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How to Lower Medical Expenses

reducing medical billsHealth care bills are notoriously confusing. Of course, Medicare all by itself is a maze, but beyond that there’s also the out-of-pocket expenses that Medicare doesn’t cover. These can be a significant financial obligation: almost $200,000 for a married couple over the course of their retirement according to one estimate. Here are some steps you can take to try to make these expenses more manageable. 1. Use in-network providers Whenever possible, use in-network providers for all your care. This can lower your bill tremendously, as in-network providers have previously negotiated what they’ll charge with your insurance company. Take the time to sit down with your plan to understand what is covered and what isn’t. This can result in significant savings, both immediately for particular medical events and over time. 2. Examine your bill closely Whenever we get a bill, many of us will quickly write a check out of habit, wanting to be prompt and on top of these sort of things. However, it’s worth taking the time to go over medical bills line-by-line, as they frequently contain errors and services that you or your loved one didn’t receive (as often as 80% of the time!). This is the time to be a pain and question anything you don’t understand: don’t pay until you’re confident about what you’re paying for. You’ll also want to verify the basics, such as your name, address and date of service. You may be surprised at how often it’s worth it and that being thorough leads to savings. Plus, it’s a much better idea to do this up front. If you discover an error later, it may be very difficult to get a refund from the provider after you’ve paid. Unfortunately, they’ll tend to be more responsive when they’re eager to get the matter resolved and have your payment in hand. 3. Verify that the bill has been adjusted for insurance payment One important item to note when reviewing your bill is whether the different line items have been adjusted to reflect the insurance rates. If you don’t see this, insurance was not applied. You should contact the office right away to make sure they run the charges through your insurance first. 4. Check the bill against your EOB You should never pay a medical bill without getting an EOB from your insurance company first. This document will verify what you’re supposed to pay. This is an important step for eliminating possible errors. Be wary if the bill arrives much sooner than the EOB does–this means that the medical provider has not received payment from your insurance company yet. 5. Be proactive Don’t just let errors slide–contact both your insurance company and the provider to resolve billing issues. Often it will be important to be persistent: sadly, larger companies will try to win in these disputes by ignoring you sometimes. At the same time, make sure you keep the lines of communication open with all parties. If you are waiting to hear from your insurance company before you pay the doctor, let their office know what the delay is. Otherwise, they may be very quick to assume that you’re trying to dodge the bill and send the account to collections. This will be counterproductive, resulting in more unnecessary charges and time spent resolving the issue. 6. Negotiate Even if you don’t have insurance, you can try asking providers if they’ll charge you the same rate they charge insurance companies. Also, if a bill is more than you can afford right away, see if the provider will lower it in exchange for faster payment. You can also try asking for financial assistance. Some providers will let you pay in interest-free installments or work out some other reasonable arrangement. They would much rather get the bill paid than have you feel the situation is hopeless and ignore it.
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How to Tell When a Loved One with Dementia Is Sick

dementia and illnessDementia can make it difficult to tell when a loved one has come down with a cold or another illness. They may not be able to tell you how they’re feeling in an intelligible way. By being observant and keeping an eye out for certain signs, you can spot when they may need a little extra TLC, medication, or a trip to the doctor. Here are some tips.
  • A runny nose or sneezing by itself may not be a cold or flu–it might be just allergies instead. Try to determine if your loved one has additional symptoms, like fever or tiredness. If they do have a cold, make sure that they stay well-hydrated.
  • Those with dementia or Alzheimer’s are unfortunately susceptible to urinary tract infections. Due to the intimate nature of the task, keeping these areas clean isn’t always easy for caregivers. If their urine has a strong sour smell, they likely have an infection and need treatment. Urine may also be darker or even contain blood, and your loved one will have to use the bathroom more frequently than usual. Finally, urinary tract infections can cause behavior changes in seniors and even bring on dementia symptoms. If you notice any of these signs, be sure to treat the infection right away. A neglected urinary tract infection can land a senior in the hospital.
  • Look for signs that your loved one is paying attention to or favoring one part of the body over others. That could indicate that they’re experiencing pain. Do a thorough check of the area to see if there are any bruises or other abnormalities.
  • Watch for changes in bowel movements and abnormal stool. If problems don’t respond to over-the-counter medication, seek the advice of your loved one’s doctor.
  • Changes in speaking patterns or behavior is another important sign. If a loved one’s demenaor suddenly changes without obvious explanation, and attempts to distract or calm them down don’t work, illness or injury is often the cause. They may also attempt to “speak” to you using gibberish. Even though your loved one cannot express themselves properly, they’re trying to give you information.
Your best tool as your loved one’s primary caregiver is intimate knowledge of their usual habits and behavior. Once you notice variations from what’s typical, you should begin to suspect that problems are afoot. If you have any concerns about your loved one’s health, be sure to get in touch with their physician.
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The Connection Between Dementia and Depression

depression and dementiaDementia and depression share many common symptoms: withdrawal from loved ones, decreased interest in activities that were once enjoyable, memory difficulties, and an increase in sleep. Researchers have begun to explore the connection between the two and to ask whether dementia causes depression, or if perhaps depression causes dementia? One study has found that those who have had a incident of depression are three times as likely to develop dementia. Other studies discovered that when in their life a person experiences depression can influence what kind of dementia they get. Those whose depression begins in mid-life are more likely to get vascular dementia. However, if the episode of depression occurs late in life, Alzheimer’s disease is more likely. Researchers aren’t sure what causes these links, but they do have some theories. One is that when an individual is experiencing depression, their body produces a greater amount of the stress hormone corisol. This hormone has been shown to do damage to the areas of the brain that manage learning and short-term memory. Depression can also cause inflammation which can harm blood vessels. Finally, there’s also the possibility that the hippocampus, which helps the brain process information and create memories, is harmed when the brain experiences stress long-term. Some even speculate that since depression causes people to be less active both physically and socially, that less challenging lifestyle may accelerate the decay of the mind. Researchers are very careful to state though that they still have much to learn about this area of study. The connection also seems to work in reverse, with dementia patients being more likely to become depressed after the disease has taken hold. Also, the similarities of the two conditions and the fact that they share many differences make the connection between them difficult to tease out. One implication that is relatively clear, however: depression needs to be taken seriously and treated as soon as it’s caught. Left alone, it can cause too much damage to an individual’s brain, even if that person eventually moves past depression without intervention. Seniors and their caregivers should know that depression is not a normal sign of aging: it is a mental health issue that needs to be addressed no matter the age of the patient. This is certainly an area of research to watch over the coming years, and holds promise for helping us understand how conditions of the mind and spirit can ultimately affect the body.
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Dealing with a Loved One Who Wants to Go Home

seniors who want to go homeThere are many seniors who make the transition to assisted living or memory care comfortably. But unfortunately, due to the nature of the disease, sometimes loved ones are faced with an uncomfortable request: “I want to go home.” Such a plea is heartbreaking, and when you hear it every time you visit it can leave you quite distressed. The first thing to know is that when your loved one says “home,” they probably don’t mean their previous residence. Remember that due to Alzheimer’s and dementia, they’re living in their earlier years. Home is most likely their childhood home, and that place and the people they lived with may be long gone. So before you beat yourself up with guilt, know that they are requesting something impossible that you couldn’t give them no matter how hard you tried. The best way to deal with this request is with gentleness and a little bit of subterfuge. This is one of those moments where enabling your loved one’s denial may be the better course. Avoid correcting or arguing with your loved one, as this will only cause distress without really aiding them in recognizing the truth. First, use positive body language such as nodding your head. Then try to change the subject. Look for something interesting going on in the immediate environment. Maybe there’s a bird outside the window, or a colorful painting nearby. Point this out to them and shift the conversation. It may also be helpful if you can move them physically: guide them to the object of interest or turn them to face a different direction. You are trying to get them out of an unproductive rut. From there, seguey into your loved one’s memories. Get them to talk about what “home” was. This will help them pay this cherished place a visit, if only in their minds. A photo album might be helpful here if you have one. Your discussion may give you some clues about how you can bring home to them in their new living space. Perhaps there are beloved objects or furniture that will help their new surroundings feel more familiar. Your loved one will likely not completely stop talking about home, and you’ll likely continue to feel the pangs of heartbreak. However, some knowledge about where the request is coming from can help you accept it. This is a case where you may not be able to change external circumstances, but you can change how you react to them.
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Advice for New Caregivers

advice for new caregiversTaking charge of mom or dad’s affairs and becoming the one responsible for their well-being may have happened suddenly with a crisis event, or it may have snuck up on you over time. However you ended up here, you likely feel like you need some advice. Here are some things to keep in mind as you navigate this new world. Set Good Boundaries Setting good boundaries can be difficult when it comes to the loved ones who are closest to us, like our parents. They sacrificed so much for us, right? However, if you drop everything for mom and dad it will cause much larger problems, and you’ll be so burned out you won’t be able to be there for them. If mom is calling you from assisted living mulitple times throughout the workday, you need to be clear that this is preventing you from fulfilling your obligations to your employer or clients. This may seem harsh, but if you career begins to suffer you won’t be as effective when it comes to caring for her. Understand that Needs Change If you’ve been thrust into your new role by a stroke, accident, or other crisis event, there will be a time when life begins to settle into a routine again. But don’t get too set in your ways: there may be another crisis that’s somewhere around the bend. It’s simply part of the unpredictability of life, and you will need to adapt if you’re going to keep up with your parent’s needs. What worked before may not work now. Don’t be afraid to ask for help or to look into adding new care. Reach Out to Others in Your Situation You’ll get a great deal of support from those whose loved ones have more advanced Alzheimer’s or dementia. You can find a caregiver support group somewhere near you, or you can seek out others online. This may in fact be better since you and other caregivers probably don’t have much time for face-to-face meetings. Try the Alzheimer’s Association or your local hospital for recommendations. Notice that a lot of this advice has to do with taking care of yourself, your physical well-being, and your own mental state. The old cliche of helping yourself before you can help others has never been more applicable than when it comes to caregiving. Your loved one is counting on your health for their own wellbeing.
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Five Steps to Convince Your Parent to Move to Memory Care

convince parent to move to memory careMaking the decision to enter memory care is difficult for seniors, and it’s a process to get them to accept that this is the right choice. They of course want to remain on their own as long as possible. A big decision like this can’t be forced. Your best chances of success lie in helping your parent own the decision, so that they have the feeling that this is something they’re choosing for themselves. Here’s a step-by-step plan for how to get your parent to accept a move to memory care. 1. Help mom or dad begin to get used to the idea. Identify problems that would be solved by a move to memory care and how that move would improve quality of life. For example: “You know, mom, you wouldn’t have to worry about hiring someone to take care of the lawn if you were in memory care.” Or, “Dad, wouldn’t it be nice if you lived somewhere with people your own age around?” 2. Offer to help them tour some nearby memory care facilities on a no-strings-attached basis. Try to seek out activity times when they can notice the residents having fun. However, it may still be too soon for them. Be prepared to just drop it if they show resistance to the idea. 3. Help them see the signs that it’s the right time for this sort of care by connecting this need to things that happen. For example, when mom leaves the stove on, gently but tactfully use the opportunity to point out that both of you would be less worried about these incidents if she were in memory care. Be careful not to be too pushy here, unless there really is a crisis brewing that would necessitate moving quickly. 4. See if anyone your parent knows has made a move to memory care, assisted living, or a similar facility who is happy with their choice. Or see if the relatives of any of your own friends are enjoying senior living. Take your parent to visit that person, or at least set up a phone call. This will help make the idea more real to them, and may make moving to the same facility more appealing. Even having one friend in a new place can help. 5. When you go on tours, point out all the positive aspects of the facility. Be as excited as you would be about renting a new apartment or buying a new home: focus on the possibilities. Would mom’s favorite antique chair look good in the rooms of a particular facility? Does the activity room have a piano so that dad could still play? Once you’ve gone through this process, wait for all that you have seen and discussed to sink in. Don’t expect that they’ll have that “Aha!” moment right away: unfortunately, it often takes some sort of accident or crisis for a move to seem necessary. They are making a huge life decision, and that needs to be respected. If you are feeling the need to move your parent along in this process, however, the most effective argument would be to say that you and other family members would have much greater peace of mind if they were in a memory care facility. Remind them how much their safety means to you. This will hopefully help them to see the importance of making the move.
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The Challenges of Early Alzheimer’s

early alzheimers medical challengesOne hardship for those with Alzheimer’s is a lack of understanding about this disease from those in the general public. Though it may hurt sometimes, to some extent this is understandable. We can’t all be expected to be knowledgeable about every disease, even more common ones. Typically, we forgive those who are important to us if they need a little education. But many Alzheimer’s sufferers and their caregivers are surprised to discover that many in the medical field, who do not work with memory care patients frequently, also do not have a good understanding of what Alzheimer’s is. Imagine someone in the early stages of Alzheimer’s falls and breaks their hip, requiring a stay in the hospital. When the doctor interviews her and her son to learn about other medical conditions that may affect treatment, they mention that she has early Alzheimer’s. The doctor seems to ignore this information, which he fails to see as relating to the broken hip, especially since after a casual interaction he notices no cognitive impairment. However, our patient quickly runs into problems. The doctor goes over instructions for her pain medication at a time when her son isn’t at the hospital, expecting that she will manage this on her own. The next time her son comes in, he finds her in extreme pain because she hasn’t taken the medicine on schedule. He points out this problem to the doctor. The hospital staff then goes to the other extreme, hovering over the patient excessively, speaking to her in slow loud voices, and even spoon-feeding her! Those with early Alzheimer’s know that this clearly is not the appropriate response either. Unfortunately, the fact is that medical professionals just don’t receive adequate training on how to handle those with more mild cognitive impairments. They are able to address severe impairments, but the shades of gray in between just aren’t discussed. However, that’s cold comfort to early Alzheimer’s patients and their caregivers, who feel ignored and misunderstood by the system. There’s no real answer to this problem for individual patients and families, since the issue is entrenched in our larger health care system. Hopefully in the future, all doctors, nurses, social workers, aides, and others will receive more refined training on how to deal with those with early Alzheimer’s and similar cognitive conditions. In the meantime, caregivers and patients should not assume that doctors and others will understand what they mean when they disclose early Alzheimer’s. Be specific about the kinds of communication you expect about the person’s treatment and how Alheimer’s will affect it.
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How to Thank Assisted Living Staff

gifts for assisted living staffIf you’ve chosen a good assisted living facility, chances are you feel a strong sense of gratitude towards the staff for the excellent care they’re providing for your loved one. It’s common in these situations for families and others to want to show that gratitude with a gift. Below are some tips to keep in mind when deciding how you want to go about saying thanks.
  • First, check with management at the facility to find out their policy about gifts. Many places have rules about what employees can accept, especially when it comes to recognizing individual employees over the staff as a whole. There may be one person who has gone above and beyond who you’d like to do something really nice for, but you don’t want to put them in an awkward situation where they have to refuse your gift or worse, get them in trouble with their boss or even fired!
  • If you can’t recognize that one special staff person with a present, there’s never anything wrong with sending them a thank you card or personal note expressing your appreciation. Even better, send a letter to their supervisor singing their praises. You may be able to help them get a raise or a promotion later on down the line. Make sure you send the note to both the boss and the employee, so that you can be sure they both know you sent it. You may also want to consider making a donation to a charity in that employee’s name, especially if you happen to know of an organization that means a lot to them.
  • If you do get the green light from management to give gifts to specific employees, but are stumped for ideas, you may want to consider ordering a gift basket, or even making your own custom gift basket yourself. Fruit and sweets are of course popular treats, but if those ideas seem stale you can really get creative here. Consider bath items, coffee or tea, or baskets with a theme that include food and non-food items. For example, a summer basket could include flip-flops, lemonade mix, a gift card for a local ice cream shop, tickets to a summer event, key lime flavored goodies, and body lotion with a summertime scent.
  • Other ideas for individual gifts: if you know what sport teams the person follows, some memorabilia will probably be appreciated. Women are often glad to get a bouquet of flowers or a gift certificate for a manicure and/or pedicure. If the staff member was emotionally close to your loved one and they have passed away, you might also consider giving the staff member a momento from their personal belongings.
  • Gift cards are tempting because they’re easy, but they can come off as impersonal. Unless you know the staff member is a big fan of a particular store or restaurant, try to choose something a little more heartfelt.
  • If you want to get gifts for the whole staff or floor, food is always popular. You may want to consider that some people may be burned out on cookies and candy or unable to have them for various reasons. In that case, consider fruit (Edible Arrangements gift baskets are a crowd-pleaser), fancy cheese and crackers, sandwiches, bagels and coffee/tea, or a few boxes of pizza.
  • Check with management to see how many people work in the facility or on the floor. It’s likely more than you think, and you want to be sure you have enough for everyone.
  • Don’t forget the late shift! Though you may never see them, they are working hard, at odd hours, to take care of your loved one as well! When you drop off your gift, insist that some be set aside specifically for them. Even if you bring plenty for all, if it’s just left out it’s too likely to disappear. Physical therapy staff are also often forgotten too.
  • Lots of families bring gifts for the staff around the holidays, and it can easily become too much. Food brought in at this time could go to waste and be thrown away. Your gift will make a much bigger impression if you give it at a quieter time of year.
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Should You Seek an Alzheimer’s Diagnosis?

seeking an alzheimer's diagnosisYou’ve noticed some recent changes in your loved one. Up until recently, your dad was working at a job he enjoyed and intended to do until he couldn’t anymore. But then he had trouble keeping himself organized and he made the decision to move on. Now, your once-driven father seems to be doing not much of anything, withdrawing from all but his closest friends and family. You suspect something is wrong, and know that Alzheimer’s disease or another form of dementia is a strong possibility. Should you act? If you do, what should you do next? Talk to dad? Talk to his doctor? And is there any point to pursing a diagnosis? You know that even medical experts can’t be completely sure someone has Alzheimer’s. Will the diagnosis only bring unnecessary pain and conflict to someone who only has a few years of life left? Yes, it is true that diagnosing Alzheimer’s isn’t an exact science. No doctor knows without a doubt that a person has the disease: it can only be determined after death when the person’s brain can be examined for the plaque and tangles that characterize this illness. Furthermore, recent research has found that only about a third of Alzheimer’s diagnoses are completely correct. In another third of cases the evidence is murky and the last third are completely misdiagnosed! But to put aside the issue of imperfect medical knowledge, even assuming one could know with certainty that they had Alzheimer’s, would they want to? Those who are labeled with the disease do often experience friends and family drifting away as they become uncomfortable. Illness is never an easy thing to witness, and for some people it’s just too much. And beyond the isolation issue, accepting an Alzheimer’s diagnosis means accepting that one’s cognitive abilities, and quality of life, will be declining. Many prefer to put off facing this reality for as long as possible. On the other hand, knowledge does bring power. For example, it may be useful to know that a loved one’s problems are NOT caused by Alzheimer’s or dementia, so that appropriate treatment can be pursued. It may be possible that your loved one’s condition can be easily remedied. The symptoms of a number of medical problems can be confused with Alzheimer’s: difficulty hearing, medication interactions, thyroid diseases, depression, heart problems, urinary tract infections, and diabetes. These concerns may be more treatable. Finally, having an Alzheimer’s diagnosis can enable the patient and their family to plan more effectively for the future. It can prompt everyone to have a discussion about how the person wants to be cared for as they decline, while they are still able to have a meaningful conversation. It is also easier to make the appropriate legal, financial, and medical arrangements in the earlier stages of the disease. And finally, having a concrete reason for the behavior can be comforting to seniors and their loved ones. Otherwise, it’s all to easy for them to think that they’re “going crazy” or otherwise defective in some way. There is a reasonable fear around seeking confirmation of suspicions of Alzheimer’s disease, but the disease itself is not going to go away. Many may find, as is often the case with fear, that the best way to escape it is to face it head on.
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Physical Therapy for Parkinson’s Disease

physical therapy Parkinson'sPhysical therapy can do seniors with Parkinson’s disease a world of good, slowing the decline that these patients experience. The physical challenges that those with the disease face–slow movement, hesitation, balance issues, rigidity, and resting tremors–can severely impact their ability to complete everyday functions. A physical therapist should be able to design an exercise plan that can enable Parkinson’s patients to overcome these problems and achieve maximum mobility. In addition to improving physical abilities, a physical therapist can also take a look at the senior’s home environment for potential safety problems and usability issues. Maybe there are throw rugs that should be removed, or grab bars in strategic places in the bathroom would be helpful. They can also give advice on what exercise is best given a senior’s particular medication, so that they can get the most benefit from their treatment. They will also send the senior home with a plan to continue treatment outside of the therapy setting. One of the greatest benefits of physical therapy is that it can provide help with walking, which is a particular challenge for Parkinson’s patients. A good therapist will know how to overcome the “freezing” reaction that many patients experience. They may use an auditory cue, such as a ticking metronome, to prompt the patient to take steps, or visual reminders on the floor may help them remember how to walk in such a way that the chance for a fall is reduced. Some physical therapists may incorporate tai chi, yoga, or pilates and can address rigidity and balance problems, as well as build strength. They can also help Parkinson’s patients determine whether a cane, a Rollator (a walker with wheels), or a similar device would be a good thing to obtain. Consider physical therapists with BIG certification. These therapists have been trained to work specifically with Parkinson’s patients. The recommendation used to be that Parkinson’s patients wait until the later stages of the disease to start physical therapy, but this is no longer the case. Instead, it is advised that patients start treatment as soon as possible, as this can have benefit before a major event like an injury or another type of decline. By building up these habits of physical activity now, they may be much better off as the disease progresses. If a loved one has Parkinson’s disease and there isn’t currently a physical therapist on their treatment team, take some steps to bring one aboard.
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