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Who are you caring for?
Which best describes their mobility?
How well are they maintaining their hygiene?
How are they managing their medications?
Does their living environment pose any safety concerns?
Fall risks, spoiled food, or other threats to wellbeing
Are they experiencing any memory loss?
Which best describes your loved one's social life?
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By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington. Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services. APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid. We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour. APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment. You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints. Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights. APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.I agree that: A.I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information"). B.APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink. C.APFM may send all communications to me electronically via e-mail or by access to an APFM web site. D.If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records. E.This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year. F.You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
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Mostly Independent
Your loved one may not require home care or assisted living services at this time. However, continue to monitor their condition for changes and consider occasional in-home care services for help as needed.
Remember, this assessment is not a substitute for professional advice.
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Call Independent Health and they will assign a person to you to help with all your questions. They call it the Red Shirt treatment. You will have a single person to contact and they will call you periodically. You should also talk with the Discharge Planner at the hospital. Hopefully your parents signed up for the premium coverage. My card says "Encompass Plus B1" which is excellent, but remember, there are several different plans. The co-pays are listed on the front of the card. For example it might say "Hospital $240" which means
I am not an expert on insurance but am pretty sure after a certain amount of time on observation the hospital has to make the decision to discharge or admit. Being he was in the hospital that long, it would not be considered observation status anymore. Medicare should cover 100% but check with billing dept. at the hospital. The secondary insurance if hospital is in their network should pick up rest of bill if not covered. Your dad will need rehab after this long stay as he has probably become weak. You may want to start looking around for ones in your area that are more reputable. The case manager or social worker would be the one to arrange that. Medicare will cover so much rehab and the secondary may cover some extra days. You want him to be at the best strength he can be so he does not deteriorate further. Take all the rehab you can get. I know this is not your case but sometimes when people decide to leave hospital against medical advice( AMA),insurance will not pay for the bill of what services they had already received up to that point.
Bookluvr has brought up a mucho importante point about "observation status". If they are under observation, Medicare does not cover their stay to the same degree as for a true 'hospitalization". So look into that first.
Then they (you) need to check to see if the providers (MD's, PT's, etc) are "in network" for Independent Health insurance plan and if they all accept Medicare. If so then, those providers have an established fee schedule and fee reduction as they are "participating providers" for the insurance plan. BUT if they aren't then the provider can bill at whatever their private pay rate is and your parents are fully expected to pay the bill. It could be quite a bit of money. I would suggest you do this pretty soon so you all don't get taken by total surprise on all this.
For example, in my area (New Orleans) People's Health & Ochsner Health are both bigger providers of secondary insurance polices for those on Medicare. But they both have specific lists of providers which are affiliated with their program for coverage. So if say you go to a physician group that is affiliated with Touro Infirmary (another hospital group), you can as you always have freedom of choice BUT it is considered "out of network" and copay is either zero or limited to 10 -25% of the bill depending on your contract. The bill can be at whatever private pay rate the provider wants to charge too. Understand?
Now for Medicare, they should be getting a statement of services paid for and disallowed. It will show what your parents are responsible for. Now CMS (Centers for Medicare & Medicaid) mails these out about every 3 - 5 weeks but the info is on-line @ CMS pretty well as soon as billing is done. You can go on-line for your folks to the CMS site to do an account for them to see what's what on charges too.
My dad spent about 3 weeks in the hospital last year with pneumonia. Medicare did not cover it completely. You may need to check if your father has Medicare A. And what is His Deductible before Medicare will start paying for his stay. Also make sure if your father was in the hospital for Observation (from what I understand is not covered by Medicare) or as In-Patient (80% covered by Medicare.) Dad's 3 weeks stay in which Medicare did not pay and his Secondary insurance Refuse to pay was $1900.00.
What do you mean by "independent living?" His Medicare insurance will likely pay for almost all of his hospital expenses plus rehab, which he will certainly need after such a long hospitalization. Medicare is VERY good insurance, better than most people have in their employer-provided policies. If your father cannot return home and has to go to a nursing home, that is NOT covered by Medicare. If your parents do not have the money to pay for a nursing home, he may be able to qualify for Medicaid. You might want to sit down with an elder care attorney. It can be a complex process and your mother needs to be protected. Ask some friends for referrals and ask the attorney about their fees before you make an appointment with them.
By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington.
Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services.
APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid.
We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour.
APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment.
You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints.
Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights.
APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.
I agree that:
A.
I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information").
B.
APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink.
C.
APFM may send all communications to me electronically via e-mail or by access to an APFM web site.
D.
If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records.
E.
This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year.
F.
You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
Then they (you) need to check to see if the providers (MD's, PT's, etc) are "in network" for Independent Health insurance plan and if they all accept Medicare. If so then, those providers have an established fee schedule and fee reduction as they are "participating providers" for the insurance plan. BUT if they aren't then the provider can bill at whatever their private pay rate is and your parents are fully expected to pay the bill. It could be quite a bit of money. I would suggest you do this pretty soon so you all don't get taken by total surprise on all this.
For example, in my area (New Orleans) People's Health & Ochsner Health are both bigger providers of secondary insurance polices for those on Medicare. But they both have specific lists of providers which are affiliated with their program for coverage. So if say you go to a physician group that is affiliated with Touro Infirmary (another hospital group), you can as you always have freedom of choice BUT it is considered "out of network" and copay is either zero or limited to 10 -25% of the bill depending on your contract. The bill can be at whatever private pay rate the provider wants to charge too. Understand?
Now for Medicare, they should be getting a statement of services paid for and disallowed. It will show what your parents are responsible for. Now CMS (Centers for Medicare & Medicaid) mails these out about every 3 - 5 weeks but the info is on-line @ CMS pretty well as soon as billing is done. You can go on-line for your folks to the CMS site to do an account for them to see what's what on charges too.
His Medicare insurance will likely pay for almost all of his hospital expenses plus rehab, which he will certainly need after such a long hospitalization. Medicare is VERY good insurance, better than most people have in their employer-provided policies.
If your father cannot return home and has to go to a nursing home, that is NOT covered by Medicare.
If your parents do not have the money to pay for a nursing home, he may be able to qualify for Medicaid.
You might want to sit down with an elder care attorney. It can be a complex process and your mother needs to be protected. Ask some friends for referrals and ask the attorney about their fees before you make an appointment with them.