TULSA - At the end of one's life, medical bills can turn into financial mountains. An elderly widower fought for thousands of dollars in refunds for billing mistakes that happened in the days before his wife passed away.
For more than half a century, she was the love of his life.
"She was the best thing that ever happened to me," said J.W. Robertson in a soft voice.
He was talking about his wife, Annetta, and says every day he spent with her, every minute, was precious.
But in the twilight of their life together, J.W.'s heart was broken after his wife was diagnosed with vascular dymentia and he had no choice but to put her into a nursing facility, Homestead Assisted Living of Owasso.
"They did give her good care, I will say that," J.W. says.
Eventually, J.W. says Annetta needed to be transferred to another facility for a few days for evaluation.
It ended up being 42 days before she returned to Homestead.
A few days later, Annetta's health took a terrible turn.
"She got worse, complications ensued and we lost her."
Then, another nightmare for J.W -- a battle over Annetta's medical bills.
After paying upfront for her care, he says getting his money back for those 42 days she wasn't even at Homestead was next to impossible.
He says the facility had earlier agreed to a $4,000 refund.
"It seems when you shake hands or you make an agreement, it should be lived up to," J.W. told us.
As J.W. dug deeper into his wife's nursing home bills, he found they were charged more than $200 for medications that she was never given since her doctor had taken her off those meds a week before she passed away.
One of those charges appeared on the day Annetta died.
J.W. says he called the office time after time and wrote a letter to Homestead's parent company, Midwest Health, in Topeka, Kan. He sent it by certified mail.
J.W. says, "We're still waiting for the check they've been promising for three to six months."
We got in touch with management at Midwest Health and made sure they knew about J.W.'s problem.
An executive there says there had been staff changes at their Owasso facility and promised to look into the situation.
Finally, 10 months after Annetta passed away, J.W. received an apology and a check for more than $4,200, including money for that medication.
For that, J.W. says he's grateful.
Choosing an assisted living center or nursing home is a big decision for many families. There are resources you can use in trying to make that decision.
When choosing an assisted-living facility, the most important thing you can do is plan ahead.
If you have concerns about the ability of an aging parent or relative to live independently, you may want to investigate assisted living-and sooner rather than later.
"The best time to look is six months to a year before your parent will need to make the move," says Paula Carder, an assistant professor at the Institute on Aging at Portland State University in Oregon and co-author of "Inside Assisted Living: The Search for Home" (Johns Hopkins University Press, 2009).
If you wait until your parent is being discharged from a hospital or rehab center, you'll have fewer choices.
Assisted-living facilities are residential units that sometimes include a kitchen, housekeeping, meals, transportation to doctors and activities and various levels of personal assistance.
Fees can run $5,000 a month or more depending on the size of the unit and the care that's needed. The average length of stay is about 28.3 months.
More than 900,000 Americans now live in about 39,500 assisted-living facilities, according to estimates, but there is no federal oversight of the industry.
Each state sets its own definition of assisted living and decides what licensing procedures and inspections are required.
One result is that there are more than 26 designations used to refer to what is commonly known as assisted living, including "residential care," "board and care," "adult home" and "retirement residence."
The following game plan will help you find the best facility for an aging relative.
Is assisted living appropriate?
Your first step is to make an honest appraisal of whether your relative can continue to live at home.
If he or she needs only a minimum of help and dislikes the idea of moving, home care might be a better choice.
But for gregarious people who are beginning to experience a decline in function, assisted living might be a good option.
For help assessing your relative's physical, mental, and financial situation, consider consulting a geriatric-care manager, who should be knowledgeable about the assisted-living options in your area, including the facilities' financial strength.
You can search for one on the National Association of Professional Geriatric Care Managers website at www.caremanager.org .
"You can also get recommendations from family doctors or local senior centers," says Molly Shomer, an elder-care adviser who runs ElderCareTeam.com .
Several websites provide
information on nearby facilities.
"I like SnapforSeniors.com," says Kathleen Cameron, chairwoman of the Consumer Consortium on Assisted Living (CCAL), a nonprofit advocacy group. "It seems to be the most comprehensive, and it has some good information on long-term-care and funding options, too."
Shomer recommends NewLifeStyles.com .
"You aren't required to enter personal information on the site, and it doesn't make referrals, which prevents lots of annoying phone calls later," she says.
Once you have a list of facilities, make an appointment to visit them with your parent or relative.
You can find a checklist of things to look for and questions to ask on the CCAL website at www.ccal.org .
Your first tour will probably be led by the director of marketing. You will see the common areas and available apartments. Notice if the facility's décor suits your parent's taste but don't let that be the deciding factor.
"Nice chandeliers and fancy furniture don't provide good care," Shomer says.
Of course, the place should be clean and well lit.
Look for safety features like grab bars on all the walls, including the hallways and nonslip flooring materials, especially in the bathrooms.
Try to have a meal while you're there to check out the food.
Watch for red flags.
Observe the interaction between staff members and residents.
Is it cheerful and respectful?
Do staff members seem genuinely interested in the residents?
If you see few residents in the common areas or participating in activities, it might signal that the facility is not full, which could bode ill for its financial stability.
Get a copy of the admissions contract and the residence rules.
If you sense reluctance by administrators to part with such information at this early stage, consider it a red flag.
The facility's contract outlines fees, services provided and residents' rights and explains who will handle medications, when reassessments of a resident's condition take place and when a resident might be asked to leave because he or she needs more services than the facility provides.
The contract should also specify whether a resident is allowed to return to the same unit after a hospital stay.
Nursing homes are required to hold a room for Medicaid patients, but many assisted-living facilities are not.
Make sure that yours will.
Return unannounced several times to your top two or three choices.
Visit at different times of day, especially around mealtimes and the early evening to see how they are managed at busy and quiet times.
Ask to speak with the residence administrator.
"Even if it means coming back for another appointment, this is important," Carder says. "He or she is the person who sets the mood and philosophy of the whole place."
When you meet, ask to review the facility's licensing or certification inspection report.
This should be readily available to the general public and will outline any complaints or black marks the residence has received during inspections.
Ask how any problems were corrected.
Also ask about who will draw up the care plan for your relative and how much input he or she and the family will have.
Find out how the facility will accommodate your relative's current and future needs.
For example, someone with diet-controlled diabetes might eventually need insulin.
How will the facility handle that?
Find out how many employees are assigned to each resident.
And look for a facility that has a licensed nurse on duty or on call at all times.
Ask about the staff's training in such areas as safety, emergency care, first aid, mental health, residents' rights, and medication administration.
Add up the costs carefully
When you've narrowed the field to one, review the fees.
Note the costs for any extra services your relative will need, policies regarding the return of a deposit or down payment, costs involved during hospitalizations, and the possibility of unexpected rate increases.
Most costs for assisted living have to be paid out-of-pocket.
The national average monthly base rate for an assisted living unit (which includes room, board, and some personal care) was $3,131 last year, up from $2,379 in 2003, according to a survey by the MetLife Mature Market Institute.
Make sure you take into account the possibility of added costs if your relative needs more assistance than the level covered in the base rate.
For example, if more help is needed with what are known as instrumental activities of daily living, such as medication management, or some activities of daily living, such as bathing or toileting, the average additional fee is $347 a month for each service, according to the MetLife survey.
Contact your state's long-term-care ombudsman, who acts as an independent resident advocate.
He or she will have a record of complaints lodged against a facility and how they were handled. You can find your state's contact information through the National Long-Term Care Ombudsman Resource Center, at www.ltcombudsman.org
or by calling 202-332-2275.
Finally, have the contract reviewed by an attorney before you sign it. You can find one in your area who specializes in elder-care issues on the Web site of the National Academy of Elder Law Attorneys, at www.naela.org .
Here's more information from Assisted Living Today .
The desire of an elderly person to stay in their own home must be weighed against the type of care they require. A time may come when your parent or grandparent will have to be placed in a skilled nursing facility.
Otherwise known as nursing homes and convalescent homes, these facilities are able to provide the extensive nursing care that your loved one may need.
Here are some tips to help you choose the right home and elder care help when the time comes.
1. Staff Matters
Ask about the staff turnover within the home. Working in a nursing home is an extremely demanding job both physically and mentally.
Any nursing home will have a high turnover rate, but a quality one will also have staff members who have been there for many years and seem to be happy.
Staffing during the workweek is usually adequate, but ask what the specific staffing levels are on the weekends, holidays, and evenings.
Elderly care never ends; you want to choose a facility that maintains proper staffing even during these non-peak times.
Does the staff seem to genuinely care about the residents in the home? Do they interact with them and talk to them with respect and care?
The job satisfaction of the staff will have a profound impact on the quality of elder heath care they provide.
2. The Other Residents
Take a good look at the other residents.
Ask yourself if they seem to be happy.
Look to see if any are actively engaged in activities or games. Are they clean and groomed; wearing clean clothes.
Try to observe the nursing home during meal times as well as during activities.
If you happen to encounter another visiting family, stop and ask them how happy they are with their elder care services and the home in general.
3. The Facility
Look for a facility that is clean and does not have any strong odors.
A heavy deodorizer scent may be masking the smell of urine. Check above door jams to see if areas are being dusted regularly.
Look at fire extinguishers to see if they are being turned and shaken every month in accordance with fire code.
A quality facility will have dieticians on staff to ensure that a balanced diet is being served.
Find out if they can handle special dietary needs.
Ask if special treats or meals are allowed to be brought in for your family member.
Do the residents all enjoy meals together in one large room or do they eat separately?
Regular activities are important for people of all ages, including the elderly. Find out if they have an activity director. If not, ask how they handle having regular activities for the residents. Find out if outdoor activities are included as well as indoor options.
Find out if there are people on staff who are experienced in elder care nursing and can handle your loved one's condition.
Whether the concern is diabetes or Alzheimer's, you want to know that there are people in the home who are familiar with the condition and will be able to help manage it.
7. Licensing Requirements
Ask to see the licenses held by the facility.
Choose one that has all required state licenses.
Find out what the state requirements regarding the ratio of staff members to clients and then make sure the home you choose consistently maintains that ratio.
The location you choose is extremely important.
You want to choose one that is close to home so it will be more convenient for you to visit.
Choosing one that is nearby can also make it easier to bring your loved one home for holiday visits and other special occasions.
Location should not be the only deciding factor, but it should definitely be kept in mind.
9. Check for Complaints and Violations
Violations of state code become public record.
Don't just look at the number of violations; look to see what they are for.
Violations can range from a minor housekeeping issue to serious issues of abuse or neglect.
Check into the facility's record before making any final decisions.
10. Surprise Visit
Any nursing home worth using will be willing to let you drop in for a visit.
If they require that you schedule a visit days or weeks in advance, ask them why they require that much notice.
Visiting at the last minute will provide you with a solid glimpse of how clean the facility normally is, how it usually operates, and what level of elder health care they need.
Medicare also has information that can be used when making a decision about assisted living and nursing home selection.
Follow this link to Medicare's website: www.medicare.gov/caregivers
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