Medical Essentials for Elder Care

Reprinted from http://www.caring.com with permission.

1. How to Get a Full Medical Evaluation and Why It's Critical

To get more than the usual 10 to 15 minutes with the doctor, you'll need to request a full evaluation of your parent's physical, cognitive, mental, emotional, psychological, and social needs. Start with your parent's primary care doctor or internist, who ideally has experience caring for older people and those with chronic, complex conditions. And expect to schedule two or more visits over a several-week period to address all the concerns you might have.

If you don't already have a doctor you like, make an appointment with a geriatrician -- something that's especially helpful if your parent has multiple or complex medical problems. (Geriatricians specialize in and are sensitive to the unique healthcare needs of older adults.)

To locate a geriatrician, visit the Physician Referral Service of the American Geriatrics Society's Foundation for Healthy Aging or call (800) 563-4916. Or search for a board-certified geriatrician on these websites: the American Board of Family Medicine or the American Medical Association. Ask for referrals or recommendations from your parent's primary physician, specialists, or other health professionals, friends who have aging parents, or the nearest university or medical center.

How to prepare for the medical evaluation:

• Gather all medical records you can readily put your hands on.
• Bring all medications your parent currently takes, including vitamins, over-the-counter drugs, and herbals.
• Jot down notes about how your parent is functioning physically, mentally, and emotionally, and take these with you to the doctor's office.The National Institute of Aging provides a handy worksheet that covers most areas of concern to the elderly.
• Write up a list of concerns you'd like addressed during the visit.
• Review information about any existing medical conditions so you can ask informed questions during the visit.

How to get the most out of the evaluation itself:

• Take notes or record (with permission) what the doctor has to say.
• Get written materials -- patient information sheets -- from the doctor or nurse about health conditions or treatments.
• Prioritize health concerns; ask what two or three things need to be tackled first.
• Find out if a social worker is available at the doctor's office for an evaluation.
• Ask for recommendations for other resources.
• Make an appointment for a prompt follow-up.
• You might also consider getting a second opinion if you have any doubts or concerns about the diagnosis (or the lack of a diagnosis) during the doctor's visit.

Why a full medical evaluation is important:

A doctor's assessment can:

• Rule out problems, establish a diagnosis, and assess existing ailments.
• Explain what to expect at each stage of a diagnosed condition.
• Initiate treatment. Generally speaking, medications to slow a disease's progress are most effective when started early.
• Establish a baseline by which to compare future changes.
• Speed acceptance of a new reality. This helps everyone plan future care and take steps to support quality of life.

2. Why You Need a Medical "Care Notebook" and What to Put in It

You'll be surprised how many details you'll need to track and how often you'll be asked to provide the same information. Having everything in one place keeps you organized and provides continuity if more than one person accompanies your parent to health appointments.

A portable dedicated file (such as a three-ring binder with dividers or accordion file with tabs) should be brought to every appointment. Include:

• A copy of the signed HIPAA medical information release form.
• A copy of the power of attorney for health and power of attorney for finances.
• Personal medical history (including allergies).
• Family medical history.
• Copies of key test and lab results.
• Living will.
• Contact information for all physicians, including dentist and ophthalmologist or optometrist; therapists, pharmacy, and healthcare providers.
• Key insurance papers (copies of enrollment cards, front and back).
• Blank pages for questions and notes.
• A complete medications list. Be sure to keep it updated with each drug's name, dosage, purpose, and schedule. Include vitamins and supplements. Keep a separate copy in your wallet, so you have access to it at all times.

Why and how to create a medication tracking system for someone in declining health

It's all too common among seniors to forget to take medicines or take them at the wrong times, which can lead to falls, depression, confusion, or other dangerous side effects. Try:

• A days-of-the-week pillbox. If medications are taken mornings and evenings, use separate boxes labeled a.m. and p.m.
• An electronic pill dispenser; some use lights and voice reminders.
• A wristwatch that can be set to beep at preset times.

You can find medication-tracking products at medical supply stores, many drugstores, or online by searching using the keywords automatic pill dispensers.

Monitor medicine taking closely. If you notice skipped pills, your parent probably can't remember what the prompt is for. Or he may forget some health concerns and think the medication is no longer needed. If that's the case, someone will need to remind him in person each time to make sure drugs are taken.

If your parent is struggling to take all his medication, ask his doctor if the medication regimen can be simplified to address this concern. (It often can.)

3. Why and how to review insurance coverage for someone in declining health

You'll need a complete picture of what's covered under your loved one's health insurance policies to estimate future costs and make care plans. Pay especially close attention to coverage for drug benefits, home aides, adult day services, and long-term care.

Plans and policies to look into include following:

• Medicare

  This usually includes Part A hospital insurance and Part B medical insurance.

What to look for: If your loved one is age 65 or older, he or she will likely have a Medicare identification card, which has a beneficiary number on it and identifies whether he or she is enrolled in Part A, Part B, or both.

Why it matters: Knowing the Medicare number is essential for all contact with Medicare itself and with any healthcare provider.


• Medicare Advantage (Part C) managed care plan

  Your loved one might be enrolled in Part C instead of Medicare Parts A and B; this means membership in an HMO or similar private health plan.

What to look for: If he or she has Part C, expect to find a separate enrollment card, identified with the name and number of the managed care plan and your loved one's membership number.

Why it matters: You need the name, address, and membership number of the plan for all correspondence. Also, members can switch into or out of a Part C plan during the plan's open enrollment period, which lasts for at least a month in the autumn.


• Medicare Part D prescription drug plan

  This plan is issued and administered not by Medicare but by a private insurance company, which handles all its own paperwork.

What to look for: This plan also has its own enrollment card, identified by the issuing company's name and the name of the plan.

Why it matters: Filling prescriptions under the plan may be limited to certain pharmacies, which you can find out by contacting the plan or going to its website. Also, Part D plans have a yearly open enrollment period from November 15 to December 31; your loved one may want to switch plans if health needs -- or the coverage itself -- have changed.


• Medigap

This is a private health insurance policy supplementing Medicare coverage; the company issuing the policy issues its own paperwork.

What to look for: If your loved one has a Medigap policy, he or she will have a copy of the original policy, an identification card issued by the insurance company, and regular bills for payment of their premiums.

Why it matters: The terms of the policy will tell you what it covers and how much it pays. The policy name and number is necessary for all contact with healthcare providers and the insurance company concerning bills and coverage.


• Retiree health coverage

  Your loved one may have this from previous work; it would supplement Medicare.

What to look for: You'll find a copy of the policy in paperwork from either the private insurance company that issues the policy or from the benefits office of your loved one's previous employer.

Why it matters: The policy name and number is required for all claims. Also, the policy may have a claims process that requires a separate submission of medical bills and records.


• Veterans health coverage

This offers a system of healthcare as a supplement or even an alternative to Medicare, if your loved one was in the military.

What to look for: If your loved one receives medical coverage from the Department of Veterans Affairs healthcare system, he'll have a card that indicates the V.A. ID number and the level of care he's entitled to. He may also have records indicating specific V.A. medical facilities where he's received care.

Why it matters: V.A. medical care may cost much less than care that is only partly paid for by Medicare.


• Medicaid

  Operated by the state, this may be available to cover almost all medical care if your loved one has very low income and few assets other than his or her home.

What to look for: Look for a Medicaid identification card and number. If your loved one isn't enrolled in Medicaid but has low income and few assets other than a home, contact your local social services agency to see if he or she can qualify.

Why it matters: If your loved one is enrolled in Medicaid, he or she can only receive its benefits if he or she gets health care from participating providers. If he or she qualifies for Medicaid but isn't enrolled, he or she may be spending far too much in out-of-pocket medical expenses.


• Long-term care insurance

You should become familiar with the coverage and other terms of such insurance as your loved one ages.

What to look for: Long-term care insurance is issued by a private insurance company and will have a policy with very detailed provisions regarding eligibility for benefits and other conditions. There will also be billing documents showing the monthly premiums.

Why it matters: Getting to know what your loved one's policy does and doesn't cover, and how he or she might qualify for benefits, can help you and your loved one plan for long-term care and arrange it when the time comes in a way that maximizes benefit payments.

4. How to Build a Support Network When Caring for Someone in Declining Health

Caring for someone in declining health may mean many emotional and practical challenges that can make burnout a risk. Where to turn for help:

Start with the agency on aging in your parent's city or county. This federally mandated agency can provide general information about eldercare and offers referrals to local eldercare services (many free or at low cost), such as case managers, transportation, meals, adult day services, in-home caregivers, and legal assistance.

Other helpful resources:

• Senior centers. They vary greatly by location, but many provide services directly; some offer referral services to local resources. Many also offer workshops and support groups.
• Churches, synagogues, or mosques. Even if your parent isn't affiliated with one, many provide services such as meals or transportation to people of all faiths.
• Local organizations or local chapters of national organizations. Jewish Family Services, the United Way, the Alzheimer's Association, the Arthritis Foundation, the Lion's Club, and many other community groups offer eldercare services.
• Hospitals and health professionals. Many hospitals offer programs and classes on eldercare, and discharge planners (usually nurses or social workers) are usually quite knowledgeable about housing, home care, and community services. It's best to approach them while your parent is in the hospital, but some will offer guidance even if your parent isn't a patient.

Other tips:

• Start a list of contacts who offer to lend a hand, even if you don't need it now. Later these helpers can provide rides, deliver meals, run errands, make social visits, or provide company and care when you must go out. You'll also need a circle of friends you can just call for a sympathetic ear when you're stressed. Be sure to express your thanks to all of these people -- they're helping you and your parent keep going.
• Collect handy references. The people in your loved one's daily life can sometimes point you to handymen, yard care companies, reliable taxi services, volunteer networks, and other helpful services.
• Identify backup care. Primary caregivers need someone with good judgment and the ability to provide the level of care needed to relieve them in an emergency or when they must get away. If you can, find a familiar face. (To hire professional backup care, contact a local home health or personal-care agency. Ask if the same one or two aides can consistently help.)
• Keep your network informed. Offer periodic health updates. Don't be shy about asking for specific help when you need it, but remember to thank people for their aid. Two easy communication tools: group e-mails or an online calendar for coordinating help, such as Lotsa Helping Hands.
• Find support groups. Don't overlook online support groups for family members and caregivers for free, anonymous, 24-hour support.