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. 

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?

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 Support Translates to Saved $$

Caregiver stress can have debilitating consequences on senior caregivers. Reports show that family caregivers tend to experience anxiety, loss of sleep, and become ill more frequently than their non-caregiving counterparts. An estimated 5.2 million Americans have Alzheimer's disease in 2014. Seniors suffering from Alzheimer’s disease require increasing assistance with basic activities of daily living (ADLs) such as eating, bathing, dressing, and toileting. These individuals eventually need around-the-clock care. Because of that, their family caregivers find themselves especially overwhelmed. When caregivers feel they can no longer cope, patients are more likely to be placed in institutional settings such as nursing homes.

Costs of Nursing Home Placement
According to the Alzheimer’s Association, in 2014 the direct costs to American society of caring for those with Alzheimer's will total an estimated $214 billion, including $150 billion in costs to Medicare and Medicaid. Alzheimer's will cost an estimated $1.2 trillion (in today's dollars) in 2050.

Medicare covers short-term skilled care up to 100 days the first 20 days are covered at 100% and from day 21 to day 100 the patient (or their family) has a daily co-pay. Medicaid is a state/federal program that does pay the cost of nursing home care for eligible individuals, however the patient must meet income and resource requirements. 

Families’ and patients’ total out of pocket costs for nursing home care in 2014 is estimated at $36 billion.

Image Source: Alzheimer’s Association

If we can delay the nursing home placement of patients with Alzheimer’s disease and dementia, can substantial money be saved? If Alzheimer’s and dementia patients are aging in place longer, doesn’t that mean more stress (and its inherent problems) for family caregivers?

States are seeking to provide real and meaningful support for patients and their caregivers. Many states are looking to increase their funding for community-based programs to support individuals and families facing the challenges of Alzheimer’s disease, and in doing so, significantly reduce their state’s Medicaid costs. Recently, Minnesota determined it could save almost $1 billion in Medicaid over the next decade if the state adopted a new dementia caregiver support model, according to a study published Monday in the journal Health Affairs. That support model was introduced by a program called New York University Caregiver Intervention (NYUCI).

New York University Caregiver Intervention (NYUCI) is a counseling and support intervention for spouse caregivers that is intended to improve the well-being of caregivers and delay the nursing home placement of patients with Alzheimer's disease. The program also aims to help spouse caregivers mobilize their social support network and help them better adapt to their caregiving role.

The program consists of four components:

  • Two individual counseling sessions of 1 to 3 hours tailored to each caregiver's specific situation,
  • Four family counseling sessions with the primary caregiver and family members selected by that caregiver,
  • Encouragement to participate in weekly, locally available support groups after participation in the intervention, and
  • Ad hoc counseling, counseling provided by telephone to caregivers and families whenever needed to help them deal with crises and the changing nature of their relative's symptoms.The program is delivered by counselors with advanced degrees in social work or allied professions.

In addition, many states are seeking increased funding for the Alzheimer’s Disease Community Assistance Program (AlzCAP), which provides educational initiatives and caregiver respite programs. Paired with funded public awareness campaigns, the hope is that by addressing and getting in front of the challenges of the family caregiver, the length of time before placing a care recipient into a nursing home setting can be extended, saving everyone a lot of money.

What would help you, as a caregiver, reduce your stress and help care for a family member longer? If you or someone you know is overwhelmed with the task of senior caregiving, Caregiverlist® suggests you consider the possibility of hiring respite care from a quality senior home care agency.

Caregiverlist Featured on Chicago Tribune's Blue Sky Innovation

Senior care and the need for quality caregivers has made eldercare one of the fastest growing industries in America. It is projected that by 2050 the senior population will reach 88.5 million, or 20% of the entire United States. As a result, the burden of care will continue to shift from family caregiving to professional senior care, through in-home health care services, nursing homes and assisted living facilities.

Julie Northcutt, CEO and founder of Caregiverlist, discusses her vision and mission to provide online resources for seniors and professional caregivers through Cargiverlist.com on Chicago Tribune’s new small business entrepenuer spotlight, Blue Sky Innovation.

In his Letter from the Editor, Gerould Kern, Senior Vice President and Editor of Chicago Tribune writes, “Blue Sky Innovation will carry news about Chicago’s emerging business development landscape — startups, technology, innovative new products, services and entrepreneurial best practices.”

Personal and Home Care Aides and Home Health Aides are projected to be the second and third fastest-growing occupations in the country between 2006 (the year of Caregiverlist’s inception) and 2016 — increasing by 51 percent and 49 percent, respectively. In addressing that market need, Caregiverlist’s mission is one of connecting seniors with quality care choices with the assistance of innovative technology.

“Almost nobody plans ahead for senior care,” says Julie. “You’re encouraged to save money for retirement, and they always show you sailboats and going on cruise ships, but the reality is you may need that money to pay for caregiving services.”

Caregiverlist works with quality home care agencies to provide the most economical senior care by keeping seniors in their own homes longer. Caregiverlist also called 18,000 nursing homes to provide information on daily costs nationwide in its Nursing Home Star Rating tool.

Caregiverlist’s Caregiver Training University (CTU) announced the launch of Caregiverlist Basic Training earlier this year, providing training that meets industry standards for professional competency. The digital training platform allows caregivers to take the training course from their laptop, desktop or smartphone.

Caregiverlist is constantly striving to provide the most ground-breaking tools to serve this burgeoning industry. You can watch Julie Northcutt discuss Caregiverlist on Blue Sky Innovation here.

 

Long-Term Care Ombudsman - Advocate for Quality of Life

What does a Nursing Home Ombudsman do? It’s a question we get a lot here at Caregiverlist.

Ombudsman comes from the Swedish word meaning, literally, representative. It’s the Long-Term Care Ombudsman’s responsibility to advocate for residents of nursing homes, assisted living facilities and other adult care facilities. They investigate citizen complaints, report findings, and suggest solutions. They are also advocates for on a legislative level to improve the quality of care for seniors.

Senior care costs, especially within institutional settings, are spiraling. With approximately 1.6 million Americans over the age of 65 living in institutions such as nursing homes, it is vital that residents and their families are getting the best service for the money they are paying. Long-Term Care Ombudsmen are at the front line, investigating nursing home violations and ensuring that quality care is provided.

The Ombudsman Program began in 1972 as a Public Health Service demonstration project in seven states, responding to the problems of nursing home residents and operated under the authorization of the Older Americans Act. The program was transferred to the Area on Aging in 1974 and in 1978, Congress amended the OAA to include a requirement that each state develop a Long-Term Care Ombudsman Program.

There are 53 state ombudsmen (50 states, plus the District of Columbia, Puerto Rico, and Guam). Each Office of the State Long-Term Care Ombudsman is headed by a director who oversees thousands of local ombudsman staff and volunteers. The services of the office are free and confidential. In 2011 (the most recent annual report to Congress), Ombudsmen nationwide completed resolution work on 204,044 complaints and resolved or partially resolved 73 percent of these complaints to the satisfaction of the resident or complainant.

Simply put, the Long-Term Care Ombudsman’s role is to preserve the Residents' Rights Guarantee Quality of Life.

The 1987 Nursing Home Reform Law protects the following rights of nursing home residents:

  • Right to Be Fully Informed of available services, facility rules, survey reports and the like, and in a language they understand.
  • Right to Complain without fear of reprisal.
  • Right to Participate in One's Own Care including the right to be informed of their medical condition, participate in their care-planning, and also the right to refuse medication and treatment.
  • Right to Privacy and Confidentiality regarding medical, personal, or financial affairs.
  • Rights During Transfers and Discharges.
  • Right to Dignity, Respect, and Freedom from mental and physical abuse, corporal punishment, involuntary seclusion, and physical and chemical restraint.
  • Right to Visits by a resident’s personal physician, relatives, friends, and anyone of the resident’s choosing. A resident also has the right to refuse visitors.
  • Right to Make Independent Choices both inside and outside the nursing home.

If you or a senior you know has need of a Long-Term Care or Nursing Home Ombudsman, you can find yours in Caregiverlist’s By-State information. They are there to resolve nursing home complaints, request better care and for feedback when choosing a nursing home.

Cartoonist Scott Adams: I Hope My Father Dies Soon

Dilbert cartoon followers know the humor the cartoon strip writer Scott Adams uses to entertain us with the happenings of daily office life.  The cartoon can always spark a life for those of us who show up for work at an office each day.  Now Mr. Adams has opened up to share the challenges of caring for an aging parent with his blog post titled:  "I Hope My Father Dies Soon".  

Mr. Adam's father, age 86, is bed-ridden and as Mr. Adams says, if his father were a cat, he would have been put to sleep long ago and nobody would have ever looked back.  It would have been the right answer for someone who has lost 98% of their mind and has lost their physical capabilities.  Instead, he pays $8,000 a month to stay in a state of perpetual suffering.  Mr Adams has a way with words and I encourage you to read his blog post on why he hopes his father will die soon.  

Senior care services can easily cost $8,000 a month for round-the-clock care.  And right now, Medicare and Medicaid really provide all or nothing senior care services when it comes to long-term care.  Medicaid, a service provided in conjunction with state and federal funds, provides ongoing nursing home care until someone dies but unfortunately that care usually must be provided only in a nursing home.  And a senior must qualify for this level of total care.  

Medicare does NOT pay for long-term care.  This means most of us will be in the same situation as the Dilbert cartoonist's father - we will have to privately pay for the senior care services and if we have not invested in long-term care insurance, these costs could become as high as $8,000 per month and burn through our life-savings.

The hope is that most seniors will only need part-time senior care to maintain their daily activities of living.  But insurance analysts suggest that everyone plan for 2 years of senior care services.

As the nation's baby boomer population continues to live longer and will increase by as much as 70% in the coming decade, the ethical issues around keeping seniors alive when there is no longer any quality of life will become one of the areas of concern for everyone.  Especially as we must tackle how to pay for senior care for both those who can privately pay and through our tax dollars for those who cannot privately pay for senior care and are on Medicaid care.

Mr. Adams shares that he feels doctor-assisted suicide should be an option, as none of us should be forced to die a long, slow painful death when it has already been confirmed we are at the end of our road.

How much does senior care cost?:

Nursing home care gives the best view into the real costs of full nursing care for seniors.  Here are some of the costs of nursing homes:

  • Alden Estates of Barrington in Barrington, Illinois costs $263 to $362 per day for nursing home care
  • Brighton Place in Spring Valley, California costs $165 per day for nursing home care
  • Mount Vernon Nursing and Rehabilitation Center in Alexandria, Virginia costs $236 to $270 per day for nursing home care

Learn about nursing home care costs in the Caregiverlist Nursing Home Directory and share with us your comments on end-of-life care.

 

 

 

 

 

 

 

Medicare Open Enrollment Deadline on the Horizon

If you or someone you know receives Medicare benefits, now is the time to review that coverage. Open enrollment for supplemental Medicare insurance, also known as Medigap, started on October 15 and ends on December 7. Seniors can change their Medicare supplemental health and drug coverage only during this open enrollment period.

Medicare is the government-sponsored healthcare coverage for Americans over 65 years of age. However, Medicare does not cover all healthcare costs. That’s why, during this open enrollment period, the elderly and senior caregivers can shop around for Medigap insurance.

Medicare supplemental insurance helps pay the "gap" between what Original Medicare (Medicare Parts A and B) pays for your health care and what you pay out of your own pocket, including deductibles, copayments and coinsurance. There are four parts to Medigap insurance:

  • Part A: hospital insurance
  • Part B: medical insurance
  • Part C: Medicare Advantage (offered by private companies approved by Medicare, like an HMO)
  • Part D: prescription drug coverage

If a senior already has a Medicare Advantage plan or a stand-alone Part D plan, they will have received an Annual Notice of Change (ANOC) and/or Evidence of Coverage (EOC) from their plan. This is the time to review the plan's costs, benefits and rules for the upcoming year. Changes made to coverage will take effect January 1 of the next year.

It is recommended that you compare prices for all of your supplemental insurance. Caregiverlist has partnered with eHealth Medicare to provide Medicare Supplemental Insurance plan quotes outside “the Marketplace”. We invite you to shop around by going through this trusted Medicare Supplemental site or by calling 888-353-4215.

Understand the difference between the Fall Open Enrollment Period and Open Enrollment for the Health Insurance Marketplaces. The Health Insurance Marketplaces (also known as Exchanges) open enrollment for uninsured or underinsured Americans that began on October 1, 2013 has nothing to do with Medigap or Medicare supplemental coverage. The Marketplaces are not meant for people with Medicare. People with Medicare do not change their Medicare supplemental insurance through the government's HealthCare.gov.

Caregiver Support a Future Concern

I’m part of the Baby Boomer generation that provides family caregiving to an aging parent. As such, I and my siblings provide much of my mother’s long term services and support (LTSS) which allows her, at 80, to comfortably age in place, at home. I have three siblings to share in that care. In my old age, family care will be split between two children. As Americans age and their families shrink, there is concern for the future supply of relatively inexpensive family support for elderly individuals.

A recent report released by the AARP Public Policy Institute indicates a rapid decline of family caregivers within the next 20 years. The drop in the caregiver support ratio, or the number of family caregivers (adult children) available to care for their elderly parents, prompts a call for policy action to find new solutions to finance LTSS.

 According to the report, "The departure of the boomers from the peak caregiving years will mean that the population aged 45 to 64 is projected to increase by only 1 percent between 2010 and 2030, During the same period, the 80-plus population is projected to increase by a whopping 79 percent."

The shortage trend continues until 2050, when the population of parents to children is expected to balance again.

The call to action has been to federal and state Departments of Aging to provide more caregiver training and more affordable and quality nursing homes in order to fill the gap left by the decreasing number of family caregivers.

Right now, AARP projects these states to have the best and worst caregiver ratios in 2030:

Best:
District of Columbia: 6.4
Utah: 5.8
Alaska: 5.3
Illinois: 4.9
Georgia, New York and Texas: 4.8

Worst:
Arizona: 2.6
Florida and Hawaii: 2.9
New Mexico: 3.2
Iowa: 3.3
Maine, Nevada, Vermont and West Virginia: 3.4

How about you? Do you provide family caregiving to a senior loved one? With how many people do you share in that care? How many people will you have to care for you in your old age?

Living and Aging Well at Home

Caregiverlist welcomes Dr. Doris Bersing, PhD. as our new Home Care Expert. Dr. Bersing is the founder and president of Living Well Assisted Living at Home, Dr. Bersing discusses how to successfully age in place at home. If you have any questions regarding the elderly aging at home, especially those with Alzheimer's disease or dementia, feel free to post your questions here.

How to Have More Choices to Age Well at Home?

We all hope to age in a healthy way and most of us avoid thinking about frailty or problems before they arise. However, If we force ourselves to plan, we can make informed choices.

90% of people want to live in their own homes. This has been true for all of our history. Moving out of home to an “age segregated community” is a modern phenomenon. Maximize your choices by planning your estate, your home, your health, and your wellness.

To Maximize your Choices:

Do some planning: financial and legal

It’s no surprise that with age, seniors often experience increased limitations, the loss of certain abilities and require more assistance with the activities of daily living. It is equally unsurprising that one’s finances largely influence the types of services and long-term care available to that individual. An experienced financial planner and long term care specialist can provide you with invaluable advice on money issues and more, to help you find the appropriate solution to your particular situation.

Aging well at home usually involves not just healthcare but money and legal matters, as well. That might include estate planning, getting legal forms such as advance health care directives and power of attorney for finances in place, and understanding the coverage and policies -such as Medicare and Social Security benefits – available to you of the person in your care.

Look at your home

Is it safe? Can you make it more safe? Can you use new techologies to enhance your wellbeing. These technologies are improving everyday and offer real benefits. Look into Universal Design options. Can your home be made more suitable for your changing needs? Does it make sense to move to smaller home and use the extra money to pay for your support?

Be active

It matters less what you do, but that you do something that is meaningful to you and that uses your mind, spirit and body. No need to commit to one thing – change your mind as often as you want, and give any challenge a try!

Take charge of your health

Your Doctor may know best, but does she know and hear you. Do you have a system for understanding what you need to do to care for yourself and for learning about recommended procedures? Are your medical records and Powers of Attorney in a safe place? NOBODY should face serious medical decisions alone. We all need advocates. Medications are potent (that’s why they work). Learn about them and find ways to take them as prescribed.

Tackle your fears about memory changes

Learn about what things you need to worry about and what you can adapt to. Don’t panic! Don’t let others around you panic! – But don’t deny and pretend you are OK, if you are having problems. Changes to your environment and social support can make all the difference. Talk to your friends, doctors and family. Dementia is not a new problem – humans have been having memory loss for centuries – let’s learn from our predecessors.

Be open to smart technology

There are numerous studies, projects, and research aiming to use integrated information technology systems to support and enhance the health, safety and social connectedness of older people living in their own homes. Currently, there are many exciting technologies being developed to help seniors to stay independent and aging in place are many, some of these are: home-monitoring systems, telemedicine devices, tracking systems like GPS shoes and GPS watches, electronic walking aids, intelligent phones, and even robotic nurses.

Never give up your home without weighing all the choices

Is this the right time? Be curious about why you are making life changing decisions, weigh the consequences, think about your motivations, get input from trusted people. It’s rarely a good idea to make a life transition when grieving, adapting to a change in health status, or because you are appeasing anybody. It somebody tries to persuade you to make big changes during these times, question their motivation. The old choices of struggling alone at home or moving to an institution are being replaced by new ones. Stay on the cutting edge. Learn what the options are, participate in creating those options. Make your voice heard. 

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