Caregiver Hints

The Harriet Carter catalog is often a good place to find helpful care items.

One I saw recently is a MUST HAVE. The “What my Family should know” notebook is a handy repository for all that important information you will need to know if a loved one becomes too ill to take care of their affairs, and it’s only $10. My Mother didn’t share anything about her health or finances unless it was absolutely necessary, and when she began to get sick, I had to sort through piles of papers and disorganized folders to find out what I needed to take care of everything. There was a lot she didn’t even remember, like the insurance policy she had been paying on for years that expired about a year after I found the documentation. That would have really helped with the funeral expenses.

Don’t wait until your parents, or family, has already gotten ill, you may miss something. Get one of these notebooks and start meeting to write down all this handy info and keep it is a safe place…a safe-deposit box even. And make sure it gets updated!

Medicare Advantage plans have come on the scene within the last 2-3 years to help deal with the immense overhead of Medicare billing in the US, at least as I understand it. My past experience with Medicare is that they were often backlogged, meaning slow to pay bills, and dealing with them to resolve billing issues was often an exercise in frustration. Some medical offices would even refuse to bill Medicare, leaving the patient to do this, because the cost of delayed payments and dealing with them was too costly for smaller offices. In other cases, the offices would send the benefit claims, but require up-front payment of bills, and then instruct Medicare to send you (the patient or bill payer) a check for the amount covered. Larger medical facilities usually don’t have a problem, but if there is a dispute, the patient generally has to call the Medicare offices to resolve it. There are a number of Pros and Cons to these plans, so generally you will have to review the issues and see what decision is best for you. Unfortunately, in my opinion, this is not as simple as you might hope.

Blue Cross/Blue Shield (or in my case Blue Cross of California) was one of the first companies to instate a Medicare Advantage (or replacement) policy*. When first introducing the policy, Blue Cross set up seminars that people could attend free of charge, to get an explanation of the policy benefits, and to ask questions. Representatives would also help you fill out forms and get additional information. As far as I know, they are still doing this, so best to check out their website at http://bluecross.com/ or check your local area for an office you can call for more information. At the time I was investigating (about 2 years ago), they were not offering the Medicare Advantage plans in all states.

The policy in California was called Freedom Blue, and for $7 per month, you could get a full coverage PPO style health plan. This made it a very affordable plan for older people who do not have health plan coverage through their spouse or former workplace. Another option was that you could have your plan premiums automatically deducted from your Social Security payments, meaning one less bill to worry about.

One of the distinct downsides of these plans, that I have found, is that many medical facilities are not aware of these plans or how they work. On several occasions, in spite of my instructions to the contrary, facilities would bill directly to Medicare (which would say they are not handling the patient) and then turn around and bill us for the full amount with a note saying that Medicare denied charges. I would then have to call them back and explain the whole thing again, and even then, some places would continue getting it wrong. It was quite a headache at times. Hopefully this will get better in the future, but keep this in mind if your state or area has just begun accepting this kind of plan.

In the case of Blue Cross, they will explain that this particular plan is a low-cost solution that is best for people who are still in relatively good health that are seeing doctors only occasionally for checkups. In my Mother’s case, it might not have been optimal since she was dealing with Diabetes, and a number of other health problems. We had tried it in an attempt to circumvent other problems we were having dealing with Medicare and her primary physician.

You will have to explore these options for yourself at length, but I would say that it is best designed for people who need some medical and prescription help, but are still doing well, and are active, but don’t have any regular health coverage.

(*information about insurance companies and their policies are not endorsements, but are simply accounts of my experience. I recommend you check several different policies and companies before making a choice.)

A common problem (which I cover as a major topic) is the stress related to juggling too many responsibilities related to caring for others. These tasks are, of course piled on top of one’s normal, personal responsibilities. While there is always a compulsion to allow yourself to be manipulated by guilt, responsibility, or the urgings of the individual being cared for, it is extremely important to set boundaries for yourself to prevent you from getting burnt out…an all too common occurrence, especially for the lone caregiver.

One of my biggest failings when I first started caring for my Mother is that I would spend multiple hours visiting her. She liked the company and didn’t want me to leave so I would draw this out as long as I could. This often meant I would get home arounf 9 or 10 pm, not leaving me enough time to do chores, pay bills, or even eat a healthy meal without staying up late and affecting my sleeping patterns. This habit will (and did, in my case) snowball into more and more problems down the line.

I found the best way to combat this was to keep visits relatively short, about 30-45 minutes, with a definite deadline to leave, and sometimes with a specific agenda like bringing books or groceries. Once this pattern was established, it was easier for both me and my Mother. Granted, she still wanted me to stay, but I felt less rushed and tense which made it a more pleasant visit I think. Also, the shorter visits made it a little easier to throw in an extra short visit from time to time. It also seemed to help to keep the visits on a schedule so they fell on the same days most of the time. This seemed better for my Mom since instead of wondering when I would stop by, she could always look forward to my visits on particular days. Elderly people seem to be comforted by consistency and knowing when things are going to happen.

Also, make use of the phone. In lieu of a visit, or if you can’t make a visit, call the person on the phone (using the same time boundaries…or shorter) so they know you are thinking of them. If a person with physical disabilities starts to have trouble with the phone, this pattern may have to change. I’ll cover more on this in other postings.

Thanks to the folks over at Content.Robot, you can now access this site easily on an iPhone! If you come to the site using Safari on the iPhone or iPod Touch, the content will be reformatted to fit nicely on the screen with a very elegant and simplified theme. I almost wish the “regular” site looked like that. If you’re browsing the site with an iPhone, leave a comment or drop me a note to let me know how you like it. One of my objectives of the site is to help busy people (and who isn’t busy) get quick, useful information to help them with the job of caring for others. Hopefully this addition will make it easier for some folks by allowing them to use that time sitting on the bus, or waiting in the doctor’s office more productively.

Dementia is the progressive decline in cognitive function due to damage or disease in the brain beyond what might be expected from normal aging. Particularly affected areas may be memory, attention, language, and problem solving. (from Wikipedia)

Full entry on Dementia is here.

In the past, this condition was referred to as “senility” or “being senile”. I’m not certain, but I believe that the term senile began to have a derogatory connotation. To say someone was “senile” was associated with loosing one’s faculties and being forgetful. I remember this term is use as I was growing up. I believe the term “dementia” started as an academic or medical term for this, but seems to be gaining more popular usage in recent years.

My first introduction of the term came a few years ago with the diagnosis of my Mother’s mental state after a series of hospital stays. Also, it is very common for Assisted Living communities, or facilities, to perform mental acuity tests to determine what level of assistance the residence needs.

Diagnosis of dementia can be a sign of other health ailments, so it is best to consult a doctor about additional testing. In the case of my Mother, she had diabetes and during cases of low blood sugar, she would exhibit symptoms of disorientation and some memory loss. In her case, while this did amplify the problem, she also had regular dementia caused by micro-vascular strokes, a minor form of stroke that often has no outward symptoms, but over time can degenerate the brain’s function. Dementia, high blood pressure, or micro-strokes can be a sign of things to come, most likely more severe strokes which lead to paralysis and decrease in brain and body functions. This was the diagnosis for my Mom and the more severe stroking compounded with her other health problems was more than her body could take. Regular doctor visits are the best way to handle this, but be prepared that preventative measures may or may not be effective. This can be the toughest time during the care of an ailing family member because there seems to be little that you can do.

I will cover more of this in another posting.

NOTE: You should keep in mind that if someone is diagnosed with dementia, you may no longer be able to authorize a Power of Attorney or Will, since most legal entities will no longer allow individuals to sign such documents if there is evidence that they are not fit to make that decision. If you suspect that a family member is developing any impairment, or if your family has a history of mental disease, get this sort of paperwork done EARLY.