The Senior List Article Center

Have You Been Told Your Loved One Needs a Guardianship?

noreply@blogger.com (Senior Lister) — Wed, 13 May 2009 23:22:00 +0000

We often receive calls from potential clients who have been told that their loved one needs the assistance of a legal guardian. In the most common situation, the person has been living independently, but is showing signs of dementia, and has been doing things that put themselves or others at risk of harm. Examples include leaving the stove burners on, locking themselves out of their home, wandering out of their home and getting lost, and mixing-up their medications. Other times a senior will have a behavioral disturbance, such as striking out at care center staff and fellow residents, and a guardian is needed to consent to psychiatric medical treatment and consent to placement in a secure care facility.

A guardian is person who is appointed by a court to make health care and placement decisions for another person. We start the guardianship process by filing a court petition, explaining the circumstances to the court, and asking the court to appoint a legal guardian. We send out notices to interested persons, including close family members and people serving as trustee, power of attorney, and health care representative. A copy of the legal notice is personally delivered to the person in need of a guardianship (called a "respondent"). The respondent and interested parties have 15 days to object to the appointment of a legal guardian.

During the 15-day waiting period, a trained psychologist or nurse, known as the "court visitor," is appointed by the Judge to interview the respondent and all persons who are knowledgeable about the respondent's circumstances. The court visitor reports his or her findings to the Judge, including the visitor's opinion about whether a guardian should be appointed.

From our first contact, it normally takes 20 to 25 days to obtain a guardianship. Sometimes there is an emergency situation requiring immediate action. The most common example is a respondent with a behavioral disturbance requiring immediate psychiatric treatment. In these situations, we can request a temporary emergency guardianship, which we can normally obtain within 5 or 6 days.

Sometimes the decision to file for guardianship is easy- the respondent's behavior is creating an immediate and serious risk of harm. Other times it is more difficult. For example, we often meet with adult children of aging parents concerned about the parent's ability to live independently, but the parent has "not yet" done anything risky or suffered harm. Filing for guardianship can create real animosity between adult children and aging parents. It is not a decision to be taken lightly. Sometimes the best decision is not to file for guardianship. An experienced elder law attorney can be of tremendous help in weighing the pros and cons, and the timing, of a guardianship petition.

Geoff Bernhardt is an elder law attorney in Portland, Oregon. For more information on
his firm and on guardianships, please visit his website at www.elderlawpdx.com.

Oregon's State Budget is in Trouble: What Does It Mean for Seniors and Long-Term Care?

noreply@blogger.com (Senior Lister) — Sat, 24 Jan 2009 19:19:00 +0000

The economic news has been bleak. A year ago, who would have imagined the federal government taking over large banks and insurance companies? Seemingly every day we see news that things are getting tougher: rising unemployment, plummeting stock and bond markets, and retirement accounts cut in half.

Most recently, we see the economy affecting state budgets. A declining economy leads to reduced tax revenue for the state. Oregon is affected more than other states, since we are so dependent on the income tax. There will be less money available to help people with serious health problems. Make no mistake: state programs that serve seniors will suffer significant cuts. We saw this in the 2002-2003 recession, when 4,500 vulnerable seniors lost their Medicaid long-term care benefits.

What do these economic problems at the national and state level mean for the average senior? What can a retired person on a fixed income do to minimize the impact on him or herself and their families? The answer is that those who have planned in advance will be miles ahead. Recent law changes make it important to establish a long-term care plan well in advance of the need for care, while you are still healthy. Ideally, the plan should be created five years before long-term care may be needed.

If you are a married senior, have you considered what would happen if you or your spouse need long-term care? The average cost of long-term care in Oregon is almost $6,500 per month. Contrary to popular belief, Medicare does not pay for long-term nursing home care. Without proper planning, most of your assets would be spent on the care of the ill spouse. The healthy spouse could be left in poverty.

An unmarried senior must spend all of his or her assets, including the family home, down to $2,000, before qualifying for government assistance. The rules on these programs are complicated. Often, the ill senior will be left with only $30 per month from his or her Social Security to pay for personal needs. Without careful advance planning, this senior is literally out of money and out of options. In situations like these, we see children spending their own savings in support of their parents, leaving them unprepared for their own retirement. A cycle of poverty can be created.

None of these things needs to happen, but they do all the time when people fail to plan. An experienced elder law attorney can help create a plan for good quality long-term care and protection of a healthy spouse and disabled children. Don't wait until it's too late - plan today to protect yourself and your family.

Geoff Bernhardt is an elder law attorney in Portland, Oregon. For more information on his firm and on Medicaid planning, please see his website at www.elderlawpdx.com.

The Future of Elder Care: Part 1: Elder Cohousing

noreply@blogger.com (Senior Lister) — Tue, 18 Nov 2008 02:16:00 +0000

In my work with families who are placing a loved one in a care community, I am often asked about the future of long term care. Many people I talk with are uncomfortable with the concept of long term care for themselves but think it's adequate for their parents. I have good news and bad news: There is an alternative to long term care options known as Elder cohousing, but don't expect it to show up in your neighborhood anytime soon.

The cohousing model was adopted from Denmark and migrated to the US in 1988. Initially conceived as multi-generational cohousing, neighbors adopted rules and built structures that allowed them to live supportively with one another, sharing common facilities and incorporating non-hierarchical decision-making, two of the six main characteristics that all cohousing communities share. Now, a similar concept, Elder cohousing, is becoming more popular with the 50 and older crowd in the US. Elder cohousing is an environmentally sustainable alternative to the existing models of housing for boomers and elders alike who yearn for their independence within a supportive community environment.

There are three elder cohousing projects that have been completed in the US. The three lucky states are Virginia, California, and Colorado. To date, there are eight elder cohousing projects actively underway according to Eldercohousing.org. Some communities are spearheaded by a group of friends or neighbors; others are formed by a few members who then recruit other future "neighbors" for investment and participation.

Studies suggest that people remain healthier and may live more independently if they have strong community ties. Cohousing fits this prescription perfectly as each member of a cohousing project has duties and contributions they are expected to provide. In one cohousing community, members' professions included the following:
* Architect and Project Manager
* Technical illustrator/painter/sculptor
* Librarian
* Builder/Developer
* Teacher
* Retired English professor
* Financial planner
* Ombudsman
* Psychotherapist
* Retired businessman
* Social services for youth in prison.

If a member of an elder cohousing project needs care at some point in their journey, they continue to live at the site for as long as possible. Members are expected to help provide for one another; some will hire in-home care or employ caregivers for those who are in need. In the event that a member needs to live in a long term care community, members of the elder cooperative will continue to remain a part of the member's life. This allows members to age in place for as long as possible, decreasing the financial, psychosocial, and health burden of the individual.

If you would like to learn more about elder cohousing, or how to form your own cohousing project, visit www.eldercohousing.org.

Amie Clark, Founder, The Senior List
www.theseniorlist.com

Forget Me Not: November is National Alzheimer's Awareness Month

noreply@blogger.com (Senior Lister) — Wed, 12 Nov 2008 22:27:00 +0000

Dementia is a major issue for older people and their families. According to the Centers for Disease Control and Prevention, 47% of people age 85 and older have some kind of dementia. In my elder law practice, I find it helpful to have a working knowledge of the different types of dementia affecting our clients and their families. The major categories of dementia are as follows:

Mild Cognitive Impairment. This exists when a person has a complaint about memory loss that is corroborated by someone else. Neuropsychological testing will show that these patients have an objective memory impairment when compared to peers of similar age and educational background. At this stage, the person appears to have normal general cognitive function and can perform activities of daily living. Mild cognitive impairment is not in itself a diagnosis of dementia. However, many people diagnosed with mild cognitive impairment will progress to a diagnosis of Alzheimer's Disease.

Alzheimer's Disease. This may start with a loss of short-term memory. As it progresses, the patient will experience an impairment in executive function (the ability to make and carry out a plan) and judgment. He or she will have difficulty making appropriate choices. Social skills may be lost. Next, the patient may experience aphasia, or language impairment. Initially, this manifests as difficulty making word choices. As the illness progresses, the patient's verbal communication is very difficult to understand, and in late stages, the patient may not speak at all. Another symptom is called apraxia, which is motor memory impairment. This is where the person has difficulty with activities of daily living, such as bathing and dressing. The person may easily become disoriented as to time and place, and is at risk of getting lost. Finally, the person may experience symptoms of agnosia, which is the inability to recognize the purpose of an object. He or she may not know what to do with a toothbrush, or may take a cup of coffee and pour it on the floor. Approximately 10% of Alzheimer's Disease cases are so-called "early onset," with diagnosis prior to age 65. These cases tend to progress faster than "late onset" Alzheimer's Disease.

Vascular Dementia. This is a decline in cognitive ability that is usually the result of a stroke. It is the second leading cause of dementia. It occurs when brain tissue is damaged because of reduced flow of blood to the brain. The brain cells have difficulty working together to process information. Executive function is often affected, but memory impairment may be less severe than with Alzheimer's Disease.

Lewy Body Dementia. This is a progressive dementia characterized by a significant fluctuation in the person's cognitive impairment. There will be periods of acute confusion, and recurrent, detailed visual hallucinations. The person may show motor symptoms similar to Parkinson's Disease, such as changes in gait. He or she may shuffle or walk stiffly. There may be frequent falls. People with Lewy Body dementia are very sensitive to anti-psychotic medications, which can worsen cognition and motor control issues, and increase hallucinations. For this reason, it is very important that proper diagnosis is made and health care providers are educated about this form of dementia.

Frontal-Temporal Dementias. These are dementias of behavior rather than memory. The onset is more rapid than with Alzheimer's Disease. Symptoms include early and severe changes in personality, judgment, planning, and social function. Pick's Disease is an example of a frontal-temporal dementia.

One of the most important things a person with mild cognitive impairment or early
dementia/Alzheimer's can do is to develop a plan to insure good care and quality of life, and to make sure their legal affairs are in order. Alzheimer's Disease and Dementia Planning is one of our specialties. If you know someone affected by Alzheimer's Disease, please give him or her a copy of this article.

Geoff Bernhardt is an elder law attorney in Portland, Oregon. For more information on
his firm and on Medicaid planning, please see his website at www.elderlawpdx.com.

Understanding Compulsive Hoarding

noreply@blogger.com (Senior Lister) — Tue, 21 Oct 2008 21:46:00 +0000

We have all heard stories about compulsive hoarders. Maybe you have been to someone's house and had to navigate via "goat trails" in and out of the person's accumulated possessions. I have always thought of this as simply an eccentric behavior. But recently I read a story that caused me to think more deeply about this problem.

A man had been married to his wife for over 50 years. She was a compulsive hoarder. They had separate rooms in their home. His was meticulously clean; hers was absolutely jam-packed with junk. He took care of his wife when her health went into decline. As she was dying, her last words were not something like "I love you", instead, her last words were "please don't touch my stuff".

Hoarding is defined as the acquisition of, and inability to discard items, even though they appear to others to have no value. People with compulsive hoarding syndrome have immense difficultly throwing things away, even items of little or no value such as old newspapers, bits of string, worn-out clothes, and junk mail.

A person who is a compulsive hoarder has a variety of thoughts going through his or her mind. Items may be perceived to have sentimental value, and "If I throw it away, I am throwing away part of myself." Hoarders have a difficult time making decisions. They fear making the wrong decision, so they will save an item to avoid making a "bad choice" of getting rid of it. Hoarders may feel responsible for those around them, so they will save items "just in case I or my loved ones need them".

Hoarders also have control issues. They may feel that the moment they throw something away, they are no longer in control, and what happens to this item is in the hands of others. Hoarders are also afraid of forgetting what something looked like, or its content, and fear that "once the item is gone, it's gone forever." There is also a fear of "letting go." For example, a hoarder may fear that once she has thrown something away, that part of her life, no matter how insignificant, is gone forever.

Hoarding also creates safety issues. Excessive clutter causes fire and tripping/fall hazards. People have trapped themselves in homes and apartments, and floors have collapsed due to the weight of hoarded materials.

Hoarding also creates a stress for family members, who may feel embarrassed, frustrated, or resentful of the hoarding behavior. They are ashamed of the clutter, but are forced to live amidst chaos. Family members often resort to "self-help" methods by attempting to clean or organize without the consent of the hoarder, which leads to arguments and fights.

Compulsive hoarding is considered to be a form of obsessive-compulsive disorder (OCD). There are two forms of treatment: medications and behavioral techniques. People working with compulsive hoarders should encourage them to find a psychiatrist or therapist who is experienced in the treatment of OCD who can prescribe appropriate medications and help teach the person to gradually begin to discard items.

Geoff Bernhardt is an elder law attorney in Portland, Oregon. For more information on elder law issues, check out his website at www.elderlawpdx.com.

The How, When and What-If's of Talking to your Parents About Aging Issues

noreply@blogger.com (Senior Lister) — Wed, 08 Oct 2008 21:02:00 +0000

If you're reading this you've probably reached a point where your parents have gotten old. You see them struggling to do day-to-day things like cooking or cleaning. You start to wonder about talking with them because you worry about their health and wellbeing. Yet you also wonder what to say to them and whether they'll listen.

In the following pages, I've provided some tips and tools for talking with your aging parents about concerns you have for them. There's also information to help you determine if your parent's safety is at issue. In the event your mother or father doesn't want to talk about the safety issues you see, there are several ideas for ways to handle the situation. Finally, there is a list of the many care options available to your parents along with a brief description and the pros and cons of each option in my opinion.

HOW TO TALK WITH YOUR AGING PARENTS ABOUT CONCERNS YOU HAVE FOR THEM
Give some thought to the emotional response your concerns may bring up. Often, when
adult children with aging parents are scared or worried they begin to make demands. They tell their parents what to do.

I encourage you to step back from your emotions and identify your concerns. This increases the chance of a having a successful conversation with your parent(s). I suggest you write down what's going through your head when you think about the situation and what you think needs to be done. Then write these reasons down, starting with the word, "because."
My concern Because...
You can't live alone anymore.
I'm afraid you're going to start a fire because you can't see as well as you used once did.
I'd never forgive myself if you got hurt.
I worry that you'll fall and won't be found for days.
You can't drive anymore. I'm afraid you'll get in a wreck and be seriously hurt or die.
I'm worried you'll hurt yourself or someone else.

The "because" column is how you want to start the conversation with your parent(s). Notice the language in the first column compared to the second column. You vs. I. Generally the reaction to the word "you" is defensiveness. When that happens conversations turn into a battle of wills. So speaking from your own perspective, using "I," reduces defensiveness. It also comes from a place of caring and concern. Your parent is more likely to respond when they know you're concerned and care about them. Parents usually don't want their kids to suffer. Ask for their input. Do they worry about falling? Have they thought about getting into a car accident? Older adults are painfully aware of how aging is affecting their bodies though they may not talk about it. So chances are that they've given some thought to what might need to change.

Ask them how they'd solve the problem. Include your parents in the solution. Too often, as people age, they are ignored or overlooked. It's a societal problem. It's also extremely frustrating and if your parent(s) think they don't have a choice, or their opinions don't matter, they're more likely to dig in their heels. But, more importantly, it is their life you're talking about. They should have the power to choose their destiny and will be more likely to be happier with the decisions.
Be aware that your parent is afraid of losing their independence. Chances are, you're both on the same page where their independence is concerned. Discussing your concerns sooner rather than later decreases the chances they'll harm themselves or come to any harm. By recognizing that they may be afraid of losing their rights, their ability to choose and control over their own lives, you'll better understand why they may say or react they way they do. You'll be better able to talk with them and relate to what they're going through and more likely to be successful in talking with them.

WHAT IF I THINK MY PARENT IS UNSAFE AT HOME?
If you feel your parents may be putting themselves or someone else at risk it's important to address it as soon as possible. Most older adults have one primary fear: that their independence will be taken away. Contrary to how they often see it, reducing their chances of getting hurt is the best way to maintain their independence. An obvious safety concern is driving. If you suspect, or know, your parents are unsafe behind the wheel then it's probably necessary to intervene. You may have noticed how often there's news coverage of an older motorist hitting someone or something. Some of these accidents have injured, or even killed, the older adult or other people. Admittedly, this is a tricky area to discuss with your parents, which I'll explain later, so it's a common issue that children with aging parents avoid. Doing so, however, keeps your parent and others at risk. Another concern is safety in the home. Poor balance, strokes that affect your parents ability to get around, overmedication, and the need to go up and down stairs daily are some common things that increase a person's risk for falls. Poor eyesight or an inability to think clearly or react quickly [due to a stroke, reduced oxygen to the brain, overmedication, or the beginning stages of dementia] can create a situation where your mother or father aren't able to prevent a fire from starting if a hot pad falls onto a burner or a candle tips over, for example.

H*#@ NO, I WON'T GO
Even though you feel you feel your parents are unsafe, they may not agree. I suggest to clients that they give their parents several choices and a deadline for deciding. A script for this:
"I know you don't want to discuss leaving your home; however, the reality is you can't stay here unless you accept in-home help or, you have the option of moving to assisted living. You'll have to decide by [give them a specific deadline]. I know this isn't easy for you and I'm sorry about that."

Your parent may continue to object and you may need to continue repeating some version of what I've outlined above. Showing compassion yet being firm can move many parents who dig their heels in, but not all. Despite all your efforts your parent may continue to live in an unsafe environment until something serious happens that makes it impossible for them to return home. Depending on the issue that prevents them from moving home, they may have few options.
It's not unusual for assisted living facilities to have waiting lists. Depending on your parent's health situation he/she may have to skip assisted living entirely and go to a skilled nursing facility. The best you may be able to do is talk with facilities near you, or near your parent's home, and ask to be put on a waiting list. This gives you some control over circumstances if you have to make quick decisions about your parent's living situation later on. Facilities will check with you if your name is getting near the top of their move-in list as apartments become available. If circumstances haven't changed for you, most facilities will move your name to the
end of the list.

CARE OPTIONS
There are many types of care options and each has its pros and cons.

Living with Adult Children
This option is not for everyone. I ask clients who are considering this if they've sat down and discussed it with their parents. It's not uncommon for adult children to feel it's their duty to move their parents into their home and care for them. However, when they talk with their mother or father about this they're often surprised their parent doesn't want this. Likewise, some elderly parents expect their kids to make a place for them in their home when they can no longer care for themselves. This often isn't realistic. Adult children may literally not have space for their mother or father to move in; money to pay for things their parent needs as
they age [or to move to a bigger home]; be able to afford to work less hours or take time off to provide the help their parent needs or, may not have the fortitude to be with their parents that much. Unless adult children and their mother or father have established a relationship as adults that allows for each other's differences, throwing parents and children together after years of being apart can create a lot of stress for both parties. Even if the parent/child relationship is strong and both sides are respectful of each other's time, space and lifestyle, adding a parent to your household can be hard on significant others and grandchildren. This decision takes careful consideration for everyone involved, you, your parent, your kids, your significant other, your siblings, because it impacts all of them in some way.
Pros...

an opportunity to give back to your mother or father for all they've done for you

Cons...

if the above benefit sounds rosey it's because it usually is. Rarely does the dream match reality.
high stress simply because your parent's needs will increase the older they get.

In-Home Care
There are companies that provide caregivers that will come to your parent's home. Services vary but generally they provide light housekeeping, prepare meals, write letters, provide socialization (visit with your family member), transport to appointments, help bathing and dressing and medication reminders. These companies may, or may not, provide nursing services (described below).
Pros...

your parent can continue to live in their home
may be less expensive than assisted living
covered by long-term care insurance

Cons...

Depending on the cost your parent may still be home alone much of the time. Having a device like Lifeline is one solution. You might remember the ads on television, "Help, I've fallen and I can't get up." Your parent wears a device around his/her neck and if something happens and they need help they push this button. When your mom or dad activates the device, several things may happen: some devices allow your parent to talk to a person who assesses what's needed and/or talks to your parent until help arrives; other types of devices alert a dispatcher at the company who works from a list of contacts provided by the family, if they are unable to reach anyone or, after a certain period of time, 911 is called. The main challenge with these types of devices is getting your parent to wear it ALL the time.
Your mom or dad may be limited in where they can go, or when they can schedule appointments if they have to be within the hours the caregiver is present. This is one of the biggest obstacles older adults face if they stay in their home. It's one of the main reasons they continue to drive when they shouldn't. Imagine what it would be like to always have to rely on someone else to take you where you want to go. Most U.S. lack a good public transportation system so there are many places, besides rural areas, where public transportation is not available.
Parents can be uncomfortable having caregivers do things for them so they may use the time for visiting or encourage them to leave before they've completed their chores. Asking the staff of the home care company how they address these issues before you hire them is one way to deal with this problem. Continuing to ask the company for caregiver feedback is another. Asking your parent what things the caregiver is doing for them may also give you a feel for what's being done, or not being done.

In-Home Skilled Nursing
Companies that offer this service may provide many of the same services in-home care providers do but they also provide nursing services such as: giving medications, reporting conditions and changes to your parent's doctor, taking vitals, drawing blood, giving injections, setting up medications and physical and occupational therapy.
Pros & Cons are similar to those of in home care above.

Retirement Communities
Generally these are independent living communities of people 55 and older. The living quarters can be homes or apartments, depending on the community, and residents may have the option to buy or to rent. Retirement communities are much like independent living but some services may be provided and residents are usually 55 years of age and above.
Pros:

Less upkeep than a home- Generally the dues or rent include services for grounds keeping; house cleaning services may be offered; a dining room or other type of meal service may be available and other amenities may be offered.
Less likelihood your parents will be isolated. There are often activities, excursions, etc. offered in these communities and residents tend to reach out to one another.

Cons:

Potential for narrowed thinking- While your parent may not be isolated from others, residents are primarily spending time with their own age group. Their experiences outside of the community may also be limited. These factors create the potential for them to view the world more narrowly.

Assisted Living
These facilities have apartments with kitchenettes. Generally they provide three meals a day that are part of the monthly rent. Most only serve meals in the facility's dining room. There is a nurse on staff and nursing aides who administer medications (some facilities will let residents who are cognitively able manage their own medications). Most facilities offer outings throughout the month for residents. Housekeeping is provided.
Pros:

Your parent will be less isolated
They can get their care needs met less expensively than with in-home care

Cons:

Facilities can be fairly regimented- It's less expensive and more convenient for the facility to provide meals and some services to residents on a schedule. This can be fairly frustrating since this is another area older adults lose control over basic things: when to eat; bathe, etc.
Your parents daily needs may not be met quickly- A focus on turning a profit and a lack of employee commitment to the work (usually due to low wages) often means facilities are understaffed

Skilled nursing facility (a.k.a. nursing homes)
This is the type of facility that was available for your parents' parents. Most confuse assisted living with this type of facility. Nursing homes have become skilled nursing facilities (SNF pronounced like sniff) because medical insurers can save costs by moving patients here who need rehabilitation or a longer recovery period after their hospital procedure. It is not true, as your parents may believe, that you never get out of a SNF. It depends on why someone is there. Usually people stay long term if their needs are more than an assisted living facility can provide. (This would be similar to in-home skilled nursing services; the needs are greater than "basic" service: wheelchair bound; need helping getting in and out of bed, chairs, etc. can't walk without assistance, etc.) Some people on Medicaid may be in a SNF because they can't find an assisted living facility that will take Medicaid. Some people may not have enough money for assisted living but have too much for Medicaid. There may be a unique reason a person would stay in a nursing home long term besides those I've mentioned.
Pros:

Staff have the training to take care of extensive medical needs
It is less expensive than in-home care

Cons:

Facilities are often understaffed and employees are usually overworked
Privacy is often at a minimum
Your parent has little control over their environment

Continuing Care Retirement Communities (Three in One)
Some senior housing options have a retirement community, assisted living and skilled nursing (or only the last two) all in the same place.
Pros:

Your parent can get the level of care they need without having to leave familiar surroundings and friends

Cons

Any of the cons I've mentioned above

I hope this report helps you feel more confident in dealing with the issues that come up as your parent's age, in talking with them about your concerns and in helping them make the right decisions for their health and wellbeing.

Lynne Coon, MS
Counseling and Resources for Adults with Aging Parents
www.lynnecooncounseling.com

Understanding Life Sustaining Measures

noreply@blogger.com (Senior Lister) — Thu, 18 Sep 2008 00:18:00 +0000

You have decided to follow your doctor's advice and complete an Advance Directive for Health Care thus providing a clear understanding of your wishes as they relate to life sustaining measures. You understand the significance of having an Advance Directive, but as you research the process, you are confronted with a lack of understanding regarding what life sustaining measures encompass.

Life sustaining measures can be defined as, "Any medical treatment in which the primary goal is to prolong life rather than treat the underlying condition." In such cases an individual's own body is not capable of sustaining proper functioning on its own without medical intervention. Some examples of life sustaining measures are:

Artificial nutrition and hydration are utilized when an individual is not receiving the nutrients necessary for health and well being. Artificial nutrition (tube feeding) requires a tube be placed into the stomach or the upper intestine. Hydration (fluid replacement) involves tube placement intravenously (IV) via a needle.

Cardiopulmonary resuscitation (CPR) is used when an individual's heart beat and/or breathing has stopped. CPR includes treatments such as mouth-to-mouth resuscitation, chest compressions, electric shock and/or drugs to restart the heart. CPR can be life saving, however, there is a risk of broken or cracked ribs, punctured lungs and death.

Mechanical ventilation supports a person's breathing when they can no longer breath on their own. In this situation a machine called a ventilator forces air into the lungs via tubing in the mouth or nose.

Dialysis is the artificial process by which waste products and excess water are removed from the blood. It is used when the kidneys are no longer able to do this adequately.

These examples of life sustaining treatments are just a few of the more common measures taken to continue life when one or more body systems are not working properly. Deciding what, if any, treatments are right for you should depend on several factors:

Does the treatment relieve suffering, restore functioning, or enhance the quality of life? If so, these would be some of the benefits of treatment. Conversely, a treatment may be considered problematic if it is painful, prolongs the dying process or negatively effects the quality of life. Other questions to ask yourself might be: What are my values as they relate to life prolonging measures? Who will carry out my wishes should I become incapacitated? If I start treatment and it does not improve my status will I want to continue that treatment? If so, when? (It should be noted that it is ethically and legally acceptable to discontinue a treatment that is no longer of benefit. It is the disease not the withdrawal of treatment that causes death.)

How you choose to complete your Advance Directive and what measures you choose to take are up to you. Talk to your doctor and don't be afraid to ask questions if you find the terminology confusing or you simply don't understand. Ultimately understanding your Advance Directive and the medical terminology associated with it will enable you to communicate your wishes to those providing your health care and increase the likelihood that your wishes will be honored.

Finally, understand that completing an Advance Directive for Health Care is a gift to your loved ones. Instead of guessing about what your wishes might be, they have a clear, written, and legally binding expression of your wishes, enabling them to serve as your advocate.

Geoff Bernhardt is an elder law attorney in Portland, Oregon. For more information on his firm and on Medicaid planning, please see his website at www.elderlawpdx.com.

It's the Fourth of July - Salute our Veterans with Quality Care!

noreply@blogger.com (Senior Lister) — Fri, 04 Jul 2008 21:39:00 +0000

When families come to see me regarding the long-term care needs of a loved one, we always identify two goals. The first, and most important goal is good quality care. The second is to obtain that care in a manner that does not completely impoverish the older person and his or her spouse. In developing a plan to pay for good care, we have to identify all sources of funds to help pay for that care. The most overlooked source of help with long-term care costs is a Veteran's Administration (VA) benefit that pays monthly income to veterans and their spouses, and to the surviving spouses of deceased veterans. This benefit is commonly known as "Aid and Attendance Benefits."

In 2008, an unmarried veteran can receive a cash payment of as much as $1,554 per month. A widow or widower of a deceased veteran can receive up to $998 per month. Married veterans can receive up to $1,842 per month. While this is not enough to pay for 24-hour care, it can be of great help for the senior who is still living at home or in community-based care, and needs to bring in some extra help to remain independent.

Like Medicaid, the VA Aid and Attendance benefit is a means-tested program. Generally speaking, assets have to be reduced to approximately $80,000, plus the home and one car, in order to qualify. The applicant must have limited income, however, high medical and care costs can be used to offset the applicant's income.

In addition, the Aid and Attendance benefit is limited to wartime veterans and their spouses. The veteran does not have to have a service connected injury or have served in combat; military service during wartime for even one day is sufficient. The veteran or his or her spouse must need assistance with activities of daily living. Even if the veteran has assets exceeding $80,000, it is possible to plan to obtain Veteran's Aid and Attendance benefits.

Unlike Medicaid, there is no five-year "penalty period" if the applicant has transferred assets out of his or her name. The eligibility rules regarding planning are not as restrictive as the Medicaid eligibility rules. By doing planning to obtain Veteran's Benefits, it is sometimes possible to pay for care while staying out of the Medicaid system. Still, Veteran's Benefit planning should always be done by an experienced elder law attorney who understands the Medicaid rules, just in case the veteran may someday need to qualify for Medicaid assistance.

Do you know a military veteran who served our country during wartime, and who could use some extra money to pay for care costs? If so, please give him or her a copy of this article. Planning for Veteran's Benefits is an excellent way to provide extra income to help the veteran and his or her spouse receive the care they need, while staying independent as long as possible.

Geoff Bernhardt is an elder law attorney in Portland, Oregon. For more information on
his firm and on Elder Law planning, please see his website at www.elderlawpdx.com.

Dad's Odd Behaviors Don't Mean He Has Alzheimer's-He's Just Getting Older, Right?

noreply@blogger.com (Senior Lister) — Tue, 24 Jun 2008 14:31:00 +0000

By Jacqueline Marcell, Author, "Elder Rage"

For eleven years I pleaded with my elderly father to allow a caregiver to help him with my ailing mother, but after 55 years of loving each other--he adamantly insisted on taking care of her himself. Every caregiver I hired to help him sighed in exasperation, "Jacqueline, I just can't work with your father--his temper is impossible to handle. I don't think you'll be able to get him to accept help until he's on his knees himself."

My father had always been 90% great, but boy-oh-boy that temper was a doozy. He'd never turned it on me before, but then again--I'd never gone against his wishes either. When my mother nearly died from an infection caused by his inability to continue to care for her, I immediately flew from Southern California to San Francisco to save her life--having no idea that in the process it would nearly cost me my own.

EARLY SIGNS OF DEMENTIA?
I spent three months nursing my 82-pound mother back to relative health, while my father said he loved me one minute but then get furious over some trivial little thing and call me horrible names and throw me out of the house the next. I was stunned to see him get so upset, even running the washing machine could cause a tizzy, and there was no way to reason with him. It was so heart wrenching to have my once-adoring father turn against me.

I immediately had the doctor evaluate my father, only to be flabbergasted that he could act completely normal when he needed to! I could not believe it when the doctor looked at me as if I was crazy. She didn't even take me seriously when I reported that my father had left the gas stove on without it lighting, or that he had nearly electrocuted my mother. Luckily, I walked into the bathroom just three seconds before he plugged in a huge power strip, which was in a tub of water--along with my mother's soaking feet!

Much later, I was furious to find out that my father had instructed his doctor (and everyone he came into contact with) not to listen to anything I said because I was "just a (bleep bleep) liar"--and all I wanted was his money! (Boy, I wish he had some.)

Then things got serious. My father had never laid a hand on me my whole life, but one day he nearly choked me to death for adding HBO to his television--even though he had eagerly consented to it just a few days before. Terrified and shaking, I dialed 911 for the first time in my life. The police came and took him to a psychiatric hospital for evaluation, but I just could not believe it when they released him saying they couldn't find anything wrong with him. What is even more astonishing is that similar horrifying incidents occurred three more times.

CAREGIVER CATCH 22
I was trapped. I couldn't fly home and leave my mother alone with my father--because she'd surely die from his inability to care for her. I couldn't get healthcare professionals to believe me--because my father was always so darling and sane in front of them. I couldn't get medication to calm him, and even when I finally did--he refused to take it, threw it in my face, or flushed it down the toilet. I couldn't get him to accept a caregiver in their home, and even when I did--no one would put up with him for very long. I couldn't place my mother in a nursing home--he'd just take her out. I couldn't put him in a home--he didn't qualify. They both refused any mention of Assisted Living--and legally I couldn't force them. I became a prisoner in my parents' home for nearly a year trying to solve crisis after crisis, crying rivers daily, and infuriated with an unsympathetic medical system that wasn't helping me appropriately.

GERIATRIC DEMENTIA SPECIALIST MAKES RIGHT DIAGNOSIS
You don't need a doctorate degree to know something is wrong, but you do need the right doctor who can diagnose and treat properly. Finally, I stumbled upon a compassionate neurologist specialized in dementia, who performed a battery of blood, neurological and memory tests, along with CT and P.E.T. scans. He reviewed all of my parents' many medications and also ruled out all the many reversible dementias. And then, you should have seen my face drop when he diagnosed Stage One Alzheimer's in both of my parents--something that all of their other doctors had missed entirely.

TRAPPED IN OLD HABITS
What I'd been coping with was the beginning of Alzheimer's, which starts intermittently and appears to come and go. I didn't understand that my father was addicted and trapped in his own bad behavior of a lifetime and that his habit of yelling and pounding the table to get his way was now coming out over things that were illogical and irrational... at times. I also didn't understand that demented does not mean dumb (a concept that is not widely appreciated) and that he was still socially adjusted never to show his "Hyde" side to anyone outside the family. Even with the onset of dementia, it was amazing he could be so manipulative and crafty. On the other hand, my mother was as sweet and lovely as she'd always been.

BALANCING BRAIN CHEMISTRY
I learned that Alzheimer's is just one type of dementia (making up 65% of all dementias) and there's no stopping the progression nor is there yet a cure. However, if identified early there are medications that in most people can mask/slow the progression of the disease, keeping a person in the early independent stage longer--delaying full-time supervision and nursing home care. (Ask a Dementia Specialist about the FDA approved medications: Aricept, Exelon, Razadyne and Namenda.)

After the neurologist treated the dementia and then the depression (often-present in dementia patients) in both of my parents, he prescribed a small dose of anti-aggression medication for my father, which helped smooth out his volatile temper without making him sleep all day. (Boy I wish we'd had that fifty years ago!) It wasn't easy to get the dosages right and not perfect, but at least we didn't have to have police intervention anymore! And once my parents' brain chemistries were better balanced, I was able to optimize nutrition, fluid intake, and all their medications with much less resistance.

CREATIVE BEHAVIORAL TECHNIQUES
As soon as the medications started working, I was finally able to implement some creative behavioral techniques to cope with all the bizarre behaviors. Instead of logic and reason--I learned to use distraction, redirection and reminiscence. Instead of arguing the facts--I simply agreed, validated their frustrated feelings, and lived in their reality of the moment. I finally learned to just "go with the flow". And, if none of that worked, a bribe of vanilla ice cream worked the best to get my obstinate father into the shower, even as he swore a blue streak at me that he'd just taken one yesterday (over a week ago)!

Then finally, I was able to get my father to accept a caregiver in their home (he'd only alienated 40 that year-most only there for about ten minutes), and with the tremendous help of Adult Day Health Care five days a week for them, and a weekly support group for me, everything started to fall into place. It was so wonderful to hear my father say once again, "We love you so much, sweetheart."

ALZHEIMER'S / DEMENTIA OFTEN OVERLOOKED
What is so shocking is that no one ever discussed the possibility of Alzheimer's with me that first year. I was told their "senior moments" and intermittently odd behaviors were just old age, senility, stress, and a "normal part of aging". Since one out of every eight persons by the age of 65, and nearly half by the age of 85, get Alzheimer's Disease--I should have been alerted to the possibility. Had I simply been shown the "Ten Warning Signs of Alzheimer's", I would have realized a year sooner what was happening and known how to get my parents the help they so desperately needed.

If any of this rings true for you or someone you love, I urge you to seek early evaluation from a Dementia Specialist-immediately!

TEN WARNING SIGNS OF ALZHEIMER'S
(Reprinted with permission of the Alzheimer's Association)

1. Memory loss
2. Difficulty performing familiar tasks
3. Problems with language
4. Disorientation of time and place
5. Poor or decreased judgment
6. Problems with abstract thinking
7. Misplacing things
8. Changes in mood or behavior
9. Changes in personality
10. Loss of initiative

Expanded Descriptions: http://www.elderrage.com/alzheimers.asp

Jacqueline Marcell is a former television executive whose caregiving experience resulted in her first (bestselling) book "Elder Rage", a Book-of-the-Month Club selection being considered for a film. Over fifty endorsements include: Hugh Downs, Regis Philbin, John Hopkins Memory Clinic, and the National Adult Day Services Association who bestowed on her their Media Award. She also hosts the "Coping With Caregiving" radio program www.wsRadio.com/CopingWithCaregiving. Jacqueline is also an International speaker who has delivered over 150 keynotes, including to the Florida House of Representatives. She also writes a Q&A column for AgingCare.com, and Blogs for HealthCentral.com and ThirdAge.com. Jacqueline is also a breast cancer survivor who advocates that everyone (especially caregivers), closely monitor their own health.

Power of Attorney for Finances: An Essential Tool for Elder Care Planning

noreply@blogger.com (Senior Lister) — Thu, 12 Jun 2008 18:59:00 +0000

Most people understand the need to have a will, so that when they pass away, assets will go to their chosen beneficiaries. Most people do not realize that they also need to appoint a power of attorney to make financial decisions and manage assets for them, if they become incapacitated.

If you think about it, most any financial decision we make requires a signature. Selling a house, writing a check, entering into agreements, etc., all require that we be able to sign documents. A signature itself is not even enough; the law imposes a requirement that the person signing the document have sufficient mental capacity to understand what they are signing.

As we age, there is a greater possibility that a time will come when we are not able to sign important legal documents. Or, even if we can sign our name, we may not understand what we are signing. At that point, assets are frozen unless someone has been given the legal authority to make financial decisions for you. The best way to do this is through a power of attorney for finances.

A power of attorney for finances is a document you can sign to appoint another person to make important financial decisions for you in the event you become incapacitated. The person you appoint is called your "agent". It is a good idea to name one or more alternate agents, in the event your first choice is unable or unwilling to serve in that role.

As an Elder Law attorney, one of the most common phone calls we receive is "I need to get power of attorney for my Mom." My answer is always, "that's great, we'd love to help your Mom. Let's schedule a time for her to come in and discuss it." "Well, that's a problem," replies the caller "because Mom has Alzheimer's Disease, and she won't understand what you are talking about."

In this situation, it may be too late to get a power of attorney. A power of attorney must be signed by a person who is legally competent. This means the signer must have the ability to understand the nature and importance of the document. If someone already has Alzheimer's Disease, or dementia, or has suffered a stroke, it may be too late to sign a power of attorney. Therefore, it is important to sign a power of attorney while a person has mental capacity to understand the document.

When deciding who should be your agent, remember that the most important qualities are honesty and good financial management skills. The main disadvantage to having a power of attorney is, a dishonest agent could use the power of attorney to misappropriate your assets. Therefore, only appoint the most trustworthy people to serve in this role. There are also professional trust companies that may agree to serve as your agent.

A power of attorney should always be prepared by an experienced elder law attorney. It is possible to obtain a generic power of attorney from a legal stationery store. However, this form will not give the agent the ability to make many types of important decisions for a disabled person. An experienced elder law attorney can provide a power of attorney that will give your agent flexibility to make important financial decisions if you are not able to make them yourself, such as disability planning, creating trusts, long-term care cost planning and tax planning.

Geoff Bernhardt is an elder law attorney in Portland, Oregon. For more information on his firm and on Medicaid planning, please see his website at www.elderlawpdx.com.

How an Elder Law Attorney can Help with Long-Term Care Planning

noreply@blogger.com (Senior Lister) — Wed, 11 Jun 2008 23:13:00 +0000

Elder Law attorneys help older people and their families with all of the legal consequences of aging. These consequences tend to fall into three categories: surrogate decision making for finances and health care; estate planning; and long-term care cost planning. We use powers of attorney for finances and advance directives for health care, wills and trusts, and a variety of strategies to help people get and pay for good care. When an older person lacks the ability to pay for care over their life expectancy using private savings or long-term care insurance, an elder law attorney will advise him or her on qualifying for long-term care assistance through the Medicaid program.

It is appropriate to refer an older person and his or her family to an elder law attorney for possible Medicaid planning in most cases where there is a need for long-term care. The elder law attorney will meet with the elder and his or her supportive family members. We will look at the income and resources available to the elder, and try to assess the level of care needed. We will also consider the needs of other family members, such as a healthy spouse or a disabled child, who may be dependent on the same income and resources for support. We can then advise the elder and his or her family whether the private resources are sufficient to pay for the care of the elder and to support the healthy spouse and any disabled children. If there is any chance the private resources will be insufficient for these purposes, the elder law attorney will suggest Medicaid planning.

Medicaid planning involves the restructuring of an elder's finances in order to qualify for Medicaid long-term care assistance without losing everything. Medicaid is a means-tested program, and the elder's assets often have to be spent down to very low levels before he or she will qualify. In the case of an unmarried person, his or her assets have to be spent down to $2,000. If the ill person is married, the healthy spouse can keep a portion of the assets, however, this portion is usually insufficient to pay for the spouse's care for his or her life expectancy. Through the process of Medicaid planning, an elder law attorney can get a much better result for the ill person, a healthy spouse, and any disabled children.

The bottom line for this type of planning is good care and personal dignity for the elder. In our system of health care, money is often necessary to insure a good quality of life for the elder. Protected funds can be used to support a healthy spouse in the community, pay for a geriatric care manager for the ill spouse, and provide for special needs items for a disabled child. An elder law attorney is an important part of the long-term care team and can make a tremendous, positive difference in the dignity and quality of life for elders facing serious health issues.

Geoff Bernhardt is an elder law attorney in Portland, Oregon. For more information on his firm and on Medicaid planning, please see his website at www.elderlawpdx.com.

Assisted Living- The Good, Bad and the Ugly

noreply@blogger.com (Senior Lister) — Wed, 04 Jun 2008 22:15:00 +0000

There are almost 35,000 Assisted Living Facilities licensed and operating in the US today. These communities range widely in size, price and amenities and are all fiercely competing for your businesses. The real trick is finding the one the suites your needs, life-style, and pocketbook.

What is Assisted Living?

The typical Assisted Living model is based on apartment style living with care services built in. This model encourages independence and autonomy while providing supervision and daily assistance with care needs. Meals are typically served in a main dining area with the intent of a social gathering while enjoying meals selected by the residents. Activities will be offered, including outings, scenic bus rides, and trips to the grocery store, bank, and doctors visits on designated days of the week.

What type of care is provided in Assisted Living?

Assisted Living provides custodial care, not medical care.

Bathing, Dressing, Toileting, Grooming, Mobility, Medication Management
Cooking, Housekeeping, Transportation, Laundry

What can I expect to pay for Assisted Living?

Most Assisted Living facilities structure their costs on an "ala carte" system. You will be quoted a "base cost" or "room and board cost" ranging from $1500-$3000 per month, depending on geography, size of apartment, and amenities offered. Expect to see additional costs added on right away. Based on an assessment of your care needs, the price will increase accordingly. This price can vary from month-to-month, especially if care needs drastically improve or decline over time.

What are the advantages to Assisted Living?

Less expensive than nursing home care
Private apartments to optimize privacy, autonomy, and independence
Three meals a day served in a social dining atmosphere
Security and call bell systems
Designed with accessibility in mind (roll-in showers, etc)
Exercise programs
Care Services available- to be used as little or as much as you require
Activity programs designed to keep residents active, social, and healthy
Most have a beauty parlor on site

What are the limitations of Assisted Living?

Despite staff presence and encouragement, some residents can become isolated
Most do not allow residents to cook, for safety reasons
Assisted Living can not accommodate residents who are wandering or exit seeking
Minimal staffing requirements in most states. On average, expect to see 1 caregiver for every 30 residents during peak hours, and much less at night
While facilities tout their abilities to care for residents through the end of life, many will ask families to hire private caregivers or transfer to a higher level of care if the residents needs are beyond the scope of their staffing levels

What do I look for in an Assisted Living community?

Ask to see the latest survey
Invite yourself to lunch (most will happily invite you first). Do you have menu options? Can family or friends join you for a meal? What is the cost for guest meals?
Do the other residents interact well with each other? Are the staff friendly and kind? Do they know the residents by name?
What is the caregiver-to-resident staffing ratio for each shift?
Is a nurse available? What hours is the nurse in the building?
Does the facility have a comfortable atmosphere? Is it clean? Are there any noticeable odors? What safety features are available?
Is transportation available? Is there an additional cost?
How often is the care plan reviewed? Is the resident or responsible party involved in the review? (they should be)
What is the turn-over rate for staff? *Note* Most facilities have a high turn-over rate. It's a huge problem. What is the facility doing to keep current staff and attract new quality caregivers?
If you have a pet, ask about any fees you will be expected to pay for your pet. Typically, an additional move-in fee and cleaning deposit will be incurred.
What cost of living increases can be expected? (we have noticed 3-6% yearly for most communities)
If the community can no longer meet your needs, how much notice will you receive and what assistance will be available to relocate to another level of care?
Trust your instincts!!!

Who pays for Assisted Living?

Private Pay (you)
Long Term Care Insurance- Check your policy for coverage, waiting periods, etc...
Medicaid- If you already qualify for Medicaid, or will qualify in the near future, make sure the facility you are considering has a Medicaid contract- many do not. You can check with the facility or your local Agency on Aging office for a list of contracted facilities in your area. If a facility does have a contract, chances are they are trying to balance Medicaid v.s. private pay in the building. Some will have a waiting list for Medicaid, so plan ahead. Do not wait until a crisis to start your search!!!
MEDICARE DOES NOT PAY FOR ASSISTED LIVING

If you are just starting your search for an Assisted Living Community, you may consider working with a geriatric care manager or placement and referral agency to guide you. These professionals will know the communities in your area and save you valuable time and energy.

Amie Clark, Founder of The Senior List
www.TheSeniorList.com

What is a Retirement Community?

noreply@blogger.com (Senior Lister) — Fri, 23 May 2008 13:42:00 +0000

Retirement Communities/ Independent Living Facilities are most appropriate for seniors who can manage their health care needs on their own or with assistance from family in an apartment type setting. Independent Living does not offer health care services or assistance, but may offer a monthly meal plan, housekeeping, social activities, and transportation. Some communities will partner with an In-Home Care agency to provide some services to residents. Services may include Medication Management, Bathing and Grooming Assistance, or Incontinence care. If additional care services are being provided, at some point the cost of the apartment and care will equate that of an Assisted Living Community. Some Independent Facilities are located on a campus where other levels of care are offered should one need them in the future.

Independent Living costs range from $1000-$2500 per month, depending on apartment size, amenities, and meal plan. Some Independent Facilities will provide one to two meals per day and may offer a meal plan if a resident prefers to cook occasionally.

Only private pay is accepted at Independent Facilities. Medicaid does not cover housing costs for Independent living. Long Term Care Insurance typically does not cover Independent Living, but may cover the cost of outside in-home care services.

What are the advantages of a Retirement Community?

Nutritious Meals, Activities, and Housekeeping offered
Maintain Independence in a social setting
No upkeep or utilities to manage (except personal phone and cable)

What should I look for when searching for a Retirement Community?

I personally prefer retirement communities to be adjacent to another level of care, most commonly, an assisted living or residential care facility. If a move occurs in the future, it is much easier to move across the courtyard instead of the other side of town.
What amenities are offered? Are the activities varied? Is an exercise program offered?
If your loved one is driving, is there reserved and covered parking available for residents?
Are pets allowed? Is smoking allowed on campus?
How involved is the management staff in the lives of the residents? Will they notify you if they see changes in your loved one?
How often are meals served? Is there a flexible meal plan option? Is the cost of meals included in the overall price?
How is the food? Invite yourself for lunch (most will offer)- observe staff interacting with the residents. Is there a social atmosphere in the dining room or are residents keeping to themselves. Do residents seem happy? Do the staff know the residents by name? The dining room is a great indication of the "mood" of the building.
How does the physical building look? Is it well kept? Are repairs needed? Ask about the maintenance response time. How available are they for minor repairs for the resident's apartments (light bulbs, hanging pictures, etc...)?

When is it time to transition to higher level of care?
First, I would suggest that if a resident requires care to begin with, a retirement community will only be a temporary solution. If a resident has lived in a retirement community and is requiring more supervision, can't safely manage daily activities, and requires frequent checks from staff, a higher level of care is needed.

Amie Clark, Founder of The Senior List
www.TheSeniorList.com

What is In Home Care?

noreply@blogger.com (Senior Lister) — Fri, 16 May 2008 19:02:00 +0000

In Home Care is designed to support those who do not desire or need to leave their homes, but do require assistance with one or more of their daily activities. Care in the home can take on a variety of shapes and sizes and can incorporate family, friends, and professional assistance. I think most people, given a choice, would prefer to receive assistance from someone they know, family or friends. There are certainly situations, however, that family or friends providing care is not appropriate, or does not appeal to everyone, including the family and friends. If professional support needs to be hired, here are a few considerations and questions to ask the agencies you are interviewing.

Most In-Home Care agencies have hourly minimums, usually 2-4 hrs. If a shift does not meet these minimums, the client may still have to pay for the full shift.
Make sure the agency you are considering is licensed, and caregivers are bonded and insured.
What kind of training and orientation do the staff participate in?
Is there a nurse to oversee the caregivers and provide training?
What is the process if a caregiver is sick or does not show up for a shift?
What are the fees? Do you pay less for longer shifts? Does the agency bill monthly or weekly? Do they provide transportation to doctor appointments, grocery store, etc...?
Does the agency have access to other resources in the community should you need them?
Check inspection results at medicare.gov.
Ask to see references and testimonials. You can review online ratings from other consumers.

What is the advantage of hiring my own private caregiver?

generally less expensive than working with an agency
caregiver is your employee, they work for you.
may be able to exchange care services for room and board, this works well for students

What is the advantage of hiring an agency?

agency pays taxes, insurance, etc... No liability on your part, less risk
shift will always be covered
agencies are regulated and must pass inspections to operate

What type of Assistance can a caregiver provide?

Bathing/ Grooming
Light Cleaning
Shopping
Laundry
Meal Preparation
Toileting
Dressing
Mobility
Night care

How Much Does In-Home Care Cost?
I have seen quite a range for costs, anywhere from $12-$22 per hour, depending on geography and duties of the caregiver. If the caregiver is a CNA, the cost will typically increase due to training that the individual has received.

Who Pays for In-Home Care?

Private Pay (you)
Long Term Care Insurance- check your policy for restrictions and make sure agency is able to accept payment from Insurance provider
Some Health Insurances- check your policy
Medicaid- offers limited in-home care programs for those who qualify

Amie Clark, Founder of The Senior List
www.TheSeniorList.com

Long Term Care Options for Older Adults

noreply@blogger.com (Senior Lister) — Wed, 14 May 2008 23:29:00 +0000

The most frequently asked question people ask me is "What are my options and who pays for them?". I will address each option it's own blog to adequately cover them. The options I have listed below are specific to my geographic area and may not be available in all states. Check with your local Office on Aging for types of care in your state.

Long Term Care Options-

In Home Care
Retirement/ Independent Living
Assisted Living
Residential Care
Adult Care Homes/ Adult Foster Care
Alzheimer's/ Dementia Care
Skilled Nursing Facilities
Intermediate Care Facilities

Amie Clark, Founder of The Senior List
www.TheSeniorList.com

Surviving a Parent's Trip to the Hospital and Beyond: What to know before you go.

noreply@blogger.com (Senior Lister) — Mon, 12 May 2008 18:47:00 +0000

You find your mom on the floor in her bathroom at home. She complains of hip pain and has been there for a few hours. You make the call and a few hours later she has been admitted to the hospital with a hip fracture. Now what?

Insurance: If your loved one has Medicare or a HMO that manages Medicare benefits, the hospital stay is mostly covered. Medicare recipients will pay a $992 deductible for 2007 for hospital stays of 1-60 days. If a HMO is involved, check with the benefits administrator for specific deductibles or co-pays.

Legal Documents: If you haven't done it already, now would be a great time to have legal documents prepared for health care decisions. The most widely used form is called the Advance Directive for Health Care. This form allows your loved one to appoint someone to make decisions about health care if they are unable to do so, as well, this form also addresses end-of-life decision making. While you are helping your loved one with this document, fill one out for yourself!

Your mom has been in the hospital for two days now, and the discharge planner is telling you that she needs to leave the hospital in two days! To top if off, you have been presented with a list of in-patient rehab centers for discharge and you are expected to pick one!

Skilled Nursing Facilities (SNF): Medicare and HMO's will cover rehab centers- with a catch. Medicare recipients must have a three night hospital stay and receive a doctor's order to receive 'skilled' care in order to qualify for admission to rehab. The doctor will make a decision based on several aspects of a patient's rehab potential. HMO benefits vary greatly, check with the benefits administrator for specific requirements. .

Medicare has a great website for users to compare rehab centers based on their yearly state inspection results and other quality indicators, www.medicare.gov/NHcompare. You will also find helpful checklists to assist in your search. Select a few; go for a tour. Talk to health care professionals who can share their experiences with these facilities.

The 100-day myth: Many families leave the hospital believing their loved one will be able to stay in the rehab center for a full 100 days. It is a rare case that a resident uses their full 100 days of Medicare during a rehab stay. Medicare does not cover long term care, it is simply an insurance benefit. Medicare will cover a rehab center as long as your loved one continues to benefit from the skilled services they are receiving. Medicare does not have representatives that make this decision, instead, the decision to continue with rehab from one day to the next, is decided by the interdisciplinary team at the rehab center working with your loved one. In the case of HMO recipients, the HMO does employ case managers who keep in close contact with the rehab centers and decide when a resident is no longer eligible for skilled benefits. In either case, once it has been determined that your loved one no longer qualifies for skilled benefits, you will be presented with a Notice of Medicare Provider Non-Coverage aka, a denial letter. By law, Medicare beneficiaries must have 72 hours notice of non coverage; HMO's vary between 48-72 hours depending on the HMO.

Appeals: Once your loved one has been presented with a denial letter, several options are available. If you do not agree with the non-coverage decision, you can appeal it. You will find appeal information within the Non-Coverage letter, specific to the Medicare insurance provider. If you do agree with the non-coverage decision, it is time to make decisions about the next move for your loved one. Hopefully, you and your loved one have been discussing the plans to return home after the rehab stay. The rehab social worker can help you arrange for equipment and services to ease the transition of returning home. If returning home is not an option for your loved one, you now face a myriad of options for community based care.

Amie Clark, Founder of The Senior List
www.TheSeniorList.com