Author Archives: Dianne Savastano

Elder Care: The Intersection of Multiple Industries

“It’s been a rough summer for me but getting better. and wow, I am so excited with the progress on my sister’s situation, so I thought I would fill you in.”

That’s how the email began that I received last week from Patty, an advisory services client in Massachusetts. She reached out last spring with grave concerns about her 75-year-old sister, Caryn, who was living independently in Pennsylvania and who was exhibiting significant short-term memory issues.

Patty was initially confounded about where to start. Following our consultation and our webinar about managing cognitive decline in June, she invited her sister to visit and they developed a plan. Along the way, Patty began to recognize the need for services from among multiple industries, described below.

Continuing Care Retirement Communities (CCRC)

“I found her a terrific continuing care community four miles from me, which she visited and loves. The staff is wonderful (our mom spent her last years there in the nursing home unit) and they have super amenities — indoor pool, gym, bowling alley, gardens, 200-seat theatre, a few dining rooms, walking trails, a nice one bedroom. I know she will thrive there.”

A continuing care retirement community offers a range of care, including independent living, assisted living, and skilled nursing care for both short-term rehabilitation and long-term care. Some also offer memory care. A great deal of emphasis is placed on planning for all contingencies, allowing residents to avoiding moving off campus as their needs change.

We have many clients living in these communities and we find that there can be significant differences among them in amenities, care quality, cost, and (most important) the criteria that determine when a transition to a different level of care is warranted.

Overall, selecting a CCRC requires matching one’s needs to the services offered and then performing due diligence to fully understand all the rules, regulations, and financial obligations involved. We suggest you involve an attorney before signing contracts, to prevent making costly mistakes.

Realty Services

“I found her a realtor that specializes in working with older adults. The realtor and I coordinated daily through listings, open houses, etc. My sister signed a purchase and sale on her condo last night!”

Over the past 15 years, we have encountered numerous real estate companies expanding their services to meet the needs of an aging population. So, while traditionally these professionals may have focused exclusively on help with buying or selling a home, today, many will also assist in preparing for the sale.

This may mean coordinating a process to update and repair property, remove contents, organize estate sales, and eventually pack and move the individual. This type of service can be invaluable when your loved one lives far away.

Legal and Financial Services

“I’m working with her attorney and her financial advisor to facilitate having her designate me as her Health Care Proxy and Power of Attorney. They are also helping me to get a handle on her finances.”

While Patty and her sister are only at the beginning of their journey (Caryn can still make decisions on her own behalf), a time will come when Patty needs to step in. With that in mind, the two of them are working to get these three essential documents in place:

  • Health Care Proxy. This grants another individual permission to make healthcare-related decisions for you in the event you can’t make them for yourself. If you are designated as Health Care Proxy, be sure to have detailed discussions with your loved one about care they may — or may not — want under various circumstances.
  • Power of Attorney. POA allows a designated person to make financial decisions for you in the event you cannot make them for yourself.
  • HIPAA Release Form. A detailed document in which specific uses and disclosures of protected health information are explained in full. When signed, it allows you to have comprehensive discussions with medical providers on behalf of your loved one.

Senior Move Companies

“I found a moving company that specializes in senior moves. We have a date in mid-September. They will pack, trash, and donate, and send a consultant to help her with pre-move advice.”

This industry has also evolved significantly over the past 15 years. Overall, our clients have described the experience as much smoother than they could have achieved on their own. Services include:

  • Developing an overall move plan
  • Organizing and sorting belongings to fit into a smaller environment, such as an apartment in a Continuing Care Retirement Community
  • Arranging for the profitable disposal of unwanted items through auction, estate sale, buy-out, consignment, donation, or a combination of the above
  • Arranging shipments and storage
  • Unpacking and setting up the new home

Final Thoughts

“It is a long and slow process and has totally consumed my life. But all the elements of getting her in a high-quality care community and managing the details of her life are happening.”

When managing cognitive decline in a loved one, we (understandably) tend to emphasize the medical aspects of the process — from evaluation, through diagnosis, and treatment.

But there are other aspects of life management that also require our time, effort, and energy. Knowing how to access the services of allied professionals who specialize in working with older adults can be enormously helpful.

Recommended Reading and Resources: Cognitive Decline

At Healthassist, we try to be as pro-active as possible to prevent crises, so we pay close attention to vision and hearing issues.

As this article explains, a growing body of evidence suggests that when older people’s brains must work harder to see, declines in language, memory, attention, and more can occur. Similarly, this article discusses hearing loss and its relationship to cognitive decline.


Another thing we pay close attention to with our older adult clients is alcohol intake. We worry about changes in cognition, falls, sleep disturbances, gastrointestinal issues and, of course, alcohol’s impact on an individual’s cardiac status.

This article summarizes research on how alcohol intake can increase the risk of a cardiac arrhythmia called atrial fibrillation in people who have a history of the condition (something we see more and more of).

Two Portals Worth Knowing About

I thoroughly enjoy mentoring young professionals. When I do, I emphasize the power of networking and suggest they identify approaches for staying in touch with fabulous people they meet along the way. This newsletter, Healthassist News, is an example of that. I send it to friends, family, and professional colleagues I have met throughout my career, and it has been incredibly valuable to me both personally and professionally. (I tease my oldest grandson, who admits he always opens it but doesn’t always read it!)

This month, I’m suggesting you read an additional newsletter to mine, one that was written by a colleague that I met through networking. Ironically, I was introduced to her by the consultant, Michael Katz, who helps me write this newsletter. A great example of the power of networking!!

Michelle Morris is a Certified Financial Planner and an Enrolled Agent licensed with the IRS, so I was intrigued by her newsletter this month which encouraged individuals to check their Social Security statements. What many people don’t know is that you can access these statements online via a portal called My Social Security.

Long time readers know that I have repeatedly encouraged you to enroll in all the Patient Portals that are relevant to your healthcare. These provide a means of both accessing important data and efficiently communicating with your physicians.

Well, there are two other portals that I encourage you to enroll in as well. My Social Security, which Michelle Morris suggested, and My Medicare. Both of these can be extremely helpful to you as you prepare to enroll in Medicare.

My Social Security

When you enroll in Medicare, you enroll via The United States Social Security Administration. The specific processes you embark on differ depending on your circumstances. Typical scenarios include the following:

  • You are turning 65 and retiring.
  • You are turning 65, plan to continue to work, but you work for an employer with fewer than 20 employees.
  • You are beyond the age of 65, never enrolled in Medicare because you remained working for an employer with more than 20 employees and had health insurance through your employer. And now you plan to retire.

Enrollment can be completed in a number of ways (online, telephone, fax, or snail mail), but however you get it done, having a My Social Security account makes everything easier. It allows you to:

  • Enroll in Medicare A and B at the same time
  • Enroll in just Medicare part B if you continued to work and had health insurance through your employer
  • Monitor the administrative processing of your account as enrollment is taking place
  • See and download the letters snail-mailed to you from Social Security long before they arrive in your mailbox.

There are two significant benefits to all of this:

#1. If your enrollment is not processed within a reasonable time (14 business days), it may indicate a snag. The portal lets you keep an eye on what’s going on, and you can call your local Social Security office to troubleshoot any issues that have arisen. Speed is critical, since being fully enrolled in Medicare Part A and Part B must be achieved before enrollments in any other Medicare products can occur.

#2. If your enrollment goes smoothly, you can embark on your additional enrollments and have everything in place, long before your target date for retirement and your full transition to Medicare.

My Medicare

Once you are fully enrolled in Medicare and have a Medicare ID number (also known as a Medicare Beneficiary Identifier) and your effective dates, you can enroll in the My Medicare portal. As with most portals, this one helps you uncover important information and complete tasks quickly. For example, you can:

  • See details of your enrollment in Medicare Parts A and B and your effective dates
  • Check enrollment (now and in the past) in other products, such as a Medicare Medigap/Supplement Plan, a Medicare Advantage Plan, and a Medicare part D Prescription Drug Plan
  • See what your Part B premium and your Income Related Monthly Adjustment Amounts (IRMAA) are, if you have an IRMAA for Part B and D
  • Pay your premiums online or set up an auto pay function (Medicare Easy Pay)
  • Review your Medicare claims and match them up with explanation of benefits documents you receive in the mail from other insurance companies
  • Download a replacement Medicare card

Summary

Like I said, I really, really like portals!

All of these, whether patient portals that give you direct connections to your physicians and related services, or the two portals described above, provide more information, convenience, and speed in completing actions as needed.

Overall, the feeling of control over healthcare and insurance systems’ administrative processes and communication is fundamental to what we teach. Please take full advantage of the electronic tools at your disposal. I promise, you will benefit!

Recommended Reading and Resources: Covid among children

There is still so much we don’t know about COVID-19. Doctors are concerned about a growing number of long-haul covid cases among children, as explained in this article.


Rules designed to enforce transparency in hospital pricing were passed but many health care systems are not following them, yet! Learn more here.


I just loved this article: “There Are Two Kinds of Happy People.

“Some of us strive for a virtuous life. Others strive for a pleasant one. We could all use a better balance.”

Which type are you?

Managing Health in the “Nifty Fifties”

My cousin Caroline just turned 50. She has been reflecting on recent experiences with the healthcare system and suggested I write about healthcare consumers in her age category.

As a woman with a career, two children approaching their early teens, a husband, parents, and in-laws with recent issues requiring hospitalization, her first thought when she noticed some physical changes of her own was, “Who has time for this?”

Fortunately, she did not ignore her symptoms and sought care from a specialist physician with whom she has had a long-standing relationship.

Your Fifties Are Not Your Thirties

In the interest of preserving her privacy, I am not going to share the specifics of Caroline’s diagnosis, other than to say that it was serious and a bit of a wake-up call for her.

Further, and since both her parents and in-laws had developed conditions that required major life-style changes, she reflected on what might evolve in her own health when she reached their age. She shared that her natural inclination to not make time for exercise and healthy eating could make a significant difference down the line regarding the development of chronic medical conditions and disability. She knew it was time to make some changes in her family’s household!

She also realized that reaching out for help was not a source of weakness, but a strength. All of us in her family care so much for her that allowing us to know what was going on and assist in any way we could was not only helpful to her, but to us, too. We could demonstrate our love AND share our expertise, taking away our feelings of helplessness. She’s not sure she would have recognized this when she was younger.

Relationships and Communication

It is so important to establish and continuously cultivate relationships with our physicians. Identifying the most efficient way to communicate in-between appointments is critical, because you never know when you might need their help.

Caroline sent an email to her physician and received an immediate response. Her physician, knowing that Caroline does not always put herself first, recognized that her reaching out meant that she was concerned. That led to an urgent appointment.

Caroline learned, however, that email is not always the preferred method of communication with a physician. Unlike email, Patient Portals are secure, provide a permanent record of communication, and allow other members of the physician team to respond quickly and appropriately in providing care.

Questions to Ask Every Time

When Caroline first described her symptoms, her doctor was quite certain about her initial diagnosis. Fortunately, Caroline and I had talked about the work of Dr. Jerome Groopmanand how, when preparing an agenda for appointments, one should always plan to ask the following three questions:

#1. What else could it be? This combats search bias and leads the physician to consider a broader range of possibilities.

#2. Is there anything that doesn’t fit? This combats confirmation bias, leading the physician to think broadly.

#3. Is it possible I have more than one problem?Individuals can have multiple, simultaneous disorders that can cause confusing symptoms.

These questions led to recommendations for diagnostic testing. Sure enough, the initial diagnosis proved to be incorrect.

What and Whom to Listen To

Although she reached out to close friends and family, Caroline initially kept the circle small and made a conscious decision to consider her own opinion first regarding proposed treatment options.

As is true on so many topics, those with whom we share our concerns bring their own experiences and opinions to the discussion. Listening to too many points of view can be overwhelming, particularly when trying to assimilate new, and sometimes anxiety-provoking, information.

Caroline recognized this and made clear and concise decisions about what she was and was not willing to do. When she was younger, the opinions of others may have led to second-guessing.

What to Read

When educating herself and preparing for her appointments, Caroline sought out websites recommended by her physician, as well as some other sites I suggested (e.g., Up-to-Date).

She stayed away from those that include advertisements and focused instead on sites that provide clinical information derived from reputable research and that contribute to the development and continuous improvement of evidenced-based clinical decision support.

Overall, this helped her to outline her specific questions and led to meaningful conversations with her healthcare team. I loved seeing how she took charge!

In-Patient Experience

Overall, Caroline’s in-patent experience was positive. She was in awe at how streamlined the processes were, something she was particularly thankful for, since the pandemic meant she had to be alone.

But there were a few encounters that did not go so well. One involved feeling very rushed by a nurse to perform a bodily function that her body just wasn’t ready for. She knows now that she could have politely pushed back and asked for a greater explanation and more time.

Second, she unexpectedly had to go home, requiring her to perform a function that is usually done in a hospital by trained nurses. Here, the education and support were not the best and again, in hindsight, she realized she could have been more assertive.

Listening to Your Body

Lastly, Caroline acknowledged that her body is not as strong as it was when she was in her thirties; recovery would take longer. Even though slowing down was not something that came naturally to her, she listened to the advice of her physician and gave herself the time necessary to gradually improve, adding lots of stretching into her daily routine as well (and catching up on lots of Cobra Kaiepisodes along the way!).

Giving yourself time to heal is something I coach people about all the time — especially following a surgery that requires general anesthesia. It sounds so simple, but listening to our bodies is not easy for many of us (myself included).

Summary

I was so grateful that Caroline agreed to be interviewed for this newsletter. She shared that a conversation we had early on in her journey helped her tremendously, and she is now relaying it to others. Here is what she said.

“Acknowledge the anxiety you feel with a new medical diagnosis. Figure out what you can get answers to and work on getting those answers. Recognize that while there are unknowns, if you can learn five or six things out of ten, you have more control than you think. The rest of the answers will come in time.”