Elder Care Blog

Concierge Medicine, A Real Value

2010-02-17T14:41:00.000-08:00

The old adage is true, "You get what you pay for". Some primary care physicians, motivated by sheer exhaustion have decided to trade quality for quantity. The HMOs have had an effect on all medical practices to the point that many patients have grown used to crowded waiting rooms, lengthy waits in the office and a rushed visit with the doctor.

Concierge Physicians charge an annual fee (around $1,500 per year) to the patient, enabling the doctor to reduce their practice from about 2,000 patients to 500 patients. Now the doctor can be available for their patients who need to be seen right away, can take time to visit patients in the hospital and if needed, be on call 24 hours. Best of all, they can really spend quality time with their patients.

As a care manager, I offer this high level of service and I can do it because I do not have hundreds of clients. I appreciate the opportunity to work with concierge doctors who are available to the patients we have in common, immediately. If I visit a client and find that their new medication is making them sick, I want to have instant access to their doctor. I do not want to hear, " Go to the emergency room", like so many doctors now say to their patients.

In a perfect world, we would all have immediate access to our doctors. But in this world, if you want or need VIP treatment, you can have it, for the cost of one Starbucks coffee a day. If you do not think it is worth it now, wait until Medicare cuts physician billing AGAIN and they have to take on even more patients to make up the difference.

Many people think it should not be necessary to pay for extra service, but we do it all the time. We pay more for the box seats at the concert, we pay more for an upgraded hotel suite. We pay more for first class seats on a plane. If you feel you want upgraded medical care, it is now available and I feel, well worth it, especially if you have chronic medical conditions.

About Health Care Reform

2009-11-03T13:58:00.000-08:00

I am normally not the political type, but this Health Care Reform issue has really inspired me to at least launch my perspective into the blogisphere. I cannot believe how many people actually believe that by offering a "Public Option" we will somehow be offering FREE health care coverage to a) illegal aliens b) rich people or c) everyone, including those who can afford to pay for better coverage, thus causing the insurance companies to go out of business. It is unfortunate that fear mongering talk show " entertainers" ( not journalists) are disseminating such misinformation to the public. I want to shed some light on these matters as I see them. I am a professional advocate who is always helping senior clients find a way to cover their health care costs, so this is what I know from actual experience:

1) The only illegal aliens who receive Medicaid are those in the hospital ( coming through the emergency room), those remaining in the hospital due to brain injury or trauma, infants, pregnant mothers and frail elderly who are in nursing homes and have lived in the country documented for over five years. If they are illegal, documentation is often impossible to get, so this happens rarely. Every other illegal person who needs medical attention IS TURNED AWAY.

2) Medicare is a " Public Option" for our aged citizens. They do not have to accept Medicare. They can keep paying for and using another private insurance. Most people choose their public option and then buy a supplemental policy to pay for what the government will not cover, or they pay out of pocket for those "extra" or "luxury" services. Medicare is for every senior regardless of income or assets. Our government, at the risk of seeming like a socialist entity decided to ensure that every elderly person had some basic coverage because they knew most people would not save for their own medical expenses. How much have you saved for your golden years?

3) Social Security is another socialistist government intervention initiated by a wise President who knew that unless the general public were forced to save for retirement, they wouldn't do it or would not put away enough. Have you saved enough for your retirement?

4) A Public Option is an alternative for many hard working Americans who cannot afford health insurance, not even an HMO or who may have a pre-existing condition rendering them ineligible for insurance. Why is it that only the very poor, very young or very old in this country are allowed to partake in a government health care program? And yet it is the poorest and oldest people I know who are ranting against equal health care for all. All Americans deserve the option to have the most basic level of medical care. If we want more than the basics, we can pay for them. That is how Medicare and Medicaid work.

5) Some actually believe that there is not enough money in this country for Medicare, Medicaid and Social Security. To that I say only one word: NASA! We have billions, not millions, billions to invest in blowing up part of the moon to look for water, research on Mars and another planned moon walk. This country has a priority problem, not a money problem. We have a lobbist problem and a lawsuit problem and yes, an insurance problem. Allowing the health insurance lobby to become so powerful, our doctors to feel they are the elite and the lawyers to sue doctors and hospitals ad nausium, is a problem. Please do not worry this country will become socialist or communist. That would mean all citizens are seen as equals and there is no chance of that happening any time soon.

6) You can be a capitalist and still be your brother's keeper. As a for -profit business owner, I charge for the health care consulting I do. That said, I have so many poor, pro bono clients that I formed a non- profit corporation to care for them and raise money for them. If every successfull capitalist started even a modest non- profit company to care for the less fortunate or those who are elderly and have no family support, they would be doing their part. We can all do our part and together help our communities. Visit www.EQOLPalmBeach.com and www.vipcaremanagement.com to learn more about what I am doing. Let's loose the lables: republican, democrat, socialist, capitalist and just be citizens and take responsibility for ourselves and a few others.

When Elders Are Financially Exploited By Friends, Family and Caregivers

2009-03-27T06:53:00.000-07:00

It is a sad fact that most people who financially exploit the elderly get away with it. They often find it so easy that they do it time and time again. Each time the Exploiter becomes more and more bold. They act as though they are entitled to this money and no one else deserves it. This is why they must be prosecuted. There will be another victim.

Prosecuting these crimes is difficult for the State Attorney because of how it is done. In my career as a Professional Geriatric Care Manager in South Florida I have noticed a definite step-by-step process, almost a formula, that these Exploiters use to separate elders from their life savings. In many cases the Exploiter actually gets permission from the elder to take their money. Because of this, it can be argued that the elder "allowed" their assets to be taken and therefore, no crime took place. Furthermore, to argue that an elder was easily influenced by the Exploiter is to imply that the elder is incompetent and perhaps should not be in control of any of their finances. Few elders want to admit that. Instead they justify the theft or even cover it up. Once the elder realizes that they have been victimized, they may feel responsible, guilty or embarrassed. Few will testify against the one who stole from them.

When we think of someone who steals from the elderly, we conjure an image of the stranger lurking around the ATM machine or scam artist selling bogus products. Since Investment Broker, Bernard Madoff "made off' with his client's millions, we have all become familiar with the term "ponzi scheme". But this type of financial exploitation is rare compared to the financial exploitation elder care professionals see every day which is perpetrated by an elderly person's friends, family and caregivers. In cases I have worked I have seen that THIS type of exploitation achieved slowly, purposely and in FIVE PREDICTABLE STEPS. It is often done so artfully, that the elder and others around them see it happening but cannot believe it is true. They ignore all the small telltales signs. When the situation finally explodes, the FIVE STEPS are then seen as clear as day. By then it may be too late to do anything about it.

Here are the STEPs. Learn to recognize them and you may prevent this horrible crime from happening to yourself or someone you care about.

STEP ONE: The Exploiter comes to the rescue - they become a caregiver or helpmate when the person suffers a crisis. They may do extra favors for the elder without pay and refuse to take payment even when offered...at first. The Exploiter will later remind the elder of the favors and cause them to feel indebted to them.

STEP TWO: The Exploiter convinces the elder that they are the only one who cares about their welfare. The elder is brainwashed to believe that the true family only wants their money.

STEP THREE: The Exploiter separates the elder emotionally and physically from their family. They bring in their own family to be the "replacement family". Next they tell the elder they are like family to them. The Exploiter may even start to call the elder " Mom" or "Dad". They may deny the true family access to calling or visiting the elder and cause others in the community to regard the true family as exploiters. The elder may never know about all the family's attempts to reach them.

STEP FOUR: The Exploiter gets permission to use the elder's credit card, ATM card or other money for a small purchase. Then they continue to use the elder's assets and transfer assets little by little to their own account or distribute assets among the Exploiter's family members. The Exploiter may shop for the elder but purchase items for themselves as well. They may take the elder out to dinner but also invite their whole family and have the elder pay for it. When the Exploiter's car needs repair or gas, the elder is asked to pay for since that car is used to shop or transport the elder. The elder will feel they have no choice but to agree.

STEP FIVE: Finally, the Exploiter will attempt to take legal control over the person. They may become Power of Attorney, change the Will to disinherit the family and bequeath assets to themself and or their family. A few years ago, I had a case where an attorney changed the Will of a confused dying woman to give her home and assets to an aide whom she had only known for two years. This was especially heinous because that lawyer had previously written the Will for the family and knew that the heirs existed. This family fought the caregiver in court and had to settle for about one tenth of their original estate. I testified against the the attorney and he has tried to retaliate against me several times since. A few weeks ago I testified in a case where a caregiver in her forties married a ninety- four year old man. She was previously his maid for about two years. She had a notary perform the ceremony in their living room while her children served as witnesses. This act automatically disinherited the elderly man's entire family. The marriage was challenged and annulled. The elderly man was deemed incompetent by a court of law and assigned a guardian of his assets.

The secret weapon these perpetrators use is LOVE, ATTENTION, FAMILY- LIKE CONNECTION and even SEX...all the things human beings need but may not get once they are aged. In South Florida, many seniors retire to this area only to find themselves thousands of miles from their original family when they need them the most. This isolation creates a dangerous opportunity for exploiters.

If someone you love has a person in their life, be it friend, family, caregiver, or even a trusted professional and you feel they are taking over that person's finances, lifestyle and even thought processes, get professional help! Contact a professional such as a Geriatric Care Manager or an Elder Law attorney and make sure someone contacts Adult Protective Services. The reality is that the police and State Attorney's office will need you to practically build the case for them in order for them to prosecute. The evidence may need to be gathered secretly in order not to cause the Exploiter to quickly move to STEP FIVE. Most importantly, take action immediately. Know that the elder will feel you are meddling and taking over. They will not thank you for this because they have already been convinced that the Exploiter has somehow earned their loyalty and their money. Act anyway because it is the right thing to do. If you need assistance for an elder in South Florida call me toll free at V.I.P. Care Management, Inc. 1-877-588-5158. http://www.vipcaremanagement.com/

2005-09-14T11:25:00.000-07:00

Financial Assistance for Elderly Veterans and Their Widows
Is A Well Kept Secret.
By Sonja Kobrin, M.P.S., C.M.C. Geriatric Care Manager

Ask an elderly Veteran if they are aware they may be eligible for a pension from the Veteran’s Administration and they will tell you “I’m not eligible because I was not injured in the War.” This is a common misconception which keeps many Veterans from tapping into a benefit they well earned by serving our country. The fact is elderly, disabled Veterans and their widows may very well qualify for large sums of money, but they have to apply for the funds. There are several Veteran pensions, but the pension designed to help elderly Veterans and widows pay for costly home health care or Assisted Living Facility care is called Pension with Aid and Attendance. It is actually two pensions in one. The two pensions combined can pay a veteran up to $1,674 per month and a widow can receive up to $960 per month. The amount one receives depends upon whether or not they are married, how much their medical expenses may be and their current financial and medical status. The pension is paid by check directly to the Veteran or widow every month as long as they meet the criteria.

The Aid and Attendance Pension is the government’s best kept secret. I cannot tell you how many seniors have told me that they called the Veterans’Administration and were actually told that this pension does not exist or that they do not qualify. For twelve years, I have assisted veterans and widows in obtaining these funds – they really do exist.

To get the maximum pension amount, a veteran must qualify medically and financially and must have served their country for at least one day during “War Time”. Also the Veteran must have been honorably discharged. Every case is considered individually. If a Veteran or Veteran Widow feels they may qualify, they can apply for the pension. The pension can take many months to actually be approved. The average waiting period is three to eight months. The first check will be retroactive to the date the application arrived at the Veterans’ Administration, therefore the first check may be for thousands of dollars. Subsequent checks will arrive monthly for the approved amount. This pension money can mean the difference between affording adequate care for an aging Veteran/ Widow or having no care at all.

As with any governmental program, success is all in the paperwork. The pension application is seven pages long and some of it is in essay form. It is the exact wording used in the essay areas that mean the difference between approval and denial. Also, the Veteran’s Administration does not tell Veterans about all the supporting documents that they would like to see. The better the medical and financial records, the better the chances are of approval. Including the right medical forms signed by a doctor is very important for approval. Also typical of governmental red tape is the frustrating lack of communication. Once the application is filed and in the process of being reviewed, it is nearly impossible to get an update or check on the status of the application.

In a perfect world, financial assistance for those who qualify should be easily accessible and easy to get. But the reality is that government agencies are inherently complicated and their application processes are never self explanatory or simple. Ignorance of the rules is no excuse and no one will tell you the rules. The rules are written somewhere, but the Veterans Administration is not allowed to give them to you. Seasoned Eldercare professionals can often navigate these processes for you. They may charge for their services, but to attempt to do it yourself and have your application denied, will cost much more money. The Veterans’ Administration supposedly employs staff to help Veterans and their Widows apply for these pensions for free, but it is these very people who have told so many seniors that they do not qualify, when in fact, they could qualify if they made one small change. Perhaps the Veteran’s Administration is afraid that if they made it easy for every Veteran to apply, the pension fund would go broke. Given that War Time includes the Gulf War Era which began in 1990 and has not ended yet, I anticipate the pension fund will one day be either broke or impossible to get. For now, the money is very much available and attainable.

Here are the Aid and Attendance eligibility criteria for the year 2005.
1) Veteran served in the Military for at least one day during War Time or had a spouse who served at that time. Spouse’s are people whom you never divorced.
2) Honorably Discharged from the Military.
3) Currently has medical or psychological condition which make the Veteran or Veteran widow dependent on the aid or assistance of a non- family member in order to meet their daily care needs or they reside in an Assisted Living Facility
( not a nursing home). This claim must be supported by physician signed forms and medical records.
4) Financial: Have assets in their own name below $80,000 (if married) or below $50,000 (if single). The car and house does not count as an asset. Annual income below $16,955 (if single) or $ 20,099 (if married) after all medical expenses such as Assisted Living fees, paid caregiver salary, medications, medical transportation/ supplies, certain housing expenses, etc.

In many cases, if a person has a paid care giver, such as a nurse’s aide, or they pay an Assisted Living Facility, those expenses impact so greatly on a person’s net income, that they will meet the criteria for the income level.
If a Veteran or Veteran Widow has cash assets above the limit, they are allowed to place those assets into certain investments in order to have them “sheltered”. This sheltering does not have a penalty or “look back period” associated with it. Proper asset sheltering for Aid and Attendance should be done under the supervision of an Eldercare professional or Attorney well versed in Medicaid planning because one could easily ruin the chances of ever getting Medicaid if the VA pension planning was done incorrectly.

With a little professional planning, many Veterans and Veteran Widows can receive pensions that make a significant difference in the amount of care they receive. After all, the reason for this particular pension is to assure that a Veteran or Veteran Widow does not live in a substandard environment in their old age. It takes a little work to apply for this pension, but anything worth having usually does.