Can You See Me Now?

This is a big week for my grandmother.  Thursday night is the annual "Widows Banquet" at her church.  I did not make up this name - they really do call it the "Widow's Banquet."  Each deacon at the First Baptist Church is responsible for the care and nurture of assigned widows.  My grandmother's deacon is wonderful... and he does many very nice things for Mam-ma.  This banquet is always a HUGE deal - as much as the prom is important to any teenager.  We moved Mam-ma's hair appointment to early Thursday, so that her hair will look nice, and she will have plenty of time to rest and dress.  Usually her deacon brings her a corsage, and she wears her nicest outfit.  The church social hall is decorated, the meal is always "delicious," and there is generally live entertainment - usually a musical group.  Mam-ma talks about it for weeks before and afterward.

So Monday, as I sat down to eat a late lunch and visit with my husband and mother-in-law, the phone rang.  Mam-ma wanted to know some details about her funeral.  I explained that everything was taken care of - I had personally spoken to two owners of the funeral home, and all would be handled to her satisfaction.  Then she said, "Well... I want His Eye is on the Sparrow and Beulah Land" (meaning she wants these songs sung at her funeral).  I wrote it down.  I told her I had heard from my mom that she wanted a certain church member to sing Beulah Land after it was sung at another funeral recently.  She said it didn't matter who sang it... and I pointed out she had previously told me she wanted a men's group to sing, and she retorted, "Why, they can't sing Beulah Land!"  I laughed and made notes.  I also asked about the hymns she had told me several months ago she wanted sung.  Now she wants His Eye Is On the Sparrow and Beulah Land.  I told her this was fine - and I would note that today she wants these songs. 

Then I asked, "Are you planning on kicking off any time soon?"  "No," she laughed, "but when you sit here by yourself all alone and think about things, you get to thinking about this."  Later my mom pointed out she doesn't plan to die before the banquet!  Anyway, I tried to console her and reassure her that we would carry out her wishes.

That evening, Mam-ma phoned again.  "Debbie," she said.  "I just sat on my glasses and broke them all to pieces!"  We talked about what she could do - didn't she have another pair that was very similar and close to the same age?  Yes, but she couldn't see out of them (I didn't understand this) and they were "great big."  No, that must be another pair, I told her, but she insisted.  I told her I wasn't sure when I could get there to help her... I was expecting to have the baby the next day and Greg had afternoon appointments.  She said, "Well, that's okay... but I need to be able to see for the banquet."  I pointed out that there would be no way to get new glasses by Thursday.  Maybe these could be repaired.

So Tuesday morning, I called the eye clinic and asked if we coudl come in and see about the glasses.  I dashed to Mam-ma's and collected her.  She was wrapping her glasses in a handkerchief - mangled wire frames with both lenses out - but not broken.  I hoped the girl could repair them.  She thought she could, but there was a piece broken that required a special solder, so we were unable to repair the old set.  New frames were ordered - they will be ready in two weeks!  Mam-ma said, "I can't see out of these others."  The girl checked, and they were misaligned, and she was seeing the bifocal at the same time as the other part, so hopefully that is better now.

We had quite a discussion about whether Medicaid would pay for the glasses.  At first the receptionist said that Medicaid would pay... but when I questioned this, based on past experience, she investigated, and Mam-ma has some sort of "QMB" Medicaid that doesn't cover glasses, apparently... at least not very frequently.  So we will pay $119 - and maybe that is "our" portion for Medicaid - for new frames.  As we left, Mam-ma told the receptionist, "Now I do have Medicaid."  She replied, "Yes ma'am, I know." Under my breath, I told her, "The less Mam-ma knows about how much this is costing, the better."  The woman answered... "I gathered that!"  On the way home, Mam-ma asked, "How much are these glasses gonna cost me?"  I told her around $100 - and that she can afford it.  She always tells me how "broke" she is!

I took Mam-ma home to rest... she had washed her windows yesterday (inside), and she was exhausted. Hopefully she will feel good for Thursday. I got home before Timothy arrived... now he is giving us a workout! Timothy was 11 months old yesterday. My mother reminded me that I was his age when my sister was born! Hmm... an infant and a toddler vs. an infant and a grandmother... there is no "winner" in either of those scenarios! Both have their challenges AND rewards. Some days they are just easier to see.

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:

• http://firecrackerbaby57.blogspot.com/2006/02/medicarerx-drug-plan-is-fiasco.html
• http://firecrackerbaby57.blogspot.com/2006/02/keep-your-fingers-crossed_10.html
• http://firecrackerbaby57.blogspot.com/2006/02/its-over-hopefully.html
• http://delisandwich.blogspot.com/2008/11/if-its-november-it-must-be-time-for-new.html

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.