Check to see if your insurance policies have coverage for any senior care for services like case management, referrals, medication management or assistance with payment of non medical home based care attendants.This coverage may be part of your major medical policy.
If you have a long term care policy, review the policy language. It may pay for services in addition to traditional nursing home care. Some policies will pay for family to provide care. Older policies may have riders that you have overlooked. Terminology may have changed across time and coverages may be available if documentation is provided from your physician or healthcare provider. Help the physician with completing documentation to assure that the terminology is consistent with what the insurance company requires.
Medicare is health insurance. Take advantage of all of the coverages available. Medicare includes hospitalization insurance, outpatient services, skilled home services and prescription services. Medicare has special coverages for people with end stage renal disease. Hospice is a Medicare covered service.
The cost of medications and medication related issues often take their toll on seniors. Medication doses change, medications change, administration frequency is confusing causing not only the financial cost, but the physical cost overwhelming. The following are some issues that are frequently seen by seniors and their families.
Ask for smaller prescription quantity
When you are being given a new medication by your healthcare provider, ask for a smaller supply. Most prescriptions are written for a one month supply. If you have a return visit to the doctor in less than a month for evaluation of new medication, ask for the prescription to be less than the thirty day supply. This prevents waste of money and medication if the dose or medication is changed.
Speak to your physician about simplifying your medication regimen. If a medication is to be taken four (4) times a day, there is a very high likelihood that doses will be missed. When doses are missed, the medication is not as effective and the physician may modify the dosing causing adverse effects. Try to keep your medication administration to twice a day. There are frequently longer acting alternatives that can replace three to four time a day dosing. Ask your doctor about combination medications as well. There are many on the market and they may help with medication compliance due to ease of taking
Talk to physician about options
There are many different options for treating medical conditions. Speak to your physician about different medication options. Healthcare providers are not always knowledgeable about the cost of medications and it is important that you be your own best advocate. Expensive and new to the market medications may
be replaced with older preparations with little difference in effect, but huge differences in cost. Do not always ask for the newest medication. Physician attains much of their information about medications from pharmaceutical representative who are selling their own company’s medication. There are many ways to treat most conditions and negotiating with the healthcare provider is a way to reach a consensus that is affordable and right for you patient. If there are no other options for treatment, your healthcare provider will share this information with you.
Some pills and tablets are scored, or have an indented slash across the pill body. These medications may be broken in half for dosing. Some can be snapped in half and others require a knife or other sharp tool. Not all pills can cut in half. Some medications have special coating and others like capsules have granules of medication that must be left in the gelatin capsule to be effective. Never divide a pill in less than two parts. It is impossible to get an accurate dose. A large dose medication is sometimes less expensive than the smaller dose medication. Speak to the physician about purchasing the less expensive alternative and cutting the pills in half yourself. Do not cut pills in half if you have a vision problem like macular degeneration. It is too easy to make a medication dosing error that could be fatal.
Generics
Generic medications are manufactured using the same active ingredients that name brand medication. There is mixed consensus on the appropriateness of generics medications, but for most drugs they seem to be effective. There are some medications like Coumadin vs. warfarin that should not be interchanged. Speak to your pharmacist or healthcare provider to seek out medication that is generic equivalents. Manufacturers are able to produce these medications less expensively because the patent on the original drug has run and no longer applies.
Comparison shop
Medications comparison shopping is no different than comparison shopping for other needs. Costs vary at different pharmacies and geographically. Go to the internet and type in “medication costs”. A number of web sites will assist you in comparing your medication costs and may save your substantially on your drug costs.
Mail order
If mail order purchasing is available with your insurance coverage, it is a great time and money saver. The medication is delivered directly to your home and in 90 day or 3 month supplies. This saves time and money going to the pharmacy and waiting or remembering to call in the prescription. Do not do mail order on a new prescription because these drug regimens may change and you do not want a 90 day supply of medication sitting unused and wasted. Call you insurance company to see if and how to order through the mail.
Medicare D coverage
Medication costs are partially covered by Medicare. The program is called Medicare D. Each year the senior must select the medication provider as a beneficiary. It is worth your time to be vigilant in the search for the best provider. Formularies, lists of drugs that the pharmacy carries, changes from year to year. So even though a drug was covered currently, it may no longer be on the formulary for the future. Your drug dosing and number of prescriptions may also change substantially within a year period of time. Take the formulary of the Medicare D program to your healthcare provider. They can review the formulary drugs and order accordingly saving you money. The pharmacist is another resource to assist in the management of Medicare D. The web site www.medicare.gov will provide you with a tool to help you select a pharmacy program that best meets your needs.
Drug manufactures
Some drug manufacturers will discount or provide medication free of charge to patients. The primary criterion is level of earnings of the patient. You will need to provide an accounting of financial resources to be able to participate in these programs. If the medication is generic, this is not available. Ask your pharmacist for the name of the manufacturer of the medication that you are using. You can contact the manufacturer directly with help from the pharmacist, your healthcare provider or the internet. Documentation may seem tedious, but it can save you hundreds if not thousands of dollars a year.
Pharmacist consult
The pharmacist is truly the expert in the use, effects and side effects of medication. Their expertise is grossly under utilized by the healthcare consumer. With seniors using much different medication, there can be adverse side effects. Use only one pharmacy to fill all of you medications that way the pharmacist is able to monitor your medication profile prospectively. One of the main reasons seniors are admitted to hospitals is medication related interactions.
The pharmacist can also help prepare you for the conversation with your physician concerning your medications. They can give you data on other drug options, costs of the options and side effects profile. Not all of the medications used to treat a condition have the same side effect, for example there are many types of medication for treating high blood pressure. If you are uncomfortable speaking to the physician due to language and terminology, the pharmacist may be willing to call the healthcare provider to facilitate for you.
Medication Disposal
Do not flush medications down the commode. This is harmful to the environment. We are finding high doses of the break down products of medication in the water supply and in animals that drink the water. Call your local police station or speak to your pharmacist about a place in your area that will help you destroy unused medication. One of the risks of unused medication is other raiding your medicine cabinet for medications that can be sold on the street or used to get high. Look at medication bottles in your medicine cabinet and destroy the contents as they are expired. If you wonder if the medication is still safe, call the pharmacy where you purchased the medication and ask.
Understand your pension and retirement plans especially as it pertains to your spouse. Many spouse are impoverished because of issues surrounding these plans. Make sure that the financial planner and elder law attorney is aware of the language and coverage of your plans for the wellbeing or those left behind.
The pharmacist is the senior’s best friend. These professionals have an in depth understanding of the chemical nature of drugs, body utilization, metabolism and excretion and drug interactions. All medications should be purchased from the same pharmacy to minimize drug interactions. The pharmacist can them call the physician to alert him/her about pending interactions or duplicate medications from other practitioners. Medication wholesale purchases by the pharmacy can change and color, size and appearance of pills differ. The standard pharmacist will know this and alert you. The pharmacist and discuss the use of generic drugs and whether they are an appropriate option for you.
Polypharmacy, or many medications, is rampant with seniors. Our healthcare system of specialty physicians encourages this practice with each physician ordering medication unique to their specialty, but not necessarily knowing what the other specialists have ordered. Not taking into consideration all of the medications, including over the counter medication, leads to adverse drug reactions. Seniors are a great risk for drug interactions due to the physiologic changes from aging. A major side effect of medication is falls and hospitalization for seniors.
Medicare coverage – Review your Medicare D coverage annually to see that you are getting the best deal for the medications that you take. The formularies of providers change as do your medications. Several of the large pharmacy chains will review your coverage free of charge. The Medicare web site also has a site for this application at www.medicare.gov.
Pharmaceutical companies – The manufacturers of expensive medications may provide assistance with access to medications through free or reduced fee programs.
Physician office – Some physicians provide samples of medications. If you are starting a new medication or trying a medication on a trial basis, ask the physician if they have a sample for you to try. Medications are expensive and a bottle of unused medication is a waste of money, must be disposed of safely and is not safe to keep around the house. One of the ways teens and young adults get access to pain medications is from medicine cabinets of family.
Prescriptions - For your first prescription ask the physician to write for only enough medication to last you until your next office visit. If dose or medication needs to be changed, waste can be eliminated.
Many states have attorneys who will work pro bono or for reduced fees usually based on income. The state Bar Association in each state should be able to provide information on attorneys in your geographic area. Not being able to pay full fees does not preclude you from receiving an attorney’s advice. The American Bar Association is a good place to start your search at www.americanbar.org.
Many religious organizations have resources to assist the senior and their family. Ask what services they provide and check to see if you need to be a member to access the services. Religious organizations often provide services like transportation, respite care, spiritual counseling or education, food pantries and may have individuals who can assist with down sizing and removal of furniture.
Respite is simply temporary relief as a permanent caregiver whether the situation is that the senior is living with you or not. As a paid or unpaid caregiver we suffer from compassion fatigue. Asking for someone else’s assistance is a big step. It means giving up control and trusting others. You cannot do it all yourself. If you look at a hospital, no one team member does the entire job. As an untrained caregiver, you cannot expect to have the knowledge and skills of the entire team. Resources for respite include religious institutions, local agencies on aging often have agencies affiliations, non medical private care companies, nursing homes and assisting living facilities are all potential sites depending on the needs of the senior and the finances of the family.