Senior Safety: When Should Seniors Stop Driving?

The elderly driver who recently struck Reese Witherspoon with her car will not face criminal charges, but police have ordered her to retake her driver's test to see if she shows signs of diminished driving capabilities.

The 84-year-old Santa Monica resident will most likely need to take a written test, have an eye and hearing examination, and submit to a practical, behind-the-wheel evaluation. She may also need to supply the Department of Motor Vehicles with a list of medication she's taking.

The discussion of revoking driving privileges for the elderly is a sensitive one. Not all elder drivers pose a risk (in fact, some studies show that mature drivers have better driving records than younger drivers,) but once the driver reaches the age of 80 and older, crash rates increase. And of course, as the population ages, it is anticipated that the number of drivers age 85 and over in 2030 will be four times greater than today.

Safety concerns should prevail, for both the senior driver and potential accident victim. And although driving means more independence and autonomy for the elder, aging may indeed affect safe driving abilities. By the same token, however, elderly driving skills vary and uniformly revoking drivers licenses based on age alone is unfair.

AAA offers a Senior Driver Portal to help measure the driving skills and needs of the elderly driver. Caregivers need to evaluate the senior driver's competence and if safety is an issue, steps need to be taken.

Guest blogger and Geriatric Care Manager Charlotte Bishop discusses  "The Talk" about giving up the car keys in her most recent blog post. She gives some solid suggestions about how best to broach this potentially awkward subject with the elders in your life.

If you still find resistance, remember that each state's DMV has its own Senior Drivers License Laws. And if your elder can no longer drive, you can certainly hire a qualified caregiver to chauffeur and run errands if you are unable.

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Caregivers Can Help Seniors with Healthy Aging

September is Healthy Aging Month and while good senior home caregivers take care of important elderly care needs, great senior home caregivers can help their elderly clients or family members live a richer and more healthy life as they age. Healthy aging not only helps the individual, but helps the economy by reducing the burden on the health care system. Here are some tips for healthy aging:

  • Stay active. Try to get some sort of physical exercise (with a doctor’s permission) every day. If you’re not used to physical activity, start slow. Walking is a wonderful way to exercise. Find an activity to enjoy. Perhaps take up a long-neglected hobby.
  • Eat well. Load up on high-fiber fruits, vegetables and whole grains. As much as possible, stay away from processed foods. Remember to stay hydrated.
  • Keep your mind sharp. Board games and puzzles can help keep your brain as active as your body. Take on a new subject, like learning a new language or acquiring computer skills. Take a class. New social connections can also help strengthen the brain.

For a more comprehensive look at healthy aging, read Living Long & Well in the 21st Century, Strategic Directions for Research on Aging, released by the National Institute on Aging.

Find great home caregivers to help with the process of healthy aging in place through a quality senior home care agency.

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Labor Day and the Home Caregiver

Senior care workers are on my mind as Labor Day approaches. I am reminded of the innumerable home caregivers and the protective legislation challenges they face.

2011 is known as the first year of the “age wave”, in which every eight seconds, an American will turn 65. And while an emphasis on aging well—keeping our brains and bodies fit—can help forestall the inevitable, there is no denying that that home care is one of our nation’s fastest growing industries.

Senior caregivers provide the essential care that allows seniors to age in place by providing aid and assistance in their own homes. Very broad U.S. Department of Labor regulations have ensured that home care workers are excluded from basic minimum wage and overtime protections. Exempt “companionship” services have morphed into the wholesale exclusion of workers in the home care industry.

The Direct Care Job Quality Improvement Act – a bill that would help create a “more stable, valued direct care workforce” was introduced to Congress on June 23, 2011 and would amend the Fair Labor Standards Act (FLSA) to include basic labor protections for home care workers.

Regulation revision suggests two significant reforms: (1) it should provide that workers employed by a home care agency or other intermediary are not exempt; and (2) it should narrow the definition of “companionship” and exclude workers who perform other types of duties such as providing assistance with activities of daily living (ADLs), or instrumental activities of daily living (IADLs).

This legislation takes major steps towards ensuring the “health, autonomy and well-being of more than 13 million Americans with long-term care needs today and an estimated 27 million by 2050”.

Labor Day, the national holiday observed on the first Monday of September, was first proposed by the Central Labor Union in 1882 to celebrate "the strength and esprit de corps of the trade and labor organizations" of the community and was intended as a workingman’s holiday. At that time, the industrialized workforce demanded “Eight Hours for Work, Eight Hours for Rest, Eight Hours for Recreation.” There are agencies and alliances who are now working toward the same for a growing labor force—the home health care industry.

Learn more about these national initiatives: National Domestic Workers Alliance and their Domestic Workers Bill of Rights, Caring Across Generations: a campaign to “transform long-term care in the United States, those who rely on the support of caregivers to meet their basic daily needs, the workers who provide the support, and the families who struggle to find and afford quality care for their family members.” The National Employment Law Project (NELP): Fair Pay for Home Care Workers: Reforming the U.S. Department of Labor’s Companionship Regulations Under the Fair Labor Standards Act are a few.

If you are a home caregiver and want to increase your viability and skill set, consider Caregiverlist’s 10-hour online certification training. Upon completion you receive a certificate and your name is added to the database registry of training certified caregivers. Elevate your skills. You are invaluable. Training can be your first step to a fulfilling career and your inclusion in a growing labor movement.

And from Caregiverlist, happy end of summer!

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Hurricane, Earthquakes Prompt Renewed Concern for Elderly

Hurricanes, Earthquakes and Senior Care

When a magnitude 5.9 earthquake shook the East Coast on August 23, my thoughts immediately went to my elderly aunt living alone in Manhattan. A lifelong denizen, she refuses to leave the island. You know the type—she declined to leave even after the September 11 attacks. I imagined buildings shaking around her, and although this episode wasn’t nearly as bad as it was in my imagination, I wondered how she would fare had it been worse.

I remember the plight of the elderly when Japan suffered its July 2007 earthquake. All of the 10 people killed were older than 65.

Life expectancy, according to the U.S. census, is projected to increase from 76 years in 1993 to 82 years in 2050. We’ve seen a dramatically greater rate of growth in the most vulnerable elderly population.  Over the last decade, the number of elderly (age 65+) with mobility limitations grew by 40 percent. The oldest old (persons 85 years old and over) is the fastest growing segment of the elderly population.

Disasters, natural and otherwise, make the challenges of an aging society become very apparent. I decided it was important to create a family “disaster” plan.

According to the American Red Cross, “forty-five states and territories in the United States are at moderate to very high risk of earthquakes, and they are located in every region of the country.” They post an Earthquake Safety Checklist. Go over it with your family members, especially your seniors living alone.

Make sure they know the safest place in their home for each type of emergency. Speak to your elderly family’s neighbors—perhaps someone would be willing to help them evacuate if necessary. If they need special foods or medications, be sure to have them store several days’ worth. Make sure they know to contact you to let you know that they are safe.

Post-disaster, seniors especially can fall prey to scam artists looking to take advantage of the misfortunes of others. Look for legitimate assistance for services through your family member’s State Agency on Aging.

And if you live a distance away from your senior loved one, you might consider hiring a Home Care Agency so that someone is nearby, knows your loved one, and is ready to help.

Many elderly need assistance even in normal times. In a disaster, they can become absolutely helpless. You can help by preparing them and yourself.

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Rise of the Planet of the Apes Film Spotlights Alzheimer's Disease

Rise of the Planet of the Apes has critics divided in their reviews. For me, more honestly disturbing than the images of an ape overthrow is the movie’s depiction of the ravages of Alzheimer’s disease.

John Lithgow gives a moving performance as genetic scientist Will Rodman’s afflicted father. James Franco is at his most real when interacting with Lithgow—portraying a son’s desperate attempts to return his father to the man he once was, and the painful realization that he cannot. Says Franco of his character, “His father Charles is suffering from dementia so he moves into his father’s house, which was once Will’s childhood home, to take care of him. Being a caregiver is a role Will has never had to perform before.” The film truthfully conveys the immense frustration experienced by both patient and caregiver.

Of course, the movie also gives us villainous Gen-Sys, a large pharmaceutical corporation that’s more interested in turning profit than developing a cure.

Perhaps the proactive movement toward Alzheimer’s and dementia prevention is prescient. While researchers continue to “race toward the cure” (with better results than the movie’s, one hopes,) there is a growing focus on risk reduction and brain protection.

Guest blogger and Geriatric Care Manager Charlotte Bishop neatly summarizes University of California, San Francisco’s report on possible Alzheimer’s reduction in her latest blog Preventing Alzheimer’s Disease?  Proponents say that by leading a brain-healthy lifestyle, you may even be able to prevent the symptoms of Alzheimer’s disease.

I hope this movie helps bring Alzheimer’s and dementia into the popular discussion. Charlton Heston, star of the first Planet of the Apes movie, himself suffered symptoms of the disease. And although Lithgow’s depiction is heart-rending, it cannot truly impart the relentless daily battle faced by those affected.

Caregiverlist has partnered with Terra Nova Films to provide training videos to support caring for seniors with memory loss, including Alzheimer's Disease.

Until a real cure is found, prevention and successful caregiving are the most effective tools we can use.

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Caregiver Empathy, Try the Mitten Test

Understanding how a senior's senses change as they age can help caregivers to relate better to when they may need to step in with a helping hand.

Guest Blog post by Charlotte Bishop of Creative Case Management.

The trees are budding and blooming, the bulbs have forced their way to the surface in beautiful blossoms and the birds are twittering and nesting.  Time to put away your winter coats, wool scarves and mittens, right? Well, partly right. Your winter mittens have another useful purpose that can help you make home an easier place for your older loved ones.

As our bodies age, certain of our nerve pathways begin to fail, and the human anatomy uncannily reroutes many of the circuits as they stop firing. But with age, more and more of those pathways may slow or fail for a variety of reasons, and it just makes it harder for older adults to do the simple manual tasks they used to do without even a thought. Turning a door knob, turning on a lamp or taking the lid off a jar become challenging, maybe even impossible. It is hard for those of you who may be in the prime of your lives to really get this, no matter how empathetic, so I recommend an easy exercise to help you experience what this erosion of manual dexterity and fine motor skills feels like. In doing so, you can also help identify challenging hardware or activities that can be more easily managed with a bit of creative help.
Caregivers for seniors can take a pair of mittens, walk through each of the rooms in your elder loved one's home and go through the normal activities of the person who lives in those rooms. As you enter a room, it is may be more challenging to flip a light switch or twist the switch on a lamp with your hands in mittens. These can be remedied by retrofitting wall switches with the larger rectangular switches that one merely presses on and off. Likewise, the lamp twist switches that are challenging with mittens can be replaced with wider winged grips. And even before you enter a room, the door knob may be your undoing if the knob is too small or too slippery. Handles may be an appropriate replacement.

You would find that mittens are effective barriers to everything from opening the ketchup bottle to a twisting the lid on a jar of apple sauce or beverage bottle and more. Some of the web sites and stores with helpful assistive devices can be found in the blog Safer Senior Living-The Kitchen. And if a key itself is hard for an older loved one to grip when opening a door, hardware stores have over-sized sheaths to make gripping easier.

With your mittens still on, try tying your shoe laces or buttoning a shirt or blouse. It may be time to get creative with Velcro-equipped shoes or other substitute hardware for buttons. And go through the motions of other self-grooming activities to determine what challenges are manageable and which are just out of reach. The number of what are called "assistive devices" will amaze you as you look to television remote controls, computer access and more. Check out the Department of Health and Human Services Assistive Technology site.

Charlotte Bishop is a Geriatric Care Manager and founder of Creative Case Management.

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Caregiving Jobs

Senior caregivers are able to be hired by senior home care agencies, assisted living communities, nursing homes and hospitals.  Both companion caregiver and certified nursing aide positions are available along with part-time and full-time schedules.

As senior care must sometimes be provided around-the-clock and facilities must staff day time and night time shifts for nursing aides, there are a wide variety of employment opportunities available.

Some positions require experience and other positions only require a caring personality.

You may learn about the caregiver job description, take a practice nursing aide exam, find training programs in your area, build your own resume and apply for a caregiving job near you to begin your career path in senior care.

Healthcare Reform: Don't Forget Billions in Medicare Fraud

As the Senate debates healthcare reform and how the additional coverages would be provided, why aren't they talking about the $90 billion that has been given away for free through Medicare fraud?

A private company would close their doors if all of their earnings were being stolen by clients.  Why does the government create programs which make it possible for fraud to easily take place? 

Those of us in the healthcare industry are aware of the stories which circulate about medical equipment companies who are billing improperly to Medicare (even the Scooter Store, which advertises heavily on television with infomercials, settled a lawsuit with the federal government after an employee blew the whistle on improper claims).  Part of the problem stems from government programs which make some reimbursements a bit too large, as compared to the profitability a company would earn in the private sector - but shouldn't government pay the same as the private sector pays for products (or less, if they are guaranteeing bulk orders)?

From the government's news release on the Scooter Store fraud:

"By representing to physicians that their patients wanted and needed power wheelchairs, The SCOOTER Store obtained thousands of “Certificates of Medical Necessity” from physicians who did not know about the company’s fraudulent practices. The SCOOTER Store then billed government and private health care insurers for power wheelchairs, which were far more costly than power scooters, and collected millions of Medicare and Medicaid dollars.

The SCOOTER Store received $5,000 to $7,000 in reimbursement for each power wheelchair it sold, more than twice the amount for a scooter, which sold for around $1,500 to $2,000. Many beneficiaries had no idea what kind of equipment they were getting, until it was delivered by The SCOOTER Store.

The government’s lawsuit also alleged that The SCOOTER Store knowingly sold used power mobility equipment to beneficiaries and billed Medicare as if the equipment were new, in violation of Medicare regulations. In addition, the U.S. alleged that The SCOOTER Store charged Medicare millions for unnecessary power mobility accessories."

If seems if the government could just cut out the programs that have a bit too much frosting and whipped cream on top for certain industries, and created efficient systems for reimbursement, the billions in fraud that are saved would more than pay for additional healthcare benefits.

Check out this 60 Minutes story which aired on October 25, 2009, and profiles the billions being stolen from Medicare via fraudulent claims.  It seems it would not be that difficult to set up a better system for checking out claims to avoid this fraud, especially when people aren't just stealing a million or two million, but million after million after million without being caught. 

Medicare does not pay for long-term care and because of this, many seniors must hire their own senior caregiver and the additional cost of providing health insurance for senior caregivers is not always covered by small businesses or when a caregiver is hired directly (or when a family member must quit their job to provide for the care). 

Meanwhile, studies show the most important factor in senior care is one-on-one care services by a caregiver.  Even Medicaid-funded nursing homes often do not staff more than 1 Certified Nursing Aide for each 12 residents, which often means this nursing aide cannot adequately provide care to each senior. 

It seems eliminating the extremely high Medicare reimbursements for some medical equipment would be the first easy fix to help pay for more health insurace benefits for Americans, including benefits for senior caregivers.




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Minimum Wage Increases Today But Caregivers Already Earn More

Today the federal minimum wage increases to $7.25 per hour.  While each state offers their own minimum wage law, if it is less than the new federal minimum wage, they must now match this higher amount.  This means 13 states will increase their minimum wage to $7.25 today:  Idaho, Indiana, Maryland, Montana, Nebraska, New Jersey, New York, North Carolina, North Dakota, Oklahoma, South Dakota, Texas, Utah.  

Four other states also increased their minimum wage in the month of July (some did it just before the federal deadline - a nice political opportunity for the state government to look better to employees by beating the Feds to this):  Illinois, Kentucky and Pennsylvania, with Illinois increasing their minimum wage to $8.00 per hour.  These other 3 states just matched the federal level of $7.25.  The old minimum wage was $6.55 per hour.

Which states pay the highest minimum wage?  Oregon at $8.40 per hour and Washington at $8.55.  Only 13 states, plus DC, pay more than the federal minimum wage.

Regarding the people who say this is going to put people out of work - - - - unless they are an actual business owner who can't figure out how to save 70 cents in another area, in order to keep their employees happy and able to pay for their basic costs of living, then take their feedback with a grain of salt.  And if it is a business owner who can't figure it out well, maybe he shouldn't be in business?  Employees are the backbone of any business, find away to pay them a fair wage or don't be in business.

Those of us who are business owners and have had more than 100 people working for us, know you can always cut costs someplace, and, if necessary, if you offer a great service, you can always increase your pricing to cover a necessary increase in costs, including increases in costs of living.  And one of the best ways to have great service is to have happy employees, which is worth a few cents.  

The good news?  Senior caregivers are paid more than minimum wage along with benefits by senior home care agencies nationwide.  Senior caregivers are usually paid from $9.00 to $14.00 per hour, depending on the area of the country.  Pay is more in New York than Alabama, for example, as the costs of living are more. In addition, caregivers who are certified as nursing aides or home health aides also receive higher pay when performing those duties.  In addition, many quality senior care agencies provide performance bonuses, incentives, ongoing training and support.

You may apply for a senior caregiving job in your area on Caregiverlist and also find the details on minimum wage laws in your state.



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Senior Caregiver Checklist After Hospital Stays & Doctor Visits

Patients of even the most meticulous at-home senior caregivers encounter hospital visits due to an unexpected fall or change in health conditions. A trip to the hospital or simply an appointment with a new doctor can be stressful for seniors, who often return home without a grasp of appropriate follow-up steps for senior care based on the new conditions.


This National Alliance for Caregiving checklist, which includes follow up questions for physicians and other professionals involved with senior care, is designed for patients and caregivers to help ensure a smooth transition from the hospital to at-home care. Both parties stand to benefit from a clear understanding of the senior’s condition and recovery plan.


1.      Do you understand your health conditions? Ask what is likely to happen with your health.                                                                         

Senior ___  Caregiver ___


2.      Do you know what problems to watch for and how to handle them? Ask what to do and who to call if you have problems.                      

 Senior ___  Caregiver ___


3.      Do you know what each of your prescriptions drugs does? Do you know how to take them, and what side effects to watch for? Ask who you should call if you have questions.


Senior ___  Caregiver ___    


4.      Do you understand how much of your prescription drugs, equipment and services will be covered by your insurance and what you will have to pay? Ask to speak to a social worker about possible resources to help with insurance payment.


 Senior ___  Caregiver ___


5.      Do you have written discharge instructions that you understand, your list of drugs, and a summary of your current health status? Bring this to your next appointment.


Senior ___  Caregiver ___


6.      Do you know what appointments and tests you’ll need during the next couple of weeks?                                                                   

Senior ___  Caregiver ___


7.      Do you have a doctor or healthcare provider to call if you have questions or problems? Write down the names and contact information.


Senior ___  Caregiver ___


8.      Are you worried about how you or your family is coping with your illness? Ask to speak to a therapist or find out about support groups, if needed. 


Senior ___  Caregiver ___


9.       Do you know what medical equipment you will need? Ask who to call if you have questions about equipment.


Senior ___  Caregiver ___


10.  Do you know which of the items below you will need help with and for how long? Bathing, dressing, grooming, using the bathroom; Shopping for food, making meals, doing housework, paying bills; Getting to doctors appointments, picking up prescription drugs. 

Senior ___  Caregiver ___


Seniors often require full-time care in the weeks following a hospital visit. Caregiverlist offers free resources such as a Medication Reminder Schedule and Simple Senior Care Plan to assist caregivers in providing quality care to senior clients. These tools are especially helpful for caregivers who start seeing a new patient, or have an existing patient whose care requirements change.


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