FIRST THINGS FIRST!

BE AN ADVOCATE, BUT DON'T GET ANGRY WITH MEDICAL PROFESSIONALS! Just a few days after our loved one’s accident, we were asked to have a meeting with his assigned medical staff at the hospital. His situation was not very promising, and we were asked if we knew if he was an organ donor. This is a very hard thing to be approached with when you are confused, upset, and stressed. When our loved one left the hospital to stay at a skilled nursing facility we were told by the neurologist “This is as good as it gets!”. At the skilled nursing facility, we faced many challenges with some of the medical professionals and were asked by a pulmonologist “Is this all he does?”, because he was not familiar with our loved one’s condition outside of his own expertise. When we pulled our loved one out of the skilled nursing facility to bring him home, the comment was “Take good care of him!”. All of these comments upset us greatly. So, if something like this happens to you, just know that it is not directed at YOU. These facilities are understaffed, individuals, just like you, are also stressed, overworked, and have a huge amount of responsibility on their shoulders. Don’t take it personal! Move on … make up your own mind about the person you represent! Be their advocate and push forward! WHAT IS THE SHORT-TERM PROGNOSIS? / WHAT IS THE LONG-TERM PROGNOSIS? Much will depend on the type of treatment and recovery needed. This, of course, depends on the severity of the condition. You will need to assess this situation as early as possible. MEDICAL INSURANCE Even though this is mandatory now, many individuals still do not carry medical coverage. If there is no or inadequate insurance, immediately apply for Medicaid (some states use a different name.) Your first step will be to contact the social services office at your location and submit the information needed. Be prepared to encounter long waiting times and lots of paperwork. Inform yourself as to what you need to bring with you beforehand. If medical insurance is available, will it be sufficient to accomplish everything you hope to achieve? If you are in a position to do it, add an additional policy immediately! This is especially true if you are looking at skilled nursing facilities and neurological clinics. Find out what medical insurance companies they work with and go from there. Many believe that their patient is locked into being only a Medicaid recipient for their insurance needs. This is not true when dealing with a disabled person. Currently such Medicaid (different name in some states) recipients are eligible for Secondary Insurance. Individuals who receive Medicaid due to a disability can also obtain private insurance or other forms of coverage. This is common and often beneficial, as it can help cover additional costs that Medicaid may not fully address. If you chose to take this route, the private medical insurance policy becomes your primary insurance, while Medicaid becomes the secondary. If you are able to provide private insurance coverage, it can be quite costly, then tailor it towards the patient's needs as much as possible. You can apply yourself with available insurance companies in your area, or you can consult with an agent that specializes in this area. There is no cost involved for you to do so. Federal law requires health plans to cover adult children on a parent’s plan until they turn 26. For this reason, you may be able to add a disabled child to your sponsored plan, as long as the age of 26 has not been reached. Some states have additional guidelines that allow additions under special circumstances. You could explore that option, if needed. Medical insurance will dictate in many ways what help you will be able to receive! Always fight for the best you can get! Be willing to reach out to organizations that offer free or low-cost assistance! Set up a “Go-Fund-Me” page if you need to. Don’t accept the status quo! Be prepared to make many calls to the insurance carrier, facilities, doctors, and case workers. This seems overwhelming at first, but you’ll quickly get into the grove and learn to assert yourself as an advocate. MEDICAL POWER OF ATTORNEY If you are dealing with a family member, does your loved one have a “Medical Power of Attorney”? A medical power of attorney allows a person to specify who will make medical decisions for them if they are incapacitated. However, once they are incapacitated, they can no longer grant a power of attorney (Freewill 2023). That being said, it is not impossible to obtain it through the courts, but a little time consuming. MEDICAL DIRECTIVE Do you have access to a “Medical Directive”? A medical directive is a legal document that contains instructions to be followed regarding a person’s health care decisions if they become incapacitated. The directive will name a person (persons) that can make medical decisions on their behalf. This type of legal document also contains decisions the person may have made beforehand, for example, a request that the person does not want to be resuscitated. As with a medical power of attorney, this document cannot be created after a person becomes incapacitated. Other names for this document are: living will, instruction directive, advance healthcare directive, power of attorney for healthcare, or healthcare proxy (National Institute on Aging 2023). MEDICAL GUARDIANSHIP / CONSERVATORSHIP If there is not a “Medical Power of Attorney” or a “Medical Directive”, it might be necessary to obtain a “Medical Guardianship”. This type of guardianship can be temporary or permanent. Many people shy away from this type of control because they fear that they will be responsible for everything that concerns the person they are caregiving for. Guardianship/ Conservatorship can be tailored to your needs and can be set up to cover medical decisions only. Some states restrict the guardian's ability to sign off on mental health treatment, while others allow it. Physicians, counselors and social workers will be able to advise you further on this matter. In most jurisdictions, free help is available to work through the maze of documents that need to be prepared and filed with the court. If you are able to, consult with an attorney on this matter, as court assistive programs can only advise on information that needs to be provided, they cannot advise you on the legality of certain issues you must agree to and sign off on. This type of court proceeding will always require assessment by professionals! Get your doctors involved, as they have to prepare statements and sign off on same. The court will most likely involve a court appointed social worker to work with you as well. This process can take a while, but if you are facing a long-term recovery, it is very worthwhile to obtain guardianship / conservatorship to make decision making easier (Family & Aging Law Center 2018). SUPPLEMENTAL SOCIAL SECURITY INCOME (SSI) If a longer recovery is required an the person is unable to work, begin the process of applying for Supplemental Social Security Income. This can be a long process with affidavits needed from doctors and professionals. There are several steps to be completed, which all include many forms and paperwork. It can take over 12 months to see the first supplemental income check. So, start early. Get started by downloading forms at SSA.Gov/ssi and then make an appointment at your nearest Social Security Office (SSA.Gov. 2023). IN-HOME ASSISTANCE Some of you may not be able to physically assist a person on a 24/7 basis. Some insurance policies allow for temporary in-home assistance, some individuals may have a special policy to provide for this type of situation. If this is not available, seek help via your State's program. All states offer some type of in-home services to assist the disabled. While they are not the same across the U.S., they all cover basic assistance with self-care and household activities. These programs work through Medicaid. This is another reason to apply for Medicaid as early as possible. These programs are often guided by social workers that come into the person's home to assess what is needed. The patient becomes the client and has the ability to agree to hire a caregiver that works with the program, as well as releasing them of their assignment if the fit isn't right. If the patient is under guardianship, then that responsibility is delegated to the guardian. Karthikeya T M. 2016. “Traumatic Brain Injury”. Retrieved September 19, 2023. https://www.msn.com/en-us/health/condition/traumatic-brain-injury/hp-traumatic-brain-injury?source=bing_condition Freewill. 2023. “What Is A Medical Power of Attorney?”. Retrieved September 5, 2023. National Institute on Aging. 2023. “Advance Care Planning: Advance Directives for Health Care”. Retrieved September 5, 2023. Family & Aging Law Center. 2018. “What you need to Know About … Guardianships & Health Care Powers of Attorney”. Retrieved September 5, 2023. Social Security Administration. 2023. “Supplemental Security Income (SSI)”. Retrieved September 5, 2023.