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Are You Really “In” The Hospital

If you have Medicare, did you know that even, if you stay in the hospital overnight, HOSPITAL you might still be considered an “outpatient”?

Your hospital status (whether the hospital considers you an “inpatient” or “outpatient”) affects how much you pay, qualification for rehabilitation, and more.

Resource Information –

Next Step in Care, a campaign of United Hospital Fund, provides hospital admission and Emergency Room guides to provide basic information about “observation status” and what to ask. This information is important as it is a rising trend to be in an “observation” rather than “in-patient” in the hospital.

Click here to open the hospital admission guide.

Click here to open the Emergency Room guide.

Click here to read it as a standalone piece.

Centers for Medicare and Medicaid Services

For their publication on hospital status (observation or in-patient), click here.

New toolkit helps baby boomers transition to Medicare coverage

New toolkit helps baby boomers transition to Medicare coverage

“The Medicare Rights Center and AgeOptions announce the release of “How Medicare Works With Employer-Based Insurance: A Guide for Employers, Professionals and Consumers-”

(By Targeted News Service, December 20, 2011)

http://insurancenewsnet.com/article.aspx?id=317345

 

Tools to Help Choose a Good Nursing Home

By Carolyn M. Clancy, M.D.

December 6, 2011

Finding a high-quality nursing home for a family member is a daunting task.

Many people have not had to make this decision before. And it’s often made under stress, when asking good questions and thinking carefully about your options are harder than usual.

Fortunately, more information is available that can help you learn about nursing home quality and prepare you to make a well-informed decision.

Start this process with an online tool from the Federal Government called Nursing Home Compare. This lets you look up nursing homes in your area by name, city, county, State, or ZIP Code. First unveiled in 2009, Nursing Home Compare has detailed information on every nursing home certified by Medicare or Medicaid.

Nursing homes are rated using a 1- to 5-star scale, with those earning 5 stars being rated the highest. Ratings are based on how many and what type of staff members they have, how well they perform on health inspections, and how they rank on quality measures. Ratings for each measure are given individually and are also combined into an overall rating.

Starting in 2012, Nursing Home Compare will include a new measure that includes input from the nursing home residents. This new information will take the place of the quality measures that currently appear on Nursing Home Compare. Findings will be part of the ratings starting in April 2012.

Staffing and health inspection data add important information and will continue to be a factor in each nursing home’s overall rating. The staffing measure tells you the average staffing levels—such as the number of registered nurses, licensed practical nurses, and certified nursing assistants—for each resident each day. This is a good benchmark, but it has limits. It does not show the number of nursing staff present at any given time or describe the amount of care give to any one resident. The health inspection measure looks at many major aspects of care in a nursing home. This includes how medicines are managed, whether food is prepared safely, and whether residents are protected from inadequate care. Inspections take place about once a year, but they may be done more often if the nursing home has several problems to correct.

Even with so much good information, the Nursing Home Compare tool and rating system won’t answer all of your questions. For example, the ratings won’t tell you if the nursing home has improved, or gotten worse, in certain areas since it was rated. That’s why it’s important to visit any facility you are considering. Be sure to ask questions of the staff, especially people who provide care to residents. It’s also a good idea to visit a nursing home a second time on a different day of the week and another time of day. You may get a better idea of changes in staff, activities, and other factors that could make a difference in your choice.

An excellent list of questions to ask during such visits is available from a nursing home checklist (PDF File; PDF Help) by the Centers for Medicare and Medicaid Services (CMS). And a new handbook (PDF File; PDF Help) from CMS explains how to pay for nursing home care, describes residents’ rights, and gives alternatives to nursing home care. Another good resource is your State ombudsman; select to find yours.

click here to read more.

Educational Video about the Medicare Program in ASL

The Centers for Medicare & Medicaid Services has a new educational video about the Medicare program in ASL for people who are deaf or hard of hearing. The video gives an overview of the Medicare program, including what Medicare is, who qualifies, the four parts (A, B, C and D), new preventive services under the Affordable Care Act, and help paying Medicare costs.

click here to learn more.

National Caregiver Support Line for Veterans

The Veterans Adminstration has established a National Caregiver Support Line for Caregivers of
Veterans — spouses, children, other family members and friends of Veterans as well as Veteran themselves.  

for more information on the program, please go to https://duttonelderlaw.com/resources/articles.html

Four Drugs Cause Most Hospitalizations in Older Adults

Blood thinners and diabetes drugs cause most emergency hospital visits for drug reactions among people over 65 in the United States, a new study shows.

Just four medications or medication groups — used alone or together — were responsible for two-thirds of emergency hospitalizations among older Americans, according to the report. At the top of the list was warfarin, also known as Coumadin, a blood thinner. It accounted for 33 percent of emergency hospital visits. Insulin injections were next on the list, accounting for 14 percent of emergency visits.

Aspirin, clopidogrel and other antiplatelet drugs that help prevent blood clotting were involved in 13 percent of emergency visits. And just behind them were diabetes drugs taken by mouth, called oral hypoglycemic agents, which were implicated in 11 percent of hospitalizations.

All these drugs are commonly prescribed to older adults, and they can be hard to use correctly. One problem they share is a narrow therapeutic index, meaning the line between an effective dose and a hazardous one is thin. The sheer extent to which they are involved in hospitalizations among older people, though, was not expected, said Dr. Dan Budnitz, an author of the study and director of the Medication Safety Program at the Centers for Disease Control and Prevention.

“We weren’t so surprised at the particular drugs that were involved,” Dr. Budnitz said. “But we were surprised how many of the emergency hospitalizations were due to such a relatively small number of these drugs.”

Every year, about 100,000 people in the United States over age 65 are taken to hospitals for adverse reactions to medications. About two-thirds end up there because of accidental overdoses, or because the amount of medication prescribed for them had a more powerful effect than intended.

As Americans live longer and take more medications — 40 percent of people over 65 take five to nine medications — hospitalizations for accidental overdoses and adverse side effects are likely to increase, experts say.

In the latest study, published in The New England Journal of Medicine, Dr. Budnitz and his colleagues combed through data collected from 2007 to 2009 at 58 hospitals around the country. The hospitals were all participating in a surveillance project run by the C.D.C. that looks at adverse drug events.

A common denominator among the drugs topping the list is that they can be difficult to use. Some require blood testing to adjust their doses, and a small dose can have a powerful effect. Blood sugar can be notoriously hard to control in people with diabetes, for example, and taking a slightly larger dose of insulin than needed can send a person into shock. Warfarin, meanwhile, is the classic example of a drug with a narrow margin between therapeutic and toxic doses, requiring regular blood monitoring, and it can interact with many other drugs and foods.

“These are medicines that are critical,” Dr. Budnitz said, “but because they cause so many of these harms, it’s important that they’re managed appropriately.”

One thing that stood out in the data, the researchers noted, was that none of the four drugs identified as frequent culprits are typically among the types of drugs labeled “high risk” for older adults by major health care groups. The medications that are usually designated high risk or “potentially inappropriate” are commonly used over-the-counter drugs like Benadryl, as well as Demerol and other powerful narcotic painkillers. And yet those drugs accounted for only about 8 percent of emergency hospitalizations among the elderly.

Dr. Budnitz said that the new findings should provide an opportunity to reduce the number of emergency hospitalizations in older adults by focusing on improving the safety of this small group of blood thinners and diabetes medications, rather than by trying to stop the use of drugs typically thought of as risky for this group.

“I think the bottom line for patients is that they should tell all their doctors that they’re on these medications,” he said, “and they should work with their physicians and pharmacies to make sure they get appropriate testing and are taking the appropriate doses.”

link to original posting in the New York Times.

 

Medicare D

Just a reminder, Medicare beneficiaries have until December 7 to enroll in, or change, Medicare D coverage.

For Resources on Medicare D, please go to www.medicare.gov; www.medicareinteractive.org; www.insurance.illinois.gov/ship

Family Caregivers: How to Avoid Holiday Traps

Family Caregivers: How to Avoid Holiday Traps

Caregivers can rewrite the holiday rulebook to reduce stress, increase joy

From Vicki Rackner, MD, 

Holidays, meant to be a celebration of shared joy and connection with family and community, can quickly become a time of burden and a reminder of alienation and loss.For caregivers, holidays can bring an extra measure of activities and caregiver stress1. “I wish the calendar would flip directly from November to January,” said Fern, 67. “We just got settled into a routine now that Mom moved in with us, and all I see are a longer to-do list and disrupted schedules.”Holiday celebrations can destabilize any family, and family caregivers know this better than most because people who attend to the needs of aging parents, a sick spouse or family friend already live on the edge of a delicate equilibrium. As Gary, 59, so colorfully said, “Since Dad had his stroke, my life is held together with rubber bands and bubble gum. I’m concerned that Christmas will herald its collapse.”

For self-preservation, many caregivers let go of rules about how holidays should be celebrated. “Being a caregiver for my sick wife offers many gifts,” said John, 73. “Maybe the most important is the invitation to look at our life in a new way. Almost out of necessity, I stripped down our holiday celebrations.”

5 Holiday Traps for Caregivers
There are several common holiday traps that family caregivers fall into, but they can be avoided. Just follow a simple concept: Free yourself from ideas about what shouldhappen, and give yourself permission to celebrate holidays in a way that works for you and your family.

    • Trap #1: Planning for the worst. Many caregivers think, “This could be Dad’s last Christmas, so I want to make it really special.” Wouldn’t it be great if we came into the world with an owner’s manual that included the expiration date! We do not. I have seen patients defy all medical odds and laugh about the doctor who gave them six months to live—20 years ago. Then there are the tragic untimely deaths. We should all celebrate as if this is our last holiday season!
  • Trap #2: Creating Norman Rockwell scenes. The idea of a picture-perfect holiday has an emotional tug that’s particularly seductive to family caregivers who may long to return to earlier, carefree days of health and vitality.While there is no perfect holiday celebration, you can create holiday rituals that are perfect for your family. Say at a family meeting, “Our lives are different this year, so we need to think about how our holiday celebration will be different. What are the two or three things that make the holiday special for you?” For most people, it’s the little things that make a big difference, like the Russian Tea Cakes, the special hand-embroidered tablecloth, or playing board games. Create a montage of your family’s perfect holiday.
  • Trap #3: Buying your way out of guilt. For people in the sandwich generation2, caring for both children and parents, the guilt that someone is getting shortchanged looms large. Who doesn’t wish for more hours in the day so that children and friends, even the person in the mirror, would get more time and attention? The life of a caregiver leaves big gaps. If you try to fill the gaps with gifts, you will undoubtedly find that it does not work very well.All family members, including children, need to know they are loved and treasured. Gifts are one way to say this, but what most kids of all ages really want is more of you. Consider a different kind of holiday gift, like a coupon for 10 minutes of undivided attention each day, a trip to the ice cream store, or a visit to the zoo.During a holiday dinner, how about shining a “spotlight” on each person at the table, with each guest offering a story that demonstrates why this person is special? You could write the comments on 3×5 cards and give them wrapped in ribbon or mounted in a collage.

    Consider inviting your kids to give rather than receive by touching the lives of those less fortunate. Serve a meal at a shelter. Invite a lonely neighbor to your house. Look for a chance to give a stranger a $20 bill, or whatever you can afford.

  • Trap #4: “Smile!” This instruction, given before every photo, captures the tone for holidays. Over and over, we’re told there’s a right way to feel during a holiday, and that’s happy. Family caregivers have a spectrum of feelings that rise to the surface during holidays, like sadness or anger or disappointment. It is sad that it’s not safe for Dad to live alone any more, so set aside some time to acknowledge those dark feelings. Suppressing the feeling does not make it any less real, and adds to your holiday burden. [Note: For help with handling feelings of grief and loss, see 5 Steps to Help You Through the Grieving Process3]
  • Trap #5: Party On!If you are an extrovert—someone who gets recharged from being in the presence of others—you are in your element during holidays. Party on!For introverts who get recharged by spending time alone, or those who have limited pep because of illness, holidays can be emotionally depleting. There is still hope for a joyous holiday celebration, it just requires some advanced planning.Plan a social calendar that’s reasonable for you as a caregiver and for your loved one. Be realistic about your energy limits before you make endless commitments, and ask family members to do the same. If either you or your loved one is an introvert, it’s perfectly reasonable to respond to some invitations with, “Thanks for the lovely offer. Unfortunately, we have other plans. I’m sure you’ll have a terrific time, and I’m sorry to miss it.” The host does not need to know that your other plans are a nap.

Your life became different when you became a family caregiver, and it’s time to do things differently. Free yourself from the idea that there’s a right way to celebrate a holiday. Look at your family and decide how to make holidays work for you, and then adjust the family expectations. That’s the recipe for celebrating the blessings in your life, and the joy and love you share with others.

Vicki Rackner, MD, FACS, is a surgeon who left the operating room to help patients and family caregivers enjoy better health. A noted expert on the doctor-patient relationship, Dr. Vicki serves employers through Medical Bridges4, and welcomes everyone to join her Caregiver Club5.

Confused about Medicare?

Medicare is the primary health insurance for people are 65 and older and younger people who have a disability.

However, Medicare can be very confusing. To learn more about Medicare, what is covers, deductibles, co-pays, etc., look at  

www.medicare.gov;  

www.insurance.illinois.gov/ship

In addition, go to www.medicare.gov/publications for a resource booklets on the various aspects of Medicare.

Alzheimer’s: Early Planning Critical to Financial Health

In a recent article in Reuters Magazine, Alzheimer’s: Early Planning Critical to Financial Health, working with a certified elder law attorney is an important step in planning for the future.

Janna Dutton, founder of Dutton & Casey, is one of only 8 certified elder law attorneys in Illinois.

Click here to read the article.

For additional information on how Dutton & Casey can assist you, or someone who you care about, please go our website.

Planning for a Hospital……Discharge

An admission to, and a discharge from,  the hospital can be scary for the patient, and the family. The National Family Caregiver Alliance published a guide on the hospital discharge process. It is vital to pay attention, and be involved, in the plans being for when your relative leaves the hospital.

read the entire article.

……………….

The law firm of Dutton & Casey concentrates in assisting older adults, people with disabilities, and their families. Many times, plans following a hospital stay also include the need for legal planning.  With over 50 years in expertise and offices in Chicago, Skokie, Arlington Heights, and Vernon Hills, the advocates at Dutton & Casey are available to assist. Please click here to read more about how we can assist you or those you care about.

YOUR Elder Law Connection… From Dutton & Casey

The April, 2011 issue of the newsletter from the Law Firm of Dutton & Casey was published today.

Please take a few minutes to read the newsletter… it contains many helpful articles and resources focusing on older adults, adults who have a disability, and the people who care about them, including family members and professionals.

Should there be any questions on the newsletter, to learn more about the many resources that the attorneys and staff can provide, or/and to schedule an appointment with a firm attorney, please go to https://www.duttonelderlaw.com/

Center for Medicare Advocacy Says: You Can Leave the Nursing Home

December is a time of holidays, celebrations and school vacations. Nursing home residents often want to join in family festivities and visit with children and grandchildren but may be under the impression that they will lose Medicare coverage if they leave the facility to do so. According to the Center for Medicare Advocacy, Inc. (CMA) this is not true.

The Medicare Benefit Policy Manual recognizes that although most beneficiaries are unable to leave their facility, “an outside pass or short leave of absence for the purpose of attending a special religious service, holiday meal, family occasion, going on a car ride, or for a trial visit home, is not, by itself evidence that the individual no longer needs to be in a SNF for the receipt of required skilled care.

for more information, go to www.medicareadvocacy.org/infobytopic/skillednursingfacility/snf_youcanleavethe snf.htm