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Medicare: Challenging Hospital Discharge Decisions

Aug
31
2015

Posted by: cburden in , , , ,

Please raise your hand if you are confused and overwhelmed with Medicare, their insurance plans, how they work and what your rights are. Now, raise your hand if you want to know who is going to take the time to explain it all to you. Discharge planning has had my interest for years, I know the hospitals are under scrutiny to discharge under each diagnosis and treatment plan as quickly as they can, but seriously, what hospitals discharge department has the staff and time required to work with each and every family the way the system is designed to do and more importantly the way families would like to be handled.

After all, we are there for medical treatment and patients and family alike wish to be treated with care and compassion. If and when you or someone you know is in the position of being discharged from a hospital, you very well may want to keep a copy of the interesting facts I found about Medicare and what your rights are as a Medicare patient provided by CANHR (California advocacy for nursing home reform).

Hospital Requirements Prior to Transfer to a Health Facility

Before a hospital can transfer a patient to another health facility, the hospital must make arrangements for admission to the health facility. (22 Cal. Code of Regs. Section 70717 (f )(1)) The hospital must also have a determination from the patient’s physician that the transfer will not create a hazard to the patient. (22 Cal. Code of Regs. Section 70717 (f )(2)) In addition, the hospital must notify the patient, or the person legally responsible for the patient, or attempt to notify the legally responsible person over the 24-hour period prior to the patient’s transfer. (22 Cal. Code of Regs. Section 70717(f )(3)).

Medicare

During a hospital stay, Medicare beneficiaries have important rights to receive the medical care they need. You have these rights whether you are enrolled in the original Medicare plan or a Medicare health plan.

Hospitals have a strong financial incentive to discharge Medicare patients as quickly as possible. Medicare generally pays hospitals flat rates based on the type of medical problem being treated. If the hospital spends less money on your care than Medicare pays, it makes money, and vice versa.

To protect you from being discharged too quickly, Medicare gives you the right to appeal hospital dis- charge decisions. It also requires the hospital to provide any discharge planning services you need.

Your Medicare Rights

At or near admission, a hospital must give you the Important Message from Medicare. This Medicare notice explains that you have the right:

  • To receive Medicare covered services, including necessary hospital services and services you may need after discharge, if ordered by your doctor. You have a right to know about these services, who will pay for them, and where you can get them.
  • To be involved in any decisions about your hospital stay, and know who will pay for it.
  • To appeal if you think you are being discharged too soon. The notice also explains how to file an appeal.

Notifying You of Your Rights

To make sure you are informed about your discharge rights in a timely manner, hospitals must usually give you the Important Message from Medicare twice, once upon admission and again before discharge.

The hospital must first give you the Important Notice from Medicare at or near admission, but no later than two days after admission. At that time it must ask you to sign and date the notice. The hospital must give you the original copy of the signed notice and keep a copy for its records.

Before you are discharged, the hospital must give you another copy of the Important Message from Medicare. It must give you this notice as far in advance of your discharge as possible, but no more than 2 days before your planned date of discharge. The second notice is not required during very short hospital stays if the original notice was given to you within two days of your planned discharge date.

If the hospital gives you the second notice on the date of your discharge, it must deliver it to you at least four hours before your planned discharge.

The hospital must deliver the Important Message from Medicare to you in person. However, if you cannot understand the notice, the hospital must deliver it to your representative and ask him or her to sign it. Your representative can be someone who has legal authority to act for you, a family member or close friend.

Appealing Hospital Discharge Decisions

Your hospital, doctor, or Medicare health plan will inform you of your planned date of discharge. If you think you are not ready to leave the hospital, tell your doctor and the hospital staff immediately about your concerns. Ask your doctor to advocate for your interests. Sometimes hospitals and health plans pressure doctors to arrange quick discharges.

You should request an appeal if your concerns about early discharge are not resolved. You can stay in the hospital and Medicare will continue to cover your stay as long as you file the appeal before you are discharged. Once you appeal, you will not have to pay for the services you receive during the appeal (except for charges like copays and deductibles).

It is best to file your appeal on or just before the planned date of discharge. Ask for an “Immediate Review.” Your representative, such as a legal agent or family member, can file an appeal on your behalf.

To file your appeal, call Livanta at 1–877–588-1123. Livanta is a “Quality Improvement Organization” (QIO) – a private organization working under contract with Medicare to handle certain appeals and other matters. Tell Livanta why you object to the planned discharge and provide any information that supports your appeal. For more information about Livanta or appeals, go to the Livanta web site at http://bfccqioarea5.com/ a5.question2.html

After you file your appeal, the hospital (or your Medicare health plan) must give you a Detailed Notice of Discharge that explains the reasons it thinks you are ready to be discharged. The hospital will send a copy of your medical records to Livanta for its review.

These appeals are completed quickly. Livanta will notify you and the hospital of its decision, usually within one day after it receives the necessary information.

  1. If Livanta finds that you are not ready to be discharged, Medicare will continue to cover your hospital stay.
  2. If Livanta finds you are ready to be discharged, Medicare will continue to cover your services until noon of the day after Livanta notifies you of its decision. Livanta must notify you of its decision by telephone and in writing. The written notice will describe additional options for appeal.

Discharge Planning Services

Medicare certified hospitals must help patients arrange care needed after discharge. This service, called discharge planning, is usually provided by the hospital’s social work or discharge planning department.

Contact the discharge planning department as soon as possible after admission. Discuss help and care you will need after discharge. Ask for recommendations and help in arranging necessary care and services. Request a copy of your written discharge plan and seek changes if necessary.

Medicare certified hospitals must:

  • Determine if you need discharge planning assistance
  • Identify services you need and their availability
  • Assess whether you can get needed care where you had been living
  • Discuss evaluation results with you
  • Prepare and share with you a transfer summary that includes the treatment plan
  • Use professional staff to deliver discharge planning services
  • Ensure that necessary care and services are delivered upon discharge
  • Prepare you and your family for discharge through education and counseling
  • Transfer or refer you, along with necessary medical information, to appropriate facilities, agencies or outpatient services, as needed, for follow-up care.

These requirements are found at Title 42, Code of Federal Regulations, Section 482.43 and Title 42, United States Code, Section 1395x(ee). Additional California hospital discharge planning requirements are established at California Health and Safety Code Sections 1262.5 –1262.6.

Discharge to Long-Term Care Facilities

If you are in need of long-term care services, the hospital must provide you with contact information for at least one public or nonprofit agency or organization dedicated to providing information or referral services to community-based, long-term care options. This information must include contact information for the area agency on aging serving your county of residence, local independent living centers, or other information appropriate to your wishes and needs.

The hospital should also identify local facilities and give you information about them. It must also identify affiliated health care providers so you will know if the hospital has a financial interest in the referral. The hospital cannot force you to go to any particular facility.

Visit facilities under consideration and determine whether they meet your needs and expectations. Check CANHR’s website at www.canhr.org for nursing home lists and publications on how to evaluate facilities.

If you are referred to a facility that has a record of poor care or is too far away, tell the hospital your concerns. You do not have to go to a facility that cannot meet your needs. Ask the hospital to help you gain admission to nearby facilities that meet your care standards.

If you want Medicare or MediCal to help pay for your care, now or in the future, limit your search to facilities that are certified by these programs.

The hospital must allow you to stay if you need skilled nursing facility services but if a bed is not available in your area, Medicare covers hospital stays until a skilled nursing facility bed is located.

Refusing a Proposed Discharge

If you are unhappy with a proposed discharge placement, explain to the hospital staff, in writing if possible, what you want. Ask to speak with the hospital Risk Manager and let them know you are unhappy with your discharge plan.

If a hospital proposes an inappropriate discharge, you may refuse to go. Although you cannot stay in a hospital indefinitely, the hospital cannot discharge someone needing long-term care until it arranges safe and adequate follow–up care. California state policy and some local ordinances prohibit hospitals from discharging their patients to homeless shelters or to the streets.

Remember, if the hospital is proposing to transfer the patient to a health facility, like a nursing home, it must “have arrangements” made for the admission. So if the patient makes it clear to the receiving health facility that the patient will refuse admission, will not sign an admission agreement, and will not pay for any services, it is unlikely the hospital can claim that arrangements have been made.

Filing Complaints

You can also file hospital complaints at the Department of Public Health (DPH). To make a complaint, call the district office of the DPH Licensing and Certification Division for your area.

Additional Resources

Contact your local Health Insurance Counseling and Advocacy Program (HICAP) office for help with Medicare concerns. You can also contact Medicare directly at 1–800–MEDICARE (1–800–633–4227) or find resources on its web site at www. medicare.gov.

To see the hospital discharge planning guide the federal government provides to hospitals, which includes an extensive discussion of the requirements and best practices, see http://www. cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/ Downloads/Survey-and-Cert- Letter-13-32.pdf.

I hope this helped sort out some of the confusion when you become faced with a hospital stay. If you are unsure of your discharge or need assistance setting up home care or placement into a particular level of care, please call me for guidance. I know I can take the worry and overwhelming related stresses off your plate. Here to Help, Happy to Help!

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Medication Madness – How Do You Really Feel?

May
21
2015

Posted by: cburden in , ,

Polypharmacy is a term used when someone is taking four or more prescription drugs. Did you know over 40 percent of seniors who still live at home are subjects of Polypharmacy?

My clients range from ages 55 through 100. I very rarely meet someone who only takes an occasional aspirin. On the contrary, most attach a separate list of their medications to my client cover sheet. Just in the last three months alone, I have witnessed three of my clients who suffered the severe consequences of over-medicating. They were hospitalized for weeks, misdiagnosed, moved into ICU and once stabile discharged to rehab only to be readmitted to the hospital for further complications and unable to successfully complete their rehab therapy. It is a common problem in America and especially with our senior population. Continue reading “Medication Madness – How Do You Really Feel?”

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Seniors Choices: What are they and who makes them

Mar
25
2015

Posted by: cburden in , ,

Recently, I was given a book by a friend who wrote in it “this book made me think of you and the valuable work you do.” I got started on it almost immediately to see what lay in the pages that made him feel this way. It has only confirmed my passion and desire to help guide families to the right paths for their care choices and quality of life as life has a notso-funny way of throwing more and more curve balls at us as we age. I feel honored and privileged to be asked to consult, advocate, advise and educate families on the many choices they actually have. What astounds me is their unawareness of how many choices their aging parents and loved ones actually have. However, after what my family experienced back in 2007 it is not surprising to me, we knew very little back then also. Had my family been introduced and or educated about the available choices my father could have selected when the hospital announced it was time for his discharge, I guarantee you – he would not have gone to a nursing home as was dictated to us by the medical team in the hospital.

Our medical care system is set up to diagnose, fix and release patients—patients of all kinds suffering from any number of illnesses, chronic disease, injury. The list goes on and on. Doctors are taught to find the answers to our problems and do whatever it takes to fix them and prolong our life. But, there seems to be a very important piece of the care system lacking: the conversations prior to and following treatment. The conversation of how to cope.

I have learned that doctors have three ways of communicating with their patients: The oldest and most traditional is a paternalistic relationship. This type of relationship is where the doctor informs the patient of what they believe to be the best treatment plan for them. They have the knowledge and experience and they make the critical decisions. As quoted by Dr. Atul Gawande in his book Being Mortal, “we tell you only what we believe you need to know.” It is the priestly, doctor-knows-best model, and although often denounced it remains a common mode, especially with the vulnerable patients — the frail, the poor, the elderly and anyone else who tends to do what they are told.

The second type of relationship is termed informative. It is the opposite of paternalistic. We tell you the facts and figures; the rest is up to you. It’s termed a “retail relationship,” the doctor supplies the up-to-date knowledge and skill and the patient is the consumer, there to supply their decision. This has become increasingly more common for doctors and it tends to drive them to become more specialized. They know less and less about their patients but more and more about the science. This way can be very straightforward, doctors supply the facts and patients make their own decisions of which treatment they want based on the facts provided. You have complete autonomy.

However, doctors have found that neither type is what people desire. We want information and control, but we also want guidance. The third type of doctor-patient relationship is called interpretive. Here the doctors’ role is help patients determine what they want. Interpretive doctors ask, “What is most important to you? What are your worries?” Then once they know your answers they tell you about the different treatment options that best help you achieve your priorities. Although I’m not a doctor, I conduct my service in this manner.

Let’s say for example that you have been diagnosed with a chronic disease, one that is treatable, needs periodic managing from your doctor; however there is no cure — you just have to learn how to live with it for the rest of your life. I guess it’s a blessing that it’s treatable right? Of course it is but to what extremes? And, hopefully your caring doctor will take good care of you over the next however many years you live with it and gradually experience the many different crises that come along with it over time.

Do the doctors help you manage your care and existence once you leave their office? Is it their job to assist you in doing so? Is there a professional team of experts who come to your home and help map out your set of circumstances and priorities over the next decade or however long you are expected to remain on this earth and are they going to see to it that your quality of life is full, pain-free and enriched? Probably not, so who then is going to have the conversations with you about how these wishes can be achieved when you are diagnosed and as your disease progresses? Let’s face it, no one wants to talk about it, it’s a very delicate and emotional subject but it is critical if you know what you want your quality of life to be while you are living with your disease.

The conversations should be set around what you want now and what you want for as things progress, what you will need and what has to be done to achieve this. So really it all comes down to choices and hopefully if you have these conversations early enough in your disease with the support of your doctors and family members you will be able to make them yourself. My wish for all seniors or loved ones faced with serious illness is to be part of the process of decision making for as long as they possibly can. My reasoning for starting the conversations early on is that many things change over time that require adjustments, even our loved ones’ wishes. It is a wonderful thing to know what your loved ones want as their life expectancy narrows. Knowing their wants based on their needs can be overwhelming, like walking a tightrope of choices, it takes careful listening and considerations. It’s a process, and time is one of the delicacies of planning around the mystery of decline and sickness. But if handled carefully and with respect of their wishes it will bring you peace — of heart and mind.

Below are some tips and facts that will help us understand that sometimes it’s the small thingsthat can create the biggest changes in our lives:

I have talked about this so many times and every time I meet with a new family “it takes a small village to care for an aging or sick loved one, it’s a team effort and the person who is aged or ill should be the captain.” Each family should form a small team to support the wishes and needs of their loved one. It may start with recognizing their activities of daily living ADL’s (Activities of Daily Living); Feeding, Toileting, Selecting proper attire, Grooming, Maintaining continence, Putting on clothes, Bathing, Walking and transferring (such as moving from bed to wheelchair.) When assistance is provided for your loved ones’ ADL’s it helps lower the risk of a fall. Falls are devastating especially to our elders; they create complete havoc especially if they are already living with an illness.

Did you know that each year over 350,000 Americans fall and break a hip? Of those, 40 percent end up in a nursing home, and 20 percent are never able to walk again. The three primary risk factors for falling are 1) poor balance 2) taking more than four medications and 3) muscle weakness. Elderly people without those risks have a 12-percent chance of falling in a year. Those with all three risk factors have an almost 100-percent chance.

I would like to thank my friend for the thoughtful gift of the book Being Mortal by Atul Gawande, it is a book everyone should read and embrace.

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The Size of the Problem: Elder Abuse

Mar
25
2015

Posted by: cburden in , , ,

The cold winter months are tough to handle, like battling with the thermostats, shoveling, relying on others for necessities. For many of folks these long, cold, dark days are a real battle for depression and other disorders which tend to keep us isolated and indoors. How about already existing challenges of old age dementia, physical handicap and chronic illnesses and needing to be cared for by others? Abuse happens with or without these circumstances but adding these into the mix makes you an easier target for elder abuse. Below are some statistics as collected by the NCEA.

Types of Abuse

Elder abuse is a growing problem. While we don’t know all of the details about why abuse occurs or how to stop its spread, we do know that help is available for victims. Concerned people, like you, can spot the warning signs of a possible problem, and make a call for help if an elder is in need of assistance.

— Physical Abuse
— Sexual Abuse
— Emotional or Psychological Abuse
— Neglect
— Abandonment
— Financial or Material Exploitation
— Self-neglect

Elder mistreatment (i.e., abuse and neglect) is defined as intentional actions that cause harm or create a serious risk of harm (whether or not harm is intended) to a vulnerable elder by a caregiver or other person who stands in a trust relationship to the elder. This includes failure by a caregiver to satisfy the elder’s basic needs or to protect the elder from harm.

Unfortunately, we simply do not know for certain how many people are suffering from elder abuse and neglect. It appears that female elders are abused at a higher rate than males and that the older one is the more likely one is to be abused.

Signs of elder abuse may be missed by professionals working with older Americans because of lack of training on detecting abuse. The elderly may be reluctant to report abuse themselves because of fear of retaliation, lack of physical and/or cognitive ability to report, or because they don’t want to get the abuser (90% of whom are family members) in trouble.

Below is a sampling of findings that show what is known about the incidence and prevalence of elder abuse and neglect:

— The most recent major studies on incidence reported that 7.6 to 10 percent of study participants experienced abuse in the prior year. The study that found an incidence of 1 in 10 adults experiencing abuse did not include financial abuse.
— Available data from state Adult Protective Services (APS) agencies show an increasing trend in the reporting of elder abuse.
— Despite the accessibility of APS in all 50 states (whose programs are quite different), as well as mandatory reporting laws for elder abuse in most states, an overwhelming number of cases of abuse, neglect, and exploitation go undetected and untreated each year.
— One study estimated that only 1 in 14 cases of elder abuse ever comes to the attention of authorities. The New York State Elder Abuse Prevalence Study found that for every case known to programs and agencies, 24 were unknown.
— Major financial exploitation was self-reported at a rate of 41 per 1,000 surveyed, which was higher than self-reported rates of emotional, physical, and sexual abuse or neglect.

Those Who Abuse

In the only national study that attempted to define the scope of elder abuse, the vast majority of abusers were family members (approximately 90 percent), most often adult children, spouses, partners, and others.

Family members who abuse drugs or alcohol, who have a mental/emotional illness, and who feel burdened by their caregiving responsibilities abuse at higher rates than those who do not self-report rates of emotional, physical, and sexual abuse or neglect.

I was having a conversation with Caryn Kennedy, a local Saratoga Springs financial advisor about the problems of financial elder abuse and the different variations. She stated that people need to be aware of the many arenas of financial abuse that more and more families are experiencing. By understanding how this can happen to your loved one and the reasons their resources have become limited may help correct a serious problem before it’s too late, especially now that people are living longer and the cost of care continues to rise at a very rapid rate. Through Caryn’s research, experiences and along with Merrill Lynch and the SEC, she has put together some astonishing statistics — ones we cannot overlook.

Seniors report some kind of financial abuse. Seventy percent of the nation’s wealth is held by individuals over age 65. This kind of abuse is vastly underreported and incidents are growing quickly. More than 90 percent of financial abusers are family members.

Types of financial abuse:

— Internet/lottery scams
— Predatory lending
— Annuity purchases
— Pyramid schemes
— Identity theft
— Threatening elder with physical harm or withholding care in exchange for money

Things a Financial Advisor is trained to look for with regards to potential Financial Elder Abuse:

— Family member showing a recent interest in the elder’s financial situation
— New Power of Attorney
— New best friend in need
— Elderly client request to do risky or out of ordinary trades
— Elderly client not able to remember conversations with their Financial Advisor
— Recently widowed
— Client not sophisticated in financial matters
— Large unexplained transactions
— Request for additional ATM/debit cards in new name
— Frequent transfers
— Change of address for bank statements
— The elder does not understand financial transactions or arrangements that have been made on their behalf

Where to Report suspected activity:

— Initially report any concerns to the elderly client’s financial advisor. FAs are required by federal law to follow through on all reported concerns.
— Most of the large financial institutions have recently created departments devoted only to financial elder abuse. These are
usually under the umbrella of the Compliance Dept and can be contacted directly.
— SEC and FINRA have put in place laws and regulations to protect elderly clients. Advisors are trained in how to spot red flags and protect elderly clients.

Reporting suspected abuse can be reported to the compliance or legal department of the firm where the abuse occurred:

— Bank manager
— Investment advisor and/or manager
— Sec.gov
— Bits.org
— Investorprotection.org
— Ncea.aoa.gov (National Center on Elder Abuse)
— Aarp.gov

How to prevent:

Before symptoms of dementia begin have a trusted family member assigned to the elderly client’s accounts so the Financial Advisor is allowed to speak to them should he or she have concerns. I would like to add that a trusted attorney is also a person who will work with you and your financial advisor to ensure your best interest and that of your estate are in the right hands. You can also reach out to the Attorney General’s office if you do not have a financial advisor or attorney at your disposal, go to www.ag.ny.gov

Please, stay safe, warm and remember when putting on your sweater, coat and hat never leave the house without your smile!

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How Time Flies, As Do Our Brain Cells

Mar
12
2015

Posted by: cburden in ,

The brain is a mighty complex organ that can play many tricks on us, especially as we age and undergo a vast assortment of changes throughout our lives.

I’m not sure if most 53-year-olds think so much about these things as I do. Perhaps it is because of my line of work that makes me so aware of it or maybe it’s just part of aging.

Whatever the reason, it fascinates me most of the time, saddens me others and sometimes just plain scares the heck out of me. But have no fear. There is something we can all do about the natural decline of the brain as explained by Dr. Michael Merzenich, a professor at The University of California, during an interview with Dr. Mercola.

Below is a brief explanation of brain plasticity by Dr. Merzenich:

“It was once thought that any brain function lost was irretrievable. Today, research into what’s referred to as “brain plasticity” has proven that this is not the case. On the contrary, your brain continues to make new neurons throughout life in response to mental activity.”

Aside from toxicity, our modern lifestyle plays a part in cognitive decline, as described by Dr. Michael Merzenich, professor emeritus at the University of California, who has pioneered research in brain plasticity for more than 30 years. He founded the Scientific Learning Corporation in Oakland, California and Posit Science in San Francisco; both specializing in science research into brain training software.

Dr. Merzenich’s career arose from an interest in philosophy and a fascination with the nature and origin of the human persona and individuality, and how brain processes might account for the evolution of our individual abilities. He believed that those who have learning disabilities, the natural progressions of these brain processes must have encountered errors.

Use It or Lose It — the Principles of Brain Plasticity

The inherent plasticity of the brain was discovered some 20 years ago, when animal models demonstrated that brain deterioration and aging was in fact reversible, provided the proper stimulus. Dr. Merzenich describes brain plasticity as follows:

“It’s simple in concept. The brain changes physically, functionally and chemically, as you acquire an ability or as you improve an ability. You know this instinctively. Something must be changing as your brain advances, as it progresses.

Actually what it is doing is changing the local wiring, changing the details of how it’s connected. It’s also changing itself in other ways, physically, functionally, and those changes account for that improvement, or account for the acquisition of an ability.

You don’t realize it but as you acquire an ability – let’s say, the ability to read – you actually create a system in the brain that does not exist, or that’s not in place, in the non-reader. It [the ability] actually evolves in the brain.”

As Dr. Merzenich explains, your brain is designed and constructed to be stimulated and challenged, and to carefully examine, resolve and interpret your environment. During the early days of mankind’s development, keeping track of the details was imperative for survival.

Today, however, we tend to try to remove ourselves from the details of life. For example, instead of keeping track of appointments and to-do lists in our head, we use electronic gadgets with reminder features. Our streets are paved and lit, requiring virtually no attention to navigate from one location to another. And if you don’t sufficiently challenge your brain with new, surprising information, it eventually begins to deteriorate.

“Generally, by the third or fourth decade in life, you’re in decline,” Dr. Merzenich says. “One of the things that happens across this period is that you go from a period of the acquisition of abilities to largely using those abilities that have been acquired earlier in life. By that I mean to say, the fundamental skills that you apply in your profession or in your everyday life are things you master, and you’re doing them without thought.”

To a large extent, you’re operating most of your day without really being consciously engaged in the things you’re doing… I’ve gone without really thinking very much about the physical acts of driving. I’m substantially disengaged.

This has been contributed to substantially by modern culture. Modern culture is all about taking out surprises…to basically reduce the stimulation in a sense on one level so that we can engage ourselves in sort of an abstract level of operations.

How Your Daily Lifestyle Can Improve Your Brain Function

Aside from engaging in a computer-based brain exercise program, Dr. Merzenich lists several things you can do on a daily basis, as part of your day-to-day lifestyle, to help maintain optimal brain fitness:

  • Get 15-30 minutes of physical exercise each day. When exercising, think about using your brain to control your actions. That means, skip the iPod and instead take in the details of your environment.
  • Spend about five minutes every day working on the refinement of a specific, small domain of your physical body.
  • Find ways to engage yourself in new learning as a continuous aspect of your life, such as taking on new hobbies, learning new skills.
  • Stay socially engaged.
  • Practice “mindfulness,” in which you’re attentively focusing on the world around you again, as if you’re seeing it for the first time.

Nutrition and Brain Health

  1. Optimize your vitamin D levels through safe sun exposure, a safe tanning bed and/or vitamin D3 supplements.
  2. Take a high-quality animal-based omega-3 fat. I recommend consuming high quality krill oil to meet the optimal amount of omega-3 fats needed to achieve good health and fight cognitive decline
  3. Avoid processed foods and sugars, especially fructose. Excessive sugar and grain consumption are the driving factors behind insulin resistance, and the strategies that protect your brain are very similar to those for avoiding diabetes. There is simply no question that insulin resistance is one of the most pervasive influences on brain damage, as it contributes massively to inflammation, which will prematurely degenerate your brain. Ideally, you’ll want to restrict your total fructose consumption to below 25 grams a day. This includes refraining from eating too many fruits, if you normally eat a lot of them. If you consume more than 25 grams a day of fructose, you can damage your cells by creating insulin and leptin resistance and raising your uric acid levels.
  4. Avoid grains — Even whole, organic grains will convert to sugar in your body and spike your insulin levels.
  5. Avoid artificial sweeteners — Aspartame, for example, is an excitotoxin that can literally destroy your brain cells. There are many studies showing the dangers of aspartame.
  6. Avoid soy — Unfermented soy products are another common food that should be avoided if you want to maintain healthy brain function.

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Exploring New Beginnings And Believing You Can Get There

Dec
10
2014

Posted by: cburden in

So often when we daydream of a happy time, all the daily clutter and distractions are taken out of the equation and in your mind you have this vision of “a moment.”

We tend to not think about what it takes to get us to that moment of peace and pleasure. We just want to capture it and explore that feeling, even for a little while. It’s a snapshot of what we envision for ourselves and our loved ones. What is it going to take to make that daydream become a reality? Who is in the snapshot you envision? Continue reading “Exploring New Beginnings And Believing You Can Get There”

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Eldercare Transitions: Starting the Conversation

Dec
3
2014

Posted by: cburden in , ,

When I meet with families, it is typically the children of the senior loved ones who are requesting to consult with me. Why?

There are several reasons the children contact me and not the seniors themselves. One reason may be that their parent or parents are unaware that their lifestyle and state of mind and/or body are declining; two, they are aware of their declines but do not want to burden their children with worry or more work; three, they do not want change regardless of their situation or circumstances or it could be something altogether not touched upon.

In any case, I can empathize with all of the above; however, decline is inevitable. So, unless we have planned and prepared for changes in long-term care, we will get caught in a crisis and thrown off guard, which too is inevitable.

Many times my clients are in the position of witnessing the decline of their parent who truly could use assistance, guidance or a safer environment from the lifestyle they are accustomed to. But for one reason or another they just aren’t sure how to start the conversation without making their loved ones feel defensive about losing their independence or threatened that their children are taking over control of their life.

I would say nine out of 10 times the children ask me how they should start this touchy conversation. Now I want to remind you that I am not a psychologist; however, I see this every day as a consultant and advisor. I also have a real soft spot for seniors. If I were in their position, I would wish to be treated with honesty, compassion and respect.

The sooner you involve your parents in the process the better. Let’s face it, how many of us enjoy talking about old age, declines of physical and mental capacities, long term care and end of life planning?

Like most important decisions in life, it is a process, which takes time and careful planning. It is always best to be well-informed and have facts to support your concerns and opinions before engaging your parents in the conversation. In order to do this, it is best to consult with an expert on proper resources and guidance.

It is also wise to include your immediate family members from the start. This may be challenging for many and may take a few attempts, but it helps everyone understand one another’s concerns and you will be better able to map out a plan that everyone is involved in and on board with.

It is also very important to involve your parents in these conversations as long as their mental capacity is able to reason and make important decisions. If they are not, these conversations will most likely cause added anxiety and resistance.

Here are key considerations to help you frame your approach to this challenging subject as found on havingtheconversation.com

APPROACH

Consider your Personal Point of View

  • Begin with yourself, the adult child, and be honest. Why do you want to have these conversations? What do you want for yourself and for your parents? What are your fears or concerns? What would be your best-case scenario? What do you want to happen?
  • Be empathetic. Put yourself in your parents’ shoes. Ask them how they are doing. Ask them if they’re still able to do the things they want. Let them know you care about how they are and what they want.
  • Be a good listener. Sometimes you are afraid to hear what parents are feeling because it also makes you face getting older. Let them talk and let them know you hear them.
  • The idea that a role reversal takes place in the relationship between you and your parents is neither true nor helpful. That should never happen. A shift in your relationship may occur as you guide these conversations, but you should not consider yourself the disciplinarian or that you “know what is best.”

Before you Start Talking

  • Involve everyone in the family who should be part of the conversation and include your parents at every step.
  • Resist any temptation to jump ahead and put a plan together yourself.
  • Remember when you think about HOW to have your conversation to frame it around the five most important considerations for aging seniors: security, freedom, peace of mind, friends and choices. How can your parents best achieve these things?
  • Think about asking questions to find out whether or not your concerns are the same as your parents. Let them know what you have identified and ask if they ever think of those same concerns or if they have identified others.
  • Ask yourself if your desired outcomes are the same as theirs. Have they considered the same things you have, or are they thinking in a different direction?
  • Consider putting together a script or an outline so you have something to follow and don’t forget important points. You don’t need to have it in front of you, but it will help you organize your thoughts.
  • If you still feel nervous or afraid of getting started, run your ideas past a professional. This can be a social worker at a local agency or senior center. It might be a therapist or someone at your church or local hospital. Identify who your parents trust and respect. These can also be excellent individuals with whom to consult.
  • It helps to have conversations when you are not rushed; when there is time for small talk. Plan to talk in a quiet place where your parents won’t have trouble hearing you; where they can feel calm and focus on the conversation.
  • Always show respect and support for the fact that these are THEIR DECISIONS and THEIR LIVES.

Getting the Conversation Started

  • Ask your parents how you can work together.
  • Stress that there are not necessarily “right” or “wrong” options or ideas. It’s most helpful to consider a number of things as good options when starting to have these conversations.
  • It helps to start with small, casual conversations to plant seeds. Use phrases like, “Let’s just talk about you,” or “I’ve noticed some things take a lot more energy these days. What are the important things you really want to do? What are your priorities? Is there a way we can make it easier for you to do those things?”
  • It has also worked for some adult children to open the conversation by saying how much you admire the way your parents have handled retirement and ask their advice on what has worked well for them so that you can emulate it. This can naturally lead into a discussion about “What kind of planning comes next?”
  • Others have started conversations by talking about yourself and your kids and how you communicate with one another. Adult children may already be communicating with their kids on their next steps and their wishes surrounding those circumstances.
  • Use something neutral such as a relevant event in the news or a recent incident or anecdote about an aging family member or friend to get the conversation going. This can be an opening to mention, “We’ve never talked about these kinds of things. I don’t want to pry, but it would bring me a lot of peace of mind to know there is a plan if we need one.”
  • Build upon these more casual conversations to lead into larger decision-making conversations later.

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Balking at the Gate: Fear of What’s to Come

Aug
18
2014

Posted by: cburden in , ,

How does someone try and convince a parent or loved one that moving into a safer environment is the right choice? How do we make them see that by letting go of the present situation it is actually allowing them to keep their independence for a much longer period of time?

Change is difficult for most anyone. We feel more comfortable in familiar surroundings. It is easier for someone to procrastinate a change rather than act on it. The thought of sorting out lifelong belongings and collectibles is quite overwhelming and avoidance is the simpler way of dealing with it.

However, in the life we know, everything changes. Every day something in our lives changes in some manner. Of course we cannot change the past or predict the future, but we can try to project what we may be faced with down the road based on the past and present circumstances regarding health, finances, safety and family dynamics. Take a look at the current situation with a parent or loved one. Are there serious concerns? How will these current situations affect that person and their family if left untouched and allowed to take its own course?

One never knows when a crisis is around the corner. Let me ask you this: If your car “check engine” light comes on, do you ignore it for months, even years, because you are afraid of what the mechanic might tell you or do you have your car looked at to check for the problem before it becomes a bigger issue? It could be as simple as adding more radiator fluid or maybe it is something to do with the transmission. Either way, knowing what the problem is and having it attended to will give you peace of mind knowing your car is in a safe condition for driving on our busy roads. We must not ignore the signs given to us with cars, appliances or loved ones.

Image via Design Mind.

 

Families today see the signs of their loved ones faced with constant changing health issues, yet most seem leery of how and when to broach the subject of aging in place or getting in home assistance, seeing a specialist or moving into a safer environment. Why? Because it can be an uncomfortable topic to bring up. You feel it will become confrontational or hurtful and I can express to you that typically your loved one’s first reaction is resistance. Heels are dug in and they are not open-minded to any new changes.

This is very typical and understandable behavior from their point of view. It is a scary thought, especially the older we become; however, I can also tell you from my experiences with elders, that they do have fears and anxieties about their safety, health issues and daily declines. They remain silent about them and in many cases it is denial of aging. In other cases, it is their pride and strength of holding onto their independence.

This holding onto independence can also be interpreted as being stubborn or in other cases, they do not want to “bother or burden” their children and other family members with their worries. This becomes a cycle that can last years—years of avoidance, sweeping under the carpet, not addressing the “check engine light.” In turn, this cycle slows down the process of being proactive in the care plan for your loved ones. It doesn’t change anything, however.

I can tell you this fact: by avoiding a current or previous health condition, you are allowing more opportunities of something critical to occur.

Once something critical occurs, then your options and choices are numbered as is your time to put a plan in place according to your liking and wishes. I see it all the time. My phone rings and someone is in crisis mode. Either someone fell and needs rehab or someone takes ill and is hospitalized leaving both scenarios unsafe to be discharged home alone. Let me ask you this: How many options do think you will have and how much time will you be allowed once your loved one is faced with hospitalization or rehab? You will be under the gun to make serious life-altering decisions.

Now you are under pressure and everyone’s emotions are flying high. Waiting for a crisis to occur before putting a safe care plan in place makes things much more challenging for the whole family. Families today are busy with work schedules, children and obligations in and outside of work. Now you have this crisis sitting in the middle of your plate and it is NOW unavoidable and needs your immediate attention. Decisions need to be made, and not on your time schedule but the schedule of the hospital or rehab facility. That means fast decision making and fewer choices to choose from.

Consulting with an expert before it becomes an “in your face crisis” is the best way to start this emotional and difficult process of care transitions. It will take the constant worry off your mind. Your parents or loved ones will be more at ease knowing there is a plan for them where everyone involved is on board and you will not be forced to make life-changing decisions while under pressure from a facility. If you already have a plan in place or have been educated on the many different resources available which are appropriate for your loved ones needs, you are ahead of the game. If not, I encourage you to reach out.

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New Friends on the Beach: Keeping Your Independence

Jul
28
2014

Posted by: cburden in , ,

elderly couple beach trip

New friends on the beach.

I was visiting friends in Rhode Island a couple weeks ago who were participating in a free diving, spearfishing tournament off of Gooseberry Beach. It was a beautiful Sunday morning: sun bright, water calm. I watched them gear up in their wet suits and prepare their spear guns, other equipment and head out onto the ocean in their kayaks. What a site!

Now I would find my place on this intimate, gorgeous beach to relax, take in the sights, and await their return at 2 p.m. It gave me plenty of time to reflect and observe the patterns of the surrounding people. There was the couple to my left in their ’50s who had been there since 7 a.m. when we arrived. You could tell they were there to soak up as much sun as possible, barely spoke to one another, they were together but I sensed they could have easily been alone.

Then along came a younger family of five: three children, two girls and a boy. They quickly came on the beach and plopped down about 10 feet in front of me. They spoke loudly and aggressively toward one another. The dad was in charge and acted like he was done with the whole process already. He was clearly agitated and did not want to be asked one more question from his son who was stuck to him like glue.

They settled in, the girls went straight to the water, mom, dad and boy stayed at their site. However, with no consideration for anyone else sharing the beach on this peaceful Sunday morning, they yelled back and forth to the girls in the water, about 40 yards away, continuously about staying off “the rock.” They thought they were funny and amusing, but they were the only ones who felt that way!

The son asked the dad if he could sit on his lap and the dad snapped back with “No, go play, will you.”

It saddened me to hear those words from a father to a son, especially as I lay there missing my children and wishing they were next to me. He will one day be wishing for the same. Unfortunately that was a rude interruption to my reflecting and peaceful observing. It was now around 10 a.m. and I had plenty of time to spare. I thought to myself, should I relocate? Or, “This too shall pass.”

Then along came three elderly folks who I am guessing were Russian and spoke no English. It was a husband, wife and male best friend. If I had to guess, I’m pretty sure they were in there ’80s. The woman walked with a cane on one side and her adoring husband on the other. Their friend had a cooler in tow with a beach bag and towels. They set up to my right giving the cooler to the woman as a seat, and the men used the towels. It was apparent the woman needed assistance walking in the sand. She was dressed in shorts, a T-shirt and cap whereas, the gentlemen were both wearing speedo swimsuits, ready for the water. I felt a feeling of happy compassion from them. They were a tight team, looking after one another. I couldn’t help but watch them and take pictures of them enjoying their time together.

They were a peaceful distraction from the “noisy crew” in front of me. The men would periodically walk down to the water and cool themselves while the woman sat on the cooler and enjoyed the ocean. They had packed lunch and fruit and conversed with one another with smiles and laughter the whole time. They were living in the moment, embracing the day. Several times the men would escort their beloved wife and friend to the water for a short walk along the wet shore then back up to their spot where the sand meets the beach roses and wispy grasses. It made my heart smile.

I decided I would go for a run on the beach in hopes of returning to find the “noisy crew” had packed up for the day. I had a great run, barely anyone was on the beach and I felt great. I strolled back about an hour and a half later to find nothing had changed except for a few more parties of joyful people and pups. I lay down and with the noise from up front still present, I took some deep breaths and shortly thereafter heard them gathering things and heading off the beach. You could see other people watching them depart with relief. I look over at my elderly friends and we all smiled.

The husband had gone to the water and climbed on “the rock” to sit and enjoy the beautiful surroundings. He was smiling, content and happy, as were his wife and friend. I grabbed my phone and walked over to them and asked in hand gesture lingo and a smile if I could take her husband’s picture on “the rock.” They nodded and smiled and were so excited – they were so cute! I went down to the water and the husband began posing, took his hat off, and gave me the biggest smile. It truly was a special moment for me and probably amusing for them as well. On my way back to my spot, I stopped and took some pictures of the wife on the cooler, and she shared a great big smile.

I know this isn’t my typical writing style however, it absolutely demonstrates the power of independence and quality of life as we age. As well as how we treat the ones we love, how you make others feel and how we look after one another.

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Success Story: Client Testimonial

Jun
3
2014

Posted by: cburden in

A recent client testimonial—this is why I do what I do!
“Clare came to the rescue at a time when our family was overwhelmed with the simultaneous release of both my in-laws from hospital stays that required them to have 24 hour care while we explored options for assisted living.
She met with our family on a Sunday afternoon, less than 24 hours after receiving my call. During the meeting she was on the phone arranging for 24 hour care to begin the following day upon my in-laws release from the hospital. She then immediately informed us of options available for assisted living, many of which we were unaware of.
Clare assisted us in setting up appointments to visit facilities, and was very honest with pros and cons. She also connected us with the local Veterans representative to begin the lengthy process of obtaining benefits, as well as an elder law attorney. Once we were able to place my in-laws Clare continued to check in to see how everyone was doing and if there was anything we needed. 18 months later and I still hear from her!
Clare does this kind of work from the heart having been in this situation herself. Her fee does not come close to the value of the peace of mind that she gave us. Thank you Clare from the Kindl family!”
To read more about how I’ve helped other previous clients, check out the Success Stories section of my blog.

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