Aging Parents: How One Elder Lived Independently, Alone and Well To 101–Part 2

How 101-year old, R, staves of loneliness and remains connected and independent–continued from last post

Staying Connected

–Telephone: R used it to its full potential. Long conversations with friends and relatives were part of her daily life before and after being widowed. I think phone calls take on greater value for people living alone. R’s line was always busy–her social life and most business was handled on the phone.

–Taxi: 50 years ago as a recent, non-driving widow, R had no desire to drive. Indeed her husband’s car remained–unused–in the car port–as a burglary preventive! R took taxis.

She used that mode of transportation for decades. When she found a taxi driver she liked, she got his number and used/requested him from then on–phoning ahead to arrange a pick-up time.

She also organized her errands by location–one location on a given day (eg. grocery store/bank/pharmacy), giving the driver a time to return to take her home (long before cell phones). It always worked out for her.

–Entertainment: R enjoyed music and other cultural offerings. She’d purchase 2 tickets to the symphony, for example, inviting a friend, neighbor or family member. They drove. She’d take them or lunch or they’d take her.

Our Role in Combatting Social Isolation

As those we care about enter old age, we tend to visit them–in their home; in assisted living; in a rehab center–or nursing home if allowed. Why not make the effort to take them out and give them a change of scenery? Otherwise, doesn’t our visit usually go something like this: We visit. We make conversation. They listen and respond. They remain in place. We leave.

It’s easier for us for many reasons, but is it better for them? Going out provides:

  • Stimulation (obvious)–there’s a lot to look at out there
  • Exercise–getting in and out of a car, in addition to walking, especially important for people who should–but don’t–exercise….like my mother. See Related for my strategy with Mother.
  • Feelings of accomplishment–doesn’t accomplishing something make everyone feel good. What about including elders on short shopping trips to buy groceries or things at the drug store?
  • Fun–a meal, driving back to old neighborhood; visiting aging parents’ elderly friends; watching (the last inning, quarter?) of grandchild’s team playing sport; visiting a zoo, or any production (ballet, symphony, lecture)–handicap accessible  [if needed].
  • Change of Scenery (lake, river, mountains, ocean…)
  • A “carrot”–Sr. Advisor R always said knowing–ahead of time–that she was going out to something was “a carrot”– gave her something to look forward to

Lastly, being around a sweet babies or young children is especially uplifting to most older people. Barb, one of R’s helpful neighbors, cares for her grandson while her daughter works. Since infancy, when Barb realized she could count on his being good for a while after his nap, she would put him in the car, pick up Sr, Advisor R, and do quick errands she saved for these occasions. All was arranged around his nap schedule and included R. How thoughtful is that! P.S. Barb is quick to say her grandson: “has his moments” (was a typical 2), but R never experienced those moments.

Throughout her life R. took an active interest in–what we were doing; her neighbors and their children and grandchildren; world affairs; the latest styles of living, fashion, restaurants. In addition–even in her last months, she continued to do her part for others, saving her magazines for one neighbor and financial newsletters and each week’s Baron’s for another. Clearly not the norm, she models an elder who remained engaged and embraced connections with others.

And since we know “connections with others” is one of the 3 most important “ingredients” in aging well (MacArthur Foundation Report), don’t we think Sr. Advisor R’s life is further proof of this?

While loneliness is a great threat to longevity (last post), it isn’t a given for those who live alone. Some people can live alone and not be lonely.

…Hoping that some of preceding ideas can be used to stave off loneliness–as we try to help parents age well.

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Related: R’s 10 sayings (she made them up) that influenced the way she lived life.
Strategy with Mother to include (sneak in) exercise.

Check out “Newsworthy” (right sidebar). Links to timely tips, information and research from top universities and respected professionals–to help parents age well.

Aging Parents: How One Elder Lived Independently, Alone and Well To 101–Part 1

Aging Alone and Well. Defying the Statistics

“Do you like being alone?”  This question begins A Solitary Life Carries Risk” in the NY Times Well” sectionI’d saved it since March. While it’s aimed at us, based on research following around 3.4 million people over 7 years, it concludes “Although living alone can offer conveniences and advantages for an individual, physical health is not among them.” Indeed the lead researcher says  “Social isolation significantly predicts risk for premature mortality comparable to other well established risk factors.”

If married or with a partner, it’s inevitable one of us will be left alone. How did Sr. Advisor R, who lived alone since being widowed at 50, defy these sobering statistics? A simplistic answer could be that she maintained social connections, which all studies have found is important in aging well. That said, here’s the additional–

 Good genes and a smart, disciplined lifestyle

 At 100 all doctors said R was in amazingly good health for her age. To achieve that she took ownership of her life. This included:

Valuing “Alone.” Making it Work

While emphasizing the mortality risks that accompany living alone, the research recognized that “living alone can offer conveniences and advantages.” R was smart and creative enough (she called it “common sense”) to have both by compensating for age-related losses/changes. Examples:

  • reworking how to do things to save her energy (ie. shaking the salad greens with dressing in a plastic bag, thus not having to wash extra dishes–she didn’t use a dishwasher).
  • leaving note pads in each room with reminders (so she wouldn’t forget what she came in for)
  • putting a to-do list on the desk in her bedroom so she’d see it first thing
  • having a list of important phone numbers (friends, service people) on that desk
  • having 3 conveniently-located phones (bedroom, kitchen, den)
  • having a contractor-friend make adjustments as needed (eg.grab bars) in bathrooms

Combatting Social Isolation

As long as I knew her, R said she enjoyed her own company, treasuring the alone-days (stay-at-home days, she never drove) when she could do as she pleased. Late in life it was her major argument/defense against having any “help” except her cleaning woman in her home for 4 hours once a week. She increased that help to twice a week the last months of her life.

So how does one who values solitude fight becoming “obsolete” (a friend’s description) and remain engaged until the end? It would seem to be accomplished by:

  • the genuine interest and generosity shown towards others during her younger years–repaid by those whose lives she touched, in many thoughtful ways later on.
  • a strong will to stay engaged
  • knowing–or having cultivated friendships with–younger people (beyond family) who understand the importance of doing (and how to do) what’s better for the elder, not what’s easier for them.
  • taking the initiative, inviting others to go out (they drove) to lunch, a movie, lectures etc. R recalled when her husband died. Her social life dwindled. She realized if she didn’t take the initiative she would be sitting home, alone.

Social isolation, so common to many who live decades without a spouse–no problem! Is that incredible since–through choice–R never drove. She was happy to be a passenger. That said, Diane Ackerman’s well-known quoteI don’t want to be a passenger in my own life, seems to have been a guiding principle. R valued being in control of her life. She decided what she wanted to do and how she did it.

To be continued on Saturday with Staying Connected and Our Role in Combatting Social Isolation. We will hopefully be back in NY, having finished the majority of our work here. 

Check out “Newsworthy” (right sidebar). Links to timely tips, information and research from top universities and respected professionals–to help parents age well.

US News Best Hospitals 2015-16 Ranks Mayo Clinic (Rochester) #1 in Geriatrics

Massachusetts General Hospital-courtesy Mass General

Massachusetts General Hospital [Massachusetts General]

Massachusetts General Hospital in Boston is ranked #1 Hospital in US News’s Best Hospitals 2015-16 issue, published July 21st.

In Geriatrics Mayo Clinic in Rochester (not to be confused with their other sites) ranked #1, followed by  UCLA Medical Center (Calif.) #2; Mt. Sinai (NYC) #3; Massachusetts General (Boston) #4; and Johns Hopkins (Maryland) #5

How is this information helpful? There’s a wealth of information in the issue, most of which is available by using the search box after clicking the links above. Nationally ranked and regionally ranked hospital information provides a standard and helps with questions to ask when considering procedures for aging parents and the elderly we care for and about.

While “garden variety” procedures shouldn’t require the top experts in the field, we know it makes sense if doctors have performed the procedure hundreds of times a year vs. a hundred times a year. In the case of complicated procedures and illnesses, it makes sense to have the tops in the field. They should be the most experienced (and thus, have successfully dealt with more of the unexpected problems that can arise). That said, spending time doing the research also makes sense.

One result of doing research is finding that some of these excellent doctors have opted out of Medicare. Don’t be completely discouraged as long as your parents have Medicare Part B coverage. The no-longer-Medicare-participating doctor’s office isn’t allowed to send in Medicare claim forms, but you/your parents can do this –and be reimbursed. It most probably means there will be reimbursement, but at a lower amount than the doctor charges.

For details about Medicare reimbursement for bills from doctors who have declined Medicare participation, go to these previous posts:

Getting Reimbursed When Doctors Don’t Take Medicare

Getting Reimbursed When Doctors Don’t Take Medicare–The Form You Fill Out

When we help parents age well, we make it better for ourselves too–in so many ways.

Check out “Newsworthy” (right sidebar). Links to timely tips, information and research from top universities and respected professionals–to help parents age well.

 

 

Still need to postpone.

R’s home, where we are working each day to try to “clean out” (wish there were a better word) has no internet access. Thus, writing a post becomes a challenge–although it would be a welcome time out during the day if there were a convenient Starbucks.  No luck there.

Since I’m a morning person where writing is concerned, I can see posting the next two weeks will be “ify.”

That said, I’ve been working on: Aging Parents: How One Elder Lived Alone and Well To 101. One interesting finding: Visiting aging parents at home, in assisted living or wherever, is not always as helpful as making the effort to take them out–even for a quick ride while we do an errand–if there’s that option. One of the Key Thoughts (right sidebar near bottom): IS IT BETTER FOR PARENTS OR BETTER FOR US? comes into play here.

 

 

A Quick Break –Post postponed.

As we get ready to fly cross country and begin organizing and “cleaning out” Sr. Advisor R’s, home, the organization of my days seems to disappear. We’ll begin the “cleaning out” on Tues. and hope our blog can continue to offer posts twice a week as it has since its inception–but possibly on an unexpected day instead of Tuesday or Saturday.

l’ll  try to post tomorrow (Sunday) if time permits.

Aging Parents and You: Tips for Getting Reimbursed When Doctors Don’t Take Medicare–the Form. Part 2

Filling Out The “Patient’s Request for Medical Payment Form”

Your doctor doesn’t “take” Medicare. He or she has opted out. You have Medicare Part B coverage. You’ve paid your bill. You should have been given a copy of the bill along with a copy of your doctor’s letter, signed and dated, this includes date of service as well as the date your doctor declined Medicare participation. Now it’s time to file for your reimbursement. My understanding is that one can file up to a year after the date after the medical service–ie. 7/7/14-7/7/15. But why wait so long?

The following gives the best chance to succeed on the first try. Also remember if you have secondary coverage, Medicare will forward the necessary information to them when you check that box.

1. Fill out every applicable section of Medicare’s Patient’s Request for Medical Payment form CMS-1490S, using the preceding highlighted link or one downloaded form the last post.

2. “Send the Completed Form To” (located top right on form). Here is information for mailing your claim form  CMS-1490S. Click this link for your state’s address. The addresses begin on page 2, following an introductory letter.

3. Mail each claim in a separate envelope.
–Include CMS-1490-S form, its accompanying doctor’s opt-out letter and bill. You might be inclined to put several claims and supportive documents in the same envelope, but the person I spoke with said 1 claim form (CMS 1490S), 1 doctor’s opt-out letter and 1 bill in 1 envelope is the most foolproof. (If your inclination is to do otherwise–suggestion: call Medicare and ask their guidance).

4. Keep a copy of each-filled-out 1490S form, along with bill and doctor’s letter that you send.

I get the feeling that claims are looked at by many. Whether scanned or passed around, keeping it as simple as possible for those reviewing your claim is the way to go.

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Note: If phoning Medicare, I was also told: To reduce the wait- time after the initial hopefully not-too-long wait– at the first opportunity–press any numbered option given. It may not be the department you want, but they’ll get you to the proper place quicker. (Haven’t tried this yet.)

Related: What Medicare Part B Covers(It covers more than doctors) from Medicare’s website

Check out “Newsworthy” (right sidebar). Links to timely tips, information and research from top universities and respected professionals–to help parents age well.

Aging Parents and You: How to Get Reimbursed when Doctors Don’t Take Medicare. Part 1

Some doctors don’t “take” Medicare.
They’ve chosen to be excluded from Medicare Program participation.
Nevertheless, people with Medicare Part B  coverage can submit
claims from these doctors to Medicare for reimbursement, regardless of a doctor’s Medicare affiliation. It just entails a bit more work from you/your parents if you’re submitting 

Helping parents age well clearly includes their healthcare. And no doubt many parents have Medicare coverage, using doctors who “take” Medicare and do the paperwork so Medicare can reimburse. And this works pretty well.

But what happens when a parent with Medicare coverage uses a doctor who has opted out of Medicare Program participation and thus, doesn’t “take” Medicare? Some doctors in NY and probably other large cities have decided to be excluded from Medicare participation.

That said, it’s important to know and remember: People insured by Medicare, are covered by Medicare.  If they did not decline Part B coverage (it’s an additional cost covering doctors’  bills but many have it) they are entitled to Medicare reimbursement for their doctor’s bills, whether the doctor participates in Medicare–or not.

What’s Different?

You/your parents (not the doctor’s office) must do the paperwork and submit the following directly to Medicare:
1.  Medicare form called “Patient’s Request for Medical Payment” (*See below)
2.  doctor’s letter verifying his/her exclusion from Medicare
3.  the doctor’s bill

I recently attended a retirees’ program about health insurance. There were questions about doctors who don’t accept Medicare. Many in the audience were clueless.

Why Use a Doctor Who Doesn’t Participate?

You may require a specialist, and that particular specialist has opted out of Medicare participation.

One retiree in the audience, who had paid in full without any reimbursement, had been given the name of 2 specialists for a necessary delicate procedure. The doctor who accepted Medicare was on maternity leave. The patient couldn’t wait, thus needed to use the doctor who didn’t accept Medicare. Since she was unaware she could file her claim directly to Medicare, she “lost” that money. (Reimbursement is based on Medicare’s fee for service, no doubt less than non-Medicare-participating doctors’ fees.)

If You Have A Secondary Insurer

Some in the audience assumed Medicare wouldn’t pay, but had secondary coverage from another insurer. They submitted bills from the non-Medicare-participating doctors directly to their secondary health insurer.

In one case the secondary insurer had reduced her reimbursement by the amount it determined Medicare would have reimbursed her for the procedure, then subtracted their deductible, co-pay or whatever. Whether or not the “amount determined” was the amount Medicare would have paid is unknown. What is known is that her reimbursement was a very small amount of the original bill. Another retiree had a similar experience with his secondary insurer.

Medicare Will Send Information on to Your Secondary Insurer Afterward.

A non-participating Medicare doctor’s bill, exclusion letter, and Medicare form should first be sent to Medicare for reimbursement, which then sends everything on to the secondary insurer. There’s a place on the form (1490S) for the name and address of “Coverage Other Than Medicare.” (There’s also a box to X, “If you DO NOT want payment information on this claim released.”)  In any event, if you have Medicare Part B coverage, don’t bypass Medicare at the beginning.

While many have coverage under networks of doctors and the preceding information may seem unnecessary, emergency-type cases and in cities where doctors have excluded themselves from Medicare, this knowledge will come in handy. (A retiree under 65 in the audience said she felt good having this information in advance.)

Next post: Filling out and filing the form: 1490S. As they say, “The Devil is in the Details.”

Note: Non-participating doctors’ office personnel are evidently not allowed to give advice about Medicare.
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Medicare participants should have received Medicare & You 2015 in the mail late last fall. If questions are not answered in that booklet, contact Medicare directly (1-800-633-4227) For hard copy of booklet click: http://www.medicare.gov/Publications/Search/Results.asp?PubID=10050&Type=PubID –or download from: https://www.medicare.gov/gopaperless/home.aspx (If you download, I believe future publications will be emailed–double-check this.)

*For Medicare forms and instructions in English:  http://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/CMS1490S-ENGLISH.pdf  Forms are also available in Spanish.

Check out “Newsworthy” (right sidebar). Links to timely tips, information and research from top universities and respected professionals–to help parents age well.