Hi - My dad will be 90 in January. This past year he was in the hospital 4 times. Hee had 3 ambulance trips, and a bunch of doctor's visits.
Of course, we have been inundated with bills. He has no income besides SS. He doesn't own any property, and his only assets are about $3000 in the bank, and a car with 165,000 miles on it that currently cannot pass a safety inspection. He also has a $5000 VA death benefit policy.
I should also point out that he cannot cook for himself, drive himself, or be alone anymore. Anytime I am not able to be there, he has to hire paid help. The costs for restaurants / caregivers/ companions/ transportation have left us shellshocked. He is spending $1000 plus most weeks, including his many medications, and has depleted his savings.
At the advice of friends he has been paying each of his creditors at least $10 a month. Many of the smaller bills have been paid off. Most of the larger creditors have been fine with it, too. They understand he is on a fixed income and know he has been very ill.
Two of them though, have been a big problem. The first is an ambulance company that took my father 3 miles from his doctor to the hospital. From what I can tell they were paid about $550 by insurance and billed my dad an additional $167. They demanded immediate payment in full, when I asked them to send me a breakdown of the costs, and why it was so much?, they immediately sent to collections.
The second is a hospital. They have sent as many as seven separate bills in a month. My dad has paid $10 on each one, two have been paid off. The remainder total about $850, I'm guessing, because when I called them they would not verify that there will be no additional bills pending...
So, I told them about my dad's finances, and that he could continue to pay $10/month on each of the outstanding bills, and that would be $40 a month total.
Nope. They threatened collections. They don't seem to understand that he owes money to numerous other doctors and services too. They just want all theirs NOW.
My dad needs a hospital bed, and other things for six months now. His doctor has tried to get insurance to approve them, they keep saying they "aren't medically necessary." The cost for everything would be at least $8000. My dad is very uncomfortable and hardly can get any sleep because of COPD and pain, but he is willing to without the bed and other things because he is trying to pay all of his creditors. He has even asked me to sell his car, or offer it to the hospital to settle his bills there.
I don't know what to do. I am already supporting him as much as I can, or he would have NO money for these bills. My friend tells me that if the hospital sends him to collections he should refuse any further payment and work on the bills that aren't in collections, so his credit doesn't get dinged any worse? I have no idea what to do any longer.
Have you applied for Medicaid for your dad? It sounds as though he would be eligible. Going forward, that would pay his hospital and ambulance bills, prescriptions and might cover some home care services. Get started on the application today.
Has his doctor written a precription for the hospital bed? That's who needs to say that it's medically necessary. Call his doctor today. And get the doctor to scrpt some home care.
I would also find an eldercare lawyer who will give you a free " first consultation" to advise on the bills.
More folks will be along with more advice, I'm sure.
This must be so hard for you - I'm sorry
They told us six months ago not eligible for medicaid
Dr did write them, they said not covered. I will ask him to try again
He does not have part D medicare. I think he has part B, which paid 80% of his hospital and left them immediately demanding the balance which he cannot cover without being left destitute.
I have no plans for his future. I guess he'll live with me as long as possible. Then?
1. Is your father getting any assistance from the VA? If not, consider contacting a local VFW or American Legion post, or go directly to the VA or one of the county VA services to apply for medical assistance. If he has a service connected disability, apply for that as well.
2. I suspect your father doesn't have a supplemental insurance to pay the portion which Medicare doesn't pay. We have Medigap plans, which pay the "gap" portion, the 20% that Medicare doesn't pay. Other than direct pay for lotions and some assistive devices, all our bills have been paid by the Medigap plan.
This is the time to research the plans and decide on one before (I believe) Dec. 7, the end of the choice change period.
3. I hesitate to suggest this but perhaps bankruptcy should be considered. I don't know how changes in the bankruptcy laws as a consequence of the real estate recession might affect medical payments, but it's worth a consideration.
4. I would take a second look at the outside agencies that are providing about $1K weekly in expenses.
a. Check out paratransit options through the local public transit agency; it's cheaper than by ambulance/ambulette.
b. Consider getting Medicare Part D to provide assistance with meds; also contact the manufacturers/pharmaceutical companies directly to see if they have low income plans - that would reduce the cost somewhat if he qualifies.
c. Consider getting Meals on Wheels; the meals aren't restaurant quality, but they're also not restaurant priced. We pay $3 for a packaged meal, with a well balanced meal and sides. Meals can be ordered for the weekend as well.
d. Cook in big batches, pack in microwaveable containers if you have them. Your father can just microwave the meals; that'll save you some time in going over to cook for him.
e. Check out food pantries and see if he can get free food - canned goods, etc. Check with local bakeries to see if they have surplus outlets. In our area bread that's perhaps a day or two days old can be purchased for about 1/3 to 1/2 of the store cost.
4. Contact your county and state offices and see if they have elder law agencies. Michigan has an Elder Law organization which provides information on various assistances available for seniors - ranging from food to utilities.
5. Also contact the local senior center in your community to find out what they offer.
I think you could bring down that $1K weekly cost if you can tap into some of these local resources.
Some Senior Centers have loan closets as well; check with the more upscale ones - in our area, they're the ones that have the best selections.
I was getting him meals from the senior center for exactly what you said - $3 each. Dad won't eat them. He also refuses McDonald's or Taco Bell. He has gotten very stubborn.
A lot of the problem is his doctor, I think. When dad had his first appointment the doctor announced to me that it was time to put him into a facility - "for his final days" - he made it clear that dad would not not walk, or do anything else again. He was wrong, dad improved a lot, but he has the mindset now of not bothering to be thrifty anymore.
Instead of dinner at Denny's, he wants Sizzler... He usually GETS McDonald's, or Wendy's, etc, but does he call me names! He figures he is almost 90, has paid his way his entire life, and should not have to "eat garbage" to save every last dollar for his bills. He says the food from these fast food places makes him feel worse and have no energy.
He also blames the doctors for ruining his health. He is not really off-base with this either. I had a lawyer look at it, and he said they definitely made a bunch of questionable and poor moves, but he saw too many obstacles to a lawsuit.
He's strange. He doesn't mind going without new glasses, or dentures, or the bed he needs in order to try and pay all of his bills. But he refuses to budge on meals. He flatly refuses to eat my cooking ( I don't really blame him)
I tried buying him frozen dinners, that worked for two weeks until one of the women I hired to stay with him told him it was a shame that I "made him suffer" with TV dinners.... sigh. She also told him how "unhealthy" they were, and that killed it.
He's not the same person at all since he came back from the hospital. He used to be thrifty, easy going, and laughed a lot. Now, he's grim, contentious, and spends more than he brings in.
I have a meeting with legal aid next week. I hope they can help.
It sounds as though dad may be suffering from some cognitive impairment and from depression related to the changes in his brain. If his mood has changed significantly, meds may help. Just a thought.
Change the Dr and find one who is more tuned into the elderly. Contact your local area on aging and ask for help getting Medicaid. It certainly sounds as though it is time for Dad to be in some kind of sheltered facility. next time he has to be in the hospital get them to refer him for nursing home care and request the social worker assist with medicaid application. many nursing homes will accept a patient "Medicaid pending" Public health may also be able to help get him situated. Good idea to consult legal aid. Can you stop enabling him by buying essentials while he is paying on these bills. Chances are that if you do succeed in getting a hospital bed he will refuse to use it. I think he would be most comfortable sleeping in a recliner. you can probably find a good used one. If a hospital bed is essential The American Legion often has a free loan program and they will usually lend to anyone not just veterans. You can also try and advertise in your local paper. You may get one for around $100, same with a recliner or any other equipment you may need. If you belong to a church people there may know of one you can borrow or buy. There are lots of options you just have to get creative. Moving him into your home will probably not be a good idea as many have found out.
We have a Medicare PPO which costs $150 a month but the copays are still quite high, However last year hospitals billed almost a million for three months i spent in a couple of hospitals. Research cheaper alternative for expensive medications or odrer them from Canada or elsewhere.
I like the Lean Cuisine frozen meals; I think they're better than some of the others. Perhaps you could try one, or one of the lower salt frozen dinners.
As to Medigap plans, ours is $122.86 monthly and picks up the 20% Medicare doesn't pay, but the premium will be doubled beginning January. Still, it's necessary as we never know how much tests and hospitalizations will cost.
I will definitely go through all of these suggestions again and see what I can use. There is an Arby's near here, and I will take him there next, He will eat Subway without complaint, but they are 10 miles away.
He was supposed to get a psych evaluation in home, but she never came. I completely forgot about that that! He was also getting physical therapy visits, but they cancelled at him after two months. Get this - they said he had "low energy" and could not do all of the exercises they wanted him to. He is almost 90, has COPD, and was just back from having been dead in the hospital!
We had a visiting nurse for a few weeks, too. He refused to let her come back after she was examining him in the kitchen, tried to move him and dropped him out of his chair onto the floor. She then called 911, they sent an ambulance, and he got a $500 bill for getting him back into his chair.
The nursing place then insisted that another adult had to be here every time they visited, so if I or the neighbor was not here, it was another $100 each time to have a companion drive out here each visit. It is amazing how much everything costs when you don't have help from your family. Seriously, if I did not have great neighbors, I would have shot myself this past summer. Eventually he decided it was costing too much for the visits, and cancelled them.
Why does dad not qualify for Medicaid?
It really does sound like he needs 24/7 supervision.
Not paying the creditors is a non-starter with Dad. He is old school, and will "pay everyone he owes until he goes" as he puts it. He is very stubborn and hates being in debt, but it's getting hard for him to make enough sacrifices to pay it off as fast as some of these people want. I actually thought, considering the amount of bills he had, he was doing pretty well paying them down before this happened.
I will definitely look into a recliner. I think he'd like one rather than a bed, and much less $$$.
A couple more bits of info - my younger could help, but doesn't. Says "I have a kid." I told him he had parents first, but he doesn't care. Says to let the state look after dad.
Both his doctor and I have spoken to dad about going into a facility. He says he would rather die first. So, if he doesn't live with me, what's left?
I tried talking with the PT woman before they dropped him - told her I saw progress, she blamed her boss for the situation. She kind of explained it like Babalou did, except Babalou explained it directly, she just hemmed and hawed.
If his income is too high, you can visit an eldercare lawyer and do what's called a Miller trust. Also, find out if dad qualifies for any Medicaid waiver programs which might provide some home care.
Find out if Medicaid covers Assisted Living in your state, not hust nursing homes.
I am trying to talk to him about applying for medicaid again, but so far he refuses. He did agree to get a recliner instead of a medical bed. We also had a talk about why he won't eat the meals from the senior center - meat is too tough to chew, pasta is undercooked, and food is "way too salty."
He also says my cooking should be "used to poison dogs, or torture terrorists." At least he still has a sense of humor...
He owns no property, so a reverse mortgage won't work.
The advice on writing collections is appreciated, I'll try that while I continue to work on getting his bills down.
I also found out that his taxi rides to Walmart in town are costing $68 round trip, and to his VA clinic are $177. So basically, everytime I can't do it, or arrange someone to take him, - there goes the budget for the week.
When the elder unreasonably insists on staying home...especially if that is also ruining the care-family's financial stability too....then that elder is likely not being responsible nor prudent, but more likely, has some level of dementia. Some can be downright abusive.
Dementia can make someone seem unreasonable...at that point, whoever is the POA must be decisive and directive, whether the elder likes it or not [you are now the parent figure]...and place the elder in a facility, to save your own hides and healths.
Welfare administers one or more programs that can help, like:
==There's a Federal program which pays the Medicare Monthly premium that's normally deducted from the Social Security check;
At State level, there are food stamps; Medicaid [in CA, MediCal].
Programs might vary per State.
Usually, Medicare and Medicaid can be combined to cover facility care, as long as the patient has spent-down their assets to the State mandated limits.
States will "look-back" at where the person's assets got spent, for a 5-year period prior to applying for assistance.
Elders might loudly/emotionally dislike the idea of existing the rest of their days in a facility. OTH, families have a responsibility to themselves, too.
States do _not_ want a care-family to become yet more welfare recipients due to caring for their elder!
Sometimes, you must bring that situation to Welfare's attention....that if you continue to spend your resources, you will become welfare recipients, too; but if able to set up accounts properly, you have a better shot at not needing to be welfare recipients yourself. Sometimes that gets lost in the process, and they need reminded.
Ask the Social Worker directly, what asset limits are for your State, that your elder must spend-down to, in order to get help.
Your local Area Agency on Aging [some areas, those have other names], can often help with finding the care help and supports you need.