Ay, there’s the Rub

I’ve been working with Genworth to process a claim for The Other Guy’s long term care insurance. The minimum condition needed to qualify for a claim is that he needs either “standby assistance” or “hands on assistance” with at least two of the Activities of Daily Living. ADLs include stuff like dressing, bathing, transferring (i.e. moving from bed to chair) eating. We don’t have the Cadillac plan that covers heartache or the thousand other natural shocks that flesh is heir to, so it’s a pretty high bar. For example, the ADL about eating doesn’t mean you can’t prepare your own meals. It means you can’t feed yourself. As it happens, we’re almost there. I filed a claim after evaluation by the facility assisted living nurse (D1) confirming that he needs (and will pay for) standby assistance with bathing and dressing.

After TOG starts getting assisted living, the Genworth claim process includes three components. First, we submit a statement by TOG’s primary care physician that he needs such assistance. I took care of that. Then, we need an exam by a nurse contracted by Genworth that he needs such assistance. I took care of that. We also need a statement by the facility where he lives that he needs such assistance. I asked him to take care of that. The last time I talked to a Genworth rep a week or so ago, the facility had yet to submit their forms and itemized bills.  

So the other day, we’re out to lunch.

Me:  Have you talked to D1, D2 (assisted living coordinator) or M (business and billing manager) about submitting the facility paperwork to Genworth?

TOG:  The what? Me? Do anything? At all? Ever? (Or words to that effect.)

Me:  Remember? I asked you to follow up to be sure they sent in their form. It’s the third part of the three-part claim process.

TOG:  (Truly expert look of clueless wonder on his face) I thought all things happened by magic without me having to do anything, let alone thank you for putting money in my pocket. (Ok, he probably didn’t say those exact words, but trust me, he said words that totally sounded like that.)

Me:  Please talk to one or more of the three facility employees who can follow up on this and ask them to give you copies of what they’ve sent so I can have them in my file.

WISIMH (or maybe I said it out loud):  Look sweetie, this is money that will go to you, so there’s absolutely no financial incentive for me to lift a finger. The one tiny piece of this process I’ve asked you to be responsible for is to follow up with the people who work where you live. It’s not terribly complicated.

WISIMH (for sure, not out loud):  And by now you should know which of the three women are responsible for this. I do. It’s M. But why do I bother? The likelihood of you following up is greater than the likelihood of me being attacked by a dozen zombies on surfboards while I’m surfing off the coast of San Diego in a snowstorm. And I don’t even surf. But it gives us something to talk about when we’re together.

***

Last Week.

TOG:  Talked to D1 and D2 today. If the word Genworth crosses their paths in association with me they will alert me with copies. I will leave a message at the front desk for M so that she will do same as well as send Genworth a receipt every month. (Remember, M is the go-to person here, so by pure coincidence, he’s managed to avoid her).

WISIMH:  Yes he said that. Even when he’s attempting to use words, he doesn’t use good ones.

Me:  I’ll check w Genworth. Residence HAS rec’d something from Genworth.

WISIMH:  Tis a consummation devoutly to be wished for. Not sleep, aka death, but getting this claim processed. Ay, therein lies the fucking rub. And by rub, I mean ay, there’s the tiresome game he plays. He’s punishing me for kicking him out of his house and selling off his precious hoard piece by piece by not cooperating with anything I ask him to do, regardless of whether it’s in his interest or not. So I end up doing it anyway, but not before I first suffer the slings and arrows of his outrageous passive aggression. Eventually, inevitably, I take arms against a sea of troubles, which, by opposing, is my only hope of ending them.

Meanwhile, TOG and I have texted and it turns out he needs actual hands on assistance in bathing. This would, of course, probably be another wrench in the LTC claim process because even though it wouldn’t change the cost of the assisted living services, it would probably require re-examination and re-certification by doctors et. al. So I’ve asked him to wait on that. Which is as likely as a pod of killer whales suddenly appearing and attacking the zombie surfers, thereby allowing me to slip away unharmed into the increasingly blinding blizzard. (I'm wearing a wetsuit, so I'll be ok).

***

Yesterday:

TOG:  For your edification. As I drive through the facility Deana whispering Genworth Genworth…

WISIMH:  WTF?

Then, the cryptic text: “Wait”.

Turns out there was an “episode” where he couldn’t breathe, and couldn’t stay in dining room to finish lunch, and panicked, and almost barfed, and they had to assist him to his room, and monitor his O2 saturation rate, which bottomed out at 82 before increasing back to low 90s where he usually is.  Which clearly means he needs even more assisted living. Much suspenseful texting and waiting happened while this drama played out. I was working in the vegetable garden, so not particularly caring about this act of the play.

However, as Hamlet ruminated, conscience does make cowards of us all. I know I have to do this, even if I end up like Ophelia  - who put her head in the oven or something halfway through the play. As Hamlet ended his monologue when Ophelia showed up “The fair Ophelia!  Nymph, in they orisons/ Be all my sins remembered.” Which is as likely as that killer whale pod being ignominiously defeated by the zombie surfers and turned into zombie whales, and eventually catching up with me and turning me into a zombie surfer.

Vast Imbecility

This morning it was Randy and his granddaughter Allison who knocked at my door at 10:22 am.

It seems that "from time to time" they drop by unannounced to "chat about the Bible".  Randy was holding a briefcase which I suspect had either a) a lot of proof about the literal veracity of the Bible; or b) a very sharp butcher knife to cut my throat. Again, Allison was clearly there to assure paranoid householders that Randy wouldn't by trying to steal my money that I have squirreled away in books all over my house while I bled out on the floor.

I politely told them I was not interested.  I wonder if these white people ever knock on doors in the hood?

Here's who I'll let into to chat. If somebody knocked on my door and wanted to talk about Thomas Hardy's Nature's Questioning: "We wonder, ever wonder, why we find us here!" His best guess was:

"Has some Vast Imbecility,
Might to build and blend,
But impotent to tend,
Framed us in jest, and left us now to hazardy?"

Judging by the people who come to my door to talk about Creationism myths or chat about the Bible, I think the answer is yup.

The Slippery Slope of Child Exploitation

Three people knocked on my door at 10:18 this morning: two grown men and a four-year old boy. The boy was presumably brought along to provide assurance that the two men wouldn’t rape me or try to steal my tea towels.

Man:  Hi, I know you were not expecting us today.

Me:  No.

Man:  We wonder if we could talk to you to dispel some of the myths about Creationism.

Me:  Would the first myth be that it’s total nonsense?

Man:  Um, well….

Me: Then god no. Goodbye.

Man: Thank you for your time.

WISIMH:  I miss intelligence. And to bring a child along as part of this sad parade makes me want to call Child Protective Service to see if they could intervene and save the boy; although stifling a child’s curiosity is probably not a crime. I suppose his presence was more than assurance against rapey behavior. Perhaps it was even more than part of a program to brainwash the child into mindless acceptance of daddy’s crazy.

His presence also prevented me from unleashing a profanity-laced rant about how an inexcusable ignorance of obvious and provable scientific facts, when combined with a blind determination to stake out a position based on inferior intellectual acumen, leaves no room for your child to develop his intellectual capacity beyond the point where he follows you around to make old ladies feel safe when you show up at their front door. For shame.

And then I realized I made my daughter sell Girl Scout Cookies and I owe her an apology for pimping her out for what I still think is a good cause. But thinking about exploiting children to promote their parents’ questionable agendas then brought me a PTSD flashback circa 1958 when my parochial school made me sell subscriptions to The Catholic Standard for prizes like glow-in-the-dark light switch plates with the BVM on them. While I never labored in a Bangladesh clothing factory, or participated in a beauty pageant as a child, I feel their pain.

That upset me more than that those crazy people who knocked on my door this morning. Who will think of the children?

It's Not Going to Suck Itself

TOG got a letter from LTC, which he scanned and sent to me to read and explain. The letter says the claim is being evaluated and so far the carrier has determined that the place TOG lives is “an eligible Residential Care facility” as regulated and certified by the state and thus he’s allowed to live there. Our second choice of residential care facility - beneath the highway underpass - is probably not certified, which means the company wouldn’t pay benefits if he lived there. Which is just as well because mail delivery to that address is problematic.

But then the letter takes and ominous inscrutable turn: “Please also be aware that your policy may not provide facility benefits if you reside in an independent living bed within a facility. If we determine that you reside in an independent living bed, we will separately communicate what, if any, policy benefits may be payable.”

TOG’s bed is a hospital bed he got for his mother and it does go up and down but you need to press a button to lift or lower the head or foot. In other words, much like it's occupant, it doesn't move by itself. It doesn’t have a massage function either, so arguably it has no pulse. Thus, strictly speaking, his bed is neither independent nor living. So that is good, right? Somebody is going to have to find out what that means. Let's see how that goes. 

ME:  Now I’m getting worried that Genworth won’t pay rent but only services because your bed isn’t living independently.

TOG:  I must admit. I wouldn’t be surprised. But there still might be other things to do.

WISIMH:  Notice the passive voice here. Those things apparently will eventually do themselves.

ME:  Yeah. Like call MR (the insurance agent) and ask her.

WISIMH: Sometimes, I’m so hilarious, I crack myself up. Like he'd take a hint.

TOG:  Or R&P (the elder law attorney)

WISIMH:  I must admit. He can dish out hints while dodging them like The One in Matrix dodges bullets. He’s also a master at suggesting yet more things that might yet do themselves.

ME:  Let’s think about this for a minute R&P charge >$300 per hour and a call to MR is free.
WISIMH:  'Nother swing and a miss. Hint not taken.

TOG:  But that’s all down the road… no need planning NOW

ME:  Actually, the definition of planning is to figure out what to do before events overtake you… Why do I feel like I’m on my own here?  Oh yeah… Because if anything is going to be done it will be done by me.

TOG:  (Crickets)

WISIMH:  (Double face-palm) Lamentable, dreadful, hopeless, unsurprising, typical.

ME:  I am surrounded by people incapable of planning. I am very uncomfortable without a plan. My problem. Which I will solve by myself. Resenting those who failure to plan causes me more work and stress is an unfortunate side effect. 

WISIMH: Notice the general rather than specific claims set forth above. Let it never be said I specified who was incapable of planning and/or causing me stress. My life these days is like a popsicle: it’s not going to suck itself. 

Short Term Careless

TOG has long term care insurance. It’s time - dear god it’s time - to file a claim. By which I mean it’s time for me to do all the work necessary to give TOG more money he can use to pay his rent. The man couldn’t do this for his demented mother, so it’s not like I expected him to do it for himself. I wonder what it would be like to have someone who would care for me?  I’m a fucking saint.

So, at my initiation, we met with the nurse at La Vida Loco who took five minutes to fill out a Resident Assessment saying TOG needs the minimal help with the minimal Activities of Daily Living to file a claim.  Then I called the insurance company who, by the way, has been nothing but responsive, professional and helpful so far. Our cheap policy however provides that it’s the insurance company, not the residential nurse or his primary care doc who determine TOG’s ability to not perform the ADLs. So, I’m a bit nervous. So, the following texts:

ME:  Set up appointment and put it on calendar for nurse from insurance company to come to your place to do evaluation. I’ll bring what we need.

WISIMH:  Like your prescription list, your diagnoses, your hospital stays, your durable power of attorney, the patient statement part of the claim form which I will will, of course, fill out and put a paper clip where you sign. You know, the stuff you could print out online from Kaiser or download from the shared files in the cloud. And also, this is the time when you tell me how much you appreciate all I’m doing for you here.

TOG:  Should I set something up for just us to talk with Darlene

WISIMH:  Thank me very much. I’m welcome. Darlene? Who the hell is Darlene?

ME:  Maybe. There is some legalese that might require the facility to cooperate. Let me scan the letter then I’ll email you w specific questions for her. Who is Darlene? Not D (the nurse) or M (the business office who will have to provide statements). What’s Darlene’s role here?

TOG:  Darlene schedules “help” she is also very familiar with ADL requirements and seemed to be helpful. I suggest you call her after you read the claim form.

WISIMH:  Of course I should call Darlene. Because not only can’t you set up this process, meet with the nurse or business officer, read the claim form – let alone complete it, you can’t be bothered to talk to Darlene who works in the fucking building where you fucking live. Too bad not being a lazy slug isn’t an ADL or you would have qualified in the last century and saved thousands in premiums. Not to mention all the Xanax I've had to take every time I come to visit you.

ME:  Then I won’t even bother to send you info if you don’t want to be the go-between. What’s her last name and title?

TOG: (crickets) (Although to be fair, it turns out he was driving his bike around his 700’sq apartment looking for her card. And which, if you saw what a mess he’s made in this tiny space without a personal assistant to file, put away stuff, close cupboard doors etc is pretty impressive, so no wonder it took 15 minutes for him to find Darlene’s card.)

ME: There’s also a form to be filled out by “Attending Physician”. The form says this is the doc that “best knows the insured’s condition”. Would that be Dr. P (who he saw once when he changed his primary care to the Kaiser office closer to La Vida Loco) or Dr. S (his long-time pulmonologist who knows he has about ¼ of the functioning lungs he needs).

TOG:  ‘qA

ME:  You’re a big fucking help. Just like your mother was.

TOG:  Disregard that qA. My doctor will be Dr. fat (The spellcheck is biased against Vietnamese surnames) is closest and he’s the general practitioner of need and those things other than just pulmonary stuff here’s the info about Darlene (attaches photo of her business card) Resident services supervisor assisted living.

WISIMH:  Thanks big guy. That’s the least you could do. Seriously.

So I sent e-mail to Darlene who actually replied in person to TOG saying she’d be around to advise but didn’t need to be at the insurance company nurse exam. I also called Dr. P and left message and was later told he’d need to see us in person to do an eval – never saw that coming – and so I made an appointment for that. 

                                                                         ***

Now, before sharing the next text conversation, a bit of backstory. La Vida Loco has a menu system for assisted living services with different levels/costs based on points assigned for each specific service. You get points for such services as standby assistance for dressing and bathing, dispensing meds, and graduated increases in services until they’re giving you the bath, spoon-feeding you, and checking on you several times a day because you can’t find the I’ve Fallen Button you wear on a chain around your neck and/or remember to push it when you fall.  The menu system is set up so that he pays $300 extra per month for the minimal assistance he needs, but there’s room in the points for them to, say, order his prescriptions for him, without exceeding the points that take the cost to the next level.

When I checked the menu and the costs - because I knew he wouldn't - I’d suggested he have them order his catheters at least since he’s paying them an amount that would include that service.  Because I suggested it, needless to say, he declined. Because he’s a stubborn old man, and President-for-Life of the Passive Aggressive Spouse Club. And because there's a game for that.

TOG:  I talked to Darlene and she says the nurse will do an evaluation and then give a questionnaire for Darlene to fill out.  She also suggested that we might consider adding more items up to the 59 point level. “You have a little wiggle room”

ME:  Which I suggested earlier…

WISIMH: … you idiot…

ME:  … You should print out a copy of your prescriptions including caths. Then ask if they can order them. Since you’re paying $300 you might as well get $300 worth of services.

WISIMH:  So, it was a good idea when Darlene suggested it. Now that I’ve concurred however, I’ve initiated the game. It's called You Make a Suggestion, Then If I Concur, You Reject It. I also taunted you by reminding you that I’d suggested that weeks ago. My Spidey-sense tells me you’ll decide against the prescription ordering service. Let’s see what happens next…

TOG:  Ok but I don’t think I can start any of this prior to tomorrow…

WISIMH:  TOG’s mission statement is “Why put off until tomorrow what you can put off until the day after that?”

TOG: …Also I’m wonder if checking O2 stats daily might be better than ordering meds.

WISIMH:  I Win! We both know that while TOG has seriously bad COPD, he converts oxygen (O2 stats measure that) at > 90% which is the cutoff for prescribing an oxygen tank. But if I remind him of that, I’m playing into his hands and he’ll find a reason why this isn’t such a good idea after all.  But I love the guy, what can I say?

ME:  Why not ask doc P or doc S. You can email Dr. S and ask if she thinks that might be worthwhile.

TOG:  K

WISIMH:  Yup. When you're too lazy to type the O in OK, what are the odds you'll follow up? My Spidey-sense is tingling again, feeling suspiciously like a pain in the back of my neck.