GET THE MOST OUT OF YOUR TIME WITH YOUR DOCTOR

by Donna Q on December 17, 2012

How do you get the most out of the time spent with your doctor?

How many times have we felt helpless and inadequate when trying to deal with healthcare professionals?  Very often in the past patients have automatically deferred to their physician and trusted that all would be well.  In this day of complicated healthcare issues, we no longer have the luxury of letting others take control of our healthcare.  It is now up to us to take responsibility for choosing our healthcare providers and making certain we get what we need from them.   It probably should have been on us all along.

Find the Right Doctor for You – The first step in taking ownership of our healthcare is in choosing the right physician, one who will fulfill our needs.  Do your homework when trying to find the best doctor for you.  Many factors come into play when choosing a doctor, and all are relevant.   To be considered when making your choice:

1. Your healthcare insurance plan list of participating doctors – This is the first place you want to look for a doctor.  Different physicians accept different healthcare plans in their practices and you need to get a doctor that will accept your insurance.  Insurance companies have online services where you can get this information, or you can ask for a hard copy provider directory.

2. What is your medical history? – This is important in that you want to find a doctor that can treat what ails you.  While it is true that certain conditions will often require specialist visits, you can sometimes find a primary care physician (PCP) that has certifications in your area of need.  For instance, if you have a cardiac history you may be able to find an internist with a cardiology certification; or if you are an older individual, you may want to find a PCP with a specialty in geriatrics.

3. Where the doctor is located – This may be your next consideration in finding the right doctor for you.  There is a lot to be said for convenience.  When you are not feeling well and need to make an unplanned visit to your doctor, having the office close by can be very comforting.  A nearby office also cuts down on the time taken out of your life when going for routing check-ups.

4. In what hospital(s) does the doctor have privileges? – See the post (hospital) in which I discuss how to find the best hospital for you.  If there is an area hospital that you have a decided preference for, you may want to ask your prospective doctors’ offices if they have privileges in that facility. (See Find the Right Hospital for the Right Reasons)

5. What are the doctor’s stats? – In past years, you very often needed to get any information on how good a doctor was by word of mouth, which is woefully inadequate and very often unreliable.  This information is now readily available on the internet, and much more trustworthy.   Healthgrades.com is a great site for finding out how satisfied patients are with their physicians.  The information is free and easily accessible.

One such site is the Healthgrades website.   From this site you would click on “Find Doctors”.  You can then either click a specialty of input the name of the specific doctor you are looking for.  When you get to the individual doctor’s page, click the words “View survey results” and you will see answers to questions by patients on the office and the doctor.  On the office, the survey asks patients to rate issues such as “Scheduling Appointments: Ease of scheduling urgent appointments when you feel ill”, or “Office Friendliness: Friendliness and courtesy of the office staff” on a scale of poor to excellent.   Using the same scale, the doctor is rated on factors such as “Level of Trust: Do you trust your provider to make decisions / recommendations that are in your best interests?” and “Listens and Answers Questions: Does the provider listen to you and answer your questions?”  At the end of the survey the questionnaire asks if you would recommend this doctor to a friend.

Since 2007 there has been a voluntary Physicians Quality Reporting System (PQRS) set up by Centers for Medicare and Medicaid Services (CMS – I know it should be CMMS but it is not) but only a fraction of the professionals who were eligible actually participated.  Additionally, the results are published in groups, not individually.  This information is available as a download towards the bottom of this web page: click here

 

Prepare for Your Office Visit – Now that you have found the physician that will, you feel, best fill your needs, preparation is key in insuring you have a pleasant and productive visit.

1. Write down your list of medications – This information is very important on your first visit and can also be valuable to have with you on subsequent visits.  When writing the list of medications, be sure to include the dosage and frequency.  Also, make certain you know what medications need to be refilled prior to your visit, including those that you do not need right now, but will require prior to your next office visit.

2. Write down your health history – In your written health history include your major illnesses, chronic conditions, and all surgeries.  Be certain that you date all surgeries and illnesses, and add the date of the onset of any chronic conditions.  If your lists are neat and legible, or typewritten, many offices will not make you re-write all the information on their forms, but will instead attach your lists.  If your doctor’s office requires the information entered on their forms, having it all written down will make it much easier to remember everything in chronological order.

3. Write down your questions for the doctor as you think of them before your office visit – How  many time have we heard this and then just don’t do it?  We then go to our visit, forget half of our questions, and lament the fact later when we remember them again.  A good habit to get into is to keep a “doctor question list” somewhere handy, like on a nightstand or at your writing desk.  As you go through your daily activities, if a question arises or there is an instance of which you think the doctor should be made aware, write it down.   Remember to grab the list and take it with you when you go for your office visit.

 

Make Certain You Get What You Need from the Office Visit – You have found the right doctor, prepared for the visit.  You have done all the prep work, now you need to follow through.  Make certain you get what you need.

1. Review your medications with the doctor – Discuss any related symptoms you have and ask the doctor (or nurse practitioner) if your medicine or the dose should change.  It is also very important to relate to the doctor if you feel you are having any adverse reactions to your medicines.  People believe that if they have been on a medication for a while and have not had any side effects, they will never get them.  This is not necessarily true.  Medications you have been on for months and even years can sometimes begin to give you trouble.  What you are experiencing may have nothing to do with your medicines, but it doesn’t hurt to ask.  If you have a concern, it is always better to voice that concern. It is also important to let the doctor know if you feel the medications you are on are not, or are no longer taking care of the original problems.  You may need a change.

2. Discuss you problem list – Remember the list you have been keeping all along? Now is the time to make your thoughts known.  The doctor may be the best in the world, but it is highly doubtful that he can read your mind.  Additionally, many symptoms you have when you are not at the office are not readily apparent when you see the doctor.  Even very critical symptoms may not be visible during a doctor’s office visit.  For instance, a routing ECG will only show cardiac damage you have had in the past, or problems that you are having at the time of the test.  If you have been experiencing heart pain (angina) but it has not resulted as yet in damage to the heart, and is not occurring at the time of your visit, your ECG can look entirely normal.  Share any symptoms you have had with your physician.  In the case of the example I’ve given, if you are having any pain that may be due to a heart problem, better to seek medical attention right away.  Don’t wait for a visit.

3. Get your questions answered – Don’t leave the doctor’s office until you are certain you have received all the answers you need to your questions.  When you leave you should feel satisfied that you got everything you need from your visit.  You have a right to be treated with respect and dignity by the physician and his staff.  I would not hesitate to let them know if they are falling short, relating my needs while treating the office staff and physician with the respect I require.

4. Share your thoughts with others – Once you have returned home, take the survey on the Healthgrades site and give feedback on your visit.  Taking the survey may also solidify your thoughts on your physician.  At the end of the survey, when it asks if you would recommend this doctor to your friends, your answer will probably indicate whether you should stay with this physician or search for another.   In any event, you can be proud that you took control over your own well-being and shared your knowledge with others.

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FINDING THE RIGHT HOSPITAL FOR THE RIGHT REASONS

by Donna Q on November 25, 2012

In This Article:
Where do we go to the hospital now?

What do we know about our area hospitals?

What do we need to know about our area hospitals?

Where can we find the information that we need on the hospitals to make the right decision?

Now we know about our hospitals.  How do we use the information?

 

Where do we go to the hospital now?

During a critical or highly charged emotional occurrence is not the best time to decide where you should go if you have need of a hospital.  The best time to learn about your hospital choices is before you need them.  Not to worry, though, if you are in immediate need right now, the information you need is not difficult to obtain quickly.  First, we need to realize why we go to the hospital(s) we now go to when we need one.  Then we can decide if we have or even need other options.  As to where we go now and why:

We go where the ambulance takes us.

Most ambulance companies have strict rules as to where they can take their patients.  The guideline is to get the patient as quickly as possible to the hospital that can optimally care for that particular patient’s condition.  Given this, you do have some say in where the ambulance will take you.

A few years ago, my 12 year old daughter fell and hit her head.  She was not responding still when the ambulance got there.  When I asked, they told me they were taking her to the closest hospital, a small nearby community hospital that had very little available in services.  I gave them a “you are kidding me” look and just said, “She’s an unresponsive kid with a traumatic injury.”  Immediately the plan changed to bring her to a pediatric trauma hospital that was 20 minutes further, but best equipped to help my daughter.  The outcome was wonderful, my daughter is perfect, never had a deficit, and seven years later is top of her class in college.  I am not saying that the community hospital could not have helped my daughter.  They have a very dedicated group of professionals and I believe there was nothing short of miraculous things going on that night.  But I am saying that, if needed, I wanted my daughter to have all of the benefits modern medicine had available to her.

As mentioned, prior knowledge of the facilities around us is key in learning about our healthcare choices.   If you don’t know where you would be brought in an emergency, a quick non-emergency call to your local ambulance company will answer many questions, i.e.: If you call 911, where will the ambulance take you?  What is the option if you have a specific issue?  Heart problem, kidney, etc.?

We go to the hospital that our doctor goes to.

The doctor and the hospital are connected.  Doctors do not have carte blanche to practice and see patients at any facility; they must have “privileges”.  Therefore, the doctor sends us to the hospital in which he can follow our progress and direct our treatment.  This is sometimes non-negotiable due to the fact that the doctor may have privileges in only one hospital.  If this is the case, read on as there are many options still available to you to insure that you and your loved ones get the best possible care in the given environment.

Many times, however, the doctor will have privileges in two or more hospitals.  If this is the case, he or she may have a preference as to where they want you to go.  This is an important conversation to have with your doctor, but the most important question is “Why do you want me to go there?”  If the answer contains information on the hospital’s services, outcomes, etc., this is valuable information.  If the answer is “because it is closer to my office,” you will need to investigate further.  I’m willing to give the doctor the benefit of the doubt and say this means “I can get to you faster”; but in this chaos of a healthcare system, it could simply be for convenience sake, which is not a good reason for you to make that choice.

What is needed is a comprehensive look at what is available to us in our area hospitals in order to make an informed decision on our own care and that of our loved ones.  Being armed with this information will make this conversation with your doctor extremely productive.

 

What do we know about our area hospitals?

We know what we have heard.

For years I worked in a hospital that was extremely focused on customer service and insuring the patients have the most favorable opinion of our facility and staff after discharge.  This hospital’s mantra was:  If the patient has a good experience, they may tell two people.  If they have had a bad experience, they will likely tell 20 or more people.  If this is true, we do not, necessarily, need to discount the information we get from first hand reports of personal experiences in our hospitals, but we do need to understand that the information available from these sources is biased and limited.  All information is valuable, but when gathering information for big decisions such as these, multiple, diverse sources will give you a broader view and more peace of mind.

We know what we have read.

Hospitals are divided into two categories: For profit and Not for profit.  This distinction does not necessarily relate to care, nor does it affect the fact that hospitals must fiscally survive.  The simple truth is:  All hospitals need to make a profit to stay open.   Without a show in the black, you are frequently hearing of hospitals closing their doors.  As you have a choice in where you go to get your care, hospitals need to market their services well to stay financially sound.  All have an advertising budget and they spend millions of dollars each year to get their name out there with a positive spin.  Advertising dollars go for anything from billboards to magazine and TV ads.  There is also a great deal spent on public relation campaigns that look like real magazine and newspaper articles, but are really thinly disguised advertisements.  These ads and PR pieces do give you valuable information on what the different hospitals have available, but are not the best place to discover quality of care.  Remember that they are Madison Avenue type marketing pieces designed to “sell” you on the benefits of that particular hospital.

 

What do we need to know about our area hospitals?

What areas of expertise do our local hospitals have available, and how does my particular condition relate to what the hospitals offer?

Simply put, where you go should depend on what you need.   Not all hospitals are created equal.  In order to decide what kind of hospital you need, a few questions are to be asked.

The first question is: What condition do I have that may require specialized services?    If you do have a specific problem, or if one runs in your family, find out which hospitals in your area specialize in treating your condition and to what extent.  Some examples are provided below.

Cardiac concerns

For instance: Not all “cardiac” hospitals are equal in services.  A hospital that advertises cardiac services can provide everything from only the most basic cardiac diagnostic imagery to a world renowned cardiac transplant program. In the case of the former, a patient admitted with an acute MI (Heart attack) will possibly have a cardiac catheterization which will visualize the heart blood vessels, but then the patient will need to be moved to another facility to treat any blockages found.  A more advanced program will have the cardiac diagnostics available, but also the ability to treat those blockages with anything from opening them to placing stents to keep them open.  More advanced facilities will also have open heart surgery programs for those patients that are not a candidate for stents.

Surgical concerns

You are going into the hospital for surgery.  There are many questions you need answered, not the least of which is: what is my hospital’s post surgical infection rates?  Also a very good question is how often has this hospital mistakenly removed the wrong body part or performed the wrong operation?  Questions such as these do have answers in the public domain on websites we will discuss below.

 

Where can we find the information that we need on the hospitals to make the right decision?

Hospital Websites

The hospital and hospital system websites can be a good source of information on what is available in the facilities, but again, these are made for public relations purposes.  A good site for finding specific hospital websites is on the Agape link connection.   Click on the state and then the hospitals in that state are listed in alphabetical order.  When you click on the hospital name, it brings you to their website.  This site also pares down the list to specialties, but on a cursory glance under “Heart Hospitals” in Florida, I noted that it only listed three programs in Florida, all with the word “Heart” in the name of the hospital.  Florida has many more heart programs available.

Rankings

You can find out how your hospitals compare to other hospitals in 16 different specialties on the   US News and World report website.  This site has a ranking of the top hospitals nationally and regionally in these specialties:  Cancer, Neurology & Neurosurgery, Cardiology & Heart Surgery, Ophthalmology, Diabetes & Endocrinology, Orthopedics, Ear, Nose, & Throat, Pulmonology, Gastroenterology, Psychiatry, Geriatrics, Rehabilitation, Gynecology, Rheumatology, Nephrology, and Urology.  For this information click here.

Great Site: Hhs.gov

One of the best sites I have found for general information gathering on hospitals is the website for the US Department of Health and Human Services.  For the hospital compare site click here.   Enter your zip code and check which search you want: choose to search either generally, by medical condition, or surgical procedure to see how your hospitals stack up against others in your area.  If you choose Medical, there is a drop down box that asks you which condition.  If surgical, the drop down asks for body part and then specific procedure.  When you’ve chosen, click “Find Hospitals”.  This gives you a list of all the hospitals near your zip code that have that specialty available.  You can choose up to three at time, check the box next to them, and then hit “Compare”.

On the next page, you will see tabs to your left stating measures.  I did the search on three hospitals for “Heart attack”.    The “Process of Care Measures” encompassed what is considered standard of care for heart attack and included statements like: “Heart Attack Patients Given Aspirin at Arrival” and “Heart Attack Patients Given Beta Blocker at Discharge”.  Under each of my hospitals, the list showed what percentage of the time this hospital was compliant.    Under “Outcomes of Care Measures” the hospitals’ outcomes were compared to the national norms, better, worse, or the same.  There is also a helpful patients’ survey results tab.

This site is an excellent source for finding out how dedicated your hospitals are to standards of care in many different areas.

Even better: data.medicare.gov

An even more in depth look at outcomes can be found at the Data.Medicare.gov website.  The hospital compare is on this link: click here.

Among many other things, this site has the actual reported rate of occurrence of the following conditions per 1000 discharges, per hospital:

Objects Accidentally Left in the Body After Surgery

Air Bubble in the Bloodstream

Mismatched blood types

Severe pressure sores (bed sores)

Falls and injuries

Blood infection from a catheter in a large vein

Infection from a Urinary Catheter

Signs of Uncontrolled Blood Sugar

To make things easier on everyone, I have downloaded the information from this site onto one document which is available on this blog – myhealthcareguide.org.   The name of the file is: Hospital Acquired Condition Measures xlsx.   You can open this file and have all the information you need from the original website.

 

Now we know about our hospitals.  How do we use the information?

Exercise your rights

You are now an educated consumer in regards to your area hospitals, exercise the rights you have, and you have many.  Many times you have control as to where you and your family go when in need of a hospital.    Use the knowledge you gather to make the right choices.  When you are in a situation where you do not have complete control over the choice of where to go, you do have the right to demand excellent care.

Patient’s Bill of Rights

Ask for your hospital’s copy of the “Patient’s Bill of Rights”.  There are many versions, and each hospital has their own copy to which they commit.    There are many examples of this that you can find by putting “Patient’s Bill of Rights” in any search engine on the web.  There are generic rights and then specific rights for areas such as Hospice, Mental Health, and fro patients in hospitals.   These rights contain statement such as:  (Taken from the American Cancer Society website)

Information for patients

  • You have the right to accurate and easily-understood information about your health plan, health care professionals, and health care facilities. If you speak another language, have a physical or mental disability, or just don’t understand something, help should be given so you can make informed health care decisions.

Choice of providers and plans

  • You have the right to choose health care providers who can give you high-quality health care when you need it.

Access to emergency services

  • If you have severe pain, an injury, or sudden illness that makes you believe that your health is in danger, you have the right to be screened and stabilized using emergency services. You should be able to use these services whenever and wherever you need them, without needing to wait for authorization and without any financial penalty.

Taking part in treatment decisions

  • You have the right to know your treatment options and take part in decisions about your care. You have the right to ask about the pros and cons of any treatment, including no treatment at all. As long as you are able to make sound decisions, you have the right to refuse any test or treatment, even if it means you might have a bad health outcome as a result. You can also legally choose who can speak for you if you cannot make your own decisions.

Respect and non-discrimination

  • You have a right to considerate, respectful care from your doctors, health plan representatives, and other health care providers that does not discriminate against you based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information, or source of payment.

Confidentiality (privacy) of health information

  • You have the right to talk privately with health care providers and have your health care information protected. You also have the right to read and copy your own medical record. You have the right to ask that your doctor change your record if it’s not correct, relevant, or complete.

Complaints and appeals

  • You have the right to a fair, fast, and objective review of any complaint you have against your health plan, doctors, hospitals or other health care personnel. This includes complaints about waiting times, operating hours, the actions of health care personnel, and the adequacy of health care facilities.

Take responsibility for your own well being and for that of your loved ones

Let’s face it; no one is more interested in our situations than we are.  As dedicated and professional as most of our healthcare providers are, we need to share in the responsibility of getting and keeping ourselves well.  Let’s make it our mission to find out what is best for us and our loved ones and insure that we get it.  First, let’s find out all that we need to know about the people who will be directing our care and choose the right ones.  Choose the hospitals and providers that will best fulfill our specific needs.

Next, talk about your concerns with your healthcare providers.  The absolute optimum care may not always be available to you, but if we are more focused on the issues we have, our providers will be as well. Thus we will be able to benefit from the best care that is available.   This is no time to be polite!   Our health and that of our loved ones is at stake.  Ask what is being done specifically for you.  Ask what your options are.  And, since no one hospital is perfect; when you find that your hospital is lacking in some important areas, ask what the hospital is doing to overcome their shortcomings.  This is information they need to be able to convey to you.  At the very least, being knowledgeable will get your healthcare providers to pay attention to you.  Intelligent questions earn respect and deserve intelligent answers.  Do not settle for less.

Keep the information coming

There are no definitive sites or sources to get all the information we need to navigate this very cumbersome healthcare system, but together we can find and relay the information we need.  We will be exploring more of these areas in greater depth in future postings.  Forward going, let me know what areas you would like to learn more about and we can keep the dialogue going!

All the best to you and yours,

Donna Q Brown

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REVERSE MORTGAGE – SOLUTION OR GREATER PROBLEM?

by Donna Q on July 14, 2012

Recently I wrote a post, SENIOR LIVING – WHERE BEST TO SPEND OUR LATER YEARS? that discussed reverse mortgages as a possible option to pay for later life living arrangements.  On LinkedIn I received some very thought provoking and passionate comments from Marjorie Bard, Ph.D., CEO Nonprofit Women Organized Against Homelessness.  I thought that these comments were important and should be shared.  Marjorie wrote:

While I have issues with AARP, I do read their Bulletins and magazines.  Each year they have discussions of where best to live in varying situations of health and finances.  I’ve read through your link, and I have one very large NO regarding a suggestion.
Do NOT take out a Reverse Mortgage unless you are wealthy (and then you wouldn’t need them)!  These companies do NOT pay for your mortgage if you have property taxes, household insurance, car payments and insurance, flood insurance and anything else combined in that “mortgage.”  Also, you have to pay off your outstanding mortgage first, lessening any amount that you will get from the company.  You will have to pay for everything I have listed by yourself, including home repairs, town payments such as sidewalk repairs or street paving; it is not paid by the company.  When you add up everything you will have to pay for yourself,  most people would lose their homes within a couple of years.  You do NOT really “own” your home; the company does but doesn’t express it that way.  They say you do own it, but if you can’t pay for all of the extras, they get your house.  You only own what you can pay for.  I have been working with people who thought they were going to have a home until they die, and they are now homeless.

I have been writing about this topic (Reverse Mortgages) for many years, and both of my websites have stories from people who have gone through this hellish situation and are now homeless.  The topic was mentioned in my books about surviving DV and homelessness as well.  Yes; of course you may add my comment to your blog.  We need to help as many people as possible — especially seniors who do not really understand the way RMs work!

When these ads started appearing on TV with such actors as RJ Wagner and Jim Garner, I wrote to each and told them how they were influencing seniors’ options for permanent housing.  Jim stopped.  RJ still is suggesting this as a wonderful way to  keep one’s home “until you die.”  Middle America loves actors who advertise anything; they are trusted, and I can’t imagine why — but I spent 50 years living in Beverly Hills and realize how they become lionized by the rest of America.  I think they are the ones not to be trusted.  (There are exceptions, of course, such as Liz Taylor and her advocacy for AIDs.)  There is a lot of money in TV advertising, and most people don’t know how much in debt many actors are.  They live beyond their means to impress others, but they don’t fool the people who live, shop, and lunch with them for years.  I work with several who are about to become homeless and no one would suspect they are in serious financial trouble.  They are seeking TV ad jobs for anything at all — even if they have never used the product or expect to — or know it is dangerous.

Gullibility is our most harmful trait as humans.

Posted by Marjorie Bard, Ph.D. 

See more on Reverse Mortgages issues at: USnews.com and at: Consumersunion.org

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SENIOR LIVING – WHERE BEST TO SPEND OUR LATER YEARS?

by Donna Q on July 12, 2012

The Bell Does Toll

I’ve read that one of the biggest fears faced by seniors is a loss of independence.   There is a cycle to the life process where we start out as completely dependent on others and, if we live long enough, we experience varying degrees of that dependence at the end of our lives.  True independence is, I believe, a myth.   I find it interesting that John Donne’s Meditation XVII that begins “No man is an island” is the same famous poem that ends “…send not to know for whom the bell tolls, it tolls for thee.”  There is no real escape from interdependency; and absolute independence would seem to result in loneliness and despondency at any age.   So, putting this into perspective, if there is no true independence at any age without significant cost, of what exactly are we afraid?

 

Detail: Reflections by DQ Brown

Perhaps what we fear is a loss of the familiar.  As we age, we may be forced to leave behind our home, our possessions, friends, beloved pets, and all of our familiar support systems.  It may be that our greatest fear is a loss of control over our lives, or a combination of these things.  For many of us, our choices diminish as we age.  As young adults, we had a great deal of say over our pathways:  our career, our life mates, whether or not to have children and how many, etc.  Arguably, some people will always have more choices than others due to health and economic reasons, but few would disagree that as a rule, the elderly have fewer options available to them than the young.  There are many factors affecting how and where we will live during the end of our days, when this particular bell is tolling for us.  How well we have prepared has a direct effect on how fearful we are towards the latter end of our lives.

Contributing Factors 

Financial issues – There is no doubt that those with financial problems face greater problems when they are no longer able to work and bring home a paycheck.  Hopefully, we have been diligent in saving for our retirement, but things happen to deplete or even delete those savings.  For those of us who can’t afford our own old age, the fear of what will happen to us is valid.  Years ago, the seniors that could not afford to live alone were taken in and cared for by younger members of their families.  This does still happen, but it is no longer the norm.  For those with financial issues, BenefitsCheckUp.org is a good place to start look for help.

Social issues – For some, there are no obvious support systems in their social structure.  Some people have no family and no friends that are able to assist.  Once the individual is no longer able to perform activities of daily living, they have no one on which they can depend.  This can be a difficult time for anyone, but especially for those who see the loss of ability and control as a hopeless void.  Pets can be also difficult in that a place for the senior individual may not take a beloved pet.

Health issues – Compounding all of the issues stated above is the fact that the vast majority of us lose our health in varying degrees as we age.  The normal aging process decreases our eyesight and mobility, and then we can add a multitude of disease processes to further complicate matters.  There are very few people who maintain an optimum health throughout their lives.  With debilitated health comes further dependency.

 

Options

Private duty at home – The best of all worlds is for the person to maintain themselves in their own home. There are varying degrees of private duty help available from a home health aide giving bath assist a few days a week to 24 hour a day skilled nursing care.  Naturally, the more hours, or more skilled the need, the more expensive the care.  There is only insurance coverage for services at home when there is an established medical necessity. (See Home Health below)  For those who can’t afford private help, but own a home, an attractive – looking option is to obtain reverse mortgages to pay for the necessary care for the person so that the individual can remain at home.  This pre-supposes that the individual has enough equity in their home to pay for the care needed for a long enough period of time and, I have been told, can possibly result in people becoming homeless at the end of their days.  See: Reverse Mortgage – Solution or Greater Problem?   with thoughts by Marjorie Bard, Ph.D.   For those who do have the option to stay home but need help, the National Private Duty Association can be a big help in finding out what services are available in your area.  Click here for more information

Home health agencies – For those individuals who have a medical need, there are services that are provided in the home and are covered by insurances.  Right now, Medicare will cover a great many services from nursing care, to physical therapy, speech and occupational therapies.  Home Health Aides are also covered to a limited extent.  Medicare HMO, other HMO, and other insurances cover home health, but to a lesser extent.  Note: These services are also available to those individuals in Independent living facilities (ILF), assisted living facilities (ALF), and can help keep the individual in the facility they have grown accustomed to, rather than having to move to a and skilled nursing facilities (SNF).

Family – This can be a big step for family members to take in another member.  It is important to understand what support is available to assist when caring for the elderly.  Respite care and home health can lighten the burden when a loved one needs a great deal of care. (click here for more information on respite care.) Families can also sometimes be more amenable to taking in the individual’s pet.

Resident facilities:  ILF, ALF and SNF are all variations of what once was commonly called nursing homes.   They differ now in the services rendered and are chosen by the individual based on that person’s needs and abilities.  These facilities have, in many cases, taken the place of the families in caring for the senior individual.  Some of these facilities can also be pet friendly – click here for more information.  Depending on the level of services rendered, the cost for these facilities is usually quite high.  For those of us in dire straits there are agencies and funding available to assist, but choices are limited.  For more of a definition of these long term care centers, click here.

 

How to Decide

How much and what type of care an individual requires will directly depend on that individual’s level of function.

Independent – Those who are independent in all activities will most often not wish to change where they are living.  This is related to the old adage – If it ain’t broke, don’t fix it.  Some people, though, may opt to move in with family or an ILF for the sociability factor.  They are lonely and want company.

Minimal or Temporary Needs – Some people, like those who have been recently discharged from a hospital but are not fully capable of caring for themselves, can benefit from home health agency assistance, an inpatient rehabilitation facility, even a SNF temporarily.  The needs are filled, and very often in this instance covered by insurance to some degree.

Meals and Shopping – there are those individuals who are independent in many aspects of daily life, but who cannot drive or cook, or both.  Private duty help can cover these activities.  For those who can’t afford this help, there are agencies such as Meals on Wheels who can be of assistance. Link: Click here for more information.

Personal Care – Again, based on need and financial issues, some people may choose to remain at home with home health or private care to take care of personal needs such as bathing.  For others, the social aspect of an ALF, where the individual is assisted as needed is attractive.  These facilities have many activities for those who love to interact.  In addition, when the personal care needs are extensive, an ALF may be a good alternative.

Custodial and Secure Care – For people with advanced security and personal care needs, as with dementia or Alzheimer’s disease, an ALF or SNF may be the best option.  It can be a burden to maintain these people safely at home.  For those who do, respite care can help immensely to decrease the toll it takes on the rest of the family.

 Take time to plan

Those who plan ahead will have an advantage in later years over those who don’t.  The best way to have as many options available to you as possible is to make certain that many options will actually be available.  This may sound simplistic, but planning ahead will allow for fewer obstacles in the way of our happy retirement.  Plan financially, socially, and take care of your health for the best chance at life, as that bell does indeed toll.

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