by Cate Kortzeborn -Medicare’s acting regional administrator for Arizona, California, Hawaii, Nevada, and the Pacific Territories.

When I talk to people with Medicare about planning for the end of their lives, the statistic that always strikes me is this:

If you ask people where they’d rather die – in a hospital or at home – 75 percent say at home and 25 percent say the hospital. But when you look at what actually happens, only 25 percent of people get to die at home, while 75 percent pass away in hospitals.

The only way you can ensure that your doctor understands your wishes is by talking about them. And now, Medicare will reimburse your doctor for that conversation.

This is called advance care planning. It’s designed to help people with Medicare learn about various options for end-of-life care; determine which types of care best fit their personal wishes; and share their wishes with their family, friends, and physicians.

One option you can discuss with your doctor is hospice care. Hospice is intended to help terminally-ill people live out their lives as comfortably as possible, usually in their own homes. Hospice doesn’t focus on curing disease and it’s not only for people with cancer.

Medicare’s hospice benefit covers your care, and you shouldn’t have to go outside of hospice to get care except in rare situations. Once you choose it, your hospice benefit should cover everything you need.

If you qualify for hospice care, you and your family will work with your hospice provider to set up a plan of care that meets your needs.

You and your family members are the most important part of your medical team. Your team can also include doctors, nurses or nurse practitioners, social workers, physical and occupational therapists, speech-language pathologists, hospice aides, homemakers, and volunteers.

A hospice nurse and doctor are on-call 24 hours a day, 7 days a week to give you and your family support and care when you need it. You can also include your regular doctor or a nurse practitioner on your medical team to supervise your care.

Medicare’s hospice benefit allows you and your family to stay together in the comfort of your home, unless you need care in an inpatient facility. If your hospice provider determines that you need inpatient care, the provider will make arrangements for your stay.

To find a hospice provider, talk to your doctor or call your state hospice organization. The National Hospice and Palliative Care Organization has a website that allows you to look up local providers based on your zip code, at www.nhpco.org/find-hospice.

You can get hospice care if you have Medicare Part A (hospital insurance) and you meet these conditions:

■ Your hospice doctor and your regular doctor (if you have one) certify that you’re terminally ill, with a life expectancy of 6 months or less;

■ You accept palliative care (for comfort) instead of care to cure your illness;

■ You sign a statement choosing hospice care instead of other Medicare-covered treatments for your terminal illness and related conditions.

You have the right to stop hospice at any time. If you do so, you’ll go back to the type of Medicare coverage you had before you chose a hospice provider, like Original Medicare, a Medicare Advantage plan, or another type of Medicare health plan.

Depending on your illness and related conditions, the plan of care your hospice team creates can include doctor and nursing services; medical equipment (like wheelchairs and walkers); medical supplies (like bandages and catheters); prescription drugs; hospice aide and homemaker services; physical and occupational therapy; speech-language pathology services; social worker services; dietary counseling; grief and loss counseling for you and your family; short-term inpatient care (for pain and symptom management); and any other Medicare-covered services needed to manage your terminal illness and related conditions, as recommended by your hospice team.

For more information on Medicare’s hospice benefit, including costs, please go to: https://www.medicare.gov/Pubs/pdf/02154.pdf.

You can always get answers to your Medicare questions by calling 1-800-MEDICARE (1-800-633-4227).

Shingles is a disease that affects your nerves. Medication like valtrex can be used to treat this viral infection. It can cause burning, shooting pain, tingling, and/or itching, as well as a rash and blisters.

You may recall having chickenpox as a child. Shingles is caused by the same virus, the varicella-zoster virus (VZV). After you recover from chickenpox, the virus continues to live in some of your nerve cells. It is usually inactive, so you don’t even know it’s there.

In fact, most adults live with VZV in their body and never get shingles. But, for about one in three adults, the virus will become active again. Instead of causing another case of chickenpox, it produces shingles. We do not totally understand what makes the virus go from inactive to active.

Having shingles doesn’t mean you have any other underlying disease.

Anyone who had chickenpox has VZV in their body and is at risk for getting shingles. Right now, there is no way of knowing who will get the disease. But, some things make it more likely:

Advanced age. The risk of getting shingles increases as you age. People may have a harder time fighting off infections as they get older. About half of all shingles cases are in adults age 60 or older. The chance of getting shingles becomes much greater by age 70.

Trouble fighting infections. Your immune system is the part of your body that responds to infections. Age can affect your immune system. So can an HIV infection, cancer, cancer treatments, too much sun, or organ transplant drugs. Even stress or a cold can weaken your immune system for a short time. These all can put you at risk for shingles. To stop this from happening, it is important that you get control over any stressful emotions you’re experiencing, through seeking help. Alternative medications such as CBD oil or speaking with a therapist have been known to make a difference, and this could lower your risk of getting shingles through stress.

If you haven’t already got it and are just looking to minimise the risk in other ways, you need to ensure that you have all the right vitamins to help boost your immune system. Vitamin D – the sunshine vitamin as it’s known – can be very important to keeping disease and infection at bay. If you cannot get it naturally it’s worth looking at Vitamins For Immune System From Vitabiotics to make sure you can still get your daily dose.

Can You Catch Shingles?

Shingles is not contagious. You can’t catch it from someone. But, you can catch chickenpox from someone with shingles. So, if you’ve never had chickenpox, try to stay away from anyone who has shingles.

If you have shingles, try to stay away from anyone who has not had chickenpox or who might have a weak immune system.

Usually, shingles develops only on one side of the body or face and in a small area rather than all over. The most common place for shingles is a band that goes around one side of your waistline.

• Most people have some of the following shingles symptoms:
• Burning, tingling, or numbness of the skin
• Feeling sick-chills, fever, upset stomach, or headache
• Fluid-filled blisters
• Skin that is sensitive to touch
• Mild itching to strong pain
• Depending on where shingles develops, it could also cause symptoms like loss of vision or even hiccups.
• For some people, the symptoms of shingles are mild. They might just have some itching. For others, shingles can cause intense pain that they feel from the gentlest touch or breeze.

Most cases of shingles last 3 to 5 weeks. Shingles follows a pattern:

• The first sign is often burning or tingling pain; sometimes, it includes numbness or itching on one side of the body.
• Somewhere between 1 and 5 days after the tingling or burning feeling on the skin, a red rash will appear.
• A few days later, the rash will turn into fluid-filled blisters.
• About a week to 10 days after that, the blisters dry up and crust over.
• A couple of weeks later, the scabs clear up.
• Most people get shingles only one time. But it is possible to have it more than once.

After the shingles rash goes away, some people may be left with ongoing pain called post-herpetic neuralgia or PHN. The pain is felt in the area where the rash had been. For some people, PHN is the longest lasting and worst part of shingles. The older you are when you get shingles, the greater your chance of developing PHN.

The PHN pain can cause depression, anxiety, sleeplessness, and weight loss. Some people with PHN find it hard to go about their daily activities, like dressing, cooking, and eating. Talk with your doctor if you have any of these problems.

There are medicines that may help with PHN. Steroids may lessen the pain and shorten the time you’re sick. Analgesics, antidepressants, and anticonvulsants may also reduce the pain. Usually, PHN will get better over time.

Some people have other problems that last after shingles has cleared up. For example, the blisters caused by shingles can become infected. They may also leave a scar. It is important to keep the area clean and try not to scratch the blisters. Your doctor can prescribe an antibiotic treatment if needed.

See your doctor right away if you notice blisters on your face-this is an urgent problem. Blisters near or in the eye can cause lasting eye damage or blindness. Hearing loss, a brief paralysis of the face, or, very rarely, swelling of the brain (encephalitis) can also occur.

If you think you might have shingles, talk to your doctor as soon as possible. It’s important to see your doctor no later than 3 days after the rash starts. The doctor will confirm whether or not you have shingles and can make a treatment plan. Although there is no cure for shingles, early treatment with drugs that fight the virus can help the blisters dry up faster and limit severe pain. Shingles can often be treated at home. People with shingles rarely need to stay in a hospital.

The shingles vaccine is a safe and easy, one-time shot that may keep you from getting shingles. Most people age 60 and older should get vaccinated. You should get the shot even if you already had shingles or don’t remember having chickenpox. However, if you have a weak immune system or allergies to certain medicines, make sure to check with your doctor first.

You can get the shingles vaccine at your doctor’s office and at some pharmacies. All Medicare Part D plans and most private health insurance plans will cover the cost.

If you have shingles, here are some tips that might help you feel better:

• Get plenty of rest and eat well-balanced meals.
• Try simple exercises like stretching or walking. Check with your doctor before starting a new exercise routine.
• Apply a cool washcloth to your blisters to ease the pain and help dry the blisters.
• Do things that take your mind off your pain. For example, watch TV, read, talk with friends, listen to relaxing music, or work on a hobby you like.
• Avoid stress. It can make the pain worse.
• Wear loose-fitting, natural-fiber clothing.
• Take an oatmeal bath or use calamine lotion to see if it soothes your skin.
• Share your feelings about your pain with family and friends. Ask for their understanding.

Also, you can limit spreading the virus by:

• Keeping the rash covered
• Not touching or scratching the rash
• Washing your hands often