Archive for Case Management

Why case management is so necessary

Why Case Management is so necessary

By: Jim Krueger, Executive Director of NESCO

One thing we do regularly is help seniors in need who have no family around and we provide this service for free. One of the seniors in our neighborhood had been living in his house for years and many things were in need of repair or replacement. He is also a very proud man with no family and limited income who felt he should just grin and bear it. One of our case managers, Kate, had been visiting him over the last year and gained his confidence and trust.

On one of Kate’s regular check-ins she found that the door to his refrigerator was broken. He let Kate call Project Home on his behalf and they came out to his home. It was determined the fridge was beyond repair and Project Home was able to provide him a new one for free. They found a number of other things needing repair, including broken windows and a leak in the basement. Kate encouraged our senior to participate in the Project Home “Hammer with a Heart” Day when they fix homes in need of repairs for free. In addition to the essential repairs the workers knew that he loves baseball and made a small baseball mound in his yard. His pride in his home and himself went way up that day, and his home is safer and more energy efficient. Our case managers have developed partnership with many organizations like Project Home to provide resources for low income seniors. A special thanks to Project Home for making this all happen. This is one prime example of the significance of our case management program.


For more information about Madison’s North/Eastside Senior Coalition, please visit:

Medicare and Diabetes



Medicare beneficiaries with diabetes know that it is not always easy to figure out what parts of Medicare are covering their diabetic supplies and prescriptions related to treatment of diabetes. Medicare beneficiaries who are receiving prescription drug coverage through enrollment in a Medicare Part D plan or through enrollment in a Medicare Advantage plan that includes drug coverage will have their insulin and supplies related to the injection of insulin covered by their Medicare prescription drug coverage. Supplies related to injection of insulin include:

  • Syringes;
  • Needles;
  • Alcohol swabs;
  • and gauze.

In contrast, testing supplies like lancets and test strips continue to be covered under Medicare Part B for those with Original Medicare or through the Part B benefits included as part of a Medicare Advantage plan for those enrolled in a Medicare Advantage plan.

For Medicare beneficiaries who receive prescription drug coverage through Wisconsin SeniorCare, SeniorCare covers some insulin and Medicare Part B covers testing supplies. SeniorCare does not provide coverage for syringes, needles, alcohol swabs, and gauze.

Medicare beneficiaries who receive prescription or supplemental health insurance benefits through employment, retiree health coverage, or other sources should consult with the administrators of those plans to determine benefits related to coverage of diabetic treatment and testing supplies.

If you have questions about Medicare coverage of your diabetic prescriptions or testing supplies, contact the Coalition of Wisconsin Aging Groups at (608) 224-0606 and ask to speak with a Dane County Elderly Benefit Specialist.

Over 60 Books have arrived!



It’s that wonderful time of year again when the Over 60 books are hot off the presses. These books are provided free of charge by Dean and St. Mary’s and provides information about senior adult resources in Dane County. Copies of the book can be picked up at our office at: North/Eastside Senior Coalition, 1625 Northport Drive #125, the other senior focal points in Dane County, or the Madison libraries. It can also be found on the website of the Area Agency on Aging of Dane County

A word of caution:



A word about switching your Medicare Supplement/Medicare Advantage Plan,


A nice person gives you a call on the phone and tells you they can save you some money by switching you to new Medicare Advantage plan. Sounds good right? But buyer beware! Though the plan they offer might be a plan that is approved by Medicare it might end up costing you in the end. Often there are costs they don’t tell you about in your meeting with the salesperson, like higher nursing home co-pays, or large co-pays when you visit a specialist, or a doctor who is not your primary physician. These plans can also have restrictions about what Dr’s you can see, as some of them are HMO’s. Though sometimes a Medicare Advantage plan is the right choice for certain individuals, if you are happy with the plan you have and were not seeking out a change until the salesperson contacted you on the phone there may not be a need for you to change. You could end up in a plan that is not right for you!!

Keep these things in mind:

1. the person calling you is a sales person and does get paid to sell you new insurance, while the plan may be legitimate they are motivated to get you to switch.

2. do your research BEFORE signing ANYTHING. Get the name of the plan and the name of the person. If it sounds good call either a case manager at NESCO (243-5252) OR a Benefit Specialist from CWAG (224-0606) tell them what you have been offered and let them help you research the plan further before you invite the sales person into your home or consider making a switch.

3. If you do switch and are unhappy you MAY be stuck with the plan for at least a year, or until there is an open enrollment period so you can switch. That’s why it is important to be sure that the plan you are switching to is what you really want.

When in doubt just call a case manager and we will assist you!

Free Tax Assistance



NESCO is offering free tax assistance to those that qualify. If your income is below $25,000 per year, Liberty Tax can assist at no charge. If your income falls between $25,001-$50,000 the charge is $50. If your income is $50,001 and over then the charge is $100. To qualify you must be age 60 and over and be able to attend 2 scheduled appointments. The first appointment is to present the preparer with needed information and the second is your follow up appointment to go over your return and answer any questions. You will need to bring last year’s return, all retirement, pension and social security payments you have received, documentation regarding mortgage interest, and all medical, pharmacy and other co pays that you have paid out of pocket. To schedule your appointments, call NESCO at 243-5252. Also, AARP and St Paul’s church offers free tax assistance.

Are You Ready for the Switch to Digital?

The Digital Television Transition and Public Safety Act of 2005 requires full-power television stations to cease analog broadcasts and switch to digital after 17 February 2009. Digital broadcast television offers consumers a clearer picture, more programming choices and will free up the airwaves for better communications among emergency first responders and new telecommunications services.

Viewers of over-the-air television need to look at each analog set in their home that is not connected to cable, satellite or other pay television service and make a timely decision. They can connect their television to cable, satellite or pay television service; they can replace it with a digital TV; or they may keep it working with a TV converter box. For consumers choosing the converter box option, the TV Converter Box Coupon Program permits all households to request up to two coupons—each worth $40—toward the purchase of certified converter boxes. Coupons may be requested until 31 March 2009, or while supplies last, and only one coupon can be used to purchase each coupon-eligible converter box. Consumers can purchase a converter box at one of the more than 34,500 participating local, phone, or online retailers. Consumers will receive a list of eligible converter boxes and participating retailers with their coupons. Coupon applications can take 6-weeks to process and mail so consumers opting to purchase a converter box still have time, and should call stores before shopping to ensure the desired converter box is available. Converter boxes generally cost between $40 and $80 and coupons expire 90 days from the date they are mailed.

Households may apply for coupons online at, by phone at 1-888-DTV-2009 (1-888-388-2009), via fax at 1-877-DTV-4ME2 (1-877-388-4632) or by mail to P.O. Box 2000, Portland, OR 97208-2000. Deaf or hard of hearing callers may dial 1-877-530-2634 (English TTY) or 1-866-495-1161 (Spanish TTY). Nursing home residents may apply with the paper application available downloadable at

For more information about the Coupon Program, visit and for questions about the DTV transition, go to or call 1-888-CALL-FCC.

Let it snow, let it snow, let it snow!!!!



40.6 inches of snow and December isn’t even over yet! We are definitely on our way to another record setting year of snow.

I thought this might be a good time to review the City of Madison’s snow removal policy. Per the City of Madison Website, Madison City Ordinance 10.28 requires that sidewalks be cleared of all snow and ice not later than 12:00 noon of the day following each snowfall.  Days end and begin at 12:00 midnight.  An example would be:  Snow starts to fall on Monday morning. The snow stops at 11:59 p.m. on Monday night.  The sidewalk would have to cleared by 12:00 noon on Tuesday.  If the same snow continued until Tuesday morning at 12:00 midnight, the sidewalk would have to be cleared by 12:00 noon on Wednesday.

When public walks are found in violation, the property owner is issued a citation with an initial fine of $109.00.  All subsequent violations at the property during the current snow season will result in a $172.00 fine. After a City inspector photographs a sidewalk in violation and cites the property, the owner has until 8:00 a.m. the following morning to remove the hazard. Failure to do so will cause the City crews to do the work with costs assessed the property.  There are no warnings given for this ordinance violation.  To make a complaint, call the Building Inspection Unit between 7:30 a.m. and 4:30 p.m., Monday through Friday, 266-4551. If you have questions about snow removal ordinances, policies, or procedures, call a property maintenance inspector at 267-4997.

The inspectors are looking for reasonably safe conditions. In cases where ice has formed on the public sidewalk and cannot be removed, the property owner must use sand or salt to effectively eliminate dangerous conditions. The City provides a mixture of sand and salt for public use at the following locations:

Demetral Park (parking lot off Sixth St)
Warner Park (Sherman Ave by shelter)
Monona Golf Course (parking Lot)
Olbrich Gardens (by Walter St)
Reindahl Park (off Portage St)
School Rd Oil Site (Wheeler Rd and School)
Tenney Park Beach House

Glenway Golf Course (off Speedway)
South Point Yard Waste (402 South Point Rd) 
Brittingham Park Parking Lot (Entrance Off W Washington)
Spring Harbor Parking Lot (Norman Way)
Elver Park (off McKenna Blvd)
Garner Park (Mineral Point Rd & Rosa Rd)

Senior adults who live in their own homes (not an apartment or rental unit) can contact any of the four senior coalitions (listed below) to request to be placed on the 72 hour snow list. This allows 72 hours to clear the sidewalks without receiving a citation. Each of the coalitions also have volunteers available who love to help senior adults with the snow shoveling.

North/Eastside Senior Coalition – 243-5252

East Madison/Monona Coalition of the Aging – 223-3100

South Madison Coalition of the Elderly – 251-8405

West Madison Senior Coalition – 238-7368

The Facts about Seasonal Affective Disorder



If you notice periods of depression that seem to accompany seasonal changes during the year, you may suffer from seasonal affective disorder (SAD). This condition is characterized by recurrent episodes of depression – usually in late fall and winter – alternating with periods of normal or high mood the rest of the year.

Most people with SAD are women whose illness typically begins in their twenties, although men also report SAD of similar severity and have increasingly sought treatment. SAD can also occur in children and adolescents, in which case the syndrome is first suspected by parents and teachers. Many people with SAD report at least one close relative with a psychiatric condition, most frequently a severe depressive disorder (55 percent) or alcohol abuse (34 percent).

What are the patterns of SAD?

Symptoms of winter SAD usually begin in October or November and subside in March or April. Some patients begin to slump as early as August, while others remain well until January. Regardless of the time of onset, most patients don’t feel fully back to normal until early May. Depressions are usually mild to moderate, but they can be severe. Very few patients with SAD have required hospitalization, and even fewer have been treated with electroconvulsive therapy.

The usual characteristics of recurrent winter depression include oversleeping, daytime fatigue, carbohydrate craving and weight gain, although a patient does not necessarily show these symptoms. Additionally, there are the usual features of depression, especially decreased sexual interest, lethargy, hopelessness, suicidal thoughts, lack of interest in normal activities, and social withdrawal.

Light therapy, described below, is now considered the first-line treatment intervention, and if properly dosed can produce relief within days. Antidepressants may also help, and if necessary can be used in conjunction with light.

In about 1/10 of cases, annual relapse occurs in the summer rather than winter, possibly in response to high heat and humidity. During that period, the depression is more likely to be characterized by insomnia, decreased appetite, weight loss, and agitation or anxiety. Patients with such “reverse SAD” often find relief with summer trips to cooler climates in the north. Generally, normal air conditioning is not sufficient to relieve this depression, and an antidepressant may be needed.

In still fewer cases, a patient may experience both winter and summer depressions, while feeling fine each fall and spring, around the equinoxes.

The most common characteristic of people with winter SAD is their reaction to changes in environmental light. Patients living at different latitudes note that their winter depressions are longer and more profound the farther north they live. Patients with SAD also report that their depression worsens or reappears whenever the weather is overcast at any time of the year, or if their indoor lighting is decreased.

SAD is often misdiagnosed as hypothyroidism, hypoglycemia, infectious mononucleosis, and other viral infections.

How is winter SAD treated with light?

Bright white fluorescent light has been shown to reverse the winter depressive symptoms of SAD. Early studies used expensive “full-spectrum” bulbs, but these are not especially advantageous. Bulbs with color temperatures between 3000 and 6500 degrees Kelvin all have been shown to be effective. The lower color temperatures produce “softer” white light with less visual glare, while the higher color temperatures produce a “colder” skylight hue. The lamps are encased in a box with a diffusing lens, which also filters out ultraviolet radiation. The box sits on a tabletop, preferably on a stand that raises it to eye level and above. Such an arrangement further reduces glare sensations at high intensity, and preferentially illuminates the lower half of the retina, which is rich in photoreceptors that are thought to mediate the antidepressant response. Studies show between 50% and 80% of users showing essentially complete remission of symptoms, although the treatment needs to continue throughout the difficult season in order to maintain this benefit.

There are three major dosing dimensions of light therapy, and optimum effect requires that the dose be individualized, just as for medications.

Light intensity

The treatment uses an artificial equivalent of early morning full daylight (2500 to 10,000 lux), higher than projected by normal home light fixtures (50 to 300 lux). A light box should be capable of delivering 10,000 lux at eye level, which allows downward adjustments if necessary.

Light duration

Daily sessions of 20 to 60 minutes may be needed. Since light intensity and duration interact, longer sessions will be needed at lower intensities. At 10,000 lux – the current standard – 30-minute sessions are most typical.

Time of Day of exposure

The antidepressant effect, many investigators think, is mediated by light’s action on the internal circadian rhythm clock. Most patients with winter depression benefit by resetting this clock earlier, which is achieved specifically with morning light exposure. Since different people have different clock phases (early types, neutral types, late types), the optimum time of light exposure can differ greatly. The Center for Environmental Therapeutics, a professional nonprofit agency, offers an on-line questionnaire on its website,, which can be used to calculate a recommended treatment time individually, which is then adjusted depending on response. Long sleepers may need to wake up earlier for best effect, while short sleepers can maintain their habitual sleep-wake schedule.

Side effects of light therapy are uncommon. Some patients complain of irritability, eyestrain, headaches, or nausea. Those who have histories of hypomania in spring or summer are at risk for switching states under light therapy, in which case light dose needs to be reduced. There is no evidence for long-term adverse effects, however, and disturbances experienced during the first few exposures often disappear spontaneously. As an important precaution, patients with Bipolar I disorder – who are at risk for switching into full-blown manic episodes – need to be on a mood-stabilizing drug while using light therapy.

What should I do if I think I have SAD?

If your symptoms are mild – that is, if they don’t interfere too much with your daily living, you may want to try light therapy as described above or experiment with adjusting the light in your surroundings with bright lamps and scheduling more time outdoors in winter.

If your depressive symptoms are severe enough to significantly affect your daily living, consult a mental health professional qualified to treat SAD. He or she can help you find the most appropriate treatment for you. To help you decide whether a clinical consultation is necessary, you can use the feedback on the Personalized Inventory for Depression and SAD at

Article courtesy of NAMI.

Social Security’s 5.8 Percent Benefit Increase May Mean More Money in Your Pocket in 2009



The Social Security Administration recently announced that it would increase monthly Social Security and Supplemental Security Income (SSI) benefits by 5.8% in 2009.  This increase, known as a cost-of-living adjustment or “COLA increase,” will result in higher benefit amounts for more than 55 million Americans.  For example, the average retired couple will see their benefits increase from $1,773 per month to $1,876 per month.

This is the largest increase in benefits since 1982.  The Social Security Administration automatically increases benefits based on the rise of Bureau of Labor Statistics’ Consumer Price Index for Urban Wage Earners and Clerical Workers (CPI-W).  The increase in this year’s CPI-W was 5.8%.

Individuals who receive Supplement Security Income benefits will see the first increase in their benefits beginning December 31, 2008.  The increased payments to those who receive other Social Security benefits, such as retirement or survivor’s benefits, will begin in January 2009.

Individuals who are currently receiving other benefits, such as the Wisconsin Medicaid Purchase Plan or QMB, SLMB, SLMB+, may wonder how these benefits will be affected by the Social Security increase.  These benefit programs have income limits that are set using the federal poverty guidelines, or “FPL.”  A different government agency, the Department of Health and Human Services (DHHS), is responsible for setting the FPL each year.  DHHS typically announces the new FPL in late January to mid February. Fortunately, the cost-of-living increase to Social Security benefits is not counted for these programs until the month after the new federal poverty guidelines become effective.

The new increase is especially fantastic news for Wisconsin seniors who also receive Medicare. You may remember that Medicare announced this fall that the Part B Premium for 2009 will remain unchanged at the current $96.40 per month.  This means that Medicare recipients who are also receiving Social Security benefits will see the full increase in monthly Social Security benefits because it will not be offset by a higher monthly Part B Premium.  These days, every penny counts—and now a few more of them will be headed your way!

Questions?  Please feel free to contact the Coalition of Wisconsin Aging Groups at (608) 224-0606 and ask to speak with a Dane County Elderly Benefit Specialist.

Information courtesy of

Help After the Holidays



After working at the North/Eastside Senior Coalition for over 5 years now, I have begun to notice a pattern around the holidays. The first day after a holiday seems to be flooded with telephone calls from concerned family members wanting to know about services in the community. Family members who maybe aren’t able to visit with their parents on a regular basis are often surprised to return home only to find out that Mom or Dad is not doing as well as they thought. Holidays are a great time for family members to check-in to see how senior adults are doing at home. Family members may notice that the home is no longer as orderly as it once was, that Mom is not taking her medications as often as she should, or that Dad is not eating as much and appears thinner. Or families notice how happy their parents were when they had company and want to find social activities for them to participate in during the year. That’s when they call NESCO as they are afraid to return to their own homes again and leave Mom and Dad alone. NESCO case managers can visit with the senior adult and hopefully connect them with services so that they can continue to live independently at home. Family members are thrilled to now have a contact to talk to who will be able to continue checking on Mom or Dad while they themselves are out of town.

Don’t know what things to look for when visiting or how to discuss your concerns? The following link from the Wisconsin Alliance for Family Care Giving offers a checklist of items for family members as well as good advice on how to talk to your parents.

As always, NESCO case managers are also just a phone call away and are happy to also answer questions or address concerns….608-243-5252.