Tuesday, March 21, 2017

Eldercare Q-A: What is Long-term Care?

Good question.  A client asked me that a couple of days ago.  Her mother had been in poor health for years, but somehow had managed to remain fairly independent in a retirement community.  Until now, when things started going south.

"She's in rehab now.  And therapists say she can't go back to where she lives.  They keep using the phrase, 'Long-term care.'"

Long-term care is precisely that:  hands-on care and supervision for the long haul.  It can mean a home care agency coming into a person's home to help with bathing, dressing, medication management and more.  Long-term care can also happen in an assisted living community, a nursing home or in many states, an adult family home.

Long-term care is NOT funded by Medicare.  People pay privately, perhaps with long-term care insurance.  Or if they run out of money, there's Medicaid.

That's the skinny on long-term care.  At least the very short version. 

Tuesday, January 31, 2017

Medicare 101: Five Myths about rehab

Medicare rules about rehab coverage can be tricky. Pay attention to the following myths:

1.  After a hospitalization, rehab coverage under Medicare A is pretty much guaranteed.

Not always.  Rehab in a skilled nursing facility requires three overnights in the hospital.  In addition, the person must need skilled services, such as Physical Therapy, Occuptional Therapy or extensive nursing care. An attending physician must write orders for these services and must justify them according to the rules of Medicare.

2.  People can stay 100 days in a rehab center under Medicare A. 

It's rare for someone to actually qualify to stay the full 100 days.  The length of stay is determined by the person's diagnosis and his or her progress.  Rehab staff chart the progress and report weekly. When a person "plateaus,' or stops improving, the rehab staff gives written notice, informing the person of the last covered day under Medicare A.

3.  Medicare A services in a rehab center are covered in full by the Medicare program.

Medicare A covers the first 20 days: room and board, therapies and most supplies.  At Day 21, there is a copay of $134 or higher, depending on a person's income.  Copays are often paid by a person's health insurance.

4.  After a person leaves a rehab center, he or she can no longer receive therapies.

 Therapies can continue, providing the physician writes the orders that these will benefit the patient and comply with Medicare guidelines.  These therapies are performed less often, and can be done in an out-patient center or in a person's home.  They're covered under Medicare B. There is a copay.

5.  Medicare gives you a lot of choices for rehab centers after hospitalization. 

If you or a loved one have traditional Medicare coverage, you can choose virtually nursing home in your area for rehab.  If you have a managed care insurance, such as a Medicare Complete Plan or Tricare for military families, you may be restricted in your choices of rehab centers.

Monday, January 9, 2017

What's a Geriatrician? And whom do they best serve?

Saturday mornings, I listen to two radio programs about senior care:  Leading Edge Medicine, hosted by Jerry Mixon, MD, and AgingOptions, hosted by Rajiv Nagaich. Each has its own distinctives.  Mixon's show emphasizes keeping healthy no matter one's age.  Nagaich's program focuses on the legal, financial and medical aspects of aging.

Last Saturday Aging Options featured Chad Boldt, MD, a renowned geriatrician.  Geriatricians specialize in treating older people, especially those with multiple chronic diseases. 

Could your parent or loved one benefit from a geriatrician? Here's a test.

1.  Does your loved one suffer from four or more chronic diseases?  An example would be someone who has diabetes, congestive heart failure, depression and chronic pain.  In 2010 37% of people on Medicare fit that description. Often these patients are 85 or older and have dementia,

2.  Does your loved one take lots of medications?  "Nobody should take 20 or more medications," says Dr. Boldt. More certainly doesn't mean better, since medications can interact negatively with each other.

3.  Does your loved one get confused when multiple specialists give instructions?  As people become more frail, they may not be able to understand and comply with instructions by several physicians.

A geriatrician specializes in the elderly, especially who are medically complex. This specialty requires extra training beyond that of a medical doctor.  And unfortunately, says Dr. Boldt, fewer doctors are entering this field than in the past.

So what questions do you ask a prospective geriatrician?  Nagaich suggest these:

1.  Are you a Certified Board Physician in Geriatrics?  There may not be a geriatrician in your area, however.  Many primary care physicians have experience in geriatrics.

2.  Are you accepting new patients?

3.  Will you take my insurance?

Nagaich also suggests that if possible, people look for doctor who has good experience but who is in his or her 50s.

Another way to provide specialized care to older, frail adults is through a team approach.  A physician with expertise in geriatrics oversees the care of patients who receive direct care from a specially trained Registered Nurse, plus other staff.  Dr. Boldt participates in a program called Guided Care, in which one doctor and one specially trained nurse work together to manage medications and give directions to patients and families.

Is your loved one a candidate for a geriatrician?

Tuesday, December 20, 2016

10 Commandments for Selling to Seniors, Part II

Here is Part II of the 10 Commandments for Selling to Seniors.  Part I appeared on December 19.

Commandment 5 :  Don't ignore the senior by speaking only to the adult child.  During tours of retirement communities, I've seen marketing directors speak about 80% to the daughter or son and only about 20% to the elder.  "I kept trying to get her to include my dad in the conversation, but she didn't get it," said one daughter.  Ignoring the senior is rude to both customers. 

Commandment 6: Don't fear the "pregnant pause."  That's the lull in the conversation when we're tempted to feel nervous, wondering if we're are getting anywhere.  It's easy to fill in the
silence with our words.  Don't.  Often that silence will bring out information that never would have surfaced otherwise.  Pregnant pauses often come at the end of the meeting or when you're ready to wrap up.  Your client may be relaxed, trusting that you have their best interests in mind.  Suddenly they give you some tidbit that may be the key to their future.

Commandment 7:  Do realize that a senior often makes decisions over time and needs to mull most decisions over and over.  A senior processes information more slowly and needs time to think and rethink.  Whether it's home care or assisted living or even a new walker,  rarely is a decision made automatically.  An exception:  in an emergency, often the adult child decides on the course quickly.

Commandment 8:  Understand the power of the printed word.  Follow up letters after appointments can clarify information that was presented orally.  Brochures can bring to mind key points and pricing that may have been missed in the oral presentation.

Commandment 9:  Don't try to squeeze a senior into a mold that doesn't fit.  Sometimes the service or community you represent will not work for a senior and their family.  It's too expensive, or too fancy, too small or too large.  The best thing you can do is to encourage the family to take another route, working on their own or with a professional such as a Geriatric Care Manager (Aging Life Care Expert) or a Senior Referral Agency (Association of Senior Referral Professional in Washington) such as Silver Age Housing & Care Referrals. 

Commandment  10:  Be persistent but not pushy.  Focusing on the relationship, rather than the sale, will help.

Whether you are an adult child or a senior care professional, can you offer additional tips to help the sales process to seniors and their families?

Monday, December 19, 2016

10 Commandments for Selling to Seniors, Part I

Perhaps you are advocating for an aging family member.  Or the shoe is on the other foot.  You work with seniors and their families daily.  Either way, you recognize good service, and bad service

Here are my 10 commandments for selling to seniors.  These do's and don'ts are culled from 20-plus years working with elders and their families.  I've made mistakes and picked myself up.  I've learned from many mentors along the way.

Commandment 1:  Show up on time or a little early.  Your clients--both adult children and especially seniors--may be willing to wait for a doctor, but you are not a doctor.  I learned the hard way early on that being timely was at least as important as being knowledgeable.

Commandment 2:  Build trust in the first five minutes.  When greeting an elder, it's best to approach the person with a firm handshake, accompanied by a smile. Another tip that conveys respect is a greeting by name:  "Mrs. Smith, I see your first name is Mary.  Which name do you prefer?"  

Commandment 3:  Talk less and listen more.  The old adage, "People don't care what you know; they want to know that you care," is true.  Caring is shown by listening with our ears.  We can also
"listen" by our body language and eye contact.  These ways of listening say,  "You matter.  What you say is important." 

Commandment 4 : Ask open-ended questions.  The question "Tell me about your family" can elicit a broader response than "How many children do you have?"   Asking about favorite pastimes, favorite foods and social activities will show that you care about the client and his or her family.  It also helps you determine if your services or products will be a good fit.

Commandment 5 :  Don't ignore the senior by speaking only to the adult child.  During tours of retirement communities, I've seen marketing directors speak about 80% to the daughter or son and only about 20% to the elder.  "I kept trying to get her to include my dad in the conversation, but she didn't get it," said one daughter.  Ignoring the senior is rude to both customers. 

Look for Commandments 6 through 10 tomorrow. 

Monday, November 28, 2016

Respite: Ways a short-term stay can solve a problem

If your aging parent or loved one needs temporary care, a respite stay may help solve a problem.

Respite stays are usually done in assisted living communities.  The community provides a furnished room, meals and care for a limited time period.  In Washington State, a respite stay can't be longer than 30 days.  A respite can work well in the following situations.

1.  Your parent and you live far apart, but you desire to move him or her closer to you.  You may not be aware of all their care needs, especially if they have dementia.  A respite stay, either in their current location, or more likely, close to you, can give staff time to assess your parent's needs.  It also gives you time to search for the right long-term placement.

2.  Respite works when a caregiver needs a break.  We who do caregiving full or part-time know the drain on energy this role entails.  One of my clients named Karen came to me tired after caring for her husband for 9 years.  We discussed the respite idea.  Soon afterward she got the opportunity to go on a "girls" weekend to Canada with her daughters and sister.  I helped the family find an assisted living community which would do a respite stay.  At the end of the trip Karen returned refreshed.  So did her family and her husband.

3. Respite can help you and/or you parent make up their mind on a permanent placement.  If your parent hesitates about moving to an assisted living community, a 30-day respite "trial" may help you both decide if this is a good fit.  In most retirement and assisted living communities, a permanent move-in requires a community fee, which is generally several thousands of dollars.  A respite stay allows your parent to postpone the community fee until they decide to move in permanently.  If they don't stay past the end of the respite stay, they forfeit nothing.

4.  Respite stays help seniors who finish their rehab time after hospitalization but are not ready to return home.  They can receive some therapies plus tender, loving care to help them get stronger.

Monday, October 31, 2016

Why Your Aging Parent Hates 'the Home'

"Don't put me in 'the home'!"
"I'm never going to 'that place'!"

Perhaps you've heard your aging parent say something similar.  Why make such a fuss, especially in light of the gorgeous assisted living communities sprinkled throughout the land?  Private apartments, choices about food, activities and outings all make this type of living much more than "the home."

Here's a possible explanation for your parent's reluctance to entertain the idea of assisted living. Assisted living communities are relatively new, first introduced in about 1990.  The movement didn't get into full swing until about 2000.  Before that, there were few options:  mostly nursing homes, which started in great numbers in the 1950s.  Patterned after hospitals, they featured long, dark halls, med carts, bad smells, and people moaning and groaning.

Guess what?  Your parent's first memories of long term care were likely in a nursing home. He or she may remember visiting a parent in a setting that was less than first rate.  It was scary!

Today, your parent can visit beautiful assisted living communities, to see friends or relatives and perhaps to toy with the idea of moving there"one day."

Deep down inside, though, it's probably still "the home."

What can you do?  Give your parent information, but most of all, empathize.   And don't, whatever you do, contradict them when they call it "the home."

Tuesday, October 11, 2016

Your Aging Parent Needs Connection, Especially When Facing Loss

"Forty percent of people moving into our retirement community come from out of state."  That number from marketing staff at University House Issaquah isn't surprising.  Their community is participating in a nationwide trend.

We Boomers want our aging parents to be close to us.  Even though the move is the "right thing" and we are able to visit more often,  our parent can still experience loneliness and social isolation  

Take Doris who describes herself this way: "I was a lost soul."  An 80-something woman, Doris had moved into a new retirement community a few months before.  She was now close to her daughter but far from friends and familiar things.  Doris was afraid to leave her apartment.  She couldn't find her first friend.

Deborah Skovron, CSA, met Doris while doing research on loneliness and isolation.  She presented her findings in "Keeping It Human:  Strategies to Enhance a Sense of Purpose,  Meaning and Connection for an Engaged Life."

Why is the longing for connection so important?  Skovron says, "Loneliness and social isolation increase the risk of cognitive decline and depression.  Lonely people are twice as likely to get Alzheimers." 

On the flip side, people with the largest social networks had 39% less cognitive decline than others, says Skovron.

She has developed a program called "Circle Talk," which aims to facilitate person-to-person engagement, belonging, connection and ultimately community.  Circle Talk  is good for people who are new to a community or have recently lost a partner.  It's offered weekly for 12 weeks.

The program's steps include:  A welcome; a warmup fun activity, such as naming their favorite color or childhood activity, a recap of last week's topic, a main theme such as talking about a cherished childhood memory, regret or rejection, and making connections.

The aim is to create common ground, Skovron says.  She quotes Desmond Tutu:  "A person is a person through other people.  It is not 'I think, therefore I am.'  I am human because I belong, I participate, I share."

Friday, September 30, 2016

Eldercare Nursing Assessments: Why? How? And the Cost?

If your aging parent needs care, chances are you'll hear the word assessment.  And possibly something about a charge.   I've had several clients recently ask, "What's with the extra cost?  I'm already paying a big monthly fee."

Here's the skinny on assessments: why, how and cost.

WHY?  Assessments are like entrance exams for services and care.  That includes in-home care, assisted living, adult family homes and nursing homes. 

HOW?  A professional, usually a Registered Nurse or a Social Worker, asks key questions about your parent's care and medical history.  Some samples: Is your parent incontinent?  Does your parent have memory loss and if so, how does that affect day to day life?  Does he or she need help with bathing, dressing or transferring from a chair to standing?  What kind of care, if any, is he or she receiving now?

The assessor also obtains information from your parent's doctor and from recent hospitalizations and nursing home stays.

Your parent gets to chime in, too, if that is appropriate.  If at all possible, the assessment is done in person.

Gathering information helps determine the amount of care needed, whether the provider can meet those needs, and if so, what will be the cost.

COST?  For in-home care through an agency, there is no cost.for an assessment. For assisted living, the community's nurse does the assessment at no direct charge, although it may be part of a required move-in fee.  No assessment fee for nursing homes, either.  Adult family homes in Washington State also require assessments.  Currently assessing nurses charge between $350 and $400 to do an in-person visit as well as inputting information into a State-mandated document.

Another word in your eldercare vocabulary mastered!

Tuesday, September 13, 2016

Amazing Grace: At Life's End, It Makes Magic

I love the word Grace.  In pastoral circles, it's defined as God's unmerited favor.  I think there's another way to think of it.  It's love and acceptance with no strings attached.

Often grace appears almost magically at the end of life. People tie up loose ends.  They say things they need to say.  They offer and receive forgiveness.  And sometimes the most unlikely people are the instruments of grace:  strangers, professionals and caregivers.

So if your aging parent is at life's end, pay attention.  Be prepared for grace to surprise you.

How do I know? I work with families every day. I see grace at work.  One day two sisters spoke of needing to place their 92-year-old mother in an adult family home.  Her care needs and confusion were increasing.  As I started the process of helping them find a home, the two daughters agreed on what was most important."Our mother needs a place where she can feel safe."

Their mother Lois had been abused as a child and had married an abuser, staying with him until he died.  Even afterward, she suffered from nightmares and anxiety. She needed to heal. 

The daughters found an adult family home provider named Olga who personified motherhood.  She spoke in gentle tones.  She engaged Lois and the other residents in conversation.  Soon Lois began to feel she belonged.

Lois died just four months after arriving in the adult family home.  I expressed my condolences to one of the daughters. She said, "One night I saw Olga putting Mother to bed.  She sang her lullabies.  Afterwards, Mother said, 'Thank you, Mother.'  For the first time, Mother felt safe."

Grace, pure grace.
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