My Parent Has Long-Term Care Insurance-Now What?-Part 2

In "My Mom Has Long-Term Care Insurance-How do I Interview Nursing Homes-Part 1," we looked at the importance of first determining the per diem rate your parent's long-term care insurance policy provides. You will want to check with your health care insurance company to find out exactly how much the policy your parent purchased will pay to a nursing home for your parent's daily care.

This question is very important because different health care insurance companies provide different long-term care insurance policies purchased at different rates.

One daughter told me that her health care insurance company told her that she could pick any nursing home for her mother, so she immediately wanted to know what to look for in nursing homes.

Great question, but the first question to ask is how much will you have to spend under the terms of your parent's long-term care insurance company policy -- how much in additional funds will you or your parent have to pay if you pick a nursing home of better quality than the per diem allowable cost of Mom or Dad's long-term care plan.

As you're looking at nursing homes, ask what is the nursing homes' daily cost? Will there be extra charges for diapers, gloves, wipes, laundry, medicine? If you have to purchase these, they CAN be brought in from the outside. Don't pay the rates the nursing home charges--that's usually where they make extra money. Save your money for the important expenses. Go to Costco or Sam's Club or order on line.

There are also outside mail-order pharmacies for any medications covered or not by Medicare or secondary insurance. A good nursing home facility will help you arrange for that. If not, you can also do it on your own.

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Many facilities have trouble finding quality nurses to work in their facilities. Often you will see that they don't even have every shift covered by one registered nurse.

This is a bad sign.

You should also look at the most recent state health board report on the nursing home facility. Check out how many negative notices have been made against the nursing homes your are looking at. Often times, nursing homes will be cited for not giving medications at the proper time (very important) or skipping them altogether. Ask also what is the turnover rate of staff?

Stop in some time during the week when the nursing homes are not typically expecting family visitors and ask to take a tour -- look through the entire facility. Is there a cup with a straw and filled water pitcher by each person's bed? Is there a television, telephone?

How will you reach your parent by phone? Will your Mom or Dad have to use a cell phone to talk to you? Will you have to rely on the nurse's desk to take a phone to your parent's when you call (good luck with that!). Communication between the elder and family members is crucial to the elder's mental health. Make sure you and your family members can communicate easily with Mom or Dad.

Also ask to look into the shower areas and see how clean they are.

And, of course, as I recommended in Part 1, talk to other family members of other patients. But still make sure you make a surprise visit during the week to really see what happens when the nursing home is not typically expecting visitors.

Also, find out about doctors. Does the facility have a Medical Director who visits or is on call? Typically, only the highest-end facilities do. So, you need to make sure that your parent's physician will come to the nursing home you choose or that it's easy for you to arrange for transportation to the doctor's office.

I've written before and will mention again that elder and disability transportation services are one of the highest growth areas of necessary services as boomers and our parents age. Many available services are run very poorly.

If you are looking for a growth business, I recommend strongly that you check out elder/disability transportation service opportunities. This resource I'm recommending may look a little intimidating at first but it's a great investment in learning how to build a transportation service company--Click Here!

I can tell you from first-hand experience that a well-organized, caring, service-oriented transportation company for the aging and disabled will attract many clients, both private individuals and families as well as nursing home facilities that have to arrange for transportation of their patients to and from hospitals and doctors' appointments.

Finally, meals. Some facilities do not want to serve individuals in bed because they want them up and out, they say, it's more social for the seniors, but it's also more work for the staff. You should find a nursing home facility that will allow meals to be served in the room, at the patient's discretion. There may be days or come a time when your parent will want/need meals to be served in bed.

Keep in mind, you are not alone through all of this. We offer telephone consultations to guide you through your health care planning, both pre-planning and emergency situations. To contact us, Click Here!

Blessings and encouragement, Jane Allison

Gifting to Qualify for MediCal--Unfair For Seniors?

As an attorney, I often see colleagues' promotional materials, advertising that there are lawful ways for elders to gift their estate to other family members in order to qualify for MediCal -- what we call "Medicaid" in California. Other states use the term "Medicaid" or have created their own term.

When I first read one of these elder attorney's pamphlets, I thought whom is he representing? Does the elder who is being advised or agreeing to do this know what a MediCal/Medicaid facility looks like? The quality of care they are going to receive compared to what they may be used to in what I call "real life" -- the time before they enter Assisted Living or a Skilled Nursing Facility (SNF) -- can be much less than their current standard of living.

MediCal and Medicaid facilities may do the best they can with their limited resources, but the resources ARE limited, and it is important that any elder understand what it means if they give away their estate in order to qualify for MediCal/Medicaid. THEY NEED TO VISIT THE TYPE OF FACILITY THEY MAY HAVE TO LIVE OUT THEIR LIFE IN BEFORE THEY AGREE TO GIVE THEIR ASSETS AWAY. That's what the legal community refers to as "informed consent", but I wonder how often that happens in these types of situations.

Many attorneys get around what appears to be a major ethical dilemma by representing the children and having a written waiver from the parent that the parent should seek their own counsel and that the attorney is not representing the parent. This waiver may or may not be effective depending on the specific circumstances and the state.

There may be those unselfish parents who are willing to give it all away for the sake of their children and risk living in a bad facility for the rest of their lives if necessary. My concern is most parents don't know exactly what they are doing when they seek to give away their assets to qualify for MediCal/Medicaid.

It sounds like a great come on, but go see the fine print! If you are an elder planning on working with an attorney and your family to qualify for MediCal/Medicaid, please educate yourself, seek your own personal legal counsel, and research the potential quality of life you will face if you have to rely solely on MediCal/Medicaid and not on your own personal funds.

Legally protecting your assets and saving tax dollars is your right, but please make sure it is what is best for YOU!

Jane Allison
http://yourelderlawadvocate.com/
http://twitter.com/janeallison

Loving Your Parents Through Healthcare Turmoil!

I am so grateful to my followers on Twitter (http://twitter.com/JaneAllison) who have responded to my question about what they would do if their Mom or Dad were suddenly hospitalized. Most of the answers came back in one variation or another, "I would be there and love them and look out for them."

In an earlier Post here I discussed the matter-of-fact details of what to do when your loved one is hospitalized (see Post "Help! My Parent's in the Hospital!"), but right now I want to focus on what many of my fellow twitterers commented on -- being there and giving love.

For some of us, that's easy. The process is hard, which is why I want you to be prepared by reading the hospitalization Post to the right if you haven't already. I want to make it easier for you to navigate the health care tumult. From an emotional standpoint, many of us would immediately come from love ~~ I want to be there ~~ I want to help.

For others, the relationship with our folks may itself have been tumultuous. Perhaps rightly we feel that our needs were not met, that our parents did not love us the way they should have or been there for us when they could have. So, when the call comes to jump into the "hospitilization/time to take care of Mom or Dad and put my life aside for a period of time" fray, you may find those hurts resurface and your tendency be ~~ not me, let my brother or sister worry about it, or I'm really too busy right now with the kids and work, or they're in good hands in the hospital.

If this is you, I want to share with you a different paradigm ~~ encourage you to look through another framework at the needs of your Mom or Dad at this critical stage. We have all heard it, parents do the best they can. In my opinion, some do, some don't. But the reality is that when they are in the hospital, they are vulnerable. When they are facing end-of-life care issues, they are vulnerable.

This vulnerability may come out in anger and attack because they are scared and losing control of their bodies and their lives. But I want to encourage you the best you can to put aside any pains or grievances that remain in the relationship and SEE THIS AS AN OPPORTUNITY to reach out in love to your parent at this critical time. If they send missiles back your way, ignore them. If they are uncooperative (and chances are they will be at some point), ignore that. Be with them, tell them you love them if you can, just sit with them in silence if you can't. BE THERE.

It may seem unbelievable, but this time of your parent's life can be a wonderful opportunity for you to love, for you to be healed, for your Mom or Dad to heal from what they may know, though may not want to admit, they did to you. Elders spend a lot of time in bed contemplating their lives. Be gentle, be kind, gather up your strength and love, the best way you can. Resist the temptation to flee. If nothing else, just BE THERE BY THEIR SIDE. That will demonstrate your unspoken love.

I have seen amazing people who carry past hurts on the inside be healed in beautiful ways just by being with their parents in the hospital, assisted living facility, nursing facility, or at home. Wonderfully unexpected moments may transpire between you and Mom or Dad. Some laughs, some tears, but overall you may find a contented joy. As much as you love your spouse, there likely is no one on this earth who knows you the way Mom or Dad does. You know each other, for good and bad, in a very deep way.

When you get the call, or if you are with Mom or Dad when they fall and have to get them to the hospital, forget yourself and reach out to them in love and understanding. Sit with them through the process. "Being there" can be the greatest love of all.

Blessings, Jane Allison
http://yourelderlawadvocate.com/
http://twitter.com/JaneAllison