With open enrollment available through the end of 2008, it might be wise to check out personal options available in Medicare Advantage insurance programs.  The first step is to see which, if any, Advantage programs are available in the county of residence.  The next step is to see which medical and hospital networks are available through the competing Advantage providers.  Then it’s time to compare charges.  Many Advantage plans also have options for Medicare Plan D prescription medicine coverage, but as with all Plan D programs the available medicines, the “formulary,” the deductible and the co-pays have to be evaluated.

The comparison process can be complex and confusing to an older adult, so caregivers and friends can be especially helpful.  Medicare’s Web site, www.medicare.gov, is improved and helpful, and most state governments as well as many not-for-profits serving seniors offer individualized help programs.

Large savings are often possible with Advantage programs over older “Medi-gap” and Medicare supplemental insurance policies, but the terms of coverage need to be carefully compared before considering a switch.

Changing public policy may affect the popularity of the Advantage programs if federal payments to insurance companies offering Advantage products are significantly reduced. 

Aging is a journey - and thought by many to be a spiritual journey.  But what is spirituality?  It is often defined as having purpose and meaning in life - not to be confused with religion, which is usually characterized by organized groups.

Research by the Hartford Institute for Geriatric Nursing in 2005 reported that there is a connection between faith and health:

• 82% believe prayer assists healing
• 63% want doctors to ask about spirituality
• 75% use religious beliefs as a means of coping

In helping the older adult and the caregiver, health care providers should:

• Acknowledge the role of religion&spirituality
• Inquire about beliefs and practices
• Refer patients spiritual counseling if desired

Tips on Starting a Conversation about Spirituality

• Ask “are you at peace?” when discussing decisions and actions with client
• Ask “what does (this situation or event) mean to you?”
• Discuss spiritual and religious support
• • Ask about private religious or spiritual practices
  • Discuss values and beliefs towards self and aging
  • Ask if there is anything that the patient used to do and is now limited from doing  

Web Resources for Spirituality

www.spiritualityandaging.org/  The Center for Spirituality and Aging is a not-for-profit organization that publishes resources regarding aging and spiritual issues.  Specific resources are directed towards both caregivers and older adults. The site is nondenominational, but is run by Lutheran ministries. 

http://www.interfaithcalendar.org/  A list of religious holidays for various faiths.

I would like to talk about scams on the elderly.  I am a board certified elder law attorney and am supposed to know something about the elderly and their problems.  However, the susceptibility of the elderly to scams is something that greatly puzzles me and I do not have an answer for it.  I just cannot understand the mechanism which makes smart people (who would never fall for a scam when they were younger) fall for the same scam when they are older.  I remember a case last year in which the son of an elderly woman brought in 3 grocery bags full of scam mail his mother was answering.  She had probably wasted about $20,000 on lotteries, sweepstakes, and con mail.

Right now on my desk are three files representing clients I have dealt with for a long period of time.  I will call them Clients A, B and C.   A was an executive of a company and had to be financially sophisticated to hold that job.  He came to me a month ago with a letter saying he had won $1,000,000 but needed to send in a processing and handling fee to secure his winnings.  He wanted me to authenticate his winnings.  When I told him it was a scam, he seemed disappointed but said he valued my opinion.  In his younger years, he would have thrown the letter in the waste basket.  In his older years, he took it to his attorney hoping it was something.  Why did age make him more vulnerable?

Client B was not an executive type but a blue collar worker.  He was always very handy with everything around the house.  He saved a lot of money by doing many things for himself.  He once showed me a lake cottage he had built himself.  I know he has saved several hundred thousand dollars - some of which I think is now at risk.  His son says he has been answering scam mail and sending checks to various people to secure his winnings.  He brought me an official looking letter saying he was very close to winning a large jackpot.  I told him it was a scam but I don't think he believed me.  The con is always the same.  Tell someone they have won something and ask for some money back to secure it.

Client C, an elderly lonely gentleman, is about to be taken advantage of by a woman, who promises him companionship.  In return, he will make her financially comfortable.  He came to me for some legal documents regarding the new relationship.  After I figured out what was going on, I respectfully declined to do the work.  I said I just did not want to see him get involved and would not aid him.  Again, I asked myself why his judgment had changed.  Was it just being lonely or was the same thing at work that makes the elderly so vulnerable to sweepstakes?

I don't know but I sure have a ring side seat in watching it happen.

In past blogs, I’ve talked about how the holidays are bittersweet for many caregivers, with the increased stress levels and happy memories of the past contrasting with the difficulties of the present.  These extra demands on time and energy can seem overwhelming both to you and your aging parent.

Try to create a balance between rest and activity. In order to keep up with family traditions, take time to assess how important these traditions are and how they affect your responsibilities of caring for your aging parent - especially when your parent has Alzheimer’s or other chronic illnesses such as diabetes, CHF, or arthritis. 

Start early and write down activities that are important to you. As you are making your calendar remember to:

• Keep or adapt family traditions that are important to you
• Include your aging parent as much as possible
• Recognize that things will be different
• Encourage friends and family to visit you this year to limit the number of trips you have to arrange for your aging parent
• If your parent has Alzheimer’s, avoid crowds, changes in routine, and strange surroundings that may cause confusion or agitation 
• Do your best to enjoy yourself
• Try to find time for the holiday things you like to do, even if it means asking a friend or family member to spend time with your aging parent while you are out
• If there are occasions that are large events, try to have a space available where your parent can rest, be alone for awhile, or spend some time with a smaller number of people, if needed.

Most importantly:

• Have realistic expectations about what you can do
• Take care of your needs and keep it as simple as possible!

For more information on caregiving, you may want to visit the National Institute on Aging and explore their available publications.

Technology is being developed in a variety of areas to assist in geriatric care.  Significant efforts are underway in both the consumer and professional markets.  Already these efforts are bearing fruit.  You can read about some in my earlier blogs and I'll be highlighting others in the coming weeks.

Let's start the discussion with some categories.  Technology is entering the the consumer side of eldercare both in the home and on the Internet.  This work could be grouped as follows:

In Home:

Consumer Products 
- Family Communication 
- Wellness and Assistance
Health Products 
- Services 
- Diagnostics Reporting
Safety 
- Monitoring Services 
- Products
Research Initiatives 
- Continuous Monitoring – Automatic Detection 
- Decision Support

On the Internet:

Person Health Records
- Microsoft Vault 
- Google Health
- Hundreds of Others
Medical and Non-Medical Information
- Health Sites
- Support Group Sites
- Commercial Sites

Just to give you a feel for size and scope of the eldercare problem, I thought I'd share a few dramatic numbers. 

• By 2030 the population of seniors in the United States will be 71.5 million, more than doubling in just 30 years - Department of Health and Human Services, Administration on Aging, 2006.
• 24 billion hours were spent in caregiving in 1997. - Arno PS, Levine C, Memmott MM. The economic value of informal caregiving. Health Affairs. 1999
• In 2006, productivity loses to U.S. business were estimated at $33.6 billion. Nearly 80% of these caregivers, were caring for someone over the age of 50 - The MetLife Caregiving Cost Study: Productivity Loses to U.S. Business. MetLife Mature Market Institute and National Alliance for Caregiving. 2006.

You can see from these statistics caring for aging parents is big and growing problem.  It also too big to expect health care providers to provide the solutions.  Caregivers themselves are going to be overwhelmed, as well.  On a personal scale many are already.

Technology can help and may be the only way to cope with the growing issues.

Usually I blog about information for caregivers which are often adults.  But what about the children and teenagers who are also in the family and trying to understand grandma or grandpa's health condition?  Dementia and Alzheimer's Disease are often hard for children and teenagers to understand how the disease affects their loved one.  They don't understand why grandma doesn't know them, or why grandpa thinks they are their child, or why grandma gets angry all the time.  The Alzheimer's Association can be a great resource for information and tips on how to talk to your children and teens about this disease.  There are many children's books available that explain dementia in a way that they can understand them.  Check your local book store for more information.  For teenagers, there is a respite camp called Building Bridges.  This camp provides respite as well as educational support.  2008 was the first year for this camp and it was a great success!  The Alzheimer's Association has endorsed this camp as well.  For more information about the camp, recommended books, and additional resources, check out Building Bridges.

After posting my blog yesterday about caregiver stress, I discovered that Dear Abby just gave advice to a stressed-out reader on the 10th (read the letter by clicking here).  The letter was from ‘Overwhelmed in Cincinnati’, who is struggling to balance her roles as a caregiver for her mother, who has Alzheimer’s, and a mother of three – while also juggling a career.  She feels she’s in over her head with worries about her mother’s safety, well-being, and financial considerations. 

Dear Abby wisely referred ‘Overwhelmed’ to the Caregiver Stress Check from the Alzheimer’s Association (www.alz.org) that I mentioned in my blog yesterday.  If you’re a caregiver, please remember the importance of taking care of yourself.  If you are experiencing a lot of stress, take the quiz here.  Your local Alzheimer’s Association, health care provider, or a geriatric care manager are all good resources to help you manage your responsibilities and reduce your stress.

During this Holiday season, learn how you can recognize the signs of caregiver stress.  If you are a caregiver, it's important to take care of yourself.  The Alzheimer's Association has information specifically for caregivers or those with Alzheimer's Disease and dementia.  Take the Alzheimer's Association Stress Quiz and learn how you feel.  Then review resources, many of which can be found through the Alzheimer’s Association.  There is a special web page filled with helpful tips to make the holidays less stressful for families coping with Alzheimer's. Caregiving is stressful anytime of the year. 

If you answer YES to more than two of the following questions you may want talk to your physician.
Y    N  I don’t get enough sleep.   
Y    N  I get too much sleep.
Y    N  I have recently experienced unplanned weight gain or loss.
Y    N  I feel tired or without energy most of the time.
Y    N  I don’t have much interest in activities I used to enjoy, such as
   reading, walking, or visiting with friends.
Y    N  I am easily irritated, angered, or saddened.
Y    N  I have frequent headaches, stomachaches, or other physical 
   problems.

Remember this holiday season to take care of yourself – Make YOUR health a priority by following these tips:

• Get adequate rest.
• Exercise most days of the week.
• Eat a low-fat diet rich in fruits and vegetables.
• Participate in social activities—they can help you feel connected and may
  actually reduce stress.
• Keep in touch with friends and family.
• Find out what community resources are available to you.
• Ask for and accept help.
• Establish a routine. Prioritize and make lists.
• Look to faith-based groups for support and help.
• Visit your health care provider or doctor for a checkup if you are having physical problems.

My Mother’s  sixteen month stay at an Assisted Living facility has been tremendously impacted by staff turnover.  Every time a “new” Assisted Living Director starts we schedule a care conference to ensure that the plans for my mother are well understood and will be implemented.  However, we have found that it is not that simple… for things don’t seem to go as planned.  A recent change in Assisted Living Directors has resulted in a scarce nursing staff, laundry that does not get done, lunch that doesn’t get delivered and dishes that remain in the sink. 

The bottom line is that my Mother suffers each time staff turns over.  Caregivers suffer too, as they are concerned about lapses in care and frustrated by dealing with the same issues over and over.  It doesn’t  seem that it should be that difficult to get the laundry done….esp. when the facility is charging $5K a month. 

Turnover is a problem for everyone.   Number one – it impacts care.  Number two – it is time consuming to constantly readdress the same issues.  Number three – it can’t help but influence staff morale which can affect actions and attitudes during daily resident interactions.

Based on our experience, I would definitely ask questions about management and staff turnover when touring  Assisted Living Facilities or other senior residences.  If the number seems high, think seriously about how this will affect your parent’s care and well-being.  The most beautiful building in the world won’t make up for a breakdown in staff communication, training and service delivery.

"Caring for an older adult can be rewarding and fulfilling but can also place great physical, emotional and financial demands on those who take care of them. In fact, a recent issue of the Journal of Immunology compared Alzheimer’s caregivers to non-caregivers, finding that caregivers aged between four and eight years faster than non-caregivers. In light of these statistics, and in recognition of November as both National Alzheimer's Disease Awareness Month and National Family Caregivers Month, the American Occupational Therapy Association (AOTA) is offering tips for caring for the adult caregiver.

Research recently published in the American Journal of Geriatric Psychiatry tested an occupational therapy home intervention, the Tailored Activity Program (TAP), that systematically evaluates and tailors activities to individual capabilities and trains families in setting up and using activities in daily care. TAP reduced behaviors that trigger nursing home placement and the amount of time families spent supervising and providing care.

“Our research shows that occupational therapists play a critical role in the care of individuals with dementia and their family caregivers,” said Laura N. Gitlin, Ph.D., director of the Jefferson Center for Applied Research on Aging and Health and professor in the Department of Occupational Therapy at Thomas Jefferson University. “Occupational therapy practitioners are uniquely qualified to evaluate individual capabilities, engage individuals with dementia in activities, help families learn specific communication, task and environmental simplification strategies and to take care of themselves.”

Laurel Cargill Radley, MS, OTR, associate director of professional affairs at AOTA, adds, “Occupational therapists can help individuals and their families promote or maximize independence, safety and function.”

Occupational therapy practitioners recommend adult caregivers:

1. Join a therapy or discussion group for caregivers of older adults.
2. Share the responsibility of caring for an older adult.
3. Ask others for help.
4. Develop a schedule that distributes caregiving responsibility.
5. Consider adult daycare or home health aides to provide occasional breaks to full-time caregivers.
6. Create moments of joy throughout the day by participating in pleasurable activities.

Additional caregiver resources can be found on the Centers for Medicare&Medicaid Services’ (CMS) new Web site, http://www.medicare.gov/caregivers/.

Founded in 1917, the American Occupational Therapy Association (AOTA) represents the interests and concerns of more than 36,000 occupational therapists, assistants and students nationwide. The Association educates the public and advances the profession of occupational therapy by providing resources, setting standards including accreditations and serving as an advocate to improve health care. Based in Bethesda, Md., AOTA’s major programs and activities are directed toward promoting the professional development of its members and assuring consumer access to quality services so patients can maximize their individual potential. For more information, go to http://www.aota.org/."
This article was originally published by the American Occupational Therapy Association.

November is National Family Caregivers Month!!  National Family Caregivers Month is organized by the National Family Caregivers Association (NFCA), an organization that educates, supports, empowers, and speaks up for the more than 50 million Americans who care for a loved one.  National Family Caregivers Month is a time to celebrate all caregivers!
NFCA is hosting a free family caregivers teleclass to teach family caregivers how to improve their communication with healthcare professionals and become better healthcare advocates for themselves and their loved ones.  The 2-hour teleclass is being held November 6 and 13 at 2:00pm EST.  More information on the free teleclass is available here. 
Check your local Alzheimer's Association chapter, Area Agency on Aging, and local senior community for caregiver events in your area.

A recent New York Times article highlighted the negative impact of “elderspeak” on the mental health of older adults.  The term “elderspeak” was defined as “the sweetly belittling form of address that has always rankled older people.”  I decided to find out if lawyers thought this was a problem and I received the following response from a 76 year old lawyer, which says it all.  I will change his name to Joe Smith to protect his identity.

At my age (76), I resent being called "Joe" by younger health care workers,
so I correct them  "It's Mr. Smith to you."  Now, in restaurants when the waitress calls me "sweetie" or "honey," I don't take offense - they don't know my name.  What "bugs" me is when a waitress says to my wife and me, "What can I get for you guys?" I gently remind her that there is only one guy present.

One time I took one of those "sweet young things” (a Purdue student) aside
and told her, gently, that she could increase her tips by not calling old people
"guys," and that if she wanted to call a booth of youngsters "guys," they
probably don't mind (they don't tip very much anyhow).  She seemed to really
appreciate my suggestion.
 
What really gets me is when a particular younger usher at church greets
me with a handshake and says, "How are you today, young man?"  Every
time, I remind him that I am an old man, but he persists.  So, I think I'll use
a different entrance from now on!!!!

The article itself is worth reading and may be found at http://www.nytimes.com/2008/10/07/us/07aging.html?_r=1&oref=slogin

The Indiana Geriatrics Society hosted its annual conference in Nashville, Indiana a couple weeks ago.  It was a great day where colleagues met to network and learn about initiatives that will enhance the provision of eldercare services. The focus of the conference was on providing quality of care for older adults transitioning from one setting to another.  Latest evidence-based practices were shared formally and informally throughout the day.  Topics included a great review of psychotropic medications, a quality initiative for early screening of depression in primary care, and how to address wound care issues and fall prevention concerns.   The day ended with the vision for the future and the key role that informatics will play in assisting care providers.  Eric Tinsley summarized the day’s event explaining “caregiving” through life stages and how technology will assist older adults and their caregivers in coping with the transitions of care. Visit Eric’s blog for more information on tools for eldercare.

As a state affiliate of the American Geriatrics Society, IGS was created to enhance the visibility of geriatric medicine in Indiana, to provide local educational programs in geriatrics, and to provide input to the national organization on policy issues. This all-day conference demonstrated the intent of the organization. For more information on Indiana Geriatric Society, contact Kathy Frank RN, DNS, Geriatrics Program Administrator and the IGS COSAR representative for AGS at katfrank@iupui.edu.

It's that time of year where seniors have the opportunity to change their Medicare Prescription Drug Plan.  Open enrollment begins November 15 and ends December 31.  Seniors are encouraged to enroll or switch programs as early as possible to avoid any problems with prescription drug coverage starting in January.
Medicare Prescription Drug Coverage (or often referred to as Medicare Part D) covers prescription drugs and may help lower a person's prescription drug costs and helps protect against future higher costs.
So how does a senior know which is the best prescription drug plan for them?  A plan that has low premiums for the most coverage is ideal.  There are several ways a person can evaluate their current plan or search for alternative plans.  One way is on the internet at www.medicare.gov.  This website allows individuals the opportunity do a personalized search, which allows the person to enter in their personal information and their prescriptions; or by doing a general plan search, which allows people to search and review plans.  Navigating this website can sometimes be tedious and overwhelming, especially if multiple plans show up as alternatives...how do you choose?  The positive is that the website will list the plans in graph format in the order of most coverage to least coverage, just watch for premium costs.  Another way to evaluate your current plan or search for an alternative plan is to have your local pharmacist run your prescriptions in the Medicare system for you.  Another suggestion is to consult a professional care manager or medical social worker for guidance.  I do not suggest calling Medicare directly....I don't think I've ever talked to a human being on that phone line and callers are usually on hold for long periods of time.

In addition to caregivers having to shoulder the work load of the growing senior population, they are also naturally more engaged in caring for aging parents than health providers for most time their parents face the challenges of aging.  

If you create a "smoothed" picture of the health challenges faced by older adults, you get a continuum like the one shown below.

Each of the "humps" corresponds to major health incidents or living circumstance changes.  In the early part of the continuum, the senior is aging at home and later may require assistive care at a retirement, assisted living, or long term care community.

The health care providers only intersect with the caregiving need at the green arrows for acute or assistive care.  The vast majority of the continuum is addressed by family caregivers who are typically not trained health professionals.  These caregivers need support tools and services to provide the best quality of life for their parents and themselves.

My grandma is a 2 time breast cancer survivor, and I was informed yesterday by an old friend that his wife was battling her 3rd round of breast cancer.  Another friend of mine has a 28 year old friend with breast cancer.  Christina Applegate, a 36 year old actress, was recently diagnosed with breast cancer and chose to have a double mastectomy as her form of treatment.  I'm sure everyone can think of at least one person they know who has had breast cancer.
October is National Breast Cancer Awareness month.  For more information, education, preventative practices, and resources check out the national breast cancer awareness website or the Susan G. Komen foundation. 

Last week's Indiana Geriatric Society's Fall Conference was a terrific meeting.  Special thanks go to the speakers, the current Presidents Drs. Diane and Pat Healey, and conference organizer Kathy Frank and her team of volunteers for carrying off a great program. 

I wanted to share a few thoughts from the conference.  We are facing a serious problem in our Heath System.  The growing population of seniors, their expected longevity, and the small number of health care professionals entering geriatrics or even primary care make for an alarming future.  Health care providers simply won't be able to keep up.

This means that families will need help with aging parents.  That help will come from caregivers.  Most will be family members and some will be professionals such as Geriatric Care Managers, companions, and other eldercare service providers.

These caregivers (especially the family members) need more tools, more resources, and more expertise.  Most will not be trained health professionals and many will be caring for an senior for the first time.

I have the privilege of speaking tomorrow (October 10, 2008) at the Indiana Geriatrics Society Fall Conference. My topic is:

Vision for the Future: Impact of Informatics on the Continuum of Caregiving

At the core of the material I'll be covering I want to share ideas about how technology can improve the lives of seniors and the caregivers around them. 

This in not only a desirable thing; it is a necessary thing.  By 2030 the population of seniors in the United States will be 71.5 million, more than doubling in just 30 years according the Department of Health and Human Services, Administration on Aging, (2006). 

The truth is that there are not enough senior health care professionals, continuous care retirement communities, or even professional geriatric care managers to provide complete and meaningful support for all these seniors.  Caregivers dealing with aging parents or other loved ones must have tools that do not rely exclusively on the individual people from provider community.

After the conference tomorrow, I'll share more on these ideas. 

For a complete program on the IGS Fall Conference follow this link http://iucar.iu.edu/igsfall2008.pdf

It's that time of year to participate in the fight against Alzheimer's Disease.  The Alzheimer's Association Memory Walk is the nation's largest event to raise funding for research and raise awareness for Alzheimer's care and support.  Over 600 communities across the nation organize these walks. 
Alzheimer's Disease is the 6th leading cause of death in the U.S.  There is no current cure for Alzheimer's but researchers are hopeful and continue to make great strides in treatment options and working towards finding a cure.
I encourage everyone to participate in your local Memory Walk.  For more information, check out the national Memory Walk website to register for a walk or to donate.