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Sunday, November 14, 2010

Tips for working the Long-Term Care "System" - Federal Government

Trying to help a friend or loved one navigate through the elder care system can be daunting. Here are some tips so that you can avoid unnecessary aggravation:

Social Security: Did you know that Social Security doesn't recognize Power of Attorney documents? Well, they don't. It has something to do with Social Security being Federal and Powers of Attorney being State. So, if you need to do business with Social Security on behalf of someone else or manage someone's Social Security money. You either have to be their court appointed guardian or you need to apply to become the loved one's Representative Payee. You can find the application online if you look really, really hard. You can also go into the Social Security office and request an application.
  • If you go the the Social Security office do not go at the beginning or end of the month or the beginning of the week. The office is crazy busy during those times. Pick early afternoon on a Wednesday or Thursday.
  • When filling out the Representative Payee application you will need to include the name, address and phone number of your loved one's doctor. It doesn't say this in the instructions and there is no place on the application for it but if you don't have it the application will be handed back to you.
  • I have occasionally run into a situation where the doctor doesn't want to fill out the form. I have found that writing a letter explaining why I need to manage the client's [loved one's] money and why Power of Attorney isn't adequate in a very humble way seems to help.
  • When you receive the letter appointing your Representative Payee, keep it in a safe place because you will need to produce it at the bank and other places from time to time.

Veteran's Administration: They don't recognize a Power of Attorney, either. If your loved one cannot sign a release of information form allowing you to be their advocate, you have no choice but to initiate a petition to become the loved one's guardian. If you become the court appointed guardian, always keep a copy of your Letters of Guardianship handy so you can wave them in the face of the person who quips, "We only deal with the veteran, not the spouse [family, friend, etc.]. In this day and age of HIPAA Laws, everyone is afraid to say ANYTHING without the appropriate legal document.

  • Try to always have an appointment. The walk-in clinic is a real nightmare. If you can't avoid it, plan on being there an entire day.
  • If your loved one needs to apply for benefits for the first time, contact the local Veteran's center (VFW, DAV, etc.) to learn the best way to submit the application so that it will be processed as quickly as is reasonably possible.
  • If your loved one is a low-income non-service connected veteran, plan on the application taking a year. If they need financial assistance before then, get them signed up with your State's version of Medicaid.
  • You can fill out an application online at but please remember that you still need to print it out, have the veteran sign it and send it in even though you can electronically submit the application.
  • DON'T forget to send the required documentation. Can't find the DD-214? (Discharge papers) You can send to a certified copy on the web site.
  • If you send a copy of the DD-214, you will get a letter stating that you need to send the original or a certified copy withing a certain length of time. Writing them to tell them when you expect to be able to send it will keep the application "live."
  • Give the application a couple months before checking on the status but by all means check. Sometimes these applications seem to fall into a black hole or something. Be especially diligent if the veteran was just in the reserves. We have had more problems with applications going missing for the veterans who were in the reserves as opposed to active duty.
  • Once the veteran is approved for benefits, send updated medical records, bank statements and medical bills (paid) to the VA on a regular basis. You might want to mark your calendar for every three months or so.

If the process seems overwhelming to you, please get help with this. Call your local Area Agency of Aging to find out where you can go to get assistance. While it takes longer, the benefits from the Veteran's Administration come with fewer "strings" than the State Medicaid program.

Sunday, November 7, 2010

Amazing Will to Live - Update 11/7/2010

Amy has started eating, and keeping what she eats down. (She had been having a lot of nausea) Last Monday, she slept through the entire night for the first time since her surgery. She is now joking with the caregivers and recognizing the staff at the facility. She still has a fair amount of agitation but the caregivers and staff are trying to deal with it using exercise instead of medication. The medication makes her sleep during the day and then she is up all night. She is no longer on the oxygen. She actually gave herself a black eye fighting with the tubing! But her oxygen saturation is O.K. now. WOW!

The only real casualty was a cell phone that took a swim in the toilet. Those cell phones just don't swim well at all!

I'm looking forward to taking her to her appointment with the surgeon at the end of the month. I'm sure the surgeon will be amazed, too!

This is what Amy wanted, a chance to live pain free. She wasn't afraid to fight to beat the odds, even with severe dementia. She has taught me so much!