Crisis Management

When Your Parents Begin to Need Your Help, What First Steps Should You Take?

Parent needing help

1. Visit the Area Agency on Aging for your area.  To find your Area Agency on Aging, go to www.n4a.org and input the zipcode of the area where your loved one lives.

2. Ask your loved one what will support them in living a higher quality of life?

3. Get a complete medication list together with the name of the prescribing doctor, name of the medicine, amount and how often taken.

4. Ask your loved one what insurance they have.

5. Ask them to tell you what doctors they have seen and when their next appointment is scheduled so you can accompany them.

6. Find out what hospital they would like to use and make sure it is in their insurance network.

7. Find out what legal work they have completed and who is named as the Healthcare Power of Attorney.  Have they filled out an advance directive?  If not, visit an elder law attorney to get this work started.

Congress initiated a Patient’s Bill of Rights in 2001.  The Senate passed the Bill of Rights which included an enforcement portion, however the bill failed when it went to the House of Representatives. 

The Association of American Physicians and Surgeons adopted a list of ‘patient freedoms’ in 1990 which was modified and adopted as a ‘patients’ bill of rights’ in 1995.  All patients should be guaranteed the following freedoms:

• To seek consultation with the physician(s) of their choice;
• To contract with their physician(s) on mutually agreeable terms;
• To be treated confidentially, with access to their records limited to those involved in their care or designated by the patient;
• To use their own resources to purchase the care of their choice;
• To refuse medical treatment even if it is recommended by their physician(s);
• To be informed about their medical condition, the risks and benefits of treatment and appropriate alternatives;
• To refuse third-party interference in their medical care, and to be confident that their actions in seeking or declining medical care will not result in third-party-imposed penalties for patients or physicians;
• To receive full disclosure of their insurance plan in plain language, including:

1. CONTRACTS: A copy of the contract between the physician and health care plan, and between the patient or employer and the plan;
2. INCENTIVES: Whether participating physicians are offered financial incentives to reduce treatment or ration care;
3. COST: The full cost of the plan, including copayments, coinsurance, and deductibles;
4. COVERAGE: Benefits covered and excluded, including availability and location of 24-hour emergency care;
5. QUALIFICATIONS: A roster and qualifications of participating physicians;
6. APPROVAL PROCEDURES: Authorization procedures for services, whether doctors need approval of a committee or any other individual, and who decides what is medically necessary;
7. REFERRALS: Procedures for consulting a specialist, and who must authorize the referral;
8. APPEALS: Grievance procedures for claim or treatment denials;
9. GAG RULE: Whether physicians are subject to a gag rule, preventing criticism of the plan.

Medicare Rules Are Encouraging Doctors to Increasingly Use ‘Under Observation’ Status

Studies by researchers at Brown University in Rhode Island are showing that since 2007, doctors have kept millions of patients ‘under observation’ instead of admitting them.  This means that patients are paying more out of pocket and the number of days they are in the hospital under observation means that it does not qualify toward the ‘number of inpatient days in the hospital’ required before Medicare will pay for nursing home care.  Medicare will pay up to 100 days in a nursing home but that is very atypical.  Currently, they pay for less than half of that.  It means that patients are going to have to pay for more of their own care and they will go home sicker.  This suggests the need for in-home care for a short period of time while they recover—another out of pocket cost.

Doctors are being more cautious about who they admit and are willing to classify as inpatient, perhaps in an effort to avoid negative Medicare audits targeted at number of admissions.  The Rub:  Patients admitted to hospitals pay less than those whose status is ‘under observation’. Because Medicare rules state these individuals are “outpatient”, their co-payments are frequently considerably higher. And they may be turned down for care in nursing home facilities if they require it.

What can you do?  Talk to a hospital advocate if you feel you are being unnecessarily kept under observation.  Call your doctor if you are being treated by a hospitalist.  If you don’t get satisfaction there, contact your attorney to see if there is a way they can intervene on your behalf.

Three Common Scams Used On Older Adults

Older adults make a lucrative target because many of them own homes; have pensions; receive Social Security benefits and are often isolated so they want to talk to the caller.

Here are three common scams:

1. The Grandparent Scam – Caller from abroad claims that grandson has been arrested or had an accident and needs money.  They urge the grandparent to send money to get them out of their predicament.
2. Scammers pose as soldiers who have been serving in Afghanistan.  They call  grand-parents requesting money to come home.
3. Scammers tells the person they have won a lottery in some other country and they need to send money to receive the prize.  They may even send a fake prize check.

If they collect the bank account number, they clear out the balance of the account.

Older adults make good targets because they are often less sophisticated about technology and financial schemes.  They are also alone and lonely so they are happy to talk to someone.

What You Can Do to Protect an Older Adult:

• School them on what information they should never give out.
• Tell them what to say to get someone off the phone!  ‘Take me off your list.  I am on the No Call list’
• Place their number on the State and Federal No Call list.