Prayers for dh’s family please

[saraha]

I feel like time is of the essence to get them to decide today what they want to do for rehab because as soon as the insurance approves they’ll have to do something . 
I need to just man up and call dh right? Because sil and fil are going to be there all day and so will be the ones telling whoever what they want to do. 
Or do I leave it alone since it may not work to convince them and dh will just be mad at me?

ugh ugh ugh

Edited December 1, 2022 by saraha

[livetoread]

If I were in your shoes, I'd ask the social worker to make it clear to the others that if she stays at the hospital for rehab it will be much harder to get her into a nursing home versus doing it now. Beyond that, once again you are limited in your ability to influence or change the situation.

[Grace Hopper]

At this point, I feel like you should be at peace, knowing you have done your due diligence to advocate as much as possible for your MIL. 
 

If possible and the timing is right, I would suggest to dh that he ask the medical team to be very clear about what level of care will be required for MIL upon discharge. Seems like the fam is expecting to go “back to normal” but there’s going to be a new normal to work with. 
 

saraha, you’ve done your best. Your in-laws are a curious and stubborn bunch. Doesn’t seem much else you can do at this point other than reiterate to your dh that you will not be a full time caregiver. 

[lauraw4321]

You have done all you can do. I would relay the information about the nursing home, but it sounds like they aren’t interested in sending her to one, so it will probably be moot. My guess is that she will have another problem and be a “bounce back.”  Hospitals so get in “trouble” from Medicare if someone bounces back too quickly and then they have more incentive to find a safer environment. I understand you want to reduce her suffering. All you can do is make that clear, but you have no power here. 

Edited December 1, 2022 by lauraw4321
Grammar.

[Harriet Vane]

10 minutes ago, Grace Hopper said:

At this point, I feel like you should be at peace, knowing you have done your due diligence to advocate as much as possible for your MIL. 
 

If possible and the timing is right, I would suggest to dh that he ask the medical team to be very clear about what level of care will be required for MIL upon discharge. Seems like the fam is expecting to go “back to normal” but there’s going to be a new normal to work with. 
 

saraha, you’ve done your best. Your in-laws are a curious and stubborn bunch. Doesn’t seem much else you can do at this point other than reiterate to your dh that you will not be a full time caregiver. 

This.

 

And I am also very sorry about that waste-of-space caseworker. A good worker would pull the family together for a meeting with the doctor and be explicit about care needs and options. She simply doesn't want to do that work. What is needed is an outside voice stating the facts, and that is what social workers do all the time. This one is declining to be that voice. 

As a foster mom and also as someone who worked with difficult family and dementia needs, I have dealt with both kinds of staff--those who will help and those who are punching the clock. You got a clock puncher. I'm so sorry. 

At this point, focus on supporting your husband with this difficult journey and on maintaining boundaries. Speak the truth when you have opportunity, because you never know when someone may choose to help. 

 

As for the back-to-normal idiocy...we all know nothing will be normal. They will need something awful to happen again before they respond. There are people who willfully choose to keep their heads in the sand. All you can do is maintain your own boundaries.

Just now, lauraw4321 said:

You have done all you can do. I would relay the information about the nursing home, but it sounds like they aren’t interested in sending her to one, so it will probably be moot. My guess is that she will have another problem and be a “bounce back.”  Hospitals so get in “trouble” from Medicare if someone bounces back to quickly and then they have more incentive to find a safer environment. I understand you want to reduce her suffering. All you can do is make that clear, but you have no power here. 

Yes, and also this. Well said.

[Carol in Cal.]

Here's the thing--once either the NH or hospital surmises that Medicare won't continue to pay for rehab, they will discharge or or start charging you private pay amounts.  You will be amazed at how fast they do this--how soon they say she has to leave, and how little time you will have to make new arrangements.

So if I were you I would argue to the family that she will in no way be ready to go home once she finishes a couple weeks of rehab, and that it will be FAR CHEAPER to keep her in the NH than the hospital while you arrange the next safe placement.  Also, the NH is much more likely to have room for private pay for a few days than the hospital, so it's more of a safe, sure thing.

[saraha]

The social worker said she only has Aetna insurance

Just called the social worker back and reiterated that fil has difficulty making good care decisions and we set it up that she and a case manager will talk to fil and whatever family member is around in the morning and she will share with the doctor what I told her today

Edited December 1, 2022 by saraha

[kbutton]

1 hour ago, saraha said:

Later he apologized and basically said I love you, I tried to ask good questions, I don’t know the answers to your questions and they are going to do what they want, so just leave it alone. Which then I went behind his back and did the opposite. 

I am sorry.

As poorly as he is treated, I can't believe that if he won't stand up to them, he also won't let you do it!!!

51 minutes ago, saraha said:

Or do I leave it alone since it may not work to convince them and dh will just be mad at me?

ugh ugh ugh

You have done a good job. It's up to you how much to push. I am a pull out my can of Whoop-it sort of person in these situations, and I have had to be. All of my additional comments should be interpreted in this light--I do not suffer fools well. At all.

That said, I have hit my share of immovable obstacles, and I have been in situations where I thought it wouldn't work or didn't know who to complain to to get leverage, and it's miserable.

22 minutes ago, Grace Hopper said:

At this point, I feel like you should be at peace, knowing you have done your due diligence to advocate as much as possible for your MIL. 
 

If possible and the timing is right, I would suggest to dh that he ask the medical team to be very clear about what level of care will be required for MIL upon discharge. Seems like the fam is expecting to go “back to normal” but there’s going to be a new normal to work with. 
 

saraha, you’ve done your best. Your in-laws are a curious and stubborn bunch. Doesn’t seem much else you can do at this point other than reiterate to your dh that you will not be a full time caregiver. 

I agree.

6 minutes ago, lauraw4321 said:

You have done all you can do. I would relay the information about the nursing home, but it sounds like they aren’t interested in sending her to one, so it will probably be moot. My guess is that she will have another problem and be a “bounce back.”  Hospitals so get in “trouble” from Medicare if someone bounces back too quickly and then they have more incentive to find a safer environment. I understand you want to reduce her suffering. All you can do is make that clear, but you have no power here. 

I would try to work this angle with the social worker (but not waste a lot of time if she's not responsive). If she thinks that this is going to happen, and that you might be willing to go over her head to let the hospital know that she is not advocating for your MIL and is not keeping the hospital clear of being dinged by Medicare, she might suddenly care about helping the situation along. Going over someone's head can be easy and effective if the facts are right, and if the boss cares; money is a major motivator in those instances. 

I would consider asking if there is another social worker that can be consulted. 

Nuclear, and I don't know if I could do it...maybe contact a social worker outside of the hospital system and report neglect, using the same set of facts you gave this social worker. 

4 minutes ago, Harriet Vane said:

And I am also very sorry about that waste-of-space caseworker. A good worker would pull the family together for a meeting with the doctor and be explicit about care needs and options. She simply doesn't want to do that work. What is needed is an outside voice stating the facts, and that is what social workers do all the time. This one is declining to be that voice. 

 

As for the back-to-normal idiocy...we all know nothing will be normal. They will need something awful to happen again before they respond. There are people who willfully choose to keep their heads in the sand. All you can do is maintain your own boundaries.

Yep.

2 minutes ago, Carol in Cal. said:

Here's the thing--once either the NH or hospital surmises that Medicare won't continue to pay for rehab, they will discharge or or start charging you private pay amounts.  You will be amazed at how fast they do this--how soon they say she has to leave, and how little time you will have to make new arrangements.

So if I were you I would argue to the family that she will in no way be ready to go home once she finishes a couple weeks of rehab, and that it will be FAR CHEAPER to keep her in the NH than the hospital while you arrange the next safe placement.  Also, the NH is much more likely to have room for private pay for a few days than the hospital, so it's more of a safe, sure thing.

This is an excellent stealth option. It's working with the stubborn ostriches instead of against.

[lauraw4321]

3 minutes ago, saraha said:

The social worker said she only has Aetna insurance

Just called the social worker back and reiterated that fil has difficulty making good care decisions and we set it up that she and a case manager will talk to fil and whatever family member is around in the morning and she will share with the doctor what I told her today

She doesn’t have Medicare?? That’s very unusual. 

[kbutton]

2 minutes ago, saraha said:

The social worker said she only has Aetna insurance

Just called the social worker back and reiterated that fil has difficulty making good care decisions and we set it up that she and a case manager will talk to fil and whatever family member is around in the morning and she will share with the doctor what I told her today

You might consider giving her something in writing to share AND following up with the doctor to be sure she relays how bad it really is.

If she's taking this approach, it could be that she's newish or is more delicate about how she handles things vs. the type to just punch a clock--can't always tell in the moment. I hope so. I have seen this type of person completely upend things with the rest of those involved at a key time to get a good result. It takes some skill! Crossing my fingers she is that kind of person for you. 🙂 

[saraha]

Just now, lauraw4321 said:

She doesn’t have Medicare?? That’s very unusual. 

As far as I know, the social worker said she only has Aetna as insurance so a nursing home once rehab is over would be self pay unless the nursing home can get insurance to pay

[lauraw4321]

1 minute ago, saraha said:

As far as I know, the social worker said she only has Aetna as insurance so a nursing home once rehab is over would be self pay unless the nursing home can get insurance to pay

Medicare pays for 3 weeks of rehab. 

[prairiewindmomma]

1 minute ago, saraha said:

As far as I know, the social worker said she only has Aetna as insurance so a nursing home once rehab is over would be self pay unless the nursing home can get insurance to pay

Two things here:

1. She should have been automatically enrolled in Medicare part A based on what you told us about her having worked a long time. Are you saying Aetna is her part B coverage or that she truly has no Medicare also?

2. One has to qualify for nursing home care, but based on what you say about her ability to do daily living skills independently and her cognitive state, she should be able to pass that assessment. 
 

I feel like y’all are lacking a lot of education here about how the system works. It is a lot of bureaucracy and the timing of a number of decisions matters. 
 

And, I completely agree that you should feel like you’ve done what you can because you have zero decision making ability on this. 

[prairiewindmomma]

Thinking on this…were you referring to when the nursing home skilled nursing/rehab benefits run out? At that point, yes, she would become private pay because Medicare does not cover custodial care. Medicaid does though, once she qualifies. 
 

I suspect that is why FIL and SIL are happy she can do rehab in the hospital and then do discharge—they don’t want to do the spend down to qualify her for Medicaid and they don’t want the awkward moment of bringing her home from the nursing home when her skilled days run out.

Edited December 1, 2022 by prairiewindmomma

[Grace Hopper]

22 minutes ago, lauraw4321 said:

She doesn’t have Medicare?? That’s very unusual. 

Yes I find this odd, too. 

[skimomma]

15 minutes ago, prairiewindmomma said:

I suspect that is why FIL and SIL are happy she can do rehab in the hospital and then do discharge—they don’t want to do the spend down to qualify her for Medicaid and they don’t want the awkward moment of bringing her home from the nursing home when her skilled days run out.

This has been in the back of my head the whole time....possible financial motivations.  Is that a possibility?

[Starr]

On top of it all she may need more care once home than her current caregivers are comfortable with. I'm not sure you can do much given the vision the family has for her. I'm sorry about the stress it's causing you and your dh.

[1234]

17 minutes ago, Grace Hopper said:

Yes I find this odd, too. 

I think the OP mentioned earlier she was a public school employee. Aren’t there some states that teachers and such do not get Medicare? I’m pretty sure that’s the case for some in my family.

Edited December 1, 2022 by Joker2

[prairiewindmomma]

1 minute ago, Joker2 said:

I think the OP mentioned earlier she was a public school employee. Aren’t there some states that teachers and such do not get Medicare? I’m pretty sure that’s the case for some in my family.

But even if she didn’t qualify on her own income, shouldn’t she have been able to qualify on her dh’s? She just would have needed to enroll, as she wouldn’t have automatically been enrolled.

[saraha]

9 minutes ago, skimomma said:

This has been in the back of my head the whole time....possible financial motivations.  Is that a possibility?

Yup, totally a possibility.
I totally acknowledge that we don’t have enough information/knowledge about how everything works. I spent a bunch of time last summer researching, calling nursing homes, contacting our agency on aging, typed up and gave out all the info I could find. No one would share any insurance info with me to help me and No one did anything with the information I gave them.  Dh and I are not privy to any money/insurance information. I let dh know I talked to the social worker and there was going to be a sit down with whoever was there tomorrow sometime in the morning and asked if she had Medicare and he said he doesn’t know.

Sil wants to be in charge of everything. She also cannot do everything. Sometimes I think she thinks what she needs to know will fall out of the sky when she needs it.

dh did not get mad at me for calling the social worker and is pondering how to bring up the meeting in the morning. I think he doesn’t want to be seen as going behind their backs. I said don’t tell them, just go and maybe you’ll be the only voice, just kidding, sort of 😉

Edited December 1, 2022 by saraha

[saraha]

28 minutes ago, prairiewindmomma said:

Thinking on this…were you referring to when the nursing home skilled nursing/rehab benefits run out? At that point, yes, she would become private pay because Medicare does not cover custodial care. Medicaid does though, once she qualifies. 
 

I suspect that is why FIL and SIL are happy she can do rehab in the hospital and then do discharge—they don’t want to do the spend down to qualify her for Medicaid and they don’t want the awkward moment of bringing her home from the nursing home when her skilled days run out.

I know about the Medicaid aspect, the spend down etc, I do not know if anyone else knows/understands this

Edited December 1, 2022 by saraha

[saraha]

41 minutes ago, prairiewindmomma said:

1. She should have been automatically enrolled in Medicare part A based on what you told us about her having worked a long time. Are you saying Aetna is her part B coverage or that she truly has no Medicare also?

How would she automatically be enrolled, like who starts that process? And how would we know if she was or wasn’t?

[saraha]

11 minutes ago, Joker2 said:

I think the OP mentioned earlier she was a public school employee. Aren’t there some states that teachers and such do not get Medicare? I’m pretty sure that’s the case for some in my family.

I don’t know about Medicare, but I know she doesn’t get social security because the school employees and state employees have their own system separately.

[Starr]

Who is responsible for their care? Any of the kids or is it still your fil?

[skimomma]

It is not at all unheard of for families to try to care for an elder themselves (when they are really not capable) to avoid the spend down.  There are exceptions for spouses and I don't know how it all works, exactly, but if FIL or any of the kids is concerned about an inheritance, that could be a factor here.  I am in this soup right now and many people I talk to are perplexed that I am willing to "let" my person go into a spend down in order to qualify for medicaid in order have adequate care available.  "Don't you want to inherit that money?"  Well, it is not mine, first of all.  Second, I am not at all equipped to handle the level of care my person needs so they would suffer.  I would much MUCH rather my person gets the care they need right now than think about some type of inheritance.  No amount of money would be worth the suffering that would result in trying to manage a medical situation so far outside of my abilities.

[saraha]

3 minutes ago, skimomma said:

It is not at all unheard of for families to try to care for an elder themselves (when they are really not capable) to avoid the spend down.  There are exceptions for spouses and I don't know how it all works, exactly, but if FIL or any of the kids is concerned about an inheritance, that could be a factor here.  I am in this soup right now and many people I talk to are perplexed that I am willing to "let" my person go into a spend down in order to qualify for medicaid in order have adequate care available.  "Don't you want to inherit that money?"  Well, it is not mine, first of all.  Second, I am not at all equipped to handle the level of care my person needs so they would suffer.  I would much MUCH rather my person gets the care they need right now than think about some type of inheritance.  No amount of money would be worth the suffering that would result in trying to manage a medical situation so far outside of my abilities.

That is how dh and I feel too. We didn’t earn that money, they did. All I know about the finances is that a few years ago mil fil and the siblings all had a meeting with a lawyer. Dh has never told me any of the details. I did see through collecting their mail that the farm must be in a trust now. Other than that I know nothing

[Grace Hopper]

2 minutes ago, skimomma said:

It is not at all unheard of for families to try to care for an elder themselves (when they are really not capable) to avoid the spend down.  There are exceptions for spouses and I don't know how it all works, exactly, but if FIL or any of the kids is concerned about an inheritance, that could be a factor here.  I am in this soup right now and many people I talk to are perplexed that I am willing to "let" my person go into a spend down in order to qualify for medicaid in order have adequate care available.  "Don't you want to inherit that money?"  Well, it is not mine, first of all.  Second, I am not at all equipped to handle the level of care my person needs so they would suffer.  I would much MUCH rather my person gets the care they need right now than think about some type of inheritance.  No amount of money would be worth the suffering that would result in trying to manage a medical situation so far outside of my abilities.

Amen! I went to battle with kids of a spouse of a second marriage elder. It was awful and required lawyers. Nasty business when people are denying proper care to a senior in order to save an inheritance. 
 

I am afraid the secretive behavior of the daughter and other son here indicate they may be approaching the situation this way. 

[skimomma]

3 minutes ago, Grace Hopper said:

I am afraid the secretive behavior of the daughter and other son here indicate they may be approaching the situation this way. 

That's what this all smells like to me.  FIL probably is just in typical old age denial but when the others are backing him up, this seems a lot like, "let's let dad handle this so they don't rip through their assets."  However, it sounds as though FIL is not far from needing care himself so I cannot see this tactic working if that is indeed the motivation.

[prairiewindmomma]

I'm going to write very broadly because I think others are reading in:

In the states I live in, all of which provide Medicare to teachers, she would have received a packet of information a few months before her qualifying birthday inviting her to a meeting to learn about Medicare, how it works, and so on. https://www.medicare.gov/basics/forms-publications-mailings/mailings/signing-up/get-ready-for-medicare-package

If she didn't automatically enroll, she would have gotten the packet when she either: signed up for Medicare through the social security website, first signed up for social security benefits, or within 3 months of qualifying for disabilities: https://www.medicare.gov/basics/forms-publications-mailings/mailings/signing-up/welcome-to-medicare-package  (This looks like the same link when I post it, but I'm coming at it through two different websites.)

As a non-working spouse, she could qualify for benefits by registering for non-working spousal benefits through SSA, and then signing up for Medicare. https://www.ssa.gov/benefits/retirement/planner/applying7.html

The basics of Medicare are explained here: https://www.medicare.gov/basics/get-started-with-medicare

She also would have qualified for a "Welcome to Medicare visit" with her provider.

Let's assume that none of that happened---that they made a conscious decision to maximize dh's social security payment, and to go only to her state pension plan. Most of the state plans have the first state initial and then PERS---so KPERS, IPERS, etc.  For the state of Iowa, close to retirement, she would have had her points counted to assess her benefits: https://ipers.org/members/nearing-retirement

IPERS still uses Medicare. Here's a slideshow of how Medicare and the state insurance work together: https://ipers.org/sites/default/files/2022-06/IPERS Presentation slide 2021 SHIIP.pdf

Feel free to ping me a state, Saraha---but nearly all states actually require the state employees to access Medicare AND list the state insurance as SECONDARY because they are trying to minimize payouts for retirees.

I've got to homeschool for a bit, I will ping back in a while with the skilled nursing/nursing home/etc. info....

 

[saraha]

17 minutes ago, Starr said:

Who is responsible for their care? Any of the kids or is it still your fil?

I don’t know. I think fil and mil are each others poa, but that’s a hunch, I have no idea. 

[saraha]

1 minute ago, prairiewindmomma said:

I'm going to write very broadly because I think others are reading in:

In the states I live in, all of which provide Medicare to teachers, she would have received a packet of information a few months before her qualifying birthday inviting her to a meeting to learn about Medicare, how it works, and so on. https://www.medicare.gov/basics/forms-publications-mailings/mailings/signing-up/get-ready-for-medicare-package

If she didn't automatically enroll, she would have gotten the packet when she either: signed up for Medicare through the social security website, first signed up for social security benefits, or within 3 months of qualifying for disabilities: https://www.medicare.gov/basics/forms-publications-mailings/mailings/signing-up/welcome-to-medicare-package  (This looks like the same link when I post it, but I'm coming at it through two different websites.)

As a non-working spouse, she could qualify for benefits by registering for non-working spousal benefits through SSA, and then signing up for Medicare. https://www.ssa.gov/benefits/retirement/planner/applying7.html

The basics of Medicare are explained here: https://www.medicare.gov/basics/get-started-with-medicare

She also would have qualified for a "Welcome to Medicare visit" with her provider.

Let's assume that none of that happened---that they made a conscious decision to maximize dh's social security payment, and to go only to her state pension plan. Most of the state plans have the first state initial and then PERS---so KPERS, IPERS, etc.  For the state of Iowa, close to retirement, she would have had her points counted to assess her benefits: https://ipers.org/members/nearing-retirement

IPERS still uses Medicare. Here's a slideshow of how Medicare and the state insurance work together: https://ipers.org/sites/default/files/2022-06/IPERS Presentation slide 2021 SHIIP.pdf

Feel free to ping me a state, Saraha---but nearly all states actually require the state employees to access Medicare AND list the state insurance as SECONDARY because they are trying to minimize payouts for retirees.

I've got to homeschool for a bit, I will ping back in a while with the skilled nursing/nursing home/etc. info....

 

Thank you!!!!

[prairiewindmomma]

Again, I'm going to write really generally so that others reading in have the same basic info:

Medicare has different parts:

Part A is the basic coverage that the government provides. Part A is premium free for some people, but not all. 

Part B is a supplemental insurance that you buy through private insurance companies (like Aetna, UHC, etc.)

Part D is the drug plan.

Here's a rough run-down of what each part covers: https://www.medicare.gov/what-medicare-covers

If you don't sign up for Medicare in a timely fashion, you can still sign up for Medicare through the late enrollment process, and pay a penalty fee for each part that you sign up late for.

 https://www.medicare.gov/basics/costs/medicare-costs/avoid-penalties

The enrollment period for 2023 opened in October and goes through December 7th. 

Nearly all of your other questions are covered by the medicare booklet. https://www.medicare.gov/Pubs/pdf/10050-medicare-and-you.pdf

Skilled nursing coverage only kicks in after a 3 day minimum medically required inpatient hospital stay unless she is in a Medicare Advantage plan (page 28-29).

Home health therapy is page 43. 

Outpatient pt is page 48.

The PACE program (which for your circumstances I don't think is ideal) is on page 74.

I highly recommend skimming the entire book.

I'll post about long term care coordination next.

 

 

 

[sassenach]

2 hours ago, saraha said:

As far as I know, the social worker said she only has Aetna as insurance so a nursing home once rehab is over would be self pay unless the nursing home can get insurance to pay

She probably has Medicare advantage administrated by Aetna. FIL has the same

[sassenach]

I think you’ve done your part. You’re not going to be able to make them go to rehab so I would just let that go. 

[prairiewindmomma]

Again, I'm just writing really broadly for those reading in for some basic education, as I understand you have 0 decision making ability here. But, here's a bit more about how it works.I'm running short on time today, and I don't want to completely drop this, so I'm going to post some links:

This is the most important one, the Medicare Coverage for Skilled Nursing: Medicare Coverage for Skilled Nursing: https://www.medicare.gov/Pubs/pdf/10153-Medicare-Skilled-Nursing-Facility-Care.pdf

This is the government official long term care website: https://acl.gov/ltc/costs-and-who-pays/who-pays-long-term-care  The info there covers the basics about how Medicare covers only skilled nursing/rehab care with links to Medicaid and how that works because Medicaid does cover custodial care..

The Nursing Home Level of Care assessment is really important to wrap your head around. These are designations made by Medicaid. Basically, because your MIL would likely require dementia care, she both qualifies for a higher payout from Medicaid to the nursing home, but also, she has to be in a facility that covers that. https://www.medicaidplanningassistance.org/nursing-home-level-of-care/

At some point, we should probably also cover nursing home evictions, which is a very real threat to people needing dementia care.  These days, especially look at illegal versus legal discharges. https://www.medicaidplanningassistance.org/nursing-home-evictions/

-----

But, basically, the average person does need to know what qualifying hospitalization events for skilled nursing are (must be a 3 day inpatient stay), and then that there is assessment done to see if they would benefit from skilled nursing or rehab, then the max number of days of skilled nursing or rehab covered by Medicare within a certain time period (1 year--can someone jump in on this one?), and so on.

 

[saraha]

Dh hasn’t mentioned the meeting tomorrow to his siblings. He showed me their group text today and bil is doubling down on them aging in place and letting fil lead the decision making in response to sil saying they were going to have to move their bedroom downstairs as per the PA and she was trying to be practical and figure out who was going to do it when. Their texts read like they really think a couple of weeks of rehab and things are going to be hunky dorry. Dh is trying to figure out how to get them all to the meeting tomorrow and is already discouraged it won’t do any good. I told him he could tell the truth and say I had some questions so I called the social worker and she thought it would be helpful to meet and answer any questions they have. But I think he’s afraid they’ll be mad. I don’t know, I feel so bad for him.

He is not a talk about our feelings guy so he’s out in the barn until dinner and then going to the hospital. So I am once again turning to my online friends. Thank you so much for investing so much of your time into me today!

Its easy to tell myself that I’ve done everything I could, then I see the pain on his face and I just want to help

[Carol in Cal.]

2 hours ago, prairiewindmomma said:

Again, I'm going to write really generally so that others reading in have the same basic info:

Medicare has different parts:

Part A is the basic coverage that the government provides. Part A is premium free for some people, but not all. 

Part B is a supplemental insurance that you buy through private insurance companies (like Aetna, UHC, etc.)

Part D is the drug plan.

Here's a rough run-down of what each part covers: https://www.medicare.gov/what-medicare-covers

If you don't sign up for Medicare in a timely fashion, you can still sign up for Medicare through the late enrollment process, and pay a penalty fee for each part that you sign up late for.

 https://www.medicare.gov/basics/costs/medicare-costs/avoid-penalties

The enrollment period for 2023 opened in October and goes through December 7th. 

Nearly all of your other questions are covered by the medicare booklet. https://www.medicare.gov/Pubs/pdf/10050-medicare-and-you.pdf

Skilled nursing coverage only kicks in after a 3 day minimum medically required inpatient hospital stay unless she is in a Medicare Advantage plan (page 28-29).

Home health therapy is page 43. 

Outpatient pt is page 48.

The PACE program (which for your circumstances I don't think is ideal) is on page 74.

I highly recommend skimming the entire book.

I'll post about long term care coordination next.

 

 

 

No, this is not right.

Normally I would not contradict so bluntly, but as you mention, others are reading along.

Medicare Part A is hospitalization insurance, and is provided free by the government to those 65 and up (and to certain others under exceptional circumstandes.)  There are big deductibles that are out of pocket costs.

Medicare Part B is Major Medical insurance provided at a cost by the federal government, the cost usually coming out of the social security check if there is one.  It pays roughly 80% of medical costs for treatment and cures, not so much for preventative care, and excluding vision and dental care as well as drugs.

Medicare Supplement insurance is purchased from a private insurance company to pay the deductibles that A and B don't cover.  Coverage varies with plan type.  Plans are standardized now, legally; so a Plan F should cover the same things no matter what insurer offers it.  

Medicare Part D insurance is for drug coverage outside of an admitted hospital stay, and is purchased from a private insurance company.  

Private insurance companies can refuse to sell their Medicare supplement and Part D plans to people in poor health, EXCEPT those who apply right around the time that they apply for Medicare Part B, usually when they turn 65.  However, they can't cancel coverage once you have it, so it's pretty important to sign up for it all at the same time when you become eligible or you might never be able to get it.

There are exceptions to this, but this is the broad strokes system as it works now.

The two major exceptions are Medicare Advantage programs which bundle some all or most of the above into one big plan (Kaiser being a common example), and continuing to have employer coverage via your own employment or that of your spouse, continuously, even after you turn 65--but if you do that second thing, you must be able to prove that your coverage was continuous to be eligible to get guaranteed issue coverage after that 65th birthday window.

[Carol in Cal.]

4 hours ago, lauraw4321 said:

Medicare pays for 3 weeks of rehab. 

 

No, the limit is 100 days.  It IS unusual to get that far though.  To qualify you have to be progressing, not refusing rehab, and need skilled nursing.  A relative of mine got more than 3 weeks of rehab with 4 broken bones after a horrible fall down a flight of bare wood stairs, but they decided that even though she was progressing after 5 weeks, she no longer needed skilled nursing care, so they terminated her insurance payments and sent her out of rehab.  She was able to be moved into assisted living, and to get some PT and OT there, less than she would have in rehab but a couple of times a week instead of 5X each.  Once she moved the PT and OT were covered by Medicare but the assisted living costs were not covered at all.

[saraha]

This is all so ridiculously complicated, and at least with my old people, they don’t understand it and don’t want to ask for help either. I am sorry it has to be so hard for everyone.

[Grace Hopper]

10 minutes ago, saraha said:

This is all so ridiculously complicated, and at least with my old people, they don’t understand it and don’t want to ask for help either. I am sorry it has to be so hard for everyone.

It is truly sad that the system is so complicated to navigate, especially considering many aren’t at the top of their game when they need it. 
 

I had to go buy a book, MediCARE for Dummies. Yes, it’s a real book and it was helpful!

[Carol in Cal.]

9 minutes ago, saraha said:

This is all so ridiculously complicated, and at least with my old people, they don’t understand it and don’t want to ask for help either. I am sorry it has to be so hard for everyone.

I completely agree.  The laws are ridiculous, especially around that crucial, fraught sign up at 65.  

What you have to understand about Medicare is that it is focussed  on curing an illness or injury, not on ongoing care needs.  That ongoing care is more and more common as people live longer but not necessarily live better longer, and so it's big fat gap that previous generations were not impacted by as much.

My grandmother died of cancer at 84.  My other one died of a stroke at around the same age.  But their kids are living a decade longer, and needing much more and more lengthy care as they age.

[prairiewindmomma]

Sorry I blew it in explaining it, my relatives have Advantage.

[Corraleno]

17 minutes ago, Carol in Cal. said:

Medicare Supplement insurance is purchased from a private insurance company to pay the deductibles that A and B don't cover.  Coverage varies with plan type.  Plans are standardized now, legally; so a Plan F should cover the same things no matter what insurer offers it.  

Just to make things extra complicated, Plans C and F (which cover the Part B deductible) have been phased out; people who are already enrolled in those plans can keep them, but new enrollees do not have the option of plans that cover the Part B deductible (e.g. Plan F has been superseded by Plan G, which covers basically the same things as F except for the Plan B deductible).

[lauraw4321]

59 minutes ago, Carol in Cal. said:

 

No, the limit is 100 days.  It IS unusual to get that far though.  To qualify you have to be progressing, not refusing rehab, and need skilled nursing.  A relative of mine got more than 3 weeks of rehab with 4 broken bones after a horrible fall down a flight of bare wood stairs, but they decided that even though she was progressing after 5 weeks, she no longer needed skilled nursing care, so they terminated her insurance payments and sent her out of rehab.  She was able to be moved into assisted living, and to get some PT and OT there, less than she would have in rehab but a couple of times a week instead of 5X each.  Once she moved the PT and OT were covered by Medicare but the assisted living costs were not covered at all.

Fair enough. The broader point is that Medicare does not cover skilled nursing facility long-term.

[northcoast]

OP - are you in OH by chance?   Here's some info that may be helpful if mil is part of the State Teachers Retirement System: https://www.strsoh.org/retirees/health-care/medicare.html 

If not, just ignore.  

[Carol in Cal.]

52 minutes ago, northcoast said:

OP - are you in OH by chance?   Here's some info that may be helpful if mil is part of the State Teachers Retirement System: https://www.strsoh.org/retirees/health-care/medicare.html 

If not, just ignore.  

BUT!  At least here in CA, some school districts participate in the local STRS plan retiree medical and some do not, and I think that now there are even some that are tiered, with the more recent hires having no retiree coverage while the older ones do.  So even if you learn about a state plan, that doesn't always mean that you understand the coverage for all of the teachers in the state.  Sigh.

[Starr]

Given what you've got here's my thoughts. She should stay in whichever has the best rehab, hospital or nursing home. At the end of two weeks they will see if she can walk to the bathroom by herself or not. If so she goes home and you start all over with the mess you had before. If not they have to make changes. Now is the time for insurance review. It's the time of the year changes can be made. You are right where you were before she fell. You decide what you want to be responsible for or not. I move on from home health care when I don't agree with the medical care and or am concerned there will be a fall and I could be blamed. That's not with family but the same sets of crazy happen. You can't change them. I pray for the best. This sounds so blunt. It's a good thing the rest of my family can write better than I can.

[Longtime Lurker]

3 hours ago, Carol in Cal. said:

No, this is not right.

Normally I would not contradict so bluntly, but as you mention, others are reading along.

Medicare Part A is hospitalization insurance, and is provided free by the government to those 65 and up (and to certain others under exceptional circumstandes.)  There are big deductibles that are out of pocket costs.

Medicare Part B is Major Medical insurance provided at a cost by the federal government, the cost usually coming out of the social security check if there is one.  It pays roughly 80% of medical costs for treatment and cures, not so much for preventative care, and excluding vision and dental care as well as drugs.

Medicare Supplement insurance is purchased from a private insurance company to pay the deductibles that A and B don't cover.  Coverage varies with plan type.  Plans are standardized now, legally; so a Plan F should cover the same things no matter what insurer offers it.  

Medicare Part D insurance is for drug coverage outside of an admitted hospital stay, and is purchased from a private insurance company.  

Private insurance companies can refuse to sell their Medicare supplement and Part D plans to people in poor health, EXCEPT those who apply right around the time that they apply for Medicare Part B, usually when they turn 65.  However, they can't cancel coverage once you have it, so it's pretty important to sign up for it all at the same time when you become eligible or you might never be able to get it.

There are exceptions to this, but this is the broad strokes system as it works now.

The two major exceptions are Medicare Advantage programs which bundle some all or most of the above into one big plan (Kaiser being a common example), and continuing to have employer coverage via your own employment or that of your spouse, continuously, even after you turn 65--but if you do that second thing, you must be able to prove that your coverage was continuous to be eligible to get guaranteed issue coverage after that 65th birthday window.

Thanks for the correction. I was going to chime in, but you did it first and explained it very clearly. Part B and private supplement policies are distinct from each other and complementary to each other.

[Longtime Lurker]

3 hours ago, prairiewindmomma said:

Sorry I blew it in explaining it, my relatives have Advantage.

You got most of it right! It is ridiculously complicated. I know a lot because Dh just started Medicare and I read financial and retirement forums for fun. I also read all 83 pages of "Medicare and You" (the official US government Medicare handbook) which was very illuminating.

[Melissa in Australia]

Hugs