Wednesday, August 24, 2011

Windows: A Caregiver's Salvation

Windows can bring fresh air into difficult care issues
I recently learned of a woman caring for her husband who brought him home after a hospitalization only to discover that his care needs were more than she could manage.  The concept of “rehab” care had not been discussed by the hospital doctor or by any discharge planner. Since the wife had already been caring for her husband at home and the issue that brought him to the hospital was resolved, he was cleared to go home.Yet like most people who leave the hospital, he wasn't as strong as when he went in. That was complicated by the fact that his overall health issues were degenerative.

However, it soon became evident that his care needs were more than she could provide. She was among the fortunate who already had a relationship with a social worker who had been involved with her husband’s care. The social worker was able to tell her that there was a ‘window’ option she could consider. There is a certain amount of time after a hospitalization where a patient can be eligible for rehabilitative care. It’s a window of time. At first, she was told it may be 14 days, but the social worker would confirm. Later she was told it was 30 days. When the caregiver heard of the 14 day time limit, the she knew she had to move quickly. She had the help of the social worker who knew how to start the process for qualification quickly. It was handled through Medicare and he was placed within a few days.

            There are a few different caregiver nuggets to glean from this example. 

First, involve others in your caregiving team. Caregivers should not go through their duties alone. Whether you’re dealing with private insurance, Medicare, or VA health benefits, determine what kind of social work services you can access - and use them. It may be that the benefit falls under counseling or mental health benefits. If so, don’t let that ‘label’ for ‘mental health’ stop you. Even if there is a co-pay for such a benefit, again, try to work out using it. It may be that it’s “Dad’s” appointment, but you go with him and get the information too, or share part of the session.

Make sure the social worker is one that deals with your specific area of need and is not just seeing every kind of patient. Granted, they’re trained, but some specialize in geriatric issues. Many “geriatric case managers” are licensed social workers. Getting insurance to pay for their services as “geriatric case managers” might not work, but, applying for payment or authorization of services based on social work/counseling may. This is when a little time and work on the front end of a situation pays off with lots of time saved later on. 

The next nugget is to look for windows. Many people assume that once discharged, a patient cannot receive services or referrals from the hospital. Whenever you leave a hospital setting, make sure to get the discharge planner’s card. This is the person who comes in to see if you need home health or any other services. You may only see this person once, but learn to recognize this role. If problems arise after a hospital stay, call that person. Let them know that home care is not working and ask if they can help you find other options for care or secure more services. It might not be a rehab placement, but it might be the addition of home health services to help with bathing when your loved one has trouble with that and you can’t do it yourself until he or she gets stronger. 

Windows are helpful. Caregivers don’t know all the windows they can open to get fresh air into a stressful situation. By involving others in a care team, not only can they educate you about the windows available to you, they can help you opened them.    

Golden Nugget for Caregiver: When your caree is in the hospital, ask the staff to run a TB (Tuberculosis test) upon admission. The results of a TB test are required before a patient can be placed in any kind of skilled care facility and they take 2 days to get results. Even if you don’t anticipate a rehab stay, as the situation above illustrates, you need to be prepared. If you leave the hospital before the test results come in, plan to go back to the records department (with healthcare POA in hand) and ask for a copy of the results. The results of the test are only considered valid for 30 days. Whether you think you need them or not, getting them may save you time when you need it the most.

Friday, August 12, 2011

Financial Abuse of the Elderly - Part 5 - Final Notes

Is it time for help?
Delving into financial exploitation of the elderly has been a challenge. I’ve heard and read story after story of terrible cases where seniors who deserve comfort and security have had it ripped away from them by family members and strangers. It is a serious problem. As a final note in addressing this issue, I want to take a step back and remind you that the open door for such often comes when a senior can no longer keep up with their own finances. Do they want to admit they’re having trouble balancing a checkbook? Quite likely, no. Financial independence is something is something they’ve held as a measure of pride for the majority of their lives. If it’s your parents, they don’t want you to know they’re having trouble. It’s not easy to admit that you need help at any age, let alone break down the leadership roles you’ve held for most of your life.
Indicators That It May Be Time for Help

  • Past-Due Bills are piling up or Mom says people are calling to tell her to pay a bill she thought she’d already paid.
  • Mom or Dad keeps claiming to not have enough money. Sometimes they are fine but saying such is an indicator they aren’t feeling as secure as they once were.
  • Financial patterns change:  is Dad giving more or less in the way of financial gifts? 
  • The solicitations for donations are out of control. This may mean Dad’s been sending out a lot of donations meaning more will come as his name is shared on mail lists.
  • Mail order boxes are regularly appearing. Some seniors don’t need to shop ‘til they drop but take comfort in TV/Catalog ordering. Feeling they can buy things can nurture a sense of independence even when then items are needed. Retail therapy affects seniors too!
  • A hospitalization occurs and no one is coordinating the ongoing payment of regular bills like the mortgage/rent, utilities, etc.
Family members can step in and help. The key there is maintaining respect and communication while offering help. Try not to let judgment cloud your sensitivity to a parent’s insecurity or discomfort with a need for financial help. If your family dynamics do not include someone willing, able, and trusted by all to step in to provide the help needed, consider a financial manager. These professionals are helpful when family members disagree about who should be the one to step in and help Mom with her finances after Dad dies (a common time when financial management becomes an issue). Having an ‘outside’ party responsible may ease tensions between siblings/parents who cannot find peace with handing it within the family circle. 

The cost of financial management services will vary depending upon what intervention is needed, whether it’s the management of an investment portfolio or balancing a checkbook when the only deposits come from Social Security. Take some time to compare your fear of the expense to the fear of what could happen if even limited resources aren’t managed effectively.

 Tips when looking for an elder financial manager:
  • Research availability, services, fees
  • Ask for references and follow up by contacting them
  • Review your preferences for monthly reports
  • Determine if tax issues need to be addressed by a different professional
  • Assess the limits of the service provider (some may not be certified to a level to provide investment advice, but can still help with some of your needs and put things in order so that you can take the right information to an investment adviser)
I’ve recently had the pleasure of meeting Amy Carrick of CARRICK CONSULTING. She offered a glimpse at the complexity of many senior financial issues as well as some simple steps for solving them. She is a Certified Senior Specialist and a Dementia Specialist. She recently did a radio interview (listen to it by clicking on the link on her "About" page).  The interview focused on scams targeting seniors. She’s also dealt with a wide range of financial management issues for seniors and the disabled. Though she said it’s an extreme case, one client actually brought her boxes filled with six years’ worth of mail that had build up for an aging adult unable to manage sorting his own mail. Not knowing might be necessary information for getting man’s affairs in order, she had to go through it all. But with her eye for detail and knowledge of what was important, she managed the task and helped her client. 

Caregiver Golden Nugget:  When you find there’s an issue of care that you’re not comfortable dealing with, give yourself a pat on the back instead of a guilt trip. Many caregivers beat themselves up if they can’t handle all the issues that come up. But realizing your limits is a gift to all. It’s there that you can take action and make a positive difference.  If you’re just not a numbers person and don’t feel comfortable helping Mom manage her finances, Bravo for realizing it!  Now you can do something:  find the right person who can.  

Friday, August 5, 2011

Financial Abuse of the Elderly - Part 4 - The Legacy Lottery

Scammers prey on those wishing to leave a cash legacy

Many times letters and calls come in saying a senior has won or can win a significant amount of money. Remember the old adage “if it sounds too good to be true, it probably is.”The window for scammers comes from the deep desire seniors have to either secure their future or leave a legacy to their loved ones. Often their worries or desire to feel valuable by being generous with others will lead a senior down a path they might not otherwise follow. Insecurity can wreak havoc with judgment. If a person does fall victim to a scam or thinks they may have made a poor choice, embarrassment often keeps them talking about the issue and getting help if lured into a trap.Consider the following:
Scam 1 - A ‘winning’ letter or phone call comes in from a person claiming to be ‘an agent’of the IRS, Federal Trade Commission, or businesses sounding  like legitimate or government offices. A. They may be claiming there is a ‘problem’ with your account that needs to be cleared up. B. They may calling to say you won a prize but need to pay the taxes/fees first.
What to do?
If a phone call, ask for the contact person’s full name, phone number, and employee number along with their supervisor’s number. Write them down. If you can’t write it down, tell them to mail the information.
Why? If a caller is not willing to mail you the information or pressures you to take action now, it’s likely a scam. They may be trying applying pressure with a ‘limited time’ for prize redemption, followed by a fee requirement to ‘redeem’ the prize. They are looking for a credit card number so that processing can “begin immediately.” Though not all ‘prize’ calls are lotteries, remember that in legitimate lotteries, it’s the winner who makes the contact to collect their winnings. Lotteries don’t contact you. If they do, it’s likely you never entered in the first place and you’re about to be scammed for the cost of shipping or insuring your prize. 

Scam 2 - Wiring to Help
Beware of anyone asking you or a loved one to wire money in order to redeem a prize or in an effort to ‘help’ another person bring their money into a US account from a foreign country. This is a common scam that targets the elderly. Seniors want to help others - it builds their feeling of self-worth. If they think they might earn a helper’s fee in the process, it feels even better. There are many email (and phone) scams offering to pay a person a portion of the money for helping with transaction. Watch out for requests to wire money for any reason or give bank account information to anyone saying they need to ‘use’ your account so they can deposit into it. A related scam involves people claiming to hold the inheritance from a 'long lost relative' and they need your account information to send the money to you.

Scam 3 - The Intelligence Game
Another scam is one that preys on a senior’s ability to feel ‘smart.’ A game of some kind comes in the mail or through email. Players ‘win’ the right to move onto the next level. Their intelligence is validated. They ‘win’ several levels and then there are fees for playing the next levels where prizes are awarded. Somehow, they never quite reach that ‘winner’s’ status though and they’ve willingly paid for the chance, often multiple times.

Caregiver’s Golden Nuggets: 
The biggest thing to keep in mind here is that if you’re worried about a loved one falling victim to a scam, ask yourself ‘why?’ Do you think Mom is worried about her financial security and could be lured into such?  There is the issue. Talk about long term security.
Do you think Dad’s self esteem is falling because he doesn’t feel he has a legacy? Encourage him to realize that his legacy has nothing to do with money.
Look for the reason for your concern and you have found an opportunity to strengthen your bond, help your loved one relieve insecurities and fears, and develop a positive attitude toward the future.
  • If you think your loved one is a ripe target for scams, take time to talk about it but tread lightly so he doesn’t try to dig in his heels and try to prove himself with an “I’ll show you I know what I’m doing,” mentality. 
  • One gentle approach is to bring up concerns with an outside reference.  “Wow Mom, I heard/read about a scam going on now.  I can see how people would be taken in by it. It’s scary.”