Your Choice for Home Health Care, Therapy, and Hospice

Medicare Part D

It’s October – and the time of year when people 65 years of age and older have the opportunity to review their Medicare Part D plan. If you’re just reaching Medicare age, you might be surprised to find out that traditional Medicare doesn’t cover prescription drugs. As drug costs rose, Congress created a Medicare drug insurance program, called Medicare Part D, which went into effect in 2006.

To take advantage of this program, offered by private insurers, individuals receiving Medicare have to choose a drug plan every year, unless they have a Medicare Advantage plan that includes drug coverage or are covered through a former employer.

Plans vary by state, but most Americans have more than 25 plans to choose from, each offering different premiums, agreements with certain pharmacies and varying coverage amounts for the same drugs. This can make choosing the best plan a challenge.

Plans for 2020 will be revealed October 1 on the Medicare.gov website, and participants have from October 15 to December 7 to choose a plan that will go into effect January 1, 2020. Even if you loved last year’s plan, it’s important you shop around from scratch this year.

To make sure you’re choosing the best Medicare Part D plan for you, start with the medications you take. On the Medicare.gov website, you can enter your medications (including dosages and quantity) and the site will rank the plans by which would be cheapest for you, showing your medication costs on each plan and how much you’ll pay in premiums. You may need to search multiple times since the cost varies by pharmacy and you can compare only two pharmacies at a time.

Once you’ve narrowed your search to a few choices, you also want to check whether there are any restrictions on your medications. Certain plans, for example, may require prior authorization or step-up therapy, where you have to try and fail with one drug before the plan will approve another.

Those fortunate enough not to need any prescription medication may still want to sign up for a basic drug plan because Medicare charges a penalty if you don’t enroll when you’re first eligible. The penalty is based on how long you go without coverage.

Once you choose a plan, you can’t change it until the next open enrollment period unless you meet special circumstances, such as moving to an area where your plan is no longer offered or losing employer-based coverage. If you’re prescribed an expensive drug midyear, you’re stuck and can’t shop around for a new plan until the open enrollment period at the end of the year.

There are other opportunities within the State of Wisconsin when choosing a Medicare D plan. Have you heard of Senior Care or the State Health Insurance Assistance Programs?

YES, this process can be extremely challenging, especially if you are not Internet savvy. Help is available. The Medigap Helpline is a free, confidential counseling service for all Medicare beneficiaries, including disabled individuals and those age 65 and over. The insurance counselors at the Medigap Helpline can help you with questions about various health insurance topics:
• Medicare
• COBRA
• Medicaid
• Medicare Advantage Plans
• Guarantee Issue / Open Enrollment
• Medicare Prescription Drug Coverage (Part D) • Medicare State Health Insurance

Assistance Program (SHIP)
Medigap Helpline Telephone Counseling Service
1-800-242-1060

Medigap Part D and
Prescription Drug Helpline
1-855-67PARTD (1-855-677-2783)

You can reach out to your local ADRC (Aging and Disability Resource Center) for additional assistance.

Kathleen Weston
Director of Hospice

Assessing Home Safety

Question: My parents live in Wisconsin; I live out of state and will be visiting them soon. They have experienced some struggles that resulted in hospitalizations. They are living independently. While I am visiting, what can I look for to be sure they are still safe in their home? How can I offer assistance and share concerns?

Answer: When families live away from one another, vacations and holidays may be your only opportunity to personally observe our parents. Family members who haven’t seen their aging loved ones in a while might be shocked at what they see: A formerly healthy father looking frail, or a mom whose once well-kept home is now in disarray. Absence, even for a short period, allows us to observe a situation through new eyes. The following may indicate the need to take action to ensure your parent’s safety and good health:

Weight Loss: is one of the most obvious signs of ill health. The cause could be an array of health issues or it could be a lack of energy to cook. Certain medications and aging in general can change the way food tastes. If weight loss is a concern, schedule an appointment with the primary doctor.

Balance: Pay close attention to the way your parent moves or walks. Reluctance to walk or pain during movement can be a sign of joint or muscle problems. If they are unsteady on their feet, they may be at risk of falling, which could cause severe injury or worse.

Emotional well-being: You can’t always gauge someone’s spirits over the phone, even if you talk daily. Take note of signs of depression including withdrawal from activities, changes in sleep patterns, loss of interest in hobbies, lack of basic home maintenance or personal hygiene. The latter can be an indicator of not only depression but also dementia or physical ailments including dehydration. If you notice a change in behavior, be sure to seek medical attention.

Home environment: If your parent has been a stickler for neatness, for paying bills promptly, or if you discover excess or unsafe clutter and mail that has piled up, a problem may exist. Keep an eye out for less obvious indicators: scorched cookware could be a sign your parent is forgetting to turn off the stove. An overflowing hamper could mean they don’t have the strength or desire to do laundry. Be sure to check prescription medications and medication bottles for expiration dates. Make a list of medications and place it in their wallet.

Assessing Home Safety
If you notice these problems or others, here are some steps to take:
– Share your concerns through a heart-to-heart conversation with your parents.
– Contact the local aging department and ask about geriatric care management services that can help direct the many issues associated with aging and health care. Learn about in-home services to assist your parent with laundry, meal preparation, transportation, and other tasks.
– Identify local resources that can assist your parents, including friends, neighbors and clergy. Take time to contact those friends and ensure you have their phone numbers and e-email address.
– Compile a list of medical information about your parents’ prescriptions, doctor’s names and phone numbers.
– Obtain access to all your parent(s) vital documents including their will, power of attorney, birth certificate, social security number and insurance policies.

Remember to give your loved one the power and permission to be in control of his or her own life, as much as is reasonable. The more systems you have in place the more your loved one can remain independent and safe in their home.

Kathleen Weston
Director of Hospice Operation

Memory Tips for You and Your Loved Ones

1. Have a special place for important things. EXAMPLE: Always keep your purse and keys in the same place.
2. Write down things you need to get done in a notebook.
3. Cross off things after you do them.
4. Stay in the kitchen when you are cooking so you do not forget about the stove and oven.
5. Use timers to help you remember to take pills or to do things.
6. Write down ideas or information that you want to remember right away, before you forget it.
7. Keep a small notebook and pen in your pocket, purse, and/or tote bag to use when you are not at home.
8. Write down the names of people that you want to recall later.
9. Write down instructions or information doctors, nurses, or therapists tell you.
10. Check your calendar every day for appointments.
11. Check your “to do” list every morning.
12. Do not try to do a lot of things at once. Do big jobs in parts, one step at a time.
13. Stay calm. If you forget something, do not get upset.
14. Plan ahead. Check your schedule for tomorrow.

Stay Positive

My mother was diagnosed with Alzheimer’s dementia when she was in her late 60’s. I am like many adult children who have a parent who was diagnosed with dementia – I wonder at some point if this will be me. At 58 I find myself being very conscious about remembering people’s names and paying close attention to everything said during a conversation. When I can’t remember, I think “oh boy, here it comes.”

I read an article in “Science Daily” titled: Think Memory Worsens with Age? Then Yours Probably Will. A team of researchers from North Carolina University did a research project with older adults. The study showed older adults who think they will perform poorly on memory tests actually scored much worse than seniors who don’t buy into the stereotype about aging and memory loss. What this means is an older adult’s ability to remember suffers when negative stereotypes are “activated” in certain situations.

When older adults were preparing to take a test for their memory they actually performed poorly when they were told in advance ‘they shouldn’t be surprised if the outcome would not be good.’ Memory suffers if older adults feel they are being looked down on because of their age. Unfortunately, this situation might be a part of an older adult’s everyday experience. Being concerned about what others think can have a negative effect not only on test performance but how we live our lives.

The positive side is older adults who felt good about aging and didn’t buy into the stigma of aging performed well on the test. In other words, if you are confident aging will not ruin your memory, you are more likely not only to perform well on a memory-related test, but to live in the same manner.

While there is no guarantee I will not inherit the disease my mother suffered, I can live my life in a positive manner by not letting the stigma of aging interfere with how I live my life. These wellness steps certainly cannot hurt – in fact; they may help quite a bit.

Kathleen Weston
Director of Hospice

STARTING THE CONVERSATION

Have you seen the bumper sticker that reads: “Be nice to your children, they’ll pick your nursing home?” Although this saying might seem funny to our young grandchildren or other family members, it’s not so funny to older adults or caregivers. However, when you notice your parents or loved ones need more help than you ever imagined, you need to know how to start the conversation.

There is a long list of red flags that can tip you off when the time has come to have the conversation. A few of them are as follows: A gradual or sudden change in mood or behavior, a decline in health or increased trips to the doctor or emergency room, not enough food or rotting food in the house, a change in personal appearance or increased confusion.

This is the time to call a family meeting. It is important to have everyone involved with your parents at this meeting. Have an agenda and appoint someone to take notes. Ask questions and find out what others might be concerned about. Their responses might surprise you.

After the meeting, pick a spokesperson to lead the conversation with your parents. Explain it is your responsibility as an adult child to see that they are safe and healthy. Be respectful and explain you’re being realistic while being loving and practical, trying to avoid a crisis.

Talk about your feelings. Look for body language and facial expressions – are you hearing your parents? Are you reading them correctly? Encourage them to share their own feelings. Many older adults feel a loss of independence and are worried about their declining health and the emotional changes they are experiencing. Maybe they don’t want to be a burden to their children or caregiver. Be a good listener and be patient. Do your best to hear what they are saying – and not saying. Expect there might be some negativity in the conversation.

Take small steps. Don’t overwhelm them with too much action at once. Tackle one or two small issues such as helping around the house, gathering their important documents or offering assistance with paying their bills. Allow them to participate in the solution to whatever is going on that causes concern.

Once they accept help, do your homework. Knowing available resources is important. In the past I have stressed the importance of knowing your parent’s doctors and other vital information (Social Security number, life insurance, Medicare, bank accounts, financial investments, power of attorney documents). Start a notebook or file with this information.

You can also get expert advice from a professional geriatric care manager who can help you navigate through the system. Collaborating with a geriatric care manager can save you time and provide you with information, recommendations and serve as an advocate for you and your parents. Geriatric care management is privately paid, but also cost efficient when you think of the decreased stress and anxiety, and time away from work or your own family, while at the same time providing a valuable service to the family.

Kathy Weston
Director of Hospice Operations

The Many Faces of Caregiving

Carol Bradley identifies a caregiver as a person who takes at least some part of the responsibility for the welfare of someone sick, elderly or disabled.

There is not one specific definition of a caregiver, every individual situation is unique. Some caregivers start off by assisting a loved one with their finances, cleaning their house, or helping them get to and from their doctor’s appointments. A caregiver might immediately take over assisting with bathing, getting dressed and going to the bathroom.

A caregiver could live in the same house or reside miles away. Caregivers could be taking care of aging parents, an ailing spouse, or their children and a parent at the same time.

I read an article suggesting there are four main caregiver categories. Each has its own opportunities. Which type of caregiver might you be?

Long-distance Caregiver
These caregivers assist their elderly loved ones – but live in a different city and sometimes a different state. However, just because the caregiver lives far away doesn’t mean they aren’t often responsible for their family member’s finances, medical care and personal needs. One of the most difficult aspects of being a long-distance caregiver is figuring out how to keep an eye on your loved one from far away.

The Sandwich Generation
These caregivers created their own “buzzword” for the type of caregiving they provide. These caregivers are sandwiched between taking care of their younger children, sometimes their grandchildren, and looking out for their own aging parents.

The Spousal Caregiver
The vow, “in sickness and in health” takes on a new meaning when a person finds themselves taking care of a spouse with a serious illness. When a life partner becomes a patient, the caregiver is faced with a host of new situations that could include anything from memory loss to role reversal in the relationship.

The Working Caregiver
The dilemma the working caregiver is faced with is considering if they should quit their job to care for their loved one. We are in an era where adults – both male and female – are in the workforce. In turn, the number of working caregivers is on the rise. The working caregiver is holding down a part-time or full-time job while making sure their loved one is cared for.

There is no cookie-cutter formula for the endless roller-coaster ride that is caregiving. However, Adult/Geriatric Care Management programs are available to provide suggestions and recommendations to all types of caregivers. Care managers become partners with caregivers and their loved ones. These programs can help families manage the many issues associated with aging and healthcare. Your local Aging and Disability Resource center (ADRC) is a great resource to find an Adult/Geriatric Care Management program in your area. To find an Aging and Disability Resource Center (ADRC) in your area click here:

https://www.dhs.wisconsin.gov/adrc/consumer/index.htm

Kathleen Weston
Preceptor Director of Hospice

A Good Fit – Living Wills, Health Care Power of Attorney, and Do Not Resuscitate Orders

Just like peanut butter and jelly or green and gold, living wills and do not resuscitate orders go well together. A living will is a written document that allows you to tell your doctor about the type of life-sustaining treatment you want when you are near death or in a vegetative state. This document is created as part of your advanced directives. A living will reflects your wishes as your health situation changes. By making your wishes known, you are taking responsibility for how you want to be cared for. The State of Wisconsin has a template on their website

http://www.dhs.wisconsin.gov/forms/advdirectives/index.htm

which can be downloaded, printed and reviewed. Once you make your decisions and sign your living will, give a copy to your primary physician, your hospital and your family.

A Healthcare Power of Attorney allows people who become unable to make their own decisions to exercise their beliefs and wishes regarding medical procedures. The person’s agent can communicate on behalf of the sick or injured person, preventing unwanted treatment or making necessary decisions in the event that the individual is unable to do so. The process of denoting a Health Care Power of Attorney is fairly straightforward and the privilege can be revoked at any time by filling out a new form and destroying the old copies of the previous form. The website noted above has the form for Healthcare Power of Attorney. This form can also be downloaded, printed and reviewed. Once you make your decisions, sign the document in front of two people who are not relatives and provide a copy to your primary physician, hospital, and family.

A Do Not Resuscitate order (DNR) is a State of Wisconsin statute that encourages a conversation with your doctor. A DNR is for adults over the age of 18 who either have a terminal illness or a medical condition where CPR would be unsuccessful in restoring your heart or breathing functions. Becoming a DNR is a decision your doctor must agree is appropriate for you based on your health. If your doctor agrees, you and (s)he sign the document and a bracelet is worn identifying you as a DNR. The purpose of wearing the DNR bracelet is to alert medical professionals including EMTs, doctors, nurses, etc. that you are not to be resuscitated if you are no longer breathing, do not have a heartbeat or a pulse. There are different types of bracelets available, a plastic bracelet bearing your personal information and your doctor’s signature or a metal bracelet with your personal information and the international symbol of the Staff of Aesculapius.

If a person has a life threatening event, the DNR bracelet informs a medical provider that they should do the following to help you:
– Clear airways
– Administer oxygen
– Position for comfort
– Splint
– Control bleeding
– Provide pain medication
– Provide emotional support
– Contact hospice or home health agency if either has been involved in the patient’s care, or patient’s attending physician
– Heimlich maneuver or similar procedure used to expel an obstruction from the throat

The DNR bracelet also informs a medical provider if you are not breathing, do not have a pulse or heartbeat, they will not:
– Perform chest compressions
– Insert an airway
– Administer cardiac resuscitation drugs
– Provide ventilator assistance
– Use a defibrillator

Having a DNR in place and wearing the bracelet ensures in an emergency everyone knows your wishes. A living will confirms your wishes about end-of-life care are honored.

We all know conversations about what should be done in an emergency and as your health changes can be difficult. Everyone who cares about you has their opinion. It is a valuable gift you can give to your family when you make your wishes known about the care that is important to you. A good way to ensure your wishes will be honored is by pre-planning with your loved ones and by involving your doctor.

Kathleen Weston
Director of Hospice Operations

How can we help seniors make a successful transition back home?

The day a senior finally gets to return home after a hospital or rehabilitation stay is an exciting time in the recovery process. However, it is also a critical transition that requires advance planning and adequate care assistance once home to avoid readmission and ensure a successful recovery.

As family members, we do everything we can to set our loved ones on a path toward recovery. How can we ensure our loved one’s safety once they return home, and are there costs for these services? Preceptor Home Health can assist and prepare patients and their families for a successful transition home. Home health services are a benefit provided by Medicare and Medicare Advantage plans.

Home health care provides nursing, therapy and other specialized services in the privacy and comfort of your home. The goal is to help you continually improve, manage your illness, and keep you at home – where you most wish to be.

Your Preceptor home health partners include:

  • Our team of nurses who provide health assessments, patient and family education, IV therapy, enteral feedings, catheter or ostomy care, injections, medication management, nutrition teaching, and much more.
  • Our team of rehabilitation professionals helps bring out your best as you recover from illness or injury, or adapt to a chronic condition. Specialty programs include, but are not limited to, wound care, incontinence management and lymphedema treatment. We also have therapists who are certified in the Parkinson’s BIG and LOUD therapy programs.
  • Physical therapists help you improve strength, flexibility, balance, mobility and endurance.
  • Occupational therapists provide one-on-one assistance with daily living tasks and teach adaptations to make life at home a little easier.
  • Speech therapists help with swallowing, communication difficulties and problem-solving.
  • Our social workers will help guide you and your family members in making short- and long-term plans. They also help you connect with resources to meet your needs and goals.
  • Our home health aides provide extra help with personal care and assistance.

Who is eligible for Preceptor Home Health services? Medicare guidelines include individuals who:

  • have a physician’s order for home health services
  • have difficulty leaving their home
  • need skilled nursing services or physical, occupational or speech therapy

If you have questions about Preceptor Home Health services please call Jennifer Wooten at 262-257-9757 (email Jennifer.Wooten@preceptorhhh.com) or Shelly Darmody at 262-257-9804  (email Shelly.Darmody@preceptorhhh.com)

What Hospice is All About

I read an article published in the AARP Office of Academic Affairs (edited by Harry (Rick) Moody) about an experience someone had with hospice.  It is a touching testimony to the power of hospice care:

“This past month saw the passing of one of my oldest and dearest friends, Charles, age 89. During the last weeks of his life, I was directly involved in care-giving, along with others, including the wonderful work of Hospice of Boulder, Colorado.

“Charles was bedbound while we had an unexpected snowstorm, covering the world in white. He looked out his window and said, ‘What a beautiful day to be disabled!’ It reminded me of George Vaillant’s work on lifespan development. He was quoted as saying that successful aging doesn’t depend on health or wealth, but rather on forgiveness and gratitude. Forgiveness and gratitude is what Charles displayed in the last weeks of his life.

“When I visited Charles he wondered why it took so long to die. I replied that maybe it was needed to give time for all the people he had helped in his life to call and visit him to give him thanks. He smiled and said that was a point of view he hadn’t thought.”

These insightful moments might not have been possible without the comfort and support hospice care facilitates. I would like to remind readers hospice is a special health care option for patients and families facing a terminal illness. A team including a doctor, nurses, social worker, chaplain and volunteers works together to address the physical, social, emotional and spiritual needs of each patient and family. Hospice is not about giving up hope or waiting to die; it is about living and experiencing comfort.

Preceptor Hospice can help you live your life to the fullest by providing care and compassion to help you and your family with the many questions and concerns that come at end-of-life. Hospice is an experience of care and support, different from any other type of care.

If you have questions about hospice, please email me at Kathleen.Weston@preceptorhhh.com or call me at 262-257-9824.

Kathy Weston

Preceptor Health Care

Director of Hospice Operations

Is Humor and Laughter Really the “Best Medicine?”

Humor is infectious. How many times have you been in a conversation, someone begins to laugh and you start laughing yourself? How many times have you heard a group of people laughing and a smile came to your face? When laughter is shared, it brings people closer and increases happiness. Studies have shown laughter triggers healthy physical changes in the body. Laughter and humor can strengthen your immune system, boost your energy, lessen pain and protect you from the damaging effects of stress.

According to Paul McGee, PhD, laughter is a powerful antidote to stress, pain and conflict. Nothing works better or is more reliable to bring your mind and body back into balance than a good laugh. Humor lightens your load, inspires hope, connects you to others and keeps you grounded, focused and alert. According to Dr. McGee, “Your sense of humor is one of the most powerful tools you have to make certain your daily mood and emotional state support good health.”

There are also social benefits to laughter and humor. Lively communication can strengthen a relationship by triggering positive feelings and connecting you with someone on an emotional level. When we share laughter with someone special it is one of the most effective tools for keeping relationships fresh and special. Laughter makes us feel good, and the feeling you get when you laugh remains with you – even after the laughter subsides.

More than just a break from feeling sadness, laughter gives you the courage and strength to find new sources of meaning and hope. Even when times are difficult, a laugh or a simple smile can go a long way toward making you feel better. Laughter is contagious.

As laughter, humor and play become an integrated part of your life, your creativity will bloom and you may discover involvement with friends, loved ones and acquaintances will happen almost every day. Humor takes you to a place where you can see the world from a more relaxed, positive, creative, joyful and balanced perspective. Maybe the saying “laughter is the best medicine” holds true. Until next time…live, love and laugh,

Kathy Weston
Preceptor Health Care
Director of Hospice Operations