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Hi - My dad will be 90 in January. This past year he was in the hospital 4 times. Hee had 3 ambulance trips, and a bunch of doctor's visits.

Of course, we have been inundated with bills. He has no income besides SS. He doesn't own any property, and his only assets are about $3000 in the bank, and a car with 165,000 miles on it that currently cannot pass a safety inspection. He also has a $5000 VA death benefit policy.

I should also point out that he cannot cook for himself, drive himself, or be alone anymore. Anytime I am not able to be there, he has to hire paid help. The costs for restaurants / caregivers/ companions/ transportation have left us shellshocked. He is spending $1000 plus most weeks, including his many medications, and has depleted his savings.

At the advice of friends he has been paying each of his creditors at least $10 a month. Many of the smaller bills have been paid off. Most of the larger creditors have been fine with it, too. They understand he is on a fixed income and know he has been very ill.

Two of them though, have been a big problem. The first is an ambulance company that took my father 3 miles from his doctor to the hospital. From what I can tell they were paid about $550 by insurance and billed my dad an additional $167. They demanded immediate payment in full, when I asked them to send me a breakdown of the costs, and why it was so much?, they immediately sent to collections.

The second is a hospital. They have sent as many as seven separate bills in a month. My dad has paid $10 on each one, two have been paid off. The remainder total about $850, I'm guessing, because when I called them they would not verify that there will be no additional bills pending...

So, I told them about my dad's finances, and that he could continue to pay $10/month on each of the outstanding bills, and that would be $40 a month total.
Nope. They threatened collections. They don't seem to understand that he owes money to numerous other doctors and services too. They just want all theirs NOW.

My dad needs a hospital bed, and other things for six months now. His doctor has tried to get insurance to approve them, they keep saying they "aren't medically necessary." The cost for everything would be at least $8000. My dad is very uncomfortable and hardly can get any sleep because of COPD and pain, but he is willing to without the bed and other things because he is trying to pay all of his creditors. He has even asked me to sell his car, or offer it to the hospital to settle his bills there.

I don't know what to do. I am already supporting him as much as I can, or he would have NO money for these bills. My friend tells me that if the hospital sends him to collections he should refuse any further payment and work on the bills that aren't in collections, so his credit doesn't get dinged any worse? I have no idea what to do any longer.

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Thank you!
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Erwin, how does your Dad feel about Chinese food, or has he ever tried it? In my area we have a wonderful inexpensive carry-out with variety of food, and the food is very good. To cut down on the salt, ask for very little sauce.

My parents [in their 90's] never had Chinese food until I bought some home for them to try. At first my Mom was very leery of it, but once she tried it she was surprised. My Dad finished his whole plate :)
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One thought...see if you can pay the neighbor lady to do some casseroles frozen as individual servings. If she can do a week or two at a time, might be a good thing.
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Thank you - everyone!

I have made some progress with dad the past few days. He agreed to accept a recliner instead of a medical bed, and it has eased some of his complaints the last two nights.

I was also given a number for the transportation service. I spoke to someone there who said they don't know if they serve this area, but they are going to get back to me next week. I hope they do - it is $1.00 each way to WalMart! I can't do better driving him myself.

I had NO IDEA the VA covered any part of transportation costs - and I had asked! So thank you on that!!! You BET I WILL ask them again. If they paid even half of what it costs my dad to get there it would be a HUGE relief.

Regarding the food, he is adamant he will not eat food that he doesn't like. He will eat the casseroles that one of my friend's mom makes, oddly enough, because it reminds him of my mom's cooking. Go figure...

Insofar as the rest of it goes, he is pretty stubborn, mainly because he feels he been treated unfairly. He tells me that he had worked at five "good jobs" in his life. From these, he had earned two pensions and one 401K. The 401K, and my parent's retirement savings were wiped out when my mom had a heart attack.

The two pensions were raided by management under guise of a court order supposedly to ensure the companies stayed open - they both closed. He is extremely bitter about what he considers outright theft.

When I spoke to him about his bills, he pointed out that he has paid several of them off already, and despite his age and illness has been paying everyone. In his opinion, if they want their money faster - too bad. He also tells me that his car, and his death benefit should handle any unpaid bills upon his death.

He told me more, but I'll post that later. I'm getting tired.
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Apply for dad to be on Medicaid. In fact, I am surprised he's not on it.
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Erwin, it's time for some tough love and firm stances. You volunteer to give up your time and risk declining health when you help him. He in turn should recognize and appreciate your sacrifice and be more willing to cooperate. He doesn't get to have things his own way all the time.

And, believe me as well as anyone else who offers the same advice, make a stand now before his refusals become even more adamant. You just don't have to give in to all his demands - it only gets worse.

Raise that issue with him; you're both in this situation together; there has to be some give and take on his part in order to ensure that you're able to care for him emotionally and physically. Don't be afraid to be firm and to refuse to go along with some of his self centered mandates.

So, that means that he stops digging his heels in and refusing to cooperate.

If the meat is too tough to chew, he might have a swallowing problem. Start cutting his meat in little pieces, avoid ham (which is harder for someone with a swallowing problem to chew). Add gravies to ground meat.

Keep a log to see what causes him to choke or cough, if that's happening.

Did you investigate paratransit as I suggested? The transportation costs you're paying are exorbitant.

Cut the Walmart visits to once a month or so. He can get reimbursement from the VA for mileage. After each visit, he should fill out the mileage reimbursement request (in our VA it's on a stand, like a banking stand for completing deposit or withdrawal forms) and generally in the office rather than the medical areas.
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Thanks for your answer!
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When someone needs higher-level of care than family can provide, or the caregiver/family cannot handle the physical, mental, financial strains, it's prudent to place the elder in a facility.
When the elder unreasonably insists on staying home...especially if that is also ruining the care-family's financial stability too....then that elder is likely not being responsible nor prudent, but more likely, has some level of dementia. Some can be downright abusive.
Dementia can make someone seem unreasonable...at that point, whoever is the POA must be decisive and directive, whether the elder likes it or not [you are now the parent figure]...and place the elder in a facility, to save your own hides and healths.
Welfare administers one or more programs that can help, like:
==There's a Federal program which pays the Medicare Monthly premium that's normally deducted from the Social Security check;
At State level, there are food stamps; Medicaid [in CA, MediCal].
Programs might vary per State.
Usually, Medicare and Medicaid can be combined to cover facility care, as long as the patient has spent-down their assets to the State mandated limits.
States will "look-back" at where the person's assets got spent, for a 5-year period prior to applying for assistance.
Elders might loudly/emotionally dislike the idea of existing the rest of their days in a facility. OTH, families have a responsibility to themselves, too.
States do _not_ want a care-family to become yet more welfare recipients due to caring for their elder!
Sometimes, you must bring that situation to Welfare's attention....that if you continue to spend your resources, you will become welfare recipients, too; but if able to set up accounts properly, you have a better shot at not needing to be welfare recipients yourself. Sometimes that gets lost in the process, and they need reminded.
Ask the Social Worker directly, what asset limits are for your State, that your elder must spend-down to, in order to get help.
Your local Area Agency on Aging [some areas, those have other names], can often help with finding the care help and supports you need.
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Thanks all!

I am trying to talk to him about applying for medicaid again, but so far he refuses. He did agree to get a recliner instead of a medical bed. We also had a talk about why he won't eat the meals from the senior center - meat is too tough to chew, pasta is undercooked, and food is "way too salty."

He also says my cooking should be "used to poison dogs, or torture terrorists." At least he still has a sense of humor...

He owns no property, so a reverse mortgage won't work.

The advice on writing collections is appreciated, I'll try that while I continue to work on getting his bills down.

I also found out that his taxi rides to Walmart in town are costing $68 round trip, and to his VA clinic are $177. So basically, everytime I can't do it, or arrange someone to take him, - there goes the budget for the week.
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Forgot to say that you need to object in writing preferably certified mail.
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Not sure if this applies in all states, I am in NY. To get the collection agencies off you back, you must object to it within 30 days of the first collection notice. You can object by saying that you offered to pay $10 per month and send proof of that if you have it. You can also complain about the service they provided or that you think it was overpriced, etc. Once you object they usually kick it back to the service provider and you and/or your father are no longer in collections. For healthy meals, contact your local Office of the Aging or equivalent to inquire about meal delivery. It may be offered for free on a grant or he may qualify some other way. Now nobody can complain about unhealthy meals and it will take the burden off you for cooking. Note that these meals are usually bland and you may need to add some seasonings to make them taste better.
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I had a very similar situation and it was extremely hard to finally make my loved one go into a nursing center. I had to trick her to get her there. To my surprise, after an initial frustration, she loved it and made some good friends there. You have to know that if your dad was thinking straight, he would not want you to be burdened with all this. It's hard to see that from your perspective now. Give your dad three months in a facility. You both will have a break from each other and you will be able to rest and see the situation with new eyes. If your dad is absolutely miserable after three months, you can try something else. These facilities have a doctor on staff and wonderful nurses and caregivers that work 24 hours a day. Your dad will be taken care of.
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Have you thought about a reverse mortgage?
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finding out about Medicaid is a good idea but, in California, if you get approved they will take all but about $100 of their SS$. the rest will go to the assisted living facility.
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Ervin, I'm going to suggest you apply to medicaid again. If he gets denied, you want to know specifically, does he have too much in assets, or in income. In most states, youu need to have less than $2000. In assets. Income limit varies by state.

If his income is too high, you can visit an eldercare lawyer and do what's called a Miller trust. Also, find out if dad qualifies for any Medicaid waiver programs which might provide some home care.

Find out if Medicaid covers Assisted Living in your state, not hust nursing homes.
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Thanks again to all of you. It's very frustrating to try and figure this out as a caregiver. I really feel that everyone - from dad, to family, to everyone involved only gives me some of the information I need to try to help. It's frustrating.

A couple more bits of info - my younger could help, but doesn't. Says "I have a kid." I told him he had parents first, but he doesn't care. Says to let the state look after dad.

Both his doctor and I have spoken to dad about going into a facility. He says he would rather die first. So, if he doesn't live with me, what's left?

I tried talking with the PT woman before they dropped him - told her I saw progress, she blamed her boss for the situation. She kind of explained it like Babalou did, except Babalou explained it directly, she just hemmed and hawed.
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Thank you. I do know they asked him how much he spent in the last two years. Would that have disqualified him?
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I suggest that you contact Medicaid again. He may have been very close. I think that he cannot have more than $2,000 in assets, and his $3,000 bank account may have disqualified him. You can spend down enough of that account on things he needs in order to qualify. You local office should be able to help you determine what you need to do and what expenses are allowed.
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It was never really explained why he did not qualify for medicaid. I know they said he missed the food stamp threshold by about $70/ month on his SS. Maybe that was it?
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Babalou - that was sort of her explanation. Except he was making progress - went from wheelchair bound to walking on his own with a cane. And he did try to do his exercises - he still does - but I think they expected a lot more from him than he could really do. On that count, I don't think he was being stubborn, there was just no more in the tank. At least that is my best observation.
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Hi Veronica, thanks for the ideas.

Not paying the creditors is a non-starter with Dad. He is old school, and will "pay everyone he owes until he goes" as he puts it. He is very stubborn and hates being in debt, but it's getting hard for him to make enough sacrifices to pay it off as fast as some of these people want. I actually thought, considering the amount of bills he had, he was doing pretty well paying them down before this happened.

I will definitely look into a recliner. I think he'd like one rather than a bed, and much less $$$.
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Erwin, just so you understand, Medicare will not continue PT if the patient is not making progress towards their goals. Someone needs to talk to the PT and give them a good medical history, perhaps cajole them into another visit, and dad into doing the exercises.

Why does dad not qualify for Medicaid?

It really does sound like he needs 24/7 supervision.
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Thanks all of you!

I will definitely go through all of these suggestions again and see what I can use. There is an Arby's near here, and I will take him there next, He will eat Subway without complaint, but they are 10 miles away.

He was supposed to get a psych evaluation in home, but she never came. I completely forgot about that that! He was also getting physical therapy visits, but they cancelled at him after two months. Get this - they said he had "low energy" and could not do all of the exercises they wanted him to. He is almost 90, has COPD, and was just back from having been dead in the hospital!

We had a visiting nurse for a few weeks, too. He refused to let her come back after she was examining him in the kitchen, tried to move him and dropped him out of his chair onto the floor. She then called 911, they sent an ambulance, and he got a $500 bill for getting him back into his chair.

The nursing place then insisted that another adult had to be here every time they visited, so if I or the neighbor was not here, it was another $100 each time to have a companion drive out here each visit. It is amazing how much everything costs when you don't have help from your family. Seriously, if I did not have great neighbors, I would have shot myself this past summer. Eventually he decided it was costing too much for the visits, and cancelled them.
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Erwin, if your father likes fast food, try Arby's. It's at least healthier than the MacDonald's stuff, which is sodium laden. I wouldn't want MacDonald's food either! And there are some good sandwiches at Arby's with turkey or chicken that are acceptable.

I like the Lean Cuisine frozen meals; I think they're better than some of the others. Perhaps you could try one, or one of the lower salt frozen dinners.

As to Medigap plans, ours is $122.86 monthly and picks up the 20% Medicare doesn't pay, but the premium will be doubled beginning January. Still, it's necessary as we never know how much tests and hospitalizations will cost.
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Erwin does dad's credit rating really matter at this point? Stop paying the creditors, they can't get blood out of a stone. There is a way to stop them harassing him but I don't know how to do that but maybe someone else may.
Change the Dr and find one who is more tuned into the elderly. Contact your local area on aging and ask for help getting Medicaid. It certainly sounds as though it is time for Dad to be in some kind of sheltered facility. next time he has to be in the hospital get them to refer him for nursing home care and request the social worker assist with medicaid application. many nursing homes will accept a patient "Medicaid pending" Public health may also be able to help get him situated. Good idea to consult legal aid. Can you stop enabling him by buying essentials while he is paying on these bills. Chances are that if you do succeed in getting a hospital bed he will refuse to use it. I think he would be most comfortable sleeping in a recliner. you can probably find a good used one. If a hospital bed is essential The American Legion often has a free loan program and they will usually lend to anyone not just veterans. You can also try and advertise in your local paper. You may get one for around $100, same with a recliner or any other equipment you may need. If you belong to a church people there may know of one you can borrow or buy. There are lots of options you just have to get creative. Moving him into your home will probably not be a good idea as many have found out.
We have a Medicare PPO which costs $150 a month but the copays are still quite high, However last year hospitals billed almost a million for three months i spent in a couple of hospitals. Research cheaper alternative for expensive medications or odrer them from Canada or elsewhere.
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Erwin, another thought. Please get dad to a geriatrics doc, or to a geriatric psychiatrist ( or if you're really rural) to ant psychiatrist.

It sounds as though dad may be suffering from some cognitive impairment and from depression related to the changes in his brain. If his mood has changed significantly, meds may help. Just a thought.
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Correction - it should read "at least $350 a week" is going to companions and transportation. If it wasn't for the neighbors, that would be double.
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Thanks for all the suggestions, GardenArtist. I don't think he can afford the medigap plans, but I will look again. About $350 a week of dad's expenses have come from companion and transportation costs. Transport will not pick up out here, and a taxi into town and back is $75.

I was getting him meals from the senior center for exactly what you said - $3 each. Dad won't eat them. He also refuses McDonald's or Taco Bell. He has gotten very stubborn.

A lot of the problem is his doctor, I think. When dad had his first appointment the doctor announced to me that it was time to put him into a facility - "for his final days" - he made it clear that dad would not not walk, or do anything else again. He was wrong, dad improved a lot, but he has the mindset now of not bothering to be thrifty anymore.

Instead of dinner at Denny's, he wants Sizzler... He usually GETS McDonald's, or Wendy's, etc, but does he call me names! He figures he is almost 90, has paid his way his entire life, and should not have to "eat garbage" to save every last dollar for his bills. He says the food from these fast food places makes him feel worse and have no energy.

He also blames the doctors for ruining his health. He is not really off-base with this either. I had a lawyer look at it, and he said they definitely made a bunch of questionable and poor moves, but he saw too many obstacles to a lawsuit.

He's strange. He doesn't mind going without new glasses, or dentures, or the bed he needs in order to try and pay all of his bills. But he refuses to budge on meals. He flatly refuses to eat my cooking ( I don't really blame him)

I tried buying him frozen dinners, that worked for two weeks until one of the women I hired to stay with him told him it was a shame that I "made him suffer" with TV dinners.... sigh. She also told him how "unhealthy" they were, and that killed it.

He's not the same person at all since he came back from the hospital. He used to be thrifty, easy going, and laughed a lot. Now, he's grim, contentious, and spends more than he brings in.

I have a meeting with legal aid next week. I hope they can help.
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Another thought: check your local Area Agency on Aging and find out if it, or any agencies of which it might be aware, have loan closets. You might be able to get some of the assistive items you need on loan instead of having to pay for them.

Some Senior Centers have loan closets as well; check with the more upscale ones - in our area, they're the ones that have the best selections.
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Correction to paragraph 2: I believe the correct deadline is Dec. 15, not the 7th. Sorry for that error.
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