Aging Wisely’s team of patient advocates brings you the latest news and information relevant to caregiving, healthcare and disability care. Our weekly blog posts are designed to inform and answer some of the most frequently asked questions we get from families. We also send out a monthly “Wise Words” newsletter, and if you’d like to receive it you can contact us online with a request.

As we wrap up 2013, we thought we would share some of the top news stories we reviewed this year and their implications for you.

Healthcare Reform and Obamacare

Obamacare was one of the stories that clearly got a lot of press in every type of media outlet. A lot of the current/coming changes related to Obamacare are not directly related to most seniors, however. All the press about the changes did have one negative effect on some seniors, however, in that scammers used it to their advantage. They preyed on the confusion over Obamacare in order to obtain personal information or extract unnecessary fees from elders.

Seniors who are covered under Medicare are not affected by Obamacare mandate. There were various changes made to the Medicare program with the health reforms, such as the gradual closing of the Part D doughnut hole and expanding preventative care benefits. Medicare recipients do not have to choose new healthcare plans under the exchanges, as they will continue to be covered by Medicare. As usual, Medicare recipients have annual opportunities to make changes to plans and there likely will be some changes to the Medicare Advantage landscape as incentives/pay structure changes. To read more on this subject, check out “What to Expect from Medicare in 2014” and “The Aging Wisely Medicare 2014 Fact Sheet“.

On the other hand, Aging Wisely’s patient advocates work with many disabled, chronically or critically ill clients who are not currently covered under Medicare. Some of the Obamacare changes offer new options for these clients. You can get an overview of the changing healthcare landscape here and contact us if you need help navigating these issues.

Assisted Living Exposé Reveals Problems in the Senior Living Industry

PBS Frontline did a piece entitled “Life and Death in Assisted Living” which exposed information behind several lawsuits against Emeritus Senior Living. The piece examined the larger picture of regulation and consumer protections in this massive industry. As we know as advocates, there is good and bad care in any setting. These types of issues have been uncovered in hospitals, nursing homes, in-home care and all types of institutional care over the years. Much of the financial abuse and neglect that elders face is actually perpetrated by family members, but this special did uncover some issues within this industry that should not be ignored. Assisted living was virtually non-existent 30 years ago so this is still a relatively new industry adapting to a drastically changing clientele. The population in most assisted living facilities is now much older and sicker than originally envisioned.

In our article on this topic, we focused on what we think is most important to families about this story. Rather than simply instilling fear, we hope to provide concrete ideas of how you can better evaluate care options and advocate for your loved ones. As long time elder advocates, we provide some of our key advice on finding quality assisted living care and ensuring quality eldercare after moving in to assisted living.

The World’s Aging Population

Florida has been a unique place for our Aging Wisely team to work. Our demographics in Florida have been “ahead of the curve” with a large elder population well ahead of the much discussed Baby Boom/Age Wave. Clearwater and St. Petersburg, Florida lead the statistics in terms of elder populations among similar cities of their sizes. We also have a large demographic of people who have retired to Florida from other locations, often with family members living elsewhere. These types of demographics are becoming more widespread as the Baby Boomer generation ages and society becomes ever more mobile. On a larger scale, this phenomenon is international in nature. While developing nations may still have lower life expectancies and higher birth rates, many nations are facing an aging population and drastically lower birth rates as people marry later and have fewer children.

In the European Union, for example, life expectancy (which rose by eight years between 1960 and 2006) could continue to increase by a further five years between 2006 and 2050 and would thus result in a larger proportion of people surviving to the ages of 80 and 90. The average number of children per women stands at 1.5 whereas the replacement level is 2.1. Immigration is offsetting these lowered population numbers in many countries. Therefore we are looking at very different dynamics in terms of issues like pensions, the makeup of the working population and family caregiving.

Japan has the world’s highest percentage of population over age 65 and this occurred in the shortest time span (again related to both higher life expectancy and lower birth rates). China is a different case, where declining birth rates have been, at least in large part, caused by government policy (the “one child policy”). Of course, rapid economic/lifestyle improvements have impacted the other side of the equation, with greatly extended life expectancy. This has led to what is known as 4-2-1 conundrum, in which each (only) child has four grandparents and two parents to care for. Filial piety is a traditional value and many families live in multi-generational households, but migration and the one-child policy have put strains on this system of family care. China has been dealing with this in various ways, from a policy in which parents can sue children for not visiting to small subsidies for elders whose only child died or is disabled. Institutional and private care options are also beginning to develop, with home care companies providing in-home support, the first private assisted living facilities opening, and Buddhist temple-based nursing homes. There is also an interesting eldercare volunteer program being tested.

With globalization and shared information, nations should be able to learn from each other and determine the best options to care for their older citizens. The U.N. began looking at these issues in 1982. In 2002 the Second World Assembly on Ageing in Madrid led to the plan of action on ageing which “called for changes in attitudes, policies and practices at all levels to fulfill the enormous potential of ageing in the twenty-first century.  Its specific recommendations for action give priority to older persons and development, advancing health and well-being into old age, and ensuring enabling and supportive environments.”

We want to extend our wishes for a happy, healthy 2014 to all our clients and friends! We hope that 2014 will be a year of good news and progress toward active aging and improved quality of life for all. We encourage you to check back with us for the latest news and information and contact us any time we can help!

You can reach our advocacy team via online contact or by calling 727-447-5845. We’re here to help with your Florida elder and disability care questions, patient advocacy issues, Medicare and much more!

The holidays are typically a time for gathering with family and friends and celebrating traditions. However, for some, especially older adults, the holidays can be a challenging time. Disability or illness may limit participation in holiday events and elders may be grieving multiple losses. Here are some key facts about elders and depression:

• Depression is not a normal part of aging. Though feeling sad from time to time is normal at any age, a clinically depressed person suffers from symptoms than interfere with daily functioning.
• Depression sometimes manifests differently in older adults, with symptoms like fatigue and memory loss/trouble concentrating. Please review our article on Depression in the Elderly for signs, symptoms and risk factors.
• About 2 million older adults suffer from major depression, with another five million suffering from less severe forms of illness. Those most prone to depression are individuals with a family history and inadequate social support. Failing health and substance abuse issues are also significant risk factors.

Here are some general tips on helping seniors, to reduce the risk of isolation and depression. The Geriatric Mental Health Foundation also offers information on depression in elders during the holidays, along with the type of help available and how to talk to someone about your concerns. During the holidays, some of the things you might specifically consider to help elders:

• Make special plans to ensure your elder loved ones or friends are included in holiday celebrations. You may need to bring the celebration to them (or provide transportation), or consider modifying the time or length of the event. Or, perhaps the elder needs assistance from a senior companion/senior concierge service.
• Call and check in regularly.
• Recognize losses. Express condolences for loved ones who have died and take a few moments to reminisce about the person. Practice good listening (during the holidays when you feel hurried, consider setting aside some time to spend with the person when you will not be rushed).
• Give the gift of your time. Plan a special luncheon or just a simple visit over coffee. Take some cookies or a treat to your elderly neighbor. Find out if you can help/visit seniors in a local assisted living or nursing home (and consider doing this throughout the year, not just at holidays).

We’d like to tell you about one special program that is near and dear to our hearts. The Elves for Elders program is a community effort to connect gift givers (elves) to less fortunate seniors (elders). The goal is to provide gifts for seniors who might otherwise be forgotten during the holidays. As explained on the Area Agency on Aging Pasco Pinellas website, “This year (2013) will be the seventh year the Better Living for Seniors (BLS) Resource committee, under the auspices of the Area Agency on Aging of Pasco-Pinellas, Inc. will provide Elves for Elders in Pinellas County. More than 500 seniors receive gifts such as robes, lap blankets, stuffed animals, snacks, clothing, toiletries, and room decorations.” Since the early days of this program, the Aging Wisely team has been actively participating. We have also donated gifts to elders in Hillsborough County, through a similar program there.

Last year, our team facilitated gifts for over 50 elders in the Elves for Elders program. This year we have again been active in the planning and organizing and our office is serving as the north county collection site for gifts. We all enjoy this opportunity to add some holiday cheer to the lives of elders in Pinellas County!

You can read more about the Elves for Elders program here or contact our Senior Care Consultant, Sue Talbott, for more information.

If you know an elder who needs help this holiday season (or any time), let our eldercare experts help. Contact Sue Talbott at 727-447-5845 for a free needs analysis and resources. Our EasyLiving home caregivers offer a wide range of in-home services, senior transportation and concierge services to help elders continue to live a quality life.

Our goal is to enable every individual we work with to live the most fulfilling life possible, with utmost dignity, focusing on their physical, mental, spiritual, family and financial wellbeing.

You realize Mom needs some help at home or you are planning for the recovery period after an upcoming surgery. You know you need help that can come to the home…but beyond that it all seems quite confusing. What qualifications should you be looking for? Where do you find someone? How do you know about the quality of the home caregiver or home health agency? Will your Medicare or health insurance cover the costs (and that are the average costs)? We’ll help clear up the confusion to these and other questions, with this straightforward guide to home health care and in-home eldercare.

First of all…understanding what you need…

The first step in hiring in-home care is understanding the type of assistance you will need. A geriatric care management assessment is a great first step, because a professional can help you identify all the possible needs as well as anticipate things you may not have thought about. The care manager can also build a care plan for you, make recommendations and even carry out the process of getting the in-home caregivers in place and monitoring ongoing care.

In examining home care needs, think about the kind of tasks needed and particularly whether you need all household “hands off” help (in other words, only someone to assist with cooking, light housekeeping, and errands but no physical assistance) or whether you may need help, for example, getting in and out of bed or completing hygiene tasks. As a care manager will often suggest, it is better to err on the side of caution. If you are having surgery, you may think you’ll be able to handle all our own physical needs but you may find yourself in a weakened state or drowsy from medications. In Florida, a companion is only allowed to do household tasks and therefore could not help you if you found yourself needing assistance to get up from a chair or needing help in the bathroom.

There are certain medical tasks which require a nurse (R.N. or LPN) such as giving treatments/injections and changing surgical dressings. Usually these are intermittent tasks which can be handled by a visiting nurse and may be covered by your insurance/Medicare for short-term needs. Medication management also requires a nurse’s oversight and this help is often available through home care agencies on a set basis for long-term needs.

Now…where do I go to get help?

Many elders and families think about hiring someone themselves by putting an ad in the paper or asking friends for references. This is one option, but comes with a lot of extra work and liability for your family. You are solely responsible for the hiring, training and supervising as the employer. You also need to handle any tax and employment responsibilities. Additionally, you should consider the coverage (or lack thereof) should the employee have an accident, get sick or some other liability issue arise. You should also make a backup plan.

If you do not wish to serve as the employer and take on all these responsibilities, you can hire in-home care through an agency. In Florida, home health agencies and other medical/eldercare providers are regulated by the state. There are three basic types of companies providing in-home care to seniors and others: a fully-licensed home health agency (with medical and non-medical agencies in this category), homemaker companion services and nurse registries. You can read more about these categories of Florida Home Care on our EasyLiving home care website.

There are many benefits to hiring a licensed agency, including liability protection and assistance with all aspects of the process. The agency takes on the hiring, screening, training, supervising and can assist you with troubleshooting any concerns. A quality home health agency like our EasyLiving Home Care agency will take extra steps to ensure their caregivers are prepared for their work and continually improving. You can review state inspection reports online for most states, but you should also have a list of questions prepared to understand how the agency operates and handles quality improvement. Getting a referral from a trusted source may be your best bet for beginning this process.

What about costs and insurance coverage?

Medicare (other insurers tend to follow suit with similar rules) covers certain in-home care under limited circumstances. Most likely, the type of in-home care you are primarily seeking is what is sometimes termed “private duty home care”. Long-term care or even day-to-day care that is temporary (i.e. help during the recovery period) is usually not covered under Medicare or other medical insurance. However, long-term care insurance will often cover ongoing in-home care.

We outlined the requirements for Medicare to cover home health care in our blog post, “Paying for Home Care: What Home Health Services Does Medicare Cover?“. In order to receive Medicare home care, your doctor will need to write an order (additional visit requirements were added in recent years). Doctors often prescribe this type of care after surgery, hospitalization or a major change in functioning. Skilled home health care often includes therapy services, to increase strength or resolve specific issues. Many clients also have “private duty” services while receiving skilled care as the skilled care is only intermittent and does not fulfill many of the day-to-day/safety needs clients have in the home.

If you have a long-term care policy, your Aging Wisely care manager or EasyLiving home care representative can work with you to navigate the claims process and help get the insurance company the information needed. Most long-term care policies do cover in-home care if you meet the assessment requirements (demonstrating you need help in certain areas) after any elimination period (kind of like a deductible…you pay for so many days of care before the policy kicks in).

For those who do not have long-term care insurance and need private duty home care services, costs vary by geographic region of the country. In Tampa Bay, Florida home health agency care averages about $17-23/hour. The costs depend on whether the caregiver is a home health aide (i.e. is trained to provide hands-on care) and the amount of care needed (costs may be higher for very short periods of care, such as having a home health aide visit for 1-2 hours to help with bathing versus 6 hours in a day).

When it comes to costs, work closely with your provider or care manager on the most efficient care plan. Again, this circles back to what type of care you need. Your care plan can be built around: what times of day you have difficulties, what duties you need help with, your typical schedule and preferences. Your care plan should then be coordinated with any other care being provided (such as skilled home health care and assistance from family and friends). Because home care is usually a per hour charge, there is a great deal of flexibility to create an individualized care plan and budget.

Have questions about in-home care? Our Senior Care Consultant, Sue Talbott, can offer sage advice and will even come out to your home to complete a needs analysis for you. Call Sue at 727-447-5845 for help with in-home eldercare, Medicare and insurance issues, geriatric assessments and much more!

Sally Abrahms at AARP is one of our favorite bloggers. She covers eldercare issues on her blog, often highlighting interesting programs and news related to aging and caregiving. Sally recently shared a post about a new study on end of life issues. Some of the big findings of this end-of-life views survey include:

• 66 percent of respondents think a patient should be allowed to stop treatment and die under some circumstances.
• 31 percent disagree, saying health professionals should do everything possible to save a patient’s life.
• The “do everything” group has increased 9 percent since 2005 and 16 percent since 1990.

The group was fairly evenly divided on physician assisted suicide, with 47 percent in favor and 49 percent disapproving of laws to allow a doctor to prescribe lethal drugs to a terminally ill patient. The survey goes in to a lot of depth on various related topics, and shows the wider divides on these issues when respondents are broken down by ethnicity and religion.

Respondents also have different opinions when looking at what they would want personally, with preferences varying by hypothetical circumstances. The study shows for example, “57% say they would tell their doctors to stop treatment if they had a disease with no hope of improvement and were suffering a great deal of pain. And about half (52%) say they would ask their doctors to stop treatment if they had an incurable disease and were totally dependent on someone else for their care. But about a third of adults (35%) say they would tell their doctors to do everything possible to keep them alive – even in dire circumstances, such as having a disease with no hope of improvement and experiencing a great deal of pain.” The latter percentage has gone up, partly because more people elected to express an opinion on the issue (versus being undecided). At the same time, there’s a growing percentage that say people have a moral right to suicide (particularly when in a great deal of pain with no hope of improvement).

Obviously, these issues are very personal and potentially polarizing. A person’s background can have a big effect on his/her views on this issue, but the decisions are also greatly dependent on the circumstances. Perhaps the uptick in responses also shows that more people have thought about these issues and formed an opinion than in the past. This may be due to increased discussions, awareness and exposure (particularly as more people serve as caregivers, they see these issues played out with loved ones and may have the opportunity to form more crystallized views).

As Florida patient advocates, our team works with many clients facing chronic and terminal illnesses. Many of our clients come to us toward the end of their lives, while we work with others over a number of years throughout different stages of care and illness. This survey further brings to light some important points about end-of-life care and decisions. From this information and our patient advocacy experience, here are some take-away lessons on end of life care:

• These decisions are very personal and often situation-dependent. Therefore, it is important to have continuous conversations about care issues as circumstances change. A patient advocate can help facilitate the conversation and get critical information from providers so that patients and families can make the most informed decision.
• Advanced care planning and end-of-life care decisions are not a “once and done” issue. Completing and advance directive form, appointing a healthcare surrogate or saying you do/do not want certain measures in your living will are all only a small part of this process. Those who have cared for loved ones with chronic illness or served as patient advocates know this well. Multiple trips to the emergency room for small injuries or repeated pneumonia may lead to a discussion about continued treatment versus treating these issues as well as possible at home (or at the ALF or nursing home). When a different illness or injury comes up, this may lead to a different decision. When it comes to technologies, there may be times in a pattern of illness when a surgery or technology makes sense, weather for potential to extend life or for comfort, while at other times the same decision may not seem advisable. Treatment itself may change the process…such as for the cancer patient whose body is depleted by chemotherapy and thus not able to withstand the latest trial or the person who received radiation and is therefore not a good candidate for surgery to that area.
• Understanding the circumstances, in quality of life terms, is the most important information for the patient and family to have. Patients need to understand prognosis…both likelihood of survival as well as what that survival will look like. What side effects are to be expected? What probable complications and long-term changes will occur? What help will the person likely need after treatment? There are often many variables to weigh. A professional patient advocate can often help you get these answers and break it down in to understandable terms (as well as review them with you as often as needed). A doctor’s office or hospital room with attending medical professionals is often the start of this conversation but should not be the end. The patient and family need time, when feasible, to make these tough decisions.
• Practitioners need to take time to understand the patient/family perspective. This means having cultural awareness of different religious beliefs and cultural taboos which may be influencing both the conversation and the decisions. Fortunately, as patient advocates with social work training and a holistic viewpoint, this is an area where the Aging Wisely team shines. We understand the importance of assessment, both as a document and a process that continues. We know that it is important not only to know what diagnoses a person has, but their beliefs, their family situation, their mental health and emotional issues…and much more.

End-of-life decisions are part of a wider spectrum of care decisions that many patients and their caregivers will have to make. The conversations around these decisions are vital and good support from a professional patient advocate can facilitate the process. If your family needs help with patient advocacy…from advance care planning to navigating treatment and setting up a care plan through end of life/palliative care…give Aging Wisely’s award-winning patient advocates a call at 727-447-5845.

*Image courtesy of Vichaya Kiatying-Angsulee/ FreeDigitalPhotos.net