It is that time of year… Medicare health and drug coverage open enrollment begins on Nov 15 and ends on Dec 31.  With all the news on revamping America’s health care, you may have missed the announcement from The Centers for Medicare and Medicaid Services (CMS) that seniors or other people with Medicare (and their caregivers and/or family members) can begin to review their 2010 coverage options through  Medicare’s improved online tools.  Medicare Health Options Compare and Prescription Drug Plan Finder is located at www.medicare.gov. 

Remember, caregivers, if your loved one is a Medicare beneficiary, they are eligible for Medicare prescription drug coverage, regardless of income, health status, or current prescription expenses.

There are two types of Medicare plans that provide prescription drug coverage:

1) Medicare Prescription Drug Plans - These plans add prescription drug coverage to Original Medicare, and certain types of Medicare Health Plans.
2) Medicare Health Plans  - Some of these plans cover both health care and prescription drugs.

For caregivers and seniors that prefer to get information over the phone,

• Contact a Medicare customer service representative at toll free 1-800-MEDICARE (1-800-633-4227)
• OR contact your local State health insurance Assistance Program office (find the number online at http://www.medicare.gov/Contacts/staticpages/ships.aspx) or other health advocacy agencies for free personalized counseling.

Medicare's customer service is available 24-hours a day and 7 days a week. English and Spanish-language customer service representatives are available.

A 2010 Medicare & You handbook for seniors and their caregivers, also available on www.Medicare.gov, will be mailed to the homes of all eligible beneficiaries this month.

Medicare can be complicated, and a qualified geriatric care professional can help you figure it out if you're a caregiver.  If you're a veteran (or a caregiver for a veteran) you can also see my previous blogs, which include Information on Veterans Benefits and Part 2: Additional Information on Veterans Benefits.
 

Have you ever went to a doctor and they told you something about your treatment
option(s) that you were unsure with or didn't agree on?  If you ever feel this way, you are entitled to and should get a second opinion.  A second opinion is when a physician other than your regular physician gives their view about your health condition and how it should be treated.  Part of healthy aging is knowing and understanding your health care and treatment options and a second opinion will allow you be more informed about your health care. 

When should I get a second opinion?
You should consider getting a second opinion if  your physician tells you that you need surgery to make a diagnosis or treat a health problem that is not an emergency.  It is always up to you, the patient, to decide if and when you will have surgery.  However, if you need surgery immediately, do not wait for a second opinion.  This would include appendicitis, accidental injuries, blood clots, aneurysms, etc.  

Preparing your visit for a second opinion:
Before your appointment with the second physician, you should:

1. Have your medical records sent to the second physician.  This will inform the physician of what has been discussed and any tests that have been performed.
2. Call the second physician's office before your appointment to make sure they received your records
3. Have a list of questions on paper you want to ask and take them with you to your appointment.
4. Ask somebody close to you to come to the appointment with you. 

What should I do if the first and second opinions are different?
If the second physician does not agree with your regular physician you may want to discuss your condition more with your first physician.  Getting a second opinion does not mean you have to change doctors, it is up to you which physician you choose to see.  The final decision is up to you and should be made with all the facts. 

In my blog on Nov 9th, I discussed the end-stage dementia issues and raised the question ‘Is dementia a terminal illness?’  When faced with terminal illness, seniors and their caregivers often choose palliative care.  Today, I’ll discuss that further.

What is a terminal condition?

In most states, a terminal condition is a status that is incurable or irreversible, and in which death will occur within a short time.  There is not a precise, universally accepted definition of “a short time,” but in general it is considered to be less than one year.  When looking at the hospice benefit, it will define “short term” as six months or less.

What is palliative care?

Palliative care is a comprehensive approach to treating serious illness that focuses on the physical, psychological, spiritual, and existential needs of the patient.  Its goal is to achieve the best quality of life available to the patient by relieving suffering, by controlling pain and symptoms, and by enabling the patient to achieve maximum functional capacity.  Respect for the patient’s culture, beliefs, and values are essential components.  Palliative care is sometimes called comfort care or hospice type care.

For more information: go to Caring Connections which is a program of the National Hospice and Palliative Care Organization (NHPCO), is a national consumer and community engagement initiative to improve care at the end of life, supported by a grant from The Robert Wood Johnson Foundation. Caregivers and seniors can find them online at www.caringinfo.org.

Caregivers and seniors can also visit the National Hospice and Palliative Care Organization (NHPCO) home page at http://www.nhpco.org/templates/1/homepage.cfm.
 

Falls are a serious danger for seniors, as they can lead to broken or fractured bones, and hospital stays.  As we age, mobility often becomes an issue, and our balance can deteriorate.  Many older adults rely on the help of assistive devices such as canes.

If your doctor or therapist has ordered a cane for you, this Veteran’s Day (November 11, 2009), Sam’s Club is giving away 25,000 canes to veterans.  To find out more, please visit http://www.hugosalutes.com/.  If you’re a caregiver who is providing care for a senior, you should work with their health care providers to make sure that your loved one has the assistance he/she needs.  In addition, you can take actions to prevent falls and help ensure their safety in the home, such as removing throw rugs.  For more on fall prevention, please see my previous blog (http://myhealthcaremanager.compendiumblog.com/blog/immobility/0/0/fall-prevention-). 

Make sure to check with your health care provider before using a cane or other assistive device.

November is Alzheimer’s awareness month.  It is time to catch up with discussions about dementia and redefining dementia.  Dementia is often thought of as simply memory loss and/or a memory disorder.  While memory loss is the “hallmark” of dementia in its early stages, most caregivers treat it as illness and do not think of dementia as fatal. According to Catherine Elton at   time.com, “Experts in the field say dementia is more accurately defined as fatal brain failure: a terminal disease, like cancer, that physically kills patients, not simply a mental ailment that accompanies older age.”  Unlike other terminal diseases, as the older adult with dementia approaches the end of their life, they are often treated aggressively rather than with palliative care.  Read more about what experts are saying in Catherine Elton’s report: Experts Redefine Dementia as a Terminal Disease. 

if you're a caregiver, remember, when caring for an older adult with dementia always ask if the treatments are causing more distress AND if their pain being managed.  Check to see if the older adult has made their wishes clear regarding aggressive treatments, feeding tubes and CPR. Then advocate that their wishes are carried out. As a caregiver, if your parent or loved one is in the early stages of dementia and have not made their wishes clear, now is the time to talk to them and complete their advance directives/living will.  A geriatric care manager can help caregivers and their aging loved ones address these issues.

For more information on treating advanced dementia as a terminal illness requiring palliative care go to Catherine Elton’s report: Experts Redefine Dementia as a Terminal Disease.

We’re pleased that Alliance Care Advisors is My Health Care Manager’s new licensee for the Indianapolis and surrounding counties area.  Like our other licensees, Alliance Care Advisors will use our systems, training, and processes, including SCANS(TM) - our Senior Care Navigation System - a best-in-class knowledge management and decision support system, to provide geriatric care management by their Health Care Managers to seniors and caregivers.  To learn more about SCANS and how it’s helping seniors and caregivers nationwide, please visit our CTO Eric Tinsley’s blog.  If you are searching for geriatric care management services in the Indianapolis area you should visit their website or view their press release to learn more.  Alliance Care Advisors’ sister organization, Alliance Home Health Care, already provides complementary home health services.

The holidays are quicky approaching us!  That means traveling near and far to visit with family and loves ones.  This is such a great time of the year so I wanted to provide you with some tips to help traveling go smoothly when you are bringing along someone who has a cognitive impairment.   In addition, November is also National Alzheimer's disease Awareness Month so I wanted to address a topic related to Alzheimer's disease this month.  Below are some holiday travel tips from the Alzheimer's Association:

• Avoid having a rushed schedule.  This only increases anxiety.
• If traveling by plane, minimize stops and long layovers in the airport
• Travel at a time when the person is most alert
• Rely on familiar and comfortable destinations
• Carry identification such as the Safe Return/Medic Alert bracelet, which can be purchased through the Alzheimer's Association.

Following these tips will help the caregiver and the person with dementia have a safe and hopefully a great time when visiting families and friends.  In addition, vaccinations are also important for older adults when traveling.  For more information on vaccinations and traveling with older adults, please refer to Jean Bandos blog titled "Vaccinations and Travel Planning for the Elderly".

There has been a continuing increase in the number of new products surfacing to help with the issues of health management.  Everyone's getting into the act... even the iPhone!

MedScape is a new application for the iPhone that allows you to look-up information about medications you or your aging parent are taking.  You can review lots of information helpful in medication management - dosage, drug interactions, adverse effects, costs, and so on.  The application is currently free and can be downloaded using iTunes or directly from the App Store.

Similar information is available on the Internet from lots of resources.  WebMD is a well known example.  Most to the major pharmacy sites like CVS or Walgreens also have drug information available.

I already covered the everyday precautions individuals, including caregivers, should take to prevent flu infection, such as washing your hands and avoiding close contact with those who are sick or exhibiting flu-like symptoms.  Read my previous post to find out more.

Here are some other important actions that you can take:

• Follow public health advice regarding school closures, avoiding crowds and other social distancing measures.
• Be prepared in case you get sick and need to stay home for a week or so; a supply of over-the-counter medicines, alcohol-based hand rubs,* tissues and other related items might could be useful and help avoid the need to make trips out in public while you are sick and contagious

If you have severe illness or you are at high risk for flu complications, contact your health care provider or seek medical care. Your health care provider will determine whether flu testing or treatment is needed.  Caregivers should know the signs and symptoms of flu and contact their aging loved one's health care provider with questions.

According to the CDC, emergency warning signs that need urgent medical attention for adults include:

• Difficulty breathing or shortness of breath
• Pain or pressure in the chest or abdomen
• Sudden dizziness
• Confusion
• Severe or persistent vomiting
• Flu-like symptoms improve but then return with fever and worse cough

Caregivers can find out more from the CDC Flu site: www.cdc.gov/flu.

Sometimes, it is human nature to focus on what “is lost.”   The focus can be on tangible things such as a job, a sporting event, a favorite item or it can be on intangible things like a train of thought, youth or innocence.  When there is an Alzheimer’s diagnosis it becomes very easy to focus on what is lost, for example  when your parent forgets how to get dressed, how to use the phone and how to pay their bills.  Yet, focusing on what is lost isn’t helpful to anyone.  It causes extreme frustration for the senior and sadness within the family.  I’d like to suggest a new frame of reference for caregivers – to focus on things that are “still here” like a sense of humor, a smile returned and a love for movies and chocolate. 
Earlier this week I participated in an activity with my Mother and her fellow neighbors at a memory care unit.   The game was called Penny Ante and began with everyone receiving 25 pennies and a pot holding pennies in reserve.  Everyone took turns drawing cards from a deck and following the instructions.  For example –  “Take a penny from the pot if you have ever seen the Golden Gate Bridge” or “Give every player a penny if they have blue eyes. “ There was a lot of laughter as pennies were lost and gained.  To be honest there was some confusion too.  One player drew a card – “Take a penny if you have ever visited New York City,” but could not remember if she had been to NYC or not.  This is when my Mother shined.  For her response was “I bet you have, you should take a penny.” 

When it was my Mother’s turn, she had to give a penny to everyone wearing blue.  I happened to be the only one at the table wearing blue…which meant she had to give me a penny.  She hesitated for a minute or two and I teasingly reminded her she needed to give me a penny…thinking she had forgotten that part of the game.  She looked at me and said – “I know, I am looking for a shiny one for you.”  A few seconds later, she pushed  a shiny penny towards me, the best of the ones she had before her.   My eyes filled as I realized she wanted to give her daughter the best she had….just as she had always done. In that moment, her love shined through the memory loss, the dementia, the falls and the frailty, to remind me that the Mother I know is “still here” shining bright as a new penny. 

My last post covered some general vaccination information for seniors and caregivers.  Today, I’m going to provide you with some eldercare resources for flu season.  The best advice during this flu season is to talk to your health care provider about the seasonal flu vaccination and the “novel” H1N1 (Swine Flu) vaccination.

According to the Center for Disease Control (CDC), “One thing that appears to be different from seasonal influenza is that adults older than 64 years do not yet appear to be at increased risk of novel H1N1-related complications thus far.”  To keep up with the latest information, visit the CDC (http://www.cdc.gov/h1n1flu/).

Remember to take everyday flu-prevention and well-being precautions such as:

• Wash your hands often with soap and water   You can also use alcohol based hand cleaners
• Throw away your tissue after use
• Avoid touching your eyes, nose or mouth
• Avoid close contact with people who have flu type symptoms if at all possible
• Listen for your local public health advice especially regarding closing and crowds
• When you are sick (or have flu symptoms), stay at home and have the supplies in need in your home for a week or so. 

If you are sick with flu-like illness, CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone without the use of a fever-reducing medicine.) Keep away from others as much as possible to keep from making others sick.  If you have additional questions, please speak with your health care provider.  Your physician can also advise you on prevention measures, such as the flu vaccination.

For seniors and caregivers: if you would like to locate a flu center by zip code, visit http://www.lungusa.org/site/pp.aspx?c=aqKGLXOAIlH&b=1015035.

Hoarding is a common behavior exhibited by older adults with later stage Alzheimer’s Disease, and many caregivers will see this behavior in their loved ones.  Some seniors hide belongings, some won’t throw anything away and some spend lots of time rummaging through drawers, closets, even refrigerators.  In many cases, seniors with Alzheimer’s engage in all of these activities.

Experts have suggested that seniors with Alzheimer's engage in these behaviors because they:

• were impacted by the Great Depression and “save” things just as their families did in the past
• come across an item, don’t recognize it, don’t know why they have it, and don’t know what to do with it and because they don’t want to ask someone about it, they hide it to get rid of it
• are fearful they are going to run out of something, for example -  money, food, clothes – so hide these items from others.
   

During the past few weeks, I have been getting my Mother ready to move to a new apartment in a memory care facility.  The new apartment isn’t as large as the old one, which meant that some furniture and personal items needed to be discarded or donated.  This became a good time to reorganize and go through the apartment contents to ensure that we moved the items she was currently using or had sentimental value.  I thought this would be a relatively easy task, but I couldn’t have been more wrong. As I began the process of packing, I soon found items in strange places.  For example, I found a set of silverware in my Mother’s dresser, framed family pictures in her purse and a shopping bag with shoes, figurines, and greeting cards behind the couch.   I also learned to look through everything, such as old purses and jacket pockets, to make sure I didn’t give away anything important – and it’s probably wise for other caregivers to do the same.  For example, I found my Mother’s Medicare card innocently wrapped in a scarf at the back of a dresser drawer.

As I continued to find more items, I realized there was a theme.  The belongings hidden away were obviously things that were important to my Mother.  The family pictures, the figurines that were passed down from my Grandmother, and the greeting cards my sister and I had sent through the years had all been carefully saved, hidden and protected.  My Mother’s hoarding activities may be a “typical” Alzheimer’s behavior, but the treasures she chose to protect were mostly family mementos with great personal meaning. 

According the America Geriatrics Society,  a person is expected to live another 16 years after turning 65, a person who is 75 can be expected to live another 10 years and person 85 can expect to live another 6 years.  So even though vaccinations are focused more toward children, it is important to prevent disease as you age and practice prevention.    A recent post contained information about special vaccinations that you may need to travel to certain areas of the world, but vaccines are also an important consideration for everyday life.  Caregivers and seniors should make sure to stay on top of their preventative health plans.

A great eldercare resource is the American Geriatrics Society.  Through their site and publications you can know the latest recommendations not only for flu shots and the older adult, but also the recommendations for vaccinations and prevention tests.  Medicare does pay for some of vaccinations such as the costs of flu, pneumonia, and tetanus immunizations.


Some vaccine recommendations for seniors are:

• Influenza Vaccine - yearly
• Pneumococcal Vaccine - 1 dose at age 65
• Tetanus Vaccine - 1 booster dose every 10 years
• Shingles Vaccine - 1 dose in immunocompetent people

Always remember to discuss a preventative health plan with your health care provider.   
 

My last blog focused on a great eldercare resource for travel planning, the CDC travel site (www.cdc.gov/travel), where you can get information on recommended vaccinations and precautions.  I also gave you some preparation to do with your health care provider, including creating lists of your medical conditions and obtaining documentation of any special conditions for airport security (e.g. pacemakers, steel plates, etc).  Now you’re ready to pack – what do you need to take in terms of health care information?

Don’t forget

• a complete medication list
• enough of your medications for the duration of your trip
• a list of medical conditions (and treatments) created by your health care provider
• documentation of any conditions that airport security needs to be aware of
• alcohol-based hand sanitizer (for times when you can’t wash your hands

The medication list (including any over the counter drugs you’re taking) should include the drug names, doses, when you take them, any special instructions, and the amount of each drug you should take on the trip. 

Having all your medical information on paper (including the medication list described above) will assist you on getting through customs easier and help you if you need emergency medications.  Keep a copy on your person and copy in your luggage.

As always, protect yourself from infection by washing your hands and/or using an alcohol-based hand sanitizer prior to eating or after spending time in crowds such as on plane, bus or train.  Watch what you drink and eat.  

Plan ahead and enjoy!

We’re pleased to announce an agreement with Anthem and Wellpoint, which was covered in the August 24 – 30 issue of the Indianapolis Business Journal.  My Health Care Manager’s Eldercare benefit (which provides senior care management and caregiver support services to covered employees) will be offered in Indiana through the Anthem 360 Health program.  After the Indiana pilot, My Health Care Manager’s benefit will be rolled out by Wellpoint to all 14 states in which they operate. 

The benefit will help working caregivers balance the challenge of providing care to a loved one with work responsibilities, and also help improve the care and quality of life for the senior.  Employers assisting their employees by offering the Eldercare benefit look to reduced costs associated with working caregivers such as absenteeism, workday distractions, and time taken off to provide care.  My Health Care Manager provides an experienced nurse, a Health Care Manager, to guide the caregiver through their personal situation – and can assess a senior in the home anywhere in the U.S.

To learn more about Eldercare benefits for your business, or geriatric care management services for your family, please contact us at (800) 499-8020.

 

Fall is a great time of year to travel for the older adult - with school in session, fares drop and popular vacation sites are less crowded.  When planning a trip, an important step is to always check for health and vaccination information for your destination.  A great resource for this is the Center for Disease Control (CDC), where you can access health and vaccination information.  For caregivers and seniors, travel may require a bit more preparation.

Certain vaccines are required 6 weeks before departure, so schedule an appointment with your health care provider to discuss any travel plans and any precautions you should take.
Also, ask your physician to write down any medical problem(s) that you have - and how they should be treated. 

If you have pacemaker, steel plates, total joint or any condition that airport security needs to be aware of, have your physician provide you with the appropriate documentation. This should help you avoid unnecessary hassle or delays with airport security.

Visit the CDC travel site (www.cdc.gov/travel/) for the latest updates and information.

In earlier blogs, I've mentioned a variety of in home technology advances to assist people caring for aging parents who hope to remain living independently.  Among these are safety tools for monitoring the home environment intended to help seniors who are "aging in place". 

One thing that doesn't come up enough in the discussion of these tools is the question of ethics.  How invasive should family members, or monitoring services, be allowed to be?  There are people looking at both the technology and the surrounding ethical issues.  One such group is the Ethical Technology in the Homes of Seniors (ETHOS) effort underway at Indiana University.  The focus of the ETHOS team is developing tools and guidelines to protect the privacy of senors living at home.  According to the team, seniors often underestimate the risks to privacy involved with technology use.

You can read more about there efforts by clicking on this link http://ethos.indiana.edu/. 

We all hear everyday the risks of smoking and what it does to our health.  But, what about older adults who smoke...is it beneficial to them to quit smoking now even though they may have smoked for 30-40 years?  The answer is yes!  It's never to late to quit smoking.  Part of healthy aging is keeping our lungs clean and free of all the tar that builds up from smoking.  If you quit smoking you are more likely to add years to your life, not to mention the money you will save from not smoking.  Food will taste better and you will have more energy.

Even if you are older than 65 and quit smoking, here are the benefits it will do to your health:

1.  Decrease your risk of cancer, heart attack, and lung disease
2.  Have better blood circulation
3.  Have a more sensitive sense of smell
4.  Have healthier family members, especially children and grandchildren

Smoking is often a difficult habit to break since nicotine is so addicting, however there are products available to help you quit smoking.  Talk to your doctor first to see what choices are best for you.  There are:

1.  Nicotine gum, patches, or lozenges that you can get over the counter
2.  Join a support group
3.  Ask a friend to quit with you.  This will help to motivate each other.
4.  Stay busy
5.  Begin exercising

For more information on how to quit smoking, please visit:  www.smokefree.gov

Many adults question their memory as they get older and wonder if losing their keys is a part of normal or healthy aging.  Recently, the Alzheimer’s Association came out with a list of 10 signs to help distinguish between what is normal and what is not with your memory as you age. 
So, what is normal and what isn’t?

Typical/Normal
1. Sometimes forgetting names or appointments but remembering them later
2. Making small errors sometimes when balancing a checkbook
3. Sometimes needing help with recording a TV show or help with microwave settings
4. Getting confused what day of the week it is but later figuring out what day it is
5. Visual changes due to cataracts or other eye problems
6. Sometimes having a difficult time coming up with a word while in conversations
7. Misplacing things once in a while such as the remote control or eyeglasses
8. Sometimes making a bad decision
9. Sometimes feeling of weary of family, work or other obligations
10. Developing a routine of how to do certain things and getting irritable when the routine is done a different way

What could be signs of Alzheimer’s?
1. Memory changes that disrupt life – Asking information repeatedly
2. Challenges in planning or solving problems – May have difficulty following a familiar recipe 3. Difficulty completing tasks at home or work – May have trouble finding the location of a     place or remembering the rules of a favorite game
4. Confusion with time or place – Sometimes they forget where they are or how they got there
5. Trouble understanding visual images and spatial relationships – They may have trouble reading or judging distances
6. New problems with words with speaking or writing – May have trouble following or joining a conversation
7. Misplacing things and losing the ability to retrace steps – A person with Alzheimer’s may put things in unusual places and not remember where they put it
8. Decreased or poor judgment – They may use poor judgment when dealing with money such as giving large amounts of money to telemarketers
9. Withdrawal from work or social activities – They may have trouble remembering how to do their favorite hobby
10. Changes in mood and personality – They may become confused, suspicious, depressed, etc.

For more information on differences between normal and healthy aging vs. dementia, please visit the Alzheimer’s Association at www.alz.org or call their 24 hour helpline at 800-272-3900.