Update from the Center for Medicare Advocacy, Inc.

On August 2, 2013 the Centers for Medicare and Medicaid Services (CMS) made a decision on Observation Services.  The decision was not to make a decision related to Medicare beneficiaries!  After pages and pages of regulatory discussion and evaluation, it appears that CMS did not make a conclusive decision on whether the time spent in observation status will be counted toward the three day hospital stay to qualify for Skilled Nursing Facility (SNF) care.

Be an advocate for all Medicare beneficiaries by calling your local representatives and bringing the unfair practice of cost shifting through observation status to their attention!  Help end observation status now!  Go to www.medicareadvocacy.org  and read Observation Status: OIG Provides an Analysis and CMS Issues Final Regulations and Now is the Time to End "Observation Status."

Are You or Your Loved One Covered by Medicare?

Are you or your loved one covered by Medicare? Yes?  Then educating yourself about Observation Services/Observation Status may save you money.

When a patient is under observation status, Medicare only covers outpatient costs.  The beneficiary must pay a co-payment for all treatments, medications, testing and labs.  As you enter the ER, you are stopped to complete paperwork for your very ill loved one.  Do you read and understand every document?  Probably not.  You are concerned that they are receiving the best care and quickly!  What you may not know is that the hospital is asking you to sign a document that says the beneficiary may be under observation services/status (outpatient) and is responsible for co-payments.  This is cost shifting, shifting more of the cost of medical care to the beneficiary.

ASK if you are an inpatient or an outpatient.  It may seem that you are an inpatient because you are wearing a gown, in a bed and receiving x-rays, treatments, medications and even having blood drawn.  But...that doesn't mean you are ADMITTED to the hospital as an inpatient.  You may even go to a room and stay 3 or more days...and still not be an inpatient.

ASK your doctor, the case manager and the billing department if you are admitted as an inpatient or outpatient.  ASK the billing office to estimate your out of pocket costs as an outpatient.

ASK if you are an inpatient and qualify for rehabilitation under Medicare in a Skilled Nursing Facility.  Have the Skilled Nursing Facility verify you were admitted to the hospital as an inpatient for three consecutive 24 hour periods and are covered by Medicare for rehabilitation services.  Otherwise you may be responsible for a huge bill from the rehabilitation facility.

Ask those in the House of Representatives to support H.R. 1179: Improving Access to Medicare Coverage Act of 2013 and in the Senate to support S. 569: Improving Access to Medicare Coverage Act of 2013.

Start a conversation with your loved one about the care they want and need.  Discuss the options for care, how to stay out of the hospital and if they want heroic measures performed.

Stay tuned for the changes coming to Medicare!

Family Matters

The American Association for Marriage and Family Therapy states that "more than ever before, families are providing long-term care to older adults with limitations in the ability to perform tasks necessary for independent living. Nearly 25% of American households are providing care to people age 50 years and over. Families are the alternative foundation for a stressed healthcare system. Hospital stays are shorter than ever and family caregivers are often expected to do what healthcare professionals once did."

Family caregivers take over various responsibilities for their elders. It may be just handling finances, running errands, going to doctor appointments or taking on full 24 hour care services. In most cases one sibling in the family will become the main caregiver, but most successful ventures are supported by the entire family.
 

There is a saying that it takes a village to raise a child. This may be true, but it takes a family to care for an aging parent. As seniors lose physical and cognitive function they become vulnerable and unable to manage their own care. Who better to know their needs and desires than their own children. Even if professional care givers are providing services, family involvement makes the difference in quality of life for their parents.

"If one family member has been designated caregiver other members can give support with respite care, transportation to doctors, etc., everyone needs to be aware of all that is needed and be in total agreement to do it." "The 4 Steps of Long Term Care Planning"

Experience has shown that even families that are close can quickly grow angry, jealous and hostile towards each other when an aging parent begins to need long term care. If a sibling moves into the parent’s home, others can easily be suspicious of ulterior motives and fear to lose their inheritance. On the other hand, the child doing the entire care taking becomes bitter and feels there is no support or help from siblings.

One example of a family misunderstanding is that of a brother accusing his sister of stealing all of the money from the sale of his parent’s home.

Karen, who was a single mom with two children, moved in with her parents when her father had a stroke to help her mother take care of him. Her mother was also disabled. Needing money to pay for a home care service, Karen helped her mother do a reverse mortgage on the home, which gave the needed funds. If communication had been open and Karen’s brother had known the need and been involved with his parents care, he would not have reacted so negatively when he eventually found out about the reverse mortgage.

Every family is different. Some families are close and some have never been compatible. If your communication is strained, consider having a professional mediator present at a family meeting. The mediator will be able to keep things calm and running smoothly and help work out each persons concern.

Family matters. The experience of working together for their parents' care can give aging parents and family members a peaceful, memorable experience.

 

Changes - Factors that determine more help at home or a higher level of care is needed

 

There is an overwhelming amount of information about housing options for senior adults which causes confusion and frustration for the caregiver/adult child.  The greatest challenge is finding the “right” level of care.  Most seniors prefer the comfort of their home to an assisted living or nursing home setting.  They want to maintain their independence for as long as possible.  

 

However, the truth is some need more than “just a little” help.  

 

How do you determine when it is time for additional help or plan a move into a community where twenty-four hour assistance is available?  Here are some CHANGES to look for that signal more care or a move is needed. 

·       Safety – Leaving the gas stove on, setting fire in a microwave oven, forgetting a driving route they have traveled for years, unexplained injuries or car accidents, and letting strangers in their home without hesitation.

·       Falls – Falling without tripping, from weakness, poor balance, coordination, and  visual impairment.

·       Medication Mismanagement – Does not take medications as prescribed, forgets to take medication, improper storage, incorrect dosages, continuing to take discontinued medications.

·       Loss of Executive Function – Difficulty planning or processing information.  Inability to organize thoughts. Inappropriate social behavior.

·       Memory Loss – Unable to manage a schedule or remember appointments. Makes repetitive significant financial errors. Compensates for memory loss by asking others to “remember” for them.  Requires verbal cuing for activities of daily living, i.e., dressing, bathing, and ambulation.

·       Functional Limitations – Unsafe when stepping over a tub or getting in and out of a car.  Finds it difficult to put on clothing or shoes due to pain or limited range of motion in joints.  Visual and hearing impairments limit social interaction and miscommunication with healthcare professionals.

 

These changes signal an ALERT!!  Planning before a crisis helps you make the best decision for your loved one.  Start the conversation NOW.  Ask questions and look for these subtle but very important changes.

 

Next….what are Levels of Care?

Looking for a Special Gift?

Let C&S help you put a smile on your loved one's face this holiday season!

Senior Concerierge Services at C&S provide personalized assistance to meet the interests and needs of your loved one. What makes us unique is that our services are specifically designed and performed for seniors.

 

We are not "one size fits all". Our packages are customized for your loved one and services are provided by professionally trained caregivers who can assist those with physical or mental limitations. Need a hand with a wheelchair or walker? No problem!  What about help getting into and out of the bathroom? Again, no problem!  Our goal is to help your loved one be as independent and active as possible.

 

Here are a few examples of the services we provide:

• Travel companionship on social and cultural outings to plays, concerts or museums
• Money management and bill paying
• Errand and shopping services either with or for client
• Arranging for home services such as maintenance and repairs or yard work
• Basic home office assistance including bill paying, organization and filing
• Event or holiday planning
• Technical support with cell phones, computers and internet
• Moving services including downsizing, move coordination and set up in new home or facility

Gifts certificates are available. Call us at 281-550-8444 and let us help you make this holiday special!

Holiday Blues - Depression in the Elderly

 

The holiday season is quickly coming upon us. If you are a caregiver for an elderly loved one, you may notice a change in your loved one's mood as the holidays approach. Perhaps you are one of many, who visit elderly parents and family during the holidays who live a distance away. When you visit you may notice that loved ones are not as physically active, or they show symptoms of fatigue or sadness and have no interest in the holiday or in their surroundings.

According to the National Institutes of Health; of the 35 million Americans age 65 or older, about 2 million suffer from full-blown depression. Another 5 million suffer from less severe forms of the illness. This represents about 20% of the senior population -- a significant proportion.

Depression in the elderly is difficult to diagnose and is frequently untreated. The symptoms may be confused with a medical illness, dementia, or malnutrition due to a poor diet. Many older people will not accept the idea that they have depression and refuse to seek treatment.

What causes depression in the elderly?

It is not the actual holiday that causes depression, but the fact that holidays tend to bring memories of earlier, perhaps happier times. Additional contributing factors that bring on depression may be the loss of a spouse or close friend, or a move from a home to assisted living, or a change with an older person's routine.

Depression may also be a sign of a medical problem. Chronic pain or complications of an illness or memory loss can also cause depression. In addition, diet can also be a factor when proper nutrition and vitamins are lacking.

As an example, Selma’s husband passed away, a few months before Christmas. Her family lived close by and would call or drop in often to check on her. Selma seemed a little preoccupied and tired, but this was to be expected as she had been the caregiver for her husband for many years. It wasn’t until the family noticed that her holiday decorations were not out and her yearly routine of Christmas card writing was not happening that they began questioning her mental and physical well being.

A trip to her physician confirmed depression, caused by not only the loss of her spouse, but a vitamin B12 deficiency. There were both mental and physical reasons for her depression.

Symptoms to look for in depression might include:

·         Depressed or irritable mood

·         Feelings of worthlessness or sadness

·         Expressions of helplessness

·         Anxiety

·         Loss of interest in daily activities

·         Loss of appetite

·         Weight loss

·         Lack of attending to personal care and hygiene

·         Fatigue

·         Difficulty concentrating

·         Irresponsible behavior

·         Obsessive thoughts about death

·         Talk about suicide

How do you know if it is depression or dementia?

Depression and dementia share similar symptoms. A recent article on Helpguide.org gives some specific differences:

In depression there is a rapid mental decline, but memory of time, date and awareness of the environment remains. Motor skills are slow, but normal in depression. Concern with concentrating and worry about impaired memory may occur.

On the other hand, dementia symptoms reveal a slow mental decline with confusion and loss of recognizing familiar locations. Writing, speaking and motor skills are impaired and memory loss is not acknowledged as a being problem by the person suffering dementia.

Whether it is depression or dementia, prompt treatment is recommended. A physical exam will help determine if there is a medical cause for depression. A geriatric medical practitioner is skilled in diagnosing depression and illnesses in the elderly. If you are a care taker of an elderly person it may be beneficial for you to seek out a geriatric health care specialist. For more information on senior health services go to http://www.longtermcarelink.net/about_senior_health_services.htm

Treating depression in older people.

Once the cause of depression is identified, a treatment program can be implemented. Treatment may be as simple as relieving loneliness through visitations, outings and involvement in family activities. In more severe cases antidepressant drugs have been known to improve the quality of life in depressed elderly people. Cognitive therapy sessions with a counselor may also be effective.

As a care giver or family member of a depressed older person, make it your responsibility to get involved. The elder person generally denies any problems or may fear being mentally ill. You can make the difference in and remove the Holiday Blues from seniors suffering from depression.

The Geriatric Mental Health Foundation offers a “Depression Tool Kit.” To read more about the tool kit and depression in the elderly go to http://www.gmhfonline.org/gmhf/consumer/depression_toolkit.html

To find a Senior Health Care Services in your area on the National Care Planning Council website go to http://www.longtermcarelink.net/a7seniorshealthservices.htm

The National Care Planning Council supports the work of geriatric practitioners and their services to the growing senior population. If you are a geriatric practitioner and would like to list your services with the NCPC please call 800-989-8137.

Technology and Aging: Adventures with an iPad - Week 7

Technology and Aging:  Adventures with an iPad
Week 7:  Flow Free

True confession time…between my iPhone and my iPad I have well over 100 apps!!!  I can afford to do this because most of them are / were free.  I'm always looking for new games or activities that might be of interest to my clients, or so I tell myself as I spend hours "test driving" them to see who might benefit and how.  I'm amazed at the variety and quality (or sometimes the lack thereof) of the apps that are available and find myself frequently repeating the phrase "I'll bet there's an app for that!" before hunting one down.

One of my new favorites is Flow Free.  I feel like this gives me a glimpse into the lives of all the engineers in my family (in fact my son is currently working as a piping engineer…stick with me and you'll see why that's relevant) and it doesn't hurt that it's fun too!

Just as an aside, I found this app by searching the "Top Charts" in the App Store.  I enjoy stopping by periodically to see what the latest and greatest apps are…check it out if you haven't lately, who knows what you may find?!

Now, back to the app itself.  The goal of Flow Free is to "connect matching colors with pipe to create a flow".  Sounds easy, right?  And it is…at first.  In the beginning, there are 5 different colors on a 5x5 grid.   But as you improve, the games become more challenging by adding more colors, more squares and more complex patterns.  There have been times when I've been tempted to call my piping engineer son for clues!  (And just so you know, there's an app for that…not for calling my son but for getting "cheats" to solve the piping puzzles…crazy, right?!...an app for an app!)  The game has been great for my clients on several different levels, which I always think is a bonus. 

First, it requires fine motor skills as you use your finger to draw a line between the dots.  Then there's the mental part…looking at the grid and "seeing" how the water will flow.  No two pipes can cross over and all the squares must be filled.  Try it for yourself…it's addictive!  And that's another plus, you're exercising your brain AND having fun too!!! 

With over 750 FREE games at multiple levels, Flow Free can keep you and your clients entertained and challenged for a long time!  There's also a Time Trial version in which you solve as many games as possible in a set amount of time. 

Just remember...I told you this game is addictive.  So don't go blaming me for the hours you lose…you've been warned!
Now enjoy!

Chris Hicks, C&S Care Manager
C&S Care Management, Inc.

chicks@cs-care.com
Office: 281-550-8444
15430 Ridge Park Drive
Houston, TX  77095