May 162012

Did you talk to your parents yet? For that matter, have you talked with your own spouse and children? Do they know your wishes? Do you know your wishes? Is any of this in writing?

Today, if you do nothing else, fill out your advance directives. Encourage your parents, especially if they are elderly, to put their wishes in writing also. These are simply forms that tell medical providers what you want done in case you are unable to tell us yourself due to illness or injury. It is planning for the inevitable in advance. A living will is your directive on what you want done in regard to life-sustaining measures such as resuscitation, machines and tubes. A surrogate designation is a person you have chosen to make those decisions for you in the event a decision is needed. It should be someone you trust and that you have told your wishes to. If it is your desire that everything be done to keep you alive as long as possible, they need to know that. If you desire is comfort measures only, they need to know that too.

You do not have to have these forms drawn up by an attorney because there are free ones all over the internet. You should however, know the laws in your country or state and you might wish to discuss it with an attorney, especially if you are not familiar with these concepts.

You can start here: Advance Directives.

They have downloadable, state specific, forms as well as more information on the subject. Your local hospital and hospices will also have information on advance directives and can talk to you more about them. You owe it to the people you love to do this one thing if you have not done so already. These simple pieces of paper can also save a lot of family squabbling and heartache. You would be surprised how often people respond completely out of character when faced with the death of a loved one.

Another form that many people are turning to is called, Five Wishes. It has been approved in all but eight states. This is gaining in popularity and because of the terminology, wishes as opposed to will, people are more open to using this. You can find more information at Five Wishes. Five Wishes addresses your persona, emotional, and spiritual needs as well as your medical wishes. It is written in simple to understand language and personally I think it is a wonderful tool that everyone should at least look at using. There is a nominal charge ($5.00) for the form but you can download a sample to see what you are getting.

As a caregiver, you should bring up the subject of advance directives with your loved one. They have the right to express their wishes and in fact may wish they could but they are afraid of upsetting you. They know they are ill, they know they feel bad and they usually know they do not have long left to live; just as my patient did.

He wanted to talk about it. He had questions and he wanted to know what would be done and what choices he had. When he asked that question of me and I answered him, he and his wife were able to have a dialog and instead of spending his remaining few months tiptoeing around each other, they spent it just enjoying what time they had left.

In case you are wondering how I answered that question I will tell you. I wish I could take credit with the words that came out of my mouth that day but the truth is, they were given to me a few years earlier when I was going through my own struggle of dealing with so many of my patients dying.

Everyone has their own beliefs about life and death and I do my best to respect them all and not shove mine down anyone’s throat. Because I knew this man and his family, I knew I could say what I did.

I looked him in the eye and said, “I don’t know what it’s like to die and I’ll do my best to make sure you don’t suffer. But someone once told me that every time someone you love dies, they take a piece of you with them to be closer to God.”

May 152012

“What’s it like to die?” He sat in his wheelchair in the middle of the kitchen, looking to me as if I had all the answers. His wife sat nearby and gave a soft gasp of astonishment at his question. He had cirrhosis of the liver or liver cancer, I cannot remember which now. I do not remember the disease, but I remember him and his wife. And I remember that day and that question.

When I first went out to the home I knew his diagnosis was terminal. His wife and kids knew it too. But no one had told him. I was a bit surprised to find his family that naive. But it was too early in the relationship for me to explain to her that he had the right to know. When you are in someone’s home, especially in a professional capacity, it is a balancing act to earn trust.

In the United States, talk of death is traditionally avoided, as if by ignoring it, we can defeat it. And our desire to defeat it is evidenced in our constant battle to raise awareness about every terminal illness and find a cure. I would like to think it is because we love life so much but I suspect the truth is our fear of death. And we perpetuate that fear by not talking about it. It is not looked at as a part of the natural order of things but an enemy to be fought against.

When I first started nursing 29 years ago, I had never heard of living wills and advance directives; the right to die idea was just starting to take hold. I wish I could say that we are more enlightened now, but that is far from the truth.

People are brought in to the hospitals every day, with nothing in writing and no one appointed to make decisions for them. They have not told anyone whether or not they wish to be hooked up to machines or fed through a tube if there is no hope of recovery. And the burden then falls to the family to make that decision and many of them feel guilty, as if they are being asked to kill their loved one. Even though they may know intellectually that it is the right thing to do, it tears them apart.

On the other hand, there are those who have discussed it with their family, who have made it explicitly clear what they want done and do not want done. They have put it in writing, made their own funeral arrangements, done everything they can think of to prepare for the inevitable. When their time comes, the family is still sad, but they can grieve the loss of their loved one rather than wrestle with decisions, uncertain what to do. If a decision is left to be made they are fairly certain what their loved one wanted and they do not suffer from guilt.

As you learned from yesterday’s blog, even with everything discussed, a nurse who has seen the ugly side of prolonging life in terminal cases, the decision was still a hard one to make. If your elderly parents have not filled out their own Advanced Directives, perhaps it is time to have a conversation with them. They may find it a relief to talk about it.

Tomorrow my answer to the question, “What’s it like to die?”

May 142012

When I first started working in homecare my primary area was the drug district of the county. Crack was just coming onto the drug scene and the dealers would literally hold the bags of crack out hawking the price when I drove by. Once they learned that I was a nurse and in the area only to do a job they began watching out for me. But that is another story. I am telling you this so you will understand why Mrs. Boone and the director picked me to be their information source.

Mrs. Boone was a nurse who had come out of retirement when her husband retired. She was an older woman who always wore a skirt and did not work on Tuesdays because that was when her Bible study group met. She was the kind of person who never had to tell you she was a Christian and never judged anyone who was not. We all liked and respected her.

One morning as I arrived at work the director opened her office door and motioned me to enter. Sitting inside was Mrs. Boone. Before I could even say good morning, Mrs. Boone asked me, “Do you know where I can buy some pot?” My mouth literally hung open and I could not utter a single word. Mrs. Boone and the director both laughed at my reaction and I know it took me a full minute before I could say a word. That was the last question I expected!

Mrs. Boone usually volunteered to take on the most challenging of patients, one of whom was a young mother dieing of breast cancer. The mom was not handling the morphine well, could not eat and was always nauseated. Mrs. Boone had talked with the doctor and they had tried everything they knew. But the idea that Mrs. Boone would even consider recommending marijuana much less purchasing it herself was completely beyond my comprehension.

I told her to talk to the lady’s teenage daughter. She would know where to get it and if she got caught, the worst she would get would be a slap on the wrist. No way was I gonna buy it and I knew Mrs. Boone was not sneaky enough. I assumed she followed my advice because when I asked her later, the patient had acquired the pot and was doing well with it.

Our director was a former hospice nurse and she had seen how well marijuana worked for some people. It helps reduce pain, stimulates the appetite and lowers nausea. It also can produce a feeling of euphoria and help to combat depression. (I have to admit that I get somewhat amused at the literature that lists a feeling of euphoria as a side effect as if that is a bad thing.)

I once took care of a quadriplegic who saved the Valium his doctor gave him to control his severe muscle spasms for when he could not obtain pot. He claimed the pot worked better and he was concerned about becoming addicted to the Valium. And in all honesty, after I had seen the severity of his muscle spasms and how quickly the pot worked I only requested he not smoke it while I was there. AIDS patients, those with multiple sclerosis, sufferers of depression, people with Chron’s disease and whole list of other illnesses claim to be helped by smoking pot.

It is not legal to use marijuana for medicinal purposes in my state but that does not stop healthcare professionals from quietly recommending it to some patients. We look the other way when a patient tells us that they smoke pot because we understand that for some people, it really is a viable treatment option. We just do not admit that out loud.

Like any medication there is not guarantee that marijuana will help and is not without potential side effects such as paranoia, short-term memory impairment, difficulty learning, loss of coordination, increased heart rate or the exacerbation of an already existing lung condition. And of course the previously mentioned euphoria. Most of these, however, only last a short while.

Unfortunately, our current political climate is not conducive to scientific testing of pot and its usefulness, so most evidence is anecdotal. It may be just producing a placebo effect for those who claim it helps them. However, there is some research available and a website that offers a more balanced look at the use of medical marijuana.

Just remember, it is not legal for medical use in all states. If you live in a state where it is legal for medicinal purposes, you must have a prescription and most other states will not honor it. Also, it is still a federal offense no matter where you live.

May 072012

Are your elderly parents and their medical identity safe?

When I first heard of medical identity theft, I was confused. Why would anyone want to steal someone’s medical identity? The answer is for drugs, surgery, medical treatments and in some cases false billing. Like traditional identity theft, someone stealing your medical identity can affect your finances but it can also affect your health.

If someone is using your parent’s identity to get prescription medications, especially those that are labeled controlled substances, it could trigger an investigation of your parents. They could be denied health coverage for a condition they don’t have or try to make a legitimate claim only to be told they have reached their maximum coverage. They could be billed for services they did not receive.

With the age of computerized everything, information about the thief would be entered in they name, such as blood type, allergies, etc. and they could end up receiving improper treatment that could lead to injury, illness or worse.

Steps To Prevent Medical Identity Theft

  • Educate your parents to protect their Social Security Number, Medicare Number and Insurance information.
  • Beware of free offers for medical tests, equipment or services that then ask for Medicare or insurance information.
  • Never let anyone use their medical ID or information. Not only is it illegal it can be dangerous.
  • If their Medicare card is lost or stolen report it right away. Call Social Security at 1-800-772-1213 (TTY 1-800-325-0778) for a replacement.

Signs of Medical Identity Theft

When reviewing your parent’s claims information:

  • Are there medical services listed that they did not receive,
  • Charges for doctor’s they have never seen?
  • Are the dates listed for office visits correct?
  • Charges for medical equipment they do not have or use?
  • Were they billed for the same thing twice?

Review credit reports for any unpaid medical services or equipment that they never received.

Have your parents received notices from debt collector’s about medical debt they do not owe?

Have your parents tried to make a legitimate insurance claim and been told they have reached their limit?

Have your parents receive notice that coverage has been denied due to an illness they do not have?

Protect Them

Educate your parents about medical identity theft and what they can do to protect themselves.

Do not give out your parent’s personal or medical information over the phone or through the mail unless you initiated contact.

Beware offers of free medical services or products if they ask for health plan information. If the service or product is free, they do not need that information. Medical identity thieves may pose as employees of insurance companies, doctors’ offices, clinics, pharmacies, and even government agencies to get people to reveal their personal information.

As a caregiver of an older person, you should realize they are often targeted. Be sure to inform them of the danger of giving out personal health information. Read any bills carefully, look for the date of service and the name of the provider. If there is a discrepancy contact the health plan to report it immediately.

Also monitor you and your parent’s credit reports for any discrepancies. Keep a record of any hospitalizations, doctor appointments, treatments, medical supplies and medications. Your parent’s or you if you have their permission or guardianship, can also request copies of medical records.

If you believe your parent(s) have been a victim of medical identity theft:
1. Contact their healthcare provider. It could be a simple mistake.
2. If this does not solve the problem, report questionable charges to Medicare and any other insurance providers they may have.
3. If you suspect Medicare fraud contact the Department of Health & Human Services Office of Inspector General.
4. File a complaint with the FTC Federal Trade Commission, their local police, their health insurance/plan provider, as well as the three major credit reporting companies.
5. If coverage has been denied based on false claims or misinformation, file an appeal.
6. Hire an attorney. If your parent has had their medical identity stolen, the correction process is going to be difficult and time-consuming. A good attorney can make the process easier, less painful, less stressful and in the end, less expensive. Let them do what they do best.

You can find more information and helpful links at:

FTC Medical ID Theft

OIG Medical ID Theft

Get a free credit report each year by calling 1-877-322-8228

If you need help reading your Medicare Summary Notice: Medicare Summary Notice

An interesting article from the Journal of the American Medical Association, JAMA: Medical Identity Theft A Growing Problem