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.

Aging In Place- Pre-hospice Care Helps Patients Stay Home

Among the growing number of tools and resources aiding consumers to "age in place" is "pre-hospice." Kaiser Health News recently published an encouraging article, Pre-Hospice" Saves Money By Keeping People At Home Near The End Of Life, that well explains the concept and its promise. 

The article first discusses the practical impediments consumers face in an effort to age in place:

"Most aging people would choose to stay home in their last years of life. But for many, it doesn’t work out: They go in and out of hospitals, getting treated for flare-ups of various chronic illnesses. It’s a massive problem that costs the health care system billions of dollars and has galvanized health providers, hospital administrators and policymakers to search for solutions."

According to the article, Sharp HealthCare, a San Diego health system, devised the pre-hospice program called Transitions as a way to fulfill patients' desire to stay home, keep them out of the hospital, provide necessary care in their home, and reduce the costs of care. Social workers and nurses from Sharp regularly visit patients in their homes to explain what they can expect in their final years, help them make end-of-life plans, and teach them how to better manage their conditions, illnesses, and diseases. Physicians track their health, and eliminate unnecessary medications and treatments.  Unlike hospice care, patients don’t need to have a prognosis of six months or less to live, and they receiving curative treatment for their illnesses - not just relief from symptoms.

Transitions was among the first of its kind, but now there are several such "home-based palliative care" programs around the country. They are part of a broader push to improve people’s health and reduce spending through better coordination of care and more treatment outside of hospitals. Palliative care focuses on relieving patients’ stress and pain as their health declines, and aims to maintain quality of life. For people with serious illnesses, such as cancer, dementia, and pulmonary and heart failure, the plan is to provide patients palliative care and then transition naturally to hospice care when necessary.  The 2014 report “Dying in America,” by the Institute of Medicine, recommended that all people with serious advanced illness have access to palliative care. 

Transitions is one of the many good ideas that has come from Kaiser Permanente. Nearly 20 years ago, Kaiser created a home-based palliative care program in California and later in Hawaii and Colorado. Studies by Kaiser and others found that participants were far more likely to be satisfied with their care and more likely to die at home than those not in the program. One of the studies found that 36 percent of people receiving palliative care at home were hospitalized in their final months of life, compared with 59 percent of those getting standard care. The overall cost of care for those who participated in the program was a third less than for those who didn’t. A more recent study confirms these conclusions. 

The article also discusses that although the need for such services is increasing, "not enough trained providers are available. And some doctors are unfamiliar with the approach, and patients may be reluctant, especially those who haven’t clearly been told they have a terminal diagnosis." 

Of course hanging over ever the entire health care industry is what becomes of the Affordable Care Act.  The Affordable Care Act  established new rules and pilot programs that reward the quality rather than the quantity of care, such as “accountable care organizations,” networks of doctors and hospitals that share responsibility for providing care to patients. These organizations also share the savings when they rein in unnecessary spending by keeping people healthier. Innovations such as these are helping to make pre-hospice and home-based palliative care a more viable option.

New Guides Help Those Appointed to Manage Someone Else's Money

Have you been officially asked to manage someone else's money? For example, have you been named as an agent under a power of attorney or appointed trustee of a trust? As our society ages, more and more people are being asked to take on these roles, but they come with both powers and responsibilities, and problems can arise.

If you're not a lawyer (and even if you are), the responsibilities of these positions can seem daunting. Luckily, the federal Consumer Financial Protection Bureau – the only federal office dedicated to the financial health of Americans age 62 and over -- recently released four guides for people who have been given the responsibility of managing money or property for someone else. The guides, which are free, are collectively called “Managing Someone Else's Money.”

The Managing Someone Else's Money guides are designed to help non-lawyers; they walk you through your new responsibilities, teach you how to protect the person in your care from financial exploitation, and give you links to additional resources. For example, the guides tell you, the agent, what to do to avoid problems with family and friends who think you are doing a bad job. The guides also help you coordinate with other agents who may have been assigned to work with you and any outside professionals whose help you may need (such as lawyers, brokers, and financial planners).

The guides include help for agents under a power of attorney, court-appointed guardians of property and conservators, trustees under a revocable living trust, and representative payees and VA fiduciaries (a person who manages someone else's government benefit checks). All four types of agents are fiduciaries, which means they owe four special duties to the people for whom they are managing money or resources: the duty to act in the individual’s best interest, the duty to manage the individual’s money and property carefully, the duty to keep the individual’s money and property separate from their own, and the duty to keep good records. Every guide includes detailed information about these four duties.

If you have been assigned to be an agent for someone, that assignment should come with a document (power of attorney, trust document, court order, etc.) that will tell you what you can and cannot do. It is important to stay within the limits that document sets for you. These four guides, which were developed for the Bureau by the American Bar Association Commission on Law and Aging, are not a substitute for legal counsel, but they can help keep you on the straight and narrow.

To download one or more of the guides, go to:
 http://www.consumerfinance.gov/blog/managing-someone-elses-money/