Monday, November 25, 2019

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. 
    • 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.
    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.

    Tuesday, November 19, 2019

    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.   




    Monday, November 18, 2019

    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 

    Friday, November 15, 2019

    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.

    Thursday, November 14, 2019

    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.

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