Understanding the Need to Prepare for Long Distance Care Giving--For Both Elders and Their Loved Ones

Part 2, by Ronald J. Iverson, copyright 2007

Author's note:  This article (Part 2) enables the reader to understand the need for preparedness for those who may be called on to facilitate long--distance care giving.  The need for "coordinated caregiving" for both those in need and their children will become a significant part of the American healthcare scene as we face the needs of 76 million baby boomers, their elders, and their children in the 21st century.

As we said in Part 1, while the physical medicine needs of older people are covered by Medicare, Medicaid, Medicare Supplemental and Medicare Advantage plans, there is still a missing factor--that of being prepared for the moment when those needs surface--a pre-planned system of coordinated care.

A Long Term Care policy awaits the moment that Home Care/Home Health Care, Assisted Living, or Nursing Home/Alzheimer's Care is needed.  But, how does that implementation come about for "Mom or Dad" who are living in Phoenix, while son Jimmy is an engineer in Seattle, and daughter Sally is an accountant in Kansas City? 

Jimmy and Sally probably don't have any idea about how to prepare for these events, and lose more than a few nights' sleep worrying about what to do.  

The Problem

In America, our healthcare and healthcare delivery systems are among the worlds' best.

However, coordination of those systems is splintered, and implementing all the parts of the care often results in confusion, uncertainty, and paperwork fatigue...for an older person... 

...and even for the young or middle-aged adult.

For the elderly, the problem is multiplied, especially if they try to coordinate all the necessary components on their own.  Even though Medicare has several wonderful features, understanding the various parts can be very confusing for the retiree.  For instance, with Medicare alone, the elderly person may be confronted with initiating and combining the benefits of these six features:

1)  Medicare Part A

2)  Medicare Part B

3)  Medicare Part D

4)  Medicare Supplement policies

5)  Medicare Advantage plans

6)  or Retiree Group Health programs that coordinate with Medicare

The beneficiary or patient, may well be challenged as to how these several benefit components are initiated, activated, and coordinated.

Then, to this, add the various parts of Long Term Care, or Short Term Care, (which go beyond medical needs) and how each fits into the "care" element of needed benefits. Or, if some of the benefits of insurance are missing, how does the patient fit Medicaid into the picture.

Add to the above, the concern, or even fears, of what diseases or accidents the elderly may contract.  A heart attack, stroke, or accident, are sudden events, needing sudden answers.  Cancer and Alzheimer's are only a few examples of problems, which often go undetected until the day of diagnosis, but then, become equally as immediately important as the preceding examples.

At this point, the elderly have a serious problem on their hands. 

If they have nobody to help them coordinate all the benefit features, the problems can become bewildering, upsetting, time-consuming, and sometimes overwhelming.

Even with a loving son or daughter to help them with these problems, the hurdles are no easier for the children or siblings, who want to offer all the support and care they can, but in reality are challenged themselves with what to do first... or even... what to do next.

The Challenge

The challenge will be to inform 40 million people over 65, and 78 million baby boomers that the problem of care coordination exists. 

And... that the problem of preparation for such time as a serious medical or care need arises... can be solved.

For instance, could you currently solve the above problems for yourself, or your loved one(s)? 

Could you do the necessary tasks comfortably?

Could you do them for a loved one a thousand miles away...or even next door?

Could you do all the tasks needed on a moment's notice, perhaps after an alarming phone call?

Would you even know what questions to ask a doctor or nurse, and hope that a few minutes of telephone time would yield complete and correct answers?

More than likely, the truthful answer is "No."

But... there is a solution.
 
The Solution--Bundling and Preparation--A Practical Solution

Under the direction of CEO Dan Tobin, MD (Director of The Life Institute and Adjunct Assistant Professor of Psychiatry, Dartmouth Medical School), Care Support of America and its affiliated training centers have been involved in testing care coordination and support for over 10,000 patients, working with major health insurance companies and institutions.  The result was the development of the "Your Support Nurse" program, which utilizes advanced illness counseling and care coordination, as developed by Dr. Tobin.

The system combines emotional support and practical guidance in a powerful and affordable program for seniors, families and caregivers.  "Your Support Nurse," already in use among thousands of people nationwide, offers demonstrated success in alleviating emotional distress and enhancing quality of life.

The program follows an eight-element process designed to:

1)  Help seniors and caregivers better understand chronic illness.
2)  Guide extended planning as the disease progresses.
3)  Coordinate care by linking medical, as well as non-medical services.
4)  Coach on questions to ask the physician.
5)  Direct searches on disease information and treatment.
6)  Help seniors and caregivers with problem resolution as issues arise.
7)  Provide emotional support to seniors, families and caregivers.
8)  Provide telephonic and real-time access to registered support nurses.

Who Should Care About Care Coordination?

For simplicity's sake, let's round off some numbers.  Currently in the United States, there are roughly 40 million people over age 65.  Also, there about 78 million "Baby Boomers."  So, combined, that leaves 120 million people who need to be aware of the complexities of caregiving, whether it be at home, across town, or across the nation.  And during the next 25 years, the boomers will pass into the "over age 65" strata, thereby constituting nearly 80 million people on Social Security, Medicare, and Medicaid (when adjusted for deaths in both demographic groups).

Sounds incredible and unbelievable doesn't it?  Yes, but it's true.  We are at a point in our history when there is one elderly person for every two "children."  The pressure on our health care system will be incredible.  The pressure of how and when to communicate with a loved one during their time of need will increase proportionately simply due to the numbers involved, or, the new demographic.

To understand the needs currently, we have to look at both the over 65 and under 65 demographics.  Since there are 40 million elderly today, and 80 million boomers, the need for care giving, long distance or local, and loving are immense.
So, who should pay attention?

1)  As we know, the under 65 person is concerned about their parent or parents.  They are likely candidates to investigate caregiving in general and long-distance caregiving, in particular.

2)  Secondly, people in the over 65 group, in all likelihood, are searching for peace-of-mind solutions for themselves.  They are the ones who have something at stake in setting up preparations for events they may very well find difficult to handle in the not too distant future.  For instance, people who have lived together for 30-50 years,and have managed thousands of situations between them during that period of time, become concerned about possible health problems for each other.  As we already know, the expectance of an instance of bad health or a serious accident increases with age.

3)  So, the retiree, elderly, or seniors themselves, have an acute concern for these events taking place.  How does one spouse react to the care-giving needs of another?  How do they even know where to start, and how do their concerns for the best possible care for their spouse affect their everyday thinking and worrying? The two member household, looks for a solution to the needs and concerns of the life-long mate.

4)   While the two member household is a significant entity, the single member household is probably even more in need, because there is no partner to help them with the matters that arise regarding their care.  So, the single retiree has an even greater stake in preparing for events such as an accident or a bundling of care and medical needs, which can be counted on to allow the retiree to seek and receive the best of care. 

5)  In either case, the individual, couple, or long-distance "child" can benefit with a pre-planned coordinated care inventory solution, which the family can use to prepare for advancing illness, and the development of plans to resolve existing problems.

How, Then, Can Care Support of America, and "Your Support Nurse" Help?

1)  When a person becomes a member, their account is established by the CSA Support Center.

2)  The member's health profile and supports that are in place are recorded in the member's account in order to prepare for, and coordinate, future support needs.

3)  Membership includes a comprehensive assessment, identification of areas where the family can prepare for advancing illness, and development of plans to resolve existing problems.

4)  "Your Support Nurse" will help the member and caregiver understand an illness, its' treatment, and offer suggestions and address what questions to ask the doctor.

5)  As part of the plan development, an inventory is taken of current insurance coverages.

6)  This assistance is available to the member or caregiver by calling "Your Support Nurse" at the CSA Support Center.

7)  Support Nurses are available to visit the member's home to evaluate medical and non-medical needs.

8)  Access to the CSA website for additional information, or telephonic communication with Your Support Nurse as needed, is a part of the program.

To contact CSA and the "Your Support Nurse" program, seniors, boomers, or concerned adult children can call toll free to 1-866-439-7103, or find additional information at: www.YourSupportNurse.com. 

For further information regarding significant Long-Distance Caregiving problems, the National Institute on Aging has prepared a comprehensive booklet entitled "So Far Away--Twenty Questions for Long-Distance Caregivers."  Published in January, 2006, by the National Institutes of Health, U.S. Department of Health and Human Services, the 44-page publication presents a very interesting and appropos discussion relating to the problems we have discussed.  You may order a copy by calling the Office of Communications and Public Liaison at 1-301-496-1752 and asking for the booklet by name, or by NIH Publication No. 06-5496.