Caregiver Tip of the Month

Several factors must be taken into consideration to assure that your parent's pre-existing conditions will continue to be covered by Medicare, Medicare Supplement insurance (Medigap), Medicare's Prescription Drug plan, or by a Medicare Advantage plan.

Because different rules apply depending on the type of plan your parent has, you need to find out whether he or she is covered by:

the original Medicare Plan, a Medicare Supplemental Insurance Plan (Medigap) and an "optional" Medicare Prescription Drug Plan, OR

a Medicare Advantage Plan (these include Medicare HMOs, PPOs, etc.) that does or does not include Medicare Prescription Drug coverage.

If your parent is covered under a Medicare Advantage Plan, they can switch to a different Medicare Advantage plan without penalty between November 15th and December 31st each year. All of their pre-existing conditions will be covered by the new plan from day one. And, their acceptance into the new plan is guaranteed. That is, the new plan must accept your parent on a first come first served basis if they are accepting new applications from anyone. If your parent takes this option, they will be covered under their new plan on January 1st for all new and pre-existing health conditions.

To switch Medicare Advantage plans at any other time of the year is a bit more tricky. If your parent doesn't meet ALL of the requirements, they will lose coverage of their pre-existing conditions even IF they are accepted into their new plan (their acceptance will not be guaranteed). Furthermore,

1. Will your parent be moving out of the Medicare Advantage Plan's service area? Many plans cover multiple states. If your parent's plan covers the state into which they will be moving, they cannot switch plans without penalty until the November 15 - December 31 window.

2. Will your parent's move be permanent? Many plans provide for continuing coverage outside their coverage area on a temporary basis. Thus, snowbirds who typically live 6 months in one place and the next 6 months elsewhere don't have to switch coverage every 6 months. If your parent's move is temporary, they probably cannot switch plans in mid-year without penalty.

Before you move your parent, call their current Medicare Advantage Plan to see if either of the above conditions apply.

Whatever you do, check to see if your parent has the "optional" Medicare Prescription Drug plan. If they do, it is vitally important that their new plan will also include this coverage (it is usually applied for and purchased separately), or that they have the ability to purchase another company's free-standing Medicare Prescription Drug plan.

Page 77 of the Medicare & You 2007 booklet sent to all seniors late last year states:

What if I move out of my Medicare plan's service area?

You can call the plan to see if you can stay in the Medicare plan. If you must switch to another Medicare plan, follow the instructions on page 76 [see the next section below] for switching a Medicare plan. Your choices may include joining

• another Medicare Advantage Plan if one is available in your new area, or
• the Original Medicare Plan, and you will have the right to join a stand-alone Medicare Prescription Drug Plan, and/or buy a Medigap policy to fill the gaps in Original Medicare Plan coverage (see pages 29–31), or
• another Medicare Prescription Drug Plan.

Page 77 of the Medicare & You 2007 booklet also states:

How do I switch my Medicare Advantage Plan or Medicare Prescription Drug Plan?

You can switch your plan in one of three ways:

1. Join another plan.
2. Write or call the plan you want to join.
3. Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

If you want to switch from a Medicare Advantage Plan to the Original Medicare Plan, you need to contact your current plan or call 1-800-MEDICARE (1-800-633-4227).

If you want to buy a Medigap policy, simply signing up for the Medigap policy won't end your Medicare Advantage Plan coverage. You must disenroll [from the Medicare Advantage Plan]. In some cases, you may have certain Medigap protections that give you the right to buy a Medigap policy, but in other cases, you may not be able to buy any Medigap policy. Your rights to buy a Medigap policy can vary by state. If you want to talk to someone who can help you decide what to do, call your State Health Insurance Assistance Program (see pages 92–95 for their telephone number).

If you want to switch to a new Medicare Advantage Plan, simply join the new Medicare Advantage Plan that you want. You don't need to tell your old Medicare Advantage Plan you are leaving or send them anything. You will be disenrolled automatically from your old Medicare Advantage Plan when your new Medicare Advantage Plan coverage begins. You should get a letter from your new Medicare Advantage Plan telling you when your coverage starts.

Look over your parent's copy of the Medicare & You 2007 booklet, especially for more information about Medicare's Prescription Drug Plan. If you wish, you can download a PDF copy by clicking on http://www.medicare.gov/publications/pubs/pdf/10050.pdf.

Our visitors ask ...

Q. My 76 year old mother has been coughing (a choking kind of cough) for several years now. The problem is that right after surgery, about 5 years ago, she developed a throat clearing problem. She said it felt like something was stuck in her throat.

At first her doctors thought that the tube inserted during surgery could have nicked something. They put her to sleep and checked things out via scope and found nothing. They followed up with chest x-rays, cat scans, MRIs and scoped her to see if something was lodged in her airway; again nothing. They also checked her nose and throat via scope; then they sent her to an allergist.

From what I understand, her coughing is uncontrollable and the neighbors can hear her. She gets so tired of coughing that she tries to suppress it, then she starts panicking and it gets even worse. Off to the hospital she goes to get something to relax her. She finally goes to sleep (hardly any coughing at all) then wakes up to the same thing.

I doesn’t know what to do. She can't be comfortable with this. She calls and cries to me all the time. Do you have any ideas?

A. Two thoughts. First, talk with your mother's doctor and ask what he or she thinks about your mother being evaluated by a speech therapist. They not only help stroke victims (for example) to regain their ability to speak, but also evaluate all other aspects of speaking, including a complete evaluation of a patient's ability to swallow. The nerves that control her swallowing mechanism could have been irritated and/or damaged as a result of the tube inserted during her surgery. If so, that could have produced your mother's other symptom, that is, frequently clearing her throat because she feels something is lodged there. Clearing her throat frequently could have irritated the swallowing nerves to the extent that her body's coughing mechanism has become overly sensitized.

Second: If your mother wears an upper dental partial that includes a section that rests against the roof of her mouth, the partial could be pressing against the nerve that controls swallowing. When my own partial was first installed, the section that rested against the roof of my mouth frequently triggered my gag reflex. That was resolved by removing a portion of the back of the partial's roof section. However, when my partial is in, I still have some difficulty swallowing pills and other small things, including tiny bits of ice. But, when I take my partial out, my problem disappears completely.

Not all dentists will agree that a partial can cause that problem. I learned about the cause from my Periodontist who was installing a dental implant. On the other hand, when I told my regular dentist about my problem and its cause, he scratched his head and looked at me in disbelief.

Daily Living Solutions

— products for seniors —

As we grow older, it often becomes difficult to use many everyday products because of arthritis and other conditions. If you or a loved one needs a little help – or a lot – we've selected a group of practical and affordable solutions from our affiliated merchants to help overcome those limitations.

Whether you are looking for yourself, or to help an elderly senior continue living in their own home, you'll find a wide variety of supplies and accessories – raised toilet seats, safety rails, incontinence supplies, large-handle eating utensils, pain relief, diabetic supplies, pill splitters and crushers, big-button telephones, canes, walkers, rollators, wheelchairs – and much more.

Everything is sorted into convenient categories in our Solutions for Seniors section.

Caregiving – Finding the money for care at home

A variety of resources can help pay for care at home. We discuss these resources in some detail in our article 12 tips to help you find money (and free resources) for care at home.

Caregiver Tip #2

— Monitoring an at-risk senior at home —

Baby boomers are often concerned about the safety of elderly parents who continue living in their own homes after physical or cognitive decline sets in. Many adult children find peace-of-mind in modern technology in the form of in-home monitoring equipment and/or services. But, elderly seniors frequently reject monitoring even though the need may be obvious. To understand why, one must understand the mind of the stereotypical elderly senior.

First, losing the ability to do things they were able to do when they were younger is very frustrating, especially for people who were never couch potatoes. For most, their frustrations are a very private matter, even to the point of concealing their inabilities from their spouses until they become indisputable. To admit they need help is to admit to personal failure, especially among elderly men. As a result, they tend to refuse offers of help even when their need becomes quite obvious to their adult children. Indeed, they even resist emergency medical alert systems.

Second, retention of their personal privacy and retention of their personal dignity are two sides of the same coin. As a group, they strongly resent anyone or anything that intrudes on their privacy, regardless of their needs. Internet camera surveillance systems are a definite no-no for most. They also tend to be very negative toward sound monitoring systems similar to those used to monitor babies.

Third, many distrust technology because they don't understand it. Even though they may understand and appreciate how a motion detector will turn on floodlights at night doesn't mean that they will accept motion detectors (such as QuietCare's) inside their home as a means of monitoring their safety.

Bottom line ... even though the need may be very obvious, getting an elderly senior to accept in-home monitoring will be very challenging for most adult children.

Perhaps the best approach is to work with a geriatric care manager. Their members have a lot of experience in assessing patients' needs and then convincing the patients to accept their recommendations.

Our visitors ask ...

Q. My elderly mother can no longer live safely on her own. She's agreed to move into my home where I can help her more. How should I get my home ready for her? Is there anything else I should be aware of?

A. Several factors should be taken into consideration to avoid many of the frustrations of being a caregiver. For more information, we recommend that you read our article, Elder Care - First Steps (2 pages)

To prepare your home for an elderly person, take a look at our checklist, Is your loved one's home safe?

Regarding possible modifications to your home, AARP has an excellent section, Universal Home Design, with a wide variety of recommendations to fit the needs of your elderly parent, both today and in the future.

Finally, our sister website, Solutions for Seniors, offers a wide range of products designed especially to make everyday living easier (less frustrating) for older seniors and the elderly.

Recommended Reading and Videos

Many excellent books and videos can help guide you through the caregiving process. For our recommendations, including a brief description of each one, click here.

The material on this site is for informational purposes only, and is intended as a supplement, not a substitute for medical advice, diagnosis or treatment provided by a qualified health care provider. More