Saturday, April 22, 2017

Touring Assisted Living? A set of questions can make it easier.

Are you global? Do you look at the overall picture, and rely on intuition and your senses to know what's right?  Or are you analytical, wanting to check every box, so you ask question after question until you're finally satisfied?

Many of us are some of both.  Whatever your decision making style, the search for housing and/or care for a loved one or for yourself can be daunting. 

Before you tour assisted living communities and/or adult family homes, consider formulating a list of questions that will keep you on track.  Silver Age Housing & Care Referrals, where I work, has created a list for clients that zeros in on key categories such as results of annual state surveys, staffing levels,  levels of care, cost and price increases, plus the more intangibles like average tenure of staff and management and resident satisfaction.

Many of my clients really get into the interview process.  They ask the same questions to each provider and stay focused on the search, rather than looking around and hunting for something to say.  When they choose "the winner," they feel good about the process and their final selection.

There are others, however, who may look at the questions ahead of time, but on touring day, they go with their gut, in a global sort of way. 

I happen to be one of those globals, but even so, preformulated questions help me tremendously. Our website's resource page contains a list of questions for touring which our clients have found helpful.  Look for the questions near the bottom of the Resource Page. Happy touring1

Silver Age Resource Page

Tuesday, March 28, 2017

Eldercare Professionals: 'What ME, a minister?'

"Alice, your work is a ministry."  A friend said this to me at church when I explained what I do. I help families find housing and care for their elderly loved ones.  But how does that make me a minister?

I don't wear a clerical collar or a black habit.  Occasionally a cross hangs around my neck.  I haven't been to seminary unless Sunday School counts. 

I've been mulling over what it means to be a minister.  I had a head start on many folks, as my father was a pastor.  Living in a parsonage in rural Indiana, I attended more funerals that most people attend in their whole lives.  Mother sang solos; Daddy preached.  I don't remember their words; I do remember their kindness to those who grieved.

If faith is a big part of your life, and you work with seniors and their families, your work may be seen as a ministry. Faith, if it's real, oozes out of our lives, but especially to those who are hurting.  It's not about Bible thumping, however.

I worked for 12-plus years at Warm Beach Senior Community, a not-for-profit Christian retirement community in Washington State.  One man who was interested in moving in said, "I don't believe in God.  Will people preach at me?"

What could I say?  I knew the residents and staff understood NO meant NO when it came to religious activities.  But I wondered if he'd been pressured before to come to faith. Or if he had been hurt by religious people.

I looked him straight in the eye.  "Of course, we won't preach at you."  I paused and added.  "However, if God speaks to you, we won't stop him."  He and I both smiled.

Faith is often expressed in more subtle ways:  a nursing assistant buying a Mariner's baseball cap with her own money for a resident without family.  An activities director procuring a live pony for a resident's 100th birthday.  A group of nursing home employees planning a wedding for a couple who both were nursing home residents.  These employees hosted a bridal shower, helped the couple buy rings on line, and organized the wedding itself, with the Chaplain officiating.

Most of the time this faith stuff just happens.  More than a decade ago I met a volunteer named Elinor who served many years as a Eucharistic minister to our Catholic nursing residents.  At life's end, she chose our nursing home.  One day, I asked the Director of Nursing Services, "How is Elinor doing?"  Elinor was actively dying.

A holy hush filled her room as I walked in.  "Elinor, this is Alice.  I've worked with you over the years.  I can't give you last rites, because I'm not a priest.  But I can pray with you, if you'd like."

She squeezed my hand.  I prayed the Lord's prayer.  She mouthed the words.

What a blessing to me!  I realize that many of you who work with seniors and their families have similar stories.  God uses us, weak though we are, to bless these wonderful people. It goes without saying that they bless us.

If you work with seniors and their families, do you have stories of faith you can tell?

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?

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