• Older adults will often have their medicines sitting out on tables and nightstands and counters and sinks because seeing their medicines reminds them to take them
• Older adults have difficulty opening the “child resistant” tops on medicine bottles so they leave the tops loose or remove them all together
• Weekly medicine boxes filled with lots of pills have tops that easily flip open
• Older adults think that over-the-counter medicines are not dangerous and do not store them in safe places
• Older adults have many chronic illnesses requiring very potent and dangerous medicines

Did you know?

• Only 1 pill of some medicines can be deadly
• Unintentional poisonings from medicines cause more emergency room visits for young children each year than do car accidents
• “Every 10 minutes a young child in the U.S. is taken to the emergency room because of possible poisoning from swallowing a prescription or over-the-counter medicine”
• In one recent study, 23 % of grandparents reported storing prescription medicine in easy-to-access places, including daily-dose boxes that children can open and 18% percent of grandparents store over-the-counter medicines in easily accessible spots
• Many prescription pills resemble candy and children cannot tell the difference
• Among teenagers who are 12 to 17 years old, 7.4 % reported past-year nonmedical use of prescription medications
• One in every five teens were abusing prescription medicines in 2009, and one in every four teens in 2010

What can you do?

• Ask grandparents, aunts and uncles to move all of their medicines to a safe and secure area while your children (including teenagers) are visiting their home
• Always check around the house when you visit for any medicines that may be sitting out. Put them away in a secure safe place during the visit, but remember to put them back where you found them before you leave
• Medicine cabinets are easily accessible by both small children and teenagers so be aware of what is stored there
• Always call your local Poison Center if you suspect that any medicine has been taken or maybe missing

In Good Health,

Health Champion

The whole idea of High Deductible Health Plans was to give the patient more control over where they spend their health care dollars.  How can we be savvy shoppers when we can’t compare prices?

A recent study in a prestigious medical journal examined the inability to predict out-of-pocket costs of medical procedures and surgeries.  What they found was that even if you call the hospitals and doctor’s office and your health plan for a price before undergoing a procedure you cannot find out what your out-of-pocket costs will be.  They also found that if you are able to find out what the usual charge is for a procedure from the hospital, when you compare these charges with other hospitals the estimates can vary by thousands of dollars.

These variations in charges are not necessarily from different parts of the country or even in different states, these can be from hospitals in the same city, zip code, or just across the street!

WHO KNEW?

Did you know?

• If you have a procedure done in a hospital that you may receive 3 bills
• one from the hospital for the use of their facility and supplies
• one from the anesthesiologist
• one from the doctor (s) who did the procedure
• You can be treated by a doctor who is in-network for your health plan, but is affiliated with a hospital that is not in your network.  This means that the doctor’s charges would be considered in network, but you may have to pay out of pocket for the hospital and other charges which are out of network.
• If you have Medicare and do not check that the hospital and the doctors accept Medicare “assignment”, you may be responsible for all or part of the charges from your procedure or surgery

The moral to the story is:

• If you are able to get a quote, make sure you get it in writing
• Ask a lot of questions and keep asking until you get the information you need
• Call at least 3 times with the same questions to ensure that you are getting the “correct” answers
• Insist of speaking to a supervisor if you are not getting consistent responses to your questions
• Always document each call, the name of the person you are speaking to, and the time and date of the call.  If you are calling a health plan, as for a reference number for each call

In Good Health

Health Champion

This is because technically your mother was never admitted to the hospital. She may be in a hospital room being monitored and receiving treatment, but no admission orders had been written by a doctor, which means she was never admitted to the hospital and is considered an outpatient.

Did anyone tell her or your family that she is still an outpatient or the implications of her being in “observation”?

Is she capable at that moment to understand complicated information and to make good decisions?

WHAT DOES THIS MEAN?

 Original Medicare will not cover her hospital stay

 She will have to pay all of the hospital bills out-of-pocket (except for the treatment in the ER) if she decides to stay at the hospital to continue receiving treatment
 While still in the hospital she is presented with and asked to sign a Hospital-Issued Notice of Non-Coverage (HINN)—a written notice that she understands that Medicare is not responsible for paying for her hospital stay and that she has the right to an immediate appeal of the hospital’s decision

 If she is then transferred to a rehabilitation facility she has not met the required 2-day inpatient stay and Medicare will not pay for the room and board charges at the rehab facility

THIS CAN COST YOUR FAMILY THOUSANDS OF DOLLARS

Beware of the following scenarios:

 You come to the ED with chest pain and the hospital keeps you for 2 nights for observation

 You come to the hospital for outpatient surgery, but they keep you overnight for high blood pressure. Your doctor doesn’t write an order to admit you as an inpatient. You go home the next day.

 Your doctor writes an order for you to be admitted as an inpatient and the hospital later tells you they’re changing your hospital status to outpatient. Your doctor must agree, and the hospital must tell you in writing –while you’re still a hospital patient – that your hospital status changed

WHEN ENTERING A HOSPITAL FOR TREATMENT, ALWAYS ASK IF YOU HAVE BEEN ADMITTED, AND IF NOT, WHY

NEVER ASSUME JUST BECAUSE YOU ARE BEING TREATED IN A HOSPITAL THAT MEDICARE WILL PAY THEIR SHARE OF THE COSTS

You aren’t alone, unless they have been sharing this with you over the years you would have no idea.  Your parents have been independent and making these decisions without you for a long time.  But recently you have been switching roles, you as a caretaker and them needing more care and support.

Here is an overview of the types of health insurance they may have if they are 65 or older.

1. Medicare:  Original Medicare consists of:
1.  Part A—hospital insurance
2. Part B—outpatient insurance
3. Part D—prescription drug insurance
4. Medicare Part C :  also called Medicare Advantage , combines all of the above Parts A,B & D into one plan

2. Medicare Supplement (also known as Medigap) :  a private insurance plan that pays for many of the co-insurance charges that Original Medicare does not

3. Retirement health insurance: insurance from a former employer that provides medical coverage and often prescription coverage.  Some retirement health plans require that your parents also have Original Medicare, once they reach 65, to receive benefits from this type of insurance.

4. Long-Term Care insurance:  A private insurance policy that may cover services needed by the insured on a daily basis over an extended period of time.  This type of insurance covers some or all of the following services.  Each policy is different so read it carefully for all requirements and exemptions.  There are often waiting periods (elimination period) during which you must pay out-of-pocket for eligible services before benefits are paid.

1. Home health care-a certified Personal Care Assistant (PCA),Home Health Aide (HHA), Certified Nursing Assistant (CNA) to help people continue to live in their home by helping with personal care such as bathing, dressing, feeding, toileting, transferring from bed to chair to toilet to chair, walking and grooming.  They can also do light housekeeping, cooking and shopping.Every state has their own laws regulating home care and each policy has different qualifications.  Check with both state agencies and the policy for the rules needed to qualify for benefits.

2. Adult Day Care:  These are supervised recreational and therapeutic programs where seniors with physical and/or cognitive impairments can spend their day in a save, supportive and social environment.

3. Assisted Living-A monthly benefit to cover some portion of the monthly fee for living in an assisted living facility.  Every policy has a set monthly amount they will pay with a maximum limit.

4. Skilled Nursing Facilities (Nursing Homes):  If you parent requires this level of care, most Long-term insurance policies will pay a monthly benefit to cover a portion of the fee for living in a skilled nursing facility.  This is not the same as having a short-term stay in a rehabilitation facility due to an illness, surgery, or injury.  Those fees are usually covered by their Medicare benefit.

5. Veterans Aid and Assurance: If either of your parents is a U.S. veteran having served during a time of war, or the spouse of a veteran, they may be eligible for a monthly benefit to help defray the costs of home health aides, assisted living facilities, and/or nursing homes.  This program is asset based, but much more generous than Medicaid.  Contact your local Veterans organizations or an Eldercare Lawyer certified to see how to access the coverage or assist with the application process.  This VA benefit is normally applied for at the time home health services are needed.

6. Federal Employee Retirement Health Benefit:  If your parent  is a retired federal employee, began receiving income from an immediate annuity no later than one month after their retirement date and had participated in a Federal Employee Health Benefit Plan continuously for at least five years prior to their retirement date, they may have Federal Employee Retirement Health Benefits.  Contact their past employer for information about their benefits

Going through all of their papers will help you understand what benefits they are entitled to.

The important thing to remember is, contact every entity you find any paperwork on, you may discover benefits they are entitled to that they have forgotten about.

Some policies may still be active regardless of whether they have continued to pay premiums or not.

Do your homework ,it may save you a lot of money!!!

Original Medicare ( Parts A & B) allows you to travel anywhere in the United States and its territories and get medical care. In most cases, if you have a Medicare Advantage Plan ( Part C) your medical care – routine – will not cover you unless  emergency care or urgent care is needed.

Private Medicare Plans – Medicare Advantage Plans – may not cover you for medical care outside of their provider network unless you have a plan that allows for coverage outside of the Medicare Advantage’s network. True emergency care will usually be covered. Always best to call your health plan before you travel to get the specifics.

According to the Medicare Interactive website ( www.medicareinteractive.org) Medicare and Medicare Advantage plans must cover you for emergency services in Canada and if you are outside of the US in the following limited situation:

You are traveling between Alaska or another state and the closest hospital to treat you  is in Canada.

If you are on a cruise ship and need medical care, Medicare may pay if the following criteria is met:

• Ship is registered in the US
• Doctor is registered with the Coast Guard and,
• You receive the care while the ship is in US territorial waters – within six hours of arrival or departure from a US port.

If you are a Medicare Beneficiary, planing on foreign travel  you should consider the purchase of a Medicare Supplement Plan that covers foreign travel. Medicare Supplement Plans C through G and M and N offer foreign travel. For specifics on the extent of the coverage, contact the Medicare Supplement Carrier or go to www.medicare.gov.

There are actually many helpful assessment tools on line that can assist you in figuring out  how much help  they may or may not need.  Some useful areas of  assessment  are:

• Personal Hygiene – can your loved one take care of themself? Do they need reminders about hygiene? Is help needed occassionally or every day? When you pick them up to go out to dinner, do they look put together?
• Walking and Geting In and Out of Bed or their Favorite Chair – aided or unaided?
• Home Safety – Would your Mom know how to react to a hazardous situation in their home? Can they move around the home without falling or tripping over objects? Is the home neglected? Can they manage a stove or oven safely? What about the microwave? Can they answer the  phone appropriately?
• Meals – Is your Mom  still able to cook for herself? Are they reliant on others for meals?

When the reliance is high on others for assistance in just a few of these categories, now is the time to get a professional care manager or health care advocate on your team. A professional will do a full assessment of your loved ones living situation and assist you in deciding what actions you would need to take to assist your Mom or Dad in safely aging in place. If that is not possible, there are too many areas needing attention your advocate in assist you in identifying living options.

For further  information,

www. wnyseniorcare.org/caretool.cfm

www.caregiver.org

www.healthinaging.org

www.nfcacares.org

In good health,

The Health Champion Team

It is always best to plan ahead

Sometimes planning ahead means talking about difficult issues.

ONE OF THE GREATEST GIFTS YOU CAN GIVE YOUR CHILDREN ARE YOUR WISHES FOR WHAT YOU WANT AND DON’T WANT AT END OF LIFE.

Hard to think about? …………… Difficult to talk about?

Well consider this. How can anyone speak for you and care for you when they don’t know what you want?

They may THINK they know. Or there may be a disagreement between your children and other family members about what THEY want or think you would want.
Give your children the gift of knowing your wishes.  Relieve them of the responsibility of making decisions for you at a time that they are confused, frightened, and overwhelming sad.

1. Set some time aside to think about how you want to be treated, who you want with you, and where you want to spend your last days.

2. Go to www.agingwithdignity.org. and order a copy of Five Wishes– a self-directed living will developed by Aging with Dignity that is legal in 42 states and the District of Columbia

3. Complete the Five Wishes when it arrives!  Don’t put this off, it’s important!!!!!!

4. Have a family meeting and talk to your family about what your wishes are and everyone’s role in your care.  Show them what you have decided and make sure everyone is comfortable with the role you have chosen for them.

5. Keep the Five Wishes in a safe place with your Will and other important papers.

Now, instead of struggling with and feeling guilty about those tough decision,s they can feel proud that they can do what you want.

A true gift!

In Good Health,
Health Champion

Today, as adults, the children who received the council and wisdom of their parents are facing a reverse situation in their lives.  They are finding themselves concerned about their aging parents and what their needs will be as their health and mental abilities fail them.  In some cases the children must take the role as parent in securing the safety and well being of an elderly family member.

Sharon  lives 600 miles from her father. Knowing her father’s health is frail and he lives alone, Sharon calls her Dad every evening after work. The conversation always goes like this;

“How are you doing today Dad, Sharon asks?
“Everything’s fine”, Sharon replies.
“Are you taking your pills?”
“Yes, everything’s fine.”
“Do you need anything?”
“Everything’s fine.”

Sharon does not get much more conversation from her father. Perhaps everything is fine, or perhaps Sharon’s father  just wants Sharon to think he can take care of himself.  Even worse, Dad  could think all is fine and be forgetting his medication and not eating properly.

Is Sharon really listening? ARE YOU LISTENING?

It may be time to put your face in front of your parent and listen.

Assuming that all is well and that your elderly family member knows and does what is best for them, may be putting them at risk.

Become a partner with them in their care. The best time to form the partnership is before a crisis happens. The best time to have this conversation is before a crisis occurs.

A good way to begin is to sit with your parents and ask questions like, what are your concerns for the future. Do you want to remain in your home? Are you worried about losing your independence? Listen to their answers. You might relate your concerns as well, or you desire to be of help.

In become a partner in planning for care and helping your loved one, you need to know what legal and financial arrangements are in place. By asking, “What if you had a stroke,  I would need to know where your medical and insurance documents are and what you would have me do in your behalf.”

The next step might be to accompany them to their doctor appointment  to understand what their medical needs are and help create a plan for future needs. Or if that is not possible, engaging a geriatric case manager in your parent’s area can be a great resource to assist you. Many health care advocates offer a “medical buddy” service where a health care professional can accompany your loved one on their health care appointments. A medical buddy is there to observe, listen and ask follow up questions on behalf of the patient/family. But nothing beats spending a weekend with an elderly loved one to really be able to assess their needs. Keep that in mind as you ask your Mom or Dad, are  you ok?

In good health,

Health Champion

Medicare is constantly changing and keeping up with what’s new will help you get the most from Medicare.
There are several changes that have occurred for 2012. Here are some of the highlights:
 Between January 1–February 14, if you’re in a Medicare Advantage Plan, you can leave your plan and switch to Original Medicare. If you switch to Original Medicare during this period, you will have until February 14 to also join a Medicare Prescription Drug Plan to add drug coverage. Your coverage will begin the first day of the month after the plan gets your enrollment form.
 Medicare plans are rated for quality by a 5-star rating with 1 star being the lowest and 5 stars the highest. Between December 8, 2011 and November 30, 2012, if you are enrolled in a Medicare Advantage or Medicare Part D prescription plan you can join or switch to a plan that has a 5-STAR rating IF ONE IS AVAILABLE IN YOUR AREA. This can be done only one time during the year.

o NOTE: if you take this opportunity and enroll in a 5-star Medicare Advantage plan that does not provide prescription benefits you will not be able to enroll in a Part D (prescription) plan and you will not have prescription drug benefits until open enrollment which is from October 15 to December 7 2012. So choose wisely!!

o There are not 5-star plans available in many areas of the country. Check the Plan Finder Tool on the www.Medicare.gov website to see if any are available in your area.

 The Donut Hole (the Part D coverage gap) continues to slowly close , one of the positive benefits from the Affordable Care Act passed in March 2010. In 2012 you will continue to pay only 50% of the cost for brand named drugs and your discount for generic drugs will double to 14%. Both discounts will gradually increase until beneficiaries pay just 25% of their drug costs in 2020.
 Medicare now covers screening and counseling for alcohol misuse, depression, and obesity
I you are confused about Medicare there are experts you can speak to. Look for your state’s Department of Aging, or call a Health Care Advocate!

• a. aide to resident ratio
• b. when and who and when do they contact in case of an emergency or adverse event
• c. what is the activity schedule and how do they decide who participates
• d. Ask to speak to a few families who have a resident in the facility
• e. Ask for a copy of their last state inspection-they have to have it displayed

And remember, once your loved one is settled in their new home, visit at odd times, participate in the quarterly family conferences, and make yourself a visible presence!