Elders May Experience Deteriorating Vision

Aging Causes Cataracts

One of the many consequences of aging is deterioration in vision. Almost 70 percent of people 75 years and older have developed cataracts. Both my parents are currently in their eighties. My father’s eyesight has remained consistent for many years. My mother, on the other hand, has experienced cataracts in both eyes. As one ages, the eye’s lens becomes less flexible, less transparent and thicker. This results in areas of the lens becoming cloudy.

Many seniors are affected by cataracts that, in turn, affect their vision. It can begin to creep in on one’s peripheral vision, substantially minimizing the field of vision. If left untreated, the cataract will become white and block vision. Cataract surgery, where the eye’s natural lens is removed and replaced by an intraocular lens, tends to be very safe with a very high success rate. Yet, there are things that people with cataracts should be aware of.

When you lose something you’ve had for years, it can be traumatic. Seniors can be increasingly frustrated, and put themselves in potentially dangerous situations when their vision is failing. Simple household chores can get pushed aside. Try reading the prescription bottles with bad eyesight. Or, attempting to drive a car. Home Care Partners provides carestaff for those seniors remaining in their homes. We can help by providing a set of eyes, and ears, to insure the safety of the senior and the home environment.

Many elderly will experience some loss of vision as they age. The health of your eyes is important, and cataracts are experienced by many seniors.

Risk Factors:  Various risk factors increase the chances of cataracts. Certainly, family history and genetics are big factors. Additionally, lifestyle factors are important. Smoking, prolonged or excessive exposure to sunlight, eye injury or inflammation, and long-term use of steroids. Diabetes can greatly effect eyesight. Risks, however, can be reduced. Regardless of your age, wear UV-rated sunglasses and a wide-brimmed hat when you’re in the sun for an extended period of time. If you smoke, try to quit. Proper diet and regular exercise can also help.

Manage Your Eye Health:  An eye exam should be performed annually. Let’s face it…it’s painless, provides some assurance and peace of mind, and informative. If you are over the age of forty get a baseline exam. Signs of eye disease begin to occur in middle age.

Surgery Is An Option:  If glare, halos, blank spots, blurriness and dimmed colors are complicating your ability to drive and read, surgery may be the right option for you. However, if your eyesight is not affecting your lifestyle, you may want to wait. Those considering surgery will need to give their doctor a complete medical and eye history, including their use of medication. Certain medications can cause the iris to move out of its normal position, which can lead to complications during surgery. The surgery can still be successful, but the surgeon may need to adjust his or her surgical technique.

How to Cover Costs of Aging?

LTC Insurance Provides Security

Like any insurance product, the cost for monthly premiums is normally going to be less when you initiate coverage at an early age. The younger you are, the lower the premiums. Costs for long term care insurance are less on a monthly basis if you purchase during your 40′s than your 50′s. Certainly, this is not an easy decision. Many people are paying mortgages or college loans in mid-life. But understand, this may be the best planning option and strategy to cover the medical and non-medical costs of aging.

To access your insurance coverage, one must demonstrate the need for assistance. This may require a medical examination and written proof – either from your primary care physician or another qualified medical professional. (You should consult with your insurance provider as to specific policy requirements.) When “activities of daily living” are compromised, many elders need assistance in their daily functions and living existence. Specifically, functions such as bathing oneself, properly preparing food to eat, transporting oneself from bed to chair to couch, etc. Often the “proof” of your qualifications to receive benefits under long term health insurance includes not being able to function in your basic activities of daily living.

My parents have long term care insurance. They are ages 85 and 81, respectively. At this moment, they have not needed to access their policy for living assistance or financial coverage. However, they are housebound and do not drive. Homecare services enable them to have some assistance with daily needs and household chores, such as: laundry, meal preparation, grocery shopping, medication reminders, and bathing. Given that they remain comfortable living at home, we are investigating the coverage options to help pay for homecare services. But remember…even if you are fully paid on any/all long term care premiums, there must be a documented and demonstrated need for assistance.

Planning for your future, as it relates to aging, necessitates taking responsibility and ownership of your options. Medicare is not a long term option. Medicare will cover up to 100 days in a hospital or skilled nursing facility, but then the coverage stops. What to do then? If the average cost of care in a nursing home is $10,000. per month, you may require $240,000. for a two year period. Non-medical homecare services may be less (Home Care Partners provides 24/7 live-in staff for approximately $6,800./month). Nonetheless, a significant amount of money. One of the methods utilized to minimize your financial risk is through Long Term Care Insurance. Read the fine print. Make certain your policy covers what you expect. Ask questions. Does policy cover in-home assistance? Are costs associated with living in an assisted living facility addressed in your policy? Are special needs (example, Parkinson’s) covered? Are there limitations to your insurance coverage? What areas are NOT covered by the policy??

Long Term Health Care Insurance

Plan For Your Future

Long Term Health Care (LTC) Insurance is a life-planning strategy to insure coverage for the unexpected. Many savvy and (financially) able people initiate policy coverage in mid-life. This direction enables them to gain insurance coverage while healthy, and insure the benefits needed when they are elderly or infirm. It can be a purchase which will guarantee a minimal standard of living and treatment for those who may fall sick for an extended period late in life.

LTC comes in many sizes and shapes. Be conscientious and careful to read, review, and understand the details of the policy coverage with your insurance broker. Compare and contrast benefits. For example, Home Care Partners has worked with clients carrying widely divergent coverage benefits. In one case, our client was covered for 24 hour per day, 7 days per week homecare coverage re-imbursement. Our staff provided the homecare assistance, and the client was eventually fully re-imbursed by their insurance policy. In another case, our client took advantage of a daily per diem fee which covered homecare services. More specifically, her policy covered up to $150.00 per day of homecare services. So our client could choose to have homecare staff daily, or on selected days. And she was covered for approximately six hours of care service through her long term care insurance. Not a dime came out of her pocket. Home Care Partners directly invoiced and was paid by the insurance carrier.

Clearly, there is a “life-planning” function which will require much greater personal ownership and awareness as our population ages. This will require a complete “mind-shift” for many seniors, who: 1) never realistically expected to live this long, and 2) somehow expected and assumed that services such as Medicare would “take care of me” as needed. There are no real comprehensive and all-inclusive services available to the general population. Medicare does not cover areas such as assisted living facilities, which is a very hefty monthly expense requiring private pay. Medicaid will provide nursing home coverage for those seniors will very little financial assets.

Veteran’s Pension for Home Care

Aid & Attendance Provides Tax-Free Financial Assistance

Aid & Attendance is a federal pension benefit available to eligible veterans and surviving spouses through the Veterans Administration.   This is a tax-free, monthly pension.  Veterans/spouses with certain recurring  health/medical expenses may be able to financial assistance to help pay for homecare services.

Currently, there are less than 600,000 individuals actually receiving financial assistance. This figure represents only 5% of the population which may be eligible, and who would qualify at some level for Aid & Attendance. Under the right conditions, many seniors in this country could qualify to receive up to $2,019./month (husband & wife) in tax-free funds from the Department of Veterans Affairs.

To receive the financial benefits, a veteran must have served on active duty during a period of war and received an honorable discharge. Service in combat is not required, only that the veteran was in a branch of the military service during wartime and was discharged honorably. Single surviving spouses of such veterans are also eligible. Additional eligibility requirements include a medical/health condition (or documented medical disability) that requires regular assistance with Activities of Daily Living (ADL’s), and financial need.

Unfortunately, few people know where to turn for basic information about this pension – whether or not they might be eligible – and how to apply.

In a previous blog entry, I began to write about the “myths and misconceptions” concerning the Aid & Attendance pension benefit, the application process, and the subsequent proper use of benefit funds.  Below, I continue this discussion…

************************************************************************************

Myth # 7:  I own my home. I have lived here for 35 + years. Won’t this disqualify me?

Answer:  Quite the contrary. The Aid & Attendance pension was put in place to help seniors remain in their homes, and provide them financial assistance to do so. The benefit was established back in the 1950′s…back when there were no assisted living facilities, nor nursing homes, available to help people as they naturally aged. People remained in their own homes as they grew older.  As we all know, a bi-product of aging is a deterioration of some skill and functionality, and the Veterans Administration provides some funds to pay for services to “aid and attend to” eligible recipients.

 Myth # 8:  I have no outstanding mortgage on my home, which is my primary residence. Does this eliminate my eligibility?

Answer:  No, not at all. Whether you currently carry a mortgage on your residence, or are debt free, has no effect on eligibility. Your home is not counted in defining your “liquid assets”. Now, if you own more than one home, this may disqualify you. But if you are like many seniors, and you live in one home (whether you own, or rent), you may be eligible to receive some financial help to stay there.

Myth # 9:  I have taken out a reverse mortgage on my home, and am using it for monthly cash flow. Am I still eligible for Aid & Attendance?

Answer:  Yes, for two reasons. Number 1:) the reverse mortgage is actually a loan, so even though you may be using it to provide funds for your daily living, it is not considered or counted as income. And Number 2:), your home is not counted as an asset – so the fact that you are using it to generate spending money is your decision, and your business. But it does not effect eligibility for Aid & Attendance.

Myth # 10:  I heard that the asset ceiling for my savings and estate portfolio is $40,000. Is this true?

Answer:  No. There are many figures being tossed around concerning “total liquid assets”, and this is yet another that is incorrect. The VA has set a ceiling on liquid assets at $80,000 or less. This means, for a veteran and spouse who are thinking about preparing an application, they must have combined household assets of $80,000 or less. Similarly, for a single applicant (i.e., veteran with no dependents, or a surviving spouse of a wartime veteran), the total liquid assets need to be less than $80,000. 

Some of the misinformation in the marketplace is due to positioning for estate and financial planning.  Since there is not look-back period for Aid & Attendance, personal savings and estate portfolios can/are managed to provide proof of assets below the $80,000 ceiling.  Unfortunately, some veterans have been misinformed, and were told of a required lower assets figure in an effort to gain a business advantage.

Myth # 11:  My father already receives medical benefits through the VA. Is he eligible for Aid & Attendance?  

Answer:  Yes, he is absolutely eligible. A veteran may be wise to have medical coverage through the substantial resources offered within the VA medical system. But this in no way precludes eligibility for Aid & Attendance. The former offers hospitalization, medical care and attention. The latter provides financial assistance to help defray costs related to homecare.

Myth # 12:  I’m healthy, but my wife requires significant care. Should I look more closely at this benefit?

Answer:  Aid & Attendance may provide some financial assistance. There are generally three categories for claim applicants: A) Veteran and Spouse; B) Veteran with no dependents; and C) Surviving Spouse of eligible wartime veteran. Each of these claim categories provides a different dollar amount as a maximum benefit. One criteria to determine eligibility is having a medical/health related need, effecting two or more of your “activities of daily living”, or ADL’s. Should the spouse require care, she and her husband should think about submitting an application for benefits.

Myth # 13:  I currently receive a monthly pension through Aid & Attendance. Can I expect my monthly pension to increase?

Answer:  The Aid & Attendance benefit, in all eligibility categories, is tied to increases in social security. This year in 2012, the benefit increased approximately 3%, as did social security. Therefore, the maximum benefit levels for recipients of Aid & Attendance did show a slight increase for those receiving the pension.

How To Hire Homecare Services

Needing Additional Care Assistance at Home

Arranging home care services for yourself, a parent, grandparent, or family friend may seem like a daunting task…but it can be quite simple! Certainly, the decision making process can be quite difficult if under stress, or due to an emergency situation. Recently, Home Care Partners has provided private duty in-home care to clients under stress and deadlines. For example, a hospital discharge plan which requires the family to have 24/7 home care coverage. Or, an assisted living facility which requires residents to hire home care services to insure safety and security within the apartment living space.

Many families attempt to absorb the caregiving duties for Mom and Dad. However, there are multiple factors which can prevent family members from directly caring for aging parents. Families may be quite dispersed, with significant gaps in geographical proximity. Distance may make hands-on caregiving impossible. Professional and atomic family obligations may severely limit the available time to help. And relationships may cause a blockage. That is, mother and father may NOT want a daughter (or son) to help them with personal care needs…bathing, showering, and toileting. They may prefer a professional who is trained to provide these services. They DON’T want family members to provide this kind of assistance.

Are you truly able to care for and/or attend to the needs of one or both aging parents?

Hiring an Agency

Sometimes it is as simple as picking up the phone. You can find Home Care Partners in 1) the local phone directory; 2) online with descriptive information on our website: http://www.homecarepartnersma.com3) via our newspaper advertising; 4) or simply pick-up our corporate brochures at various Council on Aging offices.

You are encouraged to ask any/all pertinent questions.

- Does the agency conduct background checks on their care staff? Home Care Partners conducts two levels of screening. We run an online search on all candidates. And in the Commonwealth of Massachusetts, we submit a criminal background check (referred to as CORI) specific to the Commonwealth. This information will tell us whether any candidates have appeared in court on a violation, and the court determination at that time.

- Does the agency have sufficient staff resources? When a care staff has a scheduling conflict, or illness, does the agency have resources available to provide substitution for a given day, or period of time? We strive to build our roster based on localized staff. So we hope to always have local employee resources available for our clients.

Tips For Elderly Who Are Homebound

Call On Local HomeCare Resources

With winter upon us, it is difficult for many family members to assist elderly relatives. In some cases, it is a simple fact that distance makes it impossible to attend to elderly parents. But even short distances can be greatly effected by weather.  Bad driving conditions, slippery roads, poor visibility, can prevent family involvement for those who may live relatively nearby.

Take precautionary and preventative steps to keep family elders safe. Is there a back-up plan? Do you know of community resources that can provide assistance when/if needed?

Home care agencies can provide an extra set of eyes, hands, and help to insure family elders remain safe and comfortable during winter months.

Helping your loved one avoid “cabin fever.”  For homebound seniors, winter can be a time of extreme boredom. Nothing happens in their day-day living environment. Meals and watching television are the only checkpoints of their daily existence. No visitors, no events, no activities. This boredom and isolation can result in feeling quite depressed. But homecare staff can provide a daily visit. Someone to talk to. Care staff can transport your loved one to his or her usual activities, or simply get them out of the house for a short drive. Companionship is a very positive antidote to loneliness, and can engage in homebound activities such as crafts, reading, writing, organizing, board games, puzzles, and card games.

Eliminating fall hazards.  At Home Care Partners, we provide help to our elderly clients in keeping their homes clean, and orderly. Care staff can coordinate and manage functions such as snow removal from driveway, walkways, and stairs. Perhaps de-ice may be thrown out on driveway before travel. The caregiver can bring in the mail from the mailbox, or the newspaper outside the front door.

Keeping your loved one safe during power outages.  Our care staff can assure your family/parents are safe. Windstorms and heavy snow knock out power for millions each year. Darkness and cold endanger frail seniors, especially those with cognitive issues or age related dementia. Seniors who rely on electrically powered medical equipment, oxygen machines, or mobility devices can be put in life threatening situations without assistance. Home care providers can enable safety, including transportation to a warm facility, home, or designated shelter.

Winter Can Be Difficult For Elderly

A Little Help Goes A Long Way

During winter months, many seniors become stagnant. They don’t like the cold and snow, so they stay indoors. Becoming housebound can create a unique set of health and safety problems for elderly living alone.  Often, professional in-home caregivers support community seniors with time, attention and companionship to help get through the winter months.

There are many, many issues related to the ongoing health of seniors which can be categorized as physical, emotional, or home safety. Some quick thoughts on elderly health and well-being.　

Preventing hypothermia.  As we grow older, we become more sensitive to the cold. Though seniors are at higher risk of hypothermia, common health problems and some medications may cause them to be less aware that their body temperature is dropping. An indoor temperature that feels fine to younger people may be unsafe for older adults.  Staff at Home Care Partners will monitor senior clients for signs of hypothermia, and help them remain warm and comfortable, perhaps with a sweater, thermal underwear and an extra blanket for the bed.

Tasks of Personal Care.  Taking a bath or a shower means getting cold. So for this reason (and others!), many seniors try to avoid washing themselves. Caregivers help senior clients with bathing, grooming and other hygiene areas. In wintertime, often the skin needs extra attention, as cold outdoor conditions and dry indoor air can cause chapping and irritation.

Listen to the Doctor.   Our caregivers will transport seniors to doctor appointments, and sit in on the meeting. Trips to the pharmacy can be every 10 days. Our staff also provides medication reminders, and will handle grocery shopping for nutritious meals and snacks. Seniors can require constant reminders on health and safety compliance. Physical activity may be some quick exercises for muscle strength and balance needs in arms, legs, ankles, and knees. It provides better blood flow and circulation. Good health can provide a healthy emotional mood. Our caregiver staff can take your loved one for a walk in an indoor mall or help with a home exercise program.

Peace of Mind.  Having knowledgeable, local in-home care assures you that your parents are safe and accounted for. Knowing you’ve got coverage for Mom & Dad is a HUGE help. It relieves worry of the unknown. A typical snowstorm brewing means your parents might be buried until the plows finally get to their street. But you’ve got other, local people you can call for assistance and homecare services. Your loved ones are safe with homecare professionals.

Alzheimer’s – A Disease Without Boundaries

Tips to Relieve Care Burden

Few families have been left untouched by this insidious disease. Alzheimer’s, after all, is a disease that does not discriminate. It affects people of all backgrounds, ethnicities, socio-economic status, and education. What many families fail to focus on, however, is not just the person with the disease, but the caregiver.

Many caregivers experience such symptoms as denial, anger, social withdrawal, anxiety, depression, helplessness, sleeplessness, and irritability. In short, caring for a spouse or parent with Alzheimer’s often leads to exhaustion and emotional burnout.

What can caregivers do to reduce the burden? The Alzheimer’s Association and other experts offer the following recommendations:

Manage your stress level.

High levels of stress, which are very common with primary caregivers, can cause physical problems. Use various relaxation techniques to ease the stress and consult your doctor.

Take care of yourself.

Caregivers can’t ignore themselves in the process of helping their loved one. Watch your diet, exercise and get plenty of rest. Take time out for shopping, entertainment and getting away.

Become an educated caregiver.

Find out where there are support groups or contact your local Alzheimer’s association to learn more about how to cope.

Be realistic.

Many of the behaviors that occur with Alzheimer’s disease are beyond your control and the control of your loved one. Yes, you can grieve, but you must also focus on the positive moments.

Do legal and financial planning.

Consult an attorney and other specialists to discuss legal, financial and medical issues. These decisions need to be tied up sooner rather than later.

Give yourself a break.

This is considered the most important step – and the one that you can least ignore. It may mean exploring home care services, adult day care options or respite services. Home care may include companion services, a home health aide who can assist in helping with the activities of daily living (bathing, dressing, toileting and feeding), homemaking services to help around the house, or skilled care to assist with medication and other medical services. It can be live-in or hourly. Adult day care may offer music and art programs for the Alzheimer’s patient. Respite services can allow the caregiver to re-fresh her batteries by going away for the day or taking a much-needed weekend break.

Don’t be a martyr.

If at all possible, don’t do it alone. You can’t live like this for too long. Seek the support of family, friends and community resources.

Alzheimer’s disease destroys lives – and that can include the life of the caregiver as well. The adult children for one client, who called us about sending them care staffers to help their mother care for their father, said they made the call after reaching the conclusion “we have already lost dad, we can’t lose mom too.” With a dedicated person taking some of the responsibility off her shoulders, their mother was able to leave the house for several hours every day. She could take long weekends to visit her children and grandchildren. It allowed her to slowly get back to being herself again.

Alzheimer’s Disease

Disease Recognition Can Be Difficult

Very often the initial symptoms appearing in a loved one with Alzheimer’s disease are examined in hindsight. It can be a little like viewing a car accident in the rearview mirror.  At first, his/her difficulty in recalling words may seem very minor, perhaps for no other reason than a lack of sleep or a “senior moment.”  However, he/she may begin repeating himself. There is confusion and repetition evidenced by asking the same questions over and over again. It usually becomes more obvious when he/she becomes increasingly forgetful, sometimes not remembering why he/she has gone to the store or how to drive home on streets he/she has known for years. Soon, even a spouse or adult child in some state of denial will realize this is not a case of normal aging.

In addition to losing their cognitive faculties, victims of Alzheimer’s often demonstrate personality and behavior changes. They may become more contentious and demanding. And, as terrible as Alzheimer’s becomes, it is often the family member who serves as the primary caregiver who bears the largest burden.

Alzheimer’s is not necessarily a visual disease, such as cancer or diabetes. Family members may not know or understand what the primary caregiver goes through. Even in the later stages of the disease, many Alzheimer’s patients can manage to cover up so well that even adult children or siblings may see a totally different side when they visit or call. This is a facade which can completely mask the ongoing disease progression and subsequent personality/behavioral changes. Caring for a loved one with Alzheimer’s can be an all-consuming 24-hour-a-day, seven-day a week grind.

Home Care Partners provides experienced, compassionate and dependable caregivers carefully selected to provide our clients with loving care and assistance. We provide families with peace of mind.  Contact us today @ (781) 378-2164 to inquire about our affordable rates and to find a solution that fits your family, parents, or those important seniors in your community.

Medicaid: boon or busted?

I came across this article recently.  Credit to investment banking firm Wyatt Matas for this content…

Long-term care providers can expect their currently shrinking margins to disappear completely in the new year, according to a recnet report issued by the American Health Care Association, a trade group. Citing a shortfall in Medicaid funding for senior care that totaled over $6 billion in 2011, the report notes that providers who depend on Medicare cross-subsidization to maintain operations will face a tough year ahead. An expected cut in Medicare reimbursement rates and the predicted negative 14 percent Medicaid margins means that providers relying heavily on these two government payers won’t manage to break even, with average losses of nearly $20 per Medicaid patient day. In the same week that this report appeared, the US Department of Health and Human Services released an initial set of additional quality measures for Medicaid patients. Published as part of the health reform law, HHS notes that the measures will track performance and encourage quality in care coordination and chronic disease management. States that choose to adopt the additional measures will use them to form a strategy to ensure quality care to growing Medicaid populations while funding continues to shrink. This all means high volume, low margins for providers, a situation that will further stimulate M&A activity as providers scramble to scale their businesses to gain efficiencies and offset declining margins.