Patient Waiver Of Medical Necessity Form: Fill & Download for Free

EditedBefore I get into this long pro-life/pro-healthcare blog (which is largely made up of excerpts), I would like to take this opportunity to dispel some myths.Firstly, opposition to abortion can arise from both an understanding of science and basic human empathy. In my case, it has NOTHING what-so-ever to do with "theology", as at least one writer here has alluded to.Secondly, progressive-leaning Catholics (I am not Catholic) often DO support protecting the most vulnerable among us--the unborn--AND social justice reforms, such as universal healthcare.Thirdly, most in the quite socially conservative Libertarian party are pro-abortion and anti-universal healthcare.So please, let's just stop with the stereotypes.I wrote this post several months back on a pro-life website. I have recently updated this thread considerably.I will start out by clearly stating that Obamacare would NOT be my first choice for a national healthcare system. It continues to make health insurance too expensive for many by allowing “private insurance middlemen" to gobble-up huge amounts of premium-payer money. Most of the deductibles and co-pays associated with ACA plans are outrageous, and discourage people from getting medical care when they need it.IF Obama had included a public option to his plan--as he had originally pledged to do--the costs mentioned above would likely be much less than they currently are.While some paste a very "rosy" picture for healthy people prior to the ACA, they simply refuse to even consider how unregulated private insurance companies treated some of those who needed health care the most.The best parts of the ACA are the patient protections and the Medicaid expansion.Patient protections include barring insurers from excluding those with pre-existing health conditions, or from imposing life-time insurance caps It also requires that mental illnesses be covered, and it requires that pregnancy and childbirth be covered. It also expands the age from 18-22 to 26 that adults can remain on their parent's health insurance. These reforms have helped millions get and retain coverage.The Medicaid-expansion associated with the ACA has ALSO greatly expanded health care access in the states that have adopted it.On balance, Obamacare has saved lives over the 'healthcare system" that was in place before its enactment.Studies show that if Obamacare were straight up repealed and we returned to the pre-ACA era, 22 million people lose insurance, and more than 24,000 preventable deaths would occur each year. [1]"Prior to the ACA, about 12.6 million non-elderly adults were denied coverage due to having a pre-existing condition in the previous three years. This represents 36 percent of all consumers who tried to purchase health insurance directly from an insurance company in the individual insurance market"."Another method for denial was through a process called rescission. This involves applicants with expensive conditions, such as cancer, being denied coverage based on their initial health status questionnaire. Insurers retroactively cancelled applicants’ entire policies if any condition was missed. Policies could be cancelled if medical conditions were unrelated, or applicants weren’t aware of the condition at the time. Entire families’ coverage could have been revoked, as well"."Before the ACA’s start, 35 states offered those consumers denied coverage in the individual insurance market or otherwise unable to obtain insurance a high-risk pool option. This insurance imposed pre-existing condition exclusions for six months to one year. During this time, the actual condition that made someone uninsurable isn’t covered. These insurance options are also typically much more expensive than traditional plans". [2]Below is an example of how rescission worked to prevent even "insured" patients from receiving the life-saving treatment that they needed."Robin Beaton found out last June she had an aggressive form of breast cancer and needed surgery -- immediately.Her insurance carrier pre-certified her for a double mastectomy and hospital stay. But three days before the operation, the insurance company called and told her they had red-flagged her chart and she would not be able to have her surgery. The reason? In May 2008, Beaton had visited a dermatologist for acne. A word written on her chart was interpreted to mean precancerous, so the insurance company decided to launch an investigation into her medical history.Beaton's dermatologist begged her insurance provider to go ahead with the surgery. Still, the insurance carrier decided to rescind her coverage. The company said it had reviewed her medical records and found out that she had misinformed them about some of her medical history.Beaton had listed her weight incorrectly. She also didn't disclose medication she had taken for a pre-existing heart condition -- medicine she wasn't taking when she originally applied for coverage." [3]Remember the talk about "death panels"? Guess what, they are REAL, they are the US private health insurance companies!Now, an example of how lifetime insurance caps were used to deny patients care, sometimes causing DEATHS.Most average-health people likely paid little attention to the $1 million life-time cap that private insurers placed on individuals pre-ACA, unless they or a family member became seriously ill and needed continuing healthcare. Kelly and Tom Treinen were no exception. In fact, they chose their plan because the premiums were lower than another plan offered to them which offered a $5 million lifetime insurance cap."Then doctors diagnosed their teenage son, Michael, with an aggressive form of leukemia in May 2007. His treatment called for 10 doses of a chemotherapy drug that cost $10,000 per dose. A 56-day stay in an intensive care unit cost about $400,000. Michael reached his $1 million lifetime maximum in less than a year. The Noblesville, Ind., family had to issue a public plea for help after a hospital told them it needed either $600,000 in certified insurance or a $500,000 deposit to continue preparing for a critical bone marrow transplant.The Treinens raised $865,000 in six days. Money came from all over the United States and as far away as Germany. But Michael’s cancer had stopped responding to chemotherapy, and he died May 25 before he could receive the transplant". [4]This 6-year-old boy was luckier, because he was born (prematurely) just SIX DAYS after Obamacare had abolished life-time caps on medical care."He was born seven weeks premature and spent the first six months of his life in the hospital. He still has significant health issues due to a rare genetic disease. He has been under anesthesia more than 45 times". His family had spent more than $2 million during his FIRST hospital stay.His family is lobbying to keep that patient protection in place, while Republicans have given mixed messages about this provision as well as other ACA patient protections. They often speak of leaving them in place, but the House-passed Trump alternative to the ACA--the 'American Health Care Act' would allow big employers to reinstitute lifetime payment limits". [5]There is the uniquely "American" problem of ill individuals aging out of their parent's insurance plans.Before the enactment of the ACA, the cutoff age for young adults being taken off their parent's plan was 18-22. Under the ACA, it is 26, which is STILL not good enough to prevent the deaths and suffering of patients such as Alec Raeshawn.Alec had a very TREATABLE condition, Type 1 Diabetes. He required regular injections of insulin to live. He died of Diabetic ketoacidosis, which is when your body doesn't have get enough insulin."Your blood sugar gets so high that your blood becomes highly acidic, your cells dehydrate, and your body stops functioning".Alec made around 35,000 a year, which was enough to disqualify him from both Medicaid or insurance subsidies in Minnesota."Alec's pharmacist told him his diabetes supplies would cost $1,300 a month without insurance — most of that for insulin".The "best" plan that he could find had a $450 monthly premium, and an annual deductible of $7,600. "Alec decided going uninsured would be more manageable.''Alec was found dead less than a month after going off of his mother's insurance."His family thinks he was rationing his insulin — using less than he needed — to try to make it last until he could afford to buy more. He died alone in his apartment three days before payday. The insulin pen he used to give himself shots was empty". [6]The implications for the mentally-ill would be grim if key provisions of the ACA were repealed, which Trump attempted to do in his first year in office. Not only would people dealing with mental health conditions or drug dependency have had to pay much higher premiums, many may not have been covered at all!States would have been able to get waivers that could have allowed insurance providers to deny coverage of some health services, including mental health and substance abuse treatments. As the article referenced above has pointed out, if those with serious mental health conditions are left untreated, suicides are at serious risk of increasing."Adding to the number of suicides (assisted or not) will be some of the millions of mentally ill people who will be taken off their medication". [7]Since mental illness as a driver of mass shootings, legislation should be proposed to make it easier--rather than HARDER--to access mental health treatment. [8]Owing to the SCOTUS ACA ruling, Medicaid expansion--which was DESIGNED to be nationwide, is left to the option of each state.The only reason possible for many Republican governors--who have the best tax-supported medical care available for themselves and their families--to refuse to implement this life-saving portion of the ACA is their political hatred of former President Obama, period.A new University of Michigan study estimates that 15,600 people nationwide have died because their states refused the Medicaid expansion. The annual rate of such avoidable deaths in Texas alone is 730, according to the studies. [9]Florida is another state refusing the Medicaid expansion. This is the story of how one of Florida's residents--and her now three orphaned children--paid the ultimate price for living on "this" side of the Atlantic, and in a "red" state.Charlene Dill is one of thousands--if not millions--of US citizens that should have been eligible for Medicaid-expansion.She was a 32-year-old mother of three. She made too much income to qualify for Florida's regular Medicaid plan, but too little to qualify for federal subsidies to buy a plan on the ACA's private exchanges.She had a documented heart condition, but went years without the care she needed because she couldn’t afford it. She collapsed and died on a stranger’s floor on one of her THREE jobs when she was attempting to sell a vacuum cleaner. [10]Last, but certainly not least, are uninsured/underinsured women with unplanned pregnancies. Before the ACA became law, sometimes even INSURED women discovered that their private health insurance plans specifically EXCLUDED pregnancy care and childbirth!This Patheos article explains why pro-lifers should favor KEEPING--and EXPANDING--the Medicaid expansion portion of Obamacare."The cost of an uncomplicated vaginal birth is about $9600. The cost of an uncomplicated Cesarean is about $15800.24 million people will lose their healthcare if the Republicans get their way (If all or major portions of the ACA are repealed). If that happens, and if any of these 24 million people happen to be female and fertile, chances are many of them are going to get pregnant anyway. When they do, they’ll face a choice. Are they going to find a way to cough up between ten and sixteen thousand dollars and hope it doesn’t cost more? Or are they going to find a way to cough up about five hundred dollars, the average cost of an abortion?"Neither Crisis pregnancy centers, nor churches, are not financially equipped to pay women's pregnancy and delivery costs. They rely on referring women without medical insurance to Medicaid, or to Obamacare plans that include financial subsidies. [11]"Tuley-Lampke says she's seen several women decide to continue their pregnancies after learning that their medical care would be provided. After pregnant women get basic health care, she says, they can then focus on their education and career". [12]As briefly as I can, I will respond to some commonly heard criticisms regarding the government getting involved with health care.Some bring up the issue of 'medical tourism’ into the US because our healthcare is thought to be so "envied" around the world. Even "if" the health care in the US does “exceed all others" (which is a highly questionable assumption), that is little comfort to Americans who cannot ACCESS it.I will also note that many US citizens go abroad for affordable medical care each year. Some are even SENT abroad by their insurance companies! [13]When it comes to prescriptions, many Americans and even state medical systems are turning towards our Canadian neighbors."Some US states are proposing to import medicines in bulk from Canada, where many drugs are cheaper thanks to government price controls (emphasis mine)". [14]Another argument concerning the ACA is that some people were forced to change their healthcare plans owing to the fact that Obamacare mandated that all health insurance plans had to meet certain standards (discussed above), just as many other life-and-death industries do.I do not relish having to defend the ACA for the reasons that I already stated, but I cannot ignore such mind-numbing distortions of reality.The insurance policies that were "lost" under the new ACA standards were usually 'junk' plans to begin with that did not include such necessities as pregnancy care, eye care, prescriptions, etc. REAL, compliant, health insurance plans were then made available to those individuals. [15]I will touch upon the subject of health care costs.Regardless of the anti-guaranteed healthcare propaganda that has been drummed into people via conservative media, most countries with universal healthcare pay LESS per-capita for health care than the US does, AND they have better outcomes."Despite spending more on health care, Americans had poor health outcomes, including shorter life expectancy and greater prevalence of chronic conditions"."Even though the U.S. is the only country without a publicly financed universal health system, it still spends more public dollars on health care than all but two of the other countries"."Finally, despite its heavy investment in health care, the U.S. sees poorer results on several key health outcome measures such as life expectancy and the prevalence of chronic conditions". [16]Finally, this tragic death.Deamonte Driver was a 12-year-old, homeless child, who died an AVOIDABLE death in 2007, from an abscessed tooth. That is correct, something as treatable as an abscessed tooth!His family's Medicaid coverage had lapsed, and his mother had difficulty finding a dentist that would treat him. [17] If the US had universal healthcare, Deamonte--like everyone else--would automatically be covered.References:[1] The GOP plan for Obamacare could kill more people each year than gun homicides[2] Before the ACA, 1 in 7 people were denied coverage because of pre-existing conditions[3] Because Fox Asked, Here Are Examples Of People Who Were Denied Health Care[4] Health Insurance Caps Leave Patients Stranded[5] A 6-year-old, whose life depends on the ACA, heads to Capitol Hill[6] Insulin's High Cost Leads To Lethal Rationing[7] Trumpcare Will Be Catastrophic For People With Mental Health[8] Republicans say mental healthcare prevents mass shootings. They've tried to gut mental healthcare[9] "How many people die because Texas refuses Medicaid Expansion"?[10] 32-Year-Old Florida Women Is Dead Because Her State Refused To Expand Medicaid[11] The American Healthcare Act Is Not Pro-Life[12] How Crisis Pregnancy Center Clients Rely On Medicaid[13] 1.4 Million Americans Will Go Abroad for Medical Care This Year[14] States consider bringing prescription drugs from Canada to US as costs soar[15] White House tweet wrongly says Obamacare led to fewer insurance options[16] U.S. Health Care from a Global Perspective[17] Twelve-Year-Old Died in 2007 From Abscessed Tooth After His Family's Medicaid Lapsed

Yes, This is an excerpt from “Caregiving 101: A Practical Guide to Caring for a Loved One “ It will explain a bit about how to find and hire good in home help.Chapter 2.Calling in the ProsDespite all the best efforts of you and your team of caregiver heroes, there may be a time to call professional caregivers into your home. There is no shame in this. You and your team are not giving up. These folks have walked this road before. They are usually quite experienced, skilled, and knowledgeable. They can be a tremendously helpful part of the team. Professional help can fill gaps in difficult times so other caregivers can rest and rejuvenate. They can perform tasks that may be beyond the comfort level of your team. They can help lead, teach, and often defuse potential growing conflicts that are common. Asking for experienced paid help means you care more for your loved one than for your own pride, so don’t be afraid to reach out for help.We had set parameters for when we would call on paid caregivers. This helped put everyone, even Karen, at ease. It allowed us to step back from our caregiver roles for a time and be just friends, family, lovers again.Finding Good Professional Caregiver HelpSo how does one find these elusive nightingales of mercy? The first and maybe the best resource are the people in your caregiving team: your friends, neighbors, and the people all around you. Chances are, they know someone who knows someone who has been very effective in a caregiving situation.Many professional caregivers are well connected. If they can’t take the case, they may know someone who can. This is how we found the best caregivers for my mom.If you are connected with hospice, a comfort care nurse, a social worker, or a caseworker, they may be able to help you find the right professional caregivers. They may know individuals for hire as independent contractors, or they may work with an agency that places paid caregivers.Also, if you live near a school with a nursing program, the admissions people there may know of aspiring students who need work experience. Students are usually bright and enthusiastic, but they do often lack experience.A home-care agency is a company that employs and often trains and oversees caregivers in various aspects of health care, including professional home caregivers. They usually have set hours and shifts, though this may be negotiable. They charge you a fee and may work with third-party payers like your state’s Medicaid program or your private disability insurance. You can find an agency yourself online using keywords such as “home care.”Self-directed care falls somewhere between hiring a caregiver yourself and using an agency. In this model, the agency can help introduce you to the caregiver, help train them, and help you with managing the financial resources available for paid caregiving. One agency I talked to, Consumer Direct Care http://consumerdirectcare. com/, actually helps you with payroll and taxes and sometimes acts as a bridge between your Medicaid coverage and the paid caregiver. Even with all this assistance, this model is less expensive than going through a traditional agency, and the savings canresult in higher pay for the paid caregiver. Higher pay usually attracts better caregivers.Some states have allowances written into their Medicaid program for the self-directed care model as well as many other wonderful services. To find out about programs and resources in your state, search for your state Medicaid officewww.Medicaid.gov or just type “Medicaid” and the name of your state into your search engine. You may also be able to search out such agencies yourself with the keywords “self-directed care,” “self-determined care,” or “person-centered care.”…Selecting the Right ProfessionalSo many questions revolve around bringing someone into your home:• Will they be able to be there at the right times?• Do they have the skills and abilities your loved one needs?• Do they possess the temperament and personality that work with your loved one and your team?• Most importantly, do they connect and care well for your loved one and just “feel right” to you and your loved one?Trust your gut and the feedback from your care network, and invite your loved one to participate in the selection if they are able.If your loved one needs more medically related skills from a paid caregiver, such as wound dressing, care for lines like IVs or catheters, more advanced bowel or bladder care, or more advanced help with mobility, look a bit more closely at the letters behind the caregivers’ names. Below is a short list of what some common abbreviations mean in relation to training and expertise. Requirements and specific skills-and-practices acts—laws that say what each type of caregiver can and cannot do—vary somewhat state by state.Companion. This is more of a job title than a professional designation. This person may or may not have any formal training yet they can be critically important in helping someone who cannot be left alone safely. They might help with meals, light housekeeping, laundry and transportation. They cannot help with medication and probably cannot help with any more advanced nursing care. You also may see the general home care designations of direct support professional (DSP), and caregiver.People working under these designations may or may not have experience or training.Certified nursing assistant (CNA). This is probably the most common professional designation in caregivers both for in the home and in facilities such as hospitals and nursing homes. In most states, they can perform basic medical-related tasks such as changing a dressing and caring for lines (like catheters or IVs) under the supervision of a nurse or doctor. In some states, this designation is written NAC or NA-C. To earn the certificate, they must complete 75 hours of coursework and hands- on skills work, as well as take a written and skills test. NA-R means they have taken the coursework and registered but have not yet received their certificate.Certified medication aid (CMA). This person works under the supervision of a nurse or doctor and can administer most medications but not by central lines or chemotherapy depending on the state.Personal care attendant (PCA). This means the person has completed 16 hours of coursework (about three days) plus specific orientation to that case.Attendant care worker (ACW). This designation began in Arizona as a base level of training required for that state’s Medicaid reimbursement. It is now gaining favor as a benchmark for other states. It requires that people sit for an examination that includes a written test and a practical skills test. Generally the coursework to be ready for the test takes about 40 to 60 hours of focused learning.Home health aide (HHA). These people are usually capable to do many of the same basic tasks as CNA’s but their focus is more on care in the home. The formal education requirements vary state by state. However, all states do require training for someone to be certified as an HHA, with the minimum at the time of this writing being 75 training hours.…Going Through the Selection ProcessOnce you know the kind of professional help you want, make a list of candidates. I like to create a folder for each one or at least a page of paper with their name, contact information, their work experience, and any notes. On this paper you can write reminders for the questions you might want to ask during the interview. Here is a link to a fairly generic but nicely comprehensive list of possible interview questions from Find Child Care, Senior Care, Pet Care and Housekeeping http://www.care.com/senior-care-senior-caregiver-interview-tips-p1145-q7744646. When you are interviewing, write down the answers in a way that makes sense to you. Also record your overall impression of the person. I like one to five stars and a quick note as to why. Then you’re ready to contact them.Phone call. Chances are, when you call you will leave a message and ask them to call back. If they don’t call back, cross them off your list. Don’t give out your address until you are ready to set up an in-person interview. Try for at least five candidates to interview.Telephone interview. You can ask many basic questions quickly in a phone interview. Describe the days and hours you will need and the level of specific needs your loved one has, such as minimal assist with bathing, dressing, toileting, help with mobility, etc. You may ask about the person’s availability, transportation (do they have a reliable car?), allergies, whether they smoke, etc. You can ask about their work history, especially their last few jobs and why they left. You can ask what types of clients they like most and least. If they still seem like a good fit, you are ready for an in-person, in-home interview.In-home interview. For the best chance to see the person interact with your loved one and gain a good sense of your loved one’s reaction, do an in-person interview in your home. Your loved one is really the person making the choice. It’s their care. Introduce the candidate to your loved one. Does the interaction feel right? Is the person respectful, interacting well, fitting in with your family? Take your time, don’t rush. Be open. Listen. Be prepared with your care plan, the Carebook, and your interview sheet. Explain fully your needs and expectations. You may review their availability, training, prior work history, how their last job ended, and anything else that wasn’t answered well on the phone.Because I know what I’m looking for, I like to give the person an opportunity to work a little in the interview process. Can they help with whatever is needed at the time? Is there a skill you know is needed, like a maximum assist transfer? Can the candidate do it with you? Ask what their questions are. Listen, and be honest in your answers. Ask for at least three references, two of which should be professional references from people they have worked with. You may also consider a background check. Each state has its own and you may find the form by typing “background check form” and the name of your state into your search engine. Lastly, talk about salary and any benefits. You will need their social security number if you are going to hire them legally.Cultural considerations. You may notice that many agency caregivers are immigrants. This is not necessarily a problem. In some of the Muslim cultures of Africa, the Philippines, and Southeast Asia, caring for people in need is more honored than in our culture. If you are considering hiring an immigrant, can you and your loved one put aside any prejudices that may exist? Questions that are most important are more about the ability to understand each other’s communication and whether your loved one is able to connect with them comfortably.References. Yes, actually call the people the candidate says will give a good review. If it’s a professional reference, ask about the specifics of what the person did there. If the candidate stated what they were paid, you may confirm it. Confirm why they left the position. Watch for words like “difficult,” “challenged,” or other negative words. Don’t be afraid to ask whether you should hire the person. Many human resource policies will not allow a reference to tell you more than the dates of employment, but ask any questions you want, to get what you need. I like to ask things like “Would you hire them again?” or “Hypothetically, is a person like her great with nonverbal patients?” to try to get at the information you need.For a good video about hiring an in-home caregiver, check this YouTube from Washington State’s Department of Social and Health Serviceshttps://www.youtube.com/watch?v=L3skIWEmpas&feature=youtu.be.Managing Hired HelpOnce you have hired your new helper, be there to help familiarize them with care and routines. This will make everyone more comfortable and give you a chance to watch them work with your loved one. Again, are they respectful? Do the two interact well together? You can also get a better view of their skills. Once they are up and running, you will want to stop by unannounced. It’s just another way to check up on their good work.Don’t be afraid to let a paid caregiver go if the fit isn’t good. You’re paying them, you’re the boss; think of it as moving the employee on to a better-fitting job. Everyone benefits from a good match, and nobody benefits from a poor match.…Salary and BenefitsWage information varies region by region and over time, so I won’t give specifics here. You can look up expected salaries for your area by searching “salary” and the professional designation, for example, “salary CNA Seattle” or “salary homecaregiver.” Salaries are considered for 2000 hours per year, so you may calculate an hourly rate by dividing the salary by 2000.…Payroll and TaxesIf you are hiring from an agency, the caregiver is an employee of the agency so you do not need to worry about the payroll. If you hire a caregiver directly, they are your employee or a contractor. The simplest way to handle this is to file and provide them with an IRS form 1099 for independent contractors at the end of the year (or the end of their work for you, if that happens first). Keep track of your payments by tracking the checks in your bank account and/or get a receipt book.…Paying for In-home CaregiversWhen my mom was sick, her neighbor told us to get a pocketful of $100 bills and just go out and find good caregivers. This is in fact what many people do for shorter-term in-home care.Under Finding Good Professional Caregiver Help earlier in this chapter, we discussed Medicaid. Maybe that agency can help; they can be tremendously helpful with many resources for those who qualify. Many states have opted in to a waiver system that allows Medicaid to provide in-home support for people. To learn if your loved one qualifies and find out more about how Medicaid can help, see Chapter 8, Medicare, Medicaid, and Private Insurance. You also can look up your state’s website with the keywords “Medicaid” and the name of your state. One of the most clearly written and informative sites I’ve seen is Home - Long-Term Care Information http://longtermcare.gov/ medicare-medicaid-more/Medicaid/.Medicare and most private health insurance policies do not provide for home health aides or caregivers. They will provide for “skilled” in-home care. This means skilled medical services such as physical therapy, occupational therapy, speech therapy, and skills that require a nurse or nurse’s aid under the supervision of a nurse if the person is homebound. They will do this for a limited time following a recent hospital stay for the illness or injury being treated and require medical necessity and physician’s orders.Medicare supplements do not pay for in-home caregivers. They also tend to follow the Medicare guidelines listed above and are mostly focused on helping pay the amounts Medicare does not cover.The Department of Veterans Affairs (VA) provides caregiver help to veterans registered at a VA for health care. They can provide support to caregivers as well as other professional home health services. Programs include home-based primary care, home health aides, respite for family caregivers and a variety of other caregiver services. The website www.caregiver.va.gov/ is an excellent website for family caregivers to find support and services. There is also an established VA’s Caregiver Support Line 1-855-260-3274 toll-free to ask about caregiver support services. Each VA has a Caregiver Coordinator who can help caregivers find out about how to qualify for additional benefits.The Aid and Attendant program may give increased allowances to qualifying veterans to help with long term care and respite care (see below). If you don’t already have a VA caseworker, contact your VA health care team for your specific case. If your loved one is not already registered at a VA, find your local VA office by typing “Veterans Affairs” and your city into your search engine or go to www.va.gov.Various Veterans Service Organizations can you navigate the VA system and help with getting VA benefits. The Veterans of Foreign Wars (VFW), Paralyzed Veterans of America (PVA), Disabled American Veterans (DAV), and other Veteran Service Organizations may also help you navigate the system.Private disability insurance does not directly pay for in-home caregivers, but Social Security Disability (SSDI) might through Medicaid. If your loved one is already enrolled in SSI, check with their caseworker or your local Social Security office.Private long-term care insurance or combination life insurance and long-term care insurance usually does pay for home health aides and companion services.This is private insurance you buy when you’re healthy. There are many rules to follow. Read your policy carefully and ask a trusted advisor to help you decide when to start using the insurance, because most policies limit the total time you can use them. Be aware that once your insurance company gives the OK for a service, you may need to pay out of pocket for an “elimination period,” and once you start using the insurance for anything, it may start the clock ticking on a payment window that closes according to the time stated for your policy.Some life insurance policies may allow for your loved one to tap into their life insurance benefit in the form of an accelerated death benefit (ADB). Your loved one may be able to use this if they are terminally ill or have a life-threatening diagnosis, needs long-term care services for an extended amount of time, and/or is confined to a nursing home and incapable of performing activities of daily living (ADLs) independently. Typically this amount is capped at 1 percent of the death benefit per month for home care, 2 percent for nursing home care, and 50 percent total. You may want to consider that taking a lump sum of money in a person’s name may create a situation where their assets exceed the amount allowed by Medicaid or Supplemental Social Security and may jeopardize those benefits.Chapter 8, Medicaid, Medicare, and Private Insurance, has more about all this, including links to help you find a good lawyer.Making sure it “Feels Right”I leave you with this story about hiring Karin, a most wonderful caregiver who helped us when my mom was sick.Karin is a registered nurse (RN) and has a company called 24/7 staffing. She identifies herself as a terrible businesswoman.24/7 is a tax ID and a loose network of caregivers of different backgrounds and educational and credential levels, from RNs, respiratory therapists (RTs), and CNAs to folks with no credentials who are low-cost and there to be companions.Karin doesn’t take a fee or percentage from the other people in her 24/7 network. She gets her work entirely by word of mouth; the work comes to her. Usually friends of friends, family, or other people who have gone through caregiving situations say “I know someone …” If she cannot or will not take the case, she often can turn to one of her contacts in 24/7 who she feels will be a good fit. Likewise they may turn to her.The most important thing to Karin when deciding to take a case is the “fit.” It’s a feeling that she should be there with this person, with this family, in this home, helping them through this journey. The moment she met my mom, Karin knew she should help us. They reached out to each other, shook hands, and Mom smiled and then took Karin’s hand in both her hands. Their hands were warm together. She was meant to be there.* * * * *Often our most complex and important decisions are not made on what we think of as a rational basis. They are far too complex for the little wedge of neurons on the front of our brains for that. We make decisions about who to let into our homes, lives, and caring hearts because it feels right. There is so much more to it than all these forms and questions can outline. Of course we did the interview, checked the references, did all the steps listed above, and they all checked out ok. Those are important to avoid a nasty situation and help provide structure, but this is how Karin decides to take a case: if it is a good fit. This is also how we decided too. It felt right.