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I
Don’t Know How They Are Able to Do It
”They” are the Medicare beneficiaries
and “Do It” is “navigating the Medicare, Medigap, HMO
and Medicaid systems. This
thought –- “I don’t know how they are able to do
it” –- struck me more than ten years ago, shortly after I
started my volunteer counseling duties.
Observing the lack of basic knowledge by many and seeing the
problematic situations (“medical and otherwise”) that they
were experiencing, and I said to myself that this was going to be an
interesting and challenging job.
At first I thought the difficulties I was
observing were not indicative of the general senior population, but
those of only a Senior Center neighborhood – - a narrow
sampling. But over the years my
clientele has broadened considerably, including other neighborhoods
inside and outside of Manhattan, reflecting a wider educational and
economic base. And the problems
are still there. The citywide
and statewide viewpoints I have heard expressed recently at meetings
indicate a great counseling need for seniors. A community worker, long active in
senior affairs, and a senior herself, had this rejoinder to my “I
don’t know how they are able to do it”: “What makes
you think they are?”
Consequently, I believe there is enough evidence to
indicate that there are too many seniors having trouble navigating the
Medicare, Medigap, HMO and Medicaid systems. However, the problem needs to be
identified before it can be solved.
And what better way to do it in a consumer-based operation than
to ask the consumer, the Medicare Beneficiary? These rather basic and simplistic
management principles go back more than fifty years (my College
Business Management 101 course), and longer, and are still used today
in this hi-tech age by private industry and politicians campaigning for
public office. The technique
commonly employed is a focus group format, with a designed plan of
inquiry on specific subjects.
Let’s include in the dialogue the end user of the service
or product, the “individual” Medicare beneficiary –
everybody else has been in on the decision-making.
I think it important to point out that the difficulty in
operating within so varied a system –- i.e. different forms of
insurance –- government and private –- does not necessarily
reflect poorly on the value of a particular type of insurance. For example, in the last ten years of
volunteer counseling, and even before, I found that the consensus on
Original Medicare is very favorable.
I concur. But let us hear
from the seniors -- how they are managing in making their way in the
Senior Health Care System. They
have a right to “a say.”
Stay Tuned!
Updated: December 14, 2001
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A
Message to Seniors and Members of Their Families
Almost every
time a senior’s family member has been involved in his/her
counseling (in person, by phone or reviewing my written analysis or an
insurance proposal), the result has been rewarding. And in the case of a client with
language/comprehension problems, the presence of a family member may be
a key to a good outcome, since the client may be uncomfortable having
an outside translator included in a discussion of a personal nature.
The above
works out well, but what about situations where family members are not
given the opportunity to participate?
During discussions (for example, choice of coverage –
Medigap, HMO, long-term care), if I sense decision-making uncertainty
or lack of comprehension, I suggest a family member be brought in (in any
of the ways mentioned in the above opening). Some of the stock answers I hear are:
“My son/daughter has his/her own problems”; “My
son/daughter leads a very busy life – long hours, always
traveling, etc.” These
reasons for not involving family members (children, nephews, nieces,
etc.) may be true, but I also know seniors (my peers) to be proudly
independent, so that can be a barrier to family members’ attempts
to discuss health care issues with them.
For whatever
reason, I find situations where seniors appear to be on their own in
the day-to-day health care decision-making on coverage, selection of
doctors, follow-up on health problems.
And I come across the last point (follow-up) in passing, in the
course of my general counseling.
It is an area outside my counseling duties which has left a
strong impression on me.
All of the
above is a lead-in to the following: Seniors represent the highest
health-risk part of our population – “in 1997, among those
65-74 years old, 30.0 percent reported some limitation caused by a
chronic condition.” “…50.2% of those 75 years and
over reported they were limited by chronic conditions.” So health care issues in the context
of a complex system will ultimately become a very important part of
seniors’ lives. Therefore,
this senior respectfully suggests that a dialogue start as early as
possible between seniors and family members. I urge seniors to seek the input of
family members whose judgment they respect. There are all too many older people
who – certainly not by choice – have no one to consult –
must go it alone. So if you are among
the fortunate who has someone to turn to – by all means do
so. As to those family members
of seniors who would be only too glad to contribute, try to overcome
the barriers placed in your way by feisty, independent relatives. This is serious business, and one
case where the end does justify the means.
Posted August
13, 2001
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