Friday, January 21, 2011

Paper Pushing...

They say a picture is worth a thousand words, so take a look at this one of the papers I have accumulated for my grandmother. I had misplaced a piece of information, so I sat down in the floor to sort everything and see if it could be located. This was the result of my "sort and purge" - and only a couple of papers were designated for the shredder!

It's been an interesting month. We got the ball rolling for my grandmother to move to an assisted living facility (ALF) the first week of January. My husband and I took her to preview an available "apartment" at the facility – called Southridge. She declared it "beautiful." We paid the non-refundable deposit on December 31st, and I began the process of completing all the papers that filled a large envelope.

There were papers for Southridge... a request for Medicaid assistance for an ALF, a physical evaluation and "orders" to be completed by my grandmother's family physician, and more. I set up appointments for a physical exam on January 10th. The papers were turned in at the Department of Human Services (DHS), and I was given an "interview" appointment for 10:15 a.m. on January 11th. It looked like I could get this ball rolling in just a few days.

On Friday, January 7th, a cousin phoned from a nearby city to tell me that her sister had died... my grandmother's niece. This woman was the daughter of Mam-ma's oldest sister, Minnie. The visitation was scheduled for Sunday evening from 6:00 - 8:00, with the funeral set for Monday afternoon at 2:00. We knew we would be unable to attend the funeral, since Mam-ma had her physical exam scheduled for that same time period. To add to the "fun," a major snowstorm was forecast for Sunday - with snow predicted to begin around 5:00 p.m. in our area.

I told my grandmother there was no way we could go to the funeral, and I really didn't see how we could get to the visitation some 30 miles from home - I was not going to drive in the dark in a snowstorm! Sunday after church, I checked the forecast - snow was still headed right for us. I phoned my grandmother, and she said, "Well, I want to go to the visitation." I told her this was not an option. She had also mentioned she would like to go to my cousin's home and visit with family members. I offered to take her early in the afternoon to visit with family members, but we could not make the visitation work. She started to cry and said, "But I want to see EVERYBODY!" (This included all extended cousins and nieces and nephews she assumed would be at the visitaiton.)

We ended in something of a tense discussion with Mam-ma saying, "Just forget it... we won't go at all." I called my cousin and found out where the family had gathered, and I pretty much insisted we drive down for a visit. Mam-ma's comment was, "No, let's not." I asked why she didn't want to go, and she started to cry again, "Because I can't button my pants." Now I laughed. "Do you not have other pants you can wear?" "Well, yes!" This whole situation revealed itself to me when we returned from the visit and Mam-ma said, "I've got to come out of some of these clothes." She had put on thermal underwear, and the bulk prohibited her from being able to fasten the button on her pants! She found something else to wear, we drove to my cousins' home and visited for a couple of hours, and we barely got back to our own homes before the first flakes of what would be about a 4-inch snow began to fall.

Even with the snowfall, I was able to get Mam-ma to the doctor's office on Monday afternoon. He filled out his papers while we waited - an answered prayer - and I marked that off my list. Next would be DHS on Tuesday morning. The case worker began going through my papers and saying, "You'll need this... and that... and something else..." and each time, I'd say, "Got it! Here it is! Yes, that's attached." I have done this three times already over the last 7 years to admit my grandmother to the nursing home for rehab, so I know the drill... or so I thought.

I had gone to the bank and gotten an official print-out of the most current bank statement - for which the bank charged $2 - and I had all of the papers. Because my grandmother is "full Medicaid" - the case worker informed me that she cannot have any assets that exceed $2000. This includes cash, savings, checking accounts, insurance policies, and more. In the past, when Mam-ma went to the nursing home for Medicare rehab, I was told that a small life insurance policy she has did not count. In fact, I was advised to "leave it alone" because cashing it would give her excessive assets and disqualify her for assistance.

Now, it counts. We went back and forth, and I was not successful at explaining that my grandmother’s pre-paid funeral encompasses the burial insurance and it has no cash value. So I left the office with a January 21st deadline to return with proof that my grandmother's insurance policies had either been irrevocably designated toward her funeral or cashed and spent down below $2000 - and I had to have receipts to show how I spent the money.

I understand how some of this works. You can't just cash out your checking account balance and put it in your wallet. You can't write a check to someone and make a "gift." You have to "spend down" the money on things that can be shown... does your loved one need a new mattress or chair? a new coat? We bought things Mam-ma will need at Southridge... Ensure, Depends, new towels and linens, etc.

I left DHS and drove straight to the funeral home and got a letter that stated that there is NO cash value to the burial policies - they are irrevocably tied into the pre-paid funeral plan. Within 30 minutes, I was back at DHS handing this information to the case worker. I wanted her to know I am serious. She had told me that we would see if we could get this done so that Mam-ma can enter the facility on February 1st. If not, she said, "we'll work from February 1" - which means that Mam-ma would get another Social Security check which would have to be "spent down" - and basically, we would start over on the finances.

The other piece of the puzzle is an actual physical evaluation that must be performed in-home by a nurse who represents Medicaid. She has to say that my grandmother qualifies for Medicaid assistance in an ALF in order for us to get any Medicaid assistance... which basically means she determines whether Mam-ma actually can go to Southridge. I asked the DHS worker if she would go ahead and send out a nurse for this evaluation, and she said she would.

I determined that I needed to cash the life insurance policy. Since I knew that this would not happen overnight, I asked the DHS worker if I could drain my grandmother's checking account (showing a paper trail, of course) and prove that when the life insurance check comes, we will not have more than $2000 in assets. She said yes, this would definitely work.

So my goal for the rest of the week was to get the life insurance issue settled and "spend down" the checking account. I called the life insurance company to determine how to proceed, and I was told that they were not authorized to talk to me. "We have to have power of attorney papers on file... and we don't accept any power of attorney that is more than five years old." Mine was issued in 2004. I asked how I was supposed to work with them. The rep said, "I really don't know - maybe get a new power of attorney?" I told her I did not have time to do this before February 1st, and my papers were good enough for DHS and Medicare, so I wasn't sure why they weren't good enough for her company.

I told the rep, "I do not mean to offend you, but I am on a tight time line... is there someone else I could speak with who might know how I could do this?" She put me on "hold" and was gone a while, then returned and said, "We need authorization from your grandmother. I can mail her an affidavit to sign about the power of attorney." I explained we don't have this kind of time. While I was on "hold," I recalled talking once with another case worker at another agency who would not discuss my grandmother's case with me by phone, and we ended up putting Mam-ma on the line via my cell phone, and she authorized the discussion. I asked this rep... "What if you could hear from my grandmother that this is okay?" She said that would work. So I picked up my cell phone and dialed Mam-ma.

I told Mam-ma what was happening and that she needed to tell this lady on the other phone that she could talk to me. I held the phones together, and Mam-ma said, "You tell her anything you need to and ask her anything you need to." The rep said, "All I got was buzzing from the cell phone." However, she offered to conduct 3-way calling with Mam-ma if I could get Mam-ma to hang up, and she would phone her directly. We did this, and the rep asked Mam-ma (who had been napping), "What are the last 4 digits of your Social Security number." "Just a minute," Mam-ma said, setting down the phone and going to find her purse. She could not locate the Social Security card, and she did not know her number.

So the rep asked, "What is your mailing address?" Mam-ma could not remember. I finally prompted with the first digit, and she was able to give the rest. Then the lady asked Mam-ma her birthdate, and Mam-ma said, “November 5, 1912. “ The rep said, "No, that's not right." "Yes, it is," I interjected. "No, that's not what we have." I opened the original policy from 1970 and looked at the information. "I am looking right at the original policy, and the birth date is November 5, 1912." The lady insisted she could not help us because that was NOT what her records showed. Mam-ma became upset. "Well, I know my birthday IS November 5, 1912." I laughed and said under my breath to the rep, "Bet you don't get very many 98-year-olds on the phone, do you?!"

Finally the rep said, "Okay, Mrs. Chandler, is it okay if I talk with Debbie about your policy?" Mam-ma replied, loudly, "Sugar, you talk with her about anything you need to. It's just fine." The lady thanked her... I told her we would talk later, and Mam-ma hung up. I was able to ask two questions... what is the cash value of the policy, and how do I surrender it? The rep wanted me to FAX some info. I told her I do not have a FAX machine at home, but if I had to drive somewhere and find one, I could. She then said she would mail some papers to me for surrendering the policy. I explained again about our timeline, and I asked if she could FAX the papers to me? She said she could, but it would take a couple of days for her to request the proper forms to send by FAX. I told her that I would call two days later and give her the FAX number, and she promised to FAX the papers immediately.

This all came together on Thursday, January 13th. I took Mam-ma to the beauty shop to get a permanent, and I went to my old office to pick up a FAX I'd received there and mail the original insurance policy back to the company, via expedited mail. We also had to go BACK to the doctor's office to have Mam-ma's blood drawn - the lab tech was not in the office on Monday because of the snow. Thursday was a raw, bitterly cold and windy day, and by the time I got Mam-ma home, she was exhausted.

Oh, I forgot to mention... on Wednesday morning, my sister had called to say that their household had stomach flu. Timothy was recovering from it, but they didn't want him exposed again... could we keep him a few days? So Thursday, I left Timmy and my husband at home together for four hours while I ran errands with my grandmother. Timmy stayed with us from Wednesday morning to late Friday afternoon... and we loved every minute of his visit! I am blessed to have such a wonderful husband who steps in and does whatever is needed... and who loves Timmy as much as I do! And thanks be to God, neither of us ever caught the stomach bug!

So... I felt I had all of the T's crossed and I's dotted... I paid almost of my grandmother's last utility bills. I bought the Ensure and Depends and other items she will need. We saw the doctor and I surrendered the life insurance policy. I was within inches of getting all bills paid, receipts printed, and papers returned to DHS. The only “fly in this ointment” seemed to be the telephone bill, which is auto-drafted. In December, the draft was on December 17th, but by January 18th, there had still been no draft. I needed to know the amount of this bill to complete my spending.

I decided to get an online account and look at the billing. In order to do this, I had to submit Mam-ma's telephone number, and someone would call her within 15-30 minutes with a "code" that was needed to complete the login and password. I decided it was worth a shot, so I completed the process and called Mam-ma. "Someone from the phone company will call you in the next few minutes and give you a code. Have a pen and paper handy and write it down... then call me." "Okay," she said. More than an hour went by, and Mam-ma did not call me. I knew that my husband had been at her house to deliver her Meals on Wheels and change a light bulb. I thought maybe she got distracted. So I phoned. "Mam-ma - did anyone call from the phone company?" "No!" she answered. "Oh... wait! Yes, someone called, but she didn't speak English, and I couldn't understand her... then a man came on, and I thought it was a sales pitch, so I hung up." I told her that was okay, and I dismissed it. A few minutes later, Mam-ma phoned me... "I think I messed up." "No, Mam-ma, it's okay... don't worry about it."

Later in the day, I decided I really did need that phone bill info, so I thought I would try again. I called Mam-ma and said, "Okay, we're going to try this again. This time, if you can't understand the person who calls, just say so and someone else will come on the line. Write down the information they give you and call me." "Okay," she said. A few minutes later, Mam-ma phoned me... "That man said if you will call 1-800, you can get what you need." "One-eight hundred what?" I asked. "Just 1-800," she answered. "OKAAAAAYYYY!" I said! I decided to move ahead and pray the bill was drafted in a day or two. Soon Mam-ma phoned AGAIN... "Did you ever get what you need?" "Yes, Mam-ma, I have everything taken care of... thank you!" On January 19th, the phone bill draft appeared on the online banking account. Thank you, Lord!

Now I had all I needed. I wrote a letter to the DHS case worker, outlining all of the payments I had made. I printed out a current bank statement and attached copies of checks and receipts to prove that I had spent the balance. I showed proof of receipt for the insurance policy I had surrendered to the company headquarters in Kansas City. I still wanted to show the current cash value of the life insurance policy, and I also wanted to verify that the company DID receive it and all was well. So I phoned the life insurance company again… and again I was told they could not talk with me.

Cut to the chase… get Mam-ma on the line… have her tell the rep I can talk with her. AGAIN, the worker argues that the birthdate is not correct. She says her records show neither November or a five. I told her it sounds to me like someone entered the data wrong on their end, because I am looking at a copy of the original policy – which they now have – and it clearly says November 5, 1912. She said maybe the agent entered the date wrong. I pointed out that this policy was created in 1970 – on what appeared to have been a MANUAL TYPEWRITER! The bottom line was that I had to FAX my grandmother’s ID to the insurance company with proof of her birthdate. I was able to verify yesterday that this FAX was received, and hopefully a check is forthcoming.

Meanwhile, I phoned DHS and asked to speak with my case worker. I also got in the car and drove to DHS and left my letter and receipts. The very helpful receptionist date stamped everything and said she had discovered the case worker was not in the office that day, but she should be back in the office on Thursday, and my papers were atop the case worker’s desk for her review.

It took three days and several phone calls, but I was finally able to speak to my case worker, who told me she had not had time to look at my papers. I explained what I had done with the money. I assured her that there is no money left - I've spent it down and left receipts to prove it!

The case worker had told me on January 11th that she would go ahead and send a nurse to evaluate my grandmother. To date, no nurse has come. I asked if she could please send the nurse. She said that the nurses were doing double duty with another agency, and she just didn't know when the nurse could get there. I asked about the February 1st deadline, and I pointed out that we were in the midst of a second major snow event, and I am on pins and needles that my grandmother will try to get to her mailbox and fall and break a hip before I can get her admitted to Southridge. The case worker said she understood, but she said that she is the only Medicaid case worker available presently - the other worker has been ill and is on sick leave. She said there were several people ahead of us who have been waiting more than a month already.

I asked, "So your comment about getting this done by February 1... is that not still possible?" She was not sure. And she could not tell me if the nurse would be able to evaluate Mam-ma before the end of this month... "If I told you a date, I'd be lying," she said... "because I just don't know." So I do not know WHEN we will be able to move. I told the case worker, "I'm going to hang up and say a prayer." She laughed, but I hung up and did just that.
At this point, I have done all I can do. But I do not underestimate the power of prayer. I have not told Mam-ma that we might not actually move on February 1st. I'm believing that God will work in this situation and fill in the gaps now where I am powerless. If you want to agree with me in prayer, that would be great! Meanwhile, I'm washing new towels, labeling everything with Mam-ma's name, and preparing for the big move in 10 days. I'll let you know how it goes!

No comments: