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IMPinky Asked April 2022

Kaiser member: is it best to have a needs assessment done by Kaiser, or someone outside the HMO, such as an Area Agency on Aging?

I am still working on getting my MIL additional care. She is 93, has a diagnosis as of over a year ago of Mild Cognitive Impairment, however we all see more dementia behaviors and deficits in the last few months. Her mobility has also declined, and we are having to help her with dressing, getting ready for bed, and preparing her meals and making sure she eats, as well as meds management. I think it would be helpful to have someone assess her and sit down with the family, with her present, to discuss her needs and options for care.


 


Would Kaiser staff be likely to be biased toward what would be least costly to the HMO?

MJ1929 Apr 2022
do everything you can to get your mother-in-law off Kaiser. Kaiser is great if you’re healthy, but once you’re elderly and unwell the quality of care drops drastically. Keep in mind, too, that the vast majority of nursing homes don’t except Kaiser, so you have to find a place that will accept that very particular type of insurance and it narrows your choices drastically.

My dad loved Kaiser and its regimented systems, but the minute he died I got my mother off of it. Thank goodness too, because I don’t know what I would have done regarding her care. I had to move her to a nursing home three days after dad's funeral and paid out of pocket for a month until her new insurance kicked in. There was no way I would have been able to transport her to Kaiser for doctor visits and other medical needs, so I changed her insurance in the nick of time.
IMPinky Apr 2022
MJ1929, I have never been fond of Kaiser, but trying to get her to change at 93 years old would just be one more trauma for her. Kaiser has actually made our lives a bit easier lately. They provide phlebotomists that come to her home for blood draws, even though it's very rural. Most of her docs are fine with telephone appointments, unless they absolutely must see her in person. Getting her out of the house and to the car even is a major ordeal, so we really appreciate those services. Thanks for your input.
GardenArtist Apr 2022
I'm inclined to think that Kaiser, as an insurer, would want to mitigate charges and might not be as thorough.   

A geriatric specialist might be more appropriate.   But I also agree with MAC that  her doctor needs to be involved, at least as a stepping stone.

 I did ask our local AAA for an assessment, but never dealt with them after that.

The "nurse" who performed the assessment didn't even know what psychotropic drugs were.   She took it upon herself, w/o discussion from us, to assess what changes needed to be made to Dad's home so that he could remain there (this was several years after he began falling, had various stints for rehab, and more) as he approached 100 (yes, he was almost a centenarian).

She assessed the "needed" changes at $50K, just for the living room.  That included a new ceiling and I don't remember what else she cited, all verbally, not in writing.    And of course the new AAA program and its staff, and the goal of keeping elders in their home,  would "manage" the changes.  

I was so disgusted with this arrogance that I terminated the visit and obviously never considered her total lack of inability to provide construction estimates.

I had already met with another of their staff and wouldn't hire him.  He insisted on doing things that weren't necessary and ran up an estimate of several hundred dollars.  He was belligerent when I told him this wasn't the project scope, and some of his chores did NOT need to be done (trees with small trunks, such as 2 - 3 ", don't need to be stump ground.)

He became hostile, fortunately in the front yard so neighbors could call the police if he became physical, which did occur to me as he was really mad.

That was the end of AAA's involvement in my father's and my needs.  I found a REAL gardening expert for 1/4 of the price the AAA guy wanted.
IMPinky Apr 2022
GardenArtist, thank you for your reply. I'm shocked that the Area Agency on Aging would behave in such a manner, and I'm sorry you were put through that scenario. I always assumed they were strictly there for helping seniors and their families. It's just wrong that they would attempt to profit, for themselves or their affiliated contractors, from a senior/family who are just looking to do the right thing for the loved one. And to send a "nurse" who is not well-versed in all aspects of what said loved one may need, to assess that senior's need is inexcusable.

"I'm inclined to think that Kaiser, as an insurer, would want to mitigate charges and might not be as thorough." Yes, that was my first thought about have them do the assessment. Of course, my next choice would have been the AAA, so I sure appreciate the warning that even they may use unscrupulous tactics.

The placement agency I've been talking to has said that typically the facilities that are chosen will do their own assessment prior to admitting, Of course that makes sense, but doesn't help me right now to know what level of care to look for (i.e. board & care, AL, MC or SNF). I would really like to have a professional opinion on her needs, as a starting point.

We do have an appointment in a few days with MIL's primary physician, to follow up on an ER visit for cellulitis in her leg. She is very willing to fill out forms for us. I guess I'll start there.

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