Eldercare Assessment: Resources and Payment Concerns

Betty and her family were recommended by Elder Care Attorney John Smith to secure a geriatric assessment to document Betty’s current level of functioning, look at her care needs now, and project over her life expectancy what her care needs will be. The goal of this projection is to match her care needs with available resources, recommend programs and funding sources that will assist with providing care. All parties would like Betty to remain in her home if possible.

Assessing a Widower’s Resources and Needs for Home Safety

This client is an 81 year old gentleman who recently lost his wife. He was living alone in his home and his children were alternating caregiving duties, but had family and work obligations they also need to fulfill. They wanted a clear picture of his needs and what resources could help. They wanted to respect his wishes to remain in his own home if that were a viable option.

Special Needs Trust Assessment-Requested by Trust Officer

This assessment was requested by the trust officer for the client’s Special Needs Trust. The care manager begin assisting the client with some of the immediate needs during the assessment process, as some things required immediate attention (not “resolved” under presenting problems/issues). The care manager was also able to build rapport with the client and immediately begin providing emotional support and buffer the trustee from some of the anger and frustration client was feeling due to her loss of control over her life situation and money.

Unfortunately, medication errors happen. They happen in hospitals, in pharmacies, or even at home. The more information you have, the better able you are to prevent errors and to take care of yourself. You have to ask your pharmacists, doctors and nurses about your medications, and you have to expect answers. Also, if you have any chronic illnesses, pick up one of the consumer guides about medications at a bookstore or from the library. Find out all that you can about your illnesses and the medications you are taking. What you learn will help protect you later.
Aging Wisely’s care managers can help you monitor a loved one’s care in order to better manage these issues and can help with assessing possible areas of concern. A care manager can be a valuable resource in setting up systems that lead to positive outcomes for you or your loved one.
Key Questions

Your pharmacist can be your partner to prevent medication errors. Some important questions to understand:

1. What are the brand and generic names of the medications?
2. What does it look like?
3. Why am I taking it?
4. How much should I take, and how often?
5. When is the best time to take it?
6. How long will I need to take it?
7. What side effects should I expect, and what should I do if they happen?
8. What should I do if I miss a dose?
9. Does this interact with my other medications or any foods?
10. Does this replace anything else I was taking?
11. Where and how do I store it?

When you buy over-the-counter medications, read the labels carefully because they might contain ingredients you do not want or should not take. Ask your pharmacist for help if you have trouble selecting the right product.

What You Can Do…

. . . at home:

• Make a list of medications you are taking now. Include the dose, how often you take them, the imprint on each tablet or capsule, and the name of the pharmacy. The imprint can help you identify a drug when you get refills.
• Any time that your medications change, change your list, too. Double-check the imprints on the tablets and capsules.
• Also list your medication and food allergies, and any over-the-counter medications, vitamins, nutritional supplements or herbal products that you take regularly.
• Keep medications in their original containers. Many pills look alike, so by keeping them in their original containers, you will know which is which and how to take them.
• Never take someone else’s medication. You don’t know if it will interact with your medications, the dose may be wrong for you, or you may be allergic to it.
• Read the label every time you take a dose to make sure you have the right drug and that you are following the instructions.
• Turn on the lights to take your medications. If you can’t see what you’re taking, you may take the wrong thing.
• Don’t store medications in the bathroom medicine cabinet or in direct sunlight. Humidity, heat and light can affect medications’ potency and safety.
• Store medications where children can’t see or reach them, for example, in a locked box or cabinet.
• Keep medications for people separate from pets’ medications or household chemicals. Mixups are common and can be dangerous.
• Don’t keep tubes of ointments or creams next to your tube of toothpaste. They feel a lot alike when you grab quickly, but a mistake could be serious.
• Flush any old medications, including used patches, down the toilet. Children and pets might get into medications that are thrown into the wastebasket, and some drugs actually become toxic after the expiration date.
• Don’t chew, crush or break any capsules or tablets unless instructed.
• To give liquid medication, use only the cup or other measuring device that came with it. Also, household teaspoons and tablespoons are not very accurate, which is important with some medications. Your pharmacist may give you a special oral syringe instead.

. . .in the hospital:

• Take your medications and the list of your medications with you when you go to the hospital. Your doctors and nurses will need to know what you are taking.
• After your doctor has seen them, send your medications home with your family. While you are in the hospital you may not need the same medications.
• Tell your doctor you want to know the names of each medication and the reasons you are taking them. That way, if anyone tells you anything different, you’ll know to ask questions, which might prevent errors.
• Look at all medicines before you take them. If it doesn’t look like what you usually take, ask why. It might be a generic drug, or it might be the wrong drug. Ask the same questions you would ask if you were in the pharmacy.
• Do not let anyone give you medications without checking your hospital ID bracelet every time. This helps prevent you from getting someone else’s medications.
• Before any test or procedure, ask if it will require any dyes or medicines. Remind your nurse and doctor if you have allergies.
• When you’re ready to go home, have the doctor, nurse or pharmacist go over each medication with you and a family member. Update your medication list from home if any prescriptions change or if new medications are added.

. . .at the doctor’s office:

• Take your medication list every time you go to your doctor’s office, especially if you see more than one doctor.
• Ask your doctor to explain what is written on any prescription, including the drug name and how often you should take it. Then when you take the prescription to the pharmacy, you can double-check the information on the label.
• Tell your doctor you want the purpose for the medication written on the prescription. Many drug names look alike; knowing the purpose helps you and the pharmacist double-check.
• If your doctor gives you samples, make sure that he or she checks to be sure that there are no interactions with your other medications. Pharmacies have computers to check for drug interactions and allergies, but with samples this could be missed.

Source: The American Pharmacists Association through the courtesy of the
Institute for Safe Medication Practices, 1800 Byberry Road, Huntingdon Valley, PA, 19006;
(215) 947-7797; e-mail: ismpinfo@ismp.org; Web site: http://www.ismp.org

We encourage families to discuss coverage and ask questions before making major changes in insurance. Many families find their loved ones have been convinced to change plans or signed up for a Medicare Advantage plan without a full understanding of the implications.

Please note that this information changes each year, so if you have specific questions we recommend contacting us to find out the most current information for your situation. Aging Wisely’s staff receives ongoing training on insurance, Medicare, and Medicaid in order to help us guide our clients. We offer a Comprehensive Medicare Analysis package as well as assistance with a variety of personalized Medicare, insurance and patient advocacy issues. Please contact us if we can help with any of your insurance questions or concerns.

What is Medicare Part D?

Medicare Part D provides prescription drug coverage to everyone who is eligible for Medicare. All of the Part D plans are private insurance plans. It is a voluntary program; eligible beneficiaries must choose to enroll. If you receive Medicare and Medicaid you will be enrolled automatically. The initial enrollment period was November 15, 2005-May 15, 2006. The annual enrollment period is from October 15-December 7th yearly. For those newly eligible for Medicare, the enrollment period is the same as it is for enrolling in Part B (3 months prior and 3 months after turning 65 or becoming otherwise eligible).

Does it cost to participate?

There will be a monthly premium, depending upon the plan you choose, automatically deducted from your Social Security payment. If you are eligible and do not enroll and later decide to participate there is a late enrollment fee of approximately one percent of your premium for each month you delay for as long as you are enrolled in Part D (i.e. if you do not enroll for five years-60 months, your premium will be 60% higher for the remainder of the time you participate in the plan).

If your assets and income are below certain limits your premium and co-pays may be less. If you are receiving Medicaid benefits, Medicaid will pay for your premium. Medicaid will no longer pay your drug costs, the pay source will switch to one of the Medicare D providers (you may choose a provider, or will be randomly enrolled automatically).

Will I get free prescriptions if enroll?

No. Part D will only pay a portion of the cost for your prescriptions. This is an outline of the general coverage Medicare requires the plans to provide. Medicare Part D plans generally carry a copay for medications, and run using a formulary (which drugs are covered and level of copay). The Medicare D program was developed with what is known as a “donut hole” in coverage, meaning that when coverage reaches a certain level participants are responsible for all costs until hitting a “catastrophic” level of coverage. However, this doughnut hole is slowly being phased out under newer provisions and recipients currently receive a discount on medications when in the doughnut hole period.

Remember, each plan is slightly different because they are being provided by private companies. Many offer better coverage than required. You should analyze the plan based on your situation. Remember, you can change plans yearly.
If your assets and income are below certain limits, your deductibles and co-pays will be substantially reduced or eliminated.

How do I choose a plan?

You will have to choose a plan. All plans are operated by private companies, not by the government. There are two types of plans. One is prescription drug plan (PDP) which only covers drugs and is used with your traditional Medicare and/or supplemental plan. The second plan combines a prescription drug plan with a Medicare Advantage plan (similar to a HMO) that includes medical coverage for doctor visits and hospital expenses; this is known as a Medicare Advantage plus Prescription Drug Plan (MA-PD).

There will be government requirements that each plan must provide, however the plans may be different. Each plan will have a list of what drugs are covered (called a formulary) and what pharmacies you may use. Before you choose a company plan you will want to see a list of drugs to see which company will best meet your needs. (Medicare’s Compare Plans on www.medicare.gov is a helpful tool). You will be able to change plans only once a year.

What happens if my retirement plan already provides prescription drug coverage?

If your current prescription drug plan provides coverage equivalent or similar (called “creditable coverage”) to the new Medicare Part D program you will be allowed to keep that coverage and not be penalized later by Part D for not immediately signing up when eligible. You should have received information from your current plan regarding whether or not you have creditable coverage-retain this paperwork in case you later need to prove you had coverage.

When it comes to Medicare and retirement healthcare options, there are a number of decisions you have to make and “parts” to coordinate, whether you have retiree coverage, continue working, choose to receive traditional regular or benefits via a Medicare Advantage Plan. To get an overview of these options and key dates, grab our Medicare Fact Sheet (the latest version is available at www.agingwisely.com) and contact us at 727-447-5845 if you have questions or want to schedule a personal analysis.

Other good resources for information:

• Medicare Helpline 1-800-633-4227
• Social Security Administration 1-800-772-1213 (Medicare and You handbook)
• Centers for Medicare & Medicaid Services – www.cms.hhs.gov
• Medicare – www.medicare.gov* Plan Compare tool
• Medicare Rights Center – www.medicarerights.org
• FL SHINE (Serving the Health Insurance Needs of Elders)- 1-800-963-5337
• Sign up for our newsletter to get the latest from the Aging Wisely’s blog (covers a wide array of the latest Medicare News and care manager tips) and the EasyLiving blog (covering home health news, Medicare home health and payment information and resources for your in-home senior care and caregivers)

This information provided by Aging Wisely, Inc. for general information. Please contact us at 727-447-5845 or www.agingwisely.com for more information or specific assistance with this and other aging/medical issues.

Aging Wisely’s care managers can help you monitor a loved one’s care in order to better manage these issues and can help with assessing possible areas of concern. A care manager can be a valuable resource in setting up systems that lead to positive outcomes for you or your loved one.

Key Questions

Your pharmacist can be your partner to prevent medication errors. Some important questions to understand:

1. What are the brand and generic names of the medications?
2. What does it look like?
3. Why am I taking it?
4. How much should I take, and how often?
5. When is the best time to take it?
6. How long will I need to take it?
7. What side effects should I expect, and what should I do if they happen?
8. What should I do if I miss a dose?
9. Does this interact with my other medications or any foods?
10. Does this replace anything else I was taking?
11. Where and how do I store it?

When you buy over-the-counter medications, read the labels carefully because they might contain ingredients you do not want or should not take. Ask your pharmacist for help if you have trouble selecting the right product.

What You Can Do…
. . . at home:

• Make a list of medications you are taking now. Include the dose, how often you take them, the imprint on each tablet or capsule, and the name of the pharmacy. The imprint can help you identify a drug when you get refills.
• Any time that your medications change, change your list, too. Double-check the imprints on the tablets and capsules.
• Also list your medication and food allergies, and any over-the-counter medications, vitamins, nutritional supplements or herbal products that you take regularly.
• Keep medications in their original containers. Many pills look alike, so by keeping them in their original containers, you will know which is which and how to take them.
• Never take someone else’s medication. You don’t know if it will interact with your medications, the dose may be wrong for you, or you may be allergic to it.
• Read the label every time you take a dose to make sure you have the right drug and that you are following the instructions.
• Turn on the lights to take your medications. If you can’t see what you’re taking, you may take the wrong thing.
• Don’t store medications in the bathroom medicine cabinet or in direct sunlight. Humidity, heat and light can affect medications’ potency and safety.
• Store medications where children can’t see or reach them, for example, in a locked box or cabinet.
• Keep medications for people separate from pets’ medications or household chemicals. Mixups are common and can be dangerous.
• Don’t keep tubes of ointments or creams next to your tube of toothpaste. They feel a lot alike when you grab quickly, but a mistake could be serious.
• Flush any old medications, including used patches, down the toilet. Children and pets might get into medications that are thrown into the wastebasket, and some drugs actually become toxic after the expiration date.
• Don’t chew, crush or break any capsules or tablets unless instructed.
• To give liquid medication, use only the cup or other measuring device that came with it. Also, household teaspoons and tablespoons are not very accurate, which is important with some medications. Your pharmacist may give you a special oral syringe instead.

. . .in the hospital:

• Take your medications and the list of your medications with you when you go to the hospital. Your doctors and nurses will need to know what you are taking.
• After your doctor has seen them, send your medications home with your family. While you are in the hospital you may not need the same medications.
• Tell your doctor you want to know the names of each medication and the reasons you are taking them. That way, if anyone tells you anything different, you’ll know to ask questions, which might prevent errors.
• Look at all medicines before you take them. If it doesn’t look like what you usually take, ask why. It might be a generic drug, or it might be the wrong drug. Ask the same questions you would ask if you were in the pharmacy.
• Do not let anyone give you medications without checking your hospital ID bracelet every time. This helps prevent you from getting someone else’s medications.
• Before any test or procedure, ask if it will require any dyes or medicines. Remind your nurse and doctor if you have allergies.
• When you’re ready to go home, have the doctor, nurse or pharmacist go over each medication with you and a family member. Update your medication list from home if any prescriptions change or if new medications are added.

. . .at the doctor’s office:

• Take your medication list every time you go to your doctor’s office, especially if you see more than one doctor.
• Ask your doctor to explain what is written on any prescription, including the drug name and how often you should take it. Then when you take the prescription to the pharmacy, you can double-check the information on the label.
• Tell your doctor you want the purpose for the medication written on the prescription. Many drug names look alike; knowing the purpose helps you and the pharmacist double-check.
• If your doctor gives you samples, make sure that he or she checks to be sure that there are no interactions with your other medications. Pharmacies have computers to check for drug interactions and allergies, but with samples this could be missed.

Source: The American Pharmacists Association through the courtesy of the

The Vial of Life program enables emergency medical personnel to quickly obtain pertinent medical information when you are unable to communicate it. This information can be vital in saving your life.

You receive a small, standard plastic prescription bottle and corresponding forms and stickers. The sticker is placed on the door and the vial is placed in the refrigerator. The forms/information are kept inside the vial. This enables emergency personnel to quickly locate these items in a universal location. They can then see information such as current medications, diagnosis/conditions, and allergies, as well as your doctor’s contact information. This program is internationally recognized by emergency responders and has helped save lives. This program is particularly important for seniors living alone or individuals with serious health conditions. We recommend it for everyone!

You may also see the “File of Life” which is the same concept, but the information is stored in a magnetic pouch that can go on the refrigerator door.

You can obtain your Vial (or File) of Life through many local agencies, including fire and police departments and the American Red Cross. Your Aging Wisely care manager can help you obtain and set up your Vial/File of Life.

We also recommend you keep additional copies of your health information with any responsible parties or consider storing this information using an online system. See our reviews and information about Personal Health Records and Electronic Medical Records.

It can be particularly difficult to find appropriate and appreciated gifts for our elderly relatives, friends, or clients who are dealing with health issues or living in an assisted living or nursing environment. Here are some ideas that may help get you started as well as some online resources for gifts and sites geared toward seniors:

Gifts of Connection

• Photo albums, framed pictures (you may even consider “talking” frames which allow you to record a personalized greeting to be replayed or digital picture frames which allow you to send and update pictures electronically).
• “Photo” phone, allows you to program memory buttons and use a photo to indicate each number (see online resources).
• Connection via technology, by purchasing a computer and lessons for the less tech-savvy elder or setting up Skype or Facetime on a mobile phone. There are many senior-friendly programs, apps and devices, depending on your elder loved one’s level of comfort with technology.
• Phone cards or a mobile phone on a family plan/pre-paid.
• A divided box filled with greeting cards for various occasions (These can be purchased pre-packaged at card or large discount stores or homemade. Make sure to include birthday, thank you, sympathy, get-well, and blank cards and you may wish to enclose stamps.).

Treats

• Plants (check with facilities on space and safety regulations).
• Soaps and lotions.
• Tissues/decorative tissue holders.
• Homemade treats such as cookies or snack mix (check dietary restrictions).
• Holiday decorations to personalize the room.
• Bring in a nice meal or favorite family treats. Or, plan a time to get together to prepare an old family recipe together so your loved one can share their memories and provide input on the cooking/baking. For someone who lives at home whom you will not be able to see during the holidays, consider sending pre-made meals.
• Anything homemade, especially from grandchildren (pictures, poems, crafts).

Fun Stuff

• Consider a special visit or outing, especially with the grandchildren (i.e. a trip out to see the children’s holiday show at school or church). Does your loved one enjoy plays or museums? Make special arrangements and reconnect them with a favorite pastime.
• Large print books or books on tape. If they use a DVD player, purchase old movies or favorite shows to watch (or set up a Netflix or Apple TV account). Set up an iPad or iPod with music and podcasts from their church, covering favorite topics, etc.
• Games and puzzles. This automatic card shuffler is great for anyone suffering from arthritis and it’s just a cool gadget too! It includes a few decks of cards, so it makes a great gift for the card player in your life.

Make Life Comfy

• Bathrobe or housecoat, slippers (be aware of safety issues with slippers).
• Nice blankets or warm shawls/bed jackets. We love this wheelchair blanket and fleece shawl!
• “Good grips” products, including household tools like a jar/can opener or personal care tools such as the Mercer Rigid Sock Aid to make putting on socks super easy for people with limited flexibility (also great for those tricky compression socks!).
• Don’t forget the simple things or feel you must buy something more elaborate. Think of items like boxes of a preferred brand of tissues, lipstick, Vaseline, lotion, toiletries, household items, a nice new set of sheets or a holiday pin.

The Gift of Help

• Purchase companionship or extra help. If someone no longer drives, hire someone to take them on outings or set up a taxi account and put money in it for rides (check with your area about innovative programs that may allow you to purchase memberships and rides via some of your local aging agencies). Hire a cleaning service for a nice holiday cleaning or ongoing services. Offer help to a caregiver so they can take a break. Contact our team at EasyLiving, Inc. at 727-447-5845 for home care gift certificates or to set up the gift of care today.
• Consider safety and health items, but know how your family member might react. Sometimes these items approached as a gift go over better than trying to convince the person to get these items in place themselves, but others may take offense. Two examples are personal emergency response systems (such as falls detection or monitoring systems) and medical/personal records systems (you can offer to help your loved one gather the information and set up an online system known as an EMR or PHR, organize records in a notebook or flash drive, or hire a professional care manager to assist). These are gifts for your loved ones that also give you peace of mind.

Online Stores and Resources

Get our latest gift guide! Linda’s top picks: senior-friendly gifts for all interests (one click shopping)

http://www.silverts.com/ Specialized and adaptive clothing and shoes. The company has been around for over 80 years and offers a full range of comfort items and caregiver-friendly clothing. Click above for your special discount when shopping here.

www.seniorstore.com Products include grandparent items, 50th anniversary items, reminiscing games, large print books, and large print music.

www.parentgiving.com Assistive devices, home care and health products.

www.buckandbuck.com Clothing for seniors and nursing home residents, including suggestions and products for problems related to Parkinson’s, Alzheimer’s, incontinence, arthritis, and paralysis. They will put the recipient’s name in the clothing free.

Despite varying cultural and personal styles, funeral/memorial services share the common goal of honoring the person’s life and bringing closure for family and friends. There are many things to consider in making these arrangements for a loved one. You can provide a lot of peace of mind for your family by making your wishes known or pre-arranging for these needs. From selecting a funeral home and cemetery to notifying family and friends, accommodating guests from out of town, planning a service, and handling the many details, this can be an overwhelming process for a grieving person or family.

According to AARP, the basic cost of a funeral in 2001 was $5160, not including burial and related costs. A funeral can thus be a pretty costly event, although not out-of line with other major life events such as births and weddings. Ceremonies and options vary widely. These choices are very personal and influenced by the cultural, religious, and personal beliefs of the individual and family.

Quick facts and pointers:

• Irrevocable burial contracts, a burial plot and up to a $2500 burial account are exempt assets under current FL Medicaid law.
• Encourage relatives to consider pre-planning or at least putting their wishes in writing, so that the family knows what is desired.
• Remember, a will or other legal documents do not typically include this type of information. This information should be discussed and placed where easily located in time of crisis.
• You can make arrangements with a funeral provider and may or may not choose to pre-pay for arrangements. It is important to review plans every few years, to ensure they are still appropriate. For example, as areas change and families move, you may modify plans for burial sites.
• Embalming is not required by law, if the body is buried or cremated shortly after death. It is a practical necessity with some arrangements or required in certain cases by state regulation.
• There are many choices when planning a cremation. Some people have a traditional viewing and service before cremation, while others have a memorial service and there are many options for the final disposition of the remains.
• Check into the details of the plan when you choose to pre-pay costs, as well as what protection your state offers you as a consumer.
• Know your rights: the funeral rule is a federal law, enforced by the Federal Trade Commission. According to the Funeral Rule: you have the right to choose the funeral goods and services you want (with some exceptions); the funeral provider must state this right in writing on the general price list, if state or local law requires you to buy any particular item; the funeral provider must disclose it on the price list, with a reference to the specific law; the funeral provider may not refuse, or charge a fee, to handle a casket you bought elsewhere; a funeral provider that offers cremations must make alternative containers available.

Quick Resource List:

Department of Veterans Affairs Cemetery and Burial Benefits Site
http://www.cem.va.gov/
1-800-827-1000

AARP offers a basic checklist of items that should be taken care of following a loss:
AARP Final Details: A Checklist

Aging Wisely has a set of tools we provide to families when preparing for the loss of a loved one and managing the funeral and planning after death. We also offer consultations with families on these issues, with our expert care manager who has many years prior experience in the funeral industry.

The following list provides a starting point for organizing and gathering the information you might need to take care of family members who becomes ill, or at the time of death.

• Name, address, and telephone number of parent’s attorney(s).
• Location of parent’s will and any trust instruments; complete list of beneficiaries with current addresses and telephone numbers.
• Location of copies of the parent’s living will, medical directive, or durable power of attorney with the name, address, and telephone number of the agent.
• Details of desired funeral arrangements; location of burial plot, if any, and deed to it. Name and address of clergy, if appropriate.
• Location of any letter of instruction listing personal property not disposed of by will and the parent’s wishes for it’s distribution.
• Location of important papers: birth certificate, social security card, marriage and divorce certificates, education and military records, other legal documents.
• List of bank accounts, including name, address, and telephone number of each financial institution, account numbers, location of passbooks, checkbooks, certificates of deposits.
• List of stocks, bonds, real estate, and other investments. Name, addresses, and telephone numbers of financial planner, tax advisor, broker, and/or anyone else with knowledge of or control over finances.
• All insurance data (health, life, auto, homeowner/renter policies; any employee benefit or pension plans), including name, address, and telephone number of each insurance company and agent, policy numbers, and locations. Location of safe-deposit box and key(s) with a list of the contents and names of anyone with access to it.
• Location of receipts and appraisals for valuables.
• List of active credit accounts (mortgage companies, banks, oil companies, department stores, etc.), including name and address of each company, account number, and type.
• Complete information, including substantiating documentation, about any personal loans the parents owe or are owed.
• Location of copies of tax returns for the past 3 years, copies of any gift or estate tax returns filed during the period.

Contact Aging Wisely today for caregiver assistance and help for your aging parents or eldercare concerns.

Information adapted from Document Locator List provided by the Foreign Service Worker Family Liaison Office.