Thanks, Lori.

Thanks, Lori.

October 8, 2007, 10:30 am
Filed under: Alzheimer's, Health, Hospice, Sleep, Society

As I mentioned Saturday, we now have someone coming in to stay overnight three nights a week. Seems like a nice woman, but it will still be a little weird to have a stranger here on Mondays, Wednesdays, and Fridays – and there’s a chance that it won’t work out with my MIL, if she freaks out over having this strange person help her in the middle of the night.

That was one of the main reasons we’d held off on taking this step earlier: we weren’t sure whether the trade-off of getting a night’s undisturbed sleep would be worth whatever disruption it caused my MIL that we’d have to deal with the rest of the time. But when we met with the Social Worker from Hospice, a nice woman by the name of Lori, she was fairly assertive that we needed to take this step, just for our own health and sanity. Getting an outside professional’s perspective helped, and affirmed what friends and family had been suggesting for some time.

The other main reason we’d held off in doing this was insurance. Now, let me get my biases right out in front: I think that most insurance is a scam, designed to scare people and sell them policies which provide little coverage and plenty of loopholes for the company to escape payment. I know that this isn’t always the case, and yes I have always had plenty of insurance – I just accept it as a necessary and unpleasant part of life. Our experience in this case proved not to be an exception.

See, my MIL has a long-term care policy which carried an option for an ‘alternative care plan’, meaning something other than a nursing home, which could be set up with the agreement of the company (and would save the company money, since it was a lot less than what a nursing home would cost). She’s had this policy for decades. Under the provisions of the plan, the company would pay up to $xx.xx dollars per day for in-home care assistance. We wanted to have them help pay for having a home-health aide in overnight a couple of times a week. Except that the cost of doing so was a little less than twice what the per diem specified in the policy. But hey, no problem – since it is overnight, the billing could be broken into two days, and fall under the specified coverage. Logical, right?

Um, no. Not as far as the insurance company was concerned. At least that was the position they took when they denied our request. My wife argued with them. For a while. Because honestly, we didn’t have the energy to fight with them over the long haul, given that we’re exhausted from being care-providers. It was easier to just curse the bastards and drop the matter – what the insurance company counts on, no doubt.

Except then we talked with Lori, and she made her point about us needing more rest. Further, she asked about any insurance policies that might allow for some in-home care. We explained the situation we’d gone through with the insurance company earlier this year. She nodded, asked to see the policy. Looked it over. Looked at us, said, “Let me handle it. The sad fact is, I have a lot more success than our hospice clients do with these things – the insurance companies know that they can’t just wait me out.”

Three weeks later, we had a tentative agreement in place. A week after that, the paperwork was all signed. The company will indeed pay for someone being here three nights a week, billed under the per diem for six days. Starting tonight.

Thanks, Lori.

Jim Downey

6 Comments

6 Comments so far
Leave a comment

RSS feed for comments on this post. TrackBack URI