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A Tribute to our Elder Veterans (Plus Veterans Benefits Information)


Check out this history of Veterans Day to learn more about the holiday:

We wish to extend a tribute and huge thank you to all our veterans! At Aging Wisely, we are fortunate to work with many elder Vets and learn about some of their heroic stories. These veterans typically do not think of themselves ar heroes, but feel their actions were simply the necessary thing to do. Most times, we only learn about these veterans’ stories through their family members or after drawing them out after many hours spent together.

As Tom Brokaw stated, “The World War II generation did what was expected of them. But they never talked about it. It was part of the Code. There’s no more telling metaphor than a guy in a football game who does what’s expected of him-makes an open-field tackle-then gets up and dances around. When Jerry Kramer threw the block that won the Ice Bowl in ’67, he just got up and walked off the field.”

In addition to these World War II vets, we are now working with veterans of the Korean conflict, Vietnam era and the more recent Gulf wars. Florida is one of the states with the largest number of veterans, approximately 1.7 million. There are more than 9 million veterans in the U.S. over age 65. Many of these veterans now need assistance due to aging and disease, plus the number of service-connected disabilities amongst veterans has increased as well as expenditures for healthcare and disability compensation.

The Veteran’s Administration (VA) offers help for veterans in various forms, from disability compensation to employment programs and healthcare. The eligibility rules and process can be overwhelming for veterans to navigate and many times older veterans who have not used services are not aware of some of the help available. For a quick overview of some of these benefits, especially as they apply to elderly veterans, check out our article on senior care for veterans.

When we do a geriatric assessment, we review demographic and background information which helps us identify potential benefits and programs for which our clients may be eligible, such as veterans benefits. We work with our clients/families to make recommendations and provide guidance through an array of assistance.

One great resource for veterans in Florida are the counties’ Veterans Services offices. For example, you can find the Pinellas County Veterans Service Office website here for more information. Their services are free of charge and they assist with understanding programs, presenting and filing claims and appealing denied claims. Their site offers an overview of programs available and the information for making an appointment at one of the local offices. We highly recommend to all of our clients that they use the services of the county veterans’ service office to navigate the benefits’ claims process.

Solutions When You Need Them….for Florida Veterans and their families

Know an older Florida veteran needing help? Give our Senior Care Consultant a call at 727-447-5845. We can help with veterans’ home care, navigating veterans benefits, identifying various programs and services to help and manage healthcare needs…plus much more.

Our thanks to all our veterans for your service to this country!

“We owe our World War II veterans–and all our veterans–a debt we can never fully repay.”–Doc Hastings

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Medicare Advice and Analysis: The 2014 Medicare Costs


The 2014 Medicare numbers have been released. This includes the new costs you can expect for Medicare’s premiums, copays and deductibles. The numbers have not changed drastically for 2014. Some costs have stayed the same, some had small increases and the Part A premium (for those who pay it) will actually decrease. Here’s a quick summary of the how the Medicare costs for 2013 and 2014 compare:

Part A (hospital insurance) premium

Most people do not pay a premium. If you do not have sufficient work quarters, you will pay up to $426/month to buy in to Medicare A (down from $441 this year).

Part A deductibles/co-insurance for inpatient hospital stays

$1216 deductible for each benefit period (up from $1,184 in 2013)

Co-insurance of $0 days 1-60 in hospital

Co-insurance of $304/day for days 61-90 (up from $296 in 2013)

Co-insurance of $608/day for each “lifetime reserve day” after day 90 for each benefit period (up to 60 days over your lifetime, beyond reserves you pay all costs) (up from $592 in 2013)

Part A skilled nursing facility (SNF) co-pays

$0 for days 1-20

$152 for days 21-100 (up from $148 in 2013)

*Skilled nursing facility coverage is based on meeting criteria (medical necessity for skilled inpatient rehabilitation/care and services are reasonable and necessary for your condition/prognosis). You do not automatically get a full 100 days and for many conditions, less time is very likely. The SNF coverage is also dependent upon a qualifying 3-day hospital stay for the related condition. To learn more about this and when a hospital stay qualifies (i.e. is “inpatient” versus “observation”) read our article Important Information on Hospital Coverage for Medicare Recipients.

Part B (medical insurance) premium

$104.90/month for beneficiaries in the standard income category (making less than $85,000 or less as an individual) (unchanged from 2013)

Higher income individuals pay higher amounts, up to $335.70

Part B deductible

$147/year (unchanged from 2013)

Part D (prescription drugs)

Your premium is based on the plan you choose. You will also pay an extra adjustment each month if your income is greater than $85,000/year (for an individual, $170,000 for joint filers).

For an overview of all the costs plus a more detailed summary of Medicare’s parts, enrollment periods and more, check out Aging Wisely’s 2014 Medicare fact sheet. If you would like copies of this resource for your clients or community group, please contact Aging Wisely at 727-447-5845.

Aging Wisely’s patient advocates provide advice on Florida Medicare and Medicaid, a complete analysis of Medicare options for each individual and help with any insurance coverage issues. Until December 7th, Medicare recipients have the opportunity to switch plans for 2014 (Medicare D plans or switch to/from a Medicare Advantage plan). This is a critical time to evaluate if you are in the right plan, to potentially save costs for 2014. Give our Senior Care Consultant, Sue Talbott, a call at 727-447-5845 to discuss how we can help with Florida Medicare and other insurance and benefits issues! Read the rest of this entry »

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Twelve Lessons from Our Elders


In working with older clients, we are fortunate to get to know many interesting, wonderful people. We also learn a lot by working with them, talking to them and being part of their lives. Because we often work with clients and their families over an extended period of time during major life changes and some emotional circumstances, we often see their wisdom in practice. Here are just a few of the many life lessons our clients have demonstrated to us.

1. Wisdom doesn’t automatically come with age. Age gives you the chance to learn, develop and grow as a person…but not everyone does so.

2. Quality of life is very subjective and the concept of it changes. What you think might not be a good quality of life now as a healthy person might change as you age or live with disease. As humans, we adapt remarkably well to all kinds of circumstances and many people surprise others and themselves with their tenacity.

3. Laughter really can be the best medicine, especially in the toughest circumstances.

4. You always have something of value to give to someone else. Many times it is just a kind word, a bit of help or a listening ear…

5. Listen more than you talk.

6. No one has the perfect family or relationship. We are all different and we all have “issues”. But, if you are lucky enough to have a supportive family/partner, work hard to foster good relationships and appreciate how precious this is.

8. Illness or disability shouldn’t define you.

9. Everyone has a story. You can learn a lot (or just have a lot of fun) by stopping to listen to it.

10. If you are in a “caring profession” or service job, you have the ability to make things much better (or worse) for someone every day. If you are burnt out, take a break.

11. Don’t be judgmental. You don’t always know the story behind what is going on and you also don’t know what path your own life might take.

12. You can’t plan for everything, but you’ll be able to deal with the unexpected a lot better if you do some planning. This particularly applies to things like advance care planning, estate planning and general financial/life organization. It also helps those you love deal with the unexpected better.

For more on this topic, check out The Legacy Project: “The Legacy Project has systematically collected practical advice from over 1500 older Americans who have lived through extraordinary experiences and historical events. They offer tips on surviving and thriving despite the challenges we all encounter”. You can watch videos from a number of the elders on YouTube, such as this one on the importance of listening:

What lessons have your elders taught you? What wisdom would you share with someone younger?

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Medicare FAQs for Florida Seniors


That time of year is here…Medicare’s annual open enrollment. So, we thought we would answer some common Medicare questions we receive from Florida seniors and their caregivers. You might also want to check out our previous article on What to Expect from Medicare in 2014.

Do I need to switch Medicare D plans during open enrollment? What if I am happy with my plan? No, you do not necessarily need to switch Medicare plans during open enrollment but we highly recommend everyone do a review to make sure there aren’t better options. Your plan may be changing or even going away in 2014. And, each year new plans come on the market and pricing changes. If you’ve had any health changes, a review is especially necessary. Various studies continue to show that many people are in the wrong (read: more expensive) plan. We have found over the years that a lot of people see a plan advertised or hear about a plan and go with it. And, many people don’t take advantage of the annual enrollment period because they don’t have any major concerns with their current plan and don’t feel like going through the hassle of comparing. Those are legitimate thoughts, but it may truly be worth your while to compare (or get help from someone).

What if I have a major change during the year when it’s not open enrollment time? For a lot of changes such as a new diagnosis or medication, there isn’t anything you can do but bear with your current plan’s coverage until the next open enrollment period (this is the good thing about having a yearly opportunity to change and lots of options). However, if you find that a drug is not covered or your costs are very high due to some health change, you may be able to work with your medical team and advocates on some temporary solutions. Can you doctor prescribe an alternative medicine? Can you request a plan exception due to medical necessity? Will the drug company offer special financial help if it’s not covered? Additionally, there are some changes which place you in to a SEP (Special Enrollment Period) for Medicare such as moving into/out of or residing in a nursing home, moving to an area that your plan does not cover, or changing employer coverage or losing creditable coverage. There are many of these SEPs, each with specific rules and timeframes. Seek help from a Medicare Advocate, like our Aging Wisely staff.

What if all these costs are too much for me and I’m struggling financially? There are a lot of options for special help. It is important to find out if you are eligible for assistance such as Medicaid or VA benefits. There are also Medicare savings programs for eligible seniors…these offer benefits like help covering premiums. These are generally accessed through the Florida Medicaid office. Pull together your financial information/records to seek out eligibility for these programs. You will have to provide information on income and assets (bank accounts, investments, etc.).

How do Medicare Advantage plans work? Medicare Advantage plans combine various aspects (parts) of Medicare in to one private plan. These can be HMOs, PPOs or fee-for-service style plans. The companies are paid a yearly amount for each enrollee and they provide/manage the various benefits for you. This can be a more simplified and cost-effective way to receive Medicare benefits, but can also have disadvantages. Most plans have a network of providers (or doctors may choose not to accept them even if there is no formal network). For some a Medicare Advantage Plan makes sense when relatively healthy, but may limit choice if medical needs are more substantial. Medicare Advantage Plans are also sometimes called “Part C”, which is a bit confusing because they are not really another “part” of Medicare such as Part A, B and D…but a different way for receiving the usual Medicare benefits via a private company.

For answers to all your Florida Medicare questions, contact Aging Wisely at 727-447-5845. Our expert care managers can provide a full Medicare analysis package for future/current retirees or help you with your specific Medicare advocacy issue. We also assist with benefits and resource access, covering programs ranging from Medicaid and VA benefits to state and community-based programs of all types.

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Planning Considerations for LGBT Elders


Eldecare planning for LGBT eldersAs we discussed in our previous blog post, “Focus on LGBT Elders“, LGBT seniors face the same aging issues as all seniors but with some added challenges. This makes planning issues both more complex and especially important to address correctly. In addition, laws, program eligibility and other factors are in a state of flux (with some major changes still forming after this year’s Supreme Court decision on DOMA). Here, we will address some key considerations and tips for eldercare planning to help you age wisely.

1. For same-sex couples, the variation between state laws with regards to marriage can have major impacts. People may not initially think about how this impacts retirees/elders, but the differences can be significant in regards to retirement benefits and various forms of eligibility. The good news is that the treasury and IRS announced this year that all legal same-sex marriages will be recognized for federal tax purposes regardless of the state in which the couple now resides (did not apply to civil unions/domestic partnerships). This means that employer plans (spousal benefits, healthcare plans, etc.) covered under ERISA will have to recognize those marriages under the terms of their benefits. However, there are a lot of complexities with these rulings, including the fact that governmental and church plans do not fall under ERISA. We would suggest planning regular appointments to review financial, estate and tax issues since these laws and rulings are developing.

2. It is essential to get good advice on estate planning. We strongly encourage everyone to complete key legal documents related to estate planning, with the help of an experienced attorney. Because inheritance laws are typically based on “traditional” family structures, you need to ensure you have the proper documentation to reflect your preferences/plans. Meet with an experienced attorney for advice on estate planning and estate tax issues.

3. Do advance care planning. You should complete essential healthcare planning documents including a living will and power of attorney for healthcare/designation of healthcare surrogate. A durable power of attorney (for financial and other decision-making) is also an essential part of eldercare planning. In addition, talk to medical providers about completing paperwork for designating persons you would like to have access to your healthcare information (HIPPA forms). The healthcare surrogate document is typically triggered by incapacity but many people have a partner/friend assist with managing healthcare prior to being incapacitated. Having current documents in place can help clarify things for healthcare providers, and the process of completing these documents is also a good time to talk with your designated decision maker(s) about your beliefs and preferences. Some of the backup systems/laws in place governing healthcare access (such as Florida’s proxy statute) are set up based on nuclear family preference, causing potential barriers for LGBT persons and their caregivers who have not made legal provisions.

*We can refer you to elder law and estate planning attorneys in the Tampa Bay area with the knowledge and experience to help you.

4. Look at your long-term care options. Consider long-term care insurance and if you are in a same-sex partnership, find out how the insurance provider treats coverage for couples in your situation. Look at your financial preparation for long-term care needs and learn a bit about the options for getting care and related costs/programs to help. Understand program eligibility rules and how programs treat same-sex partnerships in these rules. Consider an eldercare consultation with a professional geriatric care manager, particularly if you or your loved one has a chronic or progressive diagnosis.

Our Aging Wisely eldercare planning advice is smart planning for anyone to consider in the realm of retirement and later life planning. However, due to some of the additional complexities for LGBT elders, these planning issues take on special significance. Additionally, we highly emphasize having expert input and reviewing these issue regularly. The Supreme Court DOMA decision this year and the recent rulings by the IRS and Department of Treasury are two major examples of how things are evolving. 

Contact Aging Wisely’s Senior Care Consultant at 727-447-5845 for help with your questions or concerns. For more about how we can help, our mission and resources, click the link below for our October Monthly Mission flier:

Aging Wisely, your advocacy partner, with information, resources and assistance

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Focus on LGBT Elders


LGBT senior couple stockfresh

Recent estimates suggest that there are at least 1.5 million lesbian, gay and bisexual people 65 and older in the U.S., and this population will double by the year 2030 (SAGE). While confronted with the same challenges that all elders face related to aging, LGBT elders also face unique barriers and inequalities which can impact successful aging. Some of the primary issues that national advocacy organizations and studies have identified include:

Issues of economic security:  For LGBT older adults, a lifetime of employment discrimination and other factors contributes to disproportionately high poverty rates. Major laws and social safety net programs fail to protect LGBT elders equally to their heterosexual peers, particularly in benefits access for same-sex couples.

Health disparitiesLGBT older adults experience health disparities across four general areas: access to health care, HIV/AIDS, mental health, and chronic physical conditions. Health insurance coverage and financial issues may affect proper access to preventative care and ongoing health maintenance.

Social isolation and discriminationLGBT older people are twice as likely to live alone, twice as likely to be single, and 3-4 times less likely to have children—and quite a number are estranged from members of their biological families. Living alone is one risk factor in isolation/depression and LGBT older people may also face isolation related to discrimination.

Discrimination and unmet needs within aging services: Many mainstream aging services do not account for special needs of diverse clients. Elders may also face discrimination from both service providers and other participants (i.e. residents in care facilities). For example, one study of LGBT seniors in long-term care facilities found that only 22% of respondents felt they could be open about their LGBT identities with facility staff, 89% predicted that staff would discriminate based on their sexual orientations and/or gender identities, and 43% reported instances of mistreatment. Additionally, many systematic issues in aging and healthcare programs as well as legal issues create special barriers to LGBT elders (ranging from Social Security and retirement benefits to Medicare/health insurance and all types of eligibility based on state marriage laws).

There are a number of issues we need to address societally and more specifically within aging services to better serve this growing population. It is vital that all seniors have resources they can trust to treat them with dignity and respect, to help them manage the challenges of aging. 

Our next blog post will delve more specifically into eldercare planning issues and tips for LGBT elders and caregivers. Good planning and working with sensitive, experienced providers is essential. All elders need to get expert advice, but this is particularly important for LGBT elders in light of some of the key issues raised above and different legal and systematic challenges. If you need help with planning, assessments, advice or resources, give us a call today at 727-447-5845.

Aging Wisely:

Our ethics: Our professional geriatric care managers treat clients with respect, as complete individuals with their own history, narrative and unique cultural identity.

Our mission is to enable every individual we work with to live the most fulfilling life possible, focusing on their physical, mental, spiritual, family and financial well-being.


SAGE (Services and Advocacy for Gay, Lesbian, Bisexual and Transgender Elders)

National Resource Center on LGBT Aging

Improving the Lives of LGBT Older Adults report

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What to Expect from Medicare in 2014: Medicare Advice/Analysis


Medicare Advice for 2014

There are big changes coming to healthcare in 2014 related to the Affordable Care Act (“Obamacare”) but less dramatic changes for Medicare recipients. The new state healthcare exchanges will have open enrollment from October 1, 2013 to March 31, 2014 but the Medicare open enrollment periods remain the same as last year (the health exchanges do not apply to Medicare recipients). Here we will outline some of the key information for Medicare in 2014–important dates and the changes you can expect if you are a Medicare recipient. Aging Wisely offers Florida Medicare advice/analysis, as well as help navigating other health insurance and benefits programs like Florida Medicaid and V.A. benefits. Contact us at 727-447-5845 for more information.

The standard open enrollment period for Medicare 2014 is from October 15, 2013 through December 7, 2013. This is the once yearly opportunity to review plans and make changes, such as switching Medicare D drug plans, enrolling in a Medicare Advantage plan or disenrolling from Medicare Advantage and enrolling in a stand-alone Part D plan along with returning to “regular” Medicare. Even if you are satisfied with your current plan, it makes sense to review your options to make sure there is not a more suitable plan for the coming year. Each year plans make changes and your medical situation may have changed as well. In 2012, a study indicated that some 90% of Floridians were in the wrong Florida Medicare plan, many of them paying more than necessary.

There is another annual period from January 1st to February 14th, which is specifically for disenrolling from Medicare Advantage and enrolling back in to regular Medicare and a new Part D plan. This is the only type of change that can be made during that period. There are also many special enrollment periods (SEPs), specific circumstances that may allow you to make changes. These include, for example, admission to or discharge from a nursing home. If you have problems with your Medicare plan or major changes, contact us for help navigating the options.

So what will change for Medicare recipients in 2014?

The “donut hole” (coverage gap in the Part D plans during which you must pay out-of-pocket for your drugs) continues to shrink as part of provisions made a few years back. In 2013 and 2014, you get a 52.5% discount on brand-name drugs in the donut hole; the subsidy for generic drugs in the donut hole rises from 21% to 28% in 2014.

Premiums for Part D plans are expected to remain similar in 2014, with a slight rise in the average cost from $30/month to $31. Other trends in the drug plans, such as increased copays, smaller pharmacy networks or changed drug tiers/coverage, may affect your out-of-pocket costs even if you stay in the same plan. Consider inputting your information in to Medicare’s Plan Compare Tool during the open enrollment period, or getting help from one of our Aging Wisely Patient Advocates in analyzing your best options.

Aging Wisely provides a concise “Medicare Fact Sheet” each year, which outlines the parts of Medicare and the corresponding costs for the year. You can download a copy of the 2013 Medicare Fact sheet here and keep an eye out for our 2014 information as soon as those numbers are released. Generally, there are small premium and deductible increases in each of the areas of Medicare yearly, but we do not expect anything dramatic for 2014.

Don’t forget Medicare now covers many preventative services (at 100%). For more information, check out Medicare’s Guide to Preventative Services.

Warning: Also, be aware that as Medicare plans start advertising, fraud issues are often on the rise as well. You may get false information or someone “phishing” for personal information. Do not give out personal or identifying information. Make sure you understand what you are doing before making changes and consider talking it through with a trusted family member or professional.

For new retirees trying to navigate all the Medicare and other health insurance options or current recipients trying to ensure the best coverage, we offer a Medicare Analysis Package as well as patient advocacy services to deal with specific issues. Contact Sue Talbott, Senior Care Consultant, at 727-447-5845 for questions or to schedule your appointment today!

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The Keys to Caring for Elderly Parents Long Distance


challenges of long distance caregiving

Many of the families we help at Aging Wisely are caring for elderly parents long distance. This adds a unique dimension to caregiving that can be particularly anxiety-provoking. Our website contains a number of articles about important caregiving issues and tips for long-distance caregivers. We offer many checklists and resources that can help caregivers in all types of situations, as well as one-on-one help from our care management team. Today we’ll focus on some of the most important keys for managing aging parents’ care from a distance.

As this U.S. News and World Report article reports, the approximately 14 million long-distance caregivers in the U.S. tend to feel greater anxiety, guilt and uncertainty. They often feel they don’t really know what is going on and may mistrust information given from local family or other sources. Long-distance caregivers face difficult choices in trying to decide when to visit, how to be involved and approach different concerns and how to deal with emergencies. Long-distance caregiving can often become quite costly, with last minute travel to help the caree and costs of support services.

How you will experience caring for elderly parents long distance depends a lot on your situation. Do you have other family members that are local? What type of support system do your aging parents have in the community? What resources do your aging parents have (or can access) to help? What is your lifestyle and career situation (i.e. how much time can you dedicate to caregiving tasks and how easy will it be for you to visit or get there in an emergency)?

Regardless of these specifics, though, there are certain keys to managing long distance caregiving which can help you be more prepared and reduce your anxiety. Take these key steps:

  1. Rally the troops/marshal your resources. Get to know your parents’ local support system and make some key contacts. Do a little homework on local resources and talk to some potential care providers, so you know where to turn as things change.
  2. Think safety first. Have a home safety assessment completed and get suggestions for making the environment more age-friendly. Falls are a major source of those emergency phone calls that long-distance caregivers receive. Preventative steps can reduce risk of falls and related injuries.*
  3. Open the lines of communication. This starts first between you and your aging parents, with opening the discussion about aging and eldercare issues and continuing to check in as things change. Do you have difficulty getting your aging parents to share information with you? Now’s the time to discuss it or bring in help from a geriatric care manager who can get the conversation started. If you have local loved ones, discuss how/when you are going to communicate. Think about tools that will make it easier, such as online care portals. As your parents allow, make contacts with key professionals such as doctors and advisors so they know you and can ascertain permission from your parents to share information with you.
  4. Create a “checking in” plan. Create a plan for calling and visiting regularly. Work together with other family members and local resources. Consider whether you need support like a home caregiver or geriatric care manager. A geriatric care manager can attend medical appointments and do periodic assessment visits, keeping you informed and keeping things on track. Then, you also have a resource to call upon to deal with crises. A home caregiver can not only be local “eyes and ears” for you but ensure better safety, good nutrition, and proper medication management, for example.

If you are caring for aging parents in Florida long distance, let us help you. Give us a call today to discuss options and ways to be more prepared. Our Senior Care Consultant will do a free needs analysis, in person or via phone, for you and your family. Give us a call at 727-447-5845! 

*September 22nd is National Fall Prevention Awareness Day. Aging Wisely is a proud founding member of the Pinellas County Falls Prevention Coalition (now the Fall Prevention Coalition of Pinellas Pasco). Our Senior Care Consultant, Sue Talbott, represents us on the coalition as we contribute to raising safety awareness for seniors in the local community. To learn more about Fall Prevention and the awareness day, you can visit NCOA’s site or like the Fall Prevention Coalition on Facebook.
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Florida Eldercare: The Costs of Long Term Care


the costs of florida eldercare long term care

Having an understanding of long term care costs is important for both the aging person who may need care now (or soon) and the Boomer adult who should be considering long-term care costs as part of retirement planning. Especially in light of the recent AARP study on the massive shortage of caregivers that will be available for the Boomer generation, we all need to be putting some consideration in to these issues.

Here are some quick statistics on nationwide average costs for long term care (from the 2012 MetLife market study of long term care):

  • The national average daily rate for a private room in a nursing home was $248, while a semi-private room was $222 up from $239 and $214 respectively in 2011.
  • The national average monthly base rate in an assisted living community rose from $3,477 in 2011 to $3,550 in 2012.
  • The national average daily rate for adult day services remained unchanged from 2011 at $70 in 2012.
  • The national average hourly rates for home health aides ($21) remained unchanged, while the homemaker hourly rate increased by 5.3% from $19 in 2011 to $20 in 2012. 
More specifically, the average costs of long term care in Florida are:
  • A private room in a nursing home in Florida averaged $259/day, while a semi-private room (far more common) averaged $230.
  • The assisted living base rate averaged $3234/month.
  • Adult day services averaged about $60/day throughout the state.
  • Home care costs in Florida: the rate for a home health aide averaged $18/hour and for a homemaker companion slightly less at $17 (a homemaker companion provides non-hands on help only, such as light housekeeping, meal preparation, transportation and companionship).
Florida is relatively affordable in the range of costs compared with nationwide averages, though by no means the cheapest state (and slightly above average in nursing home rates). As in most states, these costs also vary fairly significantly by area, with larger metropolitan areas like Miami tending to have higher costs. Additionally, there is wide variation from lowest to highest cost and all types of options for receiving care (from large rooms at “luxury” assisted living facilities to smaller “Mom and Pop” ALFs with options like shared rooms).
Here are some important considerations about long term care costs and Florida eldercare as you look beyond these averages:
  • Assisted living rates are given as base rates. ALF contracts and billing vary widely, with some using a “level of care” model in which they determine the additional cost based on an assessment that places you within a certain level based on your needs or a la carte pricing for specific care services. Some use a more all-inclusive pricing model or may even use a combination of approaches. 
  • Often care is closely tied in to other living expenses and comparing costs requires looking at a more comprehensive budget. For example, a person receiving care at home has normal housing and living expenses such as utilities, groceries, mortgage/rent and maintenance. In a nursing home, residents will generally not incur any of those costs unless they continue to maintain their original home. In an assisted living facility, a number of those items are rolled in to the rate, though there may be additional costs (such as paying for phone or cable or buying personal groceries or restaurant meals).
  • Related to the budgeting information above, long term care insurance will generally only pick up the costs of care. However, living expenses aren’t necessarily separated out in facility-based care (in other words, if you receive care at home, your LTC insurance will not cover utilities and home costs but a daily rate in a facility is more likely to include all of those costs).
  • What other expenses should you consider in overall costs? Do not forget, for example: medical costs/insurance, medications, travel expenses, quality of life items (newspaper subscriptions, snacks, getting your hair done, personal training services, extra companion/help), transportation costs.
  • Account for inflation. These are good estimates of today’s costs and you should expect prices to rise along with other living expenses.

A geriatric care manager can help you with understanding your potential long-term care costs, the options for eldercare and creating a projected budget. If you are a professional advisor, it may be worthwhile working in partnership with a care manager to help better prepare and advise your clients. A care manager can give you real insight about true costs so that you can really be as prepared as possible.

At the time of need, a care manager will help you access the care you need (and get the best care possible), assist with advocacy and claims, help you prepare a care plan for your budget and help you with eligibility for benefits programs. A care manager can also help you understand contracts and payment options, as well as negotiate and determine the appropriate level of care.
If you have questions or would like to set up an appointment with one of our professional geriatric care managers, give us a call any time at 727-447-5845!
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Patient Advocacy and Navigating the Changing Healthcare Maze


As the various components of Obamacare become available, healthcare options will be changing fairly dramatically, particularly for disabled and chronically ill patients. We recently shared some detailed information about Special Needs Trusts and coming changes related to the Affordable Care Act (Obamacare)Regardless of your personal feelings about the Affordable Care Act, the reality is that our healthcare landscape is changing and there will be different options for people. Clients who have had difficulties due to issues like pre-existing conditions or lifetime limits will now be offered some additional choices.

patient advocacy navigating ObamacareWe have seen the health and long-term care landscape change drastically over the years already. Consider today’s abundance of rehabilitation, assisted living and home care options. These choices did not exist when many of our grandmothers were caring for their own parents. Having the options is definitely positive, but navigating them proves a challenge for many families. We try to keep you updated with educational resources and specific information that we see affecting our clients. If you are dealing with these issues and trying to navigate how the provisions will affect you, it is worthwhile to contact a professional patient advocate such as one of our Aging Wisely care managers. 

The Affordable Care Act provides a number of mechanisms, such as mandates, subsidies and insurance exchanges designed with the goal of increasing affordability and access. Here is an overview of some of the major mechanisms of Obamacare:

  • Mandate: requires all individuals not covered by an employer plan, Medicaid, Medicare or other public insurance to purchase an approved private insurance policy or pay a penalty (waived if part of a religious group approved by IRS or for financial hardship cases)
  • Health Insurance Exchange: a set of government standardized healthcare plans from which individuals may purchase health insurance, eligible for government subsidies
  • Subsidies: tax breaks and other subsidies to assist with transition and access
  • As of January 2014, Floridians will be able to purchase private plans on the insurance exchange which must meet these minimum requirements
    • No pre-existing medical condition issues

    • No annual or lifetime limits

    • No difference in premium due to health conditions

    • The insurance is guaranteed renewable until the age of 65

    • Premium support available to purchase insurance (based on the modified adjusted gross income income)

    • The insurance must include these essential health benefits:

      1. Ambulatory patient services
      2. Emergency services
      3. Hospitalization
      4. Maternity and new born care
      5. Mental health and substance use disorder services, including behavioral health treatment
      6. Prescription drugs
      7. Rehabilitative and habilitative services and devices
      8. Laboratory services
      9. Preventative and wellness services
      10. Chronic disease management
      11. Pediatric services including oral and vision care

What will all of this mean for patients? It will certainly mean that those with chronic illness or serious disability have new alternatives. As mentioned in our previous article on Special Needs Trusts, this means the pros and cons of each choice must be carefully weighed. Professionals advising clients must make sure to have a comprehensive understanding of: the patient’s diagnosis, prognosis and medical/care needs; current and projected expenses; care and benefits options (what types of benefits is the person eligible for and how does that affect planning?); and the client’s and family’s priorities, concerns, etc.

Many of our clients are eligible for Medicare due to either age or disability. The Medicare program has already seen a number of changes related to the Affordable Care Act and its precursors. We assist our clients to stay ahead of these changes. Medicare open enrollment is coming up October 15th-December 7th and our care managers are available to help clients reexamine their plan choices. We also assist new retirees with navigating their healthcare choices and understanding the deadlines and decisions they need to make.

Our patient advocates are experts at bringing you through the healthcare maze with relative ease. We can save you costs and get you the best options, as well as assist in times of crisis or resolving problems or claims issues. Contact us at 727-447-5845 to discuss how we can help.

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Boomer Eldercare Issues: Planning for the Massive Caregiver Shortage


elder caregiver helping grandmother

A report from AARP warns that Baby Boomers should expect a massive shortage in caregivers available to provide care as they age. The report, “The Aging of the Baby Boom and the Growing Care Gap”, projects that by 2030 there will be only four potential caregivers available for each person 80 or older, down from a high of more than seven in 2010. By 2050, when Boomers are between 86 and 104, the ratio will drop below 3 to 1.

This shortage, dubbed the “2030 problem” results from several factors, such as the large number of Baby Boomers, the tendency of this generation to have less children and increased longevity. This problem affects women to an even greater degree due to higher life expectancies. The divorce rate and overall percentage of unmarried Boomers (1 in 3) means that many will not be able to rely on help from a spouse. The 80+ population will swell between now and 2040 while the younger cohort does not. As a point of reference regarding care needs, in 2010: 70.5% of those age 80+ had some disability, 55.8% had a severe disability and 30.2% needed help with daily living tasks (bathing, dressing, toileting, preparing meals, using the telephone and paying bills).

Despite stereotypes to the contrary, American families do provide the great majority of care for elders, with 80% of care provided by families. This unpaid care has a value of $450 billion dollars (statistic for 2009). Clearly, our society relies on informal caregivers to a great degree and this shortage is a major eldercare issue for both the country and individuals.

As the AARP spokesperson commented, it is going to be unrealistic for Baby Boomers to rely solely on family and friends for eldercare. It is essential that Boomers start eldercare plannng now, rather than waiting until that time when they need care. While we know that most people state the desire to stay in their own homes as they age, we also know that informal supports are a big part of that reality. Will this caregiver shortage force more people in to instutional settings? What about the parallel shortage of professionl caregivers (eldercare workers, in all settings)?

Making this problem all the more challenging for families, many Boomers are currently caring for their aging loved ones. This might raise awareness of these issues and lead to better planning, or it might affect income and savings negatively and detract attention from one’s own planning.

A Washington Post article on this report pointed to other countries with similar proportions, but noted that many have done advance planning and modified policies accordingly. Focusing legislators’ attention to this issue may not be so easy when, as Robyn Stone from Leading Age states, “Our country is sort of a muddling-through country, and we tend to respond more to crisis situations than long-term planning.” This also tends to be true of individual planning, as people still generally deal with eldercare in crisis mode. Hopefully this study is another wake up call for more individuals and families to consider proactive eldercare planning.

So what can you do as a Baby Boomer who wants to have some control over your aging process and eldercare needs?

  1. Do some reading. Check out some of the quality websites and blogs on eldercare issues (you can check out our eldercare links page, subscribe to the Aging Wisely and EasyLiving blogs and we also highly recommend Sally Abrahms on AARP). Get an understanding of the key issues, follow policy changes and be aware of important factors such as what Medicare covers and does not.
  2. Engage help for legal and financial planning. Finances play a big role in your eldercare options. The more you can do to prepare (saving, investing, purchasing insurance, understanding gaps between your assets and potential needs), the better your options. Legal planning (estate planning and advance care planning) is not just important as you reach your latter years. It should be in place for all adults. The reality is that accidents, illness, and death don’t just affect the elderly.
  3. Consider a care consultation and bringing in a care manager to your planning team. As you do your financial planning and try to understand issues like Medicare/retirement health insurance and eldercare costs, the care manager can give you practical advice and answer questions so that you have a clear understanding behind the decisions you make.
  4. Talk to your family. Keep your family informed of what you are doing and don’t make assumptions about caregiving roles. If you have family riffs, it might be especially important to address these concerns now.
To get started on proactive planning, download your free copy of our Essential Eldercare Checklist which breaks down the various tasks and time frames for different stages of eldercare. While these issues may be far in to the future, understanding them can help you to plan:

For care consultations, Medicare and health care advice and a wide array of eldercare assistance, give us a call at 727-447-5845. Our Senior Care Consultant, Sue Talbott, is standing by to help!
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Special Needs Trusts and The Affordable Care Act


Special Needs Trusts and Care Assessments

This week, Aging Wisely’s Linda Chamberlain and Sue Talbott spoke at the Tampa Bay Financial Planners’ annual symposium. Their topic was “Effects of the Affordable Care Act on Special Needs Trusts”. For our readers who might personally be helping a special needs family member and professional advisors, we’ll share an overview of the topic and get in to some detail about resources to evaluate options.

Aging Wisely does not provide legal advice, such as when a special needs trust should be used or help in drafting one. However, we do provide a number of services related to special needs care and assistance for Special Needs trustees. We work closely with elder law attorneys who specialize in advising on these issues, and can make a referral if you need advice or assistance. This information is provided for educational purposes, and not as advice for your specific situation.

What is a Special Needs Trust (SNT) and why is one used?

In simple terms, a special needs trust allows funds to be used for the benefit of the person with special needs while preserving public benefits (such as SSI and Medicaid). Some of the situations where a special needs trust may be used include when a relative would like to leave an inheritance for a special needs child or when a disabled person receives an insurance or personal injury settlement.

Though a Special Needs Trust sometimes protects income benefits (such as SSI), it is typically the public medical benefits that are the most essential protected benefits. Even a person who receives or has a large sum of money may be uninsurable in the current healthcare landscape and quickly run through funds with high medical bills.

NAMI (National Alliance on Mental Illness) provides a good overview of the statute, types of Special Needs Trusts and purposes.

There are two basic types of Special Needs Trusts:

Self-settled (1st party) are established with funds belonging to the beneficiary; these trusts require a payback provision (in other words, the costs of benefits provided by the state must be paid back to the state upon the beneficiary’s death before any residual beneficiaries can receive remaining funds).

3rd party trusts can be set up by anyone (without a financial obligation to support the beneficiary) with funds that do not belong to the beneficiary; third party trusts do not require a payback provision.

How does the Affordable Care Act (aka Obamacare) potentially change the need for a Special Needs Trust?

  • Previously uninsurable clients may now be able to get private medical insurance (due to ACA provisions eliminating pre-existing conditions and state health insurance exchanges).
  • Some clients become disabled but already have private insurance. However, they max out their policy’s lifetime benefits and thus need public benefits. Under ACA, lifetime benefits and some other restrictions will also be eliminated, which may allow private insurance to now meet these individuals’ medical needs.
Weighing the pros and cons:
Why would a person choose to pay for private healthcare versus using the public benefits and maintaining their funds for other needs?
  1. The payback provision if a 1st party trust: what if the private healthcare costs would be less than what the trust will owe back to the state?
  2. Access and quality: under private insurance, the person may have access to more providers and specialists, potentially better care options.
  3. There are costs (set up and administration) to the Special Needs Trust and it puts some potential restrictions on the freedom of the beneficiary as to how the money is spent.

Other considerations:

  1. Non-medical benefits that the person might be eligible for: under public benefits, the person might be eligible for residential services (Assisted Living, Nursing Home care), adult day care services, in-home/community based or managed care Medicaid…all of which are not part of traditional private healthcare and not added under the Affordable Care Act.
  2. Overall costs and benefits: compare all potential costs and consider future projections.
  3. Management: trusts can offer some level of protection for the beneficiary and help managing funds.
A care management assessment can be invaluable to the family and professional in looking at special needs options and related financial advice. Why is a care management assessment so important?
  • Currently, and especially as the landscape becomes more complicated, understanding the beneficiary’s needs and costs is key.
  • Understanding what benefits the person gets or could be eligible for, and future projections for a true apples to apples comparison.
  • Documenting the decision process(es) will be vital, especially as residual beneficiaries are impacted.

Good special needs financial advice and ongoing management can only be done with a clear picture. A care manager can help professional advisors and families with things like:

  • Assessment and budget: understanding of the programs and benefits that can meet the person’s needs and what their restrictions are (do they require a SNT?).
  • Disbursements/management: evaluating the needs, most effective spending with balance on restrictiveness and desires of the individual.
  • Changes: increased life expectancies with many disabilities and new options and programs may call for reevaluation.
You can read more here about the benefits of a care management assessment from Aging Wisely and view a sample Special Needs Trust assessment.

Contact us at 727-447-5845 for help with special needs assessments and planning. If you are a professional serving families with special needs, we would love to meet with you about ways that we can work together!


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United States of Aging Survey and Eldercare: What Worries You?


United States of Aging and Eldercare

The latest United States of Aging survey reports that most seniors have a positive outlook, but worry about money and community preparedness to assist with aging and eldercare issues. This telephone survey, sponsored by National Council on Aging, United Healthcare and USA Today, covers about 4,000 adults including a representative sample of 60+ year olds.

Most of the seniors in the survey reported few current issues with paying their bills. They did, however, worry about how well their communities are prepared for the burgeoning senior population.  Many wonder if their financial resources will be enough for what they will need for the rest of their lives (more than half are concerned they will outlive their money), and if community resources will be available to help.

Survey respondents reported more use of technology and cited its importance in keeping them connected. Maintaining ties with friends and family was chosen as the most important factor in quality of life.  Experts note that there is still too little emphasis on proactive prevention. Though 65% of seniors have at least two chronic health conditions, 18% never exercise and many more get very little exercise.  More than half have not set any goals to manage their health in recent months.

Despite the overall positive outlook, the survey also shows that lower income seniors and those suffering chronic health conditions face many more difficulties and worries.  These issues can be deeply troubling for those who fall in to both categories.  More than a quarter of low-income seniors had done no preparation for their elder years.

So, what take-away lessons can we gather from this survey?

  • Our communities should be prioritizing focus on aging issues and resources.  Many communities may even have a wealth of resources, but access to information or awareness may be the issue.
  • Proactive aging and preventative healthcare are still lacking. Communities and healthcare professionals should be emphasizing prevention. Few respondents received any help with creating an action plan for health or were encouraged to use community health resources. Sharing specific steps and positive role models may be more successful than simply lecturing on exercise and health.  Individuals should consider making one significant investment/step for their health this year.
  • Financial planning/evaluating resources is a key part of aging and eldercare planning.  It can help to get a basic understanding of healthcare and long-term care costs and to work closely with a financial planning professional to map out a plan.  For seniors needing eldercare, finances are an important piece of the puzzle. Geriatric care managers and elder law attorneys can help you connect the pieces.
  • Staying connected to others is not only valued, but acknowledged as key to quality of life. This should be incorporated in to aging planning just as importantly as a health plan or physical assistance.  Isolation is shown to not only increase depression, but to have direct health effects.
Take some important steps toward preparing for quality aging.  Check out Aging Wisely’s Essential Eldercare Checklist.  This checklist covers important aspects of eldercare planning and helps keep you organized and proactive in your aging process.  This is a great resource for concerned family members/caregivers to prioritize needs and to-dos.

Want some help taking control of your aging and eldercare needs?  Our Tampa Bay geriatric care management team provides help with planning, assessment, and crisis management, and connects you to the resources you need!  Along with our EasyLiving home healthcare team, we can help seniors stay active and connected with services like senior transportation, healthy meal prep, medication management and more.

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The Dark Side of Senior Living: PBS Exposé on Assisted Living


PBS FrontlineThe PBS Frontline show, Life and Death in Assisted Living, highlights some major problems in the senior living industry: our commentary and tips for families

PBS’s Frontline recently aired a show exposing some major issues in the Assisted Living industry, specifically focusing on what they uncovered over 14 months researching lawsuits against Emeritus facilities. The team of reporters examined numerous lawsuits against the corporation, interviewed employees, residents and families, reviewed Ombudsman records and talked to many experts and regulators in the industry. The reports certainly expose a lot of scary information, especially for those of us who have loved ones living in assisted living or who may need those services at some point. You can check out the show and related segments and articles at PBS: Life and Death in Assisted Living.

Undoubtedly, this series will spark a lot of debate and discussion. Is this a matter of companies putting profit over care in senior housing? Is it only the big corporations to blame? Is more regulation the answer? Are there good senior living providers? Is the answer better pay, training and support for care staff?  How do we as a society deal with elders living longer needing higher levels of care? What can families do when they need help caring for a loved one? Is this an “assisted living problem” or a more pervasive problem at different levels of senior care? The series raises these and other daunting questions, with no easy answers.

At Aging Wisely we know, however, that the most important thing for families in all of this is how to get quality care for their loved one. Clearly, there are a loft of things that may need to be done in the industry at large, and the system for regulation and oversight may need an overhaul. We don’t want to appear in any way to negate the responsibility of providers to provide quality care and adequate staffing, or to further the guilt that families may feel in this whole process. However, these problems will not be resolved easily so we want to help families with some practical tips to access/ensure better care.

Here are some essential tips for finding quality care:

1.  Start with a clear assessment of what is needed and what type of care fits best (for the person’s needs, budget, desires, lifestyle, etc.). Engage an expert, and preferably an independent one. The place to start is not with a particular facility or care provider. They may be the nicest people on earth and may very well help you, but there is naturally a bias toward the option they offer. You need to look at the person’s needs and then determine, out of the array of senior care options, what choices are most appropriate.

Some of the biggest problems exposed in assisted living have revolved around inadequate staffing in relation to the care needed. Assisted Living was not originally envisioned as providing the level of care we’re sometimes seeing now. Some Assisted Living Facilities are accepting residents that they should not be and allowing residents to stay when they need more care. Whatever the motivations behind this, it is important that you get a clear picture of how the needs match with the level of care that can really be provided.

2.  Focus behind-the-scenes.  Don’t get caught up in the physical presentation of a care facility.  It can be easy to be wowed by a beautiful place.  It is especially challenging when your parent is moving from home and you see a place that offers beautiful or large spaces, something that can be very appealing.  The search for care should be considered more like searching for the best specialist for a rare disease/surgery, rather than looking for a new home or apartment.  You can review state inspection reports, get references and most importantly, talk to someone “in the know”.

3.  First impressions should be great, but try to get a handle on what will happen after your first impressions.  In other words, you will probably meet some wonderful marketing staff when you are looking at care options. But, sales and marketing staff will not be the primary people you will deal with after moving in to assisted living.  Make sure to meet other staff and ask questions about how different issues are handled and who to contact about various needs.

What can you do after moving in to Assisted Living to help ensure good care?

1.  Oversight is essential.  Family and friends should visit often and get to know staff.  Ask questions and keep abreast of any changes.  Particularly if you live at a distance, consider hiring a geriatric care manager to make regular oversight visits and provide advocacy for your loved one.  Even if you live nearby, it is helpful to consult with a professional who can help you navigate expectations and how to get things accomplished.

2.  Assessment should be an ongoing process.  If something changes with your loved one, it might be time to get a reevaluation to ensure the care is still appropriate.  If some time has passed since your loved one moved in, consider a review of the current care plan and needs. Even if the level of care is still appropriate, there are often coordination issues and care planning changes necessary.

3.  Monitor transitions carefully.  It is well-documented that elders bounce back to the hospital at significant rates, often because of gaps in care and communication.  Evaluate the best plan of action after a hospital stay or rehabilitation.  Is the assisted living facility still able to provide the level of care needed?  Would it be useful to have some extra help during the transition?

We will share more information in future articles about the process for making complaints with care at an assisted living or other senior living facility as well as the regulations and oversight of these facilities in Florida.

You may want to check out our Guide to Choosing the Best Senior Living Facility and we invite your calls at 727-447-5845 for help any time!

Aging Wisely geriatric care managers serve as patient advocates and resource experts for families with loved ones in Tampa Bay.  We help with geriatric assessments, facility choice and transition, ongoing oversight and more!

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A Day in the Life of a Geriatric Care Manager


Geriatric care managers do a wide array of tasks for their elder clients and families.  It is almost hard to say there is a “typical day” for a geriatric care manager due to the varied nature of the job.  However, here we will share with you some of the common tasks handled by care managers and the ways these benefit clients.  You will get a good picture of the role and skills involved in quality care management. 

Aging Wisely geriatric care managers

A good care manager is an excellent planner and must manage time carefully…while at the same time having the flexibility to change courses quickly and adeptly.  A care management job by nature revolves around the particular clients the care manager is serving.  One of the unique aspects of care management is that while practices are standardized, the services aren’t “one size fits all”.  The care manager is a problem solver, which is often a bit like solving a puzzle.  The pieces may be very different, but the care manager knows common patterns and techniques to solve the puzzle.

Geriatric care managers don’t spend most days behind a desk.  You’re more likely to find them behind the wheel of the car and in and out of care facilities, doctors’ offices, hospitals and clients’ homes.  Care management has benefited from technology advances that enable the communication and research involved to be done more efficiently for a mobile workforce.

Some of the major tasks carried out by geriatric care managers (and why these are so important) include:

  • Coordinating and attending medical appointments: A big piece of quality care management is helping clients achieve better consistency and thus results from medical treatment and care, i.e. bringing a holistic picture to medical treatment that includes other aspects as well (nutrition, how the person is managing/safety at home, emotional issues, medication management and more).  The care manager helps coordinate and advocate for the individual and can help all providers achieve better results for the patient through this continuity (and communication).
  • Assessing and re-evaluating concerns/needs: Care managers not only do initial geriatric assessments in which many areas are evaluated for customized recommendations, they also evaluate on an ongoing basis.  These “routine” visits are checkups to spot things that could become a problem.  They keep things on track and also provide peace of mind to family members and others involved.
  • Coordinating providers, services, benefits:  A care manager typically makes initial recommendations and helps set up services which then evolve as needs change. This is a broad category, as a care manager could help with anything from setting up in-home care to ascertaining an appointment with a highly sought after specialist to assisting with benefits eligibility.  This is where geriatric care managers are really “resource experts”.  Because this category can cover any aspect of clients’ lives, this is also where clients benefit from a team approach like that at Aging Wisely.  The Aging Wisely client has access to the knowledge of a whole team of resource experts.
  • Communicating to involved parties: It is well documented that some of the biggest problems that arise, for example at hospital discharge or other transitions, come from communication gaps.  The care manager takes the time to: make sure parties are informed with the necessary information, ensure understanding of instructions, procedures, risks etc., ask key questions (often the most common “unasked” questions that produce misunderstandings) and provide feedback.

This “day in the life of a geriatric care manager” just highlights some of the big categories of tasks involved in the role.  The reality is that because geriatric care management is so customized, each day for each care manager can look very different.  The care manager must also be “crisis manager”, helping when a client goes to the emergency room or other immediate concerns arise. It is also for these reasons that a team approach can provide the best results for clients.  You can read more about Aging Wisely’s team approach to geriatric care management here.

Need a quality geriatric care manager in Tampa Bay, Florida?  Give us a call at 727-447-5845 for a free needs analysis and help with any and all of the above tasks!

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Mission Statement

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.