Archive for the ‘Medicare/Medicaid’ Category

If Only There Was A Second Time Around

Posted on July 9th, 2015 by karen

If Only There Was A Second Time Around

by Kim Keller

As another anniversary of our father’s passing — July 16th, to be exact — approaches, my sister Karen and I find ourselves once again filled with regret for all the lessons learned, far too late in life, about how to help someone you love through serious illness.

Dad’s health issues lingered for quite some time, but during the last year of his life, he deteriorated at a tumultuous pace. It was a painful ordeal, and if it were possible to go back in time, Karen and I would do many things differently.

We would have more actively:

  1. Insisted that our father seek better medical care earlier in his illness. The critical lesson here: sometimes you just have to travel farther for better hospitals and doctors. Dad made his choices based primarily on location, and while we often questioned the quality of his doctors and their related facilities, we weren’t comfortable pushing this point with him, until it was far too late in the game. Given what we now know, we would have kept researching hospitals in the region until we found a teaching hospital with MAGNET status. Teaching hospitals generally attract higher caliber doctors, and a MAGNET designation indicates an impressive level of quality care bestowed upon patients by the nursing staff. Naturally, there are great hospitals that are not teaching facilities, as well as many without MAGNET status, but it’s an excellent place to start.
  2. Focused on how Dad could reduce the amount of medications he was taking. He had lots of specialists, especially as his health unraveled, and each doctor added a new prescription or two. Not enough attention was paid to the possible side effects and adverse interactions caused by combining so many medications. In fact, rather than scrutinizing the burgeoning list of drugs that were being pushed at our father, each new medical issue that cropped up heralded another new prescription. Given what we know now, we would have discussed the medication list with all the various specialists, starting with these five questions: (1) Are any of Dad’s symptoms a possible side effect of another medication? (2) What are the potential side effects of each drug? (3) Is this drug safe and/or effective for someone over 65? (4) Are there any issues to watch out for when this drug interacts with Dad’s other current medications? (5) Is there any harm in changing Dad’s diet and/or exercise regimen rather than prescribing another new medication? And to help us with our own research, we would have used, which is a great tool for fleshing out medication problems.
  3. Talked with our father about end-of-life issues. Dad already had a living will in place, so we thought we were covered in this important area, but we were wrong. We soon discovered that many common scenarios needing to be fully vetted are not handled by the average living will. For example, do you continue with aggressive treatments when they can’t cure you but can only sustain a bedridden life? Not an easy question to discuss, and we certainly never discussed this as a family, but at a certain point late in the illness, Dad was no longer able to give his input, and continuing treatments no longer held any promise of recovery. We decided to maintain the full-on treatments, but we’ve never been sure this was what Dad wanted. If we’d known back then about the critical importance of a wide-ranging end-of-life discussion, we would have used It’s an important resource that walks you through the fundamental questions that every family needs to consider.
  4. Established ourselves as coordinators for keeping track of all communication between and amongst the various medical personnel and caregivers attending to Dad. Karen and I just didn’t understand, at least not at first, that someone had to pull together all the various pieces of information relating to Dad’s care, from medication mandates and treatment instructions to exercise orders and diet alterations. Counting on the medical teams to coordinate and communicate was not realistic. We eventually learned to keep track of everything and to communicate everything. There was nothing too big or too small. Here are some of our charts and checklists.
  5. Created a support team around us to help us anticipate needs, develop a plan, make better decisions, and clue us in on available resources and tools. Frankly, back then we didn’t even realize we needed a support team, other than our father’s medical attendants. Dad had been sick for so long that we never would have believed we were facing his final year. Without a support team, we spent way too much time being reactive, putting out fires, floundering with decision-making. If we could do it all over again, without the pain and torture that Dad surely experienced, we would’ve reached out to people who had been down this path before. There are many places to start building a team: in-home care agencies, for example. Or local religious organizations, many of which have outreach programs, geriatric care managers, and senior centers. When we finally did build our team, we were relieved and finally confident that we were making sound decisions. We didn’t understand at that point how close we were to the end, but we were at least able to spend our time in a far more important and valuable way: loving our father and enjoying every last minute with him.
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Financial Planning: Understanding Medicaid

Posted on March 27th, 2013 by kim

"Money money money" by Andrew Horowitz

by Kim Keller

I never imagined my father would need to be in a nursing home. The idea was profoundly sad but Karen and I realized that our mother could no longer manage Dad’s care at home, not even with help.

But there was yet another looming disaster: how would our parents pay for this care? They had no long-term-care insurance plan. Their money would be gone soon, as a consequence of Dad’s medical bills. Where would that leave him? And where would that leave our mother who still had a lot of living left to do?

It quickly became evident that we needed to understand our options and develop some sort of financial plan, in case our parents ran out money.

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Ten Tips For Financial Planning

Posted on August 6th, 2012 by kim

by Kim Keller

When our father became critically ill, Karen and I were forced to become actively involved in our parents’ finances. It became painfully apparent that there was real potential for financial ruin if we didn’t develop a program to deal with Dad’s mounting medical bills, for which there was no end in sight.

The sudden depletion of Dad’s hospitalization coverage, reported to us by the hospital business office some 16 days after the fact, was our startling wake-up call. Prior to that notice, we had absolutely no idea that Medicare could run out. We were taken completely off-guard. The situation could not have been more stressful or more dire. We needed a short-term solution and a long-term plan, and we had to find them both in a hurry.

Sadly, the long-term plan was rendered unnecessary when Dad died, just a few months after the onset of financial complications. Money should be the last thing on your mind when someone you love is so very sick, but it pained us, having to spend our time solving the financial burden when we wanted to be comforting our father all the time.

A lesson learned: Have a plan before you need a plan.

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Covering The Cost Of Care

Posted on July 9th, 2012 by kim

Cost Of Care on

by Kim Keller

The money worries began in earnest the day we realized our dad was going to need full-time care.  He didn’t have long-term care insurance and eventually the money would run out.  The worrying intensified when Dad’s Medicare coverage for skilled-nursing care (a.k.a. rehab) ran out.  We all knew that rehab was critical to his recovery, but after so many stays in rehab, Dad’s coverage was gone.

But the worries didn’t end there — it exploded into panic the day we found out that he had also depleted his Medicare hospitalization coverage.  This was now a full-blown nightmare.  What would we do?  Not only was Dad’s very life at stake, but our parents’ entire financial security was also at risk.  Money should’ve been the last thing on our minds, but we were now forced to divide our attention and focus on preventing our parents’ financial demise.  We had to make sure that Dad was receiving the best available care, while at the same time we needed to assure our parents’ financial security.

It was daunting, to say the least.

So who pays for long-term care?  Not Medicare.  Medicare generally only pays for short-term care for rehabilitation purposes.

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Our Favorite Tools: A Celebratory Retrospective

Posted on January 23rd, 2012 by kim

Green Tool Box Photo by Sue Schultz

by Kim Keller

Today In Care of Dad publishes its 101st blog!

It’s quite a milestone for us.  To celebrate this landmark occasion, we’re taking a look back at some of the most useful tools and resources we’ve written about here at In Care of Dad, items that have helped many people — just like you and me and my sister — to care for our aging parents.

Here are some of our favorite finds: — This wonderful service helps friends and families sharing a health crisis by offering space and access to any group, extended or otherwise, that wants to stay abreast of a loved one’s health status.  But more than that, Caringbridge helps families arrange their websites with the following format features:  1) journal entries to keep everyone up-to-date; 2) photo uploads to provide a visual component; and 3) a private message center where family and friends can deliver words of encouragement and support.  This service is easy to use and completely free!

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Staying On Top Of Medicare Coverage

Posted on December 14th, 2011 by kim

by Kim Keller

We found a terrific resource on the Medicare website that will quickly tell you what costs Medicare will cover and what costs it won’t.

The Medicare Coverage Database is simple to use.  You can either enter your Medicare policy ID number or you can select, from the respective drop-down menus, the appropriate state and coverage topics, which includes everything from occupational therapy to mental health care to surgical services to heart, lung, kidney, pancreas and liver transplants — it’s a huge list of options.

Then simply click View Results.  It’s that easy.

You’ll receive guidelines outlining the requirements for coverage, such as whether a doctor needs to approve the treatment, what percentage of the bill you’ll be responsible for, and who else you can contact for additional information.  The database explains the coverage situation for items such as hearing aids and wheelchairs; for tests like mammograms and blood screenings; and for services like surgery and emergency room visits.  It is a thorough database with easily accessible information.

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Understand How Medicare Works

Posted on October 5th, 2011 by kim


by Kim Keller

It would’ve been helpful if we’d had a basic understanding of Medicare from the very beginning.  Instead, we learned all about Medicare the hard way, when our dad’s coverage reached its limit.  And so we thought we’d share with you the essentials of Medicare to help you better navigate the system.

Medicare is a government health-insurance program for people 65 and over, regardless of their income level.

Medicare is broken up into four parts:

  1. Medicare Part A provides coverage for hospitalization, skilled-nursing care and in-home care, and hospice care.  Most people have this coverage automatically when they turn 65, and there is no monthly premium.  There is an exception to this:  If your parent or parent’s spouse didn’t have enough Medicare taxes deducted prior to retirement, then coverage is not automatic and a premium is required.
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