Medical Service Assessment for "Level of Care"

[Pino]

Yesterday i had my first Medical Service Assessment for "Level of Care", as we call it in Germany. Basically someone, a doctor or a nurse, is coming to your home, asking a ton of questions and looks around. They are sent by the insurance company when you ask for help with care. They decide on the situation if it is possible to get extra help or some benefits.

My wife asked me to make an application for care help, because i did had some really bad days in the last weeks and was really out of order, so i could not take care of myself like i am used to and she had to do much more than usual. So i gave in, even it was an really embarrassing situation, i do not think of myself as "helpless" or in need for care, but the reality is sometimes different, not matter i like to accept that.

I was a little nervous for the visit, but the nurse was really nice and my age. Of course she needs to ask very personal stuff.
The incontinence is a very important point in this. She asked about cause, what kind of diapers or catheters i use, how many, how i deal with it on a daily basis.
I had to confess that when i am in a "crash" i am fully diapers depended. That was hard to say, although i am incontinent now for five years and had a lot of discussions with doctors and nurses about it.

At the end she wanted to see our bathroom and the supplies and medical aids i use. I had to walk in front of her upstairs, i have difficulties with that as well, for POTS mainly. Half the way up i realized my diaper would be very recognizable for her and of course she will see that i am wearing. Never had a thought about that before.
I am not sure i will ever get used to this kind of situations. And most embarrassing, when explaining my different kind of incontinence, i was talking about the "Reflex" type, which happens rarely and that, when lifting up my legs, while already having a slight urge, relaxing my back pain this way, my bladder will loose control.
And i am demonstrating it not thinking about it really and now guess. Right, I peed myself, i am an idiot. I turned red as a tomato, but she just asked the next question.
Very professional i must say, in contrast to me.

No idea what will come out of it. But my wife is pleased and, as all married men know: Happy wife, happy life.

 

[BigAl2]

My wifes insurance Co. keeps calling her about having a nurse come to the home. She tells them no. We don't want anyone snooping around. Also the hospital sends out surveys. If we have an appt a doctor who is on their staff. We will do the ones pertaining to the visit. But not the ones about our personal life. The last one is about our emotional state. We feel like they are digging.

 

[Jojo54]

Its interesting that you posted this today, I just had my annual assessment this morning. The usual questions and such most of the nurses just look at their computers and ask questions and try to cut you programs.
Today's was different, this nurse actually tried to find new programs. She asked the usual stuff and then asked if I had ic issues. I told her yes and that I wear diapers 24/7 and I not embarrassed by it. Then she asked if I wear pullups or tabbed, and I said both but prefer tabs. She said ok, she will try to get on on a program so my insurance will pay for some of them. Which would help me enormously. Then to my great surprise, she asked if I was wet, which I slightly was and she said let's change it, that will give my a chance to check for any rash or diaper sores. She did her check very professional and even showed me a easier way to stand and diaper myself in case I need to do it in a public stall.
I always dread these assessments but this one was a blessing.

 

[Pino]

Then she asked if I wear pullups or tabbed, and I said both but prefer tabs. She said ok, she will try to get on on a program so my insurance will pay for some of them. Which would help me enormously.

I was asked about types and cost as well, she liked to know if i pay for myself or get them over insurance.

I explained my problems with the insurance and said i mostly pay by myself. She just noticed it i think, but this is a general problem in Germany, officially all insurances have to pay, but in reality it is always a fight and you just do not get that what is needed, Everything more than a "panty liner" is considered "premium" and must be at least partly payed. Most of the time this part payment is more, than this product would cost without insurance on the free market.

My energy is to precious for that fight, so i buy most of my stuff without insurance. I do only get one type over insurance, the price is reduced and this is my best option for basic care. Everything else is without help from the insurance.

We can handle it financially, but i do not need 24/7 at the moment, so i am lucky with that. My nighttime issues are low for now.

 

[mickdl]

Hi Pino,

it‘s now probably to late - how ever - it is always a good idea to have a look into the assessment criteria beforehand… But anyway - for the next time you should have a look into this document:

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md-bund.de

cu
Mick

 

[Bigbabybret]

Yeah yearly i get someone stopping by and asking lots of questions, but i dont give a tour of my house to them, both i dont walk too good and also no need for that at all.

But they go through the paperwork for the PCA's and alike, which i'm changing one pca currently so i'll most likely have them stop over before too long again. Had a PCA that was lying and NOT doing thier job and activly getting/causing medication not being taken and/or being mixed up, not a good thing.

But, the service people will always want to stop by, and its up to you wether you want to have them in the house at all, also how far in the house too.

I allow them in my office and dining room (main floor right by the front door on purpose), but dont have them in any private spaces, outbuildings, studio, bedrooms, bathroms, even the laundries. No need they need to see/look in thoes areas. I'm not really worried about it, my pca's go there all the time, but having a county or insurance person beyond the front door/office in my house is just not needed.

So, if they want to stop by, just say no to anything they dont need to see, the people havent even asked to see any private areas, and only one asked about size, my answer was a bit amused as just looking at the house from the outside will show you there is plenty or room, tons of windows, and the smallest bedroom is 400sqft, so i just laughed about it, and DID NOT offer any look.

It's your house/place and you are NOT required to show them much if anything, especially any private spaces.

 

[Pino]

Hi Pino,

it‘s now probably to late - how ever - it is always a good idea to have a look into the assessment criteria beforehand… But anyway - for the next time you should have a look into this document:

Loading…

md-bund.de

cu
Mick

Hi Mick, i had a look on a short overview, i did prepare the meeting as good as possible and the outcome was better than expected for me.
The nurse was really knowing and understood my daily problems better than most or all doctors i know.
Most important: I will get help when my wife is not able (absence) to help me out. That was one of my main issues.

 

[mickdl]

Hi Pino,

good to hear that it went well. I'll give you my fingers crossed that you'll feel better soon.

cu
Mick