Monday, May 31, 2010

Eldercare 101: Boomers' Questions on Medicare

In 14 years working with Boomers and their aging parents, I've heard many questions about Medicare. These three are among the most frequently asked.

Q What part of Medicare covers assisted living?

A None. Assisted living is long-term supportive care. Medicare only covers acute care, such as hospitalization, or periodic outpatient events, such as doctor visits.

Q My dad is in a rehab receiving therapy for a fractured hip. Will Medicare pay 100 days of nursing home care?

A Not necessarily. One hundred is the maximum number of nursing home days allowed under Medicare A. When a patient reaches his potential, or stops improving, his Medicare time ceases. Very few people stay on Medicare A the full 100 days.

Q What about home care? Does Medicare pay for that?

No. Home care is not tied to a medical condition and is not covered under Medicare.

In a nutshell, Medicare's four parts include:

Medicare hospital insurance (Part A) provides basic coverage for hospital stays, post-hospital nursing home stays and home health care.

Medicare medical insurance (Part B) pays doctor and lab costs, and some out-patient medical services (i.e. medical equipment and supplies, home health care and physical therapy.)

Medicare Advantage (Part C) Sometimes called the HMO plan, this allows people to receive their Medicare benefits through a private health insurance, rather than through Medicare Part A and B.

Medicare Prescription Drug Coverage (Part D) pays some of the cost of prescription medications.

For more information on Medicare, visit the Medicare website.

Saturday, May 29, 2010

Eldercare 101: Medicare, Medicaid Made Simple

No eldercare blog would be complete without posts on Medicare and Medicaid. Why? Most Boomers mix them up. I did when I entered the senior care field in 1994. These programs sound alike and are spelled alike. But they're as different as night and day.

Your aging parent almost certainly qualifies for Medicare. Virtually everyone over 65 is eligible, since it's funded through employment or self-employment taxes. I'll devote my next blog to explaining Medicare's various parts: A, B, C and D.

Medicaid, on the other hand, covers low-income seniors who have medical needs. Think "AID" for Medicaid. The program is administered by each state; rules and programs differ widely. In many states, a single person can have no more than $2000 in assets. In the case of a married couple, if one spouse needs care, the other spouse can often keep the home and some assets to avoid becoming impoverished.

Programs may include in-home help (i.e. transporting to doctor visits and grocery stores, preparing meals, assisting with bathing), as well as assisted living, adult family homes and skilled nursing homes. In many states, Medicaid covers services and costs Medicare doesn't pay for, including prescription drugs, preventive care and eyeglasses.

If your parent moves to an assisted living facility, an adult family home or a skilled nursing home under Medicaid, he or she will contribute his or her income toward the cost of the care, with the state returning a small amount (approximately $50) for his or her incidental expenses.

For specifics on Medicaid in your state, do a google search of "(your state) Medicaid." Or contact your local county social services, welfare or department of human services office.

For information on Medicare, see my next post.

Is there anything on Medicaid you'd like to add?

Wednesday, May 19, 2010

Geriatric Care Managers Tackle Eldercare Issues With Grace

Perhaps you're stumped because...

1. Your aging parent lives across the country. Due to multiple medical crises, you've racked up enough Frequent Flyer miles to purchase a ticket to Fiji.

2. Your siblings and you can't make peace with your parent's care.

3. Demands of work and family overwhelm you, and managing your parent's medical needs seems daunting at best.


Geriatric Care Managers can help you tackle these eldercare issues and more. Steeped in experience and expertise in geriatrics, they generally hold advanced degrees in nursing, social work or psychology. As important, they've listened to problems like yours time and time again.

First, the care manager assesses the "big picture." While he or she focuses mainly on your parent, your needs are critical, too, as are the needs of your entire family.

Next, the care manager writes a comprehensive care plan, which includes a statement of the issues, and "next steps" for implementation. If needed, he or she taps into the services of eldercare attorneys, financial advisors and other professionals.

You can hire a Geriatric Care Manager on a one-time basis--for example, finding an assisting living community or hiring in-home care. You can also call on a care manager continually or as needed, especially if your parent lives far away. He or she can advocate for your Mom or Dad, standing in your place at care conferences, checking in on caregivers, etc.

Geriatric Care Managers charge families by the hour. Before you enter into an agreement, get the rates in writing.

For some Boomers, a care manager can make a world of difference.

Take the partners who lived in New Hampshire, across the country from their parents in Washington State. These Boomers had used up all their sick leave tending to their parents' care. They were exhausted! Hiring a care manager allowed them to breathe a sigh of relief, knowing Mom and Dad were in good hands.

For more information, contact the National Association of Professional Geriatric Care Managers.

Have you worked with a Geriatric Care Manager? Tell us about it.

Saturday, May 15, 2010

Does Your Parent Care for an Ailing Spouse? Here's Help

Emil and Louise moved into our retirement community with one goal in mind: "We want to be together no matter what." Louise suffered from dementia. Emil wanted to focus on his wife's care. This new setting allowed him to do just that, since staff took care of meals, housekeeping and other maintenance. Their daughter gave her full support.

Perhaps one of your parents cares for the other full time. You may be worried, and with good reason. Recent research has shown that the stress of caring for a spouse with a disabling illness can shorten the life of the caregiving spouse. Dr. Nicholas Christakis, A Harvard Medical School physician and sociologist, came to this conclusion in a study published in February, 2006, in the American Sociological Review.

With 518,240 couples aged 65 and older, the study found that the causes of excess death in the caregiving spouse included accidents, heart attacks, lung disease and diabetes.

A woman taking care of a husband with dementia or psychiatric illness was at greater risk than if she were actually widowed, the study said. As an adult child, how can you help the reduce this stress?

1. Discover your caregiving parent's needs. That list may include help with housekeeping and home maintenance, meal preparation and shopping. As care needs increase, the ill spouse may need someone to help with bathing and dressing. And don't forget the caregiver's need for respite and renewal, as well as for friendship and camraderie.

2. Decide which needs you or other family members can meet, and which can be provided by professional service providers, such as home care agencies or adult day programs.

3. Consider a continuing care retirement community. Louise and Emil stayed together in their apartment for several years, thanks to this supportive setting. Toward the end of her life, Louise lived in the nursing home, just steps away from Emil's apartment.

4. Notice signs of stress with your caregiving parent. Some of those include high blood pressure, spiking blood sugars and shingles. Keep in close touch with your parent's physician, who may provide some objective advice. And finally, let your caregiving parent know that it's OK with you to place your other parent in a group home or nursing home, should the caregiving needs become too great.

Saturday, May 8, 2010

Is Your Aging Parent's Driving Driving You Crazy?

My 85-year-old friend Joe saddled up to me.

"Alice, guess what? I got my driver's license."

I knew about Joe's macular degeneration. How could he pass the eye exam in Washington State?

"I'm lucky," he said with a twinkle in his eye. "My cousin is an eye doctor practicing in Arizona. He signed off and I can drive." He added: "Don't tell my daughter!"

Elders will do the darndest things to continue driving. Taking away their car keys seems like cruel and unusual punishment. Yet at some point the safety factor overrules, and we must act.

Is it time for you to have the "Driving Talk"? Consider these tips.

1. Embark on a series of discussions with your parent, advises the writers of "Your Aging Parents: The American Bar Association Guide to Legal, Financial and Healthcare Issues, 2009.' Ask them, "When do you think someone should give up driving?" and "What are alternatives (carpools, public transportation, having a child drive, etc.)? Talk, too, about your own experiences with rude drivers and traffic, and the increasing difficulty so many people have in navigating the roadways.

2. As the talks progress, use "I-messages," such as "I feel worried," "I'm concerned," "I'm scared," says Dennis Gibson in "The Sandwich Years." Instead of "You're dangerous on the road," say, "I'm concerned about your safety because you've had fender benders and I don't want you to be injured!" And acknowledge your parent's feelings of disappointment in thinking about giving up driving.

3. If all else fails, ask a professional for help. Elderlaw Attorney Rajiv Nagaich, of "Aging Options" says that a neutral party, such as a physician or a geriatric care manager, often can help. "Let a care manager have a heart to heart," he says, adding that an intervention by a caring third party can avoid a winless power struggle.

As a last resort, the physician or family can report the senior negligent driver to the department of licensing. Contact your department of licensing, as laws vary by state.

Perhaps you've received some good advice on this subject. Tell us about it.

Wednesday, May 5, 2010

Mother's Day Gift Ideas from the Pros

Sees chocolates. A two-pound box, to be exact. For the last three years of my Mother's life, I knew the drill. Forget Godiva, or Russell Stover's, or Dove or Hersheys. Sees made her Queen for the Day, be it Mother's Day, birthday or any occasion.

Not everyone has it so easy. If you're stumped about what to buy your aging mother for Mother's Day, you're not alone. Today I polled professional staff and residents from Evergreen Court Retirement and Assisted Living Community, in Bellevue, Washington. I asked, "What are some great Mother's Day gifts?"

Here they are, in no particular order:

1. chocolate
2. homemade goodies (especially when you prepare their own recipes)
3. flowers (fresh or plants)
4. a cozy throw
5. framed pictures of family members
6. an electronic picture frame
7. DVD's
8. stationery and postage
9. a mini-vacuum


Happy Shopping! Can you add to the list?
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