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Wednesday, December 4, 2019

How to Have A Family Conversation with Aging Parents at the Holiday


Happy Holidays! 

 Is It Time to Have a Conversation About Long-term Care with an Aging Parent?

Like many families, mine is scattered all over the United States.  Work and other commitments make it difficult to visit distant loved ones more than a few times a year.  When visiting, it is hard to gauge the health and safety of family members because they are often not going about their normal daily activities. 
A few years ago, while visiting my dad in Oregon, I noticed that there was something not quite right with him.  He was repeating himself and telling stories about his history that I was pretty sure were not true.
Read more . . .


Monday, November 11, 2019

Podcasts for Caregivers


There are not enough hours in the day – a familiar phrase I mutter to myself while trying to accomplish the items on my ever-expanding to-do list.  That phrase may really be true for those caring for a family member with disabilities. 

Although I haven’t found a way to add hours to my day, I have found ways to extend the time available for learning new things.  I’ve discovered that I can listen to podcasts and books while doing tasks that require my physical -but not necessarily my mental – presence. 

I listen to podcasts when I’m running, doing laundry or cooking, or while I’m wandering around Trader Joe’s picking up groceries.
Read more . . .


Friday, August 17, 2018

What it means to be a healthcare surrogate


In my practice, I spend a lot of time educating clients about the need to have an Advance Directive for Healthcare in place so that someone can make healthcare decisions for them if they are unable to make those decisions or to communicate them.  But what does the healthcare agent or surrogate do?

When nominated to become a surrogate healthcare decision maker for someone, you may be asked to make decisions about what healthcare procedures and care will be appropriate for someone other than yourself. You will only be asked to make healthcare decisions if the person is not able to make or communicate those decisions.  What that means is that you may have to decide what the person would want without ever having discussed the issue with them.

In general, as a healthcare surrogate you will have the right to:

  • Make choices about all medical care for the person, to include surgery, medical tests, medical tests or pain management.
    Read more . . .


Monday, June 26, 2017

The Four Most Important Legal Documents You Will Need to Manage Your Aging Parent's Affairs

To help your parents get their affairs in order, you should first make sure that you or someone trustworthy has the legal ability to manage your parent’s affairs.  This article is a guide to the four fundamental legal documents you and your parent may need in order to get financial affairs in order.



Read more . . .


Thursday, June 22, 2017

How Safe is My Mother from Financial Exploitation?


 

Jennifer’s 80-year-old mother seemed to be running low on funds every month.  By the end of the month, she had no money for groceries.  Jennifer had helped her mother with a budget, so she thought her mother had plenty of money to make it through each month.  When she asked her mother to allow her to look at her bank statements, though, Jennifer discovered a series of automatic debits to several companies she did not recognize.  It turns out, her mother had signed up for monthly book delivery clubs, as well as recurring magazine subscriptions for magazines Jennifer knew her mother did not read.
Read more . . .


Thursday, June 1, 2017

Important Things You Should Know Before Deciding to Seek Guardianship or Conservatorship of an Adult


What exactly is a guardian, what is a conservator and when should you become the guardian or conservator of an adult?

Aunt Mary is 86 years old and has always been a little eccentric, but lately she’s been giving money to John, a much younger man that she calls her special friend.  Aunt Mary says that she knows her family doesn’t approve of her giving him money and gifts, but she has plenty of money, John has been her friend for many years, he has always helped her with her home and yard, and she doesn’t have anyone else she would rather spend her money on.  Does she need a guardian or conservator?

What is a guardian and conservator?

A guardian is a person who is legally responsible for someone who is not able to manage his or her own affairs. Guardians and conservators are appointed by the judge of the probate court in the county in which the person in need of a guardian/conservator, called a ward, resides or can be found.

In Georgia, a guardian is the term that is used for the person responsible for managing affairs related to the health and safety of the ward, while a conservator is responsible for the financial affairs of the ward.


Read more . . .


Monday, January 23, 2017

Help, I’m Lost in the Medicare Alphabet Maze!


 

Recently, I had to help a relative reinstate her Medicare Part D insurance coverage after she forgot to pay the premiums for several months.  The insurance company sent many notices advising that they would terminate coverage if the past-due premiums were not paid, but she either ignored the notices or could not comprehend what they said and eventually lost coverage.

After spending hours on the phone first with the insurance company and then with Medicare, I realized that Medicare is somewhat of a mystery to me.  Medicare is not yet my health insurance provider, so other than knowing that most of my clients are covered by Medicare and pay a monthly premium for the health insurance, I really had little idea of how Medicare works.  This blog post is a general guide to Medicare, while the next four posts will explore the alphabet of Medicare in more depth.
Read more . . .


Thursday, December 3, 2015

Important Things You Need to Know About Medicare Part D

 

This year, a relative of mine had two issues that affected her prescription plan.  First, she was diagnosed with an illness and prescribed new drugs.  Second, she forgot to pay her Medicare Part D premiums and lost her prescription coverage.  How do you choose a Medicare Part D plan?  How do changes in medication affect the Part D insurance plan a participant might choose?  

Medicare Part D is the health insurance that covers prescription medication for outpatient drugs.  Part D is a fairly recent addition to the Medicare Alphabet, having been added in 2006.  This plan seems incredibly confusing, and it can require some research to determine the best plan for each individual.

Medicare Part D is a federally subsidized drug benefit.  The participants will pay a monthly premium to an insurance company that has contracted with the government.  In 2015, the average premium is around $33.15 per month.  After a participant has paid the deductible $320.00, the participant will pay 25% of the cost of the drugs until the total cost of the prescription drugs has reached $2960.  The federal government pays $2,220 of this amount and the participant will pay $760.  

But how to choose a Medicare Part D plan?  Medicare has a pretty powerful program online that can help you make the decision.  Go to www.medicare.gov/find-a-plan.  It will ask you to enter the zip code of the participant, and then will ask for all of the medications the participant is taking, the dosage of the medications, and the number of pills purchased each time.  It will also ask for the pharmacy where the participant usually purchases the drugs.  Once all of that information is entered into the find-a-plan site, the site will spit out a list of plans with comparative information including the cost of premiums, the annual drug deductible, the estimated annual drug costs, and the rating of the plan based on 3 out of 5 stars assigned by Medicare. Medicare sometimes assigns a 5-star rating for a Part D insurance plan that will be indicated by a yellow star with a 5 in the middle next to the Medicare Part D plan.   Once you have entered all of the information, you can compare the costs of the various plans.  Of course, the information is only valid if all of the drugs in the correct dosages are entered into the system.  Be sure to check to see whether the cost of the drugs will go up during the year.  Usually, the cost of the prescription drugs goes down once the deductible is met, and goes up again when the participant hits the donut hole at $2960.

The participant will have to go to a pharmacy in the plan’s network in order to get the lower price you expect to pay. 

Not everyone needs a Medicare Part D plan.  Some retirees may have coverage under their retirement plans, veterans who qualify for free or reduced price medications may not need the coverage. That is called “creditable coverage.”  If you do need it, though, and don’t sign up for it when eligible, you will be charged a penalty when you do finally sign up.  The penalty is at least 1% for every month you delay enrolling past the Initial Enrollment Period.

 

 

 

 


Thursday, November 19, 2015

What You Should Know About Medicare Part B

 

Medicare Part B pays for doctor’s services, whether in their offices, the hospital, your home or other settings, and lab tests, screenings, medical equipment and other supplies. 

You will pay a monthly premium, which may be deducted from your Social Security, Railroad Retirement or Civil Service check.  If the premiums are not deducted from your retirement or disability check, you will be required to pay premiums quarterly.  In 2015, the monthly premium for most recipients was $104.90, though the premiums are higher if your annual income on your individual tax return is over $85,001 or on your joint return it was over $170,001.  The highest premiums in 2015 are $335.70 per month.

Once you pay the premium, there is a deductible and a coinsurance amount that you will pay.  The yearly deductible is $147, and the coinsurance amount is 20% of the Medicare-approved amount that is charged by the providers. 

For example, if you visit a doctor and the doctor accepts assignment from Medicare, the doctor agrees to accept the amount that Medicare has approved for the service.  Medicare pays 80% of the cost and you will pay 20%.  If the doctor accepts Medicare patients, but not an assignment, the doctor can charge you up to 15% more than the Medicare approved amount and you will have to pay the extra amount unless you have a Medigap policy.  If the doctor does not accept Medicare, Medicare will not pay for the service and you will be responsible for the entire amount of the service provided.  Medigap insurance won’t pay for the cost of a doctor who has opted out of Medicare.

Do I have to have Medicare Part B?  You are not required to sign up for Medicare Part B, but you will be responsible for paying privately for the services covered by Part B (unless you have a Medicare Advantage Plan) if you have chosen not to sign up.  If you don’t enroll in Part B when you turn 65 and enroll in Part A, when you do sign up for Part B you may be have to pay a higher premium for Part B.  The premium can go up 10% for each 12-month period that you could have been enrolled in Part B.  If you have insurance through an employer or have a union group health insurance plan that is your own, a spouse’s or a family member’s (if you are disabled), you do not need to sign up for Part B if that insurance will be the primary insurer.  If the plan is not the primary insurer, and Medicare is the primary, you will need to sign up for Part B.

Note that Cobra coverage does not count as employer coverage.

 

 

 

 

 


Thursday, November 12, 2015

UNDERSTANDING THE BASICS OF MEDICARE PART A

 

Medicare Part A is known as hospital insurance.  That term may be misleading, however, because services provided in the hospital by doctors, anesthetists, and surgeons are covered by Medicare Part B.  Part A covers nursing care, such as care provided by professional nurses, a semi-private room, meals, lab tests, prescription drugs, medical appliances and supplies, rehabilitation therapy.  Services provided for home health care, when you qualify, or hospice care are also covered under Part A.

Generally, the Part A premiums are paid for by the Medicare taxes withheld from your paycheck if you or your spouse has worked enough to qualify for 40 or more work credits.  If you have not worked long enough to earn the 40 credits, you may pay up to $407/month based on the number of credits earned during your employment.

You can qualify for Medicare Part A if you are age 65 or if you are disabled and qualified for Social Security Disability Insurance for 24 months. 

Most people assume that Medicare will cover the cost of all health care once you reach 65.  That is not truly accurate.  Although the premiums for Part A may be “free” because you or your spouse paid through the payroll deductions from your paycheck while you were working, in most circumstances you will be required to pay a co-pay or co-insurance.  In addition, you will be required to meet a deductible of $1,260 for each hospital benefit period in 2015.  What is a hospital benefit period?  That is the period from when you are admitted to a hospital and ends when you have been out of the hospital for 60 days in a row.  After the deductible is met, Medicare will pay for the full cost of the hospital care for 60 days.  If you go home from the hospital before the 60 days are up, but are readmitted during that 60 days, the costs of the stay will be covered.  After 60 days and before day 90, you will pay $315 for each day of the benefit period.  After 91 days, you will pay $630 per day.  (These are the 2015 costs.  The 2016 rates will most likely be higher.)

What about admission to a Skilled Nursing Facility (SNF)?  Medicare will pay the full cost of Days 1 through 20 in a SNF.  From Day 21 through 100, you must pay a daily co-pay of  $157.00 (These are 2015 costs.)  and from Days 101 on you must pay all of the costs. Before Medicare will pay for your stay in the SNF, however, you must be admitted to the hospital for a 3-day inpatient stay.

You can buy a Medigap policy to cover some of the Part A deductibles and co-pays.  If you are admitted to a SNF, long-term care insurance may cover some of the costs of your care.

Open enrollment for Medicare plans is October 15 through December 7th, 2015.  At that time, you can compare Medicare Advantage (Part C)  plans to regular Medicare plans to determine which option is the best one for you.

 

 

 

 


Thursday, August 6, 2015

Five Questions to Ask Loved Ones About End of Life Treatment

How do we decide how we want to be treated at the end of life?

What would a good day look like if you were suffering from a terminal illness?

This is one of the questions Dr. Atul Gawande asks in Being Mortal, Medicine and What Matters in the End, New York: Metropolitan Books, Henry Holt and Company, 2014, his book exploring medical treatment at the end of life.

Dr. Gawande looks at how this one question, along with a series of questions most physicians are not asking their patients, might shape the course of medical treatment and care of those who are terminally ill, as well as those frail elderly who are in need of long term care.

In the book, one patient says that he is willing to have medical treatment for his terminal illness so long as the treatment will allow him to eat ice cream and watch football on television.  However, if at the end of the treatment he can’t have that ice cream and television, he does not want the treatment.

Another patient says a great day for her would be to take her grandchildren to Disneyworld.  Unfortunately, by the time she tells her doctor this she has undergone months of aggressive treatment that leaves her tired and weak and no longer able to go to Disneyworld.  The question then might be, if your idea of one good day is to go to Disneyworld, should physicians forgo treatment that will not cure you in order for you to have at least that one good day at Disneyworld with those people you love?

In our office, we spend lots of time helping clients fill out their Advance Directives for Healthcare, a document that allows a person to nominate an agent to make healthcare decisions for them if they are not able to make or communicate those decisions.  We talk about whether the client wants extraordinary medical treatment if they have a terminal illness that will likely end in death and they are not aware of their surroundings.  Most people say that they don’t want aggressive treatment under those circumstances.  However, we don’t have a good way for clients to really communicate their wishes to their loved ones when the question may be quality of life versus quantity of life.  What decisions should a healthcare agent make if treatment will prolong life but may leave that life not worth living for the person for whom the agent is deciding?

Dr. Gawande suggests a series of questions that should be asked while a person is still able to give answers. These questions would also be appropriate to ask someone who is aging and becoming frail :

  1. What is your understanding of where you are and your illness?
  2. What are your fears and worries for the future?
  3. What are your goals and priorities?
  4. What outcomes are unacceptable to you?  What are you willing to sacrifice and not willing to sacrifice?
  5. What does a good day look like for you?

Here is a link to an article about the author, along with a video discussing the five questions:

http://www.nextavenue.org/atul-gawandes-5-questions-ask-lifes-end/

Of course, the answers to these questions will change over time and as diseases progress.  For instance, a young mother facing terminal cancer will have very different goals, fears and worries from the frail 90-year old great-grandmother facing admission to a nursing home.

How would the answers to these questions help if you were the person who has to make or communicate these decisions for someone else?  If you knew a good day for your father was for him to be able to sit and eat ice cream while watching football on T.V., would you make decisions for his care that would allow him to do that?

I know how difficult conversations about end of life can be, but perhaps asking these five questions can at least open up a dialogue that will ultimately lead to better decisions about end of life care.

 

 

 

 

 

 

 

 

 

 

 

 


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