Mom and Bill’s long-distance move from Florida to Chicago taught me numerous invaluable family-caregiving lessons which I wrote about in twenty-four blogs. I’d like to share with you the highlights of what I learned in the hopes that you can bypass some of the unexpected twists and turns of the aging parent relocation process.

• Don’t be surprised if you feel overwhelmingly helpless in the long-distance moving process from time to time. These feelings will pass as you slowly progress through each of the moving-related tasks.

• If one of your parents has a medical emergency and lands in the hospital, contact the hospital discharge planner first thing. It’s never too early to begin the process of planning for a patient’s exit strategy from the hospital. The question then becomes, where will the ailing parent live in the interim if he/she requires extended care?

• The hospital discharge planner should always be treated with as much respect as one would treat the doctor and nursing staff. Never raise your voice or speak to them in anger. Discharge planners follow doctor’s orders and comply with Medicare regulations. They are messengers of information family members often don’t want to hear when it comes to discharging patients. Family members are rarely prepared for a patient’s discharge, and often take it out on the hospital discharge planner.  So here’s a word of warning. Be VERY, VERY nice to the discharge planner because he or she holds the cards as to what happens next to your loved one.

• If one or both of your parents get sick during the move, are you aware of what Medicare does and does not pay for, and under what conditions?

• As you go through the various stages of a long-distance move, you’ll most likely be putting out emergency fires along the way. Resist the temptation to multi-task. Solve one major problem as it arises; then move on to the next.

• Do you have a reluctant parent in the move process? Is he or she up planning an “escape” of some kind? Pay close attention to the parent who does not want to move and ask him or her if there is anything you can do to make the process a little easier. Validating his/her difficulties is important.

• Very often there’s no need to stick around after the house is put on the market (especially if your parents’ health is failing). See if your real estate agent can help convince parents that it’s OK for them to move before the house sells.

Welcome to the September 1, 2010 edition of  the  EldercareABC  Blog Carnival.

The Caregiver Next Door – NYTimes.com

She and Fred won’t show up on any government or academic survey of caregiving. I doubt they’d even think the phrase applies to them. Yet I personally think she’s keeping a half-dozen people out of assisted living or nursing homes, …

Come walk with me in Alzheimer’s Association Memory Walk …

This Memory Walk can be about more than raising money for the association. It’s a way to show support for the role of caregiving, to show that the burden of this disease goes beyond its effects on the person with the diagnosis. …

Alzheimer’s Caregiving Avoiding the Urinary Tract Infection (Part …

Here are a few tips/tricks that may help you avoid the dreaded UTI — Urinary Tract Infection….. By Carole B. Larkin Alzheimer’s Reading Room First, I am not a doctor, nor am I a nurse. I am an experienced Geriatric Care Manager and a …

Sandra Haymon, Ph.D., Caregiver Guru for the Caregiver Generation …

In Dr. Haymon’s book “Baby Boomers–Sandwiched Between Retirement & Caregiving” Dr. Haymon includes her experiences as well as the experiences of hundreds of other caregivers as well as the latest research. …

The Geriatric Model Of The Future Is Home Care — HealthyLifeTips.org

As you can see, the senior care paradigm of the future extends far beyond home care, but many of these emerging products and services will support an elderly population who prefers freedom, enhancing their ability to live more …

We’ve all been raised to be polite, and never discuss the subject of money with our parents. Instead, we wonder, worry and wait. How will they pay for in-home care? How much of my own money am I expected to spend if they need help?

Sticker Shock

While parent-care expenses vary significantly by region, few people are prepared to pay the steep prices associated with living a long life:

• In-home care averages $150 a day.
• Assisted-living can run $6,000 a month.
• Home remodeling can run thousands of dollars for outdoor ramps and adjusting counter heights and door widths.
• Transportation vans when driving is no longer an option can run up a hefty tab
• And what about special diets, hearing aids, and dental care?

Importantly, Medicare, the federal health insurance plan for people over 65 years of age does not cover the care and assistance many people require as they age.   The possibility of shelling out thousands of dollars to cover parents’ expenses may be closer to reality than we’d like to admit.

Broach the “Big Talk”

Talking to parents about remaining fiscally fit starts now – before a financial crisis comes raining down on everybody.  Ask them leading questions to alert you of potential problems:

Do you have a plan in place to pay for long-term care?

Have you given any thought to seeking professional financial advice?

I found a helpful article on paying for long-term care. May I send you a copy?

Seize the moment. Any conversation they initiate regarding money is an opportunity to ask more questions. For example, you might say, “Yes, the cost of groceries sure has me on a pretty tight budget. How about you?” Or, “How can anyone afford a new roof these days?” Speaking in terms of questions, rather than statements creates a non-threatening communication environment.

Resist the temptation to “take over.” If Mom and Dad refuse to engage in a conversation with you about finances, change the subject and bring it up again in a week or two.  Keep in mind they have probably given this subject more thought than you realize.

Medicare has changed some of its wording and makes reading a little more confusing as to what will actually be applied to your out-of-pocket expenses while in the donut hole.

The Agreement

As we have been told the pharmaceutical companies have agreed to invest $18 billion towards Part D prescription drug costs for beneficiaries who fall into the Coverage Gap.  It has been agreed that they will contribute 50% of the agreed upon price and the beneficiary will pay 50% all starting in 2011.

The Concern

But a recent comment about how much would actually be applied to a beneficiary’s out-of-pocket expense had some good points.  The way things are written sounds like only the 50% copayment by the beneficiary would be applied to the out-of-pocket expense, and reaching catastrophic coverage could take much longer giving little value to the 50% discount.

The Good News

I have written before about Q1Medicare and what a great resource for Medicare Part D information.  So I asked Q1Medicare the question and they came back and told me that both contributions (1) 50% from the Pharmaceutical Company and (2) 50% from you, the beneficiary, would be applied towards the total out-of-pocket costs through the coverage gap.

What this means is if you have a prescription drug that costs $400 per month at the agreed upon price, 50% or $200 will be paid by the pharmaceutical company and 50% or $200 by the beneficiary, but $400 will count towards your total out-of-pocket expense.

Who is Eligible?

You are eligible if you have a Part D stand alone plan or a Part D plan through Medicare Advantage and you are NOT receiving any type of Low Income Subsidy (LIS). Sometimes you are referred to as a non-LIS Beneficiary.

A word of caution: In order for the “brand” name drug to be included, the pharmaceutical manufacturer must sign an agreement with Medicare.  If there is no agreement for a particular drug, then it is NOT entitled to the 50% discount.

I am sure Medicare will start posting those drugs that will be part of the Coverage Gap as the agreements are received.

Beginning October 1, 2010 Medicare Part D Prescription Drug plan Marketing Activities can begin.  This is the time you want to start getting your information together to compare other plans.

In the Research Triangle area of North Carolina, more and more elderly citizens are choosing to “age in place” by hiring providers of home care. Durham NC residents have much available to them in the way of geriatric health and living services. From the run of the mill nursing facility to luxury retirement communities – seniors have a number of lifestyle options by the time they reach the latter years of their life and determine that they’re in need of more care than they themselves, or their loved ones, can provide.

Senior care, Clayton NC to Clayton MO, is not just another small, specialized area of health care – it is an expansive and lucrative business that is rapidly growing into a colossal industry as the Baby Boom generation continues to age, demanding a whole new slew of services – and lots of them. As the population of senior citizens here in North Carolina and across the nation skyrockets, the number of seniors using home care is expected to double – likely by the year 2030. Medical professionals, social workers, advocates for the elderly – not to mention the senior citizens themselves, are quickly discovering they’re more comfortable being cared for in their homes than relocating.

Home care services can be chosen based on the needs of the patient. Depending on where you live and what you have available, you can find round-the-clock care providers or nurses to come in just a few hours of the day, on all or just certain days of the week. You can have special needs tended to as long as you have hired an agency that can dispatch medically trained caregivers. And if you’re a cancer patient, an Alzheimer’s patient, or you’re on dialysis, for instance, you can find someone to come into your home to care for you and who has specialized training and experience with some or all of your unique medical conditions.

For sick and aging citizens who don’t require health-driven home care, there are plenty of providers that offer basic care services at the patient’s home. Lots of folks just need someone to help with things around the house and maybe run a few errands. Maybe your eyesight isn’t what it used to be and you’re no longer comfortable driving but sharp as a tack and still capable of performing most normal daily tasks. This is a scenario where a provider of home care, Clayton NC or wherever you live, would really work.

Major life decisions deserve a lot of consideration, particularly if they are costly and long-term. When, either alone or with their loved ones, seniors make the choice to age in place, it’s crucial that a great deal of thought is put into the hired caregiver. Choose a home care provider in the Durham area that is reputable, well-established and that just feels right to you. Conduct thorough interviews and ask to see credentials for both the agency and the caregiver. This may be the biggest decision you’ll ever make.

Written by Jenny Heart. Quality home care Durham: Receive home care Clayton, Alzheimer’s and elder care through senior care Clayton NC, Raleigh, Cary, Wake Forest.

Imagine the plight of the busy career person struggling for success in the business world, while trying to effectively balance the responsibility of school-age children on the one hand, and in home senior care for elderly or housebound relatives on the other.

Child care has become almost a natural part of the working world and there are many facilities developing to provide a safe, supervised environment for children of all ages. In fact, many companies are providing child – care facilities or other assistance as an employee benefit. That is one of the great progressive achievements of our generation.

Unfortunately, less has been accomplished in providing in home senior care for the elderly, and the burden which this can become for a working family member is awesome. In home senior care can be a serious handicap to an otherwise productive employee, and often results in absenteeism, frequent phone calls and poor productivity for the employee who is constantly concerned and distracted by the needs of the elderly relative.

If the older family member resides in another area of the country, the problem for the employee becomes even more complex.

In home senior care for the sick and elderly has now become commonplace, and many organizations offer nursing care, therapy of various types, and other Medical Services. Few of the visiting practitioners can take the time to fill other needs of their patients.

Caring for my own senior family members made me see how critical some of these other needs can be, and how important a few simple services can be to a lonely, often housebound individual. Active, younger members of society do not usually realize how difficult basic activities can be for an older person.

A trip to the doctor’s office, to church, to the grocery store, can be a traumatic problem for the elderly. A leisurely drive in the country is often out of the question. Lunch in a restaurant is probably a fond but distant memory, as is an outing to the shop or taking in a movie or a ballgame on a sunny afternoon.

Such little things we take for granted can make a huge difference in the life of a lonely person, and in home senior care can provide this.

And, even more basic, elderly people living alone often do not eat right, have poor personal hygiene, and are not as careful as they should be about Home Security and safety. Many need help in performing simple household tasks for themselves.

We believe that older Americans who choose to live alone in their own homes are the most forgotten segment of our society, and those most in need of our attention and our compassion.

In a time when most households have to working members, there’s simply no one with the time to provide the level of in home senior care for the elderly that has always been an American tradition.

Our older Americans deserve more. After all, soon enough we will be among them.

Becci Bookner is no stranger to setting the standards in care. In 1993 she founded her first successful service company that addresses the needs of seniors. Becci’s latest book is Patterns of the Heart, Gentle Thoughts on Aging, which was published in 2007. Her website is http://www.familystaffing.com

What is Medical Nutrition Therapy?

Medical Nutrition Therapy includes nutrition, therapeutic, and counseling services.  The intention is to help you learn to eat right along with medication management.

Medical Nutrition Therapy is NOT diabetes self-management training and education although the two services appear to be somewhat similar. If you have diabetes you might be required to take Diabetes Self-Management Training first, before Medicare will approve MNT.

Because these are different benefits under Medicare, you would be required to have a referral/prescription for both services.

Do You Qualify?

If you have a chronic kidney disease (not on dialysis) or you are diabetic Medicare will cover this under Part B Outpatient Services.  You must have a doctor’s referral/prescription.  Medicare will cover 80% of the charges.

What is Covered?

• An initial assessment of nutrition and lifestyle assessment
• Nutrition counseling
• Information regarding managing lifestyle factors that affect diet
• Follow-up visits to monitor progress managing diet

During your first year, Medicare will cover up to 3 hours of one-on-one counseling services. MNT services are also given in a group class.  Medicare might require you to take a group class or require more information from your referring physician for one-on-one counseling.  Check with the service provider to make sure Medicare will allow the service.

For your second year and each year after that, Medicare will cover 2 hours each year up to a total of 8 hours.  Medicare also requires a yearly prescription for these services for them to renew.

Who Provides MNT Services?

• Only a registered dietitian or nutrition professional
• The registered dietitian/nutrition professional must be enrolled as a provider in the Medicare program

How To Find A Provider in Your Area

Generally your physician has a referral for you. But if you would prefer to find one on your own, go to www.medicare.gov and do a provider search.

On the Medicare Site, click on the Resource Locator in the green area of the page

• Click on Doctors
• This will bring you to the Healthcare Provider Directory
• Select Other
• Click on Select a Professional
• Select  Nutrition Services

Whatever you do, verify you are covered for the service your physician has prescribed for you.

Don’t assume Medicare will cover the service. If they deny the service you will be responsible to pay the charges.

Mom and Bill’s long-distance move from Florida to Chicago taught me numerous invaluable family-caregiving lessons which I wrote about in twenty-four blogs. I’d like to share with you the highlights of what I learned in the hopes that you can bypass some of the unexpected twists and turns of the aging parent relocation process.

• Packing up your parents’ belongings is only half the task. Make a plan ahead of time regarding who will unpack once the movers and boxes arrive at the new location.

• Don’t underestimate your emotional response to packing and unpacking your parents’ belongings. The grieving process has begun.

• The moving process offers abundant opportunities to capture precious present-day memories. Stay awake to the possibilities, step back and take it all in. These are the good old days.

• Delegate. Delegate. Delegate. Ask for and accept help.

• Keep your parents in control of as many decisions as possible. This keeps the trust level high.

• Even in the moving process there are opportunities for our parents to parent us. What can they teach us today?

• Selling a house among other financial transactions can get quite complicated in a later-life marriage, especially when adult children from both marriages are included in the mix. If parents own the house jointly, decide if one check or two checks should be issued at closing. Talk to an elder law attorney.

• If you have a full-time job in addition to managing the move of your parents, accept up front that you will probably use vacation days to complete the task or forfeit a vacation altogether until the move process is completed and the bulk of the boxes are unpacked.

• If your parents have a new apartment or house to furnish, consider shopping at the following lower-prices retail outlets: Costco, Ashley Furniture, Ikea, JC Penny, Hobby Lobby, Home Decorators, Marshall’s, TJ Maxx, and Value City Furniture.

• If buying new furniture for your parents’ new home, consider the cost of furniture delivery. Buying from one store can save lot of money.