; trust me, it will.

            So, how would we like 2013 to be? Well, here’s how I’d like it to be:

            On December 31^st, 2013, I want to be able to look back on what is still a “new year,” and pat myself on the back for having remembered (most of the time) that courage is NOT the absence of fear.

            Courage is staying on the ride, all the way to the end.

Peninsula Dailay News Column 1-3-13 "Empathy another form of help"

            Welcome to the first Thursday of the New Year – 2013! Who knew? 2013?? A brand new Thursday in a brand new year and another opportunity to try to “get it right” – To do the “right thing” – To end each day feeling OK about ourselves, because we did do the right thing.

            And may we all succeed! May we all decide to jettison fear and pessimism and divisiveness and simply do the “right thing.”

            And NO: As tempting as it is, I’m not going to assault us all with pretty words about high-minded New Year’s resolutions, although I reserve the right to come back to that at another time; no, I’m not going to do that because you, once again, have done a much better job of writing this column than I could ever do.

            A couple of weeks ago I went on about “help” and dignity and NEGOTIATION - Because help only helps if it helps. And if it doesn’t help, maybe what it does do is make us (or somebody we purport to love) “less than.” Here’s what a thoughtful reader took the time to say:

“Dear Mr. Harvey,
            I have been very appreciative of your column in the past, but when I read this morning's article, it really struck home for me.  My husband and I are both 72 years old, and are well able to manage our lives - better than many younger people, I believe.  Yet even our children, who admire our ability to remain active and involved in our community, are not immune to offering suggestions for how we might take better care of ourselves.  My response, and probably my husband's as well, is frequently impatient and somewhat resentful.  Just as you described, in spite of what we know is their best intentions, we respond negatively; we have been made to feel "less than"....

             Unfortunately, I myself have not always been as sensitive to the feelings of others as I should have been.  I have an all-too-clear recollection of my grandmother's appointment with a doctor at Virginia Mason Clinic in Seattle years ago.  I was only there in the role of chauffeur, but the doctor addressed ALL of his comments to me, leaving her as a bystander in a discussion of HER medical issues.  The thing I most regret is that I was proud that the doctor saw me as a competent and responsible person.  I had no thought for how my grandmother regarded his dismissive treatment of her because I was so pleased that he valued MY opinions!  I never talked to her about the incident, and I still regret that.
            There may be some "ego" element involved in the offers of help.  In some ways, it could be considered a role reversal.  Perhaps our children are pleased to "turn the tables," after years of accepting us as authority figures.  I know it isn't entirely bad for them to be concerned, but sensitivity and empathy are crucial.
            Another concern (not mentioned in today's article, but many times before) which may lead the younger generation to feel it necessary to "help" is the possibility of Alzheimer's or some other form of dementia creeping unnoticed into our lives, and requiring intervention, in spite of our wishes.  This is a very scary possibility, and one that can't be ignored.  Already, "senior moments" are no longer as amusing as they used to be.  Instead, they are cause for evaluation, to be sure that we are still competent, still able to be in charge. What if there actually is a loss of ability to cope, and we are blindly (or willfully) acting as though nothing has changed?  That poses a real dilemma for our children.
            So....  I think another "takeaway" message for your column, besides "negotiation," should be EMPATHY.  We often tend to be impatient when a decision which seems to be clearly in the best interest of a loved one encounters resistance.  I think it helps to step back a little, to try to see things from that individual's perspective, to FEEL what it would mean for that person.  But.... I don't need to tell you this, since it is obvious that you are a very kind and caring person, with an abundance of empathy!”

            Wow! Sound familiar? Me, too, as much as I’d rather avoid admitting it. Sure, I’d prefer “Mark” to “Mr. Harvey,” and sure, I think we’d all agree that I’m full of something – I’d just like to hope that it’s “empathy.” But the reader (the writer!) was being respectful, and I appreciate that.

            Respect. Empathy. Negotiation. And putting “help” in quotation marks.
            Remember up above where I said that I wasn’t going to assault us all with pretty words about high-minded New Year’s resolutions? I lied, because there they are.

            2013 – Another opportunity to do the right thing.