Sunday, November 15, 2009

Taking Care of Business

On November 5th, my grandmother celebrated her 97th birthday. We actually celebrated the day before with a lunch at our local hospital cafeteria. Everyone was there, and many local residents stopped by to wish my Mam-ma well, too, so she had a great day. I think her phone rang almost non-stop on her birthday, and her mailbox was filled with cards. She also had a few visitors drop by to say "Happy Birthday." My mother picked Mam-ma up and brought her to the lunch, then took her home. We were probably at the cafeteria for two hours or better, and when Mom pulled into the driveway, Mam-ma said, "Can't you come in and visit for a while?" No... Mom had things to do. Mam-ma also told her, "You hardly ever come to see me any more." Mom admitted she doesn't go often, but she HAD just spent two hours with my grandmother!

On Friday, November 6th, I picked Mam-ma up for her beauty shop appointment, and the house smelled like a bakery. I knew from posts on Facebook that the children of a cousin who lives in Little Rock had called and wished Mam-ma a "Happy Birthday," and one of them mentioned he liked her sugar cookies. She replied, "Well I'll bake you some, but you'll have to come see me." When I smelled the cookies, I knew she had taken his request quite literally. She began telling me that "the kids are coming," and I cautioned her that "soon" to them probably didn't mean right away. She didn't buy it. So when I got home, I posted a comment on Facebook and let them know that Mam-ma had already made the cookies for their son. They came on Sunday, so they avoided the dog house!

As we left for the beauty shop, Mam-ma said, "My walker needs new tips on the legs." Now I think I posted here a few months ago about the ordeal of getting new legs for her walker when "all I wanted was two tennis balls." So I said, "We've been through this." Well, this was ANOTHER walker, and the tips were shot. I said, "Let's take the walker I had fixed for you a few months ago, and you use this walker outside where the tips don't matter." She said, "Okay, but THIS walker has wobbly wheels." I couldn't see it, but she reluctantly took the newer walker, and I told her that the next Friday, I would factor in time to take it by the medical supply store for a look/see.

Over the weekend, my sister and I were talking, and she said, "I'm worried about Mam-ma... she said she hadn't done well for two days." I asked if Mam-ma told her about the cards, phone calls, visits, cookie baking, laundry she had folded, etc., and she said, "Noooooooooo." That explained her exhaustion!

My husband and I keep our great-nephew on Tuesday and Thursday afternoons while his mother attends college classes. Sometimes we keep him overnight and on weekends, too. Tuesday afternoon, I barely got Timothy in his crib for a nap when the phone rang. I was unable to reach it in time, but caller ID showed me it was Mam-ma. I returned her call and told her I was just putting the baby down for a nap and couldn't get to her phone call. She said, "Oh, you've got the baby?" "Yes, we have him every Tuesday and Thursday afternoon." (She knows this!) "Oh, you do? Every Tuesday and Thursday... well that's nice." She wanted to ask me what color to embroider some pillowcases I had purchased for her - just for something to do. I told her it did not matter to me... but she wanted me to pick a color!

When I picked up Mam-ma the day after her birthday, there were several pieces of mail for me... the new Aetna formularies for Medicare Part D prescription drug coverage, and two letters from the Arkansas Department of Finance telling me that Mam-ma's handicapped parking sticker is expiring. I read through everything - as expected, Aetna will not cover one of Mam-ma's most expensive medications in 2010, so for the FOURTH year in a row, I am choosing a new provider and making the switch!

One morning I sat down to review the providers and see if I could figure out which insurance company might fit Mam-ma's needs. I went to and began the comparison process. First you have to enter your Medicare ID number, your birth date, the date Medicare coverage began, and a few other things. If for any reason after you advance to the next page you hit the backspace key, you lose every bit of that info and have to retype. I know... I've learned the hard way. Now once I get to the actual page for comparing providers, I have "saved" my grandmother's prescriptions for reference, and I can edit dosages and even add or subtract prescriptions if needed. However, to do this initially, I had to enter each drug individually, along with the dosage and the number of pills she takes per month. It wasn't hard for me, but then, I am not quite a "senior" yet and consider myself fairly computer savvy.

I adjusted Mam-ma's meds and added a new one and removed the old one and SAVED my info again. But before I did this, I realized that the website now offers a "My Medicare" option, where you can create a login and password, and you will be able to retrieve all of your information about Medicare coverage, including what you have spent, what is still available and allowable, and more. So I thought, "Great! If I get a login and password, maybe I won't keep losing my info each time and having to retype things." Here's what happened. I created a login - and there were specific instructions about how to make it something you will remember, but not something others might readily know. Then I gave my e-mail address and I was told that a temporary password would be sent to my e-mail account - and mailed to Mam-ma! (Won't she be tickled?!)

I checked my e-mail account, and here's the good part... to create my temporary password, I had to take the first letter of my grandmother's first name, then add the last four digits of her Social Security number, followed by the first letter of her LAST name, followed by a code that Medicare gave me in the e-mail message. Once I was logged in with this password, I could change it to anything I wanted, as long as it included at least 8 characters, a letter AND a digit, and any number of characters such as *,&, !, and others that are generally not allowable in all things Internet or computer! Now I had to laugh... what genius came up with this procedure for SENIOR CITIZENS?! It truly boggles the mind.

I now have a call pending with the Medicare office in Dallas, as I do each year, to clarify questions for which I cannot find answers on I think I know the answer, but I have to be certain!

So Friday, I picked up my grandmother for her hair appointment, and she practically met me at the door, pillowcases and embroidery thread in hand... what did I think about lavender? I told her it was fine by me. Then I started to dispense her medications into her daily pill boxes. She had not taken her night-time medicine four out of seven nights. She had missed two morning doses, and her Friday noon medication was still there - and it was almost 2:00. I discussed this with her, and she had no clue why she had not taken all of her medicine - and honestly, she didn't realize she HADN'T taken it! She had, however, worried herself silly over a "shoebox" for the church for a project for Franklin Graham's Samaritan's Purse Organization, called "Operation Shoebox." She and her friend Ruby had both stuffed shoeboxes full of toys, candy, toiletries, small workbooks and more, and Ruby had wrapped the boxes in padding and then covered them in colorful Christmas fabric. A couple of 5-9-year-old boys in a foreign country will get a real treat this Christmas!

Mam-ma took her noon-time medicine, and we started to the beauty shop. She showed me the old walker and said, "I just took those tips off... they were shot." I told her that I planned to get her newer walker looked at while she was having her hair done. I took her to the hairdresser's, then drove to the medical supply place. A very nice man and woman looked at the walker and declared that "Someone has put the miles on this!" The wheels were worn flat and hard... and the walker itself was completely out of alignment. They could put new wheels on it, but there was nothing to be done about the alignment. The woman said, "Since Medicare has provided her with a new walker in the last five years, they will not pay for a new one, which is $120. But I have a used one that is refurbished and perfectly good that I can sell you for $50." I told her I would take it. So I got a new walker for Mam-ma to use at church and when she goes places with Ruby, and we agreed she could use the old wobbly one with new wheels outside and in the yard. When I got home, I wrote OUTSIDE in black magic marker across the handle rails of the old one, and I put her name on the new one.

But before we could get home from the errands/beauty shop, we had to stop at the Department of Motor Vehicles and get a photo ID and new handicapped parking sticker. Mam-ma somehow qualifies for two of those hangers to place on the rear view mirror, and she wanted BOTH of them. Just as it was our turn to be served, the computers went down, so we had to wait about 20 minutes. But we got the photo ID and two hanging permits.

Back at home, I started putting away my grandmother's groceries, and she said, "I don't know why I'm so out of it." and I reminded her it was due largely to not taking her medication. She didn't answer me. I insisted she has to try harder to remember to take it and not get so busy. I finished putting away the groceries and dispensing her medicine, then I took probably 10 pieces of clothing off her clothesline - she had hung each one on a hanger and pinned it to the clothesline with TWO clothespins! That line is high - I have no idea how she did that and balanced on a walker! AND... there was a THIRD walker at her back door that I had never seen before! Counting her "good" one inside, she had FOUR walkers! I folded up the one with no tips on the legs and put it in my car... and I told her it was going away!

Here's the kicker... my husband and I went to the local high school football game later that evening, and Mam-ma's Home Health Aide, whom I've known for over a decade, asked, "Did you help Mam-ma get her peanut brittle made?" "What? Peanut brittle?" I had not heard this one. The aide went on to say that when she helped Mam-ma that morning with her bath, she said, "I wish you could stay all day and help me." "With what?" the aide asked. "Making peanut brittle!" my grandmother replied. This makes the second year she has made peanut brittle "on the sly" and tried not to let me know about it, because she thinks I will fuss at her. And I might - she handles scalding molten candy in a HEAVY saucepan, and one winter she required physical therapy on her shoulder after a Christmas season of making peanut brittle. Hers is the best around, and she will probably make close to 50 lbs. of it this year. Last year she made nearly that much and never once asked me to buy as much as a peanut, much less sugar and corn syrup. She had friends and church members keep her in supplies and help with deliveries.

Knowing all of this, it's no wonder Mam-ma isn't remembering her medications... she has too much else on her mind, from embroidery to parties to peanut brittle! The aide also told me that Mam-ma nearly killed herself making THREE BATCHES of sugar cookies for the cousins who came. But she truly did enjoy them, so I guess it was worth it.

When I left my grandmother's house, I still had to return to Wal-Mart for OUR groceries. Also on my list was another box of diapers for the baby, plus formula and baby food, and a child car safety seat. I had to laugh... as I loaded my groceries into the car, I opened a door to set the car seat inside, and there was the walker. Now if I'm not covering both ends of the spectrum, nobody is! And we get to do it all over again this week!

Saturday, November 7, 2009

Here We Go Again With Medicare!

On November 5, 2009, my grandmother celebrated her 97th birthday. She is in excellent health and still lives alone in her own home. She is able to do this because of the vast assistance from her family and various agencies, including our county's Home Health department, assistance with utility bills twice a year, Medicare, Medicaid, and her monthly Social Security pension of $759. I serve as her Durable Power of Attorney and handle all of her business transactions for her.

When the Medicare Part D Prescription Drug Plan was enacted in the fall of 2006, I selected what I felt was the best plan for my grandmother. Shortly after January 1, 2007, I discovered that Medicare had "switched" my grandmother to another plan without my knowledge - a plan that did not cover her prescription medications. It took some work and the assistance of a very helpful Medicare official in Dallas, but I was able to get my grandmother switched back to CignatureRx. This was not the end of the story... there were continual struggles with CignatureRx, because drugs they said were covered in 2006 seemed to mysteriously be "no longer covered" as the year progressed.

In 2007, I learned that CignatureRx was no longer a good fit for my grandmother, due to lack of coverage and the addition of premiums and deductibles. So I repeated the process to search for a new provider, and I chose Humana. I have to say, the folks at Humana were wonderful and very customer-friendly. They tried to tell me that two of my grandmother's most expensive medications were not going to be covered, but after hearing from her physician, they gave her a "lifetime waiver" on those drugs - she could receive these drugs for the initially-agreed-upon co-pay. I thought I was set! I learned in November 2008 that "lifetime waiver" was only good for one year - that in the insurance company's terminology, a "lifetime" equals one year.

Medicare employees confirmed to me in November 2008 that most seniors will have to re-apply for coverage EVERY SINGLE YEAR, due to changes in formularies, premiums, deductibles, and more. So once again, I am searching for an insurance provider that will adequately cover my grandmother's seven daily prescription drugs.
I know this is lengthy, but believe me, I have condensed it greatly. If you were to read my blog posts of February 2006 and November 2008, you would see some of the ordeal that has transpired:

Aside from the obvious concerns over how this is handled... here are my issues with this plan. I am a 52-year-old former elementary school teacher with a MS in Education. My husband and I founded a magazine and publishing business. I know how to navigate "red tape" and make appropriate contacts, yet I still struggled with this one. If getting prescription drug coverage is this difficult for me, imagine what it would be like for seniors trying to do it themselves. They get through two pushes of the menu buttons (and there are dozens!) and they give up and go away. I figure this is the hope of many of these bureaucracies. As concisely as I can make it:

  • Medicare Part D is another example of how convoluted our health care system is.* The average senior cannot figure this out on his/her own, and I seriously doubt most have advocates to do this for them. Even four years into this, I still have to call my Medicare connection in Dallas for clarification and confirmation. I got this contact because initially I complained loudly to everyone from then Governor Mike Huckabee to Congressman Marion Berry, both of my senators, and others. Most seniors won't have the resources - or patience - to do this. (See my first blog post link for info on the responses - or lack thereof - I received!)
  • I try not to let my grandmother know how much is involved in getting this coverage each year; however, sometimes she is required to verify information on the phone for representatives, etc., so she does know there is work involved. One day she said, "I'll just not take those medicines." I quickly told her this was not an option! But I fear that this is indeed what many seniors are doing... rather than fight the phone menus, comparing plans, and more, they give up and forego needed medications. This system is designed to shoot them down quickly and frustrate the seniors into quick defeat.
  • The Medicare Part D Prescription Drug system is not equitable. So far, because of her meager "income," my grandmother has qualified for a waiver on premiums and deductibles on certain plans. Many others do not, and those premiums and deductibles add up quickly for older Americans on a fixed income. And what happens when the plans get so out of whack that my grandmother and others like her no longer qualify for waivers on these fees, as well?

  • The "donut hole" is ridiculous. The mother of my mom's neighbor had to have an extremely potent antibiotic last January. The doctor could have given her injections, which would have been covered somehow by the insurance provider as a "medical procedure" perhaps. Instead, he prescribed oral medication - to the tune of about $3000 per month. This meant that this lady was thrown into the "donut hole" in February! I have a sick feeling this is in no way an isolated instance. Yes, it was a mistake made by the physician, but it shouldn't be possible. Physicians need to be treating patients, not keeping up with which forms of certain drugs are covered by insurance companies - and how!

Thankfully, I am now semi-retired and have more time to devote to keeping my grandmother in the necessary assistance to sustain her in her own home. We've done three stints in nursing homes for rehab following injuries and illness, and that is not where she needs - or wants - to be. And frankly, keeping her at home is far more economical for the federal government, in terms of capital outlay for her care.

The bottom line for me is that this system is not working for our seniors, and it's almost as if - as a nation - we don't care! As I understand it, presently the government cannot regulate premiums, deductibles, and formularies for the pharmaceutical companies. I believe it is time to revisit this situation... and maybe this is where the public option could help... something that seniors could choose that would cover their medications without imposing these fees and restrictions. I wholeheartedly support the President's health plan, and I believe that, sadly, this fiasco with Part D coverage is only one small part of a much bigger problem. But it is one that desperately needs to be addressed.