Caregivers and Stress

[DapperButch]

Originally Posted by cathexis

Professional caregivers can also experience emotional trauma. I have been out on disability several years. It's been awhile since I have been at work, but was a RN at major trauma centers in their Surgical ICUs for 30 years. Thought that any nightmares or situational flashbacks would be long past, but not the case.

Over the past year, nightmares have resumed with a vengeance. Have been having what feels like half awake nightmares. I come out of the bed in a panic yelling being in some life death situation and needing to get there right away. Yell that I should be at the bedside doing some emergency procedure. My thought at the time is that I am being extremely guilty about not being with my patient. I will actually rise out of bed with a start rushing around the bedroom trying to take care of the situation. A few times, my Partner had to work at calming me down and trying to convince me that I am at home in my bedroom. That I am not at the hospital in this terrifying situation. Once it took Her about an hour to accomplish this.

These dreams have me afraid to fall asleep. I lay in bed with my muscles tense staring at the curtains fearing another nightmare. This is the worse stress related experience I have had, and could imagine having at this point in my nursing career. Traumatic nightmares occurring years after leaving patient care.

Have you sought out any therapy for this?

[cathexis]

Originally Posted by DapperButch

Have you sought out any therapy for this?

Am seeing a counselor, but not really confident in her. She is very young and I think my other issues already have her overwhelmed. In this small NY town 5 minutes from Canada, my options are limited. Had to hire a driver at 100 dollars each ride to the nearest city, Burlington for plastic surgeon appts. Couldn't begin to hire her weekly or bi-weekly.

One counseling center and no psychiatrists here. We have a prescribing nurse practitioner. This is the first position for most staff and they move on. My Partner and I are trying to save money to move.

[girl_dee]

My mom called 911 in the middle of the night, unable to breathe. They gave her some heavy duty meds.

They are keeping her in the hospital overnight to monitor her.

She’s in heaven, she loves being in the hospital. She’s been sending pics of her meals and saying she wants to stay there.

[Kelt]

Originally Posted by girl_dee

My mom called 911 in the middle of the night, unable to breathe. They gave her some heavy duty meds.

They are keeping her in the hospital overnight to monitor her.

She’s in heaven, she loves being in the hospital. She’s been sending pics of her meals and saying she wants to stay there.

Hey girl_dee

I'm sure you already know this, but just in case and if others don't, find out if she has been admitted or if she is there for observation. Hospitals love to play the observation game, high profit for hospital retail. I went through this with my mother about 9 months ago. Admitted=covered by medicare, observation=out of your pocket. In my mothers town observing is $5k per day and they want her for 3 days/2 midnights.

In our case they "observed" her so well that she was too dehydrated to kick out (4 hours notice/8pm before the 3rd midnight) they had to admit her and the bill got covered, but it was a close call.

They admitted her for a broken rib which she did not have. The bill was $21k, after all her insurances we paid about $400.

[girl_dee]

Originally Posted by Kelt

Hey girl_dee

I'm sure you already know this, but just in case and if others don't, find out if she has been admitted or if she is there for observation. Hospitals love to play the observation game, high profit for hospital retail. I went through this with my mother about 9 months ago. Admitted=covered by medicare, observation=out of your pocket. In my mothers town observing is $5k per day and they want her for 3 days/2 midnights.

In our case they "observed" her so well that she was too dehydrated to kick out (4 hours notice/8pm before the 3rd midnight) they had to admit her and the bill got covered, but it was a close call.

They admitted her for a broken rib which she did not have. The bill was $21k, after all her insurances we paid about $400.

Good grief!

Well she likes celebrity status and would sign up for observation if she could.

[Kelt]

Originally Posted by girl_dee

Good grief!

Well she likes celebrity status and would sign up for observation if she could.

Monitor overnight sounds a lot like observe. I hope you don't get stuck with the tab!

[girl_dee]

Originally Posted by Kelt

Monitor overnight sounds a lot like observe. I hope you don't get stuck with the tab!

well honestly they sent her home yesterday and she got worse a few hours later (urgent care). She is on treatments and they are watching her pressure. She lives far away from the airport so sending her home today would probably not been a good idea.

[Kobi]

Originally Posted by Kelt

Hey girl_dee

I'm sure you already know this, but just in case and if others don't, find out if she has been admitted or if she is there for observation. Hospitals love to play the observation game, high profit for hospital retail. I went through this with my mother about 9 months ago. Admitted=covered by medicare, observation=out of your pocket. In my mothers town observing is $5k per day and they want her for 3 days/2 midnights.

In our case they "observed" her so well that she was too dehydrated to kick out (4 hours notice/8pm before the 3rd midnight) they had to admit her and the bill got covered, but it was a close call.

They admitted her for a broken rib which she did not have. The bill was $21k, after all her insurances we paid about $400.

Kelt, a point of clarification here. Admission is covered under Medicare part A. Observation is paid under Medicare part B. Medications may not be covered under observation with part B but they are under Medicare part D.

Insurance is a game. You have to understand the rules to play it well.

One of the biggest things to remember is the billing portion is often decided after the fact by coders who may or may not know what they are doing.

Another thing to keep in mind are the multitude of rules regarding readmissions/reobservations within certain periods of time. The "re" part says to Medicare you were not treated properly to begin with. That is an internal billing issue between the facility and medicare. If a facility tries to make it your problem, dont buy into it.

Never pay a hospital bill that doesnt sound or look correct. Call and ask questions. Billing cycles do not always coincide with reimbursement cycles meaning bills get generated erroneously simply because of timing.

If the issue is still not resolved, call and double check what you were told with medicare itself - every state has an organization that administers medicare. They can interpret the bill in conjunction with the rules. This usually resolves issues and makes bills disappear.

The center for Medicare advocacy, completely separate from the actual insurance process is the best resource if you need to know the route to dispute a bill if the above doesnt solve the problem.

Another avenue is to call your congressperson for help. Their offices have differently avenues to circumvent the game of insurance. Plus, it helps to keep them aware of the unintended glitches in stuff they approve.

The bigger thing to watch for is the 3 day rule for admission to a skilled nursing facility. You have to have been billed as admitted for this is work. Otherwise, the nursing home/rehab is not covered. That is a different set of headaches but also not insurmountable.

Just an aside, facilities cannot charge you a separate fee for a private room. They still try but it is an illegal practice. The reimbursement for your care is based on diagnosis not accommodations.

This stuff was the most fun part of my job. There is something nice about being able to say.....you know that is illegal right?

[Kelt]

Originally Posted by Kobi

Kelt, a point of clarification here. Admission is covered under Medicare part A. Observation is paid under Medicare part B. Medications may not be covered under observation with part B but they are under Medicare part D.

Insurance is a game. You have to understand the rules to play it well.

One of the biggest things to remember is the billing portion is often decided after the fact by coders who may or may not know what they are doing.

Another thing to keep in mind are the multitude of rules regarding readmissions/reobservations within certain periods of time. The "re" part says to Medicare you were not treated properly to begin with. That is an internal billing issue between the facility and medicare. If a facility tries to make it your problem, dont buy into it.

Never pay a hospital bill that doesnt sound or look correct. Call and ask questions. Billing cycles do not always coincide with reimbursement cycles meaning bills get generated erroneously simply because of timing.

If the issue is still not resolved, call and double check what you were told with medicare itself - every state has an organization that administers medicare. They can interpret the bill in conjunction with the rules. This usually resolves issues and makes bills disappear.

The center for Medicare advocacy, completely separate from the actual insurance process is the best resource if you need to know the route to dispute a bill if the above doesnt solve the problem.

Another avenue is to call your congressperson for help. Their offices have differently avenues to circumvent the game of insurance. Plus, it helps to keep them aware of the unintended glitches in stuff they approve.

The bigger thing to watch for is the 3 day rule for admission to a skilled nursing facility. You have to have been billed as admitted for this is work. Otherwise, the nursing home/rehab is not covered. That is a different set of headaches but also not insurmountable.

Just an aside, facilities cannot charge you a separate fee for a private room. They still try but it is an illegal practice. The reimbursement for your care is based on diagnosis not accommodations.

This stuff was the most fun part of my job. There is something nice about being able to say.....you know that is illegal right?

Thank you Kobi for stepping in and clarifying, it's important that folks have accurate information.

I have only my own experiences and the bits of reading about some of these situations experienced by others to go on. I should have said upfront that I am certainly no authority on the subject. It's reassuring to know that Medicare part B helps with this as I'm sure it won't be my last rodeo in "observation". My mother has parts A, B, D, and medigap as well, this has been so good that there have been no significant bills over these last couple of years by the time things get processed. Something I have found is that even though there is little to pay, I do want to examine the bills in detail to check for errors, and to find out what is actually going on. Her town hospital has taken to sending bills that say "IP Inpatient" half a dozen times with differing $ figures for each line. So even though most of the bill is paid and I just get the little remainder I have established with them that I will not pay any bill until I get the detailed version, I have to call them for every bill, but they can look up the account and have accepted my terms.

Thank you also for the information on the Medicare advocacy center as I am trying to see if there is recourse for another situation involving skilled nursing this last go round and you are right, that's a whole other kettle of fish. Two years ago I couldn't get my father out (he had a crappy physicians directive), and two months ago I couldn't get my mother in costing her 100 days of room and board benefits she should have been entitled to during rehab, we are out of pocket right now. She is in a private care situation that does not accept insurance of any kind, it is very good and she will now stay there going forward, it would be nice to get reimbursed for what she should have been eligible for though. The whole town was full beds and the hospital wanted her out but there was nowhere to go. Fortunately, I spent quite a bit of time with a lawyer crafting a medical proxy that is extensive and covered every situation I had so far experienced and some others recommended by the geriatric care manager I have on retainer in case something happens to me so that she can take over. I have had to confront the hospital twice with this so far and the roadtest has worked. I now have the same proxy in place for myself.

I know you say this is not insurmountable and I agree IF you have someone with a clear head helping with or doing this part of it. This scares me for the elderly in general and myself in particular. My mother has dementia and there is no way she could even comprehend the maze much less deal with it. For myself I wonder about if I were to be badly injured or very sick, maybe drugged, and not understanding and maybe missing some deadlines or such. I am looking into maybe bringing a conservator onboard to handle my finances if I am disabled/incapacitaed with the accountant as a check/balance in that situation.

This is all damn complicated and underscores the phrase "Gettin' old ain't for sissies"!

[Kobi]

Kelt, no worries. Even those of us who did this stuff for a living get thrown now and then. It is literally built into the system. LOL.

Medicare is a lot like Mircosoft Windows. There are always unexpected glitches that occur for one reason or another that require fixes that lead to more unexpected glitches and more fixes and more glitches and on and on.

And then there are the arbitrary changes that occur every year for no discernible reason. LOL.

I hear you on the no beds available thing affecting the SNF benefit. Never ran into that problem here. Even tho the benefit allows for 100 days each benefit period, the definition of what constitutes skilled "need" and "progress" has become narrower and narrower so most people only fit into a 10-20 day time frame of coverage. If you find a way around that one even for 10-20 days, would you let me know?

You are correct, it takes a clear head and a lot of time to wade thru this stuff. I too worry for the elderly who do not have someone to help them. Then again, I also worry about the helpers who might not understand things either. It can end up being very costly if you make a mistake.

For example, people do not generally understand how medicare D works or how to assess what coverage is best for them. And, it is not the easiest thing to explain either given the way insurance companies are changing their coverage every year. You have to assess premiums, hidden deductibles aka the no deductible for tier one drugs but a 300 deductible for tier two and three, a 40% copay for tier 4 and god only knows what for tier 5. Then explain to them that every insurance company adjusts the meds in each tier every single freakin year to maximize their profits. So every year you have to run every single freakin drug thru to find out which tier it is falling on so you know your potential cost. And add in that every single freakin insurance plan negotiates their own prices with every single pharmacy chain so your out of pocket cost varies depending on the pharmacy you use i.e. lasix at CVS will cost you 10 dollars but lasix at Walgrens will cost you 15 and lasix at Rite Aid will cost you nothing. And then you have the preferred and non preferred pharmacies which also affect out of pocket expenses. And we wont mention how you used to be able to get prescription strength over the counter drugs thru insurance for a cheaper price than buying the half the normal dose over the counter pills. Now, using the prescription plan costs 3 times the cost of buying twice the amount over the counter- wee bit of a disincentive.

Every year I went thru this with my Mom. Every year it was the same thing. Took me hours to wade thru all the plans to find the best and least costly plan for her needs. Every year I would explain why I was recommending this particular plan in detail even tho I knew she had no clue what I was saying. Every year the first time she filled each of her meds I would get a phone call - last year this med cost me 10.00, this year it is 25. Why is that?

It is not a pleasant topic but glad to hear you are looking into contingency plans should you be unable to make decisions about your care or handle your finances. It is not easy to plan for but I ended up doing primary and back up on the health care decisions, and completely separate co-administrators on the fiances so 2 people are required for every financial decision/transaction with an accountant monitoring them both. A trust might be easier. Not sure yet.

Aging is definitely not for sissies. LOL.