Look for a family practitioner or general practice physician to be the primary care physician for your loved one. General and family practitioners are trained to treat all aspects of a person’s health and well-being even though they have not specialized in a specific field. They treat the elderly as well as newborns, children and adults for everything from a splinter to a more serious illness.

Health Insurance Coverage

Choosing a doctor can be based upon several factors. One of the first aspects to look at is whether or not the patient’s health coverage is accepted by the physician being considered.  Most physicians will accept Medicare but it’s important to determine whether or not they will accept Medicaid and/or the supplemental policy if one is available.  If the doctor will accept the health coverage, the next thing to look at is accessibility.

Location and Accessibility

It is important to choose a doctor whose office is located close enough to be easily accessed for routine care and emergencies. If the elderly loved one is homebound, a physician who understands this and is willing to work around this detail to provide care is ideal.

Physicians can order home health nurses to draw blood, administer injections, take vitals signs and other basic medical procedures then report to the doctor. These procedures would normally be done at the doctor’s office, but when dealing with a homebound patient, getting them into the office may be a problem.

In addition, when transporting an elderly homebound loved one, distance to the doctor’s office can play a part in the convenience of the location. Determine if the time spent driving and the distance to and from a doctor’s office makes the doctor in question an acceptable choice for your loved one’s needs. If the doctor requires that your loved one must been seen at the office frequently, then distance can be an important factor when choosing the physician.

Office Hours

When choosing a doctor there are a few important questions about the doctor’s schedule that you should ask. What kind of office hours does the doctor hold? Do they have evening or weekend hours? How can you get in touch with them when the office is closed? Are the physicians who cover the “on-call” hours acceptible to you?

Hospital Choices

Most doctors have privileges at specific hospitals. When choosing a doctor, it is important to find out which hospital or hospitals the doctor has privileges at. This is the same hospital the patient would go to for emergency care, tests and surgeries in most cases. The size, location and reputation of the hospital may play a large role in your decision to choose or not choose a specific doctor.  Some towns and cities have specialty hospitals for certain conditions.  If your loved one has a condition that is treated by one of these specialty hospitals, it is important to determine if the primary physician has priviledges there.

Personality

Even the most qualified and credentialed doctor may not be the best choice for your loved one’s personal physician if their personality clashes with yours. You’ll probably want to choose a doctor that you genuinely like and feel comfortable with. Remember that you will need to be working closely with this person to advocate for the best health care for your loved one.  Imagine my surprise when I asked my father’s physician if he might be discharged in the afternoon only to hear him say “What part of HE WILL BE DISCHARGED TOMORROW MORNING did you not understand?”  However, there are also surgeons that I have worked with in the past who had terrible bed-side manners yet they are the ones with whom I would have trusted my life.

Choose a doctor who will take the time to speak with you as you advocate for your loved one’s health care. The doctor should be willing to listen to your concerns and answer your questions to your satisfaction. Remember, you are hiring them and paying them for their time.  The days of the primadonna physician OUGHT to be over.

Another consideration is the physician’s staff.

Do you like the physician’s staff? Are the doctor’s employees personable, respectful and pleasant? If you find receptionists, nurses and other staff members to be rude, then perhaps you should consider other physicians. These are the people you will be working with to schedule appointments, update prescriptions and access patient information. If you find them difficult to work with initially, it might improve over time but don’t expect it to automatically occur.

Ask the doctor if they have a Family Nurse Practitioner or a Physician’s Assistant in practice with them. These medical professionals assist doctors in caring for patients in many private practices. Decide if this is acceptable to you for your loved one’s care. If not, then you may need to continue looking or specify in the patient records that care must be provided by the doctor.  Keep in mind though that Nurse Practitioners and Physician’s Assistants generally have more time to spend with the patient and are trained to be patient advocates.  They are also often more accessible.

Making the Choice

After taking all of these factors into consideration, decide which physician you would like to care for your loved one. Schedule a new patient appointment and commit to making the new relationship work.

It wasn’t until I began looking at them as a means of respite care placement for my father that I learned of their costs.  In my father’s case, the daily respite cost was $220 but the monthly cost would have been over $5000.00 for a semi-private room.  This rate did not include medications or transportation to medical appointments. (Rates seem to vary between $4000.00 and $7500.00 per month depending upon the residence.)   None of these facilities accepted Medi-Care and private insurances don’t cover such things.  A couple of them stated that if a person were 2 guarantee private payment for 3 years, then they would not “evict” the resident once their money was gone.  At that time, they would then accept Medicaid reimbursement. 

Recently I have read several articles about assisted living facilities being available mostly in areas of higher income.  In areas of lower income, rural areas and in areas where minorities live (and all 3 of these are equivalent to areas of lower mean income), there are less available assisted living facilities.

In a study at Brown University, a conclusion was made that hispanics would be more likely to use nursing homes than assisted living facilities because they at more likely to be at the lower end of the socio economic scale and did not have the money.  Because of lack of money, they were more likely to be placed in nursing homes with less than desirable facilities, receiving less than adequate care which sent them back to the hospital and began a downward spiral.

I think that another reason that there are fewer assisted living facilities in areas where hispanics live is that their culture has the tradition of elder care being handled by the adult children of the family in a home setting.  My best friend’s mother took care of both her mother and aunt in her home until she was physically unable to do so anymore.

Assisted living facilities vary tremendously; they can contain a myriad of amenities and consist of private apartments with a nurse on duty 24 hours a day or at the other end of the spectrum, they can be closer to a nursing home environment with semi-private areas that consist of 2 beds in a room with a television set.

Assisted living homes are not the right choice for everyone.  Unless a facility has a special unit  (and many are opting to include these), dementia patients should not be placed there.  Sometimes patients have medical conditions that are too complicated for this type of living arrangement, as well.

Nursing homes don’t have much variation.  In MY words, they are simply sad places where lonely people live out their final days. 

In between, there are skilled nursing facilities, but in most instances, these are temporary placements until the “patient” can either be returned home or to a more permanent placement in a different facility.

I’m concerned about what will happen when the aging population runs out of money to pay for these expensive assisted living homes.  At between $ 50,000 and $90,000 per year, who will be able to live there long?  Our elders were a little more prepared but I don’t believe that the baby boomer generation has prepared themselves well enough to be able to cover even a year of living there.  And now that many boomers are upside down on their mortgages, selling their home won’t help to pay for that care.  Not many of us have long term care insurance either. (And in reality, how can long term care insurance continue to exist when almost ALL of us will need it at some point?)

I also think that with health reform, more families are going to be responsible for the care of their elders.  Hospitals will discharge elder patients sooner and before they are able to care for themselves.  This is happening even now !  I literally had to beg that my father be admitted to help remove the 12 pounds of fluid that had accumulated in his legs due to congestive heart failure.  Sure…..they’ll put a defibrillator in an 86 year old man with dementia (because insurance will pay for THAT)  but when it comes to managing the care of that man post procedure, they’ll leave it to the family.   (And they won’t discuss end-of-life care…but that’s a whole other issue.)

Already, a big portion (17% of employees in south Florida, according to a recent study)* are having to leave the work force in order to care for their aging loved ones and another 15% have cut their hours. 

During the past year, as we have experienced a financial crisis, more family members are gathering together under one roof in order to make ends meet.  Do you think that we will return to the days of Leave it to Beaver and Father Knows Best where Moms become the caregivers for the family while Dads return to providing the financial contribution?

This may not sound like it’s related to caregiving at all, but indirectly, it is.  My father was a coffee drinker.  He probably went through about 2 pots a day up until his last year. He decreased his coffee intake due to “bathroom issues”.  I, on the other hand, will drink one cup, maybe one and a half cups per day (and I’m told I make weak coffee).  After my father died, it seemed wasteful to brew even half a pot of coffee when I would never finish it………..especially when it was Starbuck’s whole bean coffee that I brewed in the Grind-and-Brew system.

So when my kids asked me what I wanted for my birthday this year, I suggested the Keurig coffee system; you know, the one that comes with little pods of coffee ( Keurig’s are called K-Cups)  that brew one cup at a time AND in less than one minute!  There are a choice of coffees – for instance, Tully’s, Gloria Jeans, Newman’s Own, and several others.  There are also K-Cups of various teas and hot chocolate mixes.  I was SO excited !  THIS would be a great way not to waste money!  Or so I thought.

I was even more excited when I found a Keurig “commercial model” at the Food show.  The commercial had more stainless steel, I was told, and would “last longer”.  It was also less expensive that day (show special) and came with a display rack.  YES! I called my daughter and asked if I could go ahead and order it. 

But then it arrived and I tried my first cup.  YIKES…way too strong.  But fear not, it has a choice of brewing sizes so I then tried the 10 oz size thinking “more water/less strength”.  NO, not the case………it was still very strong.  My next attempt at coffee making was to brew a cup of coffee, dump half of it out, brew a cup of plain water, dump half of THAT out and mix the two together.  Ok, so now I’m using 2 cups and it takes 2 minutes to make coffee and I’m still not liking the taste of ANY of the coffees that came with it.  That’s okay; I’ll just go buy the Starbuck’s K-Cups.  Guess what?  They don’t MAKE Starbuck’s K-Cups.  UGH!

They do, however; make a little adapter K-Cup where you can add your own coffee and still make one cup at a time.  So things are looking up again. Another trip to the store for the adapter (at $14.95) and a pound of pre-ground Starbuck’s (pre-ground is not my fav; I prefer to grind my own beans, but the bean grinder would be another expense).  (And yes, I really do like Starbuck’s.) 

The next morning, I wake up excited for a cup of  ”not too strong” Starbuck’s, place the coffee into the adapter, place it into the machine and …………the lid won’t close !  OK, what did I do wrong?  I re-read the directions and can’t find the answer.  I rearrange everything and try it again………still, no go.  Grrrrrr

There’s a phone support number on the K-Cup adapter so I called and spoke to a nice lady who attempted to be helpful.  We went through the K-Cup adapter procedure and affirmed that it should work.  As an after-thought, she asked “what model coffee brewer do you own”.  When I told her, she said “Oooh, that’s why.  They don’t make K-Cup adapters for the commercial model”.  WHAT???? 

OK, as I’m getting ready to pack the whole thing up and sell it on eBay, she asks “what specifically did you not like about the K-Cup coffees that you’ve tried”?  When I told her that it was the strength of the coffee I didn’t like and which ones I tried,  she suggested some different K-Cup coffees that I could try for a “milder” cup of coffee. 

With renewed hope, BACK to the store I went……….but of course, they don’t carry the milder choices at the store; they’re available on-line though at Keurig.com.  Yesterday I ordered the “milder” choices on-line.  The on-line prices are more expensive and of course, they weren’t having a sale, but thankfully shipping was free with a “code”. 

While I wait for the (hopefully) “more to my taste” K-Cups of coffee, I have almost perfected my morning cup of coffee by following these steps: Brew a cup of coffee; dump one-third of it out; microwave 1/2 cup milk with an added  dash of vanilla caramel creamer to it; Combine the two.  It now takes 4 minutes to make the one-minute cup of coffee (PLUS an additional amount of time to pry open the K-Cup and place the grounds in the compost container).

Let me summarize for you the cost of “not wanting to waste money by brewing a whole pot of coffee with my former Grind and Brew system”: Keurig coffee system- $169.00; K-Cup adapter (that cannot be used) – $14.95; “milder” K-Cups purchased on-line-$68.00 for 72 cups of coffee !  Additional plastic empty K-Cups added to land-fill………..NOT priceless.

Now that I’ve written this out on “paper”, I think I’ll go back to my Grind and Brew.

Ask the Nurse is a new feature that we are offering in order to answer specific questions that you might have.  If you have any questions related to caregiving or certain illnesses, I’d be more than happy to address them.  If I don’t know the answer, I will find it.

I do not take your trust in me for granted. I try very hard to provide you with information that will benefit you as a caregiver and uplift your spirits with inspiration along the journey.

Send your questions to eldercaresupport@gmail.com.  I will  make every effort to answer within 2 days and will post the answers here.  The question will be posted but for your privacy, your name will not be.

As always, please know that this section is  for educational purposes only and that “Ask the Nurse” and The Eldercare Support Group are for informational and educational purposes only and should not be construed as medical advice, diagnosis or treatment.  Neither can we provide legal or financial advise. While our goal is to provide you with useful information and resources, we would caution you that for your own safety, you should always seek the advice of a licensed professional in your area of need.

While we can’t often change our care recipient’s situation, there are things we can do to help manage our own stress.  Certainly exercise, taking time for one’s own needs, and meditation are good stress reducers.  But concentrating on our nutritional intake is also a necessity in order to keep our stress level down.

Should these solo caregivers continue to suffer in silence and bear the burden of caregiving alone? Or should they confront their siblings about the lack of caregiving help that they are volunteering to provide to help care for an aging parent?  And how does it happen that the responsbility of caregiving often falls to just one individual?

Because you are already on the internet reading this, I’m going to make the assumption that you have access to the internet at some point during your week and will be able to visit some of the websites that I recommend, as they pertain to you.
 
First of all, let’s talk about food and meal preparation.  Planning your meals according to what is on sale that week can save you money. Always read the food ads that are found in the weekly newspaper and as you notice what is on sale, jot down recipe names that contain that product. Often coupons found in the paper correspond to what is on sale in the stores so utilize them to obtain additional savings. I have a friend who buys 3 Sunday papers each week just so she can clip the coupons. USE coupons.
 
Also, visit that store’s website to see if they have any additional coupons that can be printed out.  For instance, http://www.albertsons.com has online specials, weekly recipes and in-store coupons listed on their website this week.
 
There are other sites on the web that have valuable coupons. One such site is http://www.smartsource.com which offers various coupons in printable format.  I have also used http://www.coupons.com and http://shortcuts.com (which downloads coupons onto your loyalty program card ! )  Remember to be aware of those sites that ask for TOO much personal information – they may be less than reputable. 
 
Other ways to save money at the supermarket are 1).  Sign up for their loyalty card (or points card)  2). Ask how their promotions work – for instance, when an item is listed as 10 for $10.00, is it required that you buy 10 of a particular item or can you buy less and still receive the discount ?  3). Ask whether your supermarket matches competitors prices (bring all your fliers with you, just in case they do) 4). Shop the ethic foods isle…sometimes their prices are less than on the other isles 5.) Stock up on items that you can freeze or store and/or keep “rain-checks” for a rainy day 6). Remember that buying the bigger package of an item may not always be the best deal – most items have a cost per ounce rate listed below them on the shelves and lastly 7). Watch the cash register to make sure that you are getting the correct prices – after you’ve done all that hard work to save money, it would be a shame not to receive the savings.
 
Three websites that are worth keeping an eye on for savings of all types are: http://www.BradsDeals.com – he has everything from restaraunt savings to electronics to shoe savings listed; http://www.couponmommie.blogspot.com – she saves a LOT of money on groceries (approximately 70%); and http://www.savingthefamilymoney.com
 
Free samples are often offered on the web too !  A couple of sites of interest are: http://www.freeflys.com, http://www.startsampling.com and http://www.instoresnow.walmart.com/In-Stores-Now-free-samples.aspx  – the Walmart samples usually need to be picked up in the store.
 
And here’s a cool offer : at http://www.artscow.com when you sign up, you can get 1200 free photo prints (600 4X6s and 600 5X7s ). I have heard that the quality is good so get those those digital prints off your computer and onto some paper.  This week, new members can also get a 20 page 8X8 photo book for $6.99 with FREE shipping.
 
Other on-line photo centers can be found at http://www.snapfish.com and also through Rite-Aid and Costco’s sites.
 
Speaking of Rite-Aid, they have a good rebate plan which utilizes their website to plug in the cash register receipt numbers, item #s and dates of qualifying rebate items. Rebates will then be sent to your home.  http://www.couponmom.com is a great site for not only grocery coupons, but drug store items, as well.

Share the resources you have found for saving money in our Caregiver’s Forum.