Tips for Organizing Health Information

Tips for Organizing Health Information

A trip to the emergency room made me realize why caregivers are advised to organize heath information. When Mom broke her hip, I called an ambulance. When it arrived, I confidently recited Mom’s Medicare number. When asked what medications she took, I pulled out our basket of pill bottles. At the hospital, the questions got more complicated. Still, I knew enough to fill out the forms.
However, while I did not know it then, I would be joining Mom in the hospital the next day with an emergency of my own that kept me in the hospital for six weeks. As we both recovered, I looked for the best way to store her health information. I especially wanted an easy way to share it with others in case I am not around.

I now have a folder for paperwork that is portable and easy to maintain. It isn’t just for emergencies. We take it to every doctor visit. Now anyone who has the folder can see when Mom had her last flu shot, what medications she takes and that she had a malignant mole removed in 1981. We can all see when all medical appointments are scheduled. Even my brother, who lives at a distance, could answer medical questions if he had to take Mom to the doctor while visiting.

Information to collect

You probably have most of this information readily available. If not, begin with what you have and add information as you can. Useful information to collect includes: A medical history; health insurance and Medicare cards; a list of medications including dosages, frequency, date started and reason; a list of emergency contacts, relationship, addresses and all phone numbers; any special logs such as blood pressure readings, blood sugar levels or symptoms; a copy of a health care proxy, advanced directives or living will; and a power-of-attorney, if one is used.

What should you keep in a medical history?

Names of all physicians; known allergies or reactions to medications; all medications, including over-the-counter medicines, vitamins and herbs; health conditions and date of diagnosis; dates of most recent exams, tests and immunizations; dates and reasons for hospitalizations; dates and details of surgeries; dates and length of major illnesses; history of smoking and use of alcohol; location of living will or medical directives; history of exposure to dangerous conditions or hazards; family history including illnesses or conditions of parents and siblings; cause of death of parents and siblings and their age at death.

Recording and storing the information

While the primary copy of the health information is more practical to keep in physical form due to various cards, forms and original documents that are part of the medical record, it is highly recommended that at least the medical history also be recorded digitally so that a “backup” copy is available in case of emergencies, disasters, or as the need arises to provide other family members or doctors with the information if needed remotely.

  • For the primary copy, use a pocket folder or small three-ring binder that will hold several pages. We purchased a multi-page presentation folder with clear pockets from an office supply store.
  • Use a bold color for the cover, such as red or yellow, so that it is easy to distinguish from other papers. Label the front clearly: EMERGENCY MEDICAL INFORMATION.
  • Keep the folder in a handy location, such as a desk drawer near the entry. Make sure every potential caregiver knows where it is kept.
  • Use top loading, clear sheet protectors to hold papers. These make it easy to remove papers for photocopying or for handing to a healthcare worker.
  • Pick up a business card from each healthcare provider you see. Cards usually contain the name, specialty, address, phone and fax number. There are vinyl business card holders available at office supply stores that are the most practical way to store business cards.
  • Each time you have an appointment, take the reminder card or jot the appointment details on a 3X5 card. Slip these cards into a page protector just as you did the business cards to keep a record of the visit.
  • When you add any information to a document, put the date at the top of the page to show how current the data is.

With a Medical History in hand,  I will never again have to phone a doctor’s office to relay information I didn’t have with me at the appointment, and I’m confident that if I’m not around, someone else can tell the emergency room doctors what they need to know about my loved one.

Funeral Arrangements: Decisions to Make Now

Funeral Arrangements: Decisions to Make Now

No one wants to think about dying, but it’s going to happen to each of us sooner or later. While approaching the topic of death and dying may be difficult for caregivers, family members as well as the elderly should try to organize and prepare for the end ahead of time, to reduce the stress, confusion and the necessity of making serious and sometimes confusing decisions regarding the care and disposition of a loved one.

A variety of checklists for seniors or their caregivers may help to organize funeral arrangements and decisions regarding funeral services, contacting relatives, selling a home, shutting off utilities, down to where lists of insurance policies and bank account information are kept, right on down to who will deliver the eulogy at the funeral service.

Pre-Death Planning Checklist

While this list is by no means all-inclusive, it should give you an idea or help guide you to determining what type of arrangements need to be made prior to the death of a loved one.

  1. Prepare a phone list or address list of individuals you want to be notified in the event of a terminal illness or death.
  2. Designate a trusted family member, child, or friend to serve as your executor. This person needs to have information and locations for your insurance policies, bank accounts, safety deposit boxes, and bills, so that accounts may be canceled, closed, or paid off.
  3. Place a reminder in your file to contact the Social Security Administration or the Veterans Administration of the death along with any relevant Social Security or identification numbers.
  4. Create a contact list of utility service providers, newspaper delivery, and postal service delivery for easy cancellation of services.
  5. If your parent or loved one has pets, make arrangements ahead of time about who will take on the care of those pets.
  6. Designate a Durable Power of Attorney to make health care decisions in the event your parent or yourself is unable to make rational medical decisions regarding health care. At this time, make sure any Advance Directives or DNR (Do Not Resuscitate) documents are placed in an easy-to-access file and that a copy of such documents is/are made available to your parent’s physicians.
  7. As part of the funeral arrangements, ask your parent what information he or she would like provided in an obituary, or whether or not they even want one. At the same time, ask your parent to determine what type of funeral or memorial service they would prefer.
  8. Purchase burial plots or make arrangements for cremation or burial ahead of time. Discuss such arrangements with your parents or with spouses.
  9. Organize your finances ahead of time and make sure records are up-to-date and easily accessible to whomever is designated to take care of closing accounts or paying off balances. Documents should be together in one location and include bank details, life insurance policies, birth certificates, wills, deeds to the house, or any other pertinent information that may be necessary for the executor to close accounts, make payment disbursements, access funds and so forth.
  10. Talk about any special needs or requirements of your parent in regard to their burial or cremation. Do they want their ashes scattered? Do they want to be buried in a traditional casket or in the increasingly popular ” green burial” method?

Funeral Arrangements – Putting It All Together

Talking about the death of a loved one is difficult, but don’t leave things to chance.

Whether or not your parent has been diagnosed with a terminal illness, it always pays to talk about such concerns ahead of time. Don’t leave anything to chance.

Seniors and adult caregivers over 40 years of age should have some type of death planning arranged or at least in the discussion phase. Write it down, keep track of it, and designate someone to organize the information and put it together into an easily accessible format for family members.

Creating a Legacy for Your Parent

Creating a Legacy for Your Parent

A common regret of adult children who have lost their parents is the wish that they had asked and understood more about their own family history. This is particularly true for family caregivers, whose focus on the present is necessitated by the practical concerns of getting through the day. Taking time to learn more about the past seems like a luxury for many caregivers.

But taking that time may be beneficial to those we love and care for and provide an important opportunity to redefine and enhance our familial connections. An essential challenge for our loved ones as they approach old age is to relinquish the need to exert control and to harvest the meaning of their lives through imparting legacy. Part of facilitating this important life review is to bear witness to memories, which form the very foundation of identity and can serve as an intangible link in a powerful chain that connects us to generations that came before us.

As our parents struggle to come to terms with their losses, to recapture fragments of memory and to hold on to what remains, they are engaged in an effort to shape and understand their legacy—to reflect on the meaning of their lives and the memories that will live on with future generations after they die.

Helping a parent reflect on their life story can be a tremendously healing process. As we all must eventually confront our own mortality, may we do so with the comfort that perhaps our children will take the time to learn our stories, pass on our history, and continue our legacy through honoring and understanding the past.

Here are four tips to help the senior in your life create their own legacy:

Film Their Stories. Use a digital recorder to record a parent’s advice, memories, playful moments or laughter. Upload them and share with the whole family. Get your social-savvy generation to comment and ask more questions online. Share all the feedback with your parent so he or she feels the love.

Tell a Love Story. Sort through Mom’s handwritten keepsakes and piece together the love notes, birthday cards and photos that tell her story. Paste them into a large coffee-table-type scrapbook to make your whole family swoon.

Frame Their Phrases. Sort through the saved notes, emails, birthday cards and letters your parents have sent you, your siblings and each grandchild. Make a photocopy of each and physically cut and paste favorite phrases into a book or on a collage. Compile with some of your favorite images and display.

Transcribe Their Memories. Sit down with a computer and ask your parents all the questions you can think of. Start with Mom’s childhood or how Dad first asked her out. Ask Dad about his first car or the lessons he learned from his own father. Type with no agenda—just let it all unfold. Consider using a Dictaphone for better backup. Make sure to ask your family for the questions they’d love to know. Don’t worry about publishing the content, just make sure you have it saved.

Lowering Your Tax Burden on Retirement Savings

Lowering Your Tax Burden on Retirement Savings

You worked hard to put money away for retirement, so it is important that you understand the various strategies available to you to make sure you maximize that savings by minimizing taxes and avoiding penalties. Here are several tips to maximize your retirement savings:

Avoid early withdrawal penalties. Over and above the income tax due on your withdrawals, you must wait until age 59 ½ before tapping your retirement savings to avoid the 10% early withdrawal penalty. However, you can take penalty-free 401(k) withdrawals beginning at age 55 if you leave the job associated with that 401(k) account at age 55 or later.

Roll over your 401(k) when changing jobs. If you withdraw money from your 401(k) when you change jobs, 20 percent will be withheld for income tax, as well as paying a penalty for early withdrawals. The mechanism to avoid these costs is to roll over your 401(k) into either a new 401(k) or an IRA.

Mixing your types of retirement accounts. If you qualify for a Roth IRA, these accounts have a variety of benefits a traditional IRA does not, including more flexibility on penalty-free withdrawals and no required minimum distributions. However the biggest difference between the two types of accounts is how they are taxed. IRAs are tax-deferred, so they provide you with an immediate tax benefit, but you must pay taxes when you withdraw the money during retirement. Roth IRA accounts require paying taxes when you deposit the savings, but that means you don’t pay taxes on them during retirement. Diversifying your money in a traditional IRA as well as a Roth IRA will allow you to moderate your tax burden during retirement. Also, if you expect to be in a higher tax bracket during retirement, maximizing your retirement funds in a Roth account will allow you to lock in today’s low tax rate.

Understanding minimum distribution. You are required to withdraw money from your traditional 401(k) and IRA after age 70 1/2. If you miss a required withdrawal, you must pay a 50 percent penalty on the amount that should have been withdrawn. Make sure you mark your calendar for that cutoff date and make arrangements with your financial institution to remind you automatically about your required distribution.

Understanding the rules on your first distribution. Your first required minimum distribution is due by April 1 of the year after you turn 70 ½. All subsequent distributions must be taken by Dec. 31 each year. If you delay your first distribution until the same tax year as your second distribution, you will be required to take both distributions in the same tax year, which could result in an unusually high tax bill.

Start withdrawals in your 60s. While you must begin traditional retirement account withdrawals at age 70 ½, you can lower your tax burden by take smaller distributions starting at age 59 ½, which can spread the tax bill over more years, potentially allowing you to stay in a lower tax bracket and reducing your lifetime tax bill. Check with your financial advisor to find out if this option would make sense for you.

Calculate your tax burden with added Social Security or Pension Benefits. If you’re going to be receiving Social Security benefits or regular payouts from a pension, it’s important to incorporate them when planning your withdrawal strategy. Even if you’re receiving a relatively small amount each month from these sources, the extra income may increase your tax burden.

Keep tax-preferred investments outside retirement accounts. Investments that generate long-term capital gains receive preferential tax treatment when held outside of a retirement account. However, if you put them in a retirement account, you will pay your typically higher regular income tax rate when you withdraw the money from the account. In contrast, you can lower your tax bill by holding more highly taxed investments, including Treasury inflation-protected securities, corporate and government bonds and funds that generate short-term capital gains, inside retirement accounts.

By Caren Parnes

Hospice Care Might Benefit Your Loved One Sooner Than You Think

Hospice Care Might Benefit Your Loved One Sooner Than You Think

Promoting independence and “successful aging” is a laudable goal for many. But it’s not the reality for people caring for anyone diagnosed with a terminal illness or a relative who struggles to manage day to day as a result of debilitating health conditions and growing frailty. Most people would prefer to talk about wellness rather than illness, so we tend to avoid planning for advanced illness and ultimately death. One valuable, often overlooked, and generous Medicare benefit for those caring for a family member or friend is hospice care.

Medicare coverage for hospice
Since 1983, Medicare has paid for most hospice care received in the United States. Other payers of hospice care include Medicaid (in most states), the Department of Veterans Affairs and most private insurance plans. Typically, no one is turned away from receiving hospice. Private contributions and donations are used to help cover the cost of care for those who have no other ways to pay for this service.

Beneficiaries are eligible for hospice care when they are entitled to Medicare Part A and are certified by a physician as having a life expectancy of six months or less if the illness runs its normal course. However, living longer than six months doesn’t mean the patient loses the benefit. After the initial certification period, each beneficiary receives an unlimited number of additional 60-day periods.

Although cancer patients used to make up the vast majority of hospice recipients, that is no long the case. An increasing number of people diagnosed with late-stage Alzheimer’s disease, non-Alzheimer’s dementia, heart disease, stroke, Parkinson’s and other conditions benefit from hospice.

Hospice is underutilized
People often wait too long before seeking hospice care. In the United States, the average length of hospice care is less than 60 days with 30 percent of those who elect hospice care dying in seven days or fewer. It seems that misinformation about the benefit coupled with our general discomfort talking about end of life prevents Medicare beneficiaries and their family from taking advantage of the valuable benefit.

What services are provided?
An interdisciplinary team of health and social service professionals joined by volunteers work together to provide the following:
• Comfort care for pain and symptom management
• Maintenance care for existing chronic conditions such as diabetes or emphysema
• Support for emotional, social, psychological and spiritual needs and issues related to dying
• Needed drugs, medical supplies and equipment
• Mentoring for the individual, his or her family, and friends on best practices in patient care
• Services like speech and physical therapy, which can be accessed when needed
• If receiving hospice at home, payment for short-term inpatient care is available when symptoms become too much to manage or when caregivers need a respite break to take care of themselves
• Grief counseling is available and can take the form of a support group, one-to-one therapeutic counseling, spiritual counseling, phone check-in calls and educational materials to surviving family and friends.

Those receiving care are allowed to keep their regular physician or nurse practitioner to oversee their care or to receive care from the doctor associated with the hospice organization.
Hospice is offered by both for-profit and not-for-profit organizations and can take place:
• At the home of the patient, a family member, or friend
• At a stand-alone hospice center
• In a hospital
• In a skilled nursing facility or other assisted care residence

Pursuing the Medicare benefit and accepting help from hospice can feel like a major change in how the person receiving care and their family considers the remaining time they have together. Caring for someone with serious illness and at the end of life is a daunting task, both mentally and physically. Having a dedicated, skilled and caring team of professionals to help can allow you to focus more on quality time with the person and less on the care and maintenance of the disease. Accepting help can make a difference in everyone’s well-being.

By Leah Eskenazi, Family Caregiver Alliance, for PBS.org
https://www.pbs.org/newshour/nation/hospice-care-might-benefit-loved-one-sooner-think

Capturing Family Memories with Oral Histories

Capturing Family Memories with Oral Histories

We find ourselves in a world-wide genealogy craze, as a variety of DNA testing options have become available and increasingly affordable, and a wide array of genealogy websites invite those who are mildly curious about their ancestry to dive in—sometimes hooking them into a life-long passion. But what many people discover when they begin their genealogy research is that the most important source of information about your family is your living relatives’ memories—of their own family experiences as well as the stories passed down to them through the generations. Increasingly our Greatest Generation is passing on, taking vital information about relatives and our family stories with them.

Capturing the facts and stories about our family by asking our relatives questions is called an “oral history.” These can take the form of relatively informal question and answer sessions around a dinner table recorded by hand, to a more structured interview involving audio or video recordings that can later be edited together to provide a valuable family media archive. However you choose to approach gathering and compiling this information, there are a few basic “best practices” to keep in mind as follows.

Collaborate with other family members. Brainstorm with as many family members as you can before starting an oral history. Discuss who are the most important people to interview and what people think the key things are that need to be recorded—whether that be missing facts about relatives who have passed—names, places and dates which will be helpful in building a picture of your family tree, or the more personal family stories and traditions. It is also useful to include as many accounts of the same information as possible, since people will have different memories of the same event.

Define your project. Clarity is key. Telling an entire family history in any form is a daunting project, so start with specific questions on information you wish to know. Start by gathering short vignettes. Maybe there’s a critical aspect of your own childhood you’d like to recapture such as a memorable family vacation. Often we are trying to identify facts we may not know about specific relatives, or where our family originated and how we got to where we are today. The whole story can’t be told overnight, but as you collect these separate anecdotes, the larger story will begin to emerge.

Have a list of questions ready. Experts advise framing questions in a way that invites expansive answers. Ask about early memories, or about happiest (and saddest) moments. The idea is to get a conversation started. StoryCorps, the oral history project created by the American Folklife Center, offers suggested questions and an interactive guide (https://storycorps.org/participate/ great-questions).

Techniques for recording information. While hand-written notes may be necessary when trying to record information on the fly, you probably already have the most useful tool for an oral history in your pocket. Smartphones can be used very successfully for video or audio documentation. Also, video conferencing services such as Skype and FaceTime offer recording options for interviewing distant relatives. If you choose to create a video of your interviews, easy-to-use software such as Apple’s iMovie and Microsoft’s Movie Maker are pre-installed on your computer.

Collecting and compiling oral histories entail effort and planning, but in the end, they bring generations of families together and foster an appreciation for listening and telling stories.

By Caren Parnes