The Family Transition Blog

Choosing Your Senior Living Solution

So, the day you’ve been dreading has come.  You have concluded that you simply can’t live in your home a moment longer.  If you are like many older adults, you’ve avoided confronting this reality and don’t want to think about moving into a “facility.”   I’m happy to report that there are many wonderful options for you.  Enjoy my top strategies for choosing your senior living solution.

1. Scout ahead of time –There are many options for senior living.  If you remember going to look at colleges with your teenager you’ll know exactly what I mean.  It can be overwhelming to figure out what you need and what you want.  So start the process, even if you can’t imagine that you’ll ever choose to move.
2. Understand the math – Money does matter.  Your resources will determine the range of available options.  For example, if you have equity in your home, are a veteran, or own a long-term care insurance policy you may be in a very different situation from someone whose only resource is a monthly social security check.  Crunch the numbers ahead of time to figure out how much can be spent each month and what is included.  Most communities provide a worksheet that will help you understand this calculation. Don’t confuse the issue by spending time visiting a place that is outside of your means.
3. Narrow the choices to no more than three or four using the “Five S” method – Once you have a list of possibilities that are within your budget and preferred geography, it’s time to narrow the choices to a few where you think you will be happiest.  My “Five S” method, considers size, sights, sounds, smells, and services.  What you are really doing is looking for a good match based on a sixth “S” – similarities.  You are looking for a place where the residents are as similar to you as possible in terms of age, activity level, mental acuity, hobbies and interests, and socio-economic factors. 
4. Size – Will you be more comfortable in a larger community with many residents or a smaller, more intimate setting?  Can you still get around reasonably well, or will a large campus become frustrating?  Will you take advantage of the facilities that might be available in a larger community or will these amenities likely go unused?  Will the size of the living unit work?  To many women having a full kitchen is very important, even if they will receive two meals each day as part of their living package.  On the other hand, many men are sure they need a “den” or “office” within their living unit and won’t hear of moving into a space without it. 
5. Sights – The classic line I hear from people exploring senior living options is, “Everyone here is old!”  Sometimes that’s true.  Some communities cater to an older crowd with more physical limitations and you’ll see lots of walkers and wheelchairs.   Other communities attract younger, more physically active residents where jackets and ties at dinner are expected.  You’ll also find that there are distinct differences in the “look and feel” from one residence to the next.  Some have a homey feel, while others look like upscale hotels or even cruise ships!  And still others give a more clinical or medical impression.  Ask yourself whether you can “see” yourself in a particular community.  Take the time to notice the details, especially in the public spaces.
6. Sounds – When you first enter the community, is there a hush, or do you hear a loud television set?  Or perhaps, you hear ringing phones and beepers, much like you would in a hospital.  Do you get the impression that the residents are socializing, gathering, and participating in activities?
7. Smells – Try to visit about a half hour before mealtime, and notice the smell.  Is it appealing? When you are in the living areas, does it look and smell clean?  Does there seem to be a strong “air freshener” odor everywhere that might be used to mask less than optimal cleaning?  Our sense of smell is a fabulous clue to what’s really going on.
8. Services – Some communities offer a continuum of care, so that residents can come into an independent living situation and then move to assisted living, skilled nursing, or a memory unit if needed.  This is ideal if you and your spouse need different levels of care or if you suffer from a condition that you know will progress over time.  You’ll also want to look at the services available to help with activities of daily living, transportation, physical therapy, etc.  Take a close look at the social calendar since interaction with others is one of the huge benefits of community living.   
9. Ask for and check references – Before you decide that a particular community is on the short list, be sure to ask for and check a few references. Ask for permission to talk with the family members of two or three residents in addition to the residents themselves.  When you have these conversations, don’t be shy about asking some tough questions.

Once you have arrived at a decision, it is important that you move ahead with it quickly.  As the saying goes, “time kills all deals”, and this one is no exception.  You will always be able to come up with a reason why this isn’t the right time to move.  But the truth is, if you have reached the point where you have even started visiting communities, you probably know in your heart that this move really is in your best interest.

©2010 LifeBridge Solutions, LLC.  All rights reserved.

Medical Billing Advocate Explains How to Read Your Bills

If you have medical insurance, you’ve probably received a paper titled “Explanation of Benefits” or EOB.  Typically, just below the title, it reads, “This is not a bill.”  That said, there are dollar figures all over it.  So if this is not a bill, what exactly is it?  The EOB is exactly what it says it is: an explanation of the benefits provided by your insurance plan for a particular service on a particular date.  Its purpose is to report to you (the subscriber) and your doctor or hospital (the provider) exactly how the claim was processed.  It is critical that you review each and every EOB you receive for accuracy and the need to take action.  Not doing so may cause you to become financially responsible for charges that otherwise would have been covered by your plan.  However, most people are intimidated by the EOB and have no idea what to look at or what to do about what they see.  Here then is your guide to your EOB.

While every EOB uses slightly different terms and formats, the key items you need to review are:

• Patient Name: is this you or your dependent? If not, call the insurance company immediately and report the error.
• Date of Service: refers to the date that the visit or procedure or other service happened.  Is it accurate?  If not, report it immediately.
• Provider’s Name: this is the doctor, hospital, or other entity that provided the service.  Often, you will know that Dr. Jones was your surgeon, but the provider on the EOB will be Everytown Surgical Associates.  This is okay, as long as Dr. Jones is indeed part of that group.  If you’re not sure, call the surgeon’s office and ask.  Likewise, sometimes you will receive a bill for a provider you don’t recognize.  If you had surgery, it’s very possible that this is an anesthesiologist, radiologist, emergency room physician, or pathologist who participated in your care and who bills separately.  When in doubt, ask.
• Procedure code or type of service: this is the shorthand where the provider communicates the service for which payment is being requested and is often a five digit number or an abbreviation.  You may see several codes for one date of service as when, for example, you visit the orthopaedic surgeon and have an office visit, x-rays, and a cast applied.  Likewise, when you have surgery there are often multiple procedure codes reported.  One common question occurs when a service is reported as “surgery” but when you don’t believe you had surgery, as when you had a skin lesion removed in the office.  This doesn’t mean that your provider is doing anything wrong or trying to get away with something; rather, it is simply the language of insurer-provider communications.
• Total charge or billed amount: this is your provider’s standard charge for the service.
• Allowed amount: this is the amount your insurance plan will pay under its contract with your provider.
• PPO discount: this is the amount that is “adjusted” off of the bill due to your insurance plan’s contract with the provider.
• Not covered amount: this is the amount your plan does not cover.  Sometimes, this refers to any charge that is above the allowed amount or the “reasonable and customary” charge, and other times this refers to services that are not covered under your plan.
• Copay, coinsurance, deductible: these are the amounts that are the subscriber’s responsibility under the terms of your insurance plan.
• Patient/subscriber responsibility: This is the total dollar amount that you may be billed directly for the date and services reviewed on the EOB and may include amounts that you have already paid at the time of service.  Typically, you will pay this directly to the provider.
• Remarks/remark code/message code: This is the method by which the insurance company communicates with both you and your provider to explain how the claim was processed.  Most often, the codes will be several letters or numbers next to the particular service.  Elsewhere on the EOB you will find the “key” to these codes, which might read something like, “Duplicate charge” or “Not covered on the same date of service as the related charge” or “Not covered due to lack of timely filing”.  There are many, many codes and they vary by insurance company, but this is where you will learn what you or your provider might need to do to have the claim processed and paid correctly.  You MUST review this and take the appropriate action in a timely fashion.
• Payment assigned to provider: This means that whatever payment is being made by the insurance plan is going directly to the provider because he or she is a participating provider in your plan and you signed authorization with the physician to submit the claim on your behalf and receive direct payment.  Where this is not the case, as when you use an out-of-network provider, the check may come directly to you and you are responsible for paying the provider.

If you are confused or overwhelmed by your medical paperwork, a medical billing advocate might be helpful to you.  These professionals are well versed in the ins and outs of medical billing and can help you get problems with your claims resolved quickly and efficiently.

©2010 AttackMedicalBills.com, a division of LifeBridge Solutions, LLC.  All rights reserved.

Fight Medical Bill Errors

Medical bill errors, including those on hospital bills, can quickly become a nightmare for you, the patient, if you don't keep on top of them.  The longer an error goes uncorrected, the less likely it is that you will be able to successfully fix it.  Hospitals, physicians, and other providers are likely to send your account to collections if it is not paid within a few months.  While each entity follows its own guidelines with regard to how quickly it considers an account to be delinquent, most expect your bill to be paid in full unless other arrangements have been agreed to within 90 days of the date of service or 45 days of when your insurance plan has processed the claim.  Failing to pay your medical bills is very likely to affect your credit, and unpaid hospital bills are a major reason why people file personal bankruptcy.

It is particularly critical that you stay on top of billing errors if you have health insurance.  This is because there is something known as "timely filing" in the insurance business.  If you have medical insurance, the plan documents must indicate how long you or your provider has to submit claims.   Once that time has passed, it is permissible for the insurance company to deny your claim because it wasn't submitted within the required time period.  At this point, the entire bill becomes your responsibility.  Similarly, if you don't agree with how your claim has been processed, you have a finite period of time to appeal the decision and escalate it through the insurance plan's dispute resolution process.  If you miss the appeal deadlines, you're usually out of luck.

There are many different kinds of medical bill errors so you must have an eagle eye when you review your bills.  Perhaps the simplest error for a lay person to find is a charge for a service that was never provided.  For example, if you were billed for a hearing test that you never took, make sure to dispute it.  The fact that the clinician ordered the test and marked it on the "superbill" at the time of the visit is irrelevant if the audiologist never performed the test and recorded the results.  Your medical record is the governing document when it comes to these disputes.  If it's not in the records it shouldn't be billed.   If you find yourself in this situation, request a complete copy of your medical records and a detailed itemized statement.  Then, take the time to compare what's in the records with the statement and dispute any discrepancy.

Another common situation is duplicate charges where the provider has billed you for the same service more than once on the same day.  While this makes sense sometimes, such as when you have an x-ray of both your right foot and your left foot, the provider needs to use a special code called a modifier to explain this to the insurance company.  In addition, keep watch for charges for things that the hospital or doctor isn't supposed to bill for separately.  For example, if you have had surgery, the follow up care should be included in the "global fee" for that service.  For major procedures, that means that you shouldn't be charged for a follow up visit within 90 days of the date of the surgery.  You can, however, be charged for additional services other than the office visit itself, such as an x-ray or cast.  Similarly, if you are hospitalized, the hospital shouldn't charge separately for sheets for your bed or your hospital gown, both of which are included in the "room and board" charge.

If all of this seems a bit overwhelming, you might wish to retain a medical bill advocate.  Billing advocates are trained to spot errors, negotiate with providers, and where possible help you to reduce your bills.  You can learn more about medical billing advocacy at http://www.attackmedicalbills.com/ or http://www.billadvocates.com/. 

Budgeting For Caregiving

One of the more stressful parts of caregiving is the worry about how to pay for it.  Planning ahead can help, as can creating a caregiving budget.  Of course, once you create your budget you need to stick to it!  As a rule of thumb, if you're thinking ahead you're making a plan while if the situation is unfolding right now, you're creating a budget.  Yet, even when you are building a budget it is important to think through the "what ifs" and create a few scenarios for how your caregiving journey might unfold.  It's helpful to construct a best case, worst case, and most likely case because this view of the future might help you make decisions about what to do now.  I advise caregivers to assume that the resources available at any moment will be lower than what you expect and the needs of your care recipient will be higher.  If you think about things this way, you are more likely to be "surprised" that you have more than enough rather than the opposite.

A budget is made up of inflows, outflows and the assets and other resources available.  Inflows include your care recipient's income, social security payments, pension benefits, IRA,  401K, or annuity distributions, Veteran's benefits, long term care insurance proceeds, support from family, etc.  Outflows include all of your care recipient's expenses, not just those associated with the care itself.  For example, if Mom lives in her own apartment, you have to include her rent and utilities, not just the cost of the home health aide.  Always include a contingency or cushion line when you are fashioning a caregiving expense budget.  Be sure to consider all of the assets or other resources that are available or could become available.  These include savings, value of the home or car, gifts from others, loans, credit card limits, and life insurance policies to name a few.  It is important to know about the availability of these resources along with how to access or monetize them.  

Once you have crafted the budget, you will immediately see whether the inflows are sufficient to cover the outflows.  If they are, you have a surplus, and that's a good thing!  When you have a caregiving surplus, put it away for immediate access later.  If the outflow exceeds the inflow, a budget deficit occurs and must be funded.  That's where assets and other resources come in.  If the deficit is short term, as when extra help is required for respite, it might be feasible to fund it from savings or using a credit card.  Alternatively, if the deficit is ongoing, it's time to determine if the available resources are sufficient to cover it and for how long.  It may be time to consider making changes to the caregiving budget so things are more in balance.

A budget is like a roadmap - it gives you an idea of where you're headed.  When you're on vacation it's sometimes fun to toss the map and take the scenic route that might lead to an adventure or a great little restaurant.  However, a budget detour is less likely to be fun.  Therefore, as caregivers, it is important to periodically take a look at our directions and make sure we're heading where we planned to go.  Whether you do this weekly, monthly, quarterly or less often will depend on how tight your caregiving budget is and the stability of the caregiving needs.  For example, if yours is a deficit budget and the caregiving needs suddenly and permanently go up, it is critical to keep a very close eye on the budget.  On the other hand, if you have a surplus budget and things are stable, it is likely to be fine to check in with your budget less frequently.

When you review your caregiving budget you are looking for variances.  A variance occurs when the actual amount spent differs from what you planned when you created your budget.  A variance can be positive or negative.  For example, if inflows are greater than planned, that is a positive variance.  Similarly, if expenses are lower than planned, that's also a positive variance.  On the other hand, if inflows are lagging or expenses are higher than plan, you have a negative variance.  The idea is to explain the variance and determine whether it is likely to recur, not to blame yourself or anyone else for the fact that the variance happened.  For example, if the electricity bill is high in August relative to your budget for August, you're unlikely to be alarmed if you assumed that the bill for the year is divided evenly by month.  One way to help interpret a variance is to look at both this period (e.g., this month or quarter) and to also look at year-to-date.  In this way, you can see if a variance seems to be a one-time matter or a trend.  If you see trends, you're likely to be facing a new reality, and it's probably time to revise the budget!

New Book For Adult Children With Aging Parents

A just published book for adult children and their aging parents is "The Daughter Trap: Taking Care of Mom and Dad ... and You" by Laurel Kennedy.  This is a valuable resource for all adult children, daughters and sons alike.  Ms. Kennedy bases her work on hundreds of interviews with baby boomers in the thick of caring for their parents and the anecdotes help to illustrate her key points and make the work come alive.

The first half or so of the book frames the problem.  While this section doesn't introduce much in the way of new insights, it does effectively capture the issues faced by so many who care for aging parents and summarizes many of the important studies and resources that have been published on this important topic over the past few years.  At the end of each chapter, Kennedy has a section of "what we've learned" where she tries to guide the reader on actions they might take or things to think about.  Some of this tidbits are more helpful than others.  For example, at the end of Chapter 4, Kennedy writes, "When you need outside help -- ask for it."  This sort of feels like motherhood and apple pie.  On the other hand, in the wrap up of Chapter 6, Kennedy wisely opines, "Acknowledge your limitations and those of your family.  Develop a plan B if caregiving becomes overwhelming to the detriment of your life..."

The second portion of The Daughter Trap focuses on solutions and here is where Kennedy forges new ground. For example, in Chapter 9 entitled "It Takes A Village", Kennedy does an excellent job of bringing her readers up to date on the various initiatives underway to explore alternatvie senior living models and later chapters focus on ways that corporate America can make a difference and technology solutions that are needed.

Kudos to Kennedy for this well researched work.  For those who are well versed in the issues of baby boomers and their aging parents the second half of the book provides some "aha" moments.  For those who are just getting involved with this critical demographic reality the first half provides a thoughtful overview.

Medical Billing Advocate Shares Tips

Certain patterns seem to emerge again and again.  During a recent phone call with a new client, I began to feel like I should produce and automated recording since my initial conversation with consumers regarding the medical bill woes so often sound the same.  As a result, here's my list of the top five mistakes people make when dealing with medical bills.

Mistake # 5: Ignoring the mail

Why is it that so many of us receive mail from a medical provider or insurance company and put it in the "I'll get to it later" pile on the kitchen counter, often unopened?  The most common responses I receive when I ask a client "why" include:

• The paperwork intimidates me
• I don't understand what I'm looking at
• I have insurance, so I don't need to review this stuff
• I can't pay it anyway, so why open it and stress out about it?

While I can certainly understand each of these reasons for avoiding the medical bill mail, the reality is that taking this approach is very likely to come back to haunt you in the form of being sent to collections. 

If you don't understand the bills or explanations of benefits (EOBs) you receive following a medical service, ask someone to explain them to you.  You can call the patient billing specialist at your provider or try the customer service representative for your insurance plan.  If necessary, you can enlist a medical billing advocate to help.  Everyone needs to review their medical bills and how the claims were processed, even if you believe that you have "good" insurance or Medicare and a supplement.  Billing mistakes can and do happen, and you, the patient, are often responsible for paying for them.  While you have the right to appeal, you must do so within the timeframe required by your plan.  By ignoring the mail, you risk missing this important appeal deadline.  If you're worried that you can't pay what you owe, you're always better off to negotiate a payment plan and possibly a reduced charge than to simply ignore the demands for payment and end up damaging your credit.

Mistake # 4: Not asking for (and then reviewing) itemized statements

The best way to avoid medical bill problems is to make sure that the charges are correct in the first place.  While no one expects you to be an expert in medical terminology, by requesting and reviewing a detailed itemized statement following every episode of care you can often avoid some of the obvious problems.  For example, I recently saw a man's bill for his annual physical.  The charges included a line for a pap smear which even most lay people know is a test that is only performed on women.   Had he reviewed the bill right there at the check-out window, that charge would have been removed before the claim was ever sent in to the insurance.   I also recently saw a hospital bill that itemized 77 of the same item at $198 each.   That's more than $15,000 of charges.  This item is something that no one could have done to them 77 times in the space of a three day hospital admission.  Can you guess?  We're talking about a urinalysis.  Not only was the charge itself very high but the number of tests just didn't make any sense.  If this patient had requested and reviewed the bill, I'm pretty sure she would have picked this up.  Always take the time to ask for and look at an itemized bill and if you see something that doesn't make sense try to get it resolved immediately.  If you feel you are being charged for services you did not receive, ask for a copy of your medical record.  A medical billing advocate can match what is documented in your chart with the charges applied to your account and if she finds discrepancies, she can use this to negotiate with your provider.

Mistake # 3: Not asking for what you need

Many insurance plans limit the amount of services you are eligible for under your plan.  For example, physical therapy visits are often limited to a certain number within a period of time.  While this works out okay in many instances, sometimes a patient just needs more sessions in order to optimize her recovery.   When that happens, asking your physical therapist and/or physician to write a "letter of medical necessity" IN ADVANCE of the provision of services.  Don't wait until you've run out of visits before you ask your providers to help advocate for you.  It's your responsibility to be aware of the limits on your policy and not to just assume that your providers are on top of it. 

In other situations, doctors will prescribe a certain drug, not realizing that a particular patient's plan only covers a less expensive alternative.  There is no way that a physician can keep track of the frequently changing approved drug lists for each of her patients, so if you, the patient, go to fill the prescription and found out that the drug your doctor prescribed is not covered, it is perfectly reasonable to let your doctor know and find out whether something that is on the list will be a reasonable alternative.  If your doctor feels very strongly that you need the specific drug, don't hesitate to request that the doctor's office make a phone call or prepare a letter of medical necessity.  He may not succeed, but if you don't ask you definitely won't get the intended medication.

Mistake # 2: Not reading what you sign

What can I say?  You know that you should never sign something you haven't read and understood.  When the clipboard is shoved in your face, it's tempting to just "Sign here."  However, when you do that, you are making yourself responsible.  Another tricky point is signing for someone else.  If you are the caregiver for a patient who cannot sign medical paperwork himself, it is very important not to sign your name.  When you do, you are accepting financial responsibility for your care recipient.  Instead, if you hold power of attorney, it's better to sign their name and then your own name alongside it with "as power of attorney" noted.  If you don't hold power of attorney, it's better if you don't sign at all.  If the provider insists on a signature prior to rendering treatment make sure you sign your care recipient's name and then your own name and add "as representative".    Whatever you do, don't accept financial responsibility for another adult, even your spouse.

Mistake #1: Not understanding your coverage in the first place

The most common mistake I see are patients who have no idea how their insurance works and are shocked and confused when they owe money for medical services.  It is critically important that you as the consumer take responsibility for understanding how your health care is paid for, what is covered, the types of services that require referrals or pre-authorization, and so on.  As painful as it can be to take the time to slog through this material at the start of each plan year, the more informed you are the more benefit you will receive from the coverage that you have.

©2010 AttackMedicalBills.com, a division of LifeBridge Solutions, LLC.  All rights reserved.

Getting Your Affairs In Order: Transition Planning Makes A Difference

John and Jane Smith (names and some of the personal details changed to preserve the privacy of those involved) are a lovely couple in their mid-seventies who became southwest Florida snowbirds in 1996 and permanent residents in 2002.  When I met them, the Smiths were both healthy and engaged in an active lifestyle.  Their two adult daughters live in Connecticut and Ohio and lead busy lives with careers and families of their own.  The elder Smiths have always been highly independent and determined never to become a burden on their children.  They've consulted with an estate planning attorney and have a financial advisor they trust.  Mr. Smith has always handled the bulk of the family finances and it was the Smith's financial advisor who first suggested that they consult with me regarding putting all of their day-to-day affairs in order so that if something happened to John, Jane would be able to take over.   As it turns out, that advice was incredibly important.

When I first met with the Smiths, they weren't sure exactly why their financial advisor had suggested the meeting since John was confident that all of their financial details were under control.  During that first meeting, we discovered that while John knew all of those details, that Jane had only a vague idea of what investments they had and had no idea what the password was for their online banking service which John used to pay most of their bills.  She also didn't know where the insurance policy papers were kept or much about what they covered.  Finally, we discovered that Jane did not have a credit card in her own name.  During that first meeting, we discussed the various things that need to be done so that Jane could take care of the family finances in the event of John's incapacity.  By the end of that first meeting, the Smiths agreed that their financial advisor was right and they needed some help getting their affairs organized.

I use a very detailed approach to helping clients to organize their affairs, the goal of which is to assemble all of their critical information in one place for easy access when it's needed.   As we worked through the various topics, we made a list of all of the things that had to be done, the documents that had to be found, the bills that had to be paid, and the decisions that had to be made.  Over the next several weeks, I worked with John and Jane to make sure that everyone stayed on track.   The end product was a computer flash drive that contains all of the critical information, including scanned copies of important documents.  I also prepared one hard copy version of the information in a binder since Jane is more comfortable with holding things in her hands than with accessing them on the computer.  In addition to the things you'd expect to find, like account numbers, passwords and copies of military records, this repository also lists important vendors like the air conditioning company with which the Smiths have a service contract and the name and phone number of the dog walker for their beloved schnauzer Sam.   The idea is that if something happens, the Smith's daughters (or another trusted person) can quickly take over.

In the Smith's case, we needed for Jane to apply for a credit card in her own name, so that she would have access to credit if something happens to John.  We also discussed the Smith's end-of-life wishes and they decided to meet with a funeral director to make pre-need arrangements so that no one had to guess what they would have wanted.  Finally, we prepared documents that permitted the Smith's daughters to have access to information about their various accounts in the event that was necessary.

As the final step in our process, I facilitated a conference call between the Smiths and their daughters.  The stated objective of the conference call was to bring the girls up to speed in the event that both of their parents became incapacitated at the same time.   While John and Jane did not want to turn the flash drive containing all of the information over to their daughters immediately, they did want them to know that this resource existed and where to find it.

As luck would have it, within several months of completing this effort, John suffered a stroke.  While he is recovering well, Jane was able to easily step in and take care of the day-to-day matters that had previously been John's domain.  The fact that the Smiths had prepared for this in advance meant that both were less stressed than they would have been during an otherwise difficult period. 

©2010 LifeBridge Solutions, LLC.  All rights reserved.

Aging Parents: Tips for Making the Most of a Holiday Visit

 

Visiting your aging parents over this holiday season provides a wonderful opportunity to create memories and to take a good look at how they are doing.  Make sure you take advantage of this time to do both, especially if you live at a distance and don't get to see them often.

Perhaps the most important objective for your visit is to create memories.  After all, who knows what next year will bring?  One way to do this is to resurrect old traditions.  Maybe your mom always baked Christmas cookies when you were young, but she hasn't done so in years.  That's something you can do together, all the while chatting about the holiday in years past.   Another approach is to establish new traditions together.  Not only will these new traditions become part of your family lore, but they allow you to engage your parent in a new way.  One way to make sure your visit is full of energy is to involve the younger generations in this memory creation marathon.

Of course, if you're like most of us, you have a list of tasks you hope to accomplish for mom or dad while you're visiting.  Perhaps Dad needs help cleaning out the garage, or Mom can use some new clothes.   Maybe it would be helpful for you to accompany your parent to a doctor's appointment or to take care of some banking.   Whatever the task, taking care of some ordinary activities with your parent will give you a good idea of how he or she functions on a daily basis when you're not around.

During your visit, it is critical that you are a careful observer of both your parent and his or her surroundings.   Observe both what Mom is doing and what she's not doing.  Sometimes your best clue as to your parent's status is noticing the things they used to do with ease that they're not doing at all.    For example, if Dad used to love to garden and the yard is a mess, that's worthy of your attention.   Look for signs of deteriorating health, such as weight loss, recent ER visits, failing vision or hearing, or an empty refrigerator.  Signs of safety or mobility concerns include recent falls, unexplained bruises, medication mishaps, or leaving the tea kettle on all night.   Is Dad having trouble climbing the stairs to his bedroom?  Does Mom wear her cane like a bracelet?  Financial issues might be evidenced by piles of unopened mail, past due notices, or medical paperwork unopened or in piles.  Perhaps the home looks different than it has in the past, with lots of clutter or maintenance and repairs ignored.

A holiday visit can be a wonderful time to engage in dialogue about these matters with your parents, siblings, or other family members if you choose the right time and approach.  The right time is NOT at the dinner table on Christmas Eve or in the middle of the latke party on Hanukah!  Rather, look for less formal and quieter times or even go so far as to create opportunities.   A car ride or long walk can be a great time to talk, as can be a mother-daughter visit to the nail salon or spa.  And remember, a dialogue means that everyone gets a chance to speak and that you're having a conversation, and that it isn't necessary or even desirable to reach any conclusions.  There's time enough after your visit to work through details or logistics by telephone or email.

Finally, remember to use some of your visit to help you plan for the future.  Take home a copy of the latest yellow pages.  This can be very helpful if you need to marshal resources for your parent from a distance.  Get to know a few of your parent's neighbors if you don't already know them and make sure to take their phone numbers home with you.   Make a list of important phone numbers, such as your parent's doctors or providers of household repair services.  Anything you can do to be prepared for the day to day "crises" will help keep your stress down later on.

Above all, remember to enjoy the time with your family. 

©2009 LifeBridge Solutions, LLC.  All rights reserved.

What Is A Daily Money Manager?

 

Dear Sheri:

My husband recently passed away and he always handled our household bills and budget.  I don't even know where to begin to get everything in order.  Is there someone who can help me with this?

Intimidated Irene

Dear Irene:

First off, please accept my condolences to you on your loss.  It may help to know that your situation is not at all unusual.  Often, one spouse handles the family finances.  This works out well from the standpoint of division of labor, but leaves the other spouse at a real disadvantage when the situation changes, especially if it is a sudden and unexpected change.   As a new widow, I'm sure you have a lot on your mind, not to mention the piles of paperwork you're probably handling to settle your late husband's estate.

Fortunately, there are professionals who specialize in helping people in your situation.  They are called Daily Monday Managers, or DMMs.  DMMs offer a range of services, including helping you to manage your mail and set up a system for paying your bills, assisting with check writing and maintaining bank accounts, helping  you create a realistic budget and stick to it, and developing a tax planning and organization system.  In addition, many DMMs have expertise in medical billing advocacy and can make sure you are paying only those medical bills that have been correctly billed and processed.  A DMM can also help you with the many tasks that are necessary to settle an estate, including obtaining various records, closing accounts, and gathering items needed by attorneys and accountants.

Be sure to choose a daily money manager who is bonded and insured.  Also, be sure the person you choose specializes in working with older adults and their families and is not simply a bookkeeper for businesses.  Many DMMs are members of a national organization called the American Association of Daily Money Managers.  You can learn more about this profession, as well as search for a DMM to help you, by visiting their website at http://www.aadmm.com.

Does Your Aging Parent Need Help With Medicare?

Have you ever walked into your aging parent's home and seen a stack of Medicare papers on the kitchen table?  Has the thought crossed your mind that maybe you should have these papers come directly to you since they seem so confusing to your Mom?  Is your Dad asking you which Part D drug plan he should select, or whether he should consider a Medicare Advantage program?  Have claims been denied that your parents thought were for covered services?   If so, you're not alone.  Many seniors find dealing with their medical paperwork to be overwhelming.  

Dealing with the sheer volume of medical paperwork can be intimidating for many beneficiaries.  It is important that the explanations of benefits that are received from both Medicare and any supplemental insurance policy be reviewed promptly and if errors are detected, those should be reported immediately.  Similarly, if claims are denied, they must be reviewed and possibly resubmitted if you believe they were denied in error.  Time is of the essence for these matters, since there is a time limit for appealing the carrier's decision.  If you decide that handling these tasks are too much for your parent, you might consider handling it for them or enlisting the help of a medical billing advocate who will review all of the paperwork on a monthly basis, ensuring that your parent is getting the benefits for which she has paid.   In either case, you should be aware that Medicare will only send the paperwork to the beneficiary's address on file with the Social Security Administration or to a properly documented Representative Payee.  (Further information is available at http://www.ssa.gov/.)

What about if your parent simply needs help selecting the right plans?  Each year, Medicare-eligible people are allowed to switch their plan during "open enrollment".  This process begins on November 15th and ends on December 31st.   The best place to start is the Medicare website at http://www.medicare.gov/.   There you can learn about "original Medicare", as well as about "Medicare health plans", "Medigap policies", and "Medicare prescription drug plans."  Which offering is right for your parent will be determined based on a number of factors, including their overall health, finances, and the degree of choice they desire.  You may find that while one approach works well for Mom, Dad is better off on a different plan due to the maintenance medications he takes.  It is perfectly fine for your parents to each select the coverage that works best for him or her as an individual.  Again, if you find that this selection process is overwhelming, a medical billing advocate may be a helpful resource.