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When Do Choices Become Scams?
by Jeanne Jones, An Open Letter to
Health Care Policymakers
January
1, 2004
Dear Mr. or Ms. Health
Care Policymaker:
I am listening carefully
as you explain why you supported the recently-passed Medicare Reform
legislation. I am trying to
look into the future through your eyes and with your leadership and see
the long-range benefits for older people.
I’m attempting to look at the big picture, but, frankly, I’m
still reeling from the enormity of the little picture.
Because that little picture involves my 92-year old mother.
You see, she fell on
December 3rd and broke her knee.
She is insured by Preferred Care Gold.
They refused to admit her to a rehabilitation facility.
The rule is that a three-day hospital stay must precede admission
into a rehab facility, so she was admitted into the hospital.
This was after two days of waiting – one night in emergency and
another full day in the orthopedic unit waiting for someone to accept her.
She was finally admitted into the hospital at
6:00 pm
on Thursday, December 4th.
On Friday morning at
11:00 am
, she was notified by Preferred Care Gold that she needed to be out of the
hospital by
midnight
. That night.
She was in a cast from her ankle to her groin, she had had laser
surgery for macular degeneration on December 3rd, she could
hardly see, she is incontinent and needed help to go to the bathroom, and
her insurance carrier said to get out by
midnight
. The caseworker called
unsuccessfully all afternoon to find a rehab unit or a nursing home that
would accept her. Since it was
unsafe to discharge her, we left her at the hospital for the weekend and
brought her home on Monday. The
Visiting Nurse Service came to her home on Monday and refused to accept
her as a client saying it was unsafe for her to be there.
The hospital could not
keep her because Preferred Care Gold said she was not sick enough to be
hospitalized. The Visiting
Nurse Service refused to accept the minimal 6 hours of home health
aide/occupational and physical therapy that Preferred Care Gold had
approved, saying she was too sick to be home.
Various family members stayed with her 24 hours a day until we
could locate an adult home that would provide supervision -- at private
pay -- which my mother cannot afford.
Meanwhile, on local
television the colorful, warm and caring advertisements encourage older
people to join Preferred Care Gold. They
even offer an alternative plan with lower premiums.
Of course, if you are hospitalized you will need to pay the first
$300 (estimate) out of pocket, but the premiums will be much cheaper and
that is very appealing to older people on a fixed income.
My mother receives such offers and options on a regular basis,
which only adds to her confusion and anxiety.
(Did I mention that she is also under care for dementia?)
I have talked to many
health professionals who tell me they try to discourage their
clients/patients from enrolling in Preferred Care Gold but the
advertisements are so comforting that older people sign up, trusting they
will be taken care of.
I hear the word
“choices” being toted as one of the advantages of the Medicare Reform
legislation -- that older people will have “choices.”
Such choices for older people are very close to SCAMS.
Without a knowledgeable family member monitoring the mail and
finances, much damage can, and does, take place.
My mother is lucky.
I worked in the aging field for twenty years.
I knew what was right and wrong.
I appealed. Preferred
Care Gold’s decision was overturned.
Your parent is also lucky, Mr. Health Care Policymaker, because he
has you. You will see to it
that the system works for your mother or father.
The majority of older people do not have you or me to protect them
or make appropriate “choices.’
At this point, I cannot
see the long-term benefits of the Medicare Reform legislation.
I don’t even know what it includes or excludes.
Again, the majority of people do not.
I can only see my 92-year old mother putting all of her energy into
just staying alive and overhearing her sobbing on the other side of the
hospital curtain that she is such a burden but she doesn’t know what to
do. Do you know what I mean?
What “choices” does she really have?
Can you, Mr. Health Care
Policymaker, do something to prevent CHOICES from becoming SCAMS?
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