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.



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?!