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.

Heard at the Office: “Can’t My Spouse Automatically Speak for Me at the Hospital?”

January 30, 2014

Filed under: Estate Planning,Medical Care — Alexis @ 10:40 AM

Under the law, no. In real life, sometimes.

Many people think that they don’t need to sign a Health Care Proxy because they assume that the law permits their spouse to speak for them in medical emergencies. The law actually says quite the opposite. Only you or someone you have named in a Health Care Proxy has the authority to make medical decisions for you.

Real life doesn’t precisely follow the law. If hospital staff get the sense that the family all gets along and don’t think anyone in the family will have an issue with the well-spouse being the decision-maker, they will often turn to the well-spouse to make the decisions. But if hospital staff sense any dissent among the family, they will want to see a Health Care Proxy.

But what if you never signed one? Well, the hospital will tell your family that they need to go to court to have a guardian appointed. That costs a lot of money (your money, by the way), and takes a lot of time and emotional energy.

And even if the family all gets along just fine, there are other reasons hospital staff may ask to see a Health Care Proxy (and if there isn’t one, send your family off to court). For example, if you need antipsychotic medications, like anxiety or depression medications, the staff will ask to see a Health Care Proxy. Another common example arises when hospital staff considers inserting or removing a feeding tube, or using or discontinuing use of a ventilator. As you can see, even if your family gets along, the hospital staff still will need to see a Health Care Proxy (or, you guessed it, send your family off to court for guardianship).

Moral of the story? Put a Health Care Proxy in place now. It doesn’t take much time at all.

MOLST – Getting Your End-of-Life Wishes into Your Doctor’s Orders

May 28, 2013

Filed under: Medical Care — Tags: — Alexis @ 10:00 AM

Massachusetts has recently enacted the MOLST program – that’s Medical Orders on Life-Sustaining Treatment. This is a solution to a question that a lot of clients ask: “How do I make sure my kids do what I want with end-of-life care?” Or more typically, clients say, “I want a living will.”

MOLST is better than a living will, and it goes further than a health care proxy. Until MOLST, you might share with your children what kind of treatments and care you do and don’t want as you approach the end of your life, and you might get a chance to talk about it with your doctor, and then you hope for the best as you gradually come to rely on others to make decisions for you.

With MOLST, you have a conversation with your doctor while you are able, and then – this is the key – the doctor turns those into “doctor’s orders.” The MOLST form is a pink sheet of paper, and once that is in your medical record, it’s going to carry a lot of weight.

With MOLST, you get to think about and talk to your doctor about the things that are already on your mind – would you want CPR? Ventilation and intubation? Dialysis? Artificial nutrition and hydration? And then you turn them into medical orders. That means that there is a pretty good chance (though no system is foolproof) that as you decline, your medical providers and family will not only know your wishes, but will honor them. Having them in your record as doctor’s orders makes all the difference.

What about changing your mind? Yes, you can. At any time, you can talk to your medical staff about changing a prior decision in the MOLST.

Family members may ask what to do if a parent or loved one is already at the point where they can’t discuss end-of-life care options themselves with their doctor – the MOLST process permits a health care proxy or guardian to review end-of-life choices with the doctor as well.

For more information, and to see a sample form, see the MOLST site. It’s a well written, easy to read site.

Please note that the MOLST process is meant for people with advanced illness or injuries. If you are healthier, then the best vehicle for sharing your end-of-life wishes is something like the Your Way workbook.

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