Seniors Saved Money on Prescription Drugs in 2011
As reported in today’s Los Angeles Times, the Department of Health and Human Services has announced that 3.6 million people in the Medicare program saved $2.1 billion on prescription drugs in 2011. This is the result of both enhanced use of generic drugs and the closing of the Medicare Part D “donut hole,” which is one of the few aspects of the Affordable Care Act that went into effect before 2014. Assuming the law is allowed to stand, the savings will continue to increase, as the payment gap diminishes each year before closing entirely in 2014.
Medicare coverage for pharmaceuticals under Part D (including the “donut hole”) was originally created under President George W. Bush.
Source/more: Los Angeles Times
Medication Misuse
I attended an inservice at Home Instead Senior Care in Phoenix on medication misuse presented by staff from the Area Agency on Aging. They have received a grant to provide community outreach and education about this public health issue. We learned that 50% of elders misuse medications and ER visits are up because of related falls or accidental poisonings. These statistics resonated for me as I thought of one of our clients in particular. There are many reasons for medication misuse – some intentional, some not – and I realized that she had fallen victim to several factors that have led to numerous falls and a recent ER visit.
First of all, she lives alone. She also takes many medications given by different doctors who don’t communicate with each other. She doesn’t completely understand what each medication is for or whether there are drug interactions she should be aware of. In addition, she doesn’t always have the money to pay for her medications, so she sometimes skips doses. This leads to inconsistency in drug effectiveness.
What she does right, though, is to keep a list of current medications handy, she doesn’t mix alcohol with her medications and she never shares medications with anyone else. But there’s more she can do, and more that I, as her elder care coordinator, can do to help enhance her safety and avoid more trips to the ER.
Some solutions offered in the inservice include: (1) Know your medications – what condition are they treating, what are the potential side effects and possible drug interactions. (2) Take all medications only as prescribed. (3) For my client who keeps an accurate listing of all current medications – make sure that all treating physicians have that list, so they can be on the lookout for drug interactions. (4) Ask health care professionals if there are programs to help pay for medications if you don’t have health insurance. For additional information, contact www.aaaphx.org.
Preventative Care….for your loved ones
Yesterday, I attended the funeral of one of my weight-lifting friends, who had suddenly died of heart failure while sitting at the breakfast table. This gentleman, only a year older than I, was a PhD Physical Therapist, and the go-to person on our team for any strains or injuries we thought we had incurred during a training session. He was also a loving husband and father who cared for his wife and their children during both of his wife’s bouts with cancer.
But like the cobbler’s children who have no shoes, my friend never bothered to get checked out himself – in fact, it had been more than six years since he visited the doctor. My friend had put on some weight over the years, and he enjoyed an occasional cocktail – did he stay away from the doctor because he didn’t want to be scolded for these lifestyle choices? Was he afraid to get a definitive answer about something he suspected? Or, as a partner in a busy practice with multiple family obligations, was it just something that continually moved to the bottom of a long to-do list? Unfortunately, we will never know.
What we do know is that the choice to stay away from the doctor not only affected my friend, but also his family, his business partners, his patients and all of us who care about him.
As part of the Affordable Care Act, both Medicare and private health insurers are required to provide many preventative services, including an annual physical and screening mammograms and colonoscopies, at no cost to the patient. The purpose of this law is to give you the opportunity to learn whether you have a potentially dangerous health condition when it can still be effectively treated. It can also prevent a much deeper pain for those who can’t imagine going forward without you.
Understanding Advance Directives
As readers of this blog know, I strongly encourage my clients, groups that I have the opportunity to speak with, and my friends and family to prepare advance directives so that they can make their own decisions about what medical care they do, or do not, want to if they are unable to communicate that decision.
I recently received this article by Dr. Nathan Laufner, President of the Maricopa County Medical Association. Dr. Laufner cautions that Living Wills and Do Not Resuscitate (“DNR”) Orders are frequently misunderstood, both by the individual and the medical personnel who need to rely on it. For example, the individual may have one thing in mind when he says that he does not want treatment if he has a terminal illness, but his doctor may interpret that differently. (See Dr. Laufner’s article at http://www.mcmsonline.com/president/nathan-laufer-md/do-not-resuscitate-orders-lets-prolong-life-not-prolong-death.)
Living Wills and DNR Forms do raise complex and often confusing issues. As Dr. Laufner points out, the hospital personnel who give these forms to patients as they are being admitted may not be equipped to answer the patient’s questions, not to mention the impact of all of the emotions that person may be feeling at that time. This is why I recommend that these forms be completed in advance of any particular illness or hospitalization, when a person has time to think about what they want and confer, sometimes more than once, with family members and loved ones.
Dr. Laufner also says that, when patients hand doctors Advance Directives that they have completed previously, they often don’t understand what they mean. While “self-service” forms, available from many private organizations or state attorneys general, are certainly better than nothing, Dr. Laufner’s observation highlights the importance of working with an elder law or estate planning attorney when preparing these forms. The attorney will take the time required to explain the meaning of the various options, and is the advocate for the individual, not his family or his health care providers, who, while well-meaning, may have different perspectives and interests.
Taking Care of those who Care for our Parents
Innovations in Dementia Care
Providing meaningful stimulation to an elder with Alzheimer’s disease can be challenging even for the most experienced caregiver. At times we can be at a loss with how to relate, communicate, connect. Having been in the field many years as a geriatric social worker, I’ve long been aware of the benefits of music, pets and baby dolls to evoke memories, verbalization and connection even in people with severe dementia. But I had never heard of the use of ventriloquists until reading an article in the AARP Bulletin (December 2011, Vol. 52 No. 10). Ventriloquists are now being used in nursing homes and assisted living facilities. “The experience relies on attention, immediate memory and imagination to spark memories.” Alzheimer’s patients will “tell their whole life story and remember the character months later.”
Another innovative advancement helps keep safe persons with Alzheimer’s who are ambulatory and at risk of wandering and coming to harm. CTX Corp has developed shoes with a miniature GPS implanted in the heel. Caregivers set a perimeter called a “geo-fence”, that allows wearers unrestricted movement within a certain area. When they stray outside the area, a Google Maps message pops up on a computer to alert caregivers.
New innovations such as these help to ease the challenges caregivers face and can enrich the life of someone with dementia, even if only for a moment or two.
Still No Coverage for Dental Care
Healthy Boomers put off Advance Directives
Older Driver Safety Awareness Week, Dec. 6-10, 2011
According to the National Highway Traffic Safety Administration, the safest drivers are between the ages of 64 and 69 years old — they tend to wear their seat belts, and drive shorter distances less frequently. Driving is considered a right, and to many seniors it’s what keeps them independent and connected. However, normal aging is associated with many physical changes that can affect driving including slower reaction time, poor depth perception, visual and hearing deficits, decreased ability to focus and side effects from medications.
By 2030, one out of every five drivers will be over the age of 65 (www.aaa.com). Older Driver Safety Awareness Week is December 6-10. If you’ve had concerns about a loved one or a friend with regard to driving, here are some questions to help start a conversation (www.nhtsa.gov) — Are you:
- Getting lost on routes that should be familiar?
- Noticing new dents or scratches to the vehicle?
- Receiving a ticket for a driving violation?
- Experiencing a near miss or crash recently?
- Being advised to limit/stop driving due to a health reason?
- Overwhelmed by road signs and markings while driving?
- Taking any medication that might affect driving safely?
- Speeding or driving too slowly for no reason?
- Suffering of any illnesses that may affect driving skills?
In addition, AARP (www.aarp.org) teamed up with the MIT AgeLab – in conjunction with the Hartford — to produce “We need to talk.” This on-line course provides family members information on the emotional connection to driving, tips on observing driving skills in their elderly parents and how to broach the subject of diminished skills.
So, be prepared with your observations and questions, and if necessary, suggest possible transportation alternatives. AAA offers free mature driver safety programs, including assessments and expert advice on aging and driving. (www.aaa.com).
Medicare Premiums and Deductibles For 2012:Medicare Part D, Advantage Plans and Income Related Adjustment
According to the Centers for Medicare & Medicaid Services (CMS) Office of Public Affairs, 2012 will be bringing in some changes to Medicare and healthcare coverage for many Americans. Do you know if, or how, you will be affected? This is the third post in our “Medicare Premiums and Deductibles For 2012” series, which can also be found at http://www.talkeldercare.com.
Medicare Part D:
The CMS estimates the average 2012 Part D premium for basic coverage is $30. “This is slightly lower than the actual average for 2011 of $30.76,” reports the CMS. “The estimate for the average 2012 Part D premium for supplemental coverage is $8. The estimate for the average 2012 total Part D premium is $38.”
Medicare Advantage Plans:
On average, Medicare Advantage premiums will be four percent lower in 2012 than in 2011, and plans project enrollment to increase by 10 percent. Of people with Medicare, 99.7 percent continue to enjoy access to a Medicare Advantage plan, and benefits remain consistent with those offered in 2011.
Income Related Adjustment:
“As required in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, beginning in 2007 the Part B premium a beneficiary pays each month is based on his or her annual income,” reported the CMS. “Specifically, if a beneficiary’s “modified adjusted gross income” is greater than the legislated threshold amounts ($85,000 in 2012 for a beneficiary filing an individual income tax return or married and filing a separate return, and $170,000 for a beneficiary filing a joint tax return) the beneficiary is responsible for a larger portion of the estimated total cost of Part B benefit coverage.”
Affected beneficiaries must pay an income-related monthly adjustment amount in addition to the standard Part B premium. These income-related amounts were phased-in over three years, beginning in 2007. Luckily, most enrollees will not be affected by the slight premium raise in 2012 – only about four percent of current Part B enrollees are expected to be subject to these higher premium amounts.
The 2012 Part B monthly premium rates to be paid by beneficiaries who file an individual tax return (including those who are single, head of household, qualifying widow(er) with dependent child, or married filing separately who lived apart from their spouse for the entire taxable year), or who file a joint tax return are shown in the following table provided by the CMS:
| Beneficiaries who file an individual tax return with income: | Beneficiaries who file a joint tax return with income: | Part B income-related monthly adjustment amount | Total monthly Part B premium amount |
| Less than or equal to $85,000 | Less than or equal to $170,000 | $0.00 | $99.90 |
| Greater than $85,000 and less than or equal to $107,000 | Greater than $170,000 and less than or equal to $214,000 | $40.00 | $139.90 |
| Greater than $107,000 and less than or equal to $160,000 | Greater than $214,000 and less than or equal to $320,000 | $99.90 | $199.80 |
| Greater than $160,000 and less than or equal to $214,000 | Greater than $320,000 and less than or equal to $428,000 | $159.80 | $259.70 |
| Greater than $214,000 | Greater than $428,000 | $219.80 | $319.70 |
The information provided in this post is from a recent press release from the Centers for Medicare & Medicaid Services (CMS) Office of Public Affairs.
