The Hidden Medical Costs of Electricity Bills with Home Ventilation: How to Better

Prepare Families for Homegoing

Charlie Blotner, MSW Intern

Seattle Children’s Hospital Pulmonary Department

2018-2019 PPC Social Work Trainee

The road to today

Previous PPC Working Project Titles

Identifying Biases In Hospital Policies: How They Impact Families

Practical Needs Assistance for Families on Pulmonary Service

Addressing Family Environment Structural Inequities in the 2016 Standardized

Criteria for Discharge of an Invasively Ventilated Child to Home

The Hidden Medical Costs of Electricity Bills with Home Ventilation: How to Better

Prepare Families for Homegoing

Why hidden medical costs of electricity bills

• Motivated by parent reports of increased electrical bills by upwards of $500 per month upon being discharged with their ventilator-dependent child

• Guided by the desire to be as transparent as possible about hidden medical related costs a family can expect once they leave the hospital

• Given the amount of time and attention put into non-medical costs, ie. strollers, transportations, and housing, preparation to pay electricity bills in order to keep a child alive should be taken just as seriously

Perspectives involved

• Nursing

• Home care

• Social work

• Care coordination

• PPC Family Partner

• Respiratory therapy

• Norco medical supply

• Power companies

Discussions with Care Coordination

1. What type of formal information do you provide families about going home with a ventilator?

2. How do you discuss going home in regards to generators and batteries?

3. Is the anticipated increase in electricity bill associated with these necessities for discharge discussed and planned for with families?

Service*

Implements standardized

process to discuss electricity homegoing

needs

Provides topical electricity bill assistance materials to

all families

Believes conversations about electricity bills and ventilators are relevant to

department

Service #1 𝗫 𝗫 ✓

Service #2 𝗫 𝗫 ✓

Service #3 ✓ ✓ ✓

Service #4 𝗫 𝗫 𝗫

*Services include: PICU, Rehabilitation, General Medicine, and Pulmonary and are not listed in order given small sample size

Theme 1: Lack of topical ownership

• A lack of topical ownership was identified as a barrier to preemptively addressing the financial hardship of an unexpected increased electricity bill with having a ventilator dependent child

• Disagreements amongst departments about whose job it is to have a conversation about increased electricity usage at home

Theme 2: Families don’t ask about their electricity bill before discharge

• Without a standardized way to discuss electricity bill increases, families who do, and families who do not learn about financial assistance may come from selection bias or simply chance information

Theme 3: Refer to subject expert

• Identifying subject matter expert both helps, and hurts families by shifting information and responsibilities for care coordination

• Some care coordination departments may not have ventilator experience, comfort, or high utilizing patients

Let’s get to the numbers It isn’t the cost of the individual ventilator that leads to the bill surge – it’s everything new that’s plugged in and demanding power, combined.

If the cost for electricity is 10.77 cents /kilowatt hour (which was the average usage charge for Washington state from June 2017 to June 2018) and the patient is on the device 24hrs/day, the average daily cost of use would be:

Volts x Amps = Watts 120v x 2.1A = 252 Watts per hour 252 Watts = .252 Kilowatts .252 kilowatts/hr x 24 hours = 6.05 kilowatt hours (kwh) per day

Cost of usage per day would be 6.05 kwh x 10.77 cents = 65.1585

Approximately 65.2 cents per day, or ~$20.19 a month to use a Trilogy 24hrs/day.

(Seattle Children’s Hospital Home Care Services, 2019)

(Seattle Children’s Hospital Home Care Services, 2019)

Equipment Amperage Needed Average monthly cost

Astral 150 Ventilator Trilogy 100

3.75-5.0 amps 2.1 amps

$50.00 $20.15

C/R Monitor 0.75 amps $30.04

Masimo Oximeter 0.3 amps $2.80

Devilbiss Stationary Suction 0.75 amps $30.04

Devilbiss Portable Suction 0.75 amps $30.04

Concentrator 4.3 amps $41.35

Air compressor 5.0 amps $50.00

Cough Assist 2.5 amps $14.54

Battery charger 6.0 amps $57.66

Infinity Feeding Pump 2.4 amps $23.08

ETCO2 Monitor 1.0 amps $9.61

T-70 Cough Assist 2.0 amps $19.22

MR-850 2.73 amps $26.25

Total: $384.63 increase in electricity bill per month

Responsibility includes providing resources

Low Income Home Energy Assistance Program (LIHEAP) is a one time heating grant ranging from $100 to $1000 that assists households whose incomes are at or below 125% of the federal poverty level

The Emergency Low Income Assistance (ELIA) program is for customers who have received an "Urgent" or "Shut-Off' notice on balances of $250 or more

Project SHARE will pay up to $250 towards the customer's Seattle City Light bill for ELIA and LIHEAP program participants if they make a payment within two weeks of referral or interview

PSE HELP (Puget Sound Energy Home Energy Lifeline Program) provides $100 - $1000 of assistance to Puget Sound Energy customers who use natural gas, live in Seattle, and are at or below 150% of Federal Poverty Guidelines

(Seattle City Light, 2018; Seattle City Light, 2019; Byrd Barr Place, 2015)

Duties and responsibilities to pulmonary families

• This increased electricity bill is an ongoing, unexpected medical expense that can absolutely level people

• Families may have different expectations when they walk out the door

• It’s not ok for the information families receive to be dependent on who a family interacts with

• Ultimately, this is about informed consent and preparedness

When do we have these conversations?

• Not advocating to discuss this with families in the middle of a code blue crisis decision

• Amidst early conversations about homegoing and teaching on the floor

• Families have the right to know what home life with a ventilator dependent child entails financially – and if it’s possible for them

Education about power shut off

1. There is no law that requires electric companies to keep the power on just because power is required for life sustaining support

2. There is no standard process for how, or when the lights will be shut off if bills go unpaid. This process is loosely dependent on pay history - if there was previously a “good” payment history, companies will wait “a lot longer” to shut it off. This could be months, or is could be sooner.

(Puget Sound Energy, 2019)

Payment after shut-off

Power companies will make a “medical emergency payment arrangement” where 10% of the past due payment must be paid within one week, and the rest can be split over the next 100 days. This payment plan is made after they have completely shut power off.

• You get two shots for the payments split over 100 day payments, and need a letter within 5 days stating this necessity

(Puget Sound Energy, 2019)

Advise families to request a lift seal support

• Perhaps the most important, preemptive and protective measure a family can take is to request a lift support seal. This must be requested.

• This is a special seal that is put on the meter where if someone comes to shut the power off, they do not shut it off, and instead place a 48 hour notice on the seal to allow for payment or communication.

(Puget Sound Energy, 2019)

Recommendations 1. Implement an “electricity discharge checklist” for a subset of

care coordination teams to discuss current status of power bill at home, electricity needs, assistance programs, and future bills when working with ventilator-dependent children. These checklists should be available for review for any service.

2. Create phrasing around how to have these conversations with families so that care team members feel equipped to discuss

3. Provide all families with a financial assistance program fact sheet for families whose child is ventilator dependent

4. Teach all vent-dependent families how to request an electric life seal support

5. Continue this discussion as an area for PPC trainee advocacy with insurance companies, state, and national legislature

PPC Family Centeredness

• Regardless of the increase in a family’s electricity bill – whether it be $3, $300, or $3,000, it’s a cost increase that families need to be informed about and feel prepared to manage

• It’s our job as a part of a family’s health care team to know about this, to provide education, and resources to work towards eliminating barriers to care on all fronts – medical and financial, and otherwise

Thank you!

This project is/was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS), under grant #T72MC00007/University of Washington Pediatric Pulmonary Center/PI: Redding, for total grant amount of $1,718,642. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.

References

Byrd Barr Place. (2015). Energy Assistance & Home Heating. Retrieved from https://byrdbarrplace.org/programs-services/energy-assistance-home-heating/

Puget Sound Energy. (2019). Bill and Weatherization Assistance. Retrieved from https://www.pse.com/pages/bill-and-weatherization-assistance

Seattle City Light. (2018). Assistance Programs. Retrieved from https://www.seattle.gov/light/assistance/assistance.asp

Seattle Children’s Homecare. (2019) Amperage letters Astral Ventilator [E-mail to the author].