Insights

Meet a Neuropsychologist, Brenda Austin, PhD

Jennifer Brokaw and Brenda Austin Jennifer Brokaw and Brenda Austin discussing Brenda's experience as a neuropsychologist

Our goal at C2it Health is to demystify medical care and help people find the right care and resources they need at the right time. In this article, we introduce readers to Brenda Austin, PhD. Brenda is a neuropsychologist, a key member of a geriatric care team or any medical team taking care of someone with a brain injury.

Jennifer:

Brenda, can you tell the C2it Health community about your professional experience as a neuropsychologist? What exactly does a neuropsychologist do?

Brenda:

I’ll start with the easy part. A neuropsychologist is a doctoral-level clinical psychologist with specialized training in brain behavior–based disorders. We perform assessments, diagnose, and treat individuals of all ages. A neurocognitive assessment includes a detailed series of questions and puzzles that evaluates a person’s ability to process different types of information and remember it. A person may be referred to a neuropsychologist for an evaluation when they are experiencing a medical, neurological, developmental, or psychiatric condition that impacts their thinking, behavior, and/or emotions. We use standardized measures in addition to interview, observation, and history to identify a person’s strengths and weaknesses as compared to normal and abnormal brain function. With that information, we assist the individual, their families, physicians, and health care teams to educate and implement treatment so the person can improve or compensate for their neurologic condition.

I work with adults and older adults. In addition to assessment, I conduct cognitive rehabilitation and see people for psychotherapy.

Jennifer:

What are the most common reasons for people to be referred to a neuropsychologist? When should a family member seek to have a neuropsychologist involved in their loved one’s care?

Brenda:

A referral for neuropsychological evaluation should be considered any time there is a question about a person’s memory or mental abilities.  Family members or friends may notice:

  1. Memory problems including forgetfulness, getting lost or losing items, or even a failure to recognize familiar people or places
  2. Poor attention and concentration may initially show up as confusion in conversation or difficulty following a movie or television show
  3. Changes in visual-spatial skills are often revealed by car accidents or getting lost in familiar neighborhoods
  4. A change in personality could be seen as unexplained apathy, anxiety, or depression
  5. Poor decision-making and difficulty solving problems seen in a person with prior abilities
  6. A failure to understand or care for finances, pay bills, or budget monthly funds
  7. An inability to grasp medical information and recommendations
  8. Language difficulties such as significant trouble finding words or loss of understanding spoken language
  9. Unexplained neurologic complaints or fluctuations in mental state

In addition, a neuropsychological evaluation should be considered if there is a question about a person’s capacity to make significant life decisions such as medical, financial, or legal decisions.

Jennifer:

How does a person obtain the services of a neuropsychologist if they think they might need one?

Brenda:

A person or their family may self-refer for an evaluation. However, the majority of referrals are made by physicians, often a neurologist or a psychiatrist who has noticed changes in a person’s cognition. Internists frequently use the Mini Mental State Exam (MMSE) that was developed to screen for an Alzheimer’s-type dementia. This is a great screening tool but scoring above the cutoff score of 24 doesn’t mean that there are no cognitive problems. It’s much more complicated than that. Similarly, imaging studies such as CT and MRI show us brain structure but cannot accurately predict how a person might be functioning. Imaging cannot tell us about a person’s ability to remember new information, think through a problem, or make a decision.

… the majority of referrals are made by physicians, often a neurologist or a psychiatrist who has noticed changes in a person’s cognition

Family members would want to consider obtaining a referral for a neuropsychological evaluation to help clarify a diagnosis and to assist in developing a plan of care. An evaluation can help determine:

  1. Whether there is cognitive loss or the symptoms are related to a mood disorder
  2. Clearance to return to school or work after a neurologic injury or illness
  3. If there is cognitive impairment, what are the current strengths and weaknesses?
  4. Does the person have a dementia, and if so what type?
  5. Strategies to maintain or boost cognitive abilities and enhance daily function
  6. The type of support a person may need in order to remain in their home or whether home is the best option
  7. The efficacy of a new medication
  8. Whether a driving assessment is needed
  9. Whether the person can make important medical decisions, an advance directive, or a new will
  10. Whether a conservatorship is needed

… imaging studies such as CT and MRI show us brain structure but cannot accurately predict how a person might be functioning

Jennifer:

How long does a full cognitive assessment by a neuropsychologist take? Is it covered by insurance and/or Medicare?

Brenda:

The length of time it takes to complete a full cognitive assessment varies based on the individual’s condition, whether we are in a hospital or outpatient setting, and the referral question. A comprehensive outpatient evaluation can take six hours of face-to-face time; however, when a person is ill and in hospital an evaluation is often shortened and targeted, often taking one to two hours.

Insurance and Medicare cover neuropsychological evaluations under specific conditions and coverage depends on the insurance company as well as the particular product the individual is covered by. Again, depending on the insurance company a pre-authorization may be required. Most companies cover neuropsychological evaluations when a person is known to have a neurologic disorder. Sometimes they cover one evaluation per illness incident and sometimes more, such as in the case of stroke or traumatic brain injury where the person is improving and changing through the recovery process. It’s always best to call your insurance company and request information in writing. Your doctor may be able to help you with information about coverage as well.

Jennifer:

What is the one thing you wish more people understood about your field?

Brenda:

Many people confuse clinical neuropsychology with clinical psychology. A neuropsychologist works in the area of physical health and neurologic disorders, not in the area of mental health. While we may evaluate a person to determine whether they are suffering from a dementia versus depression, we are generally not performing assessments on people primarily because of depression, bipolar disorder, or schizophrenia. Working with people who are living with mental health disorders is really the realm of clinical psychology.

A neuropsychologist works in the area of physical health and neurologic disorders, not in the area of mental health

Jennifer:

Thank you, Brenda. If readers have more questions about neuropsychologists, please email them to us at info@C2ithealth.com

More about Brenda:

Brenda Austin, PhD, has been a member of numerous interdisciplinary medical teams in specialty areas such as physical rehabilitation, brain injury, HIV/AIDS, and general skilled nursing. She directed a clinical neuropsychology training program for advanced graduate students at one of the San Francisco Health Network’s hospitals (SF-DPH). She has served on several hospital committees including bioethics, bariatric care, and admissions. She is a fellow of the National Academy of Neuropsychology, and a past president of the Northern California Neuropsychology Forum.

 

 

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See to Your Life Goals

“What do you want to be when you grow up?” is a question everyone gets asked during childhood. My college aged daughter is now being asked: “What are you going to do with your life?” I’m watching this feeling bemused. I just turned 50, and no one is asking me: “What do you want to do with the rest of your life?” or even more to point: “What do you want to have accomplished when you die?” Truth be told, these questions are on a continual feedback loop in my mind. I find my peers, mostly finished with the heavy lifting child-rearing years, are engaging in similar exercises.

For the Future

After giving so much to develop a career and steward in a new generation, we’ve had little time to reflect about what we want for ourselves in the second half of our lives. Prioritizing your life goals should be a life-long process. It should not be one that ceases as soon as you get your last degree or first job. Take this short quiz to help you reflect on what you want to do with the rest of your life…no matter how old you are now. Know your life goals! It will be an important for any decisions concerning your future medical care or health.

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Hospital Discharge is Much Smoother With a Good Plan

Planning a Hospital Discharge Home Checklist Makes for a Safe Landing

The experience of hospital discharge, either to home or another health care facility (such as a Skilled Nursing Facility or Rehabilitation center) can be one of the most stressful and dangerous parts of someone’s health care journey. There will be over 10 million hospital discharges each  year for people over the age of 65 for the foreseeable future. In fact, one study showed that nearly 20% of patients experience an “adverse event” after hospital discharge such as medication mix-ups, hospital-acquired infections and procedural complications. A more subtle danger is the lack of follow-up on important diagnostic tests leading to missed diagnoses. Patient safety experts strongly advocate for CHECKLISTS to be employed by both health care professionals and patient’s families to ensure that the complexities of hospital discharge can be safely maneuvered. Ironically, these checklists are not widely available to the health care consumer, but we have complied a few critical CHECKLISTS to help you “see to” a safe hospital discharge!

Some of the things that are important to think about when leaving the hospital are:

  1. Do you have a new list of medications? How does it compare to the medication list before hospitalization? Which medicines should be discarded?
  2. What are the potential complications from any procedure you underwent? What should you return to the hospital for? How can you reach your doctor for any questions about symptoms or difficulties when you are home?
  3. Know when and with whom you need to follow up. Were referrals made for other specialists? When are those appointments scheduled? Do you need to make the appointment?
  4. Do you need a Nurse, Therapist, Home Health Aide or any Medical Supplies at home?
  5. What were you able to do before being admitted, what are your anticipated care needs now? How long will you need extra help?

More and more, families will be responsible for what happens after a hospitalization, especially when the destination is home. As a recent Wall Street Journal article noted, although home health is covered by some insurance, nearly 70% of patients had NO home visit from a nurse or other health care professional after hospital discharge. The article also highlights a new effort by the Family Caregiver Alliance to train family caregivers about the basics of home care after hospitalization via You Tube videos. This may be more than many families can muster on their own, so those that can afford private duty nursing services may choose to avail themselves of private nursing services after hospital discharge. Before committing to pay for a private duty nurse, it’s important to check with your insurer to see if any Home Health services are covered (some are even covered by Medicare). All families and supporters of patients coming home from the hospital should check out C2it Discharge Planners to start getting organized around this critical time in a person’s medical journey.

Go to the Discharge Medications Guide

Go to the Discharge Complications Guide

Go to the Discharge Follow Up Guide

Go to the Discharge Supplies & Services Guide

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Have You Chosen Your Health Care Agent?

When people consider completing their Advance Directive for health care, most assume they are making a decision about their desire for life support (such as CPR). It’s true that all state forms have a question about whether or not you would want to have CPR in the event of a serious illness or unexpected cardiac arrest, but it’s not the most important question on the form. In fact, you can leave that part of the form BLANK and still have a valid Directive.

The most important part of the form is the legal nomination of a health care agent (or proxy). Your agent is the person who will speak for you if you are unable to speak for yourself For example, if you are in a coma, sustain a head injury or stroke, are in severe pain or have cognitive impairment such as dementia. This person has important responsibilities. No health care professional may provide treatment without permission from the patient or their proxy.

Did you know that almost 50% of patients hospitalized over age 65 required the assistance of their health care agent to make an important decision about their care? In the absence of legal documents, the health care agent is assumed to be the next of kin. However, many people do not adequately consider whether that person is up to the job. Being a health care agent is often difficult and emotionally taxing.

To point, here are is a summary of the rights and responsibilities of a health care agent:

  1. The right to consent to or refuse medical treatment
  2. The right to review your medical records
  3. The right to decide about housing/treatment facility options after hospitalization
  4. The right to consent to or refuse organ donation
  5. The right to decide about the disposition of remains after death

It’s important to note that your health care agent does not have the right to make any decisions for you until you are deemed incapable of making decisions for yourself, unless you make your health care agent effective immediately. This is a subtle point in an advance directive that requires some thought. On the one hand, no one wants to cede control over their health care decisions too soon, but on the other, you wouldn’t wish for a delay in treatment while physicians or the court decides whether you are able to decide for yourself. Your wishes, personality and relationship with your chosen health care agent really influence whether you choose “effective immediately” or “only if I am not capable.”

We think the choice of health care agent and the communication We have developed a tool to help you consider the choice of health care agent. Even if you think you know who it should be, answer the following questions to make sure you’ve chosen well:

Take Our Healthcare Agent Quiz Now!

 

If you would like to download the California Advance Health Care Directive, click here

Contact Us if you would like help finding your state’s Advance Health Care Directive.

Insights

Right Care Action Week

We created C2it Health to help American families get the best care and support available to them. We did so because we recognized that our system is fragmented, broken and unaffordable. The Lown Institute agrees. We love their  RightCare Alliance and its new Right Care Action Week, which is taking place next week: Oct 16-22. In their words:

The Lown Institute’s RightCare Alliance initiative is the first grassroots social movement that brings together health professionals, religious and community groups, and the public. Together we are working toward a society in which the right care is accessible by all. We believe this will be made possible through a collaborative process that engages local healthcare institutions and the community in the stewardship of resources for health.

There are 3 main activities associated with RightCare Action Week: A Listening Booth, where people can come tell their stories about their experiences with the health care system (good and bad), A Story Slam, where people’s stories can be told to an audience and a “What Worries You?” initiative where patients and families can express their worries in the health care setting.

Click here to find a RightCare Action event near you. It is going to take all of us to right the boat. Tell your health care story, express your worry or LISTEN to others next week and commit yourself to a better tomorrow for doctors, patients and families.

Insights

Four Professionals Who Can Help with Senior Finances

Managing finances in the senior years is difficult for two reasons: First, the complexity of remembering to pay bills and balance a checkbook, let alone remembering to manage investments, can become overwhelming. Second, money often runs out when long-term care and other medical bills start to pile up. Here are four professionals you should know about to help keep track of finances and to find solutions when funds are short.

Certified Financial Planner

A Certified Financial Planner (CFP) is someone certified to help  you invest money to meet your current needs or future goals. Sometimes they work on commission from the financial products they sell. It may be better to work with someone who works for a flat fee. Learn more about where to find a CFP in our Professional Resources section.

Elder Law Attorney

An elder law attorney works with families to manage assets to pay for care. Many times, this involves the legalities around applying for Medicaid to finance long-term care. Medicaid requires a “spend down” of assets to qualify. Elder law attorneys can help families figure out the legal parameters of assets that qualify and the “five-year look-back” that many states use to determine Medicaid eligibility. Elder law attorneys also help  fill out the Medicaid or Veterans Affairs applications correctly.

Medical Claims Advocate/Professional

Medical Claims Professionals will read through your medical bills to determine whether you’ve been overcharged. They can obtain reimbursements for covered care and help you file appeals for denials. They usually work for an hourly rate.

Private Fiduciary

A private fiduciary is a professional who will manage a person’s assets if they are deemed incompetent to manage their money any longer. They are often court appointed, but can be hired by families for a loved one living at a distance. Services include bill pay, investment management, and the purchasing of needed goods and services. This is a high-trust relationship and profession. Only certified private fiduciaries should be considered.

See our Professional Resources page for links to these professionals in your area.

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Six Things A Patient Can Do to Prevent Surgery Infection

The last thing anyone wants to get when they go to the hospital, especially for an elective surgery or procedure, is an infection! If you are considering having an Orthopedic Procedure such as  your knee scoped, hip replaced or ACL repaired, there are things you can do to lower your risk of surgery infection, or Surgical Site Infection (SSI).

Hospital-Acquired Infections are at the top of every hospital administrator and clinicians worry list these days. In 2011, there were an estimated 157,000 reported Surgical Site Infections (ref), but thankfully, that number has decreased significantly in the last five years. This is mostly because there has been tremendous attention devoted to the problem on the health care delivery side of the equation since infections are now being tracked, reported and penalized.

Here are six things that have been shown to make a difference in preventing Surgical Site Infection (SSI) for elective Orthopedic procedures:

  1. Pick a surgeon and hospital that does a lot of the procedure, ask what their infection rate is and how it compares to the national average. (Check out the ProPublica article on why this is important)
  2. Make sure you know that an antibiotic is given within 1 hour of the start time (for Orthopedic procedures, it is usually Cafazolin)
  3. Get tested for Methicillin-Resistant Staph Aureus before the procedure with a nasal swab. If positive, get treated with anti-septic body wash and nasal antibiotic ointment for 5 days. Get re-tested.
  4. If you have diabetes, make sure your blood sugar is well-controlled before surgery.
  5. Quit smoking (!)
  6. Ask that no more than one resident physician (a surgeon still in training) participate in your surgery.

Other factors that predict surgical site infection are less in your control such as:

  1. Blood loss: the less the better. Requiring a transfusion is a risk for infection.
  2. Surgery time: more than 2.5 hours is associated with increased risk
  3. Your overall health: obesity, diabetes, underlying malignancy and rheumatoid disease all predispose you to infection risk.

When we put our life and limb in the hands of a surgeon, we often forego our own responsibilities for the outcome. That is a mistake.

When we put our life and limb in the hands of a surgeon, we often forego our own responsibilities for the outcome. That is a mistake. This list is developed from the Orthopedic literature, but many of the steps apply to any elective surgery. It’s up to all of us to ask questions, and take action to get the care and outcomes we want.

References:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4446513/

https://www.propublica.org/article/surgery-risks-patient-safety-surgeon-matters