Seeking medical emergency advice

[El Gringo]

Hi everyone.

I'm in the midst of a family medical emergency and as a young adult this is my first experience as such. I figured I'd reach out to this financially savvy community to help me understand all my options. My 60 year-old mom has been in the hospital for the past week because of a viral brain infection she mysteriously contracted. It is affecting her cognitive skills and we are hoping for a full recovery, but that may not happen. Not matter the case, it will be a long recover.

My 62 year-old dad is the main bread winner, as my parents been living off of his salary and stashing away my mom's salary. However, my parents' insurance has been through my mom. We are currently applying for FMLA for my mom. I am inquiring into other benefits that might be available through her employer, such as disability.

My dad was laid off a little over a year ago from his job and now works through a contractor. His contract is up in February and we don't know if he will have work after that or not. He's only got one week of PTO left and then has to take unpaid leave through FMLA if he needs more time off to care for my mom.

My understanding is that my mom's insurance has a $3000 deductible, but she has close to $6000 in an HRA.

Fortunately my parents own their house and they have a large chunk of cash in a savings account. I wish they had a little more stashed away in retirement savings, but it's by no means a bad amount.

Some questions I have:

-Will there potentially be other hospital costs we should anticipate/see if insurance will cover?
-Are there other questions I should ask her employer in regards to benefits?
-Are there other questions my dad should ask his employer for providing the availability for him to care for my mom?
-We won't know yet what kind of care my mom will need when she leaves the hospital. She will still be administered an antiviral via IV when she leaves the hospital and returns home and hopefully will continue to see more and more mental progress (everyone has told us that this will be a slow and long recovery). If she still has any confusion, when she returns home, she will need to have someone stay with her at all times. We have a wonderful community of friends and family who are volunteering to stay with her over the next few weeks so that my dad can return to work. But what if she needs long-term care? What options should we look into/questions should we ask?

I don't know if anyone can provide any insight or suggestions to our situation, but I figured I'd reach out to the MMM community and crowd-source your knowledge and experience.

Thanks.

[footenote]

I'm so sorry you are faced with a serious medical situation.

Contact your mom's employer's HR department. They can walk you through what benefits she has. (Or if she was great at keeping documentation, look at the the "Summary Plan Document" (SPD) paperwork she received annually describing her benefits in detail.) Ask HR what her sick leave coverage is. Often there is both Short Term Disability (STD) and Long Term (LTD) leave for illness. Commonly STD pays in full and LTD covers some portion of wages.

She may also have more robust disability coverage. This might be a separate, additional plan or just a very solid LTD plan. If she does, find (or request from HR) a copy of the disability plan and figure out coverage.

Keep good documentation of your mother's condition. You may need to provide that to the STD, LTD or other disability insurance carrier to prove eligibility for benefits.

Knowing what this will cover should help you figure out financials.

If she is disabled very long term, explore Social Security disability options.

Regarding long term care, call your local United Way's 211 line for help figuring out what community resources might be available to you.

Best of luck for a speedy and complete recovery for your mom.

[SunshineGirl]

Gosh, I'm sorry for your situation. I think the first and most important thing you can do is ascertain if your mom has short-term disability insurance and/or long-term disability insurance. Second, make sure your dad has term life insurance that would cover living expenses for your mom in case something happens to him.

Little financial things you could do: Since your mom won't be driving for awhile, would selling her car be a good idea? It would provide some cash and save on car insurance.

What public benefits might be available as your parents' income drops substantially, if it does/will? It might help just having all the facts.

Those are the things that come to me at the moment. I'm sure others will offer more ideas.

Be well. 

[Abe]

This is not my formal medical advice, as that cannot be given without examining someone first. With that disclaimer, I would anticipate further medical expenses, including potential returns to the hospital. Encephalopathy places a person at higher risk of pneumonia and falls resulting in fractures, especially if they are older. She may also require some sort of home health or occupational therapy for months to years. See if her insurance covers some of the following:

- home health (also ask if it covers longer than 30 days after discharge from hospital)
- outpatient occupational therapy (may need this depending on severity of cognitive deficits)
- inpatient rehabilitation (and coverage length after a hospitalization), she may need this if she develops a complication and is hospitalized for a long period of time.


I wish your family a speedy recovery.

[bogart]

I'm so sorry about your mom's illness.  That sounds really scary and I hope she will recover fully and as quickly as possible.

On the health insurance, most policies involve deductibles, which you've identified, and co-pays, which you don't mention.  A 20% copay isn't unusual, so in such a case besides the deductible there would be charges (to your mom) of 20% of anything up to that amount, typically up to some additional limit.  Having navigated this myself  I can tell you that assorted charges you have to pay may not count against the limit, e.g. in my case prescription co-pays didn't "count," I had to pay them, but they weren't included in calculating the amount I had spent so far that year.  Tedious (at best).  Keep good records, and be sure you have full information about what the policy does/doesn't cover.  Don't be afraid to ask questions/challenge charges.

Though your mom's not "old" it may be worth looking into whether there are resources in your community available to seniors that she would be elegible to receive.  This kind of thing (and the age cutoffs for the 60+ set) seem to vary a lot by community/state.

Given your parents' ages it is possible that your dad could file for early retirement through Social Security, defer (not collect), but still have your mom be able to collect (likely a small amount, but all the same) on his record, if she cannot return to work.  Down the road, it sounds (again, depending on when and whether she can return to work) like she may need to look into purchasing heallth insurance privately.  Hopefully as the ACA rolls out that will give her good options.

Depending on her needs and capabilities and their availability and personalities, her helpers may find that technology makes the task less burdensome -- for example a "baby" monitor could make it easier for someone in her home to keep an "ear out' for her without having to be very nearby at all times. 

Good luck to you and your mom and dad as you navigate all this.

[HamhockHammock]

Given your parents' ages it is possible that your dad could file for early retirement through Social Security, defer (not collect), but still have your mom be able to collect (likely a small amount, but all the same) on his record, if she cannot return to work. 

Sorry about your situation. Regarding the above, your mom can't get benefits from from her husband's record yet. Spouse's benefits start at 62. If you think there is even the slightest chance that she'll be out of work for a while, i would file for social security disability on her own record, if she's insured for it.

[Dicey]

Since your mom won't be driving for awhile, would selling her car be a good idea? It would provide some cash and save on car insurance.

Whatever you do, El Gringo, do not sell your mom's car! It is way too early in the game to make such an assumptive move. If/when she makes a full recovery, she could be mighty pissed at you. If she doesn't, God forbid, you'll have plenty of time to cross that bridge.

You could notify her insurance company that she will not be driving for a while to get her insurance rate reduced, based on the number of miles driven per year, but even that could be a can of worms.

You are asking the right questions, and others have offered good suggestions. It sounds like your parents are relatively financially stable. I'd recommend focusing all your might on giving both of your parents the emotional support they need to get through the next few weeks. Best of luck to all of you.

P.S. No offense SunshineGirl, but if I sold my mother's car while she was ill, she'd kill me!

[Rebecca Stapler]

If she needs LTC, she may be eligible for Medicaid, depending on your state's rules. In some states, if you're married then you can have significant savings and a home and still be able to get Medicaid LTC.

You may benefit from having a discussion with an attorney who specializes in elder law (www.naela.org is a good place to start finding one) or disability law. But there may also be free legal resources in your community because of your mother's age.

[frugaldrummer]

Have they identified the virus?  Or are they just assuming it must be a virus because they can't find another cause? 

If it's the latter, be sure to ask about the possibility of autoimmune brain disease.

[bogart]

Sorry about your situation. Regarding the above, your mom can't get benefits from from her husband's record yet. Spouse's benefits start at 62.

Whoops, yes, that's right.  My bad.

One more thought for the OP or more accurately, OP's parents:  if in a given year your medical expenses exceed 10% (I think) of your income and you itemize, you can claim the amount over that threshold as a deduction (so if e.g. it's 12% of income, you can deduct that last 2%).  It's not a huge help, but it's something.  Your mom may want to strategize when she uses HSA funds (as those are already tax-sheltered and don't "count") to maximize tax-deductible expenses, if this becomes a possibility.

[El Gringo]

Thank you everyone for your support, well-wishes, and advise. This is all very helpful. This type of illness has a lot of ups and downs - progress isn't just a linear path. But that being said, yesterday and today we've seen a lot of progress and are encouraged. It's still a long road ahead, and it's still to early to know what effects will be permanent. But after a few dark and depressing days earlier this week, we're more hopeful now.

A few questions/comments in response:

if in a given year your medical expenses exceed 10% (I think) of your income and you itemize, you can claim the amount over that threshold as a deduction (so if e.g. it's 12% of income, you can deduct that last 2%).

This is great to know! Thanks!

Your mom may want to strategize when she uses HSA funds (as those are already tax-sheltered and don't "count") to maximize tax-deductible expenses, if this becomes a possibility.

It's actually an HRA, which is a little different. I was only familiar with an HSA until her work told me about her HRA. An HRA only come from employer contribution (not employee) and is only used to reimburse actual expenses. Employees forfeit unused money in an HRA when they leave the job, unlike an HSA which employees can take with them.

Have they identified the virus?  Or are they just assuming it must be a virus because they can't find another cause? 

They have identified the virus. It's herpes simplex virus, which is the same virus that causes cold sores. This one just happened to get into the spinal cord and work it's way up to the brain, causing confusion, memory loss, and speech problems!

Keep good documentation of your mother's condition. You may need to provide that to the STD, LTD or other disability insurance carrier to prove eligibility for benefits.

What specific documentation would you suggest/you think would be necessary?

[footenote]

Re: documentation, ask hospital administration staff what type of documentation they are most often asked for by insurers and/or employers. If your mother's hospital has  patient advocacy or ombudsman staff, they would be a great place to start.

Insurers and/or employer will require documentation of your mother's doctors' assessment of her condition and of her ability to work. I encourage you to work on this now as you will want to secure short term disability benefits from her employer now. And for (we hope unnecessary) longer term assessment, it will be helpful to have continuous documentation compiled (vs going back to square one to re-create it).

Congrats on the encouraging progress!

[frugaldrummer]

Research suggesting that topical DHEA may be helpful:
http://www.jimmunol.org/content/160/6/3060.full.pdf
http://link.springer.com/article/10.1007%2FBF01310481

Oral may work too, but the first study suggests that conversion of the DHEA by the skin into androstenediol may be helpful as well.  There are other studies showing DHEA to be helpful in acute brain trauma as well.

Also make sure they check your mom's B12 level; not a cause of the encephalitis, but her brain will need adequate B12 to heal properly.

[El Gringo]

Research suggesting that topical DHEA may be helpful:
http://www.jimmunol.org/content/160/6/3060.full.pdf
http://link.springer.com/article/10.1007%2FBF01310481

Thanks for the advise. Do you know of anything written in more laymen's terms regarding DHEA?

Also, thanks everyone for your insight. Tomorrow I am hoping to meeting with HR, an insurance rep, and a social worker at the hospital. We've seen continued mental progress. Her memory, speech, and personality are gradually returning to her. Unfortunately she's been in the hospital for 10 days now and still can't kick the fever. The doctors are somewhat confused and surprised that her temperature hasn't stabilized yet. If her temperature does stabilize, then they'll be ready to release her from the hospital (and continue to administer her antiviral via her IV at home).

[SunshineGirl]

Since your mom won't be driving for awhile, would selling her car be a good idea? It would provide some cash and save on car insurance.

Whatever you do, El Gringo, do not sell your mom's car! It is way too early in the game to make such an assumptive move. If/when she makes a full recovery, she could be mighty pissed at you. If she doesn't, God forbid, you'll have plenty of time to cross that bridge.

You could notify her insurance company that she will not be driving for a while to get her insurance rate reduced, based on the number of miles driven per year, but even that could be a can of worms.

You are asking the right questions, and others have offered good suggestions. It sounds like your parents are relatively financially stable. I'd recommend focusing all your might on giving both of your parents the emotional support they need to get through the next few weeks. Best of luck to all of you.

P.S. No offense SunshineGirl, but if I sold my mother's car while she was ill, she'd kill me!

No worries! It wasn't clear to me what level of involvement the mom has in these discussions at this point.

[fallstoclimb]

Feel free to PM me if you need help accessing resources for the longterm recovery.  My MIL had a traumatic brain injury a couple of years ago and lives in the DC area.  She went from the ICU, to a long term care / skilled nursing facility, to staying at home with a full-time helper, to going to a 'brain school' a few times week.  She's mostly doing ok now. 

Older people's brains heal slowly -- my MIL couldn't talk a couple days out of the coma, couldn't remember anyone a couple weeks out, couldn't think logically a couple of months out and had attacks of rage over nothing.  These days her cognitive functioning isn't too bad, and although she does struggle with managing her emotions, its much, much better than it was.  Don't assume too much based on her current level of functioning.     

I'm so sorry you are dealing with this -- there's not a whole lot that is scarier than watching a loved one be turned into a different person.  Those were the worst months of my life.  I hope she keeps coming back to you. 

[El Gringo]

Thanks again everyone for the support! From what I can gather from the insurance company and HR, it seems like everything at the hospital will be covered after the deductible. My mom also has a ton of saved up Long Term Sickness hours. She has enough paid leave to last her through at least February, maybe even March. After that, she has both short-term and long-term disability insurance through work, covering about 66% of her salary. The social worker at the hospital has not responded to my requests to talk, so I'm still in the dark about government assistance, such as Social Security disability, but we have a lot of buffer time to figure that out.

I've seen a lot of improvement with my mom over the past few days. She still has a fever that she's been unable to kick, but we're seeing a lot of progress mentally. She actually might be released from the hospital tomorrow (Doctors haven't made a final decision yet). She still has a long road ahead of her, but we're encouraged. Her confusion has largely gone away, and her speech impediments are a fraction of what they once were (though still noticeably there). One of the biggest struggles right now is her short-term memory. She remembers a lot, but there's a lot she still struggles with. She's taking Keppra though to ensure she doesn't have any seizures, and a coworker told me today that Keppra affected her short-term memory when she was on it. So we'll see how that progresses. And yesterday she got out of her bed and walked down the hall for the first time since she was admitted 11 days ago (we, of course were walking beside her)! Fortunately we got her into the hospital and started treating the virus relatively early. So we've made a lot of progress, but we've still got a long ways ahead!

Feel free to PM me if you need help accessing resources for the longterm recovery.

Thank you so much. I'll def send you a PM!

[El Gringo]

Hey everyone. Just wanted to give you an exciting update! My mom has been out of the hospital for two weeks now. Today she got taken off of her antiviral medicine. Mentally I would say she's back to at least 90%. She still occasionally struggles with short term memory and finding word she wants to use when speaking, but every I see improvement! And she's still got plenty of time for more potential improvement. I still have hopes of her returning to 100%, but considering that herpes simplex encephalitis can be severely debilitating or even deadly at times, she's already progressed much more than I ever anticipated! Thank God that we got her into the hospital as soon early as we did!

[Norrie]

Oh man, that is great news! Congrats on having her home and healing. I hope that she continues to improve every single day.

[Dicey]

Great news, El Gringo! Glad you didn't sell her car, LOL. Most of all, thanks for keeping us updated on her progress. I hope you'll continue to do so and that her recovery will be complete.

[El Gringo]

Great news, El Gringo! Glad you didn't sell her car, LOL. Most of all, thanks for keeping us updated on her progress. I hope you'll continue to do so and that her recovery will be complete.

Haha, well actually that's another story! She normally drives a van, and when my dad was driving it the other day, the transmission failed! So now they are looking at getting a new vehicle. I'm trying to convince them to not buy another van, because they have no need for one....but so far I haven't succeeded...At least they always buy used...!

She's still on anti-seizure meds though, so she won't be driving for a little bit of time.

[giggles]

Spouse's benefits can start at 62 IF your spouse has already filed.  UNder full retirement age, she MUST file for retirement or disability under her own record before they can even look at spouse's benefits.  And then she will only get the spouse's benefit if her husband has file, and her age 66 amount must be less than half of his age 66 amount.

SSA disability on her own record is the best bet at this time.