Thursday, November 26, 2015

What to Do When Siblings Can't Agree on a Parent's Care Needs


<strong>Sibling Conflict</strong><br>Can't We All Just Get Along?
 

What to Do When Siblings Can't Agree on a Parent's Care Needs


Siblings! For some lucky families, having a bunch of adult siblings gather around and plan how to take care of Mom and Dad as their parents' health begins to fail is a great comfort. For some families, siblings who never got along as kids and have had little to do with each other as adults being thrown together to make touchy decisions is disastrous.   

For most families, the journey through the mine of elder care decisions falls somewhere between the two extremes. Elder care has a way of sneaking up on people. Generally, if there is an adult child living in the same town as the aging parents, it is this child who becomes, at the first sign of need, the default caregiver. That usually makes sense. You live in town. Your folks need some help with their Medicare forms, so you stop over. They need help with the yard, so you start taking time away from your family to help out. Then its grocery shopping and then, well, you're on your way to taking on a second job.    Ideally, before things get to this stage, you've had conversations with your parents about how they want their needs met during their later years. They've made out the papers naming a Power of Attorney for Health Care (a health directive indicating who will make health decisions if they can't and detailing their preferences for treatment) and a Power of Attorney for financial affairs. A will should be part of this, as well as other personal papers. Ideally, as well, all siblings are aware of these papers, what they contain and all are in agreement. Ideally – taking care of the elders becomes a family affair. However, life is seldom ideal.   

Even in seemingly harmonious families, the person who slowly became a default caregiver can start to feel resentful. The out-of-town siblings can conveniently slide into denial. They aren't around to see how much help is needed. They see Mom and Dad occasionally, talk to them on the phone, and all seems well. The fact that you, the in-town sibling, are the reason everything is going so smoothly doesn't really register with them.  

 This is a red flag for you. It's time to stop and consider how you are, as a family, going to handle the spiraling needs of aging parents. Most experts would suggest a family meeting. I agree. You, the hands-on caregiver, would explain all you do and give your siblings a chance to help. You'd find each other's strengths and weaknesses and work with those. You'd regularly check in with each other and update the whole family as needed. I would suggest this, because it is ideal, and many families can do this with a little work. If this works for your family, congratulations and you can quit reading here.   

Those of you who read the posts on the AgingCare.com forum will see the cold hard facts. You will see that, for many, the chances of a civil family meeting where you hash out the needs of your elders and agree who does what are, well, nil. You will see caregivers stressing over siblings accusing them of spending too much of their parents money to care for their parents. You will read the pleas for help from the one sibling who has quit his or her job to care full time for an ailing parent being either ignored by siblings, or worse, being accused of predatory intentions because they are "running the show."   

Option 1: Geriatric Care Manager  When these ugly scenes pop up, there's usually no way to go but through a third party. It's nice if you can agree on hiring a geriatric care manager, if you can find one in your area. This person would do the managing, get the help set up, and offer a cool head to work out problems, since the manager is not emotionally involved and doesn't carry family baggage.    Geriatric care managers are not available in every part of the country, and there is no over-reaching licensing, so you will want to do your homework. But sometimes, these people can make siblings see the light. They can help the ones in denial realize that the one doing hands-on care is "really working."   

Option 2: Counseling  Family counseling is also a good route, if siblings are willing to work on sibling relationships for the sake of their parents. Talking through the issue with an objective third party, who can guide the conversation and keep it civil, can help families work through the challenges associated with caring for an elderly parent. It helps everyone involved to better understand the other family member's views, frustrations and challenges, and can sometimes offer a fresh perspective.  


Elder Care Mediation  Unfortunately, many family relationships are beyond that point. This is where elder care mediators come in. These people are trained to mediate family disputes. Likely you can find one through your local court system or in the phone book.    Two online places to search for elder care mediation services are Eldercare Mediators at http://www.eldercaremediators.com/ and the Association for Conflict Resolution at http://www.acrnet.org/.    This is certainly worth trying before going to court over guardianship rights, which some families end up doing. It would be lovely if people didn't bring their baggage from childhood into adulthood, but we all do to some extent. If people could at least put sibling rivalry, greed and other undesirable behaviors aside for the sake of their elders, that would also be lovely.    But sharing the care of elderly parents doesn't always bring out the best in people. Add to that hopes of inheriting something from the estate, and it gets worse. This is when third party help is often a good option. For, if the hands-on caregiver doesn't get help somewhere, the damage done can reach far beyond the elders. Resentments nurtured at this time can poison family relationships for generations. If you are the default family caregiver, ask siblings for help early on. Let them know they are wanted (drop the martyr act).    If they have been given a chance and they refuse, try an agency designed to solve family issues. It could be one of the best investments you've ever made.


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3 Best Practices for Healthcare Consumer Billing Statements [That Are More Likely to Get You Paid]

 

How to Get Your Patients to Pay Up

Effective billing statements — ones that increase the chances for a prompt, full payment — are part art and part science. Statement colors, fonts, and a straightforward design can draw a greater response. There’s also research that shows it’s important to start with the healthcare consumer in mind (after all, the future of healthcare looks increasingly more consumer-driven).

“The shift toward consumerism is huge in the healthcare industry,” says Scott Sullivan, Account Executive of Partner Enablement at Emdeon, a company that processes 50 million statements every month. “In fact, the term ‘patient’ is increasingly shifting to ‘consumer.’”

With the proliferation of high-deductible health plans, primarily driven by the Affordable Care Act, consumers now pay an increasing share of their

healthcare expenses. “Previously, the consumer’s initial exposure to the financial side of healthcare was their co-payment. Communication in both print and digital formats is clearly more important now,” Sullivan says.

Leara Wyckoff, Solution Consultant at Emdeon, says, “We have access to the latest tactics and a wealth of information on best practices.”

Effective strategies emerging from Emdeon research into what works well include:


Best Practice #1: Send statements the way consumers want to receive them.Ask consumers how they prefer to receive statements. Some will want a paper statement and others will respond better to e-mail. “There can be generational differences here,” Sullivan said. Perhaps not surprisingly, focus group feedback shows Millenials tend to prefer digital statements and Baby Boomers favor paper statements in the mail. Also offer an e-mail opt-in on all paper statements to convert more people to digital formats.


Best Practice #2: Be clear, concise and correct.Clarity and simplicity are critical — any confusion and a consumer may call your staff for more information or, worse, just not pay. Create a legible statement that clearly lists doctor name, services performed, date of service, and other basic information. Wyckoff says, “Make sure the amount the consumer should pay is set apart in a visibly obvious way, and use unique fonts, colors, and capitalization for section headers of the statement.”


Best Practice #3. Provide a range of payment options.People are more likely to pay when a statement offers their preferred method. “Ensure you’re displaying all of the ways a patient can pay their bill, whether

in person, over the phone, online bill payment options, a traditional check mailed back to the office or a lockbox with icons or symbols (like a phone or computer). A picture says a thousand words!” Sullivan says. For people who prefer to pay in person at a local big time retailer, grocery store or pharmacy, consider adding a QR code for easy bill scanning in person. Again, it’s about consumer convenience and preferences.

The Healthcare Financial Management Association states that impactful, clear, and consumer-friendly billing statements are more likely to get you paid for services sooner, and can be worth the effort to optimize your medical practice’s revenue cycle.


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Tuesday, November 10, 2015

Caring for a Loved One with Dementia: It Takes a Village

In my last report on Charlie’s journey with his latest health crisis, he had moved to his daughter’s home five hours from me. It seemed to be going well, but then things suddenly took a turn. His daughter found that full-time caregiving in a home setting on top of responsibilities for children, a husband and a home to manage was more than she could handle. At her wits end, they arrived on my doorstep in the middle of the night three weeks ago.


Charlie was ecstatic to be home, while I welcomed him with trepidation. At the end of his hospital stay, I was prepared to place him in nursing home. To have him suddenly returned home, with all VA help discontinued, was upsetting to say the least. The first thing I did was reapply to the VA to have the Home Based Care Plan and Veterans In Place program re-established. This involved a lot of paperwork, and I am still waiting for the services to begin. In the mean time, we are muddling through, but doing surprisingly well. His condition has improved considerably since he was discharged from the hospital. In fact, physically, he is almost back to where he was before a bacterial infection and rheumatoid arthritis laid him flat. However, his mental acuity has suffered. A VA provider gave him a mental test this week in which he scored one-half what he scored six months ago. Today he cleaned his glasses with Whiteout, the product meant to cover errors on paper. In case you were wondering, no—it is not water-soluble. I laughed hysterically as I scraped it off his glasses with my fingernail.


His incontinence has also worsened since his hospitalization. The doctors are not sure what to blame for that; it may just be a result of his worsening dementia. So far, he is able to use a urinal at night, so I can sleep through the night without getting up 5-6 times to help him to the bathroom. The downside was the night he spilled his urinal on the newly cleaned carpet. There was a throw rug in place to catch such spills, but, as luck would have it, it overshot the rug. I’m afraid I lost my cool over that one. Charlie’s love affair with wine seems to be history, though. After six weeks of hospital sobriety, I decided to try playing the fool’s game. Whenever he asks for a glass of wine, I pour him a “cocktail” of red or white sparkling grape juice, fruit flavored water and ginger ale. He has never questioned what kind of “wine” he was drinking or noticed that he did not get the expected rush from the drink. After nine weeks of “freedom” while Charlie was in the hospital and with his daughter, I have found the confinement resulting from caring for someone with mental and physical ailments to be stifling and exhausting. Once I have some helpers in place, the job will not be so daunting. I can’t imagine what many of my readers are going through with little or no help available to give them a break from the stress and loneliness of caregiving. It only took Charlie’s daughter three weeks to realize she couldn’t do it, but she had a solution to her dilemma that many of you do not have access to. God bless you all.


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