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ElderCare 101: Basic Doctor Tricks for Dealing with the Healthcare System

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by Stella Fitzgibbons, MD

“You don’t mind helping Mom, do you? The rest of us are so busy with kids and in-laws…”

This classic pattern of the unmarried son or daughter looking after a widowed or ailing parent probably falls unfairly on LGBT adults. While you’re getting used to that idea, let me offer some doctor’s-eye tips to help with some of your parents’ healthcare issues.

Paperwork First
You’ve found an attorney to help Dad with the will and some of his tax issues, but the job isn’t done yet. A Medical Power of Attorney and an Advance Directive are two essential documents that will let you avoid a lot of arguments and misery later on. Discussing a Living Will with Dad lets him clear up questions that the doctor may not ask until it’s too late—like whether to put him on a ventilator when his breathing gets bad, or how he feels about hospice care.

I hope that your relatives are not the kind who second-guess all of your decisions, or who never visit until they swoop in from another state to demand that you do things differently. Even if they are, however, your parents’ legal documents will at least prevent them from doing much more than arguing with you.

Insurance: It’s Not Just Medicare Anymore
Medicare is available for U.S. residents over 65; the medicare.gov website will answer most of your questions about qualifying, application forms, and ways to get prescription coverage. But even with Part D for prescriptions, somebody with several medical problems can outspend their coverage pretty fast. And every year the Medicare paperwork gets more complicated, and the regulations more restrictive.

A number of managed-care companies offer “Medicare Advantage” plans to Medicare beneficiaries. The plus side is less paperwork and more coverage of non-hospital care; negatives include a limited panel of doctors, copayments for hospital services, and cost-control measures like requiring second opinions for expensive procedures.

This is complicated, but worth a thorough study (again at medicare.gov) since Mom or Dad may save a fair bit by choosing one of these plans. If the restrictions are unacceptable (“I’m not going to some strange doctor”), or if Mom’s newest diagnosis throws off all of your calculations, many of these “Advantage” plans can be changed back to regular Medicare. Make sure you know how and when you can change policies before signing up.

The Drug Problem
Whether it’s “just my lumbago” or heart problems and kidney failure, the number of pills a person takes tends to increase with age. The need to keep a current list of prescription and non-prescription meds is pretty obvious, as is having the doctor review it often. But also note how much each of them costs, and take a critical look at the big-ticket ones.

There are few prescription drugs on the market that can’t be safely prescribed in generic form. If a medicine is only made by one company, odds are it is not the only drug in its class, but simply the newest; an older alternative may be just as effective and will have been tested on more patients.

If a prescription drug is advertised on TV, it is likely to cost at least $150 for a month’s supply. But the vast majority have less expensive alternatives—some are available for $4 a month at Wal-Mart or another chain-store pharmacy.

Also beware of paying big bucks for convenience. Combination pills offer no medical advantage over taking two medications separately. Once-a-day antibiotics like Zithromax and Levaquin sound swell until you realize you could spend up to $200—compared with $4 for the twice-a-day alternative.

Doctors may want to try a different blood pressure pill so a patient doesn’t skip doses to save money. There are dozens of choices for treating common conditions, so finding another medicine is rarely hard.

“He Can Leave the Hospital, But…”
The hospital doctors have pinned the hip fracture, treated the pneumonia, or opened up a couple of arteries. But major surgery or a week of bed rest can convert somebody who occasionally had trouble with stairs into someone who needs serious therapy before going home. Don’t just talk to the doctor—ask the nurses about who is helping with the discharge plan.

Hospital case managers are nurses and/or social workers who are expert in arranging post-hospital care and getting insurance to pay for it. They can tell you if Mom needs aggressive rehab (three hours a day of physical therapy), a long-term acute care hospital (which can do most of what a hospital does), or a skilled nursing facility offering less-intensive physical or other therapy.

Case managers don’t just try to push Mom or Dad out of the hospital; they want to make sure that the care given is right for the situation. Hospitals cannot provide some of the services offered in rehab facilities, which also offer a far less stressful environment. Visit the places the case manager suggests, compare their ratings at medicare.gov, and make the best choice you can.

“Grant Me the Serenity…”
Yes, you will make mistakes and kick yourself for them, but some of your plans will work out better than you expected. There is a ton of support out there, from healthcare professionals to neighbors, Facebook friends, and even that pastor whose sermons you never liked. Reviewing things with somebody outside the family will reassure you that things are nowhere near as bad as Aunt Sarah says they are.

If you weren’t a good son or daughter, you wouldn’t even be trying to help your elderly parents in their time of need. Reward yourself once in a while, because I guarantee that you deserve it.

Stella Fitzgibbons, MD, has practiced medicine in Houston since 1981, both in primary care and in hospitals. Her interest in LGBT issues started with a gay brother and continued through the years since HIV appeared.

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