GRAY MATTERS
Notes, News & Musings on Elder Care

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On Our Minds!

9 May 2017, by

SuperGrammy!

 

As Mother’s Day nears, our newest team member, Michelle Jephcott is reflecting on an important figure in her life–SuperGrammy!

My Grammy was a feminist and a pioneer, and I’m pretty sure she has never realized it. She was smart, funny, strong-willed, adventurous, and intense. She had a career as a bookkeeper before many married women had careers.  She raised three strapping sons who are each as different as night and day. She taught me that numbers were nothing to be scared of, that accounting could be interesting, and that its rules are comforting.

In a relatively short span during a bygone era, and in search of a better life, my grandparents moved their family to three different continents.  First, they moved from Birmingham, England to Woomera, Australia; when that didn’t work, they moved back to England.  Then they moved to Northern Rhodesia (now Zambia) in Africa – and back to England when locals sought independence from British colonization. Finally, they moved to Vancouver, Canada.  Their journeys to Australia and Africa came at a time when traveling long distances meant weeks, if not months, living on ships, which could not have been an easy endeavor for a young couple with three active boys.

Today Grammy is a ninety-four year-old widow who lives in an assisted living facility in Montreal, Canada, near my dad.  My bold and brave hero now has depression, fear, and loneliness as her constant companions.  My dad and stepmother do as much as they can for her, of course; though in Grammy’s eyes nothing could ever make up for a family that now lives in three different countries, as far from each other as possible.  My daughter and I send cards, care packages, and call, but she does not hear well and won’t wear her hearing aid, so conversations are difficult. I wish I could do more but all the miles between us make it difficult.

French photographer Sacha Goldberger faced a similar situation with his grandmother. The results of his talent, creativity, and his grandmother’s spirit are plain to see in his photo series depicting her as a heroine of epic proportions.  (View Goldberger’s photos here). If time and distance weren’t a concern, I think it would be so much fun for Grammy and I do something similar.  I can see it now, “SuperGrammy!”  My number-crunching, hug-giving, bad joke-telling rock.

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Property Tax Freeze and Relief

Property Tax Freeze and Relief

Many seniors want to stay in their home for as long as possible. However, the expense of property taxes can be a major burden, especially for seniors on a fixed income. Often, the property tax bill can equal or exceed a senior’s full month of income.

The State of Tennessee recognizes this burden and has put in place programs to help certain elderly and disabled individuals pay their property taxes. Property tax relief is a program whereby the state will pay or reimburse a portion of the property taxes of a qualifying individual. The property tax freeze program allows counties to lock in the tax amount due so that is will not increase in future years.

There are two programs for tax relief. One is for elderly or disabled homeowners. The other is for disabled veterans or their widow(er)s.

Once qualified, the state will pay or reimburse the property taxes on the first $23,000 of appraised value of the person’s property tax. Because property tax rates vary between counties, the actual dollar amount of the relief varies as well. In Knox County, for example, the program provides a benefit of up to $145.00 a year. The individual must pay the normal tax rate on the appraised value above $23,000. In other words, if the senior’s home has a tax appraised value of $70,000, the state would pay the taxes on the first $23,000. The senior would still be responsible for the taxes on the remaining $47,000.

It is important to note that this program can apply to both city and county taxes. That means a Knoxville resident, for example, can get the full reimbursement amount twice. He or she can receive it once on the city taxes and once for the county taxes. In order to do this, the senior would have to apply separately to the city and the county.

 

Qualification For Elderly and Disabled Homeowners Tax Relief

In order to qualify, an individual must meet a number of income and other eligibility requirements. First, the person has to be elderly or disabled. To qualify as elderly, the applicant must be 65 or older during the year in which you apply. So, if you are applying for relief of your 2015 taxes, you must turn 65 before the end of 2015. To qualify as disabled, an applicant must have been rated totally and permanently disabled by the Social Security Administration before December 31 in the year you apply. You may apply for relief beginning the day you receive your tax bill until 35 days after the bill is delinquent.

The combined 2014 income of the applicant, the applicant’s spouse, and all other owners of the property cannot exceed $28,690. Note that the income of the applicant’s spouse counts, regardless of whether the spouse is a co-owner on the property.

Annual income includes income from all sources. This specifically includes, but is not limited to:

  • Social Security (after Medicare is deducted)
  • Supplemental Security Income (SSI)
  • Retirement or Pension benefits
  • Veterans’ Administration benefits
  • Workers’ Compensation
  • Salaries or Wages
  • Interest or Dividends

 

There is no asset test to receive tax relief. In other words, it does not matter how much money an applicant has or how much the home is worth. The test is how much income the applicant made in the last year.

A final requirement is that the applicant must own and use the property as his or her principal residence. Proof of residency may be requested. If a qualified individual owns multiple properties, they can only receive the relief on their principal residence. If the person is going to be away from the home for an extended period of time, he or she should notify the collecting official of the absence.

In order to apply, a senior will have to provide evidence of their age. A disabled individual will have to provide proof of their disability. In addition, an applicant may have to provide evidence of 2014 income, such as a tax return, 1099, or W-2.

Tax Relief For Disabled Veterans or Widow(er)

Many of the rules for Disabled Veterans and their Widow(er)s are the same, but there are significant differences. First, the benefit amount is different; the state will pay the taxes on the first $100,000 of appraised value. This was lowered from $175,000 last year.

The income limit is also different. The combined annual income for the disabled veteran, spouse, and all other owners of the property must be $60,000 or lower. Again, the income of the spouse counts, even if he or she is not a co-owner of the property. Prior to 2015, an income limit was not required. The same sources of income are counted, namely annual income from all sources. It is especially important to note for disabled veterans that VA benefits do count as income.

The disability requirements for a disabled veteran are more stringent than the disabled individual rules. There are three ways to qualify as a disabled veteran.

  1. The veteran has a total and permanent disability rating from a service-connected disability;
  2. The veteran has a 100% total and permanent disability rating from being a prisoner of war.
  3. The veteran has a service-connected disability that resulted in one of the following:
    1. Paraplegia; or
    2. Permanent paralysis of both legs and lower part of the body resulting from traumatic injury or diseases to the spinal cord or   brain; or
    3. Loss, or loss of use of, two (2) or more limbs; or
    4. Legal blindness

Please note that it is not enough to be rated 100% disabled from a service-connected disability. The veteran must have the permanent and total rating as well.

Tax relief will also be extended to the surviving spouse of a disabled veteran who was eligible for property tax relief when the veteran died. In addition to the qualifications for disability above, a spouse qualifies if the veteran’s death either:

  1. Resulted from:
    1. A service connected, combat related cause, or
    2. Killed in Action (combat related);
  2. Or resulted from being:
    1. Deployed, and
    2. Away from home base of training; and
    3. In support of combat or peace operations.

A surviving spouse must have been married to the disabled veteran at the time of death and can not have subsequently remarried.

Most of the other rules are the same as for seniors and disabled individuals. The veteran or widow(er) may only apply for relief on his or her primary residence. The disabled veteran or widow(er) can receive relief on both city and county taxes. Documentation of residence, income, and disability will be required. In addition, the applicant will have to file a consent form that allows the VA to disclose the veteran’s disability to the office. These forms can be found at the applicant’s county trustee’s office or at the city collecting official’s office.

Tax Freeze

The tax freeze program allows qualifying seniors to have the property taxes on their principal place of residence frozen. Unlike the Tax Relief program, the tax freeze is not mandatory. Individual cities and counties get to decide whether to participate in the program. Knox County, for example, has decided to implement a tax freeze program, but it is not available for Knoxville city taxes.

Once a homeowner is approved, his or her property taxes are frozen at a base rate. As long as the homeowner continues to qualify, his or her taxes cannot increase because of a higher valuation or an increase in property tax rates. There is an exception if the homeowner makes improvements to the property resulting in an increase in value, such as adding a new room or a pool. Also, property rates are not fixed if the homeowner sells the home and buys a new residence.

The freeze only applies to a homeowner’s principal place of residence. The applicant must be 65 or older at some point during the year that they apply. Finally, the senior must have income from all sources that does not exceed the county limit. Income limits vary by county. In Knox County, for example, the limit is $37,980 dollars a year. A list of income limits per county can be found at: https://www.comptroller.tn.gov/pa/pdf/TaxFreezeIncomeLimits2014List.pdf

Conclusion

Tennessee’s property tax relief and tax freeze programs provide an invaluable savings for many seniors. For more information, or to apply, contact your county trustee or city’s property tax collector. Applications for some jurisdictions, such as Knox County, can be found online. Other jurisdictions, such as the City of Knoxville, require an application in person or on the phone.

 

 

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We are proud to announce that our very own Monica Franklin honored to participate in the revision of  The Legal Handbook for Tennessee Seniors for 2014.  Monica’s contribution focused on Medicare and Long-Term Care Services and Support through Medicaid or CHOICES.

Please feel free to share this link with family and friends who may be dealing with one or more of the legal topics concerning seniors covered in the handbook.

Information from Elizabeth Todaro on the TBA site:

The TBA Public Education Committee has updated The Legal Handbook for Tennessee Seniors for 2014. The updated Handbook contains practical information on a wide range of topics, including issues such as applying for Social Security benefits, long-term care considerations and estate planning, as well as completely new sections addressing online security and new health care legislation. An updated list of resources relevant for Tennessee Seniors is also included.

Copies are available now for download or by order in printed form. For more information about the project, to request a presentation in your area or to volunteer to help promote the Handbook,  contact TBA Access to Justice / Public Education Coordinator Liz Todaro.

This publication is based largely on a previous edition of the handbook that was published and distributed in 2001 by the TBA Elder Law Section, the TBA Young Lawyers Division and the TBA Senior Lawyers Division. The TBA Public Education Committee worked this year under the leadership of Co-Chair Angelia Nystrom. The project was spearheaded by TBA President Cindy Wyrick, who identified this as a priority to help meet the needs of the growing and frequently underserved senior adult population in Tennessee.

Fortunately, there are many ways we can now distribute this valuable resource: via website download, electronic flashdrive or printed copy. The updated handbook is available (at no cost) to TBA Members via digital format for their use in counseling their clients. TBA Members are invited to add their firm’s logo and contact information to the Handbook cover for distribution to their clients. Electronic and printed copies are also available to the public directly from the TBA. This book promises to be a great benefit for the members of our communities and for the clients that we serve and all resources are available here on the TBA website and will be updated regularly.

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Tennessee has a new program aimed at getting important health information in the hands of first responders immediately following a serious accident:

The Tennessee Yellow DOT Program is designed to provide first responders with an individual’s medical information in the event of an emergency on Tennessee’s roadways.  The information can mean the difference between “life and death” in the “Golden Hour” immediately following a serious incident.

Participants in the program will receive a Yellow DOT decal, a Yellow DOT folder, and a medical information sheet; a personalized photo will be taken and placed on the sheet.  The participant will complete the medical information sheet which consists of their emergency contact information, medical information, recent surgeries, hospital preferences, current medications, insurance and physicians’ information.  This information will be the sole responsibility of the participant.

The Yellow DOT decal will be placed on the driver’s side rear window of their vehicle.

Enrollment sites are being setup across the state. Click here or the link below for the locations of these sites.

To download the form or for more information, go here.

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Center for Medicare Advocacy
(November, 2013 Update)
Late November is often a time for gatherings with family and friends – Thanksgiving and Hanukkah, soon followed by Christmas and the New Year. Nursing home residents often want to participate in these gatherings but may worry that they will lose Medicare coverage if they leave the facility to do so. Residents and their families can put their minds at ease. According to Medicare law, nursing home residents may leave the facility for holidays without losing their Medicare coverage. However, depending on the length of their absence, beneficiaries may be charged a “bed hold” fee.

The Medicare Benefit Policy Manual recognizes that although most beneficiaries are unable to leave their facility,

“an outside pass or short leave of absence for the purpose of attending a special religious service, holiday meal, family occasion, going on a car ride, or for a trial visit home, is not, by itself evidence that the individual no longer needs to be in a SNF for the receipt of required skilled care.”[1]

A facility should NOT notify patients that leaving the facility will lead to loss of Medicare coverage. The Medicare Benefit Policy Manual says that such a notice is “not appropriate.”[2]

If the resident begins a leave of absence and returns to the facility by midnight, the facility can bill Medicare for the day’s stay.[3] If the resident is gone overnight (i.e., past midnight) and returns to the facility the next day, the day the resident leaves is considered a leave of absence day. Clarifying what seemed to be conflicting provisions in the Manuals, the Centers for Medicare & Medicaid Services (CMS) confirms that the facility can bill a beneficiary for bed-hold days during a SNF absence.[4]

Chapter 6 of the Medicare Claims Processing Manual provides that the facility cannot bill a beneficiary during a leave of absence, “except as provided in Chapter 1 of the manual at §30.1.1.1.”[5] That section authorizes skilled nursing facilities (SNFs) to bill a beneficiary for bed-hold during a temporary “SNF Absence” if the SNF informs the resident in advance of the option to make bed-hold payments and of the amount of the charge and if the resident “affirmatively elect[s]” to make bed-hold payments prior to being billed.[6] Charges to hold a bed and maintain the resident’s “personal effects in the particular living space…are calculated on the basis of a per diem bed-hold payment rate multiplied by however many days the resident is absent, as opposed to assessing the resident a fixed sum at the time of departure from the facility.”[7] CMS distinguishes bed-hold payments from payments for admission or readmission, which are “not allowed.”[8]

Residents can leave their SNFs for short periods, such as a day or two, to enjoy the holidays with their families and friends without losing Medicare coverage. Their SNFs are, however, allowed to bill them to hold their beds under Medicare rules.

For more information, contact attorney Toby S. Edelman (tedelman@medicareadvocacy.org) in the Center for Medicare Advocacy’s Washington, DC office at (202) 293-5760.

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First posted in 2010, this “News” bears repeating as we celebrate Thanksgiving this week.

Once again Science, via controlled empirical study, has affirmed an experiential truth: a grateful heart is a happier heart.

I love that researchers are more engaged in the pursuit of Happiness. It seems like a no-brainer, but there was a time, not so long ago, that the roots of happiness were believed to dwell somewhere deep beneath a wounded unconscious.  Painful excavation was considered necessary to discover and eject the demons responsible for igniting individual and collective angst. The “proof” of a positive relationship between happiness and gratitude offers profound hope to seekers. Punitive superego: move over. We can actually get there from here!

Co-Investigators Robert A. Emmons, University of California, Davis and Michael E. McCullough, University of Miami are engaged in a long-term research project, inquiring into the nature of gratitude and thankfulness and its impact on health and wellbeing.

They found that grateful people report higher levels of positive emotions, life satisfaction, vitality, and optimism and lower levels of depression and stress.  Grateful people do not deny or ignore the negative aspects of life. Gratitude appears to enhance pleasant feeling states more than it diminishes unpleasant emotions.

The researchers also note that those strongly disposed toward gratitude have the capacity to be empathic and to understand the point of view of others. People in the social networks of those that are grateful are rated as more generous and more helpful by others (McCullough, Emmons, & Tsang, 2002).

There is huge value in “practicing” gratitude in concrete ways, thus becoming more aware of blessings. Keeping a gratitude journal on an at least weekly basis by taking just a few minutes to list those things for which one is grateful had a significant impact upon study participants. They reported more regular exercise, fewer physical symptoms, feeling better about their lives overall, and were more optimistic in the following week compared with those who recorded problems and stresses, or neutral life events (Emmons & McCullough, 2003).

A related benefit was observed in the realm of personal goal attainment:  Participants who kept gratitude lists were more likely to have made progress toward important personal goals. Gratitude also translated into decreased envy and materialism!

I think most profound and important is a major Kumbayah factor: the finding that grateful people are more likely to acknowledge a belief in the interconnectedness of all life and a commitment to and responsibility to others (McCullough et. al., 2002). (!)

The happy fruits of gratitude are borne through mindfulness: becoming conscious and attentive to the blessings in your life. This Thanksgiving begin the lucrative practice of creating a list of blessings for which you are grateful. Then at least weekly take a little time to focus on the abundance in your life by continuing to journal simple lists. And breathe deeply. And celebrate.

“Both abundance and lack exist simultaneously in our lives, as parallel realities. It is always our conscious choice which secret garden we will tend… when we choose not to focus on what is missing from our lives but are grateful for the abundance that’s present — love, health, family, friends, work, the joys of nature and personal pursuits that bring us pleasure — the wasteland of illusion falls away and we experience Heaven on earth.” –Sarah Ban Breathnach

Happy Thanksgiving from Monica, Judy, Susie, Trish, Gwen, Gabe, Brooke, Glen  and  Scout!

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To all of the men and women currently serving and to the many veterans who proudly and honorably served, we salute you.  To all of the families who have lost loved ones in battle, we remember you and thank you for the service that was given.  Veteran’s Day only lasts a short time, but our gratefulness does not end.  Thank you!

In honor of the day, we compiled some links and websites related to Veteran’s Day. To learn more about its history, go here.

Organizations

There are some fantastic organizations working with our veterans.  See the links below to learn more about the programs and how you may be able to help.

  • Train a Dog—Save a Warrior connects warriors with PTSD with trained TADSAW’S PTSD service dogs. Although TADSAW is based in San Antonio, Texas, the program has Dog Trainers and Teams in-training all over the United States, including Tennessee. It is a small organization taking on the weight of the problem, and not putting limitations as to the Veterans surviving with PTSD from World War II to the present.  In Tennessee, TADSAW has taken 91 applicants with 55 training or waiting to find a shelter dog and 14 service dog teams accredited.  Go here or here to learn more about their organization and how you can help.
  • Honor Air Knoxville is a local organization providing free trips to Washington DC for area veterans.  They are currently accepting applications for veterans of WWII and Korea.  Many of our clients have had the opportunity to fly with Honor Air and describe it as a trip of a lifetime. Go here for more information about applying for a vet, volunteering, or donating.
  • The Wounded Warrior Project has a mission to raise awareness and enlist the public’s aid for the needs of injured service members.  To learn more about this national organization, go here.
  • One more simple way to help those currently serving in the military is to send them coupons that they can use at commissaries.  Gabrielle’s daughter’s Girl Scout troop is collecting current and expired coupons (the commissaries will take them up to 1 month from expiration) to mail to a regional military base.  If you would like to help, you may drop off or mail coupons to our office to Gabrielle Blake’s attention. This project will last through April of 2014.

Veteran’s Services

For services for veterans, the US Dept of Veteran’s Affairs and the State of Tennessee Office of Veteran’s Affairs are fantastic resources.  The State of Tennessee Office of Veteran’s Affair office in Knoxville is where we recommend clients visit when applying for Aid and Attendance.  Contact our office if you have any questions about how these resources might fit into your Life Care Plan.

Freebies and Fun

Many stores and restaurants offer discounts or freebies for military men and women and veterans.  For a listing of some of these great deals, go to Real Housewives Clip Coupon’s blog post here.  If you are looking for a fun activity for today, consider attending the Knoxville Veteran’s Day Parade.

Thank you to our veterans!  God Bless our great United States of America!

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With Daylight Savings Time “Fall Back” arriving soon, now is a good time for a reminder of the importance of fall prevention.  In Knox County, more than 1,800 people aged 65 and older sought hospital care for falls in 2009 (the most current data), and approximately 19 people aged 65 or older die each year from their injuriesThe CDC estimates that 1 in 3 older adults fall each year but only half talk with healthcare providers about itFalls are the leading cause of fatal and nonfatal accidents in older adults, with around 2.3 million falls treated in the ER in 2010.

Not only are falls affecting the health of older adults, they are also affecting their pocketbooks.  In 2006, the direct medical cost of fall related injuries in older adults was $20 billion, and this number has risen with inflation and the aging of the Baby Boomer generation.  While Medicare and other supplemental insurances cover part of that cost, out of pocket medical expenses are many times a burden on the elderly and their caregivers.  After falls, elderly often see a decline in independence and may need personal care attendants or assisted living services, neither of which is covered by medical insurance.

What can be done?

Benjamin Franklin once said, “An ounce of prevention is worth a pound of cure,” and this quote can also apply to fall prevention.  Take these steps to help reduce your risk:

  • Exercise regularly.  Remember to talk with your healthcare provider before starting any new exercise regimen.  Seek out free or low cost options through your local senior centersTai Chi has been found to be especially helpful in reducing falls and reducing serious injuries in people who do fall.
  • Talk with your healthcare providers, including pharmacists, about how medications may relate to fall risk.  Bring an up-to-date list of medications you are taking, including over the counter and herbal remedies, to each medical appointment.  One provider may prescribe a medication that would interact with a medicine another doctor prescribed.  When your healthcare providers have your full list of medications it can help to reduce the risk of adverse drug interactions and over medication.
  • Regularly have your vision checked, and follow recommendations that your doctor makes.  Eyeglasses are only helpful if you actually wear them.
  • Work with your family members to make your home safer.  Installing tools like grab bars in the bathroom and using tools like raised toilet seats can be helpful.  Reduce the clutter in your home, especially on floors and in walkways, to reduce risk of tripping over things.  If you care for grandchildren, work with them on the importance of putting away toys when not in use.  Wear shoes with good traction and add non-slip bathmats beside your tub.
  • If you are a caregiver, talk with healthcare providers to learn proper lifting techniques and ways to assist your loved one when transferring to different positions.
  • Use common sense.  When walking outside for exercise, let someone know where you will be, use trails, walk with a buddy, and stay in well lit areas.
  • Consider installing a service such as Lifeline to call for help if you fall and are unable to reach the phone.  If unable to subscribe to this service due to finances, some scholarships may be available.  If unwilling to subscribe to such a service, then making sure to carry a portable phone with you when walking through your home or outside. This can at least give you access to dialing 911 if you are conscious after falling.

What else?

  • Talk with your family about your wishes and preferences for long term care.  Unfortunately many older adults do not have conversations about long term care with family members.  Having a good understanding of your wishes gives family members guidance for your care.
  • If you do not already have one in place, talk with our office about powers of attorney documents.  Think you are too young to have these documents?  Remember that many of the cases that have garnered national attention about end of life decisions involve people who were in their 30s and 40s without these documents in place.
  • It is the desire of most of our clients to stay as independent as possible for as long as possible.  While it may sound paradoxical, sometimes the best way to do that is to get a little help with care.  Having someone there to help with transfers and walking may help to prevent injury.  Talk with your elder care coordinators about ways in which personal care attendants might be of help.

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Imagine this scenario.  Your father falls in the bath and is raced to the hospital.  The ER doctor says that a bone is broken and he will be moved upstairs for a few days.  Three days later, you meet with the discharge planner and ask about skilled rehabilitative care.  The discharge planner surprises you by saying that your father is not eligible for Medicare payment of skilled care because he was never admitted to the hospital.  “There must be some mistake.  He has been on this hospital floor for three days.” She responds, “He was on the floor for observation.  It is different from being admitted, and therefore Medicare won’t pay for treatment at a skilled nursing facility.”

This scenario has become more common in recent years as Medicare has become more stringent with hospitals over admission criteria, especially for shorter lengths of stay.  The American College of Emergency Physicians explains:

With short inpatient hospital stays (less than the average LOS) Medicare is concerned about overpayment and appropriateness of the admission. As a result, Medicare and a state’s Quality Improvement Organization (QIO) monitor hospital discharge data and specifically target short hospital stays.

If a hospital is found to have a high frequency of short inpatient hospital stays Medicare will investigate and if inappropriate admissions are found the sanctions can be severe. As a result, hospital health information management (HIM) and utilization management (UM) staff closely monitor the medical necessity of inpatient hospital admissions and short inpatient hospital stays. Their efforts can put pressure on emergency department physicians to make sure that each inpatient admission from the [emergency department is] medically necessary and will pass fiscal intermediary or Medicare Area Contractor (MAC) scrutiny.

In some cases the use of observation status might be an alternative to an immediate inpatient admission.

Why does this matter?

Medicare will only pay for skilled nursing care after a person has been admitted to the hospital for three midnights.  If faced with a decision to pay out of pocket for skilled care (to the tune of thousands of dollars) or to forego treatment, many choose the latter option placing them at a higher risk for re-hospitalization.  They are still eligible for home health, but home health care does not provide the intensity and frequency of therapy seen in skilled nursing facilities.

Skilled care is offered on a separate hospital floor or inside a nursing home, which has the added benefit of providing day-to-day care while undergoing therapy.  If not receiving skilled care, extra help may be needed for your loved one either through informal assistance from family members and friends or through paid services such as sitters, assisted living care, or long term care at a nursing home.

Cost of hospitalization is another important issue.  While observational care may look and feel like a hospital admission, it is billed differently and that difference can mean a hefty bill at the end of treatment.  The Centers for Medicare and Medicaid Services explain:

  • Medicare Part A (Hospital Insurance) covers inpatient hospital services.  Generally, this means you pay a one-time deductible for all of your hospital services for the first 60 days you’re in the hospital.
  • Medicare Part B (Medical Insurance) covers most of your doctor services when you’re an inpatient. You pay 20% of the Medicare-approved amount for doctor services after paying the Part B deductible.

The Center for Medicare Advocacy, Inc. also warns that the level of care can change without notice or can be retroactively reversed :

As a consequence of the classification of a hospital stay as outpatient observation (or of the reclassification of a hospital stay from inpatient care, covered by Medicare Part A, to outpatient care, covered by Medicare Part B), beneficiaries are charged for various services they received in the acute care hospital, including their prescription medications.  They are also charged for their entire subsequent [skilled nursing facility] stay, having never satisfied the statutory three-day hospital stay requirement.

So what can you do?

  1. Familiarize yourself with the differences in admission and observation status.  For a helpful pamphlet from Medicare detailing the differences, go here.
  2. When you or a loved one visit the ER make sure to give the doctor the full clinical picture.  It may help to have the primary care physician consult with the ER doctor and/or fax recent records.  If you are unable to be with your loved one, phone the ER department and request to give information to the doctor or nurse.
  3. If treatment goes beyond the ER, ask what level of care determination has been made.  Ask this question daily to make sure the status has not changed.  If you do not agree with the level of care, try to have it changed by speaking with the doctor, utilization review nurse, and case manager.  Ask your primary care doctor to consult with the hospital doctor.
  4. Begin working with the discharge planner as early as possible.  Many discharge planners do not work weekends, but you can still ask to leave a voicemail for him/ her to phone you as soon as he/she returns to the hospital.  If ineligible for Medicare payment of skilled nursing care, make sure that an order for home health is written and the referral process is begun.  Remember, you do not have to do this alone!  Your elder care coordinators want to help and can make recommendations for other services such as personal care attendants, respite care in an assisted living, and medical equipment companies for adaptive equipment that may be needed.
  5. For more information on appeals you can read the Center for Medicare Advocacy, Inc’s helpful Self Help Packet for Medicare “Observational Status”.
  6. Share your knowledge with others.  Help those in your life with Medicare by sharing this information and the information from the websites we have linked in this article.  Talk with your congressional representatives about the need for Medicare reform on this issue.  Share with them the AMA’s most recent letter to the Centers for Medicare and Medicaid Services in hopes that they will support the proposed changes.

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The YouToons Get Ready for Obamacare
Having difficulty understanding the complexities of health reform as part of the Affordable Care Act? This cute video gives a good overview of the program.

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