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How to Manage Elderly Parent Healthcare Disasters
Pamela D. Wilson - Caregiving Expert, Advocate & Speaker Pamela D. Wilson - Caregiving Expert, Advocate & Speaker
For Immediate Release:
Dateline: Denver, CO
Wednesday, May 22, 2024


How to Manage Elderly Parent Healthcare Disasters

The Caring Generation®—Episode 193, May 22, 2024. Elderly parent healthcare disasters often happen unexpectedly. High levels of caregiver stress result from managing falls, fractures, memory loss, and other health conditions that are affected by various factors. Caregiving expert Pamela D Wilson shares strategies to get ahead of health issues before they get ahead of you and your loved ones.

How to Deal With Elderly Parent Healthcare Disasters

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Elderly parent healthcare disasters happen unexpectedly. High levels of caregiver stress result from managing falls and fractures, memory loss and related health conditions, and medication-related side effects that are affected by various factors.
The word disaster for this blog post is situational. How often have you heard someone say, “This is such a disaster, what a mess. I never thought this would happen or that was unexpected.”
In this transcript and additional information for The Caring Generation Episode 193, you will find strategies and proven tips to get ahead of unforeseen health issues before they negatively impact you or your loved ones. Creating an emergency medical plan for elderly parents is a good idea.
These include:
  • The benefits of having a trusted primary care physician, especially for referrals or pre-authorization of medical care treatments
  • How Medicare plans can affect access to medical care
  • The relationship between hip fractures, surgery, and memory loss
  • The benefits of specialists for managing health conditions and medications
If you have been taking parents to see doctors or going for tests or treatments, you know that the more interaction you have with healthcare systems, the more challenging coordinating care can be. In today’s virtual world, the staff you talk to on the phone may not physically be at your doctor’s office. They might be in a different state or another part of the world.
If your loved one is relatively healthy, the information and recommendations you will find are even more important. A loved one’s health condition can change overnight. You may find yourself unprepared to deal with a care system with little interest in helping you.
If you’re already feeling overwhelmed about finding care for elderly parents, these tips and strategies will help.

Benefits of Having a Trusted Primary Care Physician

Seeing a primary care physician you and your parents trust at least once a year can make access to care and medical treatments easier—especially in the event of a healthcare disaster. The doctor can access prior medical appointment notes, review health diagnoses, and prescribe medications. The office staff is more likely to be helpful if a parent needs insurance pre-authorization for treatment or medication.
Alternatively, in the event of a health emergency, going to a walk-in clinic may be convenient, but it’s not the best for ongoing medical care and follow-ups. The staff in these clinics changes frequently.
The same applies to using emergency rooms as a replacement for having a relationship with a primary care physician. Like walk-in clinics, hospital emergency rooms do not offer follow-up care.
So, while the immediate issue may be treated at a walk-in clinic or the emergency room, there may be other conditions that would benefit from attention and ongoing care.
If your parents do not trust or like their current physician, making a change can seem like a hurdle. However, it is worth the effort to find someone you feel you can work with.

How Medicare Plans Can Affect Access to Medical Care

There are two types of insurance for persons 65 or older: original Medicare—the red, white, and blue card—or Medicare Advantage, known as fee for service. With original Medicare, you can see any doctor who accepts Medicare. Medicare pays 80% of costs. A health insurance supplement plan can be purchased to cover the remaining 20%.
Medicare Advantage plans are known as managed care. You must see a doctor within the health insurance network. MA plans are offered by private insurance companies. In many cases the same companies who offered private insurance through an employer plan while you were working.
The goal of Medicare Advantage plans for persons over age 65 is to contain or limit care costs to deliver profits to the corporation and its shareholders.
The Medicare Advantage disadvantage is that when claims, treatments, and pre-authorizations are denied, patients and their caregivers spend hours navigating the appeals process with their doctor’s office.
So, know that the type of Medicare chosen by an elderly parent makes a difference. While Advantage plans may be lower in cost, there is a reason. MA plans focus on controlling costs, which means how much care they provide for their members.
Even still many elderly and their caregivers are surprised to learn that Medicare doesn’t pay for everything. Many care costs, like in-home caregivers or community care, are paid for privately.

New CMS Regulations for Medicare Advantage Plans Take Effect in 2026

Challenges specific to pre-authorizations by Medicare Advantage plans have been confirmed as a known problem. CMS, The Centers for Medicare and Medicaid, recently issued a final rule 2024-00895.
This rule prevents Medicare Advantage plans from delaying pre-authorizations beginning in 2026. Responses to pre-authorization requests must be received within seven calendar days or less in an emergency.
Timelines for pre-authorizations or pre-approvals are vital because persons over age 65 have multiple medical conditions like heart conditions, circulatory conditions that result in strokes, lung conditions, diabetes, or cancer plus dementia or Alzheimer’s disease.
For caregivers and patients, avoiding elderly parent healthcare disasters means understanding how these conditions interact with each other. Research confirms that at least 50% of persons over age 65 have five or more health conditions plus memory loss. Keeping elderly parents healthy requires looking at exercise, nutrition, and a number of other factors.
Persons with early memory loss—that may be undiagnosed face potential disasters waiting to happen. Older adults with memory loss can experience a loss or weakening of physical function.
This means difficulty with walking or balance, tripping on curbs, having difficulty walking up or down stairs, or walking distances. Healthcare researchers question if memory loss or other conditions pre-date falls and hip fractures.

The Effect of Surgery on Persons with Memory Loss

Let’s look at what happens when an elderly parent healthcare disaster like a fall or hip fracture happens.
  • What is known is that if there is any memory loss, the trauma of hip surgery fast-forwards the memory loss, and the person may never cognitively be the same.
  • Doctors or surgeons who do not have experience with multiple health conditions and memory loss rarely counsel or advise family caregivers about the combined effects of health problems and memory loss.
Even if there is no memory loss pre-surgery, caregivers can find themselves shocked at a loved one’s physical and mental decline after surgery and wonder why no one advised of the potential negative consequences. Creating a plan for loved ones with memory loss is important.
In fact, some orthopedic surgeons unfamiliar with memory loss may make treatment decisions with little disregard for patient recovery. One example is a client with memory loss who fractured a hip.
Instead of a full hip replacement, which would have had my client standing within days of the surgery, the order was no weight bearing for 6 to 8 weeks.
The result? My client with memory loss forgot how to walk and became permanently wheelchair-bound. Hip fractures for elderly parents can be very serious. 
The change of forced immobility resulted in greater overall physical weakness and the eventual need for a Hoyer lift for transfers. Other health conditions spiraled out of control, and following statistics for deaths related to hip fractures, my client died within a year.
This type of situation represents an elderly parent healthcare disaster for many families who trust surgeons to do the right thing.

Hip Fractures, Surgery and Memory Loss

While there has been some suspicion that the cause of worsening memory might be the anesthesia used in surgery, it is more likely that the physical event – the fall and trauma of the surgery is the most common cause of advancing memory loss.
So, if you have a parent who falls and breaks a hip, know that you may see a sharp decline in their mental capabilities after surgery. They may be more forgetful. Less able to initiate activities, which can mean their ability to walk again and be physically active, may be at significant risk.
They may be unable to return home and live alone. A high number, almost 50% of individuals who experience a hip fracture die within the first year. So falls and hip fractures can fast forward one closer to the end of life.
In these cases, be positive with elderly parents and encourage them as much as possible. Your parents may want to return to their prior abilities, but mentally and physically, they may be struggling.
Unless you have had surgery, it’s impossible to realize its effect on the body and mind.
Physicians or surgeons can describe the after-effects documented in medical journals and studies. Until you experience surgery yourself – this information holds no meaning.
To help you relate, being unable to imagine the effects of surgery is like the difference between caregivers and non-caregivers. As a caregiver, your friends or family—who are not caregivers—have zero understanding of the work you do and the physical and emotional effects of your daily efforts.
So, concerning surgery, hope for the best. Realize the health condition of your parent before surgery has a huge, huge, huge impact on how they will do after surgery. Returning to their previous activity level will likely take considerable effort over weeks or months.

Medications, Side-Effects, and Mental Status

Another complication after surgery can be the prescription of pain medications or, in some cases, medication to treat delirium, which can present as mental confusion or agitated behaviors.
In many cases, persons with memory loss are prescribed memory loss medications plus medications for behaviors. While medications help many health conditions, they can also cause more health conditions due to individual sensitivity levels to medication side -effects.
Some types of medications, which are processed by the body, cause more problems for older adults as the body ages.
All medications pass through the liver, which metabolizes the ingredients. Then, the kidneys take over and excrete the medications. With age, the liver and the kidneys can become less efficient at performing their work.
Elderly parents who don’t drink enough fluids can become dehydrated, affecting the body’s ability to absorb, process, and eliminate food and medications. This means that the medications they take can have more side effects.
What can happen is that one medication is added to manage the side effects of a prior medication. The next thing you know—if one is not proactive about asking questions or reporting side effects to a doctor—an elderly parent is taking 5 to 10 medications. Instead of feeling better, they feel worse and are more mentally confused and physically weak.

Who Should Be Prescribing Your Medications?

Let’s examine the risks of primary care providers or internal medicine physicians who prescribe medications for various health conditions. Did you consider there might be a risk? Who should be prescribing and monitoring medications for the elderly?
Medications and the diagnosis of advancing chronic health conditions benefit from seeing specialists like cardiologists, endocrinologists, pulmonologists, etc. These physicians specialize in medical conditions and medications.
However, the problem adults over age 65 experience is that their health insurance may not allow them to see a specialist or may make it more difficult. If you want good care, having trusted relationships and working with medical providers is important.
The ability of elderly parents to see specialists depends on having original Medicare or a Medicare Advantage program. You pay a little more for original Medicare, but you can see any doctor who accepts Medicare. There is no “in-network” requirement.
As previously mentioned, Medicare Advantage programs may lower overall costs but restrict or manage care to keep patient care costs low and insurance companies profitable. With most Medicare Advantage plans, a referral or a pre-authorization is required to see a specialist.
Let’s return to the question of who prescribes medications. Specifically for persons with Alzheimer’s or dementia, a research study by Geisinger confirmed that 26% of 1739 patients in a study who were prescribed medications for dementia or Alzheimer’s (Aricept, Exelon, Razadyne, Namenda) were sub-optimally prescribed.
Sub-optimally means not prescribed at the proper dosage or frequency, which means taking the medications does not offer the full potential benefit. This is similar to throwing money for prescriptions down the drain.

The Right Medication at the Right Time at the Right Dose

This mis-prescribing or mis-dosing can happen with medications that are initially prescribed by specialists and taken over by primary care physicians. So if you or your elderly parent sees a specialist who prescribes medications, make sure to see that specialist at least once a year to have health conditions and medications reviewed.
While it may be easier for a primary care physician or internal medicine physician to renew prescriptions, this path may not be the best. For this reason, if a loved one has Alzheimer’s, dementia, heart or breathing problems, diabetes, or other difficult conditions to manage, see a specialist. Have this specialist continue to manage and prescribe medications.
Geriatric pharmacists can also be beneficial in reviewing medications; however, they are rare. Scheduling a consultation with the pharmacist at your local pharmacy can help you understand the best times to take medications and identify potential side effects.
Not taking medications or not taking medications appropriately is another reason for the elderly to be admitted to hospital emergency rooms. When in doubt, write up medication lists and use medication boxes to take recommended doses.
Know that the wait time to schedule an appointment with a specialist can be months, depending on the specialty. So, plan ahead to establish a relationship with a specialist if you or a loved one has health conditions.
Don’t wait for an elderly parent’s healthcare emergency to happen. Get ahead of the curve.
Understandably, there may be concern about seeing a primary care doctor and several specialists. Would you rather see a doctor lacking the expertise to treat specialized conditions or two or three doctors with the skills to improve your daily health?
Coordinating care between multiple physicians can become the responsibility of the patient and the caregiver. Especially if the healthcare record systems of these physicians are not electronically connected.
Taking a more active role in managing health is a positive step for patients and their caregivers. The benefit is becoming educated about health conditions, prescriptions, and treatments. Taking these steps presents the opportunity to make better decisions and receive better care —instead of having access to care be limited to one provider or a health insurance plan.

Antipsychotics, Benzodiazepines, and Other Questionable Medications for the Elderly

For persons with memory loss, antipsychotic medications, benzodiazepines, pain medications, and medications for urinary incontinence can have mentally disabling side effects or result in a higher likelihood of falls.
So regardless of whether you are the caregiver or the patient, it is crucial to monitor health conditions and the medications prescribed to treat the conditions to avoid elderly parent healthcare disasters.
family caregiver support programsMy best advice is to be proactive about caring for elderly parents and loved ones. Caregivers, be proactive about your health to avoid the health issues of your elderly family members. Help elderly parents remain independent and live in their homes.
While some health issues can be hereditary, more result from lifestyle and habits. So, if you choose good nutrition, exercise, and stay active, you are more likely to remain healthy instead of being diagnosed with health conditions that can complicate your abilities to live the way you want today and in retirement years.

Looking For Help Caring for Elderly Parents? Find the Information, Including Step-by-Step Processes, in Pamela’s Online Program.

©2024 Pamela D. Wilson All Rights Reserved.
The post How to Manage Elderly Parent Healthcare Disasters appeared first on Pamela D Wilson | The Caring Generation.

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Pamela D. Wilson, MS, BS/BA, CG, CSA, is an international caregiver subject matter expert, advocate, speaker, and consultant. With more than 20 years of experience as an entrepreneur, professional fiduciary, and care manager in the fields of caregiving, health, and aging, she delivers one-of-a-kind support for family caregivers, adults, and persons managing health conditions.

Pamela may be reached at +1 303-810-1816 or through her website.

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Dateline: Golden, CO United States
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