Too often, caregivers do not take a break and this can have grave consequences—for their health and wellbeing. But, from a practical perspective, how does one get away when they need to be there for their loved one? What if Mom or Dad lives in the home and cannot stay alone, or stay safely alone for a long period of time? What if Mom lives in a care facility and you worry about not visiting for a week? What if there is an emergency? How can you think of going on a cruise knowing you might be called back if something happens?

There are several options for enabling caregivers to get away. Many families share the care and have a sibling come to stay or the care recipient go to stay with another family member, but this is not always feasible or available as an option. If not, consider various options for respite care. If an elderly parent lives with you in the home, professional in home care may be the most viable option. But, how do you know where to find good help? What happens if someone does not show up to help while you are gone? A professional care manager is the solution. A care manager deals with setting up in home care regularly, so he or she knows the best resources and can explain the details to you. A care manager works to find the most appropriate caregivers for your loved one’s needs. Typically, a care manager will coordinate with a licensed home health agency (either independent of they may have their own or work in conjunction with one) so that you have liability and other legal protections. Then, the care manager works to coordinate the care plan and the caregivers. Most importantly, the care manager helps monitor the care while you are gone and provides on call assistance if there are any problems or emergencies. You can have the peace of mind to know someone is handling any issues that arise.

If your loved one resides in their own home and does not need direct care but you check in and worry about being far away, a care manager can take over those duties for the time you are gone. The care manager can check in and be on call if needed.

Alternatively, if your loved one lives in a care facility, the care manager can monitor the care there while you are away, and be the alternative emergency contact if needed. A care manager can also help set up a respite stay in a care facility while you are gone. This may be a good option if your loved one requires some care or assistance, rather than bringing in home care. The care manager can help you assess and decide what is best for your loved one. They can address the pros and cons of different options. For instance, someone with dementia may benefit from the consistency of staying in a familiar setting with caregivers coming in, but others may have trouble getting used to the unfamiliar faces (which a care manager can help work through and provide techniques to help). Others may benefit from the socialization and activities at a care facility—and this can be a particularly good option if you want to start getting your loved one and yourself familiar with a facility for possible future needs.

Whatever your situation as a caregiver—consider talking to someone about the options and know that there are options. You can come back refreshed and better able to do your job as a caregiver. It may seem impossible, but don’t rule it out until you have checked out the options.

Contact Aging Wisely today for assistance with such needs in the Tampa Bay area. We can be reached at 727-447-5845 or admin@agingwisely.com.

• What Do You Mean I’m a Caregiver! How Is a Sandwich Generationer and Booomer Supposed To Do It All?

Many, if not most, of us will be both in our lifetimes — caregiver and the cared-for. We may slip into these roles so gradually that we scarcely realize it. Or, as the social scientists say, we may not self-identify.

And Thou Shalt Honor examines the various aspects of caregiving in a warm and caring documentary coming to WEDU in May 2008.

Watch a program sample Now

Encores air on May 21st from 1-3pm and on May 25th from 3-5pm

May 15th Town Hall Meeting

Here’s the website: http://www.wedu.org/caregiving/

“The Magic of Caring”

5/1-5/4/2008

Buena Vista Palace Resort

Lake Buena Vista, FL

Aging Wisely’s Linda Chamberlain, Liz Barlowe, Shannon Martin are featured speakers, Aging Wisely will be featured at an exhibit booth as well.

http://www.caremanager.org/cde.cfm?event=201501

When you are worried about an aging loved one or client, you may suggest taking a look at an assisted care setting. Often, this does not go over well. It seems that most people have the notion that staying in their own home forever is the ideal. For many people, this may be possible, depending on their health situation, support system, and financial status. Aging Wisely helps families analyze options and resources for remaining safe and happy at home.

For others, a retirement community, assisted living facility, or nursing facility may not only be necessary, but a truly positive change. For information on terminology and levels of assisted care in Florida, see our article: http://www.agingwisely.com/assisted-living-options-in-florida/.

What are some of the benefits of moving into a retirement community that offers some services or assistance?

• Safety and oversight (however, it is important to make sure the level of oversight matches your loved one’s needs and ensure the community offers what you think you’ll be getting)
• Socialization-particularly as individuals get older and have health problems or friends and family die, they may withdraw from normal activities; these settings may afford them easier opportunities to socialize (picking a place that has the right level and type of activities for a particular person is key)
• On site medical attention (varies by community, some offer primary care physician’s visits onsite, nursing services, podiatry, psychiatric/psychological services, physical therapy)
• Convenience-amenities such as transportation, meals, trips and activities, disaster planning make life simpler (the right mix is important to consider, facilities offer a variety and some services may be included while others carry additional fees)

Some of the guidance Aging Wisely frequently provides to family members includes:

• How to approach this subject with their loved ones.
• Providing an independent assessment of the situation and options.
• Giving guidance about resources, options, costs and facilities.
• Choosing the right facility for the individual.
• Analyzing a budget, insurance and benefit options and costs/benefits of various scenarios.
• Help completing necessary paperwork and understanding admissions process.
• Complete coordination (or ala carte services) of the move including setting up movers, downsizing, estate sales, real estate professionals, changing addresses, and all the little details.
• Helping with the emotional aspects of the transition. Advising families on the best ways to make the transition and helping introduce clients to their new environment and make it a positive move.
• Oversight and coordination at the facility for out of area family members, acting as their eyes and ears and being the local emergency contact.
• Being another set of eyes and ears for local families and giving the professional expertise often needed, reviewing the client’s chart, and noticing changes or concerns that our experience may alert us to more quickly; advocating for clients.
• Helping families get the best care for their loved ones, understanding realistic care expectations and help navigating the care system and managing crises or changes that arise.

Who do we help?

• Family members concerned about their aging loved one and needing guidance, an independent assessment, or help convincing family members to get help.
• Professionals assisting clients or families in planning for their later years.
• Responsible parties, whether family members or professionals, trying to decide on the best care setting and options for their loved one/client.
• Professionals with a fiduciary duty or other responsibility to a client, helping to ensure wise choices are made.
• Clients who need help organizing a move and are overwhelmed by all the tasks.
• Facility staff who have potential residents who might be hesitant to move, by helping clients see the benefits of moving and assisting them with the overwhelming process.
• Case managers and social workers having difficulty finding placement for client’s special needs or concerned that someone is unsafe to return home.
• Family members who have begun looking for facilities but realize it is a complex decision and want to make the best choice for their loved one.
• Families who are disagreeing about what is best for a loved one, or the professionals who are working with such families or clients.
• Families looking to move their aging or disabled loved one to the Tampa area.
• Out of area families wishing to relocate their loved one to a facility nearer to them.

Hospice of the Florida Suncoast Garden House

Contact Shannon Martin at 727-447-5845 for more information.

Meets monthly, 4th Tues. of the month. Location alternates between Pinellas County (Hospice) and Tampa (Stetson Law-Tampa Campus)

When someone first becomes eligible for Medicare (age 65 or typically, 25 months after Social Security Disability payments begin) they must make a decision to participate in Parts B and D within a 7 month window (including the 3 months before and after eligibility) or face penalties later for not applying. If someone is covered by an employer or other plan, they should confirm their plan is “creditable” (the same or better than what Medicare offers) and save their letter of creditable coverage. If later, this coverage ends through no fault of the individual, they can enroll without penalty.

The penalty for not enrolling in a Part D plan is 1% of the national base beneficiary premium (changes yearly) multiplied by the number of months you did not enroll and were eligible (and went without creditable coverage for 63 continuous days or more), rounded to the nearest 10 cents. This amount is added to your monthly premium every month as long as you are enrolled. Therefore, it is important for individuals to consider some type of coverage to avoid potentially steep penalties later.

In most cases the only chance to enroll or switch plans after initial eligibility for Part D is this annual election period. Exceptions include moving out of a plan’s coverage area, losing creditable coverage, or being misled or not fully covered by a plan (or if a plan stops coverage). Some individuals have older Medigap (supplemental) polices that included prescription drug coverage, and they may choose to keep this if it is a creditable plan (again, save proof of creditable coverage) but will face penalties if it is not creditable. One cannot have one of these older Medigap policy with drug benefits and a Part D plan. Current Medigap policies do not include drug benefits, but only serve to help with copays and deductibles and some extra benefits. These plans are all standardized and cannot be used in conjunction with a Medicare Advantage plan.

People who are “Dual Eligibles”, eligible for both Medicaid and Medicare, will be automatically enrolled by Medicare into a Part D plan, but can chose another plan if they would like. The Part D plan pays the majority of drug costs, whereas Medicaid used to pay these. Individuals will have co-pays on their medications through Part D, unless they are “institutionalized”, i.e. in a nursing home or long term care facility (note: this does not include assisted living facilities and these co-pays can become a big issue for someone in assisted living under Medicaid who receives limited personal needs allowance).

Many Part D plans have what is known as a “donut hole” or coverage gap, meaning that once you received a certain amount of coverage each year, you pay all out of pocket costs until you reach “catastrophic coverage” (no more than $4050, but may be less depending on the plan). There are a number of plans that offer gap coverage, although it may only be for specified drugs. This, along with the varying premiums and co-pays for medications, dictates the importance of comparing plans individually and estimating which plan best fits your circumstances. Many people did not switch plans during the last annual enrollment period, which hopefully signifies they are happy with their plan, but for many it may not be their best option. There is also special help available for those who have limited income and assets.

Medicare offers a plan compare tool that is very helpful in looking at personalized choices. To use this tool, the individual should have available their Medicare #, effective date for Medicare (both are found on the Medicare card), last name, date of birth, and zip code, as well as a list of all medications including dosages and frequency. In addition to showing cost projections for the plan, you can review the plan’s performance and see details regarding customer service.

The Medicare Advantage Plans (AKA Part C) are privately run plans approved by Medicare, and generally combine a number of the different benefits into one plan. These include HMOs, PPOs, and Fee for Service plans. Medicare pays a nice incentive to them per enrollee, so they are often able to include extra benefits such as health club memberships or vision/dental coverage. These companies do a lot of marketing and we find that clients sometimes enroll without a full understanding. They are being more carefully monitored because of some past deceptive marketing practices, but it is still easy for clients to enroll without a full understanding given the complexity of choices.

These plans may be appropriate for certain individuals, especially those looking for extra benefits at lower cost. However, many individuals who sign up do not realize the potential restrictions. The HMO and PPO plans have networks of providers, meaning the potential doctors, specialists, and rehab./nursing facility choices may be limited. The Fee for Service plans do not have networks per se and are thus marketed as having full choice, but not all providers chose to participate due to the negotiated fees and thus in reality, choices may be limited. Clients should review all options carefully and weigh the pros and cons of each plan. If clients find themselves in a plan they do not like, especially when in a crisis, there are options for disenrolling.

If you or your clients need help with this or other insurance and benefits issues, our Benefits Specialists at Aging Wisely can help. We can run comparisons for clients and help them or their families in selections, assist with paperwork, deal with customer service and appeals issues, research claims or insurance issues, and help with filing claims or reviewing explanation of benefits.

We have also enclosed a 2008 Medicare Fact Sheet, with the latest copay and deductible information for the coming year, which we welcome you to reproduce for your clients or post in your office. Contact us if you would like additional copies or need any additional Aging Wisely brochures or information for your office.

Contact us at 727-447-5845 or 813-249-6507 or toll free at 1-888-807-2551. We can also be reached via email at admin@agingwisely.com.

Aging Wisely, providing Comprehensive Care Management and Consultation for seniors, disabled individuals and their families since 1998 throughout Pinellas, Pasco & Hillsborough counties.

Is it Alzheimer’s or Dementia? Dementia is a general term used to describe many different diseases. Dementia is the syndrome of symptoms such as memory loss and decreasing ability to handle the daily functions of life. Dementia is not an early form of Alzheimer’s or some less serious disease, it is simply a catch-all term that describes Alzheimer’s, Vascular Dementia, and other specific diseases. It is frequently used because people may not know have a specific diagnosis yet or due to the fact that many of the symptoms are common in any type of dementia. Because professionals often interchange the terms for general discussion purposes, people have become confused about the distinctions. Types of dementia may include Alzheimer’s, Lewy Body Disease, Pick’s Disease, Parkinson’s related dementia, and Vascular Dementia. Alzheimer’s is the most common type, and Vascular Dementia is second most common. Some people have a mix of types of dementia.

What’s normal? Normal aging can cause some minor changes in memory or learning, but not in a way that affects functioning. If you know someone who repeats questions frequently, has trouble following their daily routine, frequently cannot find the right word, or is disoriented to time and place, these are signs of Alzheimer’s or another type of dementia—not normal aging. It is important to get a good diagnosis, because there are some reversible causes of these symptoms. Depression, medication misuse or side effects, thyroid problems, and vitamin deficiencies can all present symptoms similar to Alzheimer’s. It is important to get a thorough medical workup if you identify these symptoms. The Alzheimer’s Association offers a great fact sheet that explains symptoms of Alzheimer’s and compares them to “what’s normal”: http://www.alz.org/alzheimers_disease_symptoms_of_alzheimers.asp.

Mild cognitive impairment (MCI) is a condition which has many of the symptoms of Alzheimer’s and other dementias, but is not severe enough to interfere with daily functioning. Research indicates people with MCI are at increased risk of developing Alzheimer’s, but not all go on to have the disease. Medications may help ward off progression, and it is important that if someone you know exhibits these symptoms, they be evaluated and followed by medical professionals.

Vascular dementia develops when impaired blood flow to parts of the brain deprives cells of food and oxygen. This may be most obvious after a major stroke (post stroke dementia) or as a result of “mini strokes” (also known as multi-infarct dementia). Vascular dementia may show more sudden progressions, or occur in “steps” as a result of these vascular incidents, rather than a more steady progression as is seen in Alzheimer’s. Someone diagnosed with vascular dementia may benefit from the same medications and preparations as someone with Alzheimer’s, but would additionally need their vascular health monitored (blood pressure, proper medications, etc.).

Sundowner’s Syndrome or Sundowning describes a typical pattern of behavior present in many people with Alzheimer’s and some of the other forms of dementia. Individuals typically exhibit increased confusion, agitation, and wandering in the late afternoon and early evening hours. See our article on sundowner’s syndrome

Myths about Alzheimer’s Disease:
http://www.alz.org/alzheimers_disease_myths_about_alzheimers.asp

Help for Alzheimer’s Caregivers: Aging Wisely is a good place to start if you have concerns that a loved one might have some form of dementia, or if your loved one has been diagnosed. A care manager can help in the early stages by coordinating medical professionals, securing a good diagnostic workup, walking you through what to expect and options, and planning ahead. Often, families have trouble because their loved one does not wish to acknowledge there is a problem and they do not know how to get them to accept help, or even go to a doctor for an evaluation. A care manager can be invaluable in strategizing ways to work through these challenges. Our services are customized to work with just these types of situations.

As the disease progresses, your care manager can be your caregiving coach and resource partner. Our job is to anticipate needs and issues and help you plan, as well as to be a sounding board to your frustrations and concerns. There are many issues that may arise: the need for in home help, wandering, driving concerns, knowing when it may be time to consider a care facility, navigating the Medicare and insurance maze, respite care—we’re here to help with them all.

Aging Wisely will be exhibitng at this conference.  For more information, see http://www.law.stetson.edu/conferences/SNT/