INSIDE

1Be Mindful with Medications:

Practical Safety Tips

4 Visit with a Caregiver

5 Senior Care Pharmacists Support Caregivers with Medication Management

7 Medication Management by Home Care Agencies

9 Don’t Google, Use Grillo!

11 Community Resources

13Spring Cleaning

Managing Medication Costs

Dear Caregiver, Prescription medications are a fact of life for many older adults, and thus for their family caregivers. Proper use of medications can help older adults live longer, healthier lives, but improper use of prescription medications (as well as over-the-counter remedies) is a leading cause of health problems and hospitalizations. Medicines are powerful stuff, and it’s important to treat them with a healthy respect and be armed with knowledge about what they do and how they should be used. This issue is all about prescription medications, and it covers a lot of ground, with articles by a senior care pharmacist, a hospital pharmacist, home care nurses, a Medicare counselor, and more. The issue is full of information, and we hope it will help you manage your own medications—and those of elder loved ones—as wisely and safely as possible. Best wishes to you.The Editors

Be Mindful with Medications: Practical Safety Tips by Laura Staisiunas, BS, RPh, MBA

edications play an expanding role in health care as we grow older. People are more likely to develop one or more chronic illnesses

with advancing age, and appropriate medications can help seniors live longer and more active lives. However, medication use in older adults is also more likely to be associated with safety concerns. Take Medication as Prescribed You are unique! Your physician prescribed medication specifically with you in mind. Always take your medicine regularly and don’t skip doses, take extra doses, or stop taking your medicine without first consulting your doctor. The average senior takes about seven different medications every day, so it’s little wonder that it can be difficult to remember and keep track of them. Make sure your prescription containers are clearly marked with the reason you are taking the medicine. Many medications have names that are easy to mix up and can be confused with each other; for example,

M

CAREConnectionsInformation and Inspiration for Caregivers

A Publication of Boulder County Area Agency on Aging March/April 2016

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is published six times a year by Boulder County Area Agency on Aging (BCAAA). To subscribe or respond to articles, contact:

Care ConnectionsBoulder County Area Agency on Aging P. O. Box 471Boulder, CO 80306303-678-6116 (ph)303-678-6285 (fax)InfoCaregiver@bouldercounty.org

Care Connections is offered free to residents of Boulder County, though donations are gratefully accepted. Agencies, businesses, and professionals are encouraged to donate to Care Connections in an effort to keep it available at no cost to caregivers. Subscriptions to addresses outside of Boulder County may be obtained by a one- time donation of $10.00.

Care Connections is supported in large part by the ads of local agencies and businesses. For information on advertising, call 303-678-6116. Ads, while appreciated, do not constitute specific endorsement by Boulder County Area Agency on Aging.

Editorial Advisory Committee Emily Cooper Susan Damon Claudia Helade Lynn Malkinson Mary Kathleen Rose

Newsletter Design StudioBlue West, Newport, Oregon

Reproduction of Care Connections articles is permitted with credit to Boulder County Area Agency on Aging.

CAREConnectionsZantac® for heartburn and Zyrtec® for allergies, or Celebrex® for arthritis and Celexa® for depression. Some pills may look similar to each other and can also add confusion to the medicine regimen. Forgetfulness is one of the most common causes of non-compliance, so setting up reminders is important. One simple solution is using a multi-day pill box that organizes medicines by the day and time they should be taken. The medication container can be filled in advance to help prevent the wrong medication from being taken in a moment of confusion. Set a regular time each week to refill the container; for example, every Sunday morning after breakfast. Some people are more visual, and a checklist in an easy-to-read format or calendar is a great way to keep track of when it’s time to take their medicine. There are more sophisticated reminder systems that can be programmed with an alarm that beeps to alert the person that it’s time to take their medicine. Other devices have a visual reminder to help ensure that the person is taking their medicine as prescribed. Ask your local pharmacy for information on these products to find one that best suits your needs. Another way to remember to take a medication safely is to take it at the same time every day. Do you watch the evening news on television every day? This may be a great reminder to take evening or bedtime medication. How about taking morning medicine after you brush your teeth in your morning routine? Another useful tip is to place a different colored label on each medicine bottle to simplify your routine. For example, blue labels can be for morning medicines, yellow for afternoon, and red for bedtime. A coding system for your medications may make them easier to remember.Keep an Up-to-date List of Medications Many pharmacies will supply a complete record of medications filled at their store. Keep this list up to date! Be sure to include any over-the-counter products such as Tylenol® , Motrin®, or cough and cold products on your list. And add any vitamins and herbal or dietary supplements you’re taking like Co-Q-10 or a probiotic. The list should have the medicine’s brand name or generic name, the dosage or strength, how often you are to take the medicine, and what the medicine is for. Here’s an example: Drug Name: Lisinopril® 10mg tablet How to take: By mouth, swallowed When to take: Once a day in the morning Used for: Blood pressure

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Whenever your doctor prescribes a new medication, update this list right away and write down any advice and instructions given, such as the time of day the medication should be taken. If you’re seeing multiple health providers, bring your list to each office visit. Keep the list in your purse or wallet. It’s a good idea for a family member or caregiver to keep a copy as well. This is important particularly in case of an emergency.Nonprescription Medicines Over-the-counter, or nonprescription medica-tions, are very handy since they don’t require a prescription from your doctor. Many of these products provide temporary relief of conditions like headache, cough and cold symptoms, or indigestion. But they are usually meant for short-term use, and if symptoms don’t go away—or if they worsen—call your doctor. Pick over-the-counter medicines that treat only the symptoms you have; for example, avoid multi-symptom cold remedies if all you have is a stuffy nose. Always read and follow the “Drug Facts” label on nonprescription products to avoid potential problems. This label has important information and tells you what the medicine is for, how and when to take it, active and inactive ingredients, and warnings. Some medical conditions, including high blood pressure and asthma, make certain nonprescription medicines potentially harmful. Even if you have been taking a nonprescription medicine for years, ask your doctor or pharmacist if it’s still okay to take it now.Review Medications with Your Health Care Provider It’s a good idea to review your medications with your physician at every visit. Bring the up-to-date list of current medications you’re taking or bring your prescription bottles with you to your office visit. Your doctor should be told about any over-the-counter products, vitamins, or herbal and dietary supplements that you’re taking either

routinely or on an as-needed basis, or if you have recently discontinued any products. Before your visit, write down any questions or concerns you have in a small notebook and share them with your health care provider. The more information your provider has, the more accurately he or she can pinpoint any potential side effects or drug interactions and customize the medication to fit your needs. And before starting a new medication, ask your pharmacist or doctor if it can cause problems if taken with food, other medications, or herbal or dietary supplements. Storing Your Medication Always store your medication in a secure and dry place away from windows and especially out of reach of children (including visiting grand-children). Keep all medications in their original bottle, box, or tube. It may be tempting to store your medicine in the bathroom medicine cabinet, but the warmth and dampness from showers and baths can cause medicines to break down. As a result, they may not work as well as they should. If you get refills on certain medicines, don’t combine the older pills with the new ones, as you won’t be able to tell the difference or know the expiration date. And never put more than one kind of medicine in the same container. Each time you pull medicine from your kitchen cupboard or drawer for yourself or a family member, be sure to double-check that you have: • The right medication • For the right person • In the right amount • At the right time If you or a family member will be traveling by air, be sure to keep all medicines with you in a carry-on bag and do not place them in luggage that you check in. If traveling by car, do not place medicines in the glove compartment. Have an up-to-date list of your medicines with you just in case you lose a prescription or have a health situation

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that takes you to an Urgent Care center in a town away from home. And plan ahead: be sure you have enough medication when you’re away and in case you have unexpected travel delays. Family members and caregivers are a patient’s best advocate when it comes to medication safety. By learning about the benefits and risks of medication, they can help everyone get the most from their medicine, avoid problems, and stay safe.

Laura Staisiunas, BS, RPh, MBA, is a clinical pharmacist and the Medication Safety Pharmacist at Longmont United Hospital.

VISIT WITH A CAREGIVER

Deborah is the “secondary,” or backup, caregiver for her 94-year-old mother, Ann, who lives alone in Colorado Springs. Deborah’s brother, Rob, lives thirty minutes away and is considered the “primary” caregiver. Ann has congestive heart failure, which has caused hard-to-heal wounds on her legs, among other health concerns. The wounds involve nerves, so she’s in constant pain and re-quires pain medications. A nurse visits her daily for wound care, and she sees her doctor weekly.

Care Connections: I understand you live in the mountains west of Boulder. Traveling from there to Colorado Springs must take you quite a bit of time.

Deborah: Yes, what used to be a two-hour drive one way can sometimes take well over that de-pending on traffic, road conditions, and weather. I’m also backup for my brother when he goes out of town or if there are special caregiving needs. I recently stayed with my mother for five days when she was hospitalized for a procedure

to open the arteries in her legs to increase the blood flow in hopes of healing the wounds and ultimately saving her legs.

CC: That’s a long drive and a long time to be away from home.

Deborah: Yes, it can be a long and exhaust-ing drive, and prior to leaving my home, I need to make arrangements for the care of my pets and the house. I do my best to visit my mother once a month. I stay in a room in her house and attempt to not add disruption to her routine.

CC: Do you have other obligations you must arrange for?

Deborah: I work part-time and need to request time off. It is part of our family’s tradition—to help and be there for each other as much as possible.

CC: Can you tell us about that tradition?

Deborah: My mother was an Air Force wife with four children. Our father died of cancer in 1974, when he was 53. Mother has been a widow for more than 40 years, and it hasn’t been easy for her. After Dad’s passing, Mom had a couple of male friends but never remarried. Like many women of her generation, she had no women friends. This was standard practice at that time; her role was to “take care of a man.”

CC: Besides this early loss, what character or personality traits of your mother influenced you and your siblings?

Deborah: Her background is Polish and German. She’s a hard worker, determined, dis-ciplined, and strong. We all have many of these traits. Mother was active mentally, physically, and spiritually until she was 89 and underwent open heart surgery. Her mind is still quite active but, sadly, her body is failing. She’s proud and doesn’t ask for help.

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Senior Care Pharmacists Support Caregivers with Medication Managementby Neda Leonard, MS, PharmD

F amily caregivers play a critical role in helping older adults with healthcare needs;

however, they are usually faced with many challenges. One common puzzle for them is managing multiple medications. The medication list is often long and overwhelming for older adults with multiple chronic conditions. Managing medications can be especially frustrating during transitions, such as from hospital to home, when changes in medications can cause confusion and lead to medication errors that expose older loved ones to health risks. So what are the odds against the older adult you are caring for regarding medication management? • 10.7% of hospital admissions in older adults

are associated with adverse drug reactions (ADRs).

• ADRs cause over 100,000 deaths per year in the U.S., making them the fourth leading cause of death.

• Older adults are 2.5 times more likely than younger individuals to visit an emergency room due to an ADR.

CC: Does this last trait affect your relationship?

Deborah: We have a good relationship, but it’s hard when she resists asking for and accepting help.

CC: I suppose it’s the way with all traits: there are up sides and down sides to this kind of self-reliance and independence.

Deborah: Yes. When she’s home, she manages, without help, all her complicated medications. She recognizes each pill by its shape, color, and size and checks each one before she puts it in her mouth. She has devised a system for know-ing what to take and when, without the standard pillbox. In the morning, she lines up the bottles, white caps up, and turns them over with caps down when she takes a pill or vitamin. By bedtime, the whole row has been flipped over. True to form, her system is efficient, failsafe, and all her own. She tries to be independent and self-reliant.

CC: How do you see this playing out in the future?

Deborah: My mother is set in her ways. She doesn’t want to be dependent on others and wants to stay home by herself. She knows she could lose both her legs, and we all know that if amputation is the only choice, she would need to be in a nursing home and would not survive surgery or the experience. She has told the family numerous times she is “ready to go.” She’s a spiritual woman and talks to God quite a bit; she wonders why He won’t let her go.

CC: We were speaking earlier about life lessons your mother gave her family.

Deborah: We’ve all adopted and understand the importance of routine, respect for others, car-ing for oneself physically and spiritually. Being responsible is another value. Our mother was a model of how to live a good and decent life. She has passed on the tradition of sending a birthday card and giving each child a check written for his

or her birthday age. By now that makes 13 checks a year for the grandchildren and great grandchil-dren. She did stop doing this when we reached the age of 40 (she now has grandchildren approach-ing that age), but she still sends a card and a few dollars. She doesn’t have a lot of money but fac-tors birthdays and holidays into her budget as she feels it is important to remember her children and grandchildren on their special day.

CC: Thanks, Deborah, for talking to us. It was a pleasure getting to know a bit about you and your family.

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• About 1 in 3 older persons taking at least 5 medications will experience one adverse drug event each year, and about two-thirds of these patients will require medical attention.

As a senior care pharmacist specializing in older adults and with over 15 years of experience, I’ve come across frustrated caregivers who express concern and confusion about giving medications, reconciling new medications with old ones, and just understanding why so many medications are needed and for what reason each of them is given. It is a valid frustration given the complexity of the medication regimen of older adults. Here are a couple of scenarios described by family caregivers: “I was told that after discharge from the hospital, there would be 8 medications to give. I think some of them I can’t mix. I believe I heard that one can cause nosebleed or maybe it was dizziness—I can’t remember. They talked about so many things and they told me not to worry about it because it is all written down. Now I’m looking at the discharge papers, and the information is surely here, somewhere hidden in the 14 pages in front of me! I am officially overwhelmed. Wish someone could simplify this for me.” “I was so excited to get him home until I was faced with putting his new pills with the old ones. Some with different names, different colors and shapes! Not sure if it is the different pharmacy I used or if these are all new and improved pills. Not sure what the three new pills are for? One looks just like the old tablet he was taking years ago for high blood pressure. Don’t want to give him extra tablets if they are the same. Help!” Sound familiar? Why do older adults take so many medications? One common reason is that patients demand symptom relief from physicians. Media influence is strong in encouraging patients to demand medications to resolve symptoms. The result is

that more attention is given to adding medications than to taking away the ones no longer needed or the ones causing unwanted symptoms. Is there anything you can do as a caregiver about this phenomenon? Yes, you can call a consultant senior care pharmacist to evaluate the appropriateness of each medication for your loved one and avoid those medications that might be harmful if used by older adults. The senior care pharmacist does this by conducting a Comprehensive Medication Review. It is a free benefit for anyone with multiple medical conditions taking many medications and receiving Medicare Part D. For those not eligible, it is an investment leading to reassuring safety for an older person under your care. A senior care pharmacist is able to coach a caregiver in how to approach a physician to make medication changes, such as simplifying a dosing regimen or reducing the number of medications (when safely possible). If you are unsure if your loved one is at risk for medication-related problems, you may use the following assessment questionnaire from American Society of Consulting Pharmacists (Levy 2003): • Do you currently take five or more medications? • Do you take twelve or more medication doses

each day? • Do you take any of the following medications? o carbamazepine (e.g. Tegretol®) o lithium (e.g. Eskalith®) o phenytoin (e.g. Dilantin®‚ Phenytek®) o quinidine (e.g. Quinidex®) o warfarin (e.g. Coumadin®) o digoxin (e.g. Lanoxin®‚ Lanoxicaps®) o phenobarbital o procainamide (e.g. Procanabid®‚ Pronestyl®) o theopylline (e.g. Theo-dur®‚ Theo-24®‚

Slo-bid™, Theospan®‚ Uniphyl®)

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• Are you currently taking medications for three or more medical problems?

• Have your medications or the instructions on how to take them been changed four or more times this past year?

• Does more than one physician prescribe medications for you on a regular basis?

• Do you get your prescriptions filled at more than one pharmacy?

• Does someone else bring any of your medications to your home for you (such as a delivery person, the pharmacy, spouse, friend, or neighbor)?

• Is it difficult for you to follow your medication regimen or do you sometimes choose not to?

• Of all your medications, is there any particular medicine for which you do not know the reason for taking it?

If the answer is “yes” to many of the previous questions, it may be advisable for you to contact a senior care pharmacist for a Comprehensive Medication Review. First gather the following information: • Current medication list that includes not only

prescription drugs but also over-the-counter items and herbal products.

• Drugs you have taken in the past that have caused allergic reactions, adverse reactions, or intolerable side effects.

• Physicians and other prescribers and which medicines they have prescribed.

• Pharmacy or pharmacies you have used to fill each prescription

• List of your medical conditions and diseases.

How can a senior care pharmacist help you? Senior care pharmacists provide an array of services such as managing a patient’s medications, providing advice on the correct way to administer medications, guiding caregivers, and assessing a patient’s drug regimen. More specifically, they:

• Provide professional, unhurried visits, and un-derstandable patient and caregiver information.

• Identify and reduce medication-related problems, such as side effects and drug interactions.

• Eliminate unnecessary medications, simplify taking medications, and reduce medication costs.

• Serve as your advocate with your physicians to ensure the use of the most appropriate medications.

• Promote wellness and disease prevention. • Identify untreated problems (such as in-

continence, depression, osteoporosis). • Recommend appropriate packaging and dosage

forms for easier use of medications. If you have questions about your loved one’s (or your own) medications, consider making an appointment with a senior care pharmacist.

Neda Leonard, MS, PharmD, is a board-certified Pharmacotherapy Specialist and Geriatric Pharmacist and is owner of Consult A Pharmacist, LLC, at 303-709-8272.

Medication Management by Home Care Agencies

by Joan Lutz, RN, and Ruth Rowse, RN

W hen a patient is able, they can take their pre-scribed medications without any help. But

what can be done when the patient is cognitively or physically unable to safely take medications as scheduled? What if they forget, and take either too many pills, or not enough, or drop them on the floor, or take them at the wrong time? One solution is to hire a nurse from a Class A home care agency to prefill a medication box. (There are two types of home care agencies licensed in Colorado: Medical, or Class A, agencies, which provide services by licensed or certified health care practitioners, such as nurses; and Non-medical, or Class B, agencies, which provide personal care services that assist with

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activities of daily living, such as bathing, dress-ing, or toileting.) For some patients, this will be enough to keep them safe. The medication box, or med box, should be clearly marked with the day and time of each dose. According to Colorado law, the filling of the med box with pills must be by the patient (if com-petent), a family member, a nurse, or a pharma-cist. Those are the only people allowed to fill med boxes. In Colorado, hired personal care workers (unlicensed persons) cannot fill the trays. Certi-fied Nursing Assistants (CNAs) or Qualified Medication Administration Personnel (QMAPs) also are not allowed to fill the med box for a pa-tient living in a private home. Many patients who can no longer accurately fill their med box by themselves will also need re-minders about taking their medications. Once the med box is filled, unlicensed personal care providers can remind the patient about their medications, such as asking whether medications were taken, verbally prompting a patient to take medications, handing the appropriately marked med box to the patient, and opening the appropri-ately marked med box for the patient if the patient is physically unable to open it themselves. Any irregularities noted in the med box such as medications taken too often, not often enough, or not at the correct time as marked on the med box, are to be reported immediately by the personal care worker to their supervisor. Another possibility is to use a digital pill dis-penser that opens the slot where the scheduled pills are located and then flashes or beeps if the medicine is not taken. There are models that can be monitored remotely. However, this doesn’t prevent pills from being spilled by a shaky hand, or placed on the table to take later and then mis-takenly “counted” as being taken. And a qualified individual is still needed to fill the digital pill dis-penser when it’s empty.

On a final note, if any medication is to be taken not on a regular schedule, but only as needed (also called prn medication), then a competent patient, nurse, or family member has to determine wheth-er the prn medication should be taken. Medica-tion aides can only administer regularly prescribed medications. A QMAP is not trained or autho-rized to make decisions based on judgment, as-sessment, or evaluation of a patient. However, a registered nurse can make these decisions. For example, if the physician’s order is for a certain higher dose of medication when the patient is in pain, an unlicensed personal care provider cannot decide when that higher dose of medication is warranted, but a nurse has the training to make such a decision. Finally, for people receiving medication admin-istration services, a current medication adminis-tration record must be maintained according to state law. The health professional (generally a nurse) administering medication must monitor for effectiveness, drug interactions, and adverse ef-fects. The nurse should keep the patient’s physi-cian informed about how the patient is doing with his or her medications. The nurse can only ad-minister medications as ordered by a physician. Colorado’s regulations about medication ad-ministration are not arbitrary; instead the rules were developed to protect patients from medica-tion errors. Always consider what level of care your loved one needs, and rethink it whenever their condition changes. Some people start out functioning very well with twice-a-month med box fills by a nurse; others will need more over-sight to stay safe.

Joan Lutz and Ruth Rowse are nurses with Dig-nity Care, a Class A medical home care agency.

Our AdvertisersThanks to the agencies and businesses that help support Care Connections with their

advertisements. For information on joining them, please call 303-678-6116 or email InfoCaregiver@bouldercounty.org.

Mesa Vista

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Don’t Google, Use Grillo!by Johnny Daurio

D o you need reliable information about a re-cent medical diagnosis? Or about someone

you care for who is struggling with an illness or chronic condition? The Grillo Health Information Center can answer your personal questions with current information that is trusted by physicians—all for free!What We Do Over the past 16 years, the Grillo Health Infor-mation Center has provided easy and confidential access to personal health research for thousands of individuals and families, with special focus on the elderly, a critical population for which health issues are prominent. The Grillo Center uses specialized databases with the most current, evi-dence-based health and medical information. In addition to answering questions, the Grillo Center provides community health lectures on many top-ics. Research shows 97% of surveyed patrons rated the quality of services as excellent, and 90% found the medical research useful in making better decisions about health care and treatment options. If you just want to know and trust what is going on with you or your loved one, the Grillo Center can help answer your questions. The Grillo Center does not advise patrons and strongly encourages consultation with medical practitioners.Doctor and Patron Approved “The Grillo Center continues to be a reliable and dependable resource of health information for me…. Thank you to everyone involved with such a wonderful community service.” (Patron) “This research will assist me in asking ques-tions when I go to the doctor….” (Patron) “We are fortunate to have the Grillo Health In-formation Center as a resource for our patients. Often, healthcare providers have neither the time nor resources to answer the myriad questions

that arise when a patient has a health- related issue. The Grillo Center is a great place we can direct our patients to. Patients will get reliable, evidence-based information they need to be bet-ter participants in their health care decisions.” (Dr. Paul Lewis, MD, Chief Medical Officer, Boulder Community Hospital)How to Use Grillo Health Information Center’s Services 1. Submit specific questions in person, over the

phone, or by email. 2. Trained personnel quickly respond with

up-to-date and reliable health research on your specific question.

3. Use this information to make better health care decisions, to improve your personal health, strengthen communication with your doctor, or help a family member.

Johnny Daurio is Executive Director of Grillo Health Information Center, located in The Tebo Family Medical Pavilion, Boulder Community Foothills Hospital, at 4715 Arapahoe Avenue, in Boulder. For more information, go to their website at www.GrilloCenter.org , email (via the website), or call 720-854-7293.

“Flowers always make people better,

happier, and more helpful;

they are sunshine, food and

medicine to the mind.”

—Luther Burbank

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Hello, In Boulder County, thousands of family caregivers—people like you—provide compassionate care to elder family members and friends. Caregivers are one of the greatest resources of our community, and Boulder County Area Agency on Aging (BCAAA) is honored to offer programs for their education and support. BCAAA caregiver programs include Information and Referral, which helps link family caregivers to useful local resources and offers emotional support for the challenges of caregiving; Care Connections newsletter, which shares information, tips, and encouragement with thousands of caregiving readers; caregiver training courses, which provide much-needed training in practical caregiving skills and caregiver self-care; and the Caregiving Symposium, the annual event that brings together hundreds of family caregivers for a full day of workshops, resource information, and connection. Here’s what one family caregiver has to say about these programs: “We could not have cared for our loved one without all the amazing resources offered within this county. I am grateful that we had somewhere to turn, with a lot of knowledgeable people to give us a hand.” We hope you have benefitted from at least one of BCAAA’s caregiver programs over the last year, and that you’ll continue to benefit from the programs throughout the course of your caregiving. We are committed to the continuation, and hopefully growth, of our caregiver services, but of course those services (which are entirely grant-funded) come at a significant cost. That’s why we’re turning to those who have personally benefitted from them for support. If these programs have been helpful to you—and if you realize their importance to all of our county’s family caregivers—we hope you’ll consider making a donation to support them. If you choose to help with a gift of any size, please make your check payable to Aging Services Foundation (the non-profit fundraising arm of BCAAA) and designate your gift to Caregiver Programs. Send it to Aging Services Foundation, Attn: Alan Castle, P. O. Box 471, Boulder, CO 80306. To make a donation by credit card, go to www.ColoradoGives.org and type “Aging Services Foundation (ASF) of Boulder County” in the search box. Then click “Donate” on the ASF box. Please type “Caregiver Programs” in the special instructions box. Your contribution is tax-deductible and will go directly to BCAAA’s caregiver programs. Thank you. Please don’t hesitate to contact me for information and support.

Sincerely,

Emily Cooper, Information and Referral Specialist - Caregiver Programs, BCAAA303-678-6116, InfoCaregiver@bouldercounty.org.

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COMMUNITY RESOURCES

This column provides information about events and classes, services, and other resources that may be of interest to family caregivers in Boulder County. Please remember that it is each person’s right and responsibility to research a service provider or event before taking action. See “Information and Assistance in Boulder County” on the back page for ways to learn more about these and other resources. (To share information about a resource for family caregivers, email InfoCaregiver@bouldercounty.org or call 303-678-6116. The deadline for the May/June 2016 issue is March 25.)

Medicare Counselors with Boulder County Area Agency on Aging hold Medicare Basics Classes for anyone wanting to learn more about enrollment, benefits, costs, and choices under Medicare, on Thursdays, March 3 or April 7, 2 – 4 p.m., at East Boulder Senior Center, 5660 Sioux Drive, Boulder (call 303-441-1546 to register); on Mondays, March 21 or April 18, 10 a.m. – 12 p.m., at Longmont Senior Center, 910 Longs Peak Avenue, Longmont (call 303-651-8411 to register); and on Wednesday, March 16, 1:30 – 3:30 pm., at Louisville Senior Center, 900 W. Via Appia, Louisville (call 303-666-7400 to register). These classes are free, but donations are appreciated.

The Respite Assistance Program, of Boulder County Area Agency on Aging, offers financial assistance for respite care to Boulder County residents caring for loved ones age 60 and over (or of any age if they have dementia). The program provides up to $500 per calendar year in reimbursement for the costs of hiring a substitute caregiver so the primary caregiver can take a needed break—or respite. The substitute care can be provided by a friend, relative, home health care agency, adult day program, or long-term care facility. Applications are being taken now for 2016 funds; contact

your local Resource Specialist (see the back page of this issue for phone numbers) or the ADRC Helpline, at 303-441-1617.

The Alzheimer’s Association Colorado Chapter offers The Basics: Memory Loss, Dementia and Alzheimer’s, on Wednesday, March 16, 4:30 – 6:30 p.m., at Lafayette Senior Center, 103 S. Iowa Avenue, Lafayette; Healthy Habits for a Healthier You (in Spanish), on Wednesday, March 23, 10 – 11:30 a.m., at Longmont Senior Center, 910 Longs Peak Avenue, Longmont; Know the 10 Signs: Early Detection Matters, on Monday April 11, 1 – 3 p.m., at Kaiser Rock Creek Clinic (Aspen Creek 1), 280 Exempla Circle, Lafayette; and Living with Alzheimer’s: For Middle Stage Caregivers (two-part), on Fridays, April 15 and 22, 9 a.m. – 12 p.m., at Longmont Senior Center (address above); and on Wednesdays, April 20 and 27, 9 a.m. – 12 p.m., at East Boulder Senior Center (Eldorado), 5660 Sioux Drive, Boulder. Pre-registration is required. Register for classes at Longmont Senior Center at 303-651-8411; register for all other classes at 1-800-272-3900. See class descriptions at www.alz.org/co (Classes and Workshops).

Longmont Senior Center offers several classes for people with any degree of hearing loss, and for their family, friends, and caregivers. Transitions: Understanding Hearing Loss (two-part), which covers the themes of awareness, equipment, interactions, experiences, and action related to hearing loss, is on Thursdays, March 17 and April 21, 4 – 5:30 p.m.; and Social Sign Language: Visual Communication for People with Hearing Loss, about using modified American Sign Language (ASL) to supplement spoken language (no signing experience needed), is on Fridays, April 29 and June 17, 9:30 – 11 a.m.; all at Longmont Senior Center, 910 Longs Peak Avenue, Longmont. The classes are taught by

Rebecca Herr, MA, president of Association of Late Deafened Adults (ALDA) – Boulder. There is no charge, but pre-registration is required, at 303-651-8411.

You Can Become a Savvy Caregiver, a training program that strives to help family caregivers increase their understanding of dementia, build their confidence, and reduce the adverse affects of caregiving by managing and caring for themselves daily, is on Wednesdays, April 6 – May 11, 6 – 8 p.m., at Longmont Senior Center, 910 Longs Peak Avenue, Longmont. The course is open to family caregivers of loved ones with early- to mid-stage dementia (Alzheimer’s or another type). Attendance at all classes is required, and class size is limited. Pre-registration is required; call 303-651-8414.

Boulder County Area Agency on Aging offers the National Caregiver Training Program, an 18-hour course (meets once a week for 3 hours), taught by a registered nurse, that helps family caregivers acquire skills needed to provide safe, confident home care for frail older loved ones, on Thursdays, April 7 – May 12, 1:30 – 4:30 p.m., in Boulder. There is no charge, but donations are appreciated. Financial assistance for respite care (substitute elder care during class sessions) is available. For more informa-tion or to register, call 303-678-6116 or email InfoCaregiver@bouldercounty.org .

Longmont Senior Center hosts two panel presentations on the “basics:” Long-Term Care Basics, about long-term care financial options and planning, including VA benefits, the difference between Medicaid and Medicare coverage, how long-term care insurance policies work, and applying for and benefits of Long-Term Care Medicaid, with attorney Roseann Murray, Long-Term Care Medicaid supervisor Amelia Groves, and long-term care insurance professional Michael Bellmont, on Thursday, April 14, 4 – 5:30 p.m.; and Nursing Home

Basics, about the different kinds of facility care, what makes Assisted Living different than Skilled Nursing facilities, how to know when skilled nursing-level care is needed, and more, with BCAAA Long-Term Care Ombudsman Erica Corson, Cinnamon Park Assisted Living Director Debbie Setlock, and Life Care Center Admissions Director Jolene McGee, on Thursday, April 21, 4 – 5:30 p.m. The presentations are free, but pre-registration is required, at 303-651-8411.

The 11th Annual Caregiving Symposium is on Thursday, May 19, 9:30 a.m. – 5 p.m. (come for all or part), at the Plaza Convention Center, in Longmont. This popular event features a large resource fair of local service providers, a dozen-plus workshops on caregiving topics, informative handouts, complimentary lunch, and more. Pre-registration is required for admission with lunch. Register online at www. caregivingsymposium2016.eventbrite.com or by calling 303-441-1685 (both start March 1). Walk-in registration, without lunch, is permitted. Free on-site elder care is available by reservation; call 303-441-1543. The full agenda will be posted on the event website (above) on April 1. The Caregiving Symposium is sponsored by Boulder County Area Agency on Aging with the generous support of co-sponsors Aging Services Foundation, Life Care Center of Longmont, The Peaks at Old Laramie Trail, HomeCare of the Rockies, Hover Community, Allegiance Home Care, 50 Plus Marketplace News, The Peaks Care Center & Frontier Therapy, Meals on Wheels of Boulder, Professional Home Health Care/ Care Link Adult Day Program, Synergy HomeCare, Via Mobility Services, and Windhorse Family and ElderCare.

For a list of caregiver support groups that meet in Boulder County, call 303-678-6116 or email InfoCaregiver@bouldercounty.org .

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Managing Medication Costsby Jan Van Sickle

t’s no secret that prescription drug costs are on the rise, and that most Americans are

taking more than one prescription drug by the time they reach their senior years. While many common generic drugs are affordable; even with health insurance coverage, the copayments on some brand-name or specialty drugs can be pro-hibitive. Some people, if unable to afford the cost of a drug, simply walk away from the pharmacy without it. Some may skip doses or split pills to save money. The ensuing guilt over not following the doctor’s instructions may lead to avoiding fol-low-up visits, as well as the obvious consequence of leaving a health condition improperly treated. But there are strategies to reduce prescription drug costs, and it’s worth trying as many as apply in your particular situation: • Foremost, make your prescribing doctor aware

that prescription drug prices are a concern. Your doctor may be unaware that the newest medication she’d like you to take is financially out of your reach. Ask about generic equiva-lents or similar drugs that are more affordable.

• If you are without health insurance and under age 65, check to see if you’re eligible for Med-icaid or a subsidized market plan. You can ap-ply online at www.connectforhealthco.com , or for personal assistance, call 303-441-1000 and ask to speak with a health coverage guide.

• If you are 65 or older and have Medicare, be sure to enroll in a Part D (prescription drug) plan or a Medicare Advantage/Health plan with drug coverage. Check to see if you are eligible for assistance with both the plan pre-mium and drug copays through Extra Help (also known as LIS). Apply online at www.ssa.gov or call Boulder County Medicare Counseling at 303-441-1546 and ask for a paper application. Also, check your Part D prescription drug plan each fall by using the

T

Spring Cleaningby Desiree Firle and Neal Waite

he annual ritual of spring cleaning can be joy-ful for some and annoying for others; but

regardless, it gives us the opportunity to rid ourselves of items we don’t need or use. An important part of our spring cleaning ritual should be discarding med-ications that are out of date or no longer needed. We’re all guilty of holding on to the bottle of TUMS© we purchased years ago and the cough drops that have adhered to their wrappers. We might find an old bottle of Roxicodone® pre-scribed by one doctor next to the Omeprazole® prescribed by another and wonder, “What were these for?” We can learn about these and other medications by visiting the Aging and Disability Resources for Colorado website at www.BoulderCountyHelp.org , clicking on “Library” (on the title bar), and searching for individual medications. There we can read about Roxicodone®, the narcotic our father took after his knee replacement, and Omeprazole®, the medication that was prescribed to our partner for chronic heartburn. For every medication listed, we can learn its brand names, what it does, how to take it, possible side effects and interactions, and much more. Now we can check each medication’s hard-to-find expiration date and collect all the old TUMS®, cough drops, Roxicodone®, Omeprazole®, sup-plements, and more. We shouldn’t flush these medications down the toilet or dump them in the trash, so we’ll call our local public safety office for the date of the next Drug Take-Back event in our community: Boulder County Sheriff - 303-441-4444, Boulder Police - 303-441-3333, Long-mont Police - 303-651-8555, Louisville Police - 303-666-8634, and Lafayette Police - 303-665-5571. Spring cleaning … check!

Desiree Firle, ADRC Coordinator, and Neal Waite, ADRC Program Assistant, are with Boulder County Area Agency on Aging.

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Plan Finder on www.Medicare.gov to be sure your plan is the least expensive one that cov-ers your drugs. You can change Part D plans or Advantage/Health plans with drug cover-age each year during the Open Enrollment Period from Oct. 15 – December 7.

• Shop pharmacies for the best price. Drug pric-ing can vary widely among pharmacies, and the big chain pharmacies aren’t always the lowest. Some pharmacies offer in-house ge-neric specials. Remember, you don’t have to run all of your prescriptions through your health insurance plan if the store’s in-house plan is cheaper. However, it is wise to use one pharmacy for all of your prescriptions to avoid dangerous drug interactions that may not be flagged if different pharmacies are used.

• Ask if a 90-day or mail-order prescription will save you money. Many times you can get three months’ worth of drugs for the price of two months. But don’t assume this is the case: on Medicare drug plans, the mail-order price is of-ten higher if brand-name drugs are prescribed!

• Try using prescription discount cards that of-fer savings on a variety of medications. There are numerous prescription discount cards to be found online or simply on display at phar-macies and other retail locations. Some can’t be combined with other insurance, and almost none will work if you have Medicare. Most are safe to use, but don’t use one that asks you to register with personal information in order to get the card—unless you’re using a card that is for one specific drug. Those almost always will ask for personal information prior to use. You can ask the pharmacy assistant to try different cards to see which gives you the best price.

• Look for manufacturers’ patient assistance pro-grams (PAPs) and copay assistance programs. Drug manufacturers often have PAPs to allow patients to access their high-priced medica-tions. There is a two-part application process

that requires you to give financial information (their income limits are generally much more generous than government assistance programs like Extra Help), and then your doctor must complete part of the application. Many PAPs will provide the drug for free to qualifying pa-tients, while the copay assistance programs will pay or reimburse a portion of your copay-ment. The best place to find these programs is at www.NeedyMeds.org. This non-profit re-source has a comprehensive list of brand-name and generic drugs, along with the programs that might assist with the cost for each. It also lists drugs by diagnosis and can direct you to other support programs for specific diseases and conditions.

• If you don’t have insurance, you can try online pharmacies, but you must use caution. Many online pharmacies that claim to be U.S. phar-macies are not, and they may dispense drugs made abroad that are not inspected by the FDA. You may be getting counterfeit drugs that are ineffective or even dangerous. Be wary of any online pharmacy that doesn’t ask for a doctor’s prescription. Consumer Reports recommends using only an online pharmacy that displays the “VIPPS” symbol to show that it is a Veri-fied Internet Pharmacy Practice Site. One widely recognized reputable online drugstore is www.Healthwarehouse.com .

• Try negotiating. Again, if you don’t have insur-ance, the retail price you are first quoted likely will be higher than the pharmacy actually ex-pects you to pay. Always ask, “Is this your best price?” You can check fair pricing at www.GoodRx.com and use the price you find there as a negotiating tool.

Jan Van Sickle is a Medicare Counselor with Boulder County Area Agency on Aging.

CARE ConnectionsBoulder County Area Agency on AgingP. O. Box 471Boulder, CO 80306

INfORMATION ANd ASSISTANCE IN BOUldER COUNTY

Within Boulder County, there are several ways to access information and assistance about resources and services for older adults and their family caregivers: • Check out Network of Care for Seniors and People with Disabilities, a comprehensive

online service directory, at www.BoulderCountyHelp.org • Call the ADRC Help Line, at 303-441-1617, and Boulder County Area Agency on Aging

staff will respond to your message. • Call the resource specialist in your community (numbers below). Services vary by

community but include identifying needs, exploring options, finding solutions, and providing in-depth assistance.Allenspark area 303-747-2592City of Boulder 303-441-4388 (bilingüe: 303-441-3918)City of Lafayette 303-661-1499City of Longmont 303-651-8716 (bilingüe), 303-774-4372 City of Louisville 303-335-4919Erie 303-441-1617Lyons area 303-823-9016Nederland area 303-258-3068Niwot area 303-441-1617Superior 303-441-1617