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Aging Wisely July 2011 - Aging Wisely

Hedging Your Bets: Aging in Place and Taking Risks with Independence


A common scenario to many families: Mama Mary lives alone, widowed several years ago and has several health conditions. Family members live up north and visit a few times per year, and have been trying to visit more often since Mary lost her husband to help her manage her household. Mary answers all questions/concerns with “I’m fine” and gets very upset when her granddaughter brings up an assisted living community. The family isn’t very familiar with what other types of help might be available and since Mary always says she’s fine, Mary is getting by with occasional assistance from friends and neighbors. Her daughter calls her every day for her own peace of mind and her son has started to help her go over bills and help with finances.

The biggest concern with this scenario is the potential risks the senior (and therefore, by extension, the family, who will likely step in if/when anything happens) is taking with regard to safety, but also continued independence and choices. One fall or major health problem could have a significant impact on this senior’s options. And, with little planning or resources in place, everyone may be ill-equipped to deal with that crisis. And, a few minor changes and resources to support Mary could make a big difference in reducing risks.

Does this sounds familiar? What could this family do to relieve their worries and better ensure the safety of Mary?

With our years of experience in eldercare and patient advocacy, we have come to see that while maintaining independence is often seen as keeping everything status quo, those who make proactive changes truly guide their own paths. Here are some tips we share with families about the fine balance between independence, safety and risk-reduction.

• Don’t shy away from conversations about your concerns. Your loved one may try to brush off the topic, but find ways to discuss your concerns and some options to help. Ask your loved one to consider some small changes or getting an assessment or home safety review as a way to get started.
• Do some homework. Find out about some of the support options in your community or plan an eldercare consultation with one of our care managers (we often do these with family members over the phone and discuss ways to address the subject with their loved ones). You can be prepared even if your loved one doesn’t want to take part in this process right now.
• Take advantage of “windows of opportunity”. For example, if a loved one is hospitalized, has surgery or is weakened by an illness, introduce support services which might be welcomed and needed at that time. It is often fear of the unknown that causes the most resistance. Also, when an event occurs (even with a friend or other family member), use that as a conversation starter.
• Identify areas where your loved one may acknowledge needing help, or offer care/assistance as a gift. For example, you may be able to give the gift of some home-delivered meals or transportation and help around the house.
• Know when to “put your foot down” (with kindness). If your Mom is truly putting herself at risk, explain your concerns and why you feel she is being unfair to herself and you.
• When exploring options, a care management consultation can help you see a variety of pros and cons. A good care plan takes in to account a variety of factors about the individual and situation. A care manager may have a unique view on things that helps you and your family look at things in a new way.

You might also benefit from reading our handout entitled “Help! Mom Won’t Listen! What to do when you’re concerned about an aging loved one“.

Contact us for nationwide eldercare consultations, home safety assessments in Florida, expert advice and oversight/options for Florida seniors.

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What Will Respite Care Cost?


Respite care is generally not covered by insurance or Medicare, as it is considered custodial care (vs. skilled care). Most respite care is privately paid (i.e. paid by the individual or family out of income and assets). The good news about respite care is that there are a range of options to put together an affordable plan. Additionally, it is important for families to consider the value of respite’s benefits. By providing a break for a primary caregiver, respite care helps to maintain the valuable support and care to the individual.

Here is a very general breakdown of possible respite care costs (statistics taken from MetLife’s Mature Market Institute Study of Long-Term Care Costs nationwide averages and additional information from our care management team’s expertise):

Home Care, provided by a home care agency:
$21/hour for home health aide
$19/hour for homemaker/companion (non-hands on care)
$18.73 in Tampa Bay, Florida for home health aide
$17.95 in Tampa Bay, Florida for homemaker/companion

To learn more/access in-home respite care in Pinellas County/Tampa Bay, visit EasyLiving’s respite care post.

Adult Day Services:
$67/day (8 hours/day, 5 days/week)
$66/day in Tampa, Florida and vicinity
*Adult Day Services can vary widely, as they can be provided by community groups as well as local Assisted Living Facilities and some offer half-day or hourly care as well. Some funding may be available for sliding-scale or free care in your community in adult day care provided by community organizations.

Assisted Living Facility:
$2650/month average in Tampa Bay area but $100 or more/day is typical for respite care, short-term rate
*For respite care, most Assisted Living Facilities charge a daily rate which may be slightly more than pro-rating the monthly rate.

Nursing Home:
$205/day for semi-private room ($212/day average in Tampa Bay, Florida)
$229/day for private room ($235/day average Tampa area)
* It is less common to use nursing home care for respite, but it may be necessary for an individual requiring skilled, medically-complex care. If an individual has had some major exacerbation or health issues, it may be possible that Medicare covers a short-term stay in a nursing facility if preceded by a 3 day hospital stay for the condition.

Some considerations and tips on respite care costs and options:

• Consider hiring a care manager to put together a plan with a mix of options, customized to meet your needs/budget. For example, you might employ a combination of family care or monitoring technology with home care or adult day care.

• Remember all the costs involved and what is being provided for each rate. For example, all meals will generally be included at an Assisted Living Facility. Adult Day Care usually provides a mid-day meal and some provide transportation to and from the program. Add up any additional costs to get a true budget. When our care managers make recommendations, we offer you a budget that helps you compare choices with all the information at hand.

• Research financial support through community programs. Some disease-specific organizations, such as the Alzheimer’s Association and the M.S. Society, provide some funding to assist with respite care. Find out if this is available and what parameters/eligibility are involved. There are also caregiver support programs available through aging services. Be aware that funding sources are often limited and may be wait-listed, so check in advance when you can or get advice on programs to target.

• Talk to family members about respite care. Can another family member (or combination) provide respite? If not, can family members pitch in to help cover the cost of respite care?

• Consider simplifying the process by using a geriatric care manager. First, a geriatric care manager can help you identify options and find help with funding. Second, you might hire a professional care manager to oversee the respite care and handle medical appointments and emergencies. We’ve helped many families this way, providing them the peace of mind to enjoy their vacation, family event or just take a break for self-care and renewal.

CONTACT US for help with respite care options, eldercare advice and care management/local oversight for seniors in Clearwater/Tampa Bay, Florida.

Further reading: you may want to read our article on Respite Options for Family Caregivers and Tips for Preparing for a Good Respite Care Experience.

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Respite Care: Tips to Prepare Substitute Caregivers


If you read our last post on respite care options you know that there are several options for those times when you need a break or have conflicting demands as a caregiver. How do you make the respite experience go as smoothly as possible for you and your loved one? How do you ensure it really is a break and not a series of phone calls and worries?

Here are some tips about how you can prepare to have the best respite care experience possible:

• Organize your loved one’s records: health history, medication list, doctors and other providers, key contacts and vital information. This is helpful for you as a caregiver in many situations, but will be vital to communicate to whoever is caring for your loved one in your absence. Ensure important documents such as advance directives are accessible as well.

• Consider the what ifs…if you serve as your loved one’s sole POA/Healthcare Surrogate, can you be reached in case of an emergency/decision? This is something to consider in initial planning as well, as there may be benefits to having a secondary decision maker. Consult with your attorney. Make sure providers understand who can make decisions and have copies of documents.

• Prepare some information that will help the substitute caregivers to maintain routines. What is your loved one’s typical schedule? Favorite foods? Likes and dislikes? Behavioral patterns? Comforts?

• Give substitute caregivers who do not have a history with your loved one some background information. Tell them a little bit about your loved one. (For family members helping out but who are not there on a regular basis, share recent changes and plan some overlap so that they have a chance to adjust.)

• Test the waters. If you are going to use adult day care or facility-based care, do a trial run while you are in town or for a short period if possible. For home care, give yourself a small break while caregivers stay with your loved one before taking a long trip or trying many hours.

• Consider the “triage” plan if something goes wrong. If you are going far away or may be hard to reach, can you plan to have another relative handle immediate needs? Would you benefit from having a geriatric care manager to check in on things while you are gone? Remember that if you bring in a privately-hired caregiver, you won’t have agency oversight, supervision or substitutes if something goes wrong.

• Let go (easier said than done). No one is likely to provide the care you do for your loved one, but it is vital to get a break so you can continue providing that great care. Do it in a way you are comfortable with and start slow, but you will have to relinquish some control.

• Acknowledge the benefits. We have reiterated the benefits to you as a caregiver, which therefore benefit your loved one. But, sometimes there are other unexpected benefits. Your loved one really starts to like the home caregiver you brought in and now you have someone you can count on for ongoing needs. Your sister who comes to stay understands better what your day-to-day is like, easing your relationship. Your Mom feels like she had a mini-vacation at the Assisted Living and is worn out from attending non-stop activities.

Come back to visit us for more eldercare tips and advice for caregivers (or check us out on Facebook and Twitter)!

Aging Wisely helps family caregivers identify solutions on a range of issues. Regarding respite care, we can help you determine the best options, identify programs to help, prepare for transitions and oversee care while you are away. We have helped many families by “filling in” to check in on loved ones in facilities or with home care during a caregiver’s trip. Many times families decide to have us continue some oversight when they are back in town as they appreciate the professional consultation and additional advocacy. Contact us if you need to talk to someone about eldercare options in Florida and beyond.

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Caregiver Breaks: Do you know your options for respite care?


There are times it will be essential for any elder caregiver to take a break. Your health and well-being, and most importantly your ability to continue providing good care for your loved one, depend on you having some rest and time for other activities. Read our blog posts from Stress Awareness Month with important information on Caregiver Stress Awareness, Tips for Reducing Stress and Resources to Help with Eldercare.

It is important that caregivers be able to retain outside activities, and getting away for a vacation can be vital. However, it may seem impossible for caregivers to do. There may also be times when you need to have a break because other demands conflict with your caregiving; for example, activities with other family members such as dealing with a spouse’s ill health, attending a child’s activities, attending a funeral of a loved one, and more.

You may be able to turn to other family members and your support system for help during these times. You may find this article on EasyLiving’s Caregiver Tips blog helpful: Creating an Elder Care Team.

The other solution for caregiver breaks, vacations, and conflicts is respite care. Respite means a rest period, therefore this care is designed for short-term periods to provide care to an elder in substitute for the primary caregiver (so you can get a break, whether for rest or another need). Respite care can be provided in a variety of methods and settings, and this is designed as a primer on those options. Check with a geriatric care manager or the Area Agency on Aging to find out what options are available in your area.

Home Care Respite care can be provided in the care recipient’s home by a home care agency/elder caregivers. A home care company will meet with you, assess your loved one’s needs and develop a care plan for short-term assistance while you will be away. If your loved one requires 24-hour care, the company will provide a team of caregivers to cover the shifts.

We will cover some additional tips for selecting an agency/caregivers, preparing for your break (and preparing the caregivers) and how to set the home care team up for success in additional posts. An advantage to this respite option is the consistency of allowing your loved one to remain in the familiar home environment. This may be especially advantageous for someone with dementia, if you and your care team set things up to provide a smooth transition and consistency (for example, training caregivers on likes/dislikes, schedules, routines).

Assisted Living Facility or Nursing Home Respite Care Most eldercare facilities offer respite care stays, as long as they have space available. You should pick a facility as if your loved one were moving there: finding out about the quality of care; identifying facilities capable of managing your loved one’s needs; reviewing location, activities and other important factors. Consider hiring one of our geriatric care managers to help you with Florida assisted living options, and possibly help with the transition and oversight.

Typically, facilities will charge a daily rate for respite stays. Assisted Living Facilities usually designate furnished rooms to accommodate respite, so that you only have to pack personal belongings for the stay. In Florida, facilities are required to complete the same type of admissions paperwork as they would on any resident. One advantage to having your loved one stay at a care facility may be that it gives you and your loved one some insight in to how this may work, if needed as an option in the future. Sometimes it can be a “mini-vacation” for your loved one too, if they enjoy the activities and amenities the facility offers.

Adult Day Care and other community programs may provide respite options as well. For example, if your loved one only needs help during daytime hours or there is another family member who works during the day, an adult day program may be ideal. These may be offered through stand-alone adult day programs (possibly run by aging organizations/local non-profits) or care facilities. They typically charge a daily (or portion thereof) rate (for example, some elders attend a morning-only program, paying a half day rate and others may even offer hourly rates). Your community may have additional elder support programs to help as well, ranging from meal and transportation programs to telephone check-in services.

Respite care is not typically covered by Medicare or health insurance. Most of the options above would be paid for privately, although some funding may be available through caregiver support programs or disease-specific organizations. For example, chapters of the Alzheimer’s Association and organizations like the National MS Society sometimes have funding available to help offset the costs. Additionally, programs may be available through your local Area Agency on Aging.

Subscribe to our newsletter to receive our additional tips on the topic of respite care and other Florida eldercare advice. Or, CONTACT US today for consultations, assistance and advice for families caring for elderly loved ones.

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Florida Nursing Home Staffing Levels Dropped


As of July 1, 2011, the state has reduced required staffing levels in Florida nursing homes. This measure is part of efforts to help nursing homes deal with the $187.5 million in Medicaid cuts outlined in the state’s budget. The state uses a formula of required “direct care hours per patient”. Under the new rule, Nursing home residents will be entitled to a minimum of 3.6 hours of direct care per day, down from 3.9. Advocates for nursing homes claimed this was necessary because staffing rates had been raised, while budgets had been chopped.

Nursing homes must meet these minimum requirements, but can choose to staff at higher levels. With many relying on Medicaid for a big portion of payment, the state of Florida’s Medicaid budget cuts make a big impact and many appear to be cutting back on staff. They may look at other ways to improve care, but research has shown that higher staffing levels are associated with fewer falls and bedsores. Staffing requirements vary from state to state, and many states do not set minimum levels.

Read more from Health News Florida on this new law and the Florida statute on certification of nursing assistants working in nursing homes.

What can concerned families do to ensure good care when an elderly loved one is in a nursing facility?

• Consider hiring a geriatric care manager for the initial selection process of a care facility. A geriatric care manager can help you determine what type of facility can best meet your elder loved one’s needs and which offer quality care. The care manager can assist with the transition in a variety of ways, including understanding levels of care, payment options and what to expect. Even if your loved one is going from the hospital to short-term inpatient rehabilitation, a care manager can help you identify the best options which can greatly benefit your loved one’s recovery.
• Visit often and be involved. Get to know facility staff and check in regularly. Be alert to changes or concerns and constructively address them with appropriate staff. Attend care plan meetings. Ask friends and family to visit to help ensure your loved one has regular visitors. (If you are caregiving from a distance, consider having a care manager do monitoring visits in addition to having friends or neighbors check in.)
• Find out who to address concerns with and the chain of command if you do not feel your concerns are being addressed. All Florida nursing homes will have residents’ rights and complaint information posted, so that you also know where to address complaints not handled sufficiently by the facility. The Florida Ombudsman program offers volunteer advocates to help residents and families.
• Nights, weekends and holidays are the most problematic times for staffing at facilities. Visit during different times to get an idea of how things operate and any potential hazards. Find out how the facility handles management of these times.
• Keep apprised of changes by reviewing the chart and attending care plan meetings (or having a professional geriatric care manager, trained in these issues, involved in this process). While you should be informed of any significant changes, it helps to keep an eye on things and ask questions.
• Consider hiring a private duty caregiver for extra attention and care. Read more about how caregivers can benefit elders in care facilities.

CONTACT US if we can help you with eldercare advice and concerns, selecting a quality Florida eldercare facility or monitoring and advocating for your loved one in Florida.

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Payment Concerns
Not sure how you are going to pay for elder care?

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Find out if its time to seek help for your loved one.

Aging in Place
How to keep a loved one safe at home, and when it may be time to consider assisted living.

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