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.   
 

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.

 

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.

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.

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.

Not to be out done by the Navigator development team, the SCANS team is continuing their "rolling release" of V1.3.  SCANS is the Senior Care Navigation System that provides geriatric care managers with expert advice, best practices, and practical tools to help families with the well-being or their parents.

The June edition of V1.3 includes 26 new resources, process, or tools.  The list includes items like these:

• Death in the Home – Information for Caregivers
• Tips for Alzheimer Caregivers
• Delirium vs. Dementia
• Transitioning an Individual with Dementia into a Facility
• Member Portal Instructions
• Continence Education – Constipation
• Urinary Incontinence – When to Seek Immediate Medical Attention
• Crime Prevention Education for Older Adults
• IADL (Independent Activities of Daily Living) Education
• Physical Therapy and Occupational Therapy
• My Medicare Matters
• Advance Directives for Mental Health Treatment
• Drug Review and Side Effects
• Geriatric Friendly Pharmacy
• Medicine Reconciliation:  Brown Bag Consultation
• Feeding Tube Education
• Special Diet Needs Education
• Defibrillator Education
• Diabetes Education
• Fibromyalgia Education
• Pacemaker Education
• Physician Planner Case Note
• Alternative Living Options Education
• Speech Therapy Education
• Social Participation Barriers
• Social Support Plan

These tools are available to the clients of My Health Care Manager and our affiliates.  Some of the content is also discussed in our blogs and can be accessed for free.  Check out Natalie Langley's blog titled "Healthy Aging".  Natalie is one of the principle researchers and authors of the tools in SCANS.  Her blog covers a holistic look at healthy aging and senior well-being.

My Health Care Manager's care management system (Navigator) has just been updated to version 1.9.  This is the core system that geriatric care managers use to assist families caring for aging parents.  From past blogs you may know that this includes the assessment, care planning, implementation, and tracking support for seniors and their families.

Navigator 1.9 includes:

• Key changes for work flow
• Assessment and tracking improvements in the following dimensions:
  • Client Designees
  • Financial
  • Advance Directives
  • Engagement – Social Support
  • Provider Information
  • Medication History
  • Family Medical Health History
  • Functional Status
  • Assistive & DME Devices
  • Sensory Status
  • Nutritional Status
  • Anxiety
  • Environmental
• Reporting enhancements in areas like legal and Insurance, personal health record outputs, services listing, and more

This system is available to our clients and clients of our affiliates and partners.  We also provide much of this information in our Guide for Senior Well-being and Eldercare.  This is a self help guide is available at http://www.myhealthcaremanager.com/guide/product.asp.

As a caregiver, the responsibility for decisions regarding your parent’s care falls to you.  Often you wish you could discuss the options, choices and next steps with your parent, just as you discussed so many choices in the past…where to go to college, where to have your wedding reception, which neighborhood to select.  But parents with Alzheimer’s cannot help with current decisions as their ability to reason, compare and choose has been ravaged by the disease.  Sadly, dementia robs them of their ability to chart their own course.

So, what should caregivers do when faced with a variety of paths – how do you know how to choose what is best for your parent? How do you know when a parent’s living environment is no longer safe? How do you know when a parent needs more assistance? 

Here are a few suggestions:

• Pay attention to your parent – they may be confused, but they will give you clues when things aren’t going well.  They may seem more agitated, confused or disoriented.  Their routine may change and a situation that has worked well in the past, now poses problems.  For example, they may no longer want to eat dinner because they either can’t remember where the Assisted Living Dining Room is located, or they are afraid to leave their apartment.  
• Check in with their caregivers – have other family members, a companion, assisted living staff or adult day care workers noticed a change in your parent?  Are they concerned? 
• Take your parent in for a check-up – have the Doctor evaluate your parent and review their medications and mental and physical health. 
• Review your parent’s ability to complete Activities of Daily Living – things like bathing, dressing, continence, mobility, feeding.  Has there been a change in their ability to do these things?
• Engage a Geriatric Care Manager – have them conduct an independent assessment to provide an unbiased view of the situation.

Once you have gathered the above information, spend time thinking and talking to others you trust about the findings.  Choose the next step based on what you think is best for your parent at this moment in time.   For instance, if you determine that they need more assistance, think about the pros and cons of providing additional assistance in their current environment vs. moving them to a new environment such as a Memory Care Unit.   There is no “right” decision.  Take comfort in the fact that you have been both thorough and thoughtful when you made the decision.  Always remember that your parent is better off when you address concerns as they arise vs. postponing decisions until a crisis arises.

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.

Our Senior CAre Navigation System (SCANS) has released in a new edition - Version 1.2!
 
This version includes major extensions of the search functionality to make it easier for geriatric care managers to find specific tools and solutions.  This provides quicker access to hands on practical solutions for families caring for aging parents.  Of course, the structure and caregiver advice in each of the 25 Care Categories remains in place to assist the geriatric care manager overall care planning.

Also including in the 1.2 release are a variety new solutions, actions, resources and other content for helping with senior well-being and senior health care.

HBO is doing a documentary series on Alzheimer's starting this Sunday, May 10.  Titled 'The Alzheimer's Project', the series is comprised of four parts.

1. The Memory Loss Tapes
2. Grandpa, Do you know who I am? (with Maria Shriver)
3. Momentum in Science
4. Caregivers

There is also an accompanying book and DVD, as well as supplemental series of 15 videos focusing on the research and medical side of Alzheimer's available to stream online.

A national survey completed in conjunction with The Alzheimer's Project found that 54% of the US population has been affected by some way in Alzheimer's.  With such a huge impact on our society, I encourage health care providers, caregivers, seniors, and anyone else affected by Alzheimer's or a loved one's cognitive decline to watch this series.

The website has great information, but please make sure to ask your health care provider if you have questions.  A geriatric care manager can also help caregivers and seniors address issues associated with Alzheimer's and cognitive decline.

For more information on the series, visit http://www.hbo.com/alzheimers/index.html.
To watch the supplemental series, visit http://www.hbo.com/alzheimers/the-supplementary-series.html.

Caregivers for those with cognitive decline or Alzheimer's can find free help from their local Alzheimer's Association.  Whether you're looking for ways to better communicate with someone with Alzheimer's, ways to reduce your caregiver stress, or even seeking other local resources, the Alzheimer's Association is a great place to start your search.

Local Alzheimer's Associations often give conferences for caregivers.  Topics often covered include communication, home safety, and well-being.  Presenters have extensive experience in geriatrics and caregiving topics.  In addition, you can connect with other caregivers for support.

There will be a caregiver's conference on May 15th in Indianapolis, and I encourage you to attend.  For more information, visit the local Alzheimer's Association website. 

For information on events in your city and state, visit the national Alzheimer's Association website.

**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).**

There are several barriers that can impact the older adult’s ability to achieve good nutrition.  The following checklist can help to ensure older adults are getting the proper nutrition. 

Determine if there is a problem that impairs their ability to eat:

1. Have a physician/pharmacist review side effects of medications.
2. Are their teeth/dentures in proper condition?
3. Are there any physical limitations relating to pain and arthritis?
4. Is there a decrease in a sense of smell and taste?
5. Are finances a barrier?
6. Is their eyesight failing?
7. Do they have weakness and are not able to carry grocery bags?
8. Is forgetfulness or dementia present?

As a caregiver or an older adult, make sure to enlist people and programs within the community to help with meal assistance.  One way is to contact your local Area Agency on Aging for meal programs for older adults, such as Meals on Wheels.  This program offers deliverable meals for older adults in their homes.  For a list of local Area Agencies on Aging, you can visit www.n4a.org. 

Another good resource for meal assistance is Seattle Sutton's.  This is an Illinois based company, but they have locations everywhere.  They offer healthy, prepared meals for a reasonable price.  To find a location near you, please visit their website at http://www.seattlesutton.com/.
 

In working with seniors and their families, end of life care issues always come up.  It is a hard decision for the senior and families to make end of life care decisions, for example, whether to continue treating an illness or disease, implementing palliative care, or inserting a feeding tube.  These difficult decisions can often be made ahead of time by the individual via a Living Will.  Living Wills allow individuals the ability to document their end of life wishes, treatment preferences, and care options.  Any person over the age of 18, who is considered competent to make their own decisions, is able to complete a Living Will.  Living Will forms can be found at your local library, the internet, or an attorney's office.  Some states develop and recognize state-specific Living Will forms.  To download your state's specific advance directives form, check out Caring Connections.

The most difficult end of life decision to make is whether to insert a feeding tube or not.  A recent article from Health Behavior News Science, addresses recent studies on this issue.  For people with Advanced Dementia or degenerative dementia, the body is unable to metabolize food properly due to the brain damage.  The biggest fear for families is wondering if their loved one is "starving to death" or experiencing pain from hunger and thirst.  Hospice studies have indicated that few people experience this type of pain.  And if pain is exhibited it is often alleviated with palliative care and pain management.  In my career, I have had several physicians state that due to the brain damage and with the body going through the end of life process, that our bodies do not feel hunger or thirst.  But will we really ever know the answer to that question??  My motto as a geriatric social worker has always been, if I've made someone as happy and as comfortable as possible while they are here with us then I've done my job.  What I do know is that the decision to place a feeding tube is an individual decision and each person's situation should be considered separately.

For more information on studies, reviews of health care interventions, and evidence of clinical trials, check out the Cochrane Collaboration.

My Mother has declined precipitously during the past six weeks.  We’ve watched helplessly as her confusion increased, her mobility worsened and her sense of time and place evaporated.  Yet, a routine Doctor’s  appointment and lab work did not reveal any treatable physical changes.
Yet, everyone around her noticed the decline – my sister, the companion, her Health Care Manager (a geriatric care manager from My Health Care Manager) and the nurses at the Assisted Living facility.  We were saddened to see my Mother struggle with this new stage of life and worked together to offer additional support.  We all ASSUMED that this was the natural progression of the dementia.

Our Health Care Manager was puzzled by what my Mother was experiencing.  She had worked with many, many seniors and felt that my Mother’s cognitive decline did not fit the typical pattern.   She felt that the changes my Mother started to experience happened overnight vs. being a gradual process.  It bothered her, so she sent a letter to my Mother’s physician and explained her concerns.  This led to a conversation between my Mother’s Doctor and the Health Care Manager.  As they reviewed my Mother’s case, a light bulb went off.  My Mother had a medication change in December….was it possible that the med change was negatively affecting her current physical and mental state?   Was it possible that the changes we’d noticed were not necessarily caused by the next stage of the dementia, but a medicine interaction? 

Thanks to the Health Care Manager’s detective work and follow up with the health care provider, we’ve stopped the new medicine that was added to my Mother’s care plan in December.  We have our fingers crossed that we will see a difference and that some of the decline will be reversed.  It is possible that there are other causes – a series of small strokes, for example.  But for now, we are addressing what the Doctor thinks is the most likely cause.

We’ve learned a good lesson.  Never assume that even small changes are “normal” …question everything!  And seek professional help whenever necessary. 

 

A number of people have been asking me about starting a Personal Health Record(PHR) with Google Health, Microsoft Vault, or other free tools.  The question eventually cycles around to, "Why would I pay for a PHR when I can get one for free?"

Good question.

Of course, the answer is as old as the health care business itself.  "There's no such thing as a free lunch" ... or even a free PHR.  It's simply a matter of what you are willing to trade for the service. 

If you build your own PHR you have to take extra time to build, maintain, and even think through all the necessary information to collect.  Likely you have to type everything by hand rather than pulling from medical records, pharmacy records, or other sources of ready data.  What you are "paying" is your time and what tools you decide to use.

I the case of Google Health of Vault you are "paying" with your personal information.  In particular, detailed information about your medical conditions, treatments, and health situation.  If you are caring for aging parents you are trading their information.  What you get in return is the result of hundreds of thousands of dollars of development and though.

But, where did all the development money come from?  Where does the money come from to pay for the computers, bandwidth, and support staff?  It comes from advertising dollars aimed directly at you, your parents, or you as a caregiver.  These advertisers love the idea of being able to get directly at you and the health problems you or your parents face.  Not all bad, really... but no so good either.

The other model of course is to pay for a PHR application yourself and eliminate the need for a "third party payer".  In this case, of course, you are paying with an annual or monthly access fee.  This is also true if you are using a geriatric care manager or other provider of eldercare services who is using a system on your behalf.

There isn't a right answer.  You simply have to evaluate the trade off between your time, your private health information, or your money.

**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).**

If you are a veteran, a surviving spouse of a veteran, or a caregiver of a either, I'm sharing some important information on veterans benefits today.  Veterans or surviving spouses of veterans who may now or in the future need caregiving assistance in the home, assisted living, or long term care facility you may be eligible for the Aid and Attendance Benefit.  Veterans Financial (not affiliated with the Veterans Administration) is an organization that can help veterans and their families obtain any eligible benefits.  Veterans Financial is accredited by the Better Business Bureau (BBB). 

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 (caregiver, home health aid, or another) 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 or nursing home due to cognitive or physical incapacity    -OR-
• Is blind, or nearly blind

For more information on Veterans Financial, Inc. please visit:
www.veteransfinancial.com or contact them at 800-835-1541.

Remember Hillary Clinton’s book It Takes a Village which was written to address caring for children?  I find this same approach applies to the senior population.  It really does take a group of people, making a concerted and coordinated effort, to assist seniors as they age.  It takes time and careful thought to build a “village” for your parent.  Following are a few ideas to help you get started:

• Family – Primary:  spouse (if living), brothers and sisters, children, grandchildren, great grandchildren
• Family – Secondary:  nieces, nephews, cousins
• Friends: lifelong friends, new acquaintances, neighbors, club associates, church members
• Health Care Providers:  Primary Care Physician, Specialty Physicians, Physical Therapists
• Geriatric Care Manager:  Professional (typically nurse or social worker) to provides care advisory/advocacy  service addressing  specific needs of senior
• Companion:  Paid caregiver to provide services as needed:  cooking, transportation, companionship, assistance with activities of daily living
• Skilled Care:  Paid clinical care provided by licensed practitioners
  Independent Living or Assisted Living Facility Staff:  Nurses, administrators, social workers, certified nurse assistants

Care assistance and expertise is available from many sources.  Plan your village now - don’t overlook the many ways a support system can be built for your parent.   
 

There are many drug-free (non-pharmacological) options that have been proven to help relieve certain types of pain, which could be from arthritis, chronic pain, or another chronic disease. These techniques can help complement the pain management medications prescribed by your doctor.
1. Apply heat or cold to the affected area
2. Ask your geriatrician or health care provider about specific exercises to help with pain
3. Find something that distracts you such as music or a hobby
4. Practice relaxation or deep breathing techniques
5. Massage or vibration can help relax you and may relieve the pain
6. Applying pressure to the area that is in pain
7. Find support groups or someone to talk with
8. Modify your environment so that it is more comfortable for you
9. Plan activities earlier in the day when pain is sometimes not as bad
10. Learn how to manage pain- learn what triggers it, what makes it worse, and what makes it better
11. Consider keeping a journal of when pain occurs and what helps relieve it
 
If you are not sure of how to use these techniques ask your health care provider and/or discuss with your Health Care Manager.  If you're a caregiver, you can discuss these options with your aging loved one and have them work with their health care provider to integrate the techniques into daily life.