Generally, elderly parents want to remain living in their own home. However, remaining in the home becomes a concern when children see their parents slowing down, perhaps even having trouble with handling stairs and doing general daily activities. Yet, with parents' mental and physical health currently not creating problems, there seems to be no imminent need to search out support services or other accommodations for aging parents.
This is now the time to evaluate the home to make it safe and secure for your loved ones -- now and in the near future -- in anticipation of aging disabilities that may occur. Help and support are available. The nation as a whole is more aware of elderly needs and services and products are becoming available at an outstanding pace.
The Bureau of Labor Statistics states,
“Employment of personal and home care aides is projected to grow by 51 percent between 2006 and 2016, which is much faster than the average for all occupations. The expected growth is due, in large part, to the projected rise in the number of elderly people, an age group that often has mounting health problems and that needs some assistance with daily activities.” Bureau of labor Statistics-Occupational Outlook Handbook, 2008-09 Edition
This growing need for aides and services also encompasses
•home remodeling services -- making a home more serviceable to the elderly;
•safety alert systems and technology;
•motion sensors to monitor movement;
•telehealth services -- using home-based computer systems for the doctors office or a nurse to monitor vital signs and
•even a pill dispenser that notifies when it is time to take medication.
Where do you begin to make sure your elderly family member is safe and managing well in his or her home?
Visit often and at different times of the day and night. Make note of daily activities that appear challenging and where changes might be made to add safety and convenience. Remove rugs that slide -- causing a fall -- and move furniture with sharp edges. Set the water heater at a lower temperature. This will protect their older sensitive skin from scalds and burns. Be sure smoke detectors and carbon monoxide detectors are in place.
Bathrooms are a hazard area for the elderly. Grab bars by the toilet and shower are a must to help prevent falls. There are easy to install bars at your local hardware store if you want to do the work yourself. Another item that is good to have is a shower stool or chair.
If you are not sure of what needs to be done, consider hiring a professional. There are companies that specialize in home remodeling and accommodation for seniors. Michelle Graham of Accessible Design by Studio G4 says about senior home remodel projects,
“The main thing we incorporate in all of our projects is a careful study of needs and potential needs that may develop throughout a client's lifespan.”
Keep in mind what future home adjustments might be needed for your parents to “age in place” in their home.
Home safety or medical alert companies provide GPS-based bracelets or pendants to track the elderly at home who tend to wander. Or the companies may provide alarm devices such as pendants or bracelets which allow the elderly to alert someone if there has been a fall or a sudden health-related attack. In the event an alarm has been triggered, a 24 hour monitoring service will alert the family or medical emergency services or call a neighbor depending on previous instructions. In addition there are companies that will install motion sensors in the home to monitor the elderly on a 24 hour basis.
Don't forget your parents' community as a valuable resource for helping them stay in their home. Take Margaret Muller as an example. At 82 years of age, Margaret lives alone in her small home. She manages very well with the help of her local Senior Center. The Center's “Senior Companion” program sees that Margaret is taken to the store for groceries and other needs and checks in with her often to see how she is doing. Once a day, the Senior Center delivers a hot healthy meal to her door. Having these services and visits gives Margaret the help she needs and peace of mind that she is not alone.
Neighbors, local church groups, senior centers and city centers are some places to look for assistance. Most of the time there is little or no cost for these services.
Your state aging services unit is a valuable community resource. The National Area on Aging website www.aoa.gov states:
“AoA, through the Older Americans Act and other legislation, supports programs that help older adults maintain their independence and dignity in their homes and communities. In addition AoA provides funding for a range of supports to family caregivers.”
Some of the programs the site lists are:
Supportive Services and Senior Centers
Nutrition Services
National Family Caregiver Support Program
Grants for Native Americans
Nursing Home Diversion Grants
Aging & Disability Resource Centers
Evidence-Based Disease Prevention
Long-Term Care Planning
Alzheimer's Disease Grants
Naturally Occurring Retirement Communities”
A few thoughts on hiring home care aides or live-in care givers.
The classifieds are filled with people looking for work as aides to the elderly. Many of these aides are well-qualified, honest people who will do a good job; but, of course, there will be some not so reputable. If you are looking to hire someone, be sure you interview and check references and qualifications. You will be responsible for scheduling that person and doing payroll and taxes as well. Be very sure you hire someone trustworthy, as the elderly seem to trust these helpers more than they should and therefore can easily be taken advantage of.
A professional home care service will eliminate your employment concerns. Professionally-provided aides are usually bonded and service is guaranteed. Home care companies take care of the scheduling and payment of their employees. Home care companies cater to the elderly in their homes by offering a variety of services. The National Care Planning Council lists many of these companies throughout the country on its website www.longtermcarelink.net .
These providers represent a rapidly growing trend to allow people needing help with long term care to remain in their home or in the community instead of going to a care facility. The services offered may include:
•companionship
•grooming and dressing
•recreational activities
•incontinent care
•handyman services
•teeth brushing
•medication reminders
•bathing or showering
•light housekeeping
•meal preparation
•respite for family caregivers
•errands and shopping
•reading email or letters
•overseeing home deliveries
•dealing with vendors
•transportation services
•changing linens
•laundry and ironing
•organizing closets
•care of house plants
•24-hour emergency response
•family counseling
•phone call checks
•and much more.
Thomas Day, Director of the National Care Planning Council states,
“Care in the home provided by a spouse or a child is the most common form of long-term care in this country. About 73% of all long term care is provided in the home environment typically by family caregivers.” As their caregiver, you can make the difference in the quality of life for your aging parents and if staying in their home is a possibility, you have the resources to make it happen.
Wednesday, May 6, 2009
Tuesday, April 28, 2009
Helping Older Parents Stay Happy and Healthy
Helping Your Older Parents Stay Happy and Healthy by Robert Stall MD, Geriatrician
If you're fortunate enough to have one or both parents still living, you may have noticed a role reversal taking place in your relationship. Remember the days when Mom shuttled you to the doctor whenever you were sick? Now, it may be you who's driving her to her medical appointments. Perhaps you've become even more involved in managing her healthcare needs – serving as her healthcare proxy, moving her into your home to care for her, or even having to select a nursing home for her to live in.
Whatever the case, it's natural to feel challenged – and, yes, intimidated – in the role you've undertaken. But if you stay positive and proactive, you'll be in a great position to advocate for your parents' optimal care. And, really, what better way is there to say "Thank You" for all they've done for you over the years?
The following six recommendations will help you understand what may be happening to your parents as they age – and what you can do to help.
1. Stay vigilant to sudden changes. Typically, sudden changes arise from sudden problems. Your elderly father who becomes confused one week but was alert and oriented the week before, or becomes unsteady walking and starts falling, is likely experiencing an acute problem – an infection, medication side effect, or perhaps, a heart attack or stroke.
If you pay attention to your parent's baseline health and behavior, you'll be alert to sudden, and subtle, fluctuations. Being attuned to what's “normal” for your parent is critical in advocating for his care. By informing his physician of these changes, you help ensure that he receives a proper diagnosis and timely treatment – especially important in acute conditions.
2. Investigate the source of gradual decline. Several years ago, I met an elderly woman living in a nursing home. Her family, assuming she had dementia, had moved her there after she had gradually stopped speaking.
After performing a brief procedure on her, I asked how she was doing. “I'm OK,” she replied.
A miracle? Not exactly. I'd removed bullet-sized pieces of wax from her ears. She'd stopped speaking because her ears were too plugged to hear.
A host of conditions can cause gradual decline. Before jumping to the conclusion – as many people do – that Alzheimer's disease is the culprit, recognize that your parent may be experiencing an altogether different problem: a vitamin B12 deficiency, an underactive thyroid, Parkinson's disease or depression, to name a few.
When discussing your parent's decline with her physician, make sure the two of you consider all the possibilities. To prepare for the appointment, make notes detailing how her decline has manifested itself – loss of appetite, a failing short-term memory and so forth – and how long you've noticed these changes. That way, you won't leave anything out. To help you, I've created a free checklist that either you or your parent can complete at seniorselfassessment.com – make sure you print or email the “Test Result Details” at the bottom of the page to analyze your responses and give you advice based on your answers.
3. Know thy parent's medicine cabinet. Familiarize yourself with the medications your parent takes: what each one is for and how often he takes them. Make sure you notify each doctor your parent visits of all the medicine he takes, including over-the-counter products. Ask what side effects you might observe from each medication and whether it's potentially dangerous if your parent takes them together. You also want to tell the doctor whether your parent drinks alcohol or caffeinated drinks and whether he smokes, as these substances can affect some medications' efficacy and safety. To recognize which medications might cause the symptoms your parent experiences, check out drugscanmakeyousick.com .
4. Discourage ageist attitudes. Simply put, ageism is prejudice against the elderly. It exists in many forms but can be particularly damaging to an older person's self-esteem when it assumes that all of her woes are age-related. Here are a couple of ways of expressing ageism to an elderly parent:
“What do you expect at your age?” “You're not getting any younger.”
If you're ever tempted to utter something similar, remind yourself that by chalking up everything that ails her to her age, you sell your parent short. If she's depressed, it may have nothing to do with the fact that she's 80 and everything to do with a biological predisposition to depression. And remember that right-knee pain in a 90 year-old can't be just from age if there's no problem with her left knee. (More about Dr. Stall and a more in-depth article on the attitude of society towards medical care for the elderly can be found at http://www.longtermcarelink.net/eldercare/medical_care_issues.htm )
5. Address not just symptoms—but emotions, too. There is disease and then there is “dis-ease” – that is, a lack of ease, security or well-being. “Dis-ease” can manifest itself as myriad emotions in an elderly person: fear, grief, boredom, embarrassment and sadness among them. The fact is, these emotions can be every bit as debilitating as disease.
Take the case of a parent who's incontinent. Too embarrassed to socialize, she cuts herself off from friends. Without companionship, she becomes lonely. Instead of allowing her to become a hermit, discuss with her doctor how to address the incontinence. Together, you can consider different solutions that will ease her embarrassment and reinvigorate her social life.
6. Strive to maximize your parent's quality of life. No matter our age, we all want to enjoy life to the fullest and have the capability to do the things we want to. Improving the enjoyment of life and a patient's functional ability are the cardinal goals of geriatric care. But you don't need a medical diploma on your wall to help your parent achieve either of those goals.
Being there to solve a problem or provide company are tremendously worthwhile services you can provide – no expertise required. Remember, as your parent gets older, his quality of life becomes more important to him than how much longer he lives. And he doesn't necessarily need medications or surgery to ensure that he's living the latter part of his life to the fullest.
If he enjoys books but has difficulty reading regular-sized type, check out sight-saving titles at the library. If he's grieving the loss of his best buddy, introduce him to new acquaintances at the senior center. If he's living in a nursing home, bring your kids there to share a meal with him.
Sometimes, it's the small gestures that have the most profound impact. As the child of an elderly parent, you are uniquely positioned to deliver these life-changing gifts.
Dr. Robert Stall is a geriatrician practicing in Tonawanda, New York and a clinical associate professor at the University of Buffalo's School of Medicine and Biomedical Sciences. He serves as medical director and attending physician at Beechwood Homes in Getzville and Blocher Homes in Williamsville. To learn more about senior care issues, visit his website at stallgeriatrics.com or call 716-213-4345. For information on a new program offering balance assessment and fall prevention tips, call 716-213-0772.
If you're fortunate enough to have one or both parents still living, you may have noticed a role reversal taking place in your relationship. Remember the days when Mom shuttled you to the doctor whenever you were sick? Now, it may be you who's driving her to her medical appointments. Perhaps you've become even more involved in managing her healthcare needs – serving as her healthcare proxy, moving her into your home to care for her, or even having to select a nursing home for her to live in.
Whatever the case, it's natural to feel challenged – and, yes, intimidated – in the role you've undertaken. But if you stay positive and proactive, you'll be in a great position to advocate for your parents' optimal care. And, really, what better way is there to say "Thank You" for all they've done for you over the years?
The following six recommendations will help you understand what may be happening to your parents as they age – and what you can do to help.
1. Stay vigilant to sudden changes. Typically, sudden changes arise from sudden problems. Your elderly father who becomes confused one week but was alert and oriented the week before, or becomes unsteady walking and starts falling, is likely experiencing an acute problem – an infection, medication side effect, or perhaps, a heart attack or stroke.
If you pay attention to your parent's baseline health and behavior, you'll be alert to sudden, and subtle, fluctuations. Being attuned to what's “normal” for your parent is critical in advocating for his care. By informing his physician of these changes, you help ensure that he receives a proper diagnosis and timely treatment – especially important in acute conditions.
2. Investigate the source of gradual decline. Several years ago, I met an elderly woman living in a nursing home. Her family, assuming she had dementia, had moved her there after she had gradually stopped speaking.
After performing a brief procedure on her, I asked how she was doing. “I'm OK,” she replied.
A miracle? Not exactly. I'd removed bullet-sized pieces of wax from her ears. She'd stopped speaking because her ears were too plugged to hear.
A host of conditions can cause gradual decline. Before jumping to the conclusion – as many people do – that Alzheimer's disease is the culprit, recognize that your parent may be experiencing an altogether different problem: a vitamin B12 deficiency, an underactive thyroid, Parkinson's disease or depression, to name a few.
When discussing your parent's decline with her physician, make sure the two of you consider all the possibilities. To prepare for the appointment, make notes detailing how her decline has manifested itself – loss of appetite, a failing short-term memory and so forth – and how long you've noticed these changes. That way, you won't leave anything out. To help you, I've created a free checklist that either you or your parent can complete at seniorselfassessment.com – make sure you print or email the “Test Result Details” at the bottom of the page to analyze your responses and give you advice based on your answers.
3. Know thy parent's medicine cabinet. Familiarize yourself with the medications your parent takes: what each one is for and how often he takes them. Make sure you notify each doctor your parent visits of all the medicine he takes, including over-the-counter products. Ask what side effects you might observe from each medication and whether it's potentially dangerous if your parent takes them together. You also want to tell the doctor whether your parent drinks alcohol or caffeinated drinks and whether he smokes, as these substances can affect some medications' efficacy and safety. To recognize which medications might cause the symptoms your parent experiences, check out drugscanmakeyousick.com .
4. Discourage ageist attitudes. Simply put, ageism is prejudice against the elderly. It exists in many forms but can be particularly damaging to an older person's self-esteem when it assumes that all of her woes are age-related. Here are a couple of ways of expressing ageism to an elderly parent:
“What do you expect at your age?” “You're not getting any younger.”
If you're ever tempted to utter something similar, remind yourself that by chalking up everything that ails her to her age, you sell your parent short. If she's depressed, it may have nothing to do with the fact that she's 80 and everything to do with a biological predisposition to depression. And remember that right-knee pain in a 90 year-old can't be just from age if there's no problem with her left knee. (More about Dr. Stall and a more in-depth article on the attitude of society towards medical care for the elderly can be found at http://www.longtermcarelink.net/eldercare/medical_care_issues.htm )
5. Address not just symptoms—but emotions, too. There is disease and then there is “dis-ease” – that is, a lack of ease, security or well-being. “Dis-ease” can manifest itself as myriad emotions in an elderly person: fear, grief, boredom, embarrassment and sadness among them. The fact is, these emotions can be every bit as debilitating as disease.
Take the case of a parent who's incontinent. Too embarrassed to socialize, she cuts herself off from friends. Without companionship, she becomes lonely. Instead of allowing her to become a hermit, discuss with her doctor how to address the incontinence. Together, you can consider different solutions that will ease her embarrassment and reinvigorate her social life.
6. Strive to maximize your parent's quality of life. No matter our age, we all want to enjoy life to the fullest and have the capability to do the things we want to. Improving the enjoyment of life and a patient's functional ability are the cardinal goals of geriatric care. But you don't need a medical diploma on your wall to help your parent achieve either of those goals.
Being there to solve a problem or provide company are tremendously worthwhile services you can provide – no expertise required. Remember, as your parent gets older, his quality of life becomes more important to him than how much longer he lives. And he doesn't necessarily need medications or surgery to ensure that he's living the latter part of his life to the fullest.
If he enjoys books but has difficulty reading regular-sized type, check out sight-saving titles at the library. If he's grieving the loss of his best buddy, introduce him to new acquaintances at the senior center. If he's living in a nursing home, bring your kids there to share a meal with him.
Sometimes, it's the small gestures that have the most profound impact. As the child of an elderly parent, you are uniquely positioned to deliver these life-changing gifts.
Dr. Robert Stall is a geriatrician practicing in Tonawanda, New York and a clinical associate professor at the University of Buffalo's School of Medicine and Biomedical Sciences. He serves as medical director and attending physician at Beechwood Homes in Getzville and Blocher Homes in Williamsville. To learn more about senior care issues, visit his website at stallgeriatrics.com or call 716-213-4345. For information on a new program offering balance assessment and fall prevention tips, call 716-213-0772.
Swine Flu Preparedness
The flu and flu outbreaks usually have a more severe effect on the elderly and children. The Centers for Disease Control and Prevention's website is a good resource for information on the issues, resources, and related matters relevant to the current swine flu outbreak. The home page is: http://www2a.cdc.gov/phlp/index.asp.
In addition, this website has links to other good resources, including state swine flu information. The website for state information is: http://www.astho.org/templates/display_pub.php?pub_id=3797&admin=1. This website is posted by the Association of State and Territorial Health Officials. If you are concerned about elderly parents living in another state, you may want to visit this website in addition to the websites for the states, cities, and local news organiziations where your parents reside.
In addition, this website has links to other good resources, including state swine flu information. The website for state information is: http://www.astho.org/templates/display_pub.php?pub_id=3797&admin=1. This website is posted by the Association of State and Territorial Health Officials. If you are concerned about elderly parents living in another state, you may want to visit this website in addition to the websites for the states, cities, and local news organiziations where your parents reside.
Tuesday, April 14, 2009
Free Online Estate Planning, Tax and Personal Finance Resource
I've been a regular reader of the Wall Street Journal for over a year now. I've found the Wall Street Journal to be a good newspaper with solid national and international reporting. And, I have a better understanding of the current financial and economic crisis because I've been a regular reader for the past year.
Before I subscribed to the Wall Street Journal, I was not aware of the personal finance, tax, and retirement planning articles published weekly in the Wall Street Journal. A great example is the Wealth Manager guide published in the the Journal Report on Monday, April 13, 2009. Several of the articles include the following:
Before I subscribed to the Wall Street Journal, I was not aware of the personal finance, tax, and retirement planning articles published weekly in the Wall Street Journal. A great example is the Wealth Manager guide published in the the Journal Report on Monday, April 13, 2009. Several of the articles include the following:
- Seven Questions to Ask When Picking a Financial Adviser
- The Mess They Leave - Many people die with nothing in order. Here's some help sorting them out.
- The Right Steps - When it comes to blended families, estate planning can be a special kind of hell.
- Financial Prescription - If you have a chronic illness, the regular rules of estate planning may need som fine-tuning. Here are things to consider as you develop your plan.
As of the date of this post, the articles can be found at: http://online.wsj.com/public/page/wealth-management-041309.html
I know many people search and use the web to find resources that will assist and educate them on various topics. I've found the Wall Street Journal to have timely articles on estate planning, taxes, and health issues. I encourage you to become familiar with the Wall Street Journal and visit its online version frequently. I think you'll be pleasantly surprised. Many of the articles can be viewed for free; however, some of the articles require an online subscription.
I'm not being paid or receiving other benefits from the Wall Street Journal for this post. I just think it's a great resource others should know about. If you visit the Journal's website, let me know what you think.
Long Distance Care Givers Receive Help
Living in a different city or state -- miles from aging parents -- can be very difficult. Keeping in touch by telephone and making long trips to help parents or aging relatives with their needs can be time consuming and not nearly as effective as being available full time in person.
Mark Sessions spent two years juggling his restaurant business with multiple daily phone calls to his elderly parents, checking on their needs and answering their questions. Family vacations were spent traveling the 500 miles to his parent's home to personally take care of home maintenance and provide health care visits to their doctor.
During his last visit, Mark noticed his father had difficulty walking and his mother was confused as to which medications she was to take and at what time. This alarming change in his parent's condition concerned Mark that his parents' care needs required more than frequent phone calls and vacation visits. Running his business and handling his parent's long distance care was now becoming very challenging.
According to a report by the Alzheimer's Association of Los Angeles & Riverside, California, there are approximately 3.3 million long distance caregivers in this country with an average distance of 480 miles from the people they care for. The report also states that 15 million days are missed from work each year because of long distance care giving. Seven million Americans provide 80% of the care to ailing family members and the number of long distance caregivers will DOUBLE over the next 15 years. Long Distance Caregiver Project – Alzheimer's Association LA & Riverside, Los Angeles, CA (May 15, 2002, National Web Seminar by Judith Delaney, MFT, Clinical Coordinator)
The long distance caregiver is a new role that is thrust upon children and younger family members. Families used to live closer together, with children residing and working near their parents. But nowadays family members are more distant from each other. Society, today, is recognizing this. Some caregiver services have tweaked their programs to work as liaisons between long distance caregivers, senior loved ones and local medical professionals.
Professional care managers -- a lso known as Geriatric Care Managers, Elder Care Managers or Aging Care Managers -- represent a growing trend to help full time, employed family caregivers provide care for loved ones. Care managers are expert in assisting caregivers, friends or family members find government-paid and private resources to help with long term care decisions.
They are professionals -- trained to evaluate and recommend care for the aged. A care manager might be a nurse, social worker, psychologist, or gerontologist who specializes in assessing the abilities and needs of the elderly. Care manger professionals are also becoming extremely popular as the caretaker liaison between long distant family members and their aging elder loved ones.
Jacqueline Marcell -- author of "Elder Rage, or Take My Father...Please! How to Survive Caring for Aging Parents" (Impressive, 2000) -- says,
"The most important thing to do is to find a geriatric care manager in the area where your loved one lives. She will have knowledge of all the services in the area and can be your eyes."
Below is a partial list of what a care manager or Professional Geriatric Care Manager might do:
Mark Sessions spent two years juggling his restaurant business with multiple daily phone calls to his elderly parents, checking on their needs and answering their questions. Family vacations were spent traveling the 500 miles to his parent's home to personally take care of home maintenance and provide health care visits to their doctor.
During his last visit, Mark noticed his father had difficulty walking and his mother was confused as to which medications she was to take and at what time. This alarming change in his parent's condition concerned Mark that his parents' care needs required more than frequent phone calls and vacation visits. Running his business and handling his parent's long distance care was now becoming very challenging.
According to a report by the Alzheimer's Association of Los Angeles & Riverside, California, there are approximately 3.3 million long distance caregivers in this country with an average distance of 480 miles from the people they care for. The report also states that 15 million days are missed from work each year because of long distance care giving. Seven million Americans provide 80% of the care to ailing family members and the number of long distance caregivers will DOUBLE over the next 15 years. Long Distance Caregiver Project – Alzheimer's Association LA & Riverside, Los Angeles, CA (May 15, 2002, National Web Seminar by Judith Delaney, MFT, Clinical Coordinator)
The long distance caregiver is a new role that is thrust upon children and younger family members. Families used to live closer together, with children residing and working near their parents. But nowadays family members are more distant from each other. Society, today, is recognizing this. Some caregiver services have tweaked their programs to work as liaisons between long distance caregivers, senior loved ones and local medical professionals.
Professional care managers -- a lso known as Geriatric Care Managers, Elder Care Managers or Aging Care Managers -- represent a growing trend to help full time, employed family caregivers provide care for loved ones. Care managers are expert in assisting caregivers, friends or family members find government-paid and private resources to help with long term care decisions.
They are professionals -- trained to evaluate and recommend care for the aged. A care manager might be a nurse, social worker, psychologist, or gerontologist who specializes in assessing the abilities and needs of the elderly. Care manger professionals are also becoming extremely popular as the caretaker liaison between long distant family members and their aging elder loved ones.
Jacqueline Marcell -- author of "Elder Rage, or Take My Father...Please! How to Survive Caring for Aging Parents" (Impressive, 2000) -- says,
"The most important thing to do is to find a geriatric care manager in the area where your loved one lives. She will have knowledge of all the services in the area and can be your eyes."
Below is a partial list of what a care manager or Professional Geriatric Care Manager might do:
- Assess the level and type of care needed and develop a care plan.
- Take steps to start the care plan and keep it functioning.
- Make sure care is in a safe and disability friendly environment.
- Resolve family conflicts and other issues with long term care.
- Become an advocate for the care recipient and the caregiver.
Manage care for a loved one for out-of-town families. - Conduct ongoing assessments to implement changes in care.
- Oversee and direct care provided at home.
- Coordinate the efforts of key support systems.
- Provide personal counseling.
- Help with Medicaid qualification and application.
- Arrange for services of legal and financial advisors.
- Provide placement in assisted living facilities or nursing homes.
- Monitor the care received in a nursing home or in assisted living.
- Assist with the monitoring of medications.
- Find appropriate solutions to avoid a crisis.
- Coordinate medical appointments and medical information.
Provide transportation to medical appointments. - Assist families in positive decision making.
- Develop care plans for older loved ones not now needing care.
Services offered will depend on the educational and professional background of the care manager, but most are qualified to cover items in the list above or can recommend a professional who can. Fees may vary. There is often an initial consultation fee that is followed by hourly fees for services. Health insurance does not generally cover these fees but long-term care insurance might.
In 2002, the AARP published a survey from geriatric care mangers about their fees:
“Respondents were asked how much they charged for their services, which might include: an initial consultation; fees on an hourly or per visit basis; fees for development of a care plan; and fees on a fixed-price contract basis. Hourly fees averaged $74 an hour. GCMs charged an average $168 to develop a care plan. Initial consultations averaged $175. Seven of ten current GCMs responded in the affirmative when asked if they had a statement that listed their fees. ” Written by Robyn Stone, DrPH, Principal Investigator; Susan Reinhard, RN, PhD, Co-Principal Investigator; Jean Machemer, MSG, Research Associate; and Danylle Rudin, MSW, Research Associate of The Institute for the Future of Aging Services, Washington, D.C.Barbara Coleman, Project Manager, AARP Public Policy Institute November 2002
When you take into account the time absent from work and time to find the right care resources for your loved ones, along with the cost of travel expenses to monitor their care, you will probably concur that using a caregiver is money well spent. Add on to this the stress of handling your own life circumstances combined with being a caregiver and you will probably wonder how you could have ever done without the care manager.
A professional or geriatric care manager can be an important asset to all families in elder care situations. Here is an example of how a care manager can help:
Mary is taking care of her aging husband at home. He has diabetes and is overweight. Because of the diabetes, her husband has severe neuropathy in his legs and feet and it is difficult for him to walk. He also has diabetic retinopathy and, therefore, cannot see very well. She has to be careful that he does not injure his feet, since the last time that happened he was in the hospital for four weeks with a severe infection. She is having difficulty helping him out of bed and with dressing and using the bathroom. She relies heavily on her son, who lives nearby, to help her manage her husband's care.
On the advice of a friend, Mary is told about a professional care manager, Sharon Brown. The cost of an initial assessment and care plan from the care manager is $175.00. Mary thinks she has the situation under control and $175.00 for someone from the outside to come in and tell her how to deal with her situation seems ridiculous.
One day Mary is trying to lift her husband and injures her back severely. She is bedridden and cannot care for her husband. Her son, who works fulltime, now has two parents to care for. On the advice of the same friend, he decides to bring in Sharon Brown and pay her fee himself.
Sharon does a thorough assessment of the family's needs. She arranges for Mary's doctor to order Medicare home care during Mary's recovery. Therapists come in and help Mary with exercises and advice on lifting.
Sharon advertises for and finds a private individual who is willing to live in the home for a period of time to help Mary with her recovery and watch over her husband. Sharon makes sure the new caregiver is reliable and honest and that taxes are paid for the employment. Sharon enlists the support of the local area agency on aging and makes sure all services available are provided for the family.
Sharon also calls a meeting with Mary's family and explains to them the care needs and how they need to commit to help with those needs. Sharon makes arrangements to rent or purchase medical equipment for lifting, moving and easier use of the bathroom facilities. Medicare will pay much of this cost.
Sharon also works closely with an elder law attorney and a financial planner who specializes in the elderly. The attorney prepares documents for the family including powers of attorney, a living will and advice on preserving Mary's remaining assets.
The financial planner recommends a reverse mortgage specialist to help Mary and her husband tap unused assets in their home's equity. Some reverse mortgage proceeds are used to pay off debt. The remaining proceeds are converted into income with a single premium immediate income annuity in order to provide Mary adequate income when her husband is gone and she looses one of the Social Security payments.
With the help of the care manager, Mary's life and future have been significantly improved. Her husband as well, if he adheres to the care plan, may end up having a better quality of life for his remaining years.
The National Care Planning Council promotes and supports professional and geriatric care managers on its website www.longtermcarelink.net .
Tuesday, February 17, 2009
Medicaid Rules for Long Term Care
When it was first created in 1965, Medicaid would only pay for nursing home care for recipients over the age of 65. But allowances were made in the legislation for exceptions or "waivers" to the nursing home coverage. In recent years, many states have applied for waivers to allow their state programs to pay for care in assisted living or at home. These waiver slots are typically administered by the local area agencies on aging. As a rule, the vast majority of elderly Medicaid recipients are still receiving their care in nursing homes.
Financial Eligibility Rules
Financial eligibility for Medicaid nursing home and community waivers requires the recipient to have less than $2,000 in resources. ($3,000 if a couple needs care)
Resources are defined as any asset that can be utilized to produce income or cash payments. There are numerous rules as well as gifting look back provisions that define what a resource is and is not. Some important assets that aren't required to be counted as resources are a personal residence, a life insurance policy with less than $1,500 cash value, a prepaid funeral and burial plan and a car (if necessary for transportation and care). If the recipient is married, the spouse at home keeps the residence and a vehicle worth any value. These excluded assets do not count against the eligibility of someone applying for Medicaid.
If the recipient is single but plans on returning home, the residence in most states is not included but is excluded for purposes of eligibility. The house would however, be subject to lien recovery at the death of the recipient. Any rental income must be applied towards the care of the recipient. An important rule change this year takes into account the market value of the home. If the home is worth more than $500,000 it prevents any single person from qualifying for Medicaid. This penalty does not apply if a spouse or dependent child is living in the home
In most states, money invested in an IRA, a 401(k) or any other tax qualified account is not counted as a resource if the Medicaid recipient is older than age 70 1/2. Mandatory withdrawals from these accounts are considered income and not assets. It's possible these assets might be subject to recovery after the death of the recipient or require assignment on tax qualified annuities.
After meeting the resource and level of care (need for care assessment) tests and qualifying for Medicaid, a recipient is required to share Medicaid costs by contributing all of his or her income to the total cost of care and Medicaid picks up the balance, if any. An allowance of $45 a month is added back in to provide monthly personal care. Also, an allowance for medical costs and insurance premiums not covered by Medicare is added back in.
Spousal Impoverishment Rules
There are special rules that apply to couples and prevent the healthy spouse from being impoverished due to a lack of assets or income.
Regardless of who owns them, all assets are considered jointly owned by the couple. Assets are totaled and then split in half and a healthy spouse at home keeps his or her half and the Medicaid applicant must spend down his or her half until it is less than $2,000. This money need not be spent on care but can be spent on any legitimate purchase. Tax qualified savings accounts under the rules above are not considered assets.
If the total amount of assets are less than $20,328, the spouse at home keeps the entire amount and does not have to split in half. If the spouse at home gets more than $101,640 after the assets have been split in half, that spouse can only keep $101,640 and all the rest of the assets have to be spent down by the person applying for Medicaid. As an example, a couple owns $400,000 in resources. The spouse at home can only keep $$101,640 and the spouse applying for Medicaid has to spend $298,360 less $2,000 before that spouse can qualify for Medicaid.
Incomes are not considered jointly owned and do not have to be split in half. If John has $3,000 a month in income and Sarah has $800 a month, and John applies for Medicaid, then John's entire $3,000 will go towards his care and Sarah will presumably be left impoverished with only $800 a month. The reverse is also true if Sarah needs the care. John can keep his $3,000 and the state must make up the difference between Sarah's $800 and the cost of the nursing home.
If John is applying for Medicaid, and in order to avoid complete impoverishment of Sarah, (she only has $800 a month) the state will transfer enough of John's income to bring Sarah's income up to $1,650 a month.
This is called the community spouse monthly income impoverishment allowance. For people receiving community waiver care there are additional allowances. The asset and income allowances are adjusted each year for inflation.Gifting RulesNew rules adopted in 2006 require any gift or a transfer-for-less-than-value within 60 months of a Medicaid community waiver or nursing home application to be counted as a resource to the extent of the amount of transfer. A transfer within 60 months from application is considered a gift whether made outright or conveyed in a trust. It makes no difference. There is a new penalty associated with these transfers. Disregard what you have heard in the past about gifts and penalties.
Here's how the new version works. Suppose Mary replaces her name with her daughter's name on the title of Mary's residence with a net value of $280,000. Mary applies for Medicaid 59 months after the title transfer and one month shy of the look back limit. Because she is inside the look back period, the gift of the house becomes a transfer for less than value. Mary has less than $2,000 in resources and could qualify for Medicaid. Medicaid will not pay a dime for Mary's care until the equivalent spend down for her gift has been paid. In other words, the state considers the gift to be cash-in-hand that should have been spent before Mary qualified for Medicaid assistance. This spend down requirement now becomes a penalty after the fact.
The penalty is determined in months of care and is calculated by dividing the amount of the gift by the state Medicaid rate which in this example is $4,000 a month. Dividing the gift by the monthly rate yields 70 (almost 6 years) months of penalty. From the date that Mary would have been approved for Medicaid someone must pay for 70 months of her care before Medicaid will take over. Note in this case the penalty is longer than the look back period.With a large gift, penalty periods could last up to five to ten years or more. If Mary applied for Medicaid 60 months and one day after making the gift there would be no penalty.
Medicaid Recovery
Medicaid recovery rules were initiated by Congress in 1993. After the death of the Medicaid recipient, Medicaid has a claim against the home that was previously excluded for eligibility. The claim is in the amount that Medicaid paid for the recipient's care. In some states a lien against the property, called a TEFRA lien, can be filed in anticipation of Medicaid's cost. Not all states file a TEFRA lien but typically file a debtor lien after the death.
As a matter of policy, some states do not make a claim against the property if the surviving spouse is living in the House. The debt is forgiven. This is only current policy since rules allow the state to initiate recovery through a lien on the property. There are also rules allowing the family to request a hardship hearing if recovery puts a burden on the family and the state also has authority to waive recovery on homes worth less than a certain dollar amount.
Common rumor among professionals who do Medicaid planning is that Medicaid recovery in many states is more "bark than bite". Numerous articles and studies indicate that states do an extremely poor job of recovering money from assets that should be subject to recovery. There is a suspicion that some property transferring in trusts or through joint tenancy may be escaping from recovery services.Do not let these statements lull you into a false sense of security. Continuing Medicaid budget deficits and a change in state leadership could result in Medicaid becoming much more aggressive about recovering money it can legally go after. The first step would be changing state code allowing for TEFRA liens. The use of such liens would preclude any transfer of property prior to satisfaction of the lien.
Financial Eligibility Rules
Financial eligibility for Medicaid nursing home and community waivers requires the recipient to have less than $2,000 in resources. ($3,000 if a couple needs care)
Resources are defined as any asset that can be utilized to produce income or cash payments. There are numerous rules as well as gifting look back provisions that define what a resource is and is not. Some important assets that aren't required to be counted as resources are a personal residence, a life insurance policy with less than $1,500 cash value, a prepaid funeral and burial plan and a car (if necessary for transportation and care). If the recipient is married, the spouse at home keeps the residence and a vehicle worth any value. These excluded assets do not count against the eligibility of someone applying for Medicaid.
If the recipient is single but plans on returning home, the residence in most states is not included but is excluded for purposes of eligibility. The house would however, be subject to lien recovery at the death of the recipient. Any rental income must be applied towards the care of the recipient. An important rule change this year takes into account the market value of the home. If the home is worth more than $500,000 it prevents any single person from qualifying for Medicaid. This penalty does not apply if a spouse or dependent child is living in the home
In most states, money invested in an IRA, a 401(k) or any other tax qualified account is not counted as a resource if the Medicaid recipient is older than age 70 1/2. Mandatory withdrawals from these accounts are considered income and not assets. It's possible these assets might be subject to recovery after the death of the recipient or require assignment on tax qualified annuities.
After meeting the resource and level of care (need for care assessment) tests and qualifying for Medicaid, a recipient is required to share Medicaid costs by contributing all of his or her income to the total cost of care and Medicaid picks up the balance, if any. An allowance of $45 a month is added back in to provide monthly personal care. Also, an allowance for medical costs and insurance premiums not covered by Medicare is added back in.
Spousal Impoverishment Rules
There are special rules that apply to couples and prevent the healthy spouse from being impoverished due to a lack of assets or income.
Regardless of who owns them, all assets are considered jointly owned by the couple. Assets are totaled and then split in half and a healthy spouse at home keeps his or her half and the Medicaid applicant must spend down his or her half until it is less than $2,000. This money need not be spent on care but can be spent on any legitimate purchase. Tax qualified savings accounts under the rules above are not considered assets.
If the total amount of assets are less than $20,328, the spouse at home keeps the entire amount and does not have to split in half. If the spouse at home gets more than $101,640 after the assets have been split in half, that spouse can only keep $101,640 and all the rest of the assets have to be spent down by the person applying for Medicaid. As an example, a couple owns $400,000 in resources. The spouse at home can only keep $$101,640 and the spouse applying for Medicaid has to spend $298,360 less $2,000 before that spouse can qualify for Medicaid.
Incomes are not considered jointly owned and do not have to be split in half. If John has $3,000 a month in income and Sarah has $800 a month, and John applies for Medicaid, then John's entire $3,000 will go towards his care and Sarah will presumably be left impoverished with only $800 a month. The reverse is also true if Sarah needs the care. John can keep his $3,000 and the state must make up the difference between Sarah's $800 and the cost of the nursing home.
If John is applying for Medicaid, and in order to avoid complete impoverishment of Sarah, (she only has $800 a month) the state will transfer enough of John's income to bring Sarah's income up to $1,650 a month.
This is called the community spouse monthly income impoverishment allowance. For people receiving community waiver care there are additional allowances. The asset and income allowances are adjusted each year for inflation.Gifting RulesNew rules adopted in 2006 require any gift or a transfer-for-less-than-value within 60 months of a Medicaid community waiver or nursing home application to be counted as a resource to the extent of the amount of transfer. A transfer within 60 months from application is considered a gift whether made outright or conveyed in a trust. It makes no difference. There is a new penalty associated with these transfers. Disregard what you have heard in the past about gifts and penalties.
Here's how the new version works. Suppose Mary replaces her name with her daughter's name on the title of Mary's residence with a net value of $280,000. Mary applies for Medicaid 59 months after the title transfer and one month shy of the look back limit. Because she is inside the look back period, the gift of the house becomes a transfer for less than value. Mary has less than $2,000 in resources and could qualify for Medicaid. Medicaid will not pay a dime for Mary's care until the equivalent spend down for her gift has been paid. In other words, the state considers the gift to be cash-in-hand that should have been spent before Mary qualified for Medicaid assistance. This spend down requirement now becomes a penalty after the fact.
The penalty is determined in months of care and is calculated by dividing the amount of the gift by the state Medicaid rate which in this example is $4,000 a month. Dividing the gift by the monthly rate yields 70 (almost 6 years) months of penalty. From the date that Mary would have been approved for Medicaid someone must pay for 70 months of her care before Medicaid will take over. Note in this case the penalty is longer than the look back period.With a large gift, penalty periods could last up to five to ten years or more. If Mary applied for Medicaid 60 months and one day after making the gift there would be no penalty.
Medicaid Recovery
Medicaid recovery rules were initiated by Congress in 1993. After the death of the Medicaid recipient, Medicaid has a claim against the home that was previously excluded for eligibility. The claim is in the amount that Medicaid paid for the recipient's care. In some states a lien against the property, called a TEFRA lien, can be filed in anticipation of Medicaid's cost. Not all states file a TEFRA lien but typically file a debtor lien after the death.
As a matter of policy, some states do not make a claim against the property if the surviving spouse is living in the House. The debt is forgiven. This is only current policy since rules allow the state to initiate recovery through a lien on the property. There are also rules allowing the family to request a hardship hearing if recovery puts a burden on the family and the state also has authority to waive recovery on homes worth less than a certain dollar amount.
Common rumor among professionals who do Medicaid planning is that Medicaid recovery in many states is more "bark than bite". Numerous articles and studies indicate that states do an extremely poor job of recovering money from assets that should be subject to recovery. There is a suspicion that some property transferring in trusts or through joint tenancy may be escaping from recovery services.Do not let these statements lull you into a false sense of security. Continuing Medicaid budget deficits and a change in state leadership could result in Medicaid becoming much more aggressive about recovering money it can legally go after. The first step would be changing state code allowing for TEFRA liens. The use of such liens would preclude any transfer of property prior to satisfaction of the lien.
Tuesday, February 10, 2009
Colorado Consumer Alert
On February 9, 2009, District Attorney Carol Chambers from Colorado's 18th Judicial District posted the following Consumer Alert:
HEARTLAND SECURITY BREACH
Heartland Payment Systems, a company that processes up to 100 million credit card, debit card and payroll transactions per month, reported on January 20th that their computer system had been hacked in 2008. To date the details of this security breach are largely unknown, but we do know that counterfeit credit cards that employ information stolen from Heartland are showing up across the country, from Illinois to California. At least one police agency in the Denver Metro area is investigating counterfeit credit cards that are tied to Heartland.
Since Heartland processes payments from most credit/debit cards, there is no way to identify holders of specific cards that should be warned. Therefore, the District Attorney is issuing the following recommendations to all credit and debit card users:
1. Check your credit card and bank statement for fraudulent charges the day you receive them.
2. Report any fraudulent or suspicious charges immediately. You have sixty (60) days from the date a fraudulent charge appears on your statement. After sixty (60) days you can be held responsible for any charges, including fraudulent ones.
3. File a report with your local law enforcement agency and request a copy of that report. You may need the report later to prove you are a victim of a crime.
Need help?
Call the Consumer Protection Line
720-874-8547
Heartland Payment Systems, a company that processes up to 100 million credit card, debit card and payroll transactions per month, reported on January 20th that their computer system had been hacked in 2008. To date the details of this security breach are largely unknown, but we do know that counterfeit credit cards that employ information stolen from Heartland are showing up across the country, from Illinois to California. At least one police agency in the Denver Metro area is investigating counterfeit credit cards that are tied to Heartland.
Since Heartland processes payments from most credit/debit cards, there is no way to identify holders of specific cards that should be warned. Therefore, the District Attorney is issuing the following recommendations to all credit and debit card users:
1. Check your credit card and bank statement for fraudulent charges the day you receive them.
2. Report any fraudulent or suspicious charges immediately. You have sixty (60) days from the date a fraudulent charge appears on your statement. After sixty (60) days you can be held responsible for any charges, including fraudulent ones.
3. File a report with your local law enforcement agency and request a copy of that report. You may need the report later to prove you are a victim of a crime.
Need help?
Call the Consumer Protection Line
720-874-8547
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