Assistance

Sometimes a person with Alzheimer's or Dementia might have trouble communicating the things they need help with.  They might need help with shaving, dressing, or toileting and be unable to tell the caregiver that.  Use this chart to explain what your loved one needs help with so that they do not become frustrated trying to tell the caregiver.

Bed Time Routine

Getting ready for bed has become somewhat of a routine for most people. They change into their pajamas, brush their teeth, then wash their face,and climb into bed. While these seem like simple tasks and an easy routine, some people that have trouble remembering things might not know what to do before bed. Use this sheet as a way to help guide the caregiver on how to put your loved one to sleep.

Meal Schedule

A person with Alzheimer's might have a hard time communicating properly or remembering the foods they like to eat and how they like them seasoned. Here is a good way to let the caregiver know what foods your loved one likes and dislikes and what they are allowed to have each meal or as a snack. 

Daily Activities

As we age, it is easy to fall into a day to day routine.  WE like things a certain way and if that works for us then we tend to keep doing it.  As a caregiver, it might be hard to know the routine of the one you care for so here is a chart that helps explain how their normal day goes.

Mobility

While some of the people we care for are completely mobile by themselves, others may require assistance now and then.  There is not always someone there to tell you how to operate the equipment or how to transfer the person properly from one position to the other.  Use this handy sheet to help the caregiver know how to move your loved one properly without hurting anyone in the process.

Health Issues

It is not always easy to know the health issues of the person you are caring for.  Even if you do know what they are, you might not know how to prevent a problem or how to resolve a problem occurring from one of the issues. Here is a chart for medical issues and what to do if there is a side effect or reaction.

Medication Chart

As we get older, we tend to take more medication and supplements than we did when we were younger.  Here is a chart that can help keep these medications in order and make sure that everything is up to date and being taken properly. 

General Information Sheet

Some people might have a loved one that is suffering from Alzheimer's or Dementia. This General Information sheet was designed to help a caregiver to be able to address their patient properly and have some other information to help with their care.

Improper Drug Use Could Be Dangerous for Elderly People

A major problem with medical treatment for the elderly is the large number of prescription medications the average older person is taking. Many older patients continue prescriptions with a number of doctors and specialists and no one doctor, not even the primary care physician, often knows the number or extent of medications being taken.

On average, a person over age 75 has five prescription drug medications and is using at least two over-the-counter medications as well as taking herbal supplements.  Over-the-counter medications and herbal preparations are not entirely harmless.  Adverse reactions can occur between various preparations of non-prescription drugs and often do occur between certain prescription drugs.

It is also surprising to some people that herbal supplements can cause drug interaction as well and in some cases might even result in death when used improperly with other medications.

Here is a list of herbal supplements that may interact or interfere with prescription drugs but this is not all-inclusive and there may be problems with other preparations as well.

·       Ginkgo Biloba

·       St. John's Wort

·       Saw Palmetto

·       Ginseng

·       Yohimbine

·       Senna Or Cascara

Doctors and pharmacists are generally careful about overdosing or using harmful mixtures of drugs, but other than amounts based on body weight, most prescription drugs do not have recommended dosages for older people. Often the doctor must experiment to find the right dosage and the problem is that many older people or their families fail to recognize drug reactions or they fail to report any problems to the doctor.

The elderly person or a responsible family member should always consult with the doctor and ask that doctor if a preparation and the amount being recommended is safe for an older person or what side effects are involved. It is not inappropriate to challenge a physician about medications. If prescription drugs are bought through a trusted pharmacist, the pharmacist may also be willing to consult on the safety of dosages for an older person.

Without the proper feedback, under-dosage or over-dosage might occur and effective treatment of the condition is not possible.  The cruel reality is improper dosage may cause more severe problems than the condition being treated.

Dealing with the Problem of Multiple Medications

A major problem with medical treatment for the elderly is the large number of prescription medications the average older person is taking. On average, a person over age 75 has five prescription drug medications and is using at least two over-the-counter medications as well as taking herbal supplements.

Many older patients continue prescriptions with a number of doctors and specialists and no one doctor, not even the primary care physician, often knows the number or extent of medications being taken. It is not surprising to see the large number of adverse drug reactions and hospitalizations and deaths due to drug reactions among the elderly.

In order to control the problem with an older person taking multiple prescriptions from many doctors, the older person or a responsible family member should bring all medications being taken by the patient to a doctor's appointment. This definitely includes all herbal supplements and over-the-counter medications as well.

It is useful to go over with the doctor what each medication is for. If there is no reason to take that medication or if it may be causing interaction the doctor should indicate that and should withdraw the prescription. As a general rule, the more the medications, the more the potential for problems. A concerted effort should be made by the physician to prescribe the fewest medications possible to control a medical problem.

One way to combat the problem with an older person who is not complying with taking pills at the proper time or not taking enough or taking too many is to use the popular "pill calendar box."  Many people have already adopted this idea but for those who haven't this is an extremely effective way to administer medications.

Many people order their medications through the mail and some may even obtain prescriptions on the Internet. Internet prescriptions might be a common practice for very popular medications such as Phetermine or Viagra. For the elderly this may not be a good practice. 

It is recommended that all medications be ordered through one pharmacist, particularly a pharmacist that has a certification in geriatric pharmacy. By controlling all medications through one database, the pharmacist can alert the older person or his or her family about a possible drug interaction or adverse drug reaction.

This central database approach should become much easier for those older people who enroll under the Medicare Part D drug program. Presumably the company offering the drug benefit will have a database for its insured.

Adverse Drug Reactions and the Elderly

A major problem with medical treatment for the elderly is the large number of prescription medications the average older person is taking. On average a person over age 75 has five prescription drug medications and is using at least two over-the-counter medications as well as taking herbal supplements. Due to impaired ability to "clear" medications from the body, recommended dosages of prescription drugs are generally too high for older people. This can result in over-dosage drug reactions and in some cases even death.

The medical community is well aware of this problem, but finding the right dosage is often a problem because drug reactions are often masked by symptoms of the many chronic medical problems most elderly endure. In addition, older people often don't recognize or they fail to report drug reactions

Here are some facts about Medications and the Elderly

·       Older Americans comprise about 13% of the population but they consume over 30% of all prescription drugs.

·       It is estimated that 30% of the older population taking medications have had an adverse drug reaction.

·       Up to 20% of hospital admissions for the elderly are due to adverse drug reactions.

·       It is estimated that over half of the deaths attributed to adverse drug reaction are for people age 60 and above.

·       The Journal of the American Medical Association recently reported that if adverse drug reactions were classified as a disease it would rank as the fifth leading cause of death in the United States.

The most common problem with medications is that the doctor or the pharmacist may not be aware that a patient is taking a number of drugs prescribed by other doctors. Many older patients continue prescriptions with a number of doctors and specialists and no one doctor, not even the primary care physician, often knows the number or extent of medications being taken. Add onto this the fact that the elderly are most likely consuming a variety of over-the-counter medications as well as herbal supplements and it is not surprising to see the large number of adverse drug reactions and hospitalizations and deaths due to drug reactions among the elderly.

Elderly people also often fail to adhere to proper dosage and frequency of dosage with their medications. Some will take more pills than prescribed because they think more is better and will cure the condition faster. Others have a non compliant attitude towards medical treatment in general and often refuse to take any drugs prescribed for them. Many are confused or have memory problems and aren't even aware they have taken pills or need to take pills.

Caregivers may not be aware of these problems.  It is extremely important for family or other people, responsible for the care of the elderly, to be aware of the danger of drug interaction and to manage medications for their loved ones.  

Lack of Incentive Means Fewer Physicians for the Elderly

There is currently little incentive to encourage established doctors or students in medical school to specialize in geriatric medicine. Even though it is a recognized specialty, according to the American Geriatrics Society, there are only about 9,000 M.D. Geriatricians and several hundred osteopathic physicians (DO) certified in geriatrics, as well as some 2,400 board-certified geropsychiatrists in the United States. (A geropsychiatrists it is a psychiatrist trained to deal with the mental health needs and specific syndromes faced by older adults).

Out of 145 medical schools in the United States only five have geriatric care departments. Many more medical schools offer elective courses in geriatrics but only 3% of all medical students ever enroll for such classes.

According to the statistical abstract of the United States there are approximately 770,000 practicing doctors of medicine in the United States. This means there is roughly 1 doctor, including specialists, for every 300 persons in the United States. Based on the number of available geriatricians, there is only about 1 Geriatrician for every 3,000 elderly persons in this country. Because there are so few of them, it may be impossible to find a physician specializing in geriatric care in some areas of the country.

Helping elderly people who are nearing the end of their lives and who suffer from multiple, incurable and chronic disorders is often not an appealing prospect to family doctors or to young medical students. Besides, geriatric care typically does not produce as much income as other specialties.

Most doctors who treat the elderly are reimbursed either through Medicare or sometimes through Medicaid or sometimes a combination of both. These government programs have become more stingy over the years. Many doctors who in the past have accepted Medicare find that they have better paying opportunities treating younger patients and as a result they will no longer accept new Medicare patients. And as long as those younger patients are available for treatment, few doctors are going to go out of their way to seek out Medicare or Medicaid reimbursement.

Fortunately, there are family physicians or internists -- non-geriatricians -- who specialize in treating older people and from experience they have probably learned many of the issues associated with treating the elderly, but many of these practitioners could probably benefit from more specialized geriatric training if it were available.

Many doctors, geriatric nurse practitioners or physicians' assistants derive satisfaction from working with older people.  They are likely taking a cut in pay by doing this. An older person or his or her family should seek to find these geriatric care specialists or if that is not possible, an effort should be made to locate a geriatric clinic in the area. Geriatric clinics are becoming more popular and they are likely to be well aware of the problems associated with treating elderly people. Many geriatric clinics include a team of specialists to help older people.

Doctors Making House Call Visits to the Elderly

Many doctors are returning to the practice of medicine a hundred years ago and are making house calls.  Certain health insurance plans including Medicare will now reimburse a doctor and possibly a staff member -- if test equipment is involved -- to visit home bound patients in their homes.

To qualify for a home visit the patient must have to experience great difficulty in leaving the home.  This does not however mean the care recipient need be completely disabled.  It simply means that transportation requirements or help needed to get to a doctor might be very expensive or difficult to provide or leaving the home might jeopardize the patient’s safety. 

Doctors are willing to visit in the home and provide service because they are paid more money by health insurance providers to compensate the doctors for their time and their loss of efficiency in meeting patients in their offices. The insurance providers reason that the additional cost of meeting with patients at home, before major medical problems evolve, is more cost effective than paying for ambulances and treatment in emergency rooms.

Doctors who make home visits are more likely to be experienced in geriatric care. This is because most home bound patients are elderly. This is a positive advantage for a family using a home visiting physician since it is better for the older person to be treated by a doctor with experience in this area. Treatment from someone experienced in geriatrics will typically result in better care.

There are also a number of other advantages to home visits compared with office visits. The patient will be more relaxed and cooperative in familiar surroundings. Older people are thrilled that a doctor would take time to visit them in their home. They will be more compliant, more open and as a result receive better treatment as oppos

ed to receiving care in the doctor's office. Typically the doctor will take more time and be able to establish a better rapport with his patient. The idea of the doctor not having to hurry off to another patient in another room is comforting to an older person.

Another very important benefit is that a physician can see the environment in which his patient is living and have a better understanding of how that environment may affect his patient's health. By seeing it first-hand he can make recommendations for care that would have been impossible in his office. In essence the doctor learns much more about a patient in her home and he can achieve a personal connection that would have been difficult to establish in the office. The ultimate outcome of a house call is that the doctor can provide a greater degree of holistic medical care.

Testing equipment in the past few years has become more portable and the doctor can bring an assistant who might provide tests on site. Heart function, lung function and simple blood tests performed on site can give the doctor an immediate feedback on the needs of his patient and allow him to make treatment decisions without the delay of waiting for test results.

It's exciting to see that innovations in home visits for patients could be creating a new level of quality care for the elderly.

A Holistic Approach to Seniors Health Care

Many health care practitioners who specialize in taking care of the elderly use a holistic approach. An attempt is made not only to treat the specific condition or conditions, but to make sure there are sufficient activity, proper nutrition and family support at home.

 Practitioners work closely with family members to make sure their loved ones are taking medications properly and are reporting their symptoms. They require those watching out for the elderly to closely monitor health conditions and report any changes before things get worse. They meet with their patients regularly enough to monitor their health. This broad-based approach results in better health and in fewer visits to the emergency room because intervention for a worsening condition is achieved at an earlier stage.

A good example of this holistic approach is the Veterans Administration Health Care System. The VA system, over the years, has become the nation's largest geriatric care provider for older men. Almost all veterans are men and because most veterans hearken back to World War II, the Korean conflict and the Vietnam War most of them are older than age 60. Because of this the, VA has found it necessary to adapt its health-care to this age group.

VA schedules regular exams at least every six months or yearly depending on available funds and personnel. A health examination typically includes lab work. Screenings for cancer, cardiovascular problems, eye problems, hearing problems and many other conditions common to aging are a routine part of Veteran's Administration health care.

VA was one of the first health providers in the nation to require its local hospitals to keep their records on computer and in a central database. This allows health practitioners in the system to quickly and efficiently access all information and avoid misdiagnoses and possible drug interactions. By taking a hands-on, preventative approach to the treatment of older men, the system is able to keep its patrons healthier and avoid costly medical interventions due to lack of follow-up.

A significant problem with providing holistic treatment is many health insurance providers, including Medicare, will not pay for routine office visits without an underlying medical complaint. Some private health plans are starting to use so-called "pay for performance" or "outcome based care" where the overall health of the patient takes precedence over the procedures used to get there. But Medicare, up to this point, has not made this change. This makes it extremely difficult for the geriatric health care provider to monitor his patients and intervene before a health problem becomes bad enough to require hospitalization or major surgery. Doctors practicing this type of medicine have to be inventive in order to provide adequate treatment. Family of the elderly can also help in this respect by "finding" medical complaints to justify setting regular appointments with the doctor.

Beware of Reverse Mortgage Specialists Who Might Take Advantage of You

A reverse mortgage specialist will help you determine whether a reverse mortgage is best for you, which type of loan is best and will help you obtain a loan. Also when you obtain a government-backed reverse mortgage there is a requirement to talk with a HUD counselor to make sure you understand why you are doing the mortgage. A person cannot rely entirely on the counselor to determine whether the mortgage is best or not. A major responsibility for dispensing advice lies with the reverse mortgage specialist.

 

Many specialists are not allowed to sell investments or insurance products using the mortgage proceeds.  However, this does not dissuade many specialists from teaming up with a financial salesperson and to have an arrangement to refer clients to this person.  Some insurance agents have been known to own a reverse mortgage company and they require their loan originators to send clients to insurance agents in order to put the money into insurance products such as annuities.

There definitely are situations where using proceeds from the mortgage solely for the purpose of investing or buying insurance could be a good idea. But in some cases it may only be a good idea for the financial salesperson to create a commission and it may end up being an expensive proposition for the homeowner.  Again, in some cases it is not a good idea to do a reverse mortgage solely for the purpose of reinvesting the money in something else. On the other hand, it may be a wise choice.  Any insurance or investment products that are purchased with reverse mortgage funds need to be part of a sound plan for estate planning.

Reverse mortgages were designed to help people pay costs or provide extra income to allow older Americans to remain in their homes. Or sometimes older people want extra cash to buy things they currently can't afford.  Such things as remodeling, finding money for a down payment for a second property, buying a new RV, financing travel, buying a new car, buying long term care insurance and so on.

When doing a reverse mortgage make sure all costs are disclosed and the alternatives are discussed as well. When choosing a reverse mortgage specialist ask for a signed statement from that person that he or she has no relationship with insurance annuity or investment companies either directly or through an associate and that he or she will make no recommendations for selling an investment vehicle.

If you want to use the money and put it in an investment, that should be your choice alone, and someone wanting to make a commission off of you should not induce you to do the mortgage for that purpose.

Using a Specialist to Prepare Financially for Long Term Care

Long Term Care Insurance Specialist

Increasingly we see insurance agents or financial advisers that are specializing solely in the sale of long term care insurance. Not only is long term care insurance a complicated product but companies are constantly coming out with new products as well.  A person selling long term care insurance also needs to have an understanding of what long term care is in order to make suitable recommendations to people buying the insurance.

 

Most insurance agents and financial planners simply don't have the time to keep up with these issues and that is why some practitioners have specialized exclusively in long term care. Here are the advantages of using a specialist.

·       The specialist often represents more than one long term care insurance company and can find the company with the best benefits and the best price.

·       The specialist often has experience with a number of companies and can recommend those that are good at paying claims, are expected to continue selling long term care insurance or are prone to rate increases.

·       The specialist has experience with medical problems involved in the issue and underwriting of long term care insurance and he or she can find the right company for underwriting or help to get the insurance through the underwriting in a chosen company.

·       Specialists are generally experts in understanding long term care issues, especially those specialists certified to sell partnership policies. Because of this knowledge, the specialist can recommend the best coverage to dovetail with the insured's assets, income and desires for care settings and services.

·       Many specialists work with a team of eldercare advisers such as care managers, pre-need funeral planners, elder law attorneys, home health providers, retirement financial planners and reverse mortgage specialists. This allows them to help the pre-retirement generation with long term care insurance and retirement planning and also help the parents of those people with elder care needs.

Elder Financial Adviser

A financial planner or adviser who works with the elderly is going to understand how to invest assets for that age group. This person will also understand how to use assets and income when there is a need for long-term care.

This person will work closely with an estate planning or

elder law attorney to make sure all arrangements for the estate, for disability, for loss of capacity, for medical treatment and for long-term care are covered.

An elder financial adviser is also likely to work with a team of eldercare advisers such as care managers, pre-need funeral planners, long-term care insurance specialists, reverse mortgage specialists and home health providers. 

Is Medicaid Planning Ethical?

As in any area of consumer spending, knowing what to look for and what strategies to use in arranging for paid care services can often result in saving money. Some strategies such as Medicaid planning allow for preserving the home or relieving the pressure of spending retirement savings. Oftentimes a strategy will provide tax advantages as well.

A person facing the prospect of long-term care with moderate income and moderate savings may eventually have to rely on Medicaid to pay part or all of the cost of care. For instance someone making $2,000 a month would not be able to afford a nursing home at $4,000 a month. Savings would be depleted quickly and the income from a spouse may be needed as well. Medicaid may become the only option.

Medicaid has provisions to protect a healthy spouse at home financially. But many states rob a healthy spouse of a previously adequate income by allowing too little in protected resources and income. Likewise, children, relatives and friends are not recognized for the financial sacrifices they make in providing the early care before a recipient becomes bad enough to need Medicaid funded professional help.

Medicaid planning, using a professional Medicaid planning adviser or qualified elder law attorney, allows families to correct inequities in the system. Medicaid planning has gotten a bad name because some individuals, who would normally have too many assets to ever qua

lify for Medicaid, deliberately use it, many years in advance, to give away everything to their family so as to qualify for Medicaid. It is wrong to abuse the system in this way and to use taxpayer dollars to insure an inheritance for the family. And if the person giving away assets is not anticipating immediate care, this strategy is just plain dumb. There are much better ways to plan for long term care in advance.

Some Medicaid planners will attempt to discredit other forms of funding long term care such as using insurance or a reverse mortgage. They do this in order to discourage the public from using these other strategies. The intent is to limit competition ensuring that paying clients will rely entirely on Medicaid planning as a solution.

On the other hand, many long term care funding specialists will use the same strategy against Medicaid planners to eliminate competition from their services. These people make Medicaid planners appear as evil or dishonest.

Medicaid planning is no different from tax planning. In fact a Supreme Court decision condones honest methods of eliminating income taxes or estate taxes. Tax planning and Medicaid planning both put an additional burden on taxpayers, but one is considered ethical and the other is often frowned upon.

All strategies have their place in the scheme of things. Medicaid planning fits certain circumstances usually where families are in a crisis mode trying to preserve a few assets such as a house or a savings plan. There is no attempt to take advantage of the taxpayers.

Using other strategies for paying the cost of care is a much better approach than Medicaid planning for a younger generation.  Not relying on Medicaid will allow greater choice in care settings and care services provided.  

Misconceptions about the Need for Long Term Care and Who Provides It

A large majority of the American public still believes that the government will provide long term care when needed. It is this misconception that most likely prevents people from planning care for themselves. In fact, a recent study revealed that many people believe they can give away assets prior to the need for long term care and qualify for Medicaid. The study supports the premise that this knowledge prevents people from considering buying long term care insurance as a way to fund the cost of future care.

Indeed it may be possible to use the system and allow Medicaid to cover care but at what cost? Why would anyone want to plan to spend his remaining years in a nursing home--which is the preferred living arrangement of Medicaid. And why go through the expense and effort of trying to manipulate the system to get welfare care, when a little preplanning at an earlier age would be a better option?

In our practice we hear frequent objection to long term care planning from people who think Medicare or the Veterans Administration will take care of them. These people simply don't understand the limitations of government systems. Below are quotes taken from individuals who, over the years, have voiced have these misconceptions.

"Uncle Jim got along just fine with the government paying his care"

"I can give away my assets and have the government pay for it"

"We have a trust and all of our assets will go to our family so the government will pay for our care"

"I'm not interested in home care or assisted living, just stick me in a nursing home and Medicaid will pay the bill"

"Long term care insurance is too expensive"

Government could be more involved in providing care but our antiquated system of delivery prevents this from happening.  The National Aging Network, a government-sponsored program, is in the best position to help people receive long-term care in their homes. And studies have shown that the cost of providing this kind of care is significantly less than the cost of providing nursing home care through government programs.

Unfortunately, for every dollar that supports a person through the aging network the government spends about $270 supporting a person in a nursing home. Because it has inadequate funding, the aging network must confine its valuable services to people who have little income or for social reasons are disadvantaged. Moderate and middle income Americans can receive some services from the network but are mostly excluded or must pay their fair share of the cost.

We believe the public's misunderstanding of Government long term care programs is an impediment to proper long term care planning. When people understand the limitations of relying on government programs they are most likely to be more motivated to plan for the future by making provisions in advance and providing advance funding to pay for care. Prior planning also allows people to have a choice in their care setting and in the type of services they receive.

Important Community Services for Long Term Care

Listed below are 14 areas of private sector advisers or providers supporting long term care.  We believe the average American is not aware of many if not all of these important services.

These are the specialists, advisers or providers that can make the difference in allowing someone needing care or his or her family to have a choice in care options. Without help, they family may not always choose the best care settings. Without help, untapped sources of government or private funding to pay the costs of care may go unrecognized.  Much of this advice and many of these services will also help improve the condition or the environment of someone needing long term care.

Families that are prepared for care in advance and understand the services available are going to be significantly more successful than families that use a last-minute "do-it-yourself" approach.  As a general rule, using a professional will save help conserve assets, uncover unknown sources of funding and relieve stress on family caregivers.

Here is a list of these services

1. Geriatric and Professional Care Managers or Geriatric Specialists
2. Geriatric Medical Services    
3. Medical and Non-Medical Home Care Services
4. Home Maintenance, Transportation & Chore Services
5. Home Disability Support and Medical Alert Systems          
6. Elder Law and Estate Planning Advice         
7. Elder Mediation Services
8. Guardianship and Trust Administration
9. Financial Services Specialists
10. Reverse Mortgage Specialist
11. Seniors Relocation and Real Estate Specialist
12. Hospice Care Provider
13. PrePlanning, PreNeed Funeral Providers
14. Veterans Benefits Consultant

To learn more about these services and how they support family caregivers please contact AllCare Living Services at 832-9888 or info@allcarelivingservices.com.

The Evolution of Long Term Care in the United States

In the first century of our country's history there was no such thing as nursing homes or assisted living. Society was mostly rural and people lived in their own homes. Families cared for their loved ones at home till death took them.

In the latter part of the 1800's because of an increasingly urban society, many urban families were often unable to care for loved ones because of lack of space or because all family members including children were employed six days a week, 12 hours a day. During this period many unfortunate people needing care were housed in County poor houses or in facilities for the mentally ill. Conditions were deplorable.

In the early 1900's home visiting nurses started reversing this trend of institutionalizing and allowed many care recipients to remain in their homes. Nursing homes or so-called rest homes were also being built with public donations or government funds. With the advent of Social Security in 1936, a nursing home per diem stipend was included in the Social Security retirement income and this government subsidy spurred the construction of nursing homes all across the country.

By the end of the 1950s it was apparent that Social Security beneficiaries were living longer and that the nursing home subsidy could eventually bankrupt Social Security. But in order to protect the thousands and thousands of existing nursing homes Congress had to find a way to provide a subsidy but remove it as an entitlement under Social Security.

In 1965, Medicare and Medicaid were created through an amendment to the Social Security act. Under Medicare, nursing homes were only reimbursed on behalf of Social Security beneficiaries for short-term rehabilitation. Under Medicaid, nursing homes were reimbursed for impoverished disabled Americans and impoverished aged Americans over the age of 65.  Since 1965 it has not been the intent of Congress to pay for nursing h

ome care for all Americans.  With the passage of the Older Americans Act, nursing home entitlement for all aged Americans was now gone.

Over the last 40 years, there has been a gradual change away from the use of nursing homes for long term care towards the use of home care and community living arrangements.

We are currently seeing a trend towards working conditions like those in urban America in the early 1900's where both husband and wife are working and putting in longer hours. We are also seeing a return of the trend in the early part of the 20th century where outside visitor caregivers are available to replace working caregivers and allow the elderly to receive long term care in their homes. In addition there is a significant trend in the past few years for Medicaid and Medicare to pay for long term care in the home instead of in nursing homes.

The return to an emphasis on the home care is encouraging because as a general rule most people do want to remain in their homes as long as possible.  With continued government support and with the proper planning and the money it provides, most of us could remain in our homes to receive long term care and we would never have to go to a nursing home.

Home Care May Not Always Be the Best Choice for Long Term Care

Despite the psychological advantage, a home may not always be the best place for those receiving care or for the caregiver. Surprisingly, it is becoming more common for people needing care or anticipating care to seek out other living arrangements in preference to the home. The reasons for preferring another living arrangement may be varied but are usually based on issues such as lack of transportation, lack of security in the neighborhood, desire to avoid maintenance and yard upkeep, the need to cash out of a home to provide funds for care or the desire to associate with other elders.

 

Many care recipients may have a fear of leaving their homes, this is called agoraphobia. Agoraphobia affects about 30% of all elderly care recipients. The fear may prevent a person from getting better care and more mental stimulation in another environment. It may even require some counseling from a professional to persuade a person to leave the home.

 In many cases the family may force this decision upon their loved one resulting in damaged relationships and psychological injury to the loved one. In an attempt to expedite the move -- due to limited time available from family -- cherished possessions may be discarded.

A key person in finding other living arrangements is often a professional care manager. Not only can the care manager help the family and care recipient understand the issues of a transition but he or she can also help with the selection of the proper setting. A manager can also make arrangements for moving the loved one and selected belongings. The cost of using a care manager is well worth the trade-off of not getting it right.

Save Money with Eldercare by Not Doing-It-Yourself

Long-term care services are complicated and expensive. Unfortunately, for the majority of Americans, eldercare is a do-it-yourself process. Using a geriatric care specialist or manager is the most cost effective and efficient way to provide help for a loved one.

Hiring professional advisers to help with long term care is no different from using a professional to help with other complex issues. Does do-it-yourself make sense in the following examples?

·       Sam has a 2003 SUV. He decides to purchase the $600 service manual and invest thousands of dollars in test equipment and in special tools to repair the vehicle himself. He feels he will save money by doing this instead of paying for dealer repair services.

·       Sally is involved in a complicated court proceeding. She decides to represent herself and invests countless hours in researching legal documents and reading books on how to represent herself in court.

·       Jim runs a business with 100 employees. He has no experience in accounting or taxes but he decides his accountant and tax person is too expensive and he will invest the time and money in software to do it himself.

·       Grace is a successful and busy professional who has little personal time. She doesn't like the idea of paying an investment adviser to manage her $1 million portfolio. She decides to manage it herself.

There is no doubt that given enough time and money a person could repair his own car, handle a court process alone, research tax laws or spend countless hours doing his own investment research. But most people are smart enough to recognize that the time and the stress involved are not worth it and they hire an expert to help them.

The same is true of using a professional geriatric care manager.  Even if a do-it-yourselfer has enough time for research on funding and finding the best care options, that person is unlikely to have the experience in understanding care situations that a professional care manager would have.

Experience only comes from dealing with countless hands-on, caregiving challenges.

A professional care manager should always be involved when the time for long term care comes. The use of this expert is crucially important in any long term care plan.

Other useful professionals to consider are an elder law attorney, a long-term care and financial planning specialist and an elder mediator. These experts help design the initial plan and can be just as valuable as a care manager in certain situations when the time for care comes.

Using the expertise of a long term care professional is likely to result in dollar savings many times larger than the cost of hiring the expert.

Geriatric Care Manager Specialists Are Essential for Success with Eldercare

Also known as Geriatric Care, Elder Care or Aging Care Managers, a Care Manager Specialist represents a growing trend to help full-time, employed family caregivers provide care for loved ones living close by or needing long-distance care. Care managers are also particularly useful in helping caregivers at home find the right services and cope with their burden.

 

Below is a partial list of what a care manager or geriatric care specialist might do:

·       Assess the level and type of care needed and develop a care plan

·       Take steps to start the care plan and keep it functioning

·       Make sure care is received in a safe and disability friendly environment

·       Resolve family conflicts and other family issues relating to long term care

·       Become an advocate for the care recipient and the family caregiver

·       Manage care for a loved one for out-of-town families

·       Conduct ongoing assessments to monitor and implement changes in care

·       Oversee and direct care provided at home

·       Coordinate the efforts of key support systems

·       Provide personal counseling

·       Help with Medicaid qualification and application

·       Arrange for services of legal and financial advisers

·       Manage a conservatorship/guardianship for a care recipient

·       Provide assistance with placement in assisted living facilities or nursing homes

·       Monitor the care of a family member in a nursing home or in assisted living

·       Assist with the monitoring of medications

·       Find appropriate solutions to avoid a family crisis

·       Coordinate medical appointments and medical information

·       Provide transportation to medical appointments

·       Assist families in positive decision making

·       Develop long range plans for older loved ones not now needing care

Services from care managers should be something that every family takes advantage of.  Unfortunately, in reality very few families use care managers. Care managers could go a long way towards helping the family find better and more efficient ways of providing care for a loved one. The concept is simple. The family hires a professional adviser to act as a guide through the maze of long term care services and providers. The care manager has been there many times. The family is experiencing it usually for the first time.

Hiring a care manager should be no different than hiring an attorney to help with legal problems or a CPA to help with tax problems. Most people don't attempt to solve legal problems on their own. And the use of professional tax advice can be an invaluable investment. The same is true of using a care manager.

To find out more about the services and the cost savings from using a care manager specialists contact (your name) at (your contact information).

Family Caregiver Disputes Can Sometimes Be Resolved By a Care Manager

Let's look at a hypothetical example to see how a care manager who provides counseling or mediation services could be invaluable to a son or daughter caring for a parent:

Michelle is a single divorced mother with two teenage children. Her mother, Martha, has a stroke, which apparently causes some memory loss as well as some disability in being able to care for herself.  Michelle decides to move in with her mother and take care of her. In return, Michelle who is temporarily out of work has a place to live and share her mother's retirement income.

Martha has mood swings and often forgets what she is doing. She seems to display a lot of anger and takes it out on Michelle, calling her all kinds of horrible names. She is never happy and is constantly calling for attention. In trying to take care of her own children as well as her mother, Michelle is quickly being drained of her physical and emotional strength.

In addition Michelle's brother and two sisters are happy she is taking care of her mother since they are now absolved of the responsibility, but they treat Michelle terribly. They call her awful names and accuse her of being a "leech". On the other hand they have plenty of advice on how to deal with their mother but never offer any of their own time to help. After all, they reason, Michelle is receiving benefits from caring for her mother and logically she should be responsible for all the care.

On the advice of a friend, Michelle hires a care manager, Brent, who comes highly recommended in solving family disputes. Brent is a certificated mediator. Brent first does a care assessment of Martha and comes away suspecting there is more to her personality disorder than a stroke. He makes arrangements to take Martha to a Geriatric Physician who does a complete physical assessment and recognizes that Martha's mental state is due more to improper medications and severe depression.

Martha's medications are reduced and changed and she is put on antidepressants. In addition, her diet is upgraded.  She is to receive more fluids, more healthy foods and especially receive vitamin supplements -- particularly vitamin B12 and vitamin D. The doctor insists on as much exercise as Martha can handle.

Brent helps convince Martha of the need for her new care program and helps oversee her following through on the exercise program. Over the ensuing months Martha's lack of memory and abusive behavior become less severe. She is also better able to care for herself without Michelle's assistance.

In addition to the assessment, one of the first things Brent does is to contact Michelle's older brother who is the family leader. He has a long talk with her brother and gives the brother a different perspective on the issues. With a better understanding of the situation, the brother calls a family meeting and Brent mediates a successful resolution of the family mistreatment of Michelle and the ensuing bad feelings.

Everyone including Michelle is called upon to do his or her part in managing the care of their mother and to work on better family relations. The issue of Michelle "sponging" off of her mother is addressed and all agrees to an adequate solution. Brent will follow up in a month to make sure everyone is following through on his or her commitment.

A year later, Michelle confides to a friend that her bringing a care manager in to help with her family dispute and her mother's caregiving was an answer to her prayers and literally saved her life.

Knowledge and Money Provide Freedom of Choice with Long Term Care

Understanding in advance, care settings and when and why they are appropriate will result in the most satisfactory experience for the caregiver, the care recipient and the family.  Also, understanding how government programs work helps with the final decision-making process as well.

·       Prior knowledge prevents crisis planning.

·       Prior knowledge will save money.

·       Prior knowledge will save precious time.

·       Prior knowledge will rescue the caregiver.

·       Prior knowledge opens the door to other options

Without money to hire professional advice or to provide the most desired care setting, the only option is to rely on Medicaid. Medicaid typically means the remaining years of life will be spent in a nursing home. Other limited options are available from Medicaid or from community aging services but there are usually waiting lists.

Here are some common funding options that can be used to provide money for care services:

·       Long-Term Care Insurance

·       Life Settlement

·       Reverse Mortgage

·       Cashing Out Of a Principal Residence through Sale or Buyback Arrangement

·       Retirement Savings Accounts

·       Life Insurance Arrangements

Here are some common asset-saving strategies:

·       Medicaid Planning

·       Rearranging Insurance Plans

·       Private Home Care Arrangements

·       Work Closely with Your Doctor

·       Understand the Pricing of Community with Care Arrangements

·       Purchase the Right Long-Term Care Insurance

·       Family Shared Care Commitments

·       Tax Advantage Strategies

To learn more about these options and strategies and to gain more knowledge about long term care contact (your name) at (contact information).

The Sooner You Start The Better Your Future