What Matters to Me Workbook

March 2, 2021

My favorite topic!

If you have been reading these newsletters, then you know that the subject that I return to over and over again (and again and again) is the health care proxy and the importance of advance care planning.  If you are ever in a situation where you are unable to make your own health care decisions, then your trusted decision makers will be able to speak for you only if you give them the authority to do so (that’s the health care proxy you signed).  But also, they will need to know what matters most to you, which turns on you knowing and conveying what matters most.

Well, you are in luck, because the good folks at Ariadne labs (that’s Atul Gawande’s lab – if you haven’t read Being Mortal, pick it up and start reading it now!) and the Conversation Project (remember Ellen Goodman from the Globe?  She’s been busy since “retirement) are here to help.  They have done the field research and reviewed the data, and they used these to develop a fabulous new workbook that helps you both think through what matters most to you and also to convey your thoughts to the people who matter most.

The new workbook is called “What Matters to Me.”  You can download it here, or contact our office and we will print one out and mail it to you.

Please take the time to complete the workbook, and then pat yourself on the back for a job well done.

– Alexis

Useful Info During COVID (v. 5)

August 15, 2020

Hello Friends!

I hope you have been enjoying / avoiding / surviving this heat, depending on your predisposition to such weather.  We live in a proper New England house with not enough storage and no A/C (just window units), so I have definitely been missing the luxurious central air conditioning in my office lately!  But we have been getting to the beach a bit, especially in the evening (the best time of day).  I hope you have too.  Don’t you just love living on the South Shore?

Let’s start at the top:

#1 If you have a loved one in a nursing home, then you know there are a lot of changes going on lately when it comes to procedures and protocols.   Here are a few places where you can go to keep up: Consumer Voice, MANR, Center for Medicare Advocacy, and mass.gov.  If you have an issue with a nursing home and you don’t feel like you are making headway, call your Ombudsman.  These are volunteers who genuinely love the role and usually want to help develop a solution that is win-win.

#2 Great news on qualifying for MassHealth home care!  As you may know, MassHealth has some programs that will pay to send home health aides into you home.  To qualify, you must (1) medically need a certain level of care, (2) be below an asset limit, and (3) be below an income limit of $2349/month.

Ironically, this last piece, the income requirement, has put home care out of reach for many over the years, needlessly forcing people into the nursing home, which MassHealth will pay for with no income cutoff.  For far too long, if an elder meets the other requirements for home care, but is $1 over the income limit, she must spend down, every single month, on medical care, every dollar over $542.  That means that she could use the excess over $542 to pay for health insurance, private aides, and the like, but then she is somehow supposed to pay for groceries, heat, home repairs, sundries, and all the rest on just $542 per month!  Impossible to do.  Most elders in that situation have no choice but to move to a nursing home (which can cost the state much more than a home care package!!).

But – great news.  On a temporary basis, during the state of emergency, MassHealth is CHANGING the rules for anyone over-income for home care.  Instead of spending down to $542, an elder can simply spend down to the actual home care income limit of $2349.  It will be very interesting to see the data as the months go by, to see how many more seniors were able to stay at home with this simple change.  But what about after the state of emergency, you may ask?  Well, there is a health care bill currently in conference at the state legislature.  Please call your state representative and your state senator, and ask them both to talk to their caucus representatives about making this change permanent.

#3 Last week I had my first telehealth appointment!  What a pleasure to not have to drive, navigate through a building, and then sit in a waiting room forever.  An added bonus was getting a glimpse into the doctor’s life and personality, as he was sitting in his studio at home, surrounded by musical instruments.  That added a new dimension to the relationship.  Congress is talking about making telehealth a more prominent part of our medical landscape post-pandemic – yes, please.

#4 This is your periodic reminder to keep your health care proxy and emergency contact information with you at all times!  If you are out and about, that could mean keeping copies in the glove compartment of your car or making up a card to keep in your wallet.  We enroll all of our clients in DocuBank, and they send you a wallet card that connects emergency responders to your key health information.  I keep my DocuBank card in my wallet, and if I am going off adventuring without my bag, I put the card in my pocket.  Like when I go rowing with the fabulous crew out of the Hull Lifesaving Museum.

#5 Along the same lines… your health care agent can do a better job for you if you have shared your care wishes.  There are some great tools out there to help you think through your priorities and wishes for yourself, and then share them with your health care agent.  One free option online is the Conversation Project.  We give our clients the Your Way Workbook.  If we gave you one and you have not completed it – go pull out your black folder with all of your estate planning documents, find the Your Way workbook in there, and fill it out!

As always, reach out with any questions related to elder law, veterans benefits, long-term care, estate planning, and special needs planning.  Get outside, and wash those hands!

– Alexis

Useful Info During COVID v.3

May 11, 2020

Dear Friends,

This is our third newsletter during these interesting COVID times.  This one shares useful info, plus something beautiful.  You can revisit our prior newsletters here.

Share Your Care Wishes with the People Who Matter Most:

None of us knows when our health will take a turn.  The best gift you can give yourself and to the people who matter most is to think through and then share what matters most to you.  Your health care proxy can do the best possible job only if she or he knows what kind of care you want and don’t want.  An EXCELLENT springboard for thinking through, documenting, and sharing what matters most with the people who matter most comes from the Conversation Project.  Visit their site for an excellent worksheet.  While you are there, check out all the other resources on their website.

Excellent Community Resources

The Alzheimer’s Association 24/7 Helpline is open.  If you are feeling at the end of your rope, or even if you are well before that point, call them.  They can help.

Remember that your local Council on Aging is a bastion of information and resources!  If you need anything, call them and they will either solve your problem or refer you to someone who can.  Yes, your local senior is open for phone calls!  (But not walk-ins.)

Technical Stuff:

If you have medical billing issues related to Medicare, check out this amazing guide from the Center for Medicare Advocacy.  It’s technical, but readable.  There have been a LOT of changes to Medicare billing and requirements in light of COVID-19.  This guide provides excellent summaries of many of them.

A Reminder (Third Time – We are Serious about This Point!):

Keep your Health Care Proxy, HIPAA Statement, and medication list at your fingertips. 

(a) If you are a client of ours, then we enrolled you in DocuBank.  Take five minutes now to update your medication list.  (Really.  Five minutes.  I updated mine recently, it was very easy.)

(b) Keep copies on your phone.  You can save the documents to your Google Drive, you can simply keep them attached to an email, whatever you like, so long as they are accessible to you on your phone.  If you would like us to email PDFs of your signed documents to you, or to someone important to you, please call us or email us (doreen@alexislevitt.com).

(c) Keep copies on the back of your front door or on your refrigerator.  Many first responders will look in these places for emergency medical papers.

(d) If you do not have a health care proxy, download one today from Honoring ChoicesYou will need to witnesses – perhaps your neighbors can watch you sign through your glass door or window.

Something Beautiful:

Have you seen the Stephen Sondheim 90th birthday party?  It is so beautiful.  (Pro tip: It’s easy to skip around if you don’t like a particular song.)  Be sure to watch the closing remarks and final song – you just may cry from the beauty in this world.

And Remember:

Our office is open.  We are working from home, but if you need anything at all, just call or email, and we will get right back to you.

We had our first outdoor signing last week, and it was actually a bit of a party, since the Xfinity truck yard next door was playing some loud music!  We can also do video signings now, thanks to a bill that the governor signed this week.  We did our first one today.  It’s certainly been a period of firsts for a lot of things.

Hang in there, and get outside for plenty of fresh air and sunshine.  And wash your hands!!

– Alexis & Doreen

Our first outdoor signing!  That’s Doreen, Rich (Alexis’ spouse, pinch-hitting as a witness), and Alexis.  Photo used with clients’ permission.


E-Newsletter: Useful Info During COVID

April 2, 2020

Following is the text of our recent e-newsletter. If you would like us to add you to our e-newsletter mailing list, please visit our homepage.

———–

Dear Friends,

This is our second newsletter during these interesting COVID times. The first newsletter offered legal information. This one shares useful info, plus something beautiful. You can revisit our first newsletter here.

We begin with a reminder:

Keep your Health Care Proxy, HIPAA Statement, and medication list at your fingertips.

(a) If you are a client of ours, then we enrolled you in DocuBank. Take five minutes now to update your medication list. (Really. Five minutes. I updated mine recently, it was very easy.)

(b) Keep copies on your phone. You can save the documents to your Google Drive, you can simply keep them attached to an email, whatever you like, so long as they are accessible to you on your phone. If you would like us to email PDFs of your signed documents to you, or to someone important to you, please call us or email us (doreen@alexislevitt.com).

(c) Keep copies on the back of your front door or on your refrigerator. Many first responders will look in these places for emergency medical papers.

(d) If you do not have a health care proxy, download one today from Honoring Choices. You will need to witnesses – perhaps your neighbors can watch you sign through your glass door or window.

We move on to community offerings:

The Wonder Duo of Two Sisters Senior Living Advisors, Michelle and Alyson, are bringing you free, professional chair yoga every Tuesday and Thursday morning! More info here (scroll down the page). Mark your calendars!

The Alzheimer’s Association 24/7 Helpline is open. If you are feeling at the end of your rope, or even if you are well before that point, call them. They can help.

The Alzheimer’s Association is also hosting a slew of webinars online. They have even found a way to continue with their support groups. Check it out. There is no need to go this alone.

Remember that your local Council on Aging is a bastion of information and resources! If you need anything, call them and they will either solve your problem or refer you to someone who can. Yes, your local senior is open for phone calls! (But not walk-ins.)

Now for Community Requests:

South Shore Hospital is requesting the following:
Financial donations
Homemade masks (attention people who love to sew!)
Supplies so that the hospital can make their own masks
Gift cards for employees in need
N95 masks, gowns, goggles, other PPE

Norwell VNA & Hospice is requesting N95 masks, gowns, goggles, and other PPE.

And, Something Beautiful:

There is a national movement to plaster our neighborhoods with hearts, in support of our health care workers who are on the front lines. In our neighborhood, teacher Kathleen Malone and her kids took the lead, and now we all have lovely homemade hearts on our doors. The ones with the Red Cross symbols were given to the nurses in our neighborhood, and they have told us that this makes them feel supported and loved. Pull out some art supplies and bring the same to your street!

   

And Remember:

Our office is open. We are working from home, but if you need anything at all, just call or email, and we will get right back to you.

Hang in there, and get outside for plenty of fresh air and sunshine. And wash your hands!!

– Alexis & Doreen

E-Newsletter: If You Are Hospitalized During the State of Emergency

March 30, 2020

Following is the text of our recent e-newsletter.  If you would like us to add you to our e-newsletter mailing list, please visit our homepage.

———–

Dear Friends,

I hope you are all staying home (unless you are an essential worker).  I want to share some important points to keep in mind if you are hospitalized during the state of emergency.  These apply whether you are hospitalized for COVID-19 specifically, or for any other reason.

1. Keep your Health Care Proxy, HIPAA Statement, and medication list at your fingertips. 

(a) If you are a client of ours, then we enrolled you in DocuBank.  Take five minutes now to update your medication list.  (Really.  Five minutes.  I updated mine recently, it was very easy.)

(b) Keep copies on your phone.  You can save the documents to your Google Drive, you can simply keep them attached to an email, whatever you like, so long as they are accessible to you on your phone.  If you would like us to email PDFs of your signed documents to you, or to someone important to you, please call us or email us (doreen@alexislevitt.com).

(c) Keep copies on the back of your front door or on your refrigerator.  Many first responders will look in these places for emergency medical papers.

2. Advocate to be coded as “inpatient” rather than “under observation.”  If you are in the hospital and then transferred to a rehab, how you were coded at the hospital will make a big difference in payment source for the rehab stay.

3. If you are transferred to rehab and told that you will be paying privately, call us.  Under the State of Emergency, some of the usual coverage triggers for payment for rehab have changed.  Nursing home billing offices could be – quite understandably – overwhelmed and perhaps not updated on the temporary changes.  We can help.

4. Call us if you need a guardianship or conservatorship.  For anyone who has not signed a health care proxy or a power of attorney, the hospital (or rehab) may tell you that you need a guardian or conservator.  This is a court proceeding handled by an attorney.

(a) It’s possible that the hospital or rehab attorney will handle the guardianship and/or conservatorship for you, for free.  If that is the case, be sure to check in with them as to who they are naming to act as the guardian or conservator, and, if you are not happy with their choice, advocate for naming someone you prefer.

(b) If the hospital or rehab tells you that you need to find your own attorney (or if you are not comfortable using their attorney), then please call our office.  This is something that we can handle for you.

5. Our office is open.  We are working from home, but if you need anything at all, just call or email, and we will get right back to you.

Hang in there, and get outside for plenty of fresh air and sunshine.

– Alexis & Doreen

Repeal & Replace of ObamaCare, a/k/a RyanCare

March 9, 2017

Filed under: Medicaid (MassHealth),Medical Care — rec1 @ 10:16 AM

There are so many articles coming out right now trying to summarize RyanCare.  I’ve gone straight to my favorite source for all things medical financing – the Kaiser Foundation.  Their reports are well researched, and not slanted one way or the other.  Just the facts.

Here’s their summary of RyanCare.  Obviously, being from a think tank rather than a newspaper, a lot of the report requires some background knowledge that most of us don’t have, but it’s still worth reading.

Repeal & Replace of ObamaCare, a/k/a RyanCare

Filed under: Medicaid (MassHealth),Medical Care — Alexis @ 10:14 AM

There are so many articles coming out right now trying to summarize RyanCare.  I’ve gone straight to my favorite source for all things medical financing – the Kaiser Foundation.  Their reports are well researched, and not slanted one way or the other.  Just the facts.

Here’s their summary of RyanCare.  Obviously, being from a think tank rather than a newspaper, a lot of the report requires some background knowledge that most of us don’t have, but it’s still worth reading.

South Shore Residents May Be Eligible for Alzheimer’s PET Scans (IDEAS)

January 24, 2017

Filed under: Alzheimer's,Medical Care — Alexis @ 1:33 PM

Beth Israel Deaconess-Plymouth is taking part in a study that uses PET scans to look for signs of Alzheimer’s. It is called the Imaging Dementia—Evidence for Amyloid Scanning (IDEAS) Study.

There are many different sources of dementia, for example Alzheimer’s, vascular, and frontal lobe. Knowing which type of dementia a person has can help patients and families know how to work with the changing mind and what to expect from the course of the disease over time.

Not everyone is eligible – this is a study, so there are various criteria that a person must meet. The PET scan is paid for by Medicare. If you or a loved one has dementia, talk to your doctor about whether you can participate in the study.

For more information, see this article.

Medicare Open Enrollment Season

October 21, 2016

Filed under: Medical Care — Alexis @ 9:46 AM

Medicare Open Enrollment is happening now: it runs from October 15 to December 7.

Now is the time to check whether your supplement and Part D plans are the right ones for you. For help with the research, you can visit www.medicare.gov and you can also make an appointment with the SHINE counselor at your local senior center.

Which Hospital Must an Ambulance Take You To – Can You Demand a Specific Hospital?

February 13, 2014

Filed under: Medical Care — Alexis @ 10:43 AM

The answer is – it depends.

If there is an emergency and you are unable to express your wishes, even if you have advanced medical directives or a health care proxy in place, the Emergency Medical Technicians or Paramedics responding to the call are obligated to stabilize you and transport you to the nearest appropriate hospital. This does not necessarily mean you’ll be transported the closest hospital – for example, if you are severely burned, the ambulance may bring you to the nearest hospital with a specialized burn unit, even if there are other hospitals closer by. Once you have been evaluated, your advanced health care directives can be implemented, including transporting you to another hospital if a transport can be done safely.

In a situation where you are able to express your wishes, an ambulance may take you to the specific hospital you demand. Some ambulances, especially town or municipal ones, may be assigned to a certain “zone,” and are unable to take you to a hospital outside of their assigned region. And, if a hospital’s emergency room is full and not accepting any more patients, an ambulance may not be able to bring you there, even if that is where you wish to go.

It is also important to note that Medicare only covers ambulance services “to the nearest appropriate medical facility that’s able to give you the care you need.” If you demand transportation and are brought to another hospital instead of a closer, equivalent facility, you could be left to foot the bill on your own. An ambulance crew cannot ask you about your insurance, but it is important to know that Medicare may not cover ambulance transport if you demand a specific hospital.

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