Wednesday, June 06, 2007
Myths Lies Medi-cal and Medicare
I have neglected pretty much all of my blogs as I have been caught up in a morays of mis-information, lies, myths and working to uncover the truths I needed in order to continue caring for my aging and ailing parents.
It was a necessary if unpleasant reality that I would need to put Dad in a nursing home as he requires 24/7 care and no matter how I try, I need some sleep sometimes. I was given a list of nursing homes by the hospital and doing what I considered to be due diligence set about visiting a good share of those on my list.
Quite frankly this is not a pleasant chore as the majority of homes I visited I would not leave my dog in overnight let alone a parent for an extended stay during rehabilitation. Many had clients falling out of wheelchairs screaming for help in the hallways. Often the smells were so vile that I had to stifle a gag response.
After the first two or so, I made a mental list of my criteria for determining where would be acceptable to place Dad. This list included noise levels within tolerance as no one gets much better if the noise level is a constant deafening experience. The second of course was smell and cleanliness of the facility. From there I also included accessible parking as I knew I would be taking my wheelchair bound mother on a frequent basis to visit her husband. There were a few more criteria that I added, but what I have mentioned was the most important issues.
Having found one that matched my criteria in good part, I spoke with them about getting my Dad into their facility. Here is where the lies and mis-information began. Now, I need to stress that I do not know if the lies are deliberate, and I would prefer to think that it is just that the folks at the homes really don't know any better. What they tell you is that Medicare will pay for the first 100 days, and that after that we will work out what costs need to be covered.
If you believe that as I did you will be in for a very rude awakening when your 100 days is up or coming close to being up. After between 5 and 20 days something kicks in that is called "share of cost" but no one tells you about this until your 100 days are up or coming close to being up.. then they will present you with a bill. I suspect it is often much higher than the one I was presented with, which was for about 9 grand.
They wanted their money of course, and of course I was totally unprepared for this. Now, we have some of those long term care insurance policies, but they are pretty much a waste of your hard earned money and here are the reasons.
First of all, they only pay between 5o and 100 dollars a day.. this won't even cover the bed let alone any medications, physical therapy, occupational therapy etc etc etc. The other problem is that they do not pay the nursing home directly, you have to pay that out of your pocket and then prove you have paid it, at which time you settle back to wait for them to process your claim which they are really in no hurry to do.
Ok, lets leave that subject for a moment and discuss affording to keep someone who needs care in a nursing facility. Unless you are independently wealthy, you can't afford it. The average cost might be higher, depending on the care needed, but what I was quoted was 5 grand a month being average when things went to private pay. I am in possession of a bill for one month in excess of 17,700.00 and there were not trachs or any machines attached, that was with physical and occupational therapy and some intravenous treatments so you can imagine if your loved one needs something like dialysis or a breathing machine etc.
Now, the truth is, that you can get the care needed without draining your entire life's savings but you have to have some help. You need experts who know the law and specifically the law about medi-cal and medicare. We have a fine family attorney, but he is not a specialist in medical and the way I knew he was good was when he flat out told me I needed an expert in the field which he was not.
I found some experts, and while they are far from cheap, in the long run they will be very worth the price since instead of having to fork over 5 grand a month, I will be forking over zero to the nursing home, and our added expense will be paying the attorney fees off. They even made arrangements for a payment plan with a sizable down payment.
The first item of business was to empty the trust. Trusts are wonderful things if you drop dead suddenly, but are a hindrance if you linger. You don't need to revoke the trust, but you do need to empty it out so that there are no attachable assets and no cash value insurance policies.
If there is a house involved, those who don't know jack about the real truths when it comes to medi-cal, will tell you the house is exempt. Guess what? this is actually another lie as it can be a real trap...here's how it works.
You put Dad in a home, and get him qualified for medi-cal. Lets say Mom then falls and breaks a hip or something and needs to be in a facility for a short time while she heals. That house that was so exempt, is no longer exempt and Medi-cal can attach the house forcing it's sale to pay for the expenses incurred by Dad to date. This leaves Mom and Dad no home to come back to.
Hopefully if you have parents or loved ones who might need or currently need the help of a nursing home, you are beginning to get the picture that you really need legal advice on how to hold onto your assets and still be able to provide the care needed.
Lets go back to the nursing home for a minute. The very well meaning book keeper (and again here I am assuming this is a well meaning person who does not mean to mis-lead you) will tell you that your "share of cost" is that person's social security check minus 35 bucks. Well, that is typical for single people, and does not take into account that a spouse at home is permitted to keep up to 2500 dollars of their joint incomes to live on. It also does not take into account that you can have your attorney go into court and show that the monthly costs of maintaining the home are in excess of that amount and request they up the amount allowed to be kept by the at home spouse.
Whatever your situation, I must stress that you cannot safely traverse the pitfalls of the medi-cal system without expert guidance. I am paying good money to my experts, and in no way are they compensating me for this recommendation. The people I have hired and would recommend to you with my highest grade for taking care of business are NHS also known as Nursing Home Solutions in Glendale Cal. They have a website where you can get more information
http://www.nhscare.com/index.html
Of course should my opinions change you can be sure to read about that here, but I suspect from what I have seen so far, that I will be able to recommend NHS for a very long time to come.
It was a necessary if unpleasant reality that I would need to put Dad in a nursing home as he requires 24/7 care and no matter how I try, I need some sleep sometimes. I was given a list of nursing homes by the hospital and doing what I considered to be due diligence set about visiting a good share of those on my list.
Quite frankly this is not a pleasant chore as the majority of homes I visited I would not leave my dog in overnight let alone a parent for an extended stay during rehabilitation. Many had clients falling out of wheelchairs screaming for help in the hallways. Often the smells were so vile that I had to stifle a gag response.
After the first two or so, I made a mental list of my criteria for determining where would be acceptable to place Dad. This list included noise levels within tolerance as no one gets much better if the noise level is a constant deafening experience. The second of course was smell and cleanliness of the facility. From there I also included accessible parking as I knew I would be taking my wheelchair bound mother on a frequent basis to visit her husband. There were a few more criteria that I added, but what I have mentioned was the most important issues.
Having found one that matched my criteria in good part, I spoke with them about getting my Dad into their facility. Here is where the lies and mis-information began. Now, I need to stress that I do not know if the lies are deliberate, and I would prefer to think that it is just that the folks at the homes really don't know any better. What they tell you is that Medicare will pay for the first 100 days, and that after that we will work out what costs need to be covered.
If you believe that as I did you will be in for a very rude awakening when your 100 days is up or coming close to being up. After between 5 and 20 days something kicks in that is called "share of cost" but no one tells you about this until your 100 days are up or coming close to being up.. then they will present you with a bill. I suspect it is often much higher than the one I was presented with, which was for about 9 grand.
They wanted their money of course, and of course I was totally unprepared for this. Now, we have some of those long term care insurance policies, but they are pretty much a waste of your hard earned money and here are the reasons.
First of all, they only pay between 5o and 100 dollars a day.. this won't even cover the bed let alone any medications, physical therapy, occupational therapy etc etc etc. The other problem is that they do not pay the nursing home directly, you have to pay that out of your pocket and then prove you have paid it, at which time you settle back to wait for them to process your claim which they are really in no hurry to do.
Ok, lets leave that subject for a moment and discuss affording to keep someone who needs care in a nursing facility. Unless you are independently wealthy, you can't afford it. The average cost might be higher, depending on the care needed, but what I was quoted was 5 grand a month being average when things went to private pay. I am in possession of a bill for one month in excess of 17,700.00 and there were not trachs or any machines attached, that was with physical and occupational therapy and some intravenous treatments so you can imagine if your loved one needs something like dialysis or a breathing machine etc.
Now, the truth is, that you can get the care needed without draining your entire life's savings but you have to have some help. You need experts who know the law and specifically the law about medi-cal and medicare. We have a fine family attorney, but he is not a specialist in medical and the way I knew he was good was when he flat out told me I needed an expert in the field which he was not.
I found some experts, and while they are far from cheap, in the long run they will be very worth the price since instead of having to fork over 5 grand a month, I will be forking over zero to the nursing home, and our added expense will be paying the attorney fees off. They even made arrangements for a payment plan with a sizable down payment.
The first item of business was to empty the trust. Trusts are wonderful things if you drop dead suddenly, but are a hindrance if you linger. You don't need to revoke the trust, but you do need to empty it out so that there are no attachable assets and no cash value insurance policies.
If there is a house involved, those who don't know jack about the real truths when it comes to medi-cal, will tell you the house is exempt. Guess what? this is actually another lie as it can be a real trap...here's how it works.
You put Dad in a home, and get him qualified for medi-cal. Lets say Mom then falls and breaks a hip or something and needs to be in a facility for a short time while she heals. That house that was so exempt, is no longer exempt and Medi-cal can attach the house forcing it's sale to pay for the expenses incurred by Dad to date. This leaves Mom and Dad no home to come back to.
Hopefully if you have parents or loved ones who might need or currently need the help of a nursing home, you are beginning to get the picture that you really need legal advice on how to hold onto your assets and still be able to provide the care needed.
Lets go back to the nursing home for a minute. The very well meaning book keeper (and again here I am assuming this is a well meaning person who does not mean to mis-lead you) will tell you that your "share of cost" is that person's social security check minus 35 bucks. Well, that is typical for single people, and does not take into account that a spouse at home is permitted to keep up to 2500 dollars of their joint incomes to live on. It also does not take into account that you can have your attorney go into court and show that the monthly costs of maintaining the home are in excess of that amount and request they up the amount allowed to be kept by the at home spouse.
Whatever your situation, I must stress that you cannot safely traverse the pitfalls of the medi-cal system without expert guidance. I am paying good money to my experts, and in no way are they compensating me for this recommendation. The people I have hired and would recommend to you with my highest grade for taking care of business are NHS also known as Nursing Home Solutions in Glendale Cal. They have a website where you can get more information
http://www.nhscare.com/index.html
Of course should my opinions change you can be sure to read about that here, but I suspect from what I have seen so far, that I will be able to recommend NHS for a very long time to come.
