Missouri Care Planning Council

Applying for the Veteran’s Aid and Attendance Pension

2011-04-15T09:58:00.000-07:00

My Personal Experience
By Melissa Howell

12:20 a.m. The clock was blurry as I rubbed the sleep from my eyes to answer the phone.
“Hello”, I said.

A weak and frightened voice on the other end pleaded, “Melissa? Is Bryan there? I can’t get out of my chair. Could you or Bryan come over?”

I sighed as I handed the phone to my husband and heard him say, “I’ll be right over, Dad.”

When Bryan left, I pondered on my father-in-law, John, and his situation. John had just come out of the hospital after a serious illness and although the doctor had assured us he would be fine, we quickly learned that he was not able to care for himself. He lived alone in a small apartment and had in-home health care assistance through his Medicare plan. They came once a day to help him with a shower and to aid him with incontinence. Bryan and I came over three times a day to help him with changing his clothes and to make his meals. In addition, we helped him with his bills and took him to his frequent doctor appointments. Tonight was the first time he had called to ask for help in the middle of the night. We needed to do something different. We were both exhausted between working our jobs and caring for our four young children and constantly running out to take care of John’s needs. It was becoming more than we could handle. We realized we really needed to get him into assisted living.

John lived comfortably on an income consisting of social security and a retirement pension, but as we visited different assisted living homes in our immediate area, we quickly realized that this income was not enough. Assisted living was really expensive!

John had served in the Navy during the Korean conflict and we had heard through a friend that veterans could receive assistance through the Department of Veteran’s affairs for health care. The catch was doing it correctly. Our friend referred us to a Veteran’s Consultant from the National Care Planning Council to provide information for the challenging task of filling out the paperwork to receive this benefit. A Veteran’s Consultant can provide general information on how a claim is filed. Our consultant told us about all of the necessary supporting documents we would need to make sure it was approved.

The paper work was pretty daunting, but we worked through each form thoroughly to be sure that we were providing all the information Veterans Affairs (VA) would need in order to expedite John’s payments.

First, I obtained a medical report from John’s doctor -- the most crucial step in the process. This form would prove that John needed aid and attendance. In our case, the doctor described his medical condition and then noted specifically his need for help with incontinence and showers, his lack of motivation to make meals for himself and his inability to leave the house alone. It was, however; important to us that the doctor wrote that John was mentally capable of making his own decisions, because we did not want to go through a delaying process of having VA assign somebody who would need to pay his bills for him (VA calls this person a fiduciary).

Another key thing was that John had to show evidence to VA that his care costs were close to or exceeded his income. Fortunately, John had a small amount of savings and he was able to pay in full for the first month’s payment to his assisted living home. This was important, because the statement showing this payment was important evidence needed to present to VA. Since his assisted living cost exceeded his income by $1,000 per month, we arranged with the director, to pay what John could afford until the benefit from VA came in and then the director agreed to pay the remaining debt balance on the account at that time.

An important form was John's original DD-214, which was the official record showing that he had been honorably discharged from the military. I quickly found a certificate of honorable discharge (DD-256) but this was not the correct form. We searched through all of his files and boxes and couldn’t find the DD-214. So I got on the Internet and found a website for the National repository where the official forms can be obtained. It appeared that it could take up to 6 weeks to receive an official copy. Fortunately, we found the original document folded in his wallet and we did not have to delay our process.

One of the forms my Consultant made me aware of was a VA power of attorney form (VA form 21-22a) that gave me the authority to fill out and submit the forms to VA on behalf of John. Although John was mentally sound, he was weak and tired and didn’t really want to do anything but watch television and eat. With this form, I was able to communicate with VA in his behalf.

There were several other forms to fill out and after all the paperwork was finished, my Veteran’s consultant gave us the address of where to send all of them. Our particular VA processing office was located in St. Paul, Minnesota.

After about two weeks, John and I each received a letter stating that VA was working on his case and they assigned him a case file number. After another two weeks, we received a letter stating that we needed to fill out some other paper work. I showed these to my consultant, who assured me, in our case, that it was standard procedure and that the paper work I had originally filed was sufficient. Within another two weeks, John received his first payment.

Because his care cost exceeded his income, he was awarded the full $1644.00 per month. VA sent another payment from the date that they had first issued his case number. So in the first month, we received two payments. These were sufficient to catch up the debt he owed to his assisted living and to continue with full payments each month.

Applying for the VA Aid and Attendance Pension was detailed, but it was not terribly frustrating because of the general information on the application process I received from my consultant. It did require extra work on my part, but it was well worth the end result of getting the care that John needed and the relief that Bryan and I needed in the end. I am grateful that we had such a wonderful resource in National Care Planning Council to help us find a capable and informative Veteran’s Consultant.

Bryan and I now see John twice a week and visit with his assisted living staff often to help him have a comfortable and enjoyable life in his new home. He is able to enjoy activities and meals with other people, have quality personal care and have the peace of mind that someone is always there to help him. I now sleep at ease through the night, knowing that his needs are taken care of and that there won’t be any middle of the night calls asking for help.

The National Care Planning Council wishes to thank Melissa for providing her experience. We maintain a list of consultants across the country which can be found at the following address: www.veteranslisting.com. We also provide a book with instructions to help people who want to file an application by themselves. This book can be purchased online at http://www.longtermcarelink.net/a16books.htm.

The Missouri Care Planning Council is a member of the National Care Planning Council. This "Planning For Eldercare" Article was published by the National Care Planning Council on July 8, 2010. For more information on the Missouri Care Planning Council, please visit www.mocpc.org or call 314-822-8389.

Recognizing Symptoms of Dementia

2011-04-14T09:34:00.000-07:00

The Brown family reunion has always been an event everyone looks forward to. Family visits, games, stories and everyone’s favorite foods are always on the agenda. On the top of the menu is Grandmas Lemon Coconut Cake. Grandma always makes the traditional cake from her old family recipe. This year, however, the cake tasted a little on the salty side, perhaps a half cup full of salty.

Though the family was disappointed over the cake, of more concern was Grandma’s confusion with the recipe and her similar confusion about the loved ones around her. Could something be wrong with grandma's mental state?

One might say that for an elder person a little forgetfulness or confusion is normal, but when do you know if there is a serious problem, such as dementia?

An online article from FamilyDoctor.org outlines some common symptoms in recognizing dementia.

"Dementia causes many problems for the person who has it and for the person's family. Many of the problems are caused by memory loss. Some common symptoms of dementia are listed below. Not everyone who has dementia will experience all of these symptoms.

•Recent memory loss. All of us forget things for a while and then remember them later. People who have dementia often forget things, but they never remember them. They might ask you the same question over and over, each time forgetting that you've already given them the answer. They won't even remember that they already asked the question.
•Difficulty performing familiar tasks. People who have dementia might cook a meal but forget to serve it. They might even forget that they cooked it.
Problems with language. People who have dementia may forget simple words or use the wrong words. This makes it hard to understand what they want.
•Time and place disorientation. People who have dementia may get lost on their own street. They may forget how they got to a certain place and how to get back home.
Poor judgment. Even a person who doesn't have dementia might get distracted. But people who have dementia can forget simple things, like forgetting to put on a coat before going out in cold weather.
•Problems with abstract thinking. Anybody might have trouble balancing a checkbook, but people who have dementia may forget what the numbers are and what has to be done with them.
•Misplacing things. People who have dementia may put things in the wrong places. They might put an iron in the freezer or a wristwatch in the sugar bowl. Then they can't find these things later.
•Changes in mood. Everyone is moody at times, but people who have dementia may have fast mood swings, going from calm to tears to anger in a few minutes.
Personality changes. People who have dementia may have drastic changes in personality. They might become irritable, suspicious or fearful.
•Loss of initiative. People who have dementia may become passive. They might not want to go places or see other people."

Dementia is caused by change or destruction of brain cells. Often this change is a result of small strokes or blockage of blood cells, severe hypothyroidism or Alzheimer’s disease. There is a continuous decline in ability to perform normal daily activities. Personal care including dressing, bathing, preparing meals and even eating a meal eventually becomes impossible.

What can family members do if they suspect dementia? An appointment with the doctor or geriatric clinic is the first step to take. Depending on the cause and severity of the problem there are some medications that may help slow the process. Your doctor may recommend a care facility that specializes in dementia and Alzheimer’s. These facilities offer a variety of care options from day care with stimulating activities to part or full-time live-in options. Sometimes if patients tend to wander off, a locked facility is needed.

In the beginning family members find part time caregivers for their loved one. At first, loved ones need only a little help with remembering to do daily activities or prepare meals. As dementia progresses, caregiving demands often progress to 24 hour care. Night and day become confused and normal routines of sleeping, eating and functioning become more difficult for the patient. The demented person feels frustrated and may lash out in anger or fear. It is not uncommon for a child or spouse giving the care to quickly become overwhelmed and discouraged.

Family gatherings provide an excellent opportunity to discuss caregiving plans and whole family support. It is most helpful if everyone in the family is united in supporting a family caregiver in some meaningful way.

"The first step to holding a family meeting, and perhaps the most difficult one, is to get all interested persons together in one place at one time. If it's a family gathering, perhaps a birthday, an anniversary or another special event could be used as a way to get all to meet. Or maybe even a special dinner might be an incentive.

The end of the meeting should consist of asking everyone present to make his or her commitment to support the plan. This might just simply be moral support and agreement to abide by the provisions or it is hoped that those attending will volunteer to do something constructive. This might mean commitments to providing care, transportation, financial support, making legal arrangements or some other tangible support." The Four Steps of Long Term Care Planning

Professional home care services are an option to help families in the home. These providers are trained and skilled to help with dementia patients. Don’t forget care facilities as well. It may be the best loving care a family member can give is to place their loved one in a facility where that person is safely monitored and cared for.

The National Care Planning Council supports caregiving services throughout the country.
www.longtermcarelink.net

The Missouri Care Planning Council is a member of the National Care Planning Council. This "Planning For Eldercare" Article was published by the National Care Planning Council on June 8, 2010. For more information on the Missouri Care Planning Council, please visit www.mocpc.org or call 314-822-8389.

The Financial Health of Aging Seniors

2011-04-13T09:31:00.000-07:00

With our current economic challenges, those of us looking forward to retirement need to be well-informed about our financial needs in coming years. And not only pre-retirees, but individuals already in retirement need to be wise to the changing economic environment. The good news is there are trained professionals who keep abreast of changes in the current economy, changes in laws and changes in government programs for the elderly. Professionals in this field are equipped to handle everything from help with retirement savings accounts, investment advice, guidance on government programs, estate planning or even new funding options such as reverse mortgages. A little planning prior to retirement will allow you to maintain your current lifestyle; whereas, a lack of planning may require you to live on an extremely tight budget. For those already retired, taking time right now to deal with financial problems instead of waiting for a crisis to happen is well advised.

A large number of retired individuals feel that they have planned well for the future only to find that rising medical costs, damage done to investment portfolios (by the current economy) and many other factors have caused them to go into debt. According to an article in "USA Today" seniors are racking up debt like never before. Elderly individuals who are in debt live with a constant burden over their heads. Most of these people are on fixed incomes and have no way of paying off credit cards and home equity loans that continue to mount to cover household budget deficits. In order to meet ongoing payments, seniors often forego purchasing medications and skimp on food budgets. They live like hermits -- never going out and pinching every penny -- in order to pay their obligations.

Most of these people worked hard their entire lives and managed their debt. They never anticipated the rising costs of prescriptions, expensive medical care or depletion of savings by living too long. The good news is there is help for these individuals. Here are just a few examples of some relief options that could be available. There are many more besides these.

Reverse mortgages - A Home Equity Conversion Mortgages (HECMs), also known as a reverse mortgage, is a risk-free way of tapping into home equity without creating monthly payments and without requiring the money to be paid back during a person's lifetime. Instead of making payments the cash flow is reversed and the senior receives payments from the bank. Thus the title "reverse mortgage". For those seniors who are less fortunate financially but own a home, a reverse mortgage can allow them to remain in the home by creating extra income.

Life settlements -- A life settlement enables older individuals, businesses and other organizations to sell life insurance policies they currently own – but no longer want or need – for an amount greater than the cash surrender value. In some cases the value can be 2-3 times the cash surrender value. Even some term life insurance policies with a conversion option to permanent coverage can qualify for a life settlement.

Government Programs -- Some government programs such as food stamps provide temporary financial help for food. Other programs provide subsidized housing, help with medical expenses and provide tax credits. For veterans there is free health care, inexpensive prescriptions and disability income. Area agencies on aging offer individual counseling, legal help and advice with Medicare costs. (National Care Planning Council)

For some, living on a fixed income and dealing with debt can be an overwhelming burden. There are knowledgeable professionals and debt relief strategies that can assist in easing this burden. The National Care Planning Council keeps a list of financial advisers and attorneys who specialize in this area of planning at www.longtermcarelink.net.

The Missouri Care Planning Council is a member of the National Care Planning Council. This "Planning For Eldercare" Article was published by the National Care Planning Council on May 5, 2010. For more information on the Missouri Care Planning Council, please visit www.mocpc.org or call 314-822-8389.

Vitamins and Mineral Supplements Are Important for Older People

2011-04-12T09:22:00.000-07:00

Research has discovered that as we age, our diets and our need for dietary supplements change. Doctors are increasingly concerned about boosting the levels of vitamins and minerals that we need as we grow older.

As most people get older, they tend to eat less due to a loss of appetite. As a result, many elderly individuals do not take in adequate amounts of vitamins and other nutrients as they did when they were younger. Other factors that can affect appetite and the inadequate uptake of vital nutrients are medications, medical complications, certain disabilities, diabetes, changes in the digestive system and even the changes in our skin as we age. One study estimates that one-third of the elderly are alarmingly low on important vitamins and minerals. Another study indicates that two thirds of the elderly patients admitted to a hospital are mal-nourished, resulting in low levels of vital nutrients. When a person is vitamin and mineral deficient, he or she is more susceptible to illness and infections. It is estimated that deaths due to infections are ten times more likely in the elderly.

Vitamins
So what is a vitamin and why is it so essential to our bodies? A vitamin is a molecule that our bodies needs to carry out certain biological functions. With only a few exceptions, the body has no way to create vitamin molecules itself, so these vital building blocks must come in through food that we eat. The human body is known to need at least 13 different vitamins. We are able to store some of these for long periods of time in fat cells or in the liver -- such as vitamin A -- but most vitamins need to be replenished frequently.

Vitamins don't supply us with energy. We need protein, carbohydrates, and fats for that. What vitamins do is to help the carbohydrates, fats, and proteins release energy. These vital compounds are very important and they are required for all sorts of complex chemical reactions in our bodies. Vitamins are also needed to assist the enzymes that repair tissue and help with the production of cells. Many studies show that vitamins and minerals can help or prevent some of the disorders or diseases related to aging.

There are two types of vitamins -- water soluble and fat soluble. Water soluble vitamins are not stored in our bodies. They pass through our bodies quickly. In order to keep these nutrients in our bodies we have to consume them frequently. Water soluble vitamins contribute to our health, energy and stamina. This type of vitamin also helps in the function of over one hundred enzymes and chemical reactions that give our bodies energy. Listed below are some of the well known water soluble vitamins and their benefits.

•Vitamin B5 – good for reducing swelling
•Vitamin B3 – reduces tissue swelling and helps increase blood flow.
•Vitamin B6 – also reduces swelling. When combined with vitamin B12 in proper concentration has shown to reduce heart disease.
•Vitamin B12 – This is the most vital of the B's. It aids in the formation of cells, myelin production, healthy nerves, and maintaining immune system and mental function.
•Vitamin C – Vitamin C helps in the formation of cartilage and bone. Some studies have shown it may reduce the progression of osteoarthritis.
Fat soluble vitamins are vitamins that stay in the body and are typically stored in the liver. You can usually receive enough of these compounds by eating a well balanced diet. Any condition that can interfere with the absorption of fat in the body like tuberculosis, cystic fibrosis, hypothyroidism, lactose intolerance, and many other diseases or disorders can cause deficiencies in these vitamins. Before taking the daily recommended dose of fat soluble vitamins you must consult your doctor. Overdosage of these substances can cause a toxic build-up in your body.
Listed below are the major fat soluble vitamins.

•Vitamin A – Lungs, throat and mouth depend on vitamin A to retain moisture. This compound is also important for your skin, bones, teeth, digestive system, urinary tract, eyes and aids in preventing skin disorders like acne, boils, and bumpy skin. Some studies show that it may aid in slowing the aging process.
•Vitamin K – plays an important role in the clotting of blood. Research has linked vitamin K to bone health.
•Vitamin D – is produced in the skin by exposure to the sun. Deficiencies mostly occur in people living in northern latitudes where daylight is brief during winter months. Changes in skin as we age can also cause poor production of vitamin D. Studies show that osteoporosis might progress faster in women with low levels of vitamin D. This compound is essential in helping the body absorb make that lowercase and maintaining strong bones.

Minerals
Unlike vitamins, minerals are not manufactured by plants or animals. Minerals form in the earth, and are absorbed by plants and found in animals that eat the plants. Listed below are some of the essential minerals needed to maintain a healthy body.

Iron – helps carry oxygen throughout the body. Iron also helps the immune system ward off foreign entities.
Calcium – Most women as they get older need calcium supplements to prevent bone loss that causes osteoporosis. Calcium supplements will not do you any good if you do not have the right levels of vitamin D. your body cannot absorb calcium without vitamin D.
Zinc – Zinc deficiencies can affect skin, nerves, and the body’s immune system.

It is important that you take vitamin and mineral supplements with food. Fat soluble vitamins require fat ingestion to result in the best absorption. It is best to take your supplements at the biggest meal of the day.

We use vitamins every day to support the processes our bodies use to maintain life. Ongoing reduced levels of vitamins can make you weak and more vulnerable to disease. Proper nutrition with vitamins and minerals is vital for seniors to maintain a healthy lifestyle. Other health issues related to aging are discussed on the National Care Planning Council website at www.longtermcarelink.net.

The Missouri Care Planning Council is a member of the National Care Planning Council. This "Planning For Eldercare" Article was published by the National Care Planning Council on April 7, 2010. For more information on the Missouri Care Planning Council, please visit www.mocpc.org or call 314-822-8389.

Employer Support for Care Giving Employees

2011-04-11T09:15:00.000-07:00

“There are only four kinds of people in this world. Those who have been caregivers, those who are caregivers, those who will be caregivers, and those who will need caregivers.” Rosalynn Carter, Former First Lady

The U.S. Department of Labor estimates that in the year 2010, 54% of workforce employees will provide eldercare for a parent or parents and that nearly two-thirds of caregivers will experience conflict between demands at home and demands from employers.

Today’s employed Baby Boomers are the caregiver generation for their parents. They are finding themselves juggling care responsibilities around their employment obligations. Sometimes employees find they have no option but to take leave from work or use sick time to meet their caregiving demands.

Employers also feel the toll it is taking on their employees. A report by the AARP describes the cost to employers:

“Companies are also seeing the emotional and physical toll that caregiving takes on their workers. In one study, 75% of employees caring for adults reported negative health consequences, including depression, stress, panic attacks, headaches, loss of energy and sleep, weight loss, and physical pain. Businesses suffer, too, by having to pay high health insurance costs and in lost productivity. That doesn’t count the promotions or assignments workers turn down that require travel or relocation away from aging relatives."

Businesses that don’t offer benefits or address eldercare wind up paying for them. A recent study by the MetLife Market Mature Institute and the National Alliance for Caregiving states that U.S. companies pay between $17.1 billion and $33.6 billion annually, depending on the level of caregiving involved, on lost productivity. That equals $2,110 for every full-time worker who cares for an adult.

Eldercare cost businesses:

•$6.6 billion to replace employees (9% left work either to take early retirement or quit)
•Nearly $7 billion in workday interruptions (coming in late, leaving early, taking time off during the day, or spending work time on eldercare matters)
•$4.3 billion in absenteeism" AARP

Typically, human resource departments work with employees on many issues that may affect their work productivity. There are programs for drug and alcohol abuse, domestic violence, illness, absenteeism and child care; but, help with eldercare issues is not normally provided.

The AARP report follows several companies who are providing help with eldercare issues and what they are doing for their employees.

•“Freddie Mac has a free eldercare consultant and access to subsidized aides for a relative up to 20 days.
•Verizon Wireless offers seminars on eldercare issues and allows full-time workers 80 hours a year in back-up care, 40 hours for part-time, and $4/hour for in-home help.
•At the Atlanta law firm Alston & Bird LLP, workers can donate vacation time to colleagues who have used up theirs to care for family members. “ AARP
A growing number of companies nationwide are directing their HR departments to provide resources, education and group help for caregiving issues by:

•Providing materials from community resources such as phone numbers to their local Senior Centers or Area Agencies on Aging.
•Making available brochures and booklets on specific programs and services by eldercare experts
•Providing speakers to educate employees on caregiving options
•Allowing options to use paid sick leave, employee job sharingand flexible hours
•Allowing employee caregivers to use business computers for caregiving research
•Contracting with companies who provide eldercare services to help employees
Eldercare service providers are also reaching out to help employee caregivers by providing informational presentations at the work place during lunch time or other times set up by employers. One such presentation provided information on reverse mortgages. Jason, who had been trying to help his parents pay for home care, learned at a work site presentation that a reverse mortgage was one way to cover caregiver expenses.

The HR Department of a local business in Utah, invited the Salt Lake Eldercare Planning Council to present a “Brown bag, Lunch and Learn” during their employees' lunch hour. In 30 minutes time, those who attended learned how the services of a Care Manger, Home Care Provider, Elder Attorney, Medicaid Planner and Financial Consultant can help with caregiving decisions. Problems were discussed, questions answered and employees left armed with information and the names of professional people they knew could help them.

“This was the most productive lunch I have ever attended”, related Mary, one of the attendees.

“I had been very hesitant to contact an attorney to discuss my parents' estate, because of the cost involved. The attorney at our 'lunch and learn' answered my few basic questions which will allow me to prepare what I need before I meet with him to finalize my parents' estate planning.”

Besides workplace help for employers and employees dealing with caregiving, the internet is also a great research tool. The National Care Planning Council website at www.longtermcarelink.net is a comprehensive resource for eldercare, senior care and long term care planning. It contains hundreds of articles on all aspects of eldercare. Professional providers list their services on the NCPC website. Each of their listings provides unique information on specific eldercare services and how to obtain help.

Employers, employees and eldercare service providers working together can make parent or senior caregiving a workable solution for all.

The Missouri Care Planning Council is a member of the National Care Planning Council. This "Planning For Eldercare" Article was published by the National Care Planning Council on March 8, 2010. For more information on the Missouri Care Planning Council, please visit www.mocpc.org or call 314-822-8389.

Caring for Senior Veterans – VA Long Term Care Benefits

2011-04-08T08:00:00.000-07:00

In the month of February we celebrate Presidents Day in honor of two great United States Presidents; George Washington and Abraham Lincoln. Both were heroes of wars fought on U.S soil for freedom and unity of our great country.

The United States has fought many wars throughout the world since that time to keep freedom here at home and continues to do so. From the beginning our country has established a program to care for the men and women of our military who fought in those wars.

The veterans assistance program goes back to 1636 when Pilgrims of Plymouth Colony fought with the Pequot Indians. The Pilgrims enacted a law from English law that reads, “If any man shall be sent forth as a soldier and shall return maimed, he shall be maintained competently by the colony during his life.” In 1789 U. S. congress passed as law that pensions were to be provided to disabled veterans and their dependents and in 1811 the first domiciliary and medical facility for veterans was completed.

Since that time the Department of Veterans Affairs has opened a multitude of care facilities nationwide. An article from the US Department of Veterans Affairs website states:

“VA's health care system has grown from 54 hospitals in 1930 to 157 medical centers in 2005, with at least one in each state, Puerto Rico and the District of Columbia . More than 5.3 million people received care in VA health care facilities in 2005, a 29 percent increase over the 4.1 million treated just four years earlier.
VA operates more than 1,300 sites of care including nearly 900 ambulatory care and community-based outpatient clinics, 136 nursing homes, 43 residential rehabilitation treatment programs, nearly 90 comprehensive home-care programs, and more than 200 Veterans Centers.”

State veterans homes have been built or are approved for future construction in many states. For a list of state veteran nursing homes go to http://www.longtermcarelink.net/ref_state_veterans_va_nursing_homes.htm#List

Here are some of the benefits provided for Veterans by the Department of Veterans Affairs:

•Health Care Clinics
•Mental Health
•Counseling
•Job training
•Burial and Memorial benefits
•Education
•VA Home Loan
•DIC
•Compensation
•Pension
•Care Management
•Home Renovation for Disability
•Assisted Living
•Prosthetics
•Rehabilitation
•Weight management
•Nursing Homes
•Prescriptions
•Hospitals
and much more

Thomas Day, founder and Director of the National Care Planning Council, has a deep gratitude for the services provided by the VA. He served as an Air Force pilot during Vietnam. Later he developed a crippling auto-immune disease. It was the doctors at the George A Wahlen VA Regional Medical Center who prescribed a new treatment that saved his life. Many of the VA programs continue to improve his life.

Tom is passionate about the Aid & Attendance Pension Benefit and the relief it brings to veterans and their families who need care services and ways to pay for it in their elder years.

“Aid and attendance" is a commonly used term for a little-known veterans’ disability income. The official title of this benefit is "Pension." The reason for using "aid and attendance" to refer to Pension is that many veterans or their single surviving spouses can become eligible if they have a regular need for the aid and attendance of a caregiver or if they are housebound. Evidence of this need for care must be certified by VA as a "rating." With a rating, certain veterans or their surviving spouses can now qualify for Pension. Pension is also available to low income veteran households without a rating, but it is a lesser dollar amount.

Pension is an underused benefit.

There are different income categories for Pension, but the highest could pay as much as $1,949 a month in disability income to a qualifying veteran household. A study commissioned by VA in 2001 estimated, over the next 14 years, only about 30% of eligible veterans would apply for Pension. This is likely due to the fact that most veterans simply don't know about it. In fact, about a third of all seniors in this country, age 65 and older, could become eligible for pension under the right circumstances. That's how many elderly war veterans or their surviving spouses there are.

To receive Pension, a veteran must have served on active duty, at least 90 days, with at least one of those days during a period of war. There must be a discharge under conditions other than dishonorable. Single surviving spouses of such veterans are also eligible. If younger than 65, the veteran must be totally disabled. If age 65 and older, there is no requirement for disability. There is no age or disability requirement for a single surviving spouse.

There are income requirements, but a special provision does allow household income to be reduced by 12 months worth of future, recurring medical expenses. Normally, income is only reduced by medical expenses incurred in the month of application. These allowable, annualized medical expenses are such things as insurance premiums, ongoing prescription drug costs, out-of-pocket cost of monthly medical equipment rental, the cost of home care, the cost of paying adult children to provide care, the cost of adult day services, the cost of assisted living and the cost of a nursing home facility. These are all considered medical costs and they can be deducted from income to receive this benefit.

According to Mr. Day,

"I talk to a number of people every day who are inquiring about this benefit. In many cases they don't know that the benefit can pay members of the family to take care of the veteran, the veteran couple or the surviving spouse at home. I have literally had people who are sacrificing dearly to take care of their loved ones at home, break down and cry when they find they can receive some money from the government for that sacrifice."

Thomas Day has written two books for the National Care Planning Council to educate and help veterans obtain this long term care benefit. The first, “How to apply for the Aid & Attendance Pension Benefit” is to educate the public what the benefit is and how to get it. The claims process for pension is described and information is provided to help understand what documentation is necessary to provide evidence of recurring medical expenses. All forms necessary for filing a claim are included in the form support section of the book. Here is a link to the book. http://www.longtermcarelink.net/a16Veterans_standard_book.htm

Although this is a do-it-yourself book, Tom recommends if you have excessive assets and income or are not sure how to apply medical deductions, use the services of a qualified consultant.

The second book, “Aid & Attendance Handbook for Professionals & Consultants,” is for the professional consultant. It is 782 pages of rules, forms, instruction on the submission process and Medicaid planning strategies as well as software for calculating income, benefit and medical expenses. Here is a link to that book. http://www.veteranbook.com

The secret for receiving a successful award for aid and attendance or housebound ratings is not in filling out the form but in knowing what documents and evidence must be submitted with the application. Knowing the secrets for a successful award -- with the special case of long term care recipients -- is 95% of the battle. Even though the form is challenging, filling out and filing a claim is a formality.

A knowledgeable consultant can provide information to shorten VA’s decision window of 6 to 12 months to possibly 3 or 4 months. The consultant also understands how to maximize the benefit or avoid a denial. The consultant can also provide guidance for meeting the asset test. Finally, the consultant can provide the actual strategies for reallocating assets and he or she can arrange for trusts or income conversions to allow for the best possible accommodation of assets for beneficiaries thus avoiding or reducing taxes, family disputes and Medicaid penalties.

“I would like to see every eligible veteran obtain the Aid & Attendance Pension Benefit for their long term care needs.” Thomas Day, Director, National Care Planning Council.

To see if your loved one qualifies for Aid & Attendance, contact Missouri Care Planning Council Member American Veterans Care Coordination at 1-866-910-AVCC or visit their website at www.homecareforveterans.com

The Missouri Care Planning Council is a member of the National Care Planning Council. This "Planning For Eldercare" Article was published by the National Care Planning Council on February 7, 2010. For more information on the Missouri Care Planning Council, please visit www.mocpc.org or call 314-822-8389.

Elder Law Attorneys Specialize in Helping the Elderly

2011-04-07T08:49:00.000-07:00

Many elderly persons rely entirely on their children, family members or other trusted individuals to help them. This dependence upon caregivers or family members makes an older person more vulnerable to abuse and financial exploitation. Legal arrangements and protective actions by family may be necessary to shield loved ones from making bad decisions or from being taken advantage of.

Though you wouldn’t think a child could take advantage of his or her mother or father, there is no way to know what someone will do who is desperate for money or who feels entitled to an inheritance. For example:

David’s parents' health was failing and living alone in their home was becoming a concern. His sister Jill wanted to look into assisted living for them. David immediately became upset at Jill for wanting to spend their money. He packed up his parents and brought them to his home. Being single and working, he was not available to them during the day, but left food and water on the table to sustain them until he returned home in the evening. Jill lived over 300 miles from David and when she could get to his house to visit; she found her parents' care was not acceptable. They could not remember if they took their medications or if they had even eaten a meal that day. David was also draining their savings account and when confronted about it, became angry and complained that he needed their money to pay expenses for their care. Clearly Jill felt her brother's care of their parents was abusive, but David’s defense was he provided a home for his parents in which he could care for them. This family needs a professional advisor to help them understand and clarify the issues concerning their parents' care.

Making legal decisions about property, finances, power of attorney, and final wishes are important tasks to complete for the final years of life. Having legal documentation for a will, for medical treatment and for the person designated to be responsible for parents' welfare can avoid family disputes and financial abuse, and help to conserve assets that are needed for care.

Elder law attorneys specialize in legal issues affecting the elderly. They are knowledgeable about Medicare and Medicaid programs. They work with the elderly in assisting them and their families with all aspects of estate planning and implementing necessary legal documents for the final years of life. In addition, they help individuals to apply for and possibly accelerate coverage from Medicaid. An elder law attorney can also help with disputes with Medicaid. Below is a partial list of what an elder law attorney might do:

•Preservation or transfer of assets seeking to avoid spousal impoverishment when a spouse enters a nursing home
•Medicaid qualification and application and Medicaid planning strategies
•Medicare claims and appeals
•Veterans Benefits claims
•Social security and disability claims and appeals
•Disability planning, including use of durable powers of attorney, living trusts and living wills
•Help with financial management and health care decisions; and other means of delegating management and decision-making to another in case of incompetence or incapacity
Probate
•Administration and management of trusts and estates
•Long term care placements in nursing homes and assisted living
•Nursing home issues with patients’ rights and nursing home quality
•Elder abuse and fraud recovery cases
A Certified Elder Law Attorney (CELA) is an elder law attorney who is highly proficient in meeting the legal needs of elders and in understanding and applying the rules of Medicaid. A CELA has successfully handled a requisite number of pertinent cases in order to receive that designation. This experience will make an attorney with this designation more competent with elder planning issues than other attorneys lacking this designation.

Most elder law attorneys do not specialize in all of the areas iterated above. When considering an attorney you will want to find one who has experience in the area you need help.

According to The National Academy of Elder Law Attorneys -- http://www.naela.org/:

“Ask lots of questions before selecting an elder law attorney. You don't want to end up in the office of an attorney who can't help you. Start with the initial phone call. It is not unusual to speak only to a secretary, receptionist or office manager during an initial call or before actually meeting with the attorney. If so, ask this person your questions.

•How long has the attorney been in practice?
•Does his/her practice emphasize a particular area of law?
•How long has he/she been in this field?
•What percentage of his/her practice is devoted to elder law?
•Is there a fee for the first consultation and if so, how much is it?
•Given the nature of your problem, what information should you bring with you to the initial consultation?"
A good way to choose an attorney is by referral from friends, family, clergy or other associations. Before you meet for your initial consultation, prepare the items you want discussed and taken care of. Bring pertinent documents and questions. Be sure you get clear answers and that you understand what your attorney is proposing.

Two-way communication is the best way your attorney can understand your needs and concerns. Does the attorney listen to what you say, appear to really care about your concerns or return your phone calls? If not find another attorney. Most Elder law Attorneys sincerely want to help make you or your parent's elder years a well planned for, peaceful experience for all involved.

There are a number of ways attorneys charge for their services. They may charge a flat hourly rate. Or they may charge hourly for some services and add on additional expense for out-of-pocket costs such as paperwork, stamps, phone calls, etc. Or they may charge a single fee for a mutually agreed-upon course of action or plan. Some attorneys who specialize in appeals for veterans benefits or Social Security may work on a contingency basis. It is important to understand how you will be billed so there will be no surprises in the end.

The National Care Planning Council lists elder law attorneys throughout the United States.
If you are in the St. Louis, MO area visit Purcell & Amen, L.L.C.'s website www.yourestatematters.com and call 314-966-8077 to schedule a FREE consultation to discuss your situation.
To find someone in your area go to http://www.longtermcarelink.net/a2cfindattorney.htm

The Missouri Care Planning Council is a member of the National Care Planning Council. This "Planning For Eldercare" Article was published by the National Care Planning Council on January 11, 2010. For more information on the Missouri Care Planning Council, please visit www.mocpc.org or call 314-822-8389.

Who Was Supposed To Be Watching Grandma?

2011-04-01T07:45:00.000-07:00

There is a popular tune played this time of year called “Grandma Got Run Over by A Reindeer” which relates that Grandma -- after drinking too much eggnog -- went out into the winter cold to get her medication and was run over by a reindeer. The question is, “Who was supposed to be watching Grandma?”

Though this little tune is just for fun, it may very well raise alarms to many caregivers of the elderly. Caregivers know that even at a holiday party they cannot let down their diligent watch over their elderly loved one. As far-fetched as it may sound, with all the people and noise, an elderly family member with dementia or Alzheimer’s may be enjoying the family gathering and then suddenly become confused and walk to the door and leave.

For family caregivers the added stress of the holidays with decorating, shopping, parties and keeping up with all the family traditions is an overwhelming quest. Feelings of isolation, depression and sadness come with this added stress. There are millions of Americans who are caring for elderly frail loved ones and most of these caregivers will go through some of these emotions, especially this time of year.

There are some things you can do as a caregiver to help you and those you care for enjoy the holiday season.

First take care of yourself. Try to eat right, get plenty of sleep and exercise. This will help reduce stress and strengthen your ability to cope with caregiving responsibilities.

Prioritize your holiday traditions. Perhaps instead of cooking a large family dinner, have everyone bring his or her favorite dish. Use paper plates. Forfeit the traditional outside light decorating for a lighted wreath on the front door. Choose one or two parties or concerts to attend instead of trying to do it all.

Arrange for help. Call on other family members to help with the caregiving while you do your shopping or go out for the evening. If family is not available, ask your church group or a neighbor if they would donate a few hours.

Use community services. Many senior centers provide meals for the elderly and supervised activities, onsite, at no charge or a minimal charge. For locating senior services in your state, call your state Area Agency on Aging or check the national locator website at http://www.n4a.org/

Use adult day care services. Some assisted living facilities provide day activities and meals for seniors on a day by day basis. Other organizations called "adult day service providers" specialize exclusively in this sort of care support at a reasonable cost. These support services provide respite for caregivers from their care giving responsibilities as well as social interaction for their elderly family members. There is a cost for adult day services, but the benefit for all is worth it.

For example:

Jean had brought her mother into her home to care for her when mom's Alzheimer’s made it impossible for her to be alone. When the Christmas season approached, Jean realized she had to make some choices. She did not want to give up the traditions she had set with her daughters in shopping and lunches, but it wouldn’t be possible with her caregiving responsibilities. In searching for a solution, Jean visited an adult day services facility near her home. She found she could schedule the days she needed off for her mother to come in. The adult day services company also provided transportation and would pick up mom and bring her home in the evening.

Although Jean's mother was not sure she would like to go at first, she found she enjoyed the programs, meals and conversation with new friends and the activities provided.

The time it gave Jean to have for herself was worth the extra cost for the day care.

Technology to the rescue. Here is a solution that would have kept “Grandma” from going out in the winter cold and getting run over by a reindeer. Companies that have created monitoring systems, security alarms and other safety equipment are “tweaking” them to adapt to the needs of seniors and their care givers.

Here are a few examples:

•Ankle or wrist bands that monitor location and alert the provider when a person has gone beyond the designated perimeter, such as out the front door of the house.
•Motion detectors. Set throughout the home, motion detectors allow someone outside the home to follow a senior as he or she moves through the house.
•Smart medication dispensers. Live monitoring and dispensing of pills.
•Emergency response alert. At a touch of a button on a desktop monitor, bracelet or necklace, emergency help is summoned.
Whether providing care in your home or helping senior family members in their own homes, your use of monitoring and “tech” help aids can provide you extra safety, and peace of mind.

You are not alone. Join a caregiving help group. Your local senior center may have one or go on the internet to find one. Hearing about other caregivers' problems and solutions and being able to share your own and ask questions is a great way to relieve stress and gain a new perspective. Check out websites like the National Family Caregivers Association at http://www.nfcacares.org/

Work with a Senior Care Professional. Recognize that you are doing the very best you know how. You are not a geriatric health care practitioner, geriatric care manager, home care nurse or aide, hospice provider or family mediation counselor, nor do you have the years of training and experience these professionals have, but you can definitely use their experience. In fact, using a senior care specialist will make caregiving easier for you and more beneficial for your elderly family member.

As an example:

Mark stopped by his father Dan’s home every night after work to help with any errands or things he needed around the house. He began to notice that Dan was not showering, dressing or even fixing meals some days. Another concern was his father's growing confusion and disorientation. A trip to the family doctor only brought more concern to Mark, since the doctor claimed it was just the aging process that caused the confusion.

Wanting a second professional opinion on what was best for his father, Mark hired Shelly -- a Professional Geriatric Care Manger -- to do an assessment. Shelly arranged for Mark and Dan to see a geriatrician, who advised that proper meals and an increase in some vitamins, would help clear up the confusion and disorientation. Shelly arranged for a home care company to come in daily to help with personal needs and prepare meals.

Soon Dan was back to his old self and able to function on his own.

You can find a wide variety of care professionals in your area on the National Care Planning Council website at www.longtermcarelink.net.

One more thing to remember. As a family caregiver, the greatest gift you are giving this holiday season is “Love.”

To learn more about this benefit go to http://www.veteransaidbenefit.org/
The Missouri Care Planning Council is a member of the National Care Planning Council. This "Planning For Eldercare" Article was published by the National Care Planning Council on December 9, 2009. For more information on the Missouri Care Planning Council, please visit www.mocpc.org or call 314-822-8389.

Long Term Care for Senior Veterans

2011-03-31T07:41:00.000-07:00

In the year 1919 President Woodrow Wilson proclaimed November 11 as Armistice Day to honor those Veterans who served during World War I. On November 11, 1954, Armistice Day was proclaimed a legal national holiday and the name was changed to "Veterans Day" to honor all veterans of all wars.

Every November 11, ceremonies are held throughout the United States honoring Veterans of wars. A National Ceremony is held at Arlington Cemetery at the Tomb of the Unknown Soldier, where the laying of the presidential wreath and military playing of “Taps” is presented.
Since its establishment in 1930, the Department of Veterans Affairs has evolved to supporting and aiding the nation’s veterans in numerous ways. One of these services for example, the Veterans Health Administration, is the largest single provider of medical care in the United States. Its 22 regions with 154 hospitals and their associated 875 outpatient clinics offer the following services.

Hospital, outpatient medical, dental, pharmacy and prosthetic services
Domiciliary, nursing home, and community-based residential care
Sexual trauma counseling
Specialized health care for women veterans
Health and rehabilitation programs for homeless veterans
Readjustment counseling
Alcohol and drug dependency treatment
Medical evaluation for disorders associated with military service in the Gulf War, or Treatment for exposure to Agent Orange, radiation, and other environmental hazards
HISA grants
Other special benefits

The Department of Veterans Affairs provides three types of long term care services for veterans.

The first are health care benefits provided to veterans who have service-connected disabilities, who are receiving VA Pension or who are considered low income. These services include free medical care, possible free prescription drugs, orthotics and prosthetics, home renovation grants for disabilities, home care, assisted living, domiciliary care, nursing home care, and a possible host of other services or benefits.

The second benefit is state veterans homes. The majority of these homes offer nursing care but some may offer assisted living or domiciliary care. The Department of Veterans Affairs in conjunction with the states helps build and support state veterans homes. Money is provided to help with construction and a federal subsidy of $72.71 a day is provided for each veteran using state veterans nursing home services. These homes are generally available for most veterans and sometimes their spouses and in some cases for so-called "Goldstar parents." Veterans homes are run by the states, sometimes with the help of contract management. There may be waiting lists in some states.

The third benefit for veterans is disability income programs. The most familiar of these benefits is an income for service-connected disabled veterans called "Compensation." The least known of these is a program officially called "Pension" but popularly known as the "aid and attendance benefit."

•All active-duty veterans who served at least 90 days during a period of war are eligible for Pension and the additional income from aid and attendance or housebound allowances. A single surviving spouse of such a veteran is also eligible.
•All qualifying veteran applicants over the age of 65 are eligible for pension but must meet income and asset tests. Applicants under the age of 65 must in addition be totally disabled to qualify. Disability does not have to be service-connected.
•A surviving spouse can be any age and there is no need for disability.
The aid and attendance benefit can pay additional income to provide for the costs associated with home care, assisted living, nursing homes, adult day care and other unreimbursed medical expenses. It can also pay for a family member other than a spouse to be the care giver. The amount of payment varies with the type of care, recipient income and the marital status of the recipient. Here are some examples of how this benefit can help veterans.

Example #1
The National Care Planning Council receives many calls from family members of veterans, asking if there is any help available to them. One such call came from a woman who had been juggling her job and caring for her father in her home for over five years. She had just lost her job and with no income, did not know how she would keep her home or give her father the care he needed. She read an article that had been written by the National Care Planning Council and published in her local newspaper and called their phone number. The article mentioned that a member of the family -- not including a spouse -- can be paid through VA to provide care for a loved one at home who is either a war veteran or the surviving spouse of a war veteran. Her father is a war veteran. When told that she could get an additional $1,644 a month through her father by providing her father's care she was shocked. She was also extremely grateful and ended up sobbing into tears over the phone when she found out about the benefit and realized it would help her keep her home and her father may probably get a check for her retroactive previous care from VA worth tens of thousands of dollars.

Example #2
Another recent caller’s mother is 89 years old and has been in assisted living for four years. As a widow of a veteran she did not qualify for the Aid & Attendance Pension 4 years ago because her assets were too high. In the meantime she has been using up her assets along with her income to pay for the assisted living. The local veterans service office has not been helpful in getting this claim approved even though she had reached the allowable asset limit over two years ago. The family was considering putting her in a less desirable facility under Medicaid. The family knew this would be devastating for their mother. Her health was still good and she had many friends and comforts at the assisted living.

The National Care Planning Council directed the caller and his family to a more cooperative veterans service office that will submit the claim and likely get it approved retroactively so that this woman can get a check for roughly $40,000 worth of previous care costs for which she was not reimbursed. In addition, she will likely get the full benefit of $1,056 a month to help pay the cost of the assisted living where she is happy.

These types of claims require medical evidence in order to receive a rating for aid and attendance or housebound allowances. These ratings must be received or certain non-medical expenses associated with long term care are not deductible from income. Special rules also allow for deducting the annual anticipated cost of month-to-month long term care from household income in order to meet the income test. This special treatment requires special documentation and evidence. In addition, those households with substantial assets will be denied for a Pension income unless those assets are below a certain level determined for each case by VA. The personal residence, personal vehicles and personal property are exempted from this asset test. Finally, evidence must be supplied every year in January that the anticipated costs for the previous year were actually incurred or VA will likely demand for its money back.
The National Care Planning Council has compiled the necessary forms, rules and information about claims together in one book titled “How to Apply for the Veterans Aid & Attendance Pension Benefit.”

This book contains information about how a typical applicant receives a successful pension award. VA often tells callers to go ahead and fill out the application but generally provides no information on the special treatment of annualization of anticipated recurring medical costs. The claims form also contains no information on this important issue. One simply has to know how to do it. This crucial information can make the difference between a successful award and being declined. All necessary forms for filing a claim are in the book.

Veterans who have substantial assets may need to do some estate planning and realigning of assets to qualify. An expert in this area should be sought to help with the application in order to avoid lengthy delays in awarding a benefit or a possible denial of benefits. For a list of individuals or companies in your area who understand how to get this benefit go to http://www.longtermcarelink.net/ref_veterans_consultants.htm

To learn more about this benefit go to http://www.veteransaidbenefit.org/
The Missouri Care Planning Council is a member of the National Care Planning Council. This "Planning For Eldercare" Article was published by the National Care Planning Council on November 11, 2009. For more information on the Missouri Care Planning Council, please visit www.mocpc.org or call 314-822-8389.

Planning for Your Elder Years

2011-03-30T07:35:00.000-07:00

If we were to ask an older person what his or her most important concerns for aging are, we would probably get a variety of different answers. According to surveys frequently conducted among the elderly, the most likely answers we would receive would include the following three principal concerns or life wishes:

1. Remaining independent in the home without intervention
from others

2. Maintaining good health and receiving adequate health care

3. Having enough money for everyday needs and not outliving
assets and income

To address these concerns or wishes and maintain the quality of life wanted in the elder years, it simply takes a little preplanning.

Few people do this kind of planning.

It is human nature not to worry about an event until it happens. We may prepare financially for unexpected financial disasters by covering our homes, automobiles and health with insurance policies.

However, no other life event can be as devastating to an elderly person’s lifestyle, finances and security as needing long term care. It drastically alters or completely eliminates the three principal lifestyle wishes listed above.

The majority of the American public does not plan for this crisis of needing eldercare. The lack of planning also has an adverse effect on the older person's family, with sacrifices made in time, money, and family lifestyles.

Because of changing demographics and potential changes in government funding, the current generation needs to plan for long term care before the elder years are upon them.

Let us look at some facts.

•The population of the "very old,"--older than age 85--is the
fastest growing group in America. This population is at
highest risk for needing care. (Statistical abstract of the United States,
2008, population)
•Medical science is preventing early sudden deaths, which
means living longer with impaired health and greater risk of
needing long term care.
•The Alzheimer's Association estimates the risk of
Alzheimer's or dementia beyond age 85 to be about 46% of
that population.
•It is estimated that 6 out of 10 people will need long term
care sometime during their lifetime.
•Children are moving far away from parents or parents move
away during retirement making long distance care giving
difficult or impossible.
•Government programs--already stretched thin for long term
care services--will experience even greater stress on
available funds in the future.
One of the important things for planning is how to maintain your lifestyle as you age. You may be healthy enough to stay in your own home with help provided for the following activities of daily living:

maintaining a home,
providing meals,
supervision,
companionship,
transportation and
shopping services.

This type of care at home is non-medical and must be provided free of charge by family, friends, or volunteers or the care must be paid for out-of-pocket by the family.

Government programs, in most cases, will not pay for this kind of care. It is estimated that 80% of all long term care is non-medical, with 90% of that care provided in the home. It is most likely that your long term care will begin with home care.

It is wise to plan now how you will pay for care when it is needed. In evaluating your future income you may find it necessary to add some resources such as long term care Insurance to pay for assisted living or nursing home costs. Long term care insurance must be purchased while you are younger and healthy. Failing health, stroke or other aging issues will not allow you to qualify for this insurance.

A reverse mortgage will also help pay for home care if staying in your home is an option.

Consider where you may want to live in your elder years. Many assisted living facilities offer complete care alternatives with a nursing home wing if needed. Senior retirement communities also offer many amenities with some including home care options.

Now is the time to do estate planning. A professional estate planner will give you direction on how best to protect your assets for future needs and for Medicaid planning.

Do your paper work. Now is the time to create your trusts, will, medical directives in a living will and any other documents you want noted for future use. Gather Insurance policies and bank records where they can be found by family members in case you are not able to get them yourself.

We don’t like to think of our elder years in terms of health problems, but a sudden stroke, heart failure or onset of dementia could make it impossible to carry out our own wishes if preparation was not made ahead of time.

The process of long term care planning involves the following four
principles:

1. Knowledge and preparation are the keys to success.
2. Having funds to pay for care expands the choices for care
settings and providers.
3. Using professional help relieves stress, reduces conflict, and
saves time and money.
4. Success is assured through a written plan accepted by all
parties involved.

(The above excerpt is quoted from "The 4 Steps of Long Term Care Planning," National Care Planning Council)

The National Care Planning Council' s website -- www.longtermcarelink.net -- provides over 700 pages of information for long term care planning and lists services of professional care providers in estate planning, long term care insurance, reverse mortgage, home care and many other important long term care services.

The National Care Planning Council' s book, “The 4 Steps of Long Term Care Planning,” provides information on what Medicaid and Medicare will cover as well as an overview of professional long term care service providers and how their services can help you create and execute your long term care plan. A check list of what to do to create a plan and forms for creating necessary paperwork are also included in the book.

The Missouri Care Planning Council is a member of the National Care Planning Council. This "Planning For Eldercare" Article was published by the National Care Planning Council on October 13, 2009. For more information on the Missouri Care Planning Council, please visit www.mocpc.org or call 314-822-8389.

Medication Problems and the Elderly

2011-03-29T08:03:00.000-07:00

At 83 years old, Martha still lived in her own home, and enjoyed working in her garden and canning peaches. It was becoming harder to motivate herself, to get up in the mornings and accomplish the day's tasks. She confided to her daughter that she felt anxious and tired. Her daughter, who was taking medication for her anxiety, took Martha to her own doctor, not Martha's and got her a prescription for Valium. In doing so, the daughter's doctor, who had never seen Martha and who did not have her medical history, was only aware of a few medications they told him she was taking.

Martha, in fact, was taking 9 different medications as well as herbal supplements.

The addition of Valium to her existing list of prescribed drugs sent her to the emergency room with respiratory distress. If she had gone to her own doctor, he would have found that a dosage adjustment of her current medications would have solved her anxiety.

Medication errors are common in the elderly. Many seniors take on average 6- 8 different prescriptions as well as over the counter drugs. Many times the elderly will not go back to their doctor to have their dosage evaluated and changed if necessary. Family members should be aware, that elderly parents may tend to take the family's advice over going to their own doctor. Even though children want to help increase the health and stamina of their parents, they may in fact be causing damage by misdirecting their loved ones.

Where a younger person can benefit from herbal supplements like Ginkgo Biloba, Saw Palmetto and others, in older people, these herbals may cause adverse reactions with their prescription medications.

In 2003, a panel of experts put together a list of potential medications that would not be appropriate to give to seniors. This is called the “ Beers List” after one of the research professionals.

Dr. Donna M Fick, R.N. one of the panel members for updating the “Beers List,” states in her article on Seniorjournal.com:

"Just as our bodies physically slow down as we age, changes occur in the way that older bodies handle pharmaceuticals, and this has motivated experts to develop a list of drugs that may be harmful to elderly patients.
"With age, drugs tend to build up in the body, and the distribution and elimination of drugs from the body changes as well," says Dr. Donna M. Fick, R.N., associate professor of nursing at Penn State. "Many drugs, like diazepam (Valium) and other anti-anxiety drugs build up fast."

An on-line article on HealthSquare.com, Titled "Drugs and the Elderly," talks about physical symptoms and medications.

“Among the first signs that a drug may not be working properly in an older person is a change in mood, energy, attitude, or memory. Too often, these alterations are overlooked, ignored, or chalked off to "old age" or senility. Older people may themselves feel that their blue mood is caused by something external such as the death of a friend or simply by boredom. Nothing could be farther from the truth. Virtually every heart medication, blood pressure drug, sleeping pill, and tranquilizer has been known to trigger depressive symptoms.

When a psychological symptom appears in an older person, examine his or her medication or drug use first. Consider, too, factors like alcohol intake, poor nutrition, and hormone imbalance. And never dismiss the possibility that a real psychological problem has developed and may itself require medication.”

There are many things family members can do to help monitor medications for their elderly parents.

•Make a list of medicines prescribed and all supplements being taken.
•Give this list to the doctor and pharmacist and have one on hand for emergencies.
•Use the same Pharmacy to fill all prescriptions. Pharmacies keep a record of your prescribed drugs and will verify your doctor's instructions. They will also tell you if foods or over the counter supplements will interact with a prescription.
•Dispense pills in a daily pill organizer box.
•Have a family member be responsible to call or physically monitor the taking of medication

Family members who live long distances from their elders have available to them new technology in medication monitoring.

•Alarms for pill boxes, watch alarms, medical alarm bands and necklaces that ring a reminder.
•Computerized pill box dispensers that ring a designated number if the pills have not been taken.
•Home Telehealth -
“Technology has developed computer and computer cameras to help the elderly in their homes stay safe and healthy. Home telehealth-set up by medical professionals in the home--enables providers to monitor such things as medications and blood pressure and actually see the patient. Patient questions are answered and advice is given, while the monitoring nurse views through the video phone how his or her patient looks physically.” The 4 Steps of Long Term Care Planning, Pg 92

•Home Care Agencies – Home care companies offer a variety of service options in helping families care for and properly dispense medication to their elder parents.
Find a home care agency in your area http://www.longtermcarelink.net/a7homecare.htm
Overmedication or taking medication incorrectly may lead to early mental confusion and decline in health in seniors. “If medication problems were ranked as a disease in cause of death it would be the 5th leading cause in the United States”. (from article on LongTermLiving)

The Missouri Care Planning Council is a member of the National Care Planning Council. This "Planning For Eldercare" Article was published by the National Care Planning Council on September 9, 2009. For more information on the Missouri Care Planning Council, please visit www.mocpc.org or call 314-822-8389.

ONE STOP SHOPPING FOR ELDERCARE SERVICES

2011-03-28T07:44:00.000-07:00

A fast-growing generation of elderly people, needing care, is starting to put a great deal of pressure on caregiving family members. More and more we are seeing articles and books about the burden of long term care on families.

According to research By the National Care Planning Council, only about 16% of long-term care services are covered by the government. The other 84% are provided free of charge by family caregivers or provided by services paid out-of-pocket by families or from those receiving care. And the bulk of government care services are provided only after a care recipient has depleted all of his or her savings. The Council also estimates that at any given time approximately 22% of the population over age 65 is receiving some form of long term care support. About 44.4 million adult caregivers provide 21 hours a week of care with 4.3 years average time spent providing care. “National Care Planning Council”

Dilemma of Finding Eldercare Services
The need for care usually occurs without warning, when a stroke, heart failure or other medical condition or illness incident to age suddenly happens to an aging senior. Family members end up in panic mode trying to understand and educate themselves on what needs to be done and what resources are available. If they need to take time from work to handle the crisis then it becomes urgent to find answers and solve caregiving needs. The need to balance work with urgent caregiving responsibilities creates untold stress on employed family caregivers.

Most family caregivers simply don't know where to turn for help and advice.
Long term care services are complicated and provider contacts are fragmented throughout the community. For the majority of Americans, eldercare becomes a frustrating do-it-yourself process. How do you find out what government services are available and what they will pay for? What legal documents are necessary and how do you protect assets? What type of home care or facility care is needed? Should you quit your job to become the caregiver? Will the government or insurance pay you for caregiving to help replace your lost income?

The question often arises as to whether to use long term care professionals or go it alone in arranging care and services.

“Using care professionals is the most cost effective and efficient way to provide help for a loved one. Hiring professional advisers or providers to help with long term care is no different than using professionals to help with other complex issues such as car repairs, dealing with taxes, dealing with legal problems, or needing trained employees to help run a business. With their education and training, long term care professionals also bring experience that only comes from dealing with countless hands- on caregiving challenges”. “The 4 Steps of Long Term Care Planning”

One Central Source for Locating Help and Advice
The National Care Planning Council recognizes the need for family caregivers to educate themselves and find the needed resources and professional help quickly.

To fill the need for caregivers nationwide, the National Care Planning Council web site "Long Term Care Link", was developed as a comprehensive resource for long term care planning. There are hundreds of pages containing articles on long term care covering all aspects of caregiving and care services. Books are also available on how to plan for long term care and how to apply for your veterans benefits for long term care. NCPC books

If you are looking for government and community resources, there are lists with applicable website links. Some of those lists include National and State Area Agency on Aging Services, Senior Centers and Veterans Service Offices.

There are over 100 links to websites filled with reference materials. For example; the Gerontological Society of America, National Nursing Home Survey, Elder Law Answers, Senior Corps.

Find Eldercare Professional Service Providers in Your Area
The National Care Planning Council lists eldercare specialists and advisers who help families deal with the crisis and burden of long term care. These specialists can be found under the services category lists like the ones below, on the website. Each professional is listed under the State and area in the State that he or she services. A caregiver can go to the National Care Planning Council website and find someone in the area of need and read about the services of the listed company, individual or facility. Website visitors needing help can then call, email or fill in a request form to receive contact from a listed provider.

Listing categories on the website include the following specific services.

•Care Management, Guardianship, Conservatorship and Dispute Resolution
•Non-Medical Home Care
•Home Health Agency – Medicare-Covered Home Care and Hospice
•Home Maintenance, Deep Cleaning, Remodeling and Yard Work
•Veterans Benefits -- Consultant for the Aid and Attendance Pension Benefit
•Geriatric Health Care Practitioner or House Call Doctor
•Reverse Mortgage Specialist
•Elder Law Advice and Medicaid Advice
•Estate Planning, Tax Planning, Trust Management Services and End-Of-Life Planning
•Care Facility or New Home Search, Relocation, Downsizing and Real Estate Services
•Adult Day Care Services
•Insurance Products, Retirement Planning and Financial Advice
•Funeral & Burial Preplanning

THE NATIONAL CARE PLANNING COUNCIL INTRODUCES
ITS STATE CARE PLANNING COUNCIL WEBSITES

A state care planning council is an informal statewide alliance of eldercare specialists and advisers that helps families deal with the crisis and burden of long term care. When you go to your state care planning website, your search for help is right in your neighborhood.

Purpose of the State Care Planning Council

1.Educate the public on the need for care planning before a crisis occurs.
2.Provide, under one source, a list of providers representing most of the available
3.government and private services for eldercare.
4.Offer a trusted team of providers and advisers that the public will recognize in their area and can turn to for expert help in dealing with the challenges of long term care.

One Stop Shopping for Eldercare Services
State Care Planning Council websites offer a closer-to-home option for finding help and services to solve caregiving problems. Many of the local service providers work together as a team to help meet specific eldercare needs of the individual.

For example:
Tim and Debra, both in their late 80’s, were adamant about staying in their home. Both were taking medications and were mobile with walkers. Their daughter, Julie was concerned about their safety in the home, especially with avoiding hazardous falls, bathing and preparing meals. Tim insisted he could drive his car, even though he was a hazard on the road. Julie had taken the car keys and therefore faced an argument every time she went to their home.

Lately, Julie noticed that the required medications were not being taken. Tim was a diabetic and required monitoring with his insulin and diet. Julie ordered “Meals on Wheels” which her mother quickly canceled. Frustrated at having no cooperation from her parents, Julie realized she needed outside help.

Checking the internet for resources in her area, she found the name of a Professional Care Manager in her area listed on her State Care Planning Council website. Jackie -- the professional care manager and family dispute professional -- had worked many times with families like Julie and her parents.

A meeting was arranged where all parties to the caregiving were involved. Tim expressed that he did not want to give up his freedom driving to the store or other places he liked to go. Jackie suggested selling the car and using the money to pay a taxi or community transit. She arranged for Tim to see a geriatric physician to get his diet under control for his diabetes. Some in-home help with bathing, meal preparation and medication reminders was arranged by having a local non-medical home care company come in daily. Jackie gave Julie explicit instructions on how to organize the house to help prevent falls. To pay for the extra expense, Jackie introduced a reverse mortgage broker who explained how their home equity-- on a risk-free basis --could provide the money they needed for their care.

Every service provider or adviser Jackie brought in worked side-by-side with her on the state care planning council. Jackie knew they could provide the needed help with expertise and integrity.

Julie found that using professionals gave her peace of mind and confidence that her parents' care was in good hands.

The State Care Planning councils are just starting to grow and be populated with professional service providers throughout the Untied States. Like the National, the State websites are filled with resource material and articles for the public use.

Locate a State Care Planning Council at http://www.longtermcarelink.net/a15state_councils.htm

The Missouri Care Planning Council is a member of the National Care Planning Council. This "Planning For Eldercare" Article was published by the National Care Planning Council on August 6, 2009. For more information on the Missouri Care Planning Council, please visit www.mocpc.org or call 314-822-8389.

Family Reunion--a Good Time for Family Planning

2011-03-25T07:44:00.000-07:00

Summertime brings a lot of family time. With family reunions, picnics, weddings and other events, long distant family members travel to gather together. It is also the perfect time to do some planning for the future. With parents aging and their health and lifestyles changing, children need to discuss some changes and decisions that will be needed in the near future. Parents should take the time to tell their children where important documents are kept and what their wishes are in the event of needing health care directives or experiencing long term care needs.

For those children who live away, the change they see in their parent's health and mental capacity may be alarming -- whereas siblings that have daily contact are working with these issues constantly. Here is the chance to compare notes and work together as a complete family in the long term care planning process.

For you parents who are well and active, this is a good time to hold a family meeting and share with your children your plan for long term care. Tell them where financial and legal documents are located. Review health care directives, living wills and long term care alternatives.

Experience has shown that even families that are close can quickly grow angry, jealous and hostile towards each other when an aging parent begins to need long term care. If a sibling moves into the parent's home, others can easily be suspicious of ulterior motives and fear losing their inheritance. On the other hand, the child providing the elder care becomes bitter and feels there is no support or help from siblings. Pre-need meetings for the purpose of making a plan, before eldercare becomes imminent, avoids these types of conflicts.

In its book, “The 4 Steps of Long Term Care Planning,” the National Care Planning Council provides guidelines and checklists for family planning meetings. Here's an excerpt from the book:

“The first step to holding a meeting, and perhaps the most difficult

one, is to get all interested persons together in one place at one time.

If it's a family gathering, perhaps a birthday, an anniversary or

another special event could be used as a way to get all to meet. Or

maybe even a special dinner might be an incentive.

The person conducting the meeting can be a parent or one person of

a couple who are doing their planning, years before the need for care

arises. A meeting on behalf of someone already receiving care or

needing care in the immediate future could be conducted by that

person or by a member of the family, by an adviser or a friend.

The agenda could be formal or informal. If you want a formal

agenda, we suggest using our care planning checklist as the agenda.

Copies of the care plan should be prepared prior to the meeting and

presented to those attending. Discussion is encouraged and we

recommend that the person in charge not dictate but encourage input

from everyone.

After a thorough discussion of the issues and the presentation of the

solutions to the problems that will be encountered, there should be a

consensus of all attending to support the plan. If the plan needs to

be altered to meet everyone's expectations then by all means do so if

that can be done. But it is not always possible to please everyone so

there must sometimes be compromise.

The end of the meeting should consist of asking everyone present to

make his or her commitment to support the plan.

GET IT IN WRITING! All good intentions seem to be forgotten

with time. It may be years after this meeting before the long term

care plan begins. If there are vocal commitments to help with

transportation to doctors, give respite to the caregiver or other

commitments, write them down on the care agreement. You can

even have each person put a signature to his or her commitment if

you think that is important.”

“The 4 Steps of Long Term Care Planning ,” by The National Care Planning Council

The U.S Department of Health and Human Services states:

“No one wants to think about a time when they might need long-term care. So planning ahead for this possibility often gets put off. Most people first learn about long-term care when they or a loved one need care. Then their options are often limited by lack of information, the immediate need for services, and insufficient resources to pay for preferred services. Planning ahead allows you to have more control over your future”.

http://www.longtermcare.gov

"Whether you plan a formal meeting with an agenda or informally gather for a discussion, when the family is together make it a point to start the long term care planning process.

There is a lot to learn and many decisions to make concerning finances, health issues and legal work. It may take research and a lot of time to put a plan together, but if everyone is involved it will work, and be worth it." National Care Planning Council, www.longtermcarelink.net

The Missouri Care Planning Council is a member of the National Care Planning Council. This "Planning For Eldercare" Article was published by the National Care Planning Council on July 9, 2009. For more information on the Missouri Care Planning Council, please visit www.mocpc.org or call 314-822-8389.

The Hidden Secret of Elder Abuse

2011-03-24T07:23:00.000-07:00

Many elderly people rely entirely on family or other trusted individuals to help them. Whether it is for physical needs or emotional needs, as people grow older they tend to need more and more help from others. This dependence on caregivers or family members makes an older person more vulnerable for abuse.

For example, an older person relying on her children to provide meals and transportation and help her with financial decisions finds it difficult to complain when one of her children takes advantage of her. If, for instance, the child takes her money, hits her or neglects her care, the parent may be threatened with loss of support from the child if the parent complains. The child may also use threats of violence to keep the parent in line.

It is estimated that 5% to 10% of elderly Americans are suffering abuse. According to the National Committee for the Prevention of Elder Abuse,

“Spiraling rates of elder mistreatment are reported by both practitioners and researchers. In a recent national study of Adult Protective Services (APS), typically the agency of first report concerning elder abuse, there were 253,421 reports of abuse of adults age 60+ or 832.6 reports for every 100,000 people over the age of 60 (Teaster, Dugar, Otto, Mendiondo, Abner, & Cecil, 2006). The National Elder Abuse Incidence Study (National Center on Elder Abuse, 1998) found that more than 500,000 persons aged 60+ were victims of domestic abuse and that an estimated 84% of incidents are not reported to authorities, denying victims the protection and support they need.”

Much attention has been focused on abuse in nursing homes but most of the elder abuse in this country is at the hands of family members or other caregivers in the home.

In 2004, Utah Adult Protective Services workers investigated approximately 2,400 allegations of abuse, neglect or exploitation of vulnerable adults. In Utah, a vulnerable adult is defined as an elder adult (65 years of age or older) or an adult (18 years of age or older) who has a mental or physical impairment, which substantially affects that person's ability to protect or provide for themselves. The majority of the victims were females between the ages of 60-89 and 60% of the perpetrators were family members/relatives, while 24% were non-related paid caregivers.

The protective needs identified were as follows:

•self-neglect 31%
•physical abuse 16%
•exploitation 19%
•caretaker neglect 12%
•emotional abuse 19%
•sexual abuse 3%

In conducting the investigations, it was not uncommon to find that adults who were self-neglecting were also being exploited or abused. As stated previously, these statistics are based on approximately 2,400 cases, thus, if only one in ten cases are ever reported, it is possible that there were actually 24,000 or more cases in Utah that year. We suspect 9 out of 10 is close to the actual ratio of unreported versus reported cases in Utah.

We also believe that Utah's lack of reporting elder abuse is not unlike other states in the country. We suspect all the states are experiencing close to the same ratios of underreporting as in Utah.

There are a number of reasons why incidents of abuse, neglect, or exploitation are not reported to Adult Protective Services or other authorities. One of the most common reasons is the victim's fear of losing support. Many of the perpetrators are family members and the victim fears that reporting the crime will result in removal of the caregiver, as the perpetrator may face incarceration or may discontinue relations with the victim once accused, charged, or convicted. Many of these victims fear that by reporting abuse they will be left alone and expected to care for themselves or they will be forced to live in a nursing home.

Many states have implemented mandatory reporting laws to assist in the prevention of abuse, neglect or exploitation of vulnerable adults. Utah is one of the many states to have a mandatory reporting law (U.C.A. § 76-5-111). Utah law states that any person who has reason to believe that a vulnerable adult has been the subject of abuse, neglect, or exploitation shall immediately notify Adult Protective Services or the nearest law enforcement agency. Anyone who makes the report in good faith is immune from civil liability in connection with the report; however, any person who willfully fails to report is guilty of a class B misdemeanor.

It is important to note that the anonymity of the person or persons making the initial report and any other persons involved in the subsequent investigation shall be preserved and may only be released in accordance with the rules of the division (U.C.A. § 62A-3-311). In addition, all investigation information is confidential.

The following is a list of indicators of abuse, neglect or exploitation. It is important to note that the following lists are merely indicators and may not always be violations.

Signs of Abuse:

•Unexplained bruises, welts, fractures, abrasions or lacerations
•Multiple bruises in various stages of healing
•Multiple/repeat injuries
•Low self-esteem or loss of self determination
•Withdrawn, passive
•Fearful
•Depressed, hopeless
•Soiled linen or clothing
•Social Isolation

Signs of Neglect/Self-Neglect:

•Dehydration
•Malnourishment
•Inappropriate or soiled clothing
•Odorous
•Over/under medicated
•Deserted, abandoned or unattended
•Lack of medical necessities or assistive devices
•Unclean environment
•Social Isolation

Signs of Exploitation:

•Missing/"disappearing" property
•Inadequate living environment
•Frequent/recent property title changes or will changes
•Excessive home repair bills
•Forced to sign over control of finances
•No/limited money for food, clothes and other amenities
Prevention can only occur if there is awareness, the statutes are adhered to, and any suspicions of abuse, neglect or exploitation of vulnerable adults are immediately reported to Adult Protective Services and/or law enforcement.

All states have agencies that receive complaints of abuse. In some states failure to report abuse of the elderly is a crime. To contact an abuse complaint department, call your local area agency on aging. To find an area agency on aging in your area go to http://www.longtermcarelink.net/eldercare/ref_state_aging_services.htm

The Missouri Care Planning Council is a member of the National Care Planning Council. This "Planning For Eldercare" Article was published by the National Care Planning Council on June 4, 2009. For more information on the Missouri Care Planning Council, please visit www.mocpc.org or call 314-822-8389.

Keeping Mom and Dad Safe at Home

2011-03-23T07:24:00.000-07:00

Generally, elderly parents want to remain living in their own home. However, remaining in the home becomes a concern when children see their parents slowing down, perhaps even having trouble with handling stairs and doing general daily activities. Yet, with parents' mental and physical health currently not creating problems, there seems to be no imminent need to search out support services or other accommodations for aging parents.

This is now the time to evaluate the home to make it safe and secure for your loved ones -- now and in the near future -- in anticipation of aging disabilities that may occur. Help and support are available. The nation as a whole is more aware of elderly needs and services and products are becoming available at an outstanding pace.

The Bureau of Labor Statistics states,

“Employment of personal and home care aides is projected to grow by 51 percent between 2006 and 2016, which is much faster than the average for all occupations. The expected growth is due, in large part, to the projected rise in the number of elderly people, an age group that often has mounting health problems and that needs some assistance with daily activities.” Bureau of labor Statistics-Occupational Outlook Handbook, 2008-09 Edition

This growing need for aides and services also encompasses

•home remodeling services -- making a home more serviceable to the elderly;
•safety alert systems and technology;
•motion sensors to monitor movement;
•telehealth services -- using home-based computer systems for the doctors office or a nurse to monitor vital signs and
•even a pill dispenser that notifies when it is time to take medication.
Where do you begin to make sure your elderly family member is safe and managing well in his or her home?

Visit often and at different times of the day and night. Make note of daily activities that appear challenging and where changes might be made to add safety and convenience. Remove rugs that slide -- causing a fall -- and move furniture with sharp edges. Set the water heater at a lower temperature. This will protect their older sensitive skin from scalds and burns. Be sure smoke detectors and carbon monoxide detectors are in place.

Bathrooms are a hazard area for the elderly. Grab bars by the toilet and shower are a must to help prevent falls. There are easy to install bars at your local hardware store if you want to do the work yourself. Another item that is good to have is a shower stool or chair.

If you are not sure of what needs to be done, consider hiring a professional. There are companies that specialize in home remodeling and accommodation for seniors. Michelle Graham of Accessible Design by Studio G4 says about senior home remodel projects,

“The main thing we incorporate in all of our projects is a careful study of needs and potential needs that may develop throughout a client's lifespan.”

Keep in mind what future home adjustments might be needed for your parents to “age in place” in their home.

Home safety or medical alert companies provide GPS-based bracelets or pendants to track the elderly at home who tend to wander. Or the companies may provide alarm devices such as pendants or bracelets which allow the elderly to alert someone if there has been a fall or a sudden health-related attack. In the event an alarm has been triggered, a 24 hour monitoring service will alert the family or medical emergency services or call a neighbor depending on previous instructions. In addition there are companies that will install motion sensors in the home to monitor the elderly on a 24 hour basis.

Don't forget your parents' community as a valuable resource for helping them stay in their home. Take Margaret Muller as an example. At 82 years of age, Margaret lives alone in her small home. She manages very well with the help of her local Senior Center. The Center's “Senior Companion” program sees that Margaret is taken to the store for groceries and other needs and checks in with her often to see how she is doing. Once a day, the Senior Center delivers a hot healthy meal to her door. Having these services and visits gives Margaret the help she needs and peace of mind that she is not alone.

Neighbors, local church groups, senior centers and city centers are some places to look for assistance. Most of the time there is little or no cost for these services.

Your state aging services unit is a valuable community resource. The National Area on Aging website www.aoa.gov states:

“AoA, through the Older Americans Act and other legislation, supports programs that help older adults maintain their independence and dignity in their homes and communities. In addition AoA provides funding for a range of supports to family caregivers.”

Some of the programs the site lists are:
“Supportive Services and Senior Centers
Nutrition Services
National Family Caregiver Support Program
Grants for Native Americans
Nursing Home Diversion Grants
Aging & Disability Resource Centers
Evidence-Based Disease Prevention
Long-Term Care Planning
Alzheimer's Disease Grants
Naturally Occurring Retirement Communities”

A few thoughts on hiring home care aides or live-in care givers.
The classifieds are filled with people looking for work as aides to the elderly. Many of these aides are well-qualified, honest people who will do a good job; but, of course, there will be some not so reputable. If you are looking to hire someone, be sure you interview and check references and qualifications. You will be responsible for scheduling that person and doing payroll and taxes as well. Be very sure you hire someone trustworthy, as the elderly seem to trust these helpers more than they should and therefore can easily be taken advantage of.

A professional home care service will eliminate your employment concerns. Professionally-provided aides are usually bonded and service is guaranteed. Home care companies take care of the scheduling and payment of their employees. Home care companies cater to the elderly in their homes by offering a variety of services. The National Care Planning Council lists many of these companies throughout the country on its website www.longtermcarelink.net.

These providers represent a rapidly growing trend to allow people needing help with long term care to remain in their home or in the community instead of going to a care facility. The services offered may include:

•companionship
•grooming and dressing
•recreational activities
•incontinent care
•handyman services
•teeth brushing
•medication reminders
•bathing or showering
•light housekeeping
•meal preparation
•respite for family caregivers
•errands and shopping
•reading email or letters
•overseeing home deliveries
•dealing with vendors
•transportation services
•changing linens
•laundry and ironing
•organizing closets
•care of house plants
•24-hour emergency response
•family counseling
•phone call checks
•and much more.

Thomas Day, Director of the National Care Planning Council states,

“Care in the home provided by a spouse or a child is the most common form of long-term care in this country. About 73% of all long term care is provided in the home environment typically by family caregivers.”

As their caregiver, you can make the difference in the quality of life for your aging parents and if staying in their home is a possibility, you have the resources to make it happen.

The Missouri Care Planning Council is a member of the National Care Planning Council. This "Planning For Eldercare" Article was published by the National Care Planning Council on May 6, 2009. For more information on the Missouri Care Planning Council, please visit www.mocpc.org or call 314-822-8389.

Long Distance Care Givers Receive Help

2011-03-22T07:36:00.000-07:00

Living in a different city or state -- miles from aging parents -- can be very difficult. Keeping in touch by telephone and making long trips to help parents or aging relatives with their needs can be time consuming and not nearly as effective as being available full time in person.

Mark Sessions spent two years juggling his restaurant business with multiple daily phone calls to his elderly parents, checking on their needs and answering their questions. Family vacations were spent traveling the 500 miles to his parent's home to personally take care of home maintenance and provide health care visits to their doctor. During his last visit, Mark noticed his father had difficulty walking and his mother was confused as to which medications she was to take and at what time. This alarming change in his parent's condition concerned Mark that his parents' care needs required more than frequent phone calls and vacation visits. Running his business and handling his parent's long distance care was now becoming very challenging.

According to a report by the Alzheimer's Association of Los Angeles & Riverside, California, there are approximately 3.3 million long distance caregivers in this country with an average distance of 480 miles from the people they care for. The report also states that 15 million days are missed from work each year because of long distance care giving. Seven million Americans provide 80% of the care to ailing family members and the number of long distance caregivers will DOUBLE over the next 15 years.
Long Distance Caregiver Project - Alzheimer's Association LA & Riverside, Los Angeles, CA (May 15, 2002, National Web Seminar by Judith Delaney, MFT, Clinical Coordinator)

The long distance caregiver is a new role that is thrust upon children and younger family members. Families used to live closer together, with children residing and working near their parents. But nowadays family members are more distant from each other. Society, today, is recognizing this. Some caregiver services have tweaked their programs to work as liaisons between long distance caregivers, senior loved ones and local medical professionals.

Professional care managers -- a lso known as Geriatric Care Managers, Elder Care Managers or Aging Care Managers -- represent a growing trend to help full time, employed family caregivers provide care for loved ones. Care managers are expert in assisting caregivers, friends or family members find government-paid and private resources to help with long term care decisions.

They are professionals -- trained to evaluate and recommend care for the aged. A care manager might be a nurse, social worker, psychologist, or gerontologist who specializes in assessing the abilities and needs of the elderly. Care manger professionals are also becoming extremely popular as the caretaker liaison between long distant family members and their aging elder loved ones.

Jacqueline Marcell -- author of "Elder Rage, or Take My Father...Please! How to Survive Caring for Aging Parents" (Impressive, 2000) -- says,

"The most important thing to do is to find a geriatric care manager in the area where your loved one lives. She will have knowledge of all the services in the area and can be your eyes."

Below is a partial list of what a care manager or Professional Geriatric Care Manager might do:

•Assess the level and type of care needed and develop a care plan.
•Take steps to start the care plan and keep it functioning.
•Make sure care is in a safe and disability friendly environment.
•Resolve family conflicts and other issues with long term care.
•Become an advocate for the care recipient and the caregiver.
•Manage care for a loved one for out-of-town families.
•Conduct ongoing assessments to implement changes in care.
•Oversee and direct care provided at home.
•Coordinate the efforts of key support systems.
•Provide personal counseling.
•Help with Medicaid qualification and application.
•Arrange for services of legal and financial advisors.
•Provide placement in assisted living facilities or nursing homes.
•Monitor the care received in a nursing home or in assisted living.
•Assist with the monitoring of medications.
•Find appropriate solutions to avoid a crisis.
•Coordinate medical appointments and medical information.
•Provide transportation to medical appointments
•Assist families in positive decision making
•Develop care plans for older loved ones not now needing care
"The 4 Steps of Long Term Care Planning," National Care Planning Council

Services offered will depend on the educational and professional background of the care manager, but most are qualified to cover items in the list above or can recommend a professional who can. Fees may vary. There is often an initial consultation fee that is followed by hourly fees for services. Health insurance does not generally cover these fees but long-term care insurance might.

In 2002, the AARP published a survey from geriatric care mangers about their fees:

"Respondents were asked how much they charged for their services, which might include: an initial consultation; fees on an hourly or per visit basis; fees for development of a care plan; and fees on a fixed-price contract basis. Hourly fees averaged $74 an hour. GCMs charged an average $168 to develop a care plan. Initial consultations averaged $175. Seven of ten current GCMs responded in the affirmative when asked if they had a statement that listed their fees. " Written by Robyn Stone, DrPH, Principal Investigator; Susan Reinhard, RN, PhD, Co-Principal Investigator; Jean Machemer, MSG, Research Associate; and Danylle Rudin, MSW, Research Associate of The Institute for the Future of Aging Services, Washington, D.C.Barbara Coleman, Project Manager, AARP Public Policy Institute November 2002

When you take into account the time absent from work and time to find the right care resources for your loved ones, along with the cost of travel expenses to monitor their care, you will probably concur that using a caregiver is money well spent. Add on to this the stress of handling your own life circumstances combined with being a caregiver and you will probably wonder how you could have ever done without the care manager.

A professional or geriatric care manager can be an important asset to all families in elder care situations. Here is an example of how a care manager can help.

Mary is taking care of her aging husband at home. He has diabetes and is overweight. Because of the diabetes, her husband has severe neuropathy in his legs and feet and it is difficult for him to walk. He also has diabetic retinopathy and, therefore, cannot see very well. She has to be careful that he does not injure his feet, since the last time that happened he was in the hospital for four weeks with a severe infection. She is having difficulty helping him out of bed and with dressing and using the bathroom. She relies heavily on her son, who lives nearby, to help her manage her husband's care.

On the advice of a friend, Mary is told about a professional care manager, Sharon Brown. The cost of an initial assessment and care plan from the care manager is $175.00. Mary thinks she has the situation under control and $175.00 for someone from the outside to come in and tell her how to deal with her situation seems ridiculous.

One day Mary is trying to lift her husband and injures her back severely. She is bedridden and cannot care for her husband. Her son, who works fulltime, now has two parents to care for. On the advice of the same friend, he decides to bring in Sharon Brown and pay her fee himself.

Sharon does a thorough assessment of the family's needs. She arranges for Mary's doctor to order Medicare home care during Mary's recovery. Therapists come in and help Mary with exercises and advice on lifting. Sharon advertises for and finds a private individual who is willing to live in the home for a period of time to help Mary with her recovery and watch over her husband. Sharon makes sure the new caregiver is reliable and honest and that taxes are paid for the employment. Sharon enlists the support of the local area agency on aging and makes sure all services available are provided for the family.

Sharon also calls a meeting with Mary's family and explains to them the care needs and how they need to commit to help with those needs. Sharon makes arrangements to rent or purchase medical equipment for lifting, moving and easier use of the bathroom facilities. Medicare will pay much of this cost. Sharon also works closely with an elder law attorney and a financial planner who specializes in the elderly. The attorney prepares documents for the family including powers of attorney, a living will and advice on preserving Mary's remaining assets. The financial planner recommends a reverse mortgage specialist to help Mary and her husband tap unused assets in their home's equity. Some reverse mortgage proceeds are used to pay off debt. The remaining proceeds are converted into income with a single premium immediate income annuity in order to provide Mary adequate income when her husband is gone and she looses one of the Social Security payments.

With the help of the care manager, Mary's life and future have been significantly improved. Her husband as well, if he adheres to the care plan, may end up having a better quality of life for his remaining years.
"The 4 Steps of Long Term Care Planning," National Care Planning Council

The National Care Planning Council promotes and supports professional and geriatric care managers on its website www.longtermcarelink.net.

The Missouri Care Planning Council is a member of the National Care Planning Council. This "Planning For Eldercare" Article was published by the National Care Planning Council on April 8, 2009. For more information on the Missouri Care Planning Council, please visit www.mocpc.org or call 314-822-8389.

Little-Known Government Program Pays the Cost of Elder Care

2011-03-21T07:25:00.000-07:00

WHAT IF 33% OF ALL SENIORS IN THIS COUNTRY could receive up to $1,949 a month in additional income from the government to help cover their elder care costs? THEY CAN!

Under the right circumstances, a little-known federal program will pay additional income to cover long term care costs for at least 1/3 of all US senior households -- that's how many war veterans or their surviving spouses there are in this country. But the provisions of this program are such a well-kept secret that only 4.7% of US seniors are actually receiving the benefit. The great news about this program is the Department of Veterans Affairs will pay you to hire your family, friends or just about anyone to take care of you (Caregiving spouses can't be paid under this program). The program is called "Veterans Pension."

Most people who have heard about Pension know that it will cover the costs of assisted living and, in some cases, cover nursing home costs as well. But the majority of those receiving long term care in this country are in their homes. Estimates are that approximately 70% to 80% of all long term care is being provided in the home. All of the information available about Pension overlooks the fact that this benefit can also be used to pay for home care.

It also comes as a surprise to most people that the Department of Veterans Affairs will allow veterans' households to include the annual cost of paying any person such as family members, friends or hired help for care when calculating the Pension benefit. This annual cost is deducted from household income and used to calculate a lower "countable income" which in turn enables families to receive this disability income from VA. Even though VA claims the benefit is for low income families, because of the special provision in the regulations -- allowing for deduction for care costs -- households earning between $3,000 to $6,000 a month or more can still qualify for Pension under the right conditions.

This extra income can be a welcome benefit for families struggling to provide eldercare for loved ones at home. Under the right circumstances, this annualized medical expense for the cost of family members, friends or any other person providing care, could create an additional household income of up to $1,056 a month for a single surviving spouse of a veteran, up to $1,644 a month for a single veteran or up to $1,949 a month for a couple.

If the disabled care recipient has been rated "housebound" or in need of "aid and attendance" by VA, all fees paid to an in-home attendant will be allowed as long as the attendant provides some medical or nursing services for the disabled person. The attendant does not have to be a licensed health professional. There is also no need to distinguish between medical and nonmedical services -- all are deductible.

For a disabled person who has been rated "in need of aid and attendance" or "housebound", a family member will be considered an in-home attendant, but that family member has to be paid for services duly rendered. There is potential for fraud here where a family member may move into the home and ostensibly receive payment as a caregiver but not actually provide the level of care paid for. Documentation for this care must be provided to VA, and it is reasonable for VA to question whether the services being purchased from a family member living in the household are legitimate. Such arrangements should be extensively documented and completely arm's-length.

The care arrangements and payment for home care must be made prior to application and there must be evidence that this care is needed on an ongoing and regular basis. We recommend a formal care contract and weekly invoice billing for services. Money must exchange hands and federal law requires employment taxes must be withheld and there must be evidence of this. All of this documentation must be provided as proof to VA when making application for the pension benefit. Costs for these services must be unreimbursed; meaning these costs are not paid by insurance, by contributions from the family or from other sources. VA will allow, however, family caregivers being paid by their loved ones, to turn around and pay the household bills for their loved ones to help defray the cost of the care.

Due to the need for a rating, documentation for annualizing care costs and the extensive proof needed to show the caregiver is indeed an employee of the care recipient, most people should not try this on their own. An expert in this area should be sought to help with the application in order to avoid lengthy delays in awarding a benefit or a possible denial of benefits. For a list of individuals or companies in your area who understand how to get this benefit go to http://www.longtermcarelink.net/ref_veterans_consultants.htm.

American Veterans Care Coordination (AVCC) provides and coordinates the appropriate community resources to provide personal aide and attendant services for veterans or surviving spouses. AVCC can be contacted at 636-720-0777 or toll free at 1-866-910-AVCC.

The Missouri Care Planning Council is a member of the National Care Planning Council. This "Planning For Eldercare" Article was published by the National Care Planning Council on March 17, 2009. For more information on the Missouri Care Planning Council, please visit www.mocpc.org or call 314-822-8389.

Nursing Homes for Veterans

2011-03-18T07:30:00.000-07:00

Nursing home coverage for veterans is available from two sources within the Department of Veterans Affairs -- the veterans health care system and the state veterans homes system.

Nursing Home Coverage through the VA Health Care System
Nursing home coverage along with other long term care services such as home care and assisted living as well as geriatric care management are available through the Veterans Health Administration for qualifying veterans.

In order to get into the veterans health care program, the veteran must have service-connected disabilities, or be below a qualifying income level or be receiving Veterans Pension income. Once in the system, veterans are not guaranteed long term care services, including nursing home care, unless they meet specific requirements. Here is a list of these requirements for nursing home coverage.

Who is Eligible for Nursing Home Care

•Any veteran who has a service-connected disability rating of 70 percent or more;
•A veteran who is rated 60 percent service-connected and is unemployable or has an official rating of "permanent and total disabled;"
•A veteran with combined disability ratings of 70 percent or more;
•A veteran whose service-connected disability is clinically determined to require nursing home care;
•Nonservice-connected veterans and those officially referred to as "zero percent, noncompensable, service-connected" veterans who require nursing home care for any nonservice-connected disability and who meet income and asset criteria; or
•If space and resources are available, other veterans on a case-by-case basis with priority given to service-connected veterans and those who need care for post-acute rehabilitation, respite, hospice, geriatric evaluation and management, or spinal cord injury.
VA's nursing home health system programs include VA-operated nursing home care units and contract community nursing homes. Many VA hospitals operate nursing home care units located in or near the hospital. Other hospitals, without adequate nursing home beds, contract with approximately 2,500 community private nursing homes nationwide to provide services.

State Veterans Homes
State veterans homes fill an important need for veterans with low income and veterans who desire to spend their last years with "comrades" from former active-duty. The predominant service offered is nursing home care. VA nursing homes must be licensed for their particular state and conform with skilled or intermediate nursing services offered in private sector nursing homes in that state. State homes may also offer assisted living or domiciliary care which is a form of supported independent living.

Every state has at least one veterans home and some states like Oklahoma have a number of them. There is great demand for the services of these homes, but lack of federal and state funding has created a backlog of well over 130 homes that are waiting to be built.

Unlike private sector nursing homes where the family can walk in the front door and possibly that same day make arrangements for a bed for their loved one, state veterans homes have an application process that could take a number of weeks or months. Many state homes have waiting lists especially for their Alzheimer's long term care units.

No facilities are entirely free to any veteran with an income. The veteran must pay his or her share of the cost. In some states the veterans contribution rates are set at a certain level and if there's not enough income the family may have to make up the difference. Federal legislation, effective 2007, also allows the federal government to substantially subsidize the cost of veterans with service-connected disabilities in state veterans homes.

State Veterans Homes Per Diem Program
The Veterans Administration pays the state veterans homes an annually adjusted rate per day for each veteran in the home. This is called the per diem. The 2008 nursing per diem amount is $74.42 and for domiciliary care it is $34.40. Adult Day Health Care - up to one-half of the cost of care -- cannot exceed $66.82 per day. The goal of state veterans homes is to get Congress to increase the per diem rate for nursing care to 75% of the state private nursing rates. In most states the per diem falls well short of this goal.

The per diem program and construction subsidies mean that State veterans homes can charge less money for their services than private facilities. Some states have a set rate, as an example $1,400 a month, and they may also be relying on qualified veterans receiving the Pension benefit with aid and attendance plus the per diem to cover their actual costs. Other states may charge a percentage of the veteran's income but be relying on other subsidies to cover the rest of the cost. Some state homes can receive Medicaid support as well.

Most of the states with income-determined rates are selective about the veterans they accept. These states may rely on a variety of private and public sources to help fund the cost of care.

Eligibility and Application Requirements for State Veterans Homes
From state to state, facilities vary in their rules for eligible veterans. And even in the same state it is common, where there is more than one state home, for some homes to have very stringent eligibility rules and others to be more lenient. These differing rules are probably based on the demand for care and the available beds in that particular geographic area.

Some homes require the veteran to be totally disabled and unable to earn an income. Some evaluate on the basis of medical need or age. Some evaluate entirely on income -- meaning applicants above a certain level will not be accepted. Some accept only former active-duty veterans, while others accept all who were in the military whether active duty or reserve. Still others accept only veterans who served during a period of war. Some homes accept the spouses or surviving spouses of veterans and some will accept the parents of veterans but restrict that to the parents of veterans who died while in service (Goldstar parents).

Federal regulations allow that 25% of the bed occupants at any one time may be veteran-related family members, i.e., spouses, surviving spouses, and/or gold star parents who are not entitled to payment of VA aid. When a State Home accepts grant assistance for a construction project, 75% of the bed occupants at the facility must be veterans.

Domicile residency requirements vary from state to state. The most stringent seems to be a three-year prior residency in the state whereas other homes may only require 90 days of residency.

All states require an application process to get into a home. Typically a committee or board will approve or disapprove each application. Many states have waiting lists for available beds.

A current contact list of all state veterans homes is available at http://www.longtermcarelink.net/ref_state_veterans_va_nursing_homes.htm

The Missouri Care Planning Council is a member of the National Care Planning Council. This "Planning For Eldercare" Article was published by the National Care Planning Council on February 26, 2009. For more information on the Missouri Care Planning Council, please visit www.mocpc.org or call 314-822-8389.

Insuring Your Retirement Funds

2011-03-17T08:20:00.000-07:00

It might sound strange to be told to insure your retirement funds, but after working hard and diligently saving all that money, wouldn't you want to make sure that the funds will be there for you when you need them?

As you move into retirement, you are also moving towards age-related health problems. Events beyond your control, such as stroke, heart disease and cognitive impairment can change one's way of life.

Many people are under the impression that government programs such as Medicare or Medicaid will cover the costs of long term care. Medicare will cover some skilled nursing for a limited period. Medicaid will only cover long term care costs for impoverished individuals. Health insurance does not cover nursing home or other long term care costs except for short-term rehabilitation.

Out of pocket costs for needed long term care resulting from age-related health problems such as home care, nursing home or assisted living will quickly deplete retirement funds and leave the remaining healthy spouse impoverished.

Long term care insurance is the answer to insure your retirement funds and provide protection so that the money stays intact and at the same time insurance provides a way to pay for elder care services.

In his book " The Total Money Makeover ," Dave Ramsey says of long term care insurance, "If you are over sixty, buy long term care insurance to cover in-home care or nursing home care. The average nursing home stay costs $40,000 per year, which will crack and scramble a nest egg in a heartbeat. Dad in the nursing home can use up Mom's $250,000 savings in just a few short years."

Long term care Insurance to insure your retirement makes sense. You insure your car against damage, your home against fire, and you purchase life insurance, so why not insure what can be the largest and most devastating risk to you and your family? And unlike the other risks you insure against, long term care is the most likely to happen. Long term care insurance will also help you keep your independence and dignity and allow you to make choices about where you want to spend your final years.

Here are some specific reasons for buying long term care insurance:

• If you are married and you have a need for long term care, your spouse will be able to pay for an outside caregiver and receive needed rest and recuperation.

• If your children promise to take care of you, then when the time comes that you need care, insurance will help them do that by paying for aides to help with tasks such as bathing and incontinence.

• If you are single and a need for long term care arises and you have no family who can help you, insurance can pay for and coordinate that care.

• If you have the desire to leave assets behind when you die, insurance will help preserve those assets from the cost of long term care.

"You should also consider buying long term care insurance at a younger age. There is an advantage for doing this. The premium is lower.

For example, a person, currently age 45, buying a typical policy with a spouse, could spend $21,146 in total premiums to age 78.

Suppose this same person chooses to wait to buy the equivalent coverage at age 65.

If that same policy were available in the future, the couple that waits could pay $52,566 in total premiums over their 13 remaining years to age 78. Because they waited, they would pay 2 ½ times more for the same policy.

In addition to the rates going up with age, the health qualifications will be stricter and development of health problems related to aging may even disqualify a person from obtaining a policy." "The 4 Steps of Long Term Care Planning," National Care Planning Council

There are dozens of long term care insurance companies selling a multitude of different policy options. It can become very confusing. For each policy, there are literally thousands of benefit combinations for home care, assisted living, nursing home care, waiting periods, payment amounts, inflation riders, and the list goes on.

You can take the time to do your own research or find a competent long term care insurance agent.

Here is a checklist of some of the things you need to know before you purchase a policy.

LONG TERM CARE INSURANCE BUYING CHECKLIST

The more "yes" answers you get the better off you are.

1) Is the insurance company rated by A. M. Best (the rating company)

with a rating of at least A, A+ or A++?

2) Is it a large diversified company with deep pockets and selling more

than just long term care insurance?

3) Is the insurance representative an expert in long term care

insurance? (Because of its complexity, almost all LTCi experts only

sell LTCi; they seldom sell anything else.)

4) Does the representative have a degree and/or industry financial

designations?

5) Does the representative own a personal long term care insurance

policy for himself or herself?

6) Is the policy you like tax qualified, and if not, do you understand the

ramifications?

7) Are there at least 6 ADL's (Activities of Daily Living) allowed for

in the benefit certification?

8) Does it allow "standby assistance"?

9) Is it a "pool of money" as opposed to a "stated period"?

10) Is it "integrated" as opposed to "2-pool"? (2-pool is not allowed in

many states.)

11) Do you understand how the elimination period works? (This is

extremely important.)

12) Does it have prohibitive cost containment provisions?

13) Is there any "capping" or other future reduction of automatic benefit

increase riders?

14) Do you understand how the waiver of premium works?

15) Does the assisted living facility benefit pay the same as for nursing

home?

16) Are you buying adequate home care coverage?

17) Does the company have a history of premium rate stability without

periodic increases?

18) Does the policy pay for homemaker services?

19) Does the policy offer an alternative plan of care for services that

don't exist today?

The National Care Planning Council provides a list of long term care insurance specialists and on its website at www.longtermcarelink.net.

The Missouri Care Planning Council is a member of the National Care Planning Council. This "Planning For Eldercare" Article was published by the National Care Planning Council on February 12, 2009. For more information on the Missouri Care Planning Council, please visit www.mocpc.org or call 314-822-8389.

Caregiver Burnout - Adult Day Care Services to the Rescue

2011-03-16T07:37:00.000-07:00

If you are a primary caregiver for a loved one, you are well aware of the daily stress and emotional and physical impact it can have on your health.

Susan learned this first hand when she and her husband, Tom, brought his Mom home to live with them. Mom suffered from dementia and had to be watched constantly. Susan found that when you become a caregiver, you start by giving up a few things you usually do for yourself to make up for the time needed for caregiving. Even though your service is one of love and you are willing to do the sacrifice on behalf of your loved one, you find yourself giving up a lot more as time goes on.

“As a caregiver,” Susan laments, “You are often frustrated that you can’t do enough for your loved one and so guilt and feelings of inadequacy set in. Couple that with feelings of being unduly burdened, of resentment, of stress and then of more guilt at having those feelings."

She continues, "Now don’t get me wrong, I am very glad that I spent those years in caregiving. There were many cherished moments with Mom that only I experienced.”

In order to enjoy those moments and sustain your caregiving momentum, a little respite is essential.

An article posted on About.com by Carrie Hill, PhD states:

“Caregivers who use respite care often tell me that although caregiving is one of the hardest jobs they've ever had, they wouldn't trade the experience for anything. Helping a family member or close friend who has Alzheimer's disease can provide a sense of purpose and great satisfaction. Still, the emotional and physical demands of caregiving make it hard to be a caregiver 24 hours a day, 7 days a week. Without respite care -- a temporary break from the demands of caregiving -- you may be more susceptible to the effects of caregiver stress, such as depression, exhaustion and other health problems.

Carrie Hill, PhD, About.com “Why Caregivers Need Respite CareGiving Yourself a Break Helps You and Your Loved One” Updated: August 3, 2008

Be on the lookout for caregiver burnout. It can creep up on you without your noticing it. Caregiver burnout symptoms can include:

•depression
•anxiety, irritability, or anger
•feelings of exhaustion
•self-criticism
•Withdrawal from usual activities
•trouble with handling caregiving responsibilities
•substance abuse

The need for support for caregivers at home has received national recognition. State Human Resource Departments and Area Agency on Aging Services are offering more counseling and respite services for caregivers. The ARCH National Respite Services is also an organization that is reaching out to educate and support caregivers in many states. There is, however, one service that is highly valuable but very underused:

Adult Day Care to the Rescue!

Adult Day Care respite is two-fold. It gives the caregivers much needed time to themselves and gives their loved ones social and interactive therapy with their peers.

Many adult day services offer such things as:

•Social activities; music, movies, crafts, excursions
•Meals
•Fellowship support
•Assistance with daily living
•Nursing care
•Help with activities of daily living
•Medications
•Physical therapy
•Transportation

Finding an Adult Day Services provider takes a little investigating on your part. It is important to know what you are getting and that your loved one is comfortable with his or her new surroundings.

First: Ask for recommendations.

Check with your local Senior Center, Area Agency on Aging Services, Mental Health Centers, Doctor, Clinic, Family, Friends and neighbors. The best recommendation is by someone who has used the adult day services or is familiar with those who run it.

Second: Call and ask the facility to send you information.

Ask specifically to be sent the application, eligibility requirements and payment information.

Ask to see the calendar of activities, menus, hours and days of operation are needed to be sure to fit your schedule.

Ask about availability of transportation to and from the location and what is the cost.

Ask who runs the facility. Is it private, non-profit or a franchise or part of an assisted living facility or a nursing home?

Third: Visit the Adult Day Care facility.

Go visit the provider location along with the person you are caring for.

See if the staff is friendly.

Check that it is clean and odor free.

Ask about the experience of the staff.

Request a list of references.

Fourth: Find out the cost and payment requirements.

A survey from NCOA/NADSA provides the following information on fees:

“Fees for Adult Day Care providers range from $25 per day to $70 per day, with the average around $50 per day. Many facilities provide services with a sliding fee scale.”

One last word of advice. Don’t feel guilty about taking your loved one to adult day care.

Susan’s mother-in-law complained bitterly about leaving home and going to the adult day care facility, expounding on how Susan just didn’t want her around anymore. This only increased the guilt Susan was already feeling, but Susan was also determined that she needed the respite time the day care would provide and they pressed forward. That evening as Susan picked up Mom and helped her into the car, Mom -- who suffered from dementia -- exclaimed, “That was the nicest resort I have ever been to!”

To learn more about the AOA National Caregiver Support Program go to:

http://www.aoa.gov/prof/aoaprog/caregiver/caregiver.aspx

The National Care Planning Council supports Caregivers and Adult Day Care Providers

http://www.longtermcarelink.net/a7adultdaycareservices.htm

The Missouri Care Planning Council is a member of the National Care Planning Council. This "Planning For Eldercare" Article was published by the National Care Planning Council on December 17, 2008. For more information on the Missouri Care Planning Council, please visit www.mocpc.org or call 314-822-8389.

Elder Mediation Resolves Family Conflicts

2011-03-15T07:51:00.000-07:00

“My daughter is insisting I move in with her,” complains Martha. “She just wants to control my life and take away my freedom,” she continues.

Jenny, Martha’s daughter worries that her mother keeps falling, and fears one day she will break her hip or hit her head.

“I’ll take my sister to court before I will let her get control of mom and my inheritance,” exclaims Jim about Jenny’s desire to move her mother in with her.

It is amazing how quickly formerly cordial relationships between family members will sour when the family has to deal with care of elderly parents or inheritance at their death. Sometimes the consequence of dealing with the final years of elderly parents can break families apart and create long-lasting animosity.

The National Care Planning Council has seen an increase in requests from caregiving children for help in solving disputes with siblings. In one case, the caregiver was being sued by her sister for abusing their parent and stealing the Social Security checks. In another, the caregiving child would not allow siblings to see their mother, claiming they would take advantage of her.

A lot of times it is a “she said,” “he said” situation with neither party really understanding what the elder person needs or wants.

Some families find it hard to communicate with each other when their parent is in need of care. Perhaps when they grew up together they were not accustomed to come together as parents and children to work out problems. And now those children are older and taking care of parents and they don't have this family council strategy to rely on. It may seem unnatural to them. But that is often exactly what is needed, especially in situations where perhaps one child is caring for the parents and the others are left out of the loop.

Children all have a common bond to their parents and as a result a common obligation or responsibility to each other. When disagreements arise, suspicions begin to grow. Suspicions or distrust often lead to anger and the anger often leads to severing the channels of communication between family members. This can occur between parent and child or between siblings or between all of them.

It is often at this point that a neutral third party can come in and repair the damage that has been done and help correct the problems that have come about because of the disagreement.

A practitioner experienced in elder mediation is a perfect choice for solving disagreements due to issues with the elderly.

WHAT IS ELDER MEDIATION?

Mediation is a non-adversarial approach to solving disputes. Mediation is a process of bringing two or more disputing parties together and having them mutually negotiate a solution to their disagreement. The mediator is not a judge and does not render a decision but is there to make sure that communication flows freely between the disputing parties. Elder Mediators are trained in the art of negotiating resolutions between elderly parents and family members.

Mediation can achieve results that the family by itself may not be capable of realizing or have the expertise of achieving. Here are some reasons that make Elder Mediation so valuable.

• A trained expert on communication gives the family a perspective it could not gain by meeting together on its own;
• All family members involved meet and prevent problems from arising by anticipating situations that may cause disputes;
• Allows for the mediator to invite experts such as care managers or other care providers into the meeting to educate the family and give them a new perspective;
• Allows parents to focus on their abilities rather than their limitations;
• Allows children to come up with and consider options not thought of previously;
• Encourages uninvolved family members to become involved;
• Allows parents to express wishes and desires that had previously gone unuttered;
• Allows for a neutral third party to challenge family members and make them take responsibility for their actions;
• Promotes consensus of all involved which in turn creates a much higher rate of compliance with the plan than with any other process; (the success rate for compliance with elder mediation is estimated to be about 80% to 85%)
• Requires a written plan with specific responsibilities which makes compliance feasible.

There are many organizations and companies throughout the country providing expertise in “Elder Mediation” to help seniors and their families. You will also find that mediators often have many coincident professional accreditations such as, Professional or Geriatric Care Manager, Elder Attorney, Clinical Social Worker or Certified Mediator.

In choosing a mediator, consider your needs. Is there a need for a medical assessment to determine the type of care? Are legal concerns with inheritance or family business or power of attorney, the main need? Perhaps, just bringing the family together to communicate on what needs to be done and who will do it is the agenda for now.

In one case, after months of dispute with her parents over their health and safety issues, Connie enlisted the service of a professional care manager mediator.

“Bringing a neutral person with a professional and compassionate attitude into our disputes was the best thing for all involved,” Connie recalled. “My parents shared their concerns and listened with acceptance to mine. All of a sudden we could communicate and work out a plan that they could live with and I could relax knowing they were safe.”

Seniors Use Mediators to help the family plan for long term care.

In the National Care Planning Council's book, “The 4 Steps of Long Term Care Planning,” the process of creating your own “Care Plan” before you need it is introduced. Quoting from the book:

“If the current or future caregiver wants the other persons attending the meeting to give support with respite care, transportation to doctors, etc., everyone needs to be aware of this and in total agreement to do it. All must also be willing to work with the member of the family, friend or professional who is designated as the Personal Care Coordinator.

If you feel the communication will be strained, consider having a professional mediator present. The mediator will be able to keep things calm and running smoothly
and help work out each person's concerns.”

“The 4 Steps of Long Term Care Planning” book can be found at http://www.longtermcarelink.net/a16four_steps_book.htm

Where to Find an Elder Mediator

• In your local phone book, on the internet or with your community senior services.
• References from friends and neighbors
• Contact the local area agency on aging
• Contact your state bar association
• Contact a local university or college and asked to speak to the department that provides mediation training and ask for a referral.
• On the internet look up mediation in your area
• Yellow pages in local phone books

The National Care Planning Council lists Professional Mediators throughout the United States on its website at http://www.longtermcarelink.net/a7mediation.htm

List your Elder Mediation service
National Care Planning Council
www.longtermcarelink.net
800-989-8137

The Missouri Care Planning Council is a member of the National Care Planning Council. This "Planning For Eldercare" Article was published by the National Care Planning Council on November 25, 2008. For more information on the Missouri Care Planning Council, please visit www.mocpc.org or call 314-822-8389.

Holiday Blues - Depression in the Elderly

2011-03-14T07:55:00.000-07:00

Did you notice any depression among elderly family, patients or friends during the holiday season? Here is an article from the National Care Planning Council explaining why depression occurs during the holidays.

Holiday Blues - Depression in the Elderly

The holiday season is quickly coming upon us. If you are a caregiver for an elderly loved one, you may notice a change in your loved one's mood as the holidays approach. Perhaps you are one of many, who visit elderly parents and family during the holidays who live a distance away. When you visit you may notice that loved ones are not as physically active, or they show symptoms of fatigue or sadness and have no interest in the holiday or in their surroundings.

According to the National Institutes of Health; of the 35 million Americans age 65 or older, about 2 million suffer from full-blown depression. Another 5 million suffer from less severe forms of the illness. This represents about 20% of the senior population -- a significant proportion.

Depression in the elderly is difficult to diagnose and is frequently untreated. The symptoms may be confused with a medical illness, dementia, or malnutrition due to a poor diet. Many older people will not accept the idea that they have depression and refuse to seek treatment.

What causes depression in the elderly?
It is not the actual holiday that causes depression, but the fact that holidays tend to bring memories of earlier, perhaps happier times. Additional contributing factors that bring on depression may be the loss of a spouse or close friend, or a move from a home to assisted living, or a change with an older person's routine.

Depression may also be a sign of a medical problem. Chronic pain or complications of an illness or memory loss can also cause depression. In addition, diet can also be a factor when proper nutrition and vitamins are lacking.

As an example, Selma’s husband passed away, a few months before Christmas. Her family lived close by and would call or drop in often to check on her. Selma seemed a little preoccupied and tired, but this was to be expected as she had been the caregiver for her husband for many years. It wasn’t until the family noticed that her holiday decorations were not out and her yearly routine of Christmas card writing was not happening that they began questioning her mental and physical well being.

A trip to her physician confirmed depression, caused by not only the loss of her spouse, but a vitamin B12 deficiency. There were both mental and physical reasons for her depression.

Symptoms to look for in depression might include:

•Depressed or irritable mood
•Feelings of worthlessness or sadness
•Expressions of helplessness
•Anxiety
•Loss of interest in daily activities
•Loss of appetite
•Weight loss
•Lack of attending to personal care and hygiene
•Fatigue
•Difficulty concentrating
•Irresponsible behavior
•Obsessive thoughts about death
•Talk about suicide

How do you know if it is depression or dementia?
Depression and dementia share similar symptoms. A recent article on Helpguide.org gives some specific differences:

In depression there is a rapid mental decline, but memory of time, date and awareness of the environment remains. Motor skills are slow, but normal in depression. Concern with concentrating and worry about impaired memory may occur.

On the other hand, dementia symptoms reveal a slow mental decline with confusion and loss of recognizing familiar locations. Writing, speaking and motor skills are impaired and memory loss is not acknowledged as a being problem by the person suffering dementia.

Whether it is depression or dementia, prompt treatment is recommended. A physical exam will help determine if there is a medical cause for depression. A geriatric medical practitioner is skilled in diagnosing depression and illnesses in the elderly. If you are a care taker of an elderly person it may be beneficial for you to seek out a geriatric health care specialist. For more information on senior health services go to http://www.longtermcarelink.net/about_senior_health_services.htm

Treating depression in older people.
Once the cause of depression is identified, a treatment program can be implemented. Treatment may be as simple as relieving loneliness through visitations, outings and involvement in family activities. In more severe cases antidepressant drugs have been known to improve the quality of life in depressed elderly people. Cognitive therapy sessions with a counselor may also be effective.

As a care giver or family member of a depressed older person, make it your responsibility to get involved. The elder person generally denies any problems or may fear being mentally ill. You can make the difference in and remove the Holiday Blues from seniors suffering from depression.

The Geriatric Mental Health Foundation offers a “Depression Tool Kit.” To read more about the tool kit and depression in the elderly go to http://www.gmhfonline.org/gmhf/consumer/depression_toolkit.html

To find a Senior Health Care Services in your area on the National Care Planning Council website go to http://www.longtermcarelink.net/a7seniorshealthservices.htm

The National Care Planning Council supports the work of geriatric practitioners and their services to the growing senior population. If you are a geriatric practitioner and would like to list your services with the NCPC please call 800-989-8137.

The Missouri Care Planning Council is a member of the National Care Planning Council. This "Planning For Eldercare" Article was published by the National Care Planning Council on November 5, 2008. For more information on the Missouri Care Planning Council, please visit www.mocpc.org or call 314-822-8389.

Dealing with the Sudden Crisis of Eldercare

2011-03-11T07:30:00.000-08:00

Eldercare providers and advisers who deal with the public know from experience that the need for long term care can often arise without warning. In many cases, desperate caregivers are frantically trying to find services, advice or care funding sources to help their loved ones with unexpected long term care needs. This sudden need for help often occurs when the loved one needing care has recently demonstrated unsafe behavior, or there has been an injury or sudden illness or there is a pending release from nursing home rehab or the current caregiver can no longer cope. Help must be found right now.

Unfortunately, many of these caregivers -- who are typically operating in crisis mode -- don't know where to turn for help. It's not that there aren't advisory services out there to help them, it's just that the caregivers often don't know where to find these services.

Government caregiver resource services such as area agencies on aging and related ADRC pilot programs typically reach out to caregivers through referrals from hospitals, discharge workers, doctors, home health agencies and nursing homes. Caregivers seeking help outside of this referral network generally aren't aware of government advisory services. In the private sector, help with caregiving issues is generally provided when a caregiver calls a specific agency, nonprofit organization or an advisor. There is no nationwide, private sector one-stop shopping source of help for all the types of care provider services that are available in the community.

The national care planning Council has discovered an answer to help desperate caregivers find the one-stop shop support they need. A 2004 study by the National Alliance for Caregiving and AARP estimates nearly six in ten (59%) caregivers are currently employed. Many of these working caregivers will use their Internet access at work to find the caregiving support they need.

The National Care Planning Council is in the process of developing websites in every state that contain the Internet resources employed caregivers are looking for. Currently, results from websites operating in 10 states indicate that harried caregivers will indeed search out these state care planning council websites for help. For example, one state website sponsored by the National Care Planning Council -- the Utah Eldercare Planning Council website, www.careUtah.com-- last year produced over 1,000 inquiries for help primarily from younger family caregivers. Additional requests for help were also received by Utah Eldercare Planning Council members through traditional outreach networking channels such as eldercare advisers, eldercare service providers, government agency referrals, associations, brochures and community presentations.

The National Care Planning Council is currently seeking qualified individuals to be Directors and oversee geographic service areas of state care planning councils. The Director's job is to coordinate local requests for help from the community and provide needed eldercare services. If you are a professional care provider or eldercare advisor please contact us about this opportunity to help the community and at the same time expand your services by becoming a Director of a Service Area. Or you may simply want to become a member of your local state care planning council.

Contact the National Care Planning Council at 800-989-8137 or by email at inquiry@longtermcarelink.net. To read more detailed information about what about state care planning councils, please go to www.longtermcarelink.net/council.pdf

The Missouri Care Planning Council is a member of the National Care Planning Council. This "Planning For Eldercare" Article was published by the National Care Planning Council on September 22, 2008. For more information on the Missouri Care Planning Council, please visit www.mocpc.org or call 314-822-8389.

Misconceptions about Who Pays for Long Term Care

2011-03-10T07:55:00.000-08:00

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 doing any planning at a younger age for the future need for care. According to the National Care Planning Council, (www.longtermcarelink.net) many people believe they can give away assets prior to the need for long term care and qualify for Medicaid. The Council suggests that this belief prevents people from considering other ways to fund the cost of future care.

As a matter of fact, 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 for Medicaid. 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 Benefits Administration will take care of them. While this is true to a certain extent, these people simply don't understand the limitations of these government programs.

Below are quotes taken from individuals who, over the years, have voiced misconceptions about long term care planning.

"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 constipated 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 National 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 from the more valuable caregiving services.

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.

The Missouri Care Planning Council is a member of the National Care Planning Council. This "Planning For Eldercare" Article was published by the National Care Planning Council on August 26, 2008. For more information on the Missouri Care Planning Council, please visit www.mocpc.org or call 314-822-8389.

2011-03-09T07:46:00.000-08:00

Bias Towards Aging Affects the Medical Treatment Seniors Receive

In many cultures in the world, elderly people are revered and their advice is sought and respected. In our culture, the wisdom, the knowledge and the social skills of the elderly are often overlooked and instead we focus on the mental and physical deficits of our older generations.

Because of this prevailing attitude, older people in our society are generally regarded as less valuable than younger people. The younger person has responsibilities of raising a family, maintaining a career and supporting the economy. The older person generally has no responsibilities and in addition is a drag on the economy since a great part of the tax base must go towards the support of older Americans.

It is inevitable that many medical care providers will unconsciously have this same attitude towards their older patients. As a result, if an older person has a medical complaint and the cause is not readily apparent, a medical practitioner is more likely to accept the condition as a consequence of old age. This attitude causes practitioners to focus treatment on making the elderly more comfortable in their old age as opposed to finding a cure. In younger people, if the medical complaint is interfering with normal daily function, typically a more concerted effort will be made to identify and correct the problem.

A 90 year old man meets with his doctor and complains about pain in his right knee. The doctor tells him,

"Well Henry, what do you expect? You're 90 years old."

Henry replies,

"But doctor my left knee is the same age as my right knee, there's no pain and it feels just fine!"

Many in the health-care profession consider old age to be a disease itself. Any medical problems are inappropriately attributed to old age as if it were a medical condition. And since there is no cure for old age, appropriate tests and treatment are never performed. Thus, medical problems that may not be related to age and may just as frequently occur in younger people are often not treated. As an example, a recent survey of physicians involved in the health-care of the elderly reported that 35% of the doctors considered hypertension a result of the aging process and that 25% of them felt that treating an 85-year-old for symptoms of hypertension would cause more harm than the benefits it would produce.

Consider This Real-Life Example as Related to the National Care Planning Council

(www.longtermcarelink.net)

A 71 year old woman has surgery on her shoulder for a bone spur that is causing her considerable pain. The surgery is successful and she goes through several months of physical therapy to help her recover. But she is not recovering as expected. She continues to experience pain that radiates through her entire back. Her physical therapist does not know how to help her and attributes her failure to recover to old age.

She visits her family care doctor at least twice over the next six months, complaining of extreme tiredness and lack of energy. He tells her to exercise patience. He tells her that older people generally don't recover as quickly from major surgery as younger people do. She should expect to be tired as surgery can have a major effect on the elderly.

Her skin color is gray and she does not look healthy. Finally she visits her doctor once again and insists he check her for some problem since she is not recovering from the surgery and she feels awful.

Based on her insistence, he does blood labs and discovers she is severely anemic. He puts her in outpatient care and gives her four units of red blood cells and puts her on iron supplementation. Within two weeks the pain has disappeared and within a month she has recovered fully from the surgery. Numerous tests are done but there is no explanation for the anemia.

Six months later she is healthy and active and her cheeks are ruddy. When she asks her doctor why he did not suspect anemia, he tells her that she has never had anemia and based on her history he would never expect her to develop it. He then tells her, in an obvious contradiction of his previous position, that older people sometimes fail to absorb iron. Ironically, she defends the action of her doctor and does not feel he acted inappropriately.

A Holistic Treatment Approach

Most practitioners who specialize in care for the elderly are aware of the above-mentioned problems with older patients and they take a holistic approach with the medical treatment of these people. An attempt is made, not only to treat the specific condition or conditions, but to make sure there is sufficient physical 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.

Geriatric-oriented practitioners require caregivers to closely monitor health conditions in their loved ones and report any changes before things get worse. These providers also meet with their patients regularly enough to monitor, on their own, their patient's current health.

his broad-based approach results in better health, more functionality and fewer visits to the emergency room because intervention for a worsening condition is achieved at an earlier stage.

The Missouri Care Planning Council is a member of the National Care Planning Council. This "Planning For Eldercare" Article was published by the National Care Planning Council on August 13, 2008. For more information on the Missouri Care Planning Council, please visit www.mocpc.org or call 314-822-8389.

Fact Sheet -- Understanding the Veterans Pension Benefit (Commonly Called Aid and Attendance)

2011-03-08T07:44:00.000-08:00

Why is it important for government agencies, care providers or eldercare advisers to know about Pension?

The national care planning Council estimates that approximately 11.5 million seniors -- about 33% of all people over 65 -- could qualify for Pension or Death Pension by meeting the tests outlined in this fact sheet. That's how many war veterans or their surviving spouses or their living spouses there are in this country. Unfortunately, few people know how to get this benefit and currently only about 543,000 individuals are actually receiving it. This represents only 4.7% of those who could be eligible.

As a professional, dealing with the public and advising them on long term care issues or retirement planning, you need to help spread the word about this extremely valuable benefit. A benefit that is very much underused. The information in this fact sheet is designed for you and will help you understand this benefit. Please feel free to copy this material and use it in any way you see fit. You have our permission to do this. A Word document version is also available at the following link: www.article-2008-7-29.doc There is also a PDF version available at this link: www.article-2008-7-29.pdf

The key to getting this valuable additional income for people you advise or help is your educating your people on what documents and evidence need to be submitted with the claims form. It is extremely important for the veteran household to submit a substantially complete claim to avoid being denied or to avoid stretching the application process out a year or more. This unfavorable claims experience is usually the case with those people who make application and don't know this important secret. The information you provide might enable those who would submit a claim to receive a favorable decision within 3 to 6 months. By the way, benefits are paid retroactively to the first day of the month following the month in which a claim is received by VA.

Having a knowledge of how Pension works and how the application process should be done can be a valuable tool in bringing new people to you for advice or for your services. There are also compliance issues and as a general rule, if you are not accredited by VA to help with the application process, you are prohibited from helping someone file a claim whether you charge a fee or not.

Our new veterans benefits consultants package has been designed for non-government care providers or advisers such as elder law attorneys, financial products practitioners, home care providers and care managers. Our package provides the following benefits to these individuals.

• Our Internet and seminar marketing strategies will bring in new clients or customers not just for VA benefits but for other services that providers or practitioners or advisers offer.

• Our lead system, tied to each consultant's, customized website and serviced by the National Care Planning Council, will produce numerous direct requests from the public to each consultant for information on how to obtain the Pension benefit.

• Our scores of pages on compliance issues will teach practitioners how to understand the prohibitions on helping with claims and yet provide a valuable service to their clients or customers and remain within the law.

• Attorneys and financial practitioners are introduced to new business strategies that will open up new areas of planning opportunities and new markets for their services or products.

• Home care providers and care managers will find the money for clients to pay for their services and in addition by finding this money be able to reach out to new clients who would not have the money without this benefit.

To learn more about the National Care Planning Council and how to become a veterans benefits consultant, please go to www.consultantspackage.com or call us at 800-989-8137

What is Pension?

Improved Pension and Death Pension are disability income programs available to veterans or to the single surviving spouses of deceased veterans. The veteran had to have served on active duty at least 90 days with one of those days during a period of war. Service in combat is not required, only that the veteran was in the service during wartime and was discharged honorably. Charts showing the available amount of income and the dates for wartime service are included below.

There is a sister benefit to Pension called Compensation. This is for veterans who are disabled because of injuries or illnesses incurred while on active duty. Compensation is generally the more desirable benefit for a number of reasons we will not go into here. A veteran household cannot receive Pension and Compensation at the same time. A decision must be made as to which benefit is better and the veteran must choose only that benefit.

Click Here for the complete article and charts.

The Missouri Care Planning Council is a member of the National Care Planning Council. This "Planning For Eldercare" Article was published by the National Care Planning Council on July 29, 2008. For more information on the Missouri Care Planning Council, please visit www.mocpc.org or call 314-822-8389.

VA Gives Veterans Money to Pay for Elder Care Services at Home

2011-03-07T07:37:00.000-08:00

Under the right conditions, about 33% of all seniors in this country could qualify for up to $1,949 a month in additional income from the Department of Veterans Affairs. This money can be used to pay just about anyone to provide elder care services at home. As an example, these funds can be used to pay children, other relatives, friends, home care companies, or domestic workers. Adequate documentation and evidence must be provided in order to receive money from VA for these services, particularly the services provided by family members or other non-professional providers. The National Care Planning Council furnishes detailed instructions and training to those practitioners who wish to help veteran households receive this valuable source of revenue to pay for home care.

This little-known source of money for paying long term care costs is known as Veterans Pension and is available to veterans who served on active duty during a period of war or to the single surviving spouses of these veterans. Pension is also known popularly as the "aid and attendance benefit." Of approximately 35 million Americans age 65 and older in this country, about 11.5 million are veterans who served during a period of war or their surviving spouses. This represents about 33% of the senior population.

The Pension benefit has an income and an asset test. Veteran households with income or assets above the test levels will not qualify for the benefit. Fortunately, there are special provisions that allow -- under certain circumstances -- individuals who would normally fail the tests to still qualify. VA typically does not tell potential applicants about the special provisions. A practitioner who understands how to obtain the aid and attendance benefit can help potential applicants receive the benefit even when they have been told by VA that they do not qualify.

Pension income is often used to pay costs of long term care such as home care, assisted living or nursing home care. That's because the nature of these expenditures allows potential applicants for the aid and attendance benefit to meet the special provisions of the income test.

Over the past 3 1/2 months the National Care Planning Council has received over 750 requests from veterans families all over the country who are trying to find help with their loved ones’ long term care needs. Many of these veterans households would likely qualify for the aid and attendance benefit mentioned above. As a result of these inquiries, the council is looking to train veterans benefits consultants to help veterans obtain their benefits and to handle these requests.

This consultants package not only provides the training but it also provides a listing service, a unique website, a seminar marketing system and business strategies to help consultants reach out to more veterans who might qualify for this benefit.

This is a new program. The first trained consultant has been in place for a little over three weeks. In that short time, his personal listing service and personal website, provided by the National Care Planning Council, have already resulted in 15 requests for his services from veterans families seeking help with the aid and attendance benefit. Other consultants who have come online since this first one are experiencing similar results.

If you are interested in becoming a consultant or you know someone who might be you can call the National Care Planning Council at 800-989-8137 or you can check out our consultants training package at www.consultantspackage.com. To learn more about the National Care Planning Council, go to www.longtermcarelink.net.

The Missouri Care Planning Council is a member of the National Care Planning Council. This "Planning For Eldercare" Article was published by the National Care Planning Council on June 11, 2008. For more information on the Missouri Care Planning Council, please visit www.mocpc.org or call 314-822-8389.

Getting the Government to Pay Family Caregivers

2011-03-04T07:45:00.000-08:00

Some 44.4 million adult caregivers -- or 21% of the U.S. adult population -- provide unpaid care to seniors or adults with disabilities, according to a 2004 study by the National Alliance for Caregiving in Bethesda, Md. On average, those caregivers provide 21 hours of care a week and the average length of time spent providing care is 4.3 years.

Over the years, the National Care Planning Council has received many public requests through our website -- www.longtermcarelink.net. A number of these requests have been from family caregivers who had to cut back on their employment or even quit their jobs in order to take care of one or both of their parents. Invariably these caregivers assume there is a government program that will pay them to provide this care. Only recently have we become aware of some programs that will pay family members. These programs are not publicized and the public is largely unaware of them or how to receive them.

Money Follows the Person—MFP (Self-Direction in Care)
In recent years, some state Medicaid programs have been experimenting with the idea of providing a budget to elderly Medicaid recipients. This money can be used to hire family or friends to provide care at home. Most of these programs are very limited, and there are waiting lists for them. Also, the amount of money available may not always be enough to compensate a family member to provide full-time care in lieu of maintaining employment.

But the attitude of government is quickly changing and there is now a new initiative to provide income for family caregivers. The Deficit Reduction Act of 2005 allocated $1.4 billion -- the largest demonstration grant in Medicaid history -- to a program called "Money Follows the Person." This program is designed to transition individuals receiving Medicaid and who are living in institutions, back into the community. In 2007, 31 states received their portion of the grant money pie to begin demonstration programs offering more choice in care besides an institution. Most of these state programs offer a concept called "self-direction" which allows a budget to be established by Medicaid for the care recipient. Self-direction allows the care recipient to spend this money hiring any caregiver of choice and this typically includes friends and family.

Unfortunately, this is not a widespread benefit for elderly Medicaid recipients and in addition only applies to bringing elderly people out of institutions and back into the community to receive care. Over the next five years, only 34,395 elderly care recipients nationwide are expected to be transitioned to community-based care through this program. Even though this represents a fraction of the elderly, who over the next five years are expected to receive Medicaid services in institutions, there is still a possibility for the family to apply for one of these programs and to have the government pay for their care services.

Using the Veterans Aid and Attendance Pension Benefit
A totally overlooked source of money to pay family caregivers to provide care at home is the aid and Attendance Pension Benefit. This money is available to veterans who served during a period of war. Pension money is also available to the widows of these veterans. This benefit, under the right circumstances, can provide up to $1,949 a month in additional income to pay family members to provide care at home.

It also comes as a surprise to many people that about 33% of all seniors could qualify for the aid and attendance benefit. That's how many veterans or their surviving spouses there are in this country.

Getting the aid and attendance benefit to pay for family caregivers is not an easy task. This is because there must be a caregiver contract in place and services for care must be initiated and thoroughly documented before application can be made. Getting these applications approved requires using a consultant who understands the documentation requirements. Very few people can do it on their own.

Fortunately, the National Care Planning Council is working on a program to train veterans benefits consultants across the country. This package will be available to attorneys, financial products practitioners, care managers, home care companies and assisted living facilities. The planned release is the first week of April, 2008.

The training package includes a 180 page training manual entitled "How to Become a Veterans Benefits Consultant" This manual describes the legal restrictions on providing consulting services for veterans and offers a number of strategies to avoid running afoul of the law. Instructions are also provided on how to use the marketing tools in the benefits consultants package to inform the public about these services. These marketing tools include educational and promotional booklets, brochures and a seminar marketing system. The use of ancillary services such as long term care planning and offering caregiver contracts are thoroughly presented as a way to attract new clients or customers and help those who are looking for income for caregiving services..

The consultants package also includes a one-year listing on the most visited webpage on the National Care Planning Council website -- www.longtermcarelink.net. Even without any listings currently on this webpage, it is amazingly producing about 6 to 7 requests a day for the services of veterans benefits consultants. A targeted listing on this exclusive webpage will only be available to individuals who own our consultants package.

The package also provides a custom-designed, veterans benefits consultant website and hosting service. Instructions are provided on how to promote this website to search engines in order to create Internet inquiries.

Using Medicaid Spend down to Pay Family Caregivers
In order to qualify for Medicaid nursing care, a person must spend his or her cash assets down to less than $2,000. Instead of giving this money to the nursing home and waiting for Medicaid to kick in, the potential beneficiary can instead transfer this money to a child in return for caregiver services. This is not considered a gift and if done properly does not create a penalty for Medicaid eligibility. The strategy also allows Medicaid to take over paying its portion of the nursing home costs much sooner.

As with the caregiver contracts for VA benefits, an expert in this area of Medicaid benefits is required in order to do it right. In fact, the same type of caregiver agreements used for obtaining extra income under the veterans benefit can also be used for Medicaid. A consultant who is proficient in both the aid and attendance benefit and Medicaid personal caregiver agreements can be of great service to the community. This contracts’ consultant can help relieve a great deal of caregiver stress by providing funds to help that caregiver cope with personal financial pressures.

We are excited to help family caregivers lessen the financial stress of their caregiving commitment.

Members of the community who wish to know more about veterans benefits consultants and caregiver agreements can contact the National Care Planning Council at inquiry@longtermcarelink.net or by calling us at 800-989-8137.

The Missouri Care Planning Council is a member of the National Care Planning Council. This "Planning For Eldercare" Article was published by the National Care Planning Council on March 19, 2008. For more information on the Missouri Care Planning Council, please visit www.mocpc.org or call 314-822-8389.

Long Term Care Insurance

2011-03-03T07:30:00.000-08:00

Why buy long term care insurance?

1. It will help you keep your independence and dignity and allow you to make choices. When the time comes for paying for your long term care needs, you may end up spending your savings and then relying on Medicaid for assistance. Medicaid typically pays for a semi-private room in a nursing home, but not all nursing homes take Medicaid. In many states it is not easy to get Medicaid to cover home care or pay for assisted living. Many people want to stay at home, but with Medicaid may not be able to. Insurance allows you to have a choice of where you want to live.

2. If you are married and you have a need for long term care, your spouse may be forced to pay for an outside caregiver. The cost is likely to come from your combined income and assets. This may leave your spouse with minimal funds in the future. Insurance solves this problem and allows the healthy spouse to keep the assets.

3. Many healthy caregiving spouses won't spend their money and choose to "tough it out" on their own without help. If care of a disabled spouse drags on too long, this can have a devastating effect on the physical and emotion health of the caregiver. Insurance will pay for professional care for the disabled spouse and allow the caregiver spouse needed rest.

4. If your children promise to take care of you when the time comes that you need care, insurance will help them do that. Probably neither you nor your children have thought of the prospects of moving you from place to place, changing your dirty diapers, cleaning up after "accidents" in the bathroom or helping you with bathing and dressing. Insurance will pay for aides to help your children with these tasks.

5. If you are single and a need for long term care arises, insurance can pay for and coordinate that care. With insurance you won't have to feel you would be a burden for family or friends.

6. If you have the desire to leave assets behind when you die, insurance will help preserve those assets from the cost of long term care.

Buy Long Term Care Insurance When You Are Younger
There is a bonus to buying long term care insurance at a younger age. The yearly premium is lower and the total premium over the life of the policy is also less. For example, a person in good health, currently age 45, buying a typical policy with inflation protection, could spend $42,075 in total premiums to age 78. The yearly premium for this policy is $1,275.

Suppose this same person chooses to wait to buy the equivalent coverage-- adjusted for inflation -- at age 65. If that same policy were available in the future, he could pay $44,759 in total premiums over his 13 remaining years to age 78. His premium is also considerably higher and in this case is $3,443 a year. By waiting, he saves no money in total cost, he will have a much higher yearly cost and in addition will definitely incur the following risks:

1.The same policies only stick around about three years and historically, new policies invariably have higher rates for the same ages as older ones. This means, all else being equal, he could pay two or three times more in total cost for an equivalent policy in the future.

2.The policy at age 45 is based on the best health rating and someone age 65 is very unlikely to get that same rating which means a much more expensive total cost in the future.

3.By waiting, his health may deteriorate to a point where he can't even qualify for a policy. Unfortunately, we have seen this happen time and time again to people who wait and all of a sudden desperately want coverage because of a change in health and can't get it.

4.He may need long term care before he turns 65. The chances of incurring a disability prior to age 65 are quite high.

We recommend you work with a long term care insurance specialist who understands the policy provisions and the coverage needed and can help you determine the best policy for what you want.

You can read more about long term care insurance and locate a specialist in your area at www.longtermcarelink.net.

How to buy long term care insurance
There are dozens of long term care insurance companies selling hundreds of different types of policies. It can become very confusing. There are various benefit options for home care and nursing home care, waiting periods, qualifying periods, inflation riders, and the list goes on. Here is a checklist of some of the things you need to know before you purchase a policy.

LONG TERM CARE INSURANCE BUYING CHECKLIST
the more "yes" answers you get the better off you are.

1) Is the insurance company rated by A. M. Best (the rating company) with a rating of at least A, A+ or A++?

2) Is it a large diversified company with deep pockets and selling more than just long term care insurance?

3) Is the insurance representative an expert in long term care insurance? (Because of its complexity, almost all LTCi experts only sell LTCi; they seldom sell anything else.)

4) Does the representative have a degree and/or industry financial designations?

5) Does the representative own a personal long term care insurance policy for himself or herself?

6) Is the policy you like tax qualified, and if not, do you understand the ramifications?

7) Are there at least 6 ADL’s (Activities of Daily Living) allowed for in the benefit certification?

8) Does it allow "standby assistance"?

9) Is it a "pool of money" as opposed to a "stated period"?

10) Is it "integrated" as opposed to "2-pool"? (2-pool is not allowed in some states and very few companies sell these policies anymore but you must be aware of this.)

11) Do you understand how the elimination period works? (This is extremely important.)

12) Does it have prohibitive cost containment provisions?

13) Is there any "capping" of automatic benefit increase riders?

14) Do you understand how the waiver of premium works?

15) Does the assisted living facility benefit pay the same as for nursing home?

16) Are you buying adequate home care coverage?

17) Does the company have a history of premium rate stability without large periodic increases?

18) Does the policy pay for homemaker services and other nonmedical home care services?

19) Does the policy offer an alternative plan of care for services that don’t exist today?

The Missouri Care Planning Council is a member of the National Care Planning Council. This "Planning For Eldercare" Article was published by the National Care Planning Council on February 20, 2008. For more information on the Missouri Care Planning Council, please visit www.mocpc.org or call 314-822-8389.

Long Term Care -- An Impending Crisis for the Elderly

2011-03-02T09:22:00.000-08:00

If we were to ask an older person what his or her most important concerns or wishes for the future are, we would probably get a variety of different answers. But according to surveys frequently conducted among the elderly, the most likely answers we would receive would include the following three principal concerns or wishes.

•Remaining independent in the home without intervention from others.
•Maintaining good health and receiving adequate health care.
•Having enough money for everyday needs and not outliving assets and income

Although the elderly are definitely concerned about the need for long term care it is not high on the list of concerns. To address these concerns or wishes and maintain the quality of life wanted in the elder years, it simply takes a little preplanning. Unfortunately, as a rule, that is not happening.

For seniors the need for eldercare is probably the most catastrophic unexpected event that could happen to them. This is because the need for care typically removes any level of security an older person may have with the three major lifestyle concerns mentioned above.

With the need for long term care the older person:

•Loses independence
•Has experienced a loss of good health
•Uses up remaining assets and income

No other late-life event can be as devastating to the lifestyle the elderly are so concerned about maintaining. No wonder many seniors, who are receiving eldercare, withdraw, become angry and suffer from severe depression.

Ironically, older people painstakingly scrape together $100-$200 a month to buy Medicare supplement insurance to cover a risk about equal to their yearly premiums. Or they will go without and sacrifice food, recreation and activities in order to hold on to the last few dollars in their savings accounts.

Yet very few elderly spend money or time to plan for the event of long term care. It seems a paradox that someone would be more concerned about buying insurance for a home fire when the risk of needing eldercare is 600 times more likely. Or what about the cost of insuring for an auto accident when the risk of long term care is 120 times more likely and is potentially 20 times more expense? Or why the overwhelming concern to buy Medicare supplement insurance when without it Medicare would still cover the bulk of their health needs after deductibles and co-pays? We're not recommending going without insurance coverage we're simply using it as an example of how people refuse to deal with the issue of long term care.

No one knows why people beyond age 65 are not more concerned about preparing for long term care. Perhaps they have seen it in their family or among friends and seen the effect that it has. Or because of the unsavory aspect of receiving long term care, perhaps the elderly prefer to ignore it rather than embrace the need for it. Perhaps they mistakenly think the government will take care of them. Or they are assured that family and friends will provide the care when needed, but don't know how difficult it really is for loved ones to provide that care when the time actually comes. Whatever the case, without proper planning, the need for eldercare can result in the single greatest crisis in any elderly person's life.

In addition, this lack of planning will always have an adverse effect on the older person's family. It usually results in great sacrifice or financial cost on the part of the spouse or children. Or for those with no immediate family, long term care can be a burden to extended family members.

We urge our readers who are planning for retirement or in their retirement years and who have not prepared for long term care to do so. As Benjamin Franklin so aptly put it "an ounce of prevention is worth a pound of cure."

The National Care Planning Council is an organization dedicated to helping the American public plan for long term care. To find out more about this organization please go to www.longtermcarelink.net.

The Missouri Care Planning Council is a member of the National Care Planning Council. This "Planning For Eldercare" Article was published by the National Care Planning Council on January 9, 2008. For more information on the Missouri Care Planning Council, please visit www.mocpc.org or call 314-822-8389.

Home Sweet Home's Decluttering Tip for January

2011-01-27T13:00:00.000-08:00

Strategies to Reduce Caregiver Stress

2011-01-27T12:24:00.000-08:00

THE EFFECTS OF CHRONIC STRESS

Last month, we discussed how chronic stress can be dangerous to the life and health of caregivers. But it isn't just just caregivers who experience chronic stress. The following information and advice can apply to anyone who experiences constant stress over many years.

Over the years, scientists have devised a simple blood test to measure stress. They measure the level of IL-6 (Interleuken 6), one of the immune system proteins produced by the stress response. If a person is experiencing stress, his IL-6 levels are high. This doesn't mean, however, that high levels of IL-6 can't occur in the absence of stress. A heavy workout can cause muscles to produce IL-6, but eventually levels return to normal after exercise ceases. It is thought the IL-6 directs the immune system to repair damaged, overtaxed muscle fibers. Fat cells also produce IL-6, so obese people sustain high levels in their blood. And chronic depression results in long-standing high levels of IL-6.

Sustained high levels of IL-6 can be dangerous, especially in adults age 50 and older, who seem to lack the ability to clear the stress response chemicals as quickly as younger people. For older adults, a constant initiation of the stress response --so-called chronic stress-- impairs the immune system and results in early aging, development of debilitating disease and early death. In this altered state, the body maintains high, potentially harmful levels of IL-6.

Prolonged high levels of IL-6 and the accompanying hormones and immune proteins have been linked to: cardiovascular disease, type II diabetes, frequent viral infections, intestinal, stomach and colon disorders, osteoporosis, periodontal disease, various cancers and auto immune disorders such as lupus, rheumatoid arthritis and multiple sclerosis. Alzheimer's, dementia, nerve damage and mental problems are also linked to high IL-6. Wounds heal slower, vaccinations are less likely to take and recovery from infectious disease is impaired. People who have depression also have high levels of IL-6. Depression in caregivers is about 8 times higher than the non-cargiving population.

LIFESTYLE CHANGES TO REDUCE STRESS.

Exercise
Exercise is a powerful and effective way to fight stress. It is recommended you do about 30 minutes of moderate exercise at least 3 days a week. Here are a few reasons why exercise works.

•Distraction--Exercise provides time away from the stresses of the day.
•Endorphins--Endorphins are opiate-like chemicals that the body produces naturally during periods of stress or physical exertion to relieve pain. Some evidence suggests that they may be involved in the regulation of mood.
•Neurotransmitters--During exercise, the body releases higher levels of dopamine. These hormones improve the thought process by facilitating transfer of information between neurons.
•Self-esteem--Exercise can be a gratifying and fulfilling activity for people. The act of doing something good for self can promote self-esteem.
•Reduces IL-6--Although muscles temporarily produce IL-6 during heavy workouts, exercise tends to lower levels between workouts.
Do a better job of managing time
In our modern world, one of the most prevalent threats to our well-being is the improper use of time. Not meeting deadlines may cost us a promotion or our career. Failure to make appointments or to meet obligations threatens our self-image or social standing. These and many more time-related threats cause stress. Finding help with managing your time would probably go a long way to relieving your stress.

Develop a support group and maintain social contacts
Participating in a support group can help manage stress. Sharing coping strategies in a group setting lets you help others while helping yourself. It may also help you to realize that some problems have no solutions and that accepting the situation is reality. Social support has a huge impact on reducing stress. Many studies show that social support decreases the stress response hormones in our bodies. In his book, Love and Survival (Harper Perennial, 1998) Dr. Dean Ornish notes that people who have close relationships and a strong sense of connection and community enjoy better health and live longer than those who live in isolation or alienation. People who suffer alone, suffer a lot.

Get adequate sleep
The catch-22 with sleep is that if you are over-stressed, you are likely to experience a disturbed sleeping pattern, and if you are experiencing a disturbed sleeping pattern, you are likely to become over-stressed! Research also shows that abnormal sleep increases levels of IL-6 while normal sleep decreases IL-6.

Sleep isn't a luxury; it's a necessity. Sleep restores the body and mind and helps us maintain our mental and physical health. Studies have shown that people who get seven to eight hours of sleep each night enjoy better health and live longer than people who get less sleep. According to the National Institutes of Health, each year approximately 60 million Americans experience frequent insomnia, the inability to get adequate sleep.

To ensure that you get enough sleep, try some of the following suggestions:

•Develop a sleep schedule and stick to it. Try to go to bed at the same time each night. Wake up at the same time, too. Avoid sleeping in on weekends; sleeping in will reset your body clock, making it harder to wake up on time on Monday.
•Get 30 or more minutes of physical activity each day. Avoid working out during the three hours before bedtime. Working out close to bedtime will energize you and may interfere with your sleep.
•Avoid caffeine, nicotine, and alcohol. These substances rob you of quality sleep. Switch to decaf or herbal tea. Quit smoking. An alcoholic beverage (a "night cap") before bed may make you drowsy but it actually deprives you of deep, restorative sleep.
•Engage in relaxing activities before bed. Think of it as "wind down" time. Read a book. Soak in a hot tub. Avoid doing physically or mentally stimulating activities such as vigorous housecleaning or intense office work close to bedtime.
•Leave your troubles outside the bedroom door. Make your bedroom a worry-free zone. If you start to ruminate about problems when you are in bed, try relaxation techniques such as deep breathing or visualization (visualize that you are in a warm, breezy, tropical place, with the sun streaming down on you, nothing but sand, surf, and coconut trees for miles...).
•Create a cozy sleep environment: wear comfortable pajamas, make the temperature of the room comfortable for you, darken the room, use soft, comfortable bedding that enhances your sleep experience. If your bed is too hard or lumpy or soft, invest in a new one. If noise is an issue, try to get at the root of the problem: ask your snoring partner to seek evaluation and treatment, ask your neighbors to be quieter, etc.
Pursue diversions, hobbies and relaxing activities
Another simple way to reduce stress is to distract yourself -- go to a movie, play a sport, immerse yourself in a hobby, listen to some favorite music or take a walk. It cannot be emphasized enough how important it is as a caregiver you spend some quality time alone every week, doing exactly what it is you like to do.

Try taking anti-depressants and anti-anxiety medications
Dr. Kiecolt-Glaser points out that anti-depressants lower IL-6 levels in chronically depressed patients, so they might be useful. She also said there have been suggestions that cholesterol-lowering statins might reduce IL-6, because they seem to reduce inflammation.

REDUCE STRESS THROUGH PROPER NUTRITION

Being overweight (eating too much)
Many people react to stress by eating. Eating too much for a long period causes obesity. This causes your heart and lungs to work harder, overloads your organs and reduces stamina. Studies show that fat cells excrete IL-6 and that overweight people have high levels of IL-6 in their blood. This in turn leads to the IL-6-associated illnesses such as heart disease, immune disorders and diabetes.

Not eating properly
Some people react to stress and stress-induced depression by not eating or eating poorly. If you eat a good, well-balanced diet, your body will be receiving all the nutrients it requires to function properly. On the other hand, if you are eating an unbalanced diet or not eating enough you may be stressing your body and contributing to stress-related complications by depriving yourself of essential nutrients.

Coffee, tea, caffeine soft drinks and chocolate
Caffeine is a stimulant. One of the reasons you probably use it is to raise your level of activity. This chemical actually enhances the stress response and thus increases your existing stress. Small quantities probably do little harm but large quantities over a long period produce excessive stress and lead to many of the physical ailments attributed to chronic stress. Too much caffeine can be dangerous. If you are drinking many cups of caffeine products a day, then you may find you can reduce a lot of stress and save your health by switching to caffeine-free products for a portion of your daily intake.

Alcohol
Some people react to stress by imbibing in alcohol. In small amounts, spirits may help you relax. In larger amounts alcohol may increase stress as it disrupts sleep. Over the long-term, alcohol will damage your body. Alcohol is also a depressant. If you're prone to depression, alcohol will only make it worse. Studies show that depressed people have eight times the level of IL-6 as compared to the general population. As we have seen, high, prolonged levels of IL-6 are a marker for debilitating illness and early death.

Tobacco
In the short-term tobacco use seems to relax people but the toxic effects of nicotine raise the heart rate and enhance the stress response. If you smoke, try taking your pulse before and after a cigarette, and notice the difference. After the initial period of giving up smoking, most ex-smokers report feeling much more calm.

Sugar and refined flour
Sugar can be a stimulant for people experiencing stress and stress-induced depression. Sugar-rich foods (the starch in refined flour is also a form of sugar) can raise your energy level in the short-term. The problem is your body copes with high levels of sugar by secreting large amounts of insulin, which in turn, quickly reduces the excess amount of sugar in your blood stream often causing blood sugar levels to swing too low.

These up and down spikes in blood sugar can cause agitation, mood swings, irritability and fatigue, which in turn can contribute to the creation of additional stress. The ups and downs of sugar spikes also contribute to depression. And of course, excess sugar is readily converted to body fat thus causing obesity. Consuming sugar in the form of complex carbohydrates--whole grains, fruits, vegetables and tubers--forces the digestive tract to release blood sugar more slowly and keeps insulin and blood sugar levels more normal. Avoid fruit drinks, sugar drinks, candy, pastas, white bread and pastries.

Nutritional supplements
There are thousands of supplement suppliers and scores of books that claim success with managing stress by using herbs, herbal extracts or synthesized biochemicals. These compounds often come with the claim of enhancing mood or strengthening the immune system. Since there are so many different competing claims, you must decide for yourself which supplements help and which don't.

CONTROLLING STRESS WITH MIND AND BODY CALMING TECHNIQUES.

Music therapy
Listening to music does wonders to alleviate stress. Choosing what will work for any individual is difficult; most people will choose something they 'like' instead of what might be beneficial. In doing extensive research on what any given piece of music produces as a physiological response, many unexpected things were found. Many of the so-called Meditation and Relaxation recordings actually produce adverse EEG patterns in the brain--just as bad as Hard Rock and Heavy Metal. The most profound finding: Any music performed live and even at moderately loud volumes even if it is somewhat discordant has a very a beneficial response.

Laughter therapy
Numerous studies show that laughter has the uncanny ability to wipe out stress. Here are some suggestions for caregivers:

•Look up jokes on the internet.
•Try to see the humor in being a caregiver.
•Write on a card "Have you laughed with your care-receiver today?" and place it in a conspicuous place in the bathroom or kitchen.
•Read funny books or jokes, listen to funny tapes or watch humorous movies or videos that make you laugh.
•Share something humorous with your care-receiver, a friend, or relative.
•Attend social groups where there is a lot of comeraderie, joy and fun.
•Be aware of how often you smile; it takes fewer muscles to smile than to frown.
•If you find that you are feeling hopeless, and humor or laughter is not affording you the up-lift you want. contact a counselor. And remember, laughter is the best medicine. Try it, you'll like it!
Laughter clubs
There is no medicine like laughter therapy. After 15 minutes of laughter, in the morning, at a local club, stress is relieved and you will continue to be able to handle new pressure throughout the day. Laughter has benefited many people who were on heavy tranquilizers and sleeping pills. Now they are getting better sleep and their depression is reduced. Under the Laughter Club concept, people laugh in a group without the help of any jokes. To make it more spontaneous and keep the sessions interesting and avoid boredom, laughter techniques need to be stimulating. That's the job of the club Certified Laughter Leader. These clubs are popular in India and England and are quickly catching on in the U.S. Just for laughs, you may want to start a local chapter.

Meditation
If you have ten free minutes a day, you can reduce stress, improve insomnia, lessen anxiety and depression, and decrease your chances of developing cardiovascular disease. Sound too good to be true? In fact, the meditative technique known as the "relaxation response" was described a quarter century ago by Harvard physician Herbert Benson, M.D. and has been scientifically proven not only to reduce stress and anxiety but also to improve symptoms of cancer, AIDS, and other conditions.

Just what is the relaxation response? Simply put, it is the opposite of the "adrenaline rush" we associate with stress and anxiety. Physiologically, our bodies respond to perceived threatening situations with an increased release of the hormones epinephrine and norepinephrine, leading to increased heart rate, increased blood pressure, accelerated breathing rate and increased blood flow to the muscles. Because these reactions prepare our bodies to flee the situation or to fight, this reaction has been termed the "fight-or-flight" response. The relaxation response described by Dr. Benson and his colleagues is a state in which our bodies undergo an opposite reaction - leading to decreased breathing rate, heart rate, blood pressure, and metabolism.

Almost anyone can learn to elicit the relaxation response, and no special equipment is necessary. The relaxation response technique consists of the repetition of a word, sound, phrase, etc. while sitting quietly with eyes closed. Intruding thoughts are dismissed by passively returning to the repetition. This should be practiced for 10-20 minutes a day in a quiet environment, free of distractions. A seated position is recommended to avoid falling asleep, and you may open your eyes to check the time but do not set an alarm. Don't feel discouraged in the beginning if it is difficult to banish intruding thoughts or worries; this technique requires practice. With consistency and time the relaxation response will occur effortlessly and smoothly.

For maximum benefits you should schedule time to practice the relaxation response into your daily routine. Many people find it helpful to practice this technique at approximately the same time each day; for example, upon returning home after a busy work day it may ease your transition to a relaxed and enjoyable evening.

Another technique is practicing what the Buddhists call 'mindfulness'. At various times of the day try to focus on your breathing. Notice how the air feels cool when you inhale, and then feels warm when you exhale.

You can do this while you are doing the washing up, making the beds, waiting at a red light, or even standing in a post office queue, etc. The instant benefit from this is that it brings you immediately to the present moment. It is also very effective if done during or before an important meeting, an exam, or even while sitting in the dentist's chair. As you breathe out, you will start to feel your body relax, and your mind will become more focused. So each time you feel yourself getting stressed or find that you have unexpected time on your hands, you can do a quick 60 second meditation.

Tai Chi
Tai Chi Ch'aun is a centuries old Chinese system of physical exercise based on the principles of effortless breathing. It can be practiced by an individual, alone, and in a limited space. It requires no equipment, except a loose-fitting garment that permits continuous rhythmic body movements. It can be learned by anyone regardless of age, sex, or athletic ability. Tai Chi emphasizes relaxation, receptivity and inner calm rather than strength. The flowing stretching movements make the body limber, tone up muscles, and help release muscle tension. This is accomplished by practicing movements slowly and evenly in circular patterns. Many people also report it is an excellent and effortless way to lose weight. Videotapes or DVDs are available for practicing this technique.

Yoga
Yoga is a wonderful way to release stress. Meditation, breathing exercises and sustained poses help you focus on relaxing your mind and body. Once having learned the techniques in a class, it can be done at home. Yoga also helps you develop greater control over your thoughts and worries.

Acupuncture
Acupuncture can treat a wide spectrum of ailments since it approaches injury and disease by looking at the underlying cause as well as the symptoms. Since acupuncture treats the root of the problem, it is favored over traditional therapy because with acupuncture symptoms rarely return. Although acupuncture is renowned for its effectiveness in the treatment of pain, such as back pain, frozen shoulders and migraines it is also effective for many other problems such as stress and anxiety

Massage therapy
Massage therapy works to improve an individual's health and well-being through the hands-on manipulation of muscles and other soft tissues of the body. Massage therapy is designed to stretch and loosen muscles, improve blood flow and the movement of lymph throughout the body. It facilitates the removal of metabolic wastes resulting from exercise or inactivity, and increases the flow of oxygen and nutrients to cells and tissue. In addition, massage stimulates the release of endorphins -- the body's natural feel-good chemicals-- into the brain and nervous system. It provides a relaxed state of alertness, reduces mental stress and enhances capacity for calm thinking and creativity. Massage also satisfies the need for caring and nurturing touch, creates a feeling of well-being and reduces anxiety levels.

Aromatherapy
Aromatherapy is the art and science of using essential oils, extracted from plants, for therapeutic benefit including stress management. It's efficacy is backed up by solid scientific research. Because aromatherapy can be done as a self-help technique, its use can be very beneficial as a stress reducer while you work. Most of the workplace applications are available in hand lotions for easy use in the office. Bergamot and lavender work well for stress and anxiety reduction. Pendants are also an excellent way to utilize aromatherapy oils in public. Nebulizers and misters are used at home. There are hundreds of unique oils and scents and each has its own medicinal or theurapeutic value. Here are some common oils: Anise, Sweet Basil, Bergamot, Cedarwood, Atlas, Blue Chamomile, Cinnamon, Clary Sage, Clove, Cypress, Eucalyptus, Sweet Fennel, Geranium, Grapefruit, Juniperberry, Lavender, Lemon, Sweet Marjoram, Nutmeg, Sweet Orange, Palmerosa, Patchouli, Black Pepper, Peppermint, Pine Needle, Rosemary, Sandalwood, Tea Tree, Vetiver, Yarrow, Helichrysum, Neroli, Grapeseed oil and Ylang Ylang.

Pet therapy
There is a saying that "dog is man's best friend." This is certainly true when it comes to dealing with your body's stress response. Many people feel more relaxed when companion animals are present. Several studies have shown that pets are good for us in numerous ways. For example, petting an animal is known to lower your heart rate, lower your blood pressure and brighten your mood. Another study found that simply watching fish in an aquarium made patients waiting to undergo medical procedures less anxious. In fact,"pet therapy" is frequently used in hospitals and nursing homes to increase socialization and to reduce depression, loneliness, anger, and stress

Secondly, having tender physical contact with your pet is also good for you. Having an animal to hold, cuddle and caress has positive effects on people. Especially those who might have limited means to give or receive physical expressions of affection. Most of us have felt a warm fuzzy feeling inside just by getting your face licked by a puppy. After a hard day at work, this kind of attention can really help you to calm down and relax.

Next, simply talking to your pet can be very therapeutic. People often talk to their pets to share their thoughts, feelings, troubles and worries. Although your pet won't give you any solutions for your problems, the very act of talking about your concerns with a good listener may help you find your own solutions. And you must admit pets are great listeners.

Finally, if you have a dog for a pet, you get to go for a walk at least 3 or four times a day. This affords you the perfect excuse to take time to yourself away from your stressors. These walks give you time to breathe fresh air, join with nature, collect your thoughts, make plans for the day, or just daydream. Also, watching your pet frolic and play can't help but bring a smile to your face and help to dry up your sea of troubles. Furthermore, the light exercise you get from walking your pet helps you to deal with the physical stress reactions you have acquired in the course of your day. Specifically, walking with your dog helps you to burn up the pent up energy your stressors have caused.

Relaxing personal retreats
Take a relaxing, scented bath with candles. Every woman knows this is a sure-fire way to relax, but how many of you take time to do it? For the guys, stay thirty minutes in a hot shower, soak in a hot tub or go to the local sauna. Take a weekend break to a spa, even the guys. Get a facial; it's great guys. Take a weekend trip with your partner or with friends. There are tons of activities you can do to remove yourself from the daily grind, have fun and just relax.

Gardening
Gardening has an important impact on the health of individuals through direct interaction with plants and the natural environment. Horticulture promotes individual health through exercise, stress reduction, social interaction and mental stimulation. Gardening is recommended by such groups as the American Heart Association as a technique to improve general physical health and thus prevent many diseases. In addition, urban agriculture can plan a role in improved health through access to high quality fresh produce either locally produced or self-produced.

The National Care Planning Council is a nationwide alliance of eldercare experts, advisers and providers who promote and support long term care planning. For more information go to our website at LongTermCarelink.net. Or call (800) 989-8137

The Missouri Care Planning Council is a member of the National Care Planning Council. This "Planning For Eldercare" Articles was published by the National Care Planning Council on January 10, 2008. For more information on the Missouri Care Planning Council, please visit www.mocpc.org or call 314-822-8389.

New Years Resolution- Plan for Long Term Care

2011-01-14T13:15:00.000-08:00

“According to some sources, 60% of us will need long term care sometime during our lives. It is important for all of us to prepare for that day when we will need to help loved ones with elder care or we will need elder care for ourselves.”

“It is simply a fact of life to prepare financially for unexpected disasters by covering our homes, automobiles and health with insurance policies and to provide funding for our retirement. But no other life event can be as devastating to our lifestyle, finances and security as needing long term care. It drastically alters or completely eliminates the three principal retirement dreams of elderly Americans, which are:

1. Remaining independent in the home without intervention from others
2. Maintaining good health and receiving adequate health care
3. Having enough money for everyday needs and not outliving assets and income

Yet, it is our experience that the majority of the American public does not plan for the devastating crisis of needing elder care. This lack of planning also has an adverse effect on the older person's family, with sacrifices made in time, money, family lifestyles and even affecting the family's or caregiver's medical and emotional health.” National Care Planning Council “ The 4 Steps of Long Term Care Planning”

Because of changing demographics and potential changes in government funding, the current generation -- more-than-ever -- needs to plan for long term care.

If you have spent time helping a parent or loved one cope with a disability resulting from aging, you know the frustration of balancing what you feel they need to do and what they want to do. Communication is strained at times, because after all, you are the child and they the parent, yet physically and mentally the rolls have changed.

When you make directives, assignments and arrangements in advance of needing elder care, then everyone involved can follow the prearranged care plan.

As an example, Jefferson Simpson wrote in his care plan that if dementia or Alzheimer's inhibited his mental abilities to communicate or recognize his surroundings, he wished to be in a respectable facility and only asked that he be visited and brought chocolates. To his children this request seemed silly at the time, but when his mental capacities did diminish, the instructions were there. No one had to wonder if they should try to take care of Father Jefferson at home and how they would do it. Without quilt or question they placed him in a respectable facility that took care of his needs. All they had to do was make loving visits, and of course they brought chocolates.

In order for Jefferson's simple request to happen, he had made financial, legal and personal long term care plans years before.

What do you want your children or friends to do on your behalf?

When it comes time for them to help, what if you can't say what you want because of a physical or mental disability? This is where a written long term care plan comes into effect.

Do you have a financial plan or long term care insurance? Retirement savings can disappear quickly when used for care services.

Where is your paperwork; insurance policies, living will, medical directives, Armed Services discharge or disability papers? Is there someone designated to know the location?

What are the legal documents that are needed for power of attorney, estate planning and disbursement of assets? When do they have to be completed?

What types of care services and facilities are available and what are the costs?

What will government programs pay for and how do you qualify?

There is a lot you can do now to put together a plan for your own long term care. You may have limited resources in the future or health problems that will inhibit your ability to take care of things you could do now. For example.

James and Cindy want to be able to stay in their home as they age. In order to do this, when they were in their 40's they took out a long term care insurance policy that will pay for home care if it is needed. The policy will also pay for nursing home costs as a care option. With taking the policy at a younger age and in good health the monthly payments are low. Extra funds can now be put away for retirement without worries of having to deplete savings for care costs.

Or consider Sarah's following experience:

After taking care of her own parents for many years, Sarah realized the importance of making, in advance, a plan and preparations for herself. She saw all of her parents' assets dissipated in order for her father to qualify for Medicaid nursing home coverage. She didn't want the same thing to happen to her. She took the time to create her own plan on paper-- expressing her wishes for her own care. A trip to her attorney provided all the legal documents and estate planning she wanted to be in place to insure care for her and an inheritance for her children.

There is much to learn about long term care and there are a lot of new services and programs available to draw from.

The National Care Planning Council has gathered together an overall review of government and private long term care services both on the Council website, www.longtermcarelink.net and in their book The 4 Steps of Long Term Care Planning.

The 4 Steps of Long Term Care Planning provides comprehensive information about long term care planning. The design also allows you to record personal information, family agreements and directions on 20 planning sheets at the back of the book. Using this book as a single-source repository for information and directions makes it much easier for you or your care coordinator to carry out your wishes when the need for care occurs.

The Missouri Care Planning Council is a member of the National Care Planning Council. This "Planning For Eldercare" Articles was published by the National Care Planning Council on January 15, 2009. For more information on the Missouri Care Planning Council, please visit www.mocpc.org or call 314-822-8389.

Guide to Long Term Care Planning

2011-01-13T09:36:00.000-08:00

"Guide to Long Term Care Planning" is a new online resource developed by the National Care Planning Council for use by the public and to support the Long Term Care Consumer Awareness Campaign from the Department of Health and Human Services.

This free, noncommercial source of information is the largest and most comprehensive work on long term care planning ever produced. This public-service, online publication contains over 670 printable pages including 96 charts and graphs. It is written by eight experts and organized into 35 chapters. It also includes a section on helping seniors with the new Medicare prescription drug benefit. The URL for this online publication is found at http://www.longtermcarelink.net/a13information_guide.htm.

The concept of eldercare or long term care planning is fairly new. A fast-growing generation of elderly people needing care is starting to put a great deal of pressure on caregiving family members and government programs for long term care. More and more we are seeing articles and books about the burden of long term care on families. And a huge group of 77 million baby boomers, poised for retirement, is causing alarm in the eldercare provider community.

Over the years, we have met with many families in a crisis mode, struggling to find services and preserve assets for loved ones needing long term care. When statistics tell us about one out of two people will need long term care, it's appalling that most of the current generation of elderly have not planned for this crisis in their lives.

And the current pre-retirement generation is doing no better. Sometimes I think Americans are about as unprepared as the ancient tribes of Israel wandering in the desert. When the time comes for long term care, most people believe help will come to them like manna from heaven. In most cases this won't happen.

I've encountered it so many times, I am no longer surprised when people ask me if there's not some kind of government program that will pay them to quit their jobs and to stay at home and provide long term care for their loved ones.

According to research By the National Care Planning Council only about 16% of long-term care services are covered by the government. The other 84% are provided free of charge by family caregivers or provided by services paid out-of-pocket by families or from those receiving care. And the bulk of government care services are provided only after a care recipient has depleted all of his or her savings. The Council also estimates that at any given time approximately 22% of the population over age 65 is receiving some form of long term care support.

According to an April 2005 congressional hearing press release from Congresswoman Nancy L. Johnson (R-CT), Chairman, Subcommittee on Health of the Committee on Ways and Means,

"...In 2004, according to CBO, approximately $135 billion was spent on long term care for the elderly. Sixty percent of this amount was financed through Medicaid and Medicare, one third through out-of-pocket payments, and the remainder by other programs and private insurance. This funding excludes the significant resources devoted to long term care by informal caregivers (primarily spouses and children). The CBO estimates that informal care is the largest single component of long term care...."

In conjunction with the spending estimates above, the National Care Planning Council has actually estimated the equivalent cost of care provided for free by informal caregivers. We think it is close to a staggering $313 billion for the year 2005. This is almost four times the amount the federal and state governments currently pay for all long term care services nationwide. It would bankrupt the federal and state governments if they had to pick up the cost of these free services. Many groups are pushing for the government to do just that -- pay a greater share of informal care services.

The process of long term care planning involves seven steps that embody the following four principles:

•Knowledge is the key to success.
•Professional help is crucial in saving time, money and stress.
•The planning process is most effective when there is money available.
•Success is assured through a written agreement with all parties involved.
Online literature and books from the National Care Planning Council provide in-depth guidance on how to accomplish the seven steps for long term care planning.

The Missouri Care Planning Council is a member of the National Care Planning Council. This "Planning For Eldercare" Articles was published by the National Care Planning Council on August 15, 2006. For more information on the Missouri Care Planning Council, please visit www.mocpc.org.

Long-term Care Insurance explored. . .

2010-04-07T08:33:00.000-07:00

The link below is a story posted on CnnMoney.com. I think there are some really good points in there, but in no way is the article complete. There are many other strategies for paying for long-term care. For instance, Veterans Aid & Attendance, Care Contracts with family or friends, or advance Medicaid Planning.

Briefly mentioned in the article are some of the many types of long-term care insurance policies and riders that can be added to a policy. For instance, a rider for inflation or a rider on a life insurance policy that provides for long-term care.

Insurance is defined by Merrian-Webster as:
1 a : the business of insuring persons or property
b : coverage by contract whereby one party undertakes to indemnify or guarantee another against loss by a specified contingency or peril
c : the sum for which something is insured
2 : a means of guaranteeing protection or safety

I think of long-term insurance as I would any other type of insurance: to protect myself against a loss from some unguaranteed event in the future.

Think for instance about buying insurance for shipping a package. You don't buy the insurance expecting to have to use it. You buy the insurance "in case" something happens. In the case of buying insurance for shipping a package, I wouldn't buy insurance to ship christmas cookies to a loved one at college. However, I would buy insurance when shipping a grand piano to a new home. If you lost the cookies, no big deal! You may have a disappointed college student, but nothing more. If you lost a grand piano, it would be difficult to replace and very expensive.

Therefore, I would only suggest long-term care insurance for someone with significant assets to protect. Otherwise, you could use some other strategies should you enter a nursing home or need other forms long-term care assistance.

Unfortunately, insurance is not something you can "wait and see" about your needs. The longer you wait, the more expensive it will be. . .and in some cases it will be too late to be insured at all.

The article below does a pretty good job of explaining how long-term care insurance can be a great solution for some, but may not be the answer for all.

http://money.cnn.com/2010/04/07/retirement/retirement_insurance_strategy.moneymag/index.htm?section=money_pf&utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+rss%2Fmoney_pf+%28Personal+Finance%29&utm_content=My+Yahoo

Of course, I would recommend meeting with a qualified Estate Planning attorney, preferrably one knowledgable about insurance policies or with many contacts available, to answer specific questions you might have regarding your own situation.

Please feel free to leave your comments below or contact our office with questions at 314-966-8077 or by email at pgantner@yourestatematters.com.

Best,

Paul M. Gantner
Attorney at Law

Staying Healthy at 50+

2010-03-02T12:14:00.000-08:00

Staying Healthy at 50+

Life expectancy has grown dramatically over the last century, but not all those living longer now are living well. The survey “Growing Old in America: The Health and Retirement Study,” (HRS) sponsored by the National Institute on Aging, found some compelling insights into the health of older Americans.

Less than half of HRS participants aged 55 to 64 said they are in very good or excellent health.
Only about one quarter of participants aged 65 and older said they are in very good or excellent health.

According to the Centers for Disease Control, the leading causes of death for U.S. adults aged 65 or older are heart disease, cancer and stroke. These account for 61 percent of all deaths in this age group.

What many people don’t realize is that behavior changes and preventive screenings can help them live better and longer lives.

Behavior
Men and women over 50 can take action to improve their overall health. It’s never too late to start.

Be tobacco free. To talk to someone about how, call the National Quitline at 1-800-QUITNOW.
Get active. Start small and work up to 30 minutes or more of moderate activity several days a week. Talk to your doctor about what you can do.
Eat healthy. Lean meats, fish, vegetables, fruits, whole grains and fat free or low fat milk and milk products are best for people of any age.
Maintain a healthy weight. Balance calorie intake with calories spent in exercise. Talk to your doctor if you start to gain or lose weight unexpectedly.
Get immunized. Influenza and pneumonia kill an average of 36,000 people a year, most of whom are women aged 65 or older. The right immunizations can prevent not only the flu and pneumonia, but whooping cough and shingles as well.

Screenings
Clinicians order diagnostic tests when they suspect someone has a disease. Screening tests, however, help check for problems before symptoms are apparent. Health experts from the U.S. Preventive Services Task Force recommend the following screenings for men and women over age 50:

Colorectal Cancer. This is the third most common type of cancer for both men and women and the second leading cause of cancer death in the U.S. More than 90 percent of cases are diagnosed in people aged 50 or older. The Task Force recommends

A fecal occult blood test every year
Flexible sigmoidoscopy every 5 years

Depression. Emotional health is as important as physical health. If you have felt down, sad or hopeless over the last two weeks, or have felt little interest or pleasure in doing things, you might have depression. Talk to your doctor about getting screened.

High Blood Pressure. Have your blood pressure checked at least every two years. If you have high blood pressure, have a blood test for diabetes.

High Cholesterol. Have your cholesterol checked regularly.

Women over age 50 should have the following screenings as well:

Breast Cancer. Mammogram every one to two years. The risk of getting breast cancer increases as a woman gets older. Nearly eight of 10 cases of breast cancer are found in women over age 50.

Cervical Cancer. Pap smear every one to three years.

Check with your doctor about what screenings you should have. Targeted screenings based on age, gender, underlying health condition or family history can make all the difference for a healthy life.

What are the symptoms of the common cold?

2009-12-11T14:41:00.000-08:00

I’m going to give you the facts/ symptoms of the common cold.

Fever: fever is rare
Coughing: A hacking (mucous- producing) cough is often but not always present.
Aches: Slight body aches and pains
Stuffy Nose: Stuffy Nose is present and typically resolves within about a week.
Chills: Chills are very common
Tiredness: Tiredness is typically fairly mild
Sneezing: Sneezing is common
Sudden Symptoms: Symptoms tend to develop over a few days
Headache: Headaches are fairly mild
Sore Throat: Sore throat is commonly present
Chest Discomfort: Chest discomfort is mild to moderate

Seasonal Flu Basics/ H1N1 Basics

2009-12-11T14:38:00.000-08:00

Influenza (commonly known as the flu) is a contagious respiratory illness caused by influenza viruses. Each year there are many types of influenza viruses. It is spread person-to-person through coughing and sneezing. Sometimes people may become infected by touching something with flu virus on it, and then touching their mouth or nose.
The seasonal flu and the H1N1 virus are two different strains of influenza. The H1N1 virus was first detected in people in the U.S. in April 2009. Because many parts of the H1N1 virus are similar to the flu virus commonly found in pigs, this virus is sometimes called “Swine Flu”. H1N1 is a novel virus because it is an infectious agent that humans have not been infected with before. Most people have been exposed to the seasonal flu at some point in their lifetime.

Symptoms of the Flu include:
· Fever
· Coughing and /or sore throat
· Runny or stuffy nose
· Headaches and /or body aches
· Chills
· Fatigue

Symptoms of H1N1 include:
Same as seasonal flu; may be more severe and may include vomiting and diarrhea.

Distinguishing between the seasonal flu and H1N1
Symptoms of seasonal flu and H1N1 are very similar. Only your healthcare provider can evaluate your symptoms and test for H1N1. You will not be able to distinguish between the seasonal flu and H1N1 on your own without testing confirmation.

Call your physician if you feel you are showing the symptoms of the flu or H1N1.

How To Stay Healthy This Flu Season

2009-12-11T14:37:00.001-08:00

Get Vaccinated. Vaccination is the best protection against any of the flu viruses. Seasonal flu vaccine is available now at most major pharmacies, grocery stores, clinics, and/or MD offices. It takes two weeks for the vaccine to become effective and it typically lasts up to three months. A minimum of 30 days must lapse between receiving the seasonal flu vaccine and the H1N1 vaccines.
The CDC recommends the following groups for H1N1 influenza vaccination:
· Pregnant women
· People who live with or provide care for infants younger than 6 months of age
· Healthcare and emergency medical service providers
· Children and young adults ages 6 months thru 24 years
· Adults 25-64 who have diabetes, heart disease, asthma, and kidney disease
Adults age 65 and older are not part of the priority group for the 2009 H1N1 vaccination. The CDC laboratory studies have shown that about one third of adults older than 60 may have antibodies against this virus. Therefore, their risk of getting the H1N1 flu is less than that of younger age groups.
Take everyday actions to stay healthy.

Differences between the common cold versus the flu

2009-12-11T14:24:00.000-08:00

How do you know if you have flu or cold symptoms? Whether it's seasonal or swine influenza, the symptoms are often similar to cold symptoms: nasal congestion, cough, aches, and malaise. But a common cold rarely has symptoms of fever above 101 degrees F. With flu symptoms, you will probably have a fever initially with the flu virus and you will feel miserable. Body and muscle aches are also more common with the flu.
WebMD has posted the following chart to help you determine your illness:

Symptoms Cold Flu

Fever Sometimes, usually mild Usual; high (100-102 F; occasionally higher, especially in young children); lasts 3 to 4 days

Headache Occasionally Common

General Aches, Pains Slight Usual; often severe

Fatigue, Weakness Sometimes Usual; can last 2 to 3 weeks

Extreme Exhaustion Never Usual; at the beginning of the illness

Stuffy Nose Common Sometimes

Sneezing Usual Sometimes

Sore Throat Common Sometimes

Chest Discomfort, Cough Mild to moderate; hacking cough Common; can become severe

Complications Sinus congestion; middle ear infection Sinusitis, bronchitis, ear infection, pneumonia; can be life-threatening

Prevention Wash your hands often; avoid close contact with anyone with a cold Wash your hands often; avoid close contact with anyone who has flu symptoms; for seasonal flu, get the annual flu shot; ask your doctor about antiviral medicine for either seasonal or swine flu.

Treatment Antihistamines; decongestants; anti-inflammatory medicines Antihistamines, decongestants, analgesics (ibuprofen, acetaminophen); antiviral drugs within the first 48 hours of seasonal or swine flu symptoms; call your doctor for more information about treatment.

When to call the doctor:

It's important to call your doctor if you also have any of the following severe symptoms:

Persistent fever: This can be a sign of another bacterial infection that should be treated.
Painful swallowing: Although a sore throat from a cold or flu can cause mild discomfort, severe pain could mean strep throat, which requires treatment by a doctor.
Persistent coughing: When a cough doesn't go away after two or three weeks, it could be bronchitis, which may need an antibiotic. Postnasal drip or sinusitis can also result in a persistent cough.
Persistent congestion and headaches: When colds cause blockage of sinus passages, they can lead to sinus infection. If you have pain around the eyes and face with thick nasal discharge after a week, you may have a bacterial infection and need an antibiotic.

In some cases, you may need to get emergency medical attention right away.

In adults, signs of a crisis include:

Severe chest pain
Severe headache
Shortness of breath
Dizziness
Confusion
Persistent vomiting

In children, signs of an emergency are:

Difficulty breathing or rapid breathing
Bluish skin color
Not drinking enough fluids
Lethargy and failure to interact normally
Extreme irritability or distress
Symptoms that were improving and then suddenly worsen
Fever with a rash

Differences between the common cold versus the flu

2009-12-11T13:34:00.000-08:00

How do you know if you have flu or cold symptoms? Whether it's seasonal or swine influenza, the symptoms are often similar to cold symptoms: nasal congestion, cough, aches, and malaise. But a common cold rarely has symptoms of fever above 101 degrees F. With flu symptoms, you will probably have a fever initially with the flu virus and you will feel miserable. Body and muscle aches are also more common with the flu.
WebMD has posted the following chart to help you determine your illness:

Symptoms Cold Flu
Fever Sometimes, usually mild Usual; high (100-102 F; occasionally higher,

especially in young children); lasts 3 to 4 days

Headache Occasionally Common

General Aches, Slight Usual; often severe

Pains

Fatigue, Sometimes Usual; can last 2 to 3 weeks

Weakness

Extreme Never Usual; at the beginning of the illness

Exhaustion

Stuffy Nose Common Sometimes

Sneezing Usual Sometimes

Sore Throat Common Sometimes

Chest Mild to moderate; Common; can become severe

Discomfort, hacking cough

Cough

Complications Sinus congestion; Sinusitis, bronchitis, ear infection,

middle ear infection pneumonia; can be life-threatening

Prevention Wash your hands often; Wash your hands often; avoid close

avoid close contact with contact with anyone who has flu symptoms;

anyone with a cold for seasonal flu, get the annual flu shot;

ask your doctor about antiviral medicine
for either seasonal or swine flu.

Treatment Antihistamines; Antihistamines, decongestants, analgesics

decongestants; anti- (ibuprofen, acetaminophen); antiviral

inflammatory medicines drugs within the first 48 hours of seasonal

or swine flu symptoms; call your doctor for

more information about treatment.

When to call the doctor:

It's important to call your doctor if you also have any of the following severe symptoms:

Persistent fever: This can be a sign of another bacterial infection that should be treated.

Painful swallowing: Although a sore throat from a cold or flu can cause mild discomfort, severe pain could mean strep throat, which requires treatment by a doctor.

Persistent coughing: When a cough doesn't go away after two or three weeks, it could be bronchitis, which may need an antibiotic. Postnasal drip or sinusitis can also result in a persistent cough.

Persistent congestion and headaches: When colds cause blockage of sinus passages, they can lead to sinus infection. If you have pain around the eyes and face with thick nasal discharge after a week, you may have a bacterial infection and need an antibiotic.

In some cases, you may need to get emergency medical attention right away.

In adults, signs of a crisis include:

Severe chest pain

Severe headache

Shortness of breath

Dizziness

Confusion

Persistent vomiting

In children, signs of an emergency are:

Difficulty breathing or rapid breathing

Bluish skin color

Not drinking enough fluids

Lethargy and failure to interact normally

Extreme irritability or distress

Symptoms that were improving and then suddenly worsen

Fever with a rash

What Is A Geriatric Care Manager?

2009-11-11T18:27:00.000-08:00

Geriatric Care Managers (GCM) are a new professional originating from different disciplines such as nursing, social work, physical and occupational therapy and gerontology. Geriatric Care Managers assess the physical, cognitive, psychosocial, legal and financial condition of the older adult and develop a Care Plan to address the unmet needs of the person. They are available to accompany older adults to medical appointments, advocate in the hospital and monitor for changing conditions. Because they are the advocate for the older adult, they often communicate with family members who are pushing for a specific course of action that may or may not reflect the desires of the older adult. They will offer alternatives and explain the normal outcome of certain decisions or courses of action.

The older adult and family members may hire a Geriatric Care Manager because they live too far to give day-to-day care and need someone closer who can be their eyes and ears. It may be that the children of the older adult are unable to take off work for doctor visits and other medical needs which can be time consuming. Geriatric Care Managers are trained in issues of aging. A GCM informs the family of their options and provides an unbiased voice. They act as a source for resource referral and education on issues of aging. Geriatric Care Managers act as surrogate family members for older adults with no children or no one to advocate on their behalf.

A GCM can assist an older adult through a transition to a residential care facility or help them to stay in their home safely with appropriate services. The goal of a GCM is the help the older adult to stay as functionally independent as possible wherever they decide to live. When an older adult struggles with living alone at home, a Geriatric Care Manager can act as the point person who brings in the appropriate services and monitors them to ensure they are working out. The GCM can handle all of the difficult day-to-day challenges that overwhelm the older adult and be the liaison to family members. In the end, everyone has more peace of mind knowing that a professional is handling the details and supporting their loved one.

Dealing With a Loved One Who Has Dementia

2009-11-11T18:06:00.000-08:00

Caregivers working with older adults with dementia find many communication challenges. Although the memory may be fading, the long term procedural memory is still there. It is possible to carry on normal conversations with persons with dementia. Since memory is diminishing, the person may repeat certain thoughts over and over again. This can be very annoying to the caregiver. Keep in mind that they do not do this to annoy the caregiver.

Persons with dementia are often aware that they cannot remember things. They can feel confused, frightened, angry and vulnerable as a result. The caregiver can help them by placing cues around the house that will trigger memory to carry out certain tasks. For instance, signs can be placed over the drawers and cabinet doors indicating what is inside so that the person with dementia will be cued as to where to find items. Organized Solutions offers labels to be used when identifying common content. They can be reached at http://www.organizedsolutions.com/. In addition, use color to make certain areas stand out and increase lighting.

Memory bracelets are available through the Alzheimer’s Association (http://www.alzstl.org/) for both caregiver and patient so that if a person with dementia gets lost, they will be able to be united with the caregiver. Likewise, if a caregiver is incapacitated, medical professionals will be aware that they were caring for someone who has dementia. In addition, alarms can be used on doors to indicate that someone is trying to go outside so that the caregiver will be aware of possible escape. Childproofing your home will ensure the safety of an older adult with dementia.

Persons with dementia often exhibit a condition called ‘sundowning’ later in the day when the sun fades. The patient may display agitation, pacing and other irritable behavior. To compensate for this, the caregiver can turn up lighting; turn on soothing music; use aromatherapy to sooth the senses; manicure nails or put on hand lotion. Sometimes giving the patient some space at this time in a safe place can also calm them. Above all, the caregiver should not take it personally. Do not argue or escalate the situation. Find tasks to keep the person with dementia feeling engaged and helpful such as folding clothes, setting the table, and other tasks with which they have familiarity and can be successful.

To assist persons with dementia in remembering past events, spend time looking at photo albums; listen to music with which the patient would be familiar. Keep a box or bin close with different textures of fabrics or a desk with items that the person would have been familiar with when they were working. Keep some dress-up clothes, shawls, hats and scarves available so that they can dress up. Stuffed toys or baby dolls may bring back memories of a time when they had young children. Rummaging is also a behavior common to dementia patients. Keep several drawers with items that are safe for them to rummage through.

One test available to measure dementia and determine the level of care and ability is the Reality Comprehension Clock Test (RCCT). It measures visual spatial ability, recall, number sequencing and recognition, functional range, stage of deterioration and potential deficits. It is capable of detecting undiagnosed infections and can act as a baseline for determining how the disease is progressing. Most importantly, it helps caregivers and family members understand the capabilities of their loved one so that activities can be designed in which they will be successful. The RCCT test determines fall risk. It also shows concretely the stage of dementia for families who are in denial about their parent's dementia. To find someone certified to administer the RCCT test, go to http://www.clocktestrcct.com/

The Alzheimer’s Association has a hotline available to assist during a difficult time. That number can be reached by calling 800-980-9080. While working with a person with dementia can be challenging, it can also be rewarding. Educating yourself on how to communicate and handle behavioral situations will reduce the number of unpleasant experiences.

Protecting the Caregiver

2009-11-11T17:59:00.000-08:00

Caregivers contribute to the well-being of older adults and aid in continuance of their functioning in family and society. The greater the level of physical impairment, the greater is the burden of stress experienced by the caregiver. Sixty percent of caregivers are women. In the past, women were in the home but as society has changed, women have jobs and careers. For a person who provides caregiving, it can mean loss of work, promotion, status, and financial condition. Spouses are also caregivers. They are often older and have impairments of their own. An average of 20 hours of caregiving are performed each week according to one study. Twelve to 18% of caregivers are under the age of 21. Caregivers face even more difficulty with finding time to socialize; obtain their education or establish careers and often experience increased depression.

What makes a successful caregiver was studied by B. J. Tarlow (2004). When caregivers felt good about themselves and their purpose, they were more successful. In addition, their outlook of life influenced their caregiving efforts. If they felt a sense of duty and obligation, they were less effective and experienced more stress. Facing disapproval from others or having a poor relationship with the care receiver contributed to poor outcomes for patient and caregiver. The level of care needed and the length of time the caring took place increased the stress burden. Competency was important as well and feeling supported. Stress symptoms might include sleep disturbance, physical impairment, feeling constantly fatigued, and depression.

Resources are available to assist caregivers. Respite services provide relief from caregiving responsibilities so that the caregiver can experience normal life activities and relationships. Some residential facilities offer respite if the family wants to go on vacation but cannot take their loved one. Adult Day Centers offer daytime physical and social activities and mental stimulation for the older adult. Geriatric Care Managers help the caregiver and family members sort out alternatives and can assist in some of the caregiving activities or arrange for services. Case managers are often available at hospitals and facilities to help manage options while the patient is at their facility. The internet can be utilized to learn more about online support groups, sources for medical supplies and information about end of life issues. In-home service personnel can be invaluable in providing day-to-day care and relieving the caregiver for some well-deserved time off. Elder estate attorneys relieve caregiver anxiety by guiding end of life planning so that healthcare powers of attorney are in place and estates can transition with the least amount of expense and hassle.

Many associations offer caregiver training, support groups and limited respite services. With today's social media, anyone can use a search engine on caregiving and come up with many helpful tips and ideas. Support groups help offer ideas on how to handle difficult issues that arise in caregiving. Members have ‘been there’ and provide emotional support to caregivers. Wise caregivers take care of themselves so that they will ensure they are available to help their loved one.

Is It Normal Aging or Dementia?

2009-11-11T17:57:00.000-08:00

Many older adults worry about the subtle changes taking place in their memory recall as they age. Memory processing in older adults does slow with aging. There may be increased difficulty concentrating or focusing with distractions and less efficient processing or storage of new information. Multi-tasking will be more difficult. Many older adults have experienced difficulty with recall of names, places or events. Just as other parts of the body are slowing down, so does the brain. It doesn’t mean that the older adult loses the information being recalled, just that it takes longer to retrieve.

Dementia impairs an individual’s ability to handle normal daily activities and social relationships. Family members may notice a lack of awareness that their loved one has forgotten something. Older adults may forget recently learned information or experience personality changes; they may have difficulty performing familiar tasks or become easily disoriented. Judgment becomes impaired. Loved ones may notice a loss of initiative. Depression and head injury can be predictive of Alzheimer’s disease. There are over 60 different types of dementia, the largest percentage being Alzheimer’s disease.

There can be many reasons for dementia that have nothing to do with a permanent condition. Certain medications or medication interactions can bring on cognitive confusion. Urinary tract infections often cause dementia or delirium and sleep apnea. Medical professionals will test to eliminate a possible disease condition that could mimic dementia. If dementia is suspected, it is critical to be tested as soon as possible so that the condition can be treated or reversed. With Alzheimer’s disease, the sooner the treatment, the longer an individual stays in the mild impairment category.

What can individuals do to protect their brain capacity? The brain uses 25% of the oxygen in the body. Therefore, exercise will increase the oxygen available to the brain. Good nutrition is also important in maintaining healthy brain functioning. Keeping the brain active is critical. Reading stimulates many different areas of the brain; creative activities, learning new skills and participating in word games are effective ways of exercising the brain.

The Alzheimer’s Association is a great source of information and support for persons with different types of dementia. They can be contacted by calling 314-432-3422. Their hotline is available 24/7 by calling 800-980-9080. For other supportive resources, check www.alzstlorg.

Manage Your Medications Wisely!

2009-11-11T17:49:00.000-08:00

Older adults process medications differently than their younger counterparts. Consequently, physicians will start their patients with lower doses to begin. Someone who is advocating for the older adult should make sure that the physician is aware of all of the medications that the older adult is taking. Keep a list of the medications with dosages ready to hand to any physician being visited. Question the necessity of multiple medications to deal with the same condition. Many older adults have multiple medical conditions and the number of medications can climb to 8 to 12 medications. After 8 medications, the patient is guaranteed of side effects.

All side effects should be reported to the physician immediately. If gait changes or instability in walking occur, it may be caused by the medications. Some medications will cause confusion and the patient may appear to have dementia. Once the medication is discontinued, their mental clarity returns. Anti-depressants can sometimes cause this reaction but they are not the only sources.

A family member may want to check with a pharmaceutical specialist who will check all medications for interactions and advise of the proper procedure for taking them. Sometimes the pharmacist at the local pharmacy will also review prescriptions and advise the patient of possible interactions if approached during off-peak hours. Do not stop a medication without first talking to your doctor. Some medications must be stopped slowly so as to not cause side effects.

Compliance in taking medications is one of the biggest challenges. Luckily, new devices are available on the market to manage medications automatically. Many older adults will have their medications in a shoe box and try to remember when they are due. This is an unreliable method and more errors can result. Today’s devices may vary from the daily pill box to computerized devices that will beep when it is time to take the medications. The compartment will only open at the appropriate time so that it is not possible to forget or to overdose. Although expensive, they are well worth it when dealing with a lot of different medications. A family member or nurse can fill the medications into the device for up to two weeks at a time.

If an older adult is not able to afford the medications, doctors often have samples that they are willing to dispense to help the patient. Drug companies have programs to assist patients who need medications but cannot afford them. Also, check with the associations connected with specific illnesses. They may have grants to help in funding medications. Some stores like Walmart have programs that reduce prices on generic drugs.

Medications are meant to help, not hinder. They must be taken as prescribed. Because older adults often take more medications, they are prone to more errors in taking the prescriptions. Finding the right method to use to aid in taking medications properly will ensure the best outcome.

Fall Prevention

2009-11-09T08:00:00.000-08:00

This is a great article from the New York Times.

Watch the Walk and Prevent a Fall

FALLS are so harmful to the elderly and so costly to society that if falling were a disease, it would be deemed an epidemic.

More than one-third of people ages 65 or older fall each year. About one fall in 10 results in a serious injury, like a hip fracture. Roughly 20 percent of older people who suffer a hip fracture die within a year.

The estimated economic cost of falls ranges widely, up to $75 billion a year in the United States, if fall-related home care and assisted-living costs are added to medical expenses.

For years, a small group of geriatric experts has studied falls and suggested preventive programs. Most of the work has relied on visits to doctors and self-reported surveys of volunteers.

But now, researchers are beginning to apply the digital tools of low-cost wireless sensors in carpets, clothing and rooms to monitor an older person’s walking and activity. The continuous measurement and greater precision afforded by simple computing devices, researchers say, promise to deliver new insights on risk factors and tailored prevention measures. Read the entire article here: Watch the Walk and Prevent a Fall

Checklist for Choosing a Home Health Agency

2009-11-04T12:50:00.001-08:00

These are the criteria you should review and questions you should ask when choosing a home health agency:
· What are the agency characteristics (i.e. name, office, ownership, certification/licensure, location, services provided)?
· Is the home health agency licensed by the state?
· Are all employees screened, bonded and insured?
· Does the agency provide ongoing communication with the client?
· Is the care supervised by a registered nurse?
· Is the care covered by Medicare or by other health insurances?
· Will the assignment of benefits be accepted?
· Does the agency provide service in the area in which you live?
· What is the minimum number of service hours that can be arranged through the agency?
· Does the agency require an advance notice to begin a case?
· Can the agency provide special help in an emergency?
· Does the agency provide case management services?
· What are the agency’s quality measures? How well do they compare to national averages?
· And finally, compare costs of the required services.