Wednesday, January 18, 2012

Finally poor enough to get some help

Let's not beat around the bush: you need to be poor to qualify for Medicaid.  But let's also be realistic--if you live long enough, yet are not the picture of health, chances are you'll be poor eventually.  When my parents had their home (damn the reverse mortgage, but it allowed them to stay there indefinitely), one car, Medicare health insureance, and a small but steady income, it was a tenable situation.  With the home, car, and income stream, they couldn't have qualified for Medicaid.  When Daddy had to leave the house, he didn't get any money because of the damn reverse mortgage.  Whether it's a retirement home, assisted living, nursing facility, or adult foster care home (and if you're good, someday I'll explain each of those in detail), the rent is more than his monthly income, so it didn't take long to blow through his limited savings and Mom's life insurance payoff.  But because he has so few expenses beyond rent and medical, after dropping his savings drastically,  he hasn't emptied the account quite as quickly as we anticipated.  They really don't want to even TALK to you until you are moments away from dropping below $2,000 in total assets.  The first time I called, she told me to call back a month later, because we were sure to get rejected at that point. 

Now we're there--the January payment for February's rent will drop him below 2K.  Then we get a bank statement and send it to our social worker, and she gets him signed up.  What does that mean?  We finally got a pretty good answer to that.

Last things first, he gets to hang onto about $160 pocket money a month.   This is for things like toothpaste ("That's a lot of toothpaste" my dad deadpanned when she mentioned that as an example), haircuts, magazines, and whatever other little toiletries or treats one needs.  The rest of his money he pays towards the rent.  But he earns less than his rent, so Medicaid covers the rest of it.  He also gets a Medicaid card to flash wherever he currently flashes his Medicare card.  This means Medicaid picks up the co-pays or whatever else isn't covered by Medicare.  (Wasn't it brilliant of them to name the two services almost the same thing?  Keeps things nice and bewildering.)  If he somehow ends up making a health-related payment out of pocket, he is supposed to give a receipt to Medicaid.  They deduct that amount of that month's portion of the rent he's responsible for, and cover that gap on their end.  So instead of just reimbursing him, they adjust the rent.  Sounds a little clunky to me, but who am I to question the mysterious workings of Government? 

This is one of those entitlement programs people keep bitching about, am I right?  Like my dad is so damn SPOILED and GREEDY for being old, sick, and broke.

I love Medicaid.  I love that they make sure you're out of money before they qualify you, because really, even an extra month or two of rent makes a difference when you multiply it by all the old people in the country.  I've hated the rigamorale we've gone through, but I respect the purpose.  I am deeply disturbed that it is so hard to find out about the program in the first place.  Without Aunt Margaret, I wonder how long it would have taken us to figure out how to do this.  We really thought one of us would have to take him in.   That's not just a matter of bad American daughters valuing their independent lifestyles over their aged parents.  None of us have first floor bedrooms or showers, none of us have wheelchair friendly houses, all of us work full time because we need the income, and he needs round-the-clock care available.  The only alternative we saw was all of us pitching in to cover his rent, and that would have been somewhere between tough and impossible.  So to have a program there to cover the basics gives all of us enormous peace of mind.  He's willing to live with just the basics.  Former world traveler who owned his own home since he was 23, he sits in a small room with a single bed and a couple pieces of borrowed furniture and is relieved he won't be asked to leave.

Remember what I said about saying something?

The first anniversary of my mom's death was a week and a half ago. 

In today's mail, I got two sympathy cards.  One was from a woman I worked for in college, decades ago and a long ways away.  We exchange Christmas cards, and when I saw her handwriting on the envelope I thought, "Oh, maybe Fleur's getting a little confused and when she got my card, thought she hadn't sent me one yet."  But in my card, I had mentioned mom's death early in 2011, and Fleur, wise and kind woman that she is, knew that the right thing to do was say something, even though a year had gone by. 

The other wasn't a sympathy card per se, but another dear old friend that we communicate with once a year had gotten the news in this year's letter from us, and expressed her sympathy in her letter back. 

They both did right.

Mountains of Paperwork

The rescheduled meeting with the Medicaid social worker went well.  She seemed quite nice, and was confident Daddy will qualify for the program.

Before the meeting, she'd sent a list of about 16 different documents to collect.  We went into a tizzy about finding out his burial plan, because we thought they were trying to establish if they'd have to pay for it when he died.  He's signed up to donate his body to science, but if he were to die of an infectious disease, the donation wouldn't be taken.  We would DEFINITELY deal with that when the time came, but we worried that Medicaid wouldn't just take our word for it.  The heroic Winemaker* made a trip to the Medicaid office to try to get this addressed before the meeting, because there seems to be some sort of DHS policy against answering your phone or returning phone calls.  It turns out they just want to know if you have a policy that could be turned into cash. 

In the meantime, my sisters and I got together for a gathering of the paperwork.  We all have piles and boxes from our parents' house in our garages.  Because my dad moved a total of three times this summer, boxes came in and out and got mixed up and nobody really knows where anything is anymore.  So we each rummaged through our own piles and brought in the things that looked most official, and after 3 hours, a lot of coffee, and one more trip back to my house for another file I suddenly recalled, we had everything together.  And a serious caffeine buzz. 

At the meeting, here's what she actually looked at: driver's license, social security card, bank statement, and paystubs from his income sources (social security, annuity, and pension). 

On the other hand, we now have all the important paperwork in one file, and we know where it is. 

*He also makes baklava.  How did I get so lucky?

Sunday, January 8, 2012

One year

Mom died 364 days and two hours ago, give or take.   The whole holiday season was a little odd this year, but not as painful as I had expected.  She had gone into the hospital on Dec. 5, so last year's holiday season was decidedly unfestive.  That Christmas day, the Winemaker and I drove down to her hospital (about 2 hours each way) to sit and hold her hand for awhile.  She was unresponsive, all tubed up after surviving heart surgery.  On New Year's, she was able to communicate, but was still tubed up and our optimism was decidedly guarded. A few days after that, she asked to have the machines disconnected. This year felt wonderfully relaxing in contrast, and I was actually able to enjoy my time off and enjoy being with my family.  Which made me think maybe this whole anniversary thing would go okay.

My plan today (and there was my first problem; the one thing last year seemed determined to teach me was to eliminate the word 'plan' from my vocabulary) was to get up before the Winemaker, so I could do my lesson planning and correcting, then go see my dad before lunch, then have the afternoon and evening free to take a walk, play some board games, read, knit, etc. 

Instead, I slept late.  Really late.  Then I got up and read the end of a book.  Brilliantly, I chose this week to finally read the memoir I've heard is so good.  It's by a middle aged mom who got breast cancer, and in the middle of her treatment, her adored father gets bladder cancer.  Yep.  Truly a brilliant choice.  So then I kind of sat on the couch for awhile.  The Winemaker came by to cuddle with me, and I started crying.  After awhile of that, I decided to make cookies.  I made a terrific new recipe I tried for the first time last month.  But today it didn't turn out right, and I couldn't figure out how to solve it.  My niece stopped by to pick something up around 2:30, and very politely ignored the fact that I was still in my pajamas and robe.  I sat down on the couch again to look at some gardening books, and instead fell asleep for a few hours.  Missed a phone call from my dad, who wanted to know if I've called the Medicaid lady to reschedule (nope) and if I knew that the anniversary of mom's death was tomorrow (yep).  Then I made nachos for dinner and proceeded to overeat.  Now I'm sitting on the couch again.  Did not visit my dad.  Did not do my work.  Did not get any exercise.  I don't think my mother ever had an unproductive day in her life, barring when she was in the hospital.  So that's an extra layer of guilt over the whole wasted day--that I'm incapacitated by grief over someone who would never have been so self indulgent.  

The Winemaker, in addition to giving me lots of hugs today, figured out a solution for my cookies, worked on the car that's been giving me issues lately, and chopped up the Christmas tree to put in the debris bin.  I'm glad someone around here is functioning.   But it's the kind of day when my husband being wonderful makes me want to cry, because someday he'll die, and how will I survive that?  Or I'll go first, and what will he do?  Okay, I take that back--it's the kind of day where these thoughts make me actually cry, not just feel weepy.  I'm really hoping that 180 chaotic sophomores do a good job distracting me tomorrow. 

And after 10 hours of sleep last night and a two hour nap this afternoon, I think I'm heading to bed early.  Grief.  It's tiring.

Friday, January 6, 2012

Just the facts, ma'am

In the meantime, I'm going to follow through on my promise to list what DHS wants to know at a Medicaid Screening.  That's a phone call or office visit where you give them the info on the applicant, and they let you know if it's even worth going further.  The most frustrating part for me was how hard it was to get ahold of people at these offices.  I realize it's an issue of underfunding and understaffing, but it's still maddening.  I can't exactly take phone calls while I'm teaching, so we got into a pattern of me calling during my prep, them returning the call the next morning around 10 am, me calling back and getting voice mail again...I finally got a sympathetic receptionist to email the social worker and ask her to please take my call, because she knew the SW was in her office right then.

When you do finally get a human on the line, this is what they need to know about the applicant:
  1. social security number
  2. date of birth
  3. full name
  4. current address
  5. emergency contact names and numbers
  6. primary care doctor and contact info
  7. diagnoses
  8. income and financial resources (They wanted to know exactly how much he had in each bank account)
  9. isurance programs and numbers for medical, life, and burial insurance
  10. monthly expenses--rent, utilities, medical bills, insurance on house, car, etc.
  11. medication
  12. what daily funcitons the applicant can and can't perform on their own (walk, dress, feed, shower, cook, laundry, etc.)
  13. cognitive ability
It took me awhile to even figure out who to call.  If you're in Oregon, they're at this website:
It's Department of Human Services, Seniors and People with Disabilities division.

Thursday, January 5, 2012


Well, that was a fail.  I took the time off work, wrote the sub plans, dashed home for my phone, and got a message that the lady was taking a sick day and we'll have to reschedule.  Hmph.

Tuesday, January 3, 2012


For years, I thought that Medicare and Medicaid were two different terms for the same program.  Like ESL and ELD, or Iran and Iraq.  (I jest.  But I do, embarrassingly, always confuse the two.)  Then my parents got old and went on Medicare, and I still didn't know the difference.  Then, in a chance conversation with my aunt about how we couldn't afford the kind of help my dad needed, she explained a bit about Medicaid.  Bless you, Aunt Margaret.  Four decades of extremely distant aunthood compensated for in an offhand comment that looks like it will save our butts.

Here's the scoop.  Medicare is a health insurance program for people over 65 or disabled.  Basically, if you qualify for social security disbursements, you qualify for Medicare.  It's not just one government program, but a group of health insurance plans approved, and, I believe, subsidised by the Medicare office.  Since my dad was self employed and my mom was, um, also self employed, they had crap insurance for much of their middle age and beyond.  As their dependent, in college I twice visited the emergency room for stuff a family doctor could have handled, just because our insurance was so lame.  In their 60s and 70s, Mom and Dad had a lot more medical issues than your average college student, so medical bills were eating up a huge amount of their income.  As a result, they were actually kind of excited to go on Medicare.  A few years ago, they got into a program that didn't even require any premiums at all, which was definitely more in line with their budget.  I don't know the details, but I think that their limited income is why they qualified for that particular arm of the program. 

Medicaid is different.  Because aid and care are different, see?  Medicaid provides financial support not just for health insurance, but for living expenses.  In order to qualify, you have to be seriously broke.  Last spring my dad was living in his own home (although with a reverse mortgage--more on that later, in the meantime, DON'T LET YOUR PARENTS GET ONE), owned a car, had a few thousand in the bank from my mom's life insurance, plus his whopping social security check and over $300 a month in pension funds heading his way.  We thought he was basically broke, but when we tried to get him Medicaid, he didn't qualify.  He was livid.  I pointed out that it meant there were people worse off than him. Somehow this didn't mollify him.

He had too much money and assets to qualify.  As long as he could stay in his house, his measley income worked out.  But when he needed more care, any option we looked at, from home help to assisted living to an adult foster care home, cost more than his income, and his savings weren't going to last long.  We were all entering a state of terror.  His main concern was that he'd end up on the streets.  This didn't seem terribly realistic to his four daughters--I mean, come on, this ain't King Lear.  But we were all wondering which of us was going to have to move into a house with ground floor bedrooms and quit her job to take care of him.  At which point, it might have become rather Shakespearean after all.  That's when Margaret said, "You need to go into a Medicaid spend-down.  They'll let him keep $2,000."  We had very little idea what she meant, but we started looking into it. 

They're serious about the $2,000.  Now that he's in adult foster care, where the rent is double his monthly income, we knew we needed to get him signed up.  But when I talked to someone at DHS and she heard he still had $5,000 in the bank, she told me to call back the next month.  So we payed the $3,300 for rent and tried again a month later.  I answered questions, and tomorrow is our intake interview.  Wish us luck.  If he qualifies, Medicaid takes over paying the rent.  They have an option to pay for food as well, if that were needed separately. 

Next time I'll go over the questions you need to be able to answer for the screening and the paperwork you need to gather for the intake interview.  Since your odds of actually getting a human being on the line at DHS are about equal to the odds of  hitting all green lights on your way to work when you're running late, it helps to know up front what they're going to ask, so you don't waste an actual conversation on just finding out what you need to know the next time you're lucky enough to get someone to pick up the phone.  And hopefully, I will also tell you that he passed the interview stage.  Did you wish us luck back in the previous paragraph?  If not, take a minute to do so now.  Thanks.

Monday, January 2, 2012


I've never blogged before.  Can you tell?  Wait, don't answer that.  Here's what I've discovered after about twenty minutes and one post.  Names are awkward.  I refuse to call my husband DH.  I don't really want to use his name, because he's a private kind of guy.  I thought about calling him Pillar of Strength, but that has a truly unfortunate acronym. But to keep calling him "my husband" is sure awkward.  I suddenly understand why Malboro Man and Mommy Scratches exist.  I mean, why their pseudonyms exist.  Oh, never mind. 

I think we'll go with the Winemaker.  Because Vitner and Enologist both sound kind of stuffy. 

What Not to Say

When my mom died last year, people were kind.  It's quite natural to want to comfort someone when they lose a loved one.  The problem is, there isn't anything you can say that actually helps.  You can, however, be annoying while not helping, or just be kind while not helping. 

In the first category, we have all the variations of  "She's in your heart" or "You'll always have her with you."  Fine.  True enough, and nearly a year into it, I'm beginning to see what you mean.  But in the thick of grieving, this is somewhat like telling someone who just lost their eyesight that they can at least remember what things look like.  I don't want memories of my mom in my heart; I want my real, loving, creative, pain-in-the-ass mother in her own damn house.  Same with telling me that the pain will recede with time.  So, you're saying you suspect I'm a callous traitor?  Now that time has passed and the pain has, yes, receded, I know that this is basically the only way we as a species, let alone me as an individual, can carry on.  But to tell me in the weeks after my mom died that I would not always be in pain felt like an accusation of betrayal.  Mom doesn't get to move on from being dead, why should I get to move on from grieving? 

And don't even get me started on the "God's plan" or "God needed an angel" people.  Come one, seriously?  God needed a bunch of dead Rwandans, everyone who was on a beach in Thailand during the tsunami, dozens of teenagers in a Colorado high school,  that little kid whose stepmom murdered him last summer--AND an old lady with limitless energy but limited patience?   The idea that there is a God who goes around intentionally slaying people in order to get more harpists is so not a comfort.  Luckily, I don't know many people who went there. 

Here's what is helpful.  Say something.  Yes, even if you say something stupid.  I resisted rolling my eyes because I knew you were trying to be kind, and it sucks to want to help when someone is dead, because you can't. But out of the grey fog that surrounds the entire time mom was sick, then in the hospital, then dying, then recently dead, I have surprisingly clear recollections of who realized the impossibility of consoling me and gave it a go anyway.  The first sympathy card I got was from the mom of a woman I've been friends with since 3rd grade.  Our moms hadn't even seen each other in 20 years, and I've only seen J. a few times in there myself.  But she sent me a card, and it was so sweet, and I will always think even better of her than I did before.  My godparents sent each of us a letter.  An old friend of my dad wrote a nice note about what that friendship has meant to him, my mom's childhood friend wrote several pages of recollections, and one of my friends who probably was briefly introduced to my mom at my wedding stopped by the house with food. I wasn't even home; I was staying with my dad, but just the idea that she took the time meant a lot.  My dad kept all the sympathy notes he received in a little basket, and all of us went through them compulsively for a few months.   Nobody can do a damn thing, but somehow it's still important to try.

Here's a funny story--well, okay, maybe not.  After missing most of the December and a huge chunk of January, I went back to work.  And nobody said anything.  It was surreal.  Then one woman, whose dad had died the year before, asked me out for a beer, and expressed her sympathy.  I thanked her, and mentioned the eerie silence I was getting from the rest of our colleagues.  She explained that our principal had asked everyone to respect my privacy and not bring it up unless I did first.  I know he meant well, but wow.  You need to say something, people.  Acknowledge it.  You can't fix it, but you can honor it by acknowledging it.

In all that time, I heard two things that actually worked for me.  First, the day mom died, I posted her birth and death dates and a photo of her on Facebook.  Then I instantly felt like an idiot, and posted a comment calling myself tacky for having done that.  A FB friend, who is more of a distant acquaintance in the real world, responded with something she had learned when her own mom died.  "There is no wrong way to grieve."  I hung on to that thought pretty tightly.  With three sisters and a dad reeling from the same pain, it didn't just help me deal with my own grief, but also helped me allow them theirs. 

My husband was every (positive) cliche possible.  Pillar of strength, shoulder to cry on, shelter in the storm--he took them all on.  His dad died a year before we met, so he had wisdom to spare.  Most of which he put to the wise use of not saying much.  But he did tell me that what would be worse than the pain and sadness would be losing a parent and not feeling very bad about it.  This didn't make much difference in the pain, but did at least make sense to me.  Months later, I was in the middle of a group of people grousing about their mothers, saying how they avoided talking to her.  I was briefly bitter, wishing as I do that I could talk to mine, then I saw my husband's point--I was so much better off for having had a close and loving relationship with my mom.

Ready for the recap?  Avoid "God's plan" crap unless you know for a fact the person you're talking to really thinks like that (and while they might have before the death, they may be revisiting that, so maybe just avoid it altogether).  Go light on the "you carry them with you," but if it's all you can think of to say, go for it.  Say something, and not just once, but the next several times you see the mourner.  And if it's you in mourning, however you're handling it is probably the right way for you.  Unless you're, y'know, mainlining heroin or beating people up.  (Bonus tip: alcohol doesn't help, but you'll probably try it a few times anyway, so you may as well buy a bottle of something you like.)