Peninsula Daily News Column 2-28-2013 "For a 'bad' time, call..."

          I think most of us are familiar, directly or indirectly, with the phrase, “For a good time, call…”

          …but how about “For a bad time, call…” – And, YES! I am serious. Look:

          If you ask most of us who are old enough to have figured out that we’re probably not going to live forever what scares us the most, you’ll get a more-or-less predictable litany of responses: Alzheimer’s, the kids moving back in, Medicare Part D “open enrollment,” the sudden realization that she or he was right when they said, “I TOLD you to go before we left…” etc., but in there, somewhere, you’re probably going to hear something like, “Being put in a nursing home.”

          We probably mean any “residential facility,” but what comes out is “nursing home.” We see it as a sentence to the 9^th level of Hell, for eternity, totally a-l-o-n-e, forgotten – Disposed of – And life goes on…Without us.

          Now, the fact is that, statistically, most of us will never reside in a facility for more than a week or two for rehab, and another fact is that, mercifully, most of our facilities around here are really pretty good, most of the time! – But that doesn’t matter, because we’re already scared and “facts” don’t always take fear away.

          …and, of course, some of us do end up there, usually because there’s no other place we can be.

          But, what if there were folks who spent some of their time being with you in that facility? Being on “your” side? Taking your side? Or just spending some time with you without messing with your body or telling you what you “need” to do? What if that?

          Well, there are, and there have been, for a quite a while. They are the good folks who volunteer for the “Long-Term Care Ombudsman Program,” going into facilities all over the Peninsula to be on your side – “Their” side – Our side.

          These are good and decent people who have had to “apply,” have their backgrounds checked, go through several days of serious training, do monthly reports, go to monthly meetings, don’t get paid and proceed to give away significant chunks of their lives for you – Her – Me. Sound fun?

          I didn’t think so; thus, for a bad time call Jane Meyer at 417-8556, or 1-800-801-0070, and tell her that human beings matter enough to you that you’re willing to be a human being. Jane runs this “Ombudsman” program in Jefferson and Clallam counties, and is looking for some more help to help make sure that a lot of those things that a lot of us are afraid of don’t happen.

          If you take a minute to visualize being in a facility, because you have to be, and something is “wrong,” it won’t take long for you to figure out that it could get pretty scary pretty quick - Whether the facility or the staff “deserve” it or not - It could. And if you can keep your eyes closed for another minute, and visualize yourself walking into that room and being with that person for no reason other than to say “hello,” or solve a problem, or advocate, or “be on their side,” you’ll get the drift.

          …and you’ll probably be able to figure out what’s in this for you; if you can’t, you’re probably not who I’m looking for, anyway.

          So, Yes: I’m asking you to call Jane by the Ides of March, 3/15; then, fill out paperwork, get interviewed, have your background checked, go through some pretty serious training blah blah blah…Then, give away a piece of your life on a regular basis and get absolutely nothing back for it, except what you visualize when you say to yourself, “There, but for the grace of God…”

          Don’t think about this long enough to talk yourself out of it. OF COURSE you don’t have time! -

          You also don’t have time not to. It’s the best “bad time” you’ll ever have.



Peninsula Daily News Column 2-21-2013 "Court improves Medicare 'standard'"



          Remember last November? Don’t feel bad, because I don’t, either; I think there were a few traumas sprinkled in there somewhere, like Part D “open enrollment” and an election and a holiday, and probably a few others that don’t need to be publicly shared, but for the sake of this morning’s missive, harken back to that part of last year and think, “Jimmo Settlement.”

          What?

          Good question, so let me take us down a rabbit trail on the way to an answer. And in order to get there from here, we need to understand a little something about Medicare, remembering that a “little something” is all any of us will ever understand about Medicare.

          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) should have access to them, right?

Right; now think about that, then say, “Wow!”

The true wonks among us (or the few of us who can actually remember something I wrote last November) may be recalling this as the “Jimmo Settlement,” and correctly so. When last we left Jimmo, it was securely in the hands of federal District Court, awaiting a decision as to why something that was never in the Medicare law got into the Medicare law; apparently, the federal District Court judge was not amused and has agreed to get rid of something in Medicare law that was never in Medicare law.

We like that. Why do we like that? Well, let’s try a little Q&A:

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

*Will this add to the number of days that Medicare will pay for in a nursing facility? Good question! But I’m sorry to say “no,” because the famous “100 days” is specified in Medicare law (alas), but it does change how you might qualify for same.

*Won’t this just cost Medicare (which is, of course, us) more and make this whole “healthcare thing” worse? …ooohh, you’re good…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, which seems to border on “intuitive.”

          So, the judge has approved the settlement and has ordered the Centers for Medicare & Medicaid services to revise its “Medicare Benefit Policy Manual,” along with numerous other non-existent policies, guidelines and instructions and to develop and implement a nationwide education campaign to inform us all of what is now true.

          I have no idea how long that will take, but here’s something I do know:

          These “new” standards apply now – Right now. Today.

          In fairness, it is entirely possible that local healthcare providers may (a) not know this, and/or (b) be more-than-a-little gun-shy of doing anything Medicare-related that isn’t clearly specified in a manual the size of New Hampshire – I understand that. I also understand that “Mrs. Jones” needs what she needs when she needs it, and she may well need it now, so…

          …IF you or somebody you like is being denied Medicare coverage based on the now non-existent “improvement standard,” you can go to http://www.medicareadvocacy.org/take-action/self-help-packets-for-medicare-appeals/ and get some good info on how to fight back, remembering that healthcare providers aren’t the “enemy.”

          I’m not trying to pretend that this will be easy, because I have yet to encounter anything in healthcare or health insurance that is “easy,” but this is your life, and you have a right to it.

          In my world, not getting worse is getting better!

Peninsula Daily News Column 2-14-2013 "Caregiving styled to individuals"

          Today is February 14 – Valentine’s Day, and I fervently hope that isn’t news to you; if it is, put this down right now and go do what will be in your eternal best interests to do – The PDN will still be here when you get back.

          Actually, I had hoped to get a little mushy for Valentine’s Day. I like “mushy!” But then, something really important came along and I thought,”…well, I’d better do this, instead…” and then I debated and considered consequences and went back-and-forth and…I think I’d better just quit while I’m ahead – Or, at least, no further behind.

          Anyway, a couple of weeks ago a number of us were having a conversation about respect, negotiation, safety and, finally, doing nothing – When nothing is all there is to do. I said:

          “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…

          Maybe it’s fear… 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…”

          I got a reply to that, from Mindi Blanchard of “Bridge Builders.” After a few kind words, Mindi said:

          “…we also hear from family who are at their wits end regarding their parents or other elderly family members. However, I want to point out as a Certified Professional Guardian that even when the Court determines someone is incapacitated, it does NOT mean that the ‘game’ changes and the client can be forced to do something he or she doesn’t want to do. I realize that public perception regarding guardianship is that guardians can do whatever they please. That may have been true fifteen years ago but it is not true today. Certified Professional Guardians are required to follow the Standards of Practice developed by the Guardian Board that oversees us. This means that we have to advocate for what our client says he/she wants even though that client really doesn’t know anymore what he/she wants. I have had extremely frustrating situations where a guardianship client with dementia needed to have medical attention for a separate medical issue but the client was resistant and the mental health professionals won’t touch anyone with the first diagnosis being “dementia.” That said who wants to drag someone kicking and screaming to the hospital or into a long-term care facility? Not me! And no facility wants someone who loudly proclaims they don’t want to be there…

So, what to do? Well, a little tough love can go a long way. Families often fall into the ‘enabling’ category without realizing that they’ve done so. The goal is making the client uncomfortable in his/her current living situation. This looks different for each client. For some, just not being as available as in the past; for example, telling Mom that you just can’t take the time to take her grocery shopping but that you would be happy to call a local caregiving agency to send someone to assist. Of course, Mom would need to pay for the service. If Mom objects, apologize but don’t rescue. For some we have had to establish a “team” including but not limited to caregivers, Adult Protective Services, law enforcement doing welfare checks, etc. During this process we always treat our client with dignity and respect. We also tell them their options and graciously accept their answers declining these options. Our goal is to plant ideas because over time the client may decide on one of the options as his/her own idea. If it seems that a client really needs to move to some sort of facility, we talk with the client about visiting facilities ‘just in case’ they might need to move into one and facilitate visits if they agree. When they complain that no one is helping them, we go through the options with them again, and again, and again. It can take many months before the client decides they would like to try a different option or it may take a medical crisis. It is time consuming and emotionally exhausting, even for those of us who don’t have the emotional connections that families do.”

So, there we are, and I thank Mindi Blanchard for caring enough to jump in. While I might argue that what she describes is a “changed game,” I think that’s about semantics – And people matter more than semantics.

Some of us will read this and a light will go on – “Oh!”

Some of us will be shocked or, perhaps, offended – “That’s cruel!”

Some of us will need to think about this in the context of respect, negotiation, safety and…doing nothing.

And many of us will just need to think about it – For a while. If we’re smart, we’ll think about it this way: “What if it were me…”

What if it were?

Love is a funny thing.



Peninsula Daily News Column 2-7-13 "Try program for help with 'tax thing'"

          In deference to, and recognition of, the simple fact that this Thursday exercise is called “Help Line,” do you suppose we ought to, at least occasionally, do something genuinely helpful? Me, too – So, we will.

          Think: taxes; well, OK, think anything you want, but the fact remains that in the not-too-distant future, many of us are going to have to think about taxes, which means that many of us are going to want to think about TAX-AIDE.

          We do this every year, because taxes (specifically, income taxes) happen to us every year. TAX-AIDE are the good guys! These are the unpaid volunteers who volunteer to spend major portions of their holidays studying tax law, then thinking about it and asking questions about it and taking tests about it, and then give away substantial portions of their lives helping us prepare our tax returns so we don’t have to do any of that. And they do it for free, which is why we call them “volunteers.”

          Did you get that? Free, as in their-help-doesn’t-cost-us-anything, and Yes: We should be grateful.

          Here’s the deal: They’re trained to help most of us low-to-middle income taxpayers. If you’re the CEO of a multi-national corporation, go to the back of the line, but for the rest of us – For MOST of us! – These are the people we want to go see.

          You don’t have to be broke and you don’t have to be or 60-or-better or anything like that. What you do have to do is show up at one of the sites (hang on, we’ll get there) and bring:

*Photo ID;

*Social Security cards for taxpayer, spouse and dependents;

*W-2’s, 1099’s and any/all other documents necessary to complete a tax return;

*Bank account routing and account numbers (a check would work) if you want a refund deposited directly (which would be smart), and…

*…last year’s tax return.

          NOTE: Think this all the way through, because it doesn’t help you, the TAX-AIDE folks or the people waiting behind you for you to show up and not have all your stuff. Good.

          Now, starting last Friday, February 1, here’s where these TAX-AIDE folks will be, in order to help us:

*At the Sequim Senior Center on Wednesdays, 12:30-4:00 p.m. and Saturdays from 9:00-4:00. Appointments are required, so call 683-6806 to make one;

*At the Port Angeles library on Wednesdays, from 9:00-3:00 and Saturday mornings, from 8:30-12:30 – No appointment, so just show up, bring a book and a patient good nature;

* The Port Angele Senior Center on Mondays, from 9:00-3:00. You need an appointment, so call 457-7004 to do that;

*At Forks City Hall, from10:00-4:00, on Feb. 16, March 2, 16& 30 and April 13. Call 780-2287 to make an appointment;

*At the Sekiu Community Center on March 1, 10:00-2:00 – No appointment, just show up;

*At the Port Townsend Community Center, Tuesdays and Fridays, 10:00-2:00. Call 385-9007 to make the appointment;

*…and at the Tri-Area Community Center on Mondays, 10:00-2:00 and on Wednesdays, from 3:00-7:00. Appointment? Yes, so call 732-4822.

          I know what you’re thinking, because I know what I’m thinking: “With the ‘fiscal cliff’ and debt ceilings and Lord-only knows what else, how bad has the whole ‘tax thing’ gotten?” Answer: Not much; well, at least, not much worse.

          If you’re single and make more than $250,000/year, or married and make more than $300,000/year, things have changed; for the rest of us, not really. The tax rates are the same, the capital gains and dividend rates are the same, the “Child Tax Credit” and “Earned Income Tax Credit,” etc. are the same. Sales taxes are still deductible, if you itemize and there’s still some “relief” for folks who lost a home to foreclosure, etc – So, really, for most of us, this year looks a lot like last year – At least, tax-wise.

          OK? Now remember, we call this “Help Line,” not “Tax Line,” so this as far as I’m going with this topic, because I know when I’m out of my league, but when you show up for help from these TAX-AIDE folks, feel free to thank them – Profusely: We are getting our taxes done! All they’re getting is a migraine.