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Scams on the Elderly: Senior Care Tips for Fraud Prevention

scams on elderly As much as Florida is the land of sunshine and beautiful beaches, it can also lay claim to being the top spot for fraud and identity theft (per the Federal Trade Commission).

Unfortunately, many scammers target the elderly as a recent WMNF Tampa radio show pointed out. Scammers prey on the trusting nature of many elders as well as fear and intimidation. The scams are constantly evolving and often target common services and products used amongst elders. Water filtration systems and other items for the household have often been targeted, convincing the person to buy something they don’t need or something at an astronomical price or taking a deposit for work which is never completed. Medicare and other official sounding programs are often used as a means of fraud and identity theft. There have been numerous scams “phishing” for information in order to steal personal/financial information or obtain someone’s identity. Targeting seniors, this has often been done under the guise of Medicare.

One of the most difficult aspects of fraud targeting seniors is that it is often perpetrated by a trusted person. Family members are the top source of financial abuse and other neighbors, friends and caretakers may also take advantage of their relationship to begin financially abusing the situation.

Some things you might notice in an elder loved one which could indicate financial abuse or being the victim of scams:

Worrying about finances, having unanticipated financial problems.
Unexplained purchases, missing cash or valuables.
Difficulty explaining purchases or confusion over a purchase or service contract; excessive repairs or items being purchased for the home.
Giving financial control to a new caregiver, neighbor or friend.
Fear or intimidation signals (mentioning, for example, that the daughter who helps out “doesn’t want me to talk about that” or doesn’t allow the elder to see the checkbook any longer or review accounts).

Financial elder abuse and scams can be very difficult to prevent or even resolve. Often elders will not report the abuse and feel embarrassed over the situation. There may be a level of intimidation and control that is hard to break through. Here are some steps we think can help, though, in overall safeguarding for elders and resources to help:

Regularly evaluate how things are going for your loved one. Hire a geriatric care manager to help you keep an eye on things from a distance, get a periodic evaluation and check in with calls and in-person visits. Continual communication can help you spot issues, as well as give your loved one opportunities to mention concerns. A professional assessment (and ongoing evaluations) can help determine when it may be necessary to assist with managing finances and household maintenance. Contact us to learn more about geriatric assessments and other eldercare assistance services.
Share information about popular scams with your loved one and educate on issues such as giving out personal information.
Help set up a dignified “out” for solicitations. Perhaps your loved one can say they have their “advisor” review everything before they make decisions (whether that really is some type of professional advisor, or running it by you). You might even suggest/share that you do the same yourself, as it is easy for anyone to get caught up in scams and some time to think about purchases and decisions helps.
Determine ways to simplify finances and possibly consider a system for oversight (regular review/access by a trusted professional or family member).

You might also want to check out our resources: Senior Safety Warning Signs and Caregiver Concerns and Florida Attorney General’s Protecting Florida’s Seniors page (with various resources and hotlines included). Reach out to Aging Wisely’s Senior Care Consultant if you spot concerns or want to find out how we can help. We offer caregiver consultations and an array of services for Florida seniors in the Tampa Bay area.

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Simplifying the Solutions to Not So Simple Senior Care Problems

solutions to the senior care maze The Wall Street Journal recently published a great essay entitled, “When Simplicity is the Solution” which details our growing “crisis of complexity” with more choices and dozens of details we encounter every day that slow us down. Of particular interest to us were the examples about Medicare, medicine bottles and the patient experience at hospitals. We wanted to share a bit about how we think this concept might just apply to you if you have been searching for eldercare answers or senior care help:

The Medicare example, “a web search on medicare.gov will return 45 plans for you to consider”, reflects the complexities families face in an array of areas when it comes to eldercare. One of the laments we hear most from families is that they have been going in circles getting more lists of numbers to call when what they’re looking for is simple…an answer. Forty-five choices is not an answer, it’s just more questions. Someone getting ready to retire has an even more complex puzzle, with all the parts of Medicare along with company benefits, VA and other insurance options playing in to the choices. Medicare has done a good job providing educational information and tools, but the complexity remains built in to the product. We created a simple solution for this common dilemma, with our Medicare Analysis package.

The article showcases another great example in the design of medication bottles. This example shows that sometimes complexity is not just an inconvenience, it is downright dangerous. Medications are a great example of how simplicity can be the solution. Beyond simplifying the packaging, reducing the complexity of the overall regime (less medications, less varying times) helps patients comply better. We talked about this and some of the other simple solutions to medication management in our recent post, Managing the Dangers of Medications: Senior Care Resources.

Our care managers often point out simple solutions like this for various senior care and elder safety issues. A simple solution can have a big impact. In a home assessment, the care manager might observe how a client has organized items in the kitchen in a way that’s making them hard to reach or leading to nutritional problems. No fancy gadgets or expensive remodeling needed, just some quick reorganization. It’s easy to feel overwhelmed with thoughts of what your elderly loved one might need to be safe. It is not unusual for us to first meet with a family and find they have a notebook full of names and numbers with long lists of assisted living facilities and various products they have been told will help, but yet they don’t really know where to start.

The Cleveland Clinic example shows how an organization can distill things down to the customer experience. They discovered it was the small details that mattered to patients, not necessarily complex initiatives or things that cost a lot of money for the organization. If you’ve ever been a hospital patient (or the advocate for a loved one while there), you can probably point out a range of examples: the drafty hospital gown, endless nighttime interruptions, communication breakdowns. We know how much the “little things” mean to our clients. When moving to an assisted living facility, for example, our care managers focus on organizing the day of the move to optimize the experience. The little details make or break that first impression, a time so filled with anxiety already. Having done it so many times, we can use that knowledge to create the best possible experience for the client (and family).

This concept is really what Aging Wisely is all about (and what we think “aging wisely” as a concept is all about too) and it is why we use the tagline, “solutions when you need them”. When we started Aging Wisely fifteen years ago, the idea was to provide simple solutions to sometimes complex problems. We did not see that available for families at the time. Perhaps now, this is even more true. Every day there is a new website or technology related to senior care. But, families still tell us what they want is solutions and answers and generally what they get is just more questions (or frustration with systems and processes that don’t seem to address little things that are important to them)…until they come to us.

Want to be lifted above the maze of eldercare, with solutions for YOU? Call us today! You can reach us at 727-447-5845.

What frustrations have you experienced in trying to find eldercare solutions? Have you found seemingly unnecessary complexities trying to navgiate senior care options?

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Senior Care Signs: You May Need a Geriatric Care Manager If…

Here’s our “top 10 list” of signs that you might want to seek help from a geriatric care manager with your aging parents’ care or eldercare concerns. These are some of the common patterns that begin to build in our lives as we strive to care for loved ones as they age or suffer from various health issues. If these patterns sound familiar, it is a perfect time to reach out to a geriatric care manager in your parents’ local area to plan a consultation and/or geriatric care management assessment.

You can reach Aging Wisely at 727-447-5845 or complete our online senior care request for geriatric care management assistance in Pinellas, Pasco, Hillsborough counties in Florida (St. Pete, Clearwater, Palm Harbor, Tampa and more).

Top 10 signs it’s time to call a geriatric care manager:

10. You sleep with your cell phone by your bed, not as an alarm clock, but because you are worried about what emergency might crop up with your elderly loved one overnight.

9. You are racking up frequent flier airlines miles, not on taking vacations or business trips, but on trips down to visit your aging parents in Florida to handle multiple crises.

8. Your office assistant is on a first-name basis with your elderly Mom, who calls with emergencies (or perceived emergencies) throughout the day.

7. Every question you ask your Dad is answered with “I’m fine” or “it’s fine” despite the various health problems he has had and the concerns you spot every time you visit.

6. Every visit to your aging parents for the past two years has consisted solely of doctor’s appointments and running errands.

5. You have your parents’ local hospital programmed in to your phone.

4. You know more than you ever wanted to about your Mom’s medical condition, but still don’t understand what the doctors are recommending or why.

3. Your used to visit websites about a favorite hobby or celebrity gossip, now you stay up late reading senior care websites and eldercare advice blogs.

2. Your worries span the generations: one moment you are thinking about your oldest daughter finding a job and the next moment you are wondering if you need to move your Mom in to your home.

And, the #1 reason why you might need a geriatric care manager is…you want to do the right thing for your aging loved ones and sometimes it is hard to know what the right thing is or how to make it happen.

Calling a geriatric care manager does not mean you are giving up the responsibility or somehow shirking your duty to help your aging parents. A geriatric care manager can be your partner in ensuring the best care for your aging parents or other elderly relatives.

How? Tools, resources, specific recommendations, patient advocacy and expertise as well as help managing tasks and ongoing monitoring to ensure things are going well…and giving you back peace of mind (and more quality time with your loved ones)

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Managing the Dangers of Medications: Senior Care Resources

At least 1.5 million Americans are sickened, injured or killed each year by errors in prescribing, dispensing and taking medications.

30% of hospitalizations for elders are thought to result from drug-related problems/toxicity. Adverse drug effects have been linked to falls, depression, constipation, confusion and immobility. If medication errors were counted as a disease, they would be the 5^th leading cause of death among seniors 65 and older.

Did you know? Some interesting facts about medications, medication management and senior medication issues:

Some foods can interact negatively with medication and certain medications should be taken properly in relation to food/drink.

Over-the-counter medications, vitamins and herbal remedies should all be analyzed when your treatments are being reviewed. These can have side effects or interactions with prescription medications.

Medications are metabolized differently in elders.

Certain medications commonly prescribed for behavioral issues can have serious negative effects on elders with dementia and can, in fact, exacerbate the various behaviors they would typically treat.

Need help with medication management concerns in the Tampa Bay area? We can provide a range of services from assessments through ongoing senior care management–in Pinellas, Pasco and Hillsborough counties (Tampa, Clearwater, St. Petersburg):

When properly managed, medications can be a vital part of the good senior healthcare. When not properly managed, the dangers can have a significant impact. For older adults who tend to take multiple medications, the risks are inherently high. This may be complicated by poor coordination and communication among multiple clinicians, patient compliance difficulties due to memory issues or practical problems and interactions/sensitivities.

Research shows that multi-faceted medication management programs lead to the best treatment outcomes and minimize mistakes.

Aging Wisely’s geriatric care managers support clients in staying safe and healthy with an individualized approach to senior care coordination, with benefits such as:

Assessing comprehensive areas including medication management and overall management of your medical conditions and senior care needs; providing senior care resources that best meet your individual needs.

Ensuring your clinicians are equipped with the best information: attending your medical appointments, keeping your records updated and communicating with your medical team and providing feedback so they can pinpoint problems early.

Advocating with your medical providers to review medications, reduce overuse of medication and simplify schedules. Fewer medications make it easier for people to correctly take their medications and can reduce interactions/side effects.

Ensuring your medications work most effectively by linking you to specialists, such as a geriatric pharmacy consultant, to review and pinpoint the best regime.

Providing solutions that help YOU: offering advice on devices and technologies that will best meet your needs, from pill boxes to medication dispensers and reminder systems.

Determining what type of personal assistance might be needed, such as engaging home health medication management including a Registered Nurse to set up your pill box and home health aides for medication reminders and assistance.

Assisting with communication and advocacy: tracking allergies and history, providing background information to clinicians and helping you to ask the right questions.

Managing transitions (such as a move to a care facility, hospitalization and discharge) to reduce mistakes, redundancies and problems.

It is vital to assess and manage medication regimes on an ongoing basis since they can have such major impacts on a person’s health and quality of life. If you have questions or know someone who might need help getting better senior care outcomes, give us a call at 727-447-5845!

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Senior Living Issues: Nurse Refuses to do CPR at Retirement Community

By now, it’s likely you have heard the news story about the nurse who refused to do C.P.R. on a retirement community resident who later died. Sally Abrahams did a good review of the story on her AARP blog. It was a startling story for many and readers weighed in all over the internet with comments. The reactions range from shock and anger that this nurse would not perform CPR to questioning the facility’s policy and contemplating the senior’s status regarding wishes (i.e. did she have advance directives or a DNR?). Rather than delve in to the facts of this specific case, we’d like to broaden the discussion to a number of important issues for all families to consider. Here are a few key take-away lessons and tips for families and elders:

When it comes to choosing a retirement community, understanding what you’re getting is vital. Your best bet to cutting through the array of choices is to hire a care manager to help. Even the reporters of this story were quite confused about the type of facility in question here, reported variously as a CCRC (Continuing Care Retirement Community), Independent Living Facility and Retirement Community. Each state has different regulations for different types of facilities, and beyond that of course there is a wide range of care quality and scope. It can take a lot of research to figure all of this out, and it can still be hard to know all the questions to ask without some help. Contact us at 727-447-5845 to talk about how we can help, if you are looking at Florida senior living options or retirement communities in Tampa Bay.

“Level of care” is a confusing issue for the public and families. Facilities provide different levels of care, from the broad categories such as independent living and assisted living to specialty licenses and extra services. The big question is: what should I be expecting and how does this fit with what my aging parent needs? It sounds like perhaps in this family’s case they did understand what this facility provided (and didn’t) and accepted the limitations, but often this is not the case. “Level of care” is not only understanding what an elder may need, but also knowing when that level of care may no longer be sufficient and what your expectations should be in different scenarios.

Independent living retirement communities are often misperceived as offering more assistance than they are designed to provide. Residents are entering retirement communities at later ages with more needs. For a number of reasons, elders or their families may not be clear on the parameters of a retirement community. The facility may indicate these issues on a contract, but during the emotional time of a major move the detailed parameters may not be evident.

Regardless of senior living situation, advance care planning issues must be addressed. While we don’t know the status of this person’s advance directives, it is a reminder about the issues of resuscitation and life support. C.P.R. is addressed through a document called a Do not resuscitate order (DNR) which is a doctor’s order and handled very specifically (by each state’s laws). It is not included in other types of advance directives (though a person may state preferences and provide guidelines in those documents, the DNR is needed in order to direct emergency personnel not to start resuscitation). These are important issues to talk about with your family members and medical providers. Make sure you really understand the documents you complete and the laws and policies about treatments and life sustaining measures.

Some additional resources and notes on senior living, C.P.R. and advance care planning:

Independent living retirement communities are especially misunderstood many times, because they may offer some supportive services on-site but should not be mistaken for a healthcare facility. Most of the time a purely independent community is not regulated by state requirements that other healthcare facilities are, but is viewed just like an apartment complex. For the various levels of care for assisted and nursing care in Florida, you can check out our overview of Florida Assisted Living Definitions.

Guide to Choosing the Right Assisted Living Community for You

Florida Department of Health Information about D.N.R.: Top Questions about Do Not Resuscitate Orders such as who should have one, the legal requirements, and the differences between a living will and do not resuscitate order.

Family Caregiver Alliance offers a helpful overview regarding end-of-life choices regarding C.P.R. and D.N.R. It is useful to read some information about C.P.R. and the elderly and talk to experienced professionals, as many people have misperceptions about the process of resuscitation (and the realities of it for frail elders). This is one of the issues our care managers often talk through with clients and families, to help gain a fully informed perspective.

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Work-Family Balance, The Work From Home Debate and Eldercare

Yahoo’s CEO has stirred up some controversy and debate with her recent work-from-home ban for her company’s employees. In case you have somehow missed the story, a memo was leaked in which the company’s head of human resources ordered telecommuting employees to begin reporting in to the office. Yahoo’s CEO has decided to end telecommuting for her employees, in efforts at improved collaboration via face-to-face interaction.

The question of telecommuting is one that each company’s leadership must address, to determine if it makes sense for them. A lot of the rancor on the internet about this decision comes from the fact that telecommuting is seen as a positive option for flexibility in the workforce–a way to keep employees engaged (or recruit employees) who are balancing work and other responsibilities (parenting, or caring for aging parents for example). Simply taking commute time out of the equation can give employees back extra hours even with the same level of productivity/hours worked.

This decision feels like a step backwards to many in terms of our modern work options and developing work-life balance options. However, different jobs require different parameters and there are still a wide array of jobs with more flexibility than in years past. In addition to attracting and retaining valuable workers, companies often benefit in cost savings (less physical infrastructure needed) and improved efficiency (a lot of studies verify this–at least with certain jobs/workers).

The good news is that this decision has really opened up the dialog on work environments and work-life balance. This issue is near and dear to our hearts at Aging Wisely as we assist so many working caregivers. Overall our society benefits from having options, and supporting good, productive employees in various ways.

Framing this within the context of eldercare, here are a few statistics on caregivers and employment*:

More than one in six Americans working full or part time report assisting with the care of an elderly or disabled family member, relative, or friend.

Caregivers working more than 15 hours/week said caregiving significantly affected their work life. 70% of working caregivers suffer work-related difficulties due to their eldercare duties.

About 50% of caregivers report working full-time, 11% work part-time and 17% are retired.

Impacts on work and the caregiver’s economic situation range from having to quit to reducing work hours, giving up promotions and more demanding jobs or duties. As with most work-family issues, the impact continues to disproportionately affect women. Studies indicate women caregivers suffer a particularly high level of economic hardship, more frequently having to make alternative work arrangements. This makes people particularly incensed about seeing these options go away.

Recruiting and retaining high quality employees remains a top issue for most industries, so companies cannot overlook these issues. AARP offers an “Insight on Issues” regarding workplace discrimination against elder caregivers, including current legal protections for caregivers and policy and practice suggestions for companies. Each workplace will be different as will its workers’ needs and what the employer can reasonably provide.

However, ignoring the issue is not only bad for our society but it doesn’t make for good business. This Forbes article demonstrates the value of employer support for eldercare and the benefits it can bring to the employer as well as the employee. Employers can look at a range of benefits and resources they can offer employees to support them, including: flex time and flexible working arrangements such as telecommuting or job sharing, leave time (short term leave, reduced work schedule temporarily, FMLA), backup care or reduced cost care/access to eldercare help, education and support resources (EAP, counseling, support groups, seminars, online resources, referral services, a geriatric care consultation or assessment).

What can you do if you are a working caregiver–an employee facing increasing eldercare responsibilities?

Find out more about the possible benefits your employer currently offers. Ask your human resources department or leadership about what kind of assistance might be available. You can explain your desire to remain productive and discuss ways to ensure continued job performance. Even making them aware that you are going through this issue and looking for resources can help your employer with awareness (the more they hear from employees having this issue, they may see the value in providing solutions).

Marshal your resources. Plan a family meeting early on in your caregiving duties, to create as much of a team approach as possible to caring for your aging parents. How can various family members, friends, neighbors, other helpers pitch in?

Evaluate your options carefully. Consider long-term financial impacts of quitting a job or reducing hours. Obviously the decision is personal and you have to consider many factors, but make sure you have a clear picture of options and costs (immediate and long-term). Are there other resources (non-employer) that could help?

Talk to key professionals. Before you make any major decisions, you may want to talk it over with your financial advisor and CPA (to understand your economic situation, how retirement saving would be impacted, possible tax deductions, and more). Consider meeting with a geriatric care manager to get a handle on your parent’s immediate and potential future needs, and support options. Plan a meeting together with your loved one and their advisors to evaluate resources (for paid care and/or qualifying for assistance).

If you need to ask for some concessions at work or make changes, lay out your accomplishments/contributions, offer suggestions of ways you might remain productive or contribute differently, and give specific plans for how such concessions could work while benefiting the company (i.e. specific ways your productivity can be measured and a process for “checking in” and evaluating if the new arrangement is working).

Take advantage of education and information. If you have an EAP at work, they likely have disease-specific information, lists of resources and educational topics related to caregiving. If your employer doesn’t offer anything, seek out information. You can start with some focused research on the internet, gather some information from the local aging organization or disease-specific group (i.e. the Alzheimer’s Association) or consult with a geriatric care manager.

Working caregivers are vital to our society. Their numbers are too big to ignore and in order to care for those in need and remain a productive society, we need to support them. This does not mean every company should let everyone telecommute or provide on-site adult day care…but it does mean that family-work balance is a real issue that companies must contend with, and create their own balance of sorts.

Aging Wisely offers an eldercare resource center, with fact sheets and educational materials for caregivers–it is a great place to start if you are facing these issues, along with our Florida eldercare websites and senior care links. You can give us a call any time at 727-447-5845 or click below to get advice and resources for your eldercare concerns:

*Statistics from Family Caregiver Alliance

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Senior Care Management Mistakes: Making a Mess of Transitions

As we age, we tend to face a lot of life changes which sometimes feel beyond our control. These transition points naturally bring stress. However, the way they are handled can make a significant difference in the experience and perception of the change.

Some of the major aging transitions elders face include moving to a care facility, bringing in help for the first time, going to (and leaving) the hospital, getting inpatient rehabilitation services, and moving in with family members. There are many accumulated losses that come with aging as well, such as the death of a spouse and other loved ones, giving up driving or other activities, reduced mobility and independence.

A lot of things can go wrong during these transition times, from little things like scheduling glitches to big mistakes and communication gaps. Here are some pointers on “what not to do” when it comes to helping with the senior care management of aging transitions. Don’t:

Rush things. Allow sufficient time for the elder to discuss/process the changes. Sometimes these changes come with a crisis and time is precious, so this can be particularly tricky. As your loved one’s advocate, you may be able to find ways to buy time and even a few minutes of listening and empathy can make a big difference (when you’re facing a crisis like this, it’s a great time to call us for immediate help!).

Ask your neighbor what to do or pick your provider based solely on what a friend suggests. It may not be the right option for you.

Get caught up in appearances. While first impressions are important, getting too caught up in appearances may steer you wrong. This is a common mistake when it comes to facilities, since you see the bricks and mortar. Quality of care is not as transparent as the lobby or the room size, but it’s far more important.

Use the list method. You get a list of all the available options (such as a list of all Assisted Living Facilities from the Area Agency on Aging or a list of local home health providers from the state’s website) and go through the list, interviewing or visiting every provider on the list. You will most likely become overwhelmed. Oftentimes, half of the list could be eliminated automatically as either not appropriate for your loved one or offering poor care. You also need to understand issues like regulations, levels of care and how options match up to what your loved one needs.

Forget about the little things. Details impact the experience, from timing and meals to comfort and having the right items available (i.e. what to pack). The day of a major transition can be a rough experience with little glitches, or a nice introduction to the new service or environment if done well.

For a good real-life example about the different ways to manage senior care transitions, you might want to check out our client’s story, “One Daughter’s Eldercare Experiences: A Tale of Two Transitions“.

We offer several good resources for facing transitions. For example, check out:

Moving Day: Making a Good Transition to a Senior Care Facility (includes our Guide to Choosing the Best Senior Care Facility)

Checklist for Discharge to a Rehabilitation Facility

Give us a call at 727-447-5845 or click below to schedule a care consultation. We can help ensure a better transition for your loved one (and peace of mind for you!) with resources, suggestions, and an analysis of options.

A few of the senior care management tasks we can assist with include:

Assessing the situation and optimal solutions; providing an evaluation of level of care needed.

Maximizing resources and help available to you.

Navigating insurance (Medicare, private insurance) and Medicaid, VA and other benefits.

Guiding conversations, providing pointers to talk with loved ones about concerns and changes.

Anticipating concerns and ways to avoid pitfalls during transitions.

Ensuring good senior care management and communications between parties.

Crisis management, helping you to “buy the time” needed to comfortably make decisions and process the change (for example, suggesting short term solutions while a more permanent decision awaits, planning discharge and working with providers on most appropriate time frames, helping with alternatives as compromise).

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Senior Living: Home Improvement Do’s and Dont’s

According to the National Association of Home Builders, nine out of 10 people over age 50 are committed to living in their own homes for as long as possible. In order to make this work, many people need to make home improvements to ensure maximum mobility when physical health declines.

According to FoxBusiness.com, companies and organizations, including the National Association of Home Builders (NAHB), are offering assistance to make homes more livable and safe as they age. The NAHB offers a three-day course that teaches contractors and remodelers techniques and strategies for making age-appropriate modifications to homes.

In addition to this list of senior living home improvement tips, there are minor modifications and resources that can make a huge difference in home safety. Check out EasyLiving’s Fall Prevention Checklist for a review of home safety. Consider getting a professional home assessment done by a geriatric care manager for a wide array of custom recommendations for your safe senior living. This advice, the resources and tips a geriatric care manager offers can be invaluable to healthy aging in the comfort of your own home.

Here are some do’s and dont’s as you approach a home remodel to better equip your home for healthy senior living:

Don’t Neglect the HVAC System

Upgrade to energy-efficient heating and cooling systems to optimize savings on electricity. The National Association for Home Builders recommends getting units that can be installed in an easily accessible location to change the filters without using a ladder.

Do Widen Narrow Door Frames

Many older homes feature narrow doorways that aren’t handicap accessible or navigable with a walker. Have door frames widened to provide at least 32 inches of clear width. Replace any doorknobs on interior doors with levered hardware.

Don’t Skimp on Lighting

Make sure that light fixtures have at least two bulbs in vital areas such as the entry way, bathrooms and kitchen. This way, when one burns one, your parents won’t be relegated to darkness while waiting for someone to come change it. Add task lighting in kitchen work areas, near the computer and at the bedside to prevent eye strain. Install a soft-glow LED in the hallway to gently illuminate the space at night and prevent falls.

Do Install an Alarm System

Elderly people are often targeted by burglars and a security system can help thwart criminals. You can check out various options online; for an example check out a home security review of LifeShield. Whatever system you choose, post the yard sign and stickers that come with the system in prominent places of your parents’ home. Often just seeing that a house is protected by security is enough to convince burglars to move on to an easier target, according to Lifehacker.com.

Consider the added security of a personal emergency response system, with a call center available in case of a fall or other concern. Many of these systems offer no or low cost installation, with a monthly fee to cover the monitoring costs. It is best to go with a system which has flexibility regarding cancelling services, in case your needs change.

Don’t Go Without a First Floor Bathroom

If your parents live in a multi-story home and don’t have a bathroom on the first floor, AARP suggests you add one. While it may seem like a big expense, it’s really an investment that can also pay off should your parents decide to eventually sell the home. If putting in a new bathroom (or remodeling a current one), review the accessibility and safety issues since the bathroom is where seniors often fall.

Do Update the Shower

Get rid of that bathtub/shower combination and replace it with a handicap-accessible curbless shower. Getting in and out of a bathtub and shower combination can be dangerous as your parents’ agility declines. Install a bench seat in the shower and wall handrails in and out of the shower to safely maneuver in and out. Adding recessed shelves are great because they’re at arm’s level and will stop your parents from having to reach down to the floor or up to the shower rack.

Don’t Forget the Toilet

Upgrade to a taller toilet basin and install an elevated toilet seat for ease of use. If your parents have knee or back problems, install grab bars on the wall to make it easier to get up. Make one bathroom the go-to bathroom for your parents with the right accessories and toiletries accessible.

Do Get Rid of Carpeting

Carpeting can be difficult to move around on for those who use a walker or wheelchair. Replace carpet with hardwood flooring, tile or another smooth surface that’s ideal for rolling wheels. Be aware of the dangers of throw rugs as well, which can pose a major risk for falls. These can be secured with double stick tape, but the best solution is to remove them.

We can help! We offer home safety assessments and our expert care managers know a wide array of resources to help with minor changes, large remodels, home medical equipment and various programs and assistance in your home. By bringing you our experience, we can often suggest no or low cost changes that can make a big difference!

You can reach us at 727-447-5845 to find out more or complete our request for a phone appointment to answer your questions.

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Discharge Planning Checklist: Stroke Care and Rehabilitation

Stroke is the leading cause of adult disability. A stroke occurs when a blood vessel to the brain is either blocked by a clot or bursts/ruptures. When either of these things happens, brain cells begin to die and brain damage occurs.

Fast, effective treatment is key to recovery from a stroke. Experts sometimes say “time is brain” as quick treatment can save brain cells and reduce residual damage from the stroke. It is vital that you know the signs of a stroke and seek immediate treatment when those signs are present.

*From the National Stroke Association

After acute care treatment, the patient faces the recovery and healing process. Rehabilitation should begin as soon as possible during this healing process. One third of stroke patients need help with activities of daily living after a stroke, and one quarter cannot ambulate without assistance. The most common effects of stroke are: speech impediment, decreased motor skill coordination, and depression. The nature and extent of disability after a stroke varies widely depending on the type of stroke and area of the brain that was impacted, as well as the course of rehabilitation.

Due to the nature of our brains, rehabilitation can be very effective in gaining back abilities, compensating and gaining new skills to be more independent–and the process can continue over a long period of time. The rehabilitation process will depend on many factors such as the nature of the stroke and resulting damage, the person’s overall health history and other diagnoses/disabilities, living situation/caregiver availability and more. Any good rehabilitation process is a coordinated team effort, involving the patient, family and various medical and rehabilitation providers.

The average length of stay for patients with an acute ischemic stroke is between 6-10 days in the acute care setting, so rehabilitation options must be evaluated quickly. Rehabilitation for stroke and other acute medical issues can occur in different settings. An acute care rehabilitation setting (inpatient in the hospital or a special hospital unit) may be advised for intensive therapy and acute/complex medical needs. This type of care is often appropriate for a stroke patient and may help extend the benefits of rehabilitation services (hospital/acute care falls in to one “bucket” under Medicare coverage, and rehabilitation/skilled nursing falls in to another “bucket” of coverage days). Rehabilitation facilities offer different types of programs and levels of intensity. Some of these may be stand-alone short term rehabilitation centers, while others may be part of a hospital campus or long-term skilled nursing facility (i.e. many nursing facilities have long term and short term sections or mixtures of patients).

Discharge planning and the appropriate rehabilitation setting depend largely on the various factors that make up the patient’s situation. As an advocate for a stroke patient, it is vital you help communicate expectations and hopes for recovery and ask questions to ascertain the proper level of care, options and expectations for possible recovery and ongoing needs. With any medical crisis, but particularly in cases like stroke where the rehabilitation process can have long-term impacts on quality of life, consider involving an expert geriatric care manager as a professional patient advocate and care coordinator.

The National Stroke Association offers a fact sheet with an overview on choosing a stroke rehabilitation program, which you may want to review and save as you go through the discharge planning process.

We have created a “Discharge planning checklist for transition to rehabilitation” to help you with the key steps and questions when transitioning to an inpatient rehabilitation program after being hospitalized for a stroke, broken hip or any other acute care need requiring rehabilitation. This discharge planning checklist is a handy tool as you evaluate options and advocate for a good transition to help the patient have the most successful outcomes possible.

As the patient progresses through the rehabilitation process, the next steps will involve discharge planning for the longer term, whether the patient returns home living independently, with some support services, with a caregiver or home caregiver services, or moves to assisted living or a skilled nursing facility. An ongoing prevention plan is essential to reduce the risks of recurrent stroke. Patients should work closely with their medical team to understand modifiable risk factors and work to reduce them, as well as follow their personalized treatment plan (medications, diet, wellness/screenings and monitoring).

Need help or have questions? Contact at 727-447-5845 or online. Our expert patient advocates can help you:

Manage the hospitalization and advocate for the best use of services and benefits to maximize recovery;

Choose the best rehabilitation options;

Navigate your insurance and other benefits;

Coordinate the discharge plan and ongoing recovery;

Attend doctors’ appointments, serve as a liaison during your treatment and coordinate ongoing prevention;

Set up services according to your goals, wishes and needs.

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A Senior Living Checklist: Evaluating Assisted Living Facilities

When a senior and family make the big decision to consider moving to senior housing, evaluating the choices can be daunting. We have several resource articles and fact sheets on different levels of care in senior living and will be covering more of your questions on this topic in upcoming posts. Today we offer some valuable information that can help you more clearly evaluate assisted living facilities.

Florida’s Agency for Healthcare Administration (AHCA) describes assisted living facilities as places “designed to provide personal care services in the least restrictive and most home-like environment. These facilities can range in size from one resident to several hundred and may offer a wide variety of personal and nursing services designed specifically to meet an individual’s personal needs”. The state licenses and regulates assisted living facilities. They can operate under a standard license or specialty licenses which permit them to provide some additional services designed to help residents “age in place”. Each state regulates their own healthcare and senior living facilities, so check with your state about regulations, oversight and service levels.

You can find the Florida AHCA Assisted Living Unit information online. FloridaHealthFinder.gov is Florida’s healthcare facility portal, offering a search tool for assisted living facilities, home health care agencies and other providers. You can use the search tool and then click on the specific facility to see details such as license, owner/administrator, contact information, and inspection reports. Most states are offering this information online now for greater consumer transparency.

Here is a checklist, as well as tips and resources, that you can use as you evaluate assisted living facilities:

Review Aging Wisely’s free guide to “Choosing an Assisted Living Facility“. This concise one-page overview gives you a road map for how to approach the search–where to begin, how to prioritize and what factors can help you narrow the search. (As an example of why this is so vital, a quick search for all assisted living facilities in Aging Wisely’s home county shows 205 facilities.)

Understand your state’s regulation of assisted living facilities and what services are permitted. Make sure the facility posts its license and provides its most recent survey information. You can likely also do some research on this online before you get started to weed out any facilities with negative reports.

Now you need to get beyond the survey, which is really only a regulation tool to identify problems and sanction providers who do not meet essential requirements. It is vital to understand the management of the facility–its history and service, daily life and how well the facility operates from basic safety needs through life enrichment. There are a number of checklists for visiting assisted living facilities, but here we have provided you with some additional tips on getting the whole picture:

How interested is the staff in you/your circumstances? Do they focus on “selling” the facility to you without finding out about your needs/if the facility is really a good fit for you?

Talk to more than just the marketing staff. Successful sales and marketing professionals do a great job welcoming you and portraying all the great things about their assisted living community, but you need to know the staff who you will be dealing with more closely after you move. Ask to meet some of the management team such as a Director of Nursing/Nursing Supervisor, Resident Services Personnel and some care staff.

Are staff open and willing to help? Are they bothered by your request or rushed with you? Do various staff offer to help or greet you when you are visiting?

If you can meet and ask some questions of the care staff, you might want to ask questions like: what do you like most about your job, what is the hardest part, how long have you worked here/how or why did you get in to this type of work and what is the best thing about this facility. You can ask positive questions that will not necessarily make the person feel they are “on the spot” to reveal anything bad about the facility, but the answers may often be revealing in their own way.

Similarly, when talking to management and marketing staff, ask some less common questions. Talk to them about how they help with the adjustment period, what residents or families say is the one best thing about the facility or the hardest thing to get used to, or to give a recent example of a resident problem and how they resolved it.

Make several visits at different times. Facilities often invite potential residents for a meal, which is a nice way to check out the food. However, it’s also great to ask to attend an activity and come by at various times to see how things operate throughout the cycle of the day.

Cleanliness and upkeep can be outward signs of good management. Bad smells or major housekeeping or maintenance issues are potential warning signs.

Get recommendations and talk to others (residents, family members, friends who have evaluated facilities for their loved ones, trusted professionals). However, take input with some caution–others may have very different circumstances or expectations than yours.

You may need to rethink perceptions/priorities. Sometimes families (and potential residents) get “hung up” on the room size, especially when moving from a large home. Assisted Living Facilities are generally designed with your room(s) being more like your bedroom at home, with common living/dining/activity rooms, so it is a shift in thinking. The room may be important, but quality care and other factors trump square footage when it comes to the reality of life in assisted living.

As you can see, the process of thoroughly evaluating assisted living facilities to make this major life decision can be daunting. Many families find the help of a professional geriatric care manager invaluable in this process. Not only can a care manager assess your needs to ensure a good fit and the correct level of care, but he or she knows the facility “beyond the inspection”. Often the care manager (or team members) are working with current residents and get to see the day-to-day operations. But, even when that is not the case, the care manager’s expertise in helping elders through such transitions and advocating for assisted living residents provides you remarkable insight during the process.

There are different options for services that can help you evaluate assisted living facilities, including referral services which do not charge you. When considering these options, make sure you understand the parameters and experience/expertise of such providers. Typically, referral services are paid through a marketing arrangement with the assisted living facilities, whether a referral fee (which is not allowed by many states, such as Florida) or some other arrangement. This may limit which facilities are promoted to you. Additionally, you want to know the background and knowledge of the provider and their experience particularly in working with assisted living residents. Last, find out what the professional’s role can/will be during and after the transition.

A geriatric care manager is: hired by you as your advocate only, paid by the client/family and not marketing arrangements, able to help you negotiate and show you a range of options as appropriate to you, and available to help with any/all aspects of the transition and ongoing oversight and troubleshooting.

Need help evaluating assisted living facilities in the Tampa Bay area? Looking for an assessment to determine best care options? Just want to talk to someone about your situation and how to get started? Call us at 727-447-5845.

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Senior Care Conflicts: A Tale of Two Daughters

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

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

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

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

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

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

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

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

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

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

Tips for the long-distance caregiver:

Express appreciation for what your sibling handles on a day-to-day basis and consider the type of stress he/she may be feeling. Long-term caregiving on a daily basis is a chronic stress. The caregiver often gets constant phone calls about little issues, but also has to worry what crisis might be happening every time the phone rings.

Consider the skewed picture you might be getting. Aging parents have a way of pulling things together for visitors (or making things seem worse or complaining to one side, depending on the personality). Your parent’s story may not really be the full one.

Think about how you raise issues and how the language you use might be perceived. To come in to the situation where your sibling has had primary responsibility with harsh words can cause an immediate wall between you.

Realize that even if your sibling has willingly taken on certain duties with little complaint, paid for care or otherwise handled tasks, he or she may be feeling a little resentful of what may seem like a skewed burden.

Offer solutions, not just criticisms. If there is something you are concerned about, think about how you want to approach the issue first and do not bring it up if you don’t have a solution to propose (and a willingness to help with it).

Try to work out some significant time to offer respite care. It can help you to see the situation more fully, in addition to giving your sibling a break. But, when you come in to help think about how changes or criticisms might be perceived as well, and do some preparation with your sibling to help the respite time go as smoothly as possible.

Tips for the local senior caregiver:

Find ways to involve the long-distance caregiver. Can senior care providers share notes with both of you (“real time” communication–especially directly from providers–versus summarizing how things are going later can make a big difference)? What tasks can the long-distance caregiver do?

Try to give your siblings and aging parents time alone when they visit.

Consider holding family meetings–when senior care needs first arise and on regular intervals. You might want to engage a geriatric care manager to help guide the agenda and conversation. This could coincide with an evaluation, so everyone can get input and suggestions from an outside party.

Express what you might want or need from the other relatives. The family conferences above can be a good time to do this, and talk through feelings you have about the care situation. A geriatric care manager or qualified counselor can help you deal with your concerns and emotions and communicate effectively. In some cases, family mediation services may be needed.

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

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

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

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

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“Smoking” Hot Eldercare Issues: Nursing Home Resident Rights

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

Residents of a St. Petersburg, Florida nursing home recently staged a protest about rule changes related to smoking. The nursing home, Shore Acres Rehabilitation and Health Center, in St. Pete has recently changed their smoking policy to better address concerns they have about resident safety. Anyone who has worked in a nursing facility or assisted residents of an eldercare facility knows smoking can be a “hot” issue. Smokers feel passionate about maintaining their right to smoke and some amount of freedom, while a facility and its staff have a duty to balance residents’ rights with the safety and health of all residents. The changes at Shore Acres in St. Pete were spurred by a letter form the Center for Medicare and Medicaid Services (CMS) about a nursing home resident who recently died in a fire when her cigarette caught her clothing on fire.

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

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

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

As a nursing home resident or family member:

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

Prior to becoming a resident/choosing an eldercare facility:

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

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

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Community Spotlight on Clearwater Health Care: Clearwater Free Clinic

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

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

Clearwater Free Clinic Martinis and Matisse 2013

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

Here is the organization’s description from their website:

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

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

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

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

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

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

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A “What Not to Do” Checklist for Aging Parents

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

caregiver with headache frustrated

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

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

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

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

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

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

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

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A Primer on Florida Medicaid (and Medicare)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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