Aging in Place: Medication Mischief Managed

Medication concerns are among the most common to cause people to consider or choose institutional care.  Failure to manage medication properly can lead to negative outcomes, disability, and loss of life.  The concerns are well justified.  Medication non-adherence (not filling prescriptions or missing dosages)  results in 10% of hospitalizations, 125,000 deaths, and costs the healthcare system up to $300 billion/year.  Consider that 1 in 5 Medicare patients are re-admitted to the hospital within 30 days after discharge – half of them because of medication non-adherence. In a study by Walgreens, researchers found that every 1% improvement in adherence saves about $50 in healthcare spending.

Technology and modern service-oriented solutions, however, increasingly offer medication management solutions.  Free apps, like Pill Reminder (iPhone) and PillsOnTime (Android) track doses to prevent non-adherence to a prescribed regime. Tracker by Medisafe (iPhone and Android), not only reminds you when it’s time for a refill but enables you to track vitals like blood pressure. Davis’ Drug Guide (iPhone) even contains detailed drug information for patients who have questions about a drug, the possible side effects, or its interactions with other medications.  Traditional retail pharmacies such as CVS, offer packaged medication helping to ensure that patients don't accidentally exclude a medicine from the regime.

For some individuals, a plastic 7-day pill container provides enough structure to enable them to manage their medications. For those who need additional help, technology-enabled containers help prevent both missing a dose or taking the wrong pill. Units are easily connected to the Internet for communication to caregivers about whether the unit was opened at the right time.

Some examples of possible solutions include:

• Tabtime Vibe Vibrating Pill Timer Reminder is a more modern version of the classic plastic pill case.  For less than $20, the Tabtime Vibe Vibrating Pill Timer Reminder has five compartments with different alarms that beep and vibrate when it’s time to take your medicine.

• PillPack (recently acquired by Amazon) delivers  packaged medication doses and has an accompanying app to track information about them. 

• Traditional retail pharmacies such as CVS offer packaged medication. 

• TabSafe is a dispenser and management system that  reminds the user, dispenses medications, alerts caregivers before a dose time is missed, and monitors adherence. TabSafe advertises that it improves medication adherence to over 96%.

• MedMinder is  an automated dispensing box that can be pre-loaded by the pharmacy.

• Guardian Angels HomeCare Medication Dispensing Management Solution (Personal Medication System) will automatically dispense medication and vitamins in accordance with your prescribed treatment program. This device is a low-cost, practical solution to ensure patients get the right dose of medications at the right time. When medicine is not taken within 30 minutes of the prescribed time, a care center is notified. A. representative will call to remind the patient to take their medicine. If the representative does not get a response from the patient, a caregiver or medical contact is then called to ensure adherence.

•  Philips Lifeline Automated Medication Dispensing Service permits a caregiver to load up to 40 days of doses which are dispensed in small cups at a cost of $59.95 per month.

The cost of these solutions are surprisingly reasonable. PillPack and MedMinder, for example, charge just the co-pay medication cost.  Regardless, there is little question that the peace of mind, security, and safety afforded these solutions are well worth the expense.

Sexual Assaults Continue to Plague Nursing Home Patients

General security risks are inherent with institutional care. One species of concern regards the safety of residents from sexual assaults.  Sexual assaults and rape continue to plague nursing homes.  A recent case in San Diego, California involved an 88-year old woman, who was sexually assaulted in a nursing home while other patients were in the room.  A DNA match led San Diego police to arrest Lusean Arline, a 48-year old the man after a DNA sample collected from the scene of the assault matched that of Arline.

Arline allegedly entered the nursing home illegally, went into the 88-year-old victim’s room, and sexually assaulted her with other patients in the room.  Screams from the victim and the other patients alerted staff to the alleged assault, but when staff responded to the room, Arline ran away, according to police.

In a second case in Dallas, Texas, police say a disabled woman was sexually assaulted by a convicted rapist who was a patient at the nursing home.  The age of the victim was not reported.  Olander Grant, 59, allegedly forced a fellow patient at Brentwood Place Nursing Home into his room, and sexually  assaulted her repeatedly.  Court records show Grant was convicted of rape in 1982 and served 25 years in prison. He remains in the Dallas County jail on an aggravated sexual assault charge.

In a third case, in Seattle, Washington, repeated sexual abuse was caught on a hidden camera. A 50-year-old woman living in an  assisted living facility complain to her family about sexual abuse.  The woman reported she was sexually assaulted by a care provider.  A family member reported the alleged assaults to local police on July 2, 2019.  After notifying police, a family member installed a hidden camera in the woman’s room. 

Tragically, from the time the assaults were reported, the victim suffered an additional four sexual assaults.  These assaults were caught on video as a result of the hidden camera.  The family promptly turned the evidence over to the police, starting the chain of events that ultimately led to formal charges and an arrest. The victim and her family say she suffered sexual abuse on multiple occasions between June 1, 2019 and July 3, 2019.

There is no more horrifying form of elder abuse.  There is no greater reason to implement a legal, financial, and social plan to age in place.  It always seems too early; until its too late.   

Aging in Place Wearables

ID 108749319 © Leowolfert | Dreamstime.com

Wearables are devices that hang around your neck, are strapped to your wrist like a watch, or are affix edin any fashion to your body or clothing.  These may collect and assemble data for a wide variety of purposes, for your own use, or the use by professionals. For those who see a wearable in a health context, they may be disappointed to learn that some doctors doesn’t seem to care or know what to do with your heart rhythm data, but you can benefit, nonetheless, from tracking your performance (exercise, heart rate), competing with yourself, and feeling the satisfaction from any improvement over time.  Simply, these devices, at a minimum can aid and encourage your efforts to live a more healthy lifestyle: 

• Wearables can measure your heart rate. Tracking heart rate is one of the most basic functions of wrist-worn wearables—and a basic element of tracking includes knowing the target (and maximum) heart rate ranges for your particular age group. The objective is to exercise to the point where your heart is beating at up to 85% of its capacity.  Seniors need to be aware that medications can impact heart rate, and for those starting out, focusing on the lower end of the range is safer.
• Wearables can track your exercise. Are you walking, running, swimming or doing an exercise that devices can detect as motion—and even count, as with steps? Whether you are exercising  to lose or maintain weight, or become or stay fit, the combination of motion and measured heart rate can be compared against goals and even recommended fitness levels. The goals can be entered into a smartphone application, such as Apple Health or Samsung Health, and the Bluetooth-synchronized device coaching feature will buzz and/or display encouragement as you move and as goals are achieved.

Wearables are often protective, safety, or security devices.  Probably the most well-known are devices that provide aid or assistance in the event of a fall.  Fall detection has been a feature of wearable Personal Emergency Response Pendants (or Medical Alerts) for the past decade. Increasingly, these devices automatically provide protection, rather relying upon the wearer to, for example,  press a button. These devices have a built-in accelerometer and gyroscope which are designed to be activated if you fall. These devices sometimes will automatically place a call to emergency services. These developments are attractive to seniors who live in retirement communities, live alone, or spend time alone such as while walking a dog or playing golf.  

Wearables can also help you findd where you’re going, ensure that you can be found by others, and can help prevent the fear and disorientation that comes with feeling lost. We are increasingly dependent on GPS location-tracking as part of mapping and directions. GPS location can be enabled in newer wearables, like Samsung’s or Apple’s. 

Some GPS wearables work independently from a smartphone or work even if the phone is turned off. A GPS-enabled device can be a lifesaver. When enabled and integrated with a service, for example, it enables responders to find your location and display that on a map. And if you lose or misplace the device, its GPS location capability can enable you to find it, similar to the Find my Phone feature.

As technology advances, wearables can provide more fundamental and necessary health information. FOR example, new wearables permit you to perform an Electrocardiogram (ECG). Checking for heart arrythmia is an even newer feature of wearables, and is included in the Apple Watch Series 4 and likely in a future Samsung Galaxy Watch Active. For individuals who are worried about abnormal heart rhythms, or AFib, which mostly affects those age 65+, these devices are useful and comforting. Experts have expressed cautious optimism, noting a high level of accuracy and ease of use.

Smartphone app integration is increasingly not required for these devices to perform capably, but integration can, nonetheless be useful.  For some wearables, the data collection from the device is collected and presented through an application on the smartphone—for example, Samsung Health or MyFitnessPal. The applications can be set up to enable you to be part of a tracking group, for example, comparing results. As with the Apple Watch (which is paired with a smartphone) or UnaliWear’s Kanega Watch (which doesn’t require a smartphone), the watch can be useful by itself—when the phone is turned off or there is no smartphone.

Emergency notifications can alert family, professional caregivers, or emergency services.  Although it may sound sensible to contact 911, those responders have complained about false alerts from accidental or incidental contacts. One firm, Fall Call Solutions, has created an app for the Apple Watch that will contact a screening call center first, as is done by MobileHelp Smart.    If you’re over 65, Apple Watch can notify emergency responders if you fall, as in a recent incident involving an 80-year-old woman.  After the product was launched, however, emergency responders expressed concerns about too many false calls.  The devices must be configured with a set of caregiving responders, which could include family, professional caregivers, or a call center.   That can be set up directly on a device or through the use of an app, like Fall Call’s Elder Check Now.

Wearables can be set up to share information with a doctor. For example, if a person has had heart trouble in the past, they may want the doctor to be informed. One of the concerns about health-related wearables is the role of the health provider. While the device can transmit information to your doctor, does the doctor even want it or know what to do with it?  Increasingly, these devices will become associated with a form of telemedicine, where the data is analyzed in real time, resulting in a doctor contacting you proactively in the event that data raises concern or suggests an emergent health event. 

Although there have been periods of pessimism about the staying power of wearables, most agree that they are here to stay—with a greater role in the future for baby boomers and beyond, whether they reside at home or in a senior living setting. Some think that baby boomers will drive market growth in 2019, with 8 million of those aged 55+ owning a smartwatch by the end of the year. One reason for a surge in adoption has been a drop in prices—some are now under $200. For the older adult, a wearable may help a person who lives alone feel safer knowing that a fall will be detected, or a useful warning will be provided, as in the case of irregular heart rhythms. 

Hearables are recent innovations designed to be more stylish than hearing aids and fit in or around the ear. Each of the functions, such as in-ear amplification, translation, fitness, predictive analytics, are available now, synchronizing activity data with a smartphone.

Smart clothing refers to any clothing item enhanced with some functionality-adding technology, including smart socks, smart shoes, active wear, and even a smart business suit.

Smart glasses may  help the legally blind actually see what’s around them.  Smart glasses can also perform just social or personal functions such as Snapchat smart glasses that can capture photos in real time and upload them to Snapchat.

Technology is providing solutions precisely at a time at which they are most needed.   

This article relies heavily upon "Can wearables help you be healthier and safer?" published on the 

Aging In Place Technology Watch, Industry Market Trends, Research & Analysis.

Medicare Part A and Part B Costs to Rise in 2020

Daily coinsurance rates for seniors in skilled nursing facilities will be rising next year. 

The Centers for Medicare & Medicaid Services on Friday announced the 2020 premiums, deductibles and coinsurance amounts for the Medicare Part A and Part B programs. 

Beneficiaries living in skilled nursing facilities will see their daily coinsurance for days 21 through 100 of extended care services during the benefit period rise from $170.50 in 2019 to $176 in 2020. 

Medicare Part B premiums will also be rising for seniors. The standard monthly premium will increase from $135.50 in 2019 to $144.60 for 2020. Annual deductibles also will increase from $185 for 2019 to $198 for 2020. 

“The increase in the Part B premiums and deductible is largely due to rising spending on physician-administered drugs. These higher costs have a ripple effect and result in higher Part B premiums and deductible,” CMS stated in a release. 

Medicare Part A covers inpatient hospital, skilled nursing facility, and some home health care services, while Part B covers physician services, outpatient hospital services, certain home health services, durable medical equipment, and certain other medical and health services not covered by Medicare Part A.

VA Caregivers Support Line

As part of National Family Caregivers Month, we want to remind everyone that  VA's Caregiver Support Line assistance is just a quick phone call away. Whether you are in need of immediate assistance or have questions about what services you may be eligible for, the caring licensed social workers who answer the support line can:

• Provide you with information about assistance available from VA;
• Help you access services;
• Connect you with the Caregiver Support Coordinator at a VA Medical Center near you, or; 
• Just listen, if that's what you need right now.

If you're just getting started with VA, calling the Caregiver Support Line at 1-855-260-3274 is a great first step to learn more about the support that is available to you.

FTC Report to Congress Details Fraud Reports from Older Consumers

The Federal Trade Commission (FTC) recently sent a report to Congress, Protecting Older Consumers 2018-2019: A Report of the Federal Trade Commission. The FTC "conducts research and analysis, publishes information about patterns and trends, and engages in coordinated efforts to protect older adults from financial loss and assist them with other consumer issues such as identity theft protection." The agency identifies "patterns and trends" and "works closely with stakeholders to learn about the top issues concerning older adults. According to the report, nearly 3.1 million consumers reported some form of financial scheme, 1.5 million reporting fraud, 444,383 reporting identity theft, and all others totaling 1.2 million. Consumers reported losing nearly $1.6 billion to fraud. About 45 percent of fraud reports filed in 2018 included consumer age information. Consumers who said they were 60 and older (older adults) filed 256,404 fraud reports with reported losses of nearly $400 million. 

Key findings from the 2018 data include:

• In 2018, older adults were still the least likely of any age group to report losing money to fraud, but their individual median dollar losses remained higher than for younger adults;
• Compared to 2017 numbers, reported median individual losses among consumers 60 and over increased, and the increase was particularly large for people 80 and over;
• Older adults were much more likely than younger consumers to report losing money on tech support scams, prize, sweepstakes and lottery scams, and family/friend impersonation;
• Phone scams were the most lucrative against older consumers in terms of aggregate losses, and online scams were a distant second;
• Gift cards became the payment of choice for scammers, but wire transfers persisted in the top spot for total dollars paid. 

There was good news in the report; the overwhelming majority of  fraud reports filed in 2018 by consumers 60 or older did not indicate any monetary loss.  Older adults filed "no-loss" reports about fraud they had spotted or encountered at nearly twice the rate of consumers ages 20-59.  Moreover, it remained true through 2018 that older adults were less likely than younger consumers (ages 20-59) to report losing any money to fraud.  This suggests that older adults may be more likely to avoid losing money when exposed to fraud, more inclined to report fraud when no loss has occurred, or a combination of these or other factors. The FTC fraud survey  found that the rates of victimization for the various categories of frauds included in the survey were generally lower for those 65 and older than for younger consumers. 

On the more bleak side of the data, older consumers who did report losing money, reported much higher individual losses. In addition, the median individual losses reported by older consumers rose significantly in 2018. In 2018, median reported losses were fairly stable for younger adults as compared to 2017, but increased for older adults. Consumers ages 80 and older reported the largest median losses of $1,700 as well as the largest increase as compared to 2017. The median dollar loss for this 80 and over age group was more than four times the median loss amount reported by consumers in their 20s and 30s and more than two to three times that of other age groups. This striking growth for people 80 and older was driven in large part by increases in reported median dollar losses on prize, sweepstakes and lottery scams, and family and friend imposter scams (often called the “grandparent scam”). For people ages 60-79, a surge in reports of losses to imposters posing as the Social Security Administration during the second half of 2018 contributed to the upward trend in median losses.

As the nation’s primary consumer protection agency, the FTC has a broad mandate to protect consumers from unfair, deceptive, or fraudulent practices in the marketplace.  It does this by, among other things, filing law enforcement actions to stop unlawful practices and, when possible, returning money to consumers. The FTC also protects the public through education and outreach on consumer protection issues. Through research and collaboration with federal, state, international, and private sector partners, the FTC strategically targets its efforts to achieve the maximum benefits for consumers, including older adults. Protecting older consumers in the marketplace is one of the FTC’s top priorities. Unfortunately, in numerous FTC cases, older  adults have been targeted or disproportionately affected by fraud. For example, the FTC has brought numerous enforcement actions in federal court to stop deceptive technical support schemes that affected older consumers. As the population of older adults grows,the FTC’s aggressive efforts to bring law enforcement action against scams that affect them, as well as provide useful consumer advice, become increasingly important.

The FTC submits an annual report to the Committees on the Judiciary of the United States Senate and the United States House of Representatives to fulfill the reporting requirements of Section 101(c)(2) of the Elder Abuse Prevention and Prosecution Act of 2017. The law requires the FTC Chairman to file a report listing the FTC’s enforcement actions “over the preceding year in each case in which not less than one victim was an elder or that involved a financial scheme or scam that was either targeted directly toward or largely affected elders.” Given the large number of consumers affected in FTC actions, this list includes every administrative and federal district court action filed in the one-year period. Appendix A to this report lists all of the FTC’s enforcement actions over the preceding year. In addition to the list, the FTC files this report to provide detail on the agency’s efforts to protect older consumers, including its research and strategic initiatives, its law enforcement actions that noted an impact on older adults, and its targeted consumer education and outreach.

The VA Honors National Family Caregivers Month

While the VA honors and celebrates caregivers who selflessly provide care to ill, injured, or disabled Veterans, year-round, November is National Family Caregivers Month. The theme for 2019 is “#BeCareCurious.”

Many Veterans suffer from chronic conditions, disabilities, disease, or daily difficulties and benefit from having a caregiver. Because the need for caregivers is expected to increase, the Department of Veterans Affairs (VA) is ready to stand shoulder to shoulder with VA and community partners to meet their needs.

VA is leading the country in providing unprecedented benefits and services to caregivers in support of Veterans. The Caregiver Support Program has two programs, one of which is the Program of General Caregiver Support Services, for eligible Veterans of all eras. In addition, the VA is working with urgency to expand the Program of Comprehensive Assistance for Family Caregivers (PCAFC), of Veterans from all service eras. VA seeks to ensure the PCAFC meets the needs of those currently in the program and those it will serve as it expands.

The expansion will occur in two phases, beginning in the summer of 2020 or once the Secretary has certified that the new information technology (IT) system is fully implemented. In addition to IT being certified by the Secretary, final regulations must be published.

Concurrently, the Caregiver Support Program Office offers some fantastic projects, which include adopting new technology and increasing educational opportunities for caregivers, to enhance their experience. A few examples are:

• Annie Caregiver Text Support - Provides stress management tips via text messaging to caregivers;
• Caregiver Dementia Video Series - Development of three new caregiver videos;
• Suicide Prevention Toolkit - Educate caregivers of Veterans to know facts about suicide prevention and when to reach out for resources and help.

This November, during National Family Caregivers Month, VA encourages caregivers to take time to #BeCareCurious about their loved one's care. Caregivers are encouraged to ask questions, explore options and share in the care decisions that affect the health and well-being of their loved ones.

We join in honoring caregivers of Veterans and acknowledging their important role in the health and well-being of Veterans! Get involved by posting:

#VACaregivers

 on Twitter, Facebook, and VA Pulse!