Is It Time To Consider Assisted Living?

It’s a tough question to even ask ourselves, and the first time the thought pops in your head, it may be overwhelming and make you feel extremely guilty. While deciding if it is time to consider assisted living for your loved one can be a very emotional topic, the ultimate concern needs to be the health and welfare of that individual.

One thing to keep in mind while you decide if it is time to discuss assisted living, is how is the parent coping with day-to-day activities. Noticing a decline in basic things like hygeine, eating and home safety may be some of the first signs that some sort of additional care needs to be discussed.

Here is a list of questions to ask that may help you make up your mind. List courtesy of agingcare.com.

• Is your parent telling you that he is eating, but you’re seeing food go bad in the refrigerator?
• Is your parent falling? To determine the answer, is your parent covering up bruises he or she doesn’t want you to see?
• Is your parent wearing the same clothes when you go to visit? Can they bathe themselves, groom adequately and launder clothes?
• When you look around the house or yard, is it as neat and clean as it used to be?
• Is your aging parent remembering to take medications correctly, with the right dosages and at the right time? Are medications expired?
• Are they able to operate appliances safely? Do they remember to turn appliances off when they are finished cooking?
• Is the home equipped with safety features such as grab bars and emergency response systems?
• Do they have a plan in place to contact help in case of an emergency?
• Are they driving? Should they be driving? Do they have alternate means of transportation?
• Are there stacks of papers and unpaid bills lying around?
• Do they have friends, or are they isolated from others most of the time?
• When you really look at your parent, do you see the bright and vibrant person from years ago, or do you see a more limited person who needs some help one hour a day, or even around the clock?

Once you’ve had some time to mull over your answers to the questions above, it may be time to have a family meeting with your loved one and express your concerns. When you do meet, make sure to keep the topic of discussion the parent’s safety and wellbeing. While having them live alone has probably been tough on the family caregivers, mentioning this fact could make the senior feel like they are being shipped off to a home to convenience you.

Be warned that having one family meeting may not bring about an immediate decision to move. There will be many things to discuss before an ultimate decision is reached. Your family may want to consult with an elder care attorney who can help you understand all aspects of moving into a elder care facility.

If you or your family needs help deciding if an assited living situation is right for a family member, please contact the Law Office of Dawn M. Weekly, PC. The law firm is located in Sandwich, Illinois and focuses on elder law and Life Care Planning for clients. Their office may be reached by calling 815-570-2334.

 

Every day of every week, Weekly Law is here for you.

Check In On Your Loved Ones This Holiday Season

This Thanksgiving while you are spending time with family and friends, take time to pay special attention to the seniors in your life. Many times we are visiting someone that we don’t see often so changes in health and mental sharpness can be more noticeable to family members that aren’t around as much. The holidays often provide an excellent opportunity to observe your loved ones and see if there are any changes in their well being. And with other family generally close at hand, there is the chance to discuss any issues and if there is need for additional care.

Depending on the length of your visit, you may want to try to observe the following:

• Status of new and pre-existing medical conditions – How is their general health? You may want to ask about common conditions like high blood pressure, high cholesterol, hearing loss, arthritis and weight gain or loss
• Memory and Emotional Changes  – Is your loved one experiencing frequent memory lapses that affect their day-to-day functionality? Emotional differences to look for are changes in personality or unusual mood swings.
• Medications – Are their perscriptions organized with weekly pill boxes? Do they have a list of all the medications (perscription & over-the-counter) they are taking and have they shown the list to all of their doctors? Are they taking their perscriptions correctly? For medications to be effective, patients need to follow directions for when to take pills and with or without food, etc.
• Home Safety – Keep an eye out for issues in the home that may limit your seniors mobility. The Centers for Disease Control and Prevention reports falls are the leading cause of injury and death for Americans age 65 years and older. Many times easy adjustments like removing throw rugs, adding a night light or simply rearranging furniture can help seniors avoid hazardous situations.
• Driving – If they are still driving, take a ride with them to see how their driving ability is or ask a neighbor if they have seen any issues.
• Doctors – Do you have a list of their doctors and their contact information in case of an emergency?
• Resources –  It may be a good time to find out what local resources are available in case your loved one needs some additional care in the future. Waiting until their well being is in danger will only add stress to an already tense situation.

Above all else, take the time to truly enjoy your loved ones this holiday season and remember what you have to be thankful for.

If you have any questions or concerns about a family member that may need additional care, please contact the Law Office of Dawn M. Weekly, PC. The law firm located in Sandwich, Illinois and focuses on elder law and Life Care Planning for clients. Their office may be reached by calling 815-570-2334.

  Every day of every week, Weekly Law is here for you.

Celebrating National Caregivers Month

Madge turned off the ringing alarm. It was 6:00AM and time to get herself ready for the day. Her son would be there soon to help her shower and dress her husband Lester. Her son came every day before work to help because Madge, at 75 years old and suffering with arthritis, could not lift Lester out of bed or help him to the shower. This has been the daily routine since Lester’s stroke a year ago. When her son leaves for work, Madge spends the remainder of the day caring for Lester’s needs.

This is a scenario that is repeated in every demographic all across America everyday. Because of the dedication of these caregivers, in 1994, President Clinton proclaimed a week in November as National Family Caregivers week to be observed with appropriate programs and activities. It has since been changed to the whole month of November with subsequent Presidents giving a yearly proclamation for its observance.

President Barack Obama, in his Presidential Proclamation of National Family Caregivers Month -2011 states:

“Across our country, millions of family members, neighbors, and friends provide care and support for their loved ones during times of need. With profound compassion and selflessness, these caregivers sustain American men, women, and children at their most vulnerable moments, and through their devoted acts, they exemplify the best of the American spirit.”

Caregiving can be very stressful and demanding. In the case of a healthy spouse or a child living with the disabled person at home, caregiving can be a 24 hour, 7 day a week commitment. But even for the caregiver not living in the home, looking after a loved one or friend can consume all of the caregiver’s free time.

Surveys and studies consistently show that depression is a major problem with full-time informal caregivers. This is typically brought on by stress and fatigue as well as social isolation from family and friends. If allowed to go on too long, the caregiver can sometimes break down and may end up needing long term care as well.

A typical pattern for caregivers may unfold:

1 to 18 months – The caregiver is confident, has everything under control and is coping well. Other friends and family are lending support.

20 to 36 months – The caregiver is taking medication to sleep and control mood swings. Outside help dwindles and except for trips to the store or doctor, the caregiver has severed most social contacts. The caregiver feels alone and helpless.

38 to 50 months – Besides needing tranquilizers or antidepressants, the caregiver’s physical health is beginning to deteriorate. Lack of focus and sheer fatigue cloud judgment and the caregiver is often unable to make rational decisions or ask for help. It is often at this stage that family or friends intercede and find other solutions for care. This may include respite care, hiring home health aides or putting the disabled care recipient in a facility. Without intervention, the family caregiver may become a candidate for long term care as well.

Since most family members go into informal caregiving without training or counseling, they often aren’t aware of the possible outcome described above. It is therefore extremely important to seek counseling and to formulate a plan of action prior to making a caregiving commitment.

Government assistance is available all over the country. Area Agencies on Aging and local senior centers give aid and support to family caregivers. Numerous religious and community organizations also lend their support.

According to the National Care Planning Council:

” In 1965, Congress passed the Older Americans Act which provides guidance and funding to the States to give help to caregivers. All states offer programs at no cost or very low cost which might include: counseling, caregiver training, respite care, adult day care, meals, support groups and much, much more. It is vital for the health and longevity of all caregivers to make use of these services.” (www.longtermcarelink.net)

This November take note of those around you, in your families and community, who are family caregivers. A message of acknowledgement of their service, a gift of thanks or even an offering of your time to give them a needed break would let them know their service is recognized and appreciated.

If you have any questions about the pros and cons of family caregiving, please contact the Law Office of Dawn M. Weekly, PC. The law firm located in Sandwich, Illinois and focuses on elder law and Life Care Planning for clients. Their office may be reached by calling 815-570-2334.

Every day of every week, Weekly Law is here for you.

What Is A Life Care Plan And Why Do I Need One?

In the elder law world we talk about the importance of having a life care plan, but what exactly is a life care plan and why should you and your loved ones have one? At its core, a life care plan is a guide that will help you navigate the often times confusing and stressful task of managing our care as we age. Some items that may be included in the plan are:

• Wills
• Trusts
• Power of attorney
• Advance directives
• Medicaid and/or VA benefits planning

What sets Life Care Planning apart from traditional elder law planning, however, is the Elder Care Coordination.  When you have a Life Care Plan, you get the services of an Elder Care Coordinator who assists you with all things related to the provision of care:  facility placement, procurement and retention of in-home care, advocacy, wellness checks, and all-around troubleshooting.  This aspect of the Life Care Plan takes the stress off family members and caregivers, and our clients tell us how relieved they are to have someone there for them.
Finally, a Life Care Plan also helps prepare you for the cost of providing long term care whether that be an assisted living facility or an in-home caregiver. MetLife issued a study this year that said, “National average rates for a private nursing home room increased 4.4 percent to $239 daily or $87,235 annually, in 2011”.
A recent article on the US News & World Report website (usnews.com) stated:
“If living longer is one of the great success stories of medicine and lifestyle changes, failing to plan for later-life care is one of the great failures. Relatively few people have any kind of plan for how they will take care of themselves or their spouses in old age. And even those who have been thoughtful are not likely to have set aside adequate resources to provide care that can easily top $100,000 a year.”
To be quite honest, most of us are ignoring the simple fact that we will get old and we will most likely require some sort of care. Genworth Financial, a major seller of long-term care insurance, recently issued the “2011 Financial Reality Check Study” which states that “6 out of 10 people will need long-term care at some point during their lifetimes, but three-fourths of adults surveyed have never had a conversation with family or friends about long-term care”.
Since it is a safe bet that health care costs will continue to rise, it may be a good time to consult an elder law attorney about putting together a life care plan that will not only provide for your future, but will also protect your family’s assests for future generations.

If you have any questions about creating a Life Care Plan for yourself or a family member, please contact the Law Office of Dawn M. Weekly, PC. The law firm located in Sandwich, Illinois and focuses on elder law and Life Care Planning for clients. Their office may be reached by calling 815-570-2334.

Every day of every week, Weekly Law is here for you.

Can I Get Paid to Care for a Senior Family Member?

As the number of family members providing care for aging parents increases, the solutions to find help with loss of income because of time off from employment for caregiving has become a major concern for many.

The demands on caregivers’ time and energy can make it impossible to maintain a full time job and take care of their loved one full time. There are several programs available to help caregivers either financially or through other methods of support.

A few examples of available programs and/or benefits are:

• National Family Caregiver Support Program
• Medicaid Cash & Counseling Program
• Veterans Aid and Attendance Pension Benefit
• Long Term Care Insurance Benefit

Below we have listed a brief description of each of these programs and how you can find out more about each topic.

National Family Caregiver Support Program
The federal government’s Agency on Aging created the National Family Caregiver Support Program in order to give support to family caregivers. The program offers support on a state and community level and provides a variety of services, which are listed below. To find an area Agency on Aging in your area and learn more about the program click here.

Services provided by the National Family Caregiver Support Program include:

• General information about available services
• Assistance to help caregivers gain access to supportive services
• Individual counseling and organization of support groups
• Training to assist caregivers in making decisions and solving problems
• Respite care to enable caregivers to be temporarily relieved from their responsibilities Supplemental services, on a limited basis, to complement the care provided by family caregivers

Medicaid Cash & Counseling Program
A Medicaid approved assistance program called Cash & Counseling may be used to provide funds to hire personal care aides as well as purchase items or services, including home modifications that help people live independently.

The PayingForSeniorCare.com website gives the following information about the program:

“For Medicaid eligible seniors, the process begins with an assessment in the home to determine the senior’s home care needs; this includes interviews with caregivers and possibly the senior’s physicians. A determination of how many monthly care hours are required is made. The benefit amount is calculated using that determination and cost of care for that geographic area. This amount can be increased or decreased as the senior’s needs change. A family care giver may need to qualify as a home health aid by the state to receive these funds.”

This program is executed by each individual state Area on Aging Services division. The program is relatively new and is not yet available in all states. Check with your state Area on Aging Services department for more information. To find an area Agency on Aging in your area click here.

Using the Veterans Aid and Attendance Pension Benefit
A totally overlooked source of money to pay family caregivers 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.

Receiving the benefit can be difficult because there must be a caregiver contract in place, a medical evaluation must be performed by a physician, income and asset qualifications must be met and proof of medical expenses provided. Submitting the correct forms and documentation can easily be accomplished with the help of a VA Accredited Consultant who understands the process.

Long-Term Care Insurance Benefit
If the senior being cared for has a long-term care insurance policy that covers home care, payment to the caregiver from this source could be arranged. Some policies require the care provider to be from a licensed home care agency. Other policies will pay for certified individual aides, which require the family caregiver to take some training courses. There are also policies that will pay a daily amount to the insured to use for their care. Check with a long-term care insurance professional about the differences in policies.

For questions concerning any of the above programs, contact the Law Office of Dawn M. Weekly, PC. The law firm located in Sandwich, Illinois and focuses on elder law and Life Care Planning for clients. Their office may be reached by calling 815-570-2334.

Every day of every week, Weekly Law is here for you.

Putting Home Care in Perspective

The Evolution of Home Care

In the first century of our country’s history there was no such thing as nursing homes or assisted living.  Society was mostly rural and people lived in their own homes.  Families cared for their loved ones at home until death took them.  In the latter part of the 1800s, because of an increasingly urban society, many families were often unable to care for loved ones due to lack of space, or because all family members including children were employed six days a week for 12 hours a day.  During this period many unfortunate people needing care were housed in County poor houses or in facilities for the mentally ill.  Conditions were deplorable.  In the early 1900s, home visiting nurses started reversing this trend of institutionalizing and allowed many care recipients to remain in their homes.  Nursing homes or so-called rest homes were also being built with public donations or government funds.  With the advent of Social Security in 1936, a nursing home per diem stipend was included in the Social Security retirement income and this government subsidy spurred the construction of nursing homes all across the country.

By the end of the 1950s it was apparent that Social Security beneficiaries were living longer and that the nursing home subsidy could eventually bankrupt Social Security.  But in order to protect the thousands and thousands of existing nursing homes Congress had to find a way to provide a subsidy but remove it as an entitlement under Social Security.  In 1965 Medicare and Medicaid were created through an amendment to the Social Security Act.  Under Medicare, nursing homes were only reimbursed on behalf of Social Security beneficiaries for short-term rehabilitation.  Under Medicaid, nursing homes were reimbursed for impoverished disabled Americans and impoverished aged Americans over the age of 65.  It has never been the intent of Congress to pay for nursing home care for all Americans.  The nursing home entitlement for all aged Americans was now gone.

Over the last 40 years, there has been a gradual change away from the use of nursing homes for long-term care, toward the use of home care and community living arrangements that also provide in-house care.

With Proper Planning People Could Remain in Their Homes for the Rest of Their Lives 
We are seeing a trend toward working conditions like those in urban America in the early 1900s where both husband and wife are working and putting in longer hours.  We are also seeing a return of the trend in the early part of the 20th century where outside visitor caregivers are becoming available to replace working caregivers and allow the elderly to receive long-term care in their homes.  In addition, there is a significant trend in the past few years for Medicaid and Medicare to pay for long-term care in the home instead of in nursing homes.

Given enough money for paid providers or government funding for the same, a person would never have to leave his home to receive long-term care.  All services could be received in the home.  Adequate long-term care planning or having substantial income can allow this to happen.

We only need to look at wealthy celebrities to recognize this fact.  Christopher Reeve, the movie star, was totally disabled but he had enough money to buy care services and remain in his home.  President Ronald Reagan suffered from Alzheimer’s for many years but received care at his California ranch.  He was also wealthy enough to pay for care when needed.  Or what about Annette Funicello or Richard Pryor?  Income from their movie careers allowed them to receive care with their multiple sclerosis at home.  We will be willing to bet that Mohammed Ali, who is severely disabled with Parkinson’s disease, will probably never see the inside of a care facility, unless he chooses to go there to die.  With the proper planning and the money it provides, most of us could remain in our homes to receive long-term care and we would never have to go to an institution or a hospital.

The Popularity of Home Care 
Most of those receiving long-term care and most caregivers prefer a home environment.  Out of an estimated 8 million older Americans receiving care, about 5.4 million or 67% are in their own home or the home of a family member or friend.  Most older people prefer their home over the unfamiliar proposition of living in a care facility.  Family or friends attempt to accommodate the wishes of loved ones even though caregiving needs might warrant a different environment.  Those needing care feel comfortable and secure in familiar surroundings and a home is usually the best setting for that support.

Often the decision to stay in the home is dictated by funds available.  It is much cheaper for a wife to care for her husband at home than to pay out $2,000 to $4,000 a month for care in a facility.  Likewise, it’s much less costly and more loving for a daughter to have her widowed mother move in to the daughter’s home than to liquidate mom’s assets and put her in a nursing home.  Besides, taking care of our parents or spouses is an obligation most of us feel very strongly about.

For many long-term care recipients the home is an ideal environment.  These people may be confined to the home but continue to lead active lives engaging in church service, entertaining grandchildren, writing histories, corresponding, pursuing hobbies or doing handwork activities.  Their care needs might not be that demanding and might include occasional help with house cleaning and shopping as well as help with getting out of bed, dressing and bathing.  Most of the time these people don’t need the supervision of a 24/7 caregiver.  There are, however, some care situations that make it difficult to provide long-term care in the home.

Please note from the first graph below that a great amount of home care revolves around providing help with activities of daily living.  Note from the second graph below that the average care recipient has need for help with multiple activities of daily living.  Finally, it should be noted from the second graph that well over half of home care recipients are cognitively impaired.  This typically means they need supervision to make sure they are not a danger to themselves or to others.  In many cases, this supervision may be required on a 24-hour basis. (Graphs were derived from the 1999 national caregivers survey, courtesy http://www.longtermcarelink.net.)

It is precisely the ongoing and escalating need for help with activities of daily living or the need for extended supervision that often makes it impossible for a caregiver to provide help in the home.  Either the physical demands for help with activities of daily living or the time demand for supervision can overwhelm an informal caregiver.  This untenable situation usually leads to finding another care setting for the loved one.  On the other hand if there are funds to hire paid providers to come into the home, there would be no need for finding another care setting.

Problems That May Prevent Home Care from Being an Option 
Caregivers face many challenges providing care at home.  A wife caring for her husband may risk injury trying to move him or help him bathe or use the toilet.  Another situation may be the challenge of keeping constant surveillance on a spouse with advanced dementia.  Or a son may live 500 miles from his disabled parents and find himself constantly traveling to and from his home, trying to manage a job and his own family as well taking care of the parents.  Some caregivers simply don’t have the time to watch over loved ones and those needing care are sometimes neglected.

The problems with maintaining home care are mainly due to the inadequacies or lack of resources with informal caregivers, but they may also be caused by incompetent formal caregivers.  These problems center on five issues:

1. Inadequate care provided to a loved one
2. Lack of training for caregivers
3. Lack of social stimulation for care recipients
4. Informal caregivers unable to handle the challenge
5. Depression and physical ailments from caregiver burnout

In order to make sure home care is a feasible option and can be sustained for a period of time, caregivers must recognize these problems, deal with them and correct them.  The responsibility for recognizing these problems and solving them is another function of the long-term care planning process and the team of specialists and advisers involved.

Adequate Funding Solves Most Problems Associated with Providing Home Care 
None of the problems discussed in this article would be an obstacle if there were enough money to pay for professional services in the home.  These services would be used to overcome the problems discussed in the previous section.  If someone desires to remain in the home the rest of his or her life, adequate preplanning could provide the solution.

This planning ideally occurs prior to retirement, but planning can still be done up to the time that a care need begins.  The most obvious way to provide sufficient funds for home care is to buy a long-term care insurance policy when someone is younger, healthy and able to afford the lower premiums.  If insurance is not an option, then money must be put aside early in life to pay for care in the future.  The only other option is to be rich.

Unfortunately, very few people address the issue of needing long-term care when they are older.  This leads to a lack of planning and in turn leads to fewer options for elder care when the time comes.  Lack of planning means most people do not have the luxury of remaining in their homes and must rely on Medicaid support in a nursing home to finish out the rest of their lives.

To find out if you’ve sufficiently planned for long term care, or to start the planning process, give our office a call and schedule a consultation.  815-570-2334.

Every day of every week, Weekly Law is here for you.

The Hidden Secret of Elder Abuse

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 nine out of ten 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 area family members and the victim fears that reporting the crime will result in removal of the caregiver, as the perpetrator may ace 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 list is merely of 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, negect 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.

Every day of every week, Weekly Law is here for you.

Medication Problems and the Elderly

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 nine 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., associate professor of nursing at Penn State and 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. Fick.  “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 further 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 and vitamins 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 have 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.  Today there are alarms for pill boxes, watch alarms, medical alarm bands, and necklaces that ring a reminder.  Additionally there are also computerized pill boxes that ring a designated number if the pills have not been taken.  Finally, home health care agencies offer a variety of service options in helping families care for and properly dispense medication to their elder parents.

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 fifth leading cause of death in the United States today.  For assistance with medications for your loved one, give Weekly Law a call.  815-570-2334.

Every day of every week, Weekly Law is here for you!

Long Distance Caregivers Receive Help

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

One of my clients 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.

At my firm, we do Life Care Planning.  What this means is that, in addition to legal and financial advice on how to pay for long-term care, I have an Elder Care Coordinator on staff.  Elder Care Coordinators are care managers who assist caregivers, friends, or family members provide care for loved ones.  They evaluate and recommend care for the aged.  Care manager professionals are becoming extremely popular as the caretaker liaison between long distance 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 an Elder Care Coordinator might do for our clients:

• 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 the 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 or VA benefit qualification and application
• 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
• Assist families in positive decision making
• Develop care plans for older loved ones not now needing care

Services offered will depend on the educational and professional background of the care manager, but most are qualified to cover items in the list above or can recommend a professional who can.

An Elder Care Coordinator, as a geriatric care manager, can be an important asset to all families in elder care situations.  Here is an example of how an Elder Care Coordinator 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.  Mary has to be careful that she does not injure his feet, because 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 Weekly Law and our Life Care Planning.  The cost of an initial consultation is $250.00.  Mary thinks she has the situation under control and $250.00 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 full time, now has two parents to care for.  On the advice of the same friend, he decides to bring in Weekly Law and pay the fee himself.

At Weekly Law, we do a thorough assessment of the family’s care needs, as well as their legal and financial needs.  Our Elder Care Coordinator arranges for therapists to come in and help Mary with exercises and give advice on lifting.  The ECC recommends some in-home care agencies to come in and help Mary with her recovery and watch over her husband, and Mary chooses one with whom she is comfortable.  The ECC also does a home safety check to make sure the home environment is safe for both Mary and her husband.

The ECC also 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.  The ECC determines, with the family’s input, that the in-home care provider should remain caring for Mary and her husband beyond Mary’s recovery time, as this will relieve Mary of most of the burden of caring for her husband.  During their initial consultation, we determined that Mary’s husband was a veteran, and we apply for a VA benefit that will help pay for the cost of care.  Additionally, we updated the couple’s estate plan, and drafted new wills and powers of attorney.  Finally, in anticipation of the possible need for Medicaid in the future, we created a Medicaid Asset Protection Trust for Mary and her husband.

All this, and Mary knew as well that for the next two years, the Elder Care Coordinator would continue monitoring their care needs and would remain available for future situations.  She recently told us that for just over $300 per month, she purchased peace of mind and can now rest easy knowing that she and her husband are taken care of.   As for Mary’s son, he says that when you take into account the time absent from work, the time to find the right care resources for your loved ones, and the cost of travel expenses to monitor their care, the cost of the Life Care Plan was money well spent.  When you add to this the stress of handling your own life circumstances combined with being a caregiver, you will probably wonder how you could have ever done without the services provided by a Life Care Plan.

For more information, give us a call at 815-570-2334.

Every day of every week, Weekly Law is here for you!

 

Keeping Mom and Dad Safe at Home

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 that 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.

A few thoughts on hiring home care aides or live-in caregivers

The classifies 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, longtermcarelink.

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.  Make us one of those resources — we have information in our office on local services.  Call us for more information.  815-570-2334.

Every day of every week, Weekly Law is here for you!