I’m Jean Bandos, MSN, CNS, APRN, BC. I’m a gerontological clinical nurse specialist with vast experience in care management of the older adult. I’ve spent the majority of my career assisting the older adult and their families navigate the health care system. In my blog, I’ll share some eldercare resources and assist in spreading the word on “tips” for caregivers of aging parents.
To learn more about me, please visit our website.
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,
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.
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.
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:
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:
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
With all of the choices available, finding the best options for insurance can be time consuming and confusing for the elderly and their caregivers. The State Health Insurance 
Assistance Program can help you sort out your options.
State Health Insurance Assistance Program
SHIP, “State Health Insurance Assistance Program”, is a national program that offers one-on-one counseling and assistance to people with Medicare and their families. SHIPs provide free counseling and resources. If you want to contact a SHIP counselor in your area who will provide you with state specific information including a counselor to help guide you through the process of picking a supplemental policy and the required paperwork visit the SHIP website www.shiptalk.org.
Caregivers should explore eligibility for Veterans benefits. Veteran health benefits are open to all Veterans. Family members may also be eligible to receive benefits. There is no monthly premium for VA care, but there may be a co-pay. For more information, visit the VA Health Care Eligibility & Enrollment www.va.gov/healtheligibility .
Additions resources are available at:
Veteran or Surviving Spouse Benefits Information
Veterans Financial, Inc. is a national company (not a part of the Veterans Administration) that provides free financial advice to veterans and their families who may now or in the future need assistance in their home, assisted living, or long term care facility. Veterans Financial helps veterans and their surviving spouses apply for the VA’s Aid and Attendance benefit to ensure they are getting the benefits they are eligible for. Aid and Attendance
The Aid and Attendance benefit is a benefit paid in addition to a monthly pension.
You may be eligible for the Aid and Attendance benefit if the veteran or the surviving spouse:
Once Veterans Financial has an idea of your specific situation, they will advise seniors and/caregivers on options you have and help with the application process to help obtain the Aid and Attendance Benefit.
For more information on Veterans Financial, Inc. please visit: www.veteransfinancial.com or contact them at 800-835-1541.
Long term care insurance is separate from Medicare, and may be a good option depending on your situation and that of your loved one. Senior and caregivers should thoroughly investigate the long term care insurance policies available, and consider finances, health, long term wishes and goals, and other factors.
Long Term Care Insurance
An experienced geriatric care manager can help you identify local resources.
My previous posts have dealt with Medicare, Medicaid, and Medigap. Here are some of the other insurance options for seniors:
Other Government and Private Insurance Policies
Things to know about insurance:
Veterans health benefits, available to all veterans, are something caregivers and seniors should be aware of. My next post will cover veterans benefits in more depth. A geriatric care manager can also help you identify your options and identify local resources.
My previous two blogs have explored Medicare eligibility and the 4 types of Medicare policies. Caregivers and seniors also need to know about Medigap, which can supplement your aging loved one’s regular Medicare coverage. In addition, caregivers should also know about Medicaid in case their aging loved one qualifies.
Medigap
Medigap policies are health insurance policies sold by private insurances to supplement costs that may not be covered under the Original Medicare Plan - this may include coverage for co pays and deductibles, some policies may cover emergency health care outside the United States. You pay a monthly premium to the private health insurance company that sells you the policy. Medicare and the Medigap policy both pay their shares of covered health care costs.
Medicaid
Medicaid covers health care expenses for people with limited income or resources- this definition varies from state to state. Medicaid will cover long term care and home care services for services that are not covered by Medicare.
A list of state Medicaid requirements is available at http://www.cms.gov/medicaid/statemap.asp and may be accessed by finding your state on a map of the United States.
Insurance is complicated and seniors have many options. Look for my next post, as it will cover other insurance options. Caregivers are often tasked with evaluating insurance options for their loved ones, and it’s important to know all of the options. If you desire more assistance, a geriatric care manager can help you identify local resources for Medicare, Medigap, and Medicaid information.
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.
Medicare is a government health insurance program administered by the Centers for Medicare and Medicaid Services (CMS).
If you meet one of the following criteria then you are likely to be eligible for Medicare benefits*:
*If you are not a citizen of the United States, but have lived in US continuously for a five year period, you can contact the Social Security Administration office at 1-800-772-1213 to discuss your Medicare enrollment and eligibility.
Medicare has two main categories/plans to choose from: the "Original Medicare Plan" and the "Medicare Advantage Plan". Under these plans there are four sub-categories: Part A, Part B, Part C, and Part D.
Look for my next post to explain the 4 Medicare policies.
As your parent ages, one of the key concerns for caregivers is insurance coverage, specifically medication coverage. Does your parent have adequate insurance coverage and do you understand what’s covered by the policy/policies? With the variety of choices being offered by Medicare, here are some facts concerning prescription coverage.
Medicare Part D Fast Facts
There are two ways to get Medicare prescription coverage:
As caregiver, you may re-evaluate your parents’ plans and change plans every year. Open enrollment, the period when you can change a plan without penalty, occurs from November 15th- December 31st.
When choosing or reviewing a plan, you should consider the medications and doses that your parent uses and the name of the pharmacy that they use. If they use multiple pharmacies, recommend that they have all their medications at one pharmacy.
There are 4 tiers of categories for coverage
Remember, many plans require a copayment and also have a coverage
gap. This means that once you have spent a certain amount of money, you
will have to cover the costs of your medications up to a set limit.
You should get a letter within a week of enrolling in the program. You may
use this letter as proof of membership until your card arrives.
Resources:
To compare plans, go to Medicare’s website: www.medicare.gov. There is a box on the right hand side of the page that allows you to compare plans based on
personal information that you enter.
For help with filling out paper work and comparing plans, go to the State Health Insurance Assistance Program's (SHIP) website at www.shiptalk.org and enter your state.
The elderly are particularly susceptible to heat stress, and it's important to keep your aging loved ones and elderly neighbors safe during the summer - especially if they are without air conditioning. A few safety tips for caregivers: In today’s world, adult children are faced not only with the effects their elderly parent(s) aging, but now they have to understand how the economy may affect their aging parent’s financial situation. Every time we turn on the TV, we are inundated with how bad the economy is and what is happening to our savings. But are you aware that older adults are struggling with excessive credit card debt, and that bankruptcies are increasing among the elderly?
So what can you do to assist your aging parents? How do you help yourself, as the caregiver, make plans for the future? Start by asking some general questions, such as:
Resource sites:
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