Caregivers often don’t recognize when they are in over their heads, and often get to a breaking point. After a prolonged period of time, caregiving can become too difficult to endure any longer. Short-term the caregiver can handle it. Long-term, help is needed.  Outside help at this point is needed.

A typical pattern with an overloaded caregiver may unfold as follows:

• 1 to 18 months – the caregiver is confident, has everything under control and is coping well. Other friends and family are lending support.
• 20 to 36 months – the caregiver may be taking medication to sleep and control mood swings. Outside help dwindles away and except for trips to the store or doctor, the caregiver has severed most social contacts. The caregiver feels alone and helpless.
• 38 to 50 months – Besides needing tranquilizers or antidepressants, the caregiver’s physical health is beginning to deteriorate. Lack of focus and sheer fatigue cloud judgment and the caregiver is often unable to make rational decisions or ask for help.

It is often at this stage that family or friends intercede and find other solutions for care. This may include respite care, hiring home health aides or putting the disabled loved one in a facility. Without intervention, the caregiver may become a candidate for long term care as well.

With the holiday season upon us, caregivers feel even more stress — with planning, shopping and participating in holiday activities. This is a perfect time for family and friends to step up and provide some respite time and caregiving help.  Whether it is provided personally or arranged as a gift of services to be provided by a professional respite company or home care provider, it is a welcome gift.

After all of the tests and waiting and treatments are completed, it is time to decide what the next steps are for your Mom or Dad. Here are some possible scenarios.

Scenario 1: The doctor wants your father to stay in the hospital

Ø      The first question is … Why?

• If it is for a blood test or x-ray that is needed tomorrow, can it be arranged and completed on an outpatient basis?
• If it is because he should not be alone for the first 24 hours, can your dad go home with you or can you stay with him?
• Does he live in an assisted living facility where you can arrange some nursing care and monitoring?
• Can he be sent home with in-home supports you can arrange, such as private home health aides?

Ø      The second question is … Will he be admitted or placed in an observation bed?

• Keeping your father in the hospital does not necessarily mean that he is going to be admitted!
• If the doctor is planning to place your father in an observation bed that means that:

–        MEDICARE WILL NOT PAY FOR ANY OF THE HOSPITAL BILLS INCURRED ONCE THE ER TREATMENT IS COMPLETED, AND

–        IF YOUR FATHER HAS TO BE TRANSFERRED TO A SKILLED NURSING FACILITY FROM THE HOSPITAL FOR REHABILITATION WITHOUT BEING ADMITTED, MEDICARE WILL NOT PAY FOR ANY OF THE BILLS FROM THE REHAB FACILITY.

• If the doctor is planning to admit your father to the hospital, that means that Medicare will most likely pay for his hospital bills, as long as it is a medically necessary admission.

Scenario 2: The doctor wants to discharge your mother

Ø      Where will your mother go?

• If she lives alone in an apartment or house

–        Does she need someone to be with her for a day, a week, or longer?

–        Does she have stairs to get to her bedroom or bathroom that are now an obstacle?

• If she lives in an assisted living facility, do you need to contact them for added services and supports to be in place before she returns home?

–        Can they have these supports available to her immediately upon her return, or does it take some time for them to arrange theses?

 Before your parent leaves the ER

Regardless of where your parent will be going, there are several issues you need to discuss with the doctor before your parent leaves the ER.

Need assistance? Wondering what the right thing to do is? Give us a call!

In good health,

The Health Champion Team

No one usually plans to go to the Emergency Room, but if you are one of 48.9 million adults caring for a parent or other senior in your life, consider this:

Adults over the age of 85 will have more than 6 ER visits before end of life. The typical reason for a visit is a fall. You may get the call from your loved one, or a neighbor may call to let you know that an “ambulance” has been called; or, it may be the assisted living staff that notifies you.

Are you prepared to be the best advocate you can be for your loved one? Not unlike the time in our lives when we prepared our “overnight” bag in preparation for the baby’s arrival, taking the time to organize and arm yourself with the following information about your parent(s), will effectively minimize the chaos that occurs when a loved one goes to the emergency room.

Here is Health Champion’s Emergency Room Checklist that will help you prepare for the inevitable time when you are called to join your loved one. Your Emergency Room kit should include:

♦ List of current medications, dosage and prescribing physician. It also helps to have the name and number of the local pharmacy your parent uses.
♦ Medication and food allergies.
♦ Current medical diagnoses and treatments and names of physicians involved in the care.
♦History of recent falls, if any. Does your parent need assistance to walk? Can they get up from a chair unaided?
♦ Brief history of prior medical issues (for example, is there a prior history of stroke, heart attack?).
♦ Any implantable devices? For example, does Mom or Dad have a pacemaker in place? Or, had a knee or hip replacement?
♦Copy of advanced directives and/or living will.
♦ Copy of power of attorney, if it is in place.
♦ Insurance information and copy of card(s) – Medicare, Medigap plan, Medicare Advantage plan and Medicare Part D, if applicable.
♦ Pad and writing implement to keep track of the event. It may be helpful to note the arrival time, name of the emergency room physician in charge of your parent’s case, names of the nursing staff involved in the care and any lab or diagnostic tests that are done.
♦ A small blanket or bed throw – not all Emergency Rooms are plush with comfort supplies and the ER can be cold.
♦ Snacks for the caregiver – you can expect to be in the emergency room between 4-6 hours. Depending on the time of day, the cafeteria may not be open and having some quick healthy snacks (granola bar, raisins etc.) may be better than the vending machine options.
♦ Take your book, kindle or ipad – there is a lot of downtime in the emergency room.

Last but not least, be prepared for a discussion about discharge planning. Depending on the outcome of the emergency room examination, mom or dad may not be immediately returning home. Are you prepared to have them go home with you? Be admitted to the hospital? Be admitted to a rehab facility? Next week’s blog will address things you should consider for each scenario.

Are you noticing that your mom or dad is starting to struggle with everyday activities?

Are they not bathing or showering as often as you think they should?

Is their refrigerator full of food that should have been discarded weeks ago?

Is your once meticulous mom or dad wearing clothing with food spots all over the front of their shirt?

Are you worried that they are not eating well and appear to be losing weight?

Do they not tell you that they have fallen or went to emergency room until days later?

You are not alone.  Over 22 million households in the U.S. are caring for a friend or relative aged 50 years or older.  So why is it so difficult?

Our older adults are trying to cope with a world that is becoming more complex while their world is growing smaller, confusing and more difficult to manage.

Consider this:

• You are dealing with people have always been independent and desperately trying to remain so
• What you may think is the best solution for a problem may be very difficult for them to understand or do
• They are trying very hard not to be a burden to anyone or interfere with your busy life
• They may be embarrassed to ask for help
• Your roles are changing you are becoming the caretaker, a role they are used to having

There are no good answers.  We are all dealing with the frustration of trying to keep them safe and yet maintain their independence.  They are dealing with the frustration of knowing that they can no longer do what they used do.  So we all end up frustrated!

Engaging an expert who is not a family member to have the frank discussions makes it easier for everyone.  It is a relief to discuss your concerns with someone who knows what supports are available, has the expertise to offer suggestions and solutions, and knows how to navigate the system on your behalf.

So arrange a time and place when everyone can come together and start the tough discussions.  It will most likely take several meetings over time, but be patient, listen to each other, and let your expert guide you.  You are essentially looking for short term solutions and a long term plan. Document the plan and make sure that family members are aware of the plan and are on board. Issues and disagreements about a plan of care for Mom or Dad should be worked out before the plan needs to be implemented.

Not sure where to begin? Some excellent resources can be found on the following websites:

Elder Care Matters www.eldercarematters.com;

National Alliance for Caregiving www.caregiving.org

National Association of Professional Geriatric Care Managers wwwcaremanager.org

In good health,

The Health Champion Team

www.healthchampion.net

Inpatient or Outpatient ?

 If you are a Medicare Beneficiary, knowing your patient status during a hospital or emergency room visit will impact reimbursement and your out of pocket expenses.

If you have a loved one who has recently been to the ER and stayed overnight in the hospital you need to be aware of the following:

Your hospital status (whether you are considered an inpatient or an outpatient) depends on whether or not your physician has written orders for an inpatient admission. In other words, your doctor has evaluated your physical status and made a determination that you need to be admitted to the hospital. Your head on the hospital pillow or lying in a bed in a hospital room does not mean you have been admitted. Only having a written physician hospital admission orders makes your status an inpatient.

You are an outpatient if you getting emergency services, being watched or observed or having outpatient tests, your status is considered outpatient.

Consider this…You go the emergency room with chest pain and the hospital keeps you for 2 nights for observation – your status is Outpatient and reimbursement is under Part B. Part B covers your physician services and hospital outpatient services such as lab tests. Part B has a deductible and coinsurance.  Part A in this situation will not reimbursement or pay for any of the services.

Depending on the amount of services your balance at the hospital can add up. To avoid any financial surprises, it is best to verify your status and if possible keep a log of services rendered.

For more information check the Medicare website, www.medicare.gov/publications

Making the decision to hire a home care service to provide care for your loved one is an important decision and can, at the same time, be very difficult.  If an illness or recovery from surgery requires nursing care or physical therapy, a physician may order skilled home care services that provide both skilled providers and personal aides.  Your decision is then based on the obvious medical determinations made by the doctor.  But what if you as the family caregiver must determine the extent of care needed without the help of a doctor?

Each home care situation is unique.  In the beginning, family or friends step in to help with simple tasks and support for aging seniors who want to stay in their homes.  As long term care needs progress, more time is required to manage those self-directed funds needs.  Physical and mental conditions change with aging making usually routine hygiene and daily living activities difficult for an aging individual.  Even with the healthiest of seniors, the ability to drive a car, shop for groceries or do general housekeeping eventually needs to be relinquished to the responsibility of another person.  How you determine what type of home care is best for your situation and which home care provider is right for your loved one is critically important to achieving and creating a successful supportive environment for your loved one. Here is a link to an article with some helpful advice.:http://www.planforcare.org

Of course, sometimes bringing in a geriatric care manager or health care advocate who can assist in navigating the choices and decisions is the better approach.

You decide to make an unannounced visit to your 82 year old mom to see how she’s REALLY doing  The previous planned visits went pretty well, but you are starting to realize that things are not going as well as she would like you to believe.  When you arrive in the early afternoon, she is still in her night gown and is sitting in the dark with all of her medicine bottles open and pills scattered on the table.  She says that she is trying to figure out what to take and what she has already taken today.  When you open the refrigerator to make her some lunch, nearly all of the food you brought her last week is still there and unopened, and she cannot remember if she had eaten breakfast this morning.

You realize that your mom can no longer manage by herself in her home.

You sit down and wonder … Now What ???

Now is the time to start the difficult conversations about what your mom wants for now and the future.  She may not want to hear that she needs help or may have to make some changes to keep her safe.

Here are some tips to help you get started:

• Keep in mind that she is probably frightened; frightened about losing her ability to do everyday things, frightened about making changes, frightened of becoming dependent on you and others, and frightened that you are going to “put her away.”
• Have the discussion slowly and over several conversations so she can think and internalize what you are saying.
• Think about whether a change you are considering is better for you or better for her.  You will have to make both types of decisions, but it is important to be aware of why you are suggesting the change.
• Do your homework, know what your options are before discussing any changes or alternatives.
• Keep her in the loop and don’t forget to allow her participate in decisions about her care and living situation.  You may ultimately have to decide on something she does not want, but she needs to be able to discuss her feelings and offer alternatives.

Here are some resources for you:

• An independent Geriatric Care Manager: Will come into her home and perform a comprehensive assessment of her home environment for safety and accessibility, her ability to care for herself, and will provide a detailed report with specific recommendations.
• An attorney:  To be sure her Will, Living Will (or Health Care Proxy) are up to date and to have a Power of Attorney designated in the event she becomes unable to make decisions for herself.
• Commission on Aging:  Provides information about all of the state-funded programs for the elderly available in her state.
• Senior Centers:  May have social workers who can help you access senior services in her area.  They also may provide day programs, discounted hot lunches, a variety of activities, and free or low-cost transportation to and from the senior center.
• Meals-on-Wheels: Is a program that delivers prepared meals to the home. Depending on her income she may qualify for the meals at no charge or a discounted price.
• A Health Care Advocate:  A health care professional who can identify and evaluate appropriate resources for you and your mom, help you understand and organize her medicines, communicate with her doctors, and be there for you as your mom ages and her needs change.

There are times when we will use this blog to share a personal story, one we hope will resonate in a universal way even as the details are singular and specific. By sharing experiences, we learn we are not alone. We learn there is healing and hope along the way.

In her own words, here is such a story —  from Ellen Sue Moses, a pharmacist and member of the Health Champion team . . .

My father has Alzheimer’s. In truth, his dementia is probably a mixture of vascular dementia and Alzheimer’s disease. But that doesn’t matter to him. Or to me. Naming his dementia doesn’t change its reality.

I’ve heard that the definition of Alzheimer’s is not when you lose your keys; it’s when you forget what your keys are for. According to the Alzheimer’s Association, as many as 5.3 Americans are living with the disease. It’s the sixth leading cause of death in the U.S.

About my dad: it’s hard to know when it started. By the time my mother died, either his disease had progressed significantly or my siblings and I were noticing it more. Ordinary activities were confusing and complicated. He couldn’t remember how to navigate the streets he had driven his whole life. He started getting frightened and having terrifying nightmares, this rock of a man who never seemed to have fear.

Then one day I noticed blank checks stuffed into his pockets; he couldn’t answer the simplest of questions without overwhelming frustration. Even with 24/7 care, he could no longer live in his apartment. To my joy, we moved Dad closer to me, into a wonderful facility dedicated to memory-impaired adults.

As we go through life, our feeling of safety is based upon lessons learned from past experiences. Dad lives in a world with no memory of the past — of what worked for him and where danger lies. Remarkably, he has adapted to this life where every day, everything is new.

All of the things Dad accumulated as he traveled through life no longer hold any value. What matters most to him is spending time with people. Not long ago he told me that he didn’t know who I was but knew I belonged to him. Caring for Dad has changed my perception of life, aging and death. From him, I am learning to live in the present; I am learning every day what matters most.

Do you have a story you’d like to share? We invite you to post your comments or send us a longer story by private e-mail. And if you need help, we’re here to guide your journey through the health care system.

Imagine this: You’re visiting your parents — maybe for the holidays — maybe it’s a casual, routine visit . . . and you suddenly realize there are a lot of medicines around the house. The first fear that comes to your mind is: how is this being managed and what about drug interactions?

It’s scary stuff. And it’s exactly what happened to a client of ours.

Medication errors are among the most common medical errors, harming at least 15 million people every year. More than one-third of the errors that occur in the U.S. happen in people 65 years of age or older. And, the more medicines a person takes, the higher the risk of having an adverse reaction from a drug interaction

So, what can you do to help your parents manage their meds without actually being there to dole them out?  The answer is education and advocacy. Partner with them and have a clear understanding of what they’re taking and why.

Here are some hints:

• Help organize their medicines; look at every bottle for the date it was dispensed. A good rule of thumb: don’t keep any medication longer than one year. Generally, if it’s that old, it’s no longer being used.

• Look for the same medicine in several bottles. Check the strength. Some people take different strengths of a medicine at different times of the day.

• Ask for permission to speak with doctors on their behalf.

• When they’re given a new prescription, make sure they ask if it’s in addition to ones they’re already taking, or a replacement med. If there’s any confusion, you should call the doctor directly.

• Call each doctor’s office and ask what drugs are being prescribed. Be clear that you want only the meds prescribed by that doctor, not just a repeat of an old drug list.

• Create a comprehensive list of all meds being taken and keep it updated. Their pharmacist is an excellent resource for this task, especially if your folks tend to use a single pharmacy. Make sure each doctor has that list, checking for possible interactions.

• Your parents should keep a copy of the current drug list in their wallet, in case of emergencies. For tech savvy parents, they should keep the list in the PDAs.

• Don’t go it alone, especially if you live in different states. Enlist the help of a health care expert to guide you and your parents through the maze of prescriptions drugs.

Finally folks are turning to generic drugs as a way to reduce their overall prescription drug costs. If you have concerns about the questions about  generic drugs check out the following article.

http://www.nytimes.com/2009/12/19/health/19patient.html