Discussing Senior Care Options with Family

As the news media reports on the presidentail campaigns, we now all know Barack Obama is taking a couple days off the campaign trail to visit his sick Grandmother, Madelyn Dunham, in Hawaii.  She was discharged from the hospital to her home and her condition is described as serious.  Details of her illness have not been released but it is clear she preferred to go home to recover.

Medicare will pay for a temporary stay in a nursing home for rehabilitation after a hospital stay.  Medicare does not pay for long-term care in the home nor in the nursing home.  Only Medicaid, which very low-income seniors can qualify for, will pay for permanent long-term care in a nursing home (there are a few states, such as Vermont, developing in-home programs for Medicaid care).  Typically states require a senior to have no more than $2,000 in assets to qualify for Medicaid benefits.

Have you had the discussion with your parents regarding where they would like to receive care if the situation would present itself?  Do they prefer to go to a nursing home for recovery?  If so, which nursing home in your community do they prefer?  Hospitals will send a patient to any nursing home in their area, based on the discharge planner's instructions.  One time I was going to a hospital to meet with a patient regarding her care needs.  She had no immediate family and when I arrived, I discovered she had already been discharged and sent to a nursing home.  Her Guradian thought she was going to be discharged to a different (and better) nursing home.  The nursing home she was sent to was primarily a nursing home for Medicaid patients and unfortunately all the stereotypes that go with that were present (it did smell like urine, patients were medicated and parked in a room, sitting in their wheelchairs for the day).  This client was uncooperative at the nursing home, as soon as she was moved back to her home she was eating and talking again and her health improved.

Every situation is different.  Many times a nursing home can be the best option.  But it is important to discuss the wishes for care with the senior and become educated on the options in your area.   Medicaid is what it is - a regular government check the nursing facility will receive until the senior passes on.  A Medicaid pateint is not going to threaten to leave if conditions are not up to par - they are receiving a free place to stay from the government and do not have that option.  As nursing homes are businesses seeking to make a profit, it is important to ask the right questions. Find out what percentage of beds are Medicaid and find out the staff-to-patient ratio.

As the cost is typically nearly the same, more and more seniors are opting to go home and receive a private duty caregiver rather than go to a nursing home - - they are guaranteed one-to-one care from a caregiver where most nursiing homes have one nursing aide for as many as 12 to 15 patients.

 

 

 

Barack Obama: Taking Time Out for Grandma

This week, Barack Obama's campaign announced that he will be taking time off from the campaign trail to visit his ailing Grandmother in Hawaii.  Barack's Grandma, Madelyn Dunham, age 86, is in declining health and her situation has become critical after being discharged from the hospital.

We will all be Caregivers at some stage of life.  As a family or professional caregiver, you will experience the daily challenges of assisting someone else with their "activities of daily living".  This is the term used in the care industry for all the tasks we engage in throughout the day from eating to bathing to exercising.  Seniors with memory loss may also require additional reminders to maintain their daily schedule.

Hospice training teaches that the healthiest way to lose a loved one is to be able to plan ahead for their death.  This allows you to better come to terms emotionally with the expected loss and to have quality time to share with them to say the things you would like.  Just being able to say goodbye makes the loss a little easier. 

I have found that this only comes true after the person you love has passed on.  It is still difficult to make peace with the loss ahead of time, as you are still dealing with anger, sadness and perhaps denial.

I respect Barack for maintaining a relationship with his Grandmother and for making the time to spend with her to say goodbye.  This sets a nice example for dealing with the loss of a loved one for other's to follow.  And it also highlights how much more difficult caregiving can be when you are a long-distance caregiver.  Caregiverlist tries to assist in long-distance caregiving by providing information on services in each state.

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Assisted Living Survey Released Today

When navigating the various options for senior care, it is important to understand not only the care requirements and costs but also the short-term and long-term care needs.   This can be especially challenging when Assisted Living becomes the senior's desired choice.  Most Assisted Living communities charge separately for caregiving services and may have limited resources for providing nursing care and assistance for those with memory loss. This is why it is important for a senior and their family to evaluate the senior's long-term care needs before making the move to an assisted living community.

Inside Assisted Living, a website for families evaluating assisted living, today released their new research study, "Assisted Living Family Attitudes and Preparedness Report."   The survey of 195 families provides an overview of important topics for seniors to understand when evaluating Assisted Living communities.  These include costs, caregiving services, and facility criteria for the senior community.

The survey found that 75% of the respondents anticipate needing assisted living for a family member in the next 10 years.

You may view the survey results and learn about Assisted Living for seniors on their website:  www.insideassistedliving.com

The website founder, Ryan Malone, learned about the challenges of finding appropriate senior care when his Mother suffered a stroke and shares his experience to make the process easier for other seniors and their families.

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Free CPR Training Videos

The Today Show provided a how-to on CPR this morning, including providing the tip to keep pace to the beat of the song "Staying Alive"  while performing chest compressions. This is because this song keeps pace at about 103 beats per minute.  A representative from the Red Cross advised that everyone should be trained on CPR and at least one member of every household should know how to perform CPR in an emergency.

You can view this informative how-to video with Matt Lauer performing CPR on a doll.

You may also watch these  free training videos on CPR from the Red Cross.  They also suggest that everyone have a first aide kit in their home.

Deffinitely family and professional Caregivers can benefit from learning CPR or taking a refresher to be ready to assist with any emergencies.  Many seniors may have a pacemaker or be taking medications which may impact their heart by speeding it up or slowing it down.  Caregivers for seniors with heart conditions are advised to be trained in CPR. 

 

Social Security Benefit Increase Announced Today

Today the government announced retired seniors will receive a raise in pay starting January, 2009.  It is the largest increase in Social Security benefits for seniors in more than 2 decades.  On average, seniors will receive an additional $63 per month with the 5.8 percent increase in this senior retirement benefit.  Seniors can begin receiving Social Security benefit payments at age 62 or wait until age 65 for an increased benefit amount.

The typical American senior who has activated their social security benefits receives about $1090.00 per month.  This amount barely covers living expenses, which can cause added stress when medical conditions require caregiving services, medications or other treaments not covered by Medicare insurance.

About 50 million seniors receive Social Security benefits and with the increases in food and gas costs we have experienced in the past year, living on a fixed income has become more challenging.

You may find out your expected monthly social security check payment, based on your current age and income, on the government's website:  www.ssa.gov

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Hospice Care: When Should It Begin?

Hospice care was developed as a care solution for terminally ill patients.  Usually family members are involved in care services when a senior or someone younger is terminally ill.  Medicare does provide for hospice care services for seniors and provides certified nursing aide caregivers, social workers and registered nurses to visit the home to assist with the senior's care needs.  Family caregivers often do not realize Medicare will pay for hospice care services for seniors to help support them.  Yet the support of hospice can make a difficult situation a little easier to manage.

Hospice will also assist with the emotional aspects of terminal illness for both the senior and their family and for professional caregivers, along with bereavement care. In addition, hospice will provide a Certified Nursing Aide to assist with tasks such as bathing.  My grandmother moved in with my Aunt when she became terminal with cancer.  While my Aunt wanted to provide for her care, it was exhausting.  She appreciated the regular check -in visits by the hospice staff.  The hospice Certified Nursing Aide assisted her with bathing assistance visits and the Registered Nurse gave her feedback on the progression of the cancer.

Hospice care may begin as soon as someone is diagnosed as terminally ill.  There are many companies which provide hospice care and your medical doctor can usually provide a referral.

Learn more about hospice care services directly from the hospice foundation.  http://www.hospicefoundation.org/

 

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The Five Wishes: An Easy Living Will

The Five Wishes is a document which was created to serve as a living will and provides questions to prompt you to think about how you would like your medical treatments and care to be provided if you were unable to speak or communicate these desires for yourself.  This living will document accounts for your medical, personal, emotional and physical needs.  It has been called a "living will with a heart". 

When I owned a Senior Home Care Agency, I placed a bulk order for the Five Wishes and gave many copies to client's family members.  The Five Wishes makes sure all the specific questions about care are answered.  For instance, laws can vary slightly in each state regarding to what is life support (is it both a feeding tube and a breathing apparatus)?  The Five Wishes is honored in 40 states and provides a starting point for you if you don't live in one of the 40 states.

Save money on Last Will and Testament

People of all ages, not just seniors, should take the time to create a living will so that family caregivers will know your desires.  The Five Wishes makes this an educational and easy task.  Definitely if you are a senior or if you do not know what your senior parent's wishes are, the Five Wishes can be a nice starting place for a discussion.

I really like The Five Wishes because it breaks it all down into specifics:  do you want life-support if you are sure to die in a short time or if you are in a coma and not expected to wake up or if you have permanent and severe brain damage and are not expected to recover?

The Five Wishes

Wish 1:  The person I want to make health care decisions for me when I can't make them for myself

Wish 2:  My wish for the kind of medical treatment I want or don't want

Wish 3:  My wish for how comfortable I want to be

Wish 4:  My wish for how I want people to treat me

Wish 5:  My wish for what I want my loved ones to know

There is a page for witness signatures and wallet cards are provided.

Creating a living will in the form of the Five Wishes makes sure you will have your desires spelled out and will prevent added stress for family members who may all have their own beliefs and desires, which may differ from yours.  You will be able to avoid a Terry Schiavo situation where the husband wanted life support removed after 15 years and her parents did not (the autopsy did confirm her brain was severly damaged, weighing half of a normal human brain, which meant she was unable to think, feel, see or interact in any way with her environment - for all that time).

The Five Wishes was introduced and originally distributed with support from a grant by The Robert Wood Johnson Foundation, the nation's largest philanthropy devoted exclusively to health and health care.

You may order a copy of The Five Wishes for $5.00 from www.agingwithdignity.com (just $1.00 per copy if you order 25 or more copies).

 

 

 

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Chicago Marathon: Older Runners and Wheelchairs

We know that exercise is good for our health, at all ages.  But if you are ever finding yourself thinking of excuses for why you shouldn't exercise, let these Chicago Marathon finishers provide you with some inspiration.

Aussie Kurt Fearnley won the men's wheelchair division and set a course record, too.  This was his second year to win the wheelchair division of the Chicago Marathon.  He was born with lumbar sacral agenesis, a condition that paralyzed his legs.

Another finisher was octogenarian Arturo Guzman, 84, who says he has been a runner all of his life.  He gets up at 5 a.m. every morning to go for an hour long run.

Yes, it must be true that you can build muscle mass at all ages.  The secret is to keep it moving!

And to find out about how to enter next year's marathon, visit:   www.chicagomarathon.com


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Caregiving as a Career

As the financial crisis in the U.S. continues to unravel and we experience an increase in unemployment, it is relevant to note the ongoing shortage of qualified caregivers in many cities across the U.S.

If you are transitioning in the job market, or looking for fulfilling part-time work, you may want to consider working as a senior caregiver.

Senior Home Care Agencies, Assisted Living Communities and Nursing Homes hire part-time and full-time caregivers to assist seniors with Activities of Daily Living.  Many Senior Home Care Agencies also hire 24-hour "live-in" caregivers.  Live-in means the caregiver stays with the senior for a few days at a time, preparing meals and eating with the client, and sleeping over night but they do not actually permanently live with the senior client.  A minimum of two caregivers will staff a live-in client, rotating days during the week to meet employment law requirements. 

What experience is required?  Companion caregivers, Certified Nursing Aides and Home Health Aides are hired as Caregivers.  Some of the best professional caregivers gained personal experience first by caring for a family member or friend.  Many Senior Home Care Agencies provide caregiver training on senior care.  Caregiver training may include specialty training for stroke care, dementia care, hospice care and education on age-related diseases.

Certification as a Nursing Aide can be obtained from nursing schools or community colleges.  Sometimes social service agencies and health care companies sponsor certification programs.  The nursing aide certification requirements vary in each state.  Most nursing aide certification classes can be completed  in  6 to 12 weeks.

Caregivers earn from $8.00 to $14.00 per hour and from $90 to $140 per day for live-in care,  depending on the geographic location. The hiring company provides for payroll taxes and Worker's Compensation insurance and other benefits

Senior care delivers fulfillment beyond a paycheck.  If you enjoyed visiting your Grandparents and appreciate the wisdom an older adult can share, you will probably enjoy working as a caregiver.  A caring personality, patience and dependability are qualities which senior care companies look for in caregivers.  Caregiver job applicants will also be required to pass a criminal background check.

If you are interested in working as a caregiver, contact your local Department on Aging for names of local companies which may be hiring or fill out a Caregiver Job Application on Caregiverlist.  You may also want to look into volunteer opportunities through local churches and senior centers to gain experience.

 

 

 

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Social Security Benefits: Not Enough to Pay for Medications

Sunday's Chicago Tribune profiled 5 senior citizens and how they are paying for their living and medical expenses on Social Security and Medicare or Medicaid.

How much money will you receive each month on Social Security?

The maximum Social Security benefits in 2008, for seniors who have reached the maximum taxable earnings is:

$1,682 per month if retiring at age 62

$2,030 per month if retiring at age 65

$2,794 per month if retiring at age 70

Let's assume your home is paid for and that you have limited expenses.  This amount probably seems adequate but the challenges arise when a senior has additional medical expenses and caregiving needs.  Medications are not completely covered by Medicare and can be rather expensive. 

One of the senior couples profiled by the Tribune were earning $3,000 per month in retirement income.  But when the husband was diagnosed with pancreatic cancer, the co-pays for medical visits and the costs of medications quickly amounted to more than their monthly income.  Fortunately the wife is able to serve as his Caregiver for free.  Another senior profiled lives on $800 per month from Social Security and another receives $998.  Unfortunately, when on a limited income, medications are typically the item the senior will do without as they will choose to pay their rent and buy food first.

A couple of these seniors found additional assistance through churches and social service agencies to help pay for their expenses.  There was no extra money to pay for Caregiving services, which also are not covered by Medicare. 

Regardless of who wins the upcoming election, I hope they will look at the need for affordable medications for seniors of all income levels.  It seems Barack Obama is a fan of affordable medical care for everyone, understanding the challenges his Mother experienced when she was diagnosed with cancer.  AARP supports more issues supported by Barack,and you can read more on their Voter Guide.  John McCain is a senior so should understand well the need for affordable medications.  This recent New Yorker article profiles Cindy McCain and her experiences with prescription medications.

 

 

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