Does this charge seem reasonable? (Details inside)

About as reasonable as the 1500$ EKG (took five minutes) I had two years ago. And in the grand scheme of what her treatment costs in total it is a drop in the bucket.

I was charged over 10K for 3 days in the hospital. It was basically a motel 6 and all they did was change my IV bag every six hours and ask if I had pooped.

So in context the charges seem reasonable. But in reality the charges are total bullshit. But we all know our healthcare system is well beyond broken.

Hearing your story reminds me of why people hide their money legally and get Medicaid, which would be then paying.

Call the nearest mainstream church and ask if there’e a nice woman who can run over to your mom’s facility for $70/a week do the chore for your mom.

Is there any possiibility that either one or more family members could be responsible for this since it’s only once per day? Would the facility allow this?

The practice of charging for every step-up of increasing care is pretty common in many places which care for impaired elderly.

I was a home caregiver for an elderly couple and after the husband died, the lady went into a senior living community with various levels of care (meals, housekeeping, medications etc) depending upon the individual’s needs.

While still at home, I used to prepare her medications weekly in those weekly containers which are available in drugstores.

Eventually, I had to give her the mess daily after she (in confusion) overdosed herself on Ambien.

However, after moving into the care community, the family discovered there would be a charge for medication management so they chose to come in once a week to organize her mets into the aforementioned containers.

I was a little surprised that the facility permitted this (since she was in an escalated state of confusion about many things) but they did.

I gave the family members my honest opinion about returning to the weekly organizing and letting her cope with the day to day herself, but they convinced themselves it would be fine.

However, your case is very different (and i only gave this as one example of a facility which was OK with family member’s involvement) but perhaps the facility where she is would allow it? If it’s at all feasible for family members to handle this, at least it wouldn’t hurt to ask.

EDIT: I just read the response of @gailcalled and that’s another worthwhile idea to be looking into.

Thieves like so much of healthcare. I mean, what leverage do you have? She needs her medication. People who need health related services are at the mercy of the system. It’s awful.

I would ask if the price is negotiable. I would ask how much it is self pay if they are putting it through insurance. I would find out how much Medicare pays for the service, and if it is less, I would argue for the Medicare price.

I had a similar experience with my own mom.This may well be a case of price-gouging as @JLeslie suggests, but on the other hand, the cost of running special-care facilities is astronomical. If the staff is doing a good job—so many of them don’t—you’re fortunate to have them and may just have to “swallow” the cost.

By the way, with due respect to @Buttonstc, I seriously doubt they will allow any outsider, no matter how well qualified, to take over this service. Insurance risk for one thing, and for another, I doubt they want to give up the income.

Don’t want to sound rude but most of you Americans just love your private healthcare.
And to answer your question it does sound over the top, but everything in your private health care system is over the top.

@Buttonstc @JLeslie @Pachy I’m afraid they’ve got us by the short hairs on this one. Administering 1 to 2 pills a day for $35.36/day comes to $1061 per month, or $12,906 a year! The facility requires that this task be done by a “licensed nurse med tech” (this is bogus, because I observed regular staff members carry out this task), so outside intervention is out of the question, unless it’s by members of the patient’s family. We all live too far away to make this practical.

Over the course of a little under 2.5 years, the cost of care at this facility has gone up from $4380 a month to $9571 a month, Every little thing they need to do for my mom gets added to the bill. On the other, the surroundings are now familiar to my mom, and she actually recognizes staff better than she recognizes us. We feel it may be much too disruptive to move her now.

There are laws about handling pills. It probably varies by state. I know my sister has to go and set up my aunts medication, the aide she has there daily cannot do it.

I remember when Clinton was in office and Hillary was researching a new healthcare system for the US. I caught her one time talking about how stupid some of the rules are. She talked about home care being cheaper in some instances than hospital care, but insurance companies didn’t care. That there were few choices for patients even when there were reasonable alternatives if anyone with half a brain was evaluating options. She talked a lot about elder care and making things easier on the patient and the family both emotionally and financially. She really looked at the costs and being practical. I wish someone would do that again.

I would check into if there is a liquid alternative for the drug. Don’t count on a doctor knowing. If it comes in liquid there might be no extra fee.

More drugs are being made in liquid form now for children and elderly patients. Several years ago a pharmacists started making better tasting elixirs for very serious medications. His daughter needed a neurological drug and that inspired him. I don’t remember the full story about it.

You think that’s expensive?? Try going to the emergency room at the hospital!

How discouraging :(

But wait….what mysterious nice woman is going to drive to the facility 7 days a week to mash up medication in applesauce at a rate of $70.00 a week which breaks down to $10.00 a day for gas,commute time and pill mashing and feeding? haha

@Coloma: Not to mention her day will be screwed up and chopped up having to keep that appointment daily.

I wonder if the pills can be chopped a week in advance and stored in a plastic container? Then you just need the chopping done once a week. You could probably pay someone to do that for less money. Gawd at $9k a month it probably seems like trying to save approx $400 a month on a creative way to chop up pills is exhausting to think about. I know how that is.

@JLeslie: I think the charge is for administering the meds, which means giving them to the patient and making sure she takes them.

@jca Then they would have been paying the fee all along. I thought she used to swallow them, but now they need to be mashed? I might have misunderstood.

Plus, unless it is a family member it is unlikely the facility would allow a stranger to distribute medications for liability reasons.

I am thinking it’s unlikely the facility would let anybody, even a family member, distribute medications as the facility would ultimately be liable, should anything occur.

@jca @JLeslie The charge for administering the 2 meds once a day without having to crush them and mix with applesauce and spoon-feed is $8.50 a day. What has me so totally pissed off is that if they have to crush, mix and spoon-feed the very same meds, also once a day, then the charge is $35.36, and increase of almost $27 a day!! Everything else in the process remains the same: the qualifications of the person administering the meds, the ensuring that the right meds go to the right patient, etc.

That’s what I thought, that there is some huge increase for crushing the meds. That’s ridiculous. Even double the fee would be more palatable, but 4 times the amount? Come on.

@2davidc8: I would go to the administrator and ask why such a difference in the fee for the crushing. Ask the administrator “If all else remains the same, the only difference being the crushing, the cost increase is $27 per day. Does that make sense to you?” See what the administrator says When I say adminstrator, I mean the Director of the facility Go right to the top. Make it clear you are paying cash for this, it’s not like it’s billable to insurance or Medicaid or Medicare. She may waive the charge, you never know. It does not hurt to discuss it with her. She may agree with you. Don’t deal with anybody other than the Director on this. Be nice about it. Good luck and please post an update about whatever route you take.

I have to wonder how profitable these elderly care facilities are.

@jca I am going to pursue this with the director of the facility. I don’t want to be adversarial or confrontational, so I’m going to have to figure out how to phrase things politely yet get my point across. I will post an update here, in a week or so, I figure.

As promised, here is an update. Got together with my siblings and drafted an email to be sent to the director of the facility. I’d like to run it by my fellow jellies and get your input before I send it. Please remember that I’d like to be polite and non-confrontational at this time. After all, they are taking care of my mother. Here’s the text:

“I am still unable to understand the new charge of 68 points, or $35.36, a day for “medical
management”, while the previous charge was 16 points, or $8.32, a day.

As I understand it, the only difference is that my mom’s pills are now crushed, mixed with applesauce and fed (2 teaspoons) to her, whereas previously the pills were handed to her and staff watched while she swallowed them with water. There is no other difference in your drug-administration protocol.

I cannot see how such a small change in protocol can cause such a great (more than 4-fold) increase in “staff time.” Please explain, in additional detail, what accounts for the increased time. How much “extra staff time” are we talking about (previous procedure vs. current procedure)? What is the extra effort?

Since the Aricept and Namenda are now useless to my mom, we are discussing this with doctors and are considering ceasing the administration of these 2 drugs.

Zoloft also comes in liquid form. There would be no crushing of pills involved. If we cease the administration of Aricept and Namenda in any form, and use the liquid form of Zoloft, would her “medical management” charge return to $8.32 a day (16 points)?

Please understand that we need to ask these questions because we must manage her money responsibly and wisely.

(Some words are in quotes because they are taken from the director’s previous email to me.)

What do you think?

Good email. Good wording. I would just add an opening paragraph explaining who you are (even if he knows, it’s a good intro and reminder) and throw in some compliments about the facility and staff. Then at the end, something like “Thank you for your time and attention to this matter.”

@jca Thank you for your input. They already know who we are and what this is about, as this will be a reply in an email chain. I like your suggestions and will incorporate them in my email.