The Yellow Wallpaper

I received a letter from the VA today, informing me that my mother had been denied the Dependency and Indemnity Compensation (DIC), as I suspected she would be. I should explain that the application I submitted actually served two purposes: one, to apply for DIC, which is awarded based on service-related medical conditions; and, two, to apply for a death pension for the surviving spouse based on medical conditions that demand “aid & attendance.” My father did not die of a service-related medical condition, so I knew that my mother would not qualify for DIC.

On the other hand, the VA did not make a determination regarding the monthly death pension (Aid & Attendance), which does not surprise me. In October, I wondered whether I should wait until my mother actually moves into assisted living to submit the application–I really couldn’t imagine the VA awarding a death pension based on anticipated expenses. And they will not. They did, though, send along VA Form 21-8416–”Medical Expense Report”–and Form 21-0518-1–”Improved Pension Eligibility Verification Report (Surviving Spouse With No Children)”–and explained that when either her income decreases or her medical expenses increase I can submit both forms to be considered for Aid & Attendance benefits.

My only quibble is that they did not consider her prescription costs this time around because these “were paid prior to your date of claim and weren’t considered to be recurring. Recurring expenses are those which occur on a regular basis and can be accurately predicted.” But I may not have represented the situation clearly enough on the application; I should probably have indicated how long she has already been taking these drugs and not have assumed that the VA would extrapolate from one monthly statement. In any case, I’ll be submitting the revised information to them shortly–although I actually have until December 31, 2008, to send them and still be considered for medical expenses paid after my original application date of October 25, 2006–so I’ll know enough to be more precise.

I didn’t expect to hear from them this soon–a month and a half after applying–so I’m impressed with the expeditiousness of the Providence office.

On a related note, I got a call from the assisted living home that there would almost certainly be an opening in January. I’ll have more particulars on Monday, but I guess I feel both relief and fear at this news. Relief because I really did not want to deal with this before Christmas, and fear–well, I probably don’t need to go into that right now.

We have been on an even keel for the past few weeks. I’ve been going into work for a few days each week, which has improved my outlook, and my mother has not been in the grip of the depression she’s experienced so often in the past. She is still losing ground cognitively, but she has improved, affectively. Her doctor has actually reduced the daily amount of her antidepressant–she had been on 7.5 mg. until her insurance, Humana, stamped their big foot and denied coverage of this amount. So it was back to 5 mg. and, interestingly, an improvement in mood. But she also has the round-the-clock presence of either my sister or me–she is not left alone at all–which is certainly alleviating her previous anxiety at being left alone.

I also visited with the social worker at the local Alzheimer’s Association, who was wonderful to talk to. She spent nearly an hour with me, discussing mostly my ongoing anxiety about assisted living. She also loaned me Moving a Relative with Memory Loss, an excellent book about how (and whether) to talk to your loved one about the impending move, and what to expect of yourself during and after it. It’s a reassuring, practical guide–I’m about to order a copy for myself from the publisher.

So here we are. It’s going to be such a big change that I can’t even think too much about it right now. All I know is that I’ve been knitting ferociously for the past few weeks–I’m finishing a sweater (not the Bohus…yet) and beginning a large lace shawl. As I knit I try to focus on the possibility that I’ll be completing this shawl in my own home. I try to imagine that my mother, after her adjustment period, settles into assisted living and actually enjoys the social stimulation. She realizes (in her way) that Liz and I will always be around, no matter where she lives. I probably shouldn’t spin too pretty a picture for myself, yet.

Just an update on my Aid & Attendance application: I mailed it–certified mail with a signature receipt–about 3 weeks ago. Within a week of mailing I received a letter from the regional VA Office here in Providence telling me that the VA does NOT accept applications based on Power of Attorney. They claim that POA is too broad, even though my particular POA document specifically states that I am given the authority to apply for benefits and pensions.

So I had my mother sign the application and re-sent it to them. I had explained to her earlier that I was applying for a benefit based on my father’s WWII service, but I had decided to sign it in the end, since I had initiated and completed the application. I thought that would be the most forthright way of applying, given that I had already been assigned her Power of Attorney. I reviewed the application with her in a very broad way before asking her to sign it, knowing that she trusts me.

Now I’m revisiting Medicare pt. D. I spent several months last year trying to figure out the new prescription insurance, before selecting what I thought would be “The Plan.” But that was the optimistic first year–the pieces are now falling into place, forcing many of us to recalculate.

I had selected Humana’s top plan for my mother because her monthly prescription costs average $600. The monthly premium was relatively high–$55–but that plan had no deductible and covered the “doughnut hole”, and I was willing to pay a higher premium and copays in order to avoid having to pay 100% of her prescription costs after we had reached the $2400 ceiling, which would have occurred sometime during April.

My mother’s monthly premium will increase to $87 next year and the plan will cover only generic drugs during the gap period. There are no plans in my area that will cover brand-name medicines through the gap period in 2007, so I’ve chosen a plan with a much lower premium. Basically, we’ll be paying 12 months of premiums for about 6 months of coverage, including the catastrophic coverage.

A good overview is here.

So I’m counting on the newly Democratic Congress to make good on their promise to work toward negotiating lower prices with the pharmaceutical companies.