Good Therapy’s “2014 10 Top Websites for Aging” honor–plus A Discussion of Differing Realities/Avoiding Arguments

Help! Aging Parents was honored in late December–selected as one of Good Therapy’s 2014 “Top 10 Websites for Aging,” they write:

As a self-proclaimed “serious, well-educated cheerleader for helping parents age well,” this blog shares information and insight about issues that affect geriatric parents and their adult children. Susan, the sole author, often tackles everyday issues that seem banal but can become problematic in old age, like swallowing medication or planning dinner events. She writes with humor and candor, and cites input from professionals as well as her “senior” advisers.

As we end the first month of 2015, much of the US is cold and elders understandably remain indoors. If we don’t live with them and are conscientious, we visit as often as possible. An issue that’s definitely “banal” (“ordinary or commonplace”) is the high temperatures at which elders set their thermostats to stay warm. It’s problematic when it’s suffocatingly warm in their home for us, but not for them.

There’s a lesson here–about who’s right and who’s wrong. It can avoid, happily more often than we like to think, arguments with older family members. First, the facts:

The NY Times addressed the issue of elders being cold in its no-longer-published Booming Blog, Factors cited include “a decrease in circulation as the walls of the blood vessels lose their elasticity and the thinning of the fat layer under the skin that helps conserve body heat. And as people age, their metabolic responses to the cold may be slower. Vasoreceptors, for example, may not be as quick to direct blood vessels to constrict to keep the body temperature up.”

Johns Hopkins’ After 50 Newsletter responds similarly to the question: “I’m older and colder. Why?then discusses Hypothermia. We learn “It doesn’t have to be subzero outside for hypothermia to set in. Research suggests that very frail, elderly people can develop hypothermia at room temperatures as high as 71 to 75 ˚ F! And 50 percent of those who develop hypothermia do not survive, usually as a result of going into cardiac arrest.” This article also has advice about staying warm, especially if elders must go out in cold weather.

Sr, Advisor S.RN adds that especially when she made home visits to those who had COPD, she “had to brace herself,” because their homes could be “so incredibly hot–like opening an oven door.” But they needed that additional heat.

OK. We know the facts; yet there’s something additional that’s important to understand. Reality is not carved in stone. In a counseling class at Teachers College years ago, the professor posed the hot/cold question. Its purpose, to legitimize people’s differing realities. He said something like “You and I are in the same room. It’s comfortable for me. It’s too cold for you. Who’s right?”  

If we keep an open mind, we can understand that both are right and save ourselves arguments. When elders are clearly “off-base,” we have choices. We can “pick our battles.”  When their “right” is clearly wrong and must be corrected, we most often must correct the wrong.

Here’s to avoiding some arguments and disagreements with our aging parents and the elders we care about.

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

 

Aging Parents, You, and Doctors Who Don’t Take Medicare

Some doctors don’t “take” Medicare. They have chosen to be excluded from the Medicare Program participation. Nevertheless, if your parents have Medicare coverage, they are entitled to reimbursement from Medicare regardless of doctor’s Medicare affiliation. It just entails a bit more work from you/your parents..

Helping parents age well clearly includes their healthcare. And no doubt a large percentage of 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 chosen to be excluded from 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: Older people insured by Medicare, are covered by Medicare, and entitled to Medicare reimbursement. Whether the doctor participates in Medicare doesn’t matter.

What’s Different?

You/your parents (not the doctor’s office) must do the paperwork and submit the proper forms to Medicare:
1.  Medicare form*
2. doctor’s letter verifying his/her exclusion from Medicare
3.  the doctor’s bill

 *(See Related below regarding forms.)

In November I attended a retirees’ program about health insurance. Some in the audience raised questions about doctors who don’t accept Medicare. It seemed everyone in the audience was clueless.

Why Use a Doctor Who Doesn’t Participate?

One retiree in the audience reported that she had to pay in full, without any reimbursement. She needed a specialist for a delicate procedure and was given two names of top doctors in her city. 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. Significant money was spent and wasn’t repaid because she didn’t know she could file her claim directly to Medicare.

The program’s speaker, from a major health insurance company, was very clear about the fact that those insured by Medicare are covered, and can submit non-Medicare-participating doctor’s bills with exclusion letter and the proper Medicare form to Medicare for reimbursement.

Most people at this retirees’ program, like the retiree above whose only choice was the non-Medicare-participating doctor, didn’t think there was any reimbursement if their doctor didn’t “take” Medicare.

Some in the audience said that while Medicare was their primary insurer, they had secondary coverage and had submitted claims for the non-Medicare-participating doctor’s services to their secondary health insurer.

One retiree related that she had submitted the necessary material to her secondary health insurer. The secondary insurer had reduced her reimbursement by the amount they determined Medicare would have paid her for the procedure, then subtracted the deductible, co-pay or whatever. Her reimbursement was a very small amount of the original bill. Another retiree had had a similar experience with his secondary insurer.

Everyone learned that 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. Don’t bypass Medicare at the beginning.

Today many have coverage under networks of doctors and the preceding information may seem unnecessary. Yet emergency-type cases, and in big cities like New York, where some doctors exclude themselves from Medicare, this knowledge could come in handy. (A retirees under 65 in the audience said she was happy to have this information in advance.)

Bottom line: A person enrolled in Medicare is covered whether nor not the doctor participates in Medicare. Non-Medicare Participating doctors offices are evidently not allowed to give advice about Medicare. If questions not answered in “Medicare and You,” contact Medicare directly.

Related: Medicare participants should have received Medicare and You 2015 in the mail late last fall. If not, get the hard copy by clicking: 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: http://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/CMS-Forms-Items/CMS012949.html –and for instructions in English: http://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/CMS1490S-ENGLISH.pdf  Forms are also available in Spanish.

The Importance of Memories for Elders and Aging Parents

“Time takes all but memories,” an inscription on a sundial that inspired a memorable sermon. That inspired my post last year, with suggestions for helping aging parents do things that will create happy memories. Following up on that inscription and that post–

We know “the whole is the sum of its parts.” We learned that in school. When people are old, with less to occupy their days, memories from the earliest days to the present take on more and more importance. The little piece below, from a student, brings it all full circle.

Today, I interviewed my grandmother for part of a research paper I’m working on for my Psychology class.  When I asked her to define success in her own words, she said, “Success is when you look back at your life and the memories make you smile.”
Here’s to creating more memories that make aging parents and those we care about smile.
 *              *            *
 Related: Making Family Memories 
             Time Takes All But Memories
*
Check out “Newsworthy” (right sidebar). Links to timely information and research from top universities and respected professionals, plus practical information–to help parents age well.

Choosing the Best Walker–101-year-old, Aging in Place: Mobility Continues 4 years After Broken Hip Surgery

The “Best” Walker is the Right Walker
(and can change as needs change)

The right cane and the right walker empower elders, enabling them to continue their routines as before. Reduced mobility, on the other hand, is obviously not empowering, creates neediness, and can lead to less contacts with others–not helpful in aging well independently and not helpful to us if we’re caring adult children.

Having the right “tools” makes everything easier–for any situation actually. (Learned this in a “Home Repair” course; found it a truism.) It’s not rocket science that an easy-to-use, dependable walker is the right “tool” to continue mobility and an active life.

But do we realize that the first walker purchased may not be the ultimate walker? Here’s why–

1. We often select quickly (possibly the one used in rehab).
2. We often select the least expensive.
3. Subsequent factors, like balance and aging parent stability may lead to buying a studier walker.

We see many people using light weight walkers with 4 legs, tennis balls or skis on the back legs. Click link to physical therapists’ video before purchasing. It discusses important limitations (ie. light weight compromises stability. It must be picked up every time a step is taken). The research, time and money to purchase a walker that fits needs and gives parents’ confidence is well-spent.

Our first trip to the surgical supply store after R’s release from rehab yielded two walkers: a basic one with front wheels and skis on back legs, and a more expensive, heavier walker with wheels, skis on back legs and a basket/seat (which she never used).

R used the basic walker in the house…until her cane arrived three days later. Basic walker went into the garage. R says once you’ve fallen you need to feel safe when you walk. Ever since rehab, her cane has given her complete confidence to walk…until a year ago. Then serious vision problems began  affecting her balance and confidence. “Bit by bit, then more and more” she used that basic walker from the garage. Last spring she needed a new walker.

Why and how it’s used–

R wanted a tray attached to her walker, but her walker wasn’t compatible with existing ones. Thus, a new walker, with tray, was purchased . According to R it’s less wide (thus more comfortable), very sturdy and weighs less. The skis on the back legs and wheels on the front work fine on carpets. R only uses it in the house. When she goes out she always uses her cane. She feels safe with that.

She switched to her current walker, this Guardian Signature walker plus extras: the front wheels (attachments): $66.75; the back legs’ ski glides: $15; attached fold-down tray: $39.95. 2014 total: $131.80 

While not covered by Medicare, it’s “worth every penny,” according to her. (She still does her own finances.)

The tray is used daily–for moving food from oven to table, refrig to oven, delivered things to kitchen, bedroom etc. Also, R still has easy-care leafy green plants that need watering. She likes taking these plants to the kitchen sink, but holding a cane and carrying a potted plant doesn’t happen! Her current walker with the 2 recessed holes filled a need.

A friend in her 70’s, who had polio as a child, has purchased countless walkers over decades. She now prefers rollators–walkers with 4 wheels, which make them very sturdy and easy to to use inside and outdoors. (I’d never heard the term before speaking with her.)

Rollators come with seats, baskets, trays, cup-holders and various other options.  She has one for indoors which has different “amenities” than the collapsable one used for going out. The latter has a fold-up seat, offering a place to sit if needed, but no tray. It’s less heavy, making it easier to lift into/out of the car. (Grandkids love to sit on it, she tells me.) That said, I know adult children who don’t like taking parents out because it entails lifting a collapsable walker. Do they need lessons?

My friend says four wheels plus good brake handles are very important if the walker is to be used out of the house (think uneven pavement and inclines). Over the years she has purchased walkers on line or through catalogs and some at stores like CVS and Walgreens, where they “fit” the walker to your measurements. The right height is extremely important. Note walkers for shorter and taller people when checking “Related” below for rollator options. (Site selected because of the excellent pictures and information.)

Great gift: Family members contribute to the purchase the right walker. For seniors who are trying desperately to maintain their independence and age in place, the right walker helps parents age well. It clearly has for R.

Related: Rollator models
              Very good video, excellence hints by 2 physical therapists: Walkers: Wheeled vs Standard

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