Supportive Care Bulletin
Helpful tips for family caregivers
Are you a family caregiver? Many relatives and friends who assist an older family member don’t realize that they in fact put in ten to twenty hours a week. Even more. And if you are new to providing elder support, this article can help you get a sense of the various aspects that might need your attention. Our middle article addresses the topic of “Medicaid spend down.” The government may help to pay for services that Medicare does not cover, but only if you qualify by having very few assets. Spending down to qualify is not a step to take lightly! Last, we look at bladder issues. If concern about accidents dominates your loved one’s daily life, consider the possibility of an overactive bladder.
What’s involved in giving care?
Perhaps you call regularly to offer emotional support. Maybe you handle finances. Perhaps you visit weekly. Or you may live with your loved one 24/7. Caring takes many forms. You may feel this is simply what a loving daughter/son/partner would do. But that doesn’t mean it isn’t time and energy from your day. Or night, if you skimp on sleep to create time to help.
Whether you provide hands-on care or assistance from afar, you ARE a family caregiver. And that means you need to watch for burnout. Use this list to take an inventory. Consider what is realistic for you. And think about options to help manage the load: Friends, family, community programs, paid help.
- Chores. Laundry, yardwork, housekeeping, repairs
- Meals. Shopping, cooking, cleanup
- Transportation. Errands, doctor appointments, worship, social activities
- Medical advocacy. Talking with doctors, deciding on treatments
- Help in a crisis. Availability on short notice. The legal right to make medical decisions if your loved one is unable to speak
- Medication management. Tracking what’s been prescribed. Getting refills on time. Daily reminders to take meds
- Coordinating care. Finding, hiring, supervising, and scheduling providers
- Money management. Paying bills, balancing the checkbook, banking. Handling investments and real estate
- Dealing with insurance. Tracking deductibles and copays. Signing up for prescription insurance, long-term care coverage, disability and veteran benefits
- Legal assistance. Ensuring paperwork is attended to: A will or living trust. Durable Power of Attorney. Advance health care directive
- Financial assistance. Finding programs and/or pitching in to cover expenses
- Intimate care. Bathing, dressing, toileting, feeding
- Emotional support. A sympathetic ear. A hug. Reassuring your relative that they are not alone
Plus the work of being constantly on the lookout for evidence of new difficulties, falls, confusion, blue mood, scammers, etc.Return to top
What is a Medicaid spend down?
There are two forms of government health insurance:
Medicare. Basically, age-based insurance for older adults (age 65+), regardless of income and assets. (Assets include money and belongings, such as a house or car.)
Medicaid. Income-based insurance funded with federal and state dollars. (The state where your relative lives may have a name different than “Medicaid.”) This insurance is for individuals who have very little means. The financial asset threshold is often set at $2000 or less.
Medicaid will sometimes pay when Medicare will not.
The most common expense covered by Medicaid is long-term care in a nursing home. Speaking very generally, Medicare pays for the first 100 days after a hospitalization. If a person needs to stay longer—permanently move into the facility—they must cover the cost from their own savings. Once nearly all their resources have been exhausted, they can apply for Medicaid, which will pick up the tab.
How to become eligible for Medicaid
Essentially, one needs to eliminate assets. Paying for care will certainly do that! For many, it’s tempting to dole out early inheritances in an attempt to “spend down” assets. Perhaps by giving the house to their children. Or passing their savings accounts to grandchildren. Beware! The government will look back for asset transfers in the past thirty months to five years. (It varies by state.) Persons deemed to have spent down by gifting are disqualified from Medicaid for an extended period of time. There is no wiggle room on this.
Get legal advice before taking action!
Spend-down restrictions vary by state and are astoundingly complex. If you think that Medicaid will be part of your loved one’s financial strategy, consult an elder law attorney immediately! It’s never too early. There are ways to protect assets, but they require planning and attention to detail. There are too many pitfalls to try this on your own.Return to top
If making it to the bathroom in time is a frequent concern for your relative, they may have an overactive bladder. More than 33 million Americans contend with this condition, in which misfiring nerves cause the bladder muscles to contract involuntarily. Your loved one may be too embarrassed to bring it up with the doctor, or even with you. But it should be checked out. It’s not a “normal” part of aging. Overactive bladder (OAB) is a real and treatable medical condition. And you certainly want to be sure it’s not something else.
The basic symptoms of OAB include an urgent need to urinate more than eight times in a day and/or more than once or twice a night.
Many people let incontinence worries run their lives. They stay close to home for fear of accidents. They withdraw from social activities, dreading they have an odor from leaks. They may become anxious or depressed. And multiple nighttime trips to the toilet can result in insomnia and fatigue, bringing on more depression.
Once a doctor has ruled out other issues, encourage your family member to use these recommended strategies to live more fully with OAB:
- Limit caffeine and alcohol, and quit smoking. All three irritate the bladder.
- Drink six to eight glasses of water a day. This seems counterintuitive, but concentrated urine is a bladder irritant.
- Eat a high-fiber diet to prevent constipation, which tends to put pressure on the bladder.
- Lose weight, also to reduce pressure.
- Do pelvic floor exercises (Kegels) to learn how to consciously stop the flow.
- Do bladder exercises to train the bladder to retain fluid for longer.
- Go to the bathroom every two hours to proactively keep the bladder empty.
Depending on the cause, suggested medical treatments may include medications, injections, gentle nerve stimulation, or surgery as a last resort.Return to top