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  1. #41

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    ^ Milanessa can I just say to all (in the US) if you have a parent that breaks a hip DO NOT LET THE HOSPITAL DISCHARGE THEM without a referral to a rehab nursing home. Thank the Lord that someone counciled me to get the Medical Social Worker on staff to do just that when my dad was doing better than expected and wanted him discharged after hip replacement. The MSW got my dad a referral to rehab otherwise it would have been out of pocket. He was there for several weeks learning to walk with the bionic hip and home health care workers came to his home to make sure the shower and toilet could accomodate his abilities. It would have cost $10,000 if they let him out of the hospital (they wanted me to drive him home in my truck that he could not get into). Instead I got an ambulance to transport him to the nursing home and I met them there to do the intake.
    "awwww....shades of Janet Lynn" - Dick Button on anyone who makes more than one mistake in their program.

  2. #42

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    Quote Originally Posted by milanessa View Post
    My guess is that he was in rehab and not a nursing home. Frequently nursing homes and rehab facilities are co-located on the same grounds because people often move from one to the other. Medicare does not pay for nursing homes - they will pay for a time in rehab as long as the patient was hospitalized just prior to admission and (as you said) continues to make progress.
    Well, it was a long time ago, but I do think it was a nursing home. Perhaps it could have been rehab, but in effect it was a nursing home in this case.

  3. #43

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    There are Rehabilitation Hospitals (like Giffords is in in Houston) that have to provide at least 3 (maybe 4?) hours of intense therapy (PT, OT, ST,...) per day (maybe except for one day a week) -- a patient has to have sufficient stamina to deal with intensive therapy, which is exhausting, in order for Medicare to pay for this.

    Nursing homes can also be called Rehabilitation Centers, and can have both Medicare and non-Medicare beds in the same facility. Patients who meet Medicare's qualifications for a sufficiently long prior hospitalization can go into a Medicare bed, where they're then expected to receive therapy on a less frequent (once a day?) basis. Their eligibility under Medicare stops as soon as they're not making fast enough progress getting better, or when they reach the Medicare maximums, though that apparently is very rare.

    We got a crash course in this after my mom's health issues; I don't think much has changed.

    Hint: You can always appeal a hospital discharge of a Medicare patient, and that discharge appeal stops everything. I had to do that when the hospital attempted to discharge my MIL without having involved us in a discharge plan, and without dealing with some complex medication issues that the nursing home needed time to prepare to handle. They were ready to ship her off without ensuring that the nursing home had a needed (and unusual) drug on a Friday afternoon, and it was one that the nursing home wasn't able to actually get until Sunday evening, which would have been a major problem. Now I know that I've got to proactively get in touch with the discharge planner the day after she's hospitalized so that they're put on warning that we need to be involved.

  4. #44

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    This is a very interesting discussion.
    I have a LTC policy, I got at age 39, now am 50. Main reasons I got it: was very low price (fixed amount per year for life), but the benefit has an inflation component and keeps growing. If I stop paying, the amount I paid in is available for future claims. If I die and never use, no benefit to anybody. At the time, and now, I am not as concerned about leaving an inheritance, but to not be burden while alive/destitute.
    I am single, no kids, and was thinking long term and short term if something should happen to me. I did not want to lose my home/use my retirement funds early.
    I have discussed with a few friends recently that are my age and up to early 60s that have looked into LTC and think I got a very good deal. I no longer work at the employer that issued it, but it is portable, which was another feature I liked.
    My Mom always said to me to not get old, it is no fun. I am good health, but maybe it is turning 50 the past year has been thoughtful. My parents have been gone along time, and so many friends that are my age are going through so much with their parents (moving in with them, illnesses etc). My Mom was right!
    As someone said (paraphrasing) - I am not afraid of Death, it is the Dying.

  5. #45

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    That sounds like a great policy, Smurfy. May I ask what insurance company it is through?

    (And in case you're looking at issues about who might handle finances for you if you become disabled or unable to do them, you might see if one of your local credit unions now has a trust department. I've got a couple of much older friends who are very glad that they've been able to use this as an option.)

  6. #46

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    Quote Originally Posted by barbk View Post
    That sounds like a great policy, Smurfy. May I ask what insurance company it is through?

    (And in case you're looking at issues about who might handle finances for you if you become disabled or unable to do them, you might see if one of your local credit unions now has a trust department. I've got a couple of much older friends who are very glad that they've been able to use this as an option.)
    Through CIGNA/INA. They send me periodic literature. But with what is posted here, I need to review things, it has been awhile.

    Another thing I do have that not many think about: I have a Will, A Financial Power of Attorney, A Medical Power of Attorney and A Living Will. Maybe because I am single, and feel very strongly which relative I want (and don't want) making decisions for me.
    I think a lot of people don't like thinking of things, but I have been Executor/Administrators of some estates, which is quite educational (financially, legally and emotionally, plus learn too much about relatives that I wish I did not learn).
    I am trying to take care of myself, and be proactive, and not leave things for others to clean up, nor be a burden.

  7. #47
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    If you're divorced or widowed, you have to update your Health Care Proxy. I know someone whose estranged wife was holding the reins when he had a stroke. She could have pulled the plug at any time and she did think about doing that to him, even though she knew he wanted to be kept on life support. His family hired a lawyer to fight her, so she backed down.

  8. #48

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    Quote Originally Posted by FigureSpins View Post
    If you're divorced or widowed, you have to update your Health Care Proxy. I know someone whose estranged wife was holding the reins when he had a stroke. She could have pulled the plug at any time and she did think about doing that to him, even though she knew he wanted to be kept on life support. His family hired a lawyer to fight her, so she backed down.
    Good point. A long time ago, I found a checklist of the paperwork you need and how often to review it. I can't find it now, but it listed reviewing all health care documents (proxy, living will, medical power of atty) and estate documents every 5 years or immediately upon a life event (birth, death, divorce, separation). If folks did that, it would save a lot of heartache.

    Also, don't forget old 401ks and employers. For a time, I had a 401k with my deceased mother as beneficiary. I just forgot to change it.
    AceOn6, the golf loving skating fan

  9. #49
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    Quote Originally Posted by sk8pics View Post
    BTW, regarding nursing home care and medicare. My father had a stroke and was in a nursing home for about 7 months before he died. Medicare paid for every day of his care, amazingly enough. They were about to cut off his medicare because he wasn't "making progress," and my mother pointed out some of the health problems he had as a result of being bedridden, and asked how he could make progress with these problems. And they said, "Oh, you're right." It was quite a relief because if they'd had to pay all of his care it would have been very tough on my mother. They'd been frugal and tried to plan, but they were not wealthy people. She was very upset about all that, in addition to the whole situation with my dad. This was more than 20 years ago, but it is just a reminder that it pays to keep asking questions.
    Typically, Medicare will pay 100% up to 28 days in post hospital rehab. After that they will usually pay a lowered percentage. It becomes less with each week beyond the 28 days. But they still pay most of it.

    Quote Originally Posted by milanessa View Post
    My guess is that he was in rehab and not a nursing home. Frequently nursing homes and rehab facilities are co-located on the same grounds because people often move from one to the other. Medicare does not pay for nursing homes - they will pay for a time in rehab as long as the patient was hospitalized just prior to admission and (as you said) continues to make progress.
    I am not familiar with medicare paying for rehab prior to nursing home admission. It has been my experience that, in order for Medicare to pay for rehab, you must go directly from a hospital. The hospital stay must be for more than 24 hours, and the doctors have to determine that the patient is ready to leave the hospital, but not ready to go home. A nurse/representative from the rehab facility will go to the hospital to approve the patient's need. But, if they go home, even for one day, they do not qualify. I went through this multiple times with my father and just recently with my mother. Even though my father was in assisted living, if he was hospitalized for more than 36 hours, the facility would not take him back without at least a few days of rehab - for liability reasons. This form of rehab is not just about getting strength back, it is also to monitor new meds the patient might have been put on. for instance, my mother was put on coumadin, and they wanted to monitor her for a few weeks to make sure she maintained a therapeutic level on the dose they prescribed. It did drop and they did have to up the dosage, so it was important that she was there. It is far less expensive for Medicare to pay for rehab than hospitals.

    Quote Originally Posted by sk8pics View Post
    Well, it was a long time ago, but I do think it was a nursing home. Perhaps it could have been rehab, but in effect it was a nursing home in this case.
    There are major, stand alone, rehab centers around here. Kessler being the most well known. But, the majority rehab centers are in nursing homes. These are most utilized by patients who just need to get stronger before they go home - elderly, joint replacement, etc. They have 24 hour nursing staff and a doctor there every day. The rehab is usually in it's own wing.

  10. #50
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    Quote Originally Posted by barbk View Post
    Their eligibility under Medicare stops as soon as they're not making fast enough progress getting better, or when they reach the Medicare maximums, though that apparently is very rare.
    But, as I said above, the maximum does not mean 100% payment beyond 28 days.

    I had to do that when the hospital attempted to discharge my MIL without having involved us in a discharge plan, and without dealing with some complex medication issues that the nursing home needed time to prepare to handle. They were ready to ship her off without ensuring that the nursing home had a needed (and unusual) drug on a Friday afternoon, and it was one that the nursing home wasn't able to actually get until Sunday evening, which would have been a major problem. Now I know that I've got to proactively get in touch with the discharge planner the day after she's hospitalized so that they're put on warning that we need to be involved.
    This kind of thing happens alot more than you would think. Especially now that we have hospitalists in charge. They can be uncommunicative and uncaring (since they don't know you). My mother's discharge was awful. The paperwork from the hopitalist was incomplete. Some of the meds were not on it - like the coumadin! The doctor at the rehab center tried to contact the hospitalist, never got a return call - for the entire 4 weeks my mother was there! The doctor at the rehab center was very proactive, and is affiliated with the hospital my mother was in, so he accessed her records remotely. Then he repeated some of the tests he could not get answers on. And the discharge planner was very nice, but clueless.

    One advantage we have is that one of our closest friends owns one of the top nursing/rehab centers in the area, and he owns a bunch of assisted living facilities (also top notch). Having the owner walk down the hall with a gift basket for Mom was very nice.

  11. #51
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    Quote Originally Posted by cruisin View Post

    It has been my experience that, in order for Medicare to pay for rehab, you must go directly from a hospital. The hospital stay must be for more than 24 hours, and the doctors have to determine that the patient is ready to leave the hospital, but not ready to go home..

    That's what I said.

    Actually the hospital stay has to be 3 days.
    3539 and counting.

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  12. #52

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    Quote Originally Posted by Aceon6 View Post
    Good point. A long time ago, I found a checklist of the paperwork you need and how often to review it. I can't find it now, but it listed reviewing all health care documents (proxy, living will, medical power of atty) and estate documents every 5 years or immediately upon a life event (birth, death, divorce, separation). If folks did that, it would save a lot of heartache.

    Also, don't forget old 401ks and employers. For a time, I had a 401k with my deceased mother as beneficiary. I just forgot to change it.
    My parents have a checklist like the one you described. Their lawyers also keep that information as one of those reminder things that you doctor's office uses when it is time for your annual physical.

  13. #53
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    Quote Originally Posted by milanessa View Post

    That's what I said.

    Actually the hospital stay has to be 3 days.
    You did, I thought you had said something about going into rehab prior to being admitted to a nursing home - was that another post? And you are right it is 3 days. My father was never in for less than 5, so that got blurred.

  14. #54
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    Quote Originally Posted by KHenry14 View Post
    The problem with LTC policies is that you can pay into them for many years and never use the policy.
    This is true of any kind of insurance policy, not just LTC -- homeowners, personal articles, auto, anything. It's all a betting game, anyway.

  15. #55

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    Quote Originally Posted by skaternum View Post
    This is true of any kind of insurance policy, not just LTC -- homeowners, personal articles, auto, anything. It's all a betting game, anyway.
    Good point. One size does not fit all. One has to look at their own situation and do what they think is best. I sometimes view an insurance policy as insurance that the thing being insured will never happen. As long as you consider possibilities and plan something for yourself - go for it!

  16. #56
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    Quote Originally Posted by smurfy View Post
    This is a very interesting discussion.
    I have a LTC policy, I got at age 39, now am 50. Main reasons I got it: was very low price (fixed amount per year for life), but the benefit has an inflation component and keeps growing. If I stop paying, the amount I paid in is available for future claims. If I die and never use, no benefit to anybody.
    I thought the premiums that we pay go into the pool of money for those who need to use it

  17. #57
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    You all seem to know a lot about long-term care and financial planning for the elderly. Maybe you could give me advice on how to approach my parents, who are now in their early 60s, about this subject.

    We've talked about it to the extent that they have directed me on what to do if they get ill, but they absolutely refuse to tell me about their assets. I have no idea what money they have where, and I have asked them repeatedly. I'm left to guess as to what kind of financial problems they have, and from observing their lifestyle and picking up on things over the years, I know this: they have refinanced their house and still do not own it, even though they bought it in the 70s; they have about $4000 left in their portion of student loans they took out to pay for half of my college; my mom has been attempting to pay off her credit card for two or three years but I don't know the amount of debt; they own two vehicles outright; my mom has a small Roth IRA; my dad has a retirement fund that is somewhere in the 20-30k range;and none of their property/assets are in my name.

    Based on this very limited information, is there anything I can do to either get through to them that they need to be more honest with me about their finances, and how do I save myself from being burdened by their debt when they can no longer work? Is there anything I can do to help them financially? My mother tells me that I should not take care of them because she has had to take care of her mother and it has been a horrible experience. My parents want me to put them in a nursing home, but I'm afraid they won't be able to afford it and will lose other assets (like the house and property).

  18. #58

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    Stanhope -- Those are some challenging circumstances. A few thoughts:
    1. You can't inherit their debt. When they die, lenders can make a claim against their estate, the mortgage holder can make a claim against the house if payments aren't made, but none of it is your responsibility. (Even though some unethical debt collectors might try and make you think so.) It may mean that there is nothing left in their estate after death for heirs, but at least you aren't saddled with debts.

    2. See if you can start small with them: 1. Do they each have a durable power of attorney for healthcare decisions? Even if it is just that each has one that specifies the other as the holder of the durable power, that's a start. 2. Do they have wills? If not, will they at least do a simple will, even if it is one that they generated using one of the software programs. (If one or both are employed, might either have a legal services plan as part of their benefits? Sometimes that provides a free or nearly free simple will.) 3. Once they have their wills, where are they stored? (Safety deposit box, filed at a state office (available in some states), in a safe at home?)

    I wouldn't approach them at this point about anything ambitious -- baby steps only.

  19. #59
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    Quote Originally Posted by stanhope View Post
    You all seem to know a lot about long-term care and financial planning for the elderly. Maybe you could give me advice on how to approach my parents, who are now in their early 60s, about this subject.

    We've talked about it to the extent that they have directed me on what to do if they get ill, but they absolutely refuse to tell me about their assets. I have no idea what money they have where, and I have asked them repeatedly. I'm left to guess as to what kind of financial problems they have, and from observing their lifestyle and picking up on things over the years, I know this: they have refinanced their house and still do not own it, even though they bought it in the 70s; they have about $4000 left in their portion of student loans they took out to pay for half of my college; my mom has been attempting to pay off her credit card for two or three years but I don't know the amount of debt; they own two vehicles outright; my mom has a small Roth IRA; my dad has a retirement fund that is somewhere in the 20-30k range;and none of their property/assets are in my name.

    Based on this very limited information, is there anything I can do to either get through to them that they need to be more honest with me about their finances, and how do I save myself from being burdened by their debt when they can no longer work? Is there anything I can do to help them financially? My mother tells me that I should not take care of them because she has had to take care of her mother and it has been a horrible experience. My parents want me to put them in a nursing home, but I'm afraid they won't be able to afford it and will lose other assets (like the house and property).
    This is a tough situation, however, are your parents in good health? Are they retired? When my parents were in their early 60's I knew nothing about their financial situation. My father was still working and was married to a much younger woman, who screwed him royally when he got sick and she left him (but that's another story). As they got older and became less healthy, it became obvious to them that my brother and I needed to know all of that information. If your parents are reluctant to share the information, it could be because they don't want to burden you or they are uncomfortable with thinking about their eventually passing. That is delicate. I took over my father's finances because he could no longer manage them. I paid his bills, his alimony payments, etc. But it was with his money. We set up all of his accounts in my name POD to him (in case something happened to me). That allowed me to make all of his deposits and write checks for all of his debts. I got a limited power of attorney, so that I could sell his house. That money was also put into an account in my name POD to him. I was the executor of his will and I knew where everything was and who was to get what. I executed the will because I was more familiar with his assets and because my brother lives farther away and it would have been more difficult for him to manage. The only thing my father did not do was arrange for burial. Not that my brother and I could not do that, but we didn't know where he wanted to be. Since he was divorced from my mother and his second wife, we just assumed he would want to be near his mother. That is what we did. Do you have siblings? Someone needs to know exactly what and where everything is, especially if their health declines. You might want to discuss with any sibs, getting together and meeting with your parents and a financial advisor. Explain to them that it is in their best interests and yours that you know where things are. That in their attempt to not burden you, they may, in fact, be putting more burden on you.

    As far as going to a nursing home, they probably could get into one, but as others have mentioned, most of the medicaid paid only homes are not so great. Some of the nicer ones will continue with medicaid only, if you can pay for the first 2 years or so.

    barbk - I agree that if they pass, the debt does not pass on. However, if they become disabled and need care, that can become a burden if no one knows what their assets are.

  20. #60

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    Stanhope, there's a financial planner on WBZ radio who does a weekly segment on all types of planning. While stuck in snow traffic last week, I heard her latest show and it was all about parents who aren't talking to their adult kids about finances and health care issues. I checked, and it's online here. Take a look, she's got some good questions outlined and has some pretty good advice.
    AceOn6, the golf loving skating fan

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