I Feel Like I’m Drowning: Asking for Help in a Healthcare Crisis

We have all been in situations where we felt totally out of control. It’s a terrible feeling, and leaves us feeling inadequate. When it involves a healthcare crisis, it can also leave us scared, and can have far reaching consequences that affect not only us, but also our loved ones. Making critical healthcare decisions should never be done in a vacuum, or under duress. It is always important to understand the problem thoroughly, research the options available, and identify the best solutions possible in order to facilitate the best outcome.Here is an example of how complicated decision making can be when it involves complex medical issues, and how much work, research and due diligence goes into lining up educated options.

John is 62 years old, and a teacher. He had two, massive ischemic strokes last year. These left him incapacitated for 6 months, with the next 5 months focused on the best rehab possible under the circumstances. John is also a Type I Diabetic, and is insulin dependent.

John’s family was completely overwhelmed. His three grown children were missing weeks of work, their lives had been turned upside down due to this healthcare crisis. They were at a turning point. Should they keep their dad at home, or place him in assisted living? What were the medical and financial ramifications of both? Also, they had not opened any bill or invoice in close to a year, so they were not only in collection, they were completely at a loss for how to even begin to organize the bills.

These were their dilemmas:

  1. Where should their dad live? At home, or in assisted living? Are there any assisted living facilities that will handle his level of care, being wheelchair bound and needing total assistance although not bed-bound, and caring for his diabetes? A facility that they can trust to offer excellent, quality, and safe care?
  2. What is the cost comparison between having him stay in his own home, with round the clock care, vs assisted living of some sort? Since he is a diabetic, the in-home care must, by law, have an RN to come in multiple times a day to test his blood sugar and administer his insulin.
  3. If he stays home, how will he get to therapy or doctors’ visits? Since John is unable to drive, making arrangements for some kind of transportation that can assist with his disability and get him to the visits.
  4. There were a year’s worth of medical bills and invoices that no one had looked at. John was in collection with three different agencies. No one had the time, energy, or experience to wade through all of the paperwork and figure it all out. There were actually over $10,000 of reimbursement checks that no one had opened. They were all focused on care for John, not the bills or paperwork. They did not fully understand his insurance benefits, what was actually covered, and what he personally would be financially responsible for.
  5. John’s retirement benefits from his teaching career – Since John was forced into early retirement due to his medical condition, what was the exact nature of his benefits – what were they and for how long?

Prism Health Advocates was appointed by John’s family during this healthcare crisis, to provide research-backed information and assistance on the following points, to help them answer critical questions and make educated decisions.

We were able to ascertain that John’s retirement benefits were $95,000 a year.

1. Research assisted living facilities and all costs involved: Because of the level of care needed for John, only one facility, in their geographic preference, was appropriate.  It was however, a 5-star facility with an impeccable reputation for outstanding care.

The range of costs were as follows:

$130-$147/day | $4,410/month | Companion Room (shared)
$195-$231/day | $6,930/month | Studio
$235-$247/day | $7,410/month | One Bedroom

Room costs include:

Three (3) meals a day, bed made daily, room and laundry cleaned weekly, and a bus anywhere
Higher level of care: 2 RNs and 4 LPNs with one nurse round-the-clock 24/7

Additional costs:

Queuing/assist with Activities of Daily Living (ADL) | $34/day
Incontinent care | $7, $12, or $17/day depending on need
12 plus meds and/or insulin | $31/day

Totals including the extra assistance he needed:

Shared Room: $224/day
$1,568/week
$6,272/month
$75,264/year

Studio Room: $308/day
$2,156/week
$8,624/month
$103,488/year

One Bedroom: $324/day
$2,268/week
$9,072/month
$108,864/year

With John’s estimated income of $95,000/year, one of these options was affordable.

It is important to know that the least expensive options listed above were used. He needed all the medical assistance. This is a basic estimate to give an idea of the comparison between assisted living and in-home care. It is also important to note that this is just the basic cost. There are always other costs involved – doctor visits, medications, barber, podiatrist, etc.

We also found, in our research, that these are close to the average costs across the country for such facilities. All facilities researched offer a high level of medical care needed.

2.  Research John’s option to stay at home with round-the-clock care and all costs involved: We identified and thoroughly vetted 5 Home Health Agencies. We provided a complete explanation of the different types of agencies and appropriate certifications required. Complete contact information was provided as well as the main point of contact they could reach out to. We encouraged the family to visit and interview all prospective agencies personally.

Summary of Home Health Care Costs:

On average, an aide in the home will range from $20/hour to $35/hour. Some agencies will provide hours of care, others only 1-2 hours at a time. Aides by law are not allowed to assist with or deliver insulin.

On Average, and LPN or RN to go into the home to assist with insulin will cost $175/visit to $225/visit.

a. For an aide 40 hours a week ($20/hour) and one nursing visit a day:
$160/day or $800/week for an aide

b. For an RN or LPN 5 days a week to come at lunch for insulin:
$175/day or $875/week

$6,700/month for the aide and RN/LPN
$5,161/month (average) for cost of house (mortgage, taxes, insurance, electric, heat)
$11,861/month total
$142,332/year

With John’s estimated income of $95,000/year, there would be a $47,332 deficit.

3.  Understand transportation options and challenges around PT and MD visits if John were to live at home. Research was done to itemize costs of this, identify options of what, if anything, was paid for by insurance and what would be out of pocket.

4.  Organize and check all the bills incurred, resolve all collection issues: A box of bills was sent to Prism. We sorted and organized all items via timelines, doctors and facilities. Once neatly categorized, phone calls were made to verify and clarify. Mistakes were cleared up, costs were lowered, collection agencies were placated, and discounts were applied for and granted. We created a clear, concise spreadsheet along with a cohesive, easy-to-manage payment schedule and timeline.

5.  Interpret insurance coverage for above as well as all retirement benefits: We compiled this information and put in writing for the family to understand and refer to in the future.

It is easy to see, from this case, how fast a life can be upended during a healthcare crisis. A young, healthy man, cut down in the prime of his life in the blink of an eye. What do you do? How do you cope? How do you know what is the best care, and how to identify it? And how do you make these momentous decisions, for a loved one let alone yourself, and believe that they are the best decisions possible under the circumstances?

Experienced, thorough research to provide the best educated options, emotional support, and a qualified team to walk you through the system can make a world of difference. You then know that there is no guess work, no struggle to understand, no confusion involved in your decisions in the face of a healthcare crisis. No matter how hard the medical challenge, how insurmountable it may be, you can rest assured you have faced it knowledgeably, chosen wisely, and can live with the consequences. And that you are not alone.

Post by Victoria

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