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".

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.

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:

• Your local VA health care facility’s Enrollment Office
• www.va.gov/healtheligibility
• www.myhealth.va.gov
• Veterans Health Benefits Service Center 1-877-222-VETS (8387)
• Family member benefits www.va.gov/healtheligibility/familymembers

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:

• Requires the ongoing aid of another person in order to perform basic personal functions required in everyday living (i.e. bathing, eating, dressing, etc.) -OR-
• Is bedridden -OR-
• Is a resident in a long term care facility due to cognitive or physical incapacity -OR-
• Is blind, or nearly blind

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

• Long term care is not covered by Medicare
• Long term care insurance can be purchased to cover the expense of long-term care
• Policies protect assets should you need extended care, such as a house for your spouse
• Many are standardized and may be purchased through authorized insurance brokers through the state.  Policies differ from state to state.  Each state must honor the policy from another state
• To find out more information about long term care insurance go to: www.medicare.gov then go to ‘search tools’ then go to ‘plan your long term care needs’

An experienced geriatric care manager can help you identify local resources.

“Still Alice,” a wonderful novel written by Lisa Genova,  is about a woman named Alice with early onset Alzheimer’s Disease.  The author, who is a neuroscientist, weaves scientific and emotional details of the disease throughout the story.  The story is told from Alice’s perspective – a 50 year old Harvard professor who begins to show symptoms of Alzheimer’s disease.  The book follows her journey from her initial assumption that her forgetfulness is due to menopause, through medical exams and testing, to telling family members and friends of her diagnosis, to living a life she had not expected.  As the story evolves, the reader learns how Alice feels as she struggles with day to day activities such as getting dressed, taking a walk and using her Blackberry.   The reader also experiences the pain felt by family members who learn how to be caregivers for Alice while coping with the knowledge that they may have inherited the gene that causes the disease.  The awkwardness expressed by former friends and colleagues jumps off the page as they struggle to interface with an Alice who is different from the Alice they remember.

The book is an emotional, honest read.   It boldly examines the frustration, depression and decline that accompany an Alzheimer’s diagnosis.  It explores Alice’s life over a three year period and is an honest, haunting and heartbreaking portrayal of life with Alzheimer’s.  Yet, the book shares hope by including discussions of possible treatments.  Most importantly, it teaches readers to view people with Alzheimer’s not as victims, but as people living their real lives. 

“Still Alice” has received high marks from the National Alzheimer’s Association… the book is featured on their website (www.alz.org).  For more information visit www.stillalice.com.   I recommend that everyone read this book, as it puts a very human face on a disease that will shape our future.

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

1. Veterans Benefits
2. Employer Benefits
3. Union Benefits

Things to know about insurance:

• If you currently have health insurance benefits through another policy, it is important to know that if you cancel it, you may not be able to re-enroll in this policy
• There are several situations in which the other benefits may pay bills before Medicare benefits will be used
• Often Medicare pays second when you are covered by insurance through a place of current employment or liability claims
• Make sure to give all insurance documents when receiving care

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.

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:

1. Join a Medicare Prescription Drug Plan- this usually involves paying a separate premium in addition to your Part B premium
   2. Join a Medicare Advantage Plan that includes prescription
   drug 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

1. Lowest copay: covers most generic drugs
2. Medium copay: covers preferred (brand name drugs that are less costly, but as effective as other drugs). There is a formulary of medications that are covered under this plan and substitutions may need to be made
3. Higher copay: covers non-preferred brand name drugs
4. Highest copay: covers unique high cost medications.

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.
 

We know so much, yet so little about Alzheimer’s Disease.  And what we do know can be very, very discouraging.  Today we know that ….there is no cure, the disease worsens as it progresses, and while the drugs available may slow down the progression, they do not stop the disease.  I find myself wondering – “Where is the hope?” “What does the future hold?” …… and most importantly “Where is the research?” 

To learn more about the disease and what is being discussed for the future – visit HBO online and view the documentary “The Alzheimer’s Project” (http://www.hbo.com/alzheimers/).  The series is divided into four segments.  Each segment focuses on a different aspect of the disease including:  The Memory Loss Tapes, Grandpa Do You Know Who I Am?, Momentum in Science, and Caregivers.

As an active caregiver for a Mother with Alzheimer’s, I found the series difficult to watch at times.  Yet, I felt an instant bond with the other families I saw struggling with the same disease and, who like me; don’t seem to have all the answers.  It was also comforting to learn about the research being done and the minor discoveries made to date.  Hopefully the research will lead to a significant breakthrough to help better understand and eventually cure Alzheimer’s Disease.

At a recent appointment with a new doctor, I revealed my family’s history of Alzheimer’s Disease.  To date, the cases I am aware of are Grandmother, Mother and Aunt.  Of course I wonder if the next generation – me and my sister- will inherit this insidious disease.  My doctor counseled that inflammation may seem to contribute to the disease.  So, I left with advice to take a daily low dose aspirin and  fish oil capsules.  How much happier I would have been to receive a vaccine like the ones available for mumps, measles, shingles, etc.   Maybe this will happen in the future – I certainly hope so.   

The final installment of the SCANS 1.3 rolling release is complete.  The July release includes some 22 new and revised tools and resources.  The list includes:

• Medicare Summary
• Medicare A Information
• Medicare B
• Insurance Resource
• SHIP
• Medigap
• Medicare C and Advantage Plans
• Earwax
• Visual Impairment Websites
• Hearing Impairment Websites
• Visual Impairment Devices
• Optometrist vs. Ophthalmologist
• Bladder Training
• Foley Catheter Care
• Urinary Continence Education
• Incontinence Supplies
• Catheter Education and Support
• Brain vs. Bladder
• Incontinence – Foods to Avoid
• Tips to manage Incontinence with dementia
• Continence Bladder Diary
• Modify Environment to Assist with Continence

Thanks to the SCANS research team for this successful (and popular) release which included some 74 new tools!  You can read more about these topics from a caregiver's perspective directly from one of our researchers Karen Witt Kelsey.  Click here to read more in her Caregiver Support blog.  Karen is a key member of the research team as well a caregiver for her own mother.  You'll enjoy her unique perspective on senior health care.

Last week I had the opportunity to present a paper at the Human-Computer Interaction International Conference.  This was the 13th occurrence of the conference and the event was well attended by key researchers and companies concerned about how computers interact with people. 

Jean Bandos co-authored the paper titled "Impacting the Continuum of Caregiving through Innovation in Informatics: Senior Care Navigation System (SCANS)".  Other members of the SCANS team contributed, as well.  You won't find the paper in the conference proceedings however, due to Intellectual Property concerns with the conference publisher's copyright requirements.  In spite of those restrictions the paper and the presentation were well received.

What struck me about the conference on a general level was the amount of attention being given internationally to the challenges of older adults and senior health care.  Conference attendees came from China, Japan, UK, Germany, India, Spain, and many other places - representing some 49 countries in all.  Support for seniors living independently and dealing with challenges like immobility, well-being, and cognitive decline surfaced as a major sub-theme to the conference.  World wide researchers are examining how computers can help with aging parents.  

The specifics were wide ranging from topics like augmented navigation for assistive mobility devices to ontologies for adaptive user interfaces to cope with the specific needs of the elderly. 

I was genuinely encouraged that so many top brains are looking for ways to improve eldercare services.