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Should Your Parent See a Geriatric Specialist?

should you see geriatric specialistYour loved one has multiple doctors already. Do they really need to add one more to the list? This post is designed to help you decide whether your loved one should consider seeing a geriatric specialist. A geriatric specialist provides comprehensive care for the elderly. They’ve completed their residency in Family or Internal Medicine, and have one or two years additional training in the various issues – physical, mental, and social – that affect this age group. There are several benefits to seeing a geriatric specialist. Seniors sometimes experience illnesses differently than younger adults, and so it helps for them to work with a doctor who understands their specific situation. Geriatric specialists are especially well-equipped to understand the particular complexity of senior health issues, which are typically caused by multiple factors. For example, they can examine a senior’s prescription drug regimine and make sure that they’re not over-medicated. They will also be familiar with the particular resources available to help your loved one in your specific local area. Whether or not a senior should see a geriatric specialist depends on their particular situation. After all, seniors themselves are different: one 80 year-old may be active with minimal health problems, while another may be struggling with serious health conditions. Geriatric specialists tend to step in when an individual’s health problems become complicated. It’s recommended that all seniors consider a visit when they turn 65, and highly recommended for those seniors who are in some way impaired, who have multiple medical problems, who are experiencing cognitive decline or dementia, or whose family members are struggling with caregiving. If you do decide to take your loved one to see a geriatric specialist, the initial assessment will take several hours. You’ll be given a detailed questionairre to fill out that your loved one will most likely need help with. Make sure you bring a list of all medications, hearing aids and dentures, eyeglass prescriptions, and information about other doctors your loved on is seeing or has seen recently. The following elements make up a typical assessment:
  • Complete physical exam
  • Detailed medical history
  • List of medications and their purpose
  • Dental exam
  • Hearing and vision tests
  • Pain level analysis
  • Cognitive evaluation
  • Osteoporosis screening
  • Dietary analysis and advice
  • Meeting with a social worker
  • Discussion with family members
Rather than being “just another doctor” a geriatric specialist can help you with managing the extensive medical care your loved one is already receiving. Many seniors and their caregivers find these physician’s particular expertise helpful.
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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 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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Should Alzheimer’s Patients Be Given Antipsychotic Drugs?

antipsychotic drugs alzheimer'sMany caregivers face the important question of whether to allow their loved one with Alzheimer’s disease to be given antipsychotic medications. The benefit of such drugs (like Abilify, Haldol, Zyprexa, Risperdal, and Seroquel) are that they reduce anxiousness, aggressive behavior, and agitation in those who have different forms of dementia. Almost all patients will experience these symptoms at some point, especially in the later stages of the disease. On the other hand, these medications come with some frightening side effects: incontinence, dizziness, confusion, and a hampered ability to speak or move, to name a few. The medicine can help to make a caregiver’s job easier and reduce their stress. This is of course not a trivial concern: if their loved one is less agitated, a caregiver in turn may be able to provide better care. However, adding one more pill to any senior’s drug regimine may cause unpredictable problems. The FDA warned in 2005 that the use of antipsychotic medications by those with Alzheimer’s and other forms of dementia may result in as much as double the chance of sudden death. Patients who are taking these drugs must be watched carefully. If your loved one is already taking these drugs, though, you may not want to take them off. Researchers recommend that seniors who respond to Risperdal keep on taking the drug. But as far as starting these medications go, the general policy is that they should only be used as a last resort. It’s estimated that in as many as two-thirds of cases, the use of these medicines is inappropriate. Use behavioral strategies to cope with anxiety and acting out instead. You may want to try giving simple acknowledgement to your loved one’s experiences, even if you know that they differ from what the rest of us would consider reality. Avoid correcting them or arguing with them. Or simply try to distract your loved one with an enjoyable activity. Also consider that the aggression and anxiety that these medicines are supposed to treat is a sign that your loved one needs something that they’re not getting. Instead of providing them with that thing, the medicine simply masks the symptoms. One tip is to respond to the emotion, not to the behavior. Look underneath their actions. Of course, the most important advice to consider when making any decision regarding antipsychotic drugs is that of your loved one’s doctor. They can help you weigh the pros and cons for your particular situation.
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Choosing a Hearing Aid

Purchasing a hearing aid requires some research.Currently, about 37 million Americans are affected by some form of hearing loss – from slight impairment to complete deafness. Of that staggering number, only about one-fourth of those individuals actually utilize hearing aids to overcome this challenge. Among the top reasons for not choosing a hearing aid: the unwillingness to admit the disability and the high cost associated with the devices. The costs for a hearing aid range from $1400 to $5000 each, according to the Hearing Loss Association (a consumer advocacy group). The market is now made up of almost all digital hearing devices which receive sound via a small microphone, process the sounds digitally using a microchip, then amplify the sound, sending it to the recipient’s ear. These are a far cry from the analog hearing aids of old, which did little more for the recipient than amplify the sound and allow him/her to adjust the volume. Overcoming hearing loss is such an individual process that the newer, digital devices allow manufacturers to adjust the devices to suit the particular needs of the buyer… and that’s great news. That is due largely to the fact that two people with the exact same level of hearing loss can process sounds entirely differently, making the selection of a hearing aid a very individualized matter. Most hearing loss evaluations are performed by audiologists or by ear, nose and throat specialists. These professionals can often also sell you devices, or recommend you to reputable vendors. If you are having trouble locating an audiologist, the American Academy of Audiologists can connect you with a list of qualified providers. A basic hearing test includes the following:
  • Speech audiometry: The patient repeats words (in silence and noisy backgrounds) to determine how the hearing loss is affecting him or her.
  • Pure tone bone conduction audiometry: This test detects where  in the ear the hearing loss has occurred, and thus how best to treat the problem.
  • Tympanogram: This test determines how well the middle ear hearing system, as well as the eardrum, is working.
  • Pure tone air conduction audiometry: This test determines how well the patient actually hears the beeps and tones given.
Once the level of hearing loss is accurately assessed, the hearing specialist should also work to determine your lifestyle, so that the hearing aid chosen will actually fit into your normal daily routine. Your specialist may want to know if you live alone or with others, in a large or small space, if you dine out regularly, if you are often in noisy environments (movies, theater, religious services, etc.), or if you’re a heavy user of your telephone or television. Before you look into the types of devices available, it is important to note that most medical insurance plans will readily cover the cost of testing, but most will cover little (if any) of the cost for the actual device. If you served in the military, be sure to start with your local Veteran’s Administration’s office, as they have some programs to address hearing loss for vets. Medicare, along with most private insurers and Medicare Advantage plans, exclude the cost of the device with some exceptions for cochlear implants designed to address the most severe of hearing loss concerns. Financial help is available through programs with Lions Club International, the Hearing Loss Association, as well as the Better Hearing Institute. Hearing aids and their capabilities have come a long way, so ask your vendor about the number of options available (as well as warranties and extra fitting fees, if any). Open fit hearing aids eliminate distractions and echoes, as do the devices outfitted with noise reduction technology. Devices with directional microphones reduce outside distractions and the Bluetooth option allows calls from your cell phone to ring directly to the hearing aid. Of course, today’s digital technology provides all types of options to accommodate your lifestyle.  
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How to Dispute Health Insurance Errors

Board care for elderly can cause medical bills to pile up.

Photo used under Creative Commons from attercop311.

With the possibility of multiple bills being generated from a single visit – along with discrepancies in the diagnosis and treatment necessary – there’s no wonder that medical bills sometimes have errors. In fact, a recent study conducted by the American Medical Association revealed that even with the recent improvements in billing accuracy, a full 10% of bills paid by private insurance companies do, indeed, have errors. Added to that is the fact that next year, in 2014, a much greater number of Americans will have health insurance coverage under the Affordable Care Act, thereby increasing the possibility of errors. There are ways consumers can dispute any health insurance billing errors they find. The following are just a few suggestions to set things right and possibly save yourself quite a bit of out-of-pocket expense in the process. First, make sure your insurance provider has the most accurate and up-to-date information about you. Though it sounds entirely too simple, such discrepancies as your date of birth, the spelling of your name or whether or not you regularly utilize your middle initial on your paperwork can create problems. A great example of how this can happen is when a person is admitted to the hospital. A hospital patient can be seen and tested in a number of different departments, and unfortunately, all the departments create separate billing for the work performed. Thus, it can be tricky to keep up with all of this and to remember it all at the time your bill is actually received. It is always best if you have a friend, family member or other patient advocate available to double-check the information while you’re being seen at the hospital. Second, review your bill. Generally, your bills come with an explanation of benefits – read them over and be sure you understand them fully. This statement will indicate what services are being paid for by your insurer and which ones are not. This is a great way to get a clear, concise explanation if your insurer doesn’t cover a particular service. Third, be sure you have a good understanding of your insurance benefits. Have a working knowledge of your deductible and your co-pays. If you have to be referred to a doctor outside the network, understand what percentages are covered for these types of visits. In the case of pricey specialists, you should know that insurance companies often work with average “industry standard” costs for certain services and often will not bend if your specialist charges significantly more than the average. Fourth, after reviewing your bill and truly understanding your benefits, don’t be afraid to ask questions if you do not understand. Challenge the charges if you deem it necessary. Be sure you keep detailed records of who you spoke with and their responses. Keep a copy of anything you fax, mail or email to your insurer. Fifth, check the medical coding information. Much of the medical billing information you receive works off of specific coding from your doctor’s office, submitted directly to the insurance company. In certain cases, you may need to go back to the doctor’s office to request a “run-down” of the medical codes associated with your visit. Compare this information to your bill. If there is, indeed, a discrepancy, you can go back to the doctor’s office and ask that the information be corrected and resubmitted. A simple error in coding the diagnosis can make a huge difference in the payment of services associated with that visit. Sixth, get agreements in writing. Promises are no good without written confirmation, preferably via email. Finally, if the dispute process seems entirely too consuming, you may consider getting a medical billing advocate to help. A growing number of consumer advocate services and software programs are now available to assist in detecting and disputing medical billing errors.  
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Preventing Problems with Medication

Los Angeles Alzheimer care facilities prevent problems with medicine.If the healthcare industry actually tallied the numbers and assigned a price tag to medication-related illness, the numbers would place it fourth-highest among “diseases” – behind cancer, Alzheimer’s and cardiovascular disease. A recent study published in the Journal of the American Medical Association, entitled: “Use of Prescription and Over-the-counter Medications and Dietary Supplements Among Older Adults in the United States,” revealed that 91% of adults over the age of 57 are taking some type of medication on a regular basis, with 81% taking a prescription medication regularly. Prescription medication was only one type of medication studied. The researchers also looked at over-the-counter medication, herbal supplements, and vitamins and minerals. The JAMA study concluded that at least half of the survey respondents were utilizing at least 5 medications regularly, which translates to a lot of chemical and natural compounds entering the body routinely. While medications are designed to assist the body in dealing with particular challenges, certain compounds react with others in a manner that can, and does, create harmful interactions. These harmful drug interactions account for an average of 175,000 trips to the emergency room each year for seniors. It is important to take into account age-related differences in the body which may affect the way a medicine reacts for a senior versus younger adults. Older adults tend to lose muscle and store more fat, and the fat balance can alter the effects of medication in the body. The health and overall functioning of the person’s eliminative organs (i.e., the liver and kidneys) has a tremendous effect on how well the medication is removed from the body. Poor elimination can spike the presence of the medication in the blood levels. Hydration (or lack thereof) can be a huge issue that seniors must guard against, since it definitely affects the way the stomach absorbs a particular substance. And what we eat, the effects of certain foods and liquids on our absorption, side effects, etc. are critical. To prevent medication-related challenges, all your healthcare professionals should be aware of every medication you are currently taking. This is not simply related to prescription medications, but should include all compounds you take on a regular basis, even the seemingly innocent ones. Antacids, aspirin regimens, vitamins, minerals, herbal supplements – if you take it regularly, every person who contributes to your healthcare in any manner should be aware of it. Ask your healthcare professionals questions. In addition to problematic drug interactions, certain combinations can deplete important nutrients from the body, so it is best to be aware of the possibilities. Your pharmacist is also your secret weapon in the fight for the prevention of medication-related challenges; he or she is often able to research the various medications you take for possible interactions. Be sure you contact them at a slower time of day so you can get the focused attention you will need. Because the needs of seniors are different, there is a specialized field of pharmacists called “Senior Care Pharmacists” which may be of particular benefit. Find one utilizing the website of the American Society of Consultant Pharmacists. Finally, you can conduct your own research by browsing through the “Beer’s List” of potentially inappropriate medications for senior adults.
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