Wednesday, July 6, 2016

Paying for In-Home Care


Paying for In-Home Care

When chronic health conditions, surgery, dementia or even the normal aging process make it unsafe for a senior to live at home, home care can provide the assistance needed, while enabling them to continue living at home. When considering this option, many families are concerned about the cost and payment options.  "Home care has many benefits, including the comfort of recovery in personal surroundings and reducing costs," explains Kate Jones, Chief Clinical Officer for Home health, Hospice and Palliative care with Amedisys Home Health. "Despite the savings compared to assisted living or a nursing home, it can still be a financial burden for seniors and their families. It is often an out-of-pocket expense."
 Options for Paying for Home Care Along with some research provided by the NAHC, Jones suggests some of the options available and some trends she has noticed.   Medicare Medicare is available to most people who are 65-years-old or older. Regulations vary widely by state, but in most cases, Medicare will provide the following services in a home setting:
  • Skilled nursing
  • Physical, occupational and speech therapy
  • Certain medical supplies (wound dressing, but not prescription drugs)
  • Durable medical equipment (such as a walker)
  • Some social services related to illness (for instance, emotional counseling)
  • Some Food and Drug Administration-approved osteoporosis drugs
However, Jones explains that Medicare does not cover 24-hour-a-day care in the home, or "custodial care" such as meal preparation, bathing, dressing and toileting. The only way Medicare will pay for custodial care is if a senior also requires skilled nursing or therapy services.   Medigap This insurance bridges the gaps in Medicare coverage. It can sometimes be purchased in addition to commercial health insurance to get additional home health care coverage. Depending on the policy, services are covered by the supplemental policy when the policyholder is also receiving Medicare coverage for them. Medigap requires physician approval and it is most helpful when individuals are recovering from surgery, an injury or an acute illness.   Medicare Managed Care Companies These companies contract with Medicare to provide a host of Medicare-covered home health services. According to Jones, instead of getting traditional Medicare, subscribers choose a private Medicare program that offers some additional benefits, and sometimes additional restrictions, too.   Medicaid This assistance for low-income individuals is administered on a state level, so it can differ greatly. That also means that each state has its own set of eligibility requirements. In general, Medicaid covers part-time nursing, home services and medical supplies and equipment. Depending on the state, Medicaid may cover occupational, speech or physical therapy, and medical social services.   Aid & Attendance for Veterans Jones admits this a little known benefit, but an important one for wartime veterans or surviving spouses of veterans who need assistance performing activities of daily living (ADLs) or are housebound. There are a number of eligibility reqiurements and the application process can be lengthy. It is strongly recommended to seek assistance from sources like the VA or Area Agencies on Aging (AAAs) before applying.   Older Americans Act This helps frail and older Americans stay independent in their own community and offers federal funds for state and local social services. Home care, personal care, meal delivery and shopping services are covered for people 60 and older. More and more, people who can afford to pay for some of these services based on their income. Most requests for assistance can be facilitated through a local Area Agency on Aging.   Long-Term Care Insurance Some long-term care insurance covers home services. Benefits vary depending on the plan, so make sure you and your loved one understand which services are covered and which are not before purchasing a policy. There can be limits on coverage based on pre-existing conditions, there may be prior hospitalization requirements and some policies cover what is already covered by Medicare. Jones says it may be worthwhile to pay a little more for this kind of policy, especially if it includes nonmedical care, because having assistance with personal care and housekeeping can keep loved ones in their home longer and give them as much independence as possible.   Commercial Health InsuranceThese plans are administered by companies like Blue Cross Blue Shield, and although policies often cover selected services, it varies from plan to plan. Many times, skilled care is offered through a cost-sharing option.   Individual Retirement AccountsIndividuals and families have many options to pay for future expenses. Working with your bank, credit union or financial planner is a good way to put together a personal savings plan. If your parent has an individual retirement account (IRA), some funds from that account may be able to be used for home care.   Health Savings Accounts (HSA) Health savings accounts (HSAs) are used to save money for future medical expenses. You — not your employer or insurance company — own and control the money in your health savings account. The funds roll over from year to year and the money is not taxed. To be eligible to open a health savings account, you must have a special type of health insurance called a high-deductible plan – sometimes referred to as "catastrophic coverage," – that acts like a safety net if extensive medical care is needed. Health Savings Accounts have only been around since the early 2000s and Jones stresses they aren't yet a common way to pay for in-home care or nonmedical health care. Jones refers to HSAs as a rising trend.   Employer-Paid Assistance Another emerging trend and hopeful direction Jones is seeing includes employers providing some sort of elder care to employees. When you consider how many hours of work are missed when an adult child has to care for their aging or ill parent, offering some kind of assistance can be good business. "We've even seen employers pay to have health care workers go into employees' parents' homes to perform assessments," adds Jones, who suggests researching options with your company's human resources department.  Jones advises that individuals or families should know the programs that are available, exhaust all eligible options and then have a plan for what is not covered. Whatever option you choose, planning ahead is by far, the best prescription

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Monday, June 27, 2016

Sibling Relationships: Resolving Issues While Caring for Parents

Issues between brothers and sisters often seem to come to a head when a parent suddenly needs care. While siblings who have always had a healthy relationship generally find ways to work through their disagreements, many who never truly got along can find themselves frustrated, hurt and even completely estranged from one another in the end. In either scenario, objective, professional advice can be helpful for those families who are working towards conflict resolution at a time when everyone should be cooperating.
 Christine M. Valentin, a Licensed Clinical Social worker in New York and New Jersey, provided with some helpful suggestions for putting an end to family feuds. Valentin owns a private counseling practice where she works with adults who are experiencing anxiety and depression related to work, relationships and family. She also specializes in counseling people who are caring for loved ones with certain medical conditions like multiple sclerosis (MS) and Alzheimer's disease (AD). Prior to opening her practice, she worked with older adults and family caregivers for many years at non-profit organizations like the Jewish Association Serving the Aging, Mount Sinai's Caregiving Program, and the Alzheimer’s Foundation of America.  CBB: Why does dysfunction seem to be so common in caregiving families?  CV: While I'm not aware of statistics that actually confirm it is widespread, I would say that some form of "family dysfunction" during the caregiving journey is almost inevitable. Caring for a loved one is a complex task that often entails making myriad decisions while also juggling financial constraints, paperwork and planning, and emotional responses. Caring for a parent in itself can be physically and emotionally demanding, and adding numerous opinions and personalities to the mix can multiply the complexities involved. This is particularly true if everyone is not on the same page regarding the care they think their parent(s) should receive.  CBB: Do you think caregiving is usually an instigating factor, or does this situation simply exacerbate a familial rift that was already present?  CV: In my experience, a family rift, dislike for one another's personality, or disapproval of each other's lifestyle choices is generally present before the caregiving duties arise. The experience tends to highlight or remind families of past conflicts and rivalries, which, in many cases, can no longer be skimmed over or avoided.  For example, a family may have always known that “Tom was Dad's favorite.” While this preferential treatment may have been accepted and politely ignored for decades, it can cause problems between the siblings, especially if Dad should begin to shower Tom with praise regardless of his contributions, while ignoring how other siblings are helping out.  CBB: Are there any common dynamics amongst caregivers that you have seen that you can comment on?  CV: A common situation that arises is when one sibling carries more responsibilities than the other(s). This typically occurs due to the primary caregiver's physical proximity to the parent, the flexibility of their schedule (whether real or perceived), and sociocultural norms and expectations within the family.  The reality is, whenever there is more than one person involved in caring for a parent, there are likely to be differing opinions on what needs to be managed, who should be handling what tasks, and when and how to intervene. If a sibling is not helping to provide hands-on care, financial assistance, emotional support or some other contribution, the sole caregiver often ends up feeling resentful, burnt out and lonely.  Common complications I have witnessed in sibling dynamics include:
  • Being upset with a sibling because they are not helping out enough
  • The primary caregiver not advocating for themselves or taking a stand with an older sibling because it goes against the established family dynamic
  • Allowing social and cultural beliefs to dictate what roles each sibling will play in caregiving, such as the oldest male child not needing to help out as much, while the youngest female child absorbs most of the hands-on work
  • Factors like childhood experiences and parenting style
How the family members interact with one another as well as each one’s current life responsibilities (career, children, relationship status, financial situation, etc.) can also have a significant impact on the level of frustration and dysfunction they experience.  Denial can cause emotional stress to spill over into how family members work and communicate with one another as well. Regardless of whether a parent simply needs help with meals and housework or they are suffering from advancing dementia, this “role reversal” forces family members to come to terms with their loved one’s mortality. This can be particularly painful for some to accept, and it is not unusual for individuals to react by lashing out and blocking or refusing to accept appropriate treatments or increasing levels of care.  CBB: How can siblings try to see one another’s perspectives or achieve better communication and understanding?  CV: There are many ways this can happen. Each one, however, is dependent on the siblings’ willingness and openness to address the issues they are facing. I suggest that family members:
  • Be open to hearing one another's feelings about the caregiving situation.
  • Be honest with yourself and each other when discussing the concerns each of you have about your parent(s) and their mortality.
  • Focus on really listening to one another’s feelings without minimizing or discounting them.
  • Respect each other’s personal opinions and points of view and be mindful of any biases or ill feelings that may be influencing your judgement and attitude.
  • Be realistic about who your family members are and what they are capable of when it comes to participating in providing care.
  • Recognize your limitations. Sometimes knowing when to stop trying to make someone understand is just as important as educating your sibling and advocating for them to be involved.
  • Set goals for productive solutions like compromise and/or forgiveness, not “being right.”
  • Have an experienced, non-partial person attend to help facilitate these discussions. Better communication and understanding can often result from having a neutral party mediate and offer an outsider’s perspective. This person can be an impartial friend, a clergy member, social worker, geriatric care manager or a mental health professional.
 CBB: What professional/therapeutic services or tactics might help mend or at least mitigate a sibling dispute?  CV: A good first step to take is to have a family meeting. Do not include the care recipient at the first meeting, but do include a trained, experienced mental health professional. Doing so can help the family gain a better understanding of everyone's feelings about the situation, as well as their expectations. It is during such consultations that families are able to hear each other out rather than letting their emotions get the best of them and closing themselves off from productive conversation. Families can also experience a sense of relief when their emotions are validated and normalized and they obtain access to helpful resources. Realizing they are not alone in how they feel and that other families experience similar issues can reduce stress and be very cathartic. Becoming aware of caring strategies to implement and potential community resources and tools they can utilize within the home can also help to lessen the burden on the family and help them arrive at a realistic solution. Sharing thoughts and resources in support groups can be especially beneficial and productive in these ways as well.  Ultimately, the goal of a family meeting is to gain a better understanding of and greater appreciation for each other's views, improve communication, and learn about strategies and tools to help with the responsibilities at hand. In some cases, having the care recipient join a subsequent session with the family can also help implement services or care plans that the family is having difficulty with. Any resistance the family may be getting from their loved one can usually be addressed during these meetings as well. If a family therapy approach is not successful, one-on-one counseling may help you learn how to deal with difficult siblings and other relatives in a healthy and productive manner.  CBB: Is there a point in time when family members must accept their differences and simply walk away?  CV: Absolutely! The point when this occurs is different for everyone since factors like history of sibling conflict, history of attempts at reconciling, and expectations of one another need to be taken into consideration. Generally speaking, siblings should detach when they feel they have made every possible effort to settle their differences and believe that the stress of getting a sibling to be on board outweighs any benefits they might bring to the table. This is a common solution for people who have narcissistic or needy siblings who use bullying, guilt and manipulation to get their way. While this can be hard to do for various reasons, it is often the best option in order to eliminate unnecessary sources of stress while caregiving.  Many people associate detachment with abandonment or feel it is a choice that indicates a lack of compassion or dedication to their loved ones. However, detaching from a family member does not mean you no longer love them or do not care about their wellbeing. Instead, you choose to create a healthy distance between the two of you, which will provide you with a buffer against their negativity, drama and other destructive tendencies.  Your sibling is responsible for their own behavior, and you are responsible for deciding how you will let their words and actions affect you. Firmly setting boundaries with your sibling is a way of taking back control over your life. This could consist of a reduction in communication, or an all-out no contact approach. Accepting that there are certain things you are incapable of changing and limiting your interactions with unhealthy, unyielding individuals will allow you to focus on your own wellbeing and providing top-notch care for your parent(s).  A healthy detachment allows you to continue caring about a sibling without enabling their bad behavior, expecting anything in return or allowing their conduct to have any impact on yours. We naturally seek approval from our family members, but this should not be the driving force behind your actions when it comes to caregiving or any other responsibilities in life.  

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Thursday, March 10, 2016

7 Best FDA Approved Health Apps — An Update



As the mobile health industry continues to rapidly expand with no signs of slowing down, FDA regulation of health apps has evolved too.

Today, there are more than 100,000 mobile health apps on the market for Apple and android devices, with mobile health revenues projected to jump to $26 billion by 2017, according to Mobile Health Economics.

In February 2015, the FDA announced plans to review mobile medical apps that interpret data and act like medical devices. (We include examples of companies the FDA warned about this at the end of this post.)

The agency is basically making a call on the safety and effectiveness of certain apps. “Some mobile apps carry minimal risks to consumer or patients, but others can carry significant risks if they do not operate correctly. The FDA’s tailored policy protects patients while encouraging innovation,” said Jeffrey Shuren, M.D., J.D., Director of the FDA’s Center for Devices and Radiological Health, in a statement.

The agency does not intend to regulate apps that track a person’s daily steps, enable patients to refill prescriptions or search medical references. Nor will they oversee the mobile devices, such as iPhones and tablets, which can run medical apps.

It’s important to know which apps are worth your precious time and money. Therefore, PYP updated our popular 2013 list of the best FDA approved health apps and devices:

AirStrip ONEAirStrip ONE evolved from a diagnostic aid that delivers patient data from medical devices, electronic medical records and patient monitors to clinicians – to a platform that enables mobile interoperability. AirStrip Technologies’ platform intends to connect clinicians with patient data and with other providers to share data and promote care collaboration.

AliveCor Mobile ECG turns your smartphone into an electrocardiogram by snapping on the back of an iPhone. To take cardiac measurements, a person presses the device against the skin over the heart. A new feature allows people to keep a digital journal and track their symptoms, activity and diet.

Diabetes Manager
This device captures blood-glucose information and transmits it in real-time. WellDoc’s system offers a personalized coach to help patients manage their medication and treatment. WellDoc now calls its device BlueStar, and offers a commercial model that also engages a healthcare team in the management of type 2 diabetes.

iExaminerWelch Allyn designed its iExaminer app and ophthalmoscope to help with detection of conditions like glaucoma or retinopathy of prematurity. The ophthalmoscope connects to an iPhone 4 or 4S and allows providers to store the pictures to a patient file or email and print them.

Mobile MIM
The first medical app ever offered through iTunes, MIM Software designed the Mobile MIM to share images from radiation oncology, radiology, nuclear medicine, neuroimaging and cardiac imaging. The company intends this health app to enhance physician access to image scans to help them consult with peers on challenging cases, reduce image distribution delays and share images with referring physicians, partner institutions and patients.

ResolutionMDResolutionMD diagnostic medical imaging software from Calgary Scientific allows providers to securely access patient images and reports across a single practice or large enterprise healthcare system. Providers can securely review and collaborate from web and mobile devices without downloading any sensitive data.

Triton iPad App
In March 2015, the FDA cleared the Triton iPad App for estimating blood loss during surgery. This app takes a photo of a blood collection container using an iPad camera, and then analyzes it in the cloud. In 2012, the FDA cleared the Pixel app, also from Gauss Surgical. Pixel estimates blood loss during surgery by scanning blood filled sponges in an operating room.

So there you have our recommendations for the most useful, not to mention coolest, FDA-approved health apps on the market for physicians.

Apps the FDA Snagged in the Past

In 2013, the FDA sent an official warning letter to Biosense Technologies Private Limited about their uChek Urine Analyzer. Although the app connects a smartphone to FDA cleared reagent strips, because it allows a phone to analyze the results, it’s considered a medical device.

The FDA might also block importation of a mobile device if a company doesn’t first secure 501(k) clearance. This was the case for EPI Mobile Health Solutions of Singapore, whose Bluetooth-enabled mobile ECG device the FDA prevented from entering the U.S. for nearly one year.

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