How To Be With Someone Grieving

The Worst Things to say someone grieving:

1. At least she lived a long life, many people die young
2. He is in a better place
3. She brought this on herself
4. There is a reason for everything
5. You can have another child still
6. She was such a good person God wanted her to be with him
7. I know how you feel
8. She did what she came here to do and it was her time to go
9. Be strong

The Best Things to say to someone grieving…

1. I am sorry for your loss.
2. I wish I had the right words, know I care and am thinking about you
3. I don’t know how you feel, but I am here If can help in anyway.
4. My favorite memory of your loved one is…
5. I am always just a phone call away
6. Give a hug instead of saying something
7. We all need help at times like this, I am here for you
8. I am usually up early or late, if you need anything
9. Saying nothing, just be with the person

care coordination too expensive for Medicare

nashville geriatric care manager

health care or sick care?

Health care or sick care: what are we reforming?

With passage of health-care reform legislation imminent, this is a significant moment. Many have fought for decades to bring about meaningful change on this issue. Whether or not you agree with the legislation, there is no denying that mountains have been moved. But let’s also be honest in acknowledging that while these changes are a start, the real work to reform health care is just beginning.

The battle over the past year wasn’t about health-care reform; it was primarily about insurance reform — how we pay for care.

They say in medicine that the real challenge is to get the diagnosis right. If there’s too much focus on the cure before it’s clear what the problem is, the “solution” won’t stick. And that is exactly what happened with the health-care debate we just witnessed.

As a nation we bypassed the diagnosis stage and quickly focused on addressing problems related to the insurance system. But those are secondary, not primary, issues. A core issue is that our nation has too many people with too many diseases that are debilitating and costly. We have focused our attention on triage — solving the immediate problems when people get sick — and not enough on getting them healthy, to reduce future problems.

The truth is, our country doesn’t really have a health-care system. We have a sick care system. Our system isn’t primarily designed to keep us healthy; it’s organized to get us well when we get sick.

Take a hard look at our real underlying disease: the lifestyle choices we make every day that lead to more sickness and thus more cost. This vicious cycle is poised to continue unless we craft a system that encourages and rewards health, rather than accepting a system that finds it easier to deal with us after we have become sick.

Now, this nation does a pretty good (albeit, costly) job of getting people well when they get sick. But we’re missing the larger question: What we can do to keep people from getting sick in the first place? The area that requires the greatest focus relates to chronic diseases.

The number of people with diabetes recently reached 24 million. The National Bureau of Economic Research estimates that obesity rates will top 40 percent by 2020, and annual related medical costs have already reached $147 billion. By some estimates, chronic diseases account for more than 70 percent of the $2 trillion spent on medical care in the United States each year.

Chronic disease results from a number of factors, including heredity. But for most people they are largely caused by unhealthy behaviors such as poor nutrition, lack of exercise, smoking or other largely preventable lifestyle choices. Amid the debate about health-care reform, why is there so little discussion of the role each of us can play to improve our health and reduce our nation’s financial burden?

Americans can’t let the health-care debate happen only around conference tables in Washington. We need to have discussions with our families around our kitchen tables. We are part of the problem and should be part of the solution. Helping pay the costs of healing sick people may be an important role for government, but doing what we can to avoid getting sick must be a commitment each of us makes to ourselves, our family and our community.

This is not about who pays for what. It’s not even really about disease. It’s about the decisions each of us make every day. We can collectively benefit our nation by making smarter choices that don’t burden others with the costs of our sick care.

For most of us, the jargon of the debate over health care isn’t what’s important. While we let our elected officials figure out how to pay for the increased access to care, why doesn’t each of us focus on staying out of the system as much as we can? That means adopting a few simple truisms that if embraced, can improve our health, and save our country a lot of money. For most of us, the jargon of the debate over health care isn’t what’s important.

While we let our elected officials figure out how to pay for the increased access to care, why doesn’t each of us focus on staying out of the system as much as we can? That means making a few simple changes that, if embraced, can improve our health and save our country a lot of money.

Good starts would be: Eat less food and make smarter choices about what to consume. Move your body more. Don’t smoke. These are all simple lifestyle choices that over time can add up to significant change and create a positive long-term impact on your health and our nation’s health-care system.

Shoring Up Medicare

Expanding Health Coverage and Shoring Up Medicare: Is It Double-Counting?

By ROBERT PEAR
Published: December 28, 2009

WASHINGTON — At the heart of the fight over health care legislation is a paradox that befuddles lawmakers of both parties.
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Separate bills passed by the Senate and the House would squeeze nearly a half-trillion dollars from projected spending on Medicare over the next 10 years. These savings would help offset the cost of providing coverage to people who are uninsured.

At the same time, federal accountants say the money would shore up the Medicare trust fund, so the program could continue paying hospitals to treat older Americans in the future.

In other words, Medicare savings mean both more money available to spend now and the appearance of more money to spend later on Medicare.

How is this possible?

The Congressional Budget Office tried to answer the question last week. In effect, it said, the same money cannot be used for both purposes without double-counting.

“To describe the full amount of hospital insurance trust fund savings as both improving the government’s ability to pay future Medicare benefits and financing new spending outside of Medicare would essentially double-count a large share of those savings, and thus overstate the improvement in the government’s fiscal position,” the budget office said.

But the clarification came too late to affect the outcome of debate over the legislation, passed Thursday in the Senate by a party-line vote of 60 to 39.

For weeks, Republicans had been saying that Democrats would plunder Medicare, raid it, use it as a “piggy bank” to pay for coverage of the uninsured under a new entitlement program.

Such fusillades frightened some older voters and prompted defensive maneuvers by Democrats, who said their bill would “save lives, save money and save Medicare,” while providing additional benefits to older Americans.

Senator Michael Bennet, Democrat of Colorado, offered an amendment that said nothing in the bill would result in a reduction of “guaranteed benefits” under Medicare. The amendment was approved, 100 to 0, on Dec. 3.

Richard S. Foster, the chief Medicare actuary, agrees with the Congressional Budget Office. He traces the confusion to different accounting rules used for the federal budget and for the Medicare trust fund.

The Senate bill would reduce the growth of Medicare spending and increase the Medicare payroll tax on high-income people. The combination of less spending and more revenue would lower the deficit, based on budget accounting rules, and extend the life of the Medicare trust fund.

However, Mr. Foster said, the same money “cannot be simultaneously used” to cover the uninsured and to extend the Medicare trust fund, “despite the appearance of this result from the respective accounting conventions.”

Senator Jon Kyl of Arizona, the No. 2 Republican in the Senate, summarized the situation with a pithy metaphor. “You can’t sell the same pony twice,” he said.

After issuing its clarification, the budget office reaffirmed its earlier estimate that the Senate bill would reduce the deficit by $132 billion in the next 10 years, compared with the deficits expected under current law.

The issue involves not only technical accounting matters, but also a huge political issue: the impact of a health care overhaul on Medicare and its beneficiaries, whose numbers are about to explode — to 60 million in 2019, from 46 million now.

On a purely technical level, the federal budget deficit — $1.4 trillion in the last year — is the difference between federal receipts and federal spending in a given year. It measures cash flows into and out of the Treasury. If Congress cuts Medicare spending, it reduces the deficit, assuming everything else stays the same.

By contrast, Medicare’s hospital insurance trust fund serves, in the words of the Congressional Budget Office, “primarily as an accounting mechanism.” Payroll taxes paid by workers and employers are credited to the trust fund. Medicare draws on this account to pay hospitals, nursing homes and certain other health care providers.

Under federal law, the Medicare hospital trust fund exists “on the books of the Treasury.” It may have a positive balance — enough money to pay expected claims for a decade or more — even though the government as a whole runs a deficit every year and borrows immense sums to pay its bills.

In one sense, money that “goes into” the Medicare trust fund cannot be used for other purposes. But it is part of a unified federal budget, which includes spending for dozens of other federal programs. So if Congress reduces Medicare payments to hospitals or private Medicare Advantage plans — and if everything else stays the same — the federal budget deficit will be lower and the balance in the Medicare trust fund higher than they otherwise would be.

The Congressional Budget Office says the Senate bill would cover 31 million uninsured people — about 10 percent of the population — while the House bill would cover 36 million. The budget office has not estimated the effects on total national health spending, but Mr. Foster, the Medicare actuary, has done so.

Mr. Foster estimates that the Senate bill would increase national health spending by a total of $234 billion, or 0.7 percent, in the decade from 2010 through 2019, while the House bill would increase it by $289 billion, or 0.8 percent.

If the savings in the Senate bill are achieved, Mr. Foster said, they would add nine years to the life of Medicare’s hospital trust fund, so it would be exhausted in 2026, rather than 2017.

But, Mr. Foster said, some of the estimated savings “may be unrealistic” because they assume increases in productivity that can probably not be attained by hospitals, nursing homes and home health agencies.

What to take to the ER

Health … Medical Care
Seniors hospital admittance emergency kit –

What should you have ready?An unexpected emergency like this can be much less stressful for you as a family caregiver if you prepare a few things in advance. Emergency Kits traditionally include bandaids, ointment, gauze pads, scissors, etc. The Aging Parents Emergency Kit I created has different contents, but is something I could grab and be out the door with in no time flat. Kind of like the suitcase I packed when I was expecting my first baby!Prepare a folder, envelope or accordion file with the copies of the vital information the hospital will need upon your parent’s arrival in the ER, including but not limited to:Advance Health Care Directive. This legal document appoints a person to make health care decisions for the patient as well as instructions for future health care.Power of Attorney for Health Care. Depending on your state of residence, this may be a separate legal document or it may be incorporated into the Advance Health Care Directive (above).Durable Power of Attorney. This legal document may or may not be requested, but it deals with the patient appointing an Attorney-in-Fact regarding financial matters in general. Again, each state could have different documents, so please check with your attorney in advance as to what your state requires. The hospital may not need all of these, but it is better to have them handy then to have to go home, find them, copy them and then bring them back.

List of Medicines, Vitamins and/or Supplements. The exact name and dosage of each as well as when they were last taken by your parent.
Copy of Medicare Card, Secondary Insurance Card and any Pharmacy Plan. It is good to have the pharmacy phone number handy for when your parent goes home, too, so the hospital can order in advance any prescriptions for medication that may need to be continued at home.
Medical History. Including major illnesses, surgeries, current medications being taken and any recent medical conditions. Writing this down in advance is very helpful and then easy to add to and keep current. Create the record with your parent so that you can get the dates as accurately as possible.
Current doctors’ names, addresses and phone numbers.I also recommend you include some comfort items for yourself. W

Waiting in Emergency Rooms can be much longer than expected. I’ve found it helpful to have on hand:Snacks and/or Beverages. You may not be able to get to the hospital cafeteria, or the cafeteria could be closed. (Do not give any food or beverages to your parent unless the hospital staff gives their OK.)Sweater or jacket. Hospitals and ER’s are generally cold. You may also want to bring a warm jacket or sweater for your parent. Seniors in general feel colder than the average person, so if you’re feeling cold, they probably are as well.Something to do while waiting. This is both for you and your parent. For example, a newspaper, magazines, books, or crossword puzzles you can do together. The patient might not feel good enough to do anything, but it is nice to have a few things handy just in case.Cell phone. So you can call relatives and/or friends to keep them updated. Or you may need to call a doctor’s office to let them know your parent is in the ER.

Alzheimers Disease and the Holidays

The bright lights, big crowds and bustle that make the holidays fun for most of us often do just the opposite for people with Alzheimer’s and those who care for them. Dr. Cindy Carlsson, UW Health geriatrics physician and Alzheimer’s disease researcher at the University of Wisconsin School of Medicine and Public Health (SMPH), says that Alzheimer’s patients may feel a sense of loss while caregivers can become frantic trying to keep up with holiday traditions and caring for their loved ones at the same time. But Carlsson has advice on making the holidays more enjoyable for everyone. Follow a Routine. Sticking to a routine can reduce the stress on the patient, caregiver and family. “Holidays are anything but routine, yet a routine is the best way to be kind to the patient,” Carlsson says. “Make sure the day is as normal as possible by providing meals at the same time they usually are.” Help Them Remember. Alzheimer’s patients can become frustrated when someone tries to challenge their memories with questions like, “Do you remember me?” and “Do you remember what we did last summer?” “Regardless of how close you are to the person, introduce yourself,” advises Carlsson. “You could also update them on your activities so that they don’t have to ask questions.” Carlsson says reminiscent therapy can be effective. She suggests going through old family photos with your loved one. In addition, consider asking guests to wear name tags. Involve Them in Activities. “We recommend that you involve an Alzheimer’s patient with straightforward activities like wrapping gifts, folding napkins or simple crafts,” says Carlsson. Activities can provide mental and physical stimulation. Take Care of the Caregiver. The best gift for a caregiver can be the gift of time and respite. The typical stress of caring for an Alzheimer’s patient can become even more overwhelming during the holidays. Carlsson says you can help a caregiver by offering to give them some “time off.” Families can even prepare a plan to share the care giving. For caregivers who will be hosting the holiday get together, Carlsson suggests smaller gatherings or even a potluck. Carlsson says besides keeping the routine, the two most important things to remember are, keep the celebration simple and include the Alzheimer’s patient.

How to Decide if Your Family Needs a Geriatric Care Manager

The holidays should be a joyful time of homecoming for families, but sometimes those visits also reveal that elderly parents are more frail or more forgetful than before. Discoveries like these may suggest that it’s time to consult a geriatric-care manager.

When Nancy Gratzel’s mother had a sudden change in her health requiring placement in a nursing home, Gratzel and her four siblings found themselves overwhelmed by the complex paperwork to qualify for Medicaid coverage. So they turned to Stephen Mielach, a geriatric-care manager based in their community of Toms River, N.J.

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“It’s a very cumbersome process because you have to find all your parents’ documents and follow the trail of their money over the past five years,” Gratzel said. “I decided that my time constraints didn’t allow me to attend to that. I commute to work, have long work days, and all my siblings are married with children and very active.”

Now Mielach also shares a power of attorney with Gratzel to assist her 88-year-old father, now living on his own, with bill-paying — a task that his wife used to perform exclusively. Her father appreciated the help and began to look forward to Mielach’s visits, she said.

“To me, that was a good use of my parents’ money which we were going to have to spend anyway [to meet Medicaid qualifications],” Gratzel said. “It afforded me the opportunity to direct my energy towards nicer things, helping my mom adjust to the facility and my dad to living at home alone. They had been married 67 years.”

While most seniors and their families do not go so far as to assign power of attorney to geriatric-care managers, members of this growing profession can assist not just with money matters but also with navigating the often complicated decisions about what care is best for mom, dad or another relative.

Sometimes they help resolve a short-term challenge such as Mielach did initially for Gratzel’s mother or they may provide assistance over a period of months or years. Sample tasks range from vetting home health aides to assessing whether a senior is able to remain at home or needs to relocate to an assisted-living community or nursing home. They may also accompany seniors to medical appointments and ensure they receive the prescribed follow-up such as lab tests and radiology scans or find contractors and coordinate bids for home repairs, for instance.

Or when a senior has no spouse or children, a geriatric-care manager may take on even more responsibilities to fill that void.

“For people who have family, I become the expert in the family,” Mielach said. “For those with no family, I become family for hire.”

Boomers’ aging parents spur demand

The profession of geriatric-care manager has been around for decades but really has taken off in the past 10 years as the baby boomers increasingly became long-distance caretakers of elderly parents, said Joyce Gray, a Philadelphia-based certified geriatric-care manager who serves on the board of the National Association of Professional Geriatric Care Managers, the industry’s trade association. The group’s membership has grown from 50 to 2,000 since its 1985 founding.

“There are a lot more older people who don’t have someone locally to look after them,” Gray said. “The baby boomers also are more used to paying for services and expecting high quality and results.”

Another change Gray has noticed is that more people are contacting her proactively rather than in the middle of a crisis such as a broken hip or an Alzheimer’s diagnosis, she said.

A decade ago, Ron Fatoullah, a New York-based certified elder law attorney, rarely recommended that his clients consult a geriatric-care manager. Now he refers at least one-third to see one, if only to validate that seniors and their family are making the appropriate care and financial decisions for their health and happiness.

“I have to know that my client is placed in the right facility, and if they’re going to be at home, that it’s the proper environment with all the safety features they need,” Fatoullah said. “The care management assessment heavily dictates how I do my legal work.”

In the case of Gratzel’s mother, all family members agreed she needed nursing home care. However, geriatric-care managers also can be valuable third-party referees, providing an impartial viewpoint to siblings or children and a parent with different opinions about what is best for the senior, Fatoullah said.

Gifts for Seniors

Choosing a gift can be difficult, especially for persons with dementia or other disabilities.

Gifts to Improve Memory and Cognitive Function:

Crossword Puzzle Books (word search, Sudoku)
Hand-held video games such as Solitaire, Bingo (also helps with dexterity)
Board games – take time to play , i.e. Tri-ominoes, Tangos, jigsaw puzzles with large pieces, or board games such as Life Stories or Reminisce.
Books on Tape or MP3 players (books can be downloaded from the local library for little to no financial outlay) old radio show cassettes that can be played on an inexpensive tape player (Find these at Cracker Barrel)
Reminiscence Magazine: http://www.ccgdata.com/2767-6.html
Gifts for Safety:

Medication compartment boxes, boxes with reminder alarms, alarm watches. E-pill is offering free shipping & handling and free gift for retail orders. Volume discounts (6 or more) and custom imprinting are available for corporate orders http://www.epill.com 1-800-549-0095
Driver’s Safety Classes www.aarp.org/families/driver_safety to find classes in your area. Many automobile insurance companies also have programs—check with agent
• Installing door alarms for wanderers. Available at RadioShack and www.improvementscatalog.com
Alzheimer’s Association’s Safe Return Program (pay the enrollment fee) www.alz.org/SafeReturn (800) 272-3900
Emergency Response Systems (Go on-line to find coupons for free installation and discounts)
Motion activated lights for path to bathroom, www.improvementscatalog.com
An electric tea kettle with automatic shut-off
For those who cannot/will not use a microwave oven: The Euro-Pro toaster oven has a timer control for automatic shut-off and is large enough for meals-on-wheels pans and frozen dinners. Available at most department stores.
Cell phone & air time! Jitterbug offers Samsung® senior friendly models and month-to-month service plans starting at $10 www.jitterbug.com 1-866-829-4527
Gifts for Comfort and Sensory Stimulation (Moderate to severe cognitive impairment): Look in catalogs such as Easy Living, Gold Violin, or Solutions for ideas.

Fidget and ‘busy box’ toys: Beyond Play (www.beyondplay.com) will offer a 10% discount for all orders over $50 which are placed by 12/31/08 – mention the promotion code LAU08
Pillows and throws in unusual textures, stuffed animals, and small sculptures
A new bathrobe
‘Pillow pal’ for something to cuddle that supports aching backs or something uniquely entertaining like a singing stuffed animal.
Potpourri, flameless scented candles/tart warmers and scented bath items–lavender scent is calming for “sundowning”—spray on pillowcase at bedtime or tuck a sachet in nightgown drawer or between linens.
Music box, wind chimes, portable radio or TV, audiotapes, or an audio-clock
Shatter resistant magnifying glass
Creative ceiling decorations for someone living in a small space such as kites, posters, or mobiles.
Buckwheat neck pillow for when sitting in wheelchair or geri-chair
Microwaveable heating pads
Twiddle-Muffs –discount for GCM members http://beaulily.com/products.html
Wheelchair Accessories – backpacks, oxygen carriers, rim covers, brake extensions, trays and seat cushions. http://www.mobilityaids.com/site/492331/page/344394?gclid=CPro4YCb5pQCFQKJx
Inexpensive amplifier headset (size of a small cassette player) http://www.amazon.com/ThinkGeek-SE4000-Super-Ear/dp/B000M3F15Y for those who can’t or won’t use but need a hearing aid.
RadioShack’s Clarity line of telephones designed for hearing enhancement

Gifts from the Heart — Gifts of Time (that cost little or no money):

Scrapbook
Creating a family memory video
Writing a memoir/personal history – call MemoryKeeper to ask about discount/services. You can even self-publish and print a hardcover version! www.lulu.com
Weeding their garden
Planting their flowers
Membership to local science center, zoo, museum (and you taking them!)
Trips to the local library
Enrolling the person in the Library of Congress’ Recorded Books Program for those with impaired vision or fine-motor coordination/strength www.loc.gov/nls or downloading MP3 audiobooks to inexpensive MP3 player (available at Wal-Mart, Staples, Target, Kmart) through local library: www.netlibrary.com/RecordedBooks . Some libraries carry audiobooks pre-loaded onto MP3 players.
Compile family recipes into a book. You can even self-publish and print a hardcover version! www.lulu.com
Pre-addressed & stamped family birthday/anniversary cards with the date to mail it written on the envelope flap so that the client can continue to be involved
Personalized Calendars with family photos and birthdates, other special anniversaries (Sam’s Club Photo, Costco, Shutterfly.com)
Jar with decorated lid (or box) filled with pieces of paper, each with a memory involving the elder and you. Open one each visit!
An IOU for a year’s worth of lawn care or 52 car washes from a teenager might be appreciated.
Personalized gifts, such as a deck of cards or jigsaw puzzles using their photo or a favorite grandchild or pet
Large poster of them with a grandchild for their walls
Bird feeder (plus the IOU to keep it filled) would add some interest to their window, and include a book on bird watching or a book or pictures of birds
Storage boxes in bright colors, personalized everything!, clothes, door decorations

Gifts for the active Senior who has everything:

Frozen steaks, salmon, gourmet dinners
Gourmet tea and coffee
Gift certificate for restaurants
Fruit of the month
Nuts
Fresh kitchen spices (these are expensive on a budget)
Tin of popcorn, microwave popcorn packets, a microwave popcorn popper that actually works: Presto® PowerPop® microwave multi-popper, or a hot air popper (both available at Target)
Gift certificates for:

Tickets to the movies, theater, zoo, or museum
Stores or shopping malls
Favorite hair salon
Massage, manicure, facial, salon/spa “day of indulgence”
Housecleaning
Subscription to magazines related to their interests
Plants or cut flowers:
Christmas cactus
Ficus
Norfolk pine
Corsage

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