For caregivers of aging parents, insurance coverage is an important topic, especially if your loved one suffers from Alzheimer’s, congestive heart failure, or other common conditions.  My last post covered the eligibility requirements for Medicare.  Once you determine eligibility, you’ll need to decide which policy or policies to choose.


1. Original Medicare Plan – If you are eligible, you will be automatically enrolled in Medicare A and then you have the option of adding Medicare Part B and Medicare Part D.  The federal government manages the Original Medicare Plan.  It operates on a fee-for-service plan. Most people pay a deductible and then a co-pay or co-insurance.  Original Medicare Plans do not cover everything. Costs that you may incur include co-insurance, co-pays, deductibles, etc.  These costs are called gaps. To help cover these costs, you might want to buy a Medigap policy.

2. Medicare Advantage Plan (Plan C) -  Seniors much choose to join.  The Medicare Advantage Plan or Plan C combines your Part A and B coverage. You have the option of adding Part D if coverage is not already included.  Medicare Advantage Plans include HMO, PPO, private fee-for-service plans, and Medicare special needs plans. The main difference in Part C is that it is provided through private insurance companies approved by Medicare. With this program, you may have lower costs and receive extra benefits. With this plan you do not need to buy a Medigap policy. 

3. Medicare Part D  - Part D is stand-alone prescription drug coverage insurance.  Most people do have to pay a premium for this coverage.  Plans vary and cover different drugs, but all medically necessary drugs are covered.  You can choose what drug plan will be best suited to your needs.

For more information regarding Medicare, contact your Medicare representative or visit www.medicare.gov and click on “Medicare and You 2009” for more information to help you meet your individual needs (or those of your aging loved one).  Also, the Medicare Options Compare website (http://www.medicare.gov/MPPF/Include/DataSection/Questions/Welcome.asp) will direct you through the various types of policies and explain what is covered under your policy.  Information is categorized on the home page by the type of plan that you have questions about.

My next blog will explain Medigap policies and Medicaid.

A colleague handed me a flyer today from a local cardiac physician group for cool little wallet sized CD they provide their patients with key medical information on it. 

The idea is that you carry this card in your wallet and in an emergency situation you can hand the card to a provider who can then view it on a computer capable of reading a data CD.  Even if you are unconscious, medical personnel can find the card style CD and view it.

The CD contains things like:

• medication lists
• current diagnosis
• current allergies
• discharge summaries
• diagnostic test results
• and even educational materials

All in all this is a good thing.  It also points out some of problems with "high tech" solutions to emergency information. 

• First, not all emergencies will allow time for medical staff to leave the patient in order to find a PC with a CD drive and review a set of unfamiliar computer documents.   
• Second, in order for this information to be easily read in an emergency situation, it is also easily read by anyone who steals or even simply has access to a person's wallet.  Because it's a CD, it's also not clear exactly what data is on the record; leaving seniors and families caring for aging parents to wonder what information is potentially disclosed.
• Additionally, the currency of the data may be questionable.  Frequent health and medication changes are common in older adults and this approach requires notification back to the provider, payment of an update fee, and the reissuing of the wallet CD.  Allowing reasonable times for such activity, it could be very difficult to keep this up to date.
• Even small scratches from "wallet wear" on the CD can render it unreadable.  Something that wouldn't be readily apparent until the CD was checked in a computer drive.  Often, I fear, at the time the information is most needed. 
• Lastly, the completeness of the data may be in question as it relies on the patient, often a senior with depression or memory loss, to report the activities of the disjoint senior health care system.

My Health Care Manager approaches this problem differently.  Our geriatric care managers collect, review, and update information across all of a client's health providers.  This Personal Health information (PHI) is then used to inform all providers engaged in the client's health.  For example, each of the client's physicians receives the medication list initially and then again for every medication update. 

For emergency situations, clients are given a Ready Reference Card which contains all the key medical information and alerts.  This PHI easily folds to the size of credit card for wallet use and multiple copies can be kept in other key areas, for example in a specially identified pocket on the client's refrigerator where emergency personnel are trained to look. 

Because the Ready Reference is a paper record it is immediately available to emergency personnel in settings where a CD reader may not be at hand such as the senior's home, as shopping center, and so on.  It is also quick and very inexpensive to reprint when updates are needed.

The point here is not that technology is bad.  On the contrary, technology enables both of these solutions.  We should put it to work in the most effective ways we can devise for seniors and their families.

The SCANS content team headed by Jean Bandos along with the development team announced today that the SCANS Version 1.3 - May release is now available.  SCANS Version 1.3 is a major content release to the SCANS Knowledge Base.

In order to make more real-world tools for eldercare available more quickly, Jean and the team have devised a "rolling release".  For 3 months beginning in May another group of resources, processes, and tools will be made available to geriatric care managers at My Health Care Manager and our affiliates.

The May release contains 57 new and/or revised resources, processes and tools.  Some sample items include: 
 

• Behaviors and Alzheimer's Disease
• Grief Education
• Activities of Daily Living Education
• Depression and Alzheimer's disease
• Early Stages and Impact on Health
• Memory & Cognition Questions
• Memory Care Unit Checklist
• Memory Care Unit Education
• Mild Cognitive Impairment
• Sobriety Programs Resource
• Handyman Resource
• Private Handyman Contractor Checklist
• Smoke & Carbon Monoxide Detectors
• Daily  Money Management Education
• Financial Planning Education
• Trust Education
• Verifying Funeral Arrangements
• Veterans Benefit Information
• Elder Law Resource & Checklist
• Medication Management Procedure
• Medication Reconciliation
• Polypharmacy
• How to Find a Pain Specialist
• Pain Education
• Pain Resources
• Pain Visual Analog Scale
• Arthritis
• Heart Failure
• Hypertension Education
• Family History - Cancer Education
• Family History - Dementia
• Family History - Diabetes Education
• Family History - Heart Education
• Seat Belt Education
• Cataracts Education
• Glaucoma Education
• Hearing Aid Education
• Sensory Changes
• Assistive Devices
• Hospice Education
• Spiritual Connections

Stay tuned; the June release will include resources on incontinence, cognition, supporting services, and more processes.

Be sure to visit Jean's blog, click here.

**The following post is from my guest blogger, Natalie Langley, MSW.  She is a Geriatric Care Research Analyst for SCANS (for more on SCANS, please see Eric Tinsley's blog by clicking here).**

Nutrition and eating right are important components to keeping us all healthy.  But what happens when a chronic illness such as diabetes, congestive heart failure, or cancer is brought into the picture?  Having a chronic illness may mean taking a few more steps to ensure the older adult is getting the appropriate nutrients daily.  Making sure that all the key nutrients are a part of your diet can actually help you stay healthy, fight off infections, and feel stronger.  Even making simple changes such as removing the salt shaker from the dining room table can help reduce the amount of salt you put on food, therefore, reducing the sodium level for someone who has Chronic Obstructive Pulmonary Disease (COPD).  Other nutrition tips can be found on the web resources below for individuals who have chronic illnesses.  If you notice you are losing weight (10 pounds or more) involuntarily over a 6 month period, please check with your primary care provider.  In addition, before making any changes in your diet, always consult with your primary care provider. 

American Heart Association
http://www.americanheart.org/presenter.jhtml?identifier=1444

American Cancer Society – Recipes high in calories and easy to eat
http://www.cancer.org/docroot/MBC/content/MBC_6_1_Recipes.asp

American Lung Association – Eating well with COPD
http://www.lungusa.org/site/c.dvLUK9O0E/b.3529631/#eating 

American Diabetes Association
http://www.diabetes.org 

National Institute of Diabetes and Digestive and Kidney Diseases
http://www2.niddk.nih.gov/ 

National Institute of Arthritis and Musculoskeletal and Skin Diseases
http://www.niams.nih.gov/

In several of my past blogs, I discussed safety concerns and the older adult.  One the main concern is medication safety. Not just the management of medications but how many are actually taken.

It is often reported in the news about a medical error made and the impact it has on individual lives.  Those articles are frequently about hospitals errors.  But have you ever thought about the older adult and how they manage at home...?  The impact our current health system has on managing medications...?  How chronic illnesses such as congestive heart failure, diabetes, and arthritis impact the older adult and his/her caregivers...?  Different providers – prescribing different medication – generic versus brand names.  multiple medications with multiple doses all affect the medication management and the safety of the older adult.

Let’s look at the key safety issue: polypharmacy (multiple medications).  
A caregiver may ask what defines polypharmacy or how many pills or too many?  The answer would have to be that different entities in the current health care system define Polypharmacy differently.  I have seen it defined as low as two or more medications, but in general it deals with using more than three to five medications or herbal supplements for longer than 90 days in a given year.  In my career I have witnessed shoe boxes filled with medications that have numbered over 20 different medications- especially when dealing with multiple chronic diseases, over the counter medications, herbs, and vitamins.

Where should the caregiver and/or older adult start in trying to deal with their medications?
First, realize that the main problem with polypharmacy is that it increases the clients’ risk for drug interactions.  Drug interactions occur when one medication or herbal supplement reacts negatively with another medication when they are taken together. It is important to report any side effects to your physician.
 
The following are some steps you can take to prevent drug interactions:

• Provide a complete list of your medications and herbal supplements to your physician and/or pharmacist
• Discuss how each medication/herbal supplement works inside the body.
• Verify with your physician that you are receiving the recommended dose of each medication/herbal supplement.
• Verify with your physician that you are receiving the recommended form of each medication/herbal supplement you are taking (pill, liquid, tea, extract).
• Determine how many times a day your medications/herbal supplements should be taken.
• Discuss any side effects that might be experienced.
• Discuss the common prescription medication interactions.
• Discuss the common herbal supplement interactions.

If you can not complete a list of medications, take them all into your physician or pharmacist and have a list made for you. 

The National Institute on Aging is a great resource for learning more about medication managements, herbs, vitamins and safety concerns - learn more by clicking here.

The My Health Care Manager's Client Portal serves as a communication platform for families caring for aging parents. It provides easy access to information like:

• Schedule of care events (e.g. medical appointments, therapy, geriatric care visits)
• Medical issues (e.g. Alzheimer's, arthritis, incontinence, congestive heart failure, diabetes, COPD)
• Health provider contact information and specialties
• Medication list including dosage, frequency, prescribing physician, and other specifics
• Recent Hospitalizations
• Client contact information
• Updates on key issues of aging such as Caregiving, Advanced Directives, Living Independently, Family Communications, Depression, and more
• Resources
• and more

It also supports secure, private interactivity with the Health Care Manager providing geriatric care for the family using tools like a discussion board, contact logs documenting visits and phone conversations, and posting of care goals like improving home safety, reducing isolation, improving depression, improving mobility, supporting treatment plans, and so on.

Do You Have Your Advance Directives Written??

 Over the last months, I have had the opportunity to assist several families that were thrown into dealing with their loved one’s end of life wishes. Each family story is different, but the common theme was “the elder parent “ had not discussed nor written down his or her end of life wishes. 

 One father’s wishes were to not have CPR and to not return to the hospital if he had an exacerbation of congestive heart failure. From code status and hospital admission, these wishes sound easy. But since the elderly parent had not discussed these wishes with his health care providers and family, the family wasn’t able to fully advocate for his rights.  When he had an exacerbation of his heart failure, the nursing home transferred him to the hospital. After being admitted, he had tests and treatments that prolonged his life. After several weeks, he died in the hospital.  If he had discussed his wishes, named a health care representative, or created a living will, the family could have advocated for his wishes and prevented this last hospitalization.  

 It doesn’t matter what age you are… if you wait until the last days of your life to make others aware of your wishes, your wishes may not be carried out.  Not because your loved ones don’t care, but because they will not have enough time to understand what you are requesting and be able to appropriately advocate for your rights. I cannot emphasize enough the importance of letting those close to you know your wishes and writing them down.

Have you had those conversations with your parents – with your children?

 If these conversations do not happen, the end of life decisions become very difficult and many times will divide a family at a time when they should be together.  Don’t let this be your family.  Do your research- and ask the hard questions. 

 An excellent site to visit is Aging with Dignity.  It will assist you in addressing those hard to discuss topics ( http://www.agingwithdignity.org). Aging with Dignity is a non-profit organization that was established to provide practical information, advice and legal tools you need to assist you in identifying and documenting your wishes and those of your loved ones.  The document called the “Five Wishes” is legally valid in 40 states.  You can obtain a copy at http://www.agingwithdignity.org/5wishes.html.

Another site is Partnership for Caring http://www.caringinfo.org/  and (1-800-989-9455). The Partnership for Caring has downloadable advance directives requirements for all 50 states, or one may call for advance directives documents. 

There is never a good time – but anytime is the right time.  Talk now.

This week marks the 10th anniversary of the "Web Log" ... the genesis of the "Blog".  Of course, sharing ideas over the internet goes back to the dawn of the net itself.  The original idea of the then government sponsored network was to connect academic institutions and government agencies for the purpose of research and collaboration.

The Blog came along originally as a way to share information about where the "blogger" had been on the internet that day and what they had experience.  It quickly became an on-line diary of sorts.  This created the "stickiness" of the concept which since evolved in that dimension and many more.  

For My Health Care Manager the concept has been extended to caregivers helping aging parents and even seniors looking to improve the health and well-being.  Take a look at the blogs listed here - you'll find information on all of the most common heath challenges facing seniors and their families.  Some examples include falls, home safety, dementia, congestive heart failure, diabetes, and many more.

Having access to key thoughts on these challenges is valuable, but even more valuable is the key blogging concept of providing direct feedback to the author.  If you have a question of a comment on an article you've read, don't hesitate to use the "Comments" link right below the posting.  You can read comments and responses from others and best of all ask your question directly. 

If you don't see an article on the subject you're most interested in, post your question as a comment to the top entry in the Blog.  We'll answer the question in a future blog, comment, or email.

I remember when my mother was struggling with health problems toward the end of her life.  She had a half a dozen doctors and a league of other health providers all trying to help manage diabetes and congestive heart failure.  As a result she was on 28 prescription medications and supplements.  Mom understood how important it was to keep track of all these for her health care.  She carried a note paper hand written on both sides listing everything she was taking.  I watched her take it out and show each health provider in turn.  The problem was you’d have thought this little slip of paper was the Dead Sea scrolls.  She didn’t want to let it out of her sight because it was her only copy.  Being hand written in mom’s distinctive cursive, it was also a bit like reading ancient Aramaic.

 

With all the tools and technologies available today, we can do better.  Our aging parents should have a copy of their medications and other key medical information for every health provider they encounter.  This information should be printed clearly and verified.

Geriatric care managers can help collect and track this kind of information, and you can do it yourself, as well.  In the coming weeks I'll explore key components in building a Personal Health Record.  Such a record can make a dramatic difference in the quality of geriatric care.