I support President Obama ‘s new health care plan and I want you to know why The aging family has a great investment in getting health care reformed. Even though all older people over 65 are on Medicare , most caregivers, except for elderly spouses , are generally in their 40’ and 50’s. These already overwhelmed caregivers are served by the wrecked health care system President Obama is trying to fix.
When insurance companies ( the prime villains ) deny coverage, increase cost of policies or won’t renew, they leave the care provider unable to take care of their own health. This crazy broken system often pushes care providers of older people over the cliff and forces them to needlessly place loved ones into a higher level of care .
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Here’s my story. I worked for a very large company and left taking Cobra with me when I was in my early 60’s. So I had health care coverage for 18 months through COBRA. At the same time, as you can see in the years of my blogs, I was caring for my aging father , who was in his eighties. He had lived with us for twenty years and was beginning to make a steep decline. In the last year I had help through the VA but it was not 24 hour care.
At the end of the 18 months of COBRA I applied for insurance through the same carrier my company had used. They turned me down flat because I had a pre-existing condition. I was left with no health insurance yet caring for a father who was increasing frail and ill. .My only alternative was a program through the state of California which cost $1200 a month.
I cared for my Dad until the spring before he died with no insurance coverage. At one point, I had walking pneumonia and had to pay out of pocket for treatment. I was so overwhelmed by the care , the illness and stress , I slid over that cliff. On one wrenching afternoon I really considered placing him in a SNF, although I had vowed to him and my mother in heaven I would never do that. I was saved by the VA, who approved care at home. Ironically my Dad was spared sinking into a nursing home because he had spent WW II in Stalag 17 and had a lifetime of PTSD.So the VA’s superb services, the great single payor US heath care system, let him die at home.
But in spite of the hand that pulled me off the edge, my husband and I were still on duty 20 hours a day and I was still ill and I still had had no insurance.
That what’s our fractured American health cares system did to me.
There are 44 million care providers out there like myself , unpaid, untrained and unsupported. They represent 78% of our nations long term care system The fatal straw that breaks the caregivers back can be no health care insurance . Sick people make bad caregivers . Yet caregivers are the worn hands that hold that fragile line , shore up the economic safely net that saves the American economy billions of bucks . The value of informal caregiving is estimated to be $200 billion a year
Informal caregiving exceeds home care expenses by 81 billion.
The economic value of informal unpaid caregiving in the United States equals about 20% of our national health care expenditures .The United States looses these savings if unpaid caregivers with no health insurance go under. It is a big economic reality.
So if you are a caregiver or in an aging family , contact your legislator and tell him or her you and 44 million other American caregivers need help We need reformed national health care because everyone, especially the aging family will go off the cliff without it.
Thursday, July 23, 2009
Monday, July 20, 2009
Avoid Hospital Readmissions - Hire a Geriatric Care Manager
If you are an adult child and your hair is on fire because you can’t do it all, here is a great tip. For weeks my blog has given readers tools to stop your sick, aging hospitalized relative from bouncing back to that hospital nanoseconds after discharge. Here’s the new solution: hire a professional to do the job for you. That magical professional is called a geriatric care manager.
President Obama's proposed health care plan may wield a knife to do some needed cost cutting on Medicare. Those pared pieces may include fines on hospitals where patients are rushed back to the ER, sirens wailing, soon after they arrived home. One in five Medicare patients returns to the hospital within one month of being discharged.
If a Medicare recipient is readmitted in 30 days, hospitals risk big penalties under Obama’s proposed new health care legislation. But the hospital will not be the only ones in pain. Aging families and older people suffer miserably when their relatives are needlessly readmitted .
Unnecessary readmission sometimes indicates the hospital did not prepare the family caregivers to minister to the older person’s needs, post discharge.
Adult children can help prevent that quick readmission. But it takes a heavy load, as I have painted in my blogs for weeks. This backbreaking task includes sometimes flying in with no notice, being with the older parent throughout the hospitalization and living on junk food from the hospital vending machines, getting the critical medication list before discharge , making sure you have complete discharge summary. Then you must, at the same time find all the community services that can help that older person stay at home by following those discharge orders.
If you say to yourself, how can I do all this-- here is great solution: Hire a geriatric care manager. Geriatric care managers are experts at navigating a hurricane warped continuum of care like hospitals and aging community services. They can be your surrogate, getting an older relative into the hospital through the hospital ,out of the hospital and back home safely, without a nightmare return trip back to the swamped emergency room..
GCM’s know the local hospitals and can work with the medical staff to get the best care for your relative while in the sickbay. They can make sure at the dangerous discharge intersection, you don’t make the wrong turn. GCM’s will get that med list and discharge summaries and literally take the patient home.They can help you hire a good and cost effective home care agency or help to train relatives, friends or extended family, to care for the older person.
The GCM can pinpoint all the local agencies needed to support the patient in the home like Meals on Wheels, senior transportation, Friendly Visitors . They can check that Medicare based services show up after discharge and are following the physicians care plan . They can coordinate Medicare based agencies and private pay home health care to be your team to keep the older person safe and sound in their own home.
Geriatric care managers can act like a GPS through the system. They navigate you and your aging family through the clogged, treacherous roads traversing the hospital, onto the dangerous intersection of hospital to home and the through those super critical first 30 days of recovering in their own residence. They will keep your older loved one where Dorothy and L. Frank Baum have been telling us we want to be for 80 years - home sweet home.
Don’t be swept up by a tornado. Call a geriatric care manager today - just enter your zip code.
President Obama's proposed health care plan may wield a knife to do some needed cost cutting on Medicare. Those pared pieces may include fines on hospitals where patients are rushed back to the ER, sirens wailing, soon after they arrived home. One in five Medicare patients returns to the hospital within one month of being discharged.
If a Medicare recipient is readmitted in 30 days, hospitals risk big penalties under Obama’s proposed new health care legislation. But the hospital will not be the only ones in pain. Aging families and older people suffer miserably when their relatives are needlessly readmitted .
Unnecessary readmission sometimes indicates the hospital did not prepare the family caregivers to minister to the older person’s needs, post discharge.
Adult children can help prevent that quick readmission. But it takes a heavy load, as I have painted in my blogs for weeks. This backbreaking task includes sometimes flying in with no notice, being with the older parent throughout the hospitalization and living on junk food from the hospital vending machines, getting the critical medication list before discharge , making sure you have complete discharge summary. Then you must, at the same time find all the community services that can help that older person stay at home by following those discharge orders.
If you say to yourself, how can I do all this-- here is great solution: Hire a geriatric care manager. Geriatric care managers are experts at navigating a hurricane warped continuum of care like hospitals and aging community services. They can be your surrogate, getting an older relative into the hospital through the hospital ,out of the hospital and back home safely, without a nightmare return trip back to the swamped emergency room..
GCM’s know the local hospitals and can work with the medical staff to get the best care for your relative while in the sickbay. They can make sure at the dangerous discharge intersection, you don’t make the wrong turn. GCM’s will get that med list and discharge summaries and literally take the patient home.They can help you hire a good and cost effective home care agency or help to train relatives, friends or extended family, to care for the older person.
The GCM can pinpoint all the local agencies needed to support the patient in the home like Meals on Wheels, senior transportation, Friendly Visitors . They can check that Medicare based services show up after discharge and are following the physicians care plan . They can coordinate Medicare based agencies and private pay home health care to be your team to keep the older person safe and sound in their own home.
Geriatric care managers can act like a GPS through the system. They navigate you and your aging family through the clogged, treacherous roads traversing the hospital, onto the dangerous intersection of hospital to home and the through those super critical first 30 days of recovering in their own residence. They will keep your older loved one where Dorothy and L. Frank Baum have been telling us we want to be for 80 years - home sweet home.
Don’t be swept up by a tornado. Call a geriatric care manager today - just enter your zip code.
Sunday, July 12, 2009
Personal Health Care Records (PHR) Products to help avoid an ambulance ride back to the hospital
Personal Health Care Records (PHR) can be a powerful tool for families who have an older member in the hospital. This is especially true at discharge.
What are PHR? Quite simply it’s just a way keeping track of information. The tracking can be as simple as a notebook or as high tech as one of the 150 PHC’s products available online like Lifeledger.
There are about 100-200 PHR on the market right now, so you have a wide range of choices. Just Google personal health care records and you will find many products, including Google’s own version.
What’s in a personal health care record maintained via computer? Most web based PHR contain data. The product information can vary but in general they include:
Identification Sheet – This may be a listing of the older family members demographic information: name, address, telephone number, insurance, and policy number.
Problem List – A list of significant illnesses and operations older family member has had.
Medication Record - A list of medicines currently prescribed to the older family member, as well as medication allergies.
History and Physical – A list of any major illnesses and surgeries the older family member has had and what the physician found when older person went to each doctor’s appointment.
Progress Notes – Notes made by the family caregiver who accompanied the older person to the medical appointment, including observations and treatment plans made by doctors, nurses, therapists, or social workers.
Consultation – An opinion about your older family member’s condition made by a physician other than older person’s primary care physician.
Physician's Orders – The older family members physician's directions to other members of the health care team regarding medications, tests, diets, and treatments.
Imaging and X-ray Reports – Findings of x-rays, mammograms, ultrasounds, and scans.
Lab Reports – Results of tests conducted on body fluids. Common examples include a throat culture, urinalysis, cholesterol level, and complete blood count (CBC).
Consent and Authorization Forms – Copies of consents for admission, treatment, surgery, and release of information.
Discharge Summary – A concise summary of a hospital stay, including the reason for admission, significant findings from tests, procedures performed, therapies provided, response to treatment, condition at discharge, and instructions for medications, activity, diet, and follow-up care.
All of these facets of the PHR are important at discharge but some are more useful.
One big help at discharge is the Progress Notes section. While the family members meet with discharge planners, physicians or training staff , like physical therapists, they can input the directions. Creating your own Cliff Notes, this allows caregivers to better recall all the critical directions being chucked at them.
The “Discharge Summary” element of PHR is a powerful tool for adult children and others .It allows you to keep a succinct summary of what you have to do as a family caregiver to safely keep the older person at home and not headed back to the ER. If you are given a discharge summary you can just scan it into the PHR .
Medication records- another great part of a PHR products The family caregiver can add all the new meds at discharge or just scan them in if the physician or discharge planner give you a hard copy. A giant portion of re-admissions come from patients and their families not taking or administering meds properly after discharge .
Make discharge safe for your older family member and not a treacherous a loop back to the hospital. Look into something as simple as a notebook and pen or as high tech as a web tool such as a PHR. Information is an electric power tool for the aging family, especially one making the dangerous transition from hospital to home .
What are PHR? Quite simply it’s just a way keeping track of information. The tracking can be as simple as a notebook or as high tech as one of the 150 PHC’s products available online like Lifeledger.
There are about 100-200 PHR on the market right now, so you have a wide range of choices. Just Google personal health care records and you will find many products, including Google’s own version.
What’s in a personal health care record maintained via computer? Most web based PHR contain data. The product information can vary but in general they include:
Identification Sheet – This may be a listing of the older family members demographic information: name, address, telephone number, insurance, and policy number.
Problem List – A list of significant illnesses and operations older family member has had.
Medication Record - A list of medicines currently prescribed to the older family member, as well as medication allergies.
History and Physical – A list of any major illnesses and surgeries the older family member has had and what the physician found when older person went to each doctor’s appointment.
Progress Notes – Notes made by the family caregiver who accompanied the older person to the medical appointment, including observations and treatment plans made by doctors, nurses, therapists, or social workers.
Consultation – An opinion about your older family member’s condition made by a physician other than older person’s primary care physician.
Physician's Orders – The older family members physician's directions to other members of the health care team regarding medications, tests, diets, and treatments.
Imaging and X-ray Reports – Findings of x-rays, mammograms, ultrasounds, and scans.
Lab Reports – Results of tests conducted on body fluids. Common examples include a throat culture, urinalysis, cholesterol level, and complete blood count (CBC).
Consent and Authorization Forms – Copies of consents for admission, treatment, surgery, and release of information.
Discharge Summary – A concise summary of a hospital stay, including the reason for admission, significant findings from tests, procedures performed, therapies provided, response to treatment, condition at discharge, and instructions for medications, activity, diet, and follow-up care.
All of these facets of the PHR are important at discharge but some are more useful.
One big help at discharge is the Progress Notes section. While the family members meet with discharge planners, physicians or training staff , like physical therapists, they can input the directions. Creating your own Cliff Notes, this allows caregivers to better recall all the critical directions being chucked at them.
The “Discharge Summary” element of PHR is a powerful tool for adult children and others .It allows you to keep a succinct summary of what you have to do as a family caregiver to safely keep the older person at home and not headed back to the ER. If you are given a discharge summary you can just scan it into the PHR .
Medication records- another great part of a PHR products The family caregiver can add all the new meds at discharge or just scan them in if the physician or discharge planner give you a hard copy. A giant portion of re-admissions come from patients and their families not taking or administering meds properly after discharge .
Make discharge safe for your older family member and not a treacherous a loop back to the hospital. Look into something as simple as a notebook and pen or as high tech as a web tool such as a PHR. Information is an electric power tool for the aging family, especially one making the dangerous transition from hospital to home .
Saturday, July 11, 2009
Care provider tools to insure a safe discharge for family members on Medicare
On Wednesday, July 8th I spoke at the San Francisco Bay area joint CMSA/ GCM meeting about care manager’s role in discharge planning .See my website for details.
When going home from the hospital, there are some tools that might help family caregiver’s insure a safe discharge . Here is a National Transitions of Care Coalitions NTOCC website that has these great tools.
At discharge, your physician or the discharge planner should give you a list of the medicines your elderly family member is taking . This inventory should include dosage , name, what you take the medication for and any special instructions.
If by chance you don’t get this list of drugs, you can use a tool on the NTOCC web site called My Medicine List, to help ask the discharge planner or physician questions to gather the needed information about your older family members medications at discharge. .
Another tool help to aging families on the same NTOCC site is Taking Care of My Health Care. In my June 29th blog , I suggested that the family of a discharged elderly patient should make sure they ask the physician or discharge planner for the discharge plan before their elderly relative goes home.
Taking Care of my Health Care gives an automatic reminder to ask for that discharge plan . It also prompts the family caregiver to ask when the discharged patient will see the next provider and who that next provider will be. It includes at reminder to ask , besides taking your medicines , what else do you have to do post hospitalization. This is a great cheat sheet when an older person begins to be discharged so you are sure they are coming home with the right information to be able to stay at home- not frantically circle back into the hospital.
A last terrific tool put out by Medicare is Planning For Your Discharge: A checklist for patients and caregivers preparing to leave a hospital setting. It is great booklet prompting families , caregivers and discharging older patients to see what needs to be done to get to home and stay there and who will do what when. Check it out.
When going home from the hospital, there are some tools that might help family caregiver’s insure a safe discharge . Here is a National Transitions of Care Coalitions NTOCC website that has these great tools.
At discharge, your physician or the discharge planner should give you a list of the medicines your elderly family member is taking . This inventory should include dosage , name, what you take the medication for and any special instructions.
If by chance you don’t get this list of drugs, you can use a tool on the NTOCC web site called My Medicine List, to help ask the discharge planner or physician questions to gather the needed information about your older family members medications at discharge. .
Another tool help to aging families on the same NTOCC site is Taking Care of My Health Care. In my June 29th blog , I suggested that the family of a discharged elderly patient should make sure they ask the physician or discharge planner for the discharge plan before their elderly relative goes home.
Taking Care of my Health Care gives an automatic reminder to ask for that discharge plan . It also prompts the family caregiver to ask when the discharged patient will see the next provider and who that next provider will be. It includes at reminder to ask , besides taking your medicines , what else do you have to do post hospitalization. This is a great cheat sheet when an older person begins to be discharged so you are sure they are coming home with the right information to be able to stay at home- not frantically circle back into the hospital.
A last terrific tool put out by Medicare is Planning For Your Discharge: A checklist for patients and caregivers preparing to leave a hospital setting. It is great booklet prompting families , caregivers and discharging older patients to see what needs to be done to get to home and stay there and who will do what when. Check it out.
Monday, July 6, 2009
Health Literacy -Training of Family Caregiver's Can Avoid Return to Hospital
If an elderly relative is in the hospital and you expect to be a family caregiver post discharge , get the hospital to step up to the plate and train you or other family caregivers. As I have said in other blogs, family caregivers are kin, not medical professionals. You often need training to carry out the caregiver tasks you will be asked to do when your relative gets out of the hospital.
Health literacy is a big-ticket item for caregivers. When you learned to drive, it was great to have driver’s ed. Now you need health ed. To maneuver the gridlocked health highways, you need health literacy . In fact, when your relative is discharged from a hospital you may have to run machines like Hoyer lifts or oxygen tanks. So operating baffling machinery fits right in to the health literacy you need to be a family caregiver.
Health literacy for family caregivers may be critical to keeping the older person safe at home and not packed into an ambulance back to the ER . I mentioned in my last blog, you should contact local senior resource agencies for help, through your area agency on aging. They not only offer a slew of services like food delivery and paratransist but some offer training of caregivers.
For example ,if your loved one was hospitalized for stroke or heart problem , contacting the local chapter of the American Heart Association can often get you post discharge support and training . Some communities have stroke centers.
The hospital itself should be training you as a family caregiver. As kin, you should check with the older person’s physician, RN , medical social worker or the discharge planner to find out if the physician has ordered physical therapy or occupational therapy to train family caregivers . If they have not and you need it , advocate for yourself and request the physician write the order.
Physical therapists can train family caregivers in transfer safety, use of assistive devices ( canes wheelchairs etc. ) ambulation , use of medical equipment and many other caregiver tasks.
This health education is not just for the patient but for the family caregiver’s safety. Family caregivers can severely injure themselves while caring for an older family member . Rather than hurt your back, ask the physician to help you get trained in the hospital before the older person comes home.
Family members are often ignored in the hospital yet asked to play a major part in the care at home. Make yourself heard by the physician and hospital staff before you needlessly injure yourself and /or your family member- putting them back in the hospital again.
Health literacy is a big-ticket item for caregivers. When you learned to drive, it was great to have driver’s ed. Now you need health ed. To maneuver the gridlocked health highways, you need health literacy . In fact, when your relative is discharged from a hospital you may have to run machines like Hoyer lifts or oxygen tanks. So operating baffling machinery fits right in to the health literacy you need to be a family caregiver.
Health literacy for family caregivers may be critical to keeping the older person safe at home and not packed into an ambulance back to the ER . I mentioned in my last blog, you should contact local senior resource agencies for help, through your area agency on aging. They not only offer a slew of services like food delivery and paratransist but some offer training of caregivers.
For example ,if your loved one was hospitalized for stroke or heart problem , contacting the local chapter of the American Heart Association can often get you post discharge support and training . Some communities have stroke centers.
The hospital itself should be training you as a family caregiver. As kin, you should check with the older person’s physician, RN , medical social worker or the discharge planner to find out if the physician has ordered physical therapy or occupational therapy to train family caregivers . If they have not and you need it , advocate for yourself and request the physician write the order.
Physical therapists can train family caregivers in transfer safety, use of assistive devices ( canes wheelchairs etc. ) ambulation , use of medical equipment and many other caregiver tasks.
This health education is not just for the patient but for the family caregiver’s safety. Family caregivers can severely injure themselves while caring for an older family member . Rather than hurt your back, ask the physician to help you get trained in the hospital before the older person comes home.
Family members are often ignored in the hospital yet asked to play a major part in the care at home. Make yourself heard by the physician and hospital staff before you needlessly injure yourself and /or your family member- putting them back in the hospital again.
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