Brain health is a topic we get asked about a lot at Aging Wisely and some of our most popular materials include our information on Memory Loss terminology, Alzheimer’s Disease and Sundowner’s Syndrome.  Our guest blogger from SharpSeniors.com has explored the topic of brain aging and some preventative, protective steps we can take as we age to give the brain its best chance for healthy aging.  You can read more about the author in the bio at the bottom of the article as well.

The brain is a marvelous machine unlike any other on the planet. Comprised of bulb-ended nerve cells that look similar to a strand of hair with the root intact, this odd organ has the consistency of firm tofu and the look of greyish-pink spaghetti noodles. In short, it’s kind of ugly, slippery and for the vast majority of people, it’s not very appetizing to look on. Oh, but what a miracle it performs and its health is absolutely essential for the proper working of the body and that amazing cyber-like space called the mind. When the brain is affected, everything is affected, so the health, nutrition and proper function of this rather unattractive mass is highly essential.

Alzheimer’s and dementia are big news in senior health today and many fear the difficult consequences of memory loss and reduced cognitive function.  While dementia is a disease process and not an inevitable part of aging, the risk increases with age and there are some less insidious cognitive changes that do occur even in the typical aging brain.  While the research is ongoing concerning prevention and cure for these diseases, there are things a senior can do to improve the brain’s chances for health and maintain cognitive fitness.

You are What you Eat

There are some adages that ring as true today as they did when first coined, such as “You are what you eat.” Nutrition always plays a role in the health and well-being of the body especially as it ages, losing natural elasticity and cellular repair. It appears to be no different for the brain, and the right nutrients affect it as much as any place in the body, perhaps more so. The brain is responsible for releasing chemicals and impulses, information and commands to the body in which it sits housed, so it makes sense that a healthy brain is required for the direction and dispensing of such invisible functions.

Omega-3 fatty acids and fruits or vegetables high in antioxidants play a large role in brain fitness. Myriad research has led scientists to understand that diet alone can make a notable impact on brain health. Tests among rats and mice returned favorable results where a blueberry compound was introduced in animals genetically bred to exhibit Alzheimer’s symptoms.

Sugars, specifically glucose, are essential for proper brain function. Have you ever witnessed someone suffering a blood-sugar crash? In extreme cases, the simple act of peeling a banana is beyond the mind of a person whose blood sugar levels are too low. This can happen due to medication switches or diabetes-related problems, but it’s frightening to watch and can even lead to coma. This doesn’t mean that extra donut is essential for good health; it means how and what you eat are important. A study published in 2006 June issue of the American Journal of Geriatric Psychiatry showed measurable changes in the brain after just 14 days where certain eating and lifestyle changes were introduced in seniors. Part of that study included changing eating patterns to five small meals a day to reduce and prevent drops in glucose levels, the sugar energy of the brain. Low glycemic-impact carbohydrates such as those found in whole grains, which burn slower than other carbs, also helped steady the blood sugar levels.

Always with the Exercise!

Self-dispensing advice to cure almost every ailment seems to be the ubiquitous imperative to watch what you eat and keep active. It turns out to be completely true. Physical activity does not necessarily mean hours at the gym; a simple thirty-minute walk a day is sufficient for keeping the body and mind alert and healthy. It extends the lifespan and increases the quality of it. Daily walks are connected with reducing the risk of Alzheimer’s as well. Bottom line: if you can walk, do it. The benefits are too outstanding not to. Stress-reducing exercises also showed as beneficial, reducing the release of a hormone called cortisol, known for a role in impairing memory and damaging brain cells.

Working Out the Mind

Your body isn’t the only thing that needs a good ‘walking’ to stay fit; so does your mind. So how do you walk your brain? While that may sound like the opener to a great punch line, the joke’s on you if you let your brain get lazy and sit in front of the TV all day snacking on bon-bons. The easiest forms of a brain workout include crossword puzzles, word searches, scrabble, and other brain teasers. A good old-fashioned game of memory, where you match cards, or mahjong, which matches tiles, are stellar stretches. Even sudoku can help stimulate the brain’s functions. Do you like video games? Tetris still rules. For strategy games, a rousing round of chess really works the brain’s muscles. Actively practice memory recall by entering a room, picking out several objects quickly, and walking out again. Write down the objects, their placement and description in the room and check your memory. Switch environments and add variety to all activities so the brain doesn’t get too used to just a few.

If you prefer tech to standard games, that can be obliged. Simply surfing the internet has been noted to enhance brain circuitry, and playing video games, especially fast-paced ones, have been determined to assist in motor functions, eye-hand coordination and increased brain activity. Even simulation games, such as for pilots, can do wonders for the mind.

Technology to Improve Existing Conditions

In August of 2012, the results of a Harvard clinical trial were published by Medical News Todayconcerning a non-invasive technology named the NeuroAd Medical Device. It delivers a two-pronged attack to Alzheimer’s by simultaneously using electromagnetic brain stimulation in conjunction with cognitive training on a computer monitor, targeting areas ravaged by the disease. It not only prevented further degeneration but also improved existing functions. Improvement was dramatic and notable, exceeding what medications are currently capable of offering.

More and more breakthroughs are occurring every day; we seem to be on the cusp of understanding dementia and diseases like Alzheimer’s, their causes and their prevention. This is exciting, hopeful news but until they can be cured or completely prevented, taking the health of your brain in hand, so to speak, is a pro-active solution to giving your brain the best chance for good health. Engage your body and brain on a regular basis; don’t get lazy about it, and take charge of your age.

Author Bio: Sarah-Elizabeth R comes from a long line of professional writers. Her extensive experience writing for various online and in print publications has given Sarah a distinct style which showcases her writing as unique, versatile, and personal. She is currently the head writer for Sharp Seniors.com, where she writes on the important issues facing today’s aging population.   

If you want to understand more about memory loss and the terminology related to dementia, we encourage you to download our fact sheet about memory loss below, or call us with your questions or concerns.  We help families during all stages of dealing with memory loss and dementia, from ascertaining a diagnosis to preparing ahead, finding assisted care options and navigating care along the way.

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Aging Wisely is proud to say that we will be celebrating 15 years of giving professional elder care advice and help in 2013.  In 1998, Linda Chamberlain recognized that many families could benefit from expert professional advice and assistance navigating elder care. 

A couple things particularly stood out as she decided to found Aging Wisely.  First, the problems families faced were often comprehensive in nature.  As an elder law attorney, she saw this as families came in to address legal problems but often had other pressing issues to address that were not of a legal nature.  Essentially, these issues included care coordination, navigating options and various psychosocial issues.  Often, families were dealing with time-sensitive issues and feeling strained trying to navigate solutions.  Second, many community eldercare programs were either means-tested or prioritized by financial need (and many public services were “wait listed” i.e. not available immediately).  She and colleagues realized that just because a family had some financial resources this did not mean they were not in need of help.

Aging Wisely’s care managers have helped hundreds of individuals and families over the years, in a wide array of circumstances.  We have developed to meet changing needs and offer more comprehensive services.  We wanted to take a few moments to say thank you to all of the professionals and families we have been privileged to work with, as well as to share some of our reflections on elder care.

Providing elder care help over the years, we see many commonalities in the issues families face, though each situation brings its unique circumstances.  We have also seen things evolving over the years, such as:

• Elder care has become part of the family life cycle.  More than 65 million people in the U.S., or greater than 1 in 4, provide care to an aging or disabled family member.  With greater life expectancies and more chronic disease, most people will fill a caregiving role at some point and many will care for multiple family members.
• The path of elder care is more complex.  Factors that make caregiving more complex for families today may include: “sandwich” generation realities (the overlap of caring for aging parents and supporting children), long-distance caregiving/family mobility, family dynamics/makeup (divorce and remarriage, step-children, etc.).
• Options for eldercare support are more diverse than before, but also more complicated to navigate.  For example, there are 205 Assisted Living facilities doing business in Pinellas County, Florida, where Aging Wisely is based.  If you take the Tampa Bay area (Hillsborough County/Tampa, Pasco County and Pinellas County) now you have 470 Assisted Living facilities within an hour or so.
• Professional help is also more widely available and there is a more developed structure of family caregiver assistance.  Our professional association, the National Association of Professional Geriatric Care Managers, was founded in 1985 by a group of about 50 business owners who were some of the first entrepreneurs to provide such services.  Over time, the association broadened and took steps such as requiring certification for membership.  To learn more about the NAPGCM and its history, check out the Care Management Association History page.  There are constantly new resources available and many different organizations to help.  Sometimes it can be challenging to figure out who’s who and where to go for quality information, however.

What does all of this mean to families providing elder care (or even those who aren’t YET)?

1. It is essential to plan for eldercare.  Start conversations now, do some pre-planning, and don’t make assumptions.  We offer an Essential Eldercare Checklist for families, covering various stages and steps to take along the way.
2. While elder care is a very personal process, at some point your family is probably going to be best served by seeking professional help.  With all the complexities mentioned above, you can save a lot of time, money and headaches by getting good advice from someone who knows the systems and processes.
3. If your family is in disagreement or you can already foresee some complexities, be open with professionals about your concerns and ask for help in creative ways to proactively address them.
4. If you have an aging loved one who lives at a distance, begin to gather resources in their local area.  Start a process for family members to “check in” and keep an eye on how things are going.  There are some great checklists available for “elderly warning signs” such as our “Should I Be Worried?“.  Take some time to gather some phone numbers and basic information on services available where your loved one lives.
5. Understand who you are dealing with and the parameters of what you are getting.  A lot of eldercare services that seem like less expensive (or free) options are that way for a reason, or may cost you more in the long term.  Different options will work for different people, but make sure you know what you’re getting and who you are dealing with before you decide.

Familes often come together this time of year, and either spot concerns or begin to think about the immediate future for an older loved one.  Inquiries to senior care businesses tend to increase after the winter holidays and in to January and February.  If you are visiting and notice concerns, we encourage you to call and find out what type of help might be available–or even how to begin approaching the situation.  Unfortunately, health and other eldercare crises don’t take holidays, so if you are in a crisis situation we are always here to help as well.

Recognizing and Supporting Youth Caregivers

Thanks to SeniorHomes.Com for providing a guest post on this less recognized eldercare issue, youth serving as elder caregivers.

With multi-generational households on the rise, it’s not uncommon for today’s youth to find themselves in a caregiving role. Often, however, they don’t even realize it. It can start off with simple medication reminders but quickly evolve into a much more complex situation.

As the aging loved one declines, the young caregiver takes on ever-increasing responsibilities. Because it can be a gradual progression, both parties can easily fail to notice how extreme the situation has become. While other family members would take steps to ease this burden, many go months without realizing what’s happening—especially when there are many miles in between.

When is it too much?

The American Society on Aging estimates there are 1.3 to 1.4 million young adults, between the ages of 10 and 20, providing care for an aging or disabled loved one. On the surface, there’s no harm in a teenager reminding her grandmother to take her medications and helping out with simple tasks. But when the situation evolves to the point at which the teen is providing all of the elder person’s care, making doctor appointments, tending to housekeeping and even helping with activities of daily living, such as bathing and dressing, it can start to take a toll on the young person’s quality of life.

Young caregivers end up stressed, they lose sleep and are fatigued during the day, their grades may start to slip or they may drop out of school altogether. It’s been said many times that caregivers must take care of themselves first, but these kids aren’t in a position in which to do so. They need help and support from other loved ones and the community.

How to recognize a youth caregiver

It’s hard to recognize a youth caregiver. On the phone, they’ll probably act like everything is fine because they don’t realize there’s a problem. If you suspect the elder’s health is declining, ask pointed questions to uncover how much care the teen is providing on a regular basis.

It’s easier to uncover youth caregiving situations in person, so make a visit if you can. The holidays are a great time to do so as many of us travel across the miles to visit loved ones we often don’t see throughout the year. Talk to your aging loved one about their daily routine and to the teen about school, work and other activities.

Look around the home. Are there signs that the young person is handling finances, grocery shopping, cleaning and maintaining the home, preparing meals and helping with activities of daily living? How independent is your elderly loved one? Does it seem as though she’s able to meet her own needs?

What to do if you think there’s a problem

You may need to have a candid discussion with both parties. They probably don’t recognize there’s a problem, so approach the topic gently.

Evaluate your options with your family.

• Are there other family members close by who are able to help alleviate some of the burden?
• What community services are available in the local area?
• What is the financial situation like—are there any resources which could be used to hire a home care agency?

Sometimes, a little outside help is all it takes to make the situation manageable. In other cases, it might be time to consider moving your aging loved one to a senior living facility. Talking with a geriatric care manager or the local Office of Aging can help you make these difficult decisions based on the resources you have available. Reach out to organizations like the American Association for Caregiving Youth (AACY), a Florida-based nonprofit which provides resources and support to young adults serving as caregivers.

Whatever decisions you make at that time, be sure to open the lines of communication. It’s amazing what a listening ear and a shoulder to lean on can do to alleviate much of the stress these young adults face every day.

About the guest author: SeniorHomes.com is a free resource for people looking for a senior home for a loved one or themselves. We provide rich information about the options available in someone’s local market as well as great content to help them through their decisions. Check out our Florida assisted living page for an example.

If you have concerns that a young person in your family may be taking on more caregiving duties or have other eldercare concerns or needs, we’re here to help.  Call us at 727-447-5845 or click below to schedule a time to talk with our Senior Care Consultant.  Get quality eldercare advice and resources to help you make the best decisions, save time and money!

Reflections After the Second Professional Patient Advocacy Conference

Aging Wisely team members Linda Chamberlain and Shannon Martin recently had the pleasure of attending and speaking at the Second Annual Patient Advocate Conference in Orlando, Florida.  We were also pleased to be part of the first conference held last year, put on by the Professional Patient Advocate Institute, and honored to be named national award winner as a Patient Advocacy Organization.  This year the conference was even bigger and a great opportunity to share our passion for advocating, care coordination and improving patient outcomes.

The field of patient advocacy is a relatively young field, though the work of advocacy has been going on forever and many different professional roles include a duty of advocacy.  As care managers, patient advocacy services have long been a big part of what we do and are integrated in to every aspect of our process.  The conference reinforced that those of us serving as patient advocates come from different background and perspectives, but share common goals.

We thought we’d share some of the “take aways” that might be most relevant to our readers, particularly if you are a patient or family wondering if you need a patient advocate or related services.

1. A common theme was the emergence of professional patient advocacy, i.e. how this role has become more necessary as our healthcare system has evolved.  No matter your thoughts on our current healthcare system and changes coming to health care (or perhaps even what country/system you are involved in), there can be no doubt that things are more complex than ever.  Even if only by the nature of our advancing knowledge, technologies and treatments, there is more for both medical providers and patients to understand (and decide upon) than ever before.  An expert can be an invaluable partner in this process.
2. It is not just the complexity of health care that warrants the need for a professional patient advocate, but the difficulty of facing chronic health issues or serious diagnoses.  A couple speakers mentioned “world stop” moments such as getting a cancer diagnosis (or the call from a loved one about their diagnosis) and if you have had one of those, you know how the world can seem to change in a moment.
3. Coordinated care improves outcomes.  Common sense tells us this as patients and medical providers, and studies back this up with results.  It is why we find medical providers referring to Aging Wisely after they have exposure to what our care managers help them (and the client/patient) accomplish.  We talked a lot about this in our session on physician appointments, because it is many of the things that happen when the patient is outside of the doctor’s office that affect how successful any treatment plan will be.
4. Patient advocates are good researchers and resource connectors.  You don’t expect your patient advocate to know about every condition and shouldn’t necessarily be identifying the best patient advocate based on their expertise in a specific diagnosis but in how he/she can help you navigate care and identify the best experts.  This is why, as one speaker reiterated, patient advocates do not necessarily have to be nurses, though many come from that background.  Our Aging Wisely team operates very much on this premise, using a social services model to bring together resources and a coordinated systems approach.  We pull together the best experts for you–whether it means bringing in a nurse consultant, locating specialists in your diagnosis or initiating a pharmacy consult.

If you are trying to determine whether you need a patient advocate, it is likely you are facing issues which would, at a minimum, benefit from a consultation.  Some of the key points at which you should consider patient advocate services are:

• upon receiving a life-changing diagnosis (which could be an acute condition needing immediate treatment or surgery or a chronic and/or progressive condition),
• when experiencing symptoms and searching for a diagnosis or worrying that you may have been misdiagnosed,
• upon hospitalization (of self or a loved one) or transition to after-care,
• when issues arise in managing chronic conditions, coordinating care or pulling together resources to manage care.

Patient advocate services are both a service Aging Wisely offers and a part of all of the services we provide to clients.  We can be your advocate and resource coordinator, from a simple care consultation to the invaluable assessment process through ongoing care coordination and insurance/Medicare navigation.  Call us at 727-447-5845 to learn more or click below to request help.  Our Care Consultant, Sue Talbott, provides a no-obligation needs and services analysis to help you locate the most appropriate options for you and your family!

Our Aging Wisely team is looking for a responsible, dedicated On-Call Care Manager to handle our clients’ varied needs after regular business hours. Duties will include managing client emergencies (meeting clients at the emergency room, responding to calls, handling emergency room visits and other issues that arise), communicating effectively to clients’ responsible parties and regular care manager, and documenting thoroughly.

The On-Call Care Manager will cover the following hours: on-call week nights Monday-Thursday, 5 P.M. – 8:30 A.M. next day and weekends (on-call begins Friday 5 P.M. – Monday 8:30 A.M). One weekend per month will be covered by other team members so the On-Call Care Manager has one weekend free. The On-Call Care Manager will be responsible for checking phones during these hours and triaging calls, responding and following up and visiting clients when urgent needs arise. If inquiry/service calls for new clients come in during these hours, the On-Call Care Manager will also follow up to determine if urgent help is needed, or to set an appointment with Aging Wisely’s Senior Care Consultant to meet/talk with the client/family.

This position requires strong patient advocacy skills and knowledge of the healthcare system, as well as the ability to competently manage potentially high-pressure and variable situations. Important skills include: excellent communication, good documentation, triaging and identifying needs and solutions, and independent critical thinking. The On-Call Care Manager should be skilled at navigating the healthcare system and dealing with older clients and the family system. You will review notes and information left for you from the care management team for pertinent information about issues that may arise, and all of your interactions will need to be communicated and documented in our online system.

This position is salaried; salary commensurate with experience. Please fax resumes to 727-461-0001 or email to admin@agingwisely.com.

Join a great team, providing quality services making a difference to clients and families! Get steady pay for varied, flexible work and enjoy having a significant impact helping clients and the Aging Wisely team.

The 2013 Medicare costs such as copays and deductibles have recently been released.  Each year, these costs change slightly and most of them will be increasing slightly for 2013:

The standard Medicare B monthly premium will increase from $99.90 to $104.90 (higher income individuals will pay more).

The Medicare B yearly deductible will increase to $147.

The Medicare A hospital deductible (for stays up to 60 days) will be $1184 and the skilled nursing co-pay will be $148/day (for days 21-100, the first 20 days are covered at 100%).

The Medicare A premium for those who must pay a premium (individuals who do not have sufficient quarters of qualifying employment) will actually decrease slightly for 2013.

Check out Aging Wisely’s Medicare 2013 Fact Sheet for all the 2013 numbers and a Medicare analysis of the various pieces of the Medicare program.

In addition to the 2013 Medicare costs, there are continuing changes to Medicare mostly as a result of the Affordable Care Act and healthcare reform.  For example, preventative care coverage has been expanded to cover many screenings.  Medicare recipients can take advantage of the yearly wellness exam to talk with their physicians about recommended preventative care and tests.  Recipients who hit the “donut hole” in drug coverage will receive additional discounts during 2013.  This gap is being phased out altogether by 2020.

Another change that will be coming to Medicare in 2013 is a result of a class action lawsuit, Jimmo v. Sebelius.  The Department of Health and Human Services settled this lawsuit, in which claimants objected to Medicare’s skilled care requirement (for home health and inpatient skilled care) that a patient must show the potential for improvement.  The lawsuit claimed that patients who could benefit from skilled care to manage their current condition or maintain their current functioning should not be denied.

This lawsuit was settled recently and the changes will be rolling out over the next couple of months to providers and consumers.  If you have a claim you feel was improperly denied or questions about current coverage, you can review Medicare’s appeal options or contact us to find out if one of our care managers can help you through the process and with care options.

For our Florida readers (and especially those in the Clearwater/St. Pete, Pinellas County area), another recent news item has potentially big impacts to the healthcare coverage of local residents.  United Healthcare and Baycare Health Systems failed to come to an agreement in negotiations and disputes over payments.  For now, this means that the Baycare system’s hospitals, ambulatory care centers and network physicians are no longer part of United’s networks.  Some patients may use out-of-network providers, typically at a higher cost.  This affects individuals on employer-based plans as well as seniors on United’s Florida Medicare Advantage plans.

Baycare Health System’s physicians have been reaching out to patients to inform them of this situation, so if you are a patient you may have heard the news.  Other individuals who may not be under a Baycare physician’s care, but who may use hospital services, may be less aware of this dispute.  Baycare Health System hospitals include: Morton Plant Mease Hospital, Mease Dunedin and Mease Countryside, Baycare Alliant long term acute care, Morton Plant North Bay in Pasco County, St. Anthony’s and St. Joseph’s (including the Children’s, Women’s and North hospitals) and South Florida Baptist Hospital.

For United Medicare Advantage holders, you may want to consider alternative plan options during the open enrollment periods, particularly if this dispute does not get settled.  The current enrollment period runs through December 7th, and the Medicare Advantage disenrollment period runs January 1st-February 14th.  During the disenrollment period, you can only disenroll from a Medicare Advantage plan back to regular Medicare, but this may be a good option if your key providers are no longer covered under a United plan.  You would need to disenroll and choose a Part D plan for drug coverage.

For help with this issue and a complete Medicare analysis of options and costs, contact us at 727-447-5845 and request a Medicare analysis (or to ask questions about how we can help). 

Some people just have a talent for buying meaningful gifts and a natural inclination for knowing the right thing to say or do in a tough situation.  Some of us have a good heart, but need a little inspiration!

We have shared some advice in the past on gifts for seniors: ideas for gifts for assisted living residents, older relatives who are downsizing or facing chronic illness.  Now, we’d like to share some ideas for what to get caregivers–what types of gifts and help caregivers might truly appreciate and need. 

Caregivers can be an overlooked group at the holidays.  Many people you know are caregiving and you may not even realize to what extent someone you know is involved in caregiving and perhaps feeling a bit stressed out this holiday season.  Similarly, many individuals and families are dealing with a chronic illness or facing a tough battle with a serious diagnosis.  Holidays can be a tough time.

First, take a little time to think about the caregiver/gift recipient.  You may be able to brainstorm and come up with some ideas just by thinking about what the person enjoys, hobbies/interests (maybe things they have not had time for lately but once enjoyed or need a “new” way to enjoy) and conversations you have had in recent months.

Here are some ideas and resources for gift giving:

The Gift of Relaxation

Caregivers are generally in great need of rest and relaxation.  Some gift ideas in this category include: a gift certificate for a massage or a “day at the spa”, relaxation music, an inspiring book, something cozy like a fuzzy blanket or warm robe or a bath gift basket/lavender scented bath salts, lotions, etc.

Think about the practicality of using the gift of relaxation.  For example, a day at the spa may seem impossible to the caregiver right now.  Perhaps you can also offer help with the care recipient or make sure help is available for using the day out (maybe it’s possible to set up someone to help and even plan and go together to the spa day?).  Or, maybe right now, the “at home” gift choice is better, such as bath salts or relaxing lotions. 

This is also true for someone who is currently dealing with his or her own illness.  The person may not feel like getting a massage right now, or might just be too exhausted to take time to go to a spa.  Do a little digging–maybe you can give a gift card for iTunes if the person likes to download music or audio books to listen to while at treatment.  Nice, personal touches can make all the difference in a hospital stay too.  Check out our special resources section for people facing hospitalization or ongoing treatments.

Time and Care Giving (giving the gift of self and assistance)

A caregiver’s most precious resource is often time (and energy!).  For a person facing an illness, much of their time and energy is also caught up in treatment and appointments.  Can you offer to help out in whatever way the person is comfortable?  For example, maybe the caregiver does not feel comfortable having someone stay with their loved one but would be glad to have your help with shopping or running an errand?  Sometimes you might need to just suggest it, i.e. “I am going to Sam’s club.  Can I pick up some items for you?” or “I’d love to see you but I know you have so many appointments right now.  Maybe I can drive you to your therapy sessions and it will give us some time together.”

Words of support and a regular phone call can be the best gift of all for someone who is feeling isolated.  Maybe you can visit and bring a special treat (go above and beyond and find out if there’s a special family recipe the person hasn’t had time to make that you could recreate and bring over). 

Depending on the situation, you might even purchase services for the person, such as a home health gift certificate that could be used for respite care or household help and errands or a cleaning service or someone to help put up the outdoor holiday decorations (there are companies that do this now!).  This can be a bit tricky–for some people, providing a cleaning company gift certificate might be highly offensive, while for others it would be a welcome relief. Bringing over meals might be appreciated, or if you are at a distance, purchase prepared meals from somewhere like Honeybaked Ham or Let’s Dish.

Special Resources (caregiver gift ideas, gifts for someone facing chronic or acute illness and recovery)

Stylish hospital gowns such as these from Annie and Isabel or other comfortable, easy clothes. Buck and Buck is one company a number of our clients have used for clothes appropriate to special conditions or for someone in a nursing home or hospital and PajamaGram sends comfy PJs in a stylish package.

Entertainment/distraction items: books (or credit for an eReader), puzzle books/crosswords, music (iTunes gift card, or get a small MP3 player and stock it up with music).  If you know the person is going to be hospitalized, find out if the hospital has a pay TV option and if you can purchase that for them.

Comfort/personal items: window clings, a framed picture, a lap blanket–anything to personalize a hospital room or serve as a reminder that you care when someone is recovering at home, in rehabilitation or undergoing treatment.  One clever idea we have seen is sending beautiful photos of flowers or nature–in place of actual flowers/plants which may be restricted or difficult if the person is moving rooms or has allergies.

Slippers or non-slip socks: hospitals usually provide the socks, but something more fun or stylish might help the patient feel a little better.  Also, flip flops or shower shoes are a good thing for patients to have at the hospital (but what is safe for the particular patient may vary).

Gift baskets: you can get creative and put your own together or do a google search for some great ideas and items targeted to someone with an illness or relaxation packages for caregivers.

Inspirational items: a book or CD/MP3 on relaxation techniques, an inspiring story or quotations. 

Finding just the right way to give is a bit of a detective game, as any of these suggestions could be right or wrong depending on the individual’s situation.  However, knowing you care and support the person is always a gift worth giving.  Just listening and spending some time together can mean a lot.  If you know of resources and ideas to help or can do a little research for the caregiver, that might also be a welcome (and useful) gift. 

Aging Wisely offers a number of caregiver and eldercare resources on our website.  If we can help to point you to anything specific or give you ideas (or you have a suggestion for us), we welcome your input or questions!  We believe in the gift of knowledge and we are happy to have you share any of our resources (check out our recommended reading for caregivers section too)!

You (or a caregiver you know) can reach us directly at 727-447-5845 for eldercare help, care consultations, caregiver resources and more!

There are several pieces to the Medicare program, and each comes with specific enrollment rules and costs. It is important to understand how these parts work together, along with how they work with other senior healthcare coverage you may have such as Veteran’s Healthcare or Employer/Retiree Insurance.

Download our Medicare 2013 Fact Sheet for a more detailed (but easy to understand) guide to the parts of Medicare, along with the costs for 2012 and key enrollment dates and facts. We explain terms such as late enrollment penalties and dual eligibility.

Here is a basic overview of the components of Medicare:

Part A: “Hospital Insurance”, covers inpatient hospital, certain skilled nursing and skilled home health services. It does not cover long term or custodial care.

Part B: “Outpatient Services”, covers Medicare eligible physician’s services, outpatient hospital services, certain home health services or therapies, and durable medical equipment.

Part D: “Prescription Drug Coverage”, offered through stand alone plans via private insurers or as part of a Medicare Advantage Plan.

Medicare Advantage Plan (AKA Part C): Health Plans such as PPOs and HMOs that are approved by Medicare and run by private companies. Beneficiaries opting for Medicare Advantage chose to receive the various Medicare benefits through the insurer rather than the traditional Medicare program.

Medigap Plan (AKA Supplemental Policy): These policies help pay some of the costs not covered by regular Medicare (such as co-pays/deductibles).

Aging Wisely’s patient advocates offer a unique Medicare Analysis program, in which we gather information from you, discuss your priorities, budget and health concerns/history and from that, provide specific guidance on how to make a wise choice for your Medicare plans.

From new years’ resolutions to year-end planning, this is the time to think about getting organized and properly prepared for 2013.  When it comes to eldercare and health care issues, there is a lot you can do to be prepared and a little bit of effort and time now can save you a lot of headaches in the long run.

Now is a great time to do a quick “self assessment” of your caregiver readiness.  Here are a few steps we recommend in that assessment:

1. Review and organize the “important papers”.  Do you have the legal paperwork necessary to step in and care for an elder loved one (or any adult loved ones or friends who wish you to help)?  How long has it been since this paperwork was completed/reviewed?  It may be time for a review appointment with the attorney.  Also, make sure necessary papers are accessible, including insurance cards, legal documents and a list of key contacts.
2. Do you have some “go to” resources “in your back pocket”?  Who would you call if your Mom fell and was hospitalized?  What would you do if Dad needed a rehabilitation facility after surgery?  How would you locate transportation or medication management services in your grandmother’s community?
3. Make a list of your key issues and concerns and consider scheduling a geriatric care management consultation to review these and get ideas.  The geriatric care manager can help you with immediate resources and longer term planning/ideas.  A quick and easy care consultation can remove a huge weight from your shoulders, giving you options, prioritizing needs and reassuring you about the job you are doing.
4. Consider bringing in a little extra help.  By introducing assistance early and for household types of tasks (extra help with shopping at the holidays for example), you and your loved one can get comfortable with a company and caregivers that may become necessary for more assistance down the road.  Check out EasyLiving home healthcare gift certificates to provide the gift of assistance.

For a complete checklist, grab your free copy of our Essential Eldercare Checklist!

Who would benefit from a care consultation?  If:

• You have an older loved one who has increasing health issues or a major new diagnosis.
• You are providing care currently to an aging or disabled loved one.
• You are concerned about your own health issues or want to look at future options such as what type of care you can afford or moving to a retirement community.
• Your family is in disagreement over a loved one’s care or you have long-term family conflict which you know will be an issue in coming together to care for an aging parent.
• You’re trying to figure out retirement health insurance options or understand medical and long-term care coverage.
• You care for a disabled adult child or family member–and want to get organized and consider future plans as you age.
• You spotted some concerns during a recent visit and don’t know where to begin (or got nowhere when you tried to bring up your concerns with your elderly loved one or other family members).
• You or a loved one is diagnosed with Alzheimer’s, other forms of dementia, progressive diseases like M.S. or Parkinson’s.
• You have a specific healthcare issue or eldercare concern that you seem unable to resolve or find help/resources to address properly.

YOU WOULD!

Aging Wisely’s eldercare consultations and geriatric assessments are two of our most popular services.  Whatever stage a family member is at in their eldercare journey, the advice from a seasoned professional can make the path smoother.  As a caregiver, the anxiety of the unknown and the fear of that emergency phone call are some of the most stressful aspects of caregiving (and for some, the surprising start to being a caregiver).  You can reduce the anxiety of the unknown by marshaling some resources, having a general understanding of options, and prioritizing steps you can take now.   

If you are facing any of the above situations, call Sue Talbott at 727-447-5845 (or click below) to book a consultation or just ask a question.  Care consultations can be done in our office or via phone or Skype, at your convenience.

In our eldercare advice series, we offer information on common topics and concerns caregivers face.  We recently gave some personal feedback from dealing with a major transition and some of the lessons we learned liquidating a household of belongings.  We’re happy today to bring a guest expert in to share more important advice on estate liquidation and transitions for elders and their families.

We hope you are not spending your Thanksgiving or holidays dealing with liquidating an estate, but the reality is that some of you are…and many families will visit together during this time and be able to heed some of the preparatory advice from our guest. 

Encore Events is an Estate Sales and Liquidation company based out of Largo, Florida and helping clients throughout the Tampa Bay area (and families far and wide).  At Aging Wisely, a number of our clients’ families have used their services and we thought it would be great to get their eldercare advice on this important topic. Working with so many elders and families in transitional times here in Florida, we appreciate the many challenges involved and hope this interview gives you some helpful advice on your eldercare journey. (We have also added a couple comments in, which you will see in italics within the interview.)

What do estate liquidation companies do?

Life has many transitions. As people age, these transitions become more difficult. When parents die or need to move into assisted living or nursing care, they must leave a home where they have spent decades, accumulating many things. For family members, decisions must be made about what to do with the home and all its contents. For financial reasons alone, family often feels pressured to get the house emptied and on the market quickly. Where does one begin?

This is where a professional estate liquidation company steps in as facilitators to help such transitions go smoothly. The primary job of an estate liquidator is to sell the contents of the home. He will stage the property, appraise and price the contents, advertise the sale and conduct a multi-day “Estate Sale” in the home. Once a client signs a contract, all she/he has to do is take away anything they want to keep, then go away and let the estate liquidator do his job.

What is the most difficult part of the process as you see it for families?

“Letting go” is often the most difficult part of the process. For someone moving to assisted living, letting go of their home and most of their possessions causes a lot of anxiety and is emotionally challenging. Decisions must be made quickly and often without any prior experience with dealing with death or a debilitating condition. Many people who die here in Florida have family who live far away. Just finding the time and money to make an extended trip to Florida to tie up loose ends (in the case of death), or arrange for moving mom or dad to an assisted living facility, is stressful enough on family members. Once they get here, they often have to deal with attorneys, Realtors, utility companies, moving companies, and try to figure out what to do with mom or dad’s “stuff”.  When this stress is combined with grief, it’s very difficult to know how to make the best decisions.

What could an individual or family do to be better prepared? (or what advice would you give after years of working with families during such times?)

Too often, we run into bereaved family members who’ve lost touch with mom or dad over the years. They arrive clueless as to what needs to be done, how to find important papers, what to do with dad’s dog, or are shocked to see that mom had become a hoarder. To be better prepared for a time that will eventually come, here’s what family members should do when they still have the luxury of time.

• Someone in the family should assume responsibility for overseeing mom or dad’s life. This might mean more frequent visits. This responsible family member should learn who is mom’s banker, lawyer, doctor, and which neighbors have house keys. Regular visits will alert this person to changes in behavior, such as dozens of Home Shopping Network packages piled up unopened in closets, or kitchen cabinets that contain more dog food and alcohol than human food. They should look for clues that mom has started to hide money or important papers in very odd places.  Long-distance families, especially, might want to consider bringing in a professional geriatric care manager to be your “local eyes and ears”—and, as geriatric professionals, we can often spot things, anticipate concerns and help with resources before problems get out-of-hand.
• No one likes to think about their parents’ passing, so perhaps that is why there is so little preparation. Whether out-of-town or in, family members would be wise to start thinking about “what’s going to happen to mom’s house when she must leave it long before it happens. This would be the time to  start looking for Realtors and estate liquidation companies when you have the leisure of getting references and interviewing.  Oftentimes, mom’s attorney is a good source for referrals as are any word-of-mouth referrals. Talk to people.

By the same token, there are some things the elderly can do, while they are still able, to make the process easier on their families:

• Start giving stuff away now. That set of china, collection of Hummels, family photo albums … ask the kids, grandkids, nieces and nephews if they want them and then give them to any takers. Not only does it eliminate some “stuff,” but it brings both the giver and the receiver pleasure.
• We often are in homes where we find “notes” inside or underneath a treasured piece. These notes sometimes convey the history of the item, where it was purchased, or its sentimental or financial value. This is very helpful both to family members who may want to retain these items, or to estate liquidators who will be able to more accurately fix its value.

What word of warning would you give to families?

Especially in families where there are two or more heirs, the best words of warning are: Don’t get greedy. We are constantly amazed how often siblings who have gotten along well for decades, suddenly become squabbling enemies when it comes to who gets mom’s stuff. We’ve seen it happen in the best of families. Two of them want that Oriental vase that belonged to mom’s grandmother.  They squabble over it, and then suddenly they are squabbling over everything. Greed causes damage among family members that sometimes never gets repaired. Families need to remember: it’s only “stuff” and most of us already have too much of it.

Greed will also lead you to make dumb decisions. We recently did an estate sale for a wealthy local family. It was in an old mansion full of old antique furniture; however both the mansion and the antiques had seen better days. When we discussed with the New York son what we thought the antiques would bring at the estate sale, he insisted on shipping 10,000 pounds of antique furniture to New York saying he could get a lot more money up there. He failed to heed our advice about how much the market for antiques has changed just in the past few years. As a result, he paid high shipping costs for a lot of furniture that is still sitting in NY consignment shops.

Another word of advice, especially for out-of-town family, is to not underestimate the work involved in settling an estate long-distance. Although decisions must be made quickly, things don’t get done quickly. There’s probate, there’s trying to sell a house in a down market, there’s the time and energy required to empty the house. (If you’ve never done it, even simple houses are surprisingly stuffed. It is not a job for the easily overwhelmed.)  If you’ve done your homework, you will have already lined up an estate liquidation company that you trust. Which leads to the next question.

How does someone find a good estate sales company/person to work with? What should they be looking for or who should they ask?

As mentioned earlier, your estate attorney (or geriatric care manager!) may be able to recommend liquidation companies he works with regularly. Or ask neighbors or friends for referrals. Word-of-mouth is much better than huge yellow page ads.

In general you want to hire an estate liquidation company that:

• has been in business a long time and has years of experience liquidating estates just like yours
• has an appraiser knowledgeable in many areas such as art, jewelry, china, silver, etc. (You don’t want to read in the news about someone buying a painting for $4 from mom’s estate that turns out to be worth $4 million.)
• is insured. Hundreds of people will attend a well-run estate sale in your parents’ home, leaving opportunity for all types of mishaps. An insured liquidator is a liquidator who takes his job seriously.
• has a stable, consistent staff. Staging a sale properly is a huge undertaking that involves many hands helping. You can feel more assured when you know the staff has longevity with the business.
• has a contract that clearly outlines both your and the liquidator’s responsibilities
• tells you how the property will be left at the end of the sale. Totally empty? Broom swept? Or will they just walk away leaving the unsold items for you to deal with.
• has a strong marketing/advertising plan in place. When the estate liquidator does heavy print advertising and has a strong Internet presence, the sale will attract more buyers which increases the net sale proceeds. Ask him how he advertises. Throwing up a sign on the street corner just won’t cut it.
• most importantly, you need to completely trust the company you hire. Hold interviews. Be looking for someone who answers all your questions, is professional in appearance and personality, and, hopefully, comes to you by recommendation.

Once you have made a choice, you should feel comfortable in turning over the keys. Aside from removing any items from the house that you do not want sold, your job is finished. Quite often, we discover important papers, cash, family photographs, jewelry, even gold coins as we begin to stage a property. At Encore Events we make sure to notify the family about such items, as would any reputable estate liquidator.

Thanks to Bill and Merry from Encore Events for taking the time to provide such thoughtful answers and advice!  If you’re in the Tampa Bay area, check out their page for services and their latest sales.  As always, if we can help you with any eldercare needs or resources, give us a call at 727-447-5845.

Aging Wisely can help in many ways during transitions and beyond, such as:

• Overseeing things for long-distance family members; acting as a local advocate and liaison;
• Mediating family discussions and care decisions-helping you to get through tough decisions/emotional times while keeping family relations intact;
• Assisting with Assisted Living, Nursing Home and other eldercare moves: everything from professional advice to make the best choice to practical help with the whole move and emotional help for your loved one to make a smooth transition;
• Advice and resources for a wide array of eldercare needs;
• and more!  We’re here to help!

We have been covering some essential advice for families who provide eldercare help to their aging parents or other loved ones, particularly focused on the complexities of managing medical care.  Becoming a loved one’s advocate takes a lot of preparation and a steep learning curve.  You have to be a skilled communicator, negotiator, relationship builder and a smart researcher.  You may feel like you have to learn a whole “new language”–terms like HIPPA, explanation of benefits, observation status, skilled nursing care and of course, the actual medical terminology for diseases, treatment, medications.

Our most recent blog posts have offered advice on preparing to handle a loved one’s medical decisions should they become incapacitated (and even how to assist if temporary or working in conjunction) as well as the importance of reviewing and updating legal documents for advance care planning.  Today’s post will delve further in to preparing to help with managing medical care and providing other eldercare help.

We are preparing to conduct a training session at the Professional Patient Advocacy Conference (in Orlando December 7, 2012) entitled, “The Successful Physician Visit: Best Practices for Advoactes”.  This is an essential topic for advocates assisting with managing medical care.  Patients with chronic conditions spend a lot of time at doctor’s appointments and often see multiple practitioners.  Older adults with multiple chronic health conditions have an average of 37 doctor visits, 14 different doctors and 50 separate prescriptions each year.  And, the more chronic conditions you have, the less likely you are to be satisfied with your doctor’s visit.  Most adult primary care patients have at least two chronic conditions, and these numbers are likely to be much higher for the elder who is being assisted by a family caregiver.

We will be sharing some of the special ways professional advocates can help elders and family members in making a doctor’s visit (and medical care overall) more successful.  We will also be continuing our series here on tips for you as the family caregiver and sharing when and how a professional patient advocate might help you.  Input your email address to get our updates!

Our tip today involves preparing a “health file” or “health record” for the patient (something valuable for you to do now proactively for yourself if possible, or something you can assist your elder relatives to do in order to be able to assist more effectively).  What does a health file need to include?

• Healthy history: diagnoses, surgeries, contact information for medical providers (for possibly obtaining records)
• Basic family medical history: immediate family history of major illnesses such as cancers, heart disease, Alzheimer’s, etc.
• List of medications: prescription, over-the-counter and herbal/vitamins with dosage and instructions (ideally, also have a list of past medications that have not worked effectively or produced side effects)
• Allergies (medications, food, etc.)
• List of current diagnoses and treatment (course of treatment, follow-up in progress or when needed, contact information for who is treating or treated the condition)
• Surgery history
• Activities of daily living/current status: an assessment of the patient’s daily living skills will help you communicate better information to the doctor.  For example, if a patient has trouble cooking meals or shopping, poor nutrition might impact health.  If the patient is falling or unable to manage hygiene tasks, this is vital for the doctor to know for determining a realistic plan of care.  Such information can be important even for very independent patients.  For example, is a spouse or support system available to help after a surgery or during treatment (cook meals, transportation, etc.)?
• Current symptoms or concerns (something to prepare prior to each appointment–wise to keep notes also and will help you be more accurate in describing the symptoms: when they occur, what precipitates them, etc.)
• List of appointments and follow up (calendar/reminder system)

Gathering and organizing this information is vital to being able to communicate with your medical providers.  Your doctors can only provide a plan of care based on the information they have, which too often is not completely accurate.  As a patient or family member assisting, this will help you tremendously.  It can save you time at each appointment, keep you from having to try to remember these details over and over again, and improve coordination.

You may want to consider using an electronic system for your health file.  This is what we do and recommend at Aging Wisely.  An electronic system can help with access, sharing (i.e. between various family caregivers) and make updating easier.  We have a detailed post on personal health records (PHRs) also known as electronic medical records (EMRs): the benefits and how to evaluate systems.

For many elders and family caregivers, this information is disjointed and will need to do some research to gather accurate and updated information.  Consider hiring professional geriatric care manager to put together your health file by researching and gathering all of your information, as well as assessing the current status and gaps.  The care management assessment will indicate issues/concerns such as how the patient is managing activities of daily living, medications and follow up, as well as areas that perhaps have either not been addressed or where a treatment plan isn’t being followed.

A geriatric assessment is an excellent way for you to prepare to provide eldercare help, as it gives you a valuable baseline about your loved one.  A care manager often uncovers concerns or small issues that can be proactively addressed to keep bigger issues at bay.  The care manager will also make specific recommendations, which serve as a sort of prioritized preparation checklist for you as a caregiver.

Considering hiring a geriatric care manager and want to learn more?  Wondering if a geriatric care assessment would help or how worthwhile it would be to have someone assist in organizing the health file?  Grab our checklist for Hiring a Geriatric Care Manager and contact us today for more information and answers to all your questions.

Our Senior Care Consultant, Sue Talbott, can be reached at 727-447-5845 or toll free at 727-447-5845 for a free phone consultation about your elder care needs, medical concerns or senior care help today.

As a follow up to our previous article on making vital elder care decisions on behalf of a loved one, we wanted to provide some additional details on the relatively new Florida Power of Attorney statute.  This is also a reminder for seniors everywhere and their caregivers to review your estate planning and advance care planning documents from time to time to ensure they are current with new laws as well as your life changes.

Florida’s new Power of Attorney statute made significant changes to the previous statutes covering Power of Attorney documents.  This bill went in to effect on October 1, 2011.  Here is a basic overview, which we provide not as legal advice, but to give you a general picture of how significant the changes are and the ways it may affect you as a Florida senior or family member to a loved one residing in Florida. 

As always, we reiterate that you should consult with your attorney about this and other legal matters.  If you do not have an attorney, and need a referral for an elder law or estate planning attorney in Tampa Bay/Clearwater/St. Petersburg, Florida or beyond, we invite you to contact us.  We wanted to review this issue on our blog because we know that a lot of people executed documents prior to these changes and may not have reviewed them since with their attorney.  Particularly for individuals with memory issues or with a worsening illness (who may be able to understand and execute a new document now but not in the near future as the disease progresses), timing is important when it comes to updating these vital documents.

This statute provides that documents which were executed and valid under the previous law will still be valid.  As we mentioned, however, we think it is best to speak to your attorney about updating your document when possible.

Here are some key provisions and changes in Florida’s new Power of Attorney statute:

• The law eliminated “springing” powers of attorney.  A springing power of attorney is one in which the document goes in to effect upon a condition being met (usually these required doctor’s certification of the person’s incapacity).  Though some people liked the concept of springing powers, others found the administrative requirements of these documents to be problematic for their practical usage.  Older springing powers of attorney would technically still be valid under this new law, but you might run into some of those administrative challenges.
• The agent (or who you appoint as “attorney-in-fact”) must be: (1) a person who is at least 18 years old; or (2) a financial institution with trust powers, that has a place of business in Florida, and which is authorized to conduct trust business in the state.   You can name a single agent or multiple (co)agents.  If co-agents are named, each may exercise its authority independently from the others.  Under the previous law, all agents were required to act jointly unless you stated otherwise in the document.
• In order to receive compensation for serving as someone’s power of attorney, the agent must fall in to certain categories.  These are: a spouse or an heir, a financial institution with trust powers that has a place of business in Florida, an attorney or accountant licensed in Florida, or a person who is a resident of Florida and who has never been an agent for more than three people at a time.  This change particularly affected (or could affect) people in the community (often guardians or related healthcare or financial professionals) who served as power of attorney for clients who might not have had or wished to make other arrangements.  This law would not allow for that type of individual to be compensated (if they help or have helped more than three people at a time), unless he or she is an attorney or accountant licensed in Florida.
• Certain powers must be specifically set out and signed/initialed by the principal (in the past, principals could include a sort of blanket statement allowing the agent to handle almost any business).  A few of the powers that must be specified include: creating a living trust; amending, modifying, or terminating a trust created by the principal; making gifts; creating/changing a beneficiary designation.

*The law also provides that Powers of Attorney executed in other states are valid in Florida if they were executed properly in the applicable state, even if they don’t comply with Florida law (which may be a big help in today’s mobile world and for many Florida snowbirds).  Additionally, it provides that a photocopy or electronic copy should suffice unless specified.

One of the challenging areas for agents acting under a durable power of attorney can be navigating its use and getting various financial and other institutions to accept the document and respond in a timely manner.  This new Florida statute laid some groundwork on that issue with rules regarding acceptance.  When a power of attorney is presented to a third party (such as a bank), the third party has to accept or reject the power of attorney within a reasonable time (four business days) and to provide a written explanation for rejection.  The law also provides for damages, including attorney’s fees and costs, when a third party who refuses to accept the new power of attorney that is in proper form and properly executed.  This does not mean families will not run in to any difficulties, but it provides a clear time frame.

On the other hand, the challenge of working with institutions as the agent for someone might be even greater if you are dealing with an outdated document, executed under the old law.  If you are unable to get an updated document and run in to such problems, you can contact your attorney for help in explaining the document’s validity to the institution and finding a solution (and/or seeking damages if the situation is not handled properly and results in costs to you or the principal). 

Unfortunately, the situations in which families need to use a durable power of attorney are often crises or subject to time constraints (for example: moving a loved one from the hospital in to a nursing home, applying for Medicaid, moving funds to pay for a surgery or an assisted living bill).  When you find yourself faced with hurdles in the process, it can be extremely frustrating.

You might also be interested in getting a copy of our fact sheet, “Getting Answers about a Loved One’s Care” which covers navigating the health care system, privacy policies, and more.  We invite you to give us a call at 727-447-5845 if you have questions, concerns or need advice about navigating elder care.

Our professional patient advocates can be an excellent resource to help your family find the answers you need, seek the highest quality care and create a plan that makes sense for you.  Whether a crisis or an opportunity to plan ahead, we’re here to help!

What Florida Elder Care issues would you like to see us cover?  Leave us a comment and let us know what topics you’d like to know more about or leave us your question!

A major role that many family caregivers will take on in eldercare is medical decision making, or at a minimum, guidance, coordination and advice on such decisions in coordination with an elder loved one.

The path of elder care is different for everyone, but often evolves and expands over time.  You may start to help an elderly parent with certain tasks or be asked to attend a doctor’s appointment or surgery consultation, or you may find yourself stepping in during a crisis.  Typically, over time, caregivers become more involved in the healthcare advocacy and medical decision making for a loved one.  If a loved one becomes incapacitated, this role may be handled solely by the family caregiver.

Making vital healthcare decisions can be extraordinarily stressful.  We all hear the stories in the news of families torn apart by such decisions.  Of course, every day families work together to make these decisions, both big and small.  Regardless, the decisions are a serious matter and one of the most stressful aspects of caregiving for many family members.

What steps can help make the healthcare decisions process smoother?

• Ensure your loved one has completed the necessary legal documents for advance care planning and decision making.  Such documents include: a healthcare power of attorney/healthcare surrogate, a living will, and a durable power of attorney.  Depending on your state and situations, the specific documents needed may vary and the language can be tailored.  Estate planning documents should also be included in this discussion, such as a will and/or trust.
• Understand the documents and ask questions.  This is a case where it should not all seem like a bunch of indecipherable “legalese” to you.  You need to understand how the documents work and clarify with questions if you are not sure.  You may need to refer back to your attorney to consult at the time the documents are used as well.  Family members sometimes run in to questions or problems when attempting to use the documents, so seek advice if need be.
• Review and update documents periodically.  If you have a major life change or wish to make a document change, don’t wait to contact your attorney to make the changes.  Additionally, it is a good idea to review the documents periodically.  In Florida, a new Durable Power of Attorney statute was passed that took effect October 1, 2011.  While older documents that were valid remain so, we recommend individuals talk to their attorney about updating to the new standards if possible.
• Get the information you feel you need from your medical providers to make an adequately informed decision.  Express your concerns and ask to consult further if you do not feel you have enough information.  Prepare questions ahead of time and take notes or work with a patient advocate to help you through the process.

An independent patient advocate can be a valuable resource as you go through the process of making various healthcare decisions on behalf of a loved one.  Here are just a few ways that a patient advocate can help you navigate elder care issues and decision-making:

• Assisting you in locating specialists and information on the particular disease or medical situation; helping you to set up appointments and locate resources.
• Helping you prepare for appointments (or attending on your behalf) to ensure you get answers to your questions and have the information needed to make the most informed healthcare decision.
• Talking through the decision and helping you process the information you have received.  These decisions can be very emotional and a third party can help you talk through your thoughts and concerns.  The patient advocate also helps you to feel you have the information and time needed to process the decision.  This may involve serving as a liaison with providers and determining what additional information is needed to make a decision.
• Care planning and coordination for your loved one.  Helping coordinate between providers and family members–keeping “everyone on the same page” as much as possible with the goal of ensuring quality care for your loved one.
• Mediating family discussions and serving as a neutral sounding board between family members who may be in disagreement.

Need help with this elder care issue?  Want to talk to someone about how to be better prepared for navigating elder care and helping to make medical decisions for a loved one?  Have a family crisis going on, family in disagreement?

Give us a call any time at 727-447-5845!

Elder Care and Elder Rage: Know the Warning Signs of Alzheimer’s

Advice and Perspective from Jacqueline Marcell, family caregiver and author of Elder Rage

Jacqueline Marcell is the author of Elder Rage, a book and website based on her caregiving experiences.  Here Aging Wisely shares some insights from Jacqueline as one of our special blog guests to hear her family caregiving perspective and some of the important advice she took away from the challenges she experienced while caring for her mother and father.

Aging Wisely: Give us a little background about your family caregiving experiences.

Jacqueline: For eleven years I pleaded with my obstinate elderly father to allow a caregiver to help him with my ailing mother, but after 55 years of loving each other he adamantly insisted on taking care of her himself. Every caregiver I hired to help him called in exasperation, “Jacqueline, I just can’t work with your father–his temper is impossible to handle. I don’t think he’ll accept help until he’s on his knees himself.”

My father had always been 90% great, but boy-oh-boy that temper was a doozy. He’d never turned on me before, but I’d never gone against his wishes either. When my mother nearly died from his inability to continue to care for her, I flew from southern California to San Francisco determined to save her life–having no idea that it would nearly cost me my own.

Tell us about the early stages of trying to get involved (and some of the early signs something more might be going wrong).

I spent three months in the hospital nursing my 82-pound mother back to relative health, while my father went from normal one minute to calling me nasty names and throwing me out of the house the next. I walked on egg shells trying not to upset him, even running the washing machine could cause a tizzy, and there was no way to reason with him. It was heart wrenching to have my once-adoring father turn against me.

I immediately took my father to his doctor, only to be flabbergasted that he could act normal when he needed to. I could not believe it when the doctor looked at me as if I were lying. She didn’t even take me seriously when I reported my father had nearly electrocuted my mother, but fortunately I walked into the bathroom three seconds before he plugged in a huge power strip that was soaking in a tub of water–along with my mother’s feet! Much later, I was furious to find out my father had instructed his doctor (and everyone) not to listen to anything I said because I was just a (bleep) liar—and all I wanted was his money!

Then things got serious. My father had never laid a hand on me my whole life, but one day nearly choked me to death for adding HBO to his television, even though he had eagerly consented to it a few days before. Terrified, I call the police for the first time in my life who took him to a psychiatric hospital for evaluation. I could not believe it when they released him right away, saying they couldn’t find anything wrong with him. What is even more astonishing is that similar incidents occurred three more times.

Then you ran in to more problems…and what you call the “Caregiver Catch 22”?

After three months, I was finally able to bring my frail mother home from the hospital, but furious to find myself trapped. I couldn’t fly home and leave her alone with my father–she’d surely die from his inability to care for her. I couldn’t get my father to accept a caregiver, and even when I did—no one would put up with his temper very long. I couldn’t get healthcare professionals to help–my father was always so darling in front of them. I couldn’t get medication to calm him, and even when I finally did—he refused to take it and flushed it down the toilet. I couldn’t place my mother in a nursing home—he’d take her out. I couldn’t put him in a home—he didn’t qualify. They both refused Assisted Living—legally I couldn’t force them. I became a prisoner in my parents’ home for nearly a year trying to solve crisis after crisis, begging for professional help—and infuriated with a medical system that I didn’t feel was helping me appropriately.

When and how did you finally get some answers?

You don’t need a doctorate degree to know something is wrong, but you do need the right doctor who can diagnose and treat dementia properly. Finally, a friend suggested I call the Alzheimer’s Association who directed me to the best neurologist in the area who specialized in dementia. He performed a battery of blood, neurological, memory tests, CT and P.E.T. scans. After reviewing my parents’ many medications and ruling out numerous reversible dementias such as a B-12 and thyroid deficiency, you should have seen my face drop when he diagnosed Stage One Alzheimer’s in both parents—something all their other healthcare professionals missed entirely.

You learned a lot about some of the most challenging aspects of Alzheimer’s, especially in the early stages which can be particularly hard for family members.

What I’d been coping with was the beginning of Alzheimer’s (just one type of dementia), which begins very intermittently. I didn’t understand that my father was addicted and trapped in his own bad behavior of a lifetime and his habit of yelling to get his way was coming out over things that were irrational… at times. I also didn’t understand that demented does not mean dumb (a concept not widely appreciated) and that he was still socially adjusted enough to never to show his ‘Hyde’ side to anyone outside the family. Even with the onset of dementia, it was astonishing he could be so manipulative. On the other hand, my mother was as sweet and lovely as she’d always been.

Share with our readers some of the important information  your learned about Alzheimer’s disease.

Alzheimer’s makes up 60-80% of all dementias.

There is not a cure and it is a progressive disease.  However, if identified early there are four FDA approved medications (Aricept, Exelon, Razadyne and Namenda) that mask symptoms, keeping the patient in the early independent stage longer, delaying the need for part to full-time care. The Alzheimer’s Association reports that with optimal lifestyle changes (proper nutrition, weight, exercise, socialization), a five year delay in the onset could save $50 BILLION in annual healthcare costs. Even a one month delay in nursing home placement of Alzheimer’s patients could save the U.S. $1 BILLION annually.

An expert in the brain chemistry can help find solutions that can make all the difference.  It sounds like this is what you experienced working closely with a neurologist?

After the neurologist worked on the Alzheimer’s treatments for my parents, he treated their depression which is often present in AD patients. It wasn’t easy to get the dosages right and it took time and patience — and no, my father wasn’t suddenly turned into an angel, but at least we didn’t need police intervention any longer!

What else were you able to do as a caregiver to stabilize the situation and make life more optimal for both you and your parents?

Once my parents’ brain chemistries were better balanced, I was able to optimize nutrition, fluids, medication, treatments, exercise and socialization with much less resistance. I was also able to implement creative techniques to cope with the intermittent bizarre behaviors. Instead of logic and reason—I used distraction and redirection to things they were interested in. I learned to use reminiscence and talk about the old days, capitalizing on their long-term memories which were still quite good. Instead of arguing the facts—I agreed, validated frustrated feelings, and lived in their realities of the moment. I finally learned to just ‘go with the flow’ and let hurtful comments roll off.

And if none of that worked, a bribe of ice cream worked the best to cajole my father into the shower, even as he swore a blue streak at me that he’d just taken one yesterday (over a week ago). I was also finally able to get my father to accept a caregiver (he’d only alienated 40 that year—most only there for about ten minutes), and then with the benefit of Adult Day Care five days a week for my parents and a support group for me, everything finally started to fall into place.

Tell us about the financial side of things.

Before long my parents’ life savings was gone and we were well into mine. I was advised to apply for Medicaid and after months of evaluation they were approved for financial help from the government. I was so relieved, until I learned it would only pay to put my parents in a nursing home, not keep them at home with 24/7 care. And, since my mother needed more skilled care than my father, they’d be separated, something they would never consent to—nor did I want after all this work to keep them together.

I could not believe it—I finally had everything figured out medically, behaviorally, socially, legally, emotionally, caregivers in place, the house elder-proofed, and all I needed was financial help to keep them at home. If I’d only made sure my parents bought Long Term Care Insurance (or bought it for them) years ago while they were healthy before diagnosis of dementia, it could have covered the cost of their care at home. Instead, I paid for their care, which nearly wiped me out in every way. After five years of managing 24/7 care for my parents, I survived invasive breast cancer.

As we mentioned, it is an all too-common phenomena that dementia is overlooked.  You learned a tough lesson in this difficult process.

What is so unsettling is that not one healthcare professional discussed the possibility of the beginning of Alzheimer’s (or any type of dementia) in my parents with me that first year, which happens far too often. Alzheimer’s afflicts 5.4 million Americans, but millions go undiagnosed for years because intermittent subtle warning signs are chalked up to stress or a ‘normal’ part of aging. Since one out of eight by age 65, and nearly half by age 85 get AD, healthcare professionals of every specialty should know the ‘Ten Warning Signs of Alzheimer’s’ and educate their patients early so everyone can save time, money—and a fortune in Kleenex!

You can grab the warning signs of dementia and our memory loss fact sheet here.  Let’s all take a valuable lesson from the tough road Jacqueline faced and help spread the word and share awareness about the signs, symptoms and terminology related to dementia. 

We also encourage you to seek help from a geriatric care manager if you are struggling with caregiving issues, or even wondering if it is time to step in when you are feeling concerns about an aging parent.  We’re here to help at 727-447-5845 or click below to schedule a consultation, to begin getting answers to your questions, resources and more:

Jacqueline Marcell is an international speaker on Eldercare & Alzheimer’s, host of the COPING with CAREGIVING radio show, and author of the best-selling book, ELDER RAGE. You can learn more about Jacqueline and all the resources she offers at www.ElderRage.com.

Hospital readmissions are costly not only to Medicare but to the elders and families involved. 

Medicare is trying to recoup some of the approximately $17 billion per year in costs associated with readmissions.  Congress gave the Centers for Medicare and Medicaid Services the power under the Patient Protection and Affordable Care Act to cut hospitals’ pay by up to 1% if they exceed a certain 30-day readmission rate for patients with heart failure, heart attack or pneumonia, starting Oct. 1, 2012. 

The health reform law also set aside $500 million for a readmissions-reduction Medicare pilot program starting this year.  The program that has been created with this funding covers over 47 communities serving high risk beneficiaries across 21 states. It is part of a larger initiative by the Obama Administration called Partnership for Patients, developed to help improve the quality, safety, and affordability of health care.  The Partnership for Patients’ expected goals by 2013 include: • 40% reduction in hospital acquired conditions • 20% reduction in 30-day hospital readmissions • Up to $35 billion in cost savings in 3 years.

There is a lot of disagreement about just how many readmissions can be prevented, but there is agreement that things can be done to improve the system and reduce certain avoidable problems. According to Stephen Jencks, MD, MPH and lead author of a 2009 New England Journal of Medicine study on this issue, about 40% — nearly 1 million rehospitalizations annually — are avoidable.  In a June 2007 report, the Medicare Payment Advisory Commission said three-quarters of readmissions are “potentially preventable.”

Clearly, readmissions are costly to Medicare and carry a great personal cost to the elders and families directly involved.  While certain readmissions will be unavoidable, most experts agree that two simple areas make all the difference in reducing complications and related eldercare costs:

1. Instructions/communications to ensure understanding of post-discharge care
2. Follow-up care after the hospital stay to keep conditions under control (and coordination/set-up of this care)

We invite you to download a copy of our discharge planning checklist (and share!) as a means to help you and your family with ensuring you have all the instructions and information you need, and have asked necessary questions to ensure appropriate follow up care.

When an elder’s transition is not well-managed, problems often arise which may lead to more long-term needs and difficulty recuperating.  Difficulties during this time may lead to an overall decline in activities of daily living and nursing home placement, particularly for elders with multiple conditions or cognitive problems/memory loss.  Clearly, this can be a devastating turn of events for the elder and family, in addition to creating greater care needs and costs.

Hospitalization and discharge are critical times.  If you have a loved one who goes to the hospital, give us a call.  We know you will find it worthwhile to talk with Sue Talbott, our Senior Care Consultant, to get advice and options.  Here are a few of the questions we often get about how and why a geriatric care manager can help:

How does a geriatric care manager help with this process?  Why do I need to bring in an outside party to help?

Though you may have great medical providers and assistance from case managers at the hospital, an outside resource can help you and your medical team effectively navigate the transition.  First of all, this is a stressful time in which your time to make decisions may be very limited.  A care manager can save you a lot of time, stress and money immediately and in the long-term.  Care managers know the variety of resources in the community and can make specific recommendations.  Because care managers work in the community, with clients in all types of situations, we anticipate concerns to help you avoid them.

What about costs?

This is our area of expertise–so we have great efficiency in managing the process for you and working within your parameters. Most importantly, the planning involved helps you potentially avoid costly mistakes.  Care managers do not receive referral fees, so we are not being paid to recommend a certain facility or provider.  Our independent recommendations are tailored to what we think will work best for you, and our experience with providers’ quality of care.  We’re glad to talk with you about how we can help in your situation and budget guidelines.

Need help NOW?  Call us any time at 727-447-5845.