health care

Recognizing the Need for outside Help in Caregiving

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.

Where do we go from here? Discharge planning after your senior parent’s ER visit

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

Are You Prepared: Going to the Emergency Room-Part One

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.

Medicare – Enrollment

“Now What” Series

At Health Champion, we hear the phrase “Now What?” from our clients so often, we have decided to create a series of “Now What” blogs.

We hope that these posts will provide you the insight and advice you need to become a successful health care consumer.

Our first “Now What” blog pertains to the following scenario:

You are turning 65, still working and plan on continuing to work. Now what should you do about Medicare, if anything?

If you have health benefits from your employer and you are continuing to work, you should sign up for Medicare Part A. You should also speak to your human resources department to determine whether or not to sign up for Medicare Part B. If you decide to enroll in Medicare Part B, then the question is, which of your insurances is the primary payer of your health care? In general, the size of the employer group determines who is primary payer for “the working aged”. (Could we please replace that phrase with something like “HIP Older Person?). Ask your human resources department who your primary payer is.

If you have worked 40 or more quarters you are eligible for Medicare Part A when you turn 65. Medicare Part A covers inpatient hospitalizations, skilled nursing, home health and hospice care and some selected outpatient services. If you have worked the 40 or more quarters there is no cost for Medicare Part A. Most individuals who are receiving Social Security will be automatically be enrolled in Medicare Part A – on the first day of the month you turn 65. If you are not receiving Social Security at age 65, you are still eligible for Medicare, but you will have to enroll yourself by contacting Social Security.

Medicare Part B, which covers physician costs among other types of services, is an option that you must elect. You should enroll in Part B 3 months before the month you turn 65, but can also enroll the month you turn 65 and 3 months after your 65 birthday. You do that by contacting your local Social Security office or on the Social Security website.

If you chose to continue to work past your 65^th birthday, and you are receiving employer sponsored health insurance, you can defer your enrollment into both Parts A and Part B. When your employer coverage ends, you can elect Part A and enroll in Part B. This is called a “special enrollment period.” The 8-month “special enrollment period” begins the month after the employment ends or the group health plan coverage ends, whichever happens first.

A word of caution, if you fail to take advantage of the special enrollment period, you risk paying a penalty later. www.medicare.gov is good resource for general overview of enrollment periods.

For more information go to:

Medicare: www.medicare.gov

Social Security Administration: 1-800-772-1213 or www.ssa.gov.

Your friend at Health Champion,

Ida

Choosing the Right Health Plan- Benefits by Design -

Continuing last week’s discussion, Choosing the Right Health Plan, let’s look at how the actual Benefit Design can — and should — shape your purchasing decision.

When we say benefit design, we’re simply acknowledging that medical insurance plans come in various shapes and sizes; you need to pick one that fits you and your family.

What’s in a Name?

Everything. The name itself often represents the type of product, reflects plan rules or highlights a unique element. Example: HDHP stands for “high deductible health plan!”

HMO, PCP, Gatekeeper — these names are associated with benefit designs from health plans versus insurance companies. They generally require a referral from a primary care physician before you see a specialist. Does that work for you? Are you willing to engage with a primary care physician as part of your health care team? Open Access, on the other hand, typically means you don’t need a referral from a primary care physician to see a specialist.

Points of Service

Before purchasing a health plan, make sure you understand how it’s designed in terms of service. For instance, will you be covered — to some degree, at least — if you see a non-participating doctor?

Warning: if you call a doctor’s office to see if they participate with your insurance and you get this response, “We accept all insurance” DO NOT think it means they participate with your plan. It simply means they’re willing to accept a check from anyone. Ask more questions.

Need physical therapy? Want to see a chiropractor? Make sure these services are covered and if there are limits on visits. It’s not unusual to see benefit designs with limited coverage for these services.

There’s a lot to consider when choosing a heath plan. And the wrong decision can be costly. Check with your state’s Department of Insurance website for a list of all licensed insurance companies and health plans doing business in your state. See what’s available. And when in doubt, consult an expert for advice.

-end-

Is this an Emergency?

There are times when you know it’s an emergency and you’re off to the ER. You don’t fool around with chest pains, for instance (no taking chances that it’s just indigestion). Ditto for broken bones and deep cuts.

But what about those other times? You know them: the sense that something’s wrong, but you’re not sure how bad it really is. it always seems to happen over a weekend or during the evening, when the doctor’s office is closed. Waiting doesn’t feel right, but neither does rushing to the emergency room.

Call your doctor. Most physicians have an answering service for this purpose. Offer the following:

Your full name; that you’re a current patient, in active treatment.
The best way to reach you (provide both cell number and land line).
The reason for your call, emphasizing that, while it doesn’t seem like an emergency, it’s a matter of serious concern that can’t wait for office hours. Don’t be too explicit, as most folks who take messages have little clinical experience. Use phrases, such as:
- My new medication is making me ill
- I am experiencing several new symptoms
- My pain has increased over the last (number of) hours and I need to discuss a different approach

Find out who’s on call. Ask the service to contact the doctor on your behalf rather than waiting for him/her to call in for messages. Note the time of your call and ask to be called back after the service relays your concerns. This will give you a time frame and help relieve anxiety.

Don’t ever hesitate to seek help. Even over a weekend. Even when you’re not sure whether or not it’s an emergency.

Where’s Common Sense When You Need It?

We’re offering a friendly challenge to the CEO’s of all health plans: leave your corner office and walk a mile in the shoes of people covered by your plan. What do you see? What touches your heart? What are you doing right? And what needs fixing? Notice a common theme in your walkabout: a lack of plain old common sense.

Here’s a case-in-point from an experience with Oxford, as we attempted to help our client through the health care maze. She engaged our services, signed a HIPAA form, as well as a form authorizing Health Champion as her representative. Because many health plans have their own authorization forms (wouldn’t standardization be in everyone’s best interests?), we immediately contacted Oxford. Here’s what ensued in our dealings with customer service:

O: Reading from the computer screen (no thinking necessary!): the completed form must be mailed to Oxford at their Bridgeport, CT address.

HC: Our client needs immediate help. Can we scan the signed form and email it?

O: No.

HC: Can we fax it?

O: No.

HC: If we overnight it, how long before the information becomes available to customer service reps?

O: About a month.

HC: Is there someway to move this along?

O: Nope.

HC: Our client needs help now. Isn’t there something we can do?

O: Well, you could get her on the phone with you, call in together so that she gives permission for the rep to answer your questions.

And you didn’t tell us that upfront?

We did just that. Our list of questions was long and the customer service rep was ill prepared to answer them, frequently placing us on hold to check with someone or something (a manual?). We reached the end of a long business day and our client was fading (remember, she’s dealing with health issues).

HC: Let’s finish this tomorrow. Can you note in the system that we received permission to speak to Oxford; can we continue the call in the morning without having to get our client back on the phone?

O: No.

HC: Why not?

O: We can’t do that. We are only allowed to get verbal approval for one call.

HC: But the call isn’t finished.

O: Sorry we can’t do that. The federal law, HIPAA, prevents us from doing that.

Since when? (When in doubt, quote the federal law, even if you’re wrong!) Now, there’s common sense in play!

CEO’s: are you paying attention? While health and clinical services are critical to accreditation from the National Committee on Quality Assurance, we suggest that, a common sense standard is just as critical.

Your thoughts? Post your experiences, comments and insights.

Everyone Has A Story: Alzheimer’s — Up Close and Personal

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.

Read Your Plan Documents

How was I to know that my health plan didn’t cover this?…

With over 25 years each working within the health care system, you can only imagine how many times we at Health Champion have heard this question. Whether receiving a unique or experimental treatment, seeking care from a state-of-the art facility, or simply seeing a doctor who happens to be outside of your health plan’s network, you can easily find yourself in a frustrating and expensive situation if you don’t know what your health plan covers.

Health insurance is a valuable benefit especially in today’s times. Unfortunately, too many people really don’t know much about their plan and don’t seek to learn about their coverage until they are in the midst of a crisis.

Fortunately, there are numerous resources available to health plan members. Health plans go to great length to provide information to their members. Benefit summaries, membership agreements and other coverage documents are typically available in hard copy or on-line. Members can contact their health plan’s customer service line or refer to the plan web site to learn how to access this information.

Health plan members should review their coverage and make certain they understand how their health plan works. And most importantly, Health Champion strongly encourages members to review their health plan before seeking care and whenever they have a question about whether a service is covered.

Prior to seeking treatment ask yourself, “Am I 100% certain these services are covered by my health plan?” If not, reach for your membership documents or call customer service! Many employer plan years begin in January. Now is a great time to review your health coverage!

Caring For Your Mental Health

If you — or someone you love — is struggling with mental illness, you already know the health care system is broken. At its best: disjointed and inadequate. At its worst: inaccessible to folks desperate for an appropriate diagnosis and treatment. The majority of individuals needing help fall between the cracks of long established requirements around age, income and insurance coverage.

Will Health Care Reform change all that?

In reality, there are very few provisions directly addressing mental health in the legislation recently approved by the House and the Senate.

But don’t be discouraged. There’s actually some good news. According to the American Psychiatric Association, the approved legislation extends mental health parity to individual and group policies purchased through government-sponsored health exchanges.

In basic terms, this legislation . . .

Mandates that these policies provide equal coverage for mental and medical conditions; they cannot differentiate between the two in establishing coverage limits. This is major! The original (2008) mental health parity legislation applied only to large employer plans in the private marketplace.
Bans companies from denying health insurance based on pre-existing conditions, including mental health diagnoses.
Eliminates lifetime limits on coverage.
Prohibits insurers from varying premiums based on an individual’s health status, one of the most frustrating issues faced by people with mental health diagnoses.

These provisions alone have the potential to extend health insurance coverage, including mental health, to approximately 30 million currently uninsured individuals and families.

Now that’s a good start. But it’s not perfect.

Like anything destined to change the way we think and do business, health care reform requires continued insight, input and evaluation. As health care advocates, we support this process and champion the inclusion of enriched mental health benefits as part of our re-designed system.

What do you think? We invite you to post comments; join the conversation on this critical issue.

Health Champion Blog

"In Your Corner"

Recognizing the Need for outside Help in Caregiving

Where do we go from here? Discharge planning after your senior parent’s ER visit

Are You Prepared: Going to the Emergency Room-Part One

Medicare – Enrollment

Choosing the Right Health Plan- Benefits by Design -

Is this an Emergency?

Where’s Common Sense When You Need It?

Everyone Has A Story: Alzheimer’s — Up Close and Personal

Read Your Plan Documents

Caring For Your Mental Health

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