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My significant other was recently moved from home to an LTC/SNF due to his advancing dementia and my inability to care for him any longer. I am sad but relieved that he is now safer there (theoretically speaking). He is a twenty year plus veteran and was receiving his meds through TriCare for Life and Direct Scripts. The LTC requires that we use their pharmacy for his meds. The first month's invoices were more than ten times higher than the meds delivered to our home from Direct Scripts. I have contacted everyone involved and basically, have been told that the TriCare for Life does not accept the facility's pharmacy and there is nothing that can be done because my SO's new residential address does not match the address that TriCare has attached to his file. Do I or should I try to change his address with Tri-Care for Life? Do I have to change it again if he should go to another facility. As a side note: This forum has been very helpful and cathartic for me over the past year. Thanx to everyone in the forum. My SO is having a very hard time adjusting to his new environs. I visit every morning through lunch, and I get calls at all hours of the night from the staff to get me to talk to him to calm him down as they aides try to assist him after dark and sundowning takes over his poor broken brain. My life is still not mine, but I can't walk away as the rest of his family seems to have done. Thanks again to all forum participants.

The SNF my ILs lived in tried the same thing - telling me we had to use their pharmacy. Turns out in my state that is illegal and when I pressed the "illegal" point, they backed down. I did have to change the order for how their meds were packaged and they were delivered directly to the nursing home while my address was their permanent address.
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Reply to OncehatedDIL
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Yes, the facility is now your husbands legal address. My Mom was in an AL and I had to use their pharmacy but my insurance was still billed to.

I would make it very plain to the Director of Nursing that you are only to receive calls from the facility in case of emergencies. Like him being sent to the hospital. Because staff does not go with them, you would need to be there. Calls can be made at appropriate times if information is needed or DH takes a turn. But you are not to be contacted all hours of the night because he is sundowning. That is why he was placed, so staff would take care of these kinds of things. The only thing you should be called about is what they have to do legally, like falling out of bed. If you use a cell, put your phone on Do Not Disturb. I set mine from 11pm to 9am. Your there daily. No reason for calls. The nursing staff can talk to you when they come in.
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Reply to JoAnn29
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swmckeown76 Nov 27, 2024
Perhaps that depends on the state. My late husband was a private-pay long-term care resident for over 6 years, 4 months due to frontotemporal degeneration. Twice during that time, I took him to the DMV to update his state ID. Its address was the condo where he lived with me prior to entering long-term care and that was considered his permanent resident. Since he was a private-pay long-term care resident, we could itemize on our taxes as well (and get a large refund). So I filed both joint state and federal income tax returns for us both every year. I even had to do that the during the last year he was alive, even though he died on January 29 of that year. I also found out that it was less costly for me to have his medications on his Part D drug plan mailed to our condo than to use their pharmacy. They weren't thrilled but they accepted it, probably because the monthly amount we paid monthly for his care was a *lot* more than they got from the approximately 70% of the residents who were on Medicaid for a portion of their long-term care expenses. His dentist also prescribed a low dose of Valium before his dental checkups to make it easier to cooperate at the dentist. They forgot to give it to him once and I pitched a fit. I had to cancel the dental appointment, but since we'd used that dentist for years, they rescheduled it without charge. Next time, I didn't leave the Valium with them the day before like I usually did. I came to pick him up in time to give him the Valium, wait for a while for it to kick in, and them drove him to the dentist.
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The facility is his new legal address BUT, problematic here is that you will have to, if you are his bill payer and the POA, get all bills that you now pay sent to YOU in your own home and in your own name. This includes taxes information, CPA, utilities, insurance, cable and etc.
Basically don't change his address until all bills are coming to YOU safely. Then change only his name and residence with post office. In our state DMV handles voting stuff, so there's that notification as well for his senior ID card and etc.

If this isn't done, all things registered in his name will go to the facility. For a while you can go through his mail or have it held for you, but it can become a problem: was a real problem for me when I was POA and Trustee for my brother while I lived in No. Cal and he in So. Cal. His facility had to be his registered residence for voting and other reasons, but I had to have anything related to taxes, billing, his Medicare info, insurance sent to me. Each entity required different papers from me, and sometimes his permission by phone.

The first year was an incredible mess, and then things started working well. This was 5 years ago and I am told by a friend recently that the nightmares are exponentially WORSE because every institution and billing and insurance is outsourcing to East Indian Populations of H 1 B work visas in the USA, and they work out of their home (know of an enclave in New Jersey, don't have correct information, basically kind of hang up the phone. Companies save on average about 25% by outsourcing their Human Resources, pensions, cable and etc. and wow, is it ever not working well for us, those being "serviced". I surely do wish you luck. You will plow slowly through it. Take heart.
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Reply to AlvaDeer
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cover9339 Nov 27, 2024
Exactly right. At the facility main insurance issues (billing, declines etc) were handled by someone working remotely.
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One of the reasons, since meds for residents can (and probably are) delivered right to the nurses station and/or their cart when they are passing them out, it makes it easier for the nurse and facility as well as the company the facility uses gets new business in the form of supplying meds the facility residents need.
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Reply to cover9339
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I suggest that you contact the VA and ask to talk to a Social Worker and find out the answer to these questions.
1. Will the VA provide the medications to the facility.
2. If not how will the VA cover the cost of the medications.
3. Would he qualify for placement in a VA facility? May depend on where and when he served and his % of Service Connected Disability if any.
4. Would he qualify for Hospice?
If he qualifies for Hospice the medications would be provided by Hospice. And the VA does have Hospice and they would then take over the meds....
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Reply to Grandma1954
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Talk to representatives from TriCare and VA to get his medications sent to you - if at all possible. Usually pharmacies for LTC put all the medications in single packs on cards to make it easier to store and give. Bottles of loose medications are a no-no.
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Reply to Taarna
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I guess it's upbto you if you want to pay the price gouging that some people see as okay. I'd change the address only it was absolutely necessary. Like not being able to deliver the meds yourself.
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Reply to Ronnyj
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Norconium8: The facility is his legal address.
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Reply to Llamalover47
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You better check with the Facility if having medications sent to you is allowed. The facility has a pharmacy they deal with. That pharmacy should except most insurances and 90 day refills. The OTC will be higher. I used to look for sales and stock up. Could not do it once Mom was in care.

I was not allowed to bring any meds from home. The facility needs to have the med come directly from their pharmacy. They need to check for errors and if any their pharmacy has to correct those errors. There is a phrase for this but it comes down to they don't want too many hands in the pot. It goes from pharmacy, to Nurse making sure the meds are correct. To the LPN who does the med pass. Sort of a chain of command.

I am sure your SO is not the only person who receives Tricare. Maybe you need to call them to see how this kind of thing can be handled. IMO, this pharmacy should be able to take Tricare's prescription provider and go by their rules.
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Reply to JoAnn29
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