A big part of my job as an attorney at Severns & Howard is to work with the families of people who are in long-term care facilities. I presently find myself on the other side of the desk, so to speak, because my father recently had a major surgery requiring a stay in a rehabilitation facility. Suddenly, I was the one sitting with my mom as she tried to make sense of insurance papers, hospital discharge instructions, and rehab facility websites. We were both tired from long hours spent at the hospital, worried about my dad’s recovery, and overwhelmed by the decisions my mom was going to have to make about the next steps in my dad’s care. I had the chance to find out what it was like to apply some of the advice I hand out on a regular basis to our clients. Here’s what I learned.
1. “Visit long-term care facilities before you make a choice.” As an attorney, I always thought this was a no-brainer. People test-drive cars before they buy them, comparison-shop for appliances, and attend open houses before making an offer on a house. We advise our clients to drop in unannounced at the facilities they are considering. We tell them to walk around, check out the dining room, and get a feel for the place, and then ask to speak to an admissions representative for more information. However, when it came time to choose a rehab facility for my dad, the idea of visiting the facility didn’t cross my mom’s mind. My dad was recovering from surgery and she didn’t want to leave him. She only had a day or two to make a decision. She didn’t really have time (or energy) to comparison shop. My mom did, however, do pretty thorough internet research on her options – she had plenty of time to do that while sitting with my dad in his hospital room. I did manage to convince her to take a few hours while my dad was napping to visit the facility that she’d chosen based on her research. She was able to meet the administrators face-to-face and make sure that the facility “felt right.” I think it made the transition from hospital to rehab a little easier, at least for her, because she felt comfortable with the facility before they took over my dad’s care.
2. “If they tell you that Medicare or your health insurance isn’t going to cover something, push back.” My dad’s insurance company originally denied the hospital’s request to discharge him to a rehabilitation facility. Fortunately for us, the hospital staff was great – they immediately scheduled a “peer to peer” conference. “Peer to peer” is typically the first step in the appeal process when pre-approval of an inpatient stay or other type of treatment is denied – the treating doctor speaks by phone to a doctor from the insurance company to discuss why insurance should cover the treatment. In our case, the peer-to-peer process was all it took to resolve the problem and get coverage for the rehab stay. In the meantime, though, it was a little hard not to panic. All my mom knew was that insurance had denied my dad’s rehab, and she was imagining having to take him back home and supervise his care by herself. The thought was overwhelming! Our first step was to make sure we were in close communication with the hospital staff who was handling the appeal, so we knew the timeline and what the hospital’s expectations were. Next, we devised some backup plans. “Plan B” was to admit my dad to rehab anyway, with the understanding that my parents may have to privately pay for his treatment there. I explained to my mom that this insurance denial did not mean that my dad could not go to a rehab facility – it was just the insurance denial of the pre-approval. It was possible, I noted, that my dad could enter rehab and we could ask the facility to “demand bill” the insurance company after he received the treatment. If the medical records from the rehab facility supported my dad’s doctor’s opinion that the treatment was medically necessary, then insurance might cover it after all. “Plan C” was to take my dad home and arrange for in-home nursing and therapy. We confirmed with the hospital staff that they would be able to help us locate good providers and get the care set up. Fortunately for us, the peer-to-peer process worked in my dad’s case, and we were able to stick with “Plan A.”
3. “Caregiver, take care of yourself!” Again, this seemed obvious when I was giving advice to people who were not my own parents. My dad has been either in the hospital or the rehabilitation facility for the past three weeks, and my mom has been in his room with him pretty much all day every day. She has been a relentless advocate for his care – at one point she dragged her chair outside his hospital room door and refused to let anyone except the nurses inside so that my dad could get some uninterrupted sleep! She has my dad’s discharge instructions and medication list memorized, and she has been vocal in questioning the rehab staff if their treatment plan has differed from the documentation she received from my dad’s surgical team. Sometimes, she’s good at asking for help – for example, she called on me to handle communications regarding the insurance appeal for the rehab stay, and she asked my sister to take care of some of the house and yard care that my dad typically does. However, my sisters and I had to step in to make sure she got some rest. Last weekend, I volunteered to stay with my dad while my mom headed back home (as if this experience wasn’t stressful enough, my dad is getting treatment out of state) to “do laundry and pet the cat,” as she put it. My sister met my mom at home, making sure she got some rest and some home-cooked meals. My other sister has been checking in daily – she lives too far away to be able to be here in person, but the phone calls, texts, and letters from her children to my parents have been a great comfort to my parents.
The biggest lesson I have learned from this experience is that my parents aren’t going to ask for help, but that doesn’t mean they don’t need me. As a working mother of teenagers, I get pretty caught up in the craziness of my own life. My parents usually help me out – showing up at band performances and choir shows, hosting holiday gatherings, and providing transportation when I have three kids who need to be in three different places at the same time. I realize that, as my parents age, I need to be aware of their changing needs so I can support them when they need it – just as they have done for me.