The Importance of "Mind Sports” Like Chess

By Guest Blogger: Evan Rabin

During the COVID-19 pandemic, thousands of seniors around the world have been and remain isolated. For over a year, they have been unable to socialize with family and friends. While progress has been made ( I have personally received my second vaccine), most people I speak with do not anticipate the world returning to “normal” any time soon.  

Mentally challenging games, such as chess, can help older adults, or anyone for that matter, manage the stressors that the pandemic has thrust upon us. There are virtual platforms for learning and playing chess with real live people which allows for safe socialization. 

In addition to relieving stress and providing for social engagement, there are studies that show that “cognitively stimulating activities,” such as chess, which require a lot of brain power, can help improve a person’s memory and slow the progression of Alzheimer’s Disease and other dementias. See https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6617066/  

About Evan:

Evan Rabin, a National Chess Master himself, is the founder and CEO of Premier Chess. If you would like to learn more about the social and health-related benefits of chess please contact Evan at Evan@PremierChess.com. Premier Chess (https://premierchess.com/) offers online and in-person individual lessons and group classes. Premier Chess partners with companies and non-profit organizations to help realize Evan’s dream that anybody who wants to play chess anywhere in the world should be able to do so.

Care Managers and the Importance of Objectivity

by Lisa Bayer, J.D., CCM

Heidi and I founded LMR Elder Care, LLC with the mission that “care management” would remain our core focus. For more than 15 years we have held true to that mission. 

Every new client of LMR Elder Care receives a disclaimer when they onboard with us. This disclaimer is as much for our clients’ protection as it is for ours. We want our clients to know that, with the help of their families, friends and trusted advisors, we will hold their hands and guide them to make informed elder care plans and decisions. But we also want our clients to know that we will always strive toward “the best interest of the client” and that we will not substitute our judgment for that of our clients or of their authorized agents. We believe in a collaborative approach to elder care and we encourage our clients to lean on all of their trusted professional and paraprofessional advisors.

One core pillar of our business is that we do not accept referral fees. That means that when we include an organization or service in our directory or recommend a provider to a client, it is because we believe that provider will provide a necessary service.  At the heart of what we do is protecting our clients. While we do our best to promote long-term care planning and healthy aging, the reality is that most clients hire us when there is already an actual (or near) crisis. It is important to us that families are not taken advantage of when they are at their most vulnerable. 

The elder care space has evolved a lot over the last 15 years since we started our practice. In this regard some home health care agencies have started offering fee-for service private pay care management services. In this instance, a client is paying the agency for care management and the client is also paying for home health care. This arrangement creates the potential of a “dual relationship” for the care manager as he or she is duty bound to the client and to the employer who is both providing the services and who is paying the care manager’s salary. With a dual relationship the boundaries are blurred and objectivity can become diluted.

Dual relationships can also rise to a true conflict of interest between the care manager and his or her clients. For example, consider a company that provides both fee-for-service private pay care management AND home health care services.  Would the geriatric care manager even be allowed by his/her employer to recommend a more appropriate agency or caregiver? What happens if the home health aide is not performing his or her job adequately or the client simply does not like the caregiver? Simply put, without the checks and balances of independent providers comes the potential for exploitation and abuse. We have seen and heard everything over the years; home health aides offering sexual favors for extra cash, dementia clients abandoned overnight when they were supposed to be under watch, and theft of family valuables. Unfortunately, anything can happen at any time, but the opportunity to correct and protect is diminished when “Peter is Paul” and “Paul is Peter”.

When working with older adults and persons living with disabling conditions, it is important to  insist on transparency, ask necessary questions, and perform reasonable due diligence on all service providers. At LMR Elder Care our number one priority is what is in the best interest of our clients. We advocate for you and only for you.

I’m Sorry, But What Did You Say???

By: Lisa Bayer, J.D., CCM

Recently, I met with Dr. Rhee Rosenman-Nesson, Au.D., CCC-A to learn more about the importance of good hearing health for everyone, but particularly older adults who may be showing signs of dementia and other age-related medical and psychological conditions. Dr. Rosenman-Nesson is the owner and founder of Hearing Doctors of New Jersey with an office in Livingston, New Jersey.

According to Dr. Rosenman-Nesson, poor hearing can increase the risk of:

·       Falls

·       Cognitive Impairment (such as Alzheimer’s disease and other dementias)

·       Social Isolation

·       Depression

Poor hearing has been associated with an increased risk of falling. A person with low hearing may miss auditory cues (such as a pet underfoot). In addition, it takes a lot of mental energy, particularly for a person experiencing hearing loss who is trying to compensate using their other senses, thereby leaving less bandwith for concentration on balance and posture.

According to Dr. Rosenman-Nesson, hearing loss can lead to an increased risk or earlier onset of Alzheimer’s disease and other dementias. She explained that when a person is deficient in one sense (hearing) they use their other senses such as watching a person’s lips while they speak, to interpret and compensate. If the hearing part of the brain remains unused, it begins to atrophy. “Use it or lose,” explains Dr. Rosenman-Nesson.

Hearing loss can also lead to social isolation and depression. Dr. Rosenman-Nesson explained that when a person is constantly asking people to repeat what they are saying they tend to, at some point, give up and sit quietly at the dinner table or alone at a party. Eventually, they may decline social invitations and avoid activities altogether leading to social isolation and consequent depression. 

Dr. Rosenman-Nesson explained that there are many new and innovative solutions for helping her patients improve hearing and that it is not “one size fits all.” For example, for active adults who do not want their hearing aid to show (if they cannot cover it by growing their hair longer) there are small, clear-colored devices that are barely noticeable. What I was most interested in are the new products that make it easier for caregivers to assist my clients with their hearing aids. For example, they make larger, more manageable devices that are harder to lose and that can be clipped to a person’s clothing if they inadvertently take them out. They also make devices that can be tracked by GPS with a smartphone.

LMR Elder Care and Hearing Doctors of New Jersey’s team approach helps to keep our clients and patients connected and living healthy, productive lives.

To learn more about Hearing Doctors of New Jersey please visit https://hearingdoctorsofnj.com/ or call Dr. Rosenman-Nesson’s office at 973.577.4100.  

The Alphabet Soup of Medicare

by Lisa Bayer, J.D., CCM

It is open enrollment time for Medicare supplemental plans and anyone who has tried to navigate the process is faced with a myriad of choices and terminology. There’s Medicare A, B, C and D. Part A is your inpatient insurance, Part B is your outpatient insurance and Part D is your prescription drug coverage. Part C is sort of a combination of A, B and D and these plans are known as “Medicare Advantage” plans.

If you do go the traditional Medicare route and you are considering a Medigap policy (a supplemental plan that helps to fill in Medicare coverage gaps) you could be looking at another mouthful of letters! For the heck of it I put in our zip code and the Medigap plans available in LMR Elder Care’s area, 07039, include A, B, C, D, F, G, K, L, M and N. And if that is not enough would I want a high deductible or “regular” Medicap plan? So how does one decide? To start, make a list of your medications and medical providers. Next, enter your information at www.Medicare.gov, access a state SHIP counselor (a volunteer trained to provide objective Medicare benefit counseling - https://www.state.nj.us/humanservices/doas/services/ship/ - in New Jersey), or get in touch with a private insurance representative that can help you select a plan at no fee to the Medicare beneficiary.

It is important to note that if you are not subject to a special enrollment period this is the only time of year that you will have the opportunity to review, and possibly decide to change, your supplemental insurance and prescription drug coverage. As Eric Cohen, Managing Director of Benefit Quest, Inc points out, “It’s important to sign up at the right time if you want to make any changes or adjustments to your health coverage or your prescription drugs.” For 2021 this review period takes place from October 15 through December 7, 2020.

Managing a Hospital Stay - "MOON" (part 1)

by: Lisa Bayer, J.D., CCM, Advanced Professional member of the Aging Life Care Association

Me: “Is she on observation status or a formally admitted inpatient?”

Client’s son: “My mom is in a private room. She was admitted yesterday evening after spending all day in the ER.”

Me: “Yes, I understand that she is in a hospital room on a floor with other patients—not the emergency room. And I understand that she gets her meals and medications delivered to her room, that she has a TV and phone and even had a consult with physical therapy earlier today. I know that she has been assigned a “hospital doctor” and has consulted with specialists. It certainly may seem that your mom is a patient in the hospital. But is she?”

Client’s son: “I just called case management. You’re right! She is still on something called “observation status.” They are keeping her again tonight but the social worker said she has not been admitted.”

Me: “OK. Let’s talk later after I visit your mom and speak with her doctor.”

------------------------------------------------------------------------------------------------

R.S. fell in front of her home. She can’t remember if she tripped over something or if she just collapsed. In fact, she does not remember falling at all. Now in the hospital, she was told that a neighbor found her, called 911, and an ambulance brought her to the emergency room.

As a geriatric care manager one of my roles is to advocate for my clients in the hospital. After speaking with her hospitalist, we learned that R.S. fractured her hip and several ribs and that she is suffering from a severe urinary tract infection. They are not sure if she needs surgery for her hip or if they are just going to set it. She also needs IV antibiotics for the infection.

The first question I asked her doctor was whether she was being treated as an outpatient or an inpatient. Her doctor hesitated a moment and then she admitted that yes, in fact, R.S. was still on “observation status.”

So why does this matter and why is it important to ask this question as soon as possible? Shouldn’t the hospital have an obligation to tell me?

To answer the second question first, the hospital does in fact have a responsibility to inform the patient if they are on “observation.” This is called the Medicare Outpatient Observation Notice or “MOON” and must be presented to the patient or his/her representative no later than 36 hours of starting to receive observation services at the hospital. The presenter is supposed to be able to orally explain the form and answer questions

It is important to understand, however, that even if the Medicare beneficiary refuses to sign the notice the hospital staff person just needs to document that the form was provided. I say “hospital staff” because there is no requirement that the form be presented by a doctor or social worker which would make the most sense. Technically, someone from dietary or even a security guard could present the form.

What happens if a person disagrees with their status or if the form is never presented as required? Nothing as far as the patient is concerned (although there could be financial consequences to the hospital if they are audited by Medicare). To be clear, there are no appeal rights for the patient if they do not receive the MOON nor if they disagree with their patient status.

So what does this all mean to Medicare beneficiaries and how can they protect themselves? Stay tuned for my next article where I discuss the financial and care-related implications for R.S. had she remained on observation status during her hospital stay.

Do I Really Need a Health Care Power of Attorney?

By Lisa Bayer, J.D., CCM

Recently, I was talking to a friend of mine who told me that her mom’s attorney is pushing her mom to appoint a health care power of attorney as she was just diagnosed with mild or “early stage” Alzheimer’s Disease. My friend wanted to know if the attorney was trying to drum up unnecessary business for himself because her dad is alive and well and perfectly capable of taking care of her mom.

I explained to my friend that the attorney was right to encourage her mom to prepare a legal document appointing someone to act on her behalf if and when she is unable to speak for herself. This representative is often called a “health care proxy” or a “health care power of attorney.”

Using her mom’s health care directive (also known as a “living will”) as a road map, this person, in this case her dad, will know what her mom would want if she could speak for herself and will have the authority to make decisions consistent with her wishes. I explained that it is also an opportunity for her mom to appoint surrogate decision makers in case her dad is unable or unwilling to act. Since my friend is an only child and lives close by it might make sense for her mom to name her as well.

Being related does not give someone the right to make health care decisions for another adult—only the health care power of attorney document accomplishes this. In my elder care consulting practice, I have seen difficult cases that have literally torn families apart where there is no health care proxy because the alternative is to go to court to petition for guardianship. The guardianship process is time consuming, financially costly and emotionally taxing. And if the guardianship is contested, this quantifiably increases the time and expense of the litigation.

Given my friend’s mom’s diagnosis, I also explained that there could come a time—and none of us has a crystal ball—where her mom would be unable to appreciate and execute the documents. Her attorney is under a legal and ethical obligation to make sure that her mom has the capacity to sign them.

I told my friend that my suggestion would be to follow her attorney’s advice and have the documents prepared as soon as possible.