October chit-chat

[Prot]

agate- You're right in what you say. I hadn't considered the technicalities of using it. Also you'd need staff there daily, not just Mon to Fi.

[agate]

Well, about the staff--they aren't allowed to lay a finger on any of us as I understand it. In fact, some years ago a resident was having a heart attack in his apartment, and a staff person (we had them back then) did CPR on him but he wasn't supposed to have done that.

Once I fell in the common-area hall, just as the manager was on her way out the front door at the end of her working day. She paused long enough to ask me if I was all right, and of course I said I was, and she went on her way--but it took two neighbors to help me up off the floor (and I wasn't so OK but didn't yet realize it). If I'd said I wasn't all right, she would have called 911 for me but that is all they're allowed to do.

I'm not sure why there is this rule but suspect it's a liability issue.

[Prot]

My daughter who has worked with a variety of people- autistic,intellectually disabled,physically disabled, dementia,severe mental illness, She's said similar in the past. She started as a basic carer, and is now the local branch manager of a home care agency.

[agate]

I'm guessing that if a staff member moves a resident or helps to lift a person up from a fall, and then the person turns out to have an injury as a result of being improperly lifted, the company hiring the staff person might be liable--in a big way.

And if you read first-aid manuals, there are situations where an injured person should not be moved, or should be moved only in a certain way.

[Virginia]

That is probably the reason Agate. There may be some liability involved.

Tim, it takes a special kind of person to do the kind of work your daughter does and do in well. How lucky you are to have her to give you a little help.

Many years ago my father suffered a stroke. Between the hospital and rehab he was gone from his home for six months. My mother was deceased so I had to kind of take over. When he was being sent home I went to a place I found back then for the elderly. I asked if they could recommend any trustworthy person. They recommended several and I made appointments at my father's house to interview them. The first one who came was named Marie. She turned out to be a gem. She went Monday thru Saturday come rain or shine. She had no car and had to transfer on the bus once to get there, but unless she got sick she was there. When snow was forecast she would pack a small bag and go to stay until the snow was gone.

She stayed for nine years until my father died. How I wish they made people like Marie today, but I certainly haven't heard of anyone. She was devoted to my father. I did his grocery shopping and picking up his medicine, etc. When he had to go to the doctor I would tell my brothers and usually the youngest one would take him because I didn't have the strength. My family was blessed with Marie. I made a good choice. At least I did one good thing in my life.

[agate]

You've done many good things, Virginia!

Just for one thing, you've stayed in contact with our Jeanie Z as well as you could, and I know she has appreciated that. I believe she's not being affected by the hurricane where she is but I have been too busy to try to contact her.

--I agree that people like your helper Marie are very rare. Is there still the same person who was coming to help you sometimes?

I recently heard that there is a proposal to have Medicare cover home health aides. That seems to me like an idea whose time has come. It may never happen, of course, but it could be really helpful to some people--and I would be one of them. The Medicaid coverage for home health aides is limited--and varies a lot from one state to another.

[Virginia]

Agate, the only person or persons I have coming is a cleaning service. None of them speak or seem to understand English. Weather two or three come, they spend 1 hour period. That is every other week. I have been thinking of contacting Laura to see if she has any time that she wants to come every other week. She is the one I had for years, but she stayed on the phone and sometimes didn't even get around to vacuuming the floors. I was doing a lot of the work and she stayed for 4 hours. However she speaks and understands English very well and there are other projects I can pay her to do for me. I am no longer able to vacuum and do some things I was doing when she was coming.

I agree that it is long past time for Medicare to come into helping the elderly at home. I read an article in the Washington Post about this and the only problem with it is that age old problem of funding. Medicare and Social Security are on track to run out of money in a few years. They say this would speed it up by a lot. I wish something could be worked out.

[agate]

I think the plan for Medicare funding of home health aides is that the drug companies' profits are going to be reined in somehow, and that will free up funds for home health aides.

Yes, Laura was the person I remember you mentioned. I had forgotten that she was no longer with you.

Once cellphones came along, my helpers tended to overuse their phones during their working hours too, and it was very irritating. Some of them had children in school, and they would get calls about a sick child at school who needed to be picked up, or a lockdown at the school due to a bomb scare, etc. There was often a good reason for the phone calls but when they wanted just to chat with someone on "my" time, it was annoying.

[Prot]

I don't know about the USA,but care workers in the UK are not paid well.

[jingle]

I have a fine young woman who comes for 3 hours just once a month. She works fast and hard. That cost $60 but I give her $10 extra because she has never asked for any sort of raise. Once a month is not enough. I wish we could change it to every other week or any increase but that's not possible.

[agate]

That would be $30 an hour, jingle? The last I heard, around here the rate is often $20/hour. If I were to pay someone to go with me to a typical medical appointment using the paratransit van, I might be paying that person $60-80. That seems like a lot but it is that person's time, and being expected to spend it waiting around with me or for me when most people would prefer to be doing something else--that's a lot to ask.

Tim, caregivers aren't paid well here either. It's a shame because I think of it as a job requiring skill and training. Experience helps a lot too. It's work that should have much better pay.

[Virginia]

Agate, back to speaking of Medicare paying for home health care, I can tell you from personal experience the insurance and drug companies are just simply no longer covering the expensive drugs like my Rebif for Medicare patients. They give a list of drug companies who offer Medicare part D coverage in the "Medicare and You" handbook that comes out every year. My Rebif is not covered by any of them in 2025. They will cover the cheaper MS drug. I have been on two others and have failed both times. There are many of them that my doctor doesn't want me on because he thinks they might cause me to start having infections. The insurance companies and drug companies always have a way of hitting back.

Also, I hate to be such a downer today, but I read an article in Medpage Today. This article talked about doctors cutting back on seeing Medicare patients because what they are to be paid by Medicare is once again to be cut when the new budget is passed. It has already been cut last year and before that. The doctors say they can not pay their office expenses and their assistants that work behind the scenes doing all the paper work and they have to pay rent, all their utilities, etc.

One doctor said he always had a private physician and he turned 65 and had to go on Medicare. He had a hard time getting someone to take him. He said he finally got someone by pulling some strings, but it made him wonder what people who didn't have those connections do.

[agate]

Ever since my primary care doctor (years ago) pointed out to me that doctors disliked seeing Medicare/Medicaid patients because they have to wait so long to get reimbursed and then aren't reimbursed the amount they think they are owed, I've just assumed that no medical professional wants to see me. All I can do is try to play nice and try not to be a bother to them in any way. Maybe then they won't kick me out entirely.

There were times when doctors were assumed to have chosen medicine as their careers because of a spirit of public service, and they were expected to treat anyone regardless of what kind of coverage they had or their ability to pay. But those times are long gone, I think.

I've heard some hard-luck stories about how doctors need to pay their overhead and pay their staff and even pay off the huge debt they racked up just to get through their training. But the fact is that doctors do make fairly good money compared to quite a few of their patients:

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Although neurologists aren't on this list of the highest paid medical specialists, neurosurgeons are at the very top of the list.

[Virginia]

They have most always been the highest paid. However, I have to agree with regular doctors such as primary care physicians. Many years ago I worked for two internist who were primary care doctors for many people. Even then it took a lot of money to run that office. They have to pay sky high rent for waiting area, reception area, exam rooms, rooms for any lab technicians they might employ, where the people who take care of filing insurance work. Then they have to pay all the people who work in those rooms plus utilities and a ton of things I can't remember. The equipment they have has to be kept up and sometimes updated. On top of that they pay a lot of money for their liability insurance.

Of course all of the above doesn't take into account their personal expenses at home and if they have a spouse and children.

I am not talking about neurologist, cardiologist and surgeons. I think there are still a few doctors who enter medicine for the right reason and just can't make it unless they moonlight on a 2nd job like working shifts at a hospital. Then they stay so tired they begin to wonder why they went into medicine. These are mostly the doctors who see Medicare patients. Many here have gotten out of medicine. On top of all I thought about they have to have an accountant and now the government demands tons of paper work from them. The ones that stay where they take a lot of Medicare patients tend to not be the cream of the crop. I have had a few that were good, but so overworked they left. The last 3 I have had I am sure are working for Duke Primary Care simply because they can't afford to pay to buy all the equipment and pay everything to set an office up. Sometimes they have their own physical problems.

All this is just my opinion from working in a medical office and being close enough to 3 or 4 doctors that I have had since going on Medicare that we were able to discuss the situation.

Then of course, there are the ones that really don't care that much and some in private practice who want the money.

[agate]

I feel lucky to have had doctors who have extended themselves to me in many ways and gone that extra mile. I was always one of the Medicare/Medicaid people they didn't want to treat--I knew they found patients like me to be a drain.

Sometimes I wanted to wear a badge saying something a friend of mine used to say: "Pardon me for living--I just fell off the hearse."