• July 14, 2014 /  Basics

    This is a continuing series using information from the booklet written by the National Institute on Aging working with the National Institutes of Health called: Talking with Your Doctor. (U.S. Department of Health and Human Services, NIH Publication No. 05-3452 August 2005 (Reprinted April 2010)

    Planning for care in the event of a serious illness is much like planning for your death, the only difference is that instead of planning for the care of your estate you are planning for the care of…you!

    Think for a moment: What happens to you if you get sick? You can probably handle that. Now what happens if you get really sick, like a flu or diarrhea that leads to dehydration? That’s a little more difficult. Now what happens if you fall and break your arm, leg or hip? Or maybe you get some serious pneumonia or, heaven forbid, cancer (I mean the life threatening kind)? Now the worst: what happens if your mind is not working and you can’t make decisions? Do you have a plan in place?

    Who cares for you in these situations?

    Along with a will or a trust a person should have an Advanced Health Care Directive (AHCD). Advance directives are written instructions letting others know the type of care you want if you are seriously ill or dying. These can be in the form of a health care proxy or a living will.

    A living will records your end of life wishes for medical treatment in case you are no longer to speak for yourself. I have seen these inserted into an estate plan in the section generally titled: Advanced Health Care Directive. I have also seen additional directives outside the estate plan: a Do Not Resuscitate (DNR) form or a Physicians Order for Life Sustaining Treatment (P.O.L.S.T.). The DNR is just signed by you but the P.O.L.S.T. is signed by you and your doctor (hence the phrase, “Physician’s Order”. The P.O.L.S.T. for is a little more comprehensive and is printed on bright pink paper so that emergency personnel are more likely to see it among the sea of white papers in a binder or on a refrigerator (think EMT). You may want to visit http://capolst.org/ for more information.

    Health care proxies, or agent/attorney in fact/surrogate, should a be a person you choose to advocate on your behalf to ask questions and find resources when you can’t or carry out your instructions listed in your P.O.L.S.T. or other directives.

    While AHCD’s are legally valid everywhere in the United States, each state has its own laws regarding format and wording. You will need to check with your attorney regarding the laws in your state. For example, the P.O.L.S.T. is accepted in California but not in Oklahoma. According to the According to the National POLST organization (http://www.polst.org/ ) many states are now going through the process of accepting this form but you will still need to discuss this with your attorney.

    Paying for medications

    This is a direct quote from the pamphlet:

    “Don’t hesitate to ask the doctor about the cost of your medications. If they are too expensive for you, the doctor may be able to suggest less expensive alternatives. If the doctor does not know the cost, ask the pharmacist before filling the prescription. Then call your doctor and ask if there is a generic or other less expensive choice. You could say, for instance: “It turns out that this medicine is too expensive for me. Is there another one or a generic drug that would cost less?

    Your doctor may also be able to refer you to a medical assistance program that can help with drug costs.”

    In case you weren’t aware, Medicare prescription drug coverage is available to people with Medicare. For information call 1-800-MEDICARE (1-800-633-4227) or visit the Medicare website atwww.medicare.gov

    Independence issues

    What about driving?

    In my post on December 10, 2013 I discuss the difficult conversation your loved one might have with you regarding driving. If you find that it is becoming more difficult to drive, it’s harder to see the road, you are bumping into things, and drivers are getting worse when they drive around you then it may be time to hang up the keys. Your doctor may have access to resources or organizations to help you plan for these events. It would make it easier on your family and the people around you if you do the research first on public/private transportation availability and recognize that if they approach you that they really are concerned.

    Assisted living

    I very rarely have clients that want to move into assisted living from their homes but if it becomes difficult for a home helper or caregiver to assist you and you find that you are not getting out to socialize then it may be time to move into an assisted living community. I will dedicate a whole post regarding this issue because there are still a lot of ways to stay at home that you may want to investigate before you make this decision.

    Woman reading

    Next: Discussing Sensitive Subjects

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  • July 7, 2014 /  Basics

    Talking with your Doctor – If you are hospitalized

    This is a continuing series using information from the booklet written by the National Institute on Aging working with the National Institutes of Health called: Talking with Your Doctor. (U.S. Department of Health and Human Services, NIH Publication No. 05-3452 August 2005 (Reprinted April 2010)

    This is a continuing series using information from the booklet written by the National Institute on Aging working with the National Institutes of Health called: Talking with Your Doctor. (U.S. Department of Health and Human Services, NIH Publication No. 05-3452 August 2005 (Reprinted April 2010)

    The pamphlet does not mention this but I believe one of the more important things you will need to do is notify the person who is your agent on your medical power of attorney, commonly known as an Advanced Health Care Directive (AHCD) or the person who is going to act as your advocate. It does not matter whether or not your visit to the hospital is a routine surgery, you need to make sure your agent knows the details. The will need to know the questions to ask in the event that you are not able to ask. They will need to know the name of your primary physician (PrP) and you need to let your PrP know your advocate may be contacting him/her in the case of emergency. While your PrP may not have any authority at the hospital he/she may have vital information that will help the hospital doctor in assessing and prescribing treatment for you.

    The pamphlet suggests that hospitals have routines and you may be able to make requests of service within those routines. For non-emergency visits there is generally a preparation period. During that time you can ask some of your questions. If you ask for the normal times your doctor is likely to visit you can prepare to have some of the more difficult questions ready when he/she visits. During emergency visits your advocate will need to ask the questions for you if you are not alert. At a minimum  and if possible, they should at least be present when the doctor explains what they are going to do and the reasons for their procedures.

    Questions for non-emergency visits

    • How long can I expect to be in the hospital?
    • When will I see my doctor?
    • What doctors and health professionals will I see?
    • What is the daily routine in this part of the hospital?

    Questions for emergency visits

    • Will you talk to my primary doctor about my care?
    • Do I need to arrange any further care? (it has been my experience that the discharge nurse or social worker will let you know)
    • May I get instructions for further care in writing? (I have found that the hospitals I have worked with all provide written instructions when they discharge you. The issues I have seen is that the patient is not usually alert enough or too distracted to ask questions at this time. This is the time for your advocate to ask. If they were not present when the doctor or staff came through then have them call the discharge nurse or social worker to ask the questions)
    • Is there someone here who speaks my language and can explain the instructions? (I am assuming here that the person reading this is advocating on behalf of a patient who doe not understand English. Hospitals are required to provide a translator or at least have the instructions written in the language of the patient. This is another good reason to have an advocate)

    Second Opinions

    This is directly from the pamphlet:

    When surgery is recommended, patients often seek a second opinion. Hearing the views of two different doctors can help you decide what’s best for you. In fact, your insurance plan may require it. Doctors are used to this practice, and most will not be insulted by your request for a second opinion. Your doctor may even be able to suggest other doctors who can review your case.

    Always remember to check with your insurance provider in advance to find out whether a second opinion is covered under your policy, if there are restrictions to which doctors you can see, and if you need a referral form from your primary doctor.”

    doctor consults with patient

    Next time: Practical Things

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