And Around and Around and Around...

And just as I was finishing the last entry I got a late e-mail from M.  She reports that

1) It will take at least a month for us to get into the CASA Medicaid system.

2) Since we've decided not to go with Guild Net, CASA requires an entirely new home care assessment.  Someone else needs to visit and start the process from scratch. (Note: I think this will be the fourth home care assessment, but I'm not sure.  I'm losing track).

3) CASA won't let us pick our own agency.  They'll assign one based on their estimate of needs.

4) In spite of this, M is going to call Premier.

5) CASA will assign its own caseworker who, I guess, will coordinate with my caseworker (that would be M).

I replied with a few questions:

1) If CASA isn't going to accept Guild Net's assessment, why did they send us a Guild Net representative in the first place?  Or did the Guild Net assessment apply only to Guild Net?

2) If CASA is going to pick its own agency, why are we contacting Premier?  If we used them, does that mean that we'd be opting out of Medicaid and deciding to pay out of pocket?

3) When will this end?

Actually, I didn't ask question 3.  At least, not aloud.  Maybe I will at some point.  Or maybe not.  I think I know what the answer will be:

1) This will never end.  You're going to spend all eternity cycling through a procession of home health care assessments and filling new sets of application paperwork.

2) Your father will outlive you.  His mind will be gone but he'll be cheerful and people will like him.  And you'll be dead.

Putting that aside - if the home care situation is never going to get resolved, is there a point where it makes more sense to give up on it and look for a facility?  My father is probably borderline-in-need of nursing home care right now.  The advantages of home care had to do with comfort and cost.  But if comfort becomes a more neutral factor and costs are the same or even higher at home, why keep him at home?

I'll have to think about that.  In the meantime I suppose I'll pour more gasoline on the asset bonfire and get comfortable.  'Cause it looks like we're gonna be sitting here in the confusion for a while.

Comments

[Cathy Ferrere]

Dear Alan, I've been reading your blog for quite awhile as my mother is just recently being diagnosed with Alzheimer's. I admire your stamina in commuting back and forth, and your patience in dealing with all the non-services. I'm brought to putting in my two cents by the frustration in this last essay. I think you will save enormous amounts of time, money, and energy if you find a decent nursing home or assisted living facility near where you live. I'm from NY myself, and I assure you EVERYWHERE is cheaper than NY. Well, maybe not DC, but Maryland must have some reasonable places for your Dad. Sublet your Dad's apartment if you want to keep it but cut yourself free of the lawyers and others who are doing nothing but bill you and find services closer to home. Best of luck whatever you choose to do. Cathy

[Alan G. Ampolsk]

We're thinking along the same lines -- I just asked M to work out the cost of keeping him in New York, and run some comparisons with suburban Maryland (and maybe Virginia). We'll see where that lands. It may also be that he really needs institutional care. There's a tendency to get so caught up in soving a particular problem -- in this case home care -- that you don't notice that conditions have changed. What you're solving is last year's problem, not this year's. That may be the case here. So, yes, I'll definitely be looking at local nursing homes. Updates on that (and much else) to follow.