Seneca Place is proud to celebrate the incredible progress of Ms. Janet Hollamon! After facing significant challenges with strength and endurance following a collapsed lung, Ms. Hollamon showed unwavering determination throughout her physical and occupational therapy journey.

Thanks to her hard work and the support of our dedicated therapy teams, Ms. Hollamon regained her independence and confidence. Her inspiring advice to others: “Do your work, not just in therapy but on your own. Listen to your therapist, but don’t only rely on them—have a positive attitude.”

We’re thrilled to share that Ms. Hollamon has returned home to her family and her garden! Congratulations on her amazing achievement!

What Is Telehealth?

Telehealth is a service that uses video calling and other technologies to help you see your doctor or other health care provider from home instead of at a medical facility. Telehealth may be particularly helpful for older adults with limited mobility and for those living in rural areas, as they will have the opportunity to see and talk with their doctor from their home. For older adults, talking with their doctor online, through a phone, tablet, or other electronic device, can often be easier, faster, and less expensive than making a trip to an office.

Telehealth can also help support family caregivers who are taking care of their loved ones either close by or from afar. If a caregiver needs to ask the doctor a question, they can do so through an online health portal rather than waiting for and traveling to an in-person appointment.

How to Prepare for a Telehealth Appointment: Tips for Older Adults

The transition from in-person to online appointments can be difficult for some people, especially those who are not familiar with the technology. By taking a few minutes before your appointment to prepare, you can set yourself up for a more successful visit.

• Add online appointments to your calendar. Once your appointment is confirmed, add it to your calendar so you don’t forget.
• Try to use the best camera you can find. This may be attached to your phone, laptop, tablet, or desktop computer. A clear picture can help your doctor understand and address your concerns more easily and effectively.
• Test the camera in advance. Practice in advance with a family member or a friend to make sure you understand how to use your camera when you have your online visit with your doctor.
• Test the sound and video on your device. Most devices have built-in microphones and speakers, but you may have to turn them on or enable the telehealth software or website to access them. Video calling a friend before your appointment can help ensure that everything is working properly. Using headphones or earbuds may make it easier for you to hear your doctor and for your doctor to hear you, but it’s good to test these out first to see what works best.
• Use the best internet connection possible. If you are not using Wi-Fi, try getting the best signal by using a wired connection to your router or an Ethernet cable. If you are using Wi-Fi, being physically close to the internet router and minimizing devices connected to it can help improve your connection.
• Charge your device. If you are using a wireless device, like a phone, laptop, or tablet, check to make sure your battery is charged enough to last through your appointment. Try charging it the night before your appointment.
• Find a quiet space and adjust lighting. Limit distractions and clutter in your space. Try finding a place with good lighting so your doctor can see you properly.
• Position yourself. Place your device on a sturdy surface so you can move around if you need to. Try positioning your device so your head and shoulders are in the camera frame.
• Prepare a list of questions/concerns. Being prepared for your appointment will help make it easier for you and your doctor to cover everything you need to talk about.

Are Telehealth Appointments Covered by Insurance?

Many insurance providers, including Medicaid and some private insurers, are beginning to cover telehealth services. However, telehealth coverage varies widely from state to state with differences in how telehealth is defined and paid for. Because insurance coverage policies differ, it’s important to check with insurance providers or your health care provider’s billing department directly for the latest information about coverage for telehealth services.

Will Medicare Cover My Telehealth Appointment?

If you are enrolled in Medicare Part B, certain telehealth services, like doctor’s visits, outpatient care, medical supplies, and preventive services may be covered.

The specific amount you will owe may depend on several factors, including:

• Other insurance you may have
• How much your doctor charges
• The type of facility
• Where you get your test, item, or service

Medicare also covers virtual check-ins and E-visits.

Medicare Advantage Plans are a type of Medicare health plan offered by a private company that contracts with Medicare to provide Part A and Part B benefits. These plans may offer more telehealth benefits than Original Medicare.

Medicare plans are constantly changing and updating. Check with your provider to see what telehealth benefits are offered for your plan.

Learn more about Medicare and telehealth services.

Online Clinical Research Assessments and Trials

Are you involved in a clinical trial or considering participating in research? Typically, clinical trials require in-person visits. However, some clinical trials are conducting initial surveys or tests for research online, while some studies and trials are being conducted entirely online. Conducting clinical studies online can help encourage people to participate. Online clinical trials help eliminate travel time to trial sites and allow patients to participate from the comfort of their own home. This is increasingly beneficial for older adults who have limited mobility.

Find a clinical trial that works for you using the Clinical Trials Finder or ClinicalTrials.gov.

Healthy eating can help you lose or maintain weight, feel better overall, and possibly decrease your chances of getting certain diseases. Making smart food choices is important at any age. But eating healthy can be difficult even if you know which foods you should buy and prepare. Your budget, physical issues, mood changes, and dietary restrictions can be roadblocks to eating food that’s best for you. Here are suggestions for dealing with common problems that can make it harder for older adults to follow through on smart food choices.

Trying to eat healthy on a budget?

Even when you know which healthy foods to choose, people living on fixed or limited incomes may not be able to buy what’s ideal. Start by deciding how much you can afford to spend on food.

There are a number of resources that can help you plan a food budget. For example, the U.S. Department of Agriculture supports Iowa State University’s Spend Smart-Eat Smart program. This website also features more than 100 inexpensive recipes, with nutrition information and cost per serving.

Once you have decided on your budget, look for grocery store advertising in the newspaper or online to see what is on sale. Try to plan some meals around featured items and consider purchasing extra nonperishables such as canned goods when they’re on sale. Use coupons when possible and ask your grocery store staff if they have a senior discount or loyalty rewards program. Consider buying store-brand products, which are often the same as more expensive brand-name ones. Focus on buying healthy and inexpensive produce. Many nutritious fruits and vegetables — such as bananas, apples, oranges, lettuce, green peppers, and carrots — may be reasonably priced.

Tired of cooking or eating alone?

Maybe you are tired of planning and cooking dinners every night. Have you considered potluck meals? If everyone brings one part of the meal, cooking is a lot easier, and there might be leftovers to share. Or try cooking with a friend to make a meal you can enjoy together. Food delivery services are yet another option. You could also look into having some meals at a nearby senior center, community center, or religious facility. Not only will you enjoy a free or low-cost meal, but you will also have some company while you eat. Visit the Eldercare Locator to search for centers in your area.

Problems chewing or swallowing food?

Do you avoid some foods because they are hard to chew? People who have problems with their teeth or dentures often avoid eating meat, fruits, or vegetables and might miss out on important nutrients. If you are having trouble chewing, see your dentist to check for problems. If you wear dentures, the dentist can check the fit.

If food seems to get stuck in your throat or is hard to swallow, it might be that you don’t have enough saliva in your mouth. Or, there may be other reasons, including problems with the muscles or nerves in your throat, problems with your esophagus, or gastroesophageal reflux disease. Talk to your doctor about what might be causing your swallowing issues.

Physical problems making it hard to eat?

Sometimes illnesses such as Parkinson’s disease, stroke, or arthritis can make it harder to cook or feed yourself. Your doctor might recommend an occupational therapist. The therapist might make a custom splint for your hand, give you special exercises to strengthen your muscles, or suggest rearranging things in your kitchen. Special utensils and plates might make mealtimes easier or help with food preparation.

Food tastes different?

Are foods not as tasty as you remember? It might not be the cook’s fault! Maybe your sense of taste, smell, or both has changed. Growing older, having dental problems, and medication side effects can cause your senses to change. Taste and smell are important for a healthy appetite and eating. Try adding fresh herbs, spices, or lemon juice to your plate.

Smoking and drinking alcohol can also affect your sense of taste. If you smoke, quitting may not only improve your sense of taste and smell, but also your health in many other ways. If you drink alcohol, consider stopping or cutting back.

Some medicines can change how food tastes, make your mouth dry, or reduce your appetite. In turn, some foods can change how certain medicines work. You might have heard that grapefruit juice is a common culprit when used with any of several drugs. Chocolate, licorice, and alcohol are some others. Whenever your doctor prescribes a new drug for you, be sure to ask about any food-drug interactions.

Just not hungry?

Changes to your body as you age can cause some people to feel full sooner than they did when they were younger. Lack of appetite can also be a side effect of a medicine you are taking. Talk with your doctor about any side effects you may be experiencing. Your doctor may be able to suggest a different drug.

Try to be more active. In addition to all the other benefits of exercise and physical activity, these may make you hungrier. If you aren’t hungry because food just isn’t appealing, there are ways to make it more interesting. Make sure your foods are seasoned well, but not by adding extra salt. Try using lemon juice, vinegar, or herbs to boost the flavor.

Vary the shape, color, and texture of foods you eat. When you go shopping, look for a new vegetable, fruit, or seafood you haven’t tried before or one you haven’t eaten in a while. Some grocery stores have recipe cards near items, or you can ask the staff for suggestions about preparing the new food or find recipes online. Foods that are overcooked tend to have less flavor. Try cooking or steaming your vegetables for a shorter time and see if that gives them a crunch that will help spark your interest.

Food allergies or dietary restrictions?

Some older adults have allergies to certain foods, such as wheat, nuts, or dairy. Others may have dietary restrictions for religious, ethical, or personal reasons. Whatever your dietary needs are, it is still possible to choose healthy foods.

Avoiding dairy? Talk to your health care provider about how to get enough calcium and vitamin D. Even lactose-intolerant people might be able to have small amounts of milk when taken with food. There are also nondairy food sources of calcium, lactose-free milk and milk products, calcium- and vitamin D-fortified foods, and supplements.

Gluten sensitivity or allergy? Check out these resources that explain the different types of gluten sensitivities and allergies and learn how to make smart food choices for each type.

Vegetarian or vegan? Check out these resources for incorporating plant-based protein into your diet.

To learn more, please visit https://www.nia.nih.gov/health/healthy-eating-nutrition-and-diet/overcoming-roadblocks-healthy-eating.

During an emergency or at the end of life, you may face questions about their medical treatment and not be able answer them. You may assume your loved ones know what you would want, but that’s not always true. In one study, people guessed nearly one out of three end-of-life decisions for their loved one incorrectly.

Research shows that you are more likely to get the care you want if you have conversations about your future medical treatment and put a plan in place. It may also help your loved ones grieve more easily and feel less burden, guilt, and depression.

What is advance care planning?

Advance care planning involves discussing and preparing for future decisions about your medical care if you become seriously ill or unable to communicate your wishes. Having meaningful conversations with your loved ones is the most important part of advance care planning. Many people also choose to put their preferences in writing by completing legal documents called advance directives.

What are advance directives?

Advance directives are legal documents that provide instructions for medical care and only go into effect if you cannot communicate your own wishes.

The two most common advance directives for health care are the living will and the durable power of attorney for health care.

• Living will: A living will is a legal document that tells doctors how you want to be treated if you cannot make your own decisions about emergency treatment. In a living will, you can say which common medical treatments or care you would want, which ones you would want to avoid, and under which conditions each of your choices applies. Learn more about preparing a living will.
• Durable power of attorney for health care: A durable power of attorney for health care is a legal document that names your health care proxy, a person who can make health care decisions for you if you are unable to communicate these yourself. Your proxy, also known as a representative, surrogate, or agent, should be familiar with your values and wishes. A proxy can be chosen in addition to or instead of a living will. Having a health care proxy helps you plan for situations that cannot be foreseen, such as a serious car accident or stroke. Learn more about choosing a health care proxy.

Think of your advance directives as living documents that you review at least once each year and update if a major life event occurs such as retirement, moving out of state, or a significant change in your health.

Who needs an advance care plan?

Advance care planning is not just for people who are very old or ill. At any age, a medical crisis could leave you unable to communicate your own health care decisions. Planning now for your future health care can help ensure you get the medical care you want and that someone you trust will be there to make decisions for you.

What happens if you do not have an advance directive?

If you do not have an advance directive and you are unable to make decisions on your own, the state laws where you live will determine who may make medical decisions on your behalf. This is typically your spouse, your parents if they are available, or your children if they are adults. If you are unmarried and have not named your partner as your proxy, it’s possible they could be excluded from decision-making. If you have no family members, some states allow a close friend who is familiar with your values to help. Or they may assign a physician to represent your best interests. To find out the laws in your state, contact your state legal aid office or state bar association.

Will an advance directive guarantee your wishes are followed?

An advance directive is legally recognized but not legally binding. This means that your health care provider and proxy will do their best to respect your advance directives, but there may be circumstances in which they cannot follow your wishes exactly. For example, you may be in a complex medical situation where it is unclear what you would want. This is another key reason why having conversations about your preferences is so important. Talking with your loved ones ahead of time may help them better navigate unanticipated issues.

There is the possibility that a health care provider refuses to follow your advance directives. This might happen if the decision goes against:

• The health care provider’s conscience
• The health care institution’s policy
• Accepted health care standards

In these situations, the health care provider must inform your health care proxy immediately and consider transferring your care to another provider.

Other advance care planning forms and orders

You might want to prepare documents to express your wishes about a single medical issue or something else not already covered in your advance directives, such as an emergency. For these types of situations, you can talk with a doctor about establishing the following orders:

• Do not resuscitate (DNR) order: A DNR becomes part of your medical chart to inform medical staff in a hospital or nursing facility that you do not want CPR or other life-support measures to be attempted if your heartbeat and breathing stop. Sometimes this document is referred to as a do not attempt resuscitation (DNR) order or an allow natural death (AND) order. Even though a living will might state that CPR is not wanted, it is helpful to have a DNR order as part of your medical file if you go to a hospital. Posting a DNR next to your hospital bed might avoid confusion in an emergency. Without a DNR order, medical staff will attempt every effort to restore your breathing and the normal rhythm of your heart.
• Do not intubate (DNI) order: A similar document, a DNI informs medical staff in a hospital or nursing facility that you do not want to be on a ventilator.
• Do not hospitalize (DNH) order: A DNH indicates to long-term care providers, such as nursing home staff, that you prefer not to be sent to a hospital for treatment at the end of life.
• Out-of-hospital DNR order: An out-of-hospital DNR alerts emergency medical personnel to your wishes regarding measures to restore your heartbeat or breathing if you are not in a hospital.
• Physician orders for life-sustaining treatment (POLST) and medical orders for life-sustaining treatment (MOLST) forms: These forms provide guidance about your medical care that health care professionals can act on immediately in an emergency. They serve as a medical order in addition to your advance directive. Typically, you create a POLST or MOLST when you are near the end of life or critically ill and understand the specific decisions that might need to be made on your behalf. These forms may also be called portable medical orders or physician orders for scope of treatment (POST). Check with your state department of health to find out if these forms are available where you live.

You may also want to document your wishes about organ and tissue donation and brain donation. As well, learning about care options such as palliative care and hospice care can help you plan ahead.

How can you get started with advance care planning?

To get started with advance care planning, consider the following steps:

• Reflect on your values and wishes. This can help you think through what matters most at the end of life and guide your decisions about future care and medical treatment.
• Talk with your doctor about advance directives. Advance care planning is covered by Medicare as part of your annual wellness visit. If you have private health insurance, check with your insurance provider. Talking to a health care provider can help you learn about your current health and the kinds of decisions that are likely to come up. For example, you might ask about the decisions you may face if your high blood pressure leads to a stroke.
• Choose someone you trust to make medical decisions for you. Whether it’s a family member, a loved one, or your lawyer, it’s important to choose someone you trust as your health care proxy. Once you’ve decided, discuss your values and preferences with them. If you’re not ready to discuss specific treatments or care decisions yet, try talking about your general preferences. You can also try other ways to share your wishes, such as writing a letter or watching a video on the topic together.
• Complete your advance directive forms. To make your care and treatment decisions official, you can complete a living will. Similarly, once you decide on your health care proxy, you can make it official by completing a durable power of attorney for health care.
• Share your forms with your health care proxy, doctors, and loved ones. After you’ve completed your advance directives, make copies and store them in a safe place. Give copies to your health care proxy, health care providers, and lawyer. Some states have registries that can store your advance directive for quick access by health care providers and your proxy.
• Keep the conversation going. Continue to talk about your wishes and update your forms at least once each year or after major life changes. If you update your forms, file and keep your previous versions. Note the date the older copy was replaced by a new one. If you use a registry, make sure the latest version is on record.

Everyone approaches the process differently. Remember to be flexible and take it one step at a time. Start small. For example, try simply talking with your loved ones about what you appreciate and enjoy most about life. Your values, treatment preferences, and even the people you involve in your plan may change over time. The most important part is to start the conversation.

How to find advance directive forms

You can establish your advance directives for little or no cost. Many states have their own forms that you can access and complete for free. Here are some ways you might find free advance directive forms in your state:

• Contact your State Attorney General’s Office.
• Contact your local Area Agency on Aging. You can find your area agency phone number by visiting the Eldercare Locator or by calling 800-677-1116.
• Download your state’s form online from one of these national organizations: AARP, American Bar Association, or National Hospice and Palliative Care Organization.
• If you are a veteran, contact your local Veteran’s Affairs (VA) office. The VA offers an advance directive specifically for veterans.

Some people spend a lot of time in more than one state. If that’s your situation, consider preparing advance directives using the form for each state, and keep a copy in each place, too.

There are also organizations that enable you to create, download, and print your forms online, but they may charge fees. Before you pay, remember there are several ways to get your forms for free. Some free online resources include:

• PREPARE for Your Care: An interactive online program that was funded in part by NIA. It is available in English and Spanish.
• The Conversation Project: A series of online conversation guides and advance care documents available in English, Spanish, and Chinese. The Conversation Project is a public engagement initiative led by the Institute for Healthcare Improvement.

If you use forms from a website, check to make sure they are legally recognized in your state. You should also make sure the website is secure and will protect your personal information. Read the website’s privacy policy and check that the website link begins with “https” (make sure it has an “s”) and that it has a small lock icon next to its web address.

Some people also choose to carry a card in their wallet indicating they have an advance directive and where it is kept. Below is an example from the American Hospital Association (PDF, 40KB).

To learn more, please visit https://www.nia.nih.gov/health/advance-care-planning/advance-care-planning-advance-directives-health-care.

Receiving a diagnosis of Alzheimer’s disease can be challenging. You may not know what to expect or what to do next. The steps below can help you get started.

Learn about Alzheimer’s disease

Being informed will help you know what to expect as the disease progresses. Here are some resources:

• Alzheimer’s and related Dementias Education and Referral (ADEAR) Center
  800-438-4380
• Alzheimers.gov
• Alzheimer’s Association
  800-272-3900
• Alzheimer’s Foundation of America
  866-232-8484

Local hospitals and community centers may have educational programs about Alzheimer’s disease and related dementias.

Get regular medical care

• Talk with your doctor about what to expect, what treatment options may be available, and what decisions you need to make.
• Attend appointments with your primary care doctor and any recommended specialists.
• Ask your doctor for a referral to a memory disorders clinic.

Find local services and support

• Find local services by visiting the Eldercare Locator online or calling 800-677-1116.
• Find local organizations and support groups through the Alzheimer’s Association or the Alzheimer’s Foundation of America.
• Contact an Alzheimer’s Disease Research Center near you.

Make legal, financial, and long-term care plans

• Get information to help you plan for the future.
• Prepare or update your will, living will, health care power of attorney, and financial power of attorney. If you want to consult a lawyer, contact your local bar association or the National Academy of Elder Law Attorneys.
• Learn about how to manage your finances with Alzheimer’s.
• Learn about long-term care you may need and how to pay for it.
• Explore getting help to pay for medicines, housing, transportation, and more.

If you are working

• Consult your employer’s human resources department or employee assistance program about family leave, disability benefits, and other employee benefits.
• If you work, consider your options. Learn more about Alzheimer’s and employment.
• If you have problems performing your job, consider reducing your hours or switching to a less demanding position.
• People with Alzheimer’s may be eligible for disability income through private disability insurance, Social Security benefits, or veterans’ benefits. Social Security’s Compassionate Allowances program may help with speeding up a disability claim. Call 800-772-1213 for more information.

If you live alone

• Find someone who can visit you regularly and be an emergency contact.
• People with Alzheimer’s are at a greater risk of falling and should consider using an emergency response system. These systems use a special pendant or bracelet that lets you summon help if you fall and can’t reach the phone.
• Contact an occupational therapist who can teach you ways to stay independent for as long as possible. Ask your doctor for more information.
• Get tips about self-care, safety, staying connected, and more.

Explore ways to make tasks easier

• Use simple memory aids such as notes for reminders, a pillbox to organize medications, and a calendar to record appointments.
• Ask family members or friends, or find local services, to help with routine tasks, such as cooking, paying bills, transportation, or shopping.
• Try using technology to help with medication management, safety (e.g., emergency response, door alarms), and other care.

Be safer at home

• Learn more about home safety and get tips.
• Ask your doctor to order a home safety evaluation and recommend a home health care agency to conduct it. Medicare may cover the cost.
• Consider enrolling in the MedicAlert + Alzheimer’s Association Safe Return program. Note that this service is not affiliated with NIA, and there may be a charge for this service.

Stay safe on the road

• Talk with your doctor if you become confused, get lost, take a long time to run a simple errand and can’t explain why, or if others worry about your driving.
• Get a driving evaluation. Ask your doctor for names of driving evaluators, contact your state’s department of motor vehicles, or visit the American Occupational Therapy Association.
• Learn more about driving safety for people with Alzheimer’s.

Make healthy lifestyle choices

• Be active. Exercise can help you feel better, and it keeps your muscles, joints, and heart in good shape.
• Eat a well-balanced diet.
• Stay connected with family and friends.
• Participate in meaningful activities, such as hobbies or volunteering, to keep your mind active and engaged.

Consider participating in Alzheimer’s research

• Ask your doctor about clinical trials or studies you might be eligible to participate in.
• Contact an Alzheimer’s Disease Research Center about potential research opportunities.
• Use the Alzheimers.gov Clinical Trials Finder to search for a clinical trial or study near you.

You can learn more about clinical trials at NIA’s Clinical Trials Information page. To read stories about the impact of clinical trials, or to find a clinical trial near you, visit the NIH Clinical Research Trials and You page.

To learn more, please visit https://www.nia.nih.gov/health/alzheimers-treatment/next-steps-after-alzheimers-diagnosis.