703-329-0900

“I don’t need help” – Part 2

When a loved one obviously needs help at home but refuses to allow it, it’s frustrating! Below are two common concerns, with suggestions for ways to problem solve together.

 

Cost is a very practical barrier
Many older adults feel particularly vulnerable where money is concerned. They don’t want to spend! But the cost of help depends on the type of help needed.

If licensed care providers are what your relative needs—for example, home visits with a physical therapist after a hip surgery—Medicare and supplemental insurance usually cover these costs.

If nonmedical help is needed (cooking, laundry, errands), there may be resources to assist. Maybe your relative has long-term care insurance. Perhaps he or she is eligible for VA benefits. Consulting with a care manager can bring those possibilities to light.

Or it may be that your loved one does not have an accurate picture of his or her financial resources. If you are the person your loved one trusts with money matters, ask if you can review the facts together to better understand his or her concerns.

 

Retaining control over their life
It’s common for accepting help to symbolize “the end of my independence.” That’s a scary thought. Realistically, though, all of us will need assistance at some point. You might try asking, “Under what circumstances would you see yourself accepting help at home?” This allows your loved one to explore his or her own red flags. Plus, it gives you insight about what life event might make home care acceptable and why.

When hiring help, look for ways your relative can retain as much control as possible:

  • Pick the caregiver.
  • Choose the days and times for help.
  • Decide on the care attendant’s tasks and participate in giving the instructions.
  • Clarify if this is a short-term or long-term arrangement.

 

Does this conversation feel like a battle?
At Senior Care Management Services we often notice that an older adult will be more resistant to their child’s suggestion regarding help than they are when they talk with a professional. With a professional, there is less face to save and no family baggage. As the Northern Virginia experts in aging well, we’d be happy to talk with you about options for introducing the subject. Give us a call at 703-329-0900. Let’s see what we can do.

Before you quit your job

It may be true: Your aging relative needs more and more care. You know you are the best person for the job. But it’s too much to do on top of your own work. Think twice before exiting the workforce, however. There are some stiff financial consequences.

For example, if you are midcareer, you are in your prime income-earning years. This is when you want to double down on retirement savings. If your employer offers retirement matching funds, you want to be in a position to grab them! And continue contributing to Social Security.

According to a Met Life study:

  • Men age 50 and over who left work to care for a parent lost an average of $89,107 in wages. The impact on their Social Security benefits was $144,609. Loss of pension income, $50,000. Altogether, early retirement cost male employees $283,716 over their lifetime.
  • Caregiving women age 50 and over got hit much harder. They tended to leave work sooner. Lost wages averaged $142,693. Women lost $131,351 in Social Security. Figuring lost pension at $50,000, early retirement cost female employees $324,044.

 

Consider these options:

  • Hiring help at home may be less expensive than losing your wages. Suggest sharing the cost with your siblings. (Show them this article!) Then no one among you bears the sole financial burden.
  • You might take advantage of an adult day center to provide care during your work hours.
  • Ask about flex-time options so you can work when others can care for mom or dad.
  • Investigate Family Medical Leave. If your company is big enough, you may be able to take weeks or months off. (It is unpaid.) That may get you through a crisis and buy you time to make other arrangements.

In your generous desire to help, be careful you don’t shortchange your own future.

Is it time to get your siblings more involved?
At Senior Care Management Services we’ve seen one sibling become the primary caregiver while others seem not to pitch in. It’s not necessarily a matter of laziness. Often it’s a matter of not understanding the needs. As the Northern Virginia expert in family caregiving, we can help you meet with your siblings and work out a plan that addresses everyone’s concerns. Give us a call at 703-329-0900.

 

Using long-term care insurance

Your relative may have bought long-term care insurance to cover the expense of care when help is needed. Activating the policy takes some lead time. It’s wise to learn all the steps and definitions so you can be strategic with your timing.

Types of care covered
Read the policy and see what kinds of care it will pay for. Options may include nursing homes, assisted living facilities, or private care at home. Check for exclusions.

“Elimination period”
Time is money in long-term care, literally. Think of this as a deductible measured in time. Check to see if the policy requires that you pay out of pocket for care for the first 30-120 days AFTER you have initiated the claim.

“Benefit trigger”
To open a claim, you must prove the need for assistance with personal care tasks: bathing, dressing, using the toilet, eating, or walking. In the case of dementia, such as Alzheimer’s, testing will be needed to prove the degree of memory loss.

Length of the benefit
Most policies have a three-year or five-year limit. Be cautious about starting your loved one’s policy too early. If your relative has dementia or any type of very long-lasting illness, you may want to delay opening a claim until he or she is quite impaired. (But don’t wait too long!)

The claims process
Each company is different, but the process starts with a “claims packet” that includes

  • claim forms. This is a statement of needs and permission to obtain information from providers;
  • physician’s statement. This is a critical document in which the primary care doctor certifies your relative cannot perform personal care tasks;
  • nursing assessment and plan of care. This is usually completed by a nurse from the company providing care;
  • provider statement. The home care agency or facility you choose must meet the policy’s criteria for payment.

 

Is long-term care on your horizon?
As the Northern Virginia expert in family caregiving, we at Senior Care Management Services can help you navigate the labyrinth of long-term care insurance. Give us a call at 703-329-0900.

Is a New Medicare Card in the Mailbox?

Medicare has started sending out new cards to all its members. The mailings will take place in waves. The person you care for may not receive theirs until later in the year. You don’t need to do anything. The new card will arrive automatically. (The only exception to this is people who are enrolled in a Medicare Advantage plan. Those cards will remain the same, so no mailing expected.)

Medicare benefits have NOT changed!
The program your loved one is enrolled in stays the same. Just the card is changing.

Why change the card?
Primarily, it’s for security reasons. When Medicare first started, it made sense to use Social Security numbers as the identifying number for beneficiaries. That was before the age of identity theft.

The Medicare Beneficiary Identifier (MBI).
Medicare is giving everyone new numbers. There will be no rhyme or reason or hidden meaning to the combination of letters and numbers assigned. Nothing to reveal information about the cardholder.

Destroy the old card securely.
Shredding or burning the card is best. It does have your relative’s Social Security number. You don’t want that getting into the wrong hands!

Watch out for scammers.
Sadly, there are always those who prey on elders during a change like this. Be aware that Medicare will telephone only if the beneficiary has phoned in and left a message requesting a call back. The insurance company for Part D (drugs) or Medicare Supplemental Insurance (Medigap) may call. But they will not ask for the Medicare Beneficiary Identifier. They will already know it. If someone calls and requests verification of the number, hang up immediately. Then call Medicare at 1-800-MEDICARE (1-800-633-4227).

You can sign up for notifications about the new card at medicare.gov/newcard/.

Confused about Medicare?
We can help. At Senior Care Management Services we understand that the health care system can be very intimidating. As the Northern Virginia expert in family caregiving, we’ve got your back. Give us a call at 703-329-0900.

Hospitalization, Skilled Nursing and Medicare

Recently, in one 48-hour period, I received similar questions from caregivers. These caregivers were not related, and they did not know one another. Each was the adult child whose parent was about to be discharged from a skilled nursing facility. Though they were very informed and had been through the hospital to skilled nursing to home process before, they were each a little unsure about their options, and wanted to be sure they did right by their parent. Their questions had to do with skilled nursing facilities, Medicare, covered days, and finally home health care options. It led me to lay out some of the information so that others could benefit. Below are the 2017 Medicare hospital and skilled nursing facility benefits. This information does not cover every aspect of the subject, but it is a start.

Medicare Part A Hospital Expenses*

Member Deductibles:

Members will have a $1316 deductible per benefit period. A benefit period starts the day you are admitted to a hospital or skilled nursing facility, and ends after you have not been in the hospital or SNF for 60 consecutive days.

Member Co-payments:

  • $0/day for days 1-60
  • $329/day for days 61-90 in hospital per benefit period.
  • $658/day for days 91-150 in hospital per benefit period (Lifetime Reserve Days).
  • No coverage after day 150 in hospital (or day 90 if Lifetime Reserve Days previously used).

Skilled Nursing Facility Expenses*

  • Full coverage of expenses in skilled nursing facility for days 1-20 when this follows a 3-day hospitalization during each benefit period.
  • $164.50/day for days 21-100 in a skilled nursing facility during each benefit period.
  • No coverage after day 100 in skilled nursing facility during each benefit period.

*Hospital and Skilled Nursing Facility daily co-pays may be covered by your Medigap policy or other commercial secondary insurance coverage.

 

 

 

Enrolling in Medicare with an Employer Health Plan – Who Pays First?

Recently, I received the following question from a reader:

“I have health insurance through my employer, my husband is self-employed. Will my insurance still be the primary insurance when my husband turns 65 and applies for Medicare?”

Suspecting this could be a complicated question, I went to the medicare.gov website to research the answer. Not too much longer I believe I found the answer in their publication CMS #02179, dated August 2015, “Your Guide to Who Pays First.”

In both the chart that starts on page 6, and in the text on page 12, they refer to such a scenario, answering that when one is 65 or older and covered by a group health plan of either oneself or one’s spouse, and the employer has 20 or more employees, the group health plan pays first, and Medicare second. When the employer has less than 20 employees, then Medicare would be the first payor.

This publication is worth a look because there are many more scenarios to consider. It is available for download on the medicare.gov website here. If you prefer to someone directly, call 1-855-798-2627.