My newest dilemma is that I need to hire at least one new caregiver to act as back up and to handle the additional hours provided. I chose the CDPAP program which means I'm responsible for choosing caregivers, directing them and scheduling them. This includes finding backup if someone calls in sick. I chose this option because I feel more comfortable making the decision who will be caring for my mother rather than letting an agency person do this. It's more work for me but allows me to rest a bit easier.
Sunday, December 7, 2014
Finally! Help has arrived!
After much back and forth, December 1st marked the first day of active service through VNS. Now the 2 caregivers work 12 hours / day instead of 7 or 8. I can also add another 4 hours/ day through the John Hancock Insurance, who will now reimburse the home care agency directly.
Monday, November 24, 2014
Approaching the finish line?
After many months of phone calls, paperwork, nurse assessments and anxiety, my mother was approved by 12 hours / day of home care by VNS. Today is November 24th and next Monday is the first, only one week away and still things are not quite in place.
Last Thursday I found that the home care agency is waiting for VNS to contact them before they can start services and VNS is waiting for Medicaid to send them their "list" showing my mother is approved. I spoke with a Medicaid caseworker on Friday and was happy to hear that my mother was on the approved list, and they were on board with the arrangements I made to divert John Hancock long term care insurance reimbursement from my mother to the home care agency which will effectively lower her surplus amount significantly (over $3000).
On Thursday VNS stated they were waiting for the list from Medicaid which would arrive on the 23rd and another on the 27th (Thanksgiving). I called VNS today and a worker told me I'd have to wait until they received this list. I expressed my concern that services were supposed to begin in one week but they explained that was procedure. After getting over my exasperation, the worker was sympathetic and stated she'd let me know tomorrow. She called me later today at about 4:00 pm to inform me that they received the list and my mother was on it.
Now I have to call VNS back tomorrow and hopefully get them to give the home care agency the thumbs up to put services in on the 1st of December. My concern is that VNS keeps on talking about the assigned nurse who will come in to do an assessment. This is fine as long as my mother is still getting home care. They seem to imply that the nurse would come in first and then assess again my mother's needs, which is disturbing since choosing VNS was contingent on the 12 hours they told me she would get. I'm staying hopeful that this will work out.
My advice is be persistent and call everyone: Medicaid, the managed long term care company and the home care agency that will be involved. I also found out last week that the home care workers who I had apply to the agency did not complete the process which is yet another area where something can go wrong. Managing the care of a loved one really is like a second job.
Last Thursday I found that the home care agency is waiting for VNS to contact them before they can start services and VNS is waiting for Medicaid to send them their "list" showing my mother is approved. I spoke with a Medicaid caseworker on Friday and was happy to hear that my mother was on the approved list, and they were on board with the arrangements I made to divert John Hancock long term care insurance reimbursement from my mother to the home care agency which will effectively lower her surplus amount significantly (over $3000).
On Thursday VNS stated they were waiting for the list from Medicaid which would arrive on the 23rd and another on the 27th (Thanksgiving). I called VNS today and a worker told me I'd have to wait until they received this list. I expressed my concern that services were supposed to begin in one week but they explained that was procedure. After getting over my exasperation, the worker was sympathetic and stated she'd let me know tomorrow. She called me later today at about 4:00 pm to inform me that they received the list and my mother was on it.
Now I have to call VNS back tomorrow and hopefully get them to give the home care agency the thumbs up to put services in on the 1st of December. My concern is that VNS keeps on talking about the assigned nurse who will come in to do an assessment. This is fine as long as my mother is still getting home care. They seem to imply that the nurse would come in first and then assess again my mother's needs, which is disturbing since choosing VNS was contingent on the 12 hours they told me she would get. I'm staying hopeful that this will work out.
My advice is be persistent and call everyone: Medicaid, the managed long term care company and the home care agency that will be involved. I also found out last week that the home care workers who I had apply to the agency did not complete the process which is yet another area where something can go wrong. Managing the care of a loved one really is like a second job.
Friday, November 7, 2014
Finally....a light at the end of the tunnel!
A few weeks ago a VNS nurse came to make an assessment. After a short meeting and my explanation of the situation she entered the data into her laptop and came up with an assessment of 6 hours. I took her outside and explained the extent of my mother's memory issues and the sympathetic nurse consulted with her supervisor. She then informed me that my mother would be approved for 12 hours of daily home care! This was the first assessment that actually provided more care then we had been able to get with the long term care insurance. I signed the necessary papers.
I still wasn't sure how the John Hancock Long Term Care Insurance would interact with this VNS plan and the nurse was not sure either. She suggested I speak to someone at the office. What proceeded was numerous phone calls to VNS without any satisfactory answers until I reached the Director of Membership Development who stated that any services I wanted to add was our choice and had no influence on the 12 hours they were providing. She added a disclaimer that she thought this was the case but could be mistaken.
I followed up with staff at the home care agency and this information was confirmed and someone actually told me that this was commonly done....which makes me wonder why something so commonly done was not known by any of the 5 insurance agencies I spoke with prior to VNS, nor Medicaid staff!
I'm currently in the process of making the home care agency the payee so that my reimbursement from John Hancock is not counted as surplus income....but I'm hopeful.
I still wasn't sure how the John Hancock Long Term Care Insurance would interact with this VNS plan and the nurse was not sure either. She suggested I speak to someone at the office. What proceeded was numerous phone calls to VNS without any satisfactory answers until I reached the Director of Membership Development who stated that any services I wanted to add was our choice and had no influence on the 12 hours they were providing. She added a disclaimer that she thought this was the case but could be mistaken.
I followed up with staff at the home care agency and this information was confirmed and someone actually told me that this was commonly done....which makes me wonder why something so commonly done was not known by any of the 5 insurance agencies I spoke with prior to VNS, nor Medicaid staff!
I'm currently in the process of making the home care agency the payee so that my reimbursement from John Hancock is not counted as surplus income....but I'm hopeful.
Thursday, August 7, 2014
Medicaid updates
Medicaid recently lowered my spend down total by about $500 after I explained some issues: an account was closed which no longer generated income which had been added to the spend down total and they were suggesting I received $3400 from my John Hancock long term care insurance which reimburse $100/day.
This adjustment was a small victory but essentially meaningless as I have yet to be offered any additional home care from any of the long-term care companies and if I agree to the spend down, which would necessitate me switching from hiring independent HHA to working with an agency would mean getting half the hours of care for the same $100. An agency typical charges about $25/ hour for an HHA. An independent HHA can be hired for $12.50 or $15. The HHA working through the agency gets around $8-$12/hour. (I've gathered $12 is unusual)
I also received a notice from Medicaid stating that my mother had to enroll in Medicare Part D which relates to Rx coverage. She is already enrolled in Part D but this letter suggested that she could be disqualified from Medicaid or a Part D program would be chosen for her. I'm not sure how to even address this. Do I need to clarify to Medicaid that she's already enrolled in Part D? It seems very sad that we have a health care system that so difficult to access and utilize and most often very inadequate in it's care of the elderly. Some day many years from now (I sincerely hope) Americans will look back with some shame at this inadequate system....what are the priorities of a society if not to provide the most basic care to it's members? Especially, it's most vulnerable members....children and the elderly.
This adjustment was a small victory but essentially meaningless as I have yet to be offered any additional home care from any of the long-term care companies and if I agree to the spend down, which would necessitate me switching from hiring independent HHA to working with an agency would mean getting half the hours of care for the same $100. An agency typical charges about $25/ hour for an HHA. An independent HHA can be hired for $12.50 or $15. The HHA working through the agency gets around $8-$12/hour. (I've gathered $12 is unusual)
I also received a notice from Medicaid stating that my mother had to enroll in Medicare Part D which relates to Rx coverage. She is already enrolled in Part D but this letter suggested that she could be disqualified from Medicaid or a Part D program would be chosen for her. I'm not sure how to even address this. Do I need to clarify to Medicaid that she's already enrolled in Part D? It seems very sad that we have a health care system that so difficult to access and utilize and most often very inadequate in it's care of the elderly. Some day many years from now (I sincerely hope) Americans will look back with some shame at this inadequate system....what are the priorities of a society if not to provide the most basic care to it's members? Especially, it's most vulnerable members....children and the elderly.
Guildnet
The Guildnet nurse came by for her assessment the other day. She was very nice (as were the nurses from Fidelis and CenterLight). I explained my situation to her. As was true with the other nurses, she was not clear on how Long Term Care Health Insurance interacted with Managed Long Term Care. I understand that this may be a complex issue that other departments handle but I imagine it's not that rare and is perhaps one of the most significant issues and barriers to getting care. At least that is the case in my mother's situation. She did a comprehensive assessment which consisted of numerous questions related to daily ability to function, and plugged the answers into her laptop computer. She appeared to be quite sympathetic to my mother's need for care (as did the other nurses) and did her best to help us make sense of all this.
At the same time, my mother, who may have dementia but who is also quite vain, did her best to minimize her need for care. The nurse seemed to pick up on this and did her best to get us the most hours of care available based on the assessment.
The end result was that she was offered about 5 hours a day. She suggested we keep on looking.
I have yet to schedule VNS and Elderserve but I'm not feeling overly optimistic at this point.
To date I've been offered the following:
Fidelis: 8 hours/day
CenterLIght: 16 hours/week
Guildnet: 5 hours/day
It seems likely that I will have to wait until my mother is no longer able to feed herself, wash herself, get up from a seated position and incontinent before I receive additional care. Meanwhile I hope that Medicaid won't simply close the case for lack of use.
At the same time, my mother, who may have dementia but who is also quite vain, did her best to minimize her need for care. The nurse seemed to pick up on this and did her best to get us the most hours of care available based on the assessment.
The end result was that she was offered about 5 hours a day. She suggested we keep on looking.
I have yet to schedule VNS and Elderserve but I'm not feeling overly optimistic at this point.
To date I've been offered the following:
Fidelis: 8 hours/day
CenterLIght: 16 hours/week
Guildnet: 5 hours/day
It seems likely that I will have to wait until my mother is no longer able to feed herself, wash herself, get up from a seated position and incontinent before I receive additional care. Meanwhile I hope that Medicaid won't simply close the case for lack of use.
Sunday, July 27, 2014
Managed Long Term Care for Medicaid
After some back and forth with Fidelis, they scheduled a nurse to come visit my mother and assess her need for home care. I made a trip out to meet her. The nurse was very nice (despite discussing the fact of my mother's dimension in front of her) but seemed to suggest that I would have to sign over all the money my mother was depositing to the Pooled Income Trust to them. I explained that if she did this she would not be able to pay her bills and remain in her home. We went back and forth for a while until I realized she didn't really understand how it worked. This has been something I've notice throughout this process and I'm not saying this to deprecate any of the workers. It is a very complicated system and everyone knows what they need to know. Nobody knows how the other piece of the puzzle works. This is probably another reason people use Eldercare Attorneys. It's their job to negotiate this system. Returning to the nurses assessment, she finally explained that they could offer 8 hours/day of home care. I explained I already had 8 hours/day of home care. She was very understanding and recommended I shop around to see if I could do better. I was very disappointed but immediately contacted two other companies and had nurse evaluations scheduled. Today I met with Centerlight. They nurse was very nice and straightforward and after asking as a number of very detailed questions and stated they could offer 16 hours/ week. She was very apologetic about this and recommended we continue shopping around. It should be noted that both nurses, unofficially, acknowledged my mother's need for 24/7 care, but both were bound by a very rigid system which uses ADLs to determine home care need. The nurse from Centerlight, explained that another client who required assistance with everything received minimal home care. I have an appointment with Guildnet in about 10 days and play to schedule one with Elderserve.
If it turns out Medicaid Long Term Care only offers 8 hours/day of home care it might mean Medicaid doesn't make sense at this time, and I will have to try again when my mother's condition has deteriorated further.
I used this guide for Long Island Managed Long Term Care companies to help me choose which companies I contacted: http://www.health.ny.gov/health_care/managed_care/mltc/consumer_guides/long_island/
If it turns out Medicaid Long Term Care only offers 8 hours/day of home care it might mean Medicaid doesn't make sense at this time, and I will have to try again when my mother's condition has deteriorated further.
I used this guide for Long Island Managed Long Term Care companies to help me choose which companies I contacted: http://www.health.ny.gov/health_care/managed_care/mltc/consumer_guides/long_island/
Applying for Medicaid
After establish a pooled income trust and seeing that my mother's assets (those not in a trust), were now within the Medicaid requirements, I began the application process. I consider myself a fairly intelligent and capable person. I have a Masters Degree. I've run my own business for close to 15 years. I manage my own finances and my mothers. I'm familiar with negotiating paperwork and I'm excellent at multi-tasking. The Medicaid application was daunting but I was determined. Over a period of about 2 months I put together the laundry list of documentation requested on the application. I'm also working, in school, have a child, and manage my mother's life as well, so time is limited. I sent the thick packet, with cover letter, to Medicaid via certified mail. I felt I had gone above and beyond, including copies of the trust and other information that wasn't required but might help clarify the entire financial picture. About a week letter I got a response from Medicaid saying that I was missing numerous items and had until the end of the week to send the missing information or the case would be closed and I'd have to start from scratch. I called the worker, whose name was listed on the form, and pleaded my case, explaining it wasn't enough time to gather the missing documents. The Medicaid worker was very nice and gave me another week. I sent another packet, thicker than the first, via certified mail. After more back and forth I ended up sending two more envelopes to Medicaid and my mother was approved with a "spend down". This was when I learned that Long Term Care Insurance reimbursement was counted as income. They added $3400 / month for this reimbursement. At this point I have followed up and explained that they only reimburse up to $100/day so it is impossible to be reimbursed more than that. They calculated this number based on reimbursements I had received the prior month. Because it is based on time sheets, and there is a delay in reimbursement, one month might be less and another more. I'm hoping they will bring this number down to $3000. Initially I was shocked that they considered this income but now I've adjusted and am trying to find a way to handle this. I've learned that, sadly, many people actually cancel their policies in order to qualify for Medicaid. I could deposit his money into the Pooled Income Trust although it would be tricky because reimbursements come in piece meal during the month. The problem is I can't pay the independent aides I hired with the Trust. The Trust will only pay an agency. Agencies charge about $25 an hour (often paying the aides $10 or less/hour) so if I did switch to an agency I'd be getting 4 hours for the same $100 instead of 8, and very likely losing the trusted aides I hired because I doubt they'd be willing to take that cut to their income.
The idea was that Medicaid would eventually pay for the home care and not just 8 hours but what my mother really needed 24/7. This was my idea anyway. Medicaid explained that I'd have to sign on with a managed long term care company who would handle the home care. There are over a dozen of these companies covering Nassau county so I checked some ratings on the Medicaid site and called the number.
The idea was that Medicaid would eventually pay for the home care and not just 8 hours but what my mother really needed 24/7. This was my idea anyway. Medicaid explained that I'd have to sign on with a managed long term care company who would handle the home care. There are over a dozen of these companies covering Nassau county so I checked some ratings on the Medicaid site and called the number.
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