Every state offers either disabled parking cards, or plates, or both. While the requirements vary by state, they are very similar. While not in every case, it often requires a doctor’s letter.

To give you an idea of what they typically require, we’re posting Wisconsin’s basic requirements below:

• Cannot walk 200 feet or more without stopping to rest;
• Cannot walk without the use of, or assistance from, another person or brace, cane, crutch, prosthetic device, wheelchair or other assistance device;
• Is restricted by lung disease to the extent that forced expiratory volume for 1 second when measured by spirometry is less than one liter or the arterial oxygen tension is less than 60 mm/hg on room air at rest;
• Uses portable oxygen;
• Has a cardiac condition to the extent that functional limitations are classified in severity as class III or IV, according to standards accepted by the American Heart Association;
• Is severely limited in the ability to walk due to an arthritic, neurological or orthopedic condition;

We’ve included links to each state so you can check the specific requirements. The links either take you to an application form, which typically include the requirements, or to their department of transportation page which discusses the application requirements. Links to Acrobat documents are noted with ‘PDF’:

• Alabama (PDF)
• Alaska
• Arizona
• Arkansas
• California
• Colorado
• Connecticut
• Delaware
• Florida
• Georgia (PDF)
• Hawaii
• Idaho (PDF)
• Iowa
• Illinois
• Indiana (PDF)
• Kansas (PDF)
• Kentucky (PDF)
• Louisiana
• Maine (PDF)
• Maryland
• Massachusetts
• Michigan (PDF)
• Minnesota
• Mississippi (PDF)
• Missouri
• Montana (PDF)
• Nebraska
• Nevada
• New Hampshire (PDF)
• New Jersey
• New Mexico (PDF)
• New York
• North Carolina
• North Dakota (PDF)
• Ohio
• Oklahoma (PDF)
• Oregon (PDF)
• Pennsylvania
• Rhode Island
• South Carolina (PDF)
• South Dakota
• Tennessee (PDF)
• Texas (PDF)
• Utah
• Vermont
• Virginia
• Washington State
• West Virginia
• Wisconsin
• Wyoming
• District of Columbia

The brochure does a pretty thorough walk through the steps that you need to take to prepare you and your loved one for a natural disaster. The major parts include:

• The Calm Before the Storm
• When to Start Planning? Long Before Disaster Strikes!
• Start with Conversations
• Then, Take Action
• A Disaster Is Imminent – What Should You Do?
• Can You Stay – or Should You Go?
• Getting Out of Harm’s Way
• Your Time Away
• The Return Home
• Planning Makes a Difference
• Checklists
• Resource

The checklist section alone is worth the trip. Check it out.

Much is said about caregivers and their need for respite time away. But what if you could make your time as a caregiver more rewarding, more fulfilling…something that you looked forward to.

No one is saying that caregiving will ever be easy, but being able to look beyond the difficulties and seeing the beauty in people despite what afflicts them is exactly what Phillip Toledano and Judith Fox have done.

Phillip Toledano’s Days with My Father is an amazing site that received a lot of recognition earlier this year and will be a book by the same name that will be out June of 2010. It’s hard to look at the site and not be moved. Toledano is clearly a talented photographer and has two other gorgeous photo books in print: Phonesex and Bankrupt which remarkably wasn’t done recently, but in 2004.

I heard Judith Fox interviewed on Fresh Air the other day and was taken by her energy and compassion. Judith married her husband just three years before he was diagnosed with Alzheimer’s. As Fresh Air puts it, “In an attempt to remove the sense of isolation that so many feel, Fox attempted to capture images of the soul of the man she still loves.” Ultimately she was encouraged to publish a book with her photographs. There’s a five-minute video that talks about the thinking that went into the photos and the book called, I Still Do: Loving and Living With Alzheimer’s.

No matter how you cut it, helping a senior transition from one home to another will take a lot of your time. If you’re working, you’ll need to take vacation time during and after the move. If you can enlist other family members to help in a tag-team approach, it’ll take stress off of a single individual.

Before the Move

If you can help remember all of the things that need to be done in advance of the move, you’ll minimize the stress that comes from discovering the forgotten detail. Make sure all of the “turn offs” and “turn ons” are scheduled. File a change-of-address form with the post office. They should notify everyone they have an account with, utility, including credit cards, insurance, and so on, as the statements come in the month before. The post office has a “Movers Guide” here. Check out our seniors moving post here for ways to notify Medicare, the IRS and more. The more things that you can have go like clockwork, the better. After that, don’t sweat the small stuff.

During the Move

Of course you and the movers, be they professional or family, will want to be as efficient as possible. But, if you’re all business, you’ll be missing an opportunity to attend to needs of the person moving. Take time for conversation. Reminisce about family events. Talk about friends and family, or what’s going on in the world. Good breaks for food and conversation will be good breaks from the uncertainty that goes along with moving to a new location.

Moving In

It would be easy to be all business while moving it. It’s a lot of work. Moving-in time is an opportunity to help your senior to get to know their neighbors. There’s a lot of time spent in public places–in the halls and in front of the building–that gives you the opportunity to introduce your senior to their new neighbors. This is where you have to be a little more gregarious than normal. Get their name. Ask them about the neighborhood. Ask them a question that your senior genuinely wants to know, because they’ve been in the same situation before and most people will recognize how disorienting things can be at first and will want to help. Get the lowdown on how things work, or what we like at SHF are some good tips to make life a little better.

After the Move

Now that you’ve showered them with attention before and during the move, you have to go back to work. Suddenly there’s a big void. Assuming that they’ve moved to a location near you, consider setting aside certain evenings and weekend days for the next few months where you can run errands, stop by to help out, or just go out to eat. Don’t focus all of your time on the chores.

If there are other family members in the area, enlist their aid. Assisted living communities have activities coordinator. Talk to her and see what she suggests that your parent may like to do to get involve in their new neighborhood. But don’t push it. It takes time to become comfortable in the new surroundings.

After all this advice, the final tip is to keep an eye on your own mental health. Clearly removing the stress from a loved one can put it on your own shoulders. You may be better prepared to take it than a senior, but you have your limits too. Don’t be afraid to ask for help and find some time for yourself.

We’ve posted before on Medicare insurance appeals for Part A/B, Medicare Advantage, and Part D. We’ve even posted on doing battle with insurance companies. The fact is, insurance appeals are time consuming and can feel like doing battle. If you can avoid one, why wouldn’t you? How likely is that you’ll have to appeal an insurance/Medicare decision? I don’t have the statistics, but I suspect that most will do it in their lifetimes. If you haven’t had to appeal, ask a couple of people. Odds are they have.

If you believe that there’s a chance that you’ll want to appeal in the future, why not reduce that chance by spending some time understanding your coverage and what it takes to avoid the calls and letter writing? Consumers Union and The Henry J. Kaiser Family Foundation did, “A Consumer Guide to Handling Disputes with Your Employer or Private Health Plan, 2005 Update” that’s all about how to deal with problems with your insurance. But the gem in there is, “a checklist for diagnosing your coverage”

The checklist covers many of the triggers that will put you in a situation for an insurance appeal. For instance, it asks you to check the medical services for which you need a referral from your primary-care physician. Sure you may know some of them, but if you dig through your insurance coverage forms and identify them in advance, you’ll reduce the chance of a denial of coverage.

There are a number of checklists that you’ll want to fill out:

• My primary-care physician has the following requirements for obtaining referrals
• My primary-care physician can refer me to specialists who
• I have reviewed the Exclusions and Limitations section in my Evidence of Coverage. My health plan will not pay for, or limits, the following services
• My plan will cover services at the following hospitals
• What should I do if I need care while I am out of my plan’s service area?
• Although I can use out-of-network doctors for most services, I cannot use out-of-network doctors for the following services
• If I use out-of-network providers, I will pay

So, here’s what you need to do:

• Print the form a checklist for diagnosing your coverage
• Fill out what you can from reading your plan
• Call your plan provider for the information you don’t have

This won’t guarantee that you won’t have a reason to appeal, but it should give you some peace of mind that you’ve reduced your chances a denial.

And, if you do have to appeal:

• Turned down for a Medicare Part A/B medical expense? Appeal! Here’s how
• How to Appeal Medicare Advantage/HMO coverage denial
• How to Appeal Medicare Part D prescription drug coverage denial
• Doing Battle with Insurance Companies

Whatever the cause, dementia is characterized by memory loss, attention loss, and/or disorientation. In order to effectively manage the day-to-day activities, while treating the person with respect, a different approach is required when interacting with someone with dementia.

In order to avoid confusion, consider these tips:

• Be direct – Instead of asking what they want for dinner tonight, you can say, “I thought I’d make lasagna for dinner.”
• Be brief – Focus on the core activity. Instead of discussing all of the activities associated with getting ready for bed, try, “Let’s get ready for bed now.”
• Set the context – When someone comes to visit, give names and a few points about the people, “Paul and Susan, our friends from next door are here for a visit.”
• Speak slowly – Don’t expect an immediate reply. Be patient.

Don’t assume too much about how someone with dementia is processing what you say. In some cases, or some days, it may be very little, or it may be everything. Instead, keep an eye on their behavior. Also, don’t assume that they can always tell you what they need. Do they have any unmet needs that they are unable to communicate?

• Do they need to use the restroom?
• Are they thirsty?
• Are they hungry?

Are they trying to tell you something else?

• Has their routine been disrupted?
• Are they too hot or too cold?

Be aware of how your tone of voice and body language may affect them. Though they may not always fully understand what you say, it doesn’t mean that they won’t perceive your frustration, or anger. Having a relaxed, positive demeanor can make them feel at ease and more comfortable with the situation. And related to that, be patient. Know that you won’t always get somewhere on time. Things won’t always go as you intially imagined. Being prepared to change plans, or have them changed for you. Roll with the punches as they say.

Remember, these tips are as much for the benefit of the caregiver as they are for the person receiving the care. They should help you avoid the anger an frustration that can result from trying to communicate with someone whose communication skills may, or may not, always be there.

Courtesy a4gpa via Flickr

We’re always looking for the best resources on the Web that can help the busy, perhaps harried, caregiver do what they need to do with confidence and compassion, while maintaining a balance in life. Sometimes it’s not easy. One thing working in our favor is that we do have the Internet and its abundance of resources. We also have the networks of caring people with which to share information and ideas. But sorting through the huge volume of information can be challenging and time consuming.

While surely not a definitive list, we thought we’d provide our picks of some of the best caregiver resources among the embarrassment of riches. Our picks were chosen to get someone a little more thoroughly grounded in role of caregiver. If we’ve missed a great resource, let us know in the comment section below.

Family Caregiver Alliance

While there’s much to be had on the Family Caregiver Alliance site, we honed in on the “Caregiving Issues and Strategies” section of the site. This page provides links to printable pages on a good number of topics, including:

• Caregiver’s Guide to Understanding Dementia Behaviors – Includes Ten Tips for Communicating with a Person with Dementia
• Caregivers’ Guide to Medications and Aging – “Any symptom in an elderly patient should be considered a drug side effect until proved otherwise.”
• Caring for Adults with Cognitive and Memory Impairments – A very thorough over of the topic, from tips on getting started to more resources.
• Caregiving and Ambiguous Loss – Addressing the stress caused by unpredictable memory loss that, “comes and goes—one moment here, the next moment gone”.
• Dementia, Caregiving and Controlling Frustration – A great guide to dealing with the personal challenges that we have to deal with.

There’s plenty more from Family Caregiver Alliance

Alzheimer’s Association CareFinder

This area of the Alzheimer’s Association website focuses on help for a person with Alzheimer’s, or their caregiver. This part of the site is well organized and serves as a good, high-level guide to addressing needs of someone with Alzheimer’s. The major sections of this site include:

• Planning Ahead
• Care Options
• Coordinating Care
• Support and Resources

The site also include an interactive tool called, “Your Personal CareFinder” that asks a number of questions about the patient so it can then recommended care options and questions to ask when screening a caregiver or facility.

Particularly helpful are the “Topic Sheets & Forms“. Included are a number of pages and PDF files categorized as, Forms, Daily Living, Financial, Legal and Insurance Issues and Home and Residential Care. Some, of particular note, are Individual Needs Assessment, Wandering: Preparing for and Preventing, Caregiver Stress and a couple of real thorough documents on taxes and Alzheimer’s.

AARP, Navigating the World of Caregiving

As you might expect, AARP has a good area on their site that helps caregivers find the kinds of information that they’ll need while helping a senior. The major, and best, parts of this site include:

• Planning Ahead
• Providing Care at Home
• Preparing Your Home
• Housing Options
• Legal and Insurance
• End of Life

There’s a lot of good detail here. While none of them are really deep, they’re helpful in that they give a good overview of each topic area.

The site has a couple of “interactive features” that are rather unimpressive. One is a quiz to see how stressed you are. You rate yourself on a number of factors and then it scores you on how stressed you are. I like that it has a button below your score that says, “Try Again”. Will me stress go down if I keep doing the quiz? There’s also a video section on the site with a lot of short videos on a variety of topics related to caregiving. Dr. Bill Thomas stars in many of them. The AARP also has a Caregiving area that has more timely articles.

Some Quick Hits

We also have a couple of quick hits for caregivers:
10 Tips for Family Caregivers (PDF) – Good tips from the National Family Caregivers Association
Stages of Caregiving – Also from National Family Caregivers Association on their Family Caregiving 101

Did we miss your favorites, or an obvious one?

Photo courtesy of furryscaly via Flickr

Many of us have been in the situation of having an insurance claim rejected. Often it can be solved by simple documentation. It’s a nuisance, but they go away quickly. In other situations, the insurance company digs in and is adamant that you shall not be covered. In some situations, they’re dead wrong and with a good deal of effort, you can prove it. In other situations, you’re either in a gray area, or totally in the wrong. In all cases, there’s a chance you can get the insurance company to pay.

Understanding your coverage

The first thing to do is to spend some time reviewing your coverage. In most cases, you probably received the detailed information on your insurance in the mail. They typically document policies on their sites. You don’t have to be a lawyer to understand most of it, thought it might help. You don’t have to read it all either, because there’s likely a section or two that cover your specific situation. Skim most of the document and mark and thoroughly read the parts that apply to the current issue.

Insurance call centers

People who manage call centers typically measure performance on things like, ‘first-call resolution’, number of calls handled by agent, agent availability and cost per call. Their motivation to solve customer situations quickly and efficiently can work for you and against you, depending on how difficult your situation is and how far apart you and the insurance company are on the claim. Don’t think that by wasting their time that you can badger them into submission. What you can do is use their motivation to satisfy your needs quickly to your advantage. Most call-center staff are trained on the ins and outs of the policies and procedures and they often have key reference materials at their fingertips. Ask questions about your coverage. If they’re denying you coverage for a specific claim, ask how this situation could be avoided in the future.

There are some specific techniques that will help you when engaging with the call center:

1. Have paper and something to write with before starting the call.
2. Take the name of the person you get on the phone. Some call centers allow you to recontact the same person, so during the call, ask how you can recontact him, or her. At minimum, the person’s name, the date/time you called and some notes on what you discussed will help you in follow-up conversations.
3. If you talk to multiple people, try to understand whether they’re all frontline employees, or if some are supervisors, or management. It can help you if you have some idea of the structure of their organization and what each person has the authority to do for you.
4. Be respectful. Treating a call-center employee any other way will not help you and, in fact, could deprive you of an ally. It’s better to have them on your side than against you.

Insurance claims strategies

• Call the insurance company and get a clear explanation of the denial. Often denials of claims come with a terse three-word explanation and a code. Get them to explain exactly what the problem is and, if possible, a more thoroughly written documentation of the issue. At minimum, get them to tell you where in the policy you can read more about it.
• Enlist the health-care provider (doctor, or hospital, insurance billing staff) to help you, or give you suggestions on how to handle it. They have some incentive to help you because, if the insurance doesn’t pay, then they have to get the money from you.
• In some situations, insurance companies will have a ‘pay to educate policy’ that they can use at their discretion. For instance, if there was ‘an inappropriate emergency admission’ they might cover it in the first instance, but not in the future. It doesn’t hurt to ask.

Enlist consumer advocates

• Need Help Navigating Medicare? SHIP is Not Far From Home
• Need Help With Veteran Benefits?
• State Insurance Commissioner – See the link to State Insurance Departments on our State & Local Resources page
• How can a long-term care ombudsman help?

Perhaps you have some tips that others can use. Let us know in the comments.

First a few simple facts, a centenarian is someone who’s lived to 100. There are about 50,000 centenarians in the U.S., or one per 6,000 people. A supercentenarian is someone who is at least 110 years old.

According to a recent Forbes magazine article, How To Live To 100, partly based an interview with Jay Olshansky, a professor of epidemiology at the University of Illinois at Chicago School of Public Health. The main points of the article were:

1. Pick your parents well – genetics play a big role.
2. Then live right – avoid obesity, heavy drinking, smoking and high blood pressure
3. Exercise–into old age – seems self explanatory
4. Avoid obesity – being obese in middle age roughly doubles mortality rates, depending on the study.
5. Don’t smoke, drink (a little vino) – The lowest mortality risk was found at four drinks a week.
6. Eat your veggies, hold the steak – diets high in fruits and vegetables are consistently associated with longer life, in epidemiological studies.

Olshansky’s site is a treasure trove of articles on aging.

Our friends at Evercare pointed us to their annual survey of centenarians called, 100@100, conducted by our research friends at GfK Roper. It’s a great peek into the lives of people who have made it that far. Some of the interesting tidbits include:

• More so than any other generation, 63% of these Centenarians say continuing to make new friends is very important to healthy aging
• 64% say they feel very independent right now
• 63% believe that our health is determined by our lifestyle choices
• 19% use cell phones
• 12% have used the Internet (think about it, they were probably in their late 80s when most of us started with the Web)
• 3% report that they have dated someone they met through an online social networking site (perhaps being young at heart is a key)

If you’d like to read the report, you can find it here: 2008 Evercare 100 at 100 Survey

Some researchers estimate that 25% of variances in life span can be attributed to genes, with the remaining 75% to environmental factors, such as exercise and diet. Though, in cases of extreme longevity, genetics probably play a much greater role.

A Loma Linda University study found that Seventh-Day Adventists who maintain healthy habits live 10 years longer than those who did not follow a vegetarian diet and did not exercise regularly. On a side note, John Harvey Kellogg, brother of William K. Kellogg the cereal entrepreneur, was a Seventh-Day Adventist who ran the Battle Creek Sanitarium, a health complex that attracted people from all over the world. The vegetarian diet there gave rise to Kellogg’s corn flakes and other cereals. C.W. Post, inspired by his time at the Sanitarium, founded the Postum Cereal Co. The Kellogg brothers both live to 91. Post was only 59 when he died.

The Living to 100 site has a life expectancy calculator that asks you 40 questions related to your health and family history and estimates how old you will live to be. According to the site, most people score in their late eighties.

Some books on living to 100

• Living To 100: Lessons In Living To Your Maximum Potential At Any Age
• Centenarians: The Bonus Years
• The Blue Zones: Lessons for Living Longer From the People Who’ve Lived the Longest
• If I Live to Be 100: Lessons from the Centenarians

Martha Stewart has her own recommendations in, Five Steps to Living to 100. They include:

• Floss Daily – The thought is that gum inflammation leads to a continuously elevated level of inflammation throughout the body.
• Find a Good Doctor and Ask the Right Questions – Being inquisitive and proactive about your health can add up to four years to your life.
• Avoid Diabetes – Keeping your blood sugar tightly controlled can add at least six years to your life
• Avoid Risky Sexual Behavior – This can add up to 20 years to your life by protecting you from diseases such as HIV, hepatitis, and cervical cancer.
• Keep Blood Pressure Under Control – Keeping your blood pressure under control can add up to 22 years to your life.

If you want to read a more technical paper on living to 100, try Living to 100 and Beyond: Search for Predictors of Exceptional Human Longevity on the Society of Actuaries site.

Finally, why stop at 100? Catch Aubrey de Grey’s TED talk: Why we age and how we can avoid it

What did we miss?

Iwan Gabovitch via Flickr on Earth Day

For those seniors who are a little more in tune with the environment there is an emerging ‘green burial’ movement. The interesting thing about the green burial movement is the variety of options offered. Most can be classified into two major categories: cremation and whole-body burial. From there many of the choices have to do with where your remains will be placed. Whatever your senior decides, or you decide for yourself, make sure that your wishes are known. Be sure to document your desires on paper, and so that it is legally binding, consider consulting an attorney.

Cremation

Surprisingly, when all things are considered, cremation is one of the greenest options available. Cremation is a process that quickly reduces the body to its elements. The energy needed for a cremation is largely offset by the equipment and labor that is needed for a grave, or a mausoleum. Shipping cremated remains has a smaller carbon footprint than does shipping a body. And modern cremation is done with scrubbers to keep air pollution to a minimum. Check with the crematorium about their equipment. Also, an ‘immediate cremation’, one without a casket or viewing, is generally the most affordable method of preparing the deceased.

Cremation is considered final disposition in just about every state, and thus a cemetery plot is not necessary. Ashes can be shared among friends and family, and scattered in a place that was important to the deceased, or put in ‘scattering gardens’ at your church. Eternal Reefs provides an alternative resting place for someone’s ashes. They mix the ashes with an eco-friendly concrete, forming a ‘reef ball.’ The balls are placed on the seabed, creating structures that attract marine species.

Whole-Body Burial

There are also a number of options for whole-body burial as well. Much of the focus for green burial is avoiding the chemicals that embalming puts in the body and thus the ground. Where toxic formaldehyde and mercuric chloride are used in the typical burial process, with green burial the body is refrigerated, or kept in dry ice, prior to the funeral. Then the body is placed in a cotton or hemp shroud before placing it into the grave. Biodegradable pine, cardboard, or wicker box, is used without a concrete burial vault.

As with cremation, location plays a factor here too. Funeral homes and cemeteries are offering green options. The Green Burial Council has a regional locator to help you find someone near you that offers these services. Some burial services have conservation areas where remains can be buried within land that is cared for in an environmentally friendly way.

If you’re truly serious about going out as green as possible, consider the rest of the arrangements surrounding your funeral. Some recommend that you ask that friends and relatives limit their travel for the funeral. Grist recommends, “Everything from using recycled paper plates to insisting on local wines and microbrews…”, and, “Just be sure to stress simple ideas and make sure to spell out how important it is to you.”

Helpful Links

There are a lot of Green Burial resources. Here are some of the better ones:

• How to green your funeral
• Environmentally Friendly Death and Funeral Choices
• Green Burial Council
• Natural Burial Company
• The Green Funeral Site
• Memorial Ecosystems
• Forever Fernwood

Related SHF Links

• Pre Paid Funerals: Weigh Your Options Carefully
• Arlington National Cemetery Eligibility Requirements
• Plan a Funeral for $800 or Less
• Funeral Resources: Whether You Need Them Now, or Not