The AFH wanted mom to change to a doctor on this side of town that is familiar with them so they could call in when they needed meds, etc. They gave me a list of preferred doctors.

I don't particularly care for her doc anyway and he's 30 miles away. So I call a few of these new ones.

None of them would take mom's HMO. They only take Medicaire. Mom has a medicaire card and I thought her hmo was only a supplement. Fianlly, the last one I called said that with mom's HMO, after the first of the year, they cancelled her medicaire!

What? Don't they have to write and tell you or let you know they are doing that?

I decide to just call her old doc for the meds she needs, tell him the whole, long tale of woes and work with him till I can find another doctor. I called for 2 days and he does not return my calls. I've left messages, talked to his nurse, told them it's an emergency.......nothing.

Finally today, I told the AFH that he just hasn't called me back. Meanwhile, Mom is raising cain, combative and cussing them and accusing them of stealing. She's still ranting about the kidnappers who picked her up at her home and took her there. She has no memory that she has been with me for months and months.

"G" told me today that she WOULD take care of it. She would call him, pick up the meds, and I could pay her tomorrow. Mom is up every morning at 4am with her bag packed.

Anyway, I called her HMO to find out what the heck happened. I guess it was part of some bill that passed and went into affect the first of the year. No need to warn you, customer service says. Her HMO has the same benefits as Medicaire.

I asked if it paid for nursing homes when her money ran out.
He says, NO! It will pay for in-home nurse's aides.

Wholly cow! Then it isn't like Medicaire.

Has anyone ever heard of this?

Hi Sandy,

Sorry, I don't know anything about HMOs. I do know that we paid for Mom's ALF and the AD unit from her money. Dad's insurance and Medicare wouldn't cover anything but the medical part of her care - no room, food, and such. It ought to be a crime.

You do have confirmation that you had nothing to do with your mother's worsening behavior, not that that's much comfort. On 2nd thought, it should be a great comfort to know that you did as well with no experience as G is doing as a nurse with 16 year's experience with AD patients. You did well!!

Good luck! Barbara

That reminds me of when my charge went into 'respite' care and promptly got expelled the next day for inappropriate behaviour .....

If the PROFESSIONALS couldn't cope, why in the heck did people expect ME to?

It's an eye opener, and the paper trail is frustrating .......

but tell me something ............. and this applies to Martha too ....

If you REFUSE to take your relative home ......... are they put on the street?

I promise I will complain less about Australia's medical system.

Hugs
Sally

Dear Sandy,

Medicare does not pay for nursing homes. It does pay for rehabilitation for a short time after an operation, injury etc. That's how my Mom got some help from them, but as soon as it became obvious that she was not learning how to walk, they dropped her. You have to apply for Medicaid, and they only take people in dire poverty.

An HMO is not a supplement to Medicare but a substiture for it. You agree to have the portion of your social security check that would have been withheld for Medicare sent right to your HMO.

After that you do have all the benefits of Medicare, BUT you are required to stay in their system, use their doctors, etc.

There would not be any great benefit to changing doctors now. I believe it is much harder to get out of an HMO than to get into it. The change that went into effect Jan 1 pertains to medicines. Many of the HMOs have their own drug system as well, and may have automatcially entered your Mom into one of the new Part D plans as part of her membership in the HMO. That was not illegal. It probably does save as much on meds as the Medicare programs do, and is cheaper.

It is possible that when all her money is gone she can still apply for Medicaid - that is not a part of Medicare and by no means happens automatically - you have MOUNTAINS of paperwork - but a state run progam. Medicare is federal.

Hope this helps

Sally, I don't think the NH could legally throw Mom out, but they could send bills to her children. Whether or not it would be legal not to pay them is a question. We can't all lose our good credit rating by having unpaid bills!

Love,
Martha

Barbara,

It did help me see that I was doing the very best I could. I felt so guilty when I learned she wasn't taking her pills. But she is taking them there, they make certain, and it made no difference. G says she is just up/down all day long. Fine/then combative. She says Zoloft just isn't enough now.

Yes, we were paying for everything, too, from her money. I knew medicaire wouldn't pay until all her money was gone. But anywhere I've taken her; doctors, hospitals, prescriptions, they always wanted her HMO card and her Medicaire card. Even G made a copy of her medicaire card. I thought it was something you had to have, whether you actually used it or not.

It amazed me that they could just cancel medicaire and leave you with the hmo so arbitrarily, no notification, etc. It's deducted from her ss check. I guess when she turned 65 and signed up for ss, she had a choice of 3 supplement plans. Everyone on the plan she chose, had medicaire cancelled at the first of the year.

Sally, I'm not sure what they'd do if someone is depending on that money from medicaire. Makes you wonder? We weren't depending on it and knew it would be awhile before we needed it to kick-in. It just upset me that she doesn't even have it and we were never notified.

I think my brothers felt like that, too, Sally. A little surprised that I'd been taking care of her in such a state when even the AFH is trying desparately to get her new meds.

I hope we can get her settled down soon. This is disturbing for us as well as her. I told dh last night, it will feel so good to see her calm again.

Martha,

Oh, I see now! I think I had Medicaire and Medicaid mixed up. Actually, Arizona doesn't have Medicaid. We have something called Access, and Altec (for elderly). So I would never have to deal with Medicaid. And if this HMO replaces medicaire, it's always worked fine for mom. Thank you....thank you........what a relief. I was so darned confused!

When these docs wouldn't take her card, I called the hmo and asked if my own gp was on the their list of network docs and he is. I'll just change mom to my doc. I can call, leave a message, etc., and I get a call-back within an hour. He has no problem giving referrals.

Her doc doesn't return our calls, and I've had this issue with him before. We have sat in their waiting room as long as 4 hours when we had an appt. It's 30 miles away. He's always been a pain to deal with! Won't refer to geriatric, etc.

I feel much better after all this info. I was just so confused about this Medicaire thing. Really, it doesn't matter at all. Her HMO has always been fine, her meds have small co-pay, doc visits are $10. I've always been happy with it.

Thank you, Martha!

Forgot to add, now that I have all this paper junk figured out!

Her HMO does pay for the first 100 days of nursing home, with doctors referral to nursing home. But, I don't think the AFH qualifies for that. I might check into that with my doctor. I can't get an answer for anything from her doctor. They said we could get something called "Prior authorization..." from the doc, because we are the ones who took her without a docs referral, and they will either deny or accept it.

I don't think I'll even worry about that. I have all the stress I can handle right now. And, when mom drops to stage 7, I don't think the AFH keeps them anymore. By then, I'll have another doctor (my own) and can get a referral to an institutional nh by him.

Oh my, it shouldn't be this difficult.