Health Care

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Taking Control of Your Health Care
Taking Control of Your Health Care 150 150 Robert Goodman, MSW

The Savvy Senior

Taking Control of Your Health Care

By Robert Goodman, MSW

 

Your health is in your hands. There are many things you can do to take control of your health care.

First, write or type an information sheet with your name, address, phone number, insurance information and insurance number. Then list all your health conditions, medications (including supplements), surgeries, allergies, and all your doctors. You should also include information on your family medical history. Keep this with you when you visit any doctor, especially new ones. You should also keep a copy of your information on your refrigerator in case of an emergency.

Who is going to make your health care decisions for you in the event that you are too ill or injured and cannot make them for yourself? You should fill out a living will and appoint a health care proxy.

Advance directives are legal documents that allow you to convey your decisions about end-of-life care ahead of time. They provide a way for you to communicate your wishes to family, friends and health care professionals, and to avoid confusion later on.

A living will tells how you feel about care intended to sustain life. You can accept or refuse medical care. There are many issues to address, including

· The use of dialysis and breathing machines

· If you want to be resuscitated if breathing or heartbeat stops

· Insertion of a feeding tube

· Organ or tissue donation

A durable power of attorney for health care is a document that names your health care proxy. Your proxy is someone you trust to make health decisions if you are unable to do so. (Source: www.nlm.nih.gov/medlineplus/advancedirectives.html)

Advance directives are available at many doctor’s offices, hospitals, and online at www.agingwithdignity.org/five-wishes.php. (There is a charge for ordering through this website.) You should keep a copy of your health care advance directives and give a copy to a family member, your doctor, and your attorney (if you have one). If you have a Do Not Resuscitate Order, keep it on the refrigerator for emergency personnel to see.

When you visit your doctor bring a list of questions. Be sure you understand the answers before you leave the office. You should be clear about what medications you are being prescribed, the purpose of the medicine, and any side effects. The same applies to any medical procedures that are being recommended.

If you are diagnosed with a particular condition learn as much as you can about the disease or disability, prognosis, and any rehabilitation services that might be needed. If appropriate, ask about community services that relate to that condition, any aids and appliances or home modifications that might be needed.

The bottom line: Have all your medical information readily available to share with your health care professionals. Understand what your health care professional is saying to you. Don’t be afraid to ask questions.

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Your Rights as a Patient
Your Rights as a Patient 150 150 Robert Goodman, MSW

Your Rights as a Patient
By Robert Goodman, MSW
Geriatric Social Worker
Medicare Appeal Rights
Do you know your rights as a healthcare consumer? Do you have a complaint about the quality of your care? Do you want to appeal a decision about a discharge from a hospital, skilled nursing facility, or home health care agency? An appeal is an action you can take if you disagree with a coverage or payment decision made by Medicare, your Medicare health plan, or Medicare Prescription Drug Plan.
You have the right to appeal if Medicare, your Medicare health plan, or your Medicare drug plan denies one of the following:

  • A request for a health care service, supply, item, or prescription drug that you think you should be able to receive.
  • A request for payment of a health care service, supply, item, or prescription drug you already use.
  • A request to change the amount you must pay for a healthcare service, durable medical equipment, or prescription drugs.

You may also appeal if Medicare or your plan stops providing or paying for all or part of a healthcare service, durable medical equipment, or prescription drug you think you still need. (Source: www.medicare.gov/claims-and-appeals).
Before filing an appeal, gather all the relevant information about the service you are appealing and the reason given for the denial of service or discharge. Then compile whatever documentation is necessary to show that you need that service to continue. This includes notes from a doctor, therapist, or another healthcare provider. Be sure the information is specific to your situation. Document every phone call, email or letter you write or receive.
Contact Kepro, the Medicare Quality Improvement Organization for Florida, at 1-844-455-8708 to file an appeal or a complaint about a service. You can learn more information about your right to appeal and download forms on their website, www.keproqio.com.
You can find interesting information on the Medicare.gov website about your rights and benefits. The website has sections where you can find and compare doctors, health plans, hospitals, medical equipment suppliers, nursing homes, home health agencies, dialysis centers, and other providers. You can also locate medical equipment suppliers.
Your Other Rights
You have the right to receive a copy of your medical records. You should keep a copy of your lab work, diagnostic reports, and other important medical information.
If you have a visual impairment, you have the right under the Americans with Disabilities Act (ADA) to request that your health care provider supply you with information written in large print. Under the ADA, any business or health care provider must make print documents available in an alternate format for people with visual impairments. This includes large print, Braille, or audio tapes. They also have the option of reading the material to a consumer.
The following are additional resources for information on health care providers:
Accreditation Association for Ambulatory Health Care
Finding out if urgent care centers and ambulatory surgical centers are accredited.
(847) 853-6060
American Association for Accreditation of Ambulatory Surgical Facilities
Finding out if an ambulatory surgical center is accredited. (888) 545-5222
American Board of Medical Specialties
Finding out if a doctor is board certified. (866) 275-2267
MAXIMUS Center for Health Dispute Resolution (CHDR)
Requesting external reviews of Medicare managed care denials.
(585) 425-5210
Florida Medical Quality Assurance Inc., The Florida ESRD Network – Network 7
Where to submit a complaint about the quality of care I received from my kidney dialysis facility.
Report Medicaid fraud and abuse: (866) 762-2237
Florida Agency for Health Care Administration
Where to submit a complaint about the quality of life or quality of care inside a nursing home. (888) 419-3456
Long Term Care Ombudsman of Florida
Obtaining information on nursing homes or resolving problems between nursing homes and residents or their families. (888) 831-0404, 561-837-5038
Florida Health Finder www.floridahealthinder.gov
Learn about medical conditions, symptoms, procedures, tests and more. Find and learn about Florida health care facilities and providers in your area.
Source: http://www.medicare.gov/contacts/topic-search-results.aspx

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Women’s Heart Health
Women’s Heart Health 150 150 Robert Goodman, MSW

Women’s Heart Health
By Robert Goodman, MSW
Do you know the signs of a heart attack? They differ between men and women. I learned this recently when a close friend experienced chest discomfort after exerting herself in the gym and ignoring the symptoms. After this recurred over several days she decided to find out what was happening. She called the doctor who immediately sent her to the hospital after hearing the symptoms. She was admitted to the hospital and needed a stent put into an artery.
I have learned from this experience that many women do not know the signs of angina or a heart attack and often ignore them thinking that it is stress related or indigestion. Heart attacks are the number one killer of women with strokes the number three killer according the American Heart Association.
Angina is a warning sign of heart disease, and recognizing it and getting treated early may prevent a heart attack. As heart disease progresses, you may have tightness, pressure or discomfort in your chest during physical activity or when stressed. But it goes away shortly after you stop the activity or get rid of the stress. 
Angina symptoms in women can also include feeling out of breath, nausea, vomiting, midepigastric discomfort or sharp chest pain.  Once the extra demand for blood and oxygen stops, so do the symptoms.
Heart Attack Signs in Women

  1. Uncomfortable pressure, squeezing, fullness or pain in the center of your chest. It lasts more than a few minutes, or goes away and comes back.
  2. Pain or discomfort in one or both arms, the back, neck, jaw or stomach.
  3. Shortness of breath with or without chest discomfort.
  4. Other signs such as breaking out in a cold sweat, nausea or lightheadedness.
  5. As with men, women’s most common heart attack symptom is chest pain or discomfort. But women are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting and back or jaw pain.

If you have any of these signs, don’t wait more than five minutes before calling for help. Call 9-1-1 and get to a hospital right away.
 
Recognizing the signs and seeking treatment is the first step. Understanding your risk factors, such as a family history, is also important to stay in tune with changes in your health. Heart disease is preventable. See your physician regularly, exercise, if you smoke: quit, eat healthy, and know your pressure, cholesterol (total, HDL, LDL, and triglycerides), and blood sugar levels..
(Source: American Heart Association: www.heart.org)
Other sources of Information: www.womenshealth.gov, http://www.nlm.nih.gov/medlineplus/womenshealth.html, http://www.cdc.gov/women/, www.webmd.com. You can also call the government’s Office of Women’s Health: 1-800-994-9662

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Are You at Risk for Falling
Are You at Risk for Falling 150 150 Robert Goodman, MSW

Are You at Risk for Falling
By Robert Goodman, MSW
Falls are a major issue for older adults and can be prevented. Most falls occur at home and can lead to fractures, trauma, and death.
1.  Over 13 million older adults fall every year; 1 of 3 if over 65, and 1 of 2 if over 80 years old.
 2.  2.2 million older adults are treated in the ER for falls.
 3.  40% of nursing home admissions are fall related. 
4. In 2009, about 20,400 older adults died from unintentional fall injuries.
There are a number of causes of falls among the elderly. They include:

  • Lack of physical activity and muscle weakness
  • Balance and gait problems
  • Visual impairment
  • Mobility impairment
  • Cognitive impairment
  • Drop in blood pressure when standing up
  • Fear of falling
  • Alcohol abuse
  • Inappropriate footwear
  • Environmental hazards. One third of all falls in the elderly population involve hazards at home. Factors include: poor lighting, loose carpets and lack of safety equipment.
  • Chronic health problems that can increase fall risk significantly are:
    • Arthritis
    • Obesity
    • Functional limitations impairing mobility (Diseases such as Parkinson’s, Alzheimer’s, COPD, Pain, etc.)
    • Multiple medications
    • Hypertension
    • Diabetes

Falls can be prevented by taking care of yourself and making changed in your environment. The following suggestions will help reduce the chances of falling/

  • Be physically active and exercise regularly.
  • Improve the lighting in your home, Keep an easy to reach lamp near your bed.
  • Move items to make them easier to reach. Arrange furniture to allow for clear pathways.
  • Get rid of loose (throw) rugs, especially if you have a visual disability. Be sure rugs are securely fastened to the floor.
  • Install grab bars in the bathroom (shower and near toilet)
  • Clear clutter from floors
  • Avoid slippery floors
  • Be careful carrying heavy or bulky things up or down stairs
  • Have Your Medicines Reviewed
  • Limit the amount of alcohol you drink. Even a small amount can affect your balance and reflexes.
  • Choose Safe Footwear
  • Be careful while walking and talking or texting on a cell phone.
  • Have Your Blood Pressure Checked When Lying and Standing
  • Get a Vision Check-Up
  • Wear your eyeglasses so you can see your surroundings clearly.
  • Check your medications: Some medicines—or combinations of medicines— can have side effects like dizziness or drowsiness. This can make falls more likely. Having a doctor or pharmacist review all your medications can help reduce the chance of risky side effects and drug interactions.

If you fall, or are afraid of falling, be sure to discuss the fall with your doctor, even if you aren’t hurt. Many underlying causes of falls can be treated or corrected.
There are a number of devices that can help prevent falls, but one must remember to use them. They include: canes, walkers, reachers, and emergency medical alerts.
People living alone should have a medical alert to contact the fire/rescue in the event of a fall. Friends and neighbors should check on their neighbors who live alone and are isolated.
To help prevent falls, We Care and Boca Raton Regional Hospital have joined forces to offer a series entitled “A Matter of Balance”. This 8 week series will be repeated often. Check with the class office for details on future sessions.
(Sources: http://nihseniorhealth.gov/fall, www.cdc.gov/features/fallrisk, Pam Hapke (Easy Living Program)

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Are You at Risk for Falling
Are You at Risk for Falling 150 150 Robert Goodman, MSW

Are You at Risk for Falling
The Savvy Senior
By Robert Goodman, MSW
This article is dedicated to the memory of a close friend who fell and as result of complications from her diabetes died earlier in the summer. Falls are a major issue for older adults and can be prevented. Most falls occur at home and can lead to fractures, trauma, and death.
1.  Over 13 million older adults fall every year; 1 of 3 if over 65, and 1 of 2 if over 80 years old.
 2.  2.2 million older adults are treated in the ER for falls.
 3.  40% of nursing home admissions are fall related. 
4. In 2009, about 20,400 older adults died from unintentional fall injuries.
There are a number of causes of falls among the elderly. They include:
Lack of physical activity and muscle weakness
Balance and gait problems
Visual impairment
Mobility impairment
Cognitive impairment
Drop in blood pressure when standing up
Fear of falling
Alcohol abuse
Inappropriate footwear
Environmental hazards. One third of all falls in the elderly population involve hazards at home. Factors include: poor lighting, loose carpets and lack of safety equipment.
Chronic health problems that can increase fall risk significantly are:
Arthritis
Obesity
Functional limitations impairing mobility (Diseases such as Parkinson’s, Alzheimer’s, COPD, Pain, etc.)
Multiple medications
Hypertension
Diabetes
Falls can be prevented by taking care of yourself and making changed in your environment. The following suggestions will help reduce the chances of falling/
Be physically active and exercise regularly.
Improve the lighting in your home, Keep an easy to reach lamp near your bed.
Move items to make them easier to reach. Arrange furniture to allow for clear pathways.
Get rid of loose (throw) rugs, especially if you have a visual disability. Be sure rugs are securely fastened to the floor.
Install grab bars in the bathroom (shower and near toilet)
Clear clutter from floors
Avoid slippery floors
Be careful carrying heavy or bulky things up or down stairs
Have Your Medicines Reviewed
Limit the amount of alcohol you drink. Even a small amount can affect your balance and reflexes.
Choose Safe Footwear
Be careful while walking and talking or texting on a cell phone.
Have Your Blood Pressure Checked When Lying and Standing
Get a Vision Check-Up
Wear your eyeglasses so you can see your surroundings clearly.
Check your medications: Some medicines—or combinations of medicines— can have side effects like dizziness or drowsiness. This can make falls more likely. Having a doctor or pharmacist review all your medications can help reduce the chance of risky side effects and drug interactions.
If you fall, or are afraid of falling, be sure to discuss the fall with your doctor, even if you aren’t hurt. Many underlying causes of falls can be treated or corrected.
There are a number of devices that can help prevent falls, but one must remember to use them. They include: canes, walkers, reachers, and emergency medical alerts.
People living alone should have a medical alert to contact the fire/rescue in the event of a fall. Friends and neighbors should check on their neighbors who live alone and are isolated. See accompanying article on medical alerts.
(Sources: http://nihseniorhealth.gov/fall, www.cdc.gov/features/fallrisk, Pam Hapke (Easy Living Program))

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HIV AIDS in the Senior Population
HIV AIDS in the Senior Population 150 150 Robert Goodman, MSW

The Savvy Senior
By Robert Goodman, MSW
The Birds and the Bees
Several years ago a friend decided to start dating after the death of her husband. Before she started dating again I told her I wanted to talk to her about something. She said “You’re not going to talk to me about the birds and the bees are you?” I said I was and proceeded to talk about sexually transmitted diseases, including HIV and AIDS. She was shocked by both my bringing up the subject and by the statistics. But this is a conversation that everyone must have.
The availability of erectile dysfunction medications has resulted in increased sexual activity among the elderly. Older adults continue to be sexually active. They also are less likely to use protection because pregnancy is not an issue after menopause. The Centers for Disease Control explains that seniors might be less knowledgeable about HIV/AIDS and therefore less likely to protect themselves with condoms or seek testing.
Heterosexual adults over age 50 account for an increasing proportion of persons living with HIV/AIDS. Statistics compiled by the New York City Department of Aging (DFTA) report that 14% of all reported HIV/AIDS cases in the United States in 2004 were among people over age 50. The HIV/AIDS issue has moved from a problem in the gay and white communities to a problem faced by minorities and the elderly. In 2003, 52% of older Americans living with HIV/AIDS were either Black or Hispanic. In addition, people who were diagnosed with HIV/AIDS at a younger age are living longer as a result of new medications.
The NYCDFTA also found that:
Older adults who are exposed to HIV are at greater risk than younger people because of weakened immune systems.
Health providers may not screen older adults for sexually
transmitted diseases because of lack of training or ageist attitudes.
Older adults are not diagnosed properly as having HIV/AIDS
because many of the symptoms resemble the symptoms of old age.
In 2009, nearly 20 percent of all new HIV and 25 percent of all AIDS diagnoses in Florida were in those older than 50. More than half of the cases were among those who live in South Florida, according to the Broward County Health Department.
Some state projections say that the majority of people with the disease will be seniors by the year 2015.
Susan Mintz has been aware of this subject for 30 years since her husband was diagnosed with HIV. She explains that the baby boomers who are now aging live with a 60s mentality that we are as invincible now as when we were teenagers. She states “ that we are now playing Russian roulette with a loaded gun.” Many baby boomers continue to use drugs and are increasingly exposed to this disease as they start dating after the loss of a spouse.
Educating older adults about HIV/AIDS has become her passion and priority. Her goal is to prevent the spread of this disease. She facilitates a support group to educate older adults about sexually transmitted diseases in our clubhouse in her quest to reach this goal. “We need to talk about it.” She explains, “this issue is not necessarily about you, but about the ones around you. We need to be concerned about our friends, acquaintances, and family members.”
The HIV/AIDS support group, which she calls “I love my life” meets on the first Monday of each month in Room G in the clubhouse at 4 PM. To learn more about the support group contact Susan at 561.271.1879.
You can also learn more about her experience with HIV/AIDS by visiting her website: www.susanmintz.com. For more information on STDs and older adults log onto www.cdcnpin.org/scripts/population/elderly.asp

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Selecting a Medicare Plan
Selecting a Medicare Plan 150 150 Robert Goodman, MSW

Medicare 2015
Senior Savvy
By Robert Goodman, MSW
 
The time has come to evaluate your Medicare coverage for 2013. From October 15 to December 7 you will have the option of joining or changing your Medicare Advantage Plan. You have several choices.
You can stay with original Medicare and/or buy a supplemental (Medigap) policy. If you want prescription drug coverage, you must also join with a Medicare Prescription Drug Plan (Part D).
You can choose to join a Medicare Advantage Plan Medicare Advantage Plans are a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Medicare Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans.
If you’re enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan and aren’t paid for under Original Medicare. Most Medicare Advantage Plans offer prescription drug coverage. You must take the drug coverage that comes with the Medicare Advantage Plan. Some plans offer additional benefits, such as vision and hearing screenings, disease management, and other services not covered under Original Medicare. Medicare Advantage Plans must offer emergency coverage outside of the plan’s service area (but not outside the U.S.).
A Health Maintenance Organization (HMO) plan is a health care plan in which you generally must get your care and services from doctors or hospitals in the plan’s network, and you may need a referral to see a specialist.
A Preferred Provider Organization (PPO) plan you can generally obtain health care from any doctor or hospital you want within their network. You have the flexibility to go to any doctors, specialists, or hospitals that aren’t in the network, but it will usually cost more. Monthly premiums and how much you pay for services vary depending on the plan.
 
Questions to ask Medicare Advantage Providers

  1. Is there a monthly premium and how much is it?
  2. What doctors can I see and how much it will cost me to see a doctor.
  3. What hospitals can I use and how much it will cost me to use a

hospital (either as inpatient or in an emergency).

  1. What happens if I am traveling and need to see a doctor?
  2. How much it will cost me for outpatient procedures.
  3. Is there a monthly drug premium and how much is it?
  4. How much it will cost me for your medicines over the course of a year.

 
Medicare beneficiaries can qualify for Extra Help with their Medicare prescription drug plan costs. The Extra Help is estimated to be worth about $4,000 per year. To qualify for the Extra Help, a person must be receiving Medicare, have limited resources and income, and reside in one of the 50 States. For information go to http://ssa.gov/prescriptionhelp.
The source for much of the information in this article is from www.Medicare.gov. You can find information on Medicare; look for a Medicare plan in your area, or compare Medicare Advantage Plans. 

  • Robert Goodman, MSW
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Women's Health
Women's Health 150 150 Robert Goodman, MSW

Women’s Health
The Savvy Senior
By Robert Goodman, MSW
 
Do you know the signs of a heart attack? They differ between men and women. I learned this recently when a close friend experienced chest discomfort after exerting herself in the gym and ignoring the symptoms. After this recurred over several days she decided to find out what was happening. She called the doctor who immediately sent her to the hospital after hearing the symptoms. She was admitted to the hospital and needed a stent put into an artery.
I have learned from this experience that many women do not know the signs of angina or a heart attack and often ignore them thinking that it is stress related or indigestion. Heart attacks are the number one killer of women with strokes the number three killer according the American Heart Association.
Angina is a warning sign of heart disease, and recognizing it and getting treated early may prevent a heart attack. As heart disease progresses, you may have tightness, pressure or discomfort in your chest during physical activity or when stressed. But it goes away shortly after you stop the activity or get rid of the stress. 
Angina symptoms in women can also include feeling out of breath, nausea, vomiting, midepigastric discomfort or sharp chest pain.  Once the extra demand for blood and oxygen stops, so do the symptoms.
 
Heart Attack Signs in Women

  1. Uncomfortable pressure, squeezing, fullness or pain in the center of your chest. It lasts more than a few minutes, or goes away and comes back.
  2. Pain or discomfort in one or both arms, the back, neck, jaw or stomach.
  3. Shortness of breath with or without chest discomfort.
  4. Other signs such as breaking out in a cold sweat, nausea or lightheadedness.
  5. As with men, women’s most common heart attack symptom is chest pain or discomfort. But women are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting and back or jaw pain.

If you have any of these signs, don’t wait more than five minutes before calling for help. Call 9-1-1 and get to a hospital right away.
 
Recognizing the signs and seeking treatment is the first step. Understanding your risk factors, such as a family history, is also important to staying in tune with changes in your health. Heart disease is preventable. See your physician regularly, exercise, if you smoke: quit, eat healthy, and know your pressure, cholesterol (total, HDL, LDL, and triglycerides), and blood sugar levels..
 
(Source: American Heart Association: www.heart.org)
Other sources of Information: www.womenshealth.gov, http://www.nlm.nih.gov/medlineplus/womenshealth.html, http://www.cdc.gov/women/, www.webmd.com. You can also call the government’s Office of Women’s Health: 1-800-994-9662

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