Peninsula Daily News Column 6-27-2013 "It’s time to talk about long-term care"

          I grew up in the Arizona desert which is, among other things, rattlesnake country. The purpose of the rattle, in addition to its appealingly rhythmic cadence, a warning, so I’m rattling before I strike: I’m setting out to talk about nursing home care; specifically paying for it.

          The reason I’m setting out to do this is because, lately, a lot of you have been asking about it, so let’s just do it, and I’m going to begin with my standard definition of a caregiver: A “caregiver” is somebody who is taking care of somebody who needs to be taken care of, whether they like it or not – Think, “long-term care.”

          Sometimes, the caregiver just can’t continue to do it anymore. There are a million good reasons why that might be true, one of the most common being advancing dementia (e.g. Alzheimer’s, etc), but there are lots of them – It doesn’t really matter, you are where you are, and the time has come – Whether you like it or not.

          So, now, you’re having to consider nursing home care – TIME OUT: I am specifically talking about nursing homes, not assisted living facilities or retirement communities or continuing care communities or adult family homes – Nursing homes, OK?

          I know (Well!) how emotionally difficult this can be for all concerned, and if you are the caregiver, thank you for hanging in there for as long as you did. You changed a life; now let go of the guilt and change your own.

          And have “Thank You” tattooed on your heart.

          But you’re “there:” You’ve got to place your person into a nursing home; obviously, there are all kinds of things to think about, like location, reputation, quality of care, the staff, the food, etc ad infinitum, but one of the things that’s bound to come up on the list is money, because nursing home care is pricey.

          If you and/or “care receiver” and/or family have substantial financial assets (Good for you!), then make your decisions based on quality of care and geographic convenience, and remember that you did your best.

          IF someone bought a “Long-Term Care” policy several decades ago and has been cheerfully paying the premiums each month since the Hoover administration, then find it and read it; then read it again. TIME OUT: If you do have a long-term care policy, whether you think you need it right now or not, find it! – Then, put it someplace where you (or somebody who isn’t you) could actually find it again. People lose these things all the time, because they never needed to care where they were; remember, everything really IS alright, as long as it is.

IF you have one of these, it might pay for some or all of the nursing home care for “X” amount of time; in fact, it might pay for some in-home care, which might change the game; either way, find it, read it, then read it again.

NO LTC policy? OK, here’s what often happens: “Care receiver” (“Dad”) has enough assets to pay for nursing home care for a while (NOTE: A few years ago, $7,000/month was a workable average, with any specific facility being a little more or a little less – I sincerely doubt that it’s gone down); hopefully, you or someone “close” has a “Durable Power of Attorney” in place (particularly important in the “dementia scenario”), and can move Dad’s income and assets around in order to do what needs to be done.

So, a facility is selected and Dad moves in and you’re paying the nursing home “X” dollars per month – Breathe a sigh of relief, because you deserve it, but don’t think for a moment that you’ve stopped being a “caregiver because you haven’t – Yes, I do get it.

Time goes by and everybody kind of settles into their new places and roles and (hopefully), everything is going reasonably well, most of the time, when it hits you: “Oh, my…Gosh! He’s going to run out of money! Now what??”

First of all, here’s what’s NOT going to help: Medicare. Yes, Medicare does pay for some nursing home care if you’ve been in the hospital and were actually “admitted” and you’re in the facility for rehab and blah blah blah, but on a long-term often permanent basis? Nope, not Medicare, so you’re going to have to think about – And deal with! – MediCAID.

Let’s back up: Dad’s income and liquid financial assets will be gone soon (NOTE: Do NOT wait until they’ll be gone next week! Start thinking about this at least two months ahead of “broke!”), no LTC policy and the family can’t just whimsically cough-up upwards of 7K every month, right? OK, then it’s “Medicaid time,” so try to relax, grab a friendly beverage and DON’T PANIC!

We can do this.



Peninsula Daily News Column 6-20-2013 "Changing face of health care in U.S."

          It’s no secret to anyone who follows this little column with any degree of regularity (and some of us would enthusiastically accept “…any degree of regularity…”) that I work in six different offices in four different counties – And Yes: There is something to be said for being a “moving target.”

          So, on the rare occasion that the phone rings in an office that I am actually in, I find it…startling; nonetheless, I readily answered with my usual, chipper, “Hi! This is Mark.”

          “NOW WHAT???” was what came back at me. The voice sounded…mature.

          “…uh…Now what, what?” I responded, with my usual immediate grasp of a situation.

          “What is THIS I’m getting from Medicare NOW??”

          “…uh…I don’t know…? What does it say?”

          The mature, female voice read as much of it as her exasperated, epithet- enabled condition would permit. I got it – To our mutual relief.

          What she had was a letter from “Medicare” about, among other things, diabetic testing supplies, so let’s back up a bit:

          Since the beginning of time (well, OK, for a very long time), Medicare has paid for “durable medical equipment” (think walker, or wheelchair or scooter) and prosthetics and orthotics and “supplies” (think, diabetic testing supplies) from more-or-less any supplier who got signed up with them and was willing to bill them – More-or-less, if a bit over-simplified.

          Starting a few years ago, CMS (Centers for Medicare & Medicaid Services) launched the “Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies Competitive Bidding Program,” affectionately referred to with the catchy acronym, “DMEPOS.” The operative phrase here is, “…competitive bidding…”

          The idea, of course, is that in a competitive bidding environment, Medicare is likely to get the best dollar-deals for DMEPOS; according to CMS, that is, in fact, proving to be the case. I have no reason not to believe that.

          The “down side” of all this is that many smaller and/or local and/or “Mom & Pop” operations that many of us have dealt with happily for years can’t compete in that world, so they are (or will be) either (a) cut out of the Medicare game, or (b) fold-up altogether.

          Remember, this is about money, right? So, DMEPOS has been (is being) phased in around the country over time, with the focus being on high-consuming, urban centers. In Washington State, that tends to be a lot of the I-5 corridor, which leaves most of us rural yokels out of the play, EXCEPT for diabetic testing supplies. Why are diabetic testing supplies included? Why do you s’pose? Money.

          So, Medicare has solicited and gotten competitive bids for mail-order diabetic testing supplies in our neck-of-the-woods (although the actual suppliers are all over the country) and is instituting a requirement that we get our supplies from one of those contractors, effective July 1^st.

          Time out: Most of us would probably agree that Medicare getting more for its money (well, OK: OUR money) is a good thing; and, if you’ve already been getting your supplies from one of these contracted suppliers OR are accustomed to the mail-order “thing,” then this is no big thing to you. If you haven’t been doing that, and have been getting your stuff locally, from people you know and trust, and have a comfortable little arrangement worked out, this is…CHANGE!

          ANOTHER thing to have to figure out and worry about and hassle with!

          Yes, it is. Welcome to the ever-changing face of healthcare and health insurance in America. Here’s the best advice that anyone is going to give you: Get used to it.

          But more to the point and MUCH more pressing: Figure out what you need to do to get your diabetic testing supplies when you need them, because the fact that health insurance is changing AGAIN has not made your diabetes go away!

          Now, remember, this is about money – Payment. If you want to keep purchasing your testing supplies from a local vendor that you know and trust, feel free to do so – Just don’t expect Medicare to pay for them. If you want Medicare to pay for them, you’re going to have to play by their rules. Period.

          You can learn a lot more about this and find a list of contract suppliers by going to www.medicare.gov/supplier/home.asp where you can search for particular manufacturers or brands; of course, if you need help figuring any of this out, call any of the numbers at the end of this column and decent people will help you, for free.

          I certainly understand that while many of us support the idea of a more cost-effective Medicare (or more cost-effective healthcare/health insurance in general), the hassle on the personal level can be…exasperating. The “good ‘ole days” when healthcare and health insurance happened TO us (kind of “on the side…”) are gone, so just think of it as a new hobby that could replace stamp collecting, since the post office may go away, anyway.

          And keep your epithets enabled.

         



Peninsula Daily News Column 6-13-2013 "Do your homework on advertisements"

          “It pays to advertise,” they say and, apparently, that’s absolutely true, as I’ve been getting a number of good questions via e-mail about this-and-that, all of which stem from advertisements, so let’s go over them as a group, shall we? Holding hands is optional.

          Let’s begin with the advertisements we see for various “panic button gizmos.” These devices are generally worn around our necks or as bracelets or some such, and they allow us to summon help via landlines or cell phones in the event that we need help, e.g. a fall. Generally, you’ll see them called “_____ Alert” or “_____ Line.”

          In my world, these devices are referred to as “personal emergency response systems,” because we like to make things sound as complicated and unfathomable as possible, but they are WONDERFUL! These things save lives! Seriously.

          They all work basically the same way, which is that if you have an emergency, you can press the button on your gadget, which calls a “response center” somewhere. Said response center then tries to call you, which is your chance to say, “Oops – Sorry…” or “Send help” or whatnot; generally, if they can’t get a response from you, they will summon help, whether that’s your niece down the block or an ambulance or whatever you’ve arranged with the vendor.

          I have absolutely no reason to think that the companies that are advertising these life-saving devices are any or more or less reliable than those that don’t advertise in expensive media, so it comes down to consumer preference. Please note that there is tremendous variation in pricing as well as add-ons (“bells & whistles”), which might be well worth the money, e.g. medication reminders, and a host of others, so it’s purely a matter of doing your homework and selecting the model, company and accessories that best suit your personal needs and tastes.

          If money is an “issue,” it would be worth your time to do a web search for “personal emergency response systems,” then take the time to do some comparison shopping. Allow me to make my obligatory, personal observation: DON’T TAKE THEM OFF WHEN YOU GET IN THE SHOWER!

          Thank you for your patience. Here’s another:

          We all know (well, many of us know) that “ObamaCare” is looming on the horizon; the “horizon” being 2014. To grossly over-simplify, the immediate 2014 issue is that “…everybody has to have health insurance…!” Well, yes, but…

          First of all, if you’re on Medicare, you have health insurance, so forget it. If you have insurance through your employer and expect that to be in place next year, forget it…etc. But if you don’t have any kind of health insurance, the odds are pretty good that you’re going to have to figure out how to get it.

          Currently, a number of us are seeing advertisements for a “Hotline” that we can call to find health insurance for ourselves and our families, that will even cover “…PRE-EXISTING CONDITIONS!” (I’m sure it will, that’s the law, but let’s not quibble).

          Here’s the deal: Come October 1, 2013, every state (including Washington) will have a “Health Benefits Exchange” up-and-running. This will be a “marketplace” (accessed via internet, or by phone, or by sitting with a live human who will help you access the internet, or whatever) where you can discover what health insurance policies are available to your family and what subsidies you might qualify for, or even whether you might qualify for Medicaid, etc. You will, as they say, be able to compare “apples to apples.”

          These Exchanges are NOT yet operative, so the “Hotline” that is offering to help you find health insurance coverage will, undoubtedly, do exactly that: Help you find one of the policies that they would like to sell to you.

          Now, in fairness, there’s nothing wrong with that, and I have no reason to believe that this isn’t a perfectly reputable operation, so if you’re looking for health insurance right NOW, you could certainly give them a call and see what happens, but the way they are linking themselves to “ObamaCare” (“Health Care Reform,” the “Affordable Care Act,” blah blah) is a bit of a…stretch. Is it a “scam?” I have no reason to think so.

          Here’s another: “A _____ for Mom” or “Dad” or something like that. A number you can call or a web site you can visit that will help you find the “best” assisted living facility or nursing home or dementia community or retirement community or wide-spot-in-the-road for Mom – FREE!

          Now, again, I have no reason or experience to think that this (These!) isn’t a perfectly reputable business, but it is a “business.” What I trip over is the word “free” – Really? Then, who’s paying the bills? Various facilities that have “subscribed?” If YES, what about wonderful facilities that haven’t subscribed (or sponsored or paid a fee or whatever)? Will said business make referrals to them? I don’t know.

          The truth is, I don’t know the true answer to any of those questions, but I’m pretty sure that somebody is paying the bill, so I…wonder; by all means, feel free to contact them and see if they are helpful to you and yours – If they are, Great! – If not, call any of the numbers at the end of this column, and we’ll see if we can help. Or, call everybody (including us), then paste all the info together in a way that works for you. Help only helps if it helps.

          Look: Most of us have been on the receiving end of advertising/marketing for as long as we can remember, so the skills that we’ve developed in the face of commercials for cars, laxatives and food processors (not necessarily in that order), need to be applied to the explosively expanding “senior market.” The fact that something (or some service) is advertised nationally doesn’t make it inherently good or inherently bad – It just means that we have to apply some common consumer sense and make informed choices.

          And remember the single MOST important word in response to any advertisement or commercial:

          REALLY?!



Peninsula Daily News Column 6-6-2013 "If it's too good to be true, verify"

          Good morning!

          Take your time and read this – Carefully:

“Subj: DO CONTACT MR.KELVIN WILLIAMS FOR YOUR ATM CARD DELIVERY

Anti-Terrorist and Monitory Crime Division.

Federal Bureau of Investigation.

Daniel McMullen (Special Agent in Charge)

 Attn: Beneficiary,

          This is to officially inform you that it has come to our notice and we have thoroughly investigated it with the help of our Intelligence Monitoring Network System that you are having an illegal Transaction with Impostors. We the Federal Bureau Of Investigation want you to stop further communication with any Impostors claiming to be official. During our Investigation, we noticed that the reason why you have not received your payment is because you have not fulfilled your Financial Obligation given to you in respect of your Contract/Inheritance Payment. Therefore, we have contacted the Federal Ministry of Finance Nigeria on your behalf and they have brought a solution to your problem by coordinating your payment in total $5,900,000.00(Five Million Nine Hundred Thousand Dollars).

          Since the Federal Bureau of Investigation is involved in this transaction, you have to be rest assured for this is 100% risk free it is our duty to protect you. We the Federal Bureau Of Investigation want you to contact the ATM CARD CENTER via email for their requirements to proceed and procure your Approval Slip on your behalf which will cost you $200 and note that your Approval Slip which contains details of the agent who will process your transaction.

 CONTACT INFORMATION

NAME: Mr. Kelvin Williams

Address: 18 Koffi Crescent Apapa Lagos Nigeria

Email: atmcardaplicationcenter@info-fbigov.us.mn

          Do contact Mr. Kelvin Williams of the ATM CARD CENTER with your details, and you full information So your files would be updated after which he will send the payment information which you'll use in making payment of $200 via Western Union Money Transfer or Money Gram Transfer for the procurement of your Approval Slip after which the delivery of your ATM CARD will be effected to your designated home address without any further delay. We order you get back to this office after you have contacted the ATM SWIFT CARD CENTER and we do await your response so we can move on with our Investigation and make sure your ATM SWIFT CARD gets to you.

          Thanks and hope to read from you soon.

  

Daniel McMullen

Special Agent in Charge

Criminal Division

FBI Los Angeles

1000 Wilshire Boulevard

Los Angeles, CA

Email: atmcardaplicationcenter@info-fbigov.us.mn

Note: Do disregard any email you get from any impostors or offices claiming to be in possession of your ATM CARD, you are hereby advice only to be in contact with Mr. Kelvin Williams of the ATM CARD CENTER who is the rightful person to deal with in regards to your ATM CARD PAYMENT and forward any emails you get from impostors to this office so we could act upon and commence investigation.

________________________________

This message may contain privileged/confidential information and is intended only for the individual or entity addressed above. If you are not the named addressee you should not disseminate, distribute or copy this email. Please notify the sender immediately if you have received this email by mistake and delete this email from your system.”

          Did anything in that little epistle look…odd, to you?

          Some of us are laughing out loud: “That’s the most ridiculous, pathetic attempt at a scam that I can imagine!” Agreed, but would you react the same way if it suddenly showed up in your “inbox?”

          Would you react the same way if you were alone, or desperate, or worried about money, or not particularly “savvy” in the ways of cyberspace or just a decent, trusting human being? Maybe.

          Maybe not.

          The reason I’ve put us all through this is that we hear about scams all the time but, often, never actually see one, so now we have. And if some of us are still laughing, remember this: The “bad guys” only have to get 1-2 of us to “bite” and BOOM! – Nice Day for the Bad Guys!

          BAD DAY for a decent, trusting human being.

          Most of us aren’t going to wake up tomorrow suddenly having evolved into slick, sophisticated scam-detectors, so let me ask this of you:

          If you get something – Anything! – That seems to be offering you something wonderful in exchange for information from you, just stop! Don’t do anything. I don’t care if it’s an e-mail or a phone call or something in the mail or or or…Just stop, and don’t do anything.

          Then, find somebody you trust to talk it over with - If push-comes-to-shove, send it to me - But usually a family member or a buddy or a neighbor or whoever will be easier to get a hold of, and ask them what they think. If what you’ve received is a legitimate offer or promotion or sales attempt, it can wait a bit; if it seems to want you to do something RIGHT NOW, then it can wait… forever.

          OK? As we say on Koffi Street in Nigeria, “Hope to read from you soon!”