Author of “Making the Golden Years Golden”

      In 2011 the first baby boomers will turn 65 years old, according to the U.S. Census. This particular group of seniors will increase at a rapid pace, reaching 72 million within the next 20 years, which is double the number of seniors there were in the year 2000. As the American population ages, the rate at which the number of seniors 65 and older grows will accelerate to represent 20 percent of the total population, according to the U.S. Census.

      According to AARP, 80 percent of seniors have at least one chronic health condition, and 50 percent of seniors have at least two, including hypertension, heart disease, diabetes, arthritis, etc. Many seniors live in an unsafe environment, and are susceptible to injuries by falls or taking their medications at inappropriate times or doses. I believe that this places a great responsibility on family members and caregivers and health services providers to educate seniors on precautions that should be taken. We as the support system of the seniors must make sure that an emergency plan is put in place, which will help them to prepare for future needs.

        In this imperfect environment our health care is provided through multiple sources and specialists. It is not easy to navigate the many options that are available, or to find substitutes where there are not, it is upon us to reach out and help. One of the basic things that each senior should have is an Emergency Plan of Action. Such a plan need not be complex, and you may want to offer to your parent such a list to help them protect themselves. In my book Making the Golden Years Golden I have an extensive emergency plan of action. Here is a sample of the plan in a short form:

EMERGENCY PLAN OF ACTION

     1. Know to recognize the signs of decline and be ready to step-in.  You may be the one that upon noticing mental or physical changes needs to establish greater oversight. Among changes that you may notice are signs of neglect, confusion, clothing soiled, and/or a significant loss of weight, which are all indicators of crisis that need to be addressed. If upon visiting we notice neglect, foul odor, a senior that is still in his or her night clothing at mid day, it should alert us that intervention is needed.

     2. Advise your parent that they will need to protect themselves legally. They need to

put in place legal instruments such as Power of Attorney, Living Will, and Health Proxy. They need to know that they should choose a Health Proxy representative that will be available to the health care providers at a time when the patient is not able to voice his or her wishes. Your parent may naturally choose you as his or her health proxy, but if you live far from them, you may want to share that responsibility with someone, a relative or a friend, that live near your parent, and can be available in time of emergency

      3.   Advise your parent to be on the alert for scamming. Last year Americans were    scammed to the tune of 60 billion dollars. According to the AARP a third of this amount was scammed out of the elderly. In my opinion this number is actually much higher as many of the seniors do not realize that they were scammed, or are embarrassed to report the fact that they were scammed. Advise your parent not to accept phone marketing calls, and just hang up. They should never give out personal information, such as social security number or bank account number, over the phone.

       4.  Advise your parent or their care giver to keep an up-to-date list of their medication. Recommend that they keep a list of medications that is current, which includes name, dosage and mode of usage. Due to multiple health issues, and care provided by several specialists, all doctors should be made aware as to what the others are prescribing. Advise your parent to take a copy of this list to all doctors’ appointments.  There are many aids to pre-pour medication to help the elderly to avoid either taking meds twice, not remembering if they took the medication already, or forgetting to take the medication altogether. 

     5. Help your parent to develop a list of emergency contacts, such as their children, other relatives, neighbors, or anyone that can be of help in a time of emergency. Your parent needs to have on this list the names of all the physicians that he or she currently receives care from.  The doctors need to be listed by name, specialty, and with phone numbers and addresses. If home care is provided through an agency, the contact information of the agency should be included on this list.

     6. Suggest to your parent to develop a list of his or her personal information, to include Medicare card information, Social Security and Insurance information. This information should be at their finger tips, for quick retrieval in a time of emergency.

    7.  Help your parent to safe-proof their home. 78% of injuries within the  senior population occurs in their homes. The elderly needs someone to walk through their home and point out the safety measures that should be implemented. These should include safety bars in the bathroom, removing of area rugs, etc.. Suggest that they develop habits that will keep them safe, such as bringing a glass of water to the bed side, to avoid trips to the kitchen in the middle of the night. Leaving a light for the night, will reduce the chance of tripping and falling, or keeping a phone in the bathroom and next to their bed, etc.

According to the Agency for Healthcare Research and Quality 79% of seniors are living in their own home with or without assistance, but most can benefit from assistance. Many of the seniors do not have someone to step in and put in place a plan for them, so the responsibility falls on all of us, the society at large to help to protect our seniors. As a first step let’s protect our loved ones and help them develop an Emergency Plan of Action for their own protection. For more info: www.goldenyearsgolden.com

Author of “Making the Golden Years Golden”

Over the last few years, my mother’s best friend has shown signs of dementia, first mild forgetfulness and then some increasingly worrisome signs of “something gone wrong.” She did not have close family to step in, so my mother and I were her support system. Neighbors began calling my mother, complaining that her friend was leaving the television on very loud for days and nights. She was walking out and leaving the door to her apartment open. She was found on occasion leaving her house inappropriately dressed, and she began calling my mother multiple times, repeating the same conversation as if there was a new issue. Being that she had been functioning quite well up until that time, and the change was acute and swift, we felt that action should be taken.

Finding the solution

We started with taking my mom’s friend to her personal physician for a full evaluation, in which her doctor referred her to a neurological evaluation. My mom and I met with the doctors, but were very disappointed. None came up with any physical justification for her signs of dementia. We went back to her personal doctor and were reviewing each of her health issues and the treatment she was receiving for them, when the doctor asked her when and how she was taking the prescribed medication. She could not clearly say, and did not even remember if she had taken her medication for that day. It was clear that she was not taking her medication properly, maybe taking too much at one time or not taking any at another time. For that reason, we put in place a system that provided her with safe and timely medication taking. We purchased a medication dispenser for weekly supply, marked by day and time. Compartments were clearly marked for day of the week, as well as morning, noon, evening, etc. If a dose was not taken, it would buzz to remind the person to take it. In my book Making the Golden Years Golden I have a few suggestions as to different options for medication dispensers.  For more info – www.goldenyearsgolden.com

    As we age and more health conditions afflict us, there are more specialists that we see and more documents that represent our medical history unfortunately, in most cases, all this documentation is dispersed among many doctors. If you have had any hospitalizations or emergency room visits, your records are in the hospital. If you have a condition that requires the care of a specialist, he or she will have your records. If you require multiple specialists, each one will have records related to the treatment they provide.

    In the best of cases, the doctors are in communication with each other, and each is aware of how the others are handling your case, especially concerning the medication they individually prescribe for you, so that there is no contraindication. However with all the medical care that the average patient receives, through specialists, and sub-specialists, there is much room for errors, misdiagnoses, and possible unnecessary treatments. This leaves the responsibility up to you to gather all your medical records, be educated about your illnesses, and read up on the medications you are taking, including their side effects. It is after all, your life that is in those records.

    You should ask your doctors for copies of all reports and tests, and copies of letters the doctors send to one another pertaining to you. To the doctor, as much as he or she may like you personally, you are one of many and it is hard for the doctor to keep track of every detail. That is where the records come in. Your doctor has a set, and you should have one too.

    Today most records can be kept in electronic form, but systems are different, so most doctors keep a paper file of their patient’s records. The best way to keep your records is in chronological order, with the most current documents on top; but there are other methods which you may want to check out at www.myphr.com . Among your medical records should also be a printout from your pharmacy of a current list of all medications that you are taking.

   You should also keep a list of all the doctors that you are using for your health care. Write a short description of each doctor’s specialty, making it clear to someone else if they read the file. Also list each doctor’s name and telephone number, so it is available in an emergency. 

    It is also advisable to have a personal file which will include your personal data, such as name, address, phone number, Social Security number, and insurance company name and identification number. Include in this file any allergies that you may have. You may want to include a copy of your Health Proxy or Living Will, or any instructions you have to your doctors.  Let a family member or a friend know where you keep the medical file in case it is needed and you are not in a condition to direct them to it. For more information go to my site: www.goldenyearsgolden.com

My father suffered from Parkinson’s disease for 14 years, the last six of which he was fully impaired by the illness. As a survivor of the Holocaust, he avoided dealing with issues involving death, so he never wrote out a will or instructed us regarding his last wishes. There would always be time for that later, he thought.

When “later” came, my mother said that my father did not want heroic measures to be implemented to unnecessarily prolong his life. I was never privy to these conversations. None of his wishes regarding the care he may require at the end stages of his life were in writing.

A month before my father died, he came down with a very severe cold. It developed quickly from an upper respiratory infection to pneumonia, and we had no choice but to hospitalize him. His condition became critical and he was transferred to an intensive care unit. My whole family stayed by his side 24/7.  After much argument among members of my family, he was put on a respirator; he was still conscious at that time, could communicate in writing, and was included in decision-making regarding the respirator. 

My siblings, mother, and I put everything on hold to stay near my father. It was clear that my father drew a great deal of support from his children and his wife being by his side. Two weeks into his stay in the ICU, my father suffered a massive heart attack. He lost consciousness and never regained it.  The doctors kept performing all kinds of neurological tests, as per our demands. But more grim news kept coming back: no brain activities could be detected, and their recommendation was to remove my father from life support equipment.

His organs were failing one by one, and though we knew that the only thing keeping him alive were the machines, I could not give my consent to pull the plug. My father never specifically told me what he wanted me to do for him if such a situation presented itself. We all agonized, debating among ourselves and struggling with the decision, with the doctors pressing us to commit to a course of action. To our eventual relief, the decision-making process was taken out of our hands three days later, when God mercifully took him. 

Helping and Guiding Your Loved Ones in Making Health Decisions for You

If there is a lesson in my personal story, it is this: Do not procrastinate. Write down your wishes. Designate a person or persons whom you want to make those decisions when you are unable to do so yourself. It makes it easier for your own peace of mind as well as for the people who love you, allowing them to follow your requests, rather than stumble through their own guesswork.

The following are two legal instruments that you can put into place that can reflect your wishes as to the care you should or should not receive at the time that you are unable to express it.

Health Care Proxy or Durable Power of Attorney for Health Care:

In either document, you can name someone to make medical decisions for you, should you be unable to make those decisions yourself. The person you appoint may be referred to as “health care agent,” “medical power of attorney,” “surrogate,” or “attorney-in-fact.” The designated person must understand that she or he will need to avail themselves to the medical care providers when any medical decisions are to be made. You do not want to choose a representative that lives in another state from you, or one that is physically unable to be available to your medical team in a time of need.

You can be the final judge as to what should or shouldn’t be done to you. These important documents can include mechanical intervention in cases of respiratory failure, or dialysis due to kidney failure, and if hydration and gastric feeding tubes should be inserted. You can decide how much or how little medical intervention you want at the last stages of your life. With the Health Proxy or Durable Power of Attorney for Health Care, you empower a person you trust to carry out your wishes. These documents are much like a will but they deal with medical issues rather than with financial ones.

Leaving your health care decisions to others without any guidance from you places a great burden on your loved ones during a very traumatic time. If there is more than one opinion regarding your care from several loved ones, there is an unnecessary strain among them that is preventable.  Worse yet, if there is no health proxy and no next of kin, a judge may appoint someone who you are not familiar with to make medical decisions for you. That person may not know what your values, beliefs, or preferences are.

There are standard forms, at no cost to you, that are available at any hospital, nursing home, and the offices of any state agency that deals with health issues. You need two witnesses to attest to your signing. Some doctors as well as hospitals will refuse to follow verbal instructions unless a written Durable Power of Attorney for Health Care or a Health Proxy is in place.

www.goldenyearsgolden.com

It’s depressing work, yes.  Often deeply so.  The situations I’m presented with are incredibly hard, emotional, painful…think “last-ditch and beyond.”  Unfortunately, there are times when I can do nothing substantive. It’s hard not to become bitter or disillusioned about our society as a whole when all you hear are the misery, the pain and the frustration almost universally presented to me every day.  There’s not much good news in my day to day working life.  Pretty much never any victories or successes, at least that I hear about.

And my role, you ask?  My title is “Disability Specialist.” I’m one of only three people in the whole country, who, by job description, is tasked to listen and advise.  The listening is the harder of the two.  Hearing the stories I hear would take almost anyone to a new emotional low damn near every day.  Exactly how I get through the days without crying all night is not something I understand.  Somehow, I just do, I guess. Although, some days are worse than others.

In this state it truly sucks to be disabled, infirm or elderly.  There’s no state level disability, no Medicaid for you unless you’re drawing Social Security Disability (SSDI) or the OTHER benefit, SSI, or Supplemental Security Income.  For most, it is NOT “supplemental.”  It’s all they get.  And it ain’t “security,” for sure.  It barely qualifies as “income,” get right down to it.  I must hear the term “fixed income” a dozen times a day sometimes.

The callers come in various flavors.  Those new to the game are disillusioned, confused, unsure. Those who’ve been in it a while are usually very angry, often militantly so.  Those in between range from passive and resigned to defeated and desperate. Some have “entitlement fever.”  A very real phenomenon, believe me.  I can usually tell what “group” they’re in within a minute of answering my phone.

Most, I willingly help. Some, I tell the facts of life in the REAL world. The smallest segment includes those I’d like to seriously smack and tell them, “The state does NOT owe you a living! Deal with it!”  Some have never worked a day in their lives, mostly because they CAN’T, no matter how much they might want to. Others have worked all their lives, have hit hard times, and are disoriented, confused and unable to grasp what’s happening.  And, of course, there’s the group that thinks the state owes them everything from a warm bed, to food in their belly to transportation to the market…or the strip club.

Virtually every human services agency in the state knows our phone number.  If they don’t want to take the time, they routinely send the caller to us, often blind transferred and the caller hasn’t a clue how or why they ended up talking to me.  Often, they’re told before being transferred that we can fix it all, make it better, take away the pain, give them money, fix their house, give their landlord hell, clean up their kitchen, find them a job, pick them up some apples on the way home!  So, my first job is usually disappointing them by telling them the truth.  “No state agency is going to do that for you.”  Not what they want to hear.  “But, the last person I spoke to said you could!”  When I ask who that person was, they have no idea.  When I tell them again that it ain’t gonna happen, they STILL claim they were told I could put Humpty Dumpty back together again. Hope is hard to kill sometimes, and it’s something I really dislike doing.

And, I have to do it way too often.  To nice people in horrible situations, awful circumstances not of their own making, more often than not.  Happenstance shows no favoritism, knows no distinctions and is about as random as it gets.  One day they’re fine.  Employed, whole, thriving, or at least surviving.  The next day, they’re disabled, permanently injured, unable to use a limb or two, blinded, deafened, paralyzed, brain damaged, deathly ill or missing pieces and parts.

The other state agencies…that’d be the ones who are SUPPOSED to help these folks, send callers to me.  I often wonder why.  I think I’ve at least partially figured it out.  They are burned out, themselves depressed and distraught because THEIR agency won’t or can’t help.  The money just isn’t there.  And, whose fault is that?  The agencies say it’s the Legislature.  The Legislature says it’s the lack of Federal money.  The non-profits say that donations have dried up.  The for-profits won’t touch you unless YOU can pay, regardless of Medicare, Medicaid, Social Security, Worker’s Comp or Unemployment.  A fistful of fingers all pointing to other agencies, other programs…even other states.

For example, in my state, if you sustain a “traumatic brain injury,” or a TBI, then you are sent OUT OF STATE once you are stabilized!  Why?  So that state level Medicaid won’t have to pay for your treatment, rehabilitation, long term care or benefits.  Or this one…Medicaid won’t pay for “out-patient” procedures that would prevent hospitalizations.  Nope.  You must be admitted, THEN they’ll pay.  Couple thousand bucks a day to keep you there, which Medicaid does not pay in full.  The rest is up to you!  And believe me, Medicaid often pays a SMALL percentage of the bill, but the hospital can charge whatever they want, leaving you and yours to go into huge debt, collection agencies calling day and night, unlawful harrassment and all the rest.  All because what they needed originally, a relatively simple out-patient thing, isn’t covered by Medicaid.

The list goes on…and on, and on.  There are dozens of instances or situations I could cite where people are just flat given misleading information by the very agency tasked, BY LAW, to assist them.  They’re told they don’t qualify when they clearly do. They’re told to call back later. The numbers they’re given don’t answer or if they do, it’s a voice mail system, from which calls are never returned.  One agency in particular, who shall remain unnamed, ROUTINELY sends callers to me for cases they are CLEARLY and SPECIFICALLY tasked to handle.  This agency only handles five different diagnoses, and yet they get fully 80% of the health care dollars given by the Legislature.  And then, they avoid caring for eligible recipients and instead, give them MY phone number.

At that point, despite my anger, I have no choice but to refer them back as this is the ONLY state agency that handles developmental disabilities, autism spectrum disorders, spina bifida, cerebral palsey and Prader-Willey Syndrome.  The ONLY agency, mind you.  Any other agency will slam the door in their face as soon as they discover the diagnosis.

So, I educate the consumer first.  Advise them that THIS agency or THAT agency IS the RIGHT agency, despite what they’ve been told.  I give them the state headquarters phone number and the name of the big cheese.  I give them the consumer complaint number for investigation of offices and agencies that don’t do what they’re supposed to do.  Sometimes, we get involved, too.  WE call, ask some very pointed and difficult questions.  “Can you identify who is giving this erroneous information?”  “Is it your policy to turn away qualified applicants for services?”  “Do you realize you are violating the law by refusing to serve these clients?”  And, my favorite…”I intend to officially notify the Attorney General’s Office of this violaton.  Are YOU the point of contact for the investigation?”

There are more subtle ways employed, too.  A case comes to mind involving interpreter services for the deaf.  A state agency sent a letter to a deaf client, telling them they would have to provide their own interpreter for an interview on an issue.  State law dictates the AGENCY is responsible for providing interpretive services.  Interestingly, the letter sent to the individual was unsigned, no signature block or name, no email address, no phone number, no identification of ANY kind regarding WHO was making this illegal demand of the consumer.  Very deliberate, very knowingly illegal, and totally immoral.

A couple of phone calls to the Secretary for this agency resulted in written and verbal apologies being issued, interpretive services WERE provided and every office of this very large Agency state-wide was formally notified to abide by the law!

Bottom line, head’s rolled, people were fired and the policy of deception was spotlighted sufficiently to prevent any OTHER office from trying the same tactic.  Yes, interpreters are expensive, but it is incumbent on the STATE to provide this support and service, regardless of budget constraints.

That’s definitely not the preferred solution, but sometimes it’s all that can be done.  Luckily, it doesn’t often come to that.  It’s a very small percentage of people, usually in management positions, who are trying to shave their budget, and the workers end up between a rock and a hard place.

You may have noticed I’ve not mentioned the state I’m in.  Let’s just say you can’t go any further South from “my” state.  Not without getting your feet wet.  Or, right now, covered in oil.

As we Boomers age, more and more of us are going to become incapicated to the point of being a “person with disabilities.”  It’s almost inevitable. Personally, I’m scared to death!  In many ways, I’d prefer to either move to another country or just flat check out, rather than deal with Medicare, Medicaid, Social Security and all the other agencies that are seemingly dedicated to making life absolutely miserable for the retired, the elderly, the disabled, the infirm and the medically needy.

And THAT, fellow Boomers, is how it is.

Today, some 15 million children already care for elderly parents, but this care is provided mostly in a fragmented manner and as a response to an emergency occurrence, such as a fall or an acute medical event.

We, as children, are reluctant to step in and take over the handling of our parents’ affairs, and are happy to push the time as far into the future as possible, until we have no choice but to act.  It is difficult to decide when it’s the right time to sit down with your parents and go over financial issues, safety issues, and planning for their senior years, without your parents thinking that you are interfering with their lives.

You need to make it clear to them that you are not after their money and possessions.  Such a conversation needs to take place, should be brought up early, and even happen a few times so as to become less threatening. The conversation should be respectful to the elder, and on their terms.

So, the most difficult question is, when do you step in?

Early planning gives both you and your parents’ control of their situation.  As our parents grow old, our roles slowly reverse; we become the care givers and they become dependent and needy. The initial stages creep up almost unnoticed, as our parent starts slipping in behavior or physical In general they seem to be doing okay, functioning in his or her daily routines.  As I mentioned in the beginning of this article, if we are unprepared, the first sign of trouble will be some emergency that will force us to step in and react to that event. Unplanned reactions tend to be costly. For example, if your parent falls and sustains a fracture, that will require time spent in rehabilitation. If you are not familiar with such facilities in the area that your parent lives in, it may be difficult to start research on such facilities and compare cost. Planning ahead and being knowledgeable on such issues will help you and your parent if the need presents itself.

The decline happens in stages:

Here are the signs when you need to begin to consider stepping in:

• Deterioration of personal hygiene
• Unpaid bills, unopened mail
• Carpets stained with food
• Trouble remembering recent events
• Change of eating habits
• Misplacing objects
• Inability to remember if medication was taken or not
• Unexplained bruises
• Frequent calls to you or others

During the next stage, the severity of the symptoms escalates, and your parent needs immediate involvement of a caregiver:

•  Odors in the house
• Urine stained carpet
• Noticeable weight gain or loss
• Skin tears or bruises
• Repetitive phone calls at odd times
• Inability to recall how the day was spent
• Offensive mouth odor
• Medication bottle either too full or too empty
• Final notices on bills
• Unexplained dents on the car

If you notice the symptoms above you have to step in before it is too late.  You will need to find the right time to sit down and talk to your parent.

The following points should be considered:

Have your parent evaluated professionally, medically, and mentally to make sure a proper diagnosis is made, and appropriate treatment is in place. Home care should be set up if needed, either by the family or paid help.

Write down all of your parents’ financial assets, all their insurance policies, real estate holdings, bank accounts, and safe combinations. Familiarize yourself with the content of all documents. Make copies of all relevant documents and place them in a different location, perhaps in your siblings’ house, for safekeeping.

Make sure that all original documents are kept in one place, and the place is known to you, or to someone else your parent trusts.

Make sure that all documents that are time-sensitive are periodically updated. Make sure that the Living Will reflects your parent’s wishes, and includes what should be done for them if they are unable to make decisions for themselves.

Review all life, health, car or property insurance and make sure that they are all in effect, and that they cover whatever they are covering to the max. You may be surprised how many elderly people are paying for policies they no longer need.

Make sure you are aware of your parent’s monthly expenses, and that they are paid on time. Elderly people commonly misplace bills, do not open them, or pay the same bill twice.

Encourage your parents to speak about, or to write down if it is easier, what their wishes are regarding the topic of funeral and burial. It may help to bring a third party into the equation; a friend, priest, rabbi, a financial advisor, or other person. At times it is easier to express oneself to a stranger than to your child, regarding one’s own death.

Even as the roles of parent and child reverse themselves in later years, we can carry out the task while continuing to recognize the fact that they are our parents. We should not make them feel childish, or that they are unable to care for themselves. We should promote a sense of dignity and self-respect in our parents and help them to know that their life is of value even though they may need help from others to maintain their everyday routines.

Popular destinations for dental care

Mexico and Central America

Quality dental care is available in many countries around the globe.  For Europeans and people in the UK, Hungary is a popular location, though a bit distant for many Americans. India and Thailand also offer excellent care at considerable savings, but are really, really far away making them impractical for North Americans.

People in the States find Mexico and Central America to be the best bet. Those in border towns often drive to Mexico for dentistry, though the escalating drug wars are cutting into trips. Frequent flights, short flight times and inexpensive ticket prices make other Central American destinations attractive for dental travelers from the States.

Central American locations are popular choices for more than their proximity to the US and their temperate climates. Countries in that part of the Americas, being closer to the US, are more likely to dentists who speak English fluently, come here for training and maybe even have practiced here at some point in their careers.

Quality care can be found in all three countries. As the table illustrates, there are differences between the destinations. Overall, Pan American Dental Tours chose Panama because of its overall superior profile.

Comparing Dental Travel Locations

Flags (top to bottom): Costa Rica, Mexico, Panama

Why Panama

1. English-Speaking Dentists

The English-speaking tradition is a strong one. Many dentists have trained, or even practiced in the States  and belong to the American Dental Association.

2. Safety

Panama City is a modern, bustling metropolis. Forbes Magazine and Business Week, among many other sources, consider Panama to be a top choice for Americans choosing to retire to a safe country.  Headlines of drug wars, kidnappings and death make Mexico a dicey place to visit. San Jose, the Capital of Costa Rica, where dental tourists go, is in many ways a Third World city. The US State Department warns the visitor.

3. Ease of Travel

On the ground, you can drive comfortably in Panama.  Roads do not abruptly end and turn to rubble (you can lose your fillings driving in many parts of Costa Rica).

4. Eco-tourism

Lonely Planet says, “Panama’s biodiversity is staggering – the country is home to 218 mammal species, 226 species of reptile, 164 amphibian species and 125 animal species found nowhere else in the world. Panama also boasts 940 avian species, which is the largest number in Central America.

5. US Dollar

From the capital city to the smallest villages, you can pay with the US dollar and even get change in dollars and coins. No fumbling with conversion rates, and hefty credit cards exchange fees will not affect you.

How to Find a Dentist Abroad

As this quote from a respected travel authority notes, the prospective dental tourist must be prepared to spend time to locate dentists. It’s even more than locating the dentists. A patient needs to have a fair amount of knowledge about dentistry and the specific procedures they require, which takes even more time. The typical patient is looking to get quality care at a savings, not a dental degree. Sometimes language gets in the way. Frustrating long distance calls to offices where English is not spoke is costly, time consuming and sometimes nerve-wracking.

The dental tourist can simplify the process and reduce their anxiety about making choices.

Finding a dentist

Friends

Recommendations from satisfied friends who have been treated abroad is always a great way to start a search.  You should find out the work that was done, the factors that appealed to your friend and their impressions of the place where he/she was treated. Their needs may be very different than your own, because they had different work done or prefer a personality that you do not like.

Internet

Web searches for “dental tourism” will yield results, in fact at last count, 1.240,000 results. The top results will include many medical tourism companies, and even the sites of dentists who offer to treat dental tourists. There must be an easier way.

Dental Tourism Facilitators

A new industry has sprung to help the dental travelers find the care they need. Dental Tourism facilitators can help the patient looking for care.  These facilitators often have relationships with dentists and sometimes tour companies in one or more locations and they work to make the process easier.

Facilitators are usually paid by the dentists, so the patient can save time and also get the knowledge base of the facilitator at no cost.  Although the facilitator has a vested interest in promoting the professionals they are partnered with, they depend on satisfied clients and referrals, so their interest is in satisfying clients.

Travelers should vet the facilitator they choose. Many facilitators work across the spectrum of medical procedures, making it unlikely they have met dentists they recommend or ever inspected their offices. Ask how they chose the dentist they recommend and when they met.

Even then, the dental traveler should exert caution. Some facilitators are travel agents and may not have specific healthcare and dental experience.

Can the facilitator provide any references from patients treated by the dentist they recommend? Do the credentials of the dentist themselves meet a set of criteria—where and when were they educated and trained? What professional societies do they belong to?

On the Ground: What a patient needs to consider

How do I know exactly what work will be done when I get in the dental chair?

Reputable facilitators will only work with patients who provide Treatment Plans and x-rays from a US dentist. Why? A patient wants/needs to know what something will cost before flying to another country. The dentist who will do the work must be able to see what is needed. As professionals, they may recommend the same, more, or less work. So the patient will know what they are getting when they arrive for treatment.  (Note: Some patients are embarrassed or afraid to ask their dentist for a copy of records. Dentists get these requests often. Federal HIPAA law says that patients are entitled to copies of medical and dental records.

How much time will it take?

Different procedures require different amounts of time. Work such as veneers, root canals or fitting for bridges or dentures can be done in one trip, with time between fitting, lab work and placement.

Implants require two visits, each about a week in length. The first visit will be for the surgery. During that visit, the dentist will see a patient upon arrival to confirm the necessary work, do the surgery on Day 2, and then check the patient as needed before they leave for home. During the second visit, crowns are made and fitted.

Can a patient travel after the work?

Patients will be free to travel between appointments or even arrange appointments to maximize travel days. In the case of implants, the second trip is only for the fitting of the crowns, which allows for ample travel time. (author’s note: I recently had implants and was pain-free after leaving the office)

What if there is a problem after arriving home?

Most dental procedures are time tested and relatively uneventful. Even major procedures like dental implants are more than 95% successful. Most problems will be detected between the time of the surgery and the visit before returning home. Still, apossibility always exists that a problem may occur after arriving home.  There is no reason a patient cannot a local dentist if necessary. Extremely cautious patients may want to purchase low-cost insurance policies from their facilitator. These policies provide ample coverage for anything that may occur when the patient gets home.

Who is the Ideal Dental Traveler?

Although every dental patient wants quality dental care at the best price, not everyone is cut out for dental travel.  Let’s paint a picture of the ideal dental tourist. He or she:

1. realizes that the US is not the only country with qualified dentists. Dental “authorities” may downgrade the quality of care abroad, or claim that sanitary conditions are inadequate. The same authorities would not dare repeat those claims to International colleagues when they meet at the American dental Association meeting or at a post-grad class at NYU!

2. has the time.  Some people may find that travel is preferable to the routine of running off to the dentist at lunch hour and returning to the office. As the author of a feature on dental tourism in the New York Times said “Remarkably, some patients argue that a flight and a few hours in the dental chair is less hassle than having to rush back to the office half-sedated. For others, turning a trip to the dentist into a family vacation takes their mind off pending procedures.”

3. feels comfortable traveling.  People who like to travel find the “free” vacations in a spot they may have overlooked to be a bonus. And as noted above, the anticipation of a vacation may take some of the fearful anticipation from a dental visit. If you have never been out of the US, this may not be the best time to start.

4. needs more than $10 thousand of work in the US. Patients who need more work will save more money. A patient who needs one implant may pay for their vacation with the amount they save, but the patient who needs six implants will pay for their travel and realizes large cash savings. Summed Up

Summary

Escalating dental costs are making many Americans consider treatment alternatives.  The global economy has made it easier to get equivalent care at substantial savings.  And, dare we say it, dental tourism is an option that may make treatment more fun than a white-knuckled drive to the dentist’s office at lunchtime. It’s not for everyone, but if you do your homework, this may be a chance to combine the work you’ve been delaying with a great vacation.

Driving into Panama City, Panama

In Part 1 of this series we looked at factors surrounding the escalating cost of dental care and its burden on patients without dental insurance (for expensive procedures like implants, most of us).  The focus of Part 2,  presented here, is to provide strategies for saving money when the cost of care goes through the roof,  First, the best thing you can do to save money on expensive dental is to spend it now. Regular dental visits, cleanings and attention to small problems before they become big ones is the best strategy. Still, heredity, lifestyle and disease has made some of us prime candidates for big time dental work. Short of extractions and full dentures, what can the financially-strapped patient do?  Let’s start with the most obvious.

Bargaining and Dental Schools

Many dental practices are slow these days, so your timing is good. Ask your dentist to give you a better price after the Novocaine wears off.  Dentists don’t like to bargain (why would they?)  and their marketing gurus have taught them to counter-offer financing, often with a “no interest” teaser.  Extended payment plans  are not reduced fees. They just pain spread over time, often 12 months. The piper must be paid, and after a set period, finance fees usually kick in. So ask. You may not save thousands, but every little bit helps.

Dental schools can be a great place to receive treatment. Students hone their skills under the watchful eye of experienced teachers. When the work is done correctly the first time,  you have a great experience. The problem is that there is no way to gauge students’ skills until after the fact. Treatment at a dental school is a money saver to be sure, but the time commitment can be deadly. You may wind up having multiple appointments, even for a simple dental.  A hygienist we know describes it, “A basic cleaning took some patients as much as 8-12 hours and three separate visits.  This is not a viable option for most people who could go to their dentists and have the same work done in a one-hour session.  I can only imagine the time involved in having more serious work completed.  You will need to decide if multiple trips to the school and hours in the chair while a dentist-in-training tests his skills is worth the savings.

With the cost of care going up annually, many Americans are pursuing a different alternativee for quality care.  Combining a vacation with a trip to the dentist can save them large sums of money, and might even make a trip to the dentist fun (well, almost fun).

Dental tourism

Traveling abroad for care is part of a growing trend called “medical tourism.” Whether leaving the US for a hip replacement or a dental implant, the patient leaves the U.S. to receive care from qualified practitioners abroad at substantial savings.

Of all the different medical tourism procedures available, dental tourism is the most popular because:

• quality dental care is widely available around the world
• most patients pay for dentistry largely or completely out-of-pocket in the US
• savings will be substantial
• dental procedures are generally minor compared to many medical  procedures.

After treatment, dental patients can be true “tourists”, and can enjoy a relaxing post-treatment vacation. A patient who goes to India for a joint replacement is unlikely to be touring for some time.

Quality dental care is available outside the US

The “American-centric” myth that quality care is only available in the States is exactly that.

“Every year we bring to NYU 110 dentists from 33 countries, train them in advanced procedures, and then they go home. There is no reason to assume the quality of care is any lower overseas.” Dr. Stewart Hirsch, associate dean of New York University College of Dentistry “

Schools outside the US produce their quotas of qualified dentists as well. Practitioners around the world have access to the same information, the same training and the same equipment. As in so many areas of science and medicine, the global economy has leveled the playing field.

The American Dental Association (ADA) has a vested interest in protecting their US-based members, and has recognized that the global economy poses a threat. Still,  they do not dispute that quality care is available abroad.  How could they? Large numbers of international dentists belong to the Association, attend its meetings and receive training through their member institutions. Of approximately 15,000 dental professionals attending the annual ADA meeting, about 1,800 are from outside the US.

Americans traveling for dental care

More and more Americans are going outside our borders for dental care. A recent New York Times article quoted a source that said 40% of all medical tourists are traveling for dental care. When the total number of all medical procedures is considered, that percent becomes even more impressive.  The total number of dental travelers is difficult to pinpoint but estimates range from approximately 200,00 to 750,000 annually. Most reports (including those of the ADA) project that number to be on the rise. The think tank Deloitte Center for Health Solutions projects a 35% annual growth rate despite, or perhaps because of, the current economy.

Examples of Savings

Savings on dental work depend upon a number of factors including the country visited, the procedure, materials used and the dentist performing the procedure. Dental implants are the most frequently requested procedure by dental travelers because of their costliness in the US.  As Figure 1 demonstrates savings on dentistry can be considerable for extensive work.

Fig 1: Implants

In Fig 1, an implant and crown in the US are estimated to cost $ 4,000 (this can be more or less depending on location).  Travel expenses are variable and include the flight and a week with moderate accommodations in Panama City, a top location for dental work. An implant patient will make 2 trips, the first for surgery and again for the crowns placed on the implant.

For patients needing less work, savings of even one or two thousand dollars may pay for treatment and a vacation, as in Fig 2. Taking care of a couple of root canals and spending the rest of the week touring can be pretty nice.

Fig 2: Root Canals

Are patients satisfied with care abroad?

This survey by the leading non-profit group in the medical tourism field, the Medical Tourism Association, looked willingness of patients to consider repeat care overseas. The percentage who said they would, 88%,  speaks highly for their level of satisfaction. A  dental-specific survey, revealed high levels of satisfaction among the thousands of dental tourists questioned. Patients who traveled abroad to receive treatment had a average satisfaction rating of 84%, a similar percentage to the general medical tourist surveyed by the MTA.

Part 3: What you need to know (coming soon)

Interested in knowing more about dental travel?  In the third and final part, we will share tips and secrets: where to go for treatment, locating the best dentists, and how to save time and money.

Entrepreneurs will find the following to be most useful:

“Knowing yourself is the beginning of all wisdom.” Aristotle said this about 2,500 years ago and it seemed to work for his prized pupil, Alexander the Great.

More and more Baby Boomers are looking at starting their own business. Whether their motivation is to boost a flagging 401-K or to fulfill a lifetime dream, you need to know that a successful business is more than a good idea.

In my six years as, I have no clients whose ideas conquered the world…yet . Whatever the merits of the business, the “big idea” often has less bearing on future success than the personality of the person starting the business. Like the stars that guided the ships of Ancient Athens, there are 10 personal questions the would be entrepreneur should ask him or herself before launching their business. Knowing yourself will help you rise above the competition.

1. Can you afford financial risk?

Because: Many new ventures do not succeed, and you may lose much of whatever money you have.  This may affect your financial goals, such as children’s college expenses, or retirement savings.

2. Are you ready to  give  up your current lifestyle for potentially a number of years?

Because: Unlike working for others, your own business may require longer workweeks, fewer or no vacations and maybe years of scrimping and saving before things take off.

3. Are you good at speaking and persuading others?

Because: In any new business, explaining your ideas—to investors, customers and employees—is a good part of what you will need to do.  You will be selling your idea and product all the time.

4. Are you prepared to run all aspects of your business?

Because: In the beginning you may need to do everything, from sales to marketing to bookkeeping.  You may not like, or feel comfortable, with some of the tasks you will need to do.

5. Are you comfortable with a lack of structure?

Because: In a new business, you will need to feel comfortable making all decisions, without any existing structure or guidance (actually SCORE can help provide guidance).

6. Are you a self-starter?

Because: Entrepreneurs need to be able to take rejection and keep going.

7. Does your “significant other” agree to your plan?

Because: Marriages and relationships can be tested by the time and money a new business requires.

8. Are you passionate about your business idea?

Because: You need to be totally motivated about your business,  and know about what you are getting into (going into a field you are not familiar with makes success more difficult).

9. Do you have a history of executing your ideas?

Because: Successful entrepreneurs usually have a history of coming up with ideas and seeing them through. A past with leadership roles may be an indication.

10. Do you need a business partner?

Because: If you don’t have all the skills you need, you may need a partner who can make up for your shortcomings.

If you cannot comfortably answer “yes” to most of these questions,  you need to think about how  you can overcome your weaknesses (you can change).  Your SCORE counselor can help with free counseling. For an online If you cannot comfortably answer “yes” to most of them,  you need to think about how  you can overcome your weaknesses or whether going into you own business is right for you.  Your SCORE counselor can help.

If you would like a free PowerPoint presentation that covers the 10 Questions in more depth, leave a comment here or send an email to me at japton@panamdentaltours.com.

Dentistry in America

The cost of dental care has been rising, no question about that.  If you have been to the dentist recently and needed any major work, the estimates for procedures from root canals to implants can leave you more numb than that last shot of Novocaine.

The eyes of America have been focused for more than a year on healthcare reform. If you are a middle-class Baby Boomer (like I am), you probably have some form of healthcare coverage. That day you go to the dentist and get an estimate for work that can easily top $10,000 or more, you realize,” I have no dental coverage. That dental bill has to be paid, out of my own pocket and likely out of a lifetime of savings.” You were not anticipating that, and you are not alone.

According to the Centers for Disease Control, by the age of 65, 46% of Americans have lost 6 or more teeth. More than 20% have no teeth at all. What can someone do who wants to keep their teeth but who also wants to keep some money in their bank account (assuming they even have that money)?

The rising cost of dentistry

Dental costs have risen, as expected, since the 1950’s, at much the same pace as medical costs (Figure 1).  The increase took a dramatic turn in the late 1980’s, tripling over the past thirty years.

The years have been good to dentists. According to the American Dental Association (ADA), the income of both general dentists and specialists tripled between 1982 and 2000,  and have continued to increase.

Dentists went from being the “also-ran” professionals to the envy of the medical field. Physician workloads have increased with paperwork and reimbursement issues making private practice unmanageable for many doctors. Rather than running faster to stay in place (as many physicians do), dentists are making more than ever working the traditional four-day week.

Dental Insurance in the US: does it even exist?

Looking at the statistics, about 50% of Americans have no dental insurance (80% of Seniors). For every adult without medical insurance, three have no dental insurance according to the US Department of Health and Human Services. Compare this to the estimates we hear about healthcare insurance, which assume 10% of Americans have no coverage. The staggering disparity in dental coverage has not factored at all in the current healthcare debate.

And those who do have dental insurance find themselves largely in the same boat as the uninsured.  For years, most dental policies have been capped at about $1500/year, which pays for a few fillings and cleanings. This is why dental insurance premiums have hardly changed over the years.  Expensive dental care has to be paid out-of-pocket by even the insured. So in effect, few if any Americans are covered for expensive dental care.

The Healthcare Debate Rages, but mouths are closed about dentistry

Why is dentistry not a priority, in fact, not even an issue in the current healthcare bill?

Dental spending by the Federal government accounts for less than 5% of their overall healthcare spending. As such, the Federal government has no more interest in escalating dental fees as it does not affect their deficits. Federal spending is largely limited to programs to get minimal care to the poor. And even less fortunate Americans do not get the care that they need.

Burton Edelstein Professor of Clinical Dentistry and Clinical Health Policy & Management at Columbia University offers a reason why dentistry is not even on the radar screen for the poor. Washington policymakers “tend to come from the segment of the population that has not experienced this type of problem. And if you’ve never had a toothache, you’ve never had a toothache.”

In an April 2009 letter, John S. Findley, D.D.S. president of the American Dental Association makes the case for the need for government to upgrade services to the needy, but pays scant attention to those who have to pay for service.

When questioned at a recent Town Hall meeting about how the government plans to deal with dental care, the President offered this advice, ”Floss. Am I right? You’ve got to floss.

Rich or poor, except for expected reductions in the allowances granted by Medicare Advantage, don’t look for the new healthcare plan to offer any relief.

The Global Economy: Dark cloud for dentists, ray of hope for consumers

In his international bestseller, The World is Flat, Tom Friedman analyzes global competition in the 21st century. The title is a metaphor for viewing the world as a level playing field for commerce. As geographic barriers fall, all players have access to the same information, which in turn provides equal opportunity for all.

Standards of training and care are similar across the industrialized world. Physicians and dentists fly around the world for training and conferences and essentially best practices are similar everywhere.

As Stewart Hirsch, associate dean of New York University College of Dentistry said, “Every year we bring to NYU 110 dentists from 33 countries, train them in advanced procedures, and then they go home. There is no reason to assume the quality of care is any lower overseas.”

Globalization has provided some benefits for dentists. Many use off-shore laboratories as far away as India to get better prices on bridges, crowns and dentures.

The rise of dental tourism is an offshoot of the global economy that may benefit patients but not be as pleasant (for dentists)

In fact, globalization has benefited dentists.

PART II: Dental Tourism: Go Abroad for Quality Care at Substantial Savings: Is it right for you? (coming soon)

Jeffrey Apton is a Boomer and president of Pan American Dental Tours (www.panamdentaltours.com) , a dentistry-only dental tourism company that helps Boomers  get excellent dental care abroad. He may be reached at: japton@panamdentaltours.com.