According to the Centers for Disease Control and Prevention in an online article entitled, Immunizations for Adults, “the most common causes of death, pneumonia and influenza remain among the top ten causes of death for older adults.  In 2000, pneumonia and influenza were responsible for 3.3% or 58,557 deaths among people 65 years of age and older.”

According to NBC’s Today Show, “The single best way to protect yourself and your loved ones against the flu is to get vaccinated.”  The online report also explains that,  “more than 110 million doses of vaccine against regular winter flu are expected this year, according to a new estimate from the Centers for Disease Control and Prevention.”

People who fall into the following groups should ensure they are vaccinated:

• Adults 50 and older.
• All children ages 6 months to 18 years.
• Pregnant women.
• People of any age with chronic health problems like asthma, heart disease or a weakened immune system.
• Health workers.
• Caregivers of the high-risk

The CDC online article, also explains, that “among person [sic] aged 65 years and older, influenza vaccination levels have increased from 33% in 1989 to 66% in 1999,  surpassing the Healthy People 2000 goal of 60%. “

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.

vieux bandit via Flickr

We recently ran across a new study by the Kaiser Family Foundation that was written by Massachusetts Institute of Technology economist Jonathan Gruber and thought it was a good time to pull together a number of great prescription and Part D resources that we’ve come across over the past few months.

Choosing a Medicare Part D Plan: Are Medicare Beneficiaries Choosing Low-Cost Plans?
The Kaiser study looked at Medicare prescription drug claims for 55,000 seniors (65 years, or older) from 2005. Gruber then modeled the plan choices for 2006 based on the advice to choose a plan based on their current medication regimen. He then compared the modeled choices to the actual choices and then calculated the differences in annual out-of-pocket prescription drug costs. Among those who didn’t choose the lowest-cost plan, enrollees would have saved $360 and $520 on average if they had chosen the lowest cost plan. On the high end, some could have saved as much as $1,360.

Open enrollment doesn’t begin until November, but it’s a good idea to keep the concepts top of mind so that you can be prepared when the time comes. You can find the full study here: Choosing a Medicare Part D Plan (PDF)

Choosing a Part D Plan? Can You Say Formulary?

Whether your choosing a standalone prescription plan, or a plan that’s part of a Medicare Advantage plan, you’ll need to know what they cover and for how much. That’s where the formulary comes in. A formulary is a list of prescription drugs covered by a drug benefit plan. It’s usually a long list of drugs with brand names and generic names, whether they’re covered by the plan and how much you might pay in terms of a copay, or a percentage of the price. You may pay varying copays for drugs that are on the formulary. For more on our post click here.

Where to Find Inexpensive Generic Meds and Why They May Not Be So Cheap in Your State

It’s likely that you’ve heard about grocery stores and pharmacies offering low prices on generic prescriptions, but you don’t know which pharmacy might offer the generic you need. Many, but not all, of the pharmacies have posted the generics that they offer at reduced prices. You might also find that those same generics aren’t available where you live. A number of states may not allow retailers to offer a product at a price below its cost. In general, there are laws against predatory pricing that, in this case, might put a local pharmacy out of business. For more on our post click here.

How to get the most from discount generic drug programs

So, what’s the best way to save money with these programs? For starters, you need to know that the stand-alone drug stores, CVS and Walgreens, charge for a generics program membership, so you won’t get the generic price automatically. Some have both 30 and 90-day prescription plans, while others only offer 90-day programs. Target, Kroger and Wal-mart provide both 30 and 90-day generic prescriptions. Most of the drugs available for a 30 days are also available for 90 days, though that’s not true of Kmart. They appear to have split the list by generics that you’re likely to get on a 30-day prescription (e.g., antibiotics for a short-term infection) from the ones that you might get with a 90-day prescription, like for chronic conditions such as high blood pressure. For more on our post click here.

Your State May Have a Prescription Drug Price Finder

We’re big fans of local resources because they tend to do a better job of meeting our specific needs. That’s why we were simultaneously excited and disappointed at the prescription drug price finders we found. A number of states offer tools that will help you find better prices on your prescriptions. We could find twelve state sites (Wisconsin thinks it’s part of Canada) that allow you to search pharmacies in your area for specific medicines. It’s difficult to tell how accurate they are, but they’re certainly worth a try. For more on our post click here.

Tips on Helping Manage Prescriptions

family and other caregivers often find themselves partially, or fully, involved in a senior’s medical regimen. This post has a number of good tips for reducing a chance of a problem with prescription, over-the-counter and herbal remedies. One of favorite parts of this post is the Pill Identification Wizard. Check it out here.

My Medicine List

This is a beautifully designed document that every senior should complete.  It comes with a coversheet that has the patient complete their personal information along with emergency contact information and information on any allergies or problems with medications. Click here to see the post on My Medicine List.

So, What Can We Flush Down the Toilet?

Finally, on the somewhat lighter side…Seniors of course take significantly more prescription medications that the average adult. And while you should follow your doctors orders and finish the medicine, it’s not uncommon for a physician to change your prescription midstream leaving you with unwanted pills. Learn about what you can and cannot flush.

Photo by a.drian via Flickr

Geriatrics is the branch of medicine that focuses on health care of the elderly. A physician who specializes geriatric medicine, a geriatrician, has training and certification in addition to their regular medical training to help them care for older adults and their specific medical needs.

According the the The American Geriatrics Society, “geriatricians manage multiple disease symptoms and develop care plans that address the special health care needs of older adults and coordinate care with other medical disciplines to treat the “whole” patient. Geriatricians are generally primary care physicians who are board-certified in either family practice or internal medicine and have also acquired the additional training necessary to obtain certification.”

While it’s not necessary that a geriatrician would become a person’s primary care physician, in certain situations it might make more sense to see a geriatrician if:

• their condition causes considerable impairment and frailty,
• they are an older adult with those medical problems primarily associated with aging,
• they have growing number of prescriptions, or
• the older adult who have multiple chronic health problems such as cardiovascular disease, memory problems, depression and a history of falls.

A geriatrician will address issues like Alzheimer’s disease (and other dementia), arthritis, chronic heart & lung disease, general decline, impaired overall function, incontinence, osteoporosis, Parkinson’s disease, sensory problems like vision and hearing, and stroke. They also will look at the possible interactions and side effects that could come from the prescription and over-the-counter medications that seniors take. The geriatrician looks for mood disorders such as depression are common in older adults as well.

If you, or a loved one might need one, ask your primary care physician about recommending a geriatrician, or you can search for one:

• The AGS Foundation for Health in Aging Physician Referral Service, or call 800-563-4916
• Wellness.com Geriatrician locator

Flickr image by aussiegall

According to the Cleveland Clinic, “depression is not a normal part of aging; but unfortunately, it is very common in the elderly.  Late-life depression affects about 6 million Americans age 65 and older, but only 10 percent receive treatment.”   Medical professionals believe that the elderly frequently confuse depression with the symptoms of other illnesses and the medications used to treat them.

Elderly females, who are widowed, have suffered stressful life events and do not have a strong social network tend to be most at risk for depression late in life.

Risk factors for the elderly include:

• Use of certain medications and/or a combination of multiple medications
• Illness
• Being socially isolated
• Bereavement
• Suffering from chronic or severe pain
• Poor body image (e.g., from amputation, surgery, heart attack, etc.)
• A personal history of depression
• Family history of depression
• Previous suicide attempts
• Substance abuse

Please review this article on the Cleveland Clinic’s website.  It also offers information on treatment options for the elderly who suffer from late-in-life bouts of depression.

The following is an email that periodically makes the rounds in email…that’s true.

This might be a lifesaver if you can remember the following advice, sent by a nurse, whose husband is a medical doctor.

Sometimes symptoms of a stroke are difficult to identify. A stroke victim may suffer permanent brain damage when people fail to recognize what’s happening. Now, doctors say any bystander can recognize a stroke, simply by asking three questions:

• Ask the individual to smile.
• Ask him or her to raise both arms.
• Ask the person to speak a simple sentence.

If he or she has trouble with any of these tasks, call 911 immediately, and describe the symptoms to the dispatcher. Researchers are urging the general public to learn to ask these three questions quickly, to someone they suspect of having a stroke. Widespread use of this test could result in prompt diagnosis and treatment of a stroke, and prevent permanent brain damage.

Bonus: The American Stroke Association has a fun and educational email application that you lets you send a message to a friend on recognizing the symptoms of a stroke.

This is a beautifully designed document that every senior should complete.  It comes with a coversheet that has the patient complete their personal information along with emergency contact information and information on any allergies or problems with medications.

It then asks the patient to complete an easy to use spreadsheet with answers to the following questions:

• Drug name
• This looks like
• How many?
• How I take it
• I started taking this on:
• I stop taking this on:
• Why I take it:
• Who told me to take it:

The table is broken out by times of day with easy to understand icons for each time of the day:

• When I get up I take:
• In the afternoon, I take:
• In the evening, I take:
• Before I go to bed, I take:
• Other medicines that I do not use every day:

The corresponding directions are easy to read and provide excellent instructions for completing the document.

Once you have completed the document, it is best to print multiple copies to keep at home wherever medications are administered and in the patient’s wallet or purse for emergencies.

Amsler Grid

It is incredibly important that we continue to see an eye specialist (e.g., opthamologist) as we age.  Our eyes change throughout our lifetimes.  One such potential change is known as macular degeneration.  Macular degeration is typically a slow, painless loss of vision.

An organization called, All About Vision,  reports that an estimated “1.75 million U.S. residents had advanced age-related macular degeration with associated vision loss, with that number expected to grow to almost 3 million by 2020.”

According to the Cleveland Clinic, “macular degeration is an eye disease that occurs when the small central portion of the retina, known as the macula is damaged.  The retina is the light-sensing nerve tissue at the back of the eye.  Because the disease develops as a person ages, it is often referred to as age-related macular degeration (AMD).”

An Amsler grid is typically used to test whether you are having problems caused by macular degeneration.  Link here for a sample Amsler grid provided by the American Macular Degeneration Foundation. 

Please keep in mind that we are not doctors.  It is important for you to see a healthcare provider regularly for diagnoses and treatments.  The Amsler grid we provide a link to is a great starting point but should not take the place of a visit to an eye specialist.

So, what’s the best way to save money with these programs? For starters, you need to know that the stand-alone drug stores, CVS and Walgreens, charge for a generics program membership, so you won’t get the generic price automatically. For CVS it’s $10 per year, per person. Walgreens charges $20 per year and $35 for a family. Kmart asks that you enroll, but they don’t charge a fee. The other programs that we reviewed don’t have a membership program. If you shop at CVS and Walgreens a lot, you may want to consider joining the program, though it’s difficult to imagine Walgreens’ plan being economical. In general, we suggest looking elsewhere.

Target, Kroger and Wal-mart provide both 30 and 90-day generic prescriptions. Most of the drugs available for a 30 days are also available for 90 days. That’s not true of Kmart, though. They appear to have split the list by generics that you’re likely to get on a 30-day prescription (e.g., antibiotics for a short-term infection) from the ones that you might get with a 90-day prescription, like for chronic conditions such as high blood pressure. Giant, which uses online grocer Peapod.com to fulfill prescriptions, only offers a 90-day program, and Giant is only in the greater Washington D.C. area. CVS and Walgreen’s programs are only for 90-day prescriptions.

How many different drugs do they each cover? Most have about 150 medications, but when you count the different sizes, you’ll see 3-400. Since your doctor may prescribe a dose not covered, we’ll give them credit for each size.

The two drug chains may have a few more (high 300s for CVS and low 400s for Walgreens), so there will certainly be some instances where you find a drug at one chain and not another. Kmart appears to have the most with their split list, weighing in at the mid 400s, though they list some drugs twice under different names (e.g., the generic Warfarin and brand named version Jantoven), so they’re only a little bigger than CVS, or Walgreens.

What do they charge? It’s pretty much universal that it’s about $4 if they offer a 30-day plan,  and $10 for the 90-day plan. There are a few drugs on each plan that cost a little more–between $15 and $30, but there are usually less than 10 on the exception list.

Bottom line, Target, Kroger and Wal-mart are nearly identical lists and no real differences. You’ll find a few drugs at Kmart, CVS and Walgreens that you won’t find elsewhere. If you’ve been prescribed a generic antibiotic, Kmart will more likely have it than the rest. Finally, Walgreens gets a slight nod over CVS on drugs covered.

Of course plans can change, so be sure to check with the web sites, or your local pharmacy for specifics on the plans. If you know of something that has changed, please let us know.

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