Healthcare Planning: Don’t Wait for the Crisis
Last month, I received an email from Patricia and Walter, an older couple who were thinking about working with us. Here is an excerpt of what they asked:
“In our meeting, we would like to have you explain what services Healthassist will provide for us after the initial assessment. Do you help families if they need care in the home? Do you vet and engage such help? Do you help your clients with filing a claim with Long-Term Care insurance companies to identify if they are eligible for benefits? Or if it becomes clear that living at home is no longer possible, do you work with families to determine the best alternative living arrangement?”
My answer to all of these questions was “Yes.”
Soon after, Patricia and Walter engaged us and we began planning for as many possible scenarios as we could think of, including several that thought through how care would be delivered as they aged. Their goal was to age at home and to only consider an alternative living arrangement in very specific circumstances.
As an inveterate project manager myself, Patricia and Walter’s proactive approach to handling their healthcare warmed my heart!
A Gift to Yourself and Your Family
Most of our clients reach out to us for the first time when they are in crisis. Maybe an unforeseen hospital admission has occurred. Maybe an older adult is about to be discharged from a rehabilitation facility and the family is unsure where their loved one should now reside.
In all cases, time is of the essence. Furthermore, the family may feel overwhelmed by the process and unsure how to balance the competing forces, priorities, and moving parts. We respond with tremendous urgency and do our best to manage the process in a way that meets the needs of the family and the older adult in question.
But… it’s not ideal.
Healthcare for an older adult typically involves a maze of primary care physicians, physician specialists, healthcare facilities, and insurance coverages. None of it is simple and when decisions must be made on a tight timeframe, options are much more limited. Not only is there less time to explore alternatives, but there are also fewer options available.
A better approach — and in my mind, one of the greatest gifts you can give to yourself and your family members — is to have a plan in place in case you become ill and/or physically unable to care for yourself.
Of course, for many older adults, it is reasonable to assume that were something unexpected to happen, a spouse and/or children would be there for them. For others, it may not be so clear. We have many clients who do not have family and even if they do, they are not close by.
Whatever the circumstances, having a plan in place, even if there are others who will gladly step up to offer support, will make the entire process go more smoothly for all involved.
Here Are Four Things to Consider As You Develop That Plan…
#1. What is the status of your health now and who is on your team?
Patricia and Walter manage chronic medical conditions, take several medications, and have different primary care physicians and specialists that they see regularly. They each have different preferred hospitals and pharmacies.
Understanding their medical conditions and the team they have in place to assist them (including the interrelationships between providers) was of great value so we know whom to turn to should a medical event occur. We made sure that provisions were in place for their physicians to share protected information with us and their health care proxies by signing the proper HIPAA release forms.
We also gained permission to access their Patient Portals, allowing us to do the following:
Review their medical records, both from the past and in real time
Schedule in-person and virtual appointments online, with their providers
Initiate email communications with their providers and their support staff
#2. What is the functional status of your current living situation?
We met Patricia and Walter in their home, allowing us to conduct a functional assessment in the setting in which they plan to age.
A functional assessment is an objective review of an individual’s mobility, including the ability to transfer out-of-bed, walk, and manage stairs. It includes a demonstration of the ability to perform activities of daily living such as self-care, bathing, dressing, feeding, toileting, and the ability to communicate effectively both verbally and/or through alternative means.
Seeing them perform in their own living space establishes a baseline, allowing us to identify potential and immediate modifications that can be made in the event a decline in functional ability occurs. Patricia and Walter were already planning a home construction project that included moving their master bedroom and a new bathroom to the first floor. The design widened doorways and provided ample space to accommodate assistive devices such as a walker or wheelchair, if ever required.
#3. Who are your care partners, including alternates?
Patricia and Walter agreed that they would first turn to each other for assistance in both physical care and decision making. Both had named each other as healthcare proxy and had prepared a living will to outline their wishes, both for medical care and for care to be delivered in their home.
But what if that were no longer possible? They have no children, and their respective siblings are much older, with health issues of their own. So, we turned next to their named healthcare proxy alternates. The names were there, but very little communication had gone on between Patricia and Walter and these individuals regarding the level of responsibility involved in being a healthcare proxy, or what the couple’s individual wishes were if the healthcare proxy alternate had to make decisions on the couple’s behalf.
The couple had already worked with their financial advisor to plan for the financial support of home-based care and had named a durable power of attorney to make financial decisions on their behalf if necessary. Their plan included the purchase of a long-term care policy with a generous daily benefit to help defray the cost of care at home. But again, no communication between relevant parties had happened.
Having laid much of the groundwork on their own (well done!), what was now needed was a meeting to discuss the interrelationship between all players. We set that up to include Patricia and Walter, their alternate healthcare proxy, their durable power of attorney, and Healthassist. Documents were shared in advance and during the meeting we reviewed the couple’s wishes and the roles of each party involved.
#4. How will everyone work together?
We agreed in the meeting that our role at Healthassist will be one of “first line communicator” with the couple’s physicians and healthcare team. We will act as “interpreter” for others about what might be going on medically.
Patricia and Walter will keep their healthcare proxy informed through planned meetings. As a result, this individual will know the intimate wishes of the couple and be able to make decisions as necessary.
Finally, we committed to working in tandem and as hard as we could to honor Patricia and Walter’s wishes that they remain in their home. When and if the time comes, we will turn to the durable power of attorney to provide the financing necessary to execute the home-based plan.
The meeting was a great success. The healthcare proxy alternate was thrilled to know he would not be alone in all of this. Patricia and Walter were relieved to know they not only had a plan in place but had both personal and professional help ready to assist them with achieving their goals.
I often describe our role at Healthassist as being futurists, anticipating how illness and aging can impact our clients’ functional abilities and their ability to care for themselves. When we have the privilege of working with a family that is interested in planning, we are much more likely to be successful in achieving their desired outcomes. In short, it is a marriage made in (or, in this case, before) heaven!