A Guide Through the Long-Term Care Insurance Maze

Last summer, Sandy’s mother was placed in an assisted living facility’s Memory Care Unit. After years of paying for a long-term care insurance policy, the time had come for her to begin collecting benefits.

Yet Sandy found that the process of accessing the long-term care benefits that had been paid for was extremely complex. And while she had been handling details of her mother’s care for some time, she knew she would need outside help dealing with the assisted living facility and the insurance company.

“I needed someone who had the expertise to be able to present herself on behalf of the family and to be on equal ground, to be able to use the same language as the doctor, the assisted living facility and the insurance company,” Sandy said. Fortunately, she found Nicole Christensen of Care Answered to help navigate the maze of paperwork.

“The LTC insurance company that my mom had spent so much money on for the past few years was giving us push back regarding the terms of coverage,” Sandy explained. “Nicole spent countless hours on the phone with me as well as with the assisted living facility and the insurance company making sure all the paperwork was correct.”

But Nicole’s help didn’t end there. “Nicole has also been the liaison with my mother’s doctors’ offices, who also have to file certain paperwork within certain time limits as per insurance company,” Sandy said. “Nicole has been on top of this process from day one. She continues to monitor all paperwork with all parties in this process.”

The impact on Sandy’s life has been immeasurable.

“Having had Nicole as our liaison now for more than a year has enabled me to be able to actually be a little calmer in regard to sharing the responsibility for paperwork and payments” Sandy said. “Nobody can fully appreciate the service that she provides until they have the need for her help, but nobody should ever even consider navigating through the system without someone like her.”

Today, Sandy wholeheartedly recommends Nicole and Care Answered to anyone dealing with a similar situation.

“I would encourage any family in any long-term care or life-changing situation to immediately contact Nicole to have her mediate for your loved one and be the advocate that you will need,” Sandy stated. “She is a wonderful listener and can put a plan into action to achieve the outcome that the family needs. Nicole is an invaluable asset every family should avail themselves of.

To learn more, give Care Answered a call at 516-584-2007.

Don’t let a chronic illness prevent you from enjoying the holidays

beansLiving with a chronic illness or as a caregiver to a loved one with a serious health issue can be stressful on a day-to-day basis. When additional activities associated with the holidays – shopping, cooking, entertaining, visiting and more – are added, it is easy to feel overwhelmed. However, careful planning and simple strategies can help you avoid exhaustion, flare-ups and stress. Here are a few tips:

  1. Plan ahead. Try to avoid last-minute parties, visits and obligations. Having a clear idea of holiday events well ahead of time can help you plan in advance. Schedule preparation time as well as rest time in order to conserve your energy so that you can be fully present.
  2. Don’t be afraid to say no. Self-awareness and self-care are essential during the busy holiday season. You know what you will be able to accomplish and how much you can handle. Give yourself permission to turn down invitations and avoid situations that will drain your energy.
  3. Remember to prioritize your health. Important routines – medication, therapy, diet, and doctors’ appointments – must be maintained, regardless of your holiday plans. Try as much as possible to maintain those schedules. In addition, be sure that caregivers are taking care of their own health. Only by remaining well can a caregiver continue to be there for their loved ones.
  4. Scale back your expectations. It’s OK to host a smaller holiday gathering, to contribute a store-bought dessert rather than a home-baked treat, or to give gift cards instead of personal gifts this holiday season. Remember that the true meaning of the holidays lies in being with friends and loved ones. Trying to live up to holidays past or your own image of the perfect celebration may not be realistic or even necessary.
  5. Do a little at a time. Whether you are addressing cards, wrapping gifts, or cooking a meal, break the task down into smaller chunks. Start early, and schedule time to rest and unwind between chores.
  6. Ask for help. How often have you heard the words, “Is there anything I can do to help?” People truly do want to lend a hand, but often they don’t know exactly what you need. Don’t hesitate to ask those around you to pitch in. If you are financially able, hire someone to help with chores such as shopping, cooking and cleaning.
  7. Take time for you. Schedule time to do things that provide you with a sense of peace and pleasure. Read a book, watch your favorite TV show, talk to a friend, meditate or just breathe. These mini-breaks will help you to recharge your batteries so that you can keep going!

Forget Politics…Talk About Healthcare Decisions this Holiday Season

Thanksgiving is right around the corner. As you get ready to roast the turkey, bake the pies and gather with loved ones, think about adding one new tradition to your family gatherings. Take politics off the table and instead use the time together to talk about healthcare. Share any important family medical history and discuss the decisions you would like made on your behalf should you become unable to make care decisions for yourself.

A good place to start is to give your loved ones peace of mind by selecting your health care proxy.

What is a Healthcare Proxy?

The New York Health Care Proxy Law allows you to appoint someone you trust — for example, a family member or close friend – to make health care decisions for you if you lose the ability to make decisions yourself. By appointing a health care agent, you can make sure that health care providers follow your wishes. Learn more here.

How do you talk about healthcare decisions?

Once you have selected your proxy, be sure to inform that person about his or her role and let him or her know about your wishes should an illness or injury leave you unable to make your own healthcare decisions.

Sometimes these topics make people uncomfortable. Try to ease the discomfort with these suggested opening lines:

“My faith is important to me and I don’t want to have….”

“I’m allergic to …. Please make sure that I don’t receive that medicine”

Talk about what you value as specifically as you can. You might say:

“I don’t want to ever be sustained by machines,” or “I have to be able to live independently,” or “There are new health findings every day. I would like to be kept alive until they find a cure.”

Points to remember about healthcare decisions

The discussion with your healthcare proxy can and should be ongoing. You cannot imagine every possible scenario but if the person you select as your healthcare proxy understands your values and knows the types of life-sustaining treatments that you would want, as well as those interventions that you would not want, your proxy will feel confident that they are following your wishes rather than having to decide your fate on their own.

This is not a contest of who loves you the most; rather, it’s about who will be able to carry out your wishes.

It is a tremendous burden to expect your loved ones to make these decisions for you if you have not expressly told them your wishes. Help them be your proxy by freely sharing your feelings.

Take time this holiday season to begin your discussion. And fill out your healthcare proxy form. Think of it as a compassionate gift to your loved ones should they ever have to make an important healthcare decision for you.

 

Do I Have to Pay This Bill?

“…in this world nothing can be said to be certain, except death and taxes.” To this list of life’s certainties attributed to Benjamin Franklin, we might also add bills. While the season of gift catalogs and holiday greetings is nearly upon us, our mailboxes are perennially filled with notices of balances due from utility companies, credit card providers, and medical offices, among many others.

When it comes to medical bills, there is often confusion about what we are responsible to pay, what should be covered by insurance, Medicare or supplemental Medicare plans, and whether other arrangements can be made.

Care Answered works with our clients before they have a medical encounter to ensure that planned services and providers will be covered by their insurance.  If you receive an unexpected bill after services are rendered by a healthcare provider, our best advice is to not automatically pay it before asking a few questions.

If you believe you received a bill for a medical encounter that should have been covered by insurance, contact your insurance provider and ask them specifically why they did not pay it. If the services provided are unclear, call the provider and ask for a detailed, itemized bill. If something listed on your bill is unclear to you, ask what it is.

Long-term skilled nursing facilities (A.K.A. nursing homes) should not bill patients who are covered by Medicaid. If your loved one has been approved for nursing home Medicaid and you receive a bill for their care, you may not be responsible to pay it.

Bills are generated by people working in billing departments; they are human and sometimes make mistakes so it always pays to check your bills carefully. If you feel you need an advocate because the billing seems wrong or if you want to make sure you don’t get charged before you go, contact Care Answered or call us at (516) 584-2007.

Untangling healthcare bills can be daunting, especially when you should be focusing on getting better.  We can help.

GuildNet MLTC Closure Update

The New York State Department of Health has affirmed that GuildNet will close as a Managed Long Term Care (MLTC) provider as of January 1, 2019. GuildNet had already ceased MLTC operations on Long Island, so this change primarily affects those in the boroughs of New York City and other parts of the state.

Current GuildNet MLTC clients need to be assessed and select a new MLTC company by December 18, 2018. Please note: if you would like to keep your current home care agency, an MLTC that has a contract with that home care agency MUST be selected.

The new MLTC is required by the state to do the following:

  • Continue to provide services under the enrollee´s existing plan of care, and utilize existing providers, for the earlier of the following: (i) one hundred twenty (120) days after enrollment; or (ii) until the new plan has conducted an assessment and the enrollee has agreed to the new plan of care.
  • Conduct an assessment within 30 days of the transfer enrollment effective date, unless a longer time frame has been expressly authorized by the Department at its sole discretion.

The new MLTC will conduct a new assessment and may recommend changes to the patient’s plan of care. Keep in mind that if you would like to change your new MLTC for any reason (for example, if they want to reduce hours of care), you MUST make that change within the first 90 days.

Click here for additional information: http://www.wnylc.com/health/news/78/

This process can be confusing and overwhelming. Contact Care Answered at 516-584-2007 with any questions or for help selecting a new MLTC agency.

Help with the Juggling Act

Michael Pacella with his youngest grandson, Ryan, his youngest great-grandson, Nolan, and daughter, Linda Wangner

Linda Wangner was in a bind, one that would be familiar to many people struggling to provide care for an elderly loved one while juggling their own lives – living far away, taking care of a spouse with a medical issue, and balancing professional and personal responsibilities.

Linda and her husband live in Arizona part of the year, and Garden City, near her 100-year-old father, the rest of the time. Her father, Michael Pacella, is able to live independently with the help of home health aides. The trouble began a few years ago when she needed to transition from one Managed Long Term Care provider to another. She spent months waiting for an intake interview, only to find that the new agency would only provide aides for eight hours a day, while Mr. Pacella needed round-the-clock care.

At the same time, Linda’s husband underwent surgery that left him immobile during his recuperation. Linda was unable to stay with her father, and unable to care for him in her home while she was on Long Island. During their time in Arizona, Linda teaches part time at the state university, serves on the board of several clubs and helps run her development’s Homeowner’s Association. As the situation in New York deteriorated, she had difficulty carrying out her normal activities due to the stress of constant telephone calls regarding issues with her father’s care. Relief aides failed to show up to take care of him. Others would leave him alone during their shifts. The police would be called, and Mr. Pacella would be taken to a hospital and then discharged to a nursing home until home care could be arranged again.

Then Linda met Nicole Christensen, a healthcare advocate and owner of Care Answered. Nicole met Mr. Pacella and the two hit it off. She was able to persuade him to visit the neurologist, and it was found that he suffered from damage to two areas of his brain that influenced his impulse control and decision making. Care Answered was then able to put in place and coordinate physical therapy at home that helped him do the things he loves.

Nicole was able to transition Mr. Pacella’s care to a new MLTC and home care providers that Linda describes as “light years better than the other agencies.”

As a result, she says, “My Dad has been calmer, easier to get along with.”

Linda has recommended Nicole to many others who are dealing with similar issues.

“Nicole got involved, and life calmed down,” she says. “I had never heard of a patient advocate before, but Nicole could be the poster child for it. She is the best in her field.”

 

 

Medicare Open Enrollment Begins October 15

Monday, October 15 begins the Open Enrollment period for 2019 Medicare. Between October 15 and December 7, you may enroll in Medicare if you became eligible in the past but did not enroll. You may also use this time to make changes to your enrollment. For example, you can switch from traditional Medicare to a Medicare Advantage Plan, change from one Medicare Advantage Plan to another, or change from one prescription drug (Part D) plan to another.

Start by reviewing your coverage. The Medicare website has a host of resources to help you learn more about plans and options so that you can evaluate your needs and select the plan that is best for you. One helpful resource is the Medicare Plan Finder tool which will help you find plans offered in your area.

There will be changes to Medicare beginning in 2019, including elimination of the so-called “donut hole” for prescription drug costs, one year ahead of schedule. Premium rates have not yet been announced, but an increase is projected. Additionally, the income threshold for the highest premium bracket has increased to $500,000 for an individual and $750,000 for a couple, up from $160,000 per individual and $320,000 per married couple.

For additional information or help navigating the complexities of Medicare, don’t be afraid to call on a professional. There are insurance brokers, healthcare advocates and others who can help you sort it all out and select the plans that are most appropriate for your individual situation. Many libraries and community based organizations can connect you with free resources. Want to learn more? Give me a call at 516-584-2007.

Alcohol Abuse in the Elderly: A Growing Problem

When you imagine an individual with a drinking problem, who do you picture? Is it a troubled teen? A college student who binge drinks on the weekend? A middle-aged man who has a few cocktails to unwind after work every evening?

Alcohol abuse can affect anyone at any age, but it is an increasing problem among the elderly. And, when older adults drink to excess, they may be opening the door to a range of other health problems.

Alcohol’s effects can be more pronounced in the body as we age, so drinking the same amount may cause a person to feel more intoxicated than they expect. Alcohol can also mask other health signs and become mistaken for symptoms of other common diseases. For example, alcohol may cause a person to become forgetful or confused, which could be mistaken for dementia or Alzheimer’s disease. Alcohol abuse can cause changes in blood vessels and the heart and could dull the pain of a heart attack leading to delayed treatment.

Alcohol abuse can worsen osteoporosis, diabetes and high blood pressure, and could contribute to strokes, ulcers and mood disorders. In addition, alcohol abuse can make it more difficult for physicians to prescribe appropriate pain relief medications should the individual require surgery or have a health issue that requires pain control.

Older adults may begin or increase their drinking to help them deal with sadness and depression. These feelings, while NOT considered a normal part of aging, are common responses to loss, loneliness and illness that many elderly people face.

If you suspect that an aging loved one may be abusing alcohol, it is important to offer support and help. Try to identify the underlying issues and find ways to address them. The causes can be complex and not easy to fix, but there are a range of community-based resources that can help. For additional information, visit the National Institute on Aging, or give me a call at 516-584-2007.

What to do when you receive a difficult diagnosis

woman listening“Everyone who is born holds dual citizenship, in the kingdom of the well and the kingdom of the sick . . . Sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place.” – Susan Sontag

Receiving a diagnosis of a chronic condition or any serious medical issue can be devastating, forcing a person to move from the kingdom of the well to the kingdom of the sick in one sudden, awful moment.

If this happens to you, take a moment to breathe. Then follow these tips to help you cope:

  1. Take some time. Unless emergency medical care is required, in most instances, there is no need to react immediately. You may find yourself overwhelmed by various emotions: anger, fear, sadness and confusion are common. Give yourself a little time to process the information you have been given.
  2. Assemble your support team. Identify the friends and family members who are willing and able to help you through this time. Assign tasks if appropriate; people will appreciate knowing that there is something they can do to help.
  3. Reach out for support. Many local hospitals and community-based organizations offer support groups that focus on specific diagnoses. Call or visit the website of your local hospital, or organizations like the American Heart Association, American Cancer Society, Alzheimer’s Foundation, and others to learn if there is a support group in your area.
  4. Consider hiring a healthcare advocate. An advocate can help you navigate the healthcare system, sort through complex medical information, arrange for the most appropriate treatment and facilities, coordinate insurance coverage, and more.
  5. Take notes. Jot down your questions prior to your doctor’s appointments and write down the information you are told. Use a journal or notebook to keep track of this information and to log appointments, tests, medications and dosages, and other details surrounding your journey.
  6. Get a second opinion. Corroboration by another trusted professional will reassure you that you are making the best decisions.
  7. Educate yourself – but be wary of what you find online. The internet has given everyone a platform to share their opinions, which can lead to confusion when you are seeking reliable information about a disease or condition. Verify the source of any information you find online and stick to well-known and respected websites and organizations.
  8. Take care of you. Remember to get enough rest, focus on managing stress through yoga or meditation, spend time with friends, and try to live as normal a life as your diagnosis allows. Keeping a positive attitude and focus on the future will help you cope with the challenges ahead.

Have a question or want to talk? Call me. I can help you figure out your next step. Give me a call at (516) 584-2007.

Healthcare 101: The Document All College Students Must Complete

It’s the time of year when parents everywhere are preparing to send their newly minted 18-year-olds off to college for the first time. Whether this rite of passage will include teary embraces and promises to check in regularly, or victory laps around the (at last!) empty nest, there is an important item that many parents neglect to add to their “to do” list. Along with dorm supplies and required vaccinations, make sure to have your child complete a health care proxy.

In New York State, when a child turns 18, he or she is considered an adult, regardless whether or not mom and dad are still paying the bills and carrying the health insurance. That means that medical professionals are bound by federal privacy laws, known collectively as HIPAA (for the Health Insurance Portability and Accountability Act), to keep your child’s medical information private, and to only discuss details with individuals who are authorized by the patient (your kid) to have that information.

You may not want to think about the potential for your child to require medical care while away at college, but accidents, injuries and illness do happen. And for a parent who is far away, trying to get information over the telephone from healthcare providers in another city or state, not having a health care proxy could be a major problem. Without the form, healthcare providers are unable to discuss your child’s specific conditions, you are unable to make decisions regarding your child’s care, and you can be denied information on what your child is suffering from, even for something as simple as a stomach bug or appendicitis.

Experts recommend having your young adult children complete a health care proxy form. Keep a copy of the form handy, and scan or take a picture of the form with your cell phone so that the document is always available.

If you have any further questions or would like a health care proxy form that you and your family can fill out before move-in day, reach out to us here at Care Answered. We’re happy to help you cross one more item off your college prep “to do” list.