Tag Archives: Doughnut Hole

Elder Care at Home

With a rapidly aging population, caring for your elders is likely going to be a big part of your life. According Medicare.com, a recent survey by the National Caregiver Alliance and the AARP Public Policy Institute revealed that approximately “34 million adults in the U.S. are unpaid caregivers to an individual over 50 years old, with 85% providing care for a family member.”

Care giving is a fairly broad term and responsibilities depend on the physical and mental health of an individual but may include anything from helping with everyday activities to medication reminders to hiring and coordinating with assisted living staff. Regardless of the level of involvement, caring for the elderly requires patience.

Every day tasks that we take for granted, such as getting up and getting ready for the day can be challenging as we age. The elderly often need help with daily living activities like bathing or getting dressed. Though these tasks may be time consuming, the physical and emotional benefits of grooming, bathing and putting on clean clothes should not be underestimated to making someone feel more good.

The National Institutes of Health National Institute on Aging (NIA) provides several resources and tips for caregivers including:


  • Be simple, direct and positive when speaking. Clear and upbeat communication is generally a good idea, especially if the person you are caring for has health problems that could affect memory and cognitive skills.
  • Establish eye contact, use the person’s name and if appropriate, touch or hold his or her hand to encourage conversation
  • Ask simple yes-or-no questions rather than open-ended questions. For example, ask “Are you hungry?” instead of, “When would you like to eat?”
  • Limit choices to reduce confusion. For example, ask, “Would you like to wear your jeans or your khakis?” instead of asking, “What do you want to wear?” You might even want to show the options to the person you are caring for to help them make the decision.

Bathing and Dressing

  • Easy wear, easy wash clothing. Comfortable, loose-fitting clothing with elastic waistbands will not only make it easier to get dressed, it will also make it easier to remove clothing to use the bathroom.
  •  Assist in dressing as needed. Let the individual do as much as possible without assistance but be ready to lend a hand. To assistance, lay out the clothes in the order they will be put on. For example, place underwear and socks before pants and shirt.
  • Make the shower safe. Use a sturdy shower chair, grab bars, non-slip bath mats and a hand-held shower-head to reduce the chance of falls.

Eliminate Safety Hazards to Prevent Falls

  • Remove or secure rugs. Try using double-sided adhesive tape to firmly attach any large area rugs.
  • Hide electrical cords. Tuck cords behind furniture, under large rugs or tack to the baseboards so they are out of the way.
  • Create clean lines and open spaces. Remove any extra furniture that would be difficult to maneuver around with a cane, walker or wheelchair.
  • Install handrails and grab bars. Most commonly used along stairways, on the side of the bed, next to the toilet and in the bath or shower.
  • Install good lighting inside and outside home. If the elderly individual has difficulty seeing, install the highest recommended bulb per light fixture. For their safety at night, install nightlights in bedrooms, bathrooms, kitchen and hallways.

Remember, it is also important to make sure your loved one not only has health food and beverages available but that they are eating regularly. Proper nutrition and hydration can have a significant impact on an individual’s physical and mental abilities.

If the time has come when your aging loved one is no longer able to live independently, please contact the knowledgeable staff at ElderLink to help you find elder care services or an assisted living facility within California that is customized for your family.

Lifting Therapy Caps Is A Load Off Medicare Patients’ Shoulders

Physical therapy helps Leon Beers, 73, get out of bed in the morning and maneuver around his home using his walker. Other treatment strengthens his throat muscles so that he can communicate and swallow food, said his sister Karen Morse. But in mid-January, his home health care agency told Morse it could no longer provide these services because he had used all his therapy benefits allowed under Medicare for the year.

Beers, a retired railroad engineer who lives outside Sacramento, Calif., has a form of Parkinson’s disease. The treatments slow its destructive progress and “he will need it for the rest of his life,” Morse said.

But under a recent change in federal law, people who qualify for Medicare’s therapy services will no longer lose them because they used too much.

“It is a great idea,” said Beers. “It will help me get back to walking.”

The federal budget agreement Congress approved last month removes annual caps on how much Medicare pays for physical, occupational or speech therapy and streamlines the medical review process. It applies to people in traditional Medicare as well as those with private Medicare Advantage policies.

As of Jan. 1, Medicare beneficiaries are eligible for therapy indefinitely as long as their doctor — or in some states, physician assistant, clinical nurse specialist or nurse practitioner — confirms their need for therapy and they continue to meet other requirements. The Centers for Medicare & Medicaid Services (CMS) last month notified health care providers about the change.

And under a 2013 court settlement, they won’t lose coverage simply because they have a chronic disease that doesn’t get better.

“Put those two things together and it means that if the care is ordered by a doctor and it is medically necessary to have a skilled person provide the services to maintain the patient’s condition, prevent or slow decline, there is not an arbitrary limit on how long or how much Medicare will pay for that,” said Judith Stein, executive director of the Center for Medicare Advocacy.

But don’t be surprised if the Medicare website doesn’t mention the change. Information on the website will be revised “as soon as possible,” said a spokesman, who declined to be identified. However, information from the 800-Medicare helpline has been updated.

Until then, patients can refer to the CMS update posted last month for providers.

Lifting the therapy caps is just one of the important changes Congress made for the 59 million people enrolled in Medicare. Here are two others:

Shrinking The ‘Doughnut Hole’

Beneficiaries have long complained about a coverage gap, the so-called doughnut hole, in Medicare drug plans. That’s when the initial coverage phase ends — this year, that happens after the beneficiaries and their insurers have paid $3,750 for covered drugs. When it happens, a patient’s share of prescription costs shoots up. This year, when people hit this stage, they are responsible for paying up to 35 percent of brand-name drug costs.

When beneficiaries’ total yearly drug expenses reach a certain amount ($5,000 this year), they enter the catastrophic coverage stage and pay just 5 percent of the costs. But studies have shown that fewer than 10 percent of beneficiaries spend enough to reach that last stage.

Beers relied on Medicare for physical therapy and other forms of therapy to help slow the progression of his Parkinson’s disease. (Bert Johnson for KHN)

The Affordable Care Act had called for the patient’s doughnut hole share to be narrowed to 25 percent by 2020, but the budget deal moved up that adjustment to 2019.

Much of the drug cost will be shouldered by pharmaceutical companies. And those payments by drugmakers will also count as money paid by patients, which will help them progress to the catastrophic level more quickly, said Caroline Pearson, senior vice president at Avalere Health, a research firm.

The deal could have an added attraction. “Premiums will come down because the drug plans are not being required to cover as much as they used to,” Pearson added.

Lower premiums will also save money for the government because it will spend less on subsidies for low-income beneficiaries.

Expanding Medicare Advantage Benefits

Another important change allows private Medicare Advantage plans in 2020 to offer special benefits to members who have a chronic illness and meet other criteria.

Currently, these private insurance plans, which limit members to a network of providers, treat all members the same.

But under the budget law, benefits targeting those with chronic diseases do not have to be primarily health-related and need have only a “reasonable expectation” of improving health. Some examples that CMS has suggested include devices and services that assist people with disabilities, minimize the impact of health problems or avoid emergency room visits.

This wider range of benefits might help people remain at home, increase their quality of life and reduce unnecessary medical expenses. “We’re really excited that the law is catching up with what plans have known for a long time,” said Mark Hamelburg, senior vice president of federal programs at America’s Health Insurance Plans, an industry association.

But the changes will affect only those beneficiaries enrolled in these private plans, about a third of the Medicare population. “We would like to see some of these innovations happen in the traditional Medicare program as well, so that all beneficiaries would be able to reap these benefits,” said Lindsey Copeland, federal policy director at the Medicare Rights Center.

by Susan Jaffe | Republished Courtesy of Kaiser Health News

Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.