Eastern Agency on Aging: Editorial Page

Long Term Care Decisions...Who Will Make Yours?  by Noëlle Merrill, Executive Director

When is the right time to start planning for your long term care needs?  It is never too early. This month I want to talk about this sensitive topic by relating the story of my own family’s recent experience. 

Discussing who will care for you and how is almost as difficult a topic for aging parents as the birds and the bees conversation was when their children were young.  I think many parents, when queried by their own children about their plans when they become too frail to live on their own, respond as my in-laws did by saying “don’t worry, we have it all worked out.”  I have heard this over and over again from my friends when they talk about concerns they have for their own parents.

What happened in my family’s case is that long term care plans were never made because they felt that it was too early.  Mind you, they were both in their 80’s last time they repeated this mantra to us.  My father-in-law would often say, “we are thinking about moving to a progressive place, where you can age in place.”  He said this as his wife became so frail that she needed nursing home level care. To their credit, they did take care of many things such as their wills, powers of attorney and they even had purchased long term care insurance.  What they never considered is who, how and where  care would be provided for one of them if the other passed away. 

Then the unthinkable happened.  My mother-in-law became bedridden due to a mix of ailments and my father-in-law decided to care for her in their home. Staff hired by their children were let go when we left.  A weekly trip to the emergency room became commonplace, but still he chose to do the caregiving alone.  They owned a home in an adult community iin a state very far from all their children and with no aging in place options such as assisted living or residential care.  Many of their friends had already passed away or moved to facilities elsewhere.  After a particularly difficult month of care for his wife, my father-in-law succumbed to a reoccurrence of cancer with very little warning.  His wife was left alone and bedridden with almost no options.  She couldn’t stay in their home anymore and had to leave.  Her children had no option but to make decisions for her because the only place she might be able to stay in her home state was a nursing home and this choice would have broken everyone’s heart.

We brought her to Maine.  Her home had been in the southwest for almost 30 years and in a matter of 10 days after her husband died, she found herself in Maine, surrounded by strangers in a place that she did not choose.  I don’t think they would have believed this would happen if you had asked them even two months ago.  Many couples think they will pass away at the same time or that the frailer person will succumb first.  Eastern Agency on Aging’s Family Caregiver staff tell me that what happened in my family is a common story.  The healthier spouse dies first because of the hard work and stress involved in caring for a loved one.  The spouse left often has no choice but to allows others to make the decisions.

I hope that readers will think about re-opening those conversations with family members regarding the long term care choices they would prefer. 

And if you want to learn more about the options that are available in any given situation, call Eastern Agency on Aging.  We strive to be the best source of information, options and services for everyone as they grow older. 

Something to Consider before Enrolling in a Medicare Advantage Plan

            Medicare Advantage Plans, or Medicare Part C, have been presented to America’s seniors as an alternative to Original Medicare with a prescription drug plan and a standard medigap policy.  And it does sound good.  Many cost little more than the Part B premium, and the coverage can be comparable to what people are used to, depending on the type of plan.  However, Medicare beneficiaries need to be sure it’s the right decision before they make the change to a Medicare Advantage Plan.

            Now, I’m not trying to say that people shouldn’t choose Part C. It is a personal choice, and while I’ve been learning a great deal about Medicare in the few months I’ve been working for the Eastern Agency on Aging, I certainly don’t know all there is to know.  My father, who lives in New Jersey, has a Medicare HMO plan with a well known national insurance company.  He’s happy with the coverage, and it meets his needs.  Unfortunately for the people who live in this agency’s coverage area, the same variety of plans that are available in other parts of the country—indeed, even other parts of the state—aren’t available here.

            But still, my dad knew about the plan before he got into it.  (In fact, the availability of this plan has factored into his decision to move to different areas.)  He knew what to expect, and he didn’t have to worry about trying to cancel his enrollment and go back to original Medicare or about switching to another plan.

And switching plans during the Annual Coordinated Enrollment Period, November 15^th to December 31^st, or during a special enrollment period is an option, but it’s not necessarily without complications.  Over the past month I’ve met with two people who had decided to participate in a Medicare Advantage plan and quickly decided to go back to Original Medicare.  The plan had a thirty day cancellation policy allowing the return without penalty.  One took two weeks to decide to go back, and the other only took a couple of days.  Both cancelled during the thirty day window, and both have had months of aggravation since.   I’ve helped both of them file the same type of complaint with Medicare—within days of each other.

Both people received timely letters from the plan acknowledging their disenrollment status and stating that they would be returned to original Medicare on the same date.  Both of them also received letters from the Centers for Medicare and Medicaid Services stating that their coverage under original Medicare would continue.  The problem is that there is a four month gap in the dates for both people.  Four months of doctor’s appointments and even multiple hospitalizations and no one to bill for them.  The plan tells the medical providers to bill Medicare, and Medicare tells them to bill the plan.  Luckily, for both people, the providers have understood the situation.  They know what a complex system Medicare is and how long things can take.  They’re helping their patients deal with it.  They’re letting them take the time with Medicare—and get our help—while the bills pile up, unpaid.

But can you expect that kind of patience from your providers?  Do you want to have to rely on it?

I’m not saying that this will happen to everyone, and I don’t want to scare people away from Medicare Advantage Plans.  There are many satisfied customers whom we haven’t heard from because they don’t need help with Medicare’s automated phone system or help navigating through a plan’s complex contact information.  I’m saying that it would be wise to compare plans and insurance companies.  Research them and get some objective information.  Perhaps learn about their customer service rankings.  Try to be as sure as possible that the plan is right for you before making a change.  But you still never know until you do it.

If you have had problems, though, or even if you would like help finding information about different plans.  Come into the agency, e-mail us, or give us a call. We can help.

Ted Perrin

ADRC Information and Referral Specialist