How Healthassist helped Pauline R.

When working with Stephen on the case of Pauline R, Healthassist provided the following services:

  • Developed a business case outlining the cost for Pauline to return to her home from a nursing home.
  • Identified a primary care physician who would support her goals.
  • Conducted a home assessment and recommended equipment and home modifications to ensure Pauline’s safety and comfort.
  • Facilitated the hiring of a 24×7 live-in caregiver, and managed the relationship with the homecare company on an ongoing basis.
  • Attended all physician appointments and coordinated all medical care.
  • Provided clear, concise communication to all team members including the local Visiting Nurse agency, medical personnel, caregivers, family members, friends, neighbors, legal and financial services professionals.
  • Helped manage acute medical crises, hospitalizations, and discharges.
  • Coordinated hospice care.

Challenging the process and saving Medicare money

At times I find myself “practicing what I preach” as I manage the healthcare concerns of my family, as when preparing for my mom’s first Total Knee Replacement (TKR) in May 2008.

While the case manager explained to me and my mother that most patients spend 3-4 days in the hospital, before being transferred to a Skilled Nursing Facility (SNF) for approximately two weeks to continue rehabilitation – I was confident my mother could bypass the nursing facility and go right home.

That’s because I knew that under her Medicare Advantage Plan, my mother was eligible to receive outpatient rehabilitation services from the local Visiting Nurse Agency (VNA).  Also in her favor were:

  • A positive outlook and motivation to be mobile and pain-free.
  • My dad’s willingness to do whatever was necessary to help her get well.
  • Her wonderful primary care physician (PCP) who would follow her medical issues closely.
  • My ability to oversee and coordinate her care.
  • My mother had prepared for the TKR by attending an educational class prior to surgery to learn about the procedure and the need to actively participate in her rehabilitation.

While we initially met some resistance from the case manager, we eventually struck a compromise – If my mother demonstrated her ability to perform certain functions outlined by the physical and occupational therapists, she could go straight home, skipping the nursing facility.

After 5 days at the hospital (one extra than originally anticipated), my mother was able to go home – saving her 14 days in the nursing facility, and Medicare a significant amount of money. Most important, my mom was much happier recuperating in familiar surroundings.

Six weeks later, when she arrived back at the hospital for the second TKR, the case manager asked if the discharge plan was the same – to go directly home with the help of the VNA, my father and me. My mom said yes, but this time she would go home a day earlier – and she did.

I share this story (thanks Mom!) as a reminder that when discharge planning begins prior to hospitalization, and patients actively participate in the decision making, the end result can be both physically and emotionally successful.

The Baby Boomers are turning 65!

cakeWith Baby Boomers turning 65, the number of questions we receive about Medicare has been steadily increasing:

  • What is Part A?
  • What is Part B?
  • Do I need Part D, prescription drug coverage?
  • Doesn’t Medicare cover everything?
  • What are Medicare Advantage plans?
  • Can I still see all my same doctors?
  • I think I have coverage as part of a retirement plan.
  • What if I keep working beyond the age of 65?

At Healthassist, we can work with you to sort through what can seem like a very complicated process.

We start by helping clients take a step back and evaluate how they have historically used the healthcare system, as well as what needs they will need met in the future. We then identify the viable options, while always ensuring clients superimpose their own preferences, priorities, past utilization patterns, potential future uses, and cost considerations on those options.

Whether your 65th birthday is in a month or a year, it’s never too early to start considering your Medicare options. If you’d like Healthassist to lend a hand, please contact us today.