for release January 12, 2001
The Sandwich Generation . . . Helping Your Aging Parents
by Carol Abaya, M.A.
Are you juggling doing errands for your aging parents, your children, yourself and working at the same time? Are you tired, stressed out and upset that your once vibrant parent is now frail and needy?
Do you feel alone? Rest assured you are not alone! The Sandwich Generation is dedicated to the 50 million Americans who may have elder/parent care concerns and/or responsibilities.
Medical Prognosis Determines If Medicare Pays Hospice
Question: My father, 78, has unbreakable cancer. Medicare has paid for hospice for four months. Because of the pain control activities, my father is eating better and even gained a couple of pounds. He can now feed himself, even though still bedridden. A home health aide comes every day to help. Now Medicare says “he’s better” and is refusing to pay for hospice, including the pain control medication and devices. My father really needs the help.
Answer: I recently asked a hospice nurse what was the toughest part of the job. He said “Having to decertify a person.” He explained the process, which seemed to me to fit your situation.
I spent an hour on the phone with the National Hospice Foundation and Medicare. Just because your father is a little better -- medically stabilized -- in itself does not mean that Medicare should stop paying.
Medicare hospice works this way:
> A doctor (or two, in some areas) must certify that given reasonable medical criteria that the person has six months or less to live.
> There are two 90-day certification periods.
> Then there are unlimited 60-day recertification periods.
> After each 90 day period, the doctor(s) must recertify the six-month prognosis.
> After each 60 day period, the doctor must evaluate the prognosis and recertify -- or decertify.
The medical rationale -- how the certification decision is arrived at -- can be tricky. Today there are so many more avenues to treat chronic and terminal illnesses and to keep a person alive longer.
Certification depends strictly on prognosis. Is it reasonable to assume the person will die within six months if the disease/illness runs its expected and natural course? This is the key!
I was told that stabilization/slight “improvement” in itself is not a reason for decertification. Improvement/stabilization should prompt the hospice team to reevaluate the situation. If the patient’s life expectancy still fits the six-month criteria, given a reasonable, natural progression of the illness, certification should continue. Even if a person stabilizes, he/she may still be expected to die within the six month time frame. So, recertification remains appropriate.
In your case, discuss the situation with the doctor and the hospice team. If they do recertify and Medicare still refuses to pay, you can appeal that decision.
In situations where cancer is not involved, it is trickier to determine whether the person may die within six months, given the natural progression of the illness.
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Question: My parents’ (70's) Medicare HMO are discontinuing covering Medicare patients. They are scared they won’t have any health coverage. What should they do?
Answer: Medicare HMO companies can terminate their contract with Medicare at any time. Patients are notified and will then automatically be returned to the traditional Medicare Plan.
While this procedure is supposed to be automatic, it is advisable to check with the Medicare provider in your state to make sure the transfer has been made.
“Medicare & You 2001" is now available. Call 1-800-633-4227; for publication number HCFA-10050-LE.
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Do you have a question? Send it in. Although letters cannot be answered individually, appropriate letters will be answered in this column whenever possible. Letters may be edited. Send letters to Ms. Carol Abaya, c/o Name\Address of YOUR newspaper (or mail direct to her at PO Box 132,Wickatunk, NJ 07765-0132) or e-mail her at SandwchGen@aol.com.
Carol Abaya is an international-award-winning journalist and creator of the unique magazine The Sandwich Generation: You & Your Aging Parents.
NOTES TO EDITORS: text = 505 words; other material = 160 words
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©2001 by Globe Syndicate, all rights reserved.