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-- Programs and Services -- Contact Information Family Caregiver Support and SHINE a perfect match
By Margie Ware, Elder Services Regional SHINE Director
In addition to my position as Elder Services SHINE (Serving Health Information Needs of Elders) Director, I also serve as Regional Coordinator for the Family Caregiver Support Program. More and more I am finding connections between these two programs, which are of great importance.
First, it is very important for any elder to advise at least one individual of the details of one’s health insurance coverage. This need not be a spouse or child, but does need to be someone you can trust and who can advocate for you in an emergency. If you are in pain, or delirious, you don’t want to be the one looking for your Medicare card. This person should know if you have Medicare, if you have supplemental insurance, or MassHealth, and have access to any other information which may be relevant. This person may or may not be your health care proxy or the person who has your durable power of attorney. But make sure you share this information with someone so that you can be helped in case you are in a medical emergency.
If you find yourself admitted to the hospital unexpectedly, one of the most important issues to think about is your discharge plan. From the moment you are admitted, individuals in the hospital’s social services department should be working with you and your support system to determine what the “next step” will be once you leave the hospital.
Family caregivers especially need to know what the options are at the point of discharge. If the hospital is suggesting a discharge to the home, are there services in place to assist the family with caring for the individual? Has Elder Services been contacted about supports that might be put in place in terms of meals and personal care? Has the VNA been contacted about home health services?
If the hospital is suggesting discharge to a skilled nursing facility for rehabilitation purposes, the patient must have spent three overnights at the hospital to qualify for Medicare coverage in the skilled nursing facility. In general, this is not a problem. Hospital social service departments know these rules. However, it does become a problem when it is unclear what level of care the patient will need.
In the most difficult situations, either a family overestimates how much care they can give (or underestimates how much care the patient will need) or the family may not fully understand what is involved in the care plan. If the patient is discharged from the hospital after one or two days, and the family finds the situation is more complex than imagined, a transfer to a skilled nursing facility will probably not be covered by Medicare.
For this reason, patients and families should make sure that they are well-informed about their rights and responsibilities at the time of discharge. If they have any concern that the situation may be more complex than indicated, the patient has the right to appeal the hospital’s notice of non-coverage. This is done by asking the hospital social services department (or the patient can do this on his or her own) to contact the Massachusetts Peer Review Organization (MassPro) at 1-800-252-5533.
You must contact MassPro by noon of the next business day after you have received a notice of noncoverage. Regardless of the outcome of the decision, you cannot be charged for any extra hospital days until noon of the day after MassPro makes its decision. The net effect of this is that you can sometimes secure a third day in the hospital.
This third day is important because it gives patients and families options. For example, the patient with a broken hip can be discharged to a skilled nursing facility to heal more completely before attempting to come home. Or, a patient with bladder or bowel difficulties has the option of going back to a skilled setting if it turns out that family members feel overwhelmed with the level of care they need to provide.
Family caregiving is one of the most rewarding ways one can spend time with a loved one. But it works best when family and friends feel rested and capable enough to take on the task. Better to ask your loved one to accept another day in the hospital, or a week or two in rehabilitation, than to exhaust yourself trying to respond to their request to “Get me out of here!”
For additional information regarding health insurance coverage, please call Elder Services’ SHINE Program at 413-499-0524 or 1-800-544-5242 and we will be happy to work with you to resolve your concerns.