As of April 1st, Medicare implements new regulations for covering skilled home health care under Medicare Part A. In order for Medicare to pay for covered home health services, the patient will need a face to face visit with the ordering physician within a specific time frame. You can read more about these new regulations on EasyLiving’s Home Care Blog.

Do you know when Medicare pays for home health care? Medicare covers skilled home health services, such as physical therapy or R.N. services. Paying for home health care via Medicare requires the following conditions:

• The patient must be homebound and under a doctor’s care.
• The patient must need skilled nursing care, or occupational, physical or speech therapy, on at least an intermittent basis (that is, regularly but not continuously).
• The services provided must be under a doctor’s supervision and performed as part of a home health care plan written specifically for that patient.
• The patient must be eligible for the Medicare program and the services ordered must be “medically reasonable and necessary”.
• The home health care agency providing the services must be certified by the Medicare program.

Medicare generally does not cover custodial care (also known as long term care services). Licensed Florida home care companies like EasyLiving typically provide day to day care, help around the house, and assistance with activities of daily living, which are paid for on a fee for service basis or via long term care insurance.

Get our latest Medicare Fact Sheet with updated costs and details at www.agingwisely.com and contact us for help navigating your Medicare and eldercare options.

Aging Wisely’s geriatric care managers can help you navigate your Medicare and long term care insurance coverage, understand eldercare costs and options, as well as identify public benefits and Florida senior resources for which you might be eligible.

We’re here to help with senior care resources and eldercare consultations.

A five year study conducted in 10 North Carolina hospitals found little progress in patient safety. The study found that “harm to patients was common and that the number of incidents did not decrease over time”. The most common problems were complications from procedures or medications and hospital-acquired infections. The study’s authors express disappointment but not surprise and feel the results would likely be found in most regions. A government report in 2008 found similar results, indicating that 13.5 percent of Medicare beneficiaries — 134,000 patients — experienced “adverse events” during hospital stays. The report said the extra treatment required as a result of the injuries could cost Medicare several billion dollars a year.

Fortunately, organizations focus increasingly on these issues. Additionally, insurers and Medicare have begun implementing financial incentives and penalties related to care quality.

On an individual level, what can be done? What tips can help you avoid medical errors for you or a loved one?

1. An patient advocate is essential for anyone having surgery, admitted to the hospital or undergoing treatment for a chronic illness. A family member, friend or professional advocate helps ensure important questions are asked and answered and is there to watch out for you. In an article for the Professional Patient Advocate Institute, Martine Ehrenclou indicates, “More than 150 doctors and nurses I interviewed said this: ‘Hospital care is in crisis. You must have someone with you at all times in the hospital. Loved ones are patients’ best advocates.’”.

2. Make a checklist of questions (and have your advocate help you think of them, and focus on them during interactions with providers). It is easy to be overwhelmed by the crisis of a diagnosis or surgery (to say nothing of the effects of not feeling well and medications). This objectivity is another reason why a professional patient advocate can be beneficial to both patient and loved ones. A professional advocate also brings experience to the situation to help those involved know what to ask and issues to anticipate.

3. Focus on key areas of concern, involved with most errors:

A. Medical history/issues that might cause complications: ensure providers have a detailed history and know about key issues. Having a health notebook or using an electronic health record will help your organize and communicate this information. Double check that providers have correct information.
B. Medications: provide clear, specific information on current medications (bring along your bottles to appointments if need be), ask questions and do not hesitate to discuss concerns with your pharmacist. Always review the medication list and ask questions about new medications, changed dosages, or discontinued medications. In our geriatric care management practice, we often pose questions upon doing a chart review that raise potential issues and head off further problems.
C. Infections: observe hygiene practices and don’t hesitate to raise concerns. Your advocate can be your eyes and ears to help spot any issues.

Contact us today for professional advocacy and care consultations. Aging Wisely’s professional geriatric care managers are here to help seniors and family caregivers with ensuring quality care.

Look for our coming article on hospital discharge and how to avoid unnecessary readmissions, prepare for discharge and how we can help.

When one is depressed, he or she may not wish to do anything or see anyone. But isolation and inactivity only make depression worse. The more active you are—physically, mentally, and socially—the better you’ll feel. Isolation and inactivity can be contributing factors to depression in the elderly. Older adults who are socially connected and engaged in activities demonstrate high levels of life satisfaction.

Depression is not a normal part of aging-visit our article on signs and symptoms of elderly depression and contact us if you are concerned about someone you love.

Here are some suggestions for activities to reduce loneliness and isolation:

• Getting out in to the world – Staying home all the time leads to isolation and contributes to feelings of depression. It is important to be involved in some activities outside the home. For those with limited mobility, a home caregiver can assist with transportation and physical assistance to maintain activities.

• Connecting to others – Connections with other people are vital to mental health–this includes going out to visit, having loved ones and friends over, and keeping in touch via email or phone.

• Participating in activities you enjoy – It is vital to continue enjoying favorite past-times. One can modify activities to changing needs when ill, but many activities can be enjoyed despite any limitations. Families might consider spending time playing favorite games or cooking traditional recipes with loved ones, or can hire a personal companion to assist with hobbies. A computer may be a way to continue playing favorite games if getting out on a regular basis is difficult. Audiobooks (Pinellas County offers a Talking Books program, as do many library systems) can be used for those who enjoy reading but have difficulty with vision or holding a book.

• Volunteering your time – Helping others is one of the best ways to feel better about yourself and regain perspective. In Pinellas County and other counties in Florida, you can contact 211 for local organizations that might need volunteers.

• Taking care of a pet – Pets provide companionship and purpose. If your elderly loved one is moving to assisted living, find out about the facility’s policy on pets since many allow animals (though there may be size/type restrictions).

• Learning a new skill – Pick something that you’ve always wanted to learn, or that sparks your imagination and creativity. Local community and senior centers, such as the Dunedin Hale Center and the Clearwater Aging Well Center, offer a wide variety of courses and activities.

• Enjoying jokes and stories – Laughter provides a mood boost, so swap humorous stories and jokes with your loved ones, watch a comedy, or read a funny book.

• Maintaining a healthy diet – Avoid eating too much sugar and junk food. Choose healthy foods that provide nourishment and energy, and take a daily multivitamin. EasyLiving Pinellas home care provides meal preparation assistance for those needing help shopping, cooking and even having a companion with which to share a meal.

• Exercising – Even if you’re ill, frail, or disabled, there are many safe exercises you can do to build your strength and boost your mood—even from a chair or wheelchair. Your doctor or physical therapist can recommend an exercise program and there are numerous senior-oriented exercise options, at your local senior center, YMCA or gym.

Contact us if we can assist with resources for remaining active, getting help for a depressed senior or to answer your questions about geriatric care management services.

The very nature of depression interferes with a person’s ability to seek help, draining energy and self-esteem. It can be even more difficult for today’s seniors, who were raised in a time when mental illness was often stigmatized and misunderstood. Some seniors don’t believe depression is a real illness or are too proud or ashamed to ask for assistance, or fear losing independence. Assistance from someone they care about can be vital.

You can make a difference by offering emotional support. Listen to your loved one with patience and compassion, not negating their feelings but pointing out hope. You can also help by seeing that your friend or family member gets an accurate diagnosis and appropriate treatment. Help your loved one find a good doctor, accompany him or her to appointments, and offer moral support.

Other tips for helping a depressed elderly friend or relative:

• Invite your loved one out. Depression is less likely when people’s bodies and minds remain active. Suggest activities to do together that your loved one used to enjoy: walks, a class, a trip to the museum or the movies—anything that provides mental or physical stimulation.
• Schedule regular social activities. Group outings, visits from friends and family members, or trips to the local senior or community center can help combat isolation and loneliness. Be gently insistent if your plans are refused: depressed people often feel better when they’re around others but lack the desire or motivation to initiate activities.
• Plan and prepare healthy meals. A poor diet can make depression worse and a poor appetite often accompanies depression, so make sure your loved one is eating right, with plenty of fruit, vegetables, whole grains, and some protein at every meal.
• Encourage the person to follow through with treatment. Depression usually recurs when treatment is stopped too soon, so help your loved one keep up with his or her treatment plan. If it isn’t helping, look into other medications and therapies. and assist in finding a good medical provider.
• Make sure all medications are taken as instructed. Remind the person to obey doctor’s orders about the use of alcohol while on medication. Help them remember when to take their dose, or consider home health medication management services.
• Watch for suicide warning signs. Seek immediate professional help if you suspect that your loved one is thinking about suicide.

Aging Wisely can help with ways to approach your loved one, assessments, community resources to assist and advocacy to get a good diagnosis and treatment. Many times a geriatric care manager visiting the person at home seems less threatening than initially visiting a psychiatrist. The care manager can then build rapport and help the person seek treatment, as well as make creative recommendations for families about how to assist the depressed person and services that may assist with the above.

EasyLiving, Inc. is our licensed, Florida home care company and provides many valuable services to support families. Their home caregivers can assist in keeping your loved one active and engaged, as well as safe. EasyLiving home care aides can provide medication management, healthy meal preparation and assistance with personal care and companionship.

The very nature of depression interferes with a person’s ability to seek help, draining energy and self-esteem. It can be even more difficult for today’s seniors, who were raised in a time when mental illness was often stigmatized and misunderstood. Some seniors don’t believe depression is a real illness or are too proud or ashamed to ask for assistance, or fear losing independence. Assistance from someone they care about can be vital.

You can make a difference by offering emotional support. Listen to your loved one with patience and compassion, not negating their feelings but pointing out hope. You can also help by seeing that your friend or family member gets an accurate diagnosis and appropriate treatment. Help your loved one find a good doctor, accompany him or her to appointments, and offer moral support.

Other tips for helping a depressed elderly friend or relative:

• Invite your loved one out. Depression is less likely when people’s bodies and minds remain active. Suggest activities to do together that your loved one used to enjoy: walks, a class, a trip to the museum or the movies—anything that provides mental or physical stimulation.

• Schedule regular social activities. Group outings, visits from friends and family members, or trips to the local senior or community center can help combat isolation and loneliness. Be gently insistent if your plans are refused: depressed people often feel better when they’re around others but lack the desire or motivation to initiate activities.

• Plan and prepare healthy meals. A poor diet can make depression worse and a poor appetite often accompanies depression, so make sure your loved one is eating right, with plenty of fruit, vegetables, whole grains, and some protein at every meal.

• Encourage the person to follow through with treatment. Depression usually recurs when treatment is stopped too soon, so help your loved one keep up with his or her treatment plan. If it isn’t helping, look into other medications and therapies. and assist in finding a good medical provider.

• Make sure all medications are taken as instructed. Remind the person to obey doctor’s orders about the use of alcohol while on medication. Help them remember when to take their dose, or consider home health medication management services.

• Watch for suicide warning signs. Seek immediate professional help if you suspect that your loved one is thinking about suicide.

Aging Wisely can help with ways to approach your loved one, assessments, community resources to assist and advocacy to get a good diagnosis and treatment. Many times a geriatric care manager visiting the person at home seems less threatening than initially visiting a psychiatrist. The care manager can then build rapport and help the person seek treatment, as well as make creative recommendations for families about how to assist the depressed person and services that may assist with the above.

EasyLiving, Inc. is our licensed, Florida home care company and provides many valuable services to support families. Their home caregivers can assist in keeping your loved one active and engaged, as well as safe. EasyLiving home care aides can provide medication management, healthy meal preparation and assistance with personal care and companionship.

The changes and losses of aging can lead to depression in older adults. It is important to note, however, that depression is not a normal part of aging. Untreated depression can take not only a heavy emotional toll, but also harm physical health. According to the National Institutes of Health, of the 35 million Americans age 65 or older, about 2 million suffer from full-blown depression. Another 5 million suffer from less severe forms of the illness.

Older adults at highest risk are those with a personal or family history of depression, failing health, substance abuse problems, or inadequate social support.

Causes and risk factors that contribute to depression in the elderly include:

• Loneliness and isolation – Living alone; a dwindling social circle due to deaths or relocation; decreased mobility due to illness or loss of driving privileges.
• Reduced sense of purpose – Feelings of purposelessness or loss of identity due to retirement or physical limitations on activities.
• Health problems – Illness and disability; chronic or severe pain; cognitive decline; damage to body image due to surgery or disease.
• Medications – Many prescription medications can trigger or exacerbate depression.
• Fears – Fear of death or dying; anxiety over financial problems or health issues.
• Recent bereavement – The death of friends, family members, and pets; the loss of a spouse or partner.

Grief and depression may seem closely related, but grieving is a normal and healthy process in response to loss. There is a difference between the healthy grieving process and unrelenting or overwhelming sadness that may be indicative of major depression. Talk to your loved one’s medical provider if you are concerned about a loved one or contact us for resources and assessments.

Recognizing depression in the elderly starts with knowing the signs and symptoms to watch for, including:

• Sadness
• Fatigue
• Abandoning or losing interest in hobbies or other pleasurable pastimes
• Social withdrawal and isolation (reluctance to be with friends, engage in activities, or leave home)
• Weight loss; loss of appetite
• Sleep disturbances (difficulty falling asleep or staying asleep, oversleeping, or daytime sleepiness)
• Loss of self-worth (worries about being a burden, feelings of worthlessness, self-loathing)
• Increased use of alcohol or other drugs
• Fixation on death; suicidal thoughts or attempts

Memory loss or trouble concentrating/thinking may also be caused by depression and screening for depression is an important part of a thorough diagnostic process for dementia/memory loss. There are additional clues to look for in older adults who deny feeling sad or depressed:

• Unexplained or aggravated aches and pains
• Hopelessness
• Helplessness
• Anxiety and worries
• Memory problems
• Loss of feeling of pleasure
• Slowed movement
• Irritability
• Lack of interest in personal care (skipping meals, forgetting medications, neglecting personal hygiene)

*Adapted from American Academy of Family Physicians

It is important to get a good diagnosis and treatment for depression. This can be challenging as the older adult may not recognize the symptoms as depression or may be reluctant to admit such feelings. The very nature of depression can make seeking help difficult, so it may be imperative for loved ones and friends to assist. Because some of the signs in an older person may be different than traditional depression symptoms, family members and even medical professionals do not always recognize the cause as depression and may initially think the problem is simply age-related or due to Alzheimer’s Disease (especially when memory or concentration issues occur).

If you have concerns about an elderly person you feel may be depressed, contact us for more information or to schedule a consultation or assessment. We can help with options, how to approach a loved one and a comprehensive analysis/assessment. Our expert, professional care managers have specialty training in aging, mental health concerns and community resources for elders.

As professionals working to help families, we can learn a lot from listening to those clients and families. What concerns them? What are their priorities as they age and face eldercare issues?

Harris Interactive conducted a poll for The National Association of Professional Geriatric Care Managers, surveying over 2,000 adults on their concerns related to aging and eldercare.

• While losing their physical or mental health was the top rated consumer concern overall (83%), at a close second (78%) was not having sufficient finances to support themselves or their spouses/partners later in life.
• A relatively high percentage of consumers (71%) were concerned about having to leave their homes or losing their independence.
• Losing a spouse/partner and/or having to live alone weighed heavily on the minds of many of the respondents (66%) as did a spouse/partner having to care for a person if he or she was to become frail or were dying.
• Other major concerns noted were losing the ability to drive (65%) and having to care for a spouse/partner as they became ill or were dying (58%).

What do these results tell us? As professionals, we can do a lot to help. We can help families feel more prepared to face aging and ensure they are able to support their care needs financially. We can educate families on the many resources for aging in place and how to retain independence and quality of life. We can support family caregivers and help them know they are not alone in their journey.

These are our areas of focus at Aging Wisely and as we kick off the New Year, we will continue to address many of these topics in our educational information, as well as one-on-one in family caregiver consultations. We encourage you to provide us with feedback and contact us if we can help with any of these issues.

You may wish to read our prior blog posts on related topics:
Americans’ Top Concerns about Retirement & Aging
Finding Affordable Care Options
One Couple’s Story of Caregiving

In a move to encourage older adults to seek preventative care, Medicare has expanded coverage for many types of preventative care, such as tests, screenings and physicals. Preventative care helps you maintain good health and wellbeing and to identify concerns early for better treatment results.

Read our article on Medicare’s 2011 changes, including information on preventative care.

The U.S. Preventative Services task force recommends the following measures for good senior health when over age 65:

• Aspirin for preventing cardiovascular disease

• Exercise (3 times/week for 30 minutes or more & strength training 2 times/week)

• Healthy diet; dietary counseling for those at risk

• Limit alcohol consumption (no more than one drink/day for women, no more than 2 drinks/day for men)

• Don’t smoke

We encourage you to talk to your doctor about recommended wellness screening and tests. The Journal of the American Medical Association offers a patient fact page on preventative care for older adults. Print out this fact sheet and discuss your screening and vaccination schedule with your or your loved one’s doctor.