Leaving the Hospital: Part One

Home Again. That’s all you and your family think when it’s finally time to leave the hospital. But once you’re home, reality sets in. You’re not really well, just well enough to be discharged. Just well enough to know there should have been better discharge planning.

True Stories:

(1) A surgical patient was sent home with a nasogastric feeding tube, a long narrow tube that goes through the nose and into the stomach, designed to carry liquids. Until he was better, this would be his source of nourishment. The patient’s wife was given written instructions on how to feed her husband through the tube; she practiced in the hospital, demonstrating her new skills to a satisfied nursing staff. Once home, she prepared the ultimate comfort food — chicken soup — and began feeding her husband. She never realized — and nobody ever told her — that the tube would handle only liquids. Hours after being discharged she had to call the nurses for help in dislodging the blocked tube. “Half information” filled with gaps and misunderstandings could have resulted in disastrous consequences. Upon discharge, she should have been told, not only what to do, but what NOT to do.

(2) As an elderly man was about to be sent home, the social worker quickly reviewed the discharge papers with him and his son. Health Champion was also there as an advocate. The son was thrilled to hear that his ordinarily agitated father — at risk for falling — was now “sleeping though the night,” and not attempting to get up. This felt wrong to us. At our insistence, the social worker checked deeper and discovered that the patient did, indeed, need to get up to use the bathroom at least twice nightly, and he required assistance. This is critical discharge information that requires home planning. We then discussed medication management, especially of the client’s psych meds. The social worker offered a plan that did not set right with us and we refused to accept the discharge plan until it was appropriately modified to cover issues of safety and physician oversight.

These real life stories show what can happen, even when you’re vigilant. Next week — in Part 2 — we’ll talk about how to ensure discharge planning that works in your best interests.

Who’s On First?

Following up on our blog from a few weeks ago — having “double the benefits” with two working spouses and two health plans — we’re adding Medicare to the mix.

Sample Scenario —

Husband: takes retirement, is 65 or older (and/or is disabled), and has Medicare as his primary health insurance coverage.

Wife: continues working, has employer based health care benefits for her and her husband.

He goes to the doctor and assumes Medicare will cover the visit and any treatments or tests. But it ain’t necessarily so! And that’s why he MUST let his health-care providers know about his wife’s employer-based plan.

In a nutshell . . .

As a non-active employee (an individual who is retired, on COBRA or Long Term Disability), the husband would typically be covered by Medicare as his primary insurance. However, as a dependent on his wife’s insurance, the size of her employer’s group will determine primacy: if there are fewer than 20 employees, Medicare pays first; more than 20, her health insurance pays first and Medicare pays second.

The rules for coordination can be complex. Keep your health plan administrators informed of changes or other coverage. Make sure your doctors know about the dual coverage and present both cards at the time of your visit.

Questions? That’s our specialty — finding answers, determining solutions. So, call if you need us. You can also contact the Medicare Coordination of Benefits Contractor at 1-800-999-1118.

Meanwhile, just remember, the answer to Who’s on First? can be a tricky one!

A Sun-Friendly Reminder

After a bleak winter and damp spring, we naturally crave sunshine, whether at the beach, on the golf course, or in our own backyard. At the same time, we’re warned that excessive sun exposure is responsible for nearly all skin cancer, with more than a million people diagnosed each year. Summer isn’t even here officially, but the sun has been high and hot and we’re all ready for a little fun. Just remember . . .

Use sunscreen.

Choose one that blocks both UVA and UVB rays, with an SPF 15 or higher. Apply about 2 tablespoons of sunscreen to your entire body 30 minutes before going outside; reapply every two hours.

Avoid direct exposure to midday sun.

The sun’s rays are strongest and brightest between 10 a.m. to 4 p.m., causing the most skin damage. If you have to go outdoors at those times, be sure to lather on sunscreen.

Spend time in the shade.

You’ll be cooler, while lowering your risk of skin cancer. But don’t be fooled: you still need to wear sunscreen. Sunlight bouncing off reflective surfaces (like water) can reach you even beneath an umbrella or a tree.

Monitor children’s sun exposure.

Did you know that many cases of skin cancer link back to bad sunburns as a child? Keep newborns out of the sun completely. Babies (over six months) and all children should wear sun block and protective clothing, like hats with brims, and stay out of the sun, enjoying the outdoors in shaded areas as much as possible.

Wear protective clothing.

Wear hats and cover exposed skin with tightly-woven light clothing. Because eyes are also susceptible to sun damage, be sure to wear sunglasses with UV protection.

Check your skin often.

Early detection of skin cancer gives you the greatest chance for successful treatment. Check your skin monthly — from head to foot — looking for any changes. If you suspect anything, see your doctor.

Enjoy your summer. Have Fun in the Sun. Just remember the basics. Especially the sunscreen!

The Truth About Pain

Don’t let anyone fool you: pain is good. It’s not fun, but it is good. Necessary. And helpful. Pain is actually a protective mechanism — our body’s way of saying, “hey, pay attention; there’s an injury going on here!” Without pain, we’d keep our hand on the hot stove, walk on a broken leg and keep abusing an injured back.

Sudden, acute pain signals a new injury; chronic pain, however, is long term, decreasing the quality of our daily life, often making us anxious, agitated and depressed. The people around us seem to have compassion for our acute pain and little patience for chronic pain. They want us to get over it (so do we, those of us who are suffering!), but it’s not always easy.

There are a lot of myths and half-truth about pain management. Let’s sort a few of them out.

Myth:
My doctor — and others — will think I’m a wimp or complainer or worse — an addict — if I ask for something stronger.

Truth:
Pain is real and needs to be aggressively controlled, often with several different drugs, at initial high doses, to enable you to function at your best. Depending upon the type of pain you’re having, drugs other than “traditional” pain relievers may be effective, such as those used for seizures or depression.

Myth:
All of the good pain medicines are addictive; I’ll instantly become addicted if I take them.

Truth:
If you need to take narcotics for your pain, it is unlikely that you will become addicted. Typically, addiction occurs when you continue taking the drug long after you need it for pain relief. It’s critical to take the drugs as prescribed.

Myth:
I should wait until the pain becomes unbearable before taking anything.

Truth:
Pain is easier to avoid and harder to treat. Translation: if you wait until the pain is intense, you will never be able to relieve it; but if you take your medicine at the first sign of the anticipated pain, you’ll be able to avoid it.

Myth:
Because over-the-counter pain medicines are safe, I can take as many as I want without hurting myself

Truth:
Over-the-counter pain medicines like acetaminophen (Tylenol®), aspirin, naproxen are very effective pain relievers, but can be just as dangerous as prescription pain medicines if you take too many or too often.

Take care of yourself: Don’t listen to the myths; listen to your body. Heal it with rest and appropriate medicine. Don’t be shy about seeking stronger relief. And if you have questions, ask until you’re satisfied with the answers.

Open Enrollment: A Critical Time for You and Your Family

Whether you’re one of the lucky folks who still have health insurance from your employer or you purchase insurance on your own, open enrollment is right around the corner. It’s a critical time in terms of choosing or renewing benefits, so approach with care and caution.

Here’s what it is:
An annual event, open enrollment gives you an opportunity to change your current health plan or benefit options, such as dental or vision care. Once open enrollment is over, you can’t make any changes to your plan design for an entire year, unless there’s an IRS qualifying event, such as marriage, divorce birth, adoption, or death.

During Open Enrollment, examine your plan choices for the following:

The Network: Compare your doctors and specialists (along with your preferred hospital) with the plan’s list of network providers. Who’s in? Who’s not? Can you live with that? Are you allowed to use out-of-network providers and hospitals? If so, what are the costs and prerequisites?

Cost Per Visit: Look at monthly charges, deductibles, and co-pay requirements for doctor and specialist visits. Do the math. If you see doctors often, you may want a higher monthly payment with lower co-pay; if you go occasionally, consider a lower payment and higher co-pay.
Prescription Coverage: Basically, you want to compare plans in relation to the annual cost of all your prescriptions. Which plans have a separate prescription deductible? What about co-pays? How much will you save with generics or ordering by mail?
Plan Features & Overall Coverage: Think about the services and supplies you normally use; now imagine the coming year and what you might need. Will you be traveling? Having surgery? Will you need short term rehabilitation and physical therapy? Does your plan require precertification? Are you covered anywhere in the U.S. or if you travel abroad? Are preventative care and immunizations covered? Of the plans you’re considering, which offers discounts for services like gym memberships? Is that important to you?

Choose your plan according to your needs — the ones you have now and the ones you envision for the coming year. You only get one chance each year to get it right. If you need help comparing plans and benefits, give Health Champion a call. We’re here to make Open Enrollment easy on you.

So you have two health plans…what should you know?

Double the Benefits

You’re married. You have jobs. And both employers provide health benefits. Double the insurance, double the benefits, right? Not so fast. And, while all the folks with little to no health insurance are likely reading this, saying, “I should have such a problem,” there really is a bit of Double Trouble when you have two sets of benefits under one roof.

The key to managing your coverage is understanding the rules, knowing which policy is your primary one and which is secondary (you don’t get to choose no matter how much you may like one plan over the other). However, you have to follow the rules of both, so pay attention to the details.

Some tips and reminders:

When there are dependent children on both policies, most plans follow the birthday rule: the parent whose birthday month falls earlier in the calendar year holds the primary plan. The actual birth year is ignored.

Make your doctor aware of all your health insurance coverage; always give copies of both cards.

Ask if your doctor’s office will send the secondary carrier a copy of the bill along with an explanation of payment. If not, you’ll need to do that. This is critical to having the claim processed correctly.

Using network/out of network providers: If your primary plan allows you to see both types of providers, but your secondary plan requires that you use only participating providers, the limitations of the secondary plan take precedence. In this case, the provider must be participating with the secondary plan. Otherwise, benefits won’t be paid.

Ditto for preauthorization or precertification: the rules of the secondary health plan have to be met in order to process the claim.

Dual coverage is definitely a benefit, but it takes vigilance to ensure you don’t fall between the cracks of your coverage. When in doubt, call your plan administrators to learn what’s covered, what’s not and how to receive maximum benefits.

Next week, we’ll look at the Medicare Factor and see its impact on coverage.

It Kills. And it’s Silent: High Blood Pressure

When the heart stops ticking, so do we. That’s the plain and simple truth. So let’s work at keeping it healthy for as long as possible. No lectures here. Just a couple of reminders and a new way of looking at things. For instance, contrary to popular assumption, heart disease is not the result of isolated, unconnected diseases; rather it runs along a continuum. And it starts with high blood pressure.

Known as the Silent Killer, high blood pressure can start in teens or early adulthood, generally has no symptoms, and can go undetected for years. Left untreated, it only gets worse. And so does your risk of stroke, heart attack and death.

Quick Review:

Your heart beats rhythmically, transporting blood through arteries and veins, stopping by the lungs to pick up oxygen and then moving on, delivering oxygen-ripe blood throughout your body, returning to the lungs and beginning the journey once again. All day. All night. This elegant system of pressure and movement keeps us alive and healthy.

Uncontrolled high blood pressure makes the heart work harder. The harder it works, the larger and less efficient it becomes, resulting in irregular heat beats (arrhythmias), blood clots — which can block veins and arteries or break off and travel to your lungs or brain — and even heart failure.

Think of high blood pressure as the beginning of heart disease — the beginning of a story where you can help write the ending with healthy behavior. Have regular check ups. Take medication if required, even if you have no symptoms. Exercise. Lay off salt. Eat well. And pay attention to the other risk factors along the continuum. Next time we talk about hearts, we’ll examine cholesterol.

Meanwhile, remember that in 2006 high blood pressure killed 56,561 people across the U.S. It’s time to change those numbers. If you’re going to be a statistic, be a good one! Start by taking care of your blood pressure.

When do you know it’s time?

We’re called the Sandwich Generation: adults caring for maturing children — who require financial, physical and emotional support — AND aging parents who may be ill, forgetful, running out of money, and unable to perform simple tasks.

One of our biggest fears is having “that conversation” with our parents. The one that begins with, “I’m worried that home may no longer be the best place for you to live anymore.”

Maybe you’ve had an initial talk and were able to modify their environment — like placing grab bars by the toilet and in the shower, removing fall risks like throw rugs, or engaging an in-home caretaker. Maybe they’ve moved closer to you or a sibling. But, eventually, they may require a higher level of care. It’s time for that conversation when you notice . . .

old and/or spoiled food in the refrigerator and cabinets
infrequent bathing; poor personal hygiene
frequent bruises due to falls
lack of movement around the house; too much time in bed
inability to transfer from bed to chair and back again
old and new medicine bottles scattered around the house
infrequent eating and/or poor nutrition
decreased ability to control urinary and fecal discharge or manage toileting

As you find yourself filled with natural feelings of guilt and confusion, remember . . .

When they were taking care of you, they made difficult decisions to keep you safe and healthy regardless of whether you agreed with them. Now it’s your turn.
When you visit, you see them at their best. Unless you’re able to spend a few days, you may not see all of their struggles.
Make sure you’re advocating change because it’s in their best interest and not simply yours. Examine your deepest motives.
Quality of life still matters. Home is not always the best place to age; it can become isolating and depressing.

If you need help or support, use available resources.

A Geriatric Care Manager can provide a full home assessment and offer impartial recommendations. Our Health Champion@ Home is here to help when the time comes: www.healthchampion.net.

In addition, contact your state’s Department of Aging and The National Area on Aging: www.aoa.gov .

Being responsible for two generations of loved ones — our kids and our folks — is challenging and fulfilling as we engage fully in the cycles of life. We just have to remember to breath. And to know when it’s time for new and next steps. As always, you’re invited to post your comments and questions.

Being There During A Medical Emergency

One moment your mom or dad is doing fine. Or fine enough, given their age, health and limitations. The next minute one of them is rushed to the emergency room. You get the call. You start putting your life on hold, knowing you need to be there overseeing care and critical decisions. But it could take hours, even a day or two, depending upon geography, work, and other family responsibilities to get there.

Now what? Unless you have a plan in place, your loved one will likely be alone in the emergency room, even if they’ve been living in an assisted living facility or nursing home. No one goes with them. And, very often, neither does critical information.

According to an article in the Journal of the American Medical Directors Association (March, 2010), researchers found that when nursing home residents are bought to an Emergency Department, typically, 10% arrive without any medical information and the remaining 90% arrive missing some critical pieces!

These same patients, alone and frightened, are often unable to answer even simple questions. This inability could be due to shock and fear, an already reduced mental ability, or a sudden change in mental status due to the acute illness.

In order to make an accurate diagnosis and begin treatment, the medical team needs basic, critical information — from current medications and allergies to a full medical history and understanding of what is considered to be the patient’s normal mental status. Having this information helps avoid complications, misdiagnoses, redundant lab work and expensive tests, unnecessary hospitalizations, increased medical costs, and discharge to a rehab facility when they can often return home with added supports.

So, you’re on your way. Meanwhile, your parent is alone in the ER … What’s the solution?

Plan ahead for the possibility. Find someone you trust to accompany your parent when an emergency occurs. Give that person all vital information and permission to serve as your parent’s advocate until you arrive. Explore Health Champion’s new Health Champion @ the ER program to see how we can fill this essential role for your family. There’s more than one way to be there.

Medicare to the Rescue

Quick Test:

Are you — or someone you’re caring for — on Medicare and suffering from a variety of chronic health conditions?
Do you worry about taking all those meds: are they more than you need; are they even necessary?
Are you concerned about side effects or drug interactions?

If you’ve answered “yes” to any of the above questions, it’s time for answers. And you won’t have to search high and low to find them. Help is available through a federal program called Medical Therapy Management (MTM), offered by your Medicare Part D or Advantage prescription plan.

With MTM, a clinical pharmacist will:

evaluate your conditions and medications to ensure safe, appropriate, and cost-effective use.
contact your doctor(s) about any problems and work to help resolve them.
meet with you several times a year to help you keep track of all of your medicines and conditions and monitor your progress.
be available for questions and problems as they arise.

The best part? If you qualify, this service is free!

Why is this important?

The more medicines you take, the greater the risk for dangerous interactions, adverse side effects and mismanagement (not taking them as directed), leading to serious consequences. In fact, this is a growing public problem across the United States. Experts estimate that 1.5 million preventable adverse events occur each year, resulting in $177 billion in injury and death.

Find out if you qualify.

Contact your Medicare Part D prescription plan or your Medicare Advantage Plan; ask about their MTM services and how to qualify. Also ask for the names of clinical pharmacists in your area. It’s that simple.

Do this for yourself. Be Informed. And stay healthy!

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"In Your Corner"