 LTC Bullet: Last Until LTC Friday, December 2, 2022 Seattle— LTC Comment: The question of how to obtain and pay for LTC is moot unless you survive long enough to need it. A guide follows the ***news.*** *** STEVE MOSES FEATURED IN HEALTH CARE NEWS: 11/18/2022, “More Families Depend on Medicaid to Pay for Long-Term Care,” by AnneMarie Schieber, Health Care News Quote: “Medicaid is the government’s health care safety net, but for LTC, it has become a hammock, says Stephen Moses, president of the Center for Long-Term Care Reform and author of the Paragon report, titled ‘Long-Term Care: The Problem.’ ‘The common wisdom is you have to become impoverished before the government helps you with long-term care, but the truth is very different,’ Moses told The Heartland Daily Podcast on November 1. ‘I call it “the fallacy of impoverishment.’” The 40-page report shows how liberal enrollment policies disincentivize families from saving for LTC and how dependence on Medicaid and Medicare has compromised care and driven out more innovative, cost-efficient options. … It is critical for Congress to start pushing for private options now, says Brian Blase, president of the Paragon Health Institute. … Moses is working on a second report on solutions.” LTC Comment: Check out the article and the podcast. Then keep an eye out for “Long-Term Care: The Solution,” forthcoming from the Paragon Health Institute. ***
LTC BULLET: LAST UNTIL LTC LTC Comment: Hospitals and long-term care are joined at the hip. One of the reasons America has a big nursing home industry is that policy makers sought to moderate Medicare expenditures at the outset in 1965. Paying for sub-acute and rehabilitation in skilled nursing facilities through Medicaid reduced higher Medicare hospitalization costs. But making the transition from acute to long-term care has always been a challenge. Often families are left with an urgent, high-pressure need to find a suitable nursing home placement when Medicare coverage runs out, private funding is unavailable, Medicaid beds are scarce and eligibility uncertain. But before you even get to cope with those issues, you must survive the hospital. So, when I read the following essay by LTCI author, trainer, producer and all around industry maven Margie Barrie, I thought it’s something all LTC Bullets readers should see. Margie’s story is all the more poignant given her and her husband-patient Bernie’s long active involvement in the LTC insurance business. Too much of what she says and warns is familiar to me as one who has managed hospitalizations for late parents and wife. In today’s government funded and regulated health care system, the funder (Medicare or Medicaid) becomes the providers’ customer, getting most of their attention, instead of the patient who needs care. Lesson learned. Don’t surrender to medical or bureaucratic authority. Demand clarity, reason and respect. A much abbreviated version of the following piece was published by ThinkAdvisor. We offer this unabridged account with the author’s permission. “8 Steps to Maneuver Through a
Medical Crisis with a Loved One” I started writing this article while sitting by my husband’s bedside in the hospital. The last few weeks have been a medical nightmare. My purpose is to share what I have learned the hard way – strategies needed to successfully maneuver through a medical crisis with a loved one. Here’s what happened: Week 1 - My husband Bernie had emergency gall bladder surgery. It was very badly infected, and he had sepsis. With the hospitalist system now in place in many hospitals, you’re assigned a surgeon in the emergency room. I will call him Dr. S. Week 3 - We had a 9 a.m. follow-up appointment with Dr. S. Bernie was still having pain and very weak. LESSON 1 – Be assertive. If you think there is a problem that is not being addressed by the doctor, don’t take no for an answer. Speak up and listen to your gut feelings. Dr. S. found that the incision was badly infected. He drained it and said Bernie should return home and a home health care nurse would visit daily to check it. I replied: “There is something really wrong here. Please do additional tests.” Dr. S. disagreed. I insisted. And finally he replied – in a very aggravated tone - that I should take him to the emergency room if I was worried. That’s what I did. After numerous tests, we were informed that the sepsis was worse, and that Dr. S. would do emergency surgery the next morning. If I had taken him home - like originally advised – my husband probably would have died. LESSON 2 – Take copious notes. If possible, record the conversation. The following morning, a surgery that was supposed to take one hour lasted three. When Dr. S. found me in the waiting room to discuss the surgery results, I was anticipating good news. I was shocked to hear what he had to say . . . that he had to do another emergency surgery in two days. I did take some notes but was so horrified that I missed a lot of what he was explaining. After Dr. S. left, the woman who had been sitting nearby came over and hugged me. She had overheard the conversation. Then I asked her to help me recall what Dr. S had said so I could take more notes. Keep a notebook. Write down the name of every person providing medical updates and what they said and when. If they know you have their name, they immediately feel accountable and will be more likely to provide the attention you want and need to stay on top of the medical crisis. LESSON 3 – Doctors and other medical personnel seem to sugarcoat the patient’s condition. Probe to get the hard facts. The following day, I called ICU for an update and was told he was doing fantastically. Meanwhile, he was on a breathing tube and heavily sedated. I wanted to know the truth. I finally drove to my primary care doctor’s office to ask him in person for more details. I then asked: “Could my husband die from this and should I have my sons fly in.” He hesitated and then said yes. Also, I learned that there were a number of small blood clots in his left leg. That could result in a stroke. Ask why various medications and IVs are being used. LESSON 4 – Be aware of the limitations of the hospitalist system. Many hospitals are now using the hospitalist system – where every doctor seeing a patient is a specialist in a certain area. From a management perspective, it is touted as providing continuity of care for an in-patient. However, from a spouse’s vantage point, it’s frustrating. I never could get in touch with any doctor who could provide a comprehensive picture of all the problems. My primary care doctor is not allowed to see inpatients, because he is with an outside group practice. But he was able to access the hospital records and keep me updated. LESSON 5 – Take control when needed. When Bernie was improving and moved to a regular hospital room, I quickly realized that the doctors were only talking to him. He was also sugarcoating the facts so I wouldn’t worry. I needed to know all the facts. I have continually reminded my husband of that – and have now been calling the Case Manager and other key people to make sure I’m in the loop. That is very important. LESSON 6 – Memorize these two magic words - Unsafe Discharge. Even if a hospital wants to discharge a patient – primarily because of the revised Medicare payment system - you can protest and insist that the patient stay longer. The words to use are “Unsafe Discharge.” And then the hospital needs to keep the person for the longer period of time while the appeal is underway. It was important that my husband be admitted to the hospital’s rehab area rather than going to an outside facility. First, the care is excellent; and two, Dr. S. wanted to continue to monitor his progress. A friend advised me to protest a discharge until my husband was strong enough to get three hours of physical therapy a day, which is the admission requirement. I called the Case Manager to introduce myself and told her upfront that I would appeal any discharge plans until my husband was approved to go to their rehab facility. And it worked - he has now been moved there. LESSON 7 – Use the CaringBridge website to provide updates. It’s wonderful to have family and friends concerned about my husband’s progress, but it’s overwhelming to be fielding numerous calls, emails and texts in addition to working and going to the hospital every day. This free website enables you to provide a journal entry and people can then comment. I read it every morning – all this support and love are so appreciated. LESSON 8 – Take time for yourself. You will need it to survive this. Many days when I leave the hospital I am exhausted and stressed. My solution right now – gourmet chocolate ice cream. It does help. Margie Barrie, an agent with ACSIA Partners, has been writing the ThinkAdvisor LTCI Insider column since 2000. She is the author of two books and a frequent conference speaker. LTC Comment: Get well soon, Bernie! |