Because We Care
Practical tips for family caregivers

Getting the most from doctor appointments

Time with a doctor is precious—and that creates pressure to make the most of each visit.

Whether your loved one’s next appointment is in person or through telehealth, a little preplanning will go a long way to making it a productive session.

Here are some helpful tips:

• Identify the goal. Are you seeking a diagnosis for new symptoms? Deciding on a specific treatment? Checking in after hospitalization? Determine what you want to get out of the meeting. Don’t assume the doctor has the same focus in mind.
• Prioritize the questions. Write down your specific questions. You may have time to ask only three, so put the most important questions at the top. And be sure to ask them!
• Clarify your role. Will you be physically attending the appointment? Joining the session remotely? Does your loved one want you to spearhead the conversation? Or is your role mostly to take notes and point out any unasked questions?
• Ensure optimal communication. If your loved one wears glasses or a hearing aid, double check that they are handy for the visit. Extra batteries, too!
• Give pertinent information. If you are updating the doctor with new information, be specific and detailed when describing recent symptoms and your sense of related events.
• Provide a list of all medications, including herbs and over-the-counter preparations. Collect them in a bag that you have at the ready to show to the doctor or intake assistant.
• Special considerations for telehealth. If this is a telehealth visit,

• • work with the staff ahead of time to be sure your loved one’s computer can connect properly. Make sure the video is clear and the audio functions work well for both hearing and speaking.
  • choose a quiet, private place for the visit. Ideally a room with privacy to respect your loved one’s confidentiality. Also, with minimal noise (no TV in the background) to reduce problems hearing or concentrating.
  • pay attention to lighting. You don’t want light behind your relative because that will cast them in silhouette. Light in front needs to be adjusted to avoid glare on glasses.
  • be ready with devices. Your loved one may need to have a blood pressure cuff nearby, or a thermometer. You may also want to have a smartphone handy because you may need to take a picture of a wound or rash.

Cold weather safety tips for indoors

The dangers of cold weather are obvious outdoors. But there are dangers indoors, too, most often because the house thermostat is set too low. People can die from being too cold. Older adults are especially at risk.

Signs of low body temperature (hypothermia). Shivering is the body’s first response to cold. Later symptoms include stiff or slowed movement, slurred speech, sleepiness, mental confusion, or a weak pulse.

If your loved one’s temperature is 96 degrees or less, call 911 for emergency assistance. While you wait, make sure the person you care for is dry. Cover him or her with a dry blanket and offer a warm, nonalcoholic beverage.

The key risk factors for hypothermia

• Health conditions that affect blood flow, such as heart disease, diabetes, and stroke
• Medications such as sleep aids and major tranquilizers
• Lack of physical activity
• Alcohol consumption and/or inadequate intake of liquids (dehydration)
• Concern about finances and the cost of heating

The key preventives

• A warm-enough house. Set the thermostat to 68–70 degrees. Even a home temperature of 60–65 degrees can set off hypothermia in an older person. Consider a thermostat that you can read remotely.
• Appropriate clothing. Many layers of light clothing trap body heat better than one heavy coat. If your family member is sedentary, consider adding a hat, mittens, or socks with fleecy slippers.
• Close doors to unused rooms. Also block drafts from windows and doors.
• Eat well and drink plenty of fluids. The body needs fuel to keep up its temperature.
• Consider a portable heat source. If you add a space heater in the bedroom or beside a favorite chair, be sure it is placed far from items that can catch fire.

Check in often to be sure they are doing well. Look for signs of hypothermia.

Options to reduce energy costs

• Add weather stripping around windows and doors. Hang curtains that keep heat in and cold out.
• Provide a personal heat source such as a hot water bottle or a warming bag that can be reheated in the microwave.
• For help with utility bills, contact your state’s branch of the national Low Income Home Energy Assistance Program (LIHEAP), or call the National Energy Assistance Referral (NEAR) project toll-free at 1-866-674-6327 for a referral.
• For help with making a home more energy efficient, contact the Weatherization Assistance Program.

Saving money on meds

Medicare’s prescription program feels a bit like Russian roulette: You are never quite sure when your loved one is going to hit the “doughnut hole” and have to pay the full cost of each medication. The doughnut hole calculator sponsored by the American Association of Retired Persons eliminates the suspense. Better yet, it identifies possible options to avoid the coverage gap altogether.

First, here are the rules of the game. If your loved one has Medicare Part D, he or she has signed up for a prescription drug plan with the following benefits:

• Initial coverage. The insured individual pays an annual deductible, and a per-prescription co-pay. The plan pays the rest, up to a specific amount. For 2009 this amount is $2700.
• Gap in coverage (the doughnut hole). The insured pays 100% of prescription costs until his or her total out-of-pocket expense reaches a specific limit. For 2009, this limit is $4350.
• Catastrophic coverage. The insured pays only 5% of prescription costs for the remainder of the calendar year. The plan pays the rest.

The doughnut hole calculator shows how your loved one’s costs accumulate over the months. It is quick and simple to use. Pull-down menus help you identify your family member’s plan, medications, and dosages. The calculator:
Presents a bar graph showing drug costs by month and if/when you’ll hit the doughnut hole.
Offers options of comparable lower cost drugs.
Prepares a letter to your doctor requesting consideration of the lower cost options.
Provides a printable wallet-size copy of your drug list.

If your loved one has limited income and resources, check to see if he or she qualifies for Medicare’s “Rx Extra Help” program.

Don’t forget: If you are considering switching your family member to a different prescription plan, the annual open enrollment period is November 15 to December 31.