Are You in the Hospital? When a Hospital Admission Isn’t

By Rosemary Fugazzotto, Geriatric Care Manager at ElderCare Solutions Inc.

78-year old Rita was being treated for cancer when she was taken to the hospital after she fell and broke her pelvis. During her five-day hospital stay, she was evaluated by her cancer doctor as well as other specialists to address her many medical problems. A list of Medicare-funded rehabilitation facilities for post-hospitalization care was considered by her family and geriatric care manager. Only after they had chosen a rehab facility, and one day before discharge, was her family told that Rita had never been formally “admitted” to the hospital. Though she was in a hospital bed and being treated on a regular hospital unit, Rita was considered to be in an “observation bed.” As a consequence of not being “admitted”, any nursing home care would have to be paid privately rather than by Medicare.

Traditionally, patients were observed either in an observation unit or in any bed within the hospital for less than 24 hours; that is no longer the case. There are many documented cases of patients staying in a hospital for 3-4 days and then learning that their hospital stay is not covered under Medicare. Over a three-year period from 2006-2009, the percentage of patients not actually admitted to the hospital but staying under “observation” tripled. Typically, patients may be observed for any of these diagnoses:

• Chest Pain
• Congestive Heart Failure
• Asthma
• Syncope (Fainting)
• Dehydration
• Abdominal-Gastrointestinal Conditions
• Head Injuries
• Headaches/Migraines
• Seizures

This leads to thousands of dollars in out-of-pocket expenses and may prevent utilizing the benefit of being admitted to a skilled nursing facility following the usual three-day hospital stay. Medicare is scrutinizing hospital bills and citing that the hospitalization was unnecessary and frivolous, denying claims weeks or months after the episode. Hospitals are being pressured to cut down on allowing patients to be admitted more than once for the same problem within 30 days to prevent fines and reimbursement denials.

Whether the patient is admitted to the hospital or being treated as an outpatient affects how much will be paid for hospital services such as X-rays, drugs and lab tests, and may also affect whether Medicare will cover the transfer to a skilled nursing facility (SNF). The use of observation beds should generally not exceed 24 hours, may sometimes be up to 48 hours, and in “only rare and exceptional cases,” might be more than 48 hours. The ultimate decision is left to the physician.

If the Medicare patient was never admitted as an inpatient, there is a way to appeal the hospital’s or physician’s decision. Having a conversation with the physician or hospital patient advocate representative prior to discharge may help, but it might be worth the effort to request that the healthcare quality improvement organization (QIO) review the hospital records post-discharge. Records can be reviewed to see if the hospital erred and should have permitted admission as an inpatient, rather than using an observation bed. If the patient was required to pay for subsequent SNF cost out-of-pocket because they didn’t have the required three-day inpatient hospital stay, the QIO will review the hospital records to see if the hospital erred. The results of the review may qualify the patient as having inpatient status to meet the 3-day qualifying hospital stay.

The only way to protect your loved one is to ask! One expert suggests asking each day in order to prevent getting surprised by a change in status. Good communication between family, hospital staff and physician is crucial to keep abreast of any changes in admission status. There is an old axiom that states, “discharge planning begins on admission,” and geriatric care managers are well equipped to assist with this new trend in healthcare.

The following article is from the August 8, 2013 “Medicare Watch Newsletter” from the Medicare Rights Center. Here is the link. Below is the article. http://www.medicarerights.org/issues-actions/medicare-watch.php

New Report Details Hospital Use of Observation vs. Short Inpatient Stays

The Department of Health and Human Services (HHS) Office of Inspector General (OIG) recently released a report describing hospitals’ use of observation stays and short inpatient stays in 2012 and the effects of observation stays on Medicare beneficiaries. OIG found that Medicare beneficiaries had 1.5 million observation stays in 2012 and an additional 1.4 million long outpatient stays, some of which may have also been observation stays. The report also revealed that beneficiaries had 1.1 million short inpatient hospital stays in 2012, and on average, these short inpatient stays cost Medicare and beneficiaries more than observation stays. OIG found that Medicare paid nearly three times more for short inpatient stays than observation stays, and beneficiaries ended up paying almost two times more.

Observation stays are opportunities for hospital physicians to determine whether or not a beneficiary should be admitted to the hospital as an inpatient. Although policies at the Centers for Medicare and Medicaid Services (CMS) state that observation services are usually needed for 24 hours or less, OIG found that 92 percent of beneficiaries spent one night or more in the hospital under observation. Observation stays are outpatient services covered under Medicare Part B—Medicare usually pays 80 percent of the cost of the claim, and the beneficiary is left to pay the remaining 20 percent, either through a supplemental insurance plan (or Medigap) or by paying out of pocket. As a result, CMS, Members of Congress and advocates have raised concerns that beneficiaries may pay more as outpatients than if they were admitted as inpatients. In addition, beneficiaries who are not admitted as inpatients may not qualify for Medicare-covered skilled nursing facility (SNF) services following discharge from the hospital.

To address these concerns, in April 2013, CMS proposed policy changes that would presume that hospital stays lasting two nights or longer would qualify as inpatient stays, and that stays lasting less than two nights would qualify as outpatient or observation stays. While OIG’s report did not contain any formal recommendations, the agency mentioned in its report that its findings do indicate that CMS may consider policy changes to address the issue of observation and inpatient stays. According to OIG, CMS should consider how to ensure that beneficiaries who need SNF services after a hospital stay are granted sufficient access to that care.

In New York, a bill passed in the State Assembly and Senate that would require hospitals to notify Medicare beneficiaries of their observation status within 24 hours of being treated under observation. It is not clear if and when the bill will be signed by the Governor; however the bill could potentially help beneficiaries access post-hospital care (i.e. SNF care) by giving them notification of the effect observation stays have on their costs and coverage. The notification of observation status is a definite step in the right direction. While it does not guarantee that a beneficiary will fully understand what an observation stay means for their costs and coverage, it provides them with information and resources to gain this understanding.

Keeping the Wrinkles out of Elder Care

By Penny Golden, RN

As science progresses and people are living longer, many of us find ourselves faced with helping to care for aging family members. This can be a confusing process. Which doctor does Mom see for her heart? Where does she get her prescriptions filled? If Dad can’t drive, how will he get his groceries? With a few simple organizational and practical tips, navigating your way through elder care can become manageable.
Ideally, steps should be taken before an aged person becomes too incapacitated to help with the process of planning for elder care.

Unfortunately, many people are uncomfortable discussing getting older, but trying to sort out doctors and medications and even who to call when a loved one dies can add more stress to an already stressful time. This is a situation where “an ounce of prevention REALLY IS worth a pound of cure!”

Accurate and regularly updated lists can help organize care of your elderly loved ones: medications; doctors and their specialties, phone numbers, fax numbers and addresses; health history, hospitalizations and surgeries; friends’ names and phone numbers. Keep all important lists in a file in a safe but easy to find location – i.e. a brightly colored file folder on top of the refrigerator.

Medications

Older people often take multiple medications prescribed by multiple doctors. Keeping a current list of medications is imperative — there can be dire consequences if some medications are mixed. Bring the list with when your loved one goes to a doctor; it can save time and possibly a life. Include on the list the medication name, dose, what it is for, times it is taken, and who prescribed it. If a medication is added or a dosage is changed, be sure to update the list accordingly. Include the phone number or email for the pharmacy where prescriptions are filled. If you have questions about a medication, ask the pharmacist!

Doctors

Because so many doctors are specialists, your family member may have several doctors to visit on a regular basis. Keeping a list of doctors and their contact information can help determine who should be contacted in an emergency or for specific symptoms. Keep a printout of directions to and from the doctors’ offices to help people who are bringing the patient to appointments.

Health History

Keeping an accurate health history with important papers can save valuable time at doctors’ appointments or emergency room visits. No one wants to have a test redone if it was done recently, and knowing when tests were done can also be helpful for comparisons. Keeping a running list of illnesses, injuries, tests and hospitalizations can help during current health crises.

Friends

Often people overlook the role friends play in their lives. At times, older people might feel more comfortable turning to a friend than turning to family. Keep a list of friends and their contact information handy. If you need answers to questions about your parents, aunt or uncle or grandparent, their friends may be your best resource. In addition, your loved one would want his or her friends contacted in the event of their death, so having all those names and numbers on one list can help at that time as well.

A Few More Helpful Ideas

Funeral planning should be done when individuals are healthy and able to let you know their wishes. Burial or cremation? Funeral Mass or memorial service? Flowers or memorial donations? What are their favorite hymns? Some individuals may even want to write their own obituary, or make a list of scriptures they want read at their funeral. Once you have these answers, write them down!
For a family member who can no longer drive or needs transportation for a short period of time, some grocery stores and pharmacies offer delivery. Check into these BEFORE you actually need the service. Another option is mail order medications, which can be sent in three month supplies and may be more economical.

Companion services can help your loved one stay in their own home. These services often include not only direct care of individuals, but light housekeeping, meal preparation, transportation services and grocery shopping.
Aging can be difficult for individuals and their families, but being prepared for aging can help! Facing later years head-on in a logical manner can prevent a world of stress and complications. Helena Rubenstein said, “Hard work keeps the wrinkles out of mind and spirit.” A little hard work can also keep the wrinkles out of elder care!

Will Your Family Need an Elder Care Advocate?

Will Your Family Need an Elder Care Advocate?

By Signe Gleeson, RNC, CCM, MS

No one should face aging and illness alone. Too often, older adults find themselves without an ally or advocate when they are most vulnerable. Illness and infirmity can diminish the best of us. This is more dramatic for older adults. It is not uncommon for an ill or hospitalized older adult to appear more confused, frail, and incapable than they actually are.

This is why an increasing number of families call on elder care advocates for assistance. At ElderCare Solutions, we support older and disabled adults and the people who care about them. Our role as elder care advocates is to help older adults achieve their goals and implement their choices when they can’t do it themselves.

Informed advocacy plays a critical role in ensuring the needs, desires and values of a disabled or older adult are recognized, respected and protected. It can be easy and expedient to make assumptions or assign a label to an older adult. It is tempting for physicians and family members to globalize an individual’s physical or cognitive limitations and to disregard the older individual’s strengths and capabilities as short- and long-term decisions are made. But as advocates, we recognize that a deficit in one area does not necessarily translate to deficiencies in other domains. For instance, an older adult who does not know the date may be well able to express his or her wishes regarding treatment.

When an individual is voiceless and/or seen with a limited perspective, the advocate gives a voice and a full sense of the person on their behalf. Advocates seek information about the individual and anticipate their present and future needs. We help to take some of the emotion out of the decisions for care, treatment and medical intervention. Part of our role is to consider the result of intervention and how it will affect the individual’s functioning.

We often see situations where a doctor may make a recommendation for a medical procedure without fully understanding the patient’s circumstances. Most people have a hard time questioning doctors. For older adults, this is particularly difficult. Family members may accede to the advice or pronouncements of professionals without questioning assumptions made with limited information or thoughtful consideration of the older individual. One of the strongest contributions we make as patient advocates, beyond our clinical skills, is to ask questions and paint a picture for the physician or family member of who this person is as an individual, how they live their life and what they value.

When to Call an Elder Care Advocate
Elder care advocates are often called in when an older adult is resisting assistance or intervention. We are also asked to assist when family members are in conflict over difficult care issues. These conflicts can arise between the elder parent and his/her children or between siblings. Our role is to be objective, provide expert assessments of the older adult’s individual needs and make specific recommendations for their care. As the advocate for the older adult, we can provide a point of view from which other family members can make decisions.

Effective advocacy involves:
– A willingness to listen to and learn about the individual/the whole person – their values and how they derive meaning in life
– A willingness and ability to intelligently investigate and even uncover options, ask questions, and, when needed, challenge assumptions and conclusions
– Being an active participant in decisions and bringing the individual into the discussion to the full extent possible.

Health care advocacy requires both fearlessness – identifying and confronting conclusions that are at odds with the best interest of the individual – and humility – openness to ongoing learning about the person and how to best discern and advance his or her needs. Health care today has increasingly become a business, in which hospitals, nursing homes and housing facilities may have interests or values that are at odds with the interest and values of the individual. That makes it increasingly important to take a “buyer beware” stance to ensure that vulnerable individuals are well served.

Learn to Set Limits

All of us want our elderly parents and relatives to be well cared for. Yet, despite the very best of intentions, we may be unable to do everything that is needed for our elders.

Meeting an elder’s needs can be exhausting and lead to a sense of failure. One critical element of effective caregiving is to learn to set limits for yourself.

Determine what you can and cannot do for an elderly relative. Doing so will help you establish and maintain a healthy relationship with your elder.

Caring for an elderly parent or relative is done best when it is a positive choice – not when it feels like an obligation or imposition. Look at your motivation and ask yourself “why do I want to help?”

The motivation for caregiving, unfortunately, too often arises from a sense of guilt or desire to repay a parent for what they’ve given you. A parent’s gift of life and rearing are not debts to be paid back – there is no way to do that. Caregiving can be motivated also by a desire for parental recognition, approval or closeness. Acting from a sense of guilt or need for approval may endanger your caregiving of a parent or lead to disappointment for you and your parent.

To determine what is best, begin by identifying your elder’s needs: the physical, social and emotional caregiving that may be required. What does your elder need to remain well cared for in his or her current environment? How much is the elder capable of doing independently?

The input of a professional may help you to understand your elder’s needs and to determine the best approach to take. Is dad’s refusal to walk alone based on a bona fide physical limitation? Is it rooted in fear? Is it the result of desiring attention? You can learn how much help is needed and what private and public resources are available to assist.

Once you determine the types of assistance an elder requires, decide what you are able to provide. Consider how your time at caregiving will affect other areas of your life, such as your relationship with a spouse or children or your career.

As you consider how to help an elder, do not underrate your own needs. As an airline attendant advises when starting on a journey, “the able person puts on their oxygen mask first.” During a crisis, elder care concerns may lead to temporary disruption in your life. But don’t allow long-term disruption. The health risks to you, the elder and to the relationship between you outweighs the benefits of putting your life “on hold.”

Don’t over promise what you will do. Be conservative in deciding how much assistance you can provide and how available you will be. It is better to promise less and do more, than to promise more and not fulfill your commitment.

If your elder wants you to do more than you can, be firm in your resolve. Focus on what you are doing and don’t let the focus shift to what you are not doing. Acknowledge the elder’s feelings with a simple, “I’m sorry you feel that way,” rather than giving a lengthy explanation that will merely exhaust you without satisfying the elder.

When you think about what you can and want to do for an elder relative, consider these questions:

1. Am I acting to relieve my own anxiety?

2. Does this situation truly demand my involvement or can somebody else meet this need for my elder?

3. How will my involvement impact other parts of my life?

4. Am I trying to meet someone’s standards other than my own?

Learning your limits and to say “no” are signs of strength. Make your caregiving a positive choice, rather than a response to guilt or a sense of duty. Doing so will give you more patience and energy for the care you do provide.

An Advocate and an Ally

“Here’s your medicine, honey,” the nurse said as she handed Mrs. Smith her morning medicine. Mrs. Smith politely took the medicine and then turned to me and commented, “I’ve been taking that medicine for longer than she’s been alive.” Her nurse was distracted by grey hair and a diminutive frame and did not allow for a capable and intelligent 84-year-old woman in the bed.

No one should face aging and illness alone. Too often older adults find themselves without an ally or advocate when they are most vulnerable. It is not uncommon for an ill or hospitalized older adult to appear more confused, frail, and incapable than they actually are. Family members may accede to the advice or pronouncements of professionals without questioning assumptions made with limited information and thoughtful consideration of the individual. Illness and infirmity can diminish the best of us. This diminishment is more dramatic for older adults.

Informed advocacy plays a critical role in ensuring the needs, desires and values of a disabled or older adult are recognized, respected and protected. It can be easy and expedient to make assumptions or assign a label to an older adult. Too often deficits are the focus with little acknowledgment of individual strengths and capabilities. Likewise a deficit in one area does not translate to deficiencies in other domains. An older adult who does not know the date may be well able to express wishes regarding treatment. It is tempting to globalize limitations and not give strength and capabilities their full weight as short and long-term decisions are made.

Advocates advance the best interests of the individual whom they are serving. That charge is not always so straightforward. Many of us, no matter our age, choose unhealthy or unwise practices. One can be foolish without being incompetent. Likewise, professionals and institutions – hospitals, nursing homes and housing facilities – may have interest or values that are at odds with the interest and values of the older individual.

When an individual is voiceless and/or seen with a limited perspective, the advocate gives a voice and a full sense of the person on their behalf.

Effective advocacy involves:
– Willingness to listen to and learn about the individual
– Willingness and ability to intelligently investigate and even unearth options ask questions and, when needed, challenge assumptions and conclusions
– Being an active participant in decisions and bring the individual into the discussion to the full extent possible

Health care advocacy requires both fearlessness – identifying and confronting conclusions that are at odds with the best interest of the individual – and humility – openness to ongoing learning about the person and how to best discern and advance his/her needs. Health care advocacy is not for the faint hearted. It involves an effort to acquire the required skills and the sensibilities to ensure that vulnerable individual are well served. That, in the end, is a service to us all.

A Reason to Wake Up

“Did the staff tell you what you COULD do?” the nurse asked Leo as he outlined all the prohibitions given to him after suffering a stroke. Indeed, without assistance in how he might creatively adapt previous activities to his new physical limitations, he felt that “my life is over.” With a singular focus on safety, Leo’s caregivers neglected to see that he was given a prescription for a life he didn’t see as worth living.

All of us, no matter how what our circumstances, need a reason to wake up in the morning. In a rush to a remedy, well meaning family members and professionals can overlook an exploration of what brings meaning to an individual’s life.

How do we reconcile the reality of necessary limitations with a desire to maintain a sense of self, a sense of competency and worth? An older adult facing a loss in function and abilities may cling to “what was”, disconnected from the caregivers and providers who, with good intent, offer encouragement and support to “move on.” The challenge is to bridge that disconnect.

In the opening of A Poisonwood Bible, author Barbara Kingsolver reminds us “one has only a life of one’s own.” An extension of that obvious statement is the often-overlooked consideration that we all learn and grow in our own way and at our own pace. Coping with grief and loss is, in many ways, a solitary and individual experience. Caring for another who is in emotional pain because of a loss of health and function includes acknowledging the experience and its pain. When we see another suffer, we may too quickly look for a remedy to make it “better”. Support often involves simply being with the other, allowing time and space for grief before urging the individual to “go forward.”

Meaning in life, it seems, comes from authentic encounters. No one can create meaning for another, but perhaps in care giving we can make a contribution. How do we help an older adult continue to look for and find meaning as opportunities seem increasingly denied? Some suggestions for opening an exchange that can help the older adult find their own answers and their own sense of meaning:

– Offer a large dose of listening before giving a small dose of advice
– Ask questions, rather than giving answers:
*What are you afraid of?
*You seem sad, are you?
* If we could change one thing to make you feel better, what would that be?
*What would you like?
*What did you like?
– Acknowledge feelings, resist labeling them as “good” or “bad”
– Express confidence, rather than pity
– Take time, not control
– Look to possibilities, rather than prohibitions

Resiliency is a gift of aging – older adults don’t achieve longevity without a significant spirit of resolve. As we care for older adults and help them accept life losses with grace and a sense of meaning, we are well advised to look to our elders for that store of resiliency and take our cues.

Power of Attorney for Health Care: Choosing Your Agent

The selection of an agent under the Power of Attorney for Health Care should be made with thought and care. The person you choose has a grave responsibility to act on behalf of an ill or elderly individual often under very difficult circumstances.

Some important guidelines in choosing and communicating with an agent include:

1) Name someone you can trust with your life – in fact that is what you are doing.

2) Don’t be afraid of hurt feelings. Choose the individual(s) you believe will serve your interests the best. Consider emotions, but don’t let them dictate the decision.

3) Your agent should be someone you can comfortably talk with about your wishes for care during illness. These conversations are best made “around the kitchen table” and should include conversations about your values. If a prospective agent isn’t comfortable with such conversations, he/she might not be the best choice.

4) Ideally, the agent is someone who can be readily available, and emotionally and intellectually capable of asking questions and of articulating and advocating the individual’s wishes in sometimes unfamiliar or overwhelming situations.

To insure that the POA is used as intended, the agent and all successor agents should have copies of the POA as should the primary physician and a family member or members. To be most effective and meaningful, it calls for an ongoing process of communication between the individual, the agent, family members and caregivers.

During illness and hospitalization, the agent should ask the physician in charge, the “attending physician,” to write an order to “contact the agent for consents for all tests and procedures” in order to ensure coordinated communication among other specialists who may be called in as consultants.

In considering interventions, the agent should consider the ultimate goals of the care. In consenting to tests, it should be clear how the information derived from the test would be used to promote the identified goals of care. It’s very easy, in this age of specialization, to treat the symptom or body “system” and lose sight of the person. The purpose of the agent is to ensure that all decisions regarding tests and procedures are made in the context of the individual and his or her values and wishes.

The Power of Attorney for Health Care is much more than a legal document. It establishes a sacred trust and demands the courage to consider the most critical life and death decisions we all ultimately face, for ourselves and for others.

WHEN A LOVED ONE IS HOSPITALIZED – SOME TIPS

Some advice from the geriatric care managers at ElderCare Solutions. When a loved one is hospitalized:

1) Get To Know The Staff

– Will one nurse be consistently in charge of your elder’s care? If not, find out who will be coordinating care and the best time to call or meet with that person. While the physician manages the medical treatment, the physician doesn’t coordinate all aspects of hospital care.

– Who will be planning for care upon discharge? Some hospitals have social workers, or in some cases, “discharge planners”. They are planning for discharge very soon after admission and so should you. Get in touch with this staff person to give you enough time to consider options:
– Will my elder be able to be discharged to home?
– Will my elder require and be eligible for home health care through Medicare upon discharge, including
nursing care and physical, occupational or speech therapy?
– Make sure that any equipment or services are put in place before discharge to home to provide for a smooth
transition
– If my elder needs care in a nursing home, what are our options?

– Contact the doctor to determine:
– What is my elder’s prognosis/chance for full recovery?
– What treatments/tests are being considered and what are the benefits and risks of
these treatments/tests?
– What happens if the treatment/test is not done?
– Are there alternative treatments or measures that can be tried?
– What are the costs? Will the costs be covered by Medicare?
– Make sure the MD has a good sense of the pre illness functioning and all medications and treatments in
place prior to hospitalization.
– Can therapy be put in place to prevent loss of function due to inactivity?

– Designate one family member as the spokesperson and information gatherer for the family. Having more than one spokesperson can lead to misunderstanding and miscommunication.

2) Help The Staff Care For Your Elder

– Provide information about your elder that will help the staff better care for him/her – food preferences, ability to hear or see well.

– Bring a picture of your elder during healthy, active days to post on the wall – it helps staff get to know the person behind the illness.

– Ask questions. Research shows that when individuals are involved in care, recovery is improved.

– Request that your elder be allowed out of bed, even if in a chair, if the physical condition allows. Inactivity and bed confinement can lead to complications and prolong recovery.

– Bring up concerns respectfully. Most staff members want to do their best to care for your elder, but working conditions can be difficult. While protecting your elder, treat the staff as a partner in recovery. If you have concerns, bring them to managers and people in authority who can resolve them.

3) Take a Hands-On Approach

– Offer to assist with little tasks- get water for your elder, help with eating and bathing, if possible – it makes you feel useful, provides an extra measure of caring and helps the staff.

– Use touch to communicate. Your elder may be too ill or tired to talk. Silence can be golden. Sitting quietly at the bedside can bring great comfort. Try a gentle hand massage. Don’t let tubes and machines get in the way of human contact.

4) End of Life Decisions

– Make the physician and staff aware of documents regarding health care decision making. A copy of the Power of Attorney for Health Care should be provided so all staff are aware of the wishes of the elder regarding use of measures to sustain life.

– Despite the fact that hospitals deal with life and death on a daily basis, discussions about end of life and the elder and family’s wishes don’t automatically occur. If an elder is very frail and/or gravely ill, it is appropriate for the family to initiate a conversation with the physician and staff about measures that may be employed, such as resuscitation, to keep your elder alive.

5) Discharge From the Hospital

– Before discharge, request written instructions for home care, goals of any home care services being prescribed, use of medication and follow-up treatment.

– If you believe discharge is premature, talk with your doctor. If your elder is covered by Medicare, you do have the right to appeal a discharge decision. The steps for appealing a discharge decision: 1) request a formal “notice of non-coverage” from hospital personnel, before discharge; 2) once you receive the notice you have until noon the following day to contact Medicare (1- 800- 647-8089) and request an immediate review of the discharge decision. A review typically takes 24 to 48 hours – your elder will not be charged for the stay during the appeal process, regardless of the appeal decision.

How to Talk to Medical Professionals

Even the most intelligent of us can become overwhelmed in an often-unwieldy health care system, in which a variety of consultants and specialists, tests and procedures demand attention and decisions.

Most decision do not need to be made urgently, but can be deliberated. Take the time to digest the information and seek clarification as needed. Often, a “watching waiting” approach is indicated.

Most health professionals are willing to answer questions, but to make life easier for everyone, designate a capable “point person.” It’s also helpful to preface a conversation with, “ I need a few minutes of your time” or “when is a good time to talk with you?” or “who is the best person to talk with?”

The underlying question individuals and families want to consider is “What do we want to accomplish?” The answer to that question will guide further questions and decisions that are made. Remember that treatments (procedures and medications) can be effective, but not necessarily have benefit for each individual. All treatments should be made in the context of the individual, their life circumstance, other health concerns and individual values.

Some other questions to consider:

1) What conditions are you trying to rule out?

2) What treatments and tests are being considered, what information are you looking for, and how will that information impact on treatment?

3) What are the benefits and risks of treatment?

4) What is the likely outcome if treatment is declined or delayed?

5) Are there other treatments/approaches that can be tried?

6) How will we know the treatment is effective and how long will treatment be necessary?

7) What is the prognosis and chances for a full recovery? What will “recovery” look like?

Thoughtful dialogue creates a partnership that keeps the ill individual central to decision making. This partnership benefits everyone, patients and practitioner alike.

Holiday Tips for Families Visiting Elderly Relatives

After many months of separation, the holiday season brings families together to celebrate and catch up. For families with older relatives, it is an opportunity to check in and make sure that all is well. Using your visit to be a thoughtful observer will help you assess an elder relative’s well being and, if necessary, take early steps to insure that small problems do not become large ones.

ElderCare Solutions, Inc., a Chicagoland area geriatric care management practice that assists families in managing the care needs of elder relatives, suggests families consider the following questions to alert them to subtle changes that may warrant professional investigation and intervention:
– Is household maintenance up to established standards?
– Does your relative tolerate activity as he/she used to? Does he/she get out of breath, easily fatigued?
– Is your elder relative interested in participating in the family’s traditional holiday activities, such as visits to other relatives or friends or preparing special foods.
– Does your elder have meaningful outside activity during your absence that he/she readily talks about?
– Is your elder able to identify friends with whom he/she has regular contact?
– Is your elder able to move around the house easily – climb stairs, get in and out of furniture – and use household equipment without difficulty?
– Can your elder recall significant people and events?
– Is there an adequate supply of food and household necessities in the house?
– Has your elder had a significant, unexpected weight loss over the past year?
– Is your elder keeping up with health care and finances?
– Does your elder seem somehow “different”?

“Very often, problems that surface may be easily remedied with early and simple interventions,” says Signe Gleeson, a registered nurse and co-founder of ElderCare Solutions. “With support, most of our relatives age easily and gracefully, learning to adapt to the changes that are part of normal aging. The most meaningful holiday gift you give your elder may be a caring and observant visit to insure they are healthy and happy and remain so during the New Year.”

For more information on caring for your elderly relatives, call the nurses of ElderCare Solutions at (630) 416-2140.