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Aging Wisely January 2013 - Aging Wisely

Senior Care Conflicts: A Tale of Two Daughters


sister on the phone conflict over senior careEach family’s senior care situation is a bit unique, but there are common conflicts that arise.  One challenging dynamic that sometimes leads to conflict is when one (or more) family caregivers live near the aging parent and the others are long-distance caregivers.  The perspectives naturally diverge, and each party may feel certain resentments toward the others, even in a family where everyone generally gets along. 

Today we want to share the story of two daughters, one local and one long-distance, dealing with Florida elder care concerns.  Though your situation may not be exactly the same, we hope the lessons and tips that arise from the story will help.

This caregiving story begins a little over five years ago, when the elderly parents began needing assistance.  Dad started having some symptoms and was diagnosed with cancer–a surgery ensued and Dad’s health begin a slow decline.  Daughter #1 lives in the same town and began spending significant time caregiving.  At one point, she was not only assisting with grocery shopping, cooking and medical appointments, but also spending many nights in the home and providing round-the-clock supervision several times when Dad was hospitalized.  She realized she had to get some outside assistance when both her health and work were significantly impacted (keep an eye out for our upcoming article giving “the real scoop” on caregiver stress and self-care).  She was able to locate home caregivers through a Florida home health agency to provide some of the hands-on care that Dad needed and give her an occasional break.  However, she still managed many tasks as well as coordinating the care and handling several “emergency” calls each day from her mother.  To ensure her parents accepted the care without letting money worries be a barrier, daughter #1 paid for the home caregiver services.

Dad died after a four-year battle with cancer.  Mom is now living alone and has caregivers helping a few times/week and daughter #1 handles all the same tasks for Mom she did for both, as well as increased time together and reassurance since Mom has become a widow.

Daughter #2 lives in the midwest, about a two hour flight from Florida.  The daughters have always been close, and both get along well with their parents.  She visits during holidays, and she tried to increase visits to once every couple months once Dad got sick.  She talks to her sister about twice/week and often more frequently.  She didn’t talk to Dad often over the phone because he was not a “phone person” but talks to Mom about once/week.  She flew down a couple times to help out during Dad’s hospitalizations, but cannot always travel due to her demanding work schedule.  Both daughters are married with older children (but still finishing college) and have full-time professional jobs.

As in many cases of one local and one long-distance caregiver managing senior care, the sisters are playing very different roles and therefore have very different perspectives.  Generally, things seemed to be going along fine until a recent holiday visit.

Daughter #2 spent time with Mom during the visit.  She noticed that Mom has become very attached to her caregivers and mentioned a few things that concerned her, such as wanting to “help out” their families.  Several things Mom said made her feel perhaps she was too attached and she wondered about the caregivers’ roles in encouraging this or having undue influence on Mom. 

She brought up her concerns to her sister and said she was “panicked” over this and what might happen.  She made a number of criticisms about the caregivers.  This immediately made her sister feel angry and unappreciated.  Daughter #1 also noted that her sister was criticizing, while offering no solution (and no offer of help).  This brought to the surface a lot of feelings about all that she has done for the past five years on a day-to-day basis (and financially).  She doesn’t feel that her sister has any understanding of the amount of stress and the time she has spent coordinating care, answering phone calls and handling every detail.  This situation has really soured the relationship…and continues to cause various repercussions for the whole family.

Senior care is tied up with many emotions for families, and the stress of the situation can easily damage even good relationships.  Most likely in this situation the long-distance caregiver did not mean for her comments to come across as they did, and many long-distance caregivers struggle with their own feelings of guilt or inadequacy (or in other situations, feeling they are being isolated from the situation or that the local caregiver has handled things inappropriately). 

The diverging perspectives open up a mine field of potential conflicts.  Here are some ideas that might help if your family is geographically separated (we have categorized them by party, but some of them apply to both parties). 

Tips for the long-distance caregiver:

  • Express appreciation for what your sibling handles on a day-to-day basis and consider the type of stress he/she may be feeling.  Long-term caregiving on a daily basis is a chronic stress.  The caregiver often gets constant phone calls about little issues, but also has to worry what crisis might be happening every time the phone rings.
  • Consider the skewed picture you might be getting.  Aging parents have a way of pulling things together for visitors (or making things seem worse or complaining to one side, depending on the personality).  Your parent’s story may not really be the full one.
  • Think about how you raise issues and how the language you use might be perceived.  To come in to the situation where your sibling has had primary responsibility with harsh words can cause an immediate wall between you.
  • Realize that even if your sibling has willingly taken on certain duties with little complaint, paid for care or otherwise handled tasks, he or she may be feeling a little resentful of what may seem like a skewed burden.
  • Offer solutions, not just criticisms.  If there is something you are concerned about, think about how you want to approach the issue first and do not bring it up if you don’t have a solution to propose (and a willingness to help with it).
  • Try to work out some significant time to offer respite care.  It can help you to see the situation more fully, in addition to giving your sibling a break.  But, when you come in to help think about how changes or criticisms might be perceived as well, and do some preparation with your sibling to help the respite time go as smoothly as possible.

Tips for the local senior caregiver:

  • Find ways to involve the long-distance caregiver.  Can senior care providers share notes with both of you (“real time” communication–especially directly from providers–versus summarizing how things are going later can make a big difference)?  What tasks can the long-distance caregiver do?
  • Try to give your siblings and aging parents time alone when they visit.
  • Consider holding family meetings–when senior care needs first arise and on regular intervals.  You might want to engage a geriatric care manager to help guide the agenda and conversation. This could coincide with an evaluation, so everyone can get input and suggestions from an outside party.
  • Express what you might want or need from the other relatives.  The family conferences above can be a good time to do this, and talk through feelings you have about the care situation.  A geriatric care manager or qualified counselor can help you deal with your concerns and emotions and communicate effectively. In some cases, family mediation services may be needed.

In many cases, these situations are more complex before the senior care even begins.  When dealing with pre-existing family conflicts or other complexities, we always advise seeking professional advice and being open with your advisors about these issues so they can help you with planning tools.

Whatever stage of caregiving or family situation you are dealing with in senior care, it’s always a good time to get some professional advice to move forward in a more positive direction.  We can help with family care planning sessions, independent assessments and more:

Just give us a call at 727-447-5845 (toll free 727-447-5845).

Have you experienced one side or the other–being the local caregiver or the long-distance caregiver?  Either side can be challenging in its own way, more so depending on the relationships involved.  We welcome your comments or input!

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“Smoking” Hot Eldercare Issues: Nursing Home Resident Rights


The Fine Line Between Freedom and Safety at Eldercare Facilities: The Issue of Smoking at Nursing Homes and Assisted Living

no smoking in nursing homeResidents of a St. Petersburg, Florida nursing home recently staged a protest about rule changes related to smoking.  The nursing home, Shore Acres Rehabilitation and Health Center, in St. Pete has recently changed their smoking policy to better address concerns they have about resident safety. Anyone who has worked in a nursing facility or assisted residents of an eldercare facility knows smoking can be a “hot” issue.  Smokers feel passionate about maintaining their right to smoke and some amount of freedom, while a facility and its staff have a duty to balance residents’ rights with the safety and health of all residents.  The changes at Shore Acres in St. Pete were spurred by a letter form the Center for Medicare and Medicaid Services (CMS) about a nursing home resident who recently died in a fire when her cigarette caught her clothing on fire.

Residents with dementia or mobility issues in particular may have less safety awareness or more difficulty safely smoking, and be more prone to burns or not putting cigarettes out safely.  A nursing home resident with dementia who has access to his cigarettes may forget that rules state there is no smoking inside and may smoke in his room and bed. 

Nursing homes have various smoking policies to address safety concerns. Shore Acres’ new policy requires residents to turn over their cigarettes and lighters to staff.  Nursing home staff will then “accompany residents on nine scheduled 20-minute smoke breaks, with a two-cigarette limit per break”.  Due to the health concerns of smoke exposure, nursing homes generally do not allow smoking inside and are permitted to modify their policies regarding smoking areas, times etc. while providing current residents with options.

Working closely with many nursing home residents over the years, we have encountered various challenges related to smoking and client safety.  Here are some tips and ideas related to this eldercare issues (which can also be applied to many other residents’ rights and safety issues):

As a nursing home resident or family member:

  • Care planning is vital for each nursing home resident.  Each resident is required to have a care plan, which is reviewed regularly (and after changes such as a hospitalization return).  Nursing homes use standard formats which cover various issues based on regulations. As an advocate for a nursing home resident, this care planning process (and resident/family/advocate input) is an essential way to cover important issues.  Take notes, prepare questions, attend the care plan meeting and discuss concerns and solutions.  This can apply to smoking and all health and care concerns and needs.
  • You can advocate more effectively with an understanding of rules, regulations and the perspective of the facility.  This helps you know what is realistic and not, what to expect (and when someone is giving you an answer that is not satisfactory or even against residents rights or regulations).  This area is one of the biggest advantages to collaborating with a geriatric care manager, who understands all the ins and outs of eldercare facilities.   
  • Come with suggestions, not just complaints.  Suggest a possible solution that might be a compromise or creatively address both sides of the issue.  Could a private duty caregiver help make your loved one’s situation better (to take the resident on more frequent breaks, personalize activities, or go out on outings)?  That is just one example, but there are many ideas that may help you work within the facility rules while personalizing the options a bit.

Prior to becoming a resident/choosing an eldercare facility:

  • Read up on Nursing Home Resident Rights.  All nursing facilities are required to post these, along with survey results and where to direct complaints.
  • Understand your care options and the pros and cons of various choices.  Talking with a geriatric care manager can help you evaluate options based on your specific needs and desires.  Which nursing facility might best meet your needs?  What factors are most important in the decision?  Would in-home care be an option?  What is daily life like in an eldercare facility?  What expectations are realistic with different care options?
  • Prepare a list of customized questions.  For example, if you are concerned about smoking or your loved one wants to ask for a special request/accomodation or your family is worried about how something will be handled, address these issues in the decision-making process.  The specific answers, but also the tone of the discussion and way the questions are addressed, may be very telling.

Give us a call today to learn how our geriatric care managers can help with: choosing Florida nursing homes or assisted living, assessing needs and providing care options, patient advocacy services and care oversight and more!  You can reach us at 727-447-5845.

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Community Spotlight on Clearwater Health Care: Clearwater Free Clinic


Our Aging Wisely team feels an important part of creating a stronger community is taking an active part in contributing to community needs.  Our team members have been involved in numerous community organizations and causes, contributing time, money and resources.  You can check out more about Aging Wisely’s Community Involvement here.

For a number of years, our company has been a proud sponsor of Martinis and Matisse, a benefit for Clearwater Free Clinic.  And, this year our bookeeper, Dotti Fischer, worked especially hard to make the event a success as event co-chair.  Care Manager Sue Lewis also served on the event committe which helped to pull together the volunteers and event logistics.  This popular event consists of an art auction, great food and drinks–all with a fun crowd getting together for a great cause in Clearwater.  You can check out more photos from this unique event, which took place this past weekend, on our Aging Wisely Facebook page.

Clearwater Free Clinic Martinis and Matisse 2013

We’d like to extend our support of this organization by sharing with our readers a little bit about what the organization does and the difference they make to Clearwater/Pinellas County residents.

Here is the organization’s description from their website:

“Since 1977, the Clearwater Free Clinic has provided problem oriented health care to low-income uninsured residents of upper Pinellas County by means of office visits, medications, lab work, x-rays, and specialty referrals.” 

The Clearwater Free Clinic is a volunteer-driven, non-governmental clinic that has served the healthcare needs of local residents, who fall in the “gap” when it comes to healthcare–not qualifying for government assistance but not being able to afford private care or insurance.  Many of the patients have chronic conditions that could lead to much more serious issues if not monitored and treated.  The patients are without healthcare coverage for various reasons, whether it is not offered at their current job, they are self-employed, working part-time or between coverage.  Having the resources available at the Clearwater Free Clinic enables many of these patients to get treatment and avoid a more costly emergency room visit.

The Clearwater Free Clinic has grown and evolved to meet more community needs since its inception, and over its history has served well over 100,000 patients with healthcare services at no cost to the patient. 

As a care management organization deeply involved in the Pinellas County healthcare community, we understand the value of these healthcare services being available to our residents in need.  We are glad to support an organization that helps keep our Clearwater community healthy.  Both Linda Chamberlain and Dotti Fischer from our Aging Wisely team currently serve as board members for the Clearwater Free Clinic.

If you know someone who needs the services of the Clearwater Free Clinic or you would like to find out about volunteering or donating to the organization, you can visit the Clearwater Free Clinic website or call 727-447-3041.

If you have questions about Clearwater or Pinellas County health care resources, financial assistance for medical or eldercare needs, we are here to help at 727-447-5845.

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A “What Not to Do” Checklist for Aging Parents


We give a lot of advice on how families can get organized to be prepared for eldercare challenges, tips for aging wisely and helpful resources such as checklists for aging parents’ care.  On the flip side, we see a lot of what goes wrong.  No family faces the same path, and you may encounter various stumbling blocks on your eldercare journey–no matter how well you feel prepared.  But, there are some common mistakes we see (i.e. things you can ignore if you want to be sure to hit some major stumbling blocks).

caregiver with headache frustrated

Here’s our aging parent checklist of 5 eldercare “don’ts” for families (and the things you can do to help make the path of eldercare smoother):

1.  Ignore family riffs and the potential repercussions.  You have the one brother who has been estranged, the sister who has constant problems, or no one gets along with Mom’s new husband–whatever iteration of family conflict you face, ignoring it is not going to help.  How you deal with it may vary, though.  You may be able to address some of the issues head on or seek counseling or mediation, or you may just need to be as prepared as possible for future conflict.  This means sharing these dynamics honestly with the professionals you trust, so they can advise you on the best ways to prepare.  We have worked with many families in conflict, who have managed to deal with eldercare issues somewhat smoothly (and keep most of the focus on the elder versus the conflict) with the help of professionals.

2.  Use the internet as your only source of information.  Is this an ironic thing to mention on a blog?  As much as we write about eldercare and provide online resources, we think of it as an important starting point and ongoing way to stay apprised of relevant eldercare issues.  We don’t think of it as a substitute for personalized, expert advice.  Just like the helpful advice of friends, you have to 1. know the source of the information and 2. realize it is general information and can never replace a medical diagnosis, legal advice, or professional recommendations.

3.  Use online forms for essential legal documents or ignore completing them all together.  This is one of those cases where professional advice makes sense…and is often much more cost-effective than people think, especially when you consider the costs of not having it done or done right.  Also, make sure to touch base with your legal professional about when you may need to have documents updated (for example, we wrote an article explaining that Florida had changed its Power of Attorney statute in the last couple years and residents should ask their attorney about whether they should update accordingly).

4.  Focus solely on price.  This is especially true because many times people aren’t doing an “apples to apples” price comparison, taking in to account all variables.  For example, you might be able to hire a college student to live in and take care of Mom for only room and board which is so much cheaper than hiring an agency at an hourly rate.  But, have you considered worker’s comp. issues, liability, supervision and backup, etc?  Talk to other caregivers and professionals about services and assistance to understand pros and cons.  Get an idea of where money is wisely spent versus better saved.  Find out what resources can help or what assistance is available if you are concerns about finances.

5.  Assume you’ll be able to easily access the information you need (even if you have the decision making/legal documents above).  In addition to planning with your attorney, you should work together with your loved one to cover some key points in case you have to step in during a crisis.  Where does Dad keep important papers?  Who are key contacts, such as doctors, attorney, financial advisor (and an introduction meeting and/or completing specific paperwork with them for information access can help)?  What about accessing electonic information?  As more of our lives are moved online, you may encounter major delays trying to access accounts, pay bills and more.  Do you have access to electronic account and password information should that be needed? (We will talk more in a future article about some different options for doing this…as privacy and fraud are also big concerns, so it’s important to balance security and access.)

You can reach out to us any time for questions, help and advice.  A care consultation is a great way to ensure you have addressed the most pressing issues for your family.  Call us at 727-447-5845 or inquire about a consultation here.

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A Primer on Florida Medicaid (and Medicare)


Florida Medicaid is a topic we get asked about a lot.  Often, family members or clients reach out to ask us about Medicaid or Medicare, many times uncertain about the difference.  It can be confusing–even for the professionals who work in this field every day!

Florida MedicaidWe’ll start with a quick definition of Medicaid and how it differs from Medicare.  Medicaid is a joint federal-state program which provides various health-related benefits to individuals who meet financial qualifications.  The federal government provides funding and the states provide additional funding, as well as administer the wide array of specific programs that fall under the category of Medicaid.  You may have heard of a poor, young child receiving Medicaid to cover doctor’s visits and medications, while at the same time you may realize this is the program your grandmother qualified for to assist her in paying her nursing home costs when she had no money left.  This is what makes Medicaid so confusing–it covers a wide range of programs and the qualifications for each vary.  The important point is to understand that it is a means-tested program, administered by the states to cover health care for various groups considered low-income/vulnerable.

Medicare was also enacted in 1965, as a healthcare program for seniors (65 and older) and disabled persons.  Medicare is funded via payroll tax and NOT means tested.  If a person qualifies by paying in to the system via payroll tax (or in some cases, via a parent for example), he or she will be eligible regardless of income or assets.  To learn more about all the parts of Medicare, eligibility and related costs, you can download our free Medicare 2013 Fact Sheet**Though not a means-tested program, higher income individuals do pay some higher Medicare premiums and special help is offered to assist those with low incomes.

At Aging Wisely, the primary questions or concerns we get related to Florida Medicaid are:

1.  What programs will help me pay for long-term care (such as Mom’s nursing home bill, the help I want to hire in my home or Assisted Living)?

The important thing to understand when looking at this question is the mechanisms for paying for long-term eldercare (also called custodial care by entities like Medicare).  Medicare is not intended to pay for long-term or custodial eldercare.  The majority of elder care is provided by families, who offer a wide array of assistance (80% of the eldercare provided in the U.S.), but there comes a time when many families cannot provide all of the eldercare needed.  Some individuals have purchased long-term care insurance and are able to make a claim to have some or all of their long-term care needs covered, while others rely on their income and assets or other private financial tools.

Medicaid does have programs which cover long-term healthcare needs.  The biggest of these programs and common to all states (though rules and qualifications vary) is the nursing home program (also known in Florida Medicaid as the Institutional Care Program).  States also have various waiver programs that have been developed to find creative solutions to long-term care needs outside of nursing homes.  Some of these in Florida Medicaid include the Nursing Home Diversion program and PACE.  The various waiver programs may assist in paying for assisted living, home care and other supportive services for seniors or disabled adults.  All of these Florida Medicaid programs for long-term care have both financial and health status/care need qualifications.

Veterans also have some benefits available to them related to healthcare and long-term care.  Some of these include Veteran’s pension programs like Aid and Attendance which can assist in paying Assisted Living costs.  The Pinellas County Veterans Service office is a great resource on these programs and offers an overview on their website.

2.  How do I qualify for Medicaid or other assistance programs if I cannot afford my long-term care?

We feel it is critical to review the financial picture related to long-term care sooner than later (in other words, don’t wait until you feel you cannot afford the costs or are in a crisis, but look at finances as part of overall care planning).  Understanding a little more about costs and options can help guide decisions and allow you to more wisely use resources, no matter what your personal finances.  This is one of the reasons we highly recommend a care consultation or geriatric care management assessment early in the long-term care or eldercare process.

Because there are various programs, as well as different ways to structure an eldercare plan, knowing your options can really help you budget and make the best use of your resources.

Just to give you a snapshot of Florida Nursing Home Medicaid qualification in 2013, an individual’s gross monthly income cannot exceed $2130 and cannot have “countable assets” above $2,000.  However, there are numerous assets which are exempt or non-countable, and there are also various provisions for a well-spouse and a mechanism for dealing with income over the $2130 called a qualified income trust.

Because of the complexities, we emphasize the value of getting professional advice on these issues.  A qualified elder law attorney who specializes in Florida Medicaid keeps up with the law changes, qualification process and tools.  Getting proper professional advice can give your family a much better road map to navigate through long-term care.  Be aware that many well-meaning friends and community members may give you advice or tell you what they learned when helping someone, but it is no substitute for personalized, professional advice.

Get the right start: find out more about getting a care consultation with one of our geriatric and disability care managers to learn more about Florida Medicaid and Medicare, eldercare options, community resources and qualified professionals who can help you.

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