Tag Archives: Planning

Caregiving Decisions Can Often Be as Clear as Mud

By Dr. Mara Karpel

Psychologist, Host of Dr. Mara Karpel & Your Golden Years, and Author of The Passionate Life: Creating Vitality & Joy at Any Age.  Find her at: DrMaraKarpel.com

 “It is not the load that breaks you down. It’s the way you carry it.” ~ Lena Horne

Whether your loved one lives with you, in the same time zone, or thousands of miles away, there are often big decisions that need to be made involving their care, living situation, medical procedures, medications, etc. Often, the right choices are not at all clear. There are many choices, frequently none of which are “perfect,” and you will likely be asked to decide — or to help your loved one decide — which is the best decision that fits for them.

Being responsible for such heavy decision-making about such important issues that can be so unclear can certainly keep any of us up at night and cause plenty of anxiety. Here are some tips for better wading through the muddy waters:

  • Get as much information as possible. Talk to professionals, research on reliable websites, ask other caregivers whom you know might have had experience with similar issues. Talk to your loved-one’s doctors, therapists, paid caregivers, and get second opinions. Read books related to the topics at hand.
  • If you’re still feeling confused and anxious about the decisions, take a break. Take walks, exercise, meditate, get out in nature, to take your thoughts off of the subject for periods of time. This will give your mind a chance to quiet down from the anxious thoughts and allow your inner knowing, your higher wisdom, to process all of the information you’ve been given and to find the answer that best fits for your specific situation. The answer may come to you as a feeling of being shouted out by your inner self, “this is it!,” or it may come as a whisper.
  • If this still doesn’t work, spend time, again, quieting your mind. Sit quietly, close your eyes, take some slow deep breaths.   Then imagine that you’ve made a decision. See and feel what life is like after that particular action has been taken. Now quiet your mind and imagine what it looks like and how it feels after making the opposite decision. This can often give greater insight about the best decision for you and your loved one’s unique situation.
  • Finally, remember that there are no perfect decisions and we only discover mistakes in hindsight. Most of us don’t own a crystal ball and cannot predict with 100% accuracy how it will work out, no matter which way we go. As I wrote about in my blog, Tips for Caregivers – Near and Far -Tip #10 – Forgive Yourself, “We all make mistakes. We’re human.” Don’t be hard on yourself for doing the best you could to figure out the right course of action.

Read similar blogs by Dr. Mara and listen to her internet radio showNow also available on Apple Podcasts.

Be sure to follow her on Facebook for updates on her show and new blogs.

And check out Dr. Mara’s internationally best-selling book, The Passionate Life: Creating Vitality & Joy at Any Age!

How Older Adults Can Stay Healthy During COVID-19

(reprinted and edited with permission from Redfin)

In the age of COVID-19, more colloquially known as the Coronavirus, and as an older adult, your health and personal safety have never been more important. The world seems very different than it was just weeks ago, but the rise of a pandemic just reaffirms what is most important: friends, family, and your health. Social distancing can be stressful, but it is among the best ways to minimize risk to both you and those around you. If you are stuck at home during these trying times, follow these health and wellness tips for older adults to stay healthy during this coronavirus pandemic.

Get Some Exercise

Exercise may be the furthest thing from your mind while stuck inside, especially while handling the stress of rapidly changing circumstances. However, even a little movement can do wonders for your overall mental, physical, and emotional health.

Depending on your physical abilities, there are many different kinds of things you can do to exercise without leaving the house. From going up and down the stairs a few times to walking laps in your home or even jogging in place, doing jumping jacks (yup, remember doing them as a kid), or just siting down and getting up from a chair numerous times, a little physical movement goes a long way in helping you feel your best. The internet is full of programs, too; fitness apps, streaming sites, and even YouTube offer countless avenues for at-home workouts at all levels of intensity and ability.

Get Plenty of Sleep

Keeping your immune system healthy is vital important and sleep is a key component of good maintenance. Sleeping seems like a simple thing to achieve while spending all day at home, but day after day without the routines of jobs, hobbies, and social outings can make time seem meaningless. It is easy to slip into negative habits, like going to bed too late out of a desire to catch just one more episode of your favorite show.

No matter what your at-home habits look like, try to establish a regular time to go to sleep and to get up in the morning. This can feel a little silly at first, especially if you have nowhere to go, but maintaining a schedule can keep your circadian rhythm in check, helping you to stay both mentally and physically healthy.

Eat Healthy Meals

Being stuck inside all day with nowhere to go can make it easy to justify a little extra junk food, but a healthy and balanced diet is a critical part of your wellness. Overall, your diet plays an important role in sustaining your immune system, so eating a steady diet of potato chips while practicing social distancing can cause you more harm than good.

When planning meals, make sure to include as many leafy greens as possible in addition to servings of fruit and protein. If regular access to fresh produce is limited, frozen alternatives are a fine substitute. Include a daily vitamin as well to hit on all the nutrients you may not be getting through diet alone. Maintaining a healthy diet is a vital part of older adults staying healthy during coronavirus.

Find New Hobbies

Sometimes, daily life feels too busy to find time to learn new skills or experiment with new leisure activities. Now, without a way to fall back on the same old habits and duties that have kept you distracted, there’s plenty of time to try something new.

Even without going outside, there are plenty of ways for older adults to stay busy at home. You could consider joining a virtual book club, taking open online courses on platforms like Coursera or edX to learn new skills or brush up on old ones. Learning to sew, knit, or cross-stitch, taking up puzzles, baking, canning, cooking elaborate dishes, or even playing virtual card games with friends online. With more free time to devote to the little things in life, you can find new ways to enjoy your leisure time.

Keep in Touch

Not being able to see friends, children, grandchildren, and extended family members can make you feel isolated if you live alone. Humans are social animals and extended distancing from necessary social interaction is often uncomfortable or distressing. Luckily, technology makes it possible to stay in touch, whether your family is across the street or around the world.

From Skype to FaceTime, it’s possible to stay connected with your friends and family, without meeting up in person. Even texting can be a great way to check-in. A simple message to a loved one and a kind response can be enough to create the kind of connection you’re missing while staying at home and staying healthy during coronavirus.

Make Plans for the Future

Staying at home and socially distancing yourself may feel like a very uncertain set of circumstances, but there’s good news: it won’t last forever. Sooner or later, the world will right itself, and life will go back to normal. And when it does, what do you want to do?

From trips to Florida with friends to dinners with your family, it’s important to think about the light at the end of the tunnel. The things you miss doing now will be available soon, so don’t let yourself be consumed by stress that can come with this challenging situation. Think up a meal plan for a family dinner, research venues for your next family reunion, or put together an itinerary for your dream vacation. It’s easier to be happier at home when you have something to look forward to.

Check-In With Yourself

It can be overwhelming to have your whole world change essentially overnight, especially when you don’t know what the immediate future may hold. In these times, it’s important to check in with yourself and make sure you are meeting your basic needs.

Do you feel emotionally healthy? Physically healthy? How is your morale?

By taking time to evaluate your wellbeing as well as your individual needs, it becomes easier to keep your health headed in the right direction. Don’t be afraid to reach out for help, the increase in telehealth services makes it easy to speak to your physician or a licensed counselor without leaving your home.

Staying as healthy as possible is always important, but now more than ever your focus should be on remaining as resilient as possible. With these tips for older adults to stay healthy during coronavirus, you can make the most of your time at home.

About the Author
is part of the content marketing team at Redfin and enjoys writing about real estate and design trends. Her dream home would be a contemporary home with an open floor plan, lots of windows, and a waterfront view.

About Well Beyond Care
Well Beyond Care is the only company that teaches families and individuals how to find and manage affordable non-medical in-home care, while solving the chronic problems of caregiver truancy and turnover through the web application, WellBeyondCare.com. The Company’s platform combines the power of the internet with the personal touch of nurses to offer families a pathway to transitional care, allowing our elderly parents to safely age-in-place. Their solution lowers stress in hiring a caregiver and saves families tens of thousands of dollars per year in care costs.

Private Duty Services for All!

Reprinted by permission from Elisabeth Hogue, Esq.; (877) 871-4062; ElizabethHogue@ElizabethHogue.net

In order to be appropriate for home care services of all types, patients must be able to care for themselves or have primary caregivers who can meet patients’ needs in between visits from professional staff from home care providers. This requirement is necessary in order to meet the eligibility of many payors, to avoid risk of legal liability and to help ensure quality of care.

Patients’ family members or others may be willing to serve as primary caregivers on a voluntary basis. If not, providers should offer patients and/or their family members the option to pay privately for primary caregivers. These services may be referred to as private duty or non-medical services.

The option to pay for private duty home care services should be offered to all patients who cannot care for themselves and who have no voluntary primary caregivers. Patients who can care for themselves or have voluntary primary caregivers may also wish to contract for additional assistance, so providers should offer this option to all patients who may benefit from these services.

Specifically, this means that:

  • Hospital discharge planners/case managers should offer private duty services to all patients who may benefit from them and assist patients to arrange for such services post-discharge as part of the discharge planning process.
  • Other types of institutional providers; such as skilled nursing facilities (SNFs), Long Term Acute Care Hospitals (LTACHs), and independent rehabilitation facilities (IRFs); should also offer patients who are being discharged the option to arrange for assistance from private duty agencies and should arrange for such services post-discharge.
  • Assisted living facilities (ALFs) should offer private duty services to all of their patients who may benefit from such services.
  • Home health agencies should offer patients the option to private pay for services if primary caregivers are no longer available to provide assistance and if patients no longer meet the eligibility requirements of payor sources.
  • Home health agencies, hospices and home medical equipment (HME) companies should educate patients about private duty services even though patients may have voluntary caregivers and help patients and their families arrange for these services.

Providers may be reluctant to offer these services to patients and their families because of their cost. They may also erroneously conclude that patients and their families cannot afford them. Providers should not jump to conclusions about who can afford these services. Instead, private duty home care services should be offered to all patients and their family members who may benefit from them.

A home health agency, for example, decided that a patient no longer met the eligibility requirements of the Medicare Program. The staff of the agency was reluctant to offer the patient the option to private pay for additional services prior to discharge because the patient lived in a “shack” and drove an old, beat-up truck. They did so anyway. To the staff’s surprise, upon receipt of the offer, the patient got out of bed, extracted a wad of cash from under the mattress and told the staff that there was plenty more money to pay for private duty services!

Private duty care has a very important role to play in the provision of home care services. This type of care should be offered to all patients whenever it seems that patients may benefit from it.

About Well Beyond Care
Well Beyond Care is the only company that teaches families and individuals how to find and manage affordable non-medical in-home care, while solving the chronic problems of caregiver truancy and turnover through the web application, Well Beyond Care. The Company’s platform combines the power of the internet with the personal touch of nurses to offer families a pathway to transitional care, allowing our elderly parents to safely age-in-place. Their solution lowers stress in hiring a caregiver and saves families tens of thousands of dollars per year in care costs.

 

Hospital Discharge Planners and Recommendations of Post-Acute Providers

Reprinted by permission from Elisabeth Hogue, Esq.; (877) 871-4062; ElizabethHogue@ElizabethHogue.net

MedPAC advises Congress about Medicare. The Remington Report in the October 4, 2017, edition of FutureFocus reported that a MedPAC staff member stated as follows at MedPAC’s September, 2017, meeting:

“The Balanced Budget Act (BBA) requires hospitals to provide beneficiaries with a list of nearby SNFs and home health agencies but the list is not required to have quality information….Medicare statute provides beneficiaries with the freedom to choose their PAC provider, the law states that hospitals may not recommend providers (emphasis added).”

Then in the March 7, 2018, edition of FutureForcus, a link was provided to a power point presentation presented by MedPAC on March 1, 2018. A slide entitled “Discharge planning is a hospital responsibility” that was included in the presentation states as follows:

“…Hospital discharge planners may not recommend specific providers-beneficiaries have freedom to choose PAC providers.”

Is it true that hospital discharge planners are prohibited from recommending post-acute providers to patients based on applicable federal requirements? The answer is a resounding NO!

The basis for the remarks of members of the staff at MedPAC seems to be Conditions of Participation (CoPs) of the Medicare Program that establish requirements for hospital discharge planning. Specifically, 42 CFR 482.43(7) says that hospitals must not specify or otherwise limit the qualified providers that are available to patients.

But making recommendations to patients about post-acute providers while emphasizing patients’ right to choose providers does not necessarily entail “specifying” or “otherwise limiting” the providers available to patients. In fact, such discussions seem to be required by applicable national standards of care the Case Management Society of America and sanctioned by the Centers for Medicare and Medicaid Services (CMS). Prohibiting these types of discussions also has practical implications for patients and their families.

Specifically, the Case Management Society of America (CMSA) first published Standards governing the practice of case management, including hospital discharge planners/case managers, in 1995. The Standards were revised in 2002, 2010 and 2016. Among other requirements, these standards require case managers to advocate on behalf of patients, including provision of assistance with making decisions about their care.

In addition, CMS sanctioned making recommendations to patients through the use of preferred providers. In final regulations of the Comprehensive Care for Joint Replacement Payment Model for Acute Care Hospitals Furnishing Lower Extremity Joint Replacement Services at 80 Fed. Reg. 73274 (November 24, 2015), CMS says on Page 73518: “We agree that hospitals should be allowed to identify preferred providers and suppliers…”

CMS goes on to say on Page 73520 that:

“…hospitals, if desired, may recommend “preferred providers,” that is, high quality PAC providers/suppliers with whom they have relationships (either financial and/or clinical) for the purposes of improving quality, efficiency, or continuity of care.”

Finally, anecdotally, hospital discharge planners/case managers often report that patients are unable to choose post-acute providers when lists are presented to them. In light of MedPAC’s comments above, it sounds like discharge planners/case managers are unable to provide assistance to patients except perhaps to hand them the equivalent of a copy of the yellow pages! From a practical point of view, this dog will not hunt! In fact, the “heart” of the discharge planning process includes recommendations from discharge planners/case managers about the best choices for patients. Patients are, of course, free to reject these recommendations.

Case management/discharge planning activities are at the heart of our healthcare delivery system. These crucial activities are finally receiving the recognition and “due” that they deserve. They should not be mischaracterized!

About Well Beyond Care
Well Beyond Care is the only company that teaches families and individuals how to find and manage affordable non-medical in-home care, while solving the chronic problems of caregiver truancy and turnover through the web application, WellBeyondCare.com.  The Company’s platform combines the power of the internet with the personal touch of nurses to offer families a pathway to transitional care, allowing our elderly parents to safely age-in-place. Their solution lowers stress in hiring a caregiver and saves families tens of thousands of dollars per year in care costs.