Dorothy’s Dilemma – Up against the medical system

Dorothy is in her 80s, a retired librarian and a firecracker of a woman. Last summer she became quite ill. One thing led to another and she was hospitalized for several weeks. Unable to help, her doctors sent her back to her apartment in an assisted living facility with an order for hospice care. Of course, the hospice folks determined that she wasn’t eligible for hospice care. Her friends made arrangements for in-home 24/7 nursing care. The nurses were kind and competent, but the assisted living facility wouldn’t allow them to transfer Dorothy to a wheelchair – something about liability exposure. Dorothy was confined to her bed, week after week after week, and she began to fail.

To add insult to injury, you cannot imagine what this level of care cost. Well, maybe you can, but I was astonished. In addition to her monthly rent and service fees, Dorothy paid $18,000 a month for nursing care. Yep, that’s right. Eighteen thousand dollars a month!

Dorothy has a wide circle of friends of all ages. Four of us got together to figure out what we could do about this situation. We couldn’t persuade the assisted living facility to allow Dorothy’s nurses to move her to a wheelchair. We couldn’t reduce the number of hours her attendants worked. We couldn’t convince Dorothy’s doctor (who hadn’t seen her since she was discharged from the hospital) to authorize her transfer to a skilled nursing facility.

We did what we could. We visited. We helped her execute a new will and an advance health care directive (called a living will in some state). Mostly we felt helpless and frustrated as Dorothy continued to decline.

And Then There Was Jill – Geriatric Care Managers as Advocates

We hired Jill to help us help Dorothy. A retired nurse and a certified financial planner, Jill is a geriatric care manager. She met with Dorothy privately to understand Dorothy’s wishes; she reviewed Dorothy’s medical records (which were incomprehensible to us); she met with us to formulate an action plan. And then she went to work.

With her lilting British accent and good humor, Jill became Dorothy’s advocate. She conferred with the assisted living facility on Dorothy’s behalf. She helped Dorothy to fire her doctor and to hire a new one, a doctor who supported Dorothy’s move to skilled nursing. She negotiated with the insurance company for the necessary authorizations. She kept us in the loop.

Four weeks later Dorothy was moved to a nearby skilled nursing facility with an excellent reputation for compassionate care. The cost? Seven thousand dollars a month, all inclusive.

Here’s the Best Part – Save Money on Long-term Health Care

The folks at the convalescent home immediately got Dorothy out of bed and into a wheelchair. She’s up most of the day now, interacting with people, sitting in the garden, receiving visitors, taking her meals in the dining room. They even bring her to church on Sundays. Dorothy looks like her old self – smiling, laughing, cracking jokes, noticing what’s going on around her.

Lessons Learned – Prepare for Long-term Care

First, Dorothy has a durable power of attorney naming her best friend as her agent. That’s what allowed us to take action on Dorothy’s behalf. If you or your parents don’t have one, get one, now. Most states have a ready-made form you can use. Check the Nolo Press website (www.nolo.com) or a good stationary store. Contact your bank and other financial institutions to see if they provide their own forms. And be sure to update your durable power of attorney every five years.

Second, a reputable geriatric care manager can be an invaluable guide when you are trying to decipher medical gobbledygook and insurance jargon, and a tireless advocate when negotiating with doctors and facilities and insurers. Jill charged a reasonable flat-fee for a care plan and an hourly fee to follow up. Her help was worth ten times that amount, easily. For recommendations, ask your hospital or check with your local city or county Commission on Aging or contact the National Association of Professional Geriatric Care Managers at www.caremanger.org.

Third, like most people her age, Dorothy does not have long-term care insurance. If you’re in your 50s or 60s, now might be a good time to consider long-term care insurance for yourself and your spouse. To begin, request a copy of “A Shopper’s Guide to Long-Term Care Insurance,” a free booklet published by the National Association of Insurance Commissioners (www.naic.org), or contact your local Health Insurance Counseling and Advocacy Program (HICAP) for objective information about long-term care planning. Check with your financial planner, accountant and/or insurance broker to determine if long-term care insurance is right for you.