Hoboken Mom Condo Living
Planning the long-term & juggling the everyday

Ever since I became a parent, my life has been fraught with interruptions. Work, showers, sleep, nothing is sacred to toddler needs. I find the sleep issue to be the hardest. I need about 6-7 hours of sleep a night in order to function reasonably well, and when I get woken up mid-sleep cycle, I just don’t feel rested. So then I fall asleep when I am putting my son to be at 9pm, wake up at 1am, and can’t get back to sleep. That is why all my emails are always timestamped at ungodly hours.

And then the next day, I can barely wake up when my husband is leaving for work, and the whole thing repeats itself. It drives both of us crazy, but I can’t seem to break the cycle.

So when a friend told me about Serenity Zen beverage and gave me a few cans, I figured, why not? At zero calories, it’s not like it’s going to break my careful calorie watching. So I stuck a few cans in the fridge, had one the following night, and thought it was a fluke when I started passing out over my keyboard around 11pm. The taste was pleasant, kind of like cream soda mixed with ginger ale.

I am not a big soda drinker, so it was about a week before I looked in the fridge for another can of Serenity. Much to my surprise, the three cans I thought I put in there were gone. I shrugged, stuck another three in there, and forgot about it for another few days, and those cans disappeared too.

That was when I yelled out to my husband, “Sweetie, did you drink the Serenity I had in the fridge?” Turns out he has been having a can a night for the last week. My husband travels overseas for business, so when he visits countries in an opposite time zone (ie. Malaysia, 12 hour time difference) it really messes with his internal clock. He started drinking the Serenity because he liked the taste, but kept going when it actually caused him to fall asleep at the right time every night.

I asked him, “Does it really work?” And he said, “Yeah, I got woken up in the middle of the night last night and felt really groggy, when normally I can’t go back to sleep.”

We are now on day 10 of my husband’s Serenity streak, and it shows no signs of abating. The guy has a pretty stressful life, so if something this small can help him relax at the end of the day, I am all for it.

Nobody wants to think about losing their job, but it an unfortunate fact of life in the US. Worse, in the current recession, the unemployed are facing lengthy joblessness. I believe in backup plans even in the best of circumstances, but how do you plan for a worst case scenario?

For starters, I advocate two years of emergency savings. I determine how much that is by undergoing an annual month-long austerity spending plan. I have established our baseline household spending at $5k/month. That works out to $60k/year, so two years of emergency savings is $120k. That $120k would come from liquid savings (socked away in a money market account) and retirement investments (Roth IRA first since you can withdraw without penalty), gulp. I do not advocate borrowing from your 401k because you have to pay that money back if your employment ends.

A good friend of mine is facing an expected layoff in six months. She works in the pharmaceutical industry, which has been quietly contracting for years now. The best time to find a job is when you are already in one, so I encouraged her to look for a new job outside of pharma. However, she should also take the next six months to come up with a backup plan, or preferably several plans.

When you are facing fiscal emergency status, the name of the game is to buy time. You want to maximize income and stretch it to last as long as possible while you try to find a new revenue source to recreate your income level. If my friend has six months of employment, then three months severance followed by 10 months of unemployment insurance, then she has essentially a year to get back on her feet, with another eight months of income supplementation ($584/week at the highest NJ unemployment benefit).

No one is immune from job loss, but advance planning can soften the impact, which is especially important if you have children. Life has its ups and downs, and it is a mistake not to take advantage of the ups to prepare for the downs. Sock money away while you are earning, because you might really need it down the road.

According to the Washington Post, healthcare reform will not change one thing in my life. My insurance coverage and taxes will remain exactly the same. Aside from the immediate goodies in the reform bill, how is this affecting my household budgeting?

For starters, I am slowly letting go of the mentality that the other shoe is about to drop. I am a member of Generation X, a tiny generation sandwiched between the vast bulk of boomers and Gen Y. Too young to benefit from pensions, too old to experience helicopter parenting, many of my friends and classmates were latchkey kids scarred by the divorce rate that took off when we were growing up in the 1970s and 80s. A lot of them don’t have kids yet or are becoming parents for the first time in their late 30s and early 40s. It’s a very strange generation to be a part of, and yet I embrace it because I understand it.

So, my generation does not have a sense of entitlement. Quite the contrary, we expect to get screwed over when it comes to retirement via scaled back or non-existent Social Security and Medicare benefits. Basically, we expect to have to contribute to the system our entire working lives and simultaneously save for retirement via individual 401k accounts. That is a large part of my long-term financial planning; to cover all eventualities.

My household management has already helped us achieve one of our life goals; buying a lifetime home. By most people’s standards, we are in fantastic financial shape. We have no debt aside from our mortgage, substantial assets, and good earning prospects. So how could one healthcare bill make such a difference in our lives?

Because it has given me peace of mind. I have a great track record at saving to meet large long-term goals, but how do you deal with catastrophe? The next ten years are going to be extremely vulnerable ones for our family of four. Most people buy term life insurance because it is inexpensive and provides large payouts for a limited time period (usually 20 years), which is really all you need to get children into a safety zone where they are old enough to fend for themselves (hmm, maybe life insurance term limits should be 30 years). But what about disability coverage?

Picture this scenario: my husband is walking to work tomorrow and gets hit by a car (could happen with the way people drive around here). He is injured badly enough that it takes him months to recover. In that time, he loses his job and we have to pay for Cobra ($1000/month?) We instantly lose all our income tax deductions because, hey, you have to have income in order to take deductions. So we are looking at $4k/month out of pocket for household maintenance, plus let’s say another $2k in living expenses. Add in medical bills because no health insurer automatically pays for 100% of every bill they get handed; another $10k/month? Oh, and let’s assume the car that hit my husband was piloted by an uninsured motorist, so we don’t get a dime from them. All this adds up to $17k/month, all with little/no income coming in because disability payments don’t kick in for 60 days and only replace about half of your income. And let’s not forget that I suddenly have an infirm husband and a household with two toddlers to care for 24/7 by myself. Plus the $10k/month for medical bills is probably too low. My friend’s mom spent $500k out of pocket a couple of years ago to treat stomach cancer, and she is a retired state employee so has decent health insurance.

So we go in one instant from thrifty, secure living to serious bankruptcy risk. I am sorry, I don’t care how good you are at money management, nobody can plan for a medical catastrophe. The only way it works is if you have serious cash in the bank, like $500k-$1MM, and my husband and I just haven’t had the time to build up savings like that because we have only been in the workforce for about 12 years (and let’s be real, I am only marginally in the workforce).

I know very well that the healthcare reform bill isn’t a panacea. I know it will decimate Medicare and raise overall healthcare costs. But I would a million times rather pay a few more thousand dollars a year as part of deep risk pool than not pay it and gamble that nobody in my family will ever get seriously sick or injured. Because a lifetime is a very long time, and nobody is immune from bad luck.

On the eve of a historic and incredibly controversial US healthcare bill, I thought it would be appropriate to review what our country needs. We need universal access to healthcare, affordable fees charged by physicians and hospitals, an end to over-treatment, and high quality. It seems almost impossible to achieve, right? And yet we have a healthcare practice right here in Hoboken that accomplishes exactly those goals.

It has been one year since PromptMD opened their doors on First Street near Willow Ave (two doors down from Dames Coffee) in Hoboken. In that time they have had over 10,000 visits ranging from H1N1 shots all the way up to food poisoning, broken bones and one heart attack. The two docs there have a devoted following of patients who rave about the superb care they receive 7 days a week. The average wait time was under half an hour, average cost was under $100, and the majority of patients got more than 60% of the costs reimbursed by insurance. Free follow-up visits ensured that patients were recovering properly from their various ailments, something hospitals don’t care about since they get paid twice if patients are readmitted.

The most amazing part is that they accomplished this with all walk-in visits. Scheduling doctor’s visits is such a huge hassle for my family that I am six months behind on my OB/GYN appointments, and I need to take the kids to the dentist. Knowing that we can walk into PromptMD before work or school whenever one of the kids spikes a fever and that we will wait less than 10 minutes is huge.

In the interest of full disclosure, I maintain the PromptMD website. We added in features like the monthly physician schedule, put all the registration & privacy forms online to save check-in time, and generally streamlined and improved the available information. However, I am not being paid to write this review, and I was a huge fan of their affordable business model before I became their webmaster. My husband and I go there for everything, from flu shots for our babysitter and entire family to allergy treatment when hay fever season approaches. Because we are frequent flyers, we receive a 10% discount on physical exams.

If my husband ever loses his job and our health insurance, knock wood, I have great peace of mind knowing that sickness or pregnancy will not bankrupt us or cause us to neglect routine doctor’s visits. The amount we pay out of pocket to PromptMD ($82/visit) is not much more than our $40 insurance copay. Drs. Islam and Jani also have relationships with specialists who they will negotiate with to get us hugely discounted care if we need additional treatment like, say, a pregnancy ultrasound. All four members of my family go to PromptMD since they treat ages 1 & up.

1/22 update: I am really glad healthcare reform has passed, but believe that practices like PromptMD are imperative to curbing skyrocketing healthcare costs. The healthcare bill extended insurance coverage to all, but does not restrict premium costs. Lower medical bills = lower premiums, and that is where PromptMD shines since their charges are 60% less than typical physician practices.

I wrote a while back about how I encourage my husband to fence because it keeps him in excellent physical condition, which saves us money in the long run. That’s great for those of us who love fencing, but what about for the other 99.5% of the population?

I have been working out for my entire life, and I can say unequivocally that I hate it. That’s quite a paradox because I am a good athlete and in excellent physical condition, so how have I accomplished that without stepping foot in a gym in years?  (Literally. We had a gym on the same floor as our two-bedroom condo at the Hoboken Grande and I used it exactly once in five years).

A friend of mine recently introduced me to Mike Ander, the owner of the newly opened Koko FitClub at 14th and Adams in Hoboken, and he invited me to come by for a complimentary workout. This is the second time I have been invited to have a personal training session in Hoboken, and the only reason why I went was because I was intrigued by the concept of computerized on-demand personal training sessions.

So I walked into the club last week, and the machines looked pretty much like all the other standard bench press-style gym equipment I have used off and on throughout my life. I entered my height, weight (had to guess there since I don’t own a scale) and age, and then sat down at the machine. The first thing I realized was that you control everything from that one spot. The weight adjustment and handle bars all adjust from the seat, and you basically never move more than a couple of steps to get set up for the next routine. Lights blink to show you what to do next, which was pretty cool.

But the really awesome part of the workout came when I sat down to work out. The computer screen tracked my progress and provided interactive feedback about whether to speed up or slow down. It was like a Wii Fit video game, only I was actually getting a workout. I could see my score and got better at the routines as I went along, adjusting my pace and technique according to the feedback I received.

When I got done, I was able to get a computerized record on my workout on a USB thumb drive that feeds directly into the main computer. You can track your progress from home, calculate the calories burned, and see how you stack up against other people your age and weight. And the thing I really liked was that there are different computer programs depending on your life status, such as one for postpartum moms.

For the first time in my life, I had a really fast, efficient, enjoyable workout. And because it’s computerized, I can walk into the Koko gym anytime they are open (and they are open for really extended hours b/c people work such long hours around here) and pick up where I left off. From a cost perspective, I really like the fact that the personal training is free. For $89/month (no contract, I have heard horror stories about those), the gym is a really good deal. You don’t have all the amenities of a spa or pool, but you’re also not paying for them. The staff are really nice and helpful, a nice bonus. And they provide free parking in the lot right in front of the gym, a necessity in Hoboken.

If you are like me and don’t have a lot of free time, the Koko Smarttraining workout makes a lot of sense. For a fun, fast, no-frills workout that fits around your schedule, I have never met its equal. And if it keeps me healthy and fit, then it will save me money in the long run with lower/nonexistent medical costs.

The curtain is about to drop on 2009, and when I look back, I realized my kids have really not been sick. A couple of weeklong colds, one 101º fever for my two year old, and that was it. What accounted for it?

For starters, my kids are not yet in school. My 3 y.o. was eligible this past fall for free Hoboken Abbott pre-k but my husband and I opted not to send her because we felt she wasn’t ready for full-time school five days a week. Instead, we hired a babysitter to take the kids to a puppet show once a week, plus paid for a family membership at Liberty Science Center. We also frequent the many Hoboken playgrounds and take trips into the city to museums and activities.

I got both kids vaccinated for influenza back in September, as soon as the vaccine became available, and for H1N1 when PromptMD got the nasal mist for ages 2 & up in November. I also have a very kind pediatrician (in Brooklyn, sorry) who allows us to make frequent office visits to space out my kids’ routine vaccinations. My daughter has never had more than one vaccination at a time, and my son has a maximum of two per visit. Neither of them has ever reacted to a vaccine, which is important since there has been a recent correlation between a genetic mitchondrial disorder that can trigger autism when aggravated by a vaccine reaction.

Keeping my kids healthy has largely been a matter of playing the odds. I take them to play outdoors whenever possible, avoiding large indoor gatherings where germs tend to accumulate and thrive. I am also a fanatic about handwashing and face touching, applying hand sanitizer whenever we are outside and I give the kids a snack or goto a restaurant. Germs are an unavoidable part of life, and up to a point are useful in developing a child’s immune system. However, frequent early illness can cause chronic inflammation of the immune system, which has lifelong repercussions.

I am well aware of the financial repercussions of staying home with my kids. This was not a decision I made lightly. My husband and I felt that my time invested now in the early years would pay off for our kids down the road, in their health, psychological stability and intellectual development. So far so good, fingers crossed that we are able to keep up our stellar track record!

A couple of days ago I stumbled across the story of Shellie Ross. As the mother of a two year old and a 3.5 year old, I was immediately horrified and saddened by hearing about her son drowning in the family’s backyard pool. I cannot imagine the pain this woman must be in, and I have been extra careful to spend time with my children since then and restrict my work to hours when they are asleep or their father is watching them (hence my 3AM post time, groan).

I have to admit, if I had never heard of Madison McGraw I most likely would not have probed further. I would have written it off as another senseless tragedy, but when I learned that Ms. Ross is a blogger and avid twitterer, a chill went up my spine. I just started tweeting a couple of months ago and am already up to 751 tweets. Similar to driving and talking on my cellphone, I have noticed my concentration really goes down when I am tweeting. I generally don’t tweet when my kids are awake, but it’s a slippery slope, right?

I draw the curtain of opinion across Ms. Ross’s activities after she found her son because anyone suffering tragedy deserves a pass. Who knows how I would react if I found my son floating in the bathtub? There but for the grace of G-d go I, and whatever works for her is fine by me.

But leading up to finding her son in the pool, that is what is hitting me hard. Pool drownings are a fact of life. Whenever I buy homeowner’s insurance (which happens far more frequently than one would think), I always get asked if there is a pool on the premises, and I give a mental sigh of relief every time I answer, “No.” Anyone who is a regular blog reader knows I am extremely fiscally conservative; I advocate two years of emergency savings when the experts recommend six months. I think the odds are extremely low that my family will ever use up the full two years, but what if healthcare costs are much higher than we expect, or my husband’s industry collapses? I would rather err on the safe side and stack the odds that we will be all right in just about any financial emergency.

The lesson I take away from Shellie Ross’s sad story is that I owe it to my children to be extra vigilant, and to play the odds. When I feel the urge to boot up the computer in the middle of the day, I resist it the majority of the time. Sure, chances are nothing will happen during an individual session of me with my computer and them playing with toys in my home office. But add up many of those periods of inattention, and the odds go way up of something happening once.

And as for the 11 year old sibling babysitter, well, I have a kid brother who is exactly 11 years younger than I am.  My parents used to leave me and my sister alone with him frequently when my parents worked evenings. I dropped him on his head when he was about nine months old because he pushed against my stomach so strongly that my arms literally could not absorb the power of his lunge. When I gave birth to my first child, I was constantly terrified I was going to drop her on her head the same way.

It has only been the last 6-12 months that I have realized that, well, I am in my early 30s and I am much, much stronger than I was when I was 11. I have never once had any problems carrying my kids even when they were lunging and throwing fits. Again, I only dropped my brother once in the hundreds of times I babysat for him when he was little. But isn’t once more than enough? Why take chances with something that is so precious and irretrievable? It’s a really good wakeup call for me, and hopefully for other parents.

I run the websites for several local businesses. One of them is for a developer who has asked me to pass the word on several units he is trying to sell and rent.

I am all about 3BRs on this blog. There are not that many in Hoboken, and the ones that exist tend to either be in non-family friendly setups (penthouse walkup w/o parking -um, no) or very expensive. So when information crosses my path that could help other moms stay in town, I gladly pass it along.

Both units are in the same building, the Neapolitan on 2nd St between Jackson and Harrison. The building is really nice, built in 2007 with over 90% of the units sold and owner-occupied (so no renter frat parties here!) The units have really beautiful Brazilian cherry hardwood floors and nice finishes (granite & stainless steel kitchens, marble bathrooms), and the building has a big gated landscaped courtyard perfect for toddlers to ride their bikes on cold afternoons. All of the units come with heated indoor parking, a rarity in Hoboken.

The 3BR for sale is a true 3BR, 1805 SF. I liked the floorplan a lot since it is very efficient plus the living room separates the bedrooms into two wings. And I liked the large walk-in master bedroom closet. The asking price of $725k works out to $402 PSF. If you look at the MLS you will not find much that is this large in that price range. When you look at comparables, the pricing looks even better since a couple of large units nearby have sold a bit lower but a whole lot more have sold much higher (high $800k range all the way up to just over $1 million). The building is really solid financially, with over $70k in reserves, and has a completed transition engineering study that didn’t turn up any major defects. Add in the expanded homebuyer tax credit, and this unit is definitely worth checking out if you want to stay in Hoboken long-term. I have seen it and it is in really pristine condition, so I don’t think it is going to last long once the spring market gets going. The only downside I saw was the lack of a coat closet, but there is room for a coat rack and shoe bench by the front door.

The 3BR for rent is actually a 1,316 SF 2BR + den. The den is very large compared to most dens in Hoboken (140 SF) and would be perfect for a home office or second child (no windows = no glare on computer screen & no need to install blackout window blinds for naptime). The HVAC and ceiling fan allow constant air circulation, so you don’t have to worry about fresh air. For $3,000/month, this is a really good price for an elevator building with parking. And of course, there is no fee for this unit. The developer is willing to consider a month-to-month lease, which is great if you want to keep your options open to buy something down the road.

The upside: you can get them if you are pregnant or asthmatic. PromptMD in Hoboken is charging $24 per shot (walk-in only).

The downside: this batch is for ages 4 & up and they contain a small amount of thimerosal (less mercury than a can of tuna). The CDC only sent 200 thimerosal-free shots to the entire state of NJ, so basically you either take the thimerosal version or you forgo the H1N1 vaccine.

The CDC is currently requiring healthcare workers to initially administer the shot only to:

• Pregnant women
• Caregivers/people in contact w/children under 6 months
• Healthcare & EMS personnel
• Anyone 6 months-24 years
• People aged 24-64 years w/health conditions

The CDC is being really strict about this b/c of the shortage, but PromptMD should be getting more flumist next week.

Medical records are stored on paper at 90% of hospitals and 83% of physician practices. What that means is that bits and pieces of your medical history are scattered across the state you live in, if not across the country. It never ceases to amaze me that health insurers can pick up tiny bits of data, like having acne, and use that to deny you coverage, and yet every time I see a physician, they have almost no information about the conditions I have experienced or the medications I have taken -I could totally lie to them and they would have no way of verifying the information I provided.

Okay, so it’s bad enough that the vast majority of your medical records are on paper and have no backup, right? Well, it gets worse. A lot of physician practices make it difficult/expensive to get copies of your medical records. Talk about a hostage audience. Another mom on my favorite Moms group recently sent out an SOS since her pediatrician was refusing to provide copies of her daughter’s records. Within a few hours of her post, six moms responded with valuable advice garnered from similar experiences -the highlights are below.

9/9/09, 3:17PM

Hi all -

I have been trying for almost 2 months to get copies of my daughter’s medical records transferred to a new pediatrician. In the meantime, I am leaving the state and am trying to get a hard copy to take with me. During this time, my new pediatrician will not immunize my daughter without these official records. As a result, my daughter is behind two cycles of shots. I have called, sent letters, tried to contact the previous pediatrician and still no records. The front office staff basically tells me that these take time and I will just have to deal. I am at my wits end. I feel like we are being held prisoner and am not sure what other steps can be taken to get these records? Do I have an attorney send a letter? Do I log a complaint with the medical board? Do I go and sit there until they give me the records?

Anyone know or have suggestions on how to get attention from this office? I want them to understand, especially the twits at the front desk, this is serious.

Any advice you have would be greatly appreciated!

Thanks in advance!

T.

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9/9/09, 9:15PM

I’ll preface this with the necessary “I am a lawyer but not a benefits/health attorney so don’t view this as true legal advice” disclaimer, but you stirred up a memory and so I did some research…try this:

To add a hammer to back up your physical presence in the waiting room, before you show up send them a certified letter (and fax it too) stating that their failure to timely turn over the records and permit you access represents a violation of the “Standards for Privacy of Individually Identifiable Health Information” (”Privacy Rule”) issued by The U.S. Department of Health and Human Services to implement the requirement of the Health Insurance Portability and Accountability Act of 1996 (”HIPAA”). Specifically, the HIPAA Privacy Rule states that Providers (like your child’s doctor) must comply with an individual’s right to, among other things, ask to see and get a copy of his/her health records, and have corrections added to such health information. In the case of a minor child, a person with parental rights (that’s you) is deemed a “Personal Representative” of the child and has the same rights as if the records were their own.

State in the letter that following repeated attempts to obtain these records (cite your previous attempts, with dates, and reference and attach copies of any letters or emails you sent), if you are not provided with the records when you arrive at their office on [X date], you will exercise your rights under HIPAA by filing a complaint with the U.S. Government (specifically the Office for Civil Rights which has responsibility for implementing and enforcing the Privacy Rule and with the Secretary of the HHS).. Since that can incur fines, it may light a fire under their arses….

To view the entire Rule, and for other additional helpful information about how it applies, see the OCR website: http://www.hhs. gov/ocr/hipaa.

And yes, the laws permit them to charge a reasonable fee for getting the records, but it can’t exceed the costs of copying and any postage.

Good luck!

K.

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9/9/09, 9:24PM

T & K,

Can I repost your two posts on my blog ? I occasionally write about our broken healthcare system and the fragmented nature of US medical records is a huge part of why medical care costs so much -every hospital and physician practice maintains separate records and don’t like to share with each other because they don’t want to lose market share. It’s like paying for six real estate management companies when you only need one.

Kathy

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9/9/09, 9:45PM

As long as I’m being used as an example and not a “source” and you make sure you include my disclaimer (that I am not an expert on health law and i don’t intend my post as legal advice - I can just see someone picking apart my response as “incomplete” somehow) and include the links to more complete information that I had in my post, I would be fine.

I should note that HIPAA doesn’t have (at least based on my quick research) any time period set out for how quickly a provider must provide the records (maybe case law covers that, but that’s a huge research project) ….and also that an individual seeking records needs to (and should) put his/her requests in writing (the rules lay out what “proper” requests for records should include) and - for prudence purposes - keep copies of his/her and the provider’s correspondence (as well as noting dates of calls and names of individuals he/she spoke with - not just “receptionist” but “Cathy” - since it’s easy to play the “gee, no one gave so and so that message” but harder for Cathy to say “gee, i never spoke with you”).

Interesting Blog, by the way.