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.



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.”   



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.