Assisted Living: Does it include a Caregiver?

Senior Assisted Living Communities vary widely in the services they provide their senior residents and the extra amenities offered.  There are no national licensing requirements for senior "assisted living" which causes even more confusion when you begin the process of looking for an appropriate community for yourself or a loved one.  Many times, communities which call themselves "independent living" may offer as many services as an Assisted Living Community.

Another challenge when evaluating an Assisted Living Community is learning about what elder care services are included.  While communities do hire a staff of Caregivers which usually including Certified Nursing Aides and Registered Nurses, they may only have a small number of these caregivers who are keeping an eye on all the residents .  These Caregivers are usually not available to work one-on-one with an individual senior resident to provide care services.  It is important to determine how much one-on-one care may be needed and how this will be provided.

Many Assisted Living Communities partner with Senior Home Care Agencies to provide private Caregivers for their senior residents, when more individual care services are required.  Seniors who have memory loss may require more care and some communities offer special customized services for these residents.  Other communities are not equipped to manage care for seniors with Alzheimer's Disease and other types of memory loss.

Separately, some Assisted Living Communities provide nursing care, just like a nursing home, and others do not.  Usually the nursing care is on a separate floor and will require the senior to move from their apartment to a room or bed in the nursing center area of the community.

What if the senior will eventually require nursing care which can cost as much as $80,000 per year - - will they need to move again or will the Assisted Living Community be able to provide this?  And what if the senior runs out of money and will need to go onto Medicaid?  Will the Assisted Living Community allow the senior to stay and accept the Medicaid payments or will the senior need to relocate to a Medicaid nursing home?

As an initial move into an Assisted Living Community may be connected with the death of a spouse or the diagnosis of a new medical condition, the emotional and social needs of the senior should also be considered.

Finding the right Assisted Living Community presents a complicated task because of all these dynamics.  In addition, another type of assisted living is called "continuing care" and available at Continuing Care Retirement Communities.  These communities usually require a large initial deposit (some seniors sell their home and use the proceeds to pay for this deposit) but guarantee the senior will be able to remain in the community as their care needs may change.  Usually condos or townhouses, apartments and nursing centers are all located on the campus and the senior may move between them, as needed.

Caregiverlist.com provides an "expert" to answer all your questions about Assisted Living.  Lisa Sneddon, owner of "Senior Living Experts" serves as a resource to families and a coach to seniors to assist with finding the right assisted living solution.

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Congress passes Medicare bill

Seniors depend on Medicare for their health insurance after age 65.  Archaic legislation would have decreased the Medicare reimbursement rates for senior's medical services by 10.6%.  This would have meant some medical doctors would opt to not accept senior clients as they could better cover their costs by focusing on clients who could pay their rates.  This especially becomes a problem in smaller population areas where there is already a shortage of medical doctors, leaving the elderly population needing to travel further for medical care.

Although President Bush says he will block the bill with a veto (since he doesn't need to worry about being re-elected), Congress has enough votes on the bill to over-ride his veto.  A few Republicans joined the "Yes" vote after Senator Ted Kennedy (also a senior) took a break from his chemotherapy treatments to fly to Washington, D.C. to break the dead-lock.

I have always thought it was interesting that Medicare will only pay to "rent" a manual wheelchair for a senior but if the qualifications are right, they will buy a power wheelchair for the senior  -  and pay what I have heard is as much as 4 times over the wholesale price for these power wheelchairs (you may remember the Scooter Store had hired their own "doctors" to write up medical authorizations for seniors to qualify for a scooter since Medicare was paying and they had no problem buying Infomercials to advertise this to seniors.  They also apparently hired telemarketers to tell seniors they could only qualify for certain expensive power wheelchairs through Medicare).  When the U.S. Justice Dept. filed suit against the Scooter Store in 2005, they had already billed Medicare for $400 million since 1997.

I am all for making a profit for providing a service that is of value, but I don't believe the government should be willing to foolishly over-spend on certain elder-care products and then be unable to pay for necessary senior services at a fair market rate.

Perhaps a new President will be able to help guide Medicare in a better direction as the voting population ages. And at least we know most most first-term Presidents want to be re-elected and should pay attention to the voice of seniors.

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Senior Care: How Much Does it Really Cost?

Fidelity Investments, a leading mutual fund company which manages the 401K retirement assets for many Americans (Fidelity manages billions in assets), recently released results of a study which found a 65-year-old couple needs $85,000 on average to cover insurance costs for long-term care such as nursing home stays in retirement. 

However, this would be the amount required just to pay for the long-term care insurance premiums.  If someone does not have long-term care insurance, they can expect to pay that much per year, just for a nursing home ($85,000).

Fidelity also reports that just about 5 million Americans are covered by long-term care insurance policies, a number which has remained mostly flat for the last 10 years.  At the same time, the number of Americans needing elder care will increase to 27 million people in the next 30 years.

I have found that most Americans assume that Medicare will pay for a nursing home and just don't think about needing to pay for these services.  This is because Medicare does pay for care in a nursing home in certain situations, for up to 100 days.  And it seems nearly everyone has a senior relative who was in a nursing home for a moment and the care was paid for by Medicare and this builds the assumption that Medicare pays for a nursing home forever.

Seniors only qualify for the Medicare nursing home benefit after a major medical event, such as a stroke, hip replacement or other major surgery and typically the care is considered rehabilitation.  When the 100 days is up, the coverage is up, and sometimes it does not even cover 100 days.

After the Medicare benefit expires for a nursing home stay, seniors must decide if they want to remain in the nursing home and pay the fees, or move to their home and hire a Senior Home Care Agency or move into an Assisted Living Community where they may need to also hire a private caregiving service.  Long-term Care Insurance usually covers caregiving for seniors in any location - at home or in a senior care facility or Assisted Living Community.

Caregiverlist.com contacted some nursing homes around the country in May to find out their daily rates.  Here are the daily costs in these nursing homes:

Balboa Nursing & Rehab Center, San Diego, California:  $260 per day for private room/$225 day for semi-private room

The Village Healthcare Center, Hemet, California:  $334 per day in a semi-private room

John Hopkins Bayview Care Center, Baltimore, Maryland:  $210 per day for a private room

Senior Citizens Home, Henderson, North Carolina:  $175 per day in a private room, $150 per day in a semi-private room

Westminster Commons, Atlanta, Georgia:  $165 per day in a private room, $155 per day in a semi-private room

Coral Reef Nursing & Rehab Center, Miami, Florida:  $295 per day in a private room, $285 per day for a semi-private room

Stoneybrook Retirement Community, Manhattan, Kansas:  $184 per day in private room, $147 per day in semi-private room

Neuro Rehab Center, Worcester, MA:  $265 per day in a private room, $245 per day in a semi-private room

Let's do the math for 365 days in a year times these daily rates:

$165 = $60,225.00 a year

$175 = $63,875.00 a year

$184 = $67,160.00 a year

$210 = $76,650.00 a year

$260 = $94,900.00 a year

$265 = $96,725.00 a year

$295 = $107,675.00 a year

$334 = $121,910.00 a year

Those are the actual nursing home costs.  These fees do not cover "extras" such as beauty parlor visits and clothing.  Keep in mind that in most nursing homes, there is just one Certified Nursing Aide taking care of 10 or more patients, so one-on-one care is not provided.  For this reason, if other dynamics are appropriate, some seniors will opt for in-home care.

How much do Senior Home Care Agencies charge?  From $15 - $26 per hour and from $150 - $275 per day for live-in care, depending on the area of the country you live in.

Annual cost of in-home elder care provided by a professional Senior Home Care Agency:

$18 per hour for 20 hours of care per week = $18,720.00 per year

$190 per day for live-in care = $69,350.00

Senior care in the home does provide the advantage of one-on-one care but seniors must also be able to pay for the costs of food and maintaining the home.

So the annual cost in a nursing home is easily equal to the cost of all the long-term care insurance premiums one could pay, according to Fidelity's study. 

Long-term Care Insurance can be sold in a variety of packages and depending on your age and health conditions upon purchase, you could spend from $2,000 on up per year - - but $5,000 a year is better than $80,000 for one year of nursing care.

You can learn more about long-term care insurance form our "expert" Chris Lynch and you may get answers to your questions to Chris in our Ask the Expert section.  Chris is one of the top long-term care insurance professionals in the nation and has also experienced caring for his own family members:  Caregiverlist.com's Ask the Expert.

And what do you do if you have no money at all, except for your monthly Social Security check?  Well, the interesting answer is, the U.S. government will provide you with admission in a nursing home, at no cost to you, via the Medicaid program.  But this is welfare-for-seniors and managed by each state.  Usually you cannot own a home and may have no more than $2,000 in assets.  You can no longer give your assets away to go on this free program as now Uncle Sam has a "look back" law.  At the same time, most seniors probably don't want to be at the mercy of the government's care unless it is a must. 

 

 

 

 

 

 

 

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AMA Ads Trying to Prevent Medicare Cuts

You may have noticed recent advertisements by the American Medical Association urging Congress to not allow cuts in reimbursement for Medicare, the health insurance for all U.S. seniors over age 65. This is an even larger issue because some medical doctors who are specialists in certain areas - from vision to heart surgery - could simply opt to not accept seniors as clients if they are using Medicare as payment.

The pressure is being placed on Senate Republicans, who sort of just let the bill drop before they left for their 4th of July holiday.  The House of Representatives passed a bill to prevent the Medicare pay cut by 355 to 59.  The cut then took effect on July 1st, as required.  The Bush Administration has delayed processing of new claims to give Congress a chance to make this right.

Why would anyone want to deny this benefit for seniors?  Some insurance companies with deep pockets don't want their payments reduced and they can afford to have lobbyists in D.C. to represent their interests.

The bill would reverse the 10.6 percent cut and increase Medicare payments to doctors by 1.1 percent in January. Under the current formula, doctors would still face cuts of more than 5 percent a year from 2010 to 2012.

Many low-income seniors have not had health insurance until they were old enough to quailfy for Medicare.  Military personnel, military retirees and their dependents receive care through a government insurance program called Tricare, which mirrors Medicare's fee structure.

There are about 44 million seniors receiving Medicare benefits and of those about 10 million have opted for a private Medicare Advantage program which offer extra benefits - even though studies show they cost the government more than traditional Medicare.

Many Republicans oppose the bill because it would finance an increase in doctors’ fees by reducing federal payments to insurance companies that offer private Medicare Advantage plans as an alternative to the traditional government-run Medicare program.

Medicare receives 15 million claims a week.  It will be interesting to watch what happens - and if I have time, I'll look to see which insurance companies have donated to which candidates up for re-election.

And we won't even mention the lack of Medicare payments to provide for senior care in the home.

 

 

Napping: Good for All Ages

Anyone caring for a senior knows that part of their daily routine includes time to take a nap.  Some seniors nap in both the morning and the afternoon, especially if they are early risers.

This week's Newsweek talks about the "Three-Martini Nap".  A new company in NYC offers private rooms with sleep pods and charges $15 for 20-minutes.  Some companies also offer a nap room now.  It seems we are realizing that a break in the day to relax will make the rest of the day much more productive.

The health benefits of napping have been proven by many studies, including a recent one by the Harvard School of Public Health and the University of Athens Medical School which showed that taking naps at least three days per week reduced coronary mortality by 37 percent.

The suggested nap length is 20 minutes, to boost alertness and motor performance.

Caregivers, especially, can find an afternoon nap a welcome reprieve from both the emotional and physical demands of their work.

I have long wished we Americans could enjoy a long lunch, followed by a siesta like our friends in Spain.....maybe that day is getting closer.

 

 

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Emergency Planning for Natural Disasters

One of Caregiverlist's Senior Home Care Agencies is located in Waterloo, Iowa, and has had to meet the challenge of providing care services while flood waters were rising.  The Senior Helpers franchise owner offered free caregiving services to seniors in his community during the flood crisis.

It seems family members are confronted with so many challenges when managing care for a loved one, that sometimes they forget about making sure the basic emergency plans are in place.  Organizing an emergency plan for an aging parent can make it easier for everyone to weather the storm when it hits.

I know we all like to think natural disasters will never strike us.  However, it is a good idea to plan, just in case, because tornadoes and hurricanes and floods really do happen,even in the middle of Iowa which is in a 500-year flood plain. 

Here are a few simple items that most Senior Home Care Agencies check for when they start senior care services for a new client:

Senior Care Emergency Planning Checklist

-Flashlight with working batteries or matches and candles located where the Caregiver will easily find them

-Heating and Air Conditioning system controls (is the water heater in the basement? etc.) and service contacts if they have problems

-Emergency Contacts: phone numbers for reaching the family decisionmaker for emergencies and a back-up contact person if the first person is unreachable at all contact numbers

-Insurance: know where to locate all insurance policies and have name, phone numbers and policy number for each type of insurance

-Medical Doctors:  name, address and phone number for all doctors

-Medications:  names of all medications and schedule for taking them along with the contact information for the doctor who wrote the prescription and for the pharmacy

-Evacuation plan:  where would the senior go if they needed to leave their home during an emergency?

Formulating a game plan and communicating it will make it easier to react to an emergency.

When I owned a Senior Home Care agency we had a client with M.S. who was a smoker.  Even though she was not supposed to smoke when she was alone, she did so and caught her bathroom on fire.  We moved her to a hotel nearby and then assisted her to find an apartment to rent while her condo was being renovated.  She did not have any family members she could stay with and also required a location with wheelchair access that would allow her to smoke.  She did not have a plan in place so we had to improvise as best we could which meant renting an apartment in an area away from her neighborhood and her friends.  Perhaps if a plan had been made ahead of time, she would have had a temporary living location in her usual neighborhood.

 

 

 

 

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Ronald Reagan: We are All the Same When it Comes to Aging

About ten years ago, I was in Los Angeles attending a trade show for business.  At the end of the trip, I had made plans to meet a former intern for brunch before flying out of town.  We decided she would pick me up at my hotel, we would grab brunch and then she would drive me to the airport so we would have more time to catch-up (she was pursuing an acting career and had some good stories to share).

We decided to go to a hotel restaurant on the beach in Santa Monica since it was on the way to the airport.  We had not made reservations anywhere because we knew we would be so busy talking that any place would do.  The Concierge informed us that their restaurant was booked, but, if we didn't mind, they would seat us in their breezeway section, right off the hotel lobby as their outside patio was closed.  We said that would be fine.

We sat down and proceeded to start talking away.  A little later a few people sat down at the other table near us but we didn't really pay attention to them as we were deep in conversation.

The waitress brought our omelets and then she delivered a bowl of fruit to the table next to us and said, very loud and slowly, "Here you go, here is your fruit".  My friend turned to me and said, "She is talking to them like they are in an old folk's home".  I looked up and then I realized that the person sitting at the other table was former President Ronald Reagan and his nurse and 2 Secret Service officers. 

He had a baseball cap on and took it off and read the name of the team logo on it as if he were seeing it for the first time.  He then looked up at me and waved and then said something to his nurse and pointed at me.  I winked at her to let her know that I knew the situation and that everything was cool.  She then said to me, "he is flirting with you".  We then all laughed and so did he.  He seemed to think that I was someone he knew. 

We continued with our breakfast and they continued with theirs.  One of the Secret Service officers came over to our table to say hello and told us that they had just gone for a walk on the beach and sometimes stopped in for breakfast afterwards (I think he probably really was flirting with us).  President Reagan finished his breakfast at about the same time we finished ours.  We decided we would hit the bathroom and then leave.  The Secret Service officers and the nurse told President Reagan it was time to go but he did not want to get up.  After we finished in the bathroom, he was still sitting at the table, refusing to leave.  The Secret Service officer said goodbye to us and said that this happens sometimes with the President - I told him I understood because we experienced the same thing with my own grandfather when he had Alzheimer's Disease.

It was amazing to me that we were next to a man who had been president of the United States for two terms but no one in this busy restaurant and hotel even knew he was there - he was sitting in the "leftover" section with us.  For all his success, he was just another guy trying to get through another day while dealing with the effects of Alzheimer's Disease.

"Meet them where they are" is the advice given to caregivers.  No matter who you are or what you've done in this lifetime, we are all equals when it comes to aging.

And that's my story about breakfast with the President.

 

 

 

 

 

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Long-distance Caregiving

As the media covered the passing of Tim Russert this weekend, there were a few stories about how he coordinated care for his father back in Buffalo, after his Mother had died and "Big Russ" was in failing health.  Tim pulled together an army of friends to stop by at different times and perform assigned tasks.  Tim coordinated everything via his cell phone and also had some paid caregivers helping to fill out all the necessary shifts.

Managing all the care tasks needed for a parent, when you don't live in the same city, can present many challenges.  This can be even more challenging if the senior has memory loss or is resistant to help in anyway.

This is when Care Management can be a huge help and a great relief.  Geriatric Care Managers perform all the tasks a terrific adult child, with all the time in the world, would perform.  And as adult children usually have jobs and obligations for their own children, it becomes impossible to be everywhere at once.  As Care Managers are usually trained as Social Workers or Registered Nurses, they can quickly assess the situation and decide on the best approach for a plan of care.  Some attorneys and therapists have also become trained as Care Managers.

Because families no longer always live in the same city, the Geriatric Care Management industry is growing rapidly and can be a welcome third party to manage care needs.

 

 

 

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Vet Caregiving Benefit: For Spouses Too

I was talking with my cousin yesterday and realized that when I was discussing care options with her Mom last fall, I totally forgot to tell her about the Veteran's Aid & Attendance Benefit which also provides care for Surviving Spouses.

My uncle served in World War II, so she definitely qualifies.  I asked my cousin to tell her Mom about the benefit, as I know it will be a weight off her shoulders to have another avenue to pay for care, should the need arise.

Our website includes the downloadable application forms for this benefit:

 

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Rosalynn Carter's Caregiving Award

A friend invited me to the Carter Center's Winter Weekend which was held in Florida in February.  I was able to meet former President Jimmy Carter and his wife, Rosalynn, and learn about all the work they both continue to do to try to make the world a better place for the rest of us.  President Carter decided he did not want to profit personally from his presidency (he would have been able to make millions by giving speeches, but he didn't go down that road).  He instead created the Carter Center which focuses on advancing human rights and alleviating unnecessary human suffering.  The Carter Center has nearly eliminated the guinea worm and river blindness in Africa and Latin America  - these are both conditions that can be prevented just by educational initiatives but had been overlooked by others.

President Carter also writes at least one book a year.  My Dad just sent me President Carter's most recent book, titled "A Remarkable Mother", about Lillian Carter.  She was a Registered Nurse and after her husband died, she invented a new life for herself.  She joined the Peace Corps at age 68 (she saw a TV commercial advertising "Age is No Barrier" and applied).  Then she worked as a housemother for the K.A. fraternity at Auburn University and later helped friends open a nursing home in Blakely, Georgia.  She kept on living life - and working - long after she was old enough to collect Social Security. 

Lillian discovered she had breast cancer which had spread to her pancreas in the summer of 1983 and passed away in October of that year.  She was fortunate to not have a long battle with the disease, and also fortunate to have a daughter-in-law who served as an advocate for caregivers.

Rosalynn Carter adopted caregiving as her initiative while at the White House and has continued to be a supporter of the needs of caregivers (she has written a few books, too, including some on caregiving).

Nominations are now being accepted for the 2008 Rosalynn Carter Caregiving Award.

Here is the scoop:

The purpose of the award is to recognize leadership in implementing innovative and creative partnerships between community agencies and caregiving researchers that bridge the gap between science and practice. The partnerships reflect best practices in providing effective caregiver supports to professional, family, and volunteer caregivers.

The award winning team will be announced at the RCI's Annual Conference, October 23 and 24, in Americus, Georgia.

First Lady Rosalynn Carter will present the team with a cash award of $20,000, to support efforts in implementing effective caregiver interventions at the community level.

For more information, visit: http://www.rosalynncarter.org/

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