States React to AARP Scorecard

Much has been made of AARP’s released report 2014 State Long-Term Services and Supports (LTSS) Scorecard. In fact, I covered the results in a recent blog.

Since the report’s release, state politicians and policy makers have been scrambling to either issue statements strongly urging for their state’s commitment to long term care improvement or stridently patting themselves on the back for a job well done.

Louisiana’s Times-Picayune article on nola.com about its senior population being over-institutionalized. Louisiana ranked 37th of the 50 states and Washington, D.C. in its overall long-term care policies. In that state, aging seniors are (predominantly) either placed in nursing homes or cared for at home by unpaid family members. And it ranked dead-last in effective transitions—meaning that a high number of nursing home residents are hospitalized because they’re not receiving the care they need. Funny, the same report found that there are a high number of nursing home residents with low-care needs. No doubt it is because of the lack of alternatives such as adult day care and other home and community-based services.

Not surprisingly, vociferous Louisiana AARP advocates call for increased funding of alternate care choices in an attempt to acquiesce to the majority of older Louisiana residents who wish to age in place, at home. Ironically, despite the article pointing to so many calls-to-action, they conclude optimistically, pointing out that “Louisiana's ranking in 2014 improved slightly from the 43rd slot, when scorecard was last issued in 2011.”

On the flip-side, Minnesota’s Office of the Governor Mark Dayton was quick to issue a press release extolling their number one spot on the scorecard for long term care access, choice, quality, and caregiver support. The release also pointed out that Minnesota ranked in first place on the 2011 Scorecard as well.

In the release, Gov. Dayton cited the following efforts that assist Minnesotans in “providing our parents, grandparents, and people with disabilities the best possible care.”

  • New incentives for providers to increase quality
  • More help for people who want to move from nursing homes and other congregate settings to homes of their own
  • More comprehensive information and referral services for individuals and family caregivers
  • Support for core community services that help people stay in their homes
  • More flexibility for consumers in choosing supports tailored to their needs
  • Promotion of competitive employment for people with disabilities
  • A stronger adult protection system; and
  • Own Your Future, an initiative that encourages Minnesotans to plan for their long-term care and is now exploring new ways Minnesotans can finance this care.


We at Caregiverlist® not only care for the caregiver, we advocate for seniors and their families. I hope that the Long-Term Care Scorecard elicits more than one-upmanship between states. It’s a great opportunity to see where your own system may be lacking and examine and adapt those state policies and approaches to long term senior care that appear to be working best.

Long Term Care Scorecard: Best and Worst States

When I was a kid, Florida and Arizona were the retirement states of choice. My parents and their friends decided that, after decades of Midwestern winters, the promise of warmth and sunshine, coupled with the notion of never picking up a snow shovel again proved too enticing to pass up. At their first opportunity, many of the “snowbirds” declared permanent residency in those sunshine states. Did they make the wrong move?

This week, AARP in conjunction with the Commonwealth Fund and the SCAN Foundation, released the 2014 State Long-Term Services and Supports (LTSS) Scorecard. In it, they rate states based on long-term services and support for the elderly, people with physical disabilities, and family caregivers. State performance was measured across five categories:

  • affordability and access,
  • choice of setting and provider,
  • quality of life and quality of care,
  • support for family caregivers, and
  • effective transitions

The report shows that in terms of quality of long-term care, Florida ranks in the bottom quartile compared to other states, although it fares better than Kentucky, Alabama, Mississippi, and Tennessee in affordability and transitions from nursing home care back to the community. This interactive map shows each state’s ranking:

The top-ranking states for long-term care and services are Minnesota, Washington, Oregon, Colorado, and Alaska; perhaps it’s not quite time to put those snow shovels on eBay.

It’s a well-known fact that few of us prepare for long-term care, although about 70% of people age 65 and up will need some sort of assistance with the activities of daily living. While most people would prefer to age at home, Medicare doesn’t cover the cost of home care provided by a Home Care Agency. Few of those in their 40s, 50s and 60s carry long-term care insurance and Medicaid is available only for low-income seniors with few assets. And before we all decide to retire to Minnesota or Washington, it’s important to note that long-term care is unaffordable for most middle-income seniors in all states.

The authors of the study see the need for a guide at the federal level to establish minimum long-term care performance standards below which no state should fall. No one anywhere in the U.S. should fear that their state cannot provide the needed level of assistance. Susan Reinhard, one of the study’s authors and senior vice president of Public Policy at AARP told Forbes magazine that she is optimistic in the incremental improvements she’s seen since a similar study was published in 2011, but admits all states can do better.

Caregiverlist® champions the need for change in the long-term care arena and urges you to contact your state legislature or your state’s Department on Aging and let them know how important it is to improve services in providing high-quality, well-coordinated, affordable long-term care.

Seniors Need Protection from Nursing Home Abuse

It’s a story I hate to write or even read, but sticking my head in the sand will not make the problem go away. And because June 15 was World Elder Abuse Awareness Day (WEAAD), I thought it would make sense to talk about the issue today.

Elder abuse takes many forms; physical, emotional, sexual and financial abuse unfortunately affects hundreds of thousands of seniors each year. Nursing home residents are especially vulnerable.

Back in February 2014, a Bronx New York nursing home employee was charged with raping an elderly resident who is unable to communicate. Manhattanville Health Care Center LLC had a Medicare overall rating of 5 stars, whereas, because of its number of reported bedsores and its low C.N.A.-staff-to-resident ratio, the facility’s Caregiverlist’s® Nursing Home Star Rating was a mere 3 stars.

Recently, a Florida nursing home CNA's father received a 7-year sentence in an identity theft case, where he used stolen identification information to file fake tax returns and get refunds, according to an article in McKinght Long Term Care News. Palm Garden in Polk County, Florida, also received only a 3-star Caregiverlist® Nursing Home Rating.

An evaluation published in the Journal of Elder Abuse and neglect details a seven state Criminal History Screening (CHS) program for long-term care workers. The report states that popular support for enhanced criminal history screening (CHS) procedures for long-term care workers in the United States is evident; case studies and news stories regarding abuse, theft, or neglect of long-term care residents are abundant yet repugnant to a society that aims to protect those that are physically and/or mentally frail.

Results of the evaluation found that, of the 204,339 completed screenings, 3.7% were disqualified due to criminal history, and 18.8% were withdrawn prior to completion for reasons that may include relevant criminal history.

The federally-funded pilot program points to a vital need to conduct thorough background checks for any potential senior caregivers, whether they be in an institutional or home setting.

The Administration on Aging has provided these tell-tale signs that a senior may be suffering elder abuse or neglect:

  • Bruises, pressure marks, broken bones, abrasions, and burns may be an indication of physical abuse, neglect, or mistreatment.
  • Unexplained withdrawal from normal activities, a sudden change in alertness, and unusual depression may be indicators of emotional abuse.
  • Bruises around the breasts or genital area can occur from sexual abuse.
  • Sudden changes in financial situations may be the result of exploitation.
  • Bedsores, unattended medical needs, poor hygiene, and unusual weight loss are indicators of possible neglect.
  • Behavior such as belittling, threats, and other uses of power and control by spouses are indicators of verbal or emotional abuse.
  • Strained or tense relationships, frequent arguments between the caregiver and elderly person are also signs.

Most importantly, be alert. The suffering is often in silence. If you notice changes in a senior’s personality or behavior, you should start to question what is going on.

President Barack Obama, in his 2012 presidential proclamation decreed June 15 as World Abuse Awareness Day stating, “Every American deserves the chance to live out the full measure of their days in health and security. Yet, every year, millions of older Americans are denied that most basic opportunity due to abuse, neglect, or exploitation. On World Elder Abuse Awareness Day, we call attention to this global public health issue, and we rededicate ourselves to providing our elders the care and protection they deserve.”

If you are a caregiver, consider taking Caregiverlist’s® Caregiver Training Course. With it, you can learn the types of abuse and neglect, legal requirements for reporting (and legal punishments for not reporting) and how to protect your senior client and yourself from physical, emotional, sexual and financial abuse.

Louisiana Nursing Homes Rank Lowest in Nation, Report Says

Nursing homes in Louisiana are rated at or near the bottom in terms of quality of care compared to the rest of the nation, according to a recent state legislative report. The report is the result of an audit of utilization, cost, and quality of care in Medicaid nursing facilities as Louisiana considers privatizing its Medicaid long-term care program and votes on whether to lock-in nursing home prices.

The Louisiana Legislative Audit concluded that, while the number of nursing home residents decreased from 26,563 in July 2011 to 25,335 in November 2013, according data from the U. S. Agency for Healthcare Research and Quality (AHRQ), Louisiana is “far from the benchmark” for several quality of care indicators.

Long-stay nursing home residents in Louisiana have a higher incidence of pressure sores, increased depression or anxiety, are more likely to be physically restrained, and spend more time in bed or in a chair compared to the national nursing home average.

Caregiverlist® Nursing Home Star Ratings lists Louisiana’s average star rating at 2.5, with only 1 out of 303 nursing homes receiving a 5-star rating. Compare that to neighboring Arkansas whose nursing homes have an average 3.0 rating with 17 of its 268 nursing homes earning a 5-star rating, or Mississippi, whose average 2.8 rating includes 5 of its 225 nursing homes in the 5-star category.

Cited nursing home deficiencies, however, were predominantly for violations categorized as “no actual harm with potential for more than minimal harm.” These included:

  • Failure to implement care plan interventions, such as oral care, reporting skin changes to nurses, or providing showers according to plan of care. Failure to reassess the care plan and include the resident and/or their family in this process.
  • Failure to ensure wheelchairs have footrests or securing dangerous chemicals in the shower rooms.
  • Failure to develop a care plan to address pressure ulcers, hospice care, or foot care for diabetic residents.
  • Failure to conduct an accurate initial or ongoing assessment of resident's activities of daily living, dental problems, or transfer needs.

Prepared by legislative auditor’s staff using January 2014 Nursing Home Compare data and information provided by DHH.

In response, Associated Press’s Melinda Deslatte writes: Joe Donchess, executive director of the Louisiana Nursing Home Association, said Monday that the facilities in Louisiana and other nearby states are graded at a harsher standard by federal officials than similar facilities in other Medicaid regions. "We provide a high quality of care to the residents. The residents are happy and safe," he said. Donchess said the reviews don't take into consideration the conditions that patients have when they enter nursing homes. He said there's no way to judge that because the state doesn't monitor home- and community-based care programs for the elderly. He said if the programs don't provide quality care, nursing homes receive residents "in a weaker condition." The Louisiana Legislative Auditor plans future reports that will examine home and community-based services.

However, quality nursing home care can be found in Louisiana, especially according to Patrick D. McCarthy, a Lafayette CPA who, in a letter to the Advocate, writes about Southwest Louisiana Veterans’ Home in Jennings. “...An incomparable staff of qualified, caring personnel, delivers service with efficiency, professionalism and competency but, most importantly, with genuine affection and good humor. I am so sick of Louisiana being categorized at the bottom of most important lists. Truly we have a gem in Jennings. I invite you to visit. I guarantee that your chest will swell with pride for what we, Louisiana citizens, have at SLVH.”

Because many of us (or our senior loved-ones) may find themselves needing to choose nursing home care, it's up to us to do the due diligence and choose nursing home care wisely. Caregiverlist® provides a Nursing Home Checklist that can help you choose the right nursing home. 

German Nursing Homes to Try 3D Printed Food for Seniors

Senior caregivers can find it quite challenging to keep the elderly well-nourished, especially if the senior has problems with chewing and swallowing. A steady diet of baby food-like mush can make seniors dread their next meal. Dealing with the challenges of feeding those seniors can lead to caregiver stress.

So, the European Union is funding a consortium of five European countries along with 14 companies called PERFORMANCE (which stands for PERsonalised FOod using Rapid MAnufacturing for the Nutrition of elderly ConsumErs), to help develop 3D-printed “smoothfood” to create a more appetizing-looking meal.

German company Biozoon created Smoothfood, in which deconstructed foods that are safe to ingest without chewing are reconstructed to look like conventional meals by using plant-based solidifying agents and poured into food-shaped silicon molds. While the food retains its shape on the plate, it completely dissolves in the mouth, making it safe for those with chewing and swallowing impairments.

Dysphagia, or difficulty swallowing food, affects as many as 15 million Americans and according to the Agency for Health Care Policy and Research (AHCPR), over 60,000 Americans die from complications associated with swallowing dysfunctions each year. Many times, victims of stroke find themselves unable to chew and swallow regular food.Currently, those seniors have no choice but to eat a variety of pureed foods, much like baby food. Needless to say, a constant diet of unappealing and uninteresting food has been shown to cause a loss of appetite and lead to malnutrition.

Nursing homes and assisted living facilities are already overtaxed and overburdened with senior care, so the objective of the PERFORMANCE project is to utilize new processing approaches and tailor-made technologies for the use by small and medium sized (SME) food producers to produce personalised food for the frail elderly European consumer, thereby improving the quality of life.

Over 1,000 retirement homes in Germany have already implemented the smoothfood concept according to Wired UK. The PERFORMANCE project is hoping to take that idea and, by applying automated 3D printing technology, make it easier and more affordable to use on a broader scale by nursing homes and assisted living facilities.

But how does that food taste? Sandra Forstner, the project manager at Biozoon spoke to food blog Munchies about the taste of 3-D printed food. “The food tastes like normal food. It is made from fresh ingredients, so the taste doesn’t change. One of our goals is not to change the flavor; the texturizing system doesn’t change it.”

10 Elder Care Tips to Make Senior Care Easier

Elder Law "Super Lawyer" Ben Neiburger shares 10 Elder Care Tips

May is Elder Law Month and when I hear “Elder Law,” I think of Caregiverlist® Elder Law Expert, Ben Neiberger. Since 1994, Ben has been giving legal and lay audiences a reprieve from some of the most complex and boring topics in the legal field (specifically, ERISA, Medicaid, and Eldercare). His delivery style helps you understand the important aspects of these topics in a way that gives you the ability to understand the legal issues you must know. Here, Ben shares his 10 Tips for surviving elder care to help you through the caregiving process and ensure you provide the best care possible for your loved one

Oh, and the moniker "Super-Lawyer" is real. Mr. Neiburger was named a “Super Lawyer” in Elder Law by Thompson Reuters and the publishers of Chicago magazine. Only three other attorneys in the state of Illinois were recognized this way in 2013. He also received this honor in 2007 and 2009 through 2014.

For Caregiverlist readers only, Ben is offering letting us give away his new ebook Brighter Skies: Your Blueprint to Navigating Elder Care. It’s a simple to understand guide that was written to make the process of Elder Care more bearable and less stressful for families. Follow these tips and you will spare yourself and your loved ones unnecessary pain in both the long and short terms.

Having practiced elder law for as long as I have, I've observed a number of issues that recur for families trying to negotiate the complex matters that come to the fore when assisting loved ones in the final stages of their life.

To that end, I’ve identified 10 principles that you need to pay attention to. Using these principles as a guide, you can develop strategies to help you and your family negotiate this very complex and emotional time.

Tip one – Put no one else before you and your family. You have a moral obligation to care for your parents, spouse and children. To do so well, you need to be informed, plan ahead, and take care of yourself first; the earlier the better.

Tip two – Let others help you. Find a trusted team of experts to help you through the health, legal and financial issues of end- of-life healthcare and planning. Geriatricians, care managers, elder law attorneys, accountants and financial planners are key advisors during this time.

Tip three – Act only with legal authority. There will come a time when you must make health-care and financial decisions for your elder when they cannot make decisions for themselves. Protect your loved one’s dignity and privacy by having them sign powers of attorney for property and health care before it’s too late.

Tip four – Rest. You are only human. Sometimes, the caregiving process requires an incredible amount of time, effort, blood, sweat, and tears. Even the strongest of us only last a matter of weeks or months before the stress of caregiving overwhelms our human capacity to provide that care. Hire caregivers, seek respite care, or let other family members, friends, or social agencies assist in providing care. You need rest and time to work and enjoy your own life, spouse and children. And only in doing so, will you be able to provide the best care for your loved one(s).

Tip five – Honor your loved one and preserve their independence as long as medically advisable. No one really wants to live in a nursing home. Most people want to live a dignified and independent life in their own home as long as possible. If it can be done safely, try to enable your loved one to live at home or in a non-nursing home community setting. If you want to support your parent in his or her home, but require additional funds for caregivers, reverse mortgages (including private family mortgages) can be a viable option.

Tip six –Make a financial plan. Assisted living and long-term care can be quite expensive. You need to take steps to ensure that your loved one’s funds last as long as possible. The longer his or her funds last, the more care options there are and the more independence they can have. Encourage your loved one to create a financial plan (including long-term care insurance, if possible) to generate enough income to cover long-term care at home, in an assisted living facility, or a nursing home when the time comes. Such a plan should be set up sooner than later.

Tip seven – Respect your loved one’s end-of-life wishes. As the last chapter of somebody’s life begins to close, the only thing many people have left is their family and personal dignity. It is your job as caregiver to do all you can to honor that dignity, as well as the wishes that preserve it. There will come a time when your loved one cannot tell you what they want. Take time to have a discussion with them beforehand on issues such as life-sustaining medical treatment and hospice, last rites, and their final resting place. Communicate these wishes to the entire family to ensure that such plans will be honored without familial strife when the time comes.

Tip eight – You can’t always control a progressive disease or sudden illness. There are some health conditions that improve with, and respond to treatment. There are others that do not, no matter what you do. Understand the condition or ailment that your loved one has, and do not expect miracles to occur as a result of treatment. Manage from that point forward. Many times, people do not recover from dementia, Alzheimer’s disease, or major strokes.

Tip nine – A nursing home placement isn't a death sentence. No one wants to go to a nursing home for their twilight years. Thirty or 40 years ago, families cared for loved ones at home until they died. Back then, people typically didn’t last longer than a few months, but with advances in medicine, the elderly now live on for years. Families need to rethink their objections to nursing homes because of the increase in end-of- life lifespans.

Tip ten – Try to mitigate family conflict. Family conflict at the end of a parent’s life is sometimes inevitable. However, an often unspoken wish for any person in the twilight of their life is the hope their children will get along after they pass on. A third-party is sometimes needed to assist in the decision making process. Sometimes transparency and disclosure will help. Other times, with a little more guidance and understanding, the children can make it through the process and keep their focus on ensuring their parents maintain their dignity as well as crucial family harmony.

I’ve create a series of short videos to further flush out these concepts. The goal is simple. Help you and your family make the best of a tough situation.

Ben is an active m

ember of the National Academy of Elder Law Attorneys (NAELA) and a member of the Executive Committee and Board of Directors for the Illinois Institute of Continuing Legal Education and through frequent speaking engagements and ongoing course work both locally and nationally, is in continuous pursuit of knowledge and insight to the laws and finances that affect our families and senior citizens. He brings this wealth of knowledge, his clear and common sense explanations, his patience, gentle humor and sensitivity to each of his legal consultations.To read more on each of these ten principles, go to generationlaw.com.

Caregiverlist's® Nursing Home Star-Ratings take the top criteria from the government inspection reports to help you choose the right and best nursing home for you or your loved one, if you should need one.

Senior Housing Building Boom: Too Much Too Soon?

I am part of a very substantial population of the United States known as Baby Boomers. According to the U.S. Census Bureau, 76.4 million American children were born post-World War II, between the years 1945 and 1964, making up almost 40% of the American population. As much as we would love to age in place, the fact is that if we see 80+ years old, we will need some sort of help with Activities of Daily Living, and the cold, hard truth is that a lot of us will receive that help in some sort of assisted living community.

It’s no wonder that many real estate developers are banking on building for a significant niche market. Home and commercial real estate building in 2014 point to a post-recession recovery. However, are those developing housing for the elderly building too much too soon?

Analysts say that a glut in the supply of senior housing is destined to hurt hurt health-care real estate investment trusts (REITs). Bloomberg News reported that the jump in supply is forecast to cut growth in senior-housing net operating income to 1.8 percent in 2015 and 1.4 percent in 2016 from 3.3 percent this year, according to Green Street Advisors Inc. These projections have translated into a 17 percent fall in the Bloomberg health-care REIT index during the last 12 months.

Brookdale Senior Living Inc. (BKD:US), is buying competitor Emeritus Corp. (ESC:US) for about $1.4 billion, Green Street Advisors told Bloomberg, making it the biggest owner of senior properties, with 1,161 senior care facilities in 46 states.

While the supply of senior care communities is increasing, the over-85 population is projected to increase to just 7 million by 2020. Senior housing won’t be in full swing for a few more years, when the nation’s “oldest old” could number as many as 31 million in 2050, although Jacob Gehl, managing director and founding partner of Blueprint Healthcare Real Estate Advisors, a brokerage and advisory firm in Chicago, told Bloomberg that peak demand is projected to be 15 to 20 years away.

It will be interesting to see how these new properties compete by way of staff, amenities, and senior housing costs. It will also be interesting to see if the trend in preferring to age at home with the assistance of quality home care continues. A lot can happen to the senior care landscape in 20 years.

Caregiverlist® would love to know about you and your family's projected needs. Where do you see yourself living when you are in need of assistance? Are you hoping your family will care for you? Do you see yourself moving into some sort of assisted living well before you absolutely need it?

CNA Doesn't Always Mean Certified Nursing Assistant

This one is on me.

I am always scanning the internet for C.N.A. news, and the following caught my eye: FCB Brasil, CNA Launch 'Speaking Exchange' (thanks Amy Poehler’s Smart Girls!)

FCB Brasil implemented a program with CNA (which I ALWAYS read as Certified Nursing Assistants) in a program to connect young Brazilians who want to learn to speak English with senior citizens living in a retirement community. The senior retirement for this pilot program is the Windsor Park Retirement Community in Chicago. Can you understand my confusion when I learned that CNA is a language school and has nothing to do with Certified Nursing Assistants?

In any case, the senior/youth connection is a brilliant one and a win-win for all involved. The webchat exchanges between the kids perfecting their English skills and the seniors who are happy to converse with them are uploaded to YouTube where instructors can assess their progress. But let’s face it, there’s a whole lot more than language learning going on here. Says Max Geraldo, FCB Brazil's executive director in an interview with Adweek: "The beauty of this project is in CNA's belief that we develop better students when we develop better people."

Watch the following video and see just how remarkable this project is. If imitation is the sincerest form of flattery, I hope this idea sparks many copycats.

If you are a senior caregiver interested in taking the next step in your career, consider becoming a C.N.A. (and this time I mean a Certified Nursing Assistant.) Caregiverlist® provides a free sample C.N.A. test to see how well you might do. Or if you are already trained as a C.N.A., fill out the Caregiverlist® 5-minute job application to reach multiple employers hiring in your area.

What Makes a Good Nursing Home?

Let’s face it, few go happily and willingly to a nursing home. While the majority of seniors prefer to age in place, at home, sometimes circumstances make it impossible to do so. Sometimes nursing home rehabilitation is necessary post-hospital stay. Perhaps a nursing home is needed when a senior needs 24/7 care and senior care costs are too high to hire at-home care.

So how do you choose a nursing home? If you’ve looked at all other long-term care options and have decided that a nursing home is the best choice for you or your loved one, you need to do a little homework to make sure the nursing home provides great care. You certainly don’t want to find that your selected nursing home administers less than ideal assistance. The obvious place to start would be geographically. The nursing home should be in an area that makes family visits possible.

After you have a list of nursing homes in your area, you’ll want to check the quality of care that nursing home provides.

Caregiverlist’s Nursing Home Star Ratings is a good place to start. Ratings from 1 to 5 stars are awarded based on criteria from the nursing homes health inspection report. But because nursing home inspections are only conducted once every 12 to 15 months, we recommend this only as a starting point. The overall Caregiverlist Nursing Home Star Ratings are calculated by taking into account the nursing home’s Medicare Rating (Overall Medicare Star Rating: 20%), Bed Sore Rating (Percent of Short-stay Residents with Bed Sores: 20%), C.N.A. Staff (Certified Nursing Aide Hours per Resident per Day: 40%), and ADL's (Percent of Long-term Residents whose Need for Help with Daily Activities has Increased: 20%). You can then compare the costs of the best possible nursing homes in your chosen area.

Once you have an initial list to work with, it’s a good idea to visit the nursing home. There are judgements you can make only if you see the facility with your own eyes.

Nursing home safety is a primary concern. Is there enough staff to assist those with special needs? Staff-to-patient ratio is extremely important. Do the facilities look safe? Frayed rugs can cause falls. Is the nursing home clean? There should be no odors of urine or feces. Are the residents clean and well-groomed?

What activities are available to residents? Are there social physical and educational activities available? Does the nursing home offer additional meals and snacks? Are there visits from community groups and outside excursions possible?

Is there high staff turnover? That can be a warning sign that staff is dissatisfied, which could translate into poor care.

Are family visits allowed any time (within reason)? No one should have to “schedule” a visit. An open visitation policy means the nursing home has nothing to hide.

Talk to the residents and ask them about the staff, the meals, the activities. Consider what special care needs may be required, such as care for memory loss, and if the nursing home provides these specialized services. Finally, if you see something troubling on any of your visits, your state’s Long Term Care Ombudsman is the primary advocate for a nursing home resident’s quality of life.

While the thought of moving to a nursing home can be stressful for the entire family, with a little due diligence, you are sure to find a safe and comfortable environment for long term care.

Caregiver Pay: Are You Living Paycheck to Paycheck?

America’s minimum wage debate continues to spark conflict. The Federal minimum wage proposal has stalled in Congress, languishing while both sides of the aisle dispute the law’s costs and benefits, pitting low income (mostly female) earners against beleaguered small business owners and big business profit margins.  Caregiver pay remains higher than minimum wage but can still be a challenge - take the survey at the bottom of this post.

The HBO Documentary: Paycheck to Paycheck: The Life and Times of Katrina Gilbert puts a name to the face of the female low-wage earner. Ms. Gilbert is a Certified Nursing Assistant, working 40 hours per week in a Tennessee nursing home, raising three children as a single woman. Filmed over the course of a year in Chattanooga, Tennessee, where minimum wage is $7.25. Gilbert’s hourly wage in the documentary is $9.49 (raised 14 cents an hour two years after filming ended) and is, as the documentary clearly illustrates, far below a comfortable living wage, especially when one is the primary breadwinner for a family of four. Although her job as a C.N.A. is above the minimum wage level, expenses force her to make choices for her family that many of us can imagine needing to make. She regularly gives up filling her own medical prescriptions in order to pay rent, car insurance and daycare. Because she has no paid sick days, if one of the children falls ill and needs to stay home, that loss of income can devastate the family budget. She is full of anxiety when she learns her family will lose its food stamps — the one reliable safety net to ensure all her children are fed.

 

Produced in association with 'The Shriver Report: A Woman’s Nation Pushes Back from the Brink’, a multi-platform project is an initiative that “illuminates the day-to-day challenges of millions of working poor women in America today.” 42 million women (one in three) in America and the 28 million children who depend on them are living in poverty or on the brink. Executive producer Maria Shriver, during a live town hall event, remarked to Oprah Winfrey that women like Ms. Gilbert are the new face of poverty. "People who live paycheck to paycheck, they don't look like they're a bum on the street," Shriver says. "They're the person sitting next to you in a cubicle." Shriver’s goal? Building women’s economic empowerment.

Some states are fully cognizant of the needs of the low income wage earner and are taking steps to increase minimum wage regardless of federal mandate.

As Caregiverlist recently reported, the Connecticut General Assembly passed a bill to raise the state’s minimum wage to $10.10 an hour by 2017. Maryland’s House passed a bill that would raise its wage to $10.10 an hour earlier this month, and Hawaii is expected to pass the legislature in April to raise its minimum wage to at least $10 an hour. ThinkProgress.org has provided a handy infographic showing the states that are currently considering a minimum wage increase or have passed one within the last year. Five other states have considered a $10.10 wage and four are looking at $10. People argue that wage would put it in line with where it would be if it had kept up with inflation since the 1960s. And though conservatives argue that higher wages will result in job loss, the following states increased their minimum wage and actually saw higher employment numbers: Rhode Island, Colorado, Montana, Vermont, Arizona, Oregon, Florida, Washington, Ohio and New York.

In Europe, Swiss voters will decide a referendum that would create a national minimum wage (there is no minimum wage present now) of 22 Swiss francs ($24.99) per hour. If approved, Switzerland will be home to the highest minimum wage in the world. There too, supporters say “the minimum wage will help elevate the country’s 330,000 mostly female low-wage workers who struggle to make ends meet in the high-priced country.” Elsewhere, Germany recently decided to raise its minimum hourly wage to 8.50 euros ($11.69), and the UK’s will increase to 6.31 pounds ($10.55).

Would the proposed minimum wage hike have any real impact on the life of someone like Ms. Gilbert, detractors ask. “I wouldn’t mind if it was $60,” she says. “Even if it was a tank of gas.” Asked what’s the single economic change would affect her life the most, Ms. Gilbert doesn’t hesitate. “I think that raising the minimum wage… sick days would be great.”

What do you think? Would raising the minimum wage affect your life? What other measures could federal or state governments mandate to make a difference to your quality of life?

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