Any checklist for aging parents should include a review of safety: home safety, medications/health, and issues like senior driving safety.  Many older drivers maintain excellent driving skills and make adjustments to ensure safety.  My grandfather (pictured right with his red corvette) taught the AARP senior driving safety course for many years and helped other seniors to make adjustments and update driving skills.  As AARP’s site states, “Some drivers age 50+ have never looked back since they got their first driver’s licenses, but even the most experienced drivers can benefit from brushing up on their driving skills”.

Though older drivers in general are safe drivers, age-related changes can affect driving abilities and this can be deadly.  The National Highway Traffic Safety Administration indicates that on the basis of estimated annual travel, the fatality rate for drivers 85 and over is nine times as high as the rate for drivers 25 through 69 years old.  Some drivers realize and acknowledge these changes, while others struggle with this transition/loss.  According to the U.S. Department of Health and Human Services, men will live an average of 6 years longer than they can drive and women, 10 years.  As our population ages, more and more families will face this issue and need help with the transition and identifying alternatives.

So, what should you do as an adult child who cares for an aging driver?  What functional skills are needed and what red flags should cause concern?

1. Drive with your aging parent and observe.  This is one of the best ways to spot red flags.  How is your elder parent’s reaction time?  Does he/she miss signs?  If you ask to go to a new spot or provide directions does this cause trouble?
2. Check car maintenance.  Ask your parent when they have the oil changed, get the care checked out.  Not all of us are good at this at any age, but this may be a sign that an aging parent can no longer handle the many tasks related to driving and auto upkeep.
3. Suggest an AARP or other safe driving course.  As mentioned, many things have changed with cars and traffic, so even the best driver can benefit.  This may also help an aging parent come to the realization that they should not drive any more.
4. Talk to a professional care manager if you feel like you need an outside assessment, help talking through/mediating about the issue and especially, a plan for post-driving.

Red flags to watch for regarding senior driving safety:

• Your parent is very cautious when driving and has narrowed driving down to only familiar locations and/or seems very nervous when driving (all of these accommodations can be good, but also indicate that your parent feels unsure and any changes could become a real issue…i.e. what would your parent do if a road was closed or something unexpected happened on the road?).
• Your parent’s friends refuse to go along in the car with him/her.
• Your parent has unexplained dents in the car or has small fender-benders or hits stationary objects.
• Memory issues or dementia are present.  Many people with early dementia or cognitive issues do not immediately give up driving and may not need to, but this is an issue to watch closely.  Driving involves highly complex thinking which is typically compromised with dementia.  A driver may remember familiar routes for now, but can be easily confused if anything changes or may do well every day up until the one day he or she gets lost.
• Eye sight, hearing, balance issues or strength are problematic.  Again, there may be accommodations for many of these issues, but it is important to assess them and plan for such accommodations.

Families call us frequently to discuss their concerns about an elder’s continued safety driving.  We hear a wide variety of stories from families, from a concerned daughter who has just visited Dad and noticed he is driving very poorly to tragic stories of families where loved ones get lost driving or get in to an accident when clearly they should not be driving any longer.  Some older drivers willingly give up driving when they do not feel safe, while others struggle with the loss and fight the change.

Aging Wisely’s care managers help families with driving safety issues, through our care management consultations and assessments.  We can: help you assess driving safety (and other safety issues as well), counsel and mediate the conversation between you and your loved one, and work with your family to create a post-driving plan by setting up resources such as senior transportation.  Contact us at 727-447-5845 or online to talk about how we can help!

Aging Wisely sponsored a series of educational events by “Keeping us Safe” including a professional Driving with Dignity certification course.  Keeping Us Safe was created by Matt Gurwell, a retired Ohio highway patrol officer, who is dedicated to helping keep older drivers safe.

Technology is taking on a bigger role in healthcare.  Healthcare reform legislation gave technology a central role and most medical providers have moved to electronic medical records, patient portals and more.  About time, some would say, but it is not an easy transition to make for a number of reasons: patient privacy and concerns of patients about what this means to them, how to implement technology across various providers which are generally not coordinated and budgeting for large scale implementations.

A couple of recent healthcare experiences have reiterated to me the positive role technology can play.  First, I have mentioned before how valuable Caring Bridge, a patient portal/communications tool, has been to my family as we faced major surgery.  This only furthered my strong belief in how these systems can improve care.  We started using similar patient portals and electronic medical/personal record keeping systems years ago at Aging Wisely and it is hard to imagine life before them.  Here are the top reasons I think they are essential:

1. Care coordination-particularly for seniors with multiple conditions, caregivers trying to manage an elder’s healthcare and the professionals helping to coordinate care, having accurate records coordinated between multiple parties is essential and can improve outcomes.
2. Communications-between providers, but also between family and friends/support networks.  This was one of the greatest values to our family, and reduced a lot of time on phone calls which allowed us to handle other tasks as well as have more family time together.
3. Emergencies-being able to provide accurate information during stressful times, helping providers to be armed with information to better do their jobs.  Our Aging Wisely care managers have found our electronic systems vital to how well we can manage emergency situations.

What are some of the vital factors to overcome barriers to technology in eldercare and healthcare?

• Technology has to solve a “pain” for consumers or medical providers…a problem that is worth the time to learn the technology and other costs.  For example, my primary care doctor started using a patient portal and because I travel a lot it is well worth having access to my information online and getting set up with an account to be able to get results and email my doctor. It saves me time, but also reduces paper which only causes me more hassle.
• The technology has to be implemented well without redundancy.  Another doctor I go to started using (I use the term loosely) a patient portal a couple years ago…but the office didn’t even know how to access it.  I was relieved that I got frustrated inputting my information and gave up when I found that out.  Imagine inputting all your data only to find out they were going to make you put it all down on paper again anyway.
• Providers have to address privacy and other patient concerns, and offer options.  For example, not long ago I joined in a discussion on Linkedin about doctors’ offices using online or email scheduling.  I love the idea of scheduling my appointments that way, because I always seem to think of making the call just after business hours or during lunch when the office is closed.  Other people felt differently.  Most practices are going to have to provide options…though consumers will likely have to adapt as well as many businesses go towards online solutions (even the Social Security Administration is ending paper statements).

Particularly as family elder caregivers juggle multiple roles and attempt to coordinate their elder’s medical care, technology provides tools to reduce stress and improve outcomes.  The question becomes which technologies really solve those caregivers’ pains and create a real demand.  As our online world becomes increasingly mobile/smartphone based, the technologies will need to adapt to fit the realities of our lives.  One of the best places to keep updated about aging and healthcare technologies and get smart analysis is Laurie Orlov’s Aging in Place Technology Watch.

Have you found any particular technology to be helpful in your caregiving duties or coordinating healthcare?  What’s a pet peeve when it comes to healthcare technology?

For more useful tips on managing eldercare and essential steps in the process, we welcome your phone calls any time at 727-447-5845 and we invite you to grab your free copy of our Essential Eldercare Checklist:

During a recent family health scare, it hit home for me how challenging things can be when you are dealing with something so deeply personal.  It also caused me to reflect on the work we do in elder care management with families dealing with healthcare crises and aging issues every day.

I will share a couple of things that struck me and some of the things we found most useful (and most challenging).  I hope that others will comment or share thoughts because while these issues are deeply personal, there are many ways we can learn from and support each other.

Here are just a few of the thoughts I had while dealing with my family healthcare concerns:

Everyone deals with things in unique ways which thus affects the type of support needed and what helps (or doesn’t).  My Mom’s relationships mean everything to her and she constantly thinks of others.  She never realized how many people she had touched until she was ill.  It meant so much to her hearing all the messages of support and positive thoughts.  We were thankful for the ways technology enabled this, using an online portal to send updates out and get messages which we read to her daily.  As much as the support meant to her and us, I cannot imagine trying to field all of that through phone calls.  Some people shut off and just need some time to process when faced with a new diagnosis.  Some people want all the positive reinforcement they can get while others may feel angry or depressed and resent positive comments.

Emotions are heightened when we’re under stress, meaning a small seemingly harmless statement or action can do a lot of perceived harm.  This affects both family relationships and professional relationships.  A kind word or minute of time can also do a lot of good.  It was incredible to see the impact one nurse or assistant could make with gentle care or taking a few minutes to chat and how a sour attitude could affect my Mom’s outlook.  This goes both ways too, and my Mom’s incredible people skills certainly had an impact on the care and attention she received.

The more resources and stress-reducing tools available, the more focus can be put on healing and coping.  As noted above, my favorite tools are online portals that enable communication and updates.  We have used patient portals at Aging Wisely for years, which enable communication and other tools for elder care management such as tracking medications and medical history. The other aspect of this is the readiness of professionals to serve as a resource…to help families find answers and take action, rather than giving vague answers or pushing responsibility off on someone else.

Insurance, admissions rules, regulations, how things operate in various healthcare facilities…all boggle the mind for most families.  I am more convinced than ever that this is one of the most vital roles for patient advocates.

People want to be prepared and knowledgeable.  The internet can have both a positive and negative role in this.  It is great for finding things like checklists for what to pack for a hospital stay, online communications portals and getting background information.  However, reading a lot about a diagnosis (which may not really reflect your specific situation) online can create unnecessary stress (or worse yet, a tendency to attempt to self-diagnose).  Experts and professional advisors play a vital role.  I chose not to read too much on my Mom’s diagnosis, but it also helped that she and other family members had quickly accessed top experts and had a good handle on the situation.

Whether you are a healthcare professional or a friend of someone dealing with a family health crisis, it is vital to keep in mind how very personal and emotional such situations are.  We can do so much harm or good.  We can take cues from our patients or friends about what they need from us.  We can work hard to always see beyond disease and vital stats to the person… the family…the network of people who are being affected.

For those of us in a professional helping role, we can easily forget that our 20 years of experience gives us a lot of insight while a patient and family may not have any idea about how things typically operate.  It is helpful for us to remember the uncertainty and other emotions in the situation and take the time to explain things. We can serve as a resource no matter what our role by knowing who to contact, how to take action and how to reassure.

Know someone who needs to talk to a professional patient advocate about their healthcare situation or concerns, get advice and resources?  Call us any time at 727-447-5845 or:

In our work with seniors and their families, we assist with Medicare analysis and advice, navigating the medical system and keeping families aware of vital issues regarding their senior healthcare and Medicare.  As the Affordable Care Act (also known as Obamacare or healthcare reform) passed and provisions have been rolling out, we have written various articles on some of the key aspects of the bills for seniors.  Recently we did a presentation reviewing the key provisions and realized this continues to be a “hot topic” on the minds of seniors, their families and their professional advisors.

Here is our analysis and summary of the Affordable Care Act’s effects on Medicare recipients and important recent senior healthcare-related changes:

Current changes to Medicare (in effect now)

Medicare Home Health Face-to-Face Requirement: In order to qualify for Medicare to pay for home health care services (such as physical, occupational and speech therapy or intermittent skilled nursing), recipients must meet a number of criteria.  In April 2011, CMS implemented a new requirement which states recipients must be seen by their doctor (or other designated healthcare professional such as a ARNP) for the reason the care is needed in order for the doctor to order the care (whereas before the doctor might not have seen the patient recently but might order the care based on history and information provided by the patient and family).  This was designed as a fraud-reducing measure and many home health companies have developed processes to work with doctors on meeting the requirements; however, it can be burdensome for homebound patients and their care providers and may create a barrier for some to get care.

Senior Preventative Care: All preventative care is now provided at 100% under Medicare (no copays/deductibles), such as screenings and an annual wellness visit.

Medicare Income-Adjusted Premiums: Both Medicare Part B (doctor’s visits, services) and Part D (prescription drugs) carry higher premiums for upper-income seniors.  This applies to individuals with incomes above $85,000 and couples above $170,000 (for example, Part B’s premium begins at $115.40 and could range up to $369 for someone in the $214,000 bracket).

Medicare Advantage Out-of-Pocket Limits: This provision required Medicare Advantage plans to limit enrollees’ maximum out-of-pocket responsibility to $6700 per year.

Ongoing changes

Medicare Part D-Closing the “Doughnut Hole”: The doughnut hole (coverage gap) in Medicare’s prescription drug benefit is being phased out, until it goes away all together in 2020.  This will mean that eventually, the prescription drug coverage that Medicare recipients receive will be more similar to what traditional insurance offers, with copays for share of costs that are similar over time.  Currently, seniors get discounts during the gap period and the discounts will increase until they are standard throughout coverage.

Five Star Medicare Advantage Plan Exception: We have listed this as “ongoing” because these ratings contine to be updated and it is projected that more plans will work to gain five-star ratings because of this and other incentives (and penalties). This provision allows Medicare recipients to switch to any five-star rated Advantage plan in their area at any time during the year, not just during the usual enrollment periods.  Right now, there are very few five-star plans and none in Florida as of this date.

Future changes and variables

Reimbursement changes for Medicare Advantage Plans: The Affordable Care Act targeted numerous changes to the ways these private Medicare plans are reimbursed.  Plans that receive high quality-of-care scores will receive bonuses. And, starting in 2014, plans must spend between 80 and 85 percent of the money they receive on improving health care quality or delivering health care services to beneficiaries (and get penalties if not).  Overall, there is going to be a gradual decrease in payments to these plans and many predict that less plans will therefore be offered.  In 2012, the Medicare Advantare market remained remarkably stable/similar to 2011 but most of these changes have yet to begin.

Program savings/cuts?: Changes such as the cuts to Medicare Advantage payments mentioned above, accountable care penalties and structural changes are supposed to provide the savings needed to cover the additional costs under healthcare reform, but there are many variables in this equation.  If savings do not materialize, the Independent Payment Advisory Board is authorized to make program cuts.  There are a lot of variables and unknowns in this and other healthcare reform provisions.

Want help navigating Medicare or the healthcare system?  Need a Medicare Analysis and advice to ensure you get the best senior healthcare at a price you can afford (from non-sales people)?  Contact us at 727-447-5845 about how we can help or click below:

Aging Wisely is hiring to fulfill the growing needs of our elder clients and families in the Clearwater/Pinellas County, Florida area and throughout Tampa Bay. Aging Wisely has been serving elderly and disabled clients and families in Tampa Bay since 1998. Our team continues to grow and develop to meet the needs of clients who wish to “age wisely” and their families and professional support systems who gain peace of mind by working with our experienced team.

We are currently seeking professional geriatric care managers who bring expertise and experience to our team in helping meet the diverse needs of our clients. You can check out our geriatric care manager job description at this link and fax your resume or email to linda(at)floridaelderlawyer(dot)com.

We are also hiring a Care Management Assistant to support our team. This position is vital to managing our busy office and supporting our mobile care managers and clients. If you are highly organized, experienced at managing a busy office and want to do work that has a real impact…check out our Geriatric Care Manager Support Staff Job Duties and send your resume over to admin(at)agingwisely(dot)com.

Why is geriatric care so complicated?  Why do so many little things seem to go wrong in the care of elders?  Some facts will shed some light on the complexities of geriatric care:

Older adults with multiple conditions have an average of 37 doctor visits, 14 different doctors and 50 different prescriptions each year.

Nine in 10 older Americans have at least one chronic health condition and 77% have multiple chronic conditions.

Large numbers of older adults with multiple chronic health conditions report duplicate tests
and procedures, conflicting diagnoses for symptoms, contradictory medical information, and not receiving adequate information about potential drug interactions.

A typical primary care doctor who sees Medicare patients must coordinate care for those
patients with 229 other physicians in 117 different practices.

Wow!  If you didn’t think geriatric care was complex before reading those statistics, they are definitely eye-opening.  They come from various studies compiled by the Campaign for Better Care, which also pulled together a great deal of information on the costs that result.  For those of us assisting clients in coordinating care, we know the impacts for individuals all too well.  With these complexities, there are many factors that can make care go wrong…or right.

In our experience helping families navigate care, here are a few of the reasons we believe geriatric care is so complex:

• Patients with multiple conditions inherently present challenges and time-intensive needs.  The balance of ensuring that all conditions are managed properly and coordinating amongst various specialists requires careful oversight.
• Older patients may not be accurate in reporting information, keeping track of medications, etc. especially if they have memory issues or simply a complicated medical situation.
• In Florida, in particular, many seniors are at a distance from adult children and other family members who may be involved in helping coordinate care.  Trying to assist a loved one to manage care from a distance comes with unique challenges.
• Seemingly simple issues can complicate care and these issues are not necessarily a typical part of the medical care process, though providers trained in geriatric care have an understanding of their importance.  Some examples include: timing of medical equipment delivery after a hospital discharge, ensuring nutritional needs, patients missing appointments due to memory issues or lack of transportation.

We have written many articles on our blog as well as for other publications about some of these issues, particularly the problems in hospital readmissions for seniors, which result from many of these complexities.  Many hospitals and other geriatric care providers are working on systems to address these issues and programs to reduce unnecessary readmissions.  While many simple individual factors may make up the problem, taken all together, the “problem” is complex to solve.

What are some of the ways families and seniors can contribute to their own improved geriatric care?

1. Find out what type of specialists you need and when.  Depending on your loved one’s age, diagnoses and history, it may be time for a geriatric specialist or someone to manage the specific condition.  A primary care physician trained in geriatrics has the training to recognize some of the issues stated above.  But, also understand that when seeing a variety of specialists, care coordination is a must and an area where the patient, family or advocate are going to have to take an active role (and/or bringing in a professional patient advocate to help).
2. Communication is one of the most important factors and frequently breaks down.  You (or your advocate) need to share you medical history, provide accurate background, and help providers to gain a picture of the situation so they can do the best job.  For example, a typical elder presenting at the emergency room without an advocate may not be able (whether due to memory issues of just being too ill) to report accurately or may not share everything that is happening.  This can make it very difficult for the providers, who are seeing this patient for the first time, to make a good decision about course of treatment/admitting the patient to the hospital.  There is also a vital need to communicate between providers, ask questions and follow up as needed.
3. Watch medication issues carefully.  When you have a hospitalization or a new specialist, check about medication interactions.  You should: always provide an up-to-date list (or the bottles themselves) of everything you are taking; consider a pharmacist review (there are geriatric consultant pharmacists also); double check that you understand all medications and how to take them; make notes of medications that cause side effects or don’t work and provide that to each medical provider as well.   Review if your loved one really understands and can manage the various medications and consider medication management services.

Need help from a professional patient advocate or want to find out more about the ways an advocate can help your family improve your geriatric care outcomes?  Call us at 727-447-5845 or click below to request more information:

We invite you to share your experiences with geriatric care in the comments section below.  What have you found most challenging?  What are your frustrations (whether as a patient, family member or medical provider)?  What resources have helped you?

One in four adults in the U.S. is caring for a loved one over 50 (family members with disability, illness or aging-related infirmities).

More and more families are also “sandwiched”: caring for aging loved ones along with children, caring for more than one adult and caregiving while also employed full or part-time.  As families have become more mobile over time, many of us are geographically separated and thus trying to manage care or obtain information from afar.

Balancing all of these duties can be overwhelming.  Though there is a lot of good information available for caregivers and resources to help, filtering through the information can be overwhelming for time-stretched caregivers.  One of our primary goals in Aging Wisely’s online communities is to provide caregivers with quality information and assist families in narrowing down where to find help for caregivers.  If you think we could improve upon this goal or you have a resource or topic to suggest, we ask you to please take a minute of your time to leave us a comment and let us know how we can help you as a caregiver.

We are continually updating our Senior Care Resource Center, which offers various handouts and downloads on eldercare and caregiving topics.  Some of our most popular resources include “Taking Away the Car Keys: Senior Driving Safety” and “The Essential Eldercare Checklist”.  Our sister company, EasyLiving also offers an Eldercare and Home Care Resource Center and one of the most requested downloads is the Alzheimer’s Specialty Care Guidebook for Dementia Caregivers.

Aging Wisely also puts together an Eldercare Resource Links page with Florida senior care resources and some of the top sites worldwide, broken down by topic/need.  There are always more great sites out there, but we have tried to bring together some of the key websites for information and state/local resources.  We think these are some of the essential places caregivers should bookmark.

Because there is so much information for caregivers to process and relevant news coming out every day, we use social media tools to share the latest news.  So, wherever you are on the web, we try to help you find what you need.  And, if that just feels overwhelming too, you can always reach out to us personally to help you find what you need.  Contact us online, send an email to shannonmartin(at)agingwisely(dot)com, or call us at 727-447-5845.

Here are a few of our tips for navigating “the information superhighway”:

As you begin your search for information about your loved one’s disease, issues like care costs and Medicare, or resources to help your family, keep a notebook of your concerns and questions.  Think about your priorities and what issues you must find answers about today.  Try to focus in on reputable sources and be skeptical of the source of information.  There are some great online communities where you can get support from other caregivers, but understand that their advice may not be right for your situation. 

Consider starting with a professional consultation with a geriatric care manager so that you can prioritize your needs and avoid spending a lot of time on a path with a dead end.

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