In late 2011, Delaware Elder Mediation Services, Inc., was formed to provide mediation services to the elderly and disabled in Delaware. The all volunteer Board initially consisted of 5 individuals and later expanded to 7. I was the primary mediator and also served as the Corporate Secretary and Executive Director. My duties included accounting, fund-raising, outreach, webmastering, and all office duties. – all as an unpaid volunteer.

         At first we thought we would charge $75 per person for mediations unless a participant was low-income. But one of first mediations taught us a lesson. A mother, who was living in public housing, requested mediation with a daughter who was living in what had been the family home. The daughter was a busy, working mother but, at first, she was quite receptive to the idea of mediation. However when I mentioned a $75 per person fee, her response was “I have spent enough money on that woman. I am not spending another cent.”  Fortunately, I was able to obtain some funding from the State of Delaware as compensation for teaching half-day seminars on the nature of elder mediation.  This state funding paid enough tto cover our initial cost of liability insurance. Later we received small grants from the Chichester duPont Foundation and the Longwood Foundation that provided funding for the corporation’s basic expenses.

         We offered mediation free of charge in order not to discourage people from coming to the mediation table. And over the next 4 years we helped many people, not only through the mediations that were held but through referrals to other sources of assistance when mediation was not appropriate. But the number of elder mediations that were actually held did not increase appreciably.

       I firmly believe that elder mediation is an essential service that will only become more important as the population ages and the pressures of care-giving impact their families.  Nevertheless, after close to four years of operation, it became very apparent that elder mediation would be difficult to sustain as a stand-alone operation.  And for me, due to a personal change of circumstances, doing the grant-writing, bookkeeping, newsletter-writing, out-reach, etc. was beginning to be a burden. So in the fall of 2015, the Board agreed to the dissolution of DEMSI as of the end of the year. The few assets that DEMSI had were donated to a local 501(c)(3) public charity that offered other mediation services and indicated it would also offer elder mediation services as well, but that has not as yet come to fruition.

       I am very grateful to the volunteer Board who were so very supportive for those four years and I am very grateful to the families that did use the mediation services and benefitted from them. I personally am still committed to helping families resolve conflicts and while I will not forgive all fees, I am willing to forgo a portion of my fee for a family member who is unemployed.

     You may ask why it is so difficult to get families to the table.  There are numerous contributing factors including.

  • Elder mediation deals with a vulnerable population. One mediation was scheduled where all participants were willing and eager to have their views heard in mediation. Then the week before the mediation was to occur, Dad went into the hospital with breathing issues for the fifth time that year. In another a participant was diagnosed with breast cancer the day before the mediation.
  • Elder mediation is not compulsory and there is no incentive for a participant with the upper hand to come to the table. A number of cases were referred to DEMSI by Adult Protective Services where to quote a worker, the actions of one family member were “immoral but not illegal”. Since the elder was “safe,” APS would not intervene. And, since APS has a "no harassment" policy, the staff would not stick around to try to pressure the “immoral” family member to the table. Why would the wrong-doer come to the table? In one case one daughter moved Mom from the family home to that daughter’s home and refused to give a sibling access to Mom. The case was referred to DEMSi but when I talked to mom I got the same response that APS had received. Yes Mom did want to see her other daughter but she did not want to have mediation if the child she was living with did not want it. If Mom is competent and not willing to stand up for her rights, there is nothing APS can do and there is no way to force mediation.
  • People change their minds. In one instance where daughters were arguing over where Mom would live, mediation was scheduled and then one daughter decided she would give up and Mom could move out of state to live near the other daughter. Mediation was canceled. Then daughter decided she wanted one more summer with Mom near her and she could move in the fall, but there was still no mediation.

(The following is for general information and should not be relied upon without reviewing your circumstances with a Medicare expert.))

   I have been a volunteer trying to help people with Medicare for over 7 years, but it is only within the last year that I have dealt first hand with one of the least understood complications in the Medicare program.

       There are limited situations when a Medicare Supplemental Insurance (also called Medigap) Company must permit a Medicare beneficiary to subscribe regardless of any pre-existing conditions:

  • During the initial enrollment period – when the individual first turns 65 (even if they have been a Medicare beneficiary following 24 months of receiving Social Security Disability payments).
  • During a delayed initial enrollment period – when the individual or the individual’s spouse was actively working so that the individual was covered by an employee group health plan (EGHP) when the individual turned 65. (The initial enrollment period is delayed until the individual or his spouse loses the EGHP or stops working whichever first occurs.)
  • During a special enrollment period – which can happen when someone moves to another state or loses employer retiree health coverage (which must have included prescription drug coverage creditable to Medicare prescription drug coverage) through no fault of their own or when an individual disenrolls from a Medicare Advantage Plan (also called a Medicare Health Plan) during the trial period (the first 12 months of membership in the Plan).

         The so-called “open enrollment period” between 10/15 and 12/7 each year is not an opportunity to enroll in a new Medicare Supplemental Insurance Plan.  During that time of the year every beneficiary can review their options for prescription drug coverage for the following year and enrollees in a Medicare Advantage Plan can change their choice of Advantage Plan.

A Medicare Supplement Insurance provider will be happy to have the business of a healthy Medicare beneficiary and will accept an application at any time. But anyone who has been ill or had a hospital stay will either not be accepted or only accepted at a higher premium.

         Where this gets even more confusing is when a participant in a Medicare Advantage Plan is beyond the 12 month trial period and wishes to disenroll. The Medicare process allows them to return to original Medicare and obtain Part B coverage of doctor visits, test, durable medical equipment, etc. without any penalty. But there is no guaranteed right to a Medicare Supplemental Insurance Plan without consideration of pre-existing conditions.

One couple, who came to the Delaware Medicare Assistance Bureau for help, wanted to disenroll from their Advantage Plan and the Medicare supplement was willing to take the husband but, because the wife was in the hospital overnight in December, the supplement would not accept her until July. If she disenrolled, she would be without coverage for 3 months. The disenrollment periods for Medicare Advantage plans are only once a year, so her choice was to take a chance for couple of months this year or wait until the next disenrollment period and hope she did not have occasion to visit the hospital in the six months before the next disenrollment period.

           Another couple were disenrolling during the twelve month trial period but the enrolling agents did not know about the special enrollment period. Not only did they seek to impose a higher premium on the wife reflecting underwriting but they initially denied acceptance in the prescription drug plan because it was not the open enrollment period. After several hours on the phone, we were able to correct the mistakes and get them properly enrolled in both the Medicare Supplemental Insurance and prescription drug plan.

            This is why I cringe when I see the TV ads for the Medicare Advantage Plans. I feel as if the ad should end with a warning similar to the drug-side-effect warning in drug ads. A quiet voice speaking very fast would say something like: “Beneficiaries enrolling in a Medicare Advantage Plan should be aware that if they disenroll after the 12 month trial period, a Medicare Supplemental Insurance Plan may subject them to underwriting, use of providers outside the plan network may increase copays and total copays may exceed the Medicare copays and deductibles in some instances.”