When Parents Need Caregivers

Correction on Wheelchairs and Medicare payments

Since my first post on this subject, I learned how Medicare works with higher priced items.  According to the supplier of our wheelchair, Medicare does a kind of Rent-to-Own deal on wheelchairs and power chairs.  They make payments for 80% of each month for 13 months, at which time the wheelchair is paid off. 

That means you or your personal insurance company would be billed 20% of each of those 13 monthly amounts.  In our case, the 20% monthly charge would have been about $9.30 per month.  That would vary of course according to the total price of the wheelchair.  My understanding is that other expensive items, like power chairs, are purchased for you the same way.

Medicare had paid their 80% immediately for smaller items, such as a walker last summer. 

Remember, you need to select a medical supplier (your doctor, hospital patient representative, or home health care provider can help), obtain a prescription from your doctor, and work with your supplier on any Medicare paperwork to be sure you qualify.

CAUTION on "The Scooter Store" ads to get you qualified for a power chair or it's free.  The Medicare rules changed last year and made it harder to qualify.  One of the reasons (according to another local store that sells electric scooters) was the fact The Scooter Store and other high-volume shops flooded the Medicare system with so many applications that one year, they used up so much of the program funds that it was nearly impossible for smaller companies to get a person qualified for a chair.

So shop around, anyone who says that they can qualify you in a day is probably too good to be true.  My other sources say that paperwork, qualification and approval could take a week or more.

Also, if you need a lift for your car, shop around for those as well.  Some smaller medical supply stores sell used scooters and even lifts, both inside the car models and ones that attach outside on a trailer hitch. 

It seems that a number of people turn in wheelchairs, scooters, and lifts after the passing of the relative that used them.  You can save big money by finding some of these used systems.  For example, a lift for the back of my car, for the weight of my heavy-duty electric scooter, costs about $2400 new.  I found a used one and had it installed for $830.   

Big name companies won't give you any deals or offer used equipment, so you need to check your local phone book and call other places that might help.  Check with trailer and trailer hitch companies and see what businesses they install equipment for.  Even companies that carry batteries carry replacement batteries for power chairs (usually much cheaper than the big name scooter companies) and may know what local medical companies use their batteries.

If you have the advantage of time to look around, you can find a good deal.

Kathy

One location in Florida is in Titusville, near Cape Canaveral. 
B & R Scooters, 1-877-921-9200

Drug Interactions

Just a quick post today.  I found a great site for anyone taking multiple medications.

First, be sure your tell your doctor about the medications you already take, the over the counter (OTC) medications you take on a regular or even occasional basis (from vitamins to Tylenol (c) for a headache, and even any herbal medications you take. 

I am currently compiling a booklet on drug interactions and I'm seeing some scary things when it comes to interactions that can increase or decrease the effect of a prescription drug, or even make it deadly.  The booklet will be reviewed by a registered pharmacist before it is published and ready for sale. 

Please, if you have any questions at all, check with your doctor or pharmacist. 

Tonight, my mother asked about taking one of her regular pain medications, Tramadol, with medication for her neuropathy, Lyrica.  I used this site to determine the interaction:  http://www.drugs.com/drug_interactions.html

There is a disclaimer that you must agree to, but then you can enter 2 or more drugs and find out if you should be concerned about mixing them.  If you have any questions, contact your doctor or pharmacist for clarification before taking the medications. 

Remember, doctors today are often rushed.  Some do not go back and verify what medications you are already taking before adding something new.  It is up to you to be an involved patient or caregiver and make sure the doctor has all the information they need to give you the best care possible.  Check the page "Medical History Example" for details.  If you wish, you can write your medical history and print out just the medications section to take with you on each doctor's visit so you have all the names and dosages of what you take handy for the doctor.  (HINT: Before each appointment, be sure to mark any medications you need refills for so you can show it to the doctor.)

Be well everyone...

Until next time,

Kathy

Back again

I haven't written anything in awhile for several reasons.  I took my mother, a wheelchair, a walker, and our two dogs and traveled out of state for my daughter's wedding.  The trip went well on the way there.  We were very busy helping with the last minute details and the wedding went well.  But....not all went well.

A week before the wedding, we went out to find a Mother-of-the-Bride dress for me.  Fortunately for all of us, my mother chose to stay home.  My daughter's house has too many steps and she decided not to try to negotiate them and join us shopping.  On the way home, just 5 houses from my daughter's house, we were rear-ended.  My daughter was driving and had whiplash and some continuing complications.  Her half-sister was a passenger and unhurt.  I was in the back seat and the back window popped out with the impact and shattered as it hit me in the back of the head.  There was no fracture but I have whiplash and a minor concussion.

The car, a sedan the couple had planned to use for their honeymoon was totaled.  In addition to all the other stress involved with a wedding, they now have to deal with insurance claims and loss of transportation.  The woman who hit us just looked at our car with a crushed up back end and no trunk, then said how glad she was to have bought the car she did since she only had a few scratches.  I wanted to strangle her for the callous comments but the gruff woman officer investigating the accident didn't appear to have a sense of humor.

I'm still dizzy from time to time and forget things frequently, among other weird feelings that come and go.  My doctor said that it can take up to a year to recover from even a minor concussion.  Right now, all I can hope for is a lessening of the complications so I can continue to take care of my mother.  I see a neurologist this week and hope he has good news for me. 

Then there are all the insurance claims and paperwork.  Confusing at anytime, but especially when you're hurt and having trouble finding a doctor who will deal with auto accidents.  I'll post more as time goes on, but at the moment, extensive research on any subject is beyond my concentration. 

To all, take care, and take care of those you love....

Kathy

Medicare and Wheelchairs

Did you know.......

As I've said in this blog, my mother, 85, broke a bone in her right knee in January.  Half way through the recover period, she developed a stress fracture in the left knee because she had been putting all her weight on the left getting in and out of the wheelchair.  We're now in Week 10 of recover and only now can she get up and use her walker for short periods of time. 

She's got a deadline of sorts.  We're leaving next week to stay with my daughter and help prepare for her wedding on the 26th.  Mom doesn't want to arrive at the chapel in a wheelchair. LOL

I started thinking about all I've learned about wheelchairs in the last couple months and thought I would pass it along.

Paying for the equipment.

Check with your insurance company about "Durable Medical Equipment."  For Medicare and most insurance coverage, you will need a prescription from a doctor or order from a home health agency that is responsible for the patient.  Equipment includes canes, walkers, wheelchairs, power chairs, and even accessories, like a commode chair to keep by the bed at night, or a respirator.

Be sure you understand what is covered.  Medicare, for example, will pay 80% but there are limitations.  They will pay as you get more physically handicapped, first a cane, then a walker, wheelchair, and power chair.  Note that you cannot go backwards, so if you have used Medicare coverage to pay for a wheelchair, you will not be covered for the cost of a walker. 

I believe you can still have a replacement after 3 years but that may have changed, so check it out.  Any medical supply house where you go to get the equipment will know the latest regulations. 

Also, Medicare will pay 80% of up to 13 months rental of a wheelchair if you have a prescription. 

This site gives a good overview of the kinds of equipment that is covered. 

http://www.careutah.com/services/a8_about_home_medical_equipment.htm

Wheelchairs come in a number of sizes, for example, my mother is 4'8" and weighs only 98 pounds.  She has a smaller, 16" wheelchair.  This measurement is the width of the seat.  To determine if a wheelchair will go through the doors in your house, talk to your provider.  Either they will have the wheel width, or you can add 8" to the seat width as an estimate.  They will also be able to tell you the appropriate size needed by the height and weight of the patient.

I was fortunate to have a handy son who came to visit and built a temporary wheelchair ramp for us, but I'll talk about ramps in another post. 

Transportation is my next challenge.  Getting two adults, two dogs, suitcases, gifts, her wheelchair and my walker all in one care for our trip to the wedding.  This should be interesting. 

Take Care

Kathy

Warning of Bank Scam

Today's thought concerns security and identity theft scams.  I got one just today.

The term "phishing" is a way for these criminals to lure you to a fraudulent web site on the pretext that you need to verify your account information, then they use that information to steal from you.  They hope they can scare you into thinking you will lose access to your account if you don't follow their instructions. 

The problem is that older people, especially those who aren't computer savvy, or are beginning to have memory or other problems like Alzheimer's, can easily be fooled by these scams.  It's up to family members to keep our parents and loved ones information about these scams to protect their identity and savings.

The scam email I received actually claimed to be from the bank's fraud detection department and had a logo that was very close to the real one.  Fortunately, the scammers didn't have English as a first language and made some obvious mistakes.  Once was a word with a capital letter in the middle of a sentence.  Another was the term "phishing" spelled as "fishing." 

I also knew from dealing with similar scams related to eBay and PayPal, that anything authentic would have my name or some other specific identifying opening, not "Dear Account Holder."  I was suspicious enough about the email to contact the bank and was told where to forward the email to the real bank fraud division so they could trace the source and shut it down.  Check with your own bank about where to send these dangerous emails.   

The following information was sent to me by the bank to help identify frauds.  I thought I would pass it along. 

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Stay safe from Phishing: Easy clues to help you keep your personal information secure.

The main goal of a phishing email is to get you to a site where you will provide your personal information. With these basic, but powerful, clues, you can easily recognize the threat and ensure the safety of your identity and finances.

1. Does the email ask you to go to a website and verify personal information? We won't ask you to verify your personal information in response to an email.

2. What is the tone of the mail? Most phish emails convey a sense of urgency by threatening discontinued service or information loss if you don't take immediate action.

3. What is the quality of the email? Many phish emails have misspellings, bad grammar, or poor punctuation.

4. Are the links in the email valid? Deceptive links in phishing emails look like they are to a valid site, but deliver you to a fraudulent one. Many times you can see if the link is legitimate by just moving your mouse over the link.

5. Is the email personalized with your name and applicable account information? Many phish emails use generic salutations and generic information (e.g. "Dear Customer" or "Dear Account Holder") instead of your name.

6. What is the sender's email address? Many phish emails come from an email address not from the company represented in the email.

7. When in doubt, type it out. If you suspect an email to be phishing, don't click on any links in the email. Type the valid address directly into your web browser.

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Be safe and be sure your family is safe as well.

Take care,

Kathy Frost

State Programs for Older Adults

Hi, it's time to look at some state level programs for older adults.  After a lot of searching on the Internet, I came across a link that will help you find what's available in your state. 

The site I found is by the National Conference of State Legislatures (NCSL).  The reports start with statistics on older adults in the state vs. the nation, such as over 65 and over 85. 

The reports list the different support network programs, such as the "Family Caregiver Support Program" and the "Aged and Disabled Adult Medicaid HCBS Waiver" program.  Each program includes what the program offers, who funds it, and basic eligibility requirements.  Offers often include things like adult day care, home modification/repairs, homemaker/chore/personal care, support groups, and legal and/or financial consultation.   Some state programs may also include information on "family members may be paid to provide any services needed by the care receiver, including personal care and respite services."   Be sure to read all the information on each of the programs available in your state and follow up on the ones that you are eligible for.

At the end of the report will be the contact information for the agency that administers the programs.  Most states will have local agencies that you should be able to find in your local phone book.  In many cases, it will be under your county, such as one in central Florida called: the Osceola County Council on Aging.

So far, I have only found one way to access the information.  I have tried going to the NCSL web site but I can't find the right option to get to the information from their home page.

Go to Google.  In the Search field type "family caregiver support" (including the quote marks) then the name of your state, such as:

"family caregiver support" Georgia

Near the top of the search results page, you'll see a link for starting with www.ncsl.org, such as www.ncsl.org/programs/health/forum/fcsgeorgia.htm.     

I'm sure this will be a good start in finding programs that will help you with some of your caregiving issues.

Take Care,

Kathy

Hiring a home health aide

Recently, I learned some interesting facts about hiring day or part time help for a parent.  Whether you need someone to come in and fix meals for your parent while you work, need someone to pick them up to take them to a doctor's appointment, or need full time care while you're away, there are some financial and safety considerations you might want to consider.  I'll cover safety issues in the next post along with some of the monitoring devices available today.

A home health aide may also be called a companion or personal attendant.  An aide can help with housekeeping, meals, laundry, getting the client in and out of bed, helping them dress, bathe and eat, and taking them to appointments.  Depending on their training, an aide may be an active part of a health care team, keeping records of condition and progress and working under the supervision of a doctor, or home health nurse or physical therapist.  An aide can come in once a day to help out or work a full days, even in shifts for 24 hour care.

First, the cost of hiring someone to help out is an important consideration in most cases.  Depending on the type of assistance needed and the length of time it will be needed, some insurance, Medicare or Medicaid may help pay a portion of the costs.  Check your specific needs with your insurer.

You could choose to hire a health care aide on your own, or select a reliable agency to provide someone for you.  There are pros and cons for each option that you need to consider carefully.

Hiring a Home Health Aide

Hiring someone on your own may sound like a cheaper option at first but there are additional costs involved.  It will take time and effort to find a reliable person.  You'll need to do a background check and other investigations to be sure the person is what they say they are, how well trained they are, and other factors, such as their driving record.  You'll also need to be concerned with things like taxes and medical insurance.  See the topic "Hiring a Home Health Aide" in the side bar for lots of suggestions and details. 

Using an Health Care Agency

While an aide from a reputable agency may appear to cost more for per hour, there are some advantages.  Primarily, an aide from an agency will have had background and health checks, training and supervision.   If they are injured on the job, such as hurting their back helping a patient out of bed, they will be covered by the agency's insurance.  The agency will also provide substitutes when an aide is ill or has days off.  You can also be confident that the aide will be honest, respectful of the client, discreet in not discussing personal information with others.  See the side bar topic, "Hiring an Aide from an Agency" for suggestions on finding an agency.

Next time, I want to look into safety issues for older adults living alone, even part of the day, and what new devices and options are available for someone living alone.

Take care until next time,

Kathy Frost

Future Topics

These are some of the topics I would like to write about over the coming weeks.  If you have any personal experiences about any of these topics that you would like to share, or suggestions for other topics you would like me to research and report on, please contact me at kfrost4@cfl.rr.com.

• How to decide when your parent(s) need care
• Downsizing - selling the family home and the emotional ties to the home and memories
• Dealing with physical limitations
• Dealing with mental limitations
• Finding and hiring household help and home health aides
• Finding local sources for information and help
• Transportation options
• Finding and assessing adult day care facilities
• Deciding when a nursing home is the answer
• Finding and assessing nursing homes
• Hospice care
• Helping parents with financial issues
• Paying for caregivers, Medicare/Medicaid, setting a family member as a caregiver with government payment for "services"
• Getting yourself named as the patient advocate to deal with SS checks, Medicare and insurance companies
• Getting your parent on no-call and no-junk mail lists to protect them from scams
• Wheelchairs, electric wheelchairs
• Handicap accessories, getting doors widened, counters lowered, other handicapped living accommodations, and how those changes affect home values
• Tax preparations
• Care of the caregiver, taking time for yourself, support groups
• Reverse mortgages
• Identify theft, services, protection, homeowner's insurance protection for identity theft

I would love to hear from you with suggestions and what topics you would like to discuss first.

Until next time,

Take care,

Kathy Frost

A Personal Medical History

Have you visited a new doctor lately, or took a trip to the ER? How long did it take to fill out those long patient history forms? Could you remember when you had your tonsils out? Or whether it was a relative on your mother's side that had diabetes or on your father's side?

Just think how much more difficult it is for an older adult to remember past surgeries and if they had measles, mumps, or both? If your parent has vision or hearing problems, so you really want to ask them questions in a quiet waiting room about personal problems, like their last menstrual cycle or a man's prostrate or ED problems?

The answer is to write a complete personal medical history, including current problems and medication, and have it available for each doctor's visit. Having all the information at your fingertips is especially important in an emergency situation or when your loved one is too ill or infirmed to answer questions.

About six years ago, I started gathering the information and writing medical histories fro each member of our family and for some of our older friends. As people grow older, they tend to need more medical care and visit more specialists. It's great to fill out only the name, address, insurance pages of the big stack of forms and write "See attached medical history" on all the others.

I have included instructions for writing a personal medical history. (Medical History Example in the sidebar) I've listed the primary topics you should include, like allergies, medications, and continuing medical conditions, with examples of the kinds of things you might put in each section.

Next to allergies, the medication section is the most important, and useful. For the emergency room or a new doctor, knowing what medicines a patient is taking will affect treatment. For example, if you have diabetes or a latex allergy, or if you are on a blood thinner, the doctor will know what you can or cannot have in the way of treatment for an injury or illness.

For regular appointments with your doctor, take your history with you. At home, mark any prescriptions you need to refill or need to ask about. Have it handy as you talk to the doctor, so he or she can easily see what you are taking, how much, and how often. Cross off any medicines that are discontinued, and write in any changes to the dosage. If the doctor adds anything new, write it down on your history as he says it, so you know you have the dose and frequency correct. This is also a good time to ask about any drug interactions or cautions, like taking the medicine with meals or do not take alcohol, cheese, or grapefruit while taking the medicine.

When you get home, update the file in your computer (using Save As with the current date as part of the title) and print a new copy for reference. (Be sure to keep the old versions of your history.  You never know when you might have to look up a date or a type of medication you took a year ago.) 

The history I wrote for my father was priceless to me as his Alzheimer's progressed. When my mother cut her leg badly and we had to call an ambulance, I got her settled with a large towel around the cut and hit the button on the computer to print copies of her history as I was talking to the 911 operator. I had one ready for the paramedics so I could concentrate on her and not on answering questions.

I gave another copy to the ER doctor. She was shocked at having everything she needed to know in one place, clearly organized. She said it saved her a lot of time in determining what medications to prescribe and what not to do. In mom's case, she doesn't take blood thinners, but she is allergic to penicillin and latex, all of which was important in her emergency care. The doctor came to find me later and thank me for having the information written up. She said so many patients come in with no idea what they are taking or the dose. Some can only vaguely remember that their doctor gave them a little white pill or a big yellow on, and they aren't sure what it was for. If someone is in great pain, or unconscious, a doctor needs to know if they have a history of seizures or a pacemaker. If you are caring for a family member, you need to know all you can about their medical conditions.

Think about preparing a medical history for yourself and your loved ones. I've actually had people pay me up to $50 to help them gather their information and get it organized. It's that important.

NOTE: This is also a good time to go through the medicine cabinet, clearing out old, outdated prescriptions, and determining what the person is actually taking, or what they should be taking but aren't. A friend had diuretics prescribed from three different doctors over a period of time, and had continued each one. By checking the prescriptions she was taking, we discovered the duplication and it answered a question about her health and weakness. Her doctor selected the right one and canceled the others.

To help someone put together their medical history information, go through the questions on the example, filling in everything they know easily. Then give them a list of things they need to look up, ask relatives, etc. After a day or two, go back and finish the history with the information they gathered. It may take a little time to set it up in the first place, but the results and security of having the right information on hand in an emergency is well worth it.

Click on Medical History Example in the side bar for more information.

Take care,

Kathy Frost

Before Your Parents Need Help

Welcome to my new blog.  I am currently the primary caregiver for my mother who is legally blind.  I also cared for my father, until his passing three years ago, both at home and in the nursing home as his Alzheimer's grew progressively worse.  I have experienced a number of situations regarding caring for aging parents and it took time to work out all the problems.  In this blog, I hope to pass along what I have learned, the experiences of others, and listen to my readers as they share their experiences or questions.  In this blog, I hope we can help each other.

Today's post concerns what you should do BEFORE your parents are in need of care.

When you were growing up, your parents were the caregivers, guiding you as you became an adult.  But in time, your parents may need you to act as their caregivers, aiding them in everything from legal and financial issues to home care if they become disabled or too frail to live alone.

Whether your parent or parents eventually develop physical problems or diseases that keep them homebound or debilitating mental health issues, such as Alzheimer's, you should do some of the preparations early, while they are still healthy with a sharp mind.

See side bar items for more details.

The Basic Three

1) A Medical Power of Attorney with a Directive to Physicians (also called a Living Will)

This document gives you the opportunity to say what measures, reasonable or extrodinary, that you wish to have taken if you are not conscious or unable to communicate your needs, and who can make decisions for you if you can't.  You can state whether you want to be resuscitated or be kept alive on a machine, or allowed to die in dignity.  You make the choices YOU want for your life and your future quality of life. 

2) Power of Attorney (POA)

Like a medical power of attorney, this document designates a representative to handle your affairs when you are unable to.  There are two types of POAs.  One is a limited POA where you specify exactly what a person can do in your name (like buy or sell a property in another state if you can't be there) and for what specific time period.  The second is a Durable POA and is in effect until your death or if you change it in the future.

3) A Will

Ideally, you should make out a will as soon as you are on your own and have any property or assets, just to be sure that in case an unexpected early death, your wishes will be known and carried out.  A will should be updated every few years, especially at major events in your life time, such as marriage, birth of a child, divorce, or death of a spouse. 

For our parents, we need to make sure that the will is current, that the person selected to be the executor is still available and able to do the job. 

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Each of these legal documents should be reviewed and updated at least every couple years.   Be sure to update the name and address of your representatives and beneficiaries when they move or when a woman marries.  I have a sheet with the current names and addresses paper clipped to each copy.  This is especially important in an emergency when a hospital needs to contact the primary representative or the alternate.

Obtaining POAs and Wills

A basic Living Will, in a very abbreviated form, can usually be obtained at your local hospital. 

For a more comprehensive Medical POA, Durable POA, and even wills, try the Internet.  The link below is a representative one and has estate planning documents that can help you do most of the work yourself and save you some money.  There are several of these sites and you may be able to find one specific for your state of residence.  http://www.expertlaw.com/library/estate_planning/medical_power_of_attorney.html  This site has one very valuable caution.  "This free legal form is provided for general informational purposes. Before you utilize any legal form you find on the Internet, you should have it reviewed by a lawyer in your jurisdiction to be sure that it meets your legal needs, and will be held valid by a court in the jurisdiction where you reside."

Be sure you keep extra copies of these documents available.  When your parent goes to a hospital, the registration office will probably ask for a copy.  You will need one to pick up medical records and x-rays.  Doctor's offices, labs, and other diagnostics centers may require one for you to access your parent's medical records or to be given medical information over the phone for the patient.  Be sure you contact each insurance company and pharmacy (local and mail-in) for their requirements.  You want your name on their account so they will have the legal authority to discuss patient records and accounts.  This includes homeowner's, life, and vehicle insurance as well as medical.  Some companies will require that the patient fill out and sign a form giving your name as an approved representative.  You must return the form with a copy of the medical POA, before they will discuss anything with you.  (Other companies may allow you to have the person speak to them on the phone, identifying themselves, and give verbal permission for you to conduct their business but this must be done each time you call and could cause a problem if you are away at work or they are at the hospital and you're at home.)  In our case, my mother is legally blind and losing her hearing.  She can't read the tiny account numbers on her insurance card or hear half the questions some customer service person asks on the phone, so we made sure my name was on each of her accounts so I could deal with any problems.

Again, these are all issues that you should work out with your parents long before the day you must take over caregiver duties on their behalf.  The documents can be put away for safekeeping until they are needed, as long as you have access to them in time of an emergency.  With luck, your parents will love a long healthy life, but if they eventually need your help, you'll be prepared.

In the next post.....

My next topic will be about writing a comprehensive medical history for each member of your family that you can print out each time you visit a new doctor, go to the hospital, or need an ambulance ride.  I'll explain why it is so important and what to include.

Until next time,

Hugs and best wishes,

Kathy Frost