Pizzaguy - I am so sorry that I missed this post! I did see the latter post just this morning. I had been wondering where you were as when I joined the forum last July your postings were some of the first I recognized. I am so sorry to hear about your sister, and of course, send all the good/healing thoughts I can. She is very fortunate to have a brother like you who is so concerned with her well-being.

I am sending healing, tranquille and restorative thoughts to you and to your sister. I am hoping that all the good wishes from your Crossfire friends will help support both you and her. Alicia

 

By now, those of you who have seen my facebook page know that my sister has withdrawn her request to live with me. It was a very good conversation - one that needed to happen.

I am now working on what I CAN do. I CAN financially help, I CAN go over and give Frank a break at times (they are 40 miles from me - it'll be an excuse to drive one of the cars) and I may even back out of the current play that I am in so I can help a bit more. We'll see.

I am also taking a bit of a more active role in finding solutions, well THE solution: a placement in a home with the services she needs.

I thank you all for your support, the offers made here an in PM's (you have no idea how awesome people are here until you are in need!!!!!!)

I am past the "crisis" and "reactionary" stuff... it's time to stop feeling, and time to think and act.

 

Pizza,
Have you/she considered home health? I know of a company in Peachtree City and I work for company that has an office in Atlanta and Gainesville, I know my company can do 24 hour skilled nursing service. If you want I can check if both companies take Kaiser and get you the numbers. Send me a PM if that is something that you think would work for her. Best of luck to you and her.

 

excellent Mark. Good work thru the stuff as it is, and then you can figure out the next steps as you go. Glad to hear Frank is stepping up here. Don't know him, but glad there seems to be some sense of responsibility. This is a good thing for all the people involved, and you'll all get to figure this out together rather than in pieces. Good work. Good results given the circumstances.

 

As always Pizza it's just one day at a time....

 

Can only offer prayers for you, 'Za.

Even though I buried one of my sisters in law who had muscular dystrophy on New Years Day ... only 58 ... I will not even speculate what you all are going through.

Maybe there's a lawyer on the board who can PM you or your sister the right way...

 

I am channeling my energy in as effective a way as I can.

I have a Social worker and my doctor saying the same thing: She needs a nursing home, the insurance (Kaiser) is contracted to pay for it. This is not medicaid or Medicare's problem - it is Kaiser's problem.

"Your next stop is an Elder Law Attorney".

My appointment with him is February 15th.

(In the past 15 minutes, I have learned that one RN and one visiting nurse have both written letters in the past month indicating to Kaiser that a nursing home placement is needed immediately. I think I have plenty to give to the lawyer, just got his info and assesment forms in email.)

 

Great job staying positive and moving forward.

And keep in mind when dealing with the insurance company, you catch more bees with honey

 

My sis HAS been understanding, patient, etc. And shouting at anyone does not work, but a well-worded document from "Sue the Bastards, Inc." often does work.

The insurance company is responding, they are ordering more in-home stuff (that won't really work - but it's obvouis to my sister that they are trying to cover their bases in preparatoin for a fight).

 

I have offered her to live here with me, but so far she sees that as "no long term answer". She is, of course, right.

 

Mark,

I also missed this until this morning.

I don't know law or social services, but my sister, brother, and I are working through similar with our parents now. It is probably a fight between your sister's insurance provider and Medicaid, but in the end, Medicaid should cover the cost of care if they can't get it from her or her insurance. We get different stories every day from Medicaid. They will end up with everything my parents worked for.

My mother has a host of mental and physical problems that require more specialized care than we can provide, so having her in one of our homes is not an option. My dad, after 64 years, won't leave her side.

I wanted to stress to you that even though you may want to do all you can for your sister, she probably needs care you are not qualified to provide. Don't beat yourself up. Working toward getting her the appropriate care is the right path.

You and your sister are in our prayers.

Michael

 

And there are those that wish to go back to letting Insurance companies do whatever they want to save a buck.

This really is a travestry of justice and human dignity. Hang in there my friend.

 

Well, thanks everyone. She has accepted that the Insurance (which I have found out is really a "front" for medicare) is not going to help.

She is pursuing a medicaid application.


I found out something really interesting from the Elder Law Attorney:

He explained to me that Kaiser is a part of Medicare in this instance. See, my sis pays $64 a month for the Kaiser coverage and Medicare pays the rest. It's convoluted, but she's essentially on Medicare - even tho she's only 56, she's on Medicare due to being disabled. She's on disability and has been for about four years. (She was on a partly-disabled status from 1991 to 2005. She worked some, but since she cannot drive or walk at all now, she can't work at all).

The lawyer says that Kaiser is being "used" by Medicare as a kind of a "firewall" between the patient and Medicare. Kaiser has to deny her, and everyone, as much as possible because they are essentially distributing Medicare money and if they approve too many people, Medicare can say that KAISER is involved in helping people defraud Medicare!

This was news to me, I did not understand the whole picture. The lawyer said that this is part of the rationing of health care that has been going on for some time - that it is nothing new. He said they have to be tough, otherwise everyone would get their relatives into homes and bankrupt the system entirely.

I still do not understand why it costs $5000 a month for a nursing home. Sure, you get 24 hour nursing, but its not like it's one nurse per patient!

Now, he DID say that for $4400 he can do an emergency medicaid application that WILL be approved in a short time. My sister is rejecting this, not sure why. I offered to pay 1/2 of this cost.

I have done what I can do, and offered to do more of what I CAN do. I can't do any more.
Added to this, I am working on a new job and will VERY likely be moving as little as 60 miles or as many as hundreds of miles for my next job. I am REALLY concerned about my long-term prospects with THIS company.

Man, I wish things had worked out for Hope and myself... life would be a lot simpler.

 

you're in a really rough spot right now, for the last year things haven't gone the way you'd hoped, but that's life, and it's about finding how to get past these without losing your sense of self. The good news is that things tend to go in cycles, that when you're on top of the world, the only way to go is down. Conversely, when things are really in the dumps you have to KNOW that they will improve. So you don't get too cocky when you're on the upside, nor get too depressed when you're on the other side.

The whole health care thing is really a mess. My Mom passed away this past week, 77 years old. It was a blessing for many reasons, and she didn't really suffer in death, but would have really struggled in life had it continued. My dad and I were really trying to figure out what plan B was going to be if she made it past 90 days because medicare would pay for that, but after that you're on your own. People blame the insurance companies but alot of it has to do with the heightened expectations our culture has gotten itself into, cradle to grave, someone is there, or should be to take care of all of us. That is simply foolishness, but that's where we are, and alot of why we're in the mess we are today.

Chin up my friend. Make a move in some direction and things will be placed in motion to change.

 

I was doing well in 2008/9. But 2010 was a MESS.

So far, 2011 just is'nt going right, either. BUT, I went for a LONG time with life very good - it' cant last forever.

Right. I'm not licked yet - and I continue to have good health, which is a tremendous blessing. I continue to try to keep healthy - doing what I can to live as smart as I can (without stuffing TOO many vegetables in my face!)

I hate to change jobs, but I really think it's time. I'm working on that, but it may be something that does not change for several months.

 

I think alot of this for alot of people is that the economy and world events really dragged alot of things and lives down, kinda like an energy vacuum. My 2010 sucked too, spent the entire year batling my ex over child support for a kid who was turning 18 later that year, and we'd been divorced for over 10 years. Talk about stupid! and 2011 right now seems like a drag on of last year, but w/o dealing with Child support services anymore thank goodness. Useless state agency in my opinion

Job is here, but no raises. My fault, no. But does that matter? Not really.

But in so many ways I'm very lucky too, and blessed with a nice home, a great wife, a job I get to go to every morning where I reasonably enjoy. When this economy starts to shake out there will be alot of changes that we can't even dream about right now. But I believe it's going to be a big one.

 

You are so right there Mark. Some day the world will wake up and discover that we're all in this together...and say screw politics let's get it solved.

I hope and pray that this works for you Pizza. It appears to e taking a better curve. Stay strong.

 

Hear hear, Bruce.