Early Warning Signs for Alzheimer's Disease

Senior caregivers know the difficulties of caring for someone with memory loss.  But sometimes when you see someone daily, you do not as easily notice some of the early warning signs for memory loss in the form of Alzheimer's Disease.  The Alzheimer's Association has been promoting their new "Know the 10 Signs" for early detection and early diagnosis of Alzheimer's Disease.

 These 10 signs include:


1) Memory changes that disrupt daily life


2) Challenges in planning or solving problems


3) Difficulty completing familiar tasks at home, at work or at leisure


4) Confusion with time or place


5) Trouble understanding visual images and spatial relationships


6) New problems with words in speaking or writing


7) Misplacing things and losing the ability to retrace steps


8) Decreased or poor judgment


9) Withdrawal from work or social activities


10) Changes in mood and personality

As soon as you notice signs of memory loss, it is a good time to make sure the senior has an estate plan in place and to understand the ways to pay for senior care as many years of caregiving are often necessary for those living with memory loss.


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Senior Caregiver Pay: How Much Should Caregivers Be Paid?

This past weekend the Washington Post magazine published an in-depth story about senior caregiving, profiling a 63-year-old caregiver, Marilyn Daniel, who cares for multiple senior clients as a home health aide.  The story mentions the turnover rate of 40 to 60% for direct-care workers and the low pay.  Although the article says caregiving does not pay much more than minimum wage, which is actually inaccurate, as the federal minimum wage is $6.55 per hour and Marilyn Daniel is paid $12.40 per hour, nearly double the federal minimum wage.

Caregiving actually does pay much more than the minimum wage in every state and Caregiverlist provides the minimum wage information in every state to help caregivers negotiate their pay rate.  The highest minimum wage is in Washington state, at $8.55 per hour, followed by Oregon state at $8.40 per hour and then by California, Connecticut, and Massachusetts, all paying $8.00 per hour.  Most state minimum wages are somewhere between $6.55 and $7.25 per hour.

As is often noted, the Bureau of Labor Statistics reports the occupation of senior home care aides as the second-fastest-growing occupation in the U.S.A. with projections for a more than 50 percent increase in caregivers during the next decade.

Payroll taxes are typically another 25% of a caregiver's pay (Social Security, Unemployment, Worker's Compensation Insurance), although a caregiver does not see this money as take-home pay, but rather as payments direct to these benefits.

How much do you think caregivers should be paid?  Should there be set increases according to advanced training completed and skills tests?

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HBO's The Alzheimer's Project:: May 10 - 12

Caregivers and family members of those with Alzheimer's Disease will find this upcoming documentary informative and supportive of the challenges of caring for seniors with memory loss.  HBO reports Alzheimer's Disease is the second most feared disease after cancer and more than 5 million Americans are affected by it.  As there is currently no cure for the disease, it is also predicted that this number will more than double in the next 30 years.

This 4-part documentary, The Alzheimer's Project, will air on May 10 - 12 on HBO and includes 15 short films highlighting the latest research for a cure, profiles community programs and looks at 7 individuals who are living with Alzheimer's Disease, including a focus on their caregivers who must cope with the progression of the disease. 

HBO has also launched a website to provide educational information on The Alzheimer's Project. Check it out and spread the word.

Caregivers and seniors can also learn more about caring for those with memory loss by reading the stories caregivers share on Caregiverlist (and you may also share your own story).

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Senior Long-term Care Costs in U.S.A.

Where are the Best Places in America for Long-Term Care?

An annual senior care cost survey highlights U.S. states with the most affordable long-term care options.  It seems the heartland states, not the sunshine states, offer the most affordable and diverse care choices for seniors.

A regional gap exists in the U.S. between areas where people have access to a broad number of affordable, long-term healthcare options for seniors, according to a recent study by Genworth Financial.

The study, which involved more than 14,000 nursing homes, assisted living facilities, and home health and adult day health care providers nationwide, found that Midwesterners enjoy more budget-friendly long-term care options than their east and west coast counterparts. 

Here’s a snapshot of the top 10 states for nursing home care availability and choice:

1. Iowa

6. Oklahoma

2. South Dakota

7. Missouri

3. Kansas

8. Arkansas

4. Nebraska

9. Wyoming

5. North Dakota

10. Louisiana

 Other key findings from the study, as published by Genworth Financial, include:
  • The cost of care in a nursing home or assisted living facility continues to rise at a rate nearly twice that of the median annual inflation rate of 2.3 percent.  The annual cost for a private nursing home room is $74,208, or $203 per day, representing an increase of 4 percent annually since 2005.  At this rate, the cost is expected to exceed $270,000 a year in 30 years, when the nation's youngest baby boomers will be in their mid-70's.
  • It is important to do research to make sure you get the most out of your investment when selecting a nursing home for an aging loved one.  You may review our complete list of  nursing homes, including details on Medicare and Medicaid, the number of beds and the owner of the facility.
  • While nursing home and assisted living costs have risen sharply over the past five years, home care costs have remained relatively flat.  The hourly private pay rate for a non-Medicare certified, state licensed home health aides is $18.50. Since 2005, the cost for this type of care has increased an annual rate of just 2 percent.

You may learn more about quality standards for senior home care agencies and request rates and services in your area to find out the pricing in your area and other details.  This can assist you in planning for a loved one's care and developing a budget or exploring long-term care insurance options to assist with payment.
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Caregiver Job Application

What information should potential caregivers expect to be asked on a senior care job application?

Individuals interested in working as senior caregivers should be able to demonstrate they are dependable and trustworthy throughout the caregiving job application process.

You will be asked about your previous caregiving experience, work experience and your caregiving skills.  Names and addresses of past employers will be needed.  You will be asked to provide the start and end dates for your previous jobs and the reason for leaving.

You will also need to provide copies of any certifications and completed training programs.

Be sure all of your information is accurate, including the previous addresses where you have lived, in order for this information to match your background check.

As the most important aspect for success in caregiving is a caring personality and an interest in providing care and assistance to someone, think about how you can communicate your reasons for seeking this type of work.  If you can share stories about experiences you have had with family members or friends or through volunteering, you will be able to provide evidence that you truly are a caring individual.

You may view a sample senior home care agency job application on Caregiverlist.

Health Care Reform Policy Debate Affects Seniors

Health care reform policy debate affects seniors
Summary: The health care policy options under debate could reduce costs and dramatically improve quality of long-term health care for seniors.
On Wednesday, Members of the Senate Finance Committee will debate health care policy options aimed at making the health care delivery system more effective and efficient. Many of the proposed options have a high potential to benefit the long-term care of seniors.
The policy options, released by Senate Finance Committee Chairman Max Baucaus (D-Mont.) and Ranking Member Chuck Grassley (R-Iowa), would create incentives for health care providers to focus on high quality care and to closely coordinate with a patient’s other doctors and providers. This is important for seniors who seek care from multiple doctors and risk doubling up on prescriptions that could have harmful interactions.
The proposed health care policy revisions, which will be debated in a closed-door hearing, also target changes in how private insurance companies bill Medicare patients, and are intended to reduce fraud, waste and abuse in the Medicare system.
The following details, as released by the Senate Finance Committee, reveal aspects of the health care policy options that would have a dramatic impact on seniors who receive continued care for chronic illness:
Promoting Quality Care: Medicare currently reimburses health care providers on the basis of the volume of care they provide. For every test, scan, or procedure conducted, providers
receive payment – regardless of whether the treatment contributes to helping a patient recover. Medicare must move to a system that reimburses health care providers based on the quality of care they provide. The policy options would shift Medicare from volumebased purchasing to valuebased purchasing. Under valuebased purchasing, Medicare would provide new payment incentives for care that contributes to positive patient outcomes. The policy options would establish a valuebased purchasing program for hospitals starting in fiscal 2012, direct CMS to develop plans to establish valuebased purchasing programs for home health and skilled nursing facility providers by 2012, strengthen and expand programs that will eventually lead to valuebased purchasing for doctors, reduce inappropriate ordering of imaging services like CT scans and MRIs, and start inpatient rehabilitation and longterm care hospital providers on a path toward valuebased purchasing program.
Promoting Primary Care: Primary care doctors are vital to reducing costs and improving quality in the health care system. Primary care doctors provide preventive care, help patients
make informed medical decisions, serve a critical care management role and help coordinate with other doctors. Despite their critical function, primary care doctors receive significantly
lower Medicare payments than other doctors, which has led to a shortage of primary care doctors. To encourage more primary care doctors to be part of the system, the policy options would provide primary care practitioners and targeted general surgeons with a Medicare payment bonus of at least five percent for five years, and provide Medicare payment to primary care practices that provide specific transitional care services for beneficiaries with high costs, chronic illnesses.
Fostering Care Coordination and Provider Collaboration: Today, many doctors want to spend more time working together, but report that current payment systems often discourage care coordination. When providers in different settings, like doctor’s offices, hospitals, nursing homes, and rehabilitation facilities work together, patients can get well sooner and costs in the
system are lower.
Chronic Care Management:To encourage chronic care management, the policy options will foster innovation by allowing broadscale Medicare pilot programs of patientcentered care
coordination models for the chronically ill that improve quality and reduce spending, and allow preliminary rapidcycle Medicare testing of evidencebased care management and coordination models across various settings to determine best models for success.
Provider Collaboration:To encourage hospitals and other health care providers to work together, the policy options will provide Medicare payment incentives to hospitals that reduce
preventable hospital readmissions, and provide a single bundled Medicare payment for acute and postacute episodes of care.
Payment for Accountable Care:To incentivize providers to improve patient care and reduce costs by offering patients access to care at a wide range of health care providers and settings, the policy options would address the impending cuts to physician reimbursement rates, allow highquality providers to share in savings they achieve to the Medicare program through increased collaboration, and expand Medicare participation in communitylevel health care delivery system reforms.
Quality Measure Development: The policy options will focus on quality measure development by requiring the Department of Health and Human Services to partner with stakeholders to
develop a national quality improvement plan and encouraging development of next generation quality measures that are aligned with delivery system reform goals like, for example, measuring
care coordination for chronically ill.
Health Care Workforce: Ensuring America’s health care system has a sufficient supply of health care professionals to meet the demands of a changing and aging population is essential to
maintaining focus on highquality, cost efficient care. To strengthen the health care workforce, the policy options would increase graduate medical education training positions for
primary care and implement other immediate modernizations to the Medicare GME program, and develop a proposal that requires Health and Human Services to work with external
stakeholders to develop and implement a national workforce strategy, in conjunction with the Senate Health, Education, Labor and Pensions Committee.
Medicare Advantage: Private insurers that participate in Medicare should bring value to the program and to beneficiaries. Health care reform should ensure payments to private insurers in the Medicare Advantage program bring high quality, efficient plans into the Medicare program. The policy options would use current measures to pay plans for quality improvement, change statutory benchmarks or set benchmarks based on competitive plan bids, provide a bonus payment to Medicare Advantage plans that use evidencebased programs to manage care of the chronically ill, and allow plans to continue to offer extra benefits, but reducing wide variation among plans.
Combating Fraud, Waste and Abuse: Reducing fraud, waste, and abuse in Medicare will reduce costs and improve quality throughout the system. The Medicare improper payment rate
for 2008 was 3.6 percent, or $10.4 billion, and the National Health Care AntiFraud Association estimates that fraud amounts to at least three percent of total health care spending, or more
than $60 billion per year. The policy options combat fraud, waste and abuse by enhancing the review of health care providers prior to granting billing privileges, leveraging technology to
better evaluate claims, educating providers to promote compliance with program requirements, monitoring programs more vigilantly, and penalizing fraudulent activity swiftly and sufficiently.
Caregiverlist provides a helpful breakdown for individuals trying to better understand what Medicare covers.
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Swine Flu Symptoms: Keep Seniors Safe

What should seniors and their caregivers be aware of with the recent announcement of the swine flu virus?

Seniors are always impacted more by illnesses because their natural defenses are no longer as strong to fight diseases and their bodies may already be weakened by age-related illnesses.  A geriatric doctor once told me that pneumonia is an old man's best friend as he had so often seen it be the cause of death when a senior was successful in fighting every other age-related disease.  Seniors and their Caregivers should be extra careful to be aware of the symptoms of the swine flu virus in order to take quick action if they occur.

The Department of Health and Human Services issued the declaration of public emergency as a routine step to make sure we stay aware and take precautions.  If a senior develops any signs of illness, as always, you should call their doctor and follow their advice.  The health alert was issued to assist Americans to learn about the illness in order to prevent further spread of the virus in the U.S.A.  The good news is you do not get the swine flu from eating pork. 

What are the symptoms of swine flu?

The symptoms of swine flu are very similar to the symptoms of regular human seasonal influenza and include fever, lethargy, lack of appetite and coughing. Some people with swine flu also have reported runny nose, sore throat, nausea, vomiting and diarrhea.

Can humans catch swine flu?
Swine flu viruses do not normally infect humans which is why this outbreak has caused some alarm.  The causes of human infections in the past have been extremely rare but have occurred when a person had direct contact with pigs with the disease, which happened in Wisconsin in 1988.  People who interact with pigs as farm workers usually are the ones who first contract the swine flu illness and then spread it to other humans.

How common is swine flu infection in humans?
The Center for Disease Control reports approximately one human swine influenza virus infection every one to two years in the U.S., but from December 2005 through February 2009, 12 cases of human infection with swine influenza were reported.

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Caregiver Reference Checks

Caregivers hired for seniors have a more rigorous screening and hiring process that most employees, including nannies.  This is because senior caregivers become a friend and confidant to their clients and many times are working with a senior who may have memory loss.  It is very important to make sure the caregiver not only has the skills and experience required for caregiving but is also dependable and trustworthy.

Professional caregivers also want to be sure that hiring senior home care agencies have policies in place to both guide and protect them from anything inappropriate as they want to continue to work in the senior care field.

How do agencies screen caregivers?

The first step is a multi-state criminal background check.  Caregiverlist provides information on background check laws by state and advocates that you should run fast if a company is offering a "free" background check - lots of websites, including nanny websites, offer free checks and a good background check is going to cost at least $15.00.  Most free checks are simply a name and social security number match and perhaps a sex offender search as these are computerized and regularly updated (mandated by law).  But there are many, many counties in the U.S.A. who do not have computerized criminal records or who do not update these records daily and for this reason, to adequately do a criminal record check, you need a human to have access to the courthouse and pay the fee for accessing these records.

Caregivers then must pass a telephone screening to be invited for an interview.  Caregivers invited for an interview must fill out an application and then meet with usually a few of the company executives (Case Managers, Staffing Coordinators, Field Supervisors) and then attend a training session and successfully complete a training test.

Reference checks are conducted on only the caregivers the agency chooses to hire.  Reference checks include personal and professional references to learn about the caregiver's dependability and character.

Information verified in reference checks include:

  • Dates of employment at former jobs
  • Attendance record
  • Reason for leaving job
  • Strengths of the employee
  • Weaknesses of the employee
  • Asking if the former managers would hire the individual to take care of their own parent or grandparent

Most agencies require 3 personal and 3 business references from caregiver job applicants.  There are many kind and caring caregivers seeking to share their skills with seniors in need of care and the hiring process, including checking references, helps validate the caregiver's qualifications.

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Use Spring Cleaning for Senior Care Needs Check

Do you think your parent or grandparent may be at a point where they need caregiving services to help them better navigate their daily living as they deal with the challenges of medical illnesses or memory loss?  Are you noticing they are not keeping up with some of their household maintenance or staying active in their interests?  And do you know where they would like to be cared for should an emergency arise - in their home by a Senior Home Care Agency or in a nursing community?

It can be difficult to start the conversation about senior care needs with a loved one.  Holidays are often the only time relatives are able to spend lengthy time with their older family members yet they are not necessarily the best time to have these conversations about life changes since holidays are often already stressful times for seniors as they are reminded of lost loved ones and the realities of growing older.

Taking the time for a spring cleaning visit can provide an opportunity to participate in a needed activity with your senior relatives while also checking up on their care needs. Parents usually are accepting of this as you are assisting with a needed task. And, while performing spring cleaning, you will have a closer look into their daily living habits to see if there are any additional care needs or medical conditions that should be checked to assist your senior loved ones to enjoy healthy aging.

Catching a senior's medical and care needs early will assist in slowing the progression of some age-related illnesses and assist in maintaining a safe environment for the senior as they age. Seniors often will not share signs of age-related illnesses because of their fears associated with dealing with the new medical conditions and other times they simply do not notice the changes because they develop slowly. Spring cleaning offers the perfect opportunity to interact with a senior and to do a health check-up on their activities of daily living.

Here are some senior spring cleaning tips and ways to incorporate checking on potential age-related diseases and conditions such as hearing loss, vision loss, weight gain, arthritis and forgetfulness as you are assisting your senior loved one with their spring cleaning.

  • Closets: Reorganize and assist with storing the out-of-season clothing and discarding the out-of-style clothing. Take a look to make sure clothing is being kept clean and well maintained.   Alert: Seniors developing vision loss, such as Macular Degeneration or memory loss, such as Alzheimer's Disease may begin to wear the same clothing over and over again and not keep up with laundry regularly.
  • Bathroom: Clean and organize the bathroom medicine cabinet and discard old or unused items. Check to see if the shower or bathtub is being used regularly and if anything is in need of repair. Check medicine cabinet and toss or remove any medications which are no longer prescribed.   Alert: Are non-skid rugs in place? Are there any new medicines or care products which would indicate new medical conditions you may not be aware of? Is it time for a grab-bar or raised toilet seat for safety? Bathrooms offer easy opportunities for falls for seniors with mobility issues which may be caused by age-related medical conditions or side-effects of medications.
  • Kitchen: Clean out the refrigerator. Are there any buried treasures with expiration dates long passed? Does it look like they are eating a nutritious diet?  Check all appliances to make sure they are functioning properly and that there have been no equipment damages due to misuse. Alert: Eating regular meals is important for good health at all ages. Consider what health conditions or medications may require special dietary needs. Check for sodium levels in prepared foods. Discuss the daily meal plans to see if additional kitchen tools might make meal preparation easier or if the senior needs help in diversifying their menu.
  • Living Room: Remove and clean curtains, vacuum and shampoo the carpet and dust and clean furniture. Are there any rugs or mats which could lend to tripping or falling more easily? Does the furniture need to be re-arranged for easier use?  Alert: Check to see if it looks like a daily routine is being maintained and notice if reading or television watching have decreased which could be signs of vision or hearing loss.
  • Bedroom: Change bed linens and check to see if bedding has been changed regularly and if they have been sleeping in the bed. Do they need new bed linens or is it time to discuss a new mattress to assist with more comfortable sleep? Alert: Seniors will sometimes begin to sleep in an easy chair or sofa instead of their bed due to a variety of conditions from depression to new physical conditions such as back, neck or leg pain or because they are becoming confused about time of day.
  • Driving: If the senior is still driving, take a ride with them to the grocery store or to run an errand to make sure they are driving safely. Check the car and garage to make sure there are no dents or damages from inappropriate driving.  Alert: Seniors who inappropriately drive risk their lives and the lives of others on the road. Learn about the senior driving laws in each state and how to find assistance if it is time to take the keys away. Office: Confirm the names and contact information for all the medical doctors and their pharmacy. Update list of medical conditions and medications. Confirm Power of Attorney for financial matters and for healthcare.

While engaged in spring cleaning, you can find a time to talk about the long-term plans for senior care by discussing what otehrs are doing and finding out their current plans for care should the need arise.  Confirm what their plan for senior care needs would be and their retirement care budget so you can be prepared in case of an emergency. Discuss long-term care insurance policy options and the financial capacity to pay for private care, as Medicare does not provide for long-term care. Usually seniors will agree to have you help with their spring cleaning and because you are spending interactive time with them, you will be more likely to notice any changes in their care needs and make necessary arrangements in order to prevent a medical emergency later.

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Senior Care Funding: Government Budgets and Private Pay

Most people do not want to think or talk about how to pay for senior care until the issue of needing a caregiver to assist with daily needs actually arrives.  Hire a senior home care agency or move to assisted living?  Recover in a nursing home or in your own home with skilled care provided by Medicare?

And what if you run out of money to pay for care yourself, do not have long-term care insurance and still need care services?  The good news is you can qualify for care as a Medicaid resident in a nursing home.  However, the number one factor in quality care is the staff to resident ratio in a nursing home.  This is why the Coalition to Protect Senior Care, representing dozens of healthcare groups throughout the country, is advocating for retaining Medicaid and Medicare funding for nursing homes at current levels and asking our government to consider the possibility of additional job creation through the funding of more frontline caregivers who provide the bedside care for nursing home residents. 

Some politicians are rightly concerned about the ongoing ability to fund senior entitlement programs.  But at the same time, all of us continue to fund these programs through our payroll deductions.  Former President Bill Clinton has been credited with passing the "look back law" which prohibits seniors from gifting their entire estates in order to avoid paying for long-term care.  Now the government can actually look back to see if any improper gifting has been done to allow a senior to have the government foot the bill for their long-term care.  However, regardless of whether the government or individuals are paying for the nursing care, adequate levels of caregiver staffing should be maintained.

Caregiverlist reports that nursing home staffing shortages contribute to lower quality care in nursing homes.  As Medicare does pay for short-term care in a nursing home, many of us will need to rely on their services, even if just for a few weeks after a hospital stay.

What can you do?  Call you Congressman and Senator's office and let them know your concerns.  Let them know that staffing in nursing homes should be a priority.

You can also visit President Barack Obama's website and let him know your thoughts as Congress begins discussing healthcare reform legislation on Tuesday.

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