Say your mother or father is in the hospital for a few days and needs to be moved to a skilled nursing facility for recovery.  While you’re at the hospital, a very important question to ask is whether they are considered to be an inpatient or outpatient.

If they were brought to the hospital on an observation status, even though they are receiving medications, meals and tests, they may be considered outpatients, if they are listed as such in their doctor’s paperwork.

Key points to remember:

• Any days you spend in the hospital as an outpatient (before the doctor writes the order for you to be admitted) aren’t counted as inpatient days.
• An inpatient stay begins on the day you’re formally admitted to the hospital with a doctor’s order. That’s your first inpatient day. The day of discharge doesn’t count as an inpatient day.
• Medicare will only cover care you get in a Skilled Nursing Facility (Rehabilitation facility) if you first have a “qualifying hospital stay.”
• A qualifying hospital stay means you’ve been a hospital inpatientfor at least 3 days in a row (counting the day you were admitted as an inpatient, but not counting the day of your discharge).
• If you need help understanding your hospital status, speak to your doctor or someone from the hospital’s utilization or discharge planning department.

Click here for a helpful brochure from Medicare that explains this distinction in detail and gives examples of some common occurrences:

Also go to this link for additional information Ask Medicare:

Here’s a book about quality end-of-life care: The Best Care Possible – A Physician’s Quest to Transform Care through the End of Life.

Dr. Byock, professor at Dartmouth Medical School and a passionate advocate for quality end-of-life care, argues that the way Americans die is among the biggest national crises facing us today. Yet in our response, politics has trumped reason and commonsense. In this groundbreaking book, Dr. Byock describes what palliative care really is, and takes us inside his leading-edge academic medical center and the lives of his patients to show what the best care through the end of life can look like, how doctors and nurses can profoundly shape the way patients and families experience illness, and how–ultimately–palliative care can save healthcare.

This book will be coming out March 15th.

I’m so happy when I hear an older person tell me about e-mailing their children, or going on Facebook to see what’s new with their grandkids!

The old saying that you’re never too old to learn is certainly true.  But it’s also true that learning how to use the internet and computers in general is not only good to keep your mind sharp, but it also helps to stay in touch with one another.

Encourage the older adults in your life to surf the net! If they’re reluctant to try, you might want to give them the following links for free computer classes.  Remind them that no one was born knowing how to use a computer, it just takes some time… like learning how to drive a car!

More and more seniors are using the internet to get health and prescription information, but there are so many opportunities for learning at websites such as:

• http://u.about.com – offers a collection of free online courses in everything from history, gardening, learning a new language, religion, sports, hobbies, etc.  Each online course is sent to you via email on a daily or weekly basis and is designed to help you learn a new specific skills or solve a particular problem.  There are no grades, only a whole lot of free online learning.

• 200 Free Online Classes to learn anything – an online education database.

• Goodwill Community Foundation – free online classes for computers, digital photography, iPad basics, reading, math, internet basics
• Jan’s Computer Literary 101 - computer lessons – free for personal use.
• Meganga – free Beginner lessons

Have fun!

This is an excerpt from an article in the Alzheimer’s Reading Room.  It’s the Valentine’s Day reflections  of  a 68 yr old woman whose husband has Alzheimers and who now lives in a residence.   It’s also about the support she gives and receives from her  twin sister whose husband has dementia.   It’s about gratitude and love for all the people who stand by and help her as she goes through this journey.

“The best Valentine message I can give is tell my husband, my sister, my brothers, my children and others who I love  – who are helping me through this journey and who care – is that I am so grateful for your love. ”

Click on the link for full article, Valentine’s Day is a Time to Thank Others.

Happy Valentine’s Day!

Here is an excerpt from Mayo Clinic’s Caregiver Newsletter with some great tips and ideas that I think you’ll find helpful.

From considering underlying reasons why mealtime might be difficult to giving concrete ideas such as:

• using white dishes
• large-handled utensils
• offering foods one at a time

See complete article Alzheimer’s – Making meals easier here.

Here’s an excerpt from an article Nine Suggestionss to Get You Through Winter (click for entire article) on the ARR website.  (Alzheimer’s Reading Room) Lots of useful ideas to fight the winter blues & good tips for you and the person you are caring for.

“The whole point is to bear in mind that living our lives as fully as possible requires us to venture outside now and then, even if it’s winter. I’m convinced that this is as true for Mom as I know it is for me.

Here are examples of some of the kinds of excursions we do that take us beyond our four walls.

Chances are good you’ve got similar opportunities and places near where you live – probably more than we do in this small city. With these possibilities in my bag of tricks, I can always find one that that allows my mom to have some moments of enjoyment or contentment while we both wait for the first signs of spring. ”

• Nurseries and Greenhouses
• Museums
• etc.

Also see our previous article: Coping with the Emotional Challenges of Winter

“An initial bone mass measurement is seriously underused…..”  Seriously?  Even though breaking a hip can have life altering affects on seniors?

A recent article in the The NY Times by Paula Span,  describes this serious flaw in our medical system.  Here are some of the key points she makes:

• Doctors often overlook the test because there are no symptoms… until a bone break
• Fractures from osteoporosis can mean long term disability
• 20% risk dying within a year of breaking a hip

By knowing if you are at risk for osteoporosis, there are steps to be taken to prevent fractures.  See article Older Women and Bone Tests and share it with your senior family members and friends so they can ask their doctors about it.

Also see our previous article: Making the most of your Doctor’s Appointment

Just like changing the batteries in our smoke detectors every year, don’t forget to update your beneficiaries regularly.

Why you Need to Update Your Beneficiaries

Do you remember the last time you reviewed the beneficiaries for your retirement plan ( IRA, ESOP), life insurance, etc.? It it seems like a faint memory, it’s probably a good time to review them to help ensure your wishes will be fulfilled.

By law, the beneficiaries you designate for an account will receive the assets in these accounts at your death.  Your will or trust can’t override account beneciaries. That’s why it’s important to review and update the beneficiary designations on all your accounts regularly and particularly when you have a major change in your life such as a marriage, divorce, birth of a child, or death in the family.

Unless you update your beneficiaries over time, your assets could be inherited by someone you no intend to receive them.

Don’t Forget to Name Contingent Beneficiaries

Contingent Beneficiaries will receive your assets if the primary beneficiaries predecease you, you it’s important to review them as well.

Naming Minors as Beneficiaries

Be careful when naming a minor child or grandchild as your beneficiary unless they’ve reached the “age of majority” or they may not be eligible to own assets. If you wish to leave assets to a minor, appoint a guardian in your will to oversee these accounts until the child is no longer a minor.

Source: courtesy of Edward Jones

If you can’t find a beneficiary form, or if you want to change your beneficiary, contact your insurance company, your employer, or the financial institution that administers your retirement plan. After you’ve updated your beneficiaries, keep a copy of each beneficiary form with your other insurance, annuity and retirement papers.  And be sure someone other than yourself knows where the copies are located.

Share this with your friends and relatives!

If you have a loved one in a nursing home and are concerned about quality of care, you should be aware of a good resource: Your local Ombudsman.

Long-term care ombudsmen are advocates for residents of nursing homes, board and care homes and assisted living facilities.  Under the federal Older Americans Act, every state is required to have an Ombudsman Program that addresses complaints and advocates for improvements in the long-term care system.

The ombudsman program is administered by the Administration on Aging (AoA).

Ombudsmen are dedicated to enhancing the lives of long term care residents.  They mediate:

• Violation of residents’ rights or dignity

• Physical, verbal or mental abuse

• Withholding of services or unreasonable confinement

• Poor quality of care

• Improper transfer or discharge of patient

• Inappropriate use of chemical or physical restraints

The program, funded by federal and state dollars.  To locate the ombudsman in your area, go to www.ltcombudsman.org.

I just read a very interesting article and I wanted to share it with you.  I’ll paraphrase the key points here:

It was about the work that Dr. Dr. Stephen Thielke and his colleagues are doing to dispel myths and stereotypes about pain and aging. Among them are the notions that: pain is a natural part of getting older, that pain inevitably gets worse once it is present, that people who tough it out become accustomed to pain, and that pain medications are highly addictive.  While it all sounds innocuous, this conventional wisdom limits the choice of treatment and the care that older adults receive and ultimately sets boundaries on their quality of life.

But their initial research shows that:

• Pain doesn’t occur more often in older adults
• That pain is more transitory than we think
• That toughing it out is not the best approach
• That the medications used to treat pain are not highly addictive in general.

The bottom line is that patients shouldn’t give up.  They should work with their providers to identify what works best for them, and that can mean physical activity in addition to pills.

Complete article Aging Doesn’t Have to Be a Pain on The John A. Hartford Foundation blog.