Supportive Care Bulletin
Helpful tips for family caregivers
The best way to beat cancer is to be proactive and detect it early. That’s why we are focusing this month on the screening tests that help you do just that! And if your loved one is hesitant, be sure to let them know that Medicare covers the cost of these tests 100%. In our middle article we continue our series about memory care and offer suggestions to make the actual day of moving easier on both of you. In our last article we look at the irritating condition of tinnitus (ringing in the ears). There are several ways to address the issue, from hearing aids to white noise machines, or cognitive behavioral therapy.
Cancer screenings covered by Medicare
If found early enough, many cancers can be kept in check. Some even eradicated. To encourage early detection, Medicare pays 100% (in most cases) for screening tests. Your loved one may have a copay and/or Medicare percentage for the doctor’s exam to administer a test. Or a facility fee for a colonoscopy. To get the most insurance coverage for screenings, look for doctors who “accept assignment” (accept what Medicare pays). With Medicare Advantage, they all do.
Remember, a screening test is preventive care. It means no cancer has been found as yet. These tests look for specific indicators. If a cancer diagnosis is made, payment for follow-up treatment, doctor visits, and testing falls within your loved one’s regular Medicare arrangement. Deductibles or copays may apply.
To secure a screening test, get an order from your relative’s primary care provider.
- Lung cancer. Low-dose computed tomography (like a low-radiation X-ray). Medicare will pay for a yearly test for persons ages fifty-five to seventy-seven who don’t currently have signs of lung cancer. (Remember, this is for screening, not treatment.) They must also be a current smoker or have quit smoking within the past fifteen years.
- Colon cancer. Occult blood tests once a year for people age forty-five and older. A flexible sigmoidoscopy or a colonoscopy is covered once every two to ten years. (They involve a look inside the colon.) The frequency depends on your loved one’s risk factors and any precancer findings on previous tests. If the procedure is done in a hospital setting, there is no deductible required for the hospital, but the facility may bill for a copay amount. If a polyp is discovered and removed, this goes from “screening”—no problems yet—to an actual medical procedure. Your loved one may then owe a copay and, for original Medicare, the percentage that is the patient’s responsibility.
- Breast cancer. Mammogram once a year for women age forty and older.
- Cervical and vaginal cancer. Pap smear and pelvic exam, typically once every two years. If your relative is high risk for these cancers or had an abnormal Pap smear in the past three years, Medicare covers the test and doctor’s exam once a year.
- Prostate cancer. PSA blood test and/or a digital exam once a year for men age fifty and older. The blood test is covered 100%. There may be a charge if the doctor does a digital exam to look for an enlarged prostate.
Moving to memory care
Once you decide memory care is the wisest path, the next step is choosing a facility and creating a smooth moving day. Many memory care communities have a “move-in coordinator” or other family liaison. Rely on this professional for guidance.
Ease the change with these tips:
- Involve your loved one in the choice of facility. Without saying why, visit each one with your relative. Have lunch there, perhaps engage in an activity. Watch how they respond and let that guide your choice.
- Wait to tell your loved one about the move. Avoid prolonged anxiety and confusion. Some experts advise that you wait until the day of the move to tell them, or when you are at the facility. Others advise no more than twenty-four to forty-eight hours before.
- Agree on “the story.” Everyone—family and staff—should say the same thing. For example, “The doctor says you need more than home care for your illness right now.” Even a fib (“The house is being tented for termites”) may be the most compassionate way to ease the transition. Imply it’s for a week or two, not a permanent move.
- Prepare logistics ahead of time. Ask the move-in coordinator what to expect, how the facility will greet your loved one, and how you will make your exit. Have a friend or family member bring photos and belongings over and set up the room before you arrive. You might want that person to spend time with you afterwards, as leaving can bring up a lot of emotions.
- The day of the move. Stick to routines as much as possible. When your relative understands what’s happening, stay calm and positive. Empathize. “This is hard for all of us. We just have to put up with it for now.” Stick to the message. Enlist the help of staff—usually a distracting activity—so you can exit quietly.
Tinnitus: Ringing in the ears
Tinnitus is often described as a ringing in the ears. But it can also be more of a clicking sound, a humming sound, or buzzing, hissing, or roaring. Ninety percent of people with the condition also have hearing loss.
Tinnitus is not a disease. Instead, it is thought to be the brain’s response to a lack of input from the ears. The brain then “tries harder” to catch the sound stimulation it expects. The result is internal noise. For many people, tinnitus is simply annoying. For roughly 10%, however, it can be quite distressing, interrupting sleep and concentration and bringing on depression and anxiety. Nearly one in four adults ages sixty-five or older experiences tinnitus.
If tinnitus interferes with daily life, talk to the doctor. There are several possible approaches.
- Address the underlying cause (if there is one). The culprit may be a buildup of earwax, which can be removed. Or, over 200 medications list tinnitus as a side effect. Aspirin and ibuprofen, for instance. Also, certain antibiotics, anticonvulsants, cancer drugs, antidepressants, and diuretics. Switching to a different prescription may help. Or hearing aids, because they deliver to the brain the auditory information it’s seeking.
- Mask the noise. A quiet room can make the buzz of tinnitus more distressing. “White noise” can provide neutral sounds to override the tinnitus. There are ear devices, even hearing aids, that can deliver white noise. If your relative has trouble sleeping, a white noise machine at night can help. A fan or air conditioner can sometimes do the same thing.
- Manage the reaction to it. Cognitive behavioral therapy can help your loved one live better with tinnitus. By learning new ways to think about the ringing, as well as relaxation and other coping strategies, your relative may feel less affected by the constant sound.