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?

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.

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.

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.

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

Amanda M Hatfield via Flickr

When I was a kid, flushing things down the toilet was good sport. Of course I was five at the time. Today it seems as though just about nothing, save the obvious, can be flushed. The concern over flushing prescription meds down the drain was amplified last year when the drinking water in 24 major cities was found to contain, “A vast array of pharmaceuticals — including antibiotics, anti-convulsants, mood stabilizers and sex hormones”.

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.

So what to do with the excess meds? The FDA says that there are a few drugs that should be flushed, many should not.

Specifically, the FDA recommends:
Follow any specific disposal instructions on the drug label or patient information that accompanies the medication. Do not flush prescription drugs down the toilet unless this information specifically instructs you to do so.

• If no instructions are given, throw the drugs in the household trash, but first:
  • Take them out of their original containers and mix them with an undesirable substance, such as used coffee grounds or kitty litter. The medication will be less appealing to children and pets, and unrecognizable to people who may intentionally go through your trash.
  • Put them in a sealable bag, empty can, or other container to prevent the medication from leaking or breaking out of a garbage bag.
• Take advantage of community drug take-back programs that allow the public to bring unused drugs to a central location for proper disposal. Call your city or county government’s household trash and recycling service (see blue pages in phone book) to see if a take-back program is available in your community.

FDA’s Director of Pharmacy Affairs, Ilisa Bernstein, Pharm.D., J.D., offers some additional tips:

• Before throwing out a medicine container, scratch out all identifying information on the prescription label to make it unreadable. This will help protect your identity and the privacy of your personal health information.
• Do not give medications to friends. Doctors prescribe drugs based on a person’s specific symptoms and medical history. A drug that works for you could be dangerous for someone else.
• When in doubt about proper disposal, talk to your pharmacist.

Bernstein says the same disposal methods for prescription drugs could apply to over-the-counter drugs as well.

Despite the FDA’s flushing policy, we recommend investigating local disposal options. Check with your doctor and pharmacist whenever you get a new prescription to see if they can dispose of them, or if can recommend an alternative. Policies are likely to change over time given the publicity over medicines in the drinking water, so keep asking. Check with your local recycling center. Our county has a program to take them and dispose of them.

What can I do? If you have a Longs Drugs, Rite Aid, or Walgreens in your area. Print this page and ask them to take your unused prescription medicines.

Additional Links

• SMARxT Disposal
• Prescription drugs that ARE recommended for flushing
• FDA Page on drug disposal

Update 9/21/09: The Environment Report – Cement Pollution & Drug Disposal

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. The National Conference of State Legislatures has a recent post on their site that speaks to the issue.

Here are the links to the pages that have generic lists and pricing:

• Low Price Generic Lists
  • CVS
  • Giant
  • Kmart
  • Kroger
  • Target
  • Wal-mart
  • Walgreen

• Some Free Antibiotics (may be for a limited time)
  • Giant
  • Meijer
  • Publix

That said, family and other caregivers often find themselves partially, or fully, involved in a senior’s medical regimen. Here are some tips for reducing a chance of a problem:

• Keep a list of every medication they are taking, including over-the-counter and herbal remedies, with the frequency and size of the medication. Keep it up to date. Recommend that they take the list and a box or bag with all the medications to every medical appointment. It is important to tell the health care provider which medications they are taking and how they are taking them.
• The patient should always let the primary care physician know when another physician prescribes a new medication, or if they have any problems with a new medication. If they are thinking of stopping a medication, or can’t afford to get all of the prescriptions filled, they should discuss it with the physician first.
• Try to use only one pharmacy for the prescriptions. A pharmacist can check for adverse drug interactions if he or she knows about all the medications they are taking. If it’s necessary to use multiple pharmacies, take the list of prescriptions and show it to the pharmacist.
• Use a weekly or daily pill organizer, especially when taking several different medications, to help ensure that they get the right dose at the right time. Establish and follow a regular routine for taking medication. An example might be taking their nighttime pills right after they brush their teeth before bedtime.
• Keep medications in their original containers, except for those they put in a pill organizer. The labels on medication bottles contain important information, such as correct dosage and expiration dates.
• Choose one day each year (their birthday is an easy reminder) to check the expiration dates of their medications and check with local recycling authorities for proper practices for disposing of prescription medicines.

Mystery Pill? Can’t figure out what a medicine is? Drugs.com has a Pill Identification Wizard that may help you figure it out. To find the information on the mystery medicine, you can enter any combination of the writing on the pill, the pill color and the shape to get to a photo of the medicine. Drugs.com has a number of other tools including ‘drugs by condition’ (e.g., hypertension) and an interaction checker, where you can enter two, or more, prescription medicines and find out about the potential interactions.

FDA: The Food and Drug Administration has a generic drug finder, where you can search on a brand name drug and possibly find a less expensive generic. If you find one, talk to your physician to see if it will work for you. Other resources on the FDA site include: U.S. approved drugs and side effects.

Listen to the story here: http://www.npr.org/templates/story/story.php?storyId=98757630

We publish SHF because we’ve spent a lot of time researching on our parents’ behalf and thought people shouldn’t have to wander in the wilderness like we did. Yes, we got some help along the way, and when we did, it was a great stress reducer. That’s why when we find a resource like SHIP (State Health Insurance Assistance Program), we cheer and cry, “Why didn’t we find this sooner?!”

In their words,

The State Health Insurance Assistance Program, or SHIP, is a national program that offers one-on-one counseling and assistance to people with Medicare and their families. Through federal grants directed to states, SHIPs provide free counseling and assistance via telephone and face-to-face interactive sessions, public education presentations and programs, and media activities.

The site’s big features are two locators. One will help you find a state SHIP and the other will help you find a counselor. One other feature of their site is promotional profiles, which are PDFs for most of the states that describe that state’s program. But the locators are the big deal here. While we haven’t done a complete census, it looks like most counties have a SHIP program.

Check it out and let us know what you think.

bartificial on Flickr

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.

Unless you only have one prescription, drug price shopping is not a matter of finding the cheapest pharmacy, it’s finding the cheapest pharmacy for each prescription. Even if you have a Medicare Part D supplier, price shopping is important for avoiding the coverage gap.

One study by Center for Studying Health System Change noted, “This analysis found that pharmacies were not consistently high- or low-priced relative to others in the market. Instead, pharmacies that were in the lowest price bracket for some drugs tended to be in the highest price bracket for others.”

The Wisconsin site bypasses local pharmacies in favor of Canadian pharmacies that, “…have been visited and found to be safe, reputable, and reliable by inspection on behalf of several state governors.”

Here are the twelve that we found. If you know of any more, let us know.

Connecticut
Florida
Indiana
Maryland
Michigan
Minnesota
Missouri
New Hampshire
New Jersey
New York
Vermont
Wisconsin (order from Canada)

We like the idea of putting more transparency into the prescription shopping process; it can only lead to lower prices. But these sites are far from perfect and they only cover twelve of 50 states and Washington D.C. And word is that Washington and Ohio dropped their prescription price comparison sites.

Please follow the instructions from your state’s site and use at your own risk. Let us know what you think.