The Future Has Arrived…and It is Safer for Seniors

Technology is invading every aspect of our lives. Did you know that there is now a coffee mug that can be temperature controlled using your smart phone? Not only that, but the average new car comes with a futuristic array of technology to help drivers stay in their lane, find their way, adjust the climate, control their speed, and more.

Seniors are among those who are most likely to benefit from advances in technology. Devices hitting the marketplace can provide peace of mind to family members of older adults who wish to maintain their independence for as long as they can.

Remote Monitoring

Do you have a pacemaker, or know someone who does? If so, you are already familiar with the role of technology in monitoring health. Pacemakers and implantable cardiac defibrillators (ICDs) can be remotely monitored. When they are triggered, ICDs record information that can be analyzed by the cardiologist to assist with diagnosis and prevention of future episodes.

Similar technology exists to monitor weight gain in patients with congestive heart failure, blood glucose in diabetics and other vital information for those with chronic conditions. The benefit is that early detection of symptoms can trigger an intervention before a condition becomes serious enough that the patient requires hospitalization.

Aging in Place

Remember the pendant that could be activated if a senior living alone fell down and could not get up? It turns out that was only the beginning. Today, concerned family members can monitor numerous aspects of an elderly loved one’s life, from the number of times they open the refrigerator, to their daily use of the restroom, to their medication compliance.

Here are just a few devices that are helping Americans age in place safely.

MedMinder – a digital pill dispenser that locks and unlocks compartments to prevent patients from taking too many pills. It also monitors whether the dose has been taken at the right time, provides auditory reminders, and contacts a family member if the patient has not complied.

Reminder Rosie – a talking clock that is programmed with a loved one’s voice offering gentle reminders to take medication, eat a meal, or complete any task.

Wellness by Alarm.com – a series of sensors set throughout the home use machine learning to notify a loved one if there is a change in routine including activity levels, bathroom use, sleeping and eating patterns.

Phillips’ Lifeline (and other emergency pendants) – can be triggered during a medical emergency. Some versions are equipped with GPS and may be used outside of the home to summon help during a fall or other medical event.

Nannycams/grannycams- a camera, hidden or exposed, in the home can help loved ones feel confident in the care their family members receive.  Whether your family is trying to determine if a loved one can continue to live alone or ensuring the selected paid caregiver is the right choice, this may be an option.

Whether or not you are a fan of technology, it is clear that the future is now. Embracing at least some of the available advances can be the key to independence, safety and better health for the elderly and the chronically ill.

Want to learn more about whether technology can help your loved one maintain their independence? Contact Care Answered for a consultation about your options.

Healthcare Financing 101: How Health Insurance Works

understanding bills, health insurance

Healthcare can be confusing. Before you even step foot in the doctors’ office, you’ll need to understand the terminology and concepts surrounding health insurance. Knowing the difference between premiums, co-pays, co-insurance and deductibles will allow you to be a savvy healthcare consumer, help you anticipate out-of-pocket expenses, and avoid costly surprises.

Premiums

Your premium is the amount of money you pay for your health insurance coverage. Premiums are usually paid monthly. If you obtain health insurance through your employer, your premium may be deducted directly from your pay check. Often, your employer will contribute a portion of the premium payment, making health insurance more affordable for you.

If you are a Medicare recipient, you may pay a premium for your coverage. Generally, Medicare Part A, hospital coverage, is provided with no premium to those over 65 who also collect Social Security or who are eligible for Social Security but elect to wait to collect it. There is a premium for Medicare Part B, which covers doctor’s visits, outpatient therapy and durable medical equipment. This premium is paid monthly; for some people, the amount is deducted from their Social Security payment.

Out-of-Pocket Costs

Out-of-pocket costs refer to the amount you will pay for medical services out of your own pocket, in addition to your premiums. There are three main types:

  1. Annual deductible – this is the total amount that you are responsible to pay before your insurance coverage kicks in. Plans with higher premiums tend to have lower annual deductibles; those with lower premiums will have higher annual deductibles. Costs of hospitalization, procedures, laboratory testing and surgery may be applied to your deductible. Co-payments and premiums do not count toward your deductible.
  2. Co-insurance – this is the amount you are responsible for after your annual deductible has been met. Together, you and your insurance company will share the total cost of your medical care.
  3. Co-pay – this is the amount that you are required to pay to your provider for an office visit or prescription.

Once your out-of-pocket maximum has been reached, you will likely no longer be responsible for co-pays and co-insurance.

Your costs may vary depending on whether you select an in-network or out-of-network provider. For this reason, it is important to read and understand your health insurance policy so that you can make informed decisions about when and where to obtain care and anticipate how much your care will cost.

Still have questions?

Contact Care Answered. If you are trying to understand medical bills, or planning for future care needs, we can help you untangle the mess and make wise, well-informed decisions.

Health Literacy: Knowledge is Power When It Comes to Your Health

Do you know the difference between hypertension and high blood pressure? Between an MI and a heart attack? Between LDL and HDL?*

As health care becomes more complex, you may feel as if you need a medical degree to understand your own well-being. More to the point, effective communication with your health care provider is essential to ensure that you are an active partner in your care, understand your treatment options, participate fully in your recovery, and follow your doctor’s recommendations.

According to the US Department of Health & Human Services, health literacy is “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.” Unfortunately, more than 35% of US adults are health illiterate.  This percentage is much higher for those over 65.

Before even seeing a doctor or other provider, a degree of literacy is required just to navigate the healthcare system, locate in-network providers and complete the required forms and paperwork. The ability to share health history and symptoms with providers is another element of the medical visit that can be impacted by health literacy.

Health literacy also involves math skills. For example, it is necessary to understand concepts such as risk, to calculate cholesterol and blood sugar levels, measure medications and understand nutrition labels. Complex math skills are also required to compare health plans, calculate co-pays and deductibles.

A basic understanding of biology and the way the human body works is another component of health literacy. This knowledge is required to comprehend the cause of illness, the relationship between lifestyle choices and health, and the need for certain tests and procedures.

Health literacy is not necessarily related to formal education. These skills and concepts are not taught in school. Many people struggle in at least one of these areas. Some experience anxiety when visiting the doctor which can affect their ability to process information.

You can overcome some of these challenges by preparing in advance for your doctor’s visit.

  • Make a list of your medications, including doses
  • Make a list of questions about your condition
  • Write down your medical history, including any hospitalizations and surgery
  • Write down your symptoms
  • Write down what your clinician says (i.e. suggestions, diagnosis, prescribed medications, tests ordered)
  • Bring a family member, friend or professional advocate

Here are more tips on preparing for a doctor’s visit from the National Institutes of Health.

Care Answered can help you navigate the healthcare system, understand your benefits, make sense of your diagnosis and treatment options, and select the most appropriate level of care. Contact us for more information.

 

*Hypertension is another name for high blood pressure. MI stands for myocardial infarction, the medical term for a heart attack. LDL is low-density lipoprotein, also known as “bad” cholesterol. HDL is high-density lipoprotein, also known as “good” cholesterol.

Cultural Competence in Healthcare: What It Is, and Why It’s Important

Mrs. M is an 80-year-old woman with congestive heart failure. She was born in Germany, but has lived in the US since she was a teenager. She is mentally sharp and understands English but still speaks with a slight German accent. Recently, she was rushed to the emergency room with difficulty breathing. “Do you have CHF?” asked a nurse. “No,” she replied. An IV was started, pumping her full of fluid. When her children arrived, they questioned why she was getting fluid, which is not typically the way she is treated due to her congestive heart failure. “She told us she doesn’t have CHF,” the nurse said. That’s because Mrs. M understands and would have answered correctly had she been asked if she has congestive heart failure, but she doesn’t know what “CHF” is.

Have you ever experienced a miscommunication with a healthcare provider? Or felt that the provider was not aware of how your individual health might be impacted by your gender, age or ethnicity? These gaps can result in misdiagnosis, inappropriate treatment, lack of treatment, or even death.

Cultural competence in healthcare is a way to bridge these gaps. It is a vitally important piece of the provider-patient relationship, particularly in an extremely diverse region like Long Island.

Cultural competence in healthcare can be defined as the ability of health care providers to recognize and address the unique values, beliefs, language, and behaviors of their patients. It is the recognition on the part of the provider that we patients are all different, and it’s important to understand how those differences affect our health

Here is a personal story to illustrate how a lack of cultural competence can impact one’s health.

YOU NEED A ROOT CANAL!

I am an African American woman and I go to the dentist about every six months. For the past 10 years different dentists have seen shadowing in x-rays on the roots of some of my teeth.  After asking me if I had any trauma to that part of face and my response was no, most of them suggested I go to an endodontist for a root canal because that shadowing means the nerves of the teeth are affected. I have never had a root canal, but I know enough that I didn’t want to sign up for one unless I really needed it.  In these ten years I have never had pain in these “shadowed teeth” so I did nothing.

After about 10 years, I switched to an African American female dentist for my six-month cleaning and check-up.  She did x-rays and saw the same shadowing. After asking me the same question regarding trauma to my face and listening to my history she said, “Oh, it’s very common in African American women as the bone density of the teeth differs in spots and the x-ray picks it up as shadows.  We will continue to watch it but no, you don’t need a root canal.”

Now, if I had a different mindset I could have caused myself needless pain and a lot of money getting several root canals because other dentists weren’t familiar with this issue and perhaps saw me as another mouth rather than an African American woman with a mouth.

Those are just two stories, but there are many more.  So many older adults get the “you’re getting older” diagnosis. I say this in all my seminars: Getting older in not a diagnosis!  If it were, I would be finest diagnostician in the world (and I don’t even hold a medical degree).  Every one of us is getting older.

Please take time to share your stories.  We can all learn from each other.

Now that you know what cultural competence is, here are some tips:

Talk to your clinician and/or the office staff with whom you make the appointment and ask questions like:

  • I am a person who is (blank). Does s/he have many patients who are (blank)?
  • As a person who is (blank), could these symptoms indicate any other diagnosis based on this?
  • If I had the same symptoms but was not of this (gender, culture, race, ethnicity, religion, etc.) would there be other suggestions you might have?
  • Do you feel comfortable treating a person of my (blank)?
  • My culture/religion/faith/ does or does not allow (blank). Do you have another potential solution for this?

If you are not comfortable with the answers, seek another clinician.  If you are not comfortable asking the questions call on an advocate; your health is at stake.

For more information, visit A.S.K. for your life, a website that provides resources that address health care disparities, with a particular focus on African-Americans.

Care Answered, as your advocate, can assist in the selection of appropriate clinicians.  We help them see you as a whole person so that you receive your best care.

 

What Does Medicare Cover, Anyway?

Medicare is the health insurance program run by the federal government for those who are 65 and older, as well as those under 65 who are disabled and collect Social Security Disability Insurance (SSDI).

When people learn that they need post-hospital care – home care, inpatient rehabilitation or a stay in a nursing home – they often assume that Medicare covers these services. But much like private insurance, there are limitations on the services that Medicare will cover.

Before you need this level of care, here is an overview of exactly what Medicare will cover.

If you are 65 or over you likely have Medicare coverage A and B. Medicare coverage part A is “hospital insurance.” It covers care you receive in the hospital. Skilled nursing (nursing home) or rehab care is covered ONLY if:

  • Your care is “medically necessary.”
  • You are expected to improve over time
  • You meet the 3 DAY inpatient hospital stay. This means you must be FORMALLY ADMITTED to the hospital. If you are in the emergency room for three days but not admitted to the hospital, or you are admitted to an “observation unit,” you will not receive insurance coverage for your rehabilitation or skilled nursing care.

Even if you feel you have great insurance to fill in the gaps of Medicare A and B coverage, if you do not satisfy the three-day admission rule, there is likely no insurance that will cover your rehabilitation or skilled nursing care.

How Much is Covered?

If you meet the three-day admission requirement, the first 20 days you spend in a skilled nursing facility is fully covered. On days 21 – 100, you are responsible for a co-pay of $167.50 per day. After the 100th day, you are responsible for all costs related to your stay in a skilled nursing facility.

What Isn’t Covered?

Custodial care, which provides assistance with performing the basic tasks of daily living, such as dressing, bathing or eating, is typically not covered by Medicare at all. You are responsible for the full cost of this type of care, which on Long Island can run upwards of $100,000 a year.

Questions? A healthcare advocate can help you navigate the system in order to maximize your benefits and help you sort out your options for care and payment.

You can learn more about Medicare Part A hospital and skilled nursing facility coverage. Visit medicarerights.org for additional information. Care Answered is available to answer your questions and help you make the best decisions based on your individual situation and needs. Contact us here or call (516) 584-2007.

 

Do you need a long-term care policy?

The statistics are staggering: up to 75% of those 65 and over may require a stay in a nursing home at some point in their lifetime[1]. Long Island is the most expensive region in the state to receive nursing home care; here it can cost an average of $390/day or $142,350[2] each year.

None of us is exempt; any illness or injury that robs us of the ability to care for ourselves can create the need for some type of long-term care at home, in an assisted living facility or a nursing home.

To help prepare for this possibility and protect their family’s assets, many people elect to purchase long-term care insurance or have a long term care rider on their life insurance policy. Long-term care insurance may cover some or all of the costs of care at home or in a facility.

“A long-term care insurance policy gives you a cushion to help prepare for the future financially without using the majority of your assets in a short period of time,” says Bonnie S. Laffie, CLU, ChFC, CLTC, a Long Island-based Investment Advisor Representative.

In addition to helping protect income and assets, some long-term care insurance premiums may be tax deductible. On the federal side, 10% of long-term care premiums are deductible up to certain limits that vary according to the taxpayer’s age. For example, those aged 40 and under may deduct up to $410; those 41 to 50 may deduct $770; between the ages of 51 and 60 the number jumps to $1530; and those between 61 and 70 may deduct $4090. Over the age of 70, the premium deduction is $5110[3].

Many people believe that there are government programs that will cover the cost of long-term care. Medicare will cover nursing home care for a limited time following a hospital stay of three days. Medicaid does provide coverage of some home care and nursing home care, however recipients are required to spend their own income and assets before they qualify for Medicaid. In this situation, the savings that you may have worked hard to accumulate will have to be spent down[4].

If you are considering purchasing long-term care insurance, speak with your financial advisor, lawyer, estate planner, and/or tax professional in order to fully understand your options. Care Answered can suggest some of afore mentioned professionals who have successfully assisted our clients.

Care Answered can help you navigate the healthcare system to select the most appropriate care setting should you need to obtain long-term care, either with or without a policy.  If you already have a long-term care policy and want to submit your claim, call us first to advocate for the full coverage you need. Contact us at any time.

[1] Genworth Financial, quoting 2015 Medicare & You Handbook, Centers for Medicare & Medicaid Services

[2] New York State Department of Financial Services: The Cost of Long Term Care in New York, http://www.dfs.ny.gov/consumer/ltc/ltc_about_cost.htm

[3] Deductibility of Long Term Care Insurance and the 2017 Limits, Ronald Fatoullah & Associates, https://www.elderlaw-newyork.com/deductibility-or-long-term-care-insurance-and-the-2017-limitations/

[4] Genworth Financial

Hospice Care vs. Palliative Care: What’s the Difference?

Patients facing a serious or life-limiting illness may sometimes be offered hospice care, palliative care or both. The terms are often confused. A lack of understanding can make the conversation around these topics emotionally fraught. Hospice care and palliative care are different in a few key ways. Here is an overview of the two:

Hospice Care

  • Hospice care may be offered to patients whose prognosis is six months or less assuming their disease follows its expected course.
  • Hospice care is provided only to patients who are no longer pursuing curative care. This might occur when the patient is no longer receiving any benefit from active treatment, or the patient has decided that he or she no longer wishes to undergo treatment.
  • Hospice care is often provided at home or in a nursing home, but there are some residential hospices as well as hospital beds designated for hospice patients.
  • hospice patient, If you no longer want to receive hospice or your prognosis changes you can discontinue hospice care at any time.
  • Hospice care is generally covered by Medicare, Medicaid, and private insurance.

 

Palliative Care

  • Palliative care may be provided to patients at any stage of the disease process, regardless of the prognosis.
  • Palliative care is focused on alleviating the pain and addressing quality of life issues that occur with serious illness. It may be provided to patients who are on hospice, or those who are continuing to receive curative treatment.
  • Palliative care may be provided in the hospital, at home or in a long-term care facility, or in the doctor’s office.
  • Aspects of palliative care, including physician visits and prescription medications, may be covered by private insurance.

 

Both

  • Both hospice and palliative care involve multidisciplinary teams of professionals, often including physicians, nurses, social workers, pain management specialists, and spiritual care personnel.
  • Both hospice and palliative care focus on the patient as well as the family unit.

 

If you or a loved one are facing a serious illness, hospice care or palliative care may be beneficial. Care Answered can help you understand and select the most appropriate care during a stressful time. For additional information, give us a call or contact us via email.

Care to Talk

Gathering with Loved Ones? Talk About Healthcare Decisions this Holiday Season

The words “We have to talk” can fill a person with dread, especially when spoken by a spouse or partner. But it is vitally important to have conversations about healthcare decision-making before we are faced with making those difficult decisions. The holiday season brings family and friends closer together and can present the perfect opportunity to talk about our wishes should we become unable to make healthcare decisions for ourselves.

Benjamin Franklin famously said that only two things are certain in life — death and taxes. While both are unfortunately unavoidable, we can promise that no one has ever died from discussing healthcare decisions. The most important thing you need to do is give your loved ones peace of mind by selecting your health care proxy.

What is a Healthcare Proxy?

The New York Health Care Proxy Law allows you to appoint someone you trust — for example, a family member or close friend – to make health care decisions for you if you lose the ability to make decisions yourself. By appointing a health care agent, you can make sure that health care providers follow your wishes. Click here to learn more.

How do you talk about healthcare decisions?

Once you have selected your proxy, be sure to inform that person about his or her role, and let him or her know about your wishes should an illness or injury leave you unable to make your own healthcare decisions.

It’s not taboo. Just bring it up at the dinner table. Try these opening lines:

“My faith is important to me and I don’t want to have….”

“I’m allergic to …. Please make sure that I don’t receive that medicine”

Talk about what you value, and be as specific as you can. You might say:

“I don’t want to ever be sustained by machines,” or “I have to be able to live independently,” or “There are new health findings every day. I would like to be kept alive until they find a cure.”

Points to remember about healthcare decisions

The discussion with your healthcare proxy can and should be ongoing. You cannot imagine every possible scenario but if the person you select as your healthcare proxy understands your values and knows the types of life-sustaining treatments that you would want, as well as those interventions that you would not want, your proxy will feel confident that they are following your wishes rather than having to decide your fate on their own.

This is not a contest of who loves you the most; rather, it’s about who will be able to carry out your wishes.

It is a tremendous burden to expect your loved ones to make these decisions for you if you have not expressly told them your wishes. Help them be your proxy.

Take time this holiday season to begin your discussion. And fill out your healthcare proxy form. Think of it as a compassionate gift to your loved ones should they ever have to make an important healthcare decision for you.

 

November is National Family Caregivers Month – Recognizing “Caregiving Around the Clock”

Are you one of the 43.5 million Americans who provide care for a loved one – a spouse, parent or in-law with Alzheimer’s disease, or a special needs child? AARP estimates that the economic value of so-called “informal caregiving” is more than $470 billion annually. But that pales in comparison to the physical and emotional toll that caregiving can take.

November is National Family Caregivers Month, recognizing “Caregiving Around the Clock.” One month hardly seems like enough time to acknowledge the many sacrifices inherent in providing care for a loved one. The average age of the informal caregiver is 49, which means that very often these individuals define the sandwich generation, caring for both aging parents and children under 18. Family caregivers spend about 24 hours each week providing care, often on top of full- or part-time jobs. No wonder they are exhausted!

Nathan Anderson

Most caregivers live within 10 miles of the care recipient. But long distance caregivers live an average of 450 miles away from care recipients, and studies show that emotional distress for the caregiver increases with distance from the recipient.

If you are a family caregiver, you know that support is essential. In particular, support communities and groups can help by providing you with a safe space to share feelings, frustrations and victories.  Here are some tips:

  • Find others (a friend, family member, or paid aide) who can provide you with a weekend, day, or even an hour off.
  • Find a caregiver’s support group in your community or online.
  • Take time for you. Exercise, read a book, take a walk, or do something that makes you happy, even if only for a few minutes each day.
  • Remember to take care of yourself, or you will not be able to take care of your loved ones who are depending on you.

The Caregiver Action Network is an excellent online resource which is offering tips for family caregivers all month long. Care Answered is also here to help. We can answer your questions and assist you in navigating the healthcare bureaucracy, identifying your options, helping you understand insurance coverage, and enabling you to obtain the most appropriate care for your loved ones.  Then YOU can spend more time being a husband, wife, daughter or son, and less time as a caregiver.

References:

https://www.caregiver.org/caregiver-statistics-demographics

http://www.caregiveraction.org/national-family-caregivers-month

Who’s Who in the Hospital?

Who are All These People in the Hospital?

A trip to the hospital can be stressful and overwhelming. Adding to the confusion is the parade of medical professionals with different roles and functions. Who should you talk to when you want information, or to voice concerns? Here is a rundown of some of the people you are likely to meet in the hospital:

  • In the Emergency Room
    • Triage nurse – This is a registered nurse who will perform an initial assessment, learn about the symptoms that have brought you to the hospital, and determine the level of acuity – or how serious – your condition may be. This information will affect how quickly you are seen by the doctor. Patients who arrive after you but who are in more serious condition will be seen sooner.
    • Emergency physicians – Their primary job functions are to resuscitate or stabilize you and refer you to the next appropriate level of care. They may decide that you require admission to the hospital, or that you may safely be sent home for follow-up with your personal physician, a referral to a specialist, or surgery.
    • Registered nurses – Nurses will monitor your condition in the emergency room, administer any medication ordered by the doctor, and participate in the care you are receiving. They can answer questions about your condition and your treatment plan.
    • Technicians – These individuals may draw your blood or perform x-rays, electrocardiograms or other diagnostic testing that has been ordered by the physician.
    • Aides – Aides can assist you with comfort needs such as providing you with a pillow or blanket. You may also see aides restocking supplies, cleaning the room, or performing other supportive tasks.
  • In the hospital
    • Hospitalists – These are physicians whose primary focus is the general medical care of hospitalized patients. They will oversee your care, coordinate with any specialists brought in to evaluate or treat you, prescribe medication, and monitor your condition. They are also responsible for deciding when you may go home and for writing your discharge orders. Because they are based in the hospital, they are often available to provide information on your progress to you or your loved ones.
    • Registered nurses – The job of the registered nurse is to monitor your condition and to provide the care that has been ordered by the physician. This includes administering medication, checking wounds and changing dressings, helping you with mobility, and making sure that you are making steady progress toward your goals. Nurses can often answer questions about your medications, treatment plan, and progress.
    • Nurse manager – The nurse manager oversees the nursing staff on a unit. If you are unhappy with your care or wish to discuss any concerns regarding staff or your treatment, you may ask to speak with the nurse manager.
    • Dietitians – Your diet during your hospital stay is often prescribed by your physician. Dietitians make sure that the food you are provided meets any restrictions necessary to speed your recovery.
    • Phlebotomists and technicians – You are likely to undergo multiple medical tests during your hospital stay. Phlebotomists will draw your blood and technicians will perform other medical exams.
    • Social workers and case managers – These individuals are there to assist with non-clinical aspects of your hospitalization. As soon as you are admitted to the hospital, they will begin to work on a plan for your discharge, including any after-care arrangements such as skilled nursing facility, rehabilitation, or durable medical equipment that you may need. They are also available to assist you with financial, social or emotional concerns related to your illness and hospitalization. They can make referrals to resources to assist you with a wide range of issues that may impact on your well-being.

 

It is important to speak up when you are a patient in the hospital. Do not be afraid to ask questions, make sure that you understand any instructions you are given, as well as any tests being administered and your diagnosis. While the medical team may be busy, it is their responsibility to treat you with respect, tell you their names and job functions, and answer your questions. And it is your responsibility to make sure you have all the information you need, that you provide them with all relevant information about your history and condition, and that you follow their instructions.

Being an active partner in your own healthcare is the best route to recovery.