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.



Peninsula Daily News Column 7-11-2013 "Aging shouldn’t be seen as abnormal"

          You are not a problem.

          Well, OK, you may be a “problem” in some ways at some times depending upon what you do or don’t do and how well you do or don’t do it and how whatever it is that you did or didn’t do effects other people who are around you, but you – Just you! – Are not a problem.

          Reassuring, isn’t it? Let me back up.

          I started out to start out this column by saying something like, “I just want to talk to older people…” when I realized that “older people” are non-existent – There’s no such thing. Older than what? Older than who? Almost everybody is older than somebody, so what does that even mean?

          And if you ask “older people” who “older people” (“seniors,” “Elders,” whatever term you like) are, they’ll tell you that they are people who are older than them. I’ve had folks in their 90’s tell me that they had no intention of going to a “senior center” because those are for “old people.”

          Now, while I happen to think that observation severely misunderstands what goes on at senior centers, that really isn’t the point. The point is that most of us don’t think of ourselves as “older people” – We think of ourselves as “people.” How…interesting.

          We are constantly hearing about how much Medicare costs and how much Social Security costs and how much Medicaid costs and healthcare and long-term care and the shortage of caregivers and how to support caregivers who are supporting older people (whoever they are) and how to survive retirement and how to keep “Mom” safe and driving and prescription drugs and nutrition and dementia and the spiraling costs of Alzheimer’s and the impact on the families and the costs of all these costs and…Problems that need to be solved!

          When did we become a “problem?” And when, exactly, did aging become a problem?

          I could easily provide us with similar lists about pre-schoolers and kids and teenagers and young adults and middle-aged, family types and…Right: Life is full of “problems;” sure, the types and the solutions might change (and they might not), but the fact remains that “problems” aren’t peculiar to “aging” (well, OK, I can think of a few peculiar problems, but we won’t go there today).

          Aging is not a problem that needs to be solved – It’s a phase, an opportunity and a universal experience unless, of course, you’re never given the opportunity to experience that phase, which is an option that few of us rush to embrace; thus, if you aren’t dead, “aging” is a universal experience, so why do we need to “solve” a universal experience?

          We don’t; but, apparently, a lot of people think we do, so they invent “programs” – And what do we all know about “programs?” Right: “Programs” are for people who need “help,” and since I don’t think of myself as someone who needs “help,” I don’t partake of said “programs” and, besides, I’m not an “older person,” anyway, so none of this has anything to do with me, right? Then, why do I feel vaguely guilty, or “less than…?” Like, there’s something wrong with me?

          Because we (the big “WE” – The US of A “we” – The most-of-the-industrialized-world “we”) talk and act like aging is a problem. Then we wonder why “older people” don’t rush to our “programs” to get the “help” they so OBVIOUSLY need.

          I know what some of you are thinking. You’re thinking, “That’s very interesting, Harvey, coming from a guy who goes on about ‘help’ and ‘programs’ all the **** time…” I know. You’re right. Here’s my answer: Because I have a peculiar (there’s that word again) ability to talk out of both sides of my mouth, at the same time! – Which probably deserves a modicum of explanation.

          I want people to live – To be as happy and healthy and productive and “fulfilled” (whatever we might decide that means) as possible and, sometimes, “programs” are the best way to help people do that – Well, OK, sometimes they’re the only way – We work with what we have. But that’s a very different matter from acting as though people are a problem, just because they aren’t dead.

          The fact is that if there were no people, there would be no problems! Well, OK, the occasional Ice Age or meteor or solar flame-out might provide a random degree of galactic-level entertainment, but mostly…No people, no problems!

          But since we have people, we have problems – Oops; so, unless we plan to dispense with people altogether (which seems universally and terrestrially unlikely), we’d better get used to it; THUS, people are not THE problem.

          And aging is not a problem that needs to be solved.

          If it were up to me (and many of us should be darned glad it isn’t), I’d draft “older people” into some kind of local/national/planetary “service” to help keep this whole “life thing” from spiraling out of control! In other words, I wouldn’t see aging as a problem that needed to be solved – I’d see it as an opportunity that needed to be exploited! But, don’t worry – My level of influence is rather severely…contained.

          Allow me to attempt to summarize this admittedly fractured treatise: I think we ought to “normalize” aging, because…it’s NORMAL! It isn’t a problem, a curse or a societal liability. It’s a blessing, an opportunity and an inherent phase of this funny thing called “life,” so run with it! Learn from it! Don’t dodge it – Whack it head-on! It’s a natural part of the ride, so ride it out!

          Because you are not a problem.



Peninsula Daily News Column 7-4-2013 "Help to navigate Medicaid is out there"

          Yes, I do know what day it is; I also know that there are a lot of folks who will say what needs to be said a whole lot better than I ever could, so I’ll just wish you a lovely 4^th of July and hope that, for today, we can all let go of our politics and just remember that freedom is NOT just another word for nothing left to lose.

          I’m picking up where we left off last week, which was that we have to find a way to continue paying for Dad’s care in a nursing home, now that we can see that his liquid financial assets will be pretty much gone in a couple of months – And that “way” is called “Medicaid.”

          In order to qualify for Medicaid in a nursing home, there are three “pieces” of eligibility: Dad has to actually need that level of care (we’ll assume that’s a “given”), he has to qualify in terms of his income and he has to qualify in terms of his assets. Let’s start with “income.”

          The income figure for nursing home Medicaid eligibility isn’t a “hard” number; on order to qualify, your monthly income has to be less than the total of the nursing home’s Medicaid rate PLUS Dad’s regular monthly medical expenses. Example: The monthly Medicaid rate for “Strawberry Fields Nursing Home” is $6,800 per month, and Dad’s monthly medical = $275.00; thus, Dad’s income has to be less than $7,075 per month. Not a problem? I didn’t think so.

          The assets piece (“resources”) is a bit more complicated, but not insurmountable; basically, a single person can’t have more than $2,000 in resources, which generally means bank accounts, property, stocks/bonds, etc. The house is often exempt, unless Dad has more than $536,000 worth of equity in it, a car usually is, as are personal belongings and what not. TIME OUT:

          The “resources” piece if Dad is married vs. the “resources” piece if Dad is single are VERY different! I’m going to refer you right now to a wonderful, free web site. Go to www.washingtonlawhelp.org and click on the “60+” icon, then click on “Long-term care assistance,” then click on “Questions and Answers on Medicaid for Nursing Home Residents.” What you’ll find is a great pamphlet on the subject by attorneys, but folks like you & I can actually understand it. Read it, please; now, read it again. I’m not going to attempt to recap everything that’s there, because that would waste your time and mine, so I’m going to jump ahead to a common scenario, but let me remind you of this: If you need any help with any of this, call any of the numbers at the end of this column, and decent people will help you, for free. Don’t hesitate: We don’t consider it an “interruption” – WE consider it to be our job.

          Here’s a common scenario for a lot of us: Dad was living alone in his house, on a low-to-moderate income, with a few bucks in the bank. When it all became too much you, Caregiver, helped him to get into a nursing home and started paying with the income and assets he had; at the same time, you (because you have a “Durable Power of Attorney”) put his house on the market for “fair market value.” His money ran out in a couple of months, so you shepherded him into Medicaid eligibility and Medicaid has been paying the nursing home bills – OK. Suddenly, the house sells! Now what?

          First (this is always first…), don’t panic. What this means is that Dad is no longer Medicaid-eligible because he just came into a substantial “resource,” so Medicaid stops. What happens is that you continue to “private pay” the nursing home for Dad’s care, out of the proceeds from the sale, and when those proceeds start getting pretty low, reapply for Medicaid – No harm, no foul, but let me point something out:

          These proceeds from the sale are, in fact, Dad’s money; so, if he needed dental work or clothes or a TV or a radio or or or, those are perfectly legitimate expenses, so don’t hesitate to spend it on his behalf. The only thing you (he) can’t do (well, shouldn’t do) is give the money away (to the granddaughter, or whomever), because THAT will disqualify him from Medicaid for “X” amount of time, but pretty much anything else on his behalf? You bet – Go for it.

          Then, again, when the money starts to dwindle, reapply for Medicaid, complete the annual REeligibility paperwork, keep the DSHS Financial Worker informed of what’s going on (financially), and things will go pretty well.

          I’m not going to pretend that this Medicaid stuff isn’t complicated – It is, but lots of us have done it, and there’s plenty of help out there for you – AND for Dad. The worst mistake is to start doing things or making decisions without understanding their implications, because once money and/or assets are gone, they’re gone.

          And if you decide to consult an attorney (which is NEVER a bad idea), be sure that said attorney is familiar with Medicaid law (“Elder law”). I’ve seen some great attorneys give lousy Medicaid-related advice because it simply wasn’t their forte, so be sure that you’re not engaging a podiatrist to do neurosurgery.

          The main point of all this was to be sure you know that there is help, and it can be done and you, Caregiver, are not alone.

          You never were. Dad said to say, “Thank you.”