Sunday, October 17, 2010

Alzeimer's Secret #4: You Are Being Over Charged

OK, before I continue, I want to share some exciting news with you.  I will soon be launching a caregiver membership website!  My partner, Diane Carbo and I have joined forces to bring you the first ever, exclusive membership site devoted entirely to caregivers helping their parents suffering from Alzheimer's dementia. We are hoping to launch before Thanksgiving.  Nobody will be excluded, the site will have 2 membership levels, Free and Gold Level.  We are committed to drop dead honesty, and making sure you are saving money and have peace of mind.  Please go to Dementia Care Secrets and sign up.  I will personally respond, and you will have the opportunity to sign up at" as a founding member (with even more bonuses than the Gold Level). 

Alzheimer's Secret #4  You are being over charged

Medications, insurance co-pay, incontinent supplies, adult day care, home health care workers, assisted living, you name it? There are people trying to make money off of you, and they are trying to make as much money as possible.

Before I continue, I must advise you that I am not an MD doctor or a pharmacist, so the following is purely my opinion, and you should make up your own mind and discuss all medication issues with your own doctor and pharmacist.
You already know about generic drugs, and that's a good start. However, you may had heard that there are some drugs that you should not get generic versions of. Hogwash. According to Consumer Reports, "Generics are copies of brand name medicines whose patents have expired". As you can imagine the FDA has strict rules about drug preparation, purity, and strength.  The only place you should concern yourself with quality is when taking vitamins and supplements.  The FDA does not oversee the makers of supplements, and there is huge disparity with manufactures. But that is a story for Dementia Care

Insurance Co-pay
Time for another qualification: I am not a financial advisor, my comments again, are only my opinion, and quite frankly might be dead wrong.  For example, personally I will never pay for my dad's doctor or hospital co-pay. After all what are they going to do, ruin his credit? In my experience, most doctor's do not care about collecting co-pay, but they are required by the government to charge Medicare and private pay patients the same, so to get the maximum Medicare reimbursement they have to ask for a co-pay. (It’s a long explanation) Especially in nursing homes and assisted living, doctors could not care less about it.
As far as I know hospitals cannot refuse you treatment, even if you owe them a million dollars.  If you show up in ER (or the paramedics deliver your mom or dad there) they will not be sent away. That leaves insurance companies: The best insurance you can have is Medi-Medi. But if you do not have the income qualification for Medicaid, then you need a good secondary, like AARP.  And if you are paying more than a nominal fee for meds or services, then you need to change your secondary. Which is very easy, and we will show you how do it on the membership site.
Incontinent supplies, bath chairs, hospital beds, etc.
If you parents are broke then you qualify for Medicaid, no problem. Medicaid covers it. Including wheelchairs (electric and regular). But if they are not broke…and their secondary insurance does not pay, you can go on Craigslist or eBay. Also check Thrift stores, and call those charities that pick up like the Vietnam Veterans groups and ask where their retail stores are. Places that pick up usually have the best selection. Even the Penny Saver carries most of the stuff you need (chairs, beds, walkers, etc.). Incontinent supplies on the other hands can be found at discount stores like Walmart.
If you have home health workers or your folk live in assisted living, or skilled nursing, make sure they are not putting two diapers on at a time. They will give you some malarkey and say that it prevents or catches leaking. That’s plain not true. the adult briefs made today can hold plenty. They are just trying to get away with changing your loved one less often - which is a major contributor to skin breakdown. So if you catch it, raise hell.

Adult Day Care
There are two types: regular adult day care and adult day health care.  Both are subsidized by the government. If you are in a big city or town, shop around, if you are more rural you will most likely have to us IHSS (a government subsidized home companion service).  But when it comes to adult day care; bargain like you are in Tijuana, try to get their daily rate for half of what they initially quote you.
home care workers
The dilemma with home health is deciding to hire your own help, or paying an agency and using their staff. They both have pluses and minuses. But if you decide on using an agency, again…shop it around for the best price.  Here agencies are less likely to negotiate, BUT you can let your fingers do the shopping and find another one that is cheaper.  Also, do not pay for more service than you need. (a Care Manager would be helpful here). Finally, you can get free home care if you have the right doctor.  Basically you need to ask the doctor to write an order home health and if he/she does Medicare will pay for it.  A good doctor will know what conditions and illnesses warrant home health and be able to write an order for it easily.  Generally the best time for getting these orders is during a short hospitalization or a short stay in a Rehab care center or nursing home.

assisted living
Times are hard for assisted living. In the last decade they over built and big companies bought too many properties. Therefore no matter what the marketing persons says, they have a lot more vacancies than they are admitting to. So the best way to save on assisted living is to first ask them to waive whatever admission fees they try to slap on you.  They might try to break it down into payments, don't fall for it. It's pure profit for them and negotiable.  Then get them to reduce the price of the room and board.  Most good places will not reduce their fees for care (medication, bathing, escorting, etc.).  But the board and care portion of the fees are negotiable.  Example:  "We have a $1000 pre-admission free, and your mom needs  X, Y and Z services for another $1500 plus room and board of $1000 for a total of $3500 move in, and $2500 per month after that."   You can fight to have them waive the $1000 pre-admission and take around 20% off of the room and board for a total of $2300 per month. The saving will add up over time.
Also most assisted living communities will give you a cost of living rent increase every year. These are negotiable and can even be waived. Just claim financial hardship. Let them know you can't pay and will have to look a new place for your parent.  Be creative, negotiate, try to postpone it 6 month. If it’s a percentage of the rent, try to get them to lower the percentage.
Another good trick, if you are just now looking to move your parent into an assisted living, show an interest in the smallest room they offer and once they have told you the cost of, then ask that they give the larger room for the same price.  This will often save you thousands a year.
nursing home
These people charge by the day and are heavily regulated. But it pays to shop around. Most people get into nursing homes / rehab hospitals when they are discharged from a hospital.  The hospital has a person that is supposed to help you with the transition, and they often recommend certain homes that they have a relationship with…or your doctor may work in certain nursing homes and want to discharge your parent to the place they want them to go to (usually those places are paying the doctor and this is a secondary income for him/her).
Often the hospital will TELL you were they are sending your parent, hoping you will be sufficiently docile and not challenge them. But it is strictly up to you what nursing home your parent goes to. Not the hosptial's nor the doctor's.  But make sure you are prepared: as soon as your parent is admitted to the hospital start shopping nursing homes. Just walk into them and ask to speak to someone about bringing your mom or dad.  Ask them what their basic daily rate is.  They will say one of two things: They will either say, it doesn’t matter Medicare pays 100% or they will say it depends on what services your mom or dad need.  (both are smoke screens). You want to know their daily base rate (never mind the extras it's too confusing).  The reason you are asking, is if your mom or dad needs a few days beyond their Medicare days, they will want to bill you directly and you want to compare and use the one with the lowest daily base rate.

Tip:  Just because a nursing home is newer doesn't mean it's good. Some of the best care I have seen was in older established nursing homes.  Two big clues: smells, and yelling. You don't want to experience either one when touring.

Then when your mom or dad is getting discharged, and the hospital discharge planner (social worker) tells you where they are sending them you simply say…no, I want them to go here: name your place Better yet, when you have decided on which nursing home, let them deal with the hospital (it's in their interest to fight for you).  Finally, the hospital's last line of defense will be your parent's doctor who may say, but if you go to that nursing home, I cannot follow them.  Your response should then be, that’s ok, as soon as they are discharged we will come by your office, and perhaps you can  talk to the doctor at  the nursing home and coordinate a care plan for mom or dad. (The only reason a doctor would say no, is they are being cheap because they cannot bill Medicare for the consultation).
This is a lot of information, and an example of  the stuff you will find on the membership site where you will be able to selectively choose the material you need and ignore the rest. Not to mention that there will be a deeper explanation as well as some advocacy tools that you can access to make all this as simple as possible.


  1. One of my desperate caregiver moments was the time that the hospital insisted on sending my dad to a rehab/nursing home after discharge when he could have received the same care, delivered better by people he knew, back home at the assisted living residence.

    The hospital social worker went so far as to lie to the assisted living director who was questioning this placement by telling her that he needed to be released with an IV--when in fact he was not. This placement, done on a Friday at 5 PM on a holiday weekend, was one of our great failures in advocating for my dad.

    It took us a full week of standing up to bullies disguised as rehab caregivers to get him released. His recovery was set back many weeks by this experience.

    We write about this and other caregiving experiences at

    Inside Aging Parent Care

  2. This will definitely help the people in care giving profession understand and adjust to their patients. Caregivers should be knowledgeable and skillful too.


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