As a nurse, I have found that the first thing to be figured out is how to make your patient as happy as possible. However, there are others that require attention to their happiness before my patient’s happiness can be addressed. It is said that you can’t make someone else happy; happiness comes from within. I think that is true for me but I don’t think everyone else got the memo.
I had to make many nursing professors, not to mention a particularly difficult organic chemistry teacher, happy by answering their test questions appropriately. After I had done enough of that, I had to make the state happy by answering their questions in the manner to which they wanted. Just to be clear, occasionally the answers my professors wanted and the answers the state board of nursing wanted were not necessarily the same answers. Truth is an elusive, gray area, but I was able to fulfill both quotients of happiness enough to get a piece of paper that granted me the opportunity to try to make others happy.
Then I had to make my employers happy by doing all the things they wanted me to do. Mostly employers have to make lawyers, doctors, the government and insurance companies happy. All of us are in the “make-people-happy” business. Often, the people who are in charge of the patient are family members who have legal documents putting them in charge of any decisions that need to be made for the patient. Add them to the list
I loved nursing school. I learned how to basically take care of patients with various illnesses. Making sick patients happy usually entails treating and or curing the disease; not in my job description. That is what doctors do. Mostly I help people be more comfortable until they are treated or cured by the medical end of health care.
All along the way, I pay attention to making the doctors happy by following their orders for treating the patient while keeping in mind the needs of hospital administrators, lawyers, insurance companies and Uncle Sam.
Once everybody else’s needs are met, then as a nurse, I can focus on finding out what a patient needs. Usually, it does not take very long to meet those needs. Of course, the documentation of what I do has to meet medical, legal and insurance company criteria. Lawyers tell us that if it is not written down, then it didn’t happen.
This brings me to a recent job I took helping a family to interpret their long-term care policy. The spouse had a dementia diagnosis and his doctor had said he met the criteria to qualify for an assisted living facility. The insurance company required three months of home care before the facility benefit period kicked in. This was called elimination period. I am not sure why it is called that, but it can be overwhelming to a family who works hard to keep loved ones at home as long as possible. Also it can be overwhelming to have someone come into your home even if you desperately need help.
After interpreting what I could from the policy, I referred the wife to several agencies and recommended she get them in as soon as possible, as the dementia process was becoming very difficult for her to handle by herself. She asked that I help her with that process and I agreed to do so. I met with the patient and, after talking with the insurance company and finding that they would accept an independent provider, I began providing care.
It was a lengthy and tedious process to make the insurance company happy. At first, the customer service people were very open with information about their requirements for providing this benefit. Then there seemed to be discrepancies among the different customer service people’s description of what it takes to make the insurance company happy. Sometimes I think what really makes insurance companies happy is for people not to make any claims on their policies. But that is a topic for a whole different article.
I finally asked to talk with a supervisor or one person who could consistently give me the information I needed. This particular insurance company does not use any email for communication with clients and I think the reason is because there is no paper trail of information. Once I received a call from the benefit analyst, she insisted that I had not been doing what would make them happy. I had to rewrite all my documentation and I was not able to bill as an R.N., but I could only bill and be paid on a home health-aide pay scale.
I agreed to do so because it made the insurance company happy and it made the family happy. I was happy, too, interestingly enough, because there really weren’t any doctors and lawyers around to make happy so I could focus all my attention on meeting the needs of this family.
I was very pleased to have finished this job, with the patient getting into an excellent facility and his wife able to get back to her life without constant worry about what her husband was doing.
I have talked with others about their long-term care policies and what I have learned is that they are all very different. When you take out a policy and pay your monthly premiums, it brings you peace of mind that everything will be taken care of when you need it. Insurance company agents are there to soothe you into that much-needed peace of mind and often do not know the mechanics of how the policy actually works. I found this to be true, as the agent told us what the customer service people told us and there were large, though not impossible, discrepancies in the interpretation of the policy with the person with the final say – the benefit analyst.
So do I have any advice for you to increase your odds of having your long-term care policy actually making you happy? The best time to take the policy out and review it is when you are not in crisis. Reading it is often confusing and it really doesn’t matter what the policy seems to say, it is how the benefit analyst interprets it. Call your insurance company and talk only to the person who is in charge of your policy and get the answers in writing, though they are hesitant to do that. Also, make sure you are socking away enough money to meet the financial responsibilities needed in order for the policy to come into effect.
The pursuit of happiness is a long road with many detours, potholes, and traffic jams, but with a little foresight with map reading and perseverance, happiness is attainable – if you are careful about what you ask for.
Lenora Trussell, R.N., is an end-of-life tour guide. She is available for presentations, workshops, and as a travel planner for that pesky end-of-life journey we are all destined to take. If you have questions, comments, suggestions, she can be reached at firstname.lastname@example.org.