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.

 

 

Aging Independently and Well Over Decades–10 How-to’s

“As we live our lives, we write our own destiny” Sr. Advisor R 

Sr. Advisor R,, my mil, was a poster child for aging independently, unselfishly and well. She said, to the extent she could, she’d done everything; helped everyone; and given to those she wanted to give. She was ready to go. It was no secret. And I’ve been thinking–since her timely death last week at 101–about how she managed life so well.

R lived by the following:   

 1.Take care of yourself (or you won’t be able to take care of anything else).
2. Be responsible
3. Don’t abuse yourself. (You get enough from the outside)
4. Know when to say “no.”
5. Simplify (as you age)
6. Don’t assume (you can be wrong; it causes unnecessary problems)
7. Don’t expect anything and you won’t be disappointed
8. Concentrate. (If your hands are doing one thing while your head is thinking another, you forget where you put things.)
9. Remember life is good–it’s the people who mess it up.
10.To bring joy in today’s world there are three things you can count on: animals, flowers, music.

Elaboration

1.  The African proverb “It Takes a Village to Raise a Child” resonates loudest. It may sound like an oxymoron. R was clearly not a child and independence was her highest priority. Making it easier for other family members was a necessity in childhood and became part of her being. She was smart–smart enough to know she couldn’t help others without taking care of herself first. At a very young age she was part of the village. Later the village gave back.

2.  “You’ve got to be responsible,” R vividly remembers her father saying when she was 4. It had a huge impact and she acted accordingly.  She recalled their quarantined home during an epidemic, an older sister’s death, another sibling’s health issues, the Great Depression, WWII, being a caregiver for close family and friends. Everyone knew R was 100% responsable. It was who she was.

3.  R’s home was the buffer for any outside abuse. She made it tranquil, lovely and loved–a place to gain strength and renewal. Widowed at 50, she didn’t indulge in activities that would be bad for her. This doesn’t mean she didn’t overdo in certain areas, but she had the discipline to know when she’d overdone and compensated as appropriate. She treated herself to things that brought joy or made life easier. Her easy-care plants symbolized life and joy thus, she replaced and watered them as needed until the week she died–not easy at 101.

4.  R taught us early there was nothing wrong with saying “no” and “I don’t know.” Simply  because someone asks, doesn’t mean we are obligated give the answer we think they want. (This doesn’t make us selfish. It makes us real–my opinion…and we can be very nice while being real.)

5.  Normal age-related changes slow us down. Simplifying allows us to continue life as we’ve known/enjoyed it. Examples:
–R’s many house plants decreased in number and care requirements as she aged. She gave many away and concentrated on the easy-care ones.
–While she went out every day in her younger years, she reduced to only one activity a day, then going out every other day. The last few months she only went out for doctors’ appointments.
–Still making her own meals, R realized she could save dish-washing by putting Trader Joe’s chopped salad greens along with salad dressing in a zip-lock bag, giving it a good shake, and spilling it out onto the plate with her dinner.

6.  Don’t assume. See #6 above. This is so true. Test it!

7.  Don’t expect. See #8 above. Seems jaded, but saves disappointment.

8.  How many times have we forgotten where we put something because our hand did one thing while our mind was on something else? We weren’t concentrating. Shortly after R was widowed she lost something important. She couldn’t remember where she put it. Without anyone to ask for help, R promised herself, from then on, she would never again lose things due to lack of concentration.

9 and 10 above: Life, animals, flowers and music–thoughts R kept front and center as she encountered the challenges of living.

In recent years R acknowledged that she did everything she felt important to do; helped everyone she’d wanted to help, and given what she could to specific charities that served a larger need-base of people and pets. She had significantly contributed to the village.

Since R’s only-child son and I live 2,000 miles away, the village–basically two wonderful neighboring women, Pam and Barb, and a nephew and his wife–made it possible, on a daily basis, for R to continue to live in her own home–with only a cleaning woman working half a day and a gardener. What better “assisted living” could anyone ask for! R had unfailingly done for them over the years and they could never do enough. R was a giver; never wanted to be a taker. In the end, what comes around, goes around.

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: Is It Better To Have A Friend Be Your Doctor?

January 20th’s NY Times, Science Section’s “Hard Cases” column, Too Close to a Patient for Comfortmakes the case, based on AMA guidelines and other sources, that objectivity in medical care may be compromised by doctor-friends. “Medical care supplied by a relative — or an old friend, or a trusted employee — just seems so logical. After all, who could care for you more? But that is just the problem…”

The article triggered 2 thoughts and a dilemma:

1. When I was too young to know about medicine, I remember hearing that a doctor could not do surgery on a family member. Might have been true—or not. A playmate was having surgery. She was 9.

2. In graduate school, the professor in “Techniques of Counseling” gave us a practical list of counseling do’s and don’ts followed by his saying something like: “Be forewarned: if you’re trying to counsel a family member, your emotions will dictate and you may forget this.”

If the emotional ties of friendship can interfere with doctors’ objectivity, how do we reconcile this when it comes to helping aging parents, the elders we care about, and ourselves?

Boomers and those older, remember doctors who knew your family, possibly made house calls, and definitely made hospital visits. It was more “warm and fuzzy” then. Today’s efficiencies, however, dictate something entirely different.

I hear people say “It’s not the doctor’s “bedside manner” that matters. Agree. Knowledge and expertise are most important. But it helps if we feel s/he cares about us, doesn’t it?

Three people immediately come to mind. They don’t have friends as their doctors; yet they’re confident in their doctor’s ability to is do what’s best for them and they feel a certain bond–perhaps a professional-type friendship. Another commonality: they make every effort to take care of themselves to the best of their ability. It appears doctors appreciate this.

1. Several weeks ago I reconnected with a friend, living in a large city in the west with excellent healthcare available. I was unaware that she has a serious, unusual vision problem. Asking about her doctor, she related she did the research and now has the best doctor–adding she was concerned that, because she’s now on Medicare, it would be a challenge finding a doctor who would take her. Then she said, laughingly, something like “When we met he told me he isn’t taking new patients, but I’m ‘vibrant’ so he’s making an exception.”

2. Sr. Advisor R, at 101, has obviously had many doctors over the years. This last year a new best ophthalmologist  (taking few new patients) has been doing his best to maintain her sight, which was rapidly worsening.

She was initially concerned that he thought “She’s old, I can’t do much.” R made him realize she takes very good care of herself (corroborated by the lab tests her primary care doctor sent), lives in her home by herself, and will do everything possible to maintain her independence. He, like her other doctors, respects that–and her. For several months there was no improvement. 12 weeks ago there was slight improvement in one eye. I drove her to her last appointment and there was even more improvement in that eye. The doctor was cautiously optimistic; said to be sure to call immediately if she noted any change–not to wait for her next appointment. He wasn’t a friend but he cared. R’s spirits lifted.

3. Next I check with my friend of decades, who had polio as a child. In her mid-70’s, she has seen countless doctors who were not friends. “Confidence in them,” she says, is a must or she finds a new doctor. She has made changes over the years, as allowed in her health plan.

And we learn a tip–

She writes thank you notes after each appointment. The notes aren’t a hidden agenda to make them like her, she says, but actually to let them know that she’s very appreciative of their help. In addition, reading her note must make them think about her again after her visit. “It puts you on a level that most patients aren’t on,” she says.

A tip for us personally? And for those we care for and about. .

 

Related: New England Journal of Medicine‘s May 2014: Ethical Challenges in Treating Friends and Family..

Aging Parents, Caregivers, Heart Health, Heart Risk

HEART HEALTH AWARENESS MONTH
Women’s Heart Attack Symptoms and Caregiver Stress

Caregivers help 1.6 million heart failure patients at home–did you know that? Many of us have–or have had–elderly family with heart issues, mine included.

If validation is needed about the importance of heart health and heart risk
–The Centers for Disease Control and Prevention call February “Heart Month:
–The National Institutes of Health recognize the month, featuring a February 2015  “tool kit” from the American Heart Assn.
–The American Assn. of Heart Failure Caregivers offers  information especially for caregivers.
–This week, February 7-14, is Congenital Heart Defects Awareness Week.
–February 6th was National Wear Red Day 

Are we all getting the message? Heart disease is the #1 cause of death for men and women. Yet many women are still not aware, evidently. In addition, more caregivers are women, and with caregiving comes stress

Women’s symptoms are listed in the American Heart Association’s “Heart Attack Symptoms in Women (updated 12/5/14). Women either aren’t keenly aware of the symptoms or don’t become as alarmed as they should– or are we simply accustomed to enduring more and/or putting our needs behind those of others?

Clearly caregiving requires putting others’ needs before our own–and we get good at it, don’t we! We can easily feel we’re indispensable. We also know if we get very sick we’re of no help to anyone—but somehow the logic escapes us when we push and overextend ourselves.

A 2013 post “Attention Busy Women Caregivers (Is that an oxymoron?)” is partially reposted here. It features a well-done, entertaining short video “Just A Little Heart Attack,” starring and directed by Emmy-nominated actress, Elizabeth Banks. Worth taking about 3 minutes out of a busy life to watch.

Not wanting to exclude men here, I wondered why I couldn’t find a similar dramatically entertaining video featuring men and heart attacks. These excerpts from the AHA/ASA article may explain the reason. In short,

Many women do not recognize the warning signs or symptoms of heart disease, which may be subtler than those exhibited by men. In addition, only 53% of women said the first thing they would do if they thought they were having a heart attack was to call 9-1-1.

and

Women age 45 and older are less likely than men of that age group − 74% vs. 81% − to survive a year after their first heart attack. In women, heart disease is too often a silent killer – nearly two-thirds of women who died suddenly had no previous symptoms.

Is it a male-thing to be more attuned to recognizing the symptoms of a heart attack and quickly acting on them?

“Place the mask over your face and mouth, before helping others…” Remembering fight attendants’ speeches preceding a commercial airplane’s take-off resonates here, especially when our goal is to help parents and the elders we care about age well.

Related:
   
Mayo Clinic: Heart Disease: Women–Symptoms and Risk Factors
   Center for Disease Control: Men and Heart Disease Fact Sheet
   American Heart Assn. Recommendation for Physical Activity in
Adults
 
 View:Just A Little Heart Attack 

 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–updated 7/15

*Note–November 2015–Awaiting Update that may negate the Part B Medicare coverage for some–although information about secondary insurance remains valid, I believe.

Some doctors don’t “take” Medicare.
They’ve chosen to be excluded from Medicare Program participation.

Nevertheless, people with Part B Medicare coverage are entitled to submit claims from individual doctors to Medicare unless they signed a form in the doctor’s office stating they would not file for Medicare benefits. Otherwise  regardless of a doctor’s Medicare affiliation, it 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 chosen to be excluded from Medicare Program participation and thus, doesn’t “take” Medicare? More and more 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.  Assuming they did not decline Part B coverage (it’s an additional cost but many have it) and signed no waiver in the doctor’s office, they are entitled to Medicare reimbursement for individual 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 and received some monies back.

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 places where doctors have excluded themselves from Medicare, this knowledge will come in handy. (A retiree under 65 in the audience said she was heartened to have this information in advance.)

Note: Non-participating doctors’ office personnel are evidently not allowed to give advice about Medicare.
*          *         *

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.

101-year-old: The Right Cane–Mobility and Aging in Place–4 years after Broken Hip Surgery 1

USING AND CHOOSING CANES WISELY

Because of R’s strong desire to remain in her home of over 65 years and live independently, alone–she may have put more thought into cane selection than many.

IMG_3693The cane she eventually purchased, she first used in rehab. While she used many canes in rehab, this one felt best to her, because of its handle, which is broad. Her palm rests on it, instead of fingers wrapping the usual more rounded handle. Thus, it felt like added support.

To backtrack a bit–

Shortly before her release from rehab a cane salesman visited her in her room. (Don’t know if this is true of most rehab centers.) I happened to be there.

He brought a good supply of canes, but none with the handle R swears by for stability and confidence. She told him what she wanted, which he didn’t have. (No one said she had to purchase his canes…I think it was a “service.”)

The day she signed out of rehab, they let her borrow the cane she liked  best. She took it to the surgical supply store. Not a stock item, It needed to be ordered and would take 2 weeks. R. was eager to get started with it. My husband ordered it through Amazon, where itt was less expensive and arrived at R’s home in 3 days. I can’t remember if Medicare covered it.

A year or so later R saw and ordered the HurryCane. One of its attributes–advertised on TV– was that it stood up by itself. R’s home is carpeted. It did not stand up on carpet. She phoned the company and spoke to “a very nice man” who said she could return it and get full credit (which she did). Although that cane didn’t work for her, she appreciated the ease of return.

She then tried a little rubber gadget that would attach to the bottom of her cane so it would stand up by itself.  But first the existing rubber tip needed to be removed. The rubber gadget didn’t work and R says the original tip could not be put back on her cane–necessitating another purchase of the original cane –with the broad handle.

When R bought the replacement cane, she went back to her rehab place to have them fit the cane so the handle was at the proper height for her. She was told when she left rehab 4 years ago how important it is that the cane is fit properly by someone knowledgeable. She’s convinced that’s why some people who, don’t stand up straight and walk properly with their cane, have problems.

R has always been creative in solving her problems. That’s undoubtedly one reason she has been able to remain independent for so long. Currently her walker, which she loves, provides a place to rest her cane in the standing position.  It’s sort of hooked to one side (see photo). It stands up and ready–always in the kitchen. And when she’s walking to other parts of her one-story home, she can lay the cane on a bed, chair, etc. where it’s easily accessible.

As parents age, inevitable problems arise. Loss of almost all vision in R’s left eye and macular degeneration in her other eye are her current concerns. Mobility isn’t one of them thanks to her cane and a walker (next post).

 
Related: Tips for Choosing and Using Canes Mayo Clinic Slide Presentation

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.