Forget Politics…Talk About Healthcare Decisions this Holiday Season

Thanksgiving is right around the corner. As you get ready to roast the turkey, bake the pies and gather with loved ones, think about adding one new tradition to your family gatherings. Take politics off the table and instead use the time together to talk about healthcare. Share any important family medical history and discuss the decisions you would like made on your behalf should you become unable to make care decisions for yourself.

A good place to start is to 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. Learn more here.

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.

Sometimes these topics make people uncomfortable. Try to ease the discomfort with these suggested 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 as specifically 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 by freely sharing your feelings.

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.

 

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.

 

You are in the hospital! Now what?

Nurse Helping Senior Woman To Walk

You are in the hospital! Now what?

You find yourself or your loved one in the hospital. It’s emotional and overwhelming. So what is the first thing you do?

First, make sure that you have a written record including your current diagnosis, any medications/supplements you take (including name, specific dosage, when you take it, how long you have been taking it).

Next, make sure that you are asking the right questions. These include:

  • What tests are being given?
  • What can these tests tell you/me?
  • What medications are being given now?
  • What are these medications for specifically?
  • Have any pre-hospitalization medications been discontinued?
  • Am I being officially admitted into the hospital?
  • What is my diagnosis?
  • Will you contact my primary care physician?

Immediately upon admission to the hospital, you and your caregivers should begin planning for your discharge.

Your safe and healthy discharge should be on your care team’s minds the moment you’re admitted. You don’t want any surprises. You should have input and understanding of your health goals. Yes, you want to get the heck out of the hospital! Make sure you are on track to leave and understand all of the steps required for you to make a full recovery.

MOST IMPORTANTLY, CONSIDER A PATIENT ADVOCATE

An advocate can help you in a variety of ways…

  • Help you understand complicated medical jargon
  • Help you make sense of your insurance coverage and your financial responsibility
  • Help you navigate the medical maze – diagnostic testing, treatment options
  • Help you transition to the next level of care – long or short-term rehabilitation, skilled nursing facility, home care
  • Act as your advocate, looking out for you and your best interests

There is so much more to do and know but this is to get you started and thinking. A professional healthcare coordinator and advocate can ensure that you cover all the bases.

Advocacy in the Hospital- Webinar 4/27/17-Register Today

Advocating in the Hospital-Webinar 4/27/17 Register today
When
Thursday, April 27, 2017 from 1:00 PM to 2:00 PM EDT
Where
This is an online event.

Family First Home Companions hosts their next webinar- Advocating For a Family Member in the Hospital.  This webinar will feature guest speaker, Nicole Christensen, patient advocate and CEO of Care Answered.  Nicole will provide tips and tricks to give you the information you need to be ready if/when your loved one is hospitalized.  The presentation will include the following:
  • Key things to watch our for to prevent medical errors
  • Communicate your loved one’s needs without alienating the medical team
  • Who to turn to for support in the hospital
  • How to interpret your hospital bill and catch mistakes
Attendees will leave this webinar fully equipped to handle the next hospitalization.
Click on the link below to register or RSVP.
About The Speaker:
Nicole Christensen is the CEO of Care Answered, a healthcare coordination and advocacy organization specializing in older adults and their families.  Care Answered expertly navigates the healthcare system for clients and helps remove the strenuous obstacles common place in the healthcare process.  Holding a Master of Science in Urban Affairs, Ms. Christensen has over 15 years of professional advocacy experience.  In her work, she had the opportunity to develop and strengthen advocacy programs in Washington DC, NYC and Long Island.  In addition to her professional experience, she has personal knowledge of the challenges of healthcare coordination and advocacy from assisting her own parents. Ms. Christensen’s expert opinions and presentations are requested by Feeding America, news outlets, businesses, civic organizations, congregations, and legislators.

Cultural Competency in Healthcare-It can be a matter of life and death

Cultural Competency; what is it and why should I care?

Are you or a loved one any of the following:

-Female                      -Black                -Latino

-Jewish                      -Christian         -Muslim

-Have immigrated to the US (no matter how many generations ago)

-LGBTQ                     -Native American

-Young                       -Old                     -Have a genetic condition

YES! It would be hard to at not have at least one of these things be true; so therefore cultural competency affects YOU and your health. Cultural competence in healthcare refers to the ability for healthcare systems to demonstrate cultural competence toward patients with diverse values, beliefs, and behaviors.

There are things Care Answered does, as your advocate, to assist in the selection of appropriate clinicians.  We can help them see you as a whole person for your best care.

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Let me share with you quick personal stories regarding cultural competency.

YOU’RE YOUNG; YOU’RE FINE

When I was in my 20s I selected a primary care doctor close to my work and made an appointment for a check-up.  I was appropriately asked if there was anything wrong and I answered “No, not particularly; I was just wanted a check up to make sure everything was going well and get a baseline”.  The doctor stated “Why are you here if you feel fine? You’re young; there is likely nothing wrong with you”. The doctor had no family health history at that point and knew nothing of my health. Now, I went through with the appointment and I was fine.  However, the assumption that if you’re young than you are fine is sadly not accurate. (Thankfully I was fine) But, perhaps that doctor did not perform all appropriate testing because of the assumption that I was fine. Or maybe some other young person did not go to him for yearly checkups because they thought it was a waste of time based on this doctor’s response to check-ups for younger adults. And we know what you don’t know can hurt you.­­­­­

 

YOU NEED A ROOT CANAL!

I am an African American woman and I go to the dentist about every 6 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 and get 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. So ten years later I see an African American female dentist for my six month cleaning and check-up.  They did the x-rays again and the same shadowing was there. 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 these 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 didn’t think outside the box and perhaps saw me as another mouth rather than an African American woman with a mouth.

So those are just two of my personal stories.  And there are so 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.

Cultural incompetency can lead to misdiagnosis, prolonged illness and even death.  So 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 (blank) does s/he have many (blank) patients?

-Could these symptoms indicate any other diagnosis?

-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 (blank) person?

-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 doctor.  If you are not comfortable asking the questions call on an advocate-your health is at stake.

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

You are in the Hospital! Now What?

Nurse Helping Senior Woman To Walk

You are in the Hospital! Now What?

You find yourself or your loved one in the hospital. It’s emotional and overwhelming. So what is the first thing you do?

GET A PATIENT ADVOCATE!

Ok no big surprise at that response, right? But let’s go through some other very basic necessities

-Have list of current diagnosis, medications/supplements (including name, specific dosage, when you take it, how long you have been taking it) with you

Here are some question that you need answers to:

-What tests are being given?

-What can these tests tell you/me?

-What medications are being given now?

-What are these medications for specifically?

-Have any pre-hospitalization medications been discontinued?

-Am I being officially admitted into the hospital?

-What is my diagnosis?

-Will you contact my primary care physician?

-I would like to discuss my discharge?, eldercare

Yes, that’s right I said discuss your discharge. Your safe and healthy discharge should be on your care team’s minds the moment you’re admitted. You don’t want any surprises. You should have input and understanding of your health goals. Yes, you want to get the heck out of the hospital! Make sure you are on track to leave with all the steps to make a full recovery to your healthy self.

There is so much more to do and know but this is to get you started and thinking. But really do call a professional healthcare coordinator and advocate.

Know Your Meds! Make your Pharmacist Your “Go To” resource

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Medication mistakes are common both in hospitals and at home. It can be easy to make a mistake and unfortunately medication mistakes can be fatal. So here are some suggestions. When you go to the doctor or hospital do you have a current list of your medications with you? If the answer is no, now is the time to change that.

Every time you go to any doctor bring your list of your medications, including the medication name, dosage, how/when you take the medications, and the reason for the medication. In that list also include herbal and vitamin supplements. The doctors may not ask you for this list; that does not mean they don’t need to see it. Ask your doctor to take a look at it. For example: Your primary care doctor may not know what your endocrinologist prescribed or visa-versa; or neither may be aware that you are taking an herbal supplement that does not work well with your prescribed medication or that you misread the directions and are taking one pill twice a day rather than two pills once a day.

Make your pharmacist your “go to” resource for medications. I often recommend using one pharmacy for all your medications. I make this recommendation because then all your medications records are in one place and they can help you track it. Pharmacists are there to answer your medication questions. Use them! If you feel somehow off and you have been taking a new medication, tell your Pharmacist and ask him/her questions. Tell your doctor too (with your medication list handy).

Lastly someone you love should have your medication list. If you are hospitalized, does someone else have your medication list? The hospital will often not have an accurate list. And when a hospital does not have an accurate list of current medications accidents can happen.

Let me know your thoughts. Do you have a medication story? Share it in comments; your story could really help someone.

If you are on Long Island join me at Pulse of NY’s annual Symposium on April 18th 2016-Medication Patient Safety

Get Your Medical Records

Beautiful three-generation family smiling at home

Your healthcare records; Who needs to know?

YOU! Yes, the answer is you. Doctors, hospitals, family, and other healthcare providers need your medical records to appropriately diagnose and meet your healthcare needs. But you are the most important member of your healthcare team. If you go into the hospital, change doctors, get a second opinion, want to ask questions, … this is VITAL information to have. Preventable medical errors is the 3rd leading cause of death in the US.

So don’t bet your life that your medical records are read and understood by your healthcare team. Make sure that you and your healthcare proxy or loved one know where your records are and their basic contents.

We don’t know what medical crisis we may have or when it may happen, and hopefully we will not have to worry about it. However, if you are hospitalized and there is information about your health that has been overlooked it can lead to catastrophic results. So give yourself the gift of knowledge and preparation.

What records did you need and how do you get them?

Some Basic Records you should have:

  • Any major diagnosis
  • Tests results that support a diagnosis
  • Any test results that are of concern
  • Baseline test results
  • Hospital discharge records

 

How do you get your records?

  • You have the right to your medical records
  • Ask the doctor or hospital
  • You may have to fill out a request for records and provide ID
  • You may have to pay up to .75 per page. (keep in mind you can request certain records or records for a certain period of time rather than every record)
  • Some hospitals have portals that you can access via computer for no charge

 

Please comment and let me know if you have your records. Or share a story of having medical records or not having medical records.

Plan Ahead-Selecting an Elder Law Attorney

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Plan Ahead-Selecting an Elder Law Attorney

Many people when they hear elder law attorney think:

  1. I don’t think I really need one; what are they for anyway?
  2. An attorney costs too much money.
  3. My cousin, sister, uncle, friend is an attorney so they will help if I need it.

Sound familiar? Well it’s time to re-evaluate.

Let’s begin with “What is an elder law attorney?”

An elder law attorney specializes in, you guessed it, elder law. “Elder and Special Needs Law are specialized areas of law that involve representing, counseling, and assisting seniors, people with disabilities, and their families in connection with a variety of legal issues, from estate planning to long term care issues, with a primary emphasis on promoting the highest quality of life for the individuals.” Typically, Elder and Special Needs Law attorneys address the client’s perspective from a holistic viewpoint by addressing legal, medical, financial, social and family issues.”-National Academy of Elder Law Attorneys.

This is a nice neat definition from NAELA. However, not only do you need to find an elder law attorney, you need to find a good one who actually does “address the client’s perspective from a holistic viewpoint.” They need to really know the many facets of elder law; law changes all the time so you need to make sure your attorney is keeping up and knows the ins and outs.

Yes, lawyers cost money. However, not putting things in place so that your needs can be addressed is much more costly and heartbreaking for your entire family. Commonly, we see elder law attorneys provide estate planning (so one’s hard earned money and assets are given and used as they wish), creating wills and power of attorney, as well as, Medicaid planning and application processing. Unfortunately, those who wait until the crisis hits to seek legal help are faced with fewer options and may lack access to the care they truly need.

 

Here is what you need from an elder law attorney:

-An elder law attorney who will first listen to your individual situation

-From this information (and potential paperwork), they lay out and explain a plan to protect your assets and promote your highest quality of life

-Follow through with this plan and tie up any loose ends so that in the event of a crisis you don’t need to worry about this aspect.

-Can refer you to a healthcare coordinator and/or patient advocate who can provide healthcare advocacy and navigate you through the system of care.

 

 

Tips to find a good elder law attorney for your needs:

-Do they offer presentations on elder law basics? Or free consultations?-This is helpful because many people don’t know how much an elder law attorney can help and this gives insight and shows they may know what’s current in the industry.

-How long have they been practicing ELDER LAW? There are plenty of young, fairly new elder law attorneys who are great. I just suggest elder law attorneys who specialize in elder law alone. It’s the old adage “a jack of all trades and an expert at none”.

-If you know some of your needs, ask the firm how many similar type cases they do annually. And ask if there are general pitfalls with this kind of case.

– (shameless plug alert) A referral from Care Answered or a friend who has used the attorney (for similar needs) with great success is also great. Care Answered only refers elder law attorneys we actually know and are trusted. Remember we only work for you and we treat you like family so we only refer lawyers we would use ourselves.

-Do your homework, just because the nursing home, long term care facility or other healthcare entity suggests a lawyer does not mean they are good. They may even work for the facility or they may have just dropped off their business card.

 

Stay tuned for more on our Planning Ahead series. And don’t forget to comment or contact us with your questions.