Check out my interview on Maximizing Social Security Benefits with Marie Theilade and Brian Purcell from Merrill Lynch Wealth Management. They joined us on “The Aging Boomers” to help our listeners better understand how to maximize social security benefits. They specialize in lifestyle transitions including retirement, layoffs, divorce and inheritance, with a focus on retirement income planning and maximizing social security benefits.
There have been several studies that have shown a link between adults with depression that lead to dementia. A just released large body of research has linked late-life depression to social isolation, poorer health and an increased risk of death. This new study finds that depression is associated with subsequent vascular dementia and Alzheimer’s disease, conditions poised to expand dramatically with the aging population. Read the full article on this study.
Some months ago on the “The Aging Boomers” radio show, I interviewed various members of the Fall Prevention Team at the Area Agency on Aging to discuss their “Matter of Balance” program to assist seniors for their everyday needs to help prevent falls. Last week, I also had the opportunity to interview Marc Mendelsohn, President of Safe Aging Solutions, which specializes in healthy & affordable solutions for safe and independent living.
According to AARP nearly 90% of seniors want to stay in their homes as they age which is no surprise, but the most substantial risk and threat to living independently at home are falls. Falls are the leading cause of injury-related visits to the emergency room in the U.S. and represent the cause of 75% of the accidental deaths in people over 65. Falls also resulted in 85% of the non fatal hospital injuries for people 65 and over.
Fortunately, a lot can be done to make homes safer for seniors in preventing falls. I personally visited Safe Aging Solutions showroom in Sonoma, and it was quite clear that there is now a large choice of product and equipment to choose from at home to decrease the chance of falls. Much of what is available is now also attractive and appropriate for use in a personal residence rather than typical of something utilized in an institutional setting.
Beginning on the outside of the home safe entry into and out of the home is tantamount. If stairs are present and the senior is able to negotiate them without issue, hand rails can be installed to match the homes décor that offer added stability. All surfaces need to be non-slip and if not should be changed to surfaces that are. This can be achieved by applying a non-slip surface over the existing medium. When stairs are a challenge, stair chair lifts, platforms lifts and elevators are all options limited only by individual budget. Basic ramping installed with a non slip surface offers another option. Automatic door openers are a wonderful option for both interior and exterior doors.
When a pool is present in the home an ADA (Americans with Disabilities Act) pool lift can make all the difference in safely entering and leaving the pool.
Bathrooms are singularly responsible for more accidents than any other place in the home and as a result walk in tubs & showers have become very popular. A walk in curb-less shower allows for access without needing to step over a curb and there are also wheelchair accessible showers that allow access in a wheelchair or with a walker.
Walk in bathtubs allow safe access while stepping over a low curb through en entry door instead of negotiating the high sides typical in standard tubs. When in the tub bathtub grab bars offer added support and there are now options in hundreds of colors and finishes to match your personal décor. The same goes for other handicap grab bars in other locations.
Toilet safety rails that fold up and out of the way when not in use add tremendous safety value around the toilet area. Many choices of bathroom safety bars are also available such as the Superpole for support in getting up and down wherever necessary. Comfort height toilets which are higher than standard toilets installed with color coordinated toilet grab bars offer safe use in the toilet area. A qualified bathroom designer can include all the necessary items in your bathroom design, rendering it both safe and attractive for years to come.
In the kitchen area and even in small kitchen designs there are some fantastic choices for safe access. When reach is an issue adjustable height kitchen cabinets are an option. If sitting is necessary while cooking a height adjustable sink and adjustable height cooktop are all options. Here again an experienced certified kitchen designer can assist you with all the options available today.
It’s essential to become familiar with key issues associated with senior living and long-term care before being confronted with the situation in your family. Most are surprised to learn about the various nuances of insurance coverage, costs and various senior living options available.
See how well you can answer these True and False statements (scroll down for answers):
1. True or False – Seniors on Medicare that need rehabilitation care to regain abilities like speaking and walking after an illness or injury such as a broken hip or a stroke are covered for 100 days.
2. True or False – Insurance coverage for caregiver assistance at home is limited only to medically necessary skilled care.
3. True or False – If a senior has been diagnosed with a type of dementia like Alzheimer’s and cannot live safely in their own home, the best option for them is in a Skilled Nursing Facility.
4. True or False – Medicare does not pay for long-term care.
5. True or False – Receiving professional care at home is more economical than living in a long-term care location like assisted living.
6. True or False – The leading cause of injury among seniors (65 years +) occur when driving.
7. True or False – Medicare can penalize hospitals for excessive readmissions, reducing Medicare insurance payments if too many patients are readmitted within 30 days of their last hospital stay.
8. True or False – About 70 percent of individuals over age 65 will require at least some type of long-term care services during their lifetime.
9. True or False – Though benefits are provided by the Veteran’s Administration for a veteran, unfortunately there are no benefits available for the veteran’s spouse.
10. True or False – From 2000 to 2010, the death rate for Alzheimer’s disease increased by 39 percent, whereas death rates for other major causes of death decreased.
ANSWERS:
1. False. As of 2013, Part A covers up to 100 days in a skilled nursing facility, and the patient receives full coverage for the first 20 days in the facility. From days 21 to 100, the patient pays $144.50 per day, and Medicare pays the rest. After 100 days, the patient must pay the full cost of staying in the facility.
2. False. Though non-medical homecare is not covered by health insurance, some is covered by long-term care insurance. Non-medical or personal assistance may be help eating, bathing, or going to the bathroom.
3. False. Those that have some cognitive impairment or dementia like Alzheimer’s, can “age in place” in residences like Assisted Living, many of which specialize in dementia care. This includes state licensed, private residences which may have 4-12 residences.
4. True. Neither will Medicare Supplement insurance. These programs will pay only for limited nursing home or home health care, and only after a patient is discharged from the hospital after a 3-day stay.
5. False. Though the majority of seniors would rather live at home, costs canreach over $10,000 a month for 24-hour care, not including all the costs associated with living in ones own home or apartment. Also, living alone can be lonely and add to depression without much social interaction. There are several options which can be far less expensive than staying at home.
6. False. According to the U.S. Centers for Disease Control and Prevention, falls are the leading cause of injury among adults age 65 and older in the United States and account for 95 percent of hip fractures. Fortunately, falls are a public health problem that is largely preventable.
7. True. The goal of the new Affordable Care Act is to is to pressure hospitals to pay attention to what happens to their patients after they walk out the door. The penalties have made hospitals pay more attention and while improving their supervision of discharged patients’ recoveries.
8. True. According to the U.S. Department of Health and Human Services.
9. False. Veteran’s aid and attendance benefits for veterans and surviving spouses who require the regular attendance of another person to assist in bathing, dressing, meal preparation, medication monitoring or other various activities of daily living. The monthly benefits can range from $1,113 for a surviving spouse to $2,054 for a married veteran.
10. True. For 2000 and 2010, the age-adjusted death rate for Alzheimer’s disease increased by
39 percent, whereas death rates for other major causes of death decreased including Stroke
(-36 percent), Heart disease (-31 percent), and Cancer (-32 percent). Centers for Disease Control and Prevention
I had the honor of interviewing Dr. G. Allen Power, MD on “The Aging Boomers” Radio Show. Dr. Power is Eden Mentor at St. John’s Home in Rochester, NY, and Clinical Associate Professor of Medicine at the University of Rochester. He is a board certified internist and geriatrician, and is a Fellow of the American College of Physicians / American Society for Internal Medicine. Dr. Power’s book, Dementia beyond Drugs: Changing the Culture of Care, won a 2010 Book of the Year Award from the American Journal of Nursing, and a Merit Award from the 2011 National Mature Media Awards.
It’s no secret that with people living longer, there continues to be an increase in family caregiving for parents and other loved ones. This trend also has a domino effect on the impact in the workplace. Just take a look at the following statistics:
• 61 percent of family caregivers over the age of 50 are employed, (50 percent full-time and 11 percent part-time). – National Alliance for Caregiving (NAC) and AARP, Caregiving in the U.S.
• 64 percent of workers with eldercare responsibilities most commonly arrive late, leave early or take off time during the day to provide care, 17 percent are reported taking a leave of absence and 9 percent have to go from full-time to part-time work. – National Alliance for Caregiving (NAC) and AARP, Caregiving in the U.S.
• 19 percent left the workplace entirely because of having to care for a spouse or other family member. – Employee Benefit Research Institute, The 2012 Retirement Confidence Survey.
These challenges will continue to rise. By 2020, one in three total U.S. households is expected to be involved with caring for an elderly relative, up from one in four today.
ELDERCARE VERSUS CHILDCARE
Even with this ongoing increase in working family caregivers, some might say that it is not too different than childcare while the baby boomers were born between the years 1946 and 1964. Let me tell you some of the key differences:
1. The beginning of eldercare and the duration is unpredictable. This can come on suddenly and often involves many family members.
2. The physical demands on eldercare can be greater since it may include intimate personal assistance of activities of daily living like bathing or toileting for a grown adult.
3. The financial costs for eldercare can add to the strain of caregiving and the effects it has on one’s job.
4. The distance between where the adult child and parents live adds to the stress and complications associated with logistics, additional expenses and the job when long-distance travel is involved.
5. Having a number of family members involved can lead to disagreements among siblings and these emotions can play a significant role when caring for a parent.
WHAT SHOULD FAMILIES DO?
Talking about your children and showing pictures of them on Smart Phones are commonplace today. Showing pictures of your elderly parents who need care is not an everyday thing. Some years back when you heard that someone died in their 70’s, it was not a big surprise. Now, the comment would be, “he (she) was so young!” Today, we hear more about people living until their late 80’s, 90’s and even 100’s.
Unfortunately, most people don’t want to face the fact that their family members are aging and may someday need care. Both the parents and adult children would rather not think about it. Since most are living longer because they are beating heart disease, cancer and other diseases, families have to change and openly discuss the facts and plan appropriately. By discussing financial matters, Durable Power of Attorney, insurance matters, parent’s wishes (if family cannot provide the hands-on care) and the list goes on. Most in the U.S. believe that if someone cannot age at home, they have to go to a nursing home. That’s just not true anymore, and there are other options.
According to the MetLife Mature Market Institute, family caregivers (50 and older) who leave the workforce to care for a parent lose, on average, almost $304,000 in wages and benefits over their lifetime. These estimates range from $283,716 for men and $324,044 for women. Planning properly will help to reduce these numbers somewhat since the caregiver’s role is also dealing with attorneys, doctors, support services and the list goes on. Here are just a few of many questions I ask adult children when a parent is going to need some level of care, whether at home or outside the home:
• Do you know how much your parent has coming in each month?
• Is there any long-term care insurance?
• Who has Durable Power of Attorney?
• Do they have an Advanced Health Care Directive?
When the answer is “I don’t know,” that adds to their stress level and now family members have to work together to get things done. Plan. Plan. Plan.
WHAT SHOULD COMPANIES DO?
A recent study from the National Alliance for Caregiving, Workplace Eldercare shows by implementing eldercare programs can benefit employees and employers with worker retention, productivity, stress levels and health among workers. Some examples of programs include:
• Referral to caregiver resources including in-home care companies, senior placement companies, health care advisors, senior move managers and more.
• Having caregiver resources speak to working caregivers and provide information at the workplace.
• On-site support groups for working caregivers.
These workplace benefits can help working family caregivers balance their work and personal lives while attending to the necessary caregiving responsibilities. The company can benefit from improved employee retention which saves money as well as recruitment efforts to attract the most talented individuals.
With the growth of individuals turning 65 and over each day, doctors and patients are turning to compounding pharmacies at an increasing rate to prepare medications with alternate doses and strengths. Jerry Greene R.Ph., FACA, Founder & Director of San Diego Compounding Pharmacy, has been a practicing compounding pharmacist in San Diego for two decades. I had the pleasure of interviewing Jerry on my radio show, “The Aging Boomers.” After listening to the interview, you’ll have a much better understanding of what a Compound Pharmacy is and how you or a loved one may benefit. Click here to listen to the interview.
There have been so many niche services and businesses developed to assist the aging and their families. I try to help educate my readers and listeners on my “Aging Boomers” radio show. One that is important to know about is a Geriatric Care Manager which is sometimes called an Elder Care Manager. Listen to my interview on “What is a Geriatric Care Manager?” Hope you enjoy it and check out the many interviews located at www.seniorcareauthority.com/radio-show.
OK, you’re back from spending time with your parents or other loved ones and realize they’re not as independent as they used to be or they need more assistance than they’ve had previously. The decision is whether to get someone to come into their home (more frequently) or having them move into a location that provides more supervision and care such as assisted living. Let’s take a look at these two options:
In-home Care
CARE – Most home care is nonmedical care provided by trained caregivers. However, some home care can only be delivered by licensed, health care professionals. Caregivers can be hired through an agency, registry, or privately, and because every state has authority to license and regulate its home care agency system, there are often variations in licensure requirements and regulations from state to state.
COSTS – According to the 2012 MetLife Market Survey of Nursing Home, Assisted Living, Adult Day Services, and Home Care Costs, the national average rate for non-medical care runs $21/hour. Rates are different from one metropolitan area to another and rates are higher for medical or nurse assistance at home.
CAUTION – Caregivers can be hired from an agency or they can be hired as a private or independent caregiver. Be careful if you are considering hiring a private or independent caregiver, since the individual becomes your employee and you become the employer. On the other hand, if you hire an agency, they may be a little higher in cost but will screen caregivers and do thorough background checks, assume full liability for all care provided, supervise caregivers, cover auto insurance, take responsibility for caregivers’ benefits, vacation days, and sick days and have a replacement caregiver available in case your regular caregiver calls in sick.
Though most seniors want to stay at home, if they are going to be home alone just with a caregiver coming in at different times, social interaction is extremely important, especially with those suffering from dementia. In this type of situation, strongly consider Adult Day Care in your community if in-home care is going to be your option.
Assisted Living
CARE – Assisted Living options range from small, family Residential Care Homes to larger, full-service communities with hundreds of residents. The smaller locations are similar to living in someone’s home with live-in caregivers who provide assistance. The larger locations (communities) are more like Senior Apartments with caregivers providing 24/7 assistance. More and more seniors are becoming residents of small, large and specialized Assisted Living facilities including dementia care. Generally speaking, Assisted Living is for people that need help with the activities of daily living (ADL’s). ADL’s are considered the routine activities that people tend do everyday without needing assistance. There are six basic ADL’s, including eating, bathing, dressing, toileting, transferring (walking) and continence. If someone has some form of dementia, like Alzheimer’s there are locations that are licensed to properly care for individuals with this disease.
COSTS – According to the 2012 MetLife Market Survey, the national average monthly base rate in an assisted living community was $3,550 in 2012. . Regardless of size, base rate fees often cover only some of the total costs of needed assisted living services. Communities will vary on the number of services that are included in the base rate. The national average monthly base rate for Alzheimer’s and dementia care is $4,807.
CAUTION – There are many choices for those needing assisted living and/or dementia care and supervision. Selecting the wrong community or residential care home for your loved one can make things even more difficult. Consider using a professional in senior care placement who is familiar with the various options, including care, costs and location. They can then suggest the best options for your loved one to continue to age in a safe place.
OVERVIEW
The MetLife Report on Aging in Place 2.0, Rethinking Solutions to the Home Care Challenge” states “although a large majority of older Americans say they want to age at home, it is often more easily said than done. Today’s care infrastructure, technologies, existing housing, funding sources, and the businesses and services available are not being fully realized in order to achieve the promise most hope for as America ages.” In addition, hiring in-home help may be a temporary fix for a permanent problem that will turn into being more expensive. Dementia is always going to progress, and a person with dementia is going to become less functional and more needy over time. Be careful of the promises you make to loved ones regarding long-term care. You may be promising something that could be less safe at a far higher cost.
With the holidays approaching, many have made plans or are making plans to visit with their parents and other loved ones. Some family members haven’t been together for quite awhile, and this is an exciting time to celebrate being with one another. While visiting and enjoying the season, it is also important to recognize the things may have changed since the last visit. In this regard, it is important to observe your parents and their surroundings to determine if they need additional help with care and/or assisted living.
Observation 1 – Changes in Parents
• Appearance of Home – Does it seem like the home needs more maintenance than usual? Offering to help with whatever needs to be done around the house will give you a pretty good idea of things that are not getting done.
• Weight – Does it seem like they’ve lost weight or are frailer?
• Hearing – If they’re giving you answers to questions that don’t make sense, they may need to be checked by a professional for their hearing.
• Medications – Are they taking their medications consistently? Check to see if medications are organized properly and try to determine if they are taking them in a timely manner. How is their balance? If there appears to be a balance problem, medications or incorrect prescription eyeglasses could be playing a role, so visit the appropriate doctor.
• Driving – How is their driving? Have them drive if you go for a ride and take notice how they are on the road.
• Bills – Are they paying their bills? Has the mail even been opened?
Observation 2 – Surroundings for Fall Prevention
• Handrails – Are there handrails on the stairway? Is the stairway well lit? Having handrails professionally installed on both sides helps avoid falls. Handrails should also be installed in showers, toilet areas or anywhere where balance has to be shifted.
• Rugs – Could rugs be a tripping hazard? A small increase in floor height of a rug could cause problems. Non-skid rugs should be used on bathroom floors.
• Bathroom – Is there a step-in bathtub or walk in shower? What about a shower chair? A toilet safety frame? Bathrooms are a common place where seniors fall, and it can be very dangerous due to hard surfaces and sharp corners.
• Clutter – Are there newspapers, magazines, shoes and other materials lying around or on the stairs? Keep these things away from common walk areas.
• Storage – Is everything within easy reach? Eliminate the use of ladders and make sure storage items are in convenient locations.
Observation 3 – Documents for Parents End of Life Wishes
• Legal documents – Power of attorney and health care directives (living will). If these documents are complete, make sure you have copies for yourself and know where they are stored. If not, help get them going. These documents are free and can be prepared without an attorney if you are comfortable with this. Don’t wait until there’s an illness that can make it then difficult to execute. Talk to your parents and make them aware of how important it is to you (and should be to them) to have these documents completed…it’s never too early to have them done!
• Keeping Records – Keep records of your parents’ doctors, medications and contact information. This can save you from both panic and stress when an emergency arises.
Observation 4 – Normal Aging or Early Signs of Dementia
Though a medical professional dealing with the elderly is the most well equipped to diagnose dementia, it is important that family is aware of any early signs. Taking a proactive approach is vital to early diagnosis and treatment. Presently, there is no cure for the progressive dementias, such as Alzheimer’s, but treatment such as medication, nutrition and interpersonal communication could help slow the disease’s progression.
Memory loss does not necessarily mean that someone has dementia. A professional in this field gave me an analogy that sticks in my mind. She said that memory loss is when someone forgets his or her car keys, but someone suffering from a form of dementia may not remember that he or she owns a car in the first place.
Following are some signs of which to be conscious in the early stages and consult with a professional if they persist:
• Changes in short-term memory
• Adding and subtracting
• Using a word incorrectly when talking
• Jumbling words
• Quiet or withdrawn
• Lack of interest or initiative
• Inability to carry out plans
• Becoming more angry, frustrated and restless
• Struggling with tasks that used to be routine
If your visiting with your family during the holidays, have a wonderful time being together. However, keep in mind that it’s important to be aware of the surroundings to create a less risky setting at home and to get the assistance necessary to keep your parents safe. Many times the relative who visits the most infrequently is the one who notices the changes.
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