News, Information and Ideas on how to deal with hearing loss in a hearing world. Plus a few other topics!
We've now become outnumbered in the Elder Care Journey.
Recently, another one of our parents became a resident in a long term care facility. Unfortunately, it's in another state. Thus, we are back to where we were just 5 months ago when my husbands' Mom was still living in another state.
While we knew that there was a possibility that this would happen based on the passing of the spouse, we were not too keen on once again having to travel a total of 8 hours in order to visit for less than 1 hour. But, when you take into consideration where the family is on that side of the family tree, you have to be practical about where your Elder is going to be. Still, it doesn't make it any easier for those that don't live close by.
Another scenario was deciding who was going to be the Guardian. Practicality told us that since we have 2 family members already in facilities that we are Guardians/Trustees/POA's for, it was time to step aside and let someone else take on the latest one. Our hearts were another story.
Having been in this world for almost a year now, we have learned so much about how to handle a lot of situations when it comes to working with facilities. Watching someone who has just entered the arena is tough. While we are tempted to micromanage their learning curve, we've had to step back and let them do it their way. The urge to pick up the phone or get into the car is tremendous. We are back to wondering how the Elders' day is going. What is the Care Plan? Is there something that they need from their house? Who's visiting them? The list goes on and on.
We have learned that communication is key to making sure all of the family members know what is going on. We've also learned that our idea of communication may differ from what other family members think should occur. So, how do we stay in the loop without further alienating others? Here's what we've come up with.
We've given the facility our email and cell phone numbers. They are aware of what we have on our plates and why we aren't in the facility at least weekly. We've asked if we can be included via phone for the Care Conferences. And, we've started depending on our friends that do live down there to let us know how our Elder is getting along. When a friend offers to go and visit, we no longer turn them down. Most of them have/had Elders in facilities and know what the distant family members are going through.
How can you possibly pay your friends back for helping you out in these situations? I still don't have the answer to that one. All that I do know is when I hear from one of them and they let me know the little things, it provides a great sense of relief on our end. The urge to get in the car and drive down there eases a bit.
I was telling my husbands' Mom on a recent visit of our new situation. She remembers well being in another state and not having us close by. I let her know that there were moments when I felt guilty spending so much time at her facility and not enough at the other one. She honestly told me that she was quite happy that she got most of our time, but, there also were a few open beds just in case we wanted to bring her a new roommate. Imagining the 2 Elders in the same place brought a smile to my face. Oh, the turmoil they could both cause, if together!
Have a great week!
One of the most uncomfortable situations for our family these days is when someone asks us why we don't take care of Mom Klink at our house? Anyone that has a family member in a nursing home dreads this question. It goes to the very core of our emotions and it's hard not to take it as a criticism of how Mom is being taken care of. There are many situations in families with different approaches on just how to take care of your 'Elder'. Here is how we made our decision.
Mom decided back in the early 1990's that she wanted to do all that she could so that she would not become a 'burden' to all of us. She moved into an Independent Living Apartment on a local health care facility campus that had options for her as the needs increased. While none of us could figure out why she wanted to live in a studio apartment in her early 60's, we also knew that family tradition for her had been this scenario. Her mother did the same thing and even added a twist of moving several states away into a similiar facility.
When the decision was made to move her to Wisconsin, we really struggled with the best route to go when it came to having her live with us or moving into an extended care facility. We knew that our house was not user friendly for her due to the fact that you have to go up 17 steps just to get to the main living area. Selling our home and finding a more appropriate one was not an option. While this enables us to have a good 'excuse' as to why we don't have Mom with us at home, it's also, in our minds, an easy answer to the question when someone asks.
To be perfectly honest, we just can't take care of her. While I have training and a background in the medical field, we also knew that if we did this, it would probably destroy our life as we know it. Brutal words, but also the ultimate reason for the decisions that were made.
We have our own business and spend days at a time on the road. Our kids are all grown and except for the youngest who recently graduated from college, the rest are out on their own. While it may sound selfish to some, we spent over 30 years taking care of our kids and now enjoy our freedom of being able to do what we want.
The downside to all of this is that we are constantly thinking about Mom. What is she doing? How are things going? Is she being taken care of as well as when we are present at the Nursing Home? Did they remember to give her the special jelly with her breakfast? Did she get her skim milk for her decaf coffee? Is anyone paying attention to her needs?
Usually, we go and see her every couple of days. We still show up at strange times and do the surprise visits. I've been known to go twice in one day just because I have an uneasy feeling that I've missed something or I just want to make sure that she really is ok after an upsetting day for her.
I see all that needs to be done for just 1 person and I know that there is no way I could do it 24/7. The staff that take care of the Long Term Care Residents have more patience than I will ever have. While I can still find things that need improvement, I also tend to be cautious on how I address those needs with the Staff. You just don't want to become the family that everyone dreads seeing walk in the door.
I see the activities that Mom is a part of there and know that if I had her here at home, she would probably be bored out of her mind. My arts and crafts days are over and I know that after having her with us for a couple of days during the move to Wisconsin, I would be tearing my hair out when I would have to answer the same questions that I answered minutes earlier. Add in the no sleep factor and it would not be a good scenario for any of us.
But, it's still tough to be asked why she's not living with us. Until you go through this with someone you love, you just don't understand all of the things associated with it. I have friends that take care of their parents in their homes. They are tired, frustrated and juggling so many balls that they've forgotten what it's like to have a normal day. But, they are determined to follow through on their vision of providing that great period of time that all of the experts and books are telling you Home Care can be. I admire all of them that are doing this. I am so happy that we are not in the same boat. It would be a fiasco.
We got lucky in that Moms' vision for this period of her life would have her in a facility. At no time has she asked to come live with any of us. While it makes it easier on us, you also have to wonder...
When it's our turn, will we be as brave?
Have a great week!
Remember when you would spend a few minutes observing your children as they struggled to learn something new? This scenario also occurs when you are caring for your Parents.
Over the last few months, we've come to realize that our roles as children have reversed to our now being the Parent of Mom. It hit me when I was observing Mom in the hospital while she was eating a meal. As I watched her pick up her empty coffee cup, I could see that she was trying to figure out why it was empty and what she should now do with it. My inclination was to take it from the tray so that she would not become frustrated with the fact that it was empty. Then, I realized that she was focusing intently on it and putting the pieces together as to how it became empty. While it was painful to watch her repeatedly pick it up, try and take a drink and then put it back down, I also was fascinated by how she was processing all of this. That's when it dawned on me that I used to watch my children do the same thing when they were trying to learn something new in their world.
Brian and I have now taken the time to watch her from afar in the nursing home. It helps us to know what kind of day she's having and how we should prepare for our visit with her. Each day is different. Sometimes, we get the Mom that we have known as adults and other times we get the 'new' Mom that will need to have things explained to her over and over. We've seen other family members of other residents become frustrated or even go to the extreme of making fun of their Elders when this happens. We've also seen that deep down they are not sure how to handle the change of personality or mental status.
Our way of doing this makes things a lot easier for us. It also helps us to learn how she is processing information and what road she is going down for the moment. Her body language has changed. When she wants to get out of the wheelchair to go to the restroom, she leans forward in the chair and looks intently at anyone that is in her vicinity. It never occurs to her to press the call button or just ask a staff member as they walk by her for assistance.
She's limited mobility wise due to the full leg cast from her broken femur. But, there are many times when she's putting the good foot on the floor and trying to figure out what she needs to do in order to stand up and walk. While it's sad to see her repeatedly put her foot on the floor, look at it and then try and figure out what step is next, it's also interesting to see how hard she is working at learning the process. While we know that her days of walking are probably over due to the fact that it's going to take at least a year for the leg to heal, we are also enlightened to see that she has not given up on the possibility of once again being able to get out of a chair on her own.
The way that some Elders, in these situations, process information is very interesting to watch. We've had to slow down our way of doing things so that we don't miss something that she's again trying to figure out. We've learned not to intervene when she's having one of these moments due to the fact that her entire body and brain are focused on this moment. To distract her would be frustrating for her and we know that her focus can be gone in an instant. This is the time when you really need to put your needs aside and let the Elder take the lead as to how the interaction is going to occur with you.
Our last visit with her was rather humorous for us. During her relocations the past few months, we've slowly disposed or dispersed of all of her belongings. In her Assisted Living Facility, they preferred that residents did not wear perfume due to some having bad reactions to it. So, we didn't bother keeping or bringing any to the nursing home. We thought that they probably had the same rule. Wrong. Mom loved a certain perfume from Avon. She asked the staff if it would be ok to wear perfume and was given the ok. She even told us that she liked to sit next to some of the other residents that had perfume on because it smelled so good. After checking with the staff, we learned that yes, she could wear perfume.
So, I got on the Avon website at home and found the scent that she loves. It should be here in a few days. We will be putting it in her Easter Basket. She also has taken a liking to candy now. All of us can remember when we would have been chastized for eating anything sweet. This was one of Moms' pet peeves that you do not put sugar in your body. That has all changed now. If she doesn't get at least 1 piece of chocolate a day, she's not a happy camper. She's requested a solid chocolate bunny. There will be one of those in her basket also. We now have to monitor how much candy is in her room and within her reach. We've seen her eat so much in one sitting that we've had to limit the number of pieces she can access. We've even caught ourselves telling her that her tummy is going to hurt if she eats too much. Just like we used to say to our own kids when they were small.
One of the defining moments for us to finally realize that our role as children had changed, was during an encounter with a doctor. He was talking to Mom and asking her questions. We could tell that things were moving too fast for her to process. While he kept talking, she looked at us and that's when we knew things were different. She was trying to tell us, just as our children once did, that she didn't understand what this person was asking of her and needed our help. Parents know that look! Your child looks to you and silently asks for you to intervene. Luckily we were paying attention and got the message.
What goes around, comes around! Sometimes, you just have to slow down so that you see it happening.
Have a great week!
It's hard to believe that we've been in this new world of Elder Care for over 6 months now. It's also frustrating to see how many things we've left behind as we continue this journey.
During one of Moms' recent hospital stays, we got a long period of having 'Mom' back. We heard her laugh, saw her sense of humor and cherished every minute of it. You never know how long you'll have these periods!
Within a couple of days, things were back to the new 'normal'. This also meant that our visits with her were going to be stressful. Mom is a very independent person. She will be the first to tell you that she does things her way. While we may not agree with how she goes about this, we also understand that one day, it will be our turn to take this journey.
In our conversations with Mom, we have a pretty good idea of where she's at in this whole process. We've also learned that there are stages to the Elder journey. Mom is convinced that she is going to live to be at least 90. She'll turn 80 in April. In order to do that, Mom has specific ideas on how to reach her goal. She's told us that she wants to do things her way. We let her until we just can't stand it anymore. Then, we cut the visit short and promise to come back soon.
We've now reached the point where there is no greeting when we walk into her room. But, she always has a request upon her seeing us. It can be something as simple as finding her nail file or as complicated as finding the right color of socks to match the outfit that she has on. Usually, it involves one of us going to a store to get the requested item. She once sent me on a mission to find sweet, perfect strawberries. I had my directions as to how she wanted them and set out to find them. Keep in mind that it's winter in Wisconsin. There are no fresh berries at farmers markets at this time of year.
Upon my return to her room with the item in hand, she looked at them and was very disappointed that they still had seeds on them. That's when I realized that she had neglected to remember that strawberry seeds irritated her gums when they got under her dentures. I'm still used to reacting to her requests. I need to learn how to think each request through so that I'm not out running around to get things and then end up disappointed myself when she reacts negatively to what I've brought. I solved this dilemma by finding sugar free, seedless smuckers strawberry jam. She loves it on her toast and she's now happy to have her strawberries.
We've also run into her critical days. We call them this since we know what is going to come when we walk into her room is nothing but criticism. No matter how we converse with her, she will find a negative. When we tell her that she's being a challenge, she turns it around the makes us out to be the problem. In one of her happier moments, I 've asked her why she does this. Her response is that she wants her thoughts and opinions to be remembered and most people will remember negative things in their lives more than the positive ones. Interesting! So, now, if she's having one of those days, we start out the visit with asking her for the most negative thing she can think of. Then, we discuss how we can make that into a positive. Sometimes it works. Sometimes....
Have a great week!
Moving Mom to Wisconsin was a great decision on her part as well as ours. As we embarked on this journey, here is one thing that we learned when it comes to the POA for Healthcare.
All states have paperwork that you can access online in order to have a POA for Healthcare in place. Most can be found via the State Dept. of Health Services websites. A lot of people think that you have to have a lawyer draw them up. In Illinois and Wisconsin, we found that not to be true.
The wrinkle in our scenario was that the Illinois one would not be honored in Wisconsin. We found this out when Mom went to the hospital for the first time in Wisconsin. After checking with the hospital legal department, we also found that there was a way to get around it.
We typed up a statement that said that even though Moms' POA for Healthcare was not enacted in Wisconsin, she wanted us to be a part of all decisions when it came to her healthcare as well as her nursing home care. This included anything that was going to affect her monetarily, medically or therapy. We had her sign it in the presence of a staff member, dated it and had it added to her file at the hospital as well as the nursing home. It was a great step on our part in that as soon as it showed up in her file, we started getting phone calls when changes were made to her care.
This also came in handy when we wanted the Wisconsin version of her POA for Healthcare to be enacted, but at the last minute, Mom decided that she 'just didn't want to give up all of that control'. You will run into these situations from time to time with your Elder. Try and put yourself in their place. They have moved into a facility, left behind most of their treasures and now don't have any control on what they can and cannot do. They want to have the ability to control something, so when someone asks them if they want the POA for Healthcare enacted and they say no, those that are taking care of things for them are really in a bad spot. You will also run into some situations where the hospital or elder care facility does not want to enact the POA for Healthcare since this now means that someone that is competent will be able to make the decisions. Thus, they run the risk of not being able to add more charges to the bills.
It was interesting to see how so many doctors felt that she was no longer competent to make these decisions, yet, when they were asked to sign the enactment page of the POA, they found a reason not to. You also need to watch other staff that have been designated as the decision person for competency. We've seen how they do this. There are about 5 questions that they ask the Elder. What day is it? What month is it? Who's the President? When is your Birthday? How old are you? This, when your Elder can't remember if they had lunch or not. While Mom answered all of the questions correctly, if you spent 10 minutes with her, it was quite obvious that she was having problems making sense of things. If you are going to evaluate the comptentcy of an Elder, you need more than a few questions in order to do it.
Another thing to be aware of once the POA for Healthcare is enacted is just what this really means for the decision makers. There is a lot of fine print on some of these POA's. In our case, it states that if there is any chance of a treatment making a person better, even if it means their quality of life will lessen, then the doctor can choose to do the treatment. In other words, the decision makers can be left out of the process if the doctor decides he wants to go ahead and treat the problem.
We all know that there are many new medications and treatments out there. While most of them are good, some need to be looked at and the conditions discussed as to whether or not this really is in the best interest of the patient. Many things can happen as more meds and treatments are added to your Elders' care. We are now at the point where we have to pay very close attention to the medical side of things. There are so many drugs involved with so many side effects. Add in the fact that you have so many doctors seeing the Elder in the hospital setting and it boggles the mind on how many of them are prescribing drugs without taking the time to see what else is already being taken. When you have the loss of your primary physician in the hospital setting along with a new 'Hospitalist' everyday, it's no wonder there is confusion.
Luckily, for us, Mom decided to have the POA for Wisconsin enacted recently. She talked to us about how she arrived at this decision and we listened. Our promise to her has always been that we will be honest with her and tell her everything that we know when it comes to her care.
Once she told 3 doctors that she wanted it enacted due to her not being able to understand everything that was going on, we were able to get the 2 Physician Signatures needed for the Enactment Form. Now, we just have to pay attention to what happens at the next hospital stay since any doctor or even Mom can decide that the Enactment needs to be rescinded. Yes, that's a possibility. But, we feel that since we have the additional signed Statement on file, we will still be able to be a part of the decision making process.
Seeing how all of this is playing out when it comes to the medical side of life for Mom has made us realize that we are going to have some tough decisions and family discussions down the road. Being a POA is a much bigger job that we had envisioned. Knowing that Mom is trusting us to make these decisions with her input is something that we did not have to think about in the past. While our recurring theme during all of this has been, 'Best for Mom', we are working on keeping our emotions out of the decisions in order to continue our theme. Somehow, we are going to have to figure out how to handle more negatives than positives. Once we realized that we can't 'fix' this, we were able to grasp how we were going to 'handle' it. A big step for all of us. With, Mom leading the way.
Have a great week!
This area cannot be emphasized enough as to its' importance! We learned the hard way just how important it is.
Here's the biggest thing that we learned by trial and error. If it saves just one of you from making the same mistake, it's worth Moms' time as well as mine to explain it to you.
Being Moms' POA for Healtcare, involves a lot of things. We learn something new with every trip to the E.R., hospital or Care Conference at a facility. Initially, I would carry all of these records around with me as we made our way to the next stop on this trip. But, almost everytime I offered to share them with medical people or staff, I was told that they really didn't need to see them. WRONG!
Getting these records is a feat within itself. You can take all of the notes that you want while in some of these places, but having the actual records of what the Doctors, Therapists, ect. are writing is an almost fool proof way to avoid problems down the road later. We started acquring Moms' records when she started becoming, what we now call, a 'Frequent Flier'. We never knew when we would be getting a call that she had once again injured something and sometimes, we would hear from her via our phone calls if something was just not right. Listen to your family members when they tell you these things. You may have staff at facilities telling you otherwise, but most of the time, the patient knows when something is not right.
We were able to obtain most of the records by my phone calls or visits to the offices and facilities as well as our explaination that we were moving Mom to Wisconsin. It took us over 4 months to realize that trying to take care of her long distance was just not going to work. We are extremely lucky in that we own our own business and were able to have at least one of us go to her when the phone rang. I have no idea how people do this when they have to work for someone else. It would be almost impossible. Another thing that needs to be looked at when it comes to family leave for medical care of your parents.
Most of the facilities would have us fill out a form that would require a copy of the POA Healtcare legal paperwork in order to get the records. Since Mom was unable to go on her own and obtain these, having the legal paperwork is paramount to your being able to obtain them. I've also now started to request her complete chart, labs, x-ray results, ect. as part of her discharge from hospitals. So far, I've been able to leave with them on dismissal day except for one hospital in Waukesha that requires you to fill out a form and then wait up to 4 weeks for them to be sent to you. They are also currently trying to charge us for them. It was interesting to note that even with the advent of electronic medical records, facilities cannot exchange those records with each other due to all of them having different software. So, where exactly is all of that money going that was slated for this project?
We thought that Mom was having another TIA episode at her facility in Waukesha. The ambulance was called after we evaluated her ourselves and she was admitted to the hospital for 2 days. There was no evidence via the CAT scan and MRI of another stroke and it was chalked up to a TIA. All of us had a little red flag going up in our heads that we were missing something. Twelve hours later, we would finally realize what that was. And, that was only due to our taking the time to go over the medical records and lab results from the last 5 years on her.
Twelve hours after her dismissal, we received a call from the Dir. of Nursing at midnight. We've now gotten used to carrying my cell phone with me at all times due to all of the phone calls we have gotten over the last 6 months concerning Mom. It still sets your heart spinning when the phone rings in the middle of the night.
Mom had gotten up and gone to the restroom. Once again she had fallen. Call button was within reach and she will be the first one to tell you that she 'probably won't push the button'. This time, she broke her femur. In four places. Brittle bones and ambulation do not go well together when you have balance issues. We were lucky in that I still had all of the medical records in my vehicle and I happened to grab them on the way into the E.R. I was still trying to see if someone would take the time to at least look at the darn things, since we were still missing puzzle pieces when it came to Mom and how some of these things were happening.
We were also very lucky in that the same E.R. doctor was on duty that had taken care of her just 2 days earlier. As they were once again doing labs and x-rays, one of the E.R. techs mentioned that her sodium was low. A lightbulb went off in my head as I realized that low sodium mimics stroke symptoms and I wondered what her levels were in the past. As I was going through all of these records looking for lab results, I started seeing low sodium levels from as far back as 5 years ago. I pointed this out to the E.R. tech, who in turn told the E.R. Doctor. When we got the lab results back again for confirmation, we had a very big answer as to why Mom would have these episodes of confusion and lack of comprehension. We are now wondering if all of the 'mini TIA's' we thought she had had these past few years were really low sodium issues. Many times, she would just work her way through the episodes and not tell any of us what was going on. Another side effect of her independent personality as well as her desire to stay in her independent apartment. Add in the fact that many years ago, she had read somewhere that a low salt, no fat, no sugar diet could help those with high blood pressure and this was all starting to make some sense. We all get stubborn as we age. I know that I have! If you are dealing with older parents, it's easy to shrug off some of their ways of doing things just to keep the peace. We did that for many years until it became quite obvious that her diet was also jeopardizing her health. Respect for your parents is one thing. Letting them continue to do things their way to the point of becoming hazardous is another. Unfortuately, it's very tough to take that step and try to find a solution that will make everyone happy. Another lesson learned for us.
Bottom line is, if I had not had all of these records, we would have never known of the sodium issues. Mom is now on salt pills. And, the sodium levels are coming up. She's also become more alert and does not get as confused anymore. At least for now. She tells us that she feels like she can 'make sense of things again'. She also tells us that she's glad she didn't try the 2 tablespoons of cinnamon a day to lower the blood pressure. It's one of the many things she heard via her circle of friends would work. She hates cinnamon! Take the time to talk to your parents. Listen to what they are talking about with their friends. Almost all of them are trying to figure out ways to avoid going to the doctors. A lot of them are now learning that all of the new meds out there also have lots of side effects. Thus, they try and avoid all of it. While this will be fine for them for a while, eventually, it will also earn them that 'Frequent Flier' badge when it comes to playing catch up. Mom has a great sense of humor. When we told her of her new designation, she wondered if that also meant that she would be earning frequent flier miles. This, from a woman that would not drive her car more than 2,000 miles a year. Don't forget to laugh when you are in these situations. Sometimes, that's the best medicine for everyone.
Have a great week!
You've tried to get information on what is going on with your Elder. You've sent emails, made phone calls and still aren't getting the information that you are asking for. What do you do?
This is a tough one. As consumers, we know that we should be looking up the State History of these facilities. But, when you look at the ways these places are inspected and licensed, it's another game of bureaucracy and wasted time from our point of view. Add in all of the paperwork that these facilities are now required to fill out and in their defense, would a complaint with more paperwork really help them to fix the problems?
Let's look at where some of these places are located. If you are lucky enough to live in a major metropolitan area, chances are, there are a multitude of places to look into. If you live in a more rural area, several factors come into play.
Major Cities have tons of resources as well as qualified personnel to staff these facilities. Add in the fact that the pay is pretty competitive and it's pretty easy to weed out the 'not so good' ones. Rural areas don't have it as easy. You have limited personnel, few facilities and it becomes a situation of 'he said, she said' on just how good some places are. It's also a family thing! If Great Grandma stayed at a place in her later years, odds are that other family members are also going to carry on that family tradition.
Here's the way that we made the decisions that we did with Moms' input. None of us lived in the same town/state that she did. One of us could actually take the time from work to go down there and stay an unlimited number of days as needed. Add in the costs of hotels, meals, gas, ect. and you now have a situation of one part of the family getting slammed financially, emotionally and physically. Yet, someone has to be there to check on things and see Mom. You've reached the point in this process where she can no longer do this on her own.
Over the last 6 months, we've seen a multitude of places and talked to numerous Directors of 'something'. We've also seen the difference between those places that take Medicaid/Title 19 patients and those that only take private pay. If you are meeting with an Admissions Director and the first question they ask is, 'How much money do you have?', think twice about going any further. If the prices aren't posted and they are writing the 'costs' on a piece of paper for you, odds are they are making it up as they go along if they know how much money is involved. You need to remember that this is a game for some of them to see how much money their facility can lock in to. I know that sounds harsh, but reality sometimes is.
Let's say that you've now reached the point where you are spending your nights fretting over the lack of information you are receiving on just what is going on with your Elder. You've tried the 'being nice' route. Sent emails and made phone calls. Yet, you are still not getting the level of communication you are looking for. At these prices, someone should be answering your questions!
We've heard so many stories from other families on this subject and yet, the facilities still don't get it. We've had situations where some of the medical professionals affiliated with places have told us or other families to file a complaint with the state and seriously look at moving their Elder to another facility. When you hear something like that, it certainly doesn't help to ease your stress.
All states have different rules on filing complaints and the timing of them. The decision that you have to make is do you really want to expend valuable time doing this? Is it going to help your Elder? Is it going to fix the problem? Try and get the facilities' chart notes to see what they are saying that they are doing when it comes to the family requests. You may be surprised to see that their story is totally different from yours. You are dealing with a business that knows how to play the game. You don't even know all of the rules of the game yet.
All that it takes is for one person at a facility that is 'in charge' to decide how to handle situations. When that person is wrong and it ends up affecting the care of your Elder, you need to act. Filing a complaint takes time and if what is happening is not healthy for your Elder, you need to step in and get the ball rolling to make other arrangements. You will also run into this problem when a facility that verbally told you upon admission that 'they can handle any type of medical situation or need' decides that your Elder is now too much for them to handle. If you are in an Assisted Living situation, one of the clues that you may have a problem is if they now ask that you hire a private CNA for 1 or more shifts due to the needs of your Elder. This is one way for them to 'price' you out of the place and get you to move your Elder someplace else.
Remember how friendly everyone was when you initally came in the door asking about availability? It's just like buying a car. Once you sign on the dotted line, they've got you. There are many ways as well as reasons these things just don't work out. Finding a good fit for the Elder as well as the family is not a one stop deal. The unfortunate thing is that you really don't know what you are getting into until your Elder has moved in.
Ask to talk to other family members of residents. There should be a Resident and/or a Family Council at the facility. Go to one of the meetings. I know that in most of these situations, you don't have the extra time to do all of this stuff. But, go into these places with your radar up and listen to that little voice in your head if you are seeing red flags. I went into one place for a meeting with the Admissions Director and the first thing she said to me was, 'Can you smell anything? See, we pass the smell test." Wow. You may pass the smell test, but how good is your quality of care?
By all means, take the time to look at the State Complaints. Ask the person that you are meeting with how they addressed these. How did their last few inspections look? Why were they fined? How did they 'fix' the deficiency? If a facility has no complaints on it, don't assume that means that they are that good. Depending on where they are, it may be a situation of no one complaining because there's no other place to go. Some States have lots of complaints via their websites, others, very few. It all depends on how many staff they have and what the state budget is for their office.
The best thing to do in any case is to take your time, show up at odd times and watch what is going on with the residents, what happens at night? Look at their staffing levels. Keep in mind that most inspections by the State are pre-arranged with the facility. Of course, they are going to have their fancy duds on. They were expecting company!
Knowing that you are putting an elderly person into a place is a lot like dropping your child off for their first day of school or daycare. The elderly person may not have the capacity to verbalize what is going on. Putting your trust in strangers is probably the biggest leap you have to take in this situation. Trust your instincts and pay attention to what's going on. If you have a doctor that is affiliated with the place, ask them what their opinion of it is. Look at the how long the staff stays employed there. Lots of state websites have this information on them. If there's high turnover of staff, that's a big red flag.
Take the time to google/search the facility on the internet. If you enter complaints followed by the name of the facility, this will usually take you to the best information. With the advent of the internet and websites, anyone can make a place look great. Pictures of pretty rooms and smiling faces are plentiful and can be posted with ease. What's the real story? Do all of us a favor and if you do find that 'perfect' place, tell the rest of us! There are some true gems out there. You just have to get through the pile of rocks to find them sometimes.
Have a great week!
Boy, did we learn a lot on this subject. After Mom was admitted to a nursing home/rehab facility, we had to figure out what to do with her current independent living apartment. Add in the emotion of things and this can become a whirlwind of questionable decisions for families.
In our case, we were all under the impression that Mom would only be in the nursing/rehab facility for a few weeks. Just long enough to get her back on her feet. We contacted the person in charge of the Independent Living Units with the intention of moving her stuff into a storage area until we could figure out what was going to be next. Unfortunately, we decided to go to the next step and move all of her stuff into her new Assisted Living Apartment at the same complex. We were on the fence as to which way to go since we knew that there was a chance a unit would not be available upon her dismissal from the nursing/rehab area. But, since she had signed up and paid for 'Lifetime Rights' several years ago, we also knew that the current rent that she was paying on her apartment was way below what was now being charged. That's probably the best benefit of her enrolling in the Lifetime Rights agreement 13 years ago. In Moms' case, she saved thousands of dollars over those years.
The Assisted Living units were much more in rent. But, we figured that since she would be moving into that area in a few weeks, we might as well get this done. It was Labor Day weekend and the remnants of Hurricane Issac were raining down upon us. We had also left Wisconsin not realizing that we were going to be moving her to another building. Being in a small town, the resources for help were limited. So, we decided to use our vehicle and start moving. This is when we all realized just how much one little lady can get into one small apartment. It was astounding! Every drawer that we opened was packed. The closets were almost inaccessible. What we thought would be a few hours turned into 2 days.
We were also trying our best to consult with Mom as to what she wanted and what could be thrown out or donated. Of course, she wanted all of it. So, after going through what we determined to be necessities and throwing out the 'garbage', we finally got her moved in. Took another couple of days to get it all unpacked and put away. Our goal at that point was to try and put things in similiar places to where she had them in the old place. We went ahead and hooked up the phone again and opted to hold off on the cable service until we had a better idea of when she would be moving in. Here's what we learned in hindsight after jumping the gun on this.
We probably should have just left her things in the independent living apartment. As it turned out, she never did move into the Assisted Living Unit and we paid the higher rent for 3 months. We could have saved ourselves a lot of time and just left things as they were. So, when you find yourself in this situation, think about the possibility of your elder not moving to Assisted Living. It's very possible that they will skip this step entirely based on their medical needs. While your emotions are telling you to take care of things like this, you may be moving too fast and not even know it. We did permanently change her address to ours at this point since none of us were going to be down there on a daily basis to get the mail.
When you get to the point where they are having you sign the 'lease', remember to read the fine print. Make sure that you know what their policy is if you are going to be vacating the unit. Usually, if it's due to a death, they will forgive the rent. Ask them! There are some places that will continue to charge the family/estate until they get the unit rented again. This could take months depending on the need in the area. This is also a good time to find out what services are covered and what are additional. There are so many different plans at these places. You can easily double your monthly rent fee if they don't include the basics such as, assistance bathing, meals, meds supervision, ect. If you need to make a notation on the lease, do it. Once you sign it, things discussed verbally are forgotten. Get a copy and make sure that they have your contact info. as well as any copies of legal papers such as the POA for Healthcare, Trustees for Financial, ect.
If, for some reason, the POA for Healthcare is not activated (all states have different rules), type up a statement requesting the facility contact you on any new things or changes that are being done for your Elder. Have the Elder sign it in front of them and request that it be part of their file. This will then give you a baseline to start with should they decide not to let you know what's going on down the road. Keep in mind, that some states will allow the Elder to rescind the POA Healthcare even if they are no longer competent to make that decision. It's just another way for the facility to get out of having to keep you updated and a great way for them to add more services (costs) at a later date. Are we having fun yet?
There are some places that may try and pressure you into moving too fast. We were lucky in that we had an exceptional Admissions person for the Independent/Assisted Living Units where Mom resided. But, we've also heard some stories from other families of high pressure tactics used to get the families to sign up for services or living arrangements when the resident is still in the nursing/rehab/hospital stage. While it's unfair for places to do this, they are also looking at their bottom lines. Think about what you really need at the time. It may save you a lot of money that is needed in the future.
As we were packing up her things to move her to Wisconsin last December, we realized that this was the time to start asking immediate family members what, if anything, they would like. We knew that her new place was going to be limited on space and also realized that some of her things, she would never be using again. This can be a very emotional stage for everyone involved. Keep in mind that you are going to have some that just don't want to deal with any of it and others that may decide that they want everything. Again, we were lucky. We all worked together on this part and everyone was happy.
We also brought Mom over to the place as packing was starting and asked her what she wanted to take. She had readily agreed to move to Wisconsin and we really admired her for making that decision. After all, we were taking her out of her world of 60+ years. We paid close attention to her emotions and even if we knew she was not going to be needing those gardening gloves, when she started telling us the story of how she had used them over the years, into the box for Wisconsin they went.
One week before Christmas, we rented a U-Haul trailer, packed Moms' stuff in it, made sure that she had a few days to say her goodbyes and headed for Wisconsin. She rode with Brian in his car and they followed behind me, towing the U-Haul. We will always remember that ride. There were a lot of emotions as well as relief in knowing that we would no longer be 4+ hours away from her. She got to take a good look at the flat lands of Illinois and wasn't too impressed with the white stuff on the ground as we made our way into Wisconsin. One of the grandkids had gotten her a Cheesehead button for her coat. Even though she's a diehard Bears fan, she wore the button proudly and told everyone that she saw on the way that she was now a Cheesehead. Keeping your sense of humor and remembering to see the good stuff during these times is a big priority for everyone involved.
We had found a great place in Waukesha for her to move into the following day. Our kids had taken time from work and also recruited additional help to get her things unloaded and moved in. One of us stayed with Mom at our house while all of this was going on. Having a fragile elderly person in your house for the night is akin to bringing a new baby home. In our case, we have 14 steps to the main level of the house. We knew that Mom couldn't climb those stairs, but our youngest son was waiting in the driveway with his deskchair when we arrived. Seeing how gently he and Brian moved her from the car to the chair and then proceeded to carry her up the front steps to the house was another moment etched in time. It's the little things that will get you on this journey!
The following morning, we loaded her in the car and drove her to her new 'home'. The staff was waiting for us and made her feel welcome. Of course, when we got her to her new 'digs', she began to tell us where she wanted things. After a few days of unpacking as well as many tours of the new facility, we could tell that she was going to be just fine. Little did we know that we still had a few surprises coming our way. More on that later!
Have a great week!
Just when you think that you know what you are doing, the game changes. As we started growing into our roles of the Elder Care World, we found large pieces of our puzzle missing. While your first instinct is to go to the source and try and get the answers, we found that most of the time, there was a lot of stuff that we weren't being told.
We would ask Mom, but also learned quickly, that her world consisted of just trying to get her shot at using the shared bathroom. We also learned that we needed to keep her world as stressfree as we could. So, we started to document what we were told and kept asking for actual copies of charts and rehab notes. Unfortunately, we were not able to always get these things. While you can blame the parties involved, you also need to navigate your way to finding the answers and information. Here's one of the ways that we were able to bypass the holders of the keys and still find out what was going on.
If at all possible, try and establish a positive relationship with those that are in the know. In our case, we had some fantastic CNA's as well as a couple of really good nurses that had direct daily contact with Mom. You first have to figure out who's really there for the right reasons and then see how open they are to actually communicating and trusting that you won't blow their cover. We had some family members of other patients tell us their tricks and some of them were pretty humorous. Once you realize that all of you are in the same boat, you grab your life jacket and start swimming.
You get to a point where you also realize that you can't react to every little thing. Believe me, in our case, this took a while. After all, your primary responsibility is to make sure that your parent is being taken care of. When you see how much it's costing them, you sometimes wonder who came up with this scenario. Luckily, for us, I was able to spend over 40 nights in local hotels over a period of 4 months and witness how all of this works. It was exhausting and much time was spent just trying to figure out the best way to achieve the desired result. Add in the fact that Mom would let us know what was not working and the emotions of the whole thing can lead you down the wrong path. When you have to deal with trying to track down little things that go missing in her world and then deal with making sure that the appropriate medical care is really being done, it will drive you nuts. Everyone has their own opinions and agendas. Including the family members that are involved. We looked at the options of where she could go were, but also had to take into consideration that she had lived in this community for over 60 years. At what point do you decide to upset their world in order to make yours more livable?
One of the best tricks that we finally found after months of frustration when it came to just exactly what was being done to or for her was the Medicare.gov website. Mom gave us permission to log in and gain access to her medicare claims. I did call Medicare to see what we needed to do in order to get access and was told that even though we had POA Healthcare and were Trustees of Financial, Medicare will not send any mail to our address since they use the patients' latest tax return via the IRS to establish the correct address of where to send claim information. Really? It was on my list to take her to a Social Security Office and get her address changed for all mailing to ours, but, when you are dealing with having to drive 30 miles to the nearest office (again, remember, we are in a rural area!), you find reasons not to venture on this journey. Mom, at this time, had broken 3 bones and was just recovering from major hip surgery to repair that area from her latest Fall at the nursing home. She was already in a fragile physical state and didn't need to be loaded into a vehicle for another trip.
At the time, I also thought that we were probably weeks away from her being mobile again. So, our decision at that time was to put it off until she was better. Little did we know at that time, that our window was closing due to the upcoming health challenges she would face. We opted instead to have all of her mail forwarded to our house in Wisconsin. After about 4 months, we received a letter from Social Security as well as Medicare that they were informed by the Post Office that her mailing address had changed. Thus, we would now start getting these summary updates on the claims. A new way to fix the problem!
By getting on the Medicare Website, we were able to see claims that were filed within about 2 weeks of something being done to Mom. Once we got over how expensive some of this stuff was, we started to learn how to check the billing codes to ensure that whomever was doing something to her wasn't trying to overbill her. This is another area that you will spend hours looking at. Get a cup of coffee and plan on at least 10 hours a week if your loved one is hospitalized, getting therapy or residing in a long term care facility. There are great websites online that will walk you down the billing codes world. Of course, for every one that you find to be questionable, you will have to contact the facility or company that sent it in and request an explaination. More time spent on not being focused on your parent. At this time, Brian, his sister and myself started figuring out who was going to be responsible for doing what. It was now too big of a monster for just one person to take on. Now, you know why you need to be keeping those good relationships going with the family members. It only takes one of them to upset this apple cart or decide that they don't have time to do any of it. Thus, you see the emotions and backlash come out within the family circle. In our case, we decided that we were not going to go down that road. Besides, none of us had time to even think about how we really felt when it came to who was doing what.
We learned a more complete story of just what was being done (or not being done) to Mom via all of these claims. We saw claims from medical professionals that we had never heard of and wondered why we weren't even told of their existence. If you can't get people to explain just what they did or why to you, don't pay the bill! This gets their attention and they will usually then take the time to let you know why they are in the long line to get paid. Once we were able to contact all of them via our info. from the Medicare Website, we were able to give them our address so that they could start sending the bills to us. If they sent them to the nursing home, Mom would just put them in a drawer somewhere and forget to tell us that she had received them until weeks later. More communication is needed when it comes to what mail your parent is getting while a resident in a facility. It's just common sense to know that if the return address is a medical facility, the family should probably be sent the letter. Right? This happened to us in 3 different facilities in 2 different states over a 6 month period. Amazing.
Our most frustrating bills/claims were from ReHab. You know that they have to send in 'progress' forms in order to continue to get the medicare payments. We were not able to get copies of these 'progress forms' at one place until we moved her to another facility. You know that the elderly patient only has 100 days of medicare coverage for Re-Hab. We didn't fully understand this until late in the game. Another error on our part based on the fact that Mom is now on her 5th broken bone and just got done with another major ortho surgery. We also didn't know that PT, OT and ST are billed in 'units'. Each unit is 15 minutes long. A patient can literally be signed up for Physical Therapy, Occupational Therapy and Speech Therapy for 3 hours a day. Start adding up these costs after the 100 days benefit period is over and you find yourself wondering who is making these decisions and why aren't they responding to your questions. Good Luck! Don't get me wrong, there are a lot of advantages to a lot of patients to participate in the Therapy programs. But, for some, common sense needs to kick in and the realization made that it's not in their best interest. Luckily, for us, Mom made the decision.
Mom made the decision after her last broken bone a couple of weeks ago here in Wisconsin, to stop all PT, OT and ST. It was quite obvious that once they got her back up to using the Walker with assistance, that this would increase her potential to fall. Add in the fact that Mom is determined to do things her way and that also adds to the problem. Even if a Call light is within reach, some elderly will not use it. The cycle was glaring, the observation to all of us was late. Another lesson learned. You also need to watch out for this in the hospital setting. Her Ortho surgeon followed protocol and ordered it. We tried to call and talk to him and could not get a response until almost a week later.
Even if the patient has an enacted POA for healthcare, they will tell you that if PT, OT or ST goes to the patient and asks them if they would like to try moving a bit, if the patient says yes, off they go. We resorted to writing her wishes of no therapy on the hospital room board and they still took her if we weren't there to intervene for her. Nothing like going to the PT dept. of a hospital and announcing that you are there to pick up your Mom who has refused all PT. Took me a few minutes to find her and as I was getting her into the wheelchair for the trip back to her hospital room, the PT person acknowledged that they had seen the note on the board, but they asked her anyway if she'd like to go move a bit and meet some new people. Of course, she said yes!
Again, no one ever called our phone number that was up on that board also. I've done a search on Physical Therapy websites for articles on how to get elderly to participate in therapies. Consumers should read some of these. The antics used to get the person to agree to go are in my opinion, not doing the right thing. Again, the bottom line is money. Having a PT, OT or ST dept. within the facility is a guarantee of thousands of dollars for their bottom line. When you see how much money Medicare spends in this area alone, it's no wonder we are in the current situation that we are. There needs to be more oversight on how these funds are spent and what the advantage to the patient is based on their physical state and prognosis.
We've had pretty good luck with most of the hospital nurses. Once they realize that you really are concerned for the patient and they've brought you in yet another change of sheets for that sofa that you've been sleeping on the past few days, they are usually pretty good about letting you know what is going on. Just make sure that you are talking to a real nurse and not a student that is doing their clinicals in the hospital. We all knew to keep an eye on what IV bags were hanging on the pole for Mom and if a new medication was added, we kept up with what it was and if there were any side effects that would happen to her based on what else they were giving her. When she broke this last bone (again due to a fall while using the walker and not pushing the call button), we found a week after discharge via the medicare website that there was a total of 7 different doctors that had been in to see her. Surprise! I'm now in the process of calling each one of them to find out why and how exactly I'm supposed to get a non-transportable person to their offices for all of these follow up appointments.
We did come up with a plan to address this. I checked with her long term care nursing home that she was tranferred to due to her new medical needs to see if we could utilize their physicians that were either part of their staff or their Medical Director. We've learned that yes, we can have them contact these doctors and coordinate Moms' care by communicating with each other and sharing lab results that can be done 'in house'. Needless to say, since Medicare will not pay for private transport to all of these places, this is a good solution for Moms' current situation. At least, we think it is. Next week, it could all change again. Depends on what happens next. Don't you just love surprises?
Have a great week!
Thought I'd share with you a few of my observations over these past 6 months. We've all had friends that have told us of the trials, challenges and joys of having older parents. Over the years, Brian and I have listened, hugged and consoled many of our friends that have lost parents or begun navigating the journey of elder care. Little did we know what they were really doing. It's one of those things in life that no matter how well you listen, unless you are in the same boat, you really have no understanding of how this affects your life as well as the lives of your family members.
Last August 29th, we got a phone call from the Independent Living Campus that Brians' Mom has resided at for over a decade. She decided to move there in her 60's and was very content in the fact that she had made the right decision that would transpire into the right care for her as her needs increased. She had her own apartment, could come and go as she pleased and was comforted in knowing that quite a few of her friends were also transitioning to this type of living arrangement. She was also very proud of the fact that, in her view, she had put things into place that would make the next steps easy for all of her kids. She even bought into the Lifetime Rights program so that she would always be guaranteed a place in the assisted living building and if needed, the nursing home/rehab facility. These were all her decisions. While she told us of her desires in person or via letters, we really didn't give it much thought at the time due to the fact that she was a very independent, strong woman. Little did we know that this would later be considered our 'quiet period'.
Mom had been having some problems over the past couple of years. She knew that her balance was not as good as it had been and with us watching, she did what she wanted to do when it came to dealing with the medical things in life. While we didn't always agree, we also respected her decisions. Back in 2001, she asked Brian to be in charge of her finances when the time came that she felt she was ready for someone else to handle this. She also had many talks with me about becoming her POA for Healthcare. All of the paperwork was in place and we all felt that we had a handle on things. Little did we know.
The phone call came from the Chaplain of the facility. Mom had been found in her Independent Living Apartment. From her schedule as well as her very well known daily routine, it was determined that she had been down for a few hours. We would have questions later as to why it took so long for someone to take a minute and go see why she had not shown up for her normal activities. When someone did find her, she was determined not to be transported to the local hospital. She had gone this route after a minor stroke in 2009 and unfortunately, the local facility usually always ended up having the patient transported to another bigger facility via ambulance 30 miles away. It's one of the things residents that live in rural areas know will happen no matter how new or good their local hospital is. Add in the fact that this is not a large population area and you can imagine the challenges when it comes to medical facilities. People don't realize that if you don't have a large resource of trained people, you can't handle everything that comes into your facility.
Due to her having suffered another stroke, she had spent most of that time on the floor of her apartment with a head injury due to her fall. We can't imagine how scared she must have been, yet still had a hard time comprehending why she didn't scoot herself to the phone and push the button for help. It was obvious that her ability to make common sense decisions was lacking at that time. She spent 4 days in the hospital and was discharged to the nursing home/rehab area of the local retirement community that she had lived in. We spent those days down there observing and getting used to our new roles. We had all of the paperwork with us and talked until we were blue in the face with any one that would listen to us on what her wishes were and who we were. In the end, it didn't really matter. We would spend hours at her bedside in the hospital to see the 'doctors' and finally realized that you never knew when they were going to show up. Usually, there was more than one, since hospitals now are using what they call, 'hospitalists'. That means that your primary care doctor doesn't come to the hospital to see you, you get random doctors that work for the hospital and then the reports are sent to your primary care physician. And yes, lots of things get lost in the communication between all of these people. It's frustrating and you soon learn to be on the defensive when it comes to anyone walking into the room and deciding what is best for her. Not a good place to be. This is when we started to realize that being able to follow through on her wishes was going to take a lot of diligence on our parts. It also brought to our attention all of the cracks in our medical care. While it's hard to place blame on just one thing, it's obvious that we have a lot of problems that no one is addressing. Common sense, at least in our view, is not being considered a part of the solution for those making the rules.
Over the next few weeks, I'll be talking about some of the challenges that we faced and are still facing. Mom wanted to write a book on all of this, but, as we looked into what was available out there, we decided that our goal was to try and get information out to those that are in the same situation, not make money or start another organization or support group. That is another whole quagmire once you start looking for help and answers. Lots of organizations out there as well as medical professionals. All of them with different opinions and 'tips'. Again, you need to rely on your common sense. You also need to keep the communication lines open with all of the family members that are involved. We are now seeing that by being a part of Moms' journey, it's turning out to be one of the best ways to cement those family relationships and know your relatives in a way that you never thought possible.
As Mom always says, 'Carry On and Be Brave'. It's going to be fun to hear her perspectives on some of her journey and with her permission, I'll be sharing some of that with all of you.
Have a great week!
The article is a good take on why H.A.'s are so costly. But, the comments section is even better! Nothing like getting a lot of people with hearing loss to anonymously comment on how they deal with things!
Have a great week!
Caption Call Phone Program
A lot of us are familiar with the different phone options available to us. Some of us have been able to use programs via the State that we reside in to obtain phones for those with hearing loss at a discount. There is now a program via the FCC that will allow anyone with hearing loss to obtain the latest technology at no cost.
The telephone is something that people without hearing loss take for granted. You can usually get one for under $15 and install it yourself. For those of us with hearing loss, there are limited options when it comes to being able to obtain a phone ‘made for us’ that doesn’t cost us money.
For those of you with a telephone and internet in your home, you may have noticed that there is a charge on your bills called a Universal Service Fund Fee. These monies go to the FCC so that they can provide programs and services such as closed captioning on television shows, specialized phone programs for some segments of the population, ECT. The FCC has a Vendor called Caption Call to get phones into the hands of those with hearing loss. There are no State vouchers to fill out and the phones are installed by a Caption Call Representative in your area. So, you also get the hands on training you need to get comfortable using the phone.
Our local HLAA Hearing Loss Support Group has been able to partner with Caption Call so that we can give out a promo code that will enable anyone with hearing loss to get in on this program free of charge. There is no cost to obtain and have this phone installed as long as you have a landline phone line and high speed internet. Our promo code is good in all 50 U.S. States. The program is only availble in the U.S. at this time.
Here is the website link for Caption Call: www.captioncall.com/CaptionCall/Products/Free-Demo.aspx
Just fill in the form and enter the promo code. This will get you into the system so that someone can contact you to set up an installation time.
Our promo code is: HS 3066
If you or someone in your home would like to actually call Caption Call to get questions answered, here’s their toll free number: 1-877-557-2227 The Reps that answer the phone call from you can also place the order for the phone as long as you have the promo code (above).
If you live close to Wales, WI, you are invited to come to our monthly meeting on Sept. 13, 2012 to see and hear (CART is used at all of our meetings) from the Caption Call Rep. for our area. She will be bringing one of the phones with her and welcomes any and all questions regarding the program. There is no charge to attend our meetings and they are always open to the public. Start time is 6:30pm. We meet at the Wales Community Center located at 216 W. South St. in Wales, WI.
I know that I have started to shy away from using the phone over the past few years. My biggest problem has been with companies that use reps. that have accents. I just don’t understand what they are saying. Add in the fact that I have a real problem hearing high pitched voices and it’s a challenge for me to have a conversation on the darn thing. And, it’s just not fun anymore! If this program will allow me to use a phone that I can now read the captions on (in almost real time), then I can see myself no longer bothering my family members to call someone for me. And, it will also help me to get my confidence up again by being independent in another area of my life!
Have a great week!
Thanks to Ed Belcher for sharing this with me. He has given me permission to publish his business plan which could, in fact, be the starting point for reducing the cost of hearing aids! If you have any questions or comments for him, his email is on the plan.
For the 1st part of this article, please go to this link: www.livinglakecountry.com/blogs/communityblogs/149995835.html
Here's the 2nd part with the actual Business Plan. I've sent it to the National HLAA office for their consideration. It will be interesting to see if something is done with it.
Description of NEWCO, a Hearing Aid Dispenser
Ed Belcher (firstname.lastname@example.org)
Can a hearing aid dispenser provide excellent service and quality aids for 25% of prices currently charged hearing-impaired customers? This paper hypothesizes such a distributor. The answer is “can be yes” with a win for well-paid company personnel, manufacturers with an increasing volume of sales, and customers obtaining excellent aids and service at a fraction of the current cost. The General Description gives a brief explanation of the company, with financial details given in Corporate Analysis and the Financial Spreadsheet.
I. General Description
NEWCO distributes hearing aids through 600 franchises spread over the 50
states. Each franchise has a lead audiologist, two hearing-technicians, a
receptionist, and a part-time bookkeeper. The franchises have the expertise
found in a typical Audiology practice and a large selection of high-end hearing
Assume NEWCO’s corporate facility negotiates directly with manufacturers and
purchases per year at least 560,000 hearing aids, the same number purchased
by the VA. The VA contracted with 5-6 manufacturers and obtained rights to
purchase quality aids averaging $340/aid over the 2010-2014 timeframe.
NEWCO obtains similar prices from the best manufacturers averaging $350/aid.
The VA currently purchases 20% of the hearing aids purchased in the USA.
NEWCO commands 25% of the non-VA market of hearing aid purchasers.
Considering the statistic that only 25% of those needing hearing aids currently
purchase them, NEWCO’s 560,000 aids represent only 1/16th or 6.25% of the
potential non-VA hearing aid market.
In addition to having low hearing aid acquisition costs, the franchises reduce
expenses by sharing advertising expenses with Corporate and sharing net-based
customer relationship software, bookkeeping software, and business
management practices/software. The franchises participate in initial and on-going
training for employees in regional workshops held in mutually convenient
A multi-outlet dispenser is not a new concept. HearUSA, Miracle-Ear, Costco,
and Walmart are just four examples of multi-outlet businesses today. NEWCO
differs from the above four companies in that each service and product is
separately priced and the total price of services and products are 25% of its
II. NEWCO ANALYSIS
This section follows the order of the Business Finances Spreadsheet at the end
of the paper and explains the numbers and the organization behind the numbers.
II. A Corporate Analysis
Corporate negotiates an average price of $350 per hearing aid. Similar to the
price negotiated by the VA for a similar volume of 560,000 aids fitted in one year.
Corporate marks up the aids not by a percentage but flat rate or $35 per aid. The sale price to the franchises is an average of $385 per aid.
The net revenue is $35 times the number of aids sold.
Administrative and Executive Branch
There are 35 members of the administrative staff ranging from assistants to
President. The average salary is $140,000 ranging from $40,000 for assistants
to hundreds of thousands of dollars for top management. Corporate does the
1. Negotiates prices and services with manufacturers.
2. Handles national advertising/branding campaigns for all of the franchises.
3. Provides at cost all franchises with bookkeeping software, customer-relations
software, and franchise-management software. These packages are all internet-
based with data stored redundantly at two separate off-site locations for safety.
4. Trains and monitors franchises in business management, operation of
software packages, and customer services. If a customer moves, s/he knows that records, warrantees, and the same expert treatment are available in any other NEWCO franchise.
Administrative space will be 10,000 square feet at $20 per square foot per year. The facility is situated in a location requiring modest rent and centrally located for travel considerations.
Corporate spends $9.65 on advertising for each hearing aid purchased or 27.6%
of markup. The resulting $5 Million will be used annually for national campaigns
that brand the franchises, their services, and features of the aids currently sold.
NEWCO expects word-of-mouth from satisfied customers to be their best
FICA and Benefits
Social Security and Medicare insurance born by the employer and employee will be 15.3% of wages. Benefits including healthcare insurance and 401(k)
contributions will be 12% of wages.
Rather than try to make this budget delineate every tax, fee and expense at this stage, a large category of Unallocated Expenses covers those expenses. Part of this amount may be corporate distributions to shareholders and bonuses.
The markup of $35 on each of the 561,508 aids sold in one year provides $19,652,780 for the corporate facility and its staff.
II.B Franchise Assumptions
Each franchise obtains a license to operate as a franchise of NEWCO and has the following benefits and obligations:
1. Top-of-the-line hearing aids cost an average of $385 each.
2. Training for staff will be available periodically each year at various locations convenient to groups of franchises featuring manufacturers under contract, and experts in business management and the field of Audiology.
3. Advertising/branding the franchise, its services and products
3. Quality software for bookkeeping, customer relations, and management.
1. Pricing for services and products is standardized
2. Quality of service and equipment exceeds standards
3. Quality of the facility exceeds standards
3. Salaries have local control with ranges related to job function.
4. The more aids and services sold, the more profit for the franchise. Profits are dispersed within the franchise for facility and equipment upgrades along with bonuses, and increased salaries.
5. Each franchise will spend approximately 2% of its revenues to augment corporate advertising.
An audiologist leads the staff. Two hearing-technicians help in areas such as
tests, fittings, adjustments, and ordering aids products. The receptionist greets
the customers, notifies the technical staff of arrivals, maintains the appointment
calendar and updates the customer relations software. A bookkeeper (or
bookkeeping firm) works approximately 16 hours/week and handles Payables,
Receivables, Payroll, Tax computations, and maintaining on-line bookkeeping
In this hypothetical company, the minimum desired salaries for the staff are:
Lead Tech $50,000
40%-time Bookkeeper $20,000
With the assumed cost/revenue structure, the franchise numbers are: Number of Aids sold per year: 916
For corporate to sell over 560,000 aids/year it needs 613 franchises
The franchise buys aids from Corporate for an average of $385/aid
The franchise sells the aids to customers for an average price of $565 each To sell 916 aids the franchise needs 458 paying customers
To get this final result the following are performed:
641 hearing tests
305 additional 30 minute visits
25 2-hour support groups
NEWCO is a fee-for-service organization. For most hearing aid sales, the following services will be needed:
1 hearing test
1 Year Support Group Membership
required part of the purchase package)
$100 (1 hour)
$150 (2 hours)
$50 each (1/2 hour each)
$50 (optional - a suggested but not a
For the activities listed above, the actual salaries are:
Lead Tech 50,088
Part-time Bookkeeper 20,235
Increased salaries or bonuses can be obtained with an increase in activity.
Rent: Assume a 2000 square-foot office at $20/square-foot-year
Equipment: Cost of Maintenance, Repair, and Replacement
Advertising: 2% of total revenue for local campaigns. Corporate supplements
advertising with a $5,400,000 national campaign to brand the business, its
service, its products and costs.
Unallocated Expenses: Expenses not covered in the allocations above, profit for shareholders and/or extra bonuses
FICA (Federal Insurance Contributions Act)
15.3% Social Security and Medicare Insurance Payments
12% 401(k) retirement account and health insurance
Work Hours (Possible and Actual)
Assume practice hours consist of five 7-hr days per week for 48 weeks per year. That would be 1680 hours/year per person. The billable hours are performed by three staff members to provide a possible total per year of 5,040 billable hours. The calculated workload (including two staff members at 25 support group
meetings) to achieve the franchise activities in the spreadsheet is 3025 hours. A 3-person staff would average 4.2 hours each per day. This leaves nearly 3 hours per day for seeing customers for other issues related to hearing and balance,
studying the current literature, and going to workshops and other outside tasks while not infringing on the 4 weeks of vacation leave.
Three major differences between NEWCO and its competition are:
1) The total package for a pair of hearing aids will average $1,530 approximately 25% of obtaining similar hearing aids from the competition.
2) Services rendered are charged whether aids are purchased or not. Assume a
customer had her hearing tested, hearing aids fitted, and three adjustments with
the purchased aids. If the customer decides not to keep the aids, she will get all
her money back except for services rendered. In the above case the services
were: test ($100), fitting ($150), and three adjustments ($ 50 each) for a total of
$400. If fewer services were rendered before the aids were returned, the cost to
the customer would be less. Charging fees for services rendered is expected in
laws affecting hearing aid distribution. It is VERY IMPORTANT that the customer
is told and agrees that charges for services rendered will be withheld from money
refunded if hearing aids are returned during the trial period.
3) A support group is available. It is two hours long and held 25 times a year.
Each meeting will be facilitated by two members of the staff (audiologist and one
of the two hearing-technicians) It is open to anyone who has paid a $50 annual
fee. This includes prospective customers and purchasers of hearing aids from
other dispensers. The two hours will have guest speakers discussing equipment
and programs available to the hearing impaired. There will be time for general
discussion of member experiences and ways to cope. Also there will be time at
each meeting where one can talk one-on-one to a staff member about a
particular issue. If more time is needed, an office visit can be scheduled.
NEWCO Business Finances Draft Rev: 17 June 2012 Ed Belcher email@example.com
Manufacturer Price 350
Number Aids Purchased 561508
Markup ($) 35
Sell Price 385
Net Revenue Central Facility 19,652,780.00
Administration 4,900,000.00 35 140000 Ave Salary See Com. 1
Rent 200,000.00 $20/sqft/year 10000 sqft
Advertising 5,418,552.20 $9.65 * number aids sold
FICA and Benefits 1,337,700.00
UnAllocated Expenses 7,796,527.80 Com. 1 Executive, contracts with manufactures,
Total 19,652,780.00 Advertising Liason, Central support, Franchise suport
Number of Franchises 613
HA purchase price 385
Sell Price 565
Number aids sold 916
Cost Hearing Exam 100
Number hearing exams 641 1 hour
Cost Fitting 150
Number of Fittings 609 2 hours
Cost Adjustment 50
Number of adjustments 1827 0.5 Assume 3 adjustments/fitting
Cost Additional Visits 50
Number of Additional Visits 305 0.5 Assume 1 visit
Cost Support Group Entry 50
Support Group Members 485 1 2-hour sessions 25 weeks/year)
Audiologist1 165,353 120,212 120000 0.44 14425.43
Audiologist2 0 0 0 0.00 0
Tech1 68,897 50,088 50000 0.19 6010.597
Tech2 57,874 42,074 42000 0.16 5048.901
Receptionist 52,362 38,067 38000 0.14 4568.054
Bookkeeper 40% 27,559 20,035 20000 0.07 2404.239
Total $ 372,045 270,477 270000 1.00
Rent 40,000.00 2000 sqft Occ Tax 0.153
Equipment 15,000.00 Benefits 0.120
Advertising 9,023.60 Total 0.273
UnAllocated Expenses 15,111.20
FICA and Benefits 101,568.34
Total Expenses 180,703.14
Total Salaries & Expenses 451,180.00 (Equals Revenue/Franchise)
Work Hours (Possible/Year) 5040 hours (3 people) 5 7-hr days/week 48 weeks/year 4 weeks vacation
Actual Contact Hours 3025 hours 60.0 % of a 7-hour day or 4.2 contact hours/day
Final Price to Customer 1530 % of 6300 = 24.3
2 aids, test, fitting, and 3 adjustments
If a one-year membership in the support group is desired, add $50 to the above price.
Table 1. Financial Spreadsheet of a hypothetical, multi-outlet dispenser of
hearing aids. See Section II. for detailed explanation of data entries.
Every once in a while, I try and put some thoughts together on the observations I've made over the years in my experiences with hearing loss. While some of this may seem a little far reaching to those without hearing loss, hopefully, it will answer or even explain some of the behaviours and tactics associated with how we think, perceive and react to the challenges that we come across in our everyday lives. Keep in mind, that this is my perception and there are probably others that have a differing opinion. With that being said, here we go!
Being a child of the 1960's, there was a very limited amount of Knowledge and 'Best Practices' when it came to Mainstreaming a child with hearing loss in the Public School System. Back then, if you were Deaf and happened to live in close proximity to an educational institution for the Deaf, you were probably immersed in the Deaf Culture way of living life. In my case, I attended the local Public School located in the small town that I grew up in. My hearing loss was not diagnosed until I was in Kindergarten. Luckily for me, my teacher was noticing that she didn't have a student that was not paying attention, but one that was really missing what was being said in the classroom. There were no hearing aids back then that would work for me and when you look at how they tested hearing at that time, they probably didn't even realize what type of loss I had or how severe it was.
The term 'Mainstreaming' was not a part of the school curriculum. Yet, in hindsight, that's what was done. As I've gone through life, I've realized that there was a lot that I missed in the classroom which in turn made it very difficult to put the pieces of the puzzle together when it came to being able to excel in Academia World. For kids like me, we usually found a way to figure things out. If we got really lucky, there would be a teacher that would spend a little extra time trying to explain things to us. Of course, we also had the teachers (through no fault of their own) that just didn't have the teaching sense to take the extra time to make sure we were on the same playing field as the other kids with normal hearing. In my case, if I did understand all of the parts of a lesson, it would show in my testing. If I was missing some key parts in a subject, the teachers would be baffled and wonder what I was up to. Again, without all of the technology and tools that we now have, there were many times where I was passed on ahead to the next level since they knew that I was intelligent. But, I'm sure that they were not quite sure of how I was processing what they were trying to teach me. I still find myself having to look things up now (thank goodness for the internet!) so that I understand how it all fits in certain subject areas. I also have to take a lot of time with my written word to make sure that I'm not jumping all over the place as well as looking words up since I'm not quite sure how to pronounce them.
As an adult, I've had many opportunities to live in both the hearing world as well as the non-hearing one. I've elected to learn as much as I can in both. Just a few years ago, I was able to broaden my world to include those that are classified as Deaf. The frustrations that I experienced were a little surprising to me. After all, at that time, I thought that there were just 2 worlds out there. Now that I've had the time to really experience and learn from some pretty awesome people, I realize that when you break down the Hearing Loss World, there are several categories that we all could fit into. There are also several thoughts and ways of doing things based on the type of hearing loss that you have. It's a never ending educational and personal journey to try and stay in step with all of it. My biggest challenge has been channeling the frustration of adapting based on which group I am in at the moment. And yes, there are many times when I'm ready to throw in the towel and retreat back to my safety zone. That's usually when I get quiet and just observe. Of course, this can also be perceived by others as rude or even condescending on my part. Again, another little nuance depending on the type of hearing loss you have or are surrounding yourself with.
I hear a lot about the inequalities experienced by all of us regardless of if we have hearing loss or not. I also get a little irritated when a person goes into the 'woe is me' mode. It's very easy to give up and expect those around you to adapt to your way of doing things. When they don't, that's usually when you start hearing about the discrimination of it all. Anger is an easy way out, in my opinion. It's one of the reasons that people tell me I'm so competitive. I compete to learn and adapt to the hearing abilities of others as well as myself. While most people only do this when they are in a game, job or testing situation, I choose to do it most of my day. It can be tough to be around me since I tend to challenge and ask a lot of questions. As my family has said many times, I am perceived as never letting my guard down. The mode of relaxing for those with hearing loss is very different from those that don't have to work on hearing everything that is going on around them. It can also lead to others thinking that you aren't quite all there if they don't understand the Hows and Whys in your approach on doing things.
Recently, I've been doing a little more work with all types of hearing loss. The modes of communication are amazing. It's also very tiring mentally for me. Imagine being in a room where you have CART (realtime captioning on a large screen for those to read that are not hearing everything), ASL (American Sign Language) and different facial expressions based on how a person is trying to get their point across in the conversation. That's 3 very big ways of communicating that you are trying to process all at the same time. Are you going to miss key points of the conversation and get left behind? You bet! Are you going to choose to just let part of the conversation 'miss' your comprehension? You sure are! Is that going to lead to you asking or answering something totally inappropriately? Definitely! And this is with people that you thought were just like you in that they are classified as having hearing loss. Imagine the confusion when you put a person in the mix that has normal hearing? The breakdowns in communication are immense and no matter how well each mode of communication is done, something is going to get lost in the translation on a personal level. If you live with someone with hearing loss, you know the frustrations you have when it comes to communicating. You also know how irritated all of us can get when talking with someone that is not 'Hearing' you correctly. No wonder there are so many issues we are all dealing with!
Add in the many businesses, articles, gadgets and latest inventions that are advertised or prescribed/recommended by the 'Professionals' and it's now turned into a very confusing world. For many years now, there have been many scams out there that have made a lot of so called 'good' Companies and Organizations a lot of money. There are some of us in hearing loss world that are still looking for that magic item, pill or cure so that we can be 'normal'. It's tough to admit that your normal is very different from those without hearing loss. And, society has always taught us that we should adjust and conform to their way of doing things. If we don't, we are automatically put into a category of 'not normal' or in some cases, 'defective'. When that happens, the situation can get negative quickly. Sometimes, it helps to step back and analyze what your personal needs are. You then have to take up the challenge of trying to meet those needs. This does not mean that someone is going to 'fix' it for you. You have to take the time to figure out what will work and what won't. And, then you have to realize that you are going to have to learn how to adapt when your situation changes due to a change in your hearing ability or even the people that you are now in a room with.
So, do you give up and become one of those that stays at home where it's safe and easy? Or, do you decide to give new things a try, talk in detail to those that you are with to explain how you communicate and learn that your situation is not unique? Take these opportunities to expand your personal horizons. Learn from others on how they communicate. You never know, you may realize that there is an immense opportunity for you to contribute to society as well as educate the people that really had no idea what the challenges are in whichever world you 'live' in.
Have a great week!
For those that are not aware of this, every State has Governor Councils. These Councils are appointed via the Governors' office and there are many opportunities for persons interested in different causes to actually have a voice in getting things done. If you would like to see the many opportunities in Wisconsin, just go to the Governors' website and click on the Council link. Here's the one for Wisconsin: www.wisgov.state.wi.us/Default.aspx
I currently serve on the Council for the Deaf/Hard of Hearing/Deaf/Blind. I've been doing it for over 3 years now. The Council meets 4 times a year and there are 9 members on it. We look at the needs and services of this segment of the population in Wisconsin and try to advocate for things that can improve their life as well as their abilities to succeed. While it can be frustrating at times to try and get things done, it's also a great way to know what is really happening at the State level.
We currently have 6 members on our Council. We need 9! We cannot have a formal meeting unless we have a quorum (6 in attendance). Thus, the need for 9 people. No, we don't get paid to go to Madison and spend 6 hours in a meeting, but there is the option of getting paid for your travel. I opt not to do that due to the fact that I learn so many things at this level that I would never know if I didn't belong to the group. No, we don't hobnob with all of the elected officials. So, if you are thinking that this might be a way to get someones' ear in a higher place, you probably will be disappointed. No, it's not all Republicans. To be quite honest, I really don't know which side of the Political Fence any of the Appointees are on. And, I really don't care since it ultimately does not make a difference in what we are trying to achieve.
If you would be interested in applying for one of these positions, just go to the link above and click on the Council that you would be interested in being chosen for. Our group is looking for 1 Hard of Hearing person, 1 Deaf person and 1 Blind or Deaf/Blind person. Yes, we have various modes of communication at our meetings. So, if you communicate using ASL, we do have translators. We also have CART for those wanting to be able to read what is going on in real time. The meeting room that we use is also set up with a Loop system for those that have hearing aids with a t-coil program on them.
Some of the things that we have been a part of in the past include:
1. Helping to get the 'Let Kids' Hear' Bill passed in 2009.
2. Emergency Preparedness for the D/HOH/Blind
3. Better Licensing requirements for Interpreters in the State.
4. Tackling topics like Mental Health Services, job development and Independent Living needs.
Currently, our meetings are held in March, June, September and December. They usually start around 9:30am and end by 4:00pm. We meet in the Health Services Building just down from the Capitol. And, yes, they do feed us a light lunch. If you have any questions, please feel free to contact me or better yet, send an email via the website link above. We'd love to have you on our team!
Have a great week!
Thanks to Ed Belcher for passing this information on to me. I'm looking forward to the 'rest' of the story!
27 April 2012
Comparison of Hearing Aids and the iPad
Ed Belcher firstname.lastname@example.org
The 2010 German Competition Regulator reported the following:
Assume Revenue for the Big-6 Hearing Aid Manufacturers is R. The Big-6 consortium reports the following costs:
Production Costs 25% of R (materials, labor, machinery maintenance, etc)
R&D Costs 5%-10% of R
Marketing Costs 20%-30% of R
The balance (35% to 50%) goes to administration, profits, and plant reinvestment.
In a study of the Apple iPad manufacturing costs and profits, the Economist, April 21st 2012 page 8, stated:
“Researchers for the Personal Computing Industry Center at the University of California, Irvine, took apart an iPad and worked out where all the various bits inside came from and what it had cost to make and assemble.” They came up with the following breakdown:
The below comparison of financial components of an iPad and HA assumes retail price = 100% and assumes that a hearing aid costing a dispenser $1000 is sold for a bundled price of $3000.
Activity Hearing Aid iPad
Production Cost 8% 55%
Dispensing 67% 15%
The manufacturing and distribution costs of a hearing aid are upside-down in comparison to the manufacturing and distribution costs of an iPad.
The iPad is subject to hard, unfettered competition resulting in its profit, marketing, R&D and dispensing costs contained within 45% of the final price. The production cost makes up 55% of the retail price.
Most hearing aids are made by the Big-6 consortium which shares patents and does business in a mutually beneficial way. The dispensing businesses have an eerily consistent, very large markup. The actual production cost of a hearing aid is only 8% of its bundled price. The remaining 92% is mostly composed of dispensing fees, administration salaries, and profits.
Hearing aid dispensing, based on my experiences when shopping in varied businesses for hearing aids, took 1 hour for the exam and discussion of HA options, 1 hour for fitting/training for purchased aids, and 2 hours for 4 30-minute additional adjustments/training, a total of 4 hours of contact time.
What would a hearing aid cost if it had the iPad cost structure? A hearing aid that a dispenser buys for $1000 costs about $250 to make (25% of manufacturer revenue). So we start with the $250 production cost.
If the iPad-structure were followed based on the $250 production cost, the retail price would be $250/.55 = $455. The price paid by the specialist would be 0.85*455 = $387. If the specialist sells two aids for $455 each and adds $400 for four hours of service, two very good aids would have a retail price of $1,310 only 22% of the $6000 currently charged. The specialist would net $536 per customer.
Can industry prosper and sell aids for $387? They have sold millions of aids to the VA with prices decreasing from $375 to $333/aid from 2004 to 2011 respectively, according to Lucille Beck, Director of Audiology, VA, and The Hill
Can a specialist prosper with a net revenue of $536/customer? Yes s/he can, but that requires another short paper to explain how.
I know of one business here in the Lake Country area that was a victim of this. A stolen credit card was used via the Relay Service to have a rather large order that ended up being sent to a warehouse address in New York where it was then sold via the non-U.S. perpetrators. While it amounted to a couple of hundred dollars loss for the business here, the bigger problem for them was trying to obtain the information on the source of the call via the Relay Service. The proof of fraud was born by the business and eventually, they gave up trying to solve the crime. In order to obtain the information from where the call originated, they were going to have to hire an attorney, get a court order and of course involve several police departments in different states. This all happened almost 3 years ago.
The Business contacted me for some help and that was when both of us realized the lack of oversight by the U.S. government/FCC on the relay call business. For those of you with questions on the Relay System, how it works, ect., here's a great link: transition.fcc.gov/cgb/dro/trs.html If you scroll down on the page, you'll also find a section titled 'complaints'. This will enable you to bring up all of the complaints by legit users made by State. It was interesting to note, that there were not many relating to the foreign use of the service along with the criminal activity involved. This leads me to believe that AT&T was not logging those in. I know that the local business here that was scammed filed a complaint with AT&T, but I have yet to find it. Yet, they continued to bill the U.S. goverment millions of dollars for the transaction of these calls.
Here's the story that came out today via USA Today on the AT&T charges via the Justice Dept. www.usatoday.com/tech/news/story/2012-03-22/att-government-suing/53711584/1
For someone that cannot hear or see well, this relay service is their lifeline to the outside world. As it has developed over the years, changes in technology have made it easier for those needing to use it. Unfortunately, the lack of oversight by the FCC has also made it easy to use for those that should not be given access to it. Add in the lack of training by AT&T as well as some of the other Relay Service providers when it comes to being able to correctly facilitate the service for the consumer and you will see via the complaints area of the link above how frustrating it can be to place a simple phone call.
If the Justice Dept. is successful in recovering the millions of dollars from AT&T, maybe someone will realize that these funds could be partially used to improve the service and get all providers back to following the rules.
Have a great week!
Lots going on the past few weeks on the Hearing Front! Saw that the USA Today is running an article on Hearing Aids today. Here's the link: yourlife.usatoday.com/health/story/2012-03-16/Hearing-aids-revolutionized-by-sound-advances-in-technology/53571198/1
Also received an email yesterday from HLAA National on the latest program being implemented by United Health Care Insurance via their new partnership with EPIC. As some of you may remember, AARP was contracting with Hears USA to provide hearing aids (along with the AARP insurance) for their clients. Hears USA declared bankruptcy last year. Thus, all of the people that bought the additional insurance were left high and dry when it came to being able to get hearing aids or service via Hears USA.
For those of you interested, here's the link to the newest affiliation. And yes, there is a lot of controversy on it with the Audi camps not liking it at all. Link: epichearing.com/
I've not had a lot of time to research all of this yet. HLAA is remaining neutral on the new development, but keep in mind that they are also one of AARP's partners. A few years ago, I did a series of articles on the America Hears hearing aid. This is the company that sends you the software so that you are able to program your own HA's via your computer. They also provide support via the phone or email. I was pleasantly surprised to learn that these would work for me if I didn't need the FM system that I have now. If you would like to read my findings, here's the link: www.americahears.com/ah_about_testimonials.html And yes, I did return them to the company after wearing them for 2 weeks in order to continue to declare myself free of alliances (getting freebies) just because I write this column.
I would be interested in hearing from readers that have decided to go down this path when it comes to getting a hearing aid. As of now, I have not been able to find any type of survey or information on how this is working out for those that have decided to have a more hands on approach to programming their HA's.
We all know that there are a few trips involved to the Audi's office after you get fitted with your HA's to iron out the programming issues. I still think that the programming is key to whether or not the consumer will continue to wear their HA's. Unfortunately, you still have HA programmers not listening to their patients and trying to 'follow the book' when it comes to programming a HA. While the Audi's are definitely not happy with this turn of events, the pricing difference will more than likely cause them to miss out on some clients. If there is legislation involved at the State Levels, get ready for a battle. When you look at the average price for a HA via an audiologists' office (in my case, around $3700 each) and then compare that to the average price from America Hears or EPIC ($600 each), there is bound to be quite a few people that are competent on their home computers that will opt to save a lot of money in order to join the 'Hearing World'.
At this point, I'm on both sides of the fence on this issue. If it will enable consumers to purchase HA's so that they can improve their hearing, then, I say, go for it!
Have a great week!
Just received this. Have a great week!
On Fri, Mar 9, 2012 at 9:13 AM, DHH.Webmaster <DHH.Webmaster@illinois.gov> wrote:
The Illinois Deaf and Hard of Hearing Commission (IDHHC) is excited to release the video “Emergency Preparedness: Together We Prepare.” The video is shown in American Sign Language and is fully captioned. Its purpose is to provide instruction to individuals and families on how to prepare for a natural disaster. IDHHC wants to thank the Illinois Emergency Management Agency for its collaboration on this important video which provides access to crucial information for the deaf and hard of hearing community.
“Emergency Preparedness: Together We Prepare” is located on IDHHC’s website at http://www.idhhc.illinois.gov under “Emergency Preparedness Tips” (located on the left side of the page). It can be watched as a complete video or by specific subject matter.
I would venture to say that almost everyone has a credit card. With the advent of online ordering, pay at the pump gas, ect., unless you plan on carrying around cash, you have and use at least 1 credit card. Add in the fact that it comes in handy on keeping track of your expenses and it's a slamdunk.
We were the unfortunate participants in a situation with our credit card this past week. If it had not been for our diligence in checking our transactions online weekly via the bank website that our credit card is affiliated with, it would have been very easy to miss the charges made by someone else.
Here's how this one works. And, here's how the perpetrator is more than likely going to be caught.
1. Our credit card number, security code (on back), name, ect. was obtained by someone that probably spends all day doing these things.
2. A variety of charges were made via online ordering at different businesses with the amounts always being under $100. This won't raise a red flag with the credit card company. Especially, if you normally use online ordering. We spent some time in December ordering things online to be sent to family members out of state for the Holidays. And yes, I always check to make sure that the website that I order from is secure (look for the padlock icon on the order page)
3. The person using our card would order an item and then have it sent to an address that just happened to be a vacant, foreclosed house in different states. You can obtain listings of foreclosed homes via the internet or just about any Realtors' website. There are also Realty companies that only sell foreclosed properties. A lot of them have popped up over the last 3 years.
4. UPS and FedEx will deliver to a vacant property. The person ordering the item puts in a request that the package be left on the front porch. Maybe UPS and FedEx need to be a bit more observant when delivering and possibly make the rule that they will not deliver to vacant properties. They usually won't deliver to a P.O. box, so this should be a no brainer.
Here's what I found after doing a little research and making a few phone calls.
1. The retailer where the orders were placed was kind enough to send me a copy of the orders via email. This had all of the information as to where the order was delivered as well as an email address of the buyer. The one thing on the order that will probably help in catching the thief is the IP address of the computer that was used to place the order. This is relatively new in that most online transactions are now tracking the IP address of where the order is coming from.
2. When I checked on the addresses used for delivery by googling the address, this is when I found that the property was for sale. I would then go to the listing and see that it was foreclosed and vacant. I called the Realtor that had the listing and asked them if they had noticed any packages on the front porch when they were showing the house. They had. But, they thought that it was a little strange that when they returned for another showing, the packages were always gone. Note to Realtors - Maybe you should contact the local authorities if you are seeing this. You should also be aware of a potential safety issue should the perpetrator be arriving to pick up their goods when you are on the property.
A few tips on protecting your credit card. Always make sure that the website that you are ordering from is a secure one. There are some companies out there that will say that it's secure, but when you look for the padlock icon, that's when you realize that it's not.
If possible, phone in your order. That way, there is no chance of your credit card being scammed via the internet. While you always run the chance of the person on the other end of the phone being able to use all of your information, those are usually caught pretty quickly.
When you are conducting a transaction in person and the clerk wants to see your card to verify the signature, try and place a finger over the security code on the back of the card. If the clerk questions why you are doing this, tell them that you've had problems with credit card fraud and you see no reason for them to be able to see the security code on the back. Offer your Drivers License as another form of ID if needed to verify the signature.
If you are paying for gas at the pump, make sure that the credit card reader looks to be intact and not tampered with. There are some that have been fitted with a card reader placed there by someone that collects credit card info and then either uses it or sells the card info to others. You can usually tell that there may be a problem if the card reader is loose or just doesn't look like it is all one piece. If in doubt, go inside to pay for your transaction.
If you happen to live next door to a foreclosed property and are noticing that there is someone that keeps showing up there to retrieve packages, alert the local authorities. This is a relatively new scam. Based on all of the foreclosed and vacant properties in almost all of the cities, it's turning out to be a bonanza for those that don't understand that Crime really doesn't pay. Looking forward to doing all that I can to put this little scumbag in jail. Odds are, I'm not the only one that he's been making money off of.
Have a great week!
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