Medicare Vs. Medicaid – The Definitive Guide A Guest Post by Kayda Norman

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Originally published on Quote Wizard at https://quotewizard.com/health-insurance/medicare-vs-medicaid

Every year, millions of Americans receive medical assistance through a pair of government funded programs: Medicare and Medicaid. Although they are often confused, they were created to help two separate groups in need of medical coverage.

Medicare provides health benefits to senior citizens. Those receiving care usually have to be at least 65 years old. Medicaid helps low-income families or children in need. Eligibility is generally based on income levels.

We’ll compare Medicare and Medicaid by looking at the history, eligibility, and benefits of both programs below.

History and Recent Changes

Medicare

The government created Medicare because senior citizens weren’t able to find quality healthcare at an affordable cost. President Lyndon B. Johnson signed the program into law on July 30, 1965. Initially, it only included Medicare Part A and Part B.  This is why they’re sometimes referred to as “Original Medicare.”

Over the years, this federal program expanded to cover more people, including those who are disabled or have end-stage renal disease. In 2003, regulations were created to allow private insurance companies to provide Medicare Parts A and B. These are called Medicare Advantage plans. Part D, the prescription portion of Medicare, was added in 2006.

Medicare and Obamacare

Although Medicare is separate from the Health Insurance Marketplace, Obamacare did change many things about Medicare.

It added certain preventive services without charging a co-pay or deductible. These services include procedures like mammograms and a yearly wellness visit. Another benefit the Affordable Care Act (ACA) added is discounts on brand name drugs. Now those who are in the “donut hole” or coverage gap can save 55 percent on brand name prescriptions.  Find out more about the donut hole and Medicare’s prescription program (Medicare Part D) here.

Medicaid

Although Medicaid was created the same year as Medicare, it was designed as a federal- and state-funded program. Because of this, Medicaid regulations differ from state to state. Medicare, on the other hand, is run by the federal government only.

Like Medicare, Medicaid has expanded over the years to allow more people into the program. According to the Centers for Medicare and Medicaid Services, Medicaid originally only provided medical coverage to those getting cash assistance. Now, others such as low-income families and the disabled are eligible.

Affordable Care Act and the Obamacare Gap

Ultimately, the goal of Obamacare was for every single American to have affordable healthcare. This is why the ACA gave states the option to expand Medicaid in 2014. This change allowed people under 65 whose families had an income below 133 percent of the Federal Poverty Level to enter the program. Currently, 19 states have not opted to expand Medicaid.

Originally, expanding Medicaid was a requirement under the ACA. Later, the requirement was dropped. This one small change created a big problem for hundreds of Americans known as the Obamacare Gap.

Why is this such an issue? The ACA states that Americans who are living above the poverty line can buy private health insurance plans. Anyone who has an income 133 percent below the poverty line can apply for no-cost state-run health insurance. This is the expanded version of Medicaid.

But because states can opt-out of the Medicaid expansion, those who are living below the poverty level but don’t meet the Medicaid requirements for their state have no affordable way to buy health coverage. Not exactly the outcome people were hoping for when they created the ACA.

To learn more about this gap, read our article “Obamacare Coverage Gap.”

Medicare and Medicaid Eligibility

Medicare

People who are 65 or older are eligible for Medicare as long as they’re also qualified to receive social security. To receive social security, you have to meet the following requirements:

  • Worked in the US a minimum of 10 years
  • Been a US citizen or legal resident for five years

Some people under 65 may also qualify for Medicare including those:

  • Who are permanently disabled and have received disability benefits for two years or more
  • With end-stage renal disease
  • With Lou Gehrig’s disease
  • Who are at least 62 years old and who have a spouse receiving Medicare

Medicaid

Under federal law, Medicaid must cover specific groups. However, state laws can then add extended coverage. This is why eligibility differs from state to state. Medicaid provides healthcare to the following groups:

  • Pregnant women
  • Children
  • Low-income families
  • Elderly
  • Disabled

Dual Eligibility

Yes, it’s possible to qualify for both Medicare and Medicaid. This can benefit policyholders since Medicaid pays for some Medicare fees like those from Medicare Part D. Medicaid will also cover medical procedures that Medicare won’t.

Not eligible for Medicare or Medicaid? Use QuoteWizard to compare health insurance plans.

Medicare and Medicaid Enrollment

Medicare

Parts A and B

There are specific timelines you must follow when signing up for Medicare. When you first receive Medicare, you’ll have a seven-month enrollment period. At this time, you can register for Original Medicare. This seven-month period includes:

  • Three months before you turn 65
  • The month you turn 65
  • Three months after you turn 65

If you’re eligible to get Part A for “free,” you can sign up for it anytime during or after your initial enrollment period. Anyone who has paid Medicare taxes is eligible to get Medicare for “free.” These taxes are automatically taken out of your paycheck.

People who missed signing up for Parts A and B during the seven-month period won’t be able to sign up again until next year’s General Enrollment period. The General Enrollment period is January 1 to March 31 every year. Sign up during this time and your coverage will kick in July 1.

Confused? Learn more about when you can sign up here.

Luckily, those getting social security or Railroad Retirement board benefits shouldn’t have to worry too much about such timelines. You’ll automatically be enrolled in Medicare Parts A and B. Also, you’ll receive information about Medicare a few months before you’re eligible.

While Medicare Part A is “free,” Medicare Part B requires you to pay a monthly premium. Because of this, you’re able to turn down part B coverage.

To turn down Part B before your coverage starts, follow the instructions on the back of your Medicare card. This card will be sent to you if you’re automatically enrolled.

If you want to sign up for Medicare and aren’t receiving social security benefits, you can apply at a Social Security office or online. To drop your Part B coverage (assuming you signed up yourself), you’ll also need to contact Social Security.

If your coverage has already started and you want to drop Part B, you’ll again contact Social Security. Chances are, though, you won’t be able to drop your plan until the next General Enrollment period.

Part C

You can enroll in a Medicare Advantage Plan instead of Parts A and B during your initial enrollment period. You’re also able to switch to this type of plan and drop Original Medicare during the Annual Election Period (AEP) every year. This occurs October 15 to December 7 every year. Similarly, if someone has a Medicare Advantage Plan and wants to switch to Parts A and B, they can do so during the AEP.

You can also drop your Medicare Advantage Plan and join Original Medicare during the Medicare Advantage Disenrollment Period. This is January 1 to February 14 annually. During this time, you may sign up for Medicare Part D. It’s important to note that you can’t switch from Original Medicare to a Medicare Advantage Plan during this period. You also won’t be able to change your Medicare Advantage Plan for a different one.

Part D

You won’t automatically be enrolled in the prescription portion of Medicare (Part D). You have to elect to receive this coverage.

MedSup Insurance

When you sign up for Medicare, you can also choose to get Medicare Supplement insurance, or MedSup coverage. This type of coverage also is called Medigap. You can buy MedSup through a private insurance company. It usually covers:

  • Co-pays
  • Deductibles
  • Co-insurance

You’re only eligible for Medigap if you have Original Medicare, not Medicare Part C.

Penalties

Policyholders who don’t sign up for Medicare Parts B and D when they’re first eligible might have to pay a late fee for as long as they have Part B or Part D. For more detailed information about late enrollment penalties, visit Medicare.gov.

Changing your plan

While you won’t need to sign up to receive Medicare each year, you’ll be able to change your plan annually. You can do this during the Medicare AEP. As discussed, this is when you can switch from a Medicare Advantage Plan to Original Medicare or vice versa. You may also enroll in a prescription plan or change your coverage. The changes you make during this period go into effect January 1.

Medicaid

To enroll in Medicaid, you first have to apply to see if you qualify (based on your income). Remember, states have different requirements for Medicaid eligibility. Check here to see if you qualify based on your salary.

Another way to apply for Medicaid is through the Health Insurance Marketplace or through your state Medicaid agency. The Centers for Medicare and Medicaid Services recommends you apply for Medicaid even if you’re not sure you’re eligible. If you are able to receive benefits, you will have met your requirements to have healthcare under the ACA. You won’t need to buy any additional health coverage.

Medicare and Medicaid Benefits

Medicare

Like all health insurance plans, Medicare isn’t a cut-and-dry program. It has four different parts. These include:

Part A

Medical insurance, or Part A, helps to pay for hospital costs such as:

  • Hospice
  • Skilled nursing facility care
  • Hospital care
  • Home health services

Costs: You won’t usually pay a monthly premium for Part A. This is paid for by the Medicare taxes you had taken out of your paycheck.

If you do need to pay for Part A, it will cost $411 a month.

Part B

Part B of Medicare is also referred to as medical insurance. It covers medically necessary procedures as well as preventive services. It pays for things like:

  • Clinical research
  • Lab tests
  • Surgeries
  • Doctor’s visits
  • Mental health
  • Ambulance services
  • Durable medical equipment

Costs: Unlike Part A, you do pay a premium for Medicare Part B. Usually this is automatically taken out from the following benefits:

  • Social Security
  • Railroad Retirement Board
  • Office of Personnel Management

The standard premium is $121.80. This may change depending on your income.

Together, Medicare Parts A and B make up Original Medicare.

Part C

Part C refers to a different way you can receive your Original Medicare. If you choose to get Part C, or a Medicare Advantage plan, then you’ll receive your Medicare coverage through a private insurance company.

Medicare Advantage plans must cover everything Original Medicare provides. The only exception is hospice care. If your Medicare Advantage plan doesn’t cover hospice care, Original Medicare will step in if needed.

Many people prefer to get Medicare Part C rather than Original Medicare because it often covers items Parts A and B don’t. This can include procedures that aren’t deemed “medically necessary,” like dental work and hearing tests.

Costs: It depends on the type of plan you choose. You may have a monthly premium, co-pay, and/or deductible.

Part D

Part D provides prescription benefits to Medicare policyholders. Participants who don’t sign up when they’re first eligible will have to pay a late enrollment fee.

Costs: Expenses depend on the drug plan you choose, but most Medicare prescription plans have a monthly charge.

Other potential expenses

Unfortunately, Medicare doesn’t cover all medical costs. As discussed, Medicare doesn’t provide annual ear, eye, and vision exams. And although you won’t have to pay a monthly premium for some parts of Medicare, you will still have co-pays and deductibles.

One way to pay for extra deductible costs is by purchasing MedSup. Looking to save on your MedSup plan? Shop around and compare quotes with multiple companies.

Medicaid

Medicaid benefits vary by state. That being said, states have to provide some benefits.

Though there are definite overlaps between what Medicaid and Medicare cover, in some cases Medicaid can provide extra insurance. While Medicare has restricted long-term care coverage, Medicaid pays for nursing home, assisted living, and other fees when needed.

“For those who need skilled nursing care, Medicare will cover a very limited number of days,” says Karen Roberts, a Medicaid Service Coordinator for a nonprofit agency in Rochester, New York. “Once a person has used up his or her resources, a social worker at a skilled nursing facility or hospital will help him or her apply for Medicaid, which then will pay without limit of days.”

According to the Medicaid.gov website, the mandatory benefits are:

  • Inpatient hospital services
  • Outpatient hospital services
  • Nursing facility services
  • Early and periodic screening, diagnostic, and treatment services
  • Family planning services
  • Physician services
  • Laboratory and X-ray services
  • Federally qualified health center services
  • Nurse midwife services
  • Certified pediatric and family nurse practitioner services (when licensed or otherwise recognized by the state)
  • Transportation to medical care
  • Tobacco cessation counseling for pregnant women

Here are some of the optional benefits and services states can provide:

  • Prescription drugs
  • Clinic services
  • Physical therapy
  • Dentures
  • Dental services
  • Podiatry services
  • Speech, hearing, and language disorder services
  • Personal care
  • Eyeglasses
  • Chiropractic services
  • Other diagnostic, screening, preventive, and rehabilitative services

These are only a few of the benefits states might offer through Medicaid. For a complete list visit Medicaid.gov.

Costs: There may be some small costs, but usually you won’t have to pay for covered procedures.

Frequently Asked Questions

Q: What is the difference between Medicare and Medicaid?

A: These two programs have a several differences, despite the fact that they were created under the same law. Medicare is a federally run insurance program primarily for citizens 65 years and older. Income isn’t a factor in determining whether you qualify. Some younger people may also be eligible if they have end-stage renal disease or Lou Gehrig’s disease.

Both the federal government and the states regulate Medicaid. It provides medical coverage for low-income families and children, the disabled, and pregnant women. Eligibility varies by state.

Q: What is the best way to compare private health insurance vs Medicare?

When deciding between Medicare or a private healthcare plan, you should know you’ll face several consequences if you don’t sign up for Medicare. These penalties only apply if you’re eligible for Medicare yourself, not if you qualify through a spouse.

For instance, if you decide to get Medicare Part B or D later, you’ll have to pay a penalty fee for the rest of the time you have the coverage.

According to Consumer Reports, you might also risk losing your Social Security benefits. In the eyes of the government, the two are linked and you can’t turn down Medicare without turning down Social Security.

In addition, you could have trouble finding a decent insurance plan due to age and pre-existing conditions. There are less private healthcare plans in general for senior citizens since most people end up using Medicare.

“For the most part, most insurance carriers will not accept an eligible [Medicare] individual for individual or private health insurance. The reason for this is that they will only cover what Medicare would not have covered and it leave the individual with higher out-of-pocket cost,” says Gladys Boutwell, Insurance Agent at PBP Insurance and author of Health Insurance Secrets Revealed. “Now, if an individual is eligible through a group plan, such as their own or their spouse, they are not obligated to sign up for Medicare and can maintain their group plan.”

If you’re looking at joining a group plan instead of Medicare, Boutwell stresses the importance of contacting an insurance agent. “The best way to compare Medicare with a group plan is to have an insurance agent help you. It will not cost anything to determine if Medicare and a supplement is best or if the group plan is best, based on needs,” she says.

Q: I’m eligible for Medicaid, but is it good insurance?

Medicaid is often the best choice for those who qualify because it is generally free. Of course, every program has its problems, including Medicaid.

“Medicaid covers most medical issues completely, but at low rates, so you may have difficulty finding medical providers,” Roberts says.

And because Medicaid is state run, the quality of care you receive differs across the country.

“Each state is different and providers may or may not treat Medicaid recipients different than those with private insurance,” Boutwell says. “The main reason for that is that they are paid a flat dollar for services for Medicaid.”

If you choose not to enroll in Medicaid, Boutwell warns you won’t be eligible for tax subsidies that help people pay for private insurance. So if you’re eligible and don’t enroll in Medicaid, you should be prepared to pay all of your private healthcare insurance costs on your own.

Q: What are the biggest challenges facing Medicare and Medicaid?

Boutwell believes Medicare and Medicaid both face their own unique challenges. She considers Medicare’s biggest problem to be getting the general public to understand what it does and doesn’t cover. Some people also don’t understand why they might need a Medicare Supplement plan.

“My suggestion is always to use an insurance professional to assist through the process, as there is no cost to the person,” Boutwell suggests.

Medicaid, on the other hand, has its own challenges. Because Medicaid is regulated through the state and federal government, there are different rules depending on where you live.

“This means that if somebody from California has Medi-Cal (California’s name for Medicaid) and they are visiting Oregon, their Medi-Cal will not cover services in Oregon,” Boutwell says. “Additionally, there may be up to a 45-day wait period for Medicaid to respond if the person qualifies or not. And then, there are limited providers that they can go to for their care, as not all providers accept Medicaid.”

Q: What do you see happening in the future with Medicaid and Medicare?

Roberts believes premiums will increase in the future for Medicare as well as co-pays and deductibles for Medicare Advantage plans.

“It’s hard to tell about Medicaid,” Roberts says. But she sees a push towards managed care. “Medicaid will probably push to get those it covers involved in that in hopes that it will help people’s health and coordinate their healthcare services.”

A Financial Advisor’s Perspective on Aging:How to Prepare for Senior Care Cost A Guest Post by Andy Smith

 

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ORIGINALLY POST IN A PLACE FOR MOM SENIOR LIVING NEWSLETTER

http://www.aplaceformom.com/senior-care-resources/articles/conversations/financial-discussions-with-aging-parents?mkt_tok=eyJpIjoiWm1Wa016Vm1NREkzTkRkaSIsInQiOiJNRFBwbVArTUZ1cUp2dzA5cFJXTWdYbzFJM0loSnFQMmVXQlhSSDNxS0NzeXdvSWc4Z2s0ZEpja0x0amdQOWxLUHhERldMdzg2SzhveUtqZ2xORGdIMm1TMW5wcXpzRnR3WmdyekZKcUlJRG1mUDV3RXZJWDFhOFRvbndoV1I0OCJ9

Going home to your parents’ house is a wonderful time where we get to spend quality time with our family. For those who live away from our parents, coming home can also be a time of recognition that they are getting older and may need extra help.

This year, take time to discuss aging, retirement and end-of-life affairs so that you hear directly from Mom and Dad about their specific wishes, enabling you to act on their behalf if anything happens. You’ll have the chance to implement a plan that protects not only them and their assets, but also you and yours.

Andy Smith, CFP®, Executive VP of Investments at The Mutual Fund Store and A Place for Mom Advisory Board member, provides financial planning to families on a daily basis and was kind enough to offer his expert guidance:

“It’s important to have the ‘tough conversation’ about finances and senior care sooner rather than later. On The Mutual Fund Show®, we talk about wanting people to do this while everyone’s healthy and sharp. The longer you wait, the more difficult and expensive these talks may be.”

THE REALITY OF RETIREMENT COSTS

Smith discusses how retirement costs are often much higher than people anticipate and can drastically affect the quality of your retirement years:

“Your average 65-year-old couple thinks they’ll spend around $50K on healthcare costs throughout retirement. In reality, their number’s closer to $241K. Depending on what they’ve done all along to prepare for retirement, they may need to drastically rethink some key pieces — Social Security strategies, healthcare cost management, debt service, estate planning… the list goes on. You have to look at all of these things, together, and you have to have the right full-scale plan in place.”

Smith recommends saving at least 10% of your gross income. Then, each year, he says you should try to save 1% more until you reach the maximum contribution limit for your employer-sponsored plans ($18K for people under the age of 50 and $24K for people over the age of 50).

Rarely do people save more than this, but if they do, that’s when it’s time to start looking at Roth IRAs or some sort of taxable brokerage account for overflow dollars.

Here’s an example of how saving 1% more each year will work for you:

Frank and Tina, 35, each earn an annual salary of $50,000 and start contributing 6% to their 401k on the same day. However, Tina increases her contributions by 1% each year until she reaches the recommended rate of 15%. Frank continues saving 6% annually and never boosts his contribution rate. Assuming annual 3% raises and a 7% annual rate of return, Tina’s balance will be $966,395.81 in 30 years, while Frank’s balance at the same time will be $453,013.86. Tina’s nest egg is worth $513,381.95 more than Frank’s because she made small changes each year to the amount she saved.

Families often come to Smith seeking this financial advice for their aging loved ones. When asked about the biggest misconception these families have, he said:

“Assumed health care costs is a big one: how people think they’re going to spend $50k on healthcare costs throughout their retirement, but that number is closer to $245k. An overwhelming majority of Americans think that Social Security is going to cover a huge part of their retirement income needs, or that there’s some magic bullet or secret formula for investing and retirement success. There’s not — it all comes down to saving as much as you can for as long as you can… all the way along.”

Whatever the “average” lifetime data is for a person, you need to have a plan for what happens if they live longer than expected. You also need to think about other costs like transportation. Transportation costs are going to be the second largest expense you have in retirement, which will account for 15% of your overall expenses.

PREPARING FOR THE CONVERSATION

If you know it’s time to talk with your loved ones about finances, but are having difficulty approaching the conversation, here are some pointers from Smith that can help you prepare:

  • Practice What You Want to Say. Just like with reading or acting, the more familiar you are with a subject, the more comfortable you will be and the more realistic things will sound. You don’t want to get too emotional, but you don’t want to be a robot, either.
  • Talk in a Comfortable Setting and Be Natural. Have a normal conversation. Act like yourself. You don’t want to heighten already-high emotions.
  • Ask Your Parents about Their Goals. It’s a great ice-breaker that provides a segue into deeper conversations:
    • When do they want to retire?
    • What does their end-of-life care look like?
    • Do they have a trusted advisor or attorney?

Smith has an excellent question to discuss with aging loved ones: “If you changed nothing about what you’re doing right now, what is the probability that your long-term plans will be successful?”

If, together, you determine that their long-term plan — or lack thereof — is not successful, he has a follow-up: “What can we change now to improve your probability of success so that you can reach your goals?”

The biggest mistake you can make is not having the conversation — it will only make things more difficult and expensive down the road.

SEEK A PROFESSIONAL’S HELP – BUT BE CAREFUL

It really helps to work with a professional advisor who can become a “quarterback… someone who can take certain burdens off the family,” notes Smith. However, make sure the person ‘on the other side of the table’ is not trying to push a product or just make a sale:

“Brokers push people into improper products for any number of reasons: greed, meeting quotas, etc. To avoid this mess, always work with a fiduciary — that’s what our advisors are: people who are legally-bound to put your loved one’s best interests first,” Smith candidly suggests.

Fiduciaries know that one size does not fit all when it comes to retirement planning, and they’ll work to get you organized and take inventory early in the process. They’ll also suggest having everyone present from the very beginning who needs to be involved in family discussions — because, more than likely, you’ll be having many conversations and you want everyone on the same page all along the way.

In partnership with your advisor, there are a few steps your family will need to take to get your aging loved one’s affairs in order:

GATHER NEEDED INFORMATION

Getting organized for all the legal documents surrounding your loved one’s estate means you’ll need to gather a lot of information. The Mutual Fund Store®’s Personal Affairs Organizer is easily downloaded and is a helpful tool that Smith shares and uses with his clients.

Here is some, but not all, of the information you‘ll need:

  • User names and passwords
  • Bank accounts
  • Retirement accounts
  • Proof of ownership (for example, a car or boat title and registration)
  • Marriage license
  • Insurance policies
  • Personal financial statements (including any outstanding debts owed)

Keep information in a secure location that’s easily accessible (a safety deposit box or safe) and known to a few trusted family members. (Don’t forget to share any keys or passwords needed to access the information!) Letting people know now where things are prevents a scramble later when emotions could be heightened and decisions would have to be made quickly.

PREPARE LEGAL DOCUMENTS (IF THEY’RE NOT ALREADY)

It is vital for your loved one, while physically and mentally able, to prepare key legal documents that will determine their end-of-life care, discuss their care wishes and protect their estate. Without these documents, families could accumulate significant costs while navigating the courts, and family relationships could become turbulent if disagreements arise regarding care for loved ones. Heartache and court costs could worsen more, too, if any loved ones suffer from cognitive impairment such as Alzheimer’s or dementia. These key documents prepared correctly, however, become like gifts to your family.

Documents to create and/or update that empower your family to better control their future?

  • Will – Someone will need to be appointed to serve as executor
  • Advanced directives, such as a living will and durable power of attorney for health care
  • Durable power of attorney for finances – Someone will have to be named as the legal authority to manage the property

UPDATE INFORMATION, AS NEEDED

While your loved one is of sound mind, it’s important to keep current all their necessary information and legal documents. Visits are great times to review your loved one’s wishes and estate plans to ensure everything remains in order. Smith comments, “Personal preferences may change over the years, so regularly revisiting your loved one’s plans and documents — just in simple, relaxed conversations — helps keep their wishes clear.”

Finally, remember that if your family is communicating, has a plan and is aware of your loved one’s health or financial issues, things are in far better shape and everyone is ready to act quickly when needed. Smith notes, “The key is to avoid tremendous amounts of emotion, headache, heartache and stress. If you’re working with a fiduciary, let that advisor be your quarterback as you work to protect assets and plan ahead.”

AFTER THE CONVERSATION

The first thing you should do after having the conversation with your loved one is to document everything and have each person document how they heard and understood the conversation. Then, come up with a common depiction of the event, so each person feels confident with the outcome. Having this documentation will make interaction with attorneys, accountants and financial advisors that much more seamless and materially worthwhile.

About Andy Smith  866-477-0836

Andy knows first-hand what’s on the mind of investors. As an advisor and CFP® practitioner with The Mutual Fund Store®, he works daily to help clients navigate the markets and provides investors with much-needed financial and retirement-planning direction.

Beyond his daily client interactions, Andy has spent more than a decade on the airwaves guiding listeners towards their investment and retirement goals… all the while offering sensible, actionable perspectives on finance, investing, and the national and global economies.

With more than 50 years of combined business experience, Andy and his co-host (and father!), Denny, have the background, experience and insight to help listeners with their financial questions each week on The Mutual Fund Show®.

Bed Sore Treatment: The Ultimate Guide A Guest Post by Tiffany Rubin, R.N. BSN

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ORIGINALLY POSTED BY JESSICA HEGG ON VIVE HEALTH: https://vivehealth.com/blogs/vive-blog/bed-sore-treatment

Bed sores are, unfortunately, one of the most common ailments resulting from mobility issues. It’s important to begin bed sore treatment at the first sign of any symptoms.  Pressure ulcers are much easier to deal with when they’re caught early.  Even better, if you understand a risk is present you can take precautions to reduce the likelihood of occurrence.

6 Crucial Tips for Successful Bed Sore Treatment

Your healthcare provider will want to examine the affected area or areas when diagnosing suspected bed sores. Surgery is usually not recommended as long as you have not progressed into later bed sore stages.

Here are simple tips to try that you can discuss with your healthcare provider:

1. Frequent Repositioning

If you are in a chair, wheelchair or bed for a long period of time you need to vary your position – This will help to facilitate blood flow and reduce pressure on your boney areas so you are less likely to get a bed sore. It is important to be regularly repositioned so the pressure is dispersed throughout the body.

Wheelchair Repositioning

  • Try shifting your weight by yourself every 15 minutes or so.  Go from left to right side of your buttox as well as shifting your position further forward or backward in your chair.
  • Consider a wheelchair or seat cushion to help re-distribute pressure across your bottom (high risk area). Avoid donut shaped cushions as they reduce blood flow to bottom increasing risk.
  • Consider a tilting, specialty wheelchair. These are expensive, but depending on your budget and access to a caregiver they can be worth it.

Bed Repositioning

  • Adjust position frequently.  Adjust between you left side, right side and back.  Ideally switching positions every 1-2 hours.
  • Consider a bed side rail to assist you with repositioning if you are unable to change positions without assistance.
  • If possible, adjust the elevation of your bed.  Do not raise it to more than 45 degrees to avoid too much pressure on the tailbone or possibility of shearing.
  • Alternating pressure mattresses provide automation to constant repositioning. Air compartments inflate or deflate (usually in 6 minute intervals) to reposition pressure areas across the body.  Alternating pressure mattresses come in 2 categories you can look into. Alternating pressure mattress overlay – pressure mattress gets placed on top of your regular or medical mattress. The overlay pad accommodates any sized mattress and can be secured underneath fitted sheets. An Alternating pressure mattress replacement – is a complete mattress replacement that goes on top of a medical bed frame. More robust system with low air loss. 

2. Proper Dressings and Wound Care

Proper dressing and cleaning of the pressure ulcer is essential.  Open wounds are particularly prone to infection. Appropriate care and use of dressings will promote healing and shield bacteria.

(Always avoid using hydrogen peroxide as it can further damage the skin.)

Proper care for bed sores is determined by the stage of the pressure sore:

Stage 1: If the skin of infected area is still intact the most important thing you can do is offload pressure immediately. Gently wash area with mild soap and water and consider asking your doctor about recommended moisturizers.
Stage 2: Be sure that area is kept clean and dry.  Use a saline rinse to rid of loose and dead tissue surrounding the bed sore.
Stage 3 & 4: Pressure sores that reach these stages are typically monitored and cared for by your health provider who will provide specific instructions for at-home care.

**Special treatment gels, foams, and dressings are available but discuss with your doctor which would be best for the condition of your bed sore.

3. Proper Nutrition

Making good food choices will help facilitate healing and help prevent future bed sores. Foods rich in vitamins A, C and E are ideal. Consider oranges, strawberries, tomatoes, broccoli, cauliflower, nuts, olives (and olive oil for cooking) as a good starting point.

Nutritional drinks, such as Juven,, support wound healing and can be incorporated into your bed sore treatment. Vitamin C, Zinc, and Omega-3s are also great supplements to include in your diet for tissue repair. (These supplements are available OTC, but remember to discuss with your doctor before starting your own regimen.)

Maintaining a healthy weight is is frequently overlooked. In many cases, bedridden patients lose bodyweight.  This means less protection between skin and bone.  Conversely, with excess weight there will be more pressure on the body creating a higher risk. Do you best to monitor your weight and make sure you are maintaining a healthy balance.

Advanced pressure ulcers can possibly be treated directly or orally with antibiotics – this would be something that your healthcare provider would discuss with you if he or she feels it’s necessary.

4. Prevent Further Injury or Shearing

Pressure ulcers and sensitive skin are susceptible to further injury with very minor force. You are at increased risk of damage from friction during repositioning or other basic movements.

Make sure to apply powder to your sheets to reduce friction. Do not engage in unnecessary exposure to pressure in sore areas.  Keep your skin as moisturized as possible by staying hydrated and get the ok from your doctor to utilize barrier cream.

5. Incontinence Management

Limited mobility combined with incontinence makes for a heightened risk of infection, particularly with open wounds. Diapers and bed incontinence pads need to be used to reduce bacteria exposure to skin. Protective lotions can also be used to shield the skin. In severe cases catheters or rectal tubes may be necessary, please consult with your healthcare provider for details.

6. Change Bedding and Clothing Frequently

A fresh set of clothes and sheets makes everyone feel better. A clean environment is especially important when bed sores or a risk of bed sores are present. During daily checks of the skin, make sure to change clothes and sheets to limit the ability for bacteria to spread. Try to time body inspection with clothing and sheet changes to avoid exposure to additional shearing or friction.

**Sheets and clothes should be made of cotton or breathable fabric. Some flannel or jersey materials are too dense, restricting airflow, and in turn inhibit healing.

Bonus Tip: Sheets can be used as a tool to help reposition bedridden patients. Sheets disperse pressure evenly across the body for gentle movement.

Avoiding Pressure Ulcers in Wheelchair

Dealing with the risk of pressure ulcers for wheelchair bound patients requires a slight variation in care and there are a few specifics you NEED to know.

1. Is your wheelchair the proper size and fit?

Factors to consider:

  • Amount of mobility
  • posture
  • discomfort level
  • inhibiting conditions

(please consult with your primary care physician before making your final selection)

Weight Restrictions:

Measure weight to ensure that desired wheelchair can properly support patient.  Also keep in mind the weight of the chair.  If you need a chair that can be easily transported, a lightweight design may be more appropriate.

The Seat:

Determine the necessary seat width you will need

It’s recommended that you measure width of patients hips and then add 2 inches

Next, you need to find the appropriate depth, measure from the back of the hip to the back of the knees and subtract 1 inch.

The Backrest:

Additional back support can be provided by certain wheelchair designs.  Again, assess the intended patient’s condition and necessities to determine most comfortable fit.

**With person seated in wheelchair, measure from collarbone to seat.

The Footrest:

Determine what special features may be needed.  Some patients require their legs to be lifted, and there are different size variations based on user’s height.

**Measure from the back of the knee to heel of the foot

The Armrests:

You may not have realized that wheelchairs are available with different armrest and height variations.

**The height of your armrests should be determined by measuring from the elbow to seat of chair with arms up and bent at 90-degree angle

Full-Length -> ideal for having to perform standing or pivoting transfers and provides surface that allows to additional push and support.

Desk-Length -> designed for patients who spend time sitting at a surface or desk, and allow for you to comfortably get closer.

2. Check for proper fit at leats twice a year

The patient may gain or lose weight over the course of time which can compromise the proper fit.

Take note of any painful areas, and let your doctor know immediately!

3. Repositioning

Shift weight to take pressure off of certain areas and promote blood flow.  Leaning forward and side to side are the easiest movements

Caregivers must assist with shift weight every 15-20 mins.  We realize that this can be very overwhelming to manage and almost unrealistic

So consider the use of medical aids. Just like bed sores, treatment for pressure ulcers from a wheelchair can be enhanced with the use of alternating pressure pads or cushions.

WARNING: Do not utilize “donut” hemorrhoid cushions
(these are not designed to reduce pressure points and can worsen your condition)

What are Bed Sores?

A bed sore is an area on your skin that’s irritated and painful due to prolonged pressure.

One of the very beginning signs of a developing bed sore is sore skin.  Light skin tones will show that area is red, discolored, or darkening; while darker skin tones present purple, blueish, or shiny areas.  If untreated, these spots generally turn hard and warm to touch as they progress into stage 2 ulcers. Pressure ulcers are categorized in stages from 1 to 4, stage 1 being least severe and stage 4 being most severe.

Stages of Pressure Ulcers

Pressure sores are categorized in one of four ways:

Stage One

Your skin is discolored, but not broken. If you have a light complexion, the pressure ulcer may appear red or could look blue or purple. If you have a dark complexion, it may look white.

stage one bed sores

Stage Two

Your skin has a break in it and there may be some dead skin around the wound. You may also notice a reddish-pink area in the center, which could also involve a blistered area.

stage two bed sores

Stage Three

The pressure ulcer takes on the appearance of a crater and may go into your fat layer. The pressure sore may also have some pus or drainage.

stage three bed sores

Stage Four

A bed sore that is this deep involves your muscle, bone and possibly tendons and joints. Your healthcare provider may also notice a substance referred to as eschar.

stage four bed sores

In extreme cases, a bed sore may actually be unstageable , but this is rare if you’re seeking treatment. In this particular case, the tissue layers involved would need to be surgically removed.

Risk Factors

People who have the highest risk for bed sores are typically:

  •      Bedridden
  •      Spend most of their day in a wheelchair
  •      Incontinent
  •      The elderly (due to decrease skin elasticity)
  •      Diabetic
  •      Have fragile skin

If you are at risk for bed sores it is important you implement a prevention plan. Movement is the best way to avoid bed sores. Make sure you stay as active as possible, try to schedule fixed times for position changes and exercise into your daily routine.

It’s also important to make sure that you eat properly and drink plenty of water. Poor nutrition can increase your chances of getting pressure sores, especially if you aren’t getting enough vitamin C, protein and zinc.

Those who smoke are also at a higher risk for bed sores. Nicotine will hinder your circulation and slow your healing process.

Bed Sore Causes

When there is too much pressure on your skin for an extended period of time, it diminishes the blood flow to that area. This increases your chances of developing a pressure ulcer. A couple of other causes are:

If you have frail, thin skin, a bruise or a scrape can lead to a pressure sore.

The friction to your skin that can come from a wheelchair that is an improper fit, or the head of your bed raised too high.

Bed – Most vulnerable parts of body for pressure ulcers

  • Tailbone
  • Back of Head
  • Buttocks
  • Shoulders
  • Heels
  • Backs of arms or legs
  • Spine
  • Ankle
  • Knee

vulnerable pressure points laying down

Wheelchair – Most vulnerable parts of body for pressure ulcers

  • Shoulder Blade
  • Buttocks
  • Heel
  • Ball of Foot

vulnerable pressure points in wheelchair

Complications:

Ignored or improperly treated bed sores can lead to some very scary complications.

-Pressure ulcers that advance to stage 3 & 4 can become life threatening and require attention immediately.

-Lack of treatment may lead to amputations of affected areas

-Infections can spread to other areas of the body such as your blood, heart, and bones

What’s next?

STICK TO THE PLAN!

It’s important to follow a routine bed sore treatment plan.Take the time to consistently apply the regimen you and your healthcare provider have put together using our treatment tips and recommended products. Remember, knowing how to treat bed sores will help to prevent future ones. This will be your best line of defense for bringing about the quickest recovery and return to your best quality of life.

This article has been approved by Tiffany Rubin, R.N. BSN
  Nursenextdoordelaware.com

 

A Geriatric Psychologist’s Perspective on Aging Parents: Guest Post by Dr. Melissa Henston

walker

5 STEPS TO TAKE DURING A VISIT

Spending quality time with loved ones is usually something you look forward to. But when you have aging parents or loved ones, going home to see them can sometimes signify a rather different, and at times, stressful experience.

You may already have an inkling that Mom, Dad or a favorite aunt or uncle is having trouble with everyday life, but sometimes seeing changes in family members after months – or maybe years – of not seeing them can be disquieting. People change in their later years, and sometimes they can decline in health and spirit faster than you expect.

A Place for Mom expert and geriatric psychologist Dr. Melissa Henston provides some guidance on how to not only spot common problems, but tips on how to deal with any issues to get your elderly loved one the help they need.

1. NOTICE WHEN SOMETHING IS “OFF”

You can spot problems the minute you drive up to your loved one’s house, Henston says.

“There are a whole bunch of warning signs that are easy to spot. For example, the exterior of the house has peeling paint, or the driveway isn’t shoveled or the walkway isn’t treated. Once you enter the home, newspapers are still in plastic wrap and mail is piled up. Maybe the house isn’t as clean as normal or has an odor. You can usually tell when something is ‘off’.”

Having a grandmother who suffered from Alzheimer’s in tandem with working in the nursing home practice in her ‘previous life’ (during college), Dr. Henston has a personal connection to the elderly. She decided from a young age that her primary focus in psychology would be issues in aging, and she has devoted her practice to improving the lives of the elderly, informing families about the signs that their loved ones need help, and helping find the right care options for each unique situation.

Since a health crisis in the elderly can escalate quickly and catch everyone involved off guard, it’s important to not ignore signs that something may be wrong. Ideally, families will have conversations with their children or loved ones about getting their affairs in order and end of life care well in advance of having any issues, but here are some signs to be cognizant of when visiting aging loved ones:

  • House and yard need care / maintenance
  • Disheveled clothing
  • Broken appliances
  • Spoiled / expired groceries
  • Poor personal hygiene
  • Cluttered / disorganized house
  • Depressed or low energy temperament

Henston emphasizes the importance to noting anything out of character or outside of normal behavior. She remembers personally having the discussion of green eggs and ham with her own father. “I told my dad, ‘Dad, you can’t eat this stuff. Ham isn’t supposed to be green.'”

If health or happiness seems to be compromised, it’s time to have a conversation and address problems.

2. APPROACH THE “TOUGH CONVERSATION” WITH CARE

Tread delicately when it comes to discussing retirement plans or end-of-life care. Henston comments, “Typically you need to look for the opening and opportunity, rather than just jumping in. Don’t try to take control. Try to get a natural conversation going.”

Remember that parents still consider you their child. You need to respect this relationship. Here are a few tips for setting the right ambiance for a positive and effective talk:

    • Sit in a comfortable location, such as over coffee.
    • Start with a normal, conversational tone.
    • Ask open-ended questions, such as “How is it around the house?” or “How is driving going?” or “What have you and Dad been doing for fun lately?” to get the conversation flowing.

3. DON’T FEEL GUILTY

Henston relays that guilt is one of the biggest problems for family members. Many families make promises to their loved ones that they will care for them, but sometimes this just isn’t feasible. Senior living is often the best option for expert care, socializing and good quality of life. She notes:

“Mom, Dad, aunts and uncles — even spouses — feel a tremendous amount of guilt about putting their loved ones in senior living. But the most important thing is to overcome the guilt and assess the situation. Look at the logistics and whether caring for your loved one is accommodating to everyone’s life. If there is a single parent, finances may be a problem. But the biggest problem is often that caring for them can be a huge disruption to your life and their life. In reality it doesn’t work out well.”

It’s important to also remember that the role of caregiver may fall solely on the elderly partner — who may have physical limitations. In many cases, caregiving is passed to family members who may or may not have the time, finances or necessary skills to provide the best care for their aging loved one. Families need to re-evaluate their initial promise and determine what is truly the best choice for their loved one.

So much goes into the decision of caring for an older relative. Here are some questions Henston notes are important to consider:

      • Can I take time off from work?
      • Can I afford to stop work for an extended period of time?
      • Can my children and older relative co-exist in harmony?
      • Will my children be able to tolerate not always coming first?
      • How will this impact my relationship?
      • How will this impact my relationship with my older relative?
      • How will my siblings and I manage this as a team?
      • How will any of this be paid for?

This line of questioning is totally realistic and an important part of the process of making informed decisions. It’s important to consider these questions before having the ‘tough conversation’ with your loved one. Henston comments,

“The ‘promise’ is often made during an emotional time in which we do not feel we have many options. There are common emotional roadblocks when making difficult choices about caregiving, and families might want to consider seeking practical guidance to help all parties feel more confident during the transition.”

4. HAVE AN HONEST CONVERSATION

Elderly loved ones usually appreciate an honest conversation. If you discuss that it’s important to communicate their wishes for retirement and end-of-life care, you’ll go farther than if you are condescending or dishonest.

Include them in the decision-making as it helps them feel as though they’re not being “put out to pasture.” Talk to them about their options; whether they include staying in their family home and what that entails, or if they want to explore and tour senior living and retirement communities to see if any seem to be the right ‘fit.’ Many people still have a stereotypical image of what assisted living and nursing homes look like. Today communities offer anything from comfortable and intimate settings to large, almost resort-like communities that offer social activities and amenities. Does your loved one like fancy, intimate, or down-home and cozy? If they help you find one that is appealing, they may be able to get over the stigma and stereotypical view.

5. CONSIDER THE RISKS

Henston discusses that it’s important to think of the risks involved if seniors live alone if they’re no longer capable. “There are many risks to consider if someone is truly living alone and shouldn’t be,” she relays. “For example, if there’s a physical issue where the senior has trouble getting around and they fall or get hurt it can be very scary. There was an elderly lady sitting on her bathroom floor who had fallen and couldn’t get up for 18 hours. Finally a neighbor noticed she hadn’t picked up the paper and checked on her to discover the problem.”

Here are some other issues to consider:

      • Elder Fraud
      • Isolation
      • Physical Constraints
      • Mental Constraints

If your loved one suffers from any of the above, there could be many consequences. From economical problems to depression and health problems; there are many things to think about. “If an elderly person can’t drive and get out easily, they can become depressed – it can become a situation of being imprisoned,” Henston candidly notes.

Above all else, approach the conversation as though it is a gift. You are concerned about their well-being and welfare. Henston reminds us, “Treat your aging loved one with love, respect, kindness and compassion. Consider what is truly the best decision for everyone involved.”

About Dr. Melissa Henston, Geriatric Psychologist

Dr. Melissa Henston is a geriatric psychologist in private practice with Colorado NeuroBehavioral Health, where she helps seniors and caregivers understand and navigate physical, cognitive and mental health changes. Additionally, Dr. Henston is a professor at the University at Denver, Graduate School of Psychology, where she teaches “Aging and Geriatric Psychology” to doctoral students.

Dr. Henston’s philosophy is that getting older is a unique process that requires self-acceptance and awareness to life values in order to achieve successful aging. She has worked with the Alzheimer’s Association, presented at conferences on aging, and lectured at the University of Colorado Health Sciences Center. She diligently works with families who are facing problems that may develop as parents transition into needing more care and performs neuropsychological evaluations on older clients to help them understand cognitive issues that can arise with aging.

http://www.aplaceformom.com/senior-care-

4 Basic Facts About Medicare :Guest Post By : GoHealth

medicaid

Originally Post on Senior Living Blog: October 16, 2016

http://www.aplaceformom.com/blog/10-06-16-basic-facts-about-medicare/

Basic Facts About Medicare

But what exactly is Medicare? What are your coverage options? Why do you need it? We take a look at four basic facts you need to know before enrolling in Medicare coverage.

1. Different plans cover different benefits.

So what are your different Medicare insurance options?

Original Medicare – or Parts A and B – covers hospital and basic medical care. Once you turn 65, you will be automatically enrolled in Part A.

Medicare Supplement – or Medigap – plans can help you pay for some health care costs not covered by Original Medicare.

Medicare Advantage – or Part C – is a private insurance option which covers the benefits of Parts A & B. Many Medicare Advantage plans also offer prescription drug coverage.

Lastly, a prescription drug plan – or Part D – offers coverage for different prescription medications.

2. The basics are required to move forward.

If you think you might want Medicare Advantage, you must first have Original Medicare, or Parts A & B. While you’ll likely automatically be enrolled in Part A once you turn 65, you must actively enroll in Part B.

3. Medicare is different than Medicaid.

They might sound similar and both start with the letter M, but Medicare and Medicaid are very different programs. We’ve already established that Medicare is health insurance coverage for those individuals aged 65 and over. Medicaid is a federally-funded health insurance program mainly for individuals and families with low incomes. Pregnant women and people with disabilities may also get coverage through Medicaid.

4. Note your needed prescription drug coverage.

Medicare Part D offers different plan options that cover different prescription medications. If choosing a Part D plan, make note of which prescriptions you or your loved ones will need in the near future. Medicare Advantage also offers some prescription drug coverage, so it’s important to review your specific needs before choosing between Part D plan options and Medicare Advantage.

Medicare has neither reviewed nor endorsed this information. 

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