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Mandated Home Healthcare Transition, this should be interesting!


1967stingray

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Monday morning, bright and early, the nurse from our newly chosen agency came by to "evaluate" Ray for Long Term Managed Care aka LTMC (formerly known as the Lombardi Program to us, or Money Follows the Person to most of you). Turns out she was really just here to sign us up immediately, no qualifications required. But she was so helpful, she stayed for two hours, and I have high hopes for the future now, at least as far as homecare. She told me of things I should have been informed of long ago: Best of all, that all Ray's everyday supplies like adult underwear, inserts, gloves, sanitizer, wipes and so on are totally covered by Medicaid. All you need is a prescription from his PCP, which she is taking care of. Then I call her place once a month and order as much as I need, and it will arrive via UPS a day or two later. Just think of all the money I've been wasting!

 

She initially tried to talk us into adult daycare, even mentioned the same facility as the Dominicans suggested last week. But it's as far away as the two I interviewed back in April, while meanwhile being in a somewhat seedy area. Probably the cheapest option. Nope, I told her part time in-home care is what we need and she said fine. She gave me way more aide hours than I really want, but I won't squabble about that right now, after all the trouble I've had. It will be a bit of an adjustment after having no help at all for the past year, but we'll sort it out. However this time I'm getting a spy cam for the bedrooms, I learned my lesson about that the hard way.

 

She also told me that hearing, vision and dental is totally covered through them, not just the visits but eyeglasses, hearing aides, dentures and anything else needed. Just the dental is great, it is something Ray has been avoiding forever (way before the stroke), but I didn't push because of the cost. The biggest change of all will be that whatever nurse we are assigned will be in charge of all our appointments, so we have to do absolutely everything through her. But it will be by phone, they don't go out in the field, so they are always available when we need them. Hallelujah! So tired of the weekly visit routine: We see enough doctors that the nurse visits were seldom useful, just us sitting around waiting for her to show up two hours late as usual, just to take his blood pressure.

 

They say in their brochure you can use any doctors you wish, but that remains to be seen. Our primary, definitely, we already have to go tomorrow to meet with him about the switch, an appointment which they set up for us. But I mentioned his ENT office, and our eye doctor, and the podiatrist, and she said they're not in their network. I know this is the latest thing that got Obama into hot water, guess it extends outside of Affordable Care. Maybe I can make a special request? She kept mentioning their network doctors in our nearby town, but none that I would pick on my own. Nothing I can do I guess, beggars can't be choosers (my new mantra!) Looks like Ray can keep his neurologist and his psychiatrist at least.

 

Then the strangest turn of events. It started with Pat our ex aide stopping by last week. I knew that she had quit the agency that supplies aides to the Dominicans; not enough clients they said, while they told us not enough aides, something's very fishy. So she is now looking for a job, and although she is a CNA she has applied to Home Depot and 7Eleven and the like. She visited for a good long time for a change and Ray was so happy to see her, he was all smiles. Then she told me something that I couldn't remember, it was called CD something, she told me to ask the new nurse about it. I forgot since I had no idea what it was. But the nurse brought it up herself, and I don't know if this is something new but it is called CD-PAS, stands for Consumer Driven Patient Aide something or other. Love those government acronyns. What it is, you can hire ANYONE to watch the patient, as long as they don't live with you. They don't even have to be certified, just someone you trust. And this agency will pay them directly for home care. So that's what Pat wanted me to find out about. And despite that one incident where I'm not sure I trust her 100% anymore, I think I might be able to trust her more than a total stranger. And she is more like a friend to Ray; I am so not looking forward to someone(s) starting from scratch and having to break them in.

 

But, to complicate things a little....as Pat had told me, her phone is "out of order" as it occasionally is. I guess she does the prepaid cell phone, and she may be a little broke right now, but how is she expecting to get a job without a phone? She is coming by next week though, to drop something off for Thanksgiving, she told me 10 times, so I will tell her then and see what happens. Our new agency starts Dec 1, so we have time to set it up. The nurse made a note and said she'd wait to hear from Pat for now.

 

Dec 1 is the official date of our transition, but the Dominicans are supposed to be in charge til then and overlap for 90 days after too, to help with the changeover. The new nurse called their office and told them we are switching as of Dec 1, which shouldn't be shocking since they are no longer an agency for aides anyway. Strangely, the Dominicans had called Friday to set up an aide for us, as a last ditch effort obviously, to come every Tues and Thurs for two hours. So I figure, three visits from him until the end of the month, at the very least. I went ahead and scheduled a way overdue haircut for myself, and was getting ready to call some girlfriends for lunch dates. But the day after the nurse's sign up call, I wait for the aide visit at the appointed hour although not with bated breath, and of course no call, no show. Same with the nurse, who usually comes the same day. Excuse me, you are still my agency at the moment, what a bunch of deadbeats. I will be writing up our whole history with them in the next few days and sending it to the proper authorities, just to get it off my chest. My experiences with them have been like the Three Stooges. I'm pretty sure they are getting paid for a lot more visits than they ever made. The nurse didn't show up for a month and a half last Dec and Jan, just for starters. They had a change in supervisors then so bet she figured she could get away with it, still burns me up. You call the office, get a machine, leave a message and never get a return call. I didn't complain at the time, they were going though a lot of changes so I figured they wouldn't care about me and my petty problems anyway.

 

So we see how it goes.......can't be much worse than what we've had to deal with so far! All the agency people who ever visit us are amazed at how much I know about their business, but how can you not? I feel sorry for anyone that doesn't have someone watching out for them, and researching all the options out there.

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I heard you about not knowing about all the options out there. It is a mess, what with insurance telling you what will be paid and not. After my stroke, I remember the thepies saying I get no help, Iam trying to hard, helping my self. She was correct, Thank God, for my family and friends.

 

I got in the crack, plus my doctor was not good, he just seemed to worry about getting paid, and putting me on new meds. Now I have a doctor who shows that she cares. She makes sure that I get all the help that is out there.

 

Yvonne

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stingray :

 

medical system along with insurance is scary in this country unless you have well persistent caregiver who is looking out for your interest, patient can just fall through crack & die. I am so glad you are not getting overwhelmed by al this chaos. I got it by just reading your blog lol

 

Asha

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Yeah talk about nutty. Our phone never rings at night (at least when there's no election in progress) but I just got a call from the old agency nurse...she always calls at 8:30 AM, but now wants to come tomorrow...plus the doctor's office; poor receptionist it's after 7PM but still on the job since 9AM. They need to move us up because there is some kind of giant emergency the doctor has to attend to, but we are obviously too important to actually cancel.

 

Meanwhile Pat the aide showed up out of nowhere today, to drop off some makeup for me (even though I don't wear makeup!) and now is bugging me about the CD-PAS job. Oy vey!! I have enough going on getting ready for Thanksgiving, it's going to be one of those holidays.

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Just when you thought it was safe to go back in the water! Glad you took a few hours off because the games are just beginning.

 

Colleen: that was good news on the LTMC application. I have had clients go through months of interviews and paperwork to apply and then have to wait to be accepted.

 

Thank you so much for taking the time to let us all know how things were going and also what was involved. Debbie

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Well at least when you get into Long Term Care, it's for life...or so the new nurse told me the other day. Scary, but also a good thing I guess. It was only easy for us because we were already on the previous (Lombardi) program. New name, with a few different rules. My main concern is if something happens to me, so it should be easy sailing for Ray if that day ever comes.

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Colleen - now this is making sense to me... all along i knew something is wrong.... here in ND- what you just described is how it works here.... non family - but i could choose ( if we were qualified financially ) -- but that is exactly what the plan would have been had others events in our life not came together.... finally something makes some sense to me.... follow up with your suspicions , something stinks in Dodge ( well NY anyway)... And I agree with your Pat issue - Ray loves her , and you are still not 100 % sure of the location ... it might show up some day- and always better to error on the side of "good" ...

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Nancy, here you can get paid to take care of someone unless you are the parent (of a child) or a spouse, you get paid from Medicaid I think. This CD-PAS may be a new twist, you get paid by the Managed Care agency, a lot of financial responsibilities are switching over to them. It's so weird, they set us up to go to the doctor today just to fill out some paperwork for this CD-PAS program. All the doctor (actually had a student doctor did most of the work) had to do is confirm Ray's limitations. So this is saving money for the state, how? I really hope that doctor appointments aren't being taken completely out of our hands now, they set us up for the afternoon so we were there for hours. It's worth getting up early to get there in the morning and not wait so long, Ray was getting kind of loud while we waited and waited in the examining room.

 

Welcome home, hope all is well at the homestead! And thanks for the advice on Pat, I figured everyone would say I was crazy....well maybe I am, a little, but it just fell into place so easily I figured I'd give it a try. I do have my eye on a spy cam though, just in case.

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the spy cam is a good idea just for almost any number of reasons... i mean even if you want to pop out to the grocery store and peek on ray .. like i do .. and there are low cost systems mine is costly because of the full package, but there are some 1 and 2 camera systems at sams club and i am sure your costco for like a 100.00 that you can hook into your iphone ( maybe a task for rays brother at thanksgiving?) and in all honesty it was reassuring looking in on the family .. dog on the chair , kid watching TV and Dan napping.... and i am not into spying even on my own family - but it was that reassurung glimpse... Pat is a good person, if she did in fact steal from you it is eating her up... she may be looking to repay you in other ways, and Ray likes her and seems to trust her, and as you said he had/has a sense about people -- if he thought she was really at fault - he would have let you know , that she couldnt even visit.. soooo i still think it will turn up...

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I'm looking at one that looks like a clock radio, that records a month's worth. With the CD-rom kind of thing to hold the videos, the whole package is over $100 but it has excellent reviews. That way if something happens, I'll have evidence this time, I want that more than anything else for the future. I would love to get something that I can peek in on Ray too; but I could kick myself that I don't have any way to see what happened that fateful day, good or bad. I really really want to stop thinking bad things about Pat. Now everything she does, I secretly think there's an ulterior motive, and that's no way to live.

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Pat is human- she is loud, funny,obnoxious ( sometimes) laughs a lot, loud - oh i said that ---lol-- and does she have ulterior motives yes... as humans we are the only creatures who plan- days , months , years in advance - not just to survive but to be happy ... so the question becomes , can you forgive ? Because i can guarantee - you will just get more of what you had with the ramen noodle guy ( unless you REALLY , REALLY luck out) at least with pat there may be a new limitation of trust for you- but her care of Ray is good - or Ray would let you know... but for the sake of sanity do assemble your valuables and place them in a area that is secure and or monitored... no matter who ends up with the job..

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No one's perfect, myself included. And I know this is a good lesson for me, to learn not to be so tied to material possessions when I'm going to have to leave them all behind someday anyway.

 

As we well know, she would never work out with Dan, but she and Ray are so alike. Loud, funny and obnoxious! Two peas in a pod. That said, I just added his Seiko watch to the lock down area too, she might be starting in a week or so at this point. It's only worth around $100, but lesson learned.

 

Oh the "ramen noodle guy", no that was a can of very saucy Spaghetti-Os or Beef A Roni actually, Pat is still a saint compared to him and his wife. Imagine if that was all that was available to us? Guess we should thank our lucky stars!!

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I don't know what's wrong with me... but I seem to be having trouble following blogs. I don't know if it's me or if maybe things are being talked about in chat, and referred to here, and then I am out of the loop and can't understand what is happening. Let me just ask... I have heard of 'money follows the person' before, and I wonder why we are not all doing it? How did you get to this point, was he in the rest home before, and now coming home? I'm not sure which piece of the puzzle I'm missing, but feel lost on trying to figure out what is happening and how it might apply to the rest of us. I'm also confused by the word MANDATED ... doesn't that mean something forced on you, like by the court, that you don't necessarily want? I hope you can share some light on me, so I can figure out what is being talked about with the correct idea of what's happening.

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Sandy, all this is involved with Medicaid which is why you don't know about it. I posted it here for people that are, or hope to be.

 

Money Follows the Person (a Medicaid program, so you have to be on Medicaid first of course) is based on the fact that it's cheaper for the government to pay someone to take care of the patient at home, no matter how much care is needed. They bend over backwards to provide you with anything you might need to accomplish your duties and keep the patient (and caregiver, to some extent) healthy and happy. This is something you arrange after the time the patient is released, or right before, I don't remember exactly when it was we signed up, but around the time he came home. It takes a few months initially to go through all the paperwork and evalutations. It is a long term care situation, so once set in place should be good for life, with annual evals being the only thing required.

 

"Mandated" Long Term Managed Care (mandated being my description), is basically the same thing as we've had but a new name, and new rules. This is tied into the Affordable Care Act and has been in the process of being phased in for us since January. It's a big learning curve for me, as well as the agencies, took most of the year for the pieces to fall into place. If we all had a choice, we probably would have given up and stayed with the status quo.

 

I'm only trying to share what I'm finding out as time goes on, and hopefully others will do the same. Just the fact that we can get our sanitary supplies free and delivered was something I felt I needed to let everyone know, since it's such a big expense when you're on a limited budget.

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Yes, we could probably make an extra house payment if not for the expense of his sanitary supplies.

 

Well, there are the 2 medicaids... the one for if you are just low income and then the institutional one. So, it sounds like you were saying that he was already in a facility on the institutional medicaid, and is being released to do it at home. I guess the part that is confusing to me is so ... you have to be IN one, to be able to get the money to follow you out? I mean, you can't be home, and say, well either the money comes in for this to happen at home, or he's going in, then I'll have to take him out so the money can follow him afterward. ?

 

I do feel this is a subject that we all need to be as versed on as possible, because life is a changing thing. Thank you for the lessons.

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Not exactly, there is only one Medicaid. Eligibility is always based on your income. When you do your income tax each year, that is what your income officially is. If it is below a certain set amount, you are eligible for Medicaid. Very cut and dried, down to the last dollar. You can only get institutional care through Medicaid if your income is where it has to be. And they recertify you annually, in case your income happens to go up, so it doesn't hurt to have a good accountant if you're borderline.

 

To get into this long term managed home care program, you have to be sick enough to need institutional care, couldn't make it on your own; but if you can arrange to be taken care of at home, with lots of oversight of course, that is what they prefer to do. It is a big money saver for them. You can get it before or after being discharged, whenever you make the decision of what is best for all concerned. We got it months after Ray came home, it takes a bit of time to get approved. Tons of paperwork, needless to say.l I never liked that odd name, Money Follows the Person, and was glad they called it something else here. Sort of nonsensical, like a program for simpletons. Every state has different Medicaid offices and rules, but that's the basic concept that they all follow, as far as I know. But I can only say what they do here in NY with complete assurance.

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I know income is what decides any medicaid... but I'm thinking regular medicaid is like income for low income families, where institutional medicaid (not usually used with the full term) is what covers being in a nursing home, and they expect to get your home to recover that nursing home bill they paid, once both husband and wife are gone. The wife can keep it while she lives, but they expect to get it after her. They used to take it right away, but it became a law something about you can't impoverish the healthy one, because the other one became in need. So, then the healthy one could keep it till her life was over. ?

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As far as I know, Medicaid is always based on income. There is no such thing as low income Medicaid, and better off Medicaid. No matter what, you make a set amount each year, and if it's under the government requirement for eligibility (which here is $20,000 or 21,000 annually, something like that, and I think that's the national figure too) then you qualify for help. They'll still take your home in the end, if you have one, or at least recoup the amount they've paid out, but at that point you probably won't care. They do keep track, that I know. Just like a mortgage.

 

Despite being placed in a nursing home, you may still have income from investments, trust funds, structured settlements or disability that would make your income too high. Check your last years income tax, bottom line, that says it all. The good news if, when the money runs out, then Medicaid will kick in. So you won't be kicked out when the going gets tough.

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low income medicaid means you have to have a low income (based on income) to get it. We are both saying the same thing. The difference was in medicaid as your income, and the version of it (institutional) that covers nursing home care. I am sure I heard about the institutional version here on this site somewhere. I am having a brain fart between medicare & medicaid nursing home coverage.

 

Are you saying that if you are that those on any medicaid will will expect them to take repayment from your home, even if you never go into a nursing home? Actually, we do not qualify for medicaid, I'm just trying to learn how it all works with nursing homes, be it medicaid or medicare.

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Medicaid is one single entity, if you are eligible they will take care of your medical bills. There are not two different versions, either you have it or you don't. Medicare is a totally different thing, you get that at a certain age (or when you are officially declared disabled) and that is based on what you paid into it all your working life. Coverage varies wildly, but doesn't cover everything by a long shot. I believe you have to pay about 20% of your bills? Or you pay Part C which is a set amount, like paying an insurance premium.

 

If you can get Medicaid as a secondary when you are on Medicare, things go a lot smoother, moneywise. That's what we did, I had a COBRA policy to cover us both until Ray turned 65, at which point I switched him over to the government. After all the taxes we paid over the years, it's only fair. He also has the VA as backup but so far we haven't needed to use them.

 

Whatever Medicaid pays out, they have on record. I'm not sure if they demand repayment from everyone, but recently we have a mother in our area who killed her three children and ended up in a psychiatric hospital, long term. Something happened where there was a multimillion dollar settlement on the crime, and she, or one of her many husbands, seemed to think they would have some kind of claim to it. Not so, Social Services said she owes them over two million dollars in care at this point. Not sure if they watch more low key, lesser paid people so carefully though.

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Although we can stay on Cobra till 2015, Bob is eligible for medicare at the 2 year mark, which will be the summer of 2014. I really don't know how I'll merge that in with medicare, or drop him from it and just do some medicares a, b, c, d whatever alphabet they force your thru till you're done. I also can stay on cobra till 2015, but hear the rates will jump after the first 2 years. We are paying $1080 right now.hmmmm..... All this insurance shake up is not helping sort this mess out, either. Fortunately, more will be settled by then and maybe I'll be able to see the way thru it.

 

For us, no, he gets too much disability to get any medicaid, so we'll have to do medicare & some other alphabet forms of it, or insurance plan.

 

I really just want to go to sleep and forget it, wouldn't that be a wonderful life... a caregivers vacation....

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Medicare A=hospital bills, there is a deductible of a bit over $1,000

Medicare B=doctor office bills, you pay 20%

Medicare C=you pay to get co-pay insurance if you wish, possibly through your current carrier

Medicare D=prescriptions, you pay 20%

 

Start researching a month or two ahead, and you'll figure it out.

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