Mild cognitive impairment (MCI) and what you can do

Mild cognitive impairment (MCI) and what you can do

Mild cognitive impairment (MCI) is the medical name for memory problems that exceed the “normal forgetfulness of aging” but are less than associated with an Alzheimer’s diagnosis. If you have received a diagnosis of MCI, you are at risk for continued significant cognitive decline. Each year about 10–15% of persons with MCI receive an Alzheimer’s diagnosis, as compared to 1–3% of all older adults.

That said, many people with MCI do not experience further decline. And some people even improve–if their memory loss was caused by something fixable like a medication reaction or untreated depression. For all these reasons, it is important to have symptoms reassessed every 6–12 months to monitor changes.

There are things you can do. While there is no medical treatment as yet for MCI, some everyday activities can help prevent or slow its progression. The goal is to increase blood flow and oxygen to your brain, and keep your mind active.

  • Manage your blood pressure. Keeping blood pressure within the normal range has a profound effect on delaying memory problems.
  • Practice healthy habits. Get regular aerobic exercise, such as brisk walking. Aim for eight hours of sleep. Eat a diet low in processed foods and high in fruits and vegetables. Limit alcohol. Quit smoking. Manage other conditions (e.g., diabetes, depression).
  • Wear your hearing aids. A loss in hearing means a loss of stimulation to the brain. Studies now connect this loss with a decline in brain function. (Plus, some things you are “forgetting” may in fact be from conversations you didn’t fully hear.)
  • Participate in social activities. Even if you don’t talk much, the stimulation of spending time with others is beneficial.
  • Learn a new skill. Make your brain exercise! Try something you’ve never done. Brush your teeth with the “opposite” hand. Or have some fun: Ping-pong? Drumming?
  • Engage your mind with puzzles. This is brain calisthenics. Keep your neurons firing with activities that make you think.

Memory aids. Accept that you are forgetful and support yourself for success. Make ample use of to-do lists, big calendars, and notes or alarms on your phone. Leverage the power of routines. Put your keys and glasses, purse/wallet in the same place every time. Set yourself up for environmental cueing, consciously putting things where you will see them when needed, such as leaving your morning pills by the coffee maker.

Worried about MCI?
Give us a call. We can help. (208) 321-5567

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How to pay for care

How to pay for care

Most people are surprised to learn that Medicare pays for only a limited amount of the daily care you are likely to need in your lifetime (about 14%).

Medicare covers only services delivered by medically trained professionals. That means you need to have savings or insurance and rely on a collection of local programs. Or family and friends who may be able to pitch in with labor or funds.

Assisted living and memory care $$$–$$$$
As nonmedical services, these settings are usually paid for out of your own savings. If you are a qualifying veteran or you have long-term care insurance, your costs may be covered. Contact the Veterans Administration or state Veterans Council. Check your long-term care insurance policy for eligibility requirements. Also ask about waiting periods. Is there a lifetime cap on the total amount they will pay?

Skilled nursing/rehab or nursing home $–$$$$$
Provided your stay follows a qualifying hospitalization, original Medicare—the government’s health insurance for seniors—will typically cover some portion of the costs for the first 100 days. You use your supplemental insurance for your copay. Or pay out of pocket if you do not have supplemental insurance. Starting day 101, you pay 100% of the cost. Medicare Advantage plans vary, so review the coverage with your insurance provider. If you have private long-term care insurance, check your policy for skilled nursing coverage. The Veterans Administration offers special facilities for qualifying vets.

The very poor may qualify for Medicaid. This program will pay 100% of costs. However, there are only a limited number of Medicaid openings available in any given facility. Those living long term in a nursing home usually exhaust all personal savings and assets. Then they switch to Medicaid. If you think you may need Medicaid, consult an elder law attorney early. Also, your financial planner for advice about liquidating your assets.

Continuing care retirement communities $$$$$
This is a very different model of care that merges housing and insurance. With a continuing care retirement community—also known as a “Life Plan Community”—you invest a substantial sum up front (often in the six figures). You also pay a monthly service fee. Start while you are healthy and live on campus to enjoy the deluxe amenities. Move to the most appropriate building as your care needs change. This is paid for almost entirely out of your own savings. If you have long-term care insurance, check your policy to see if it covers continuing care retirement communities.

Worried about paying for care?
Give us a call at (208) 321-5567.

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Choosing a long-term care facility

Choosing a long-term care facility

Judy had an emergency hip replacement after a fall. She needs to be discharged tomorrow to a skilled nursing facility. She needs several weeks of intensive physical therapy to be able to walk again. Then she may need to live in assisted living.

The discharge planner has a list of options. Judy and her daughter, who lives an hour away, don’t know how to make a wise choice.  

For short-term, urgent needs, you may be at the mercy of which facility has an opening at the time.

It pays to consult an Aging Life Care™ Manager who knows the reputation and personality of the local institutions. It’s best to have a relationship with the Aging Life Care Manager before you have an urgent need. He or she can combine extensive knowledge of local resources with a thorough understanding of your medical history, your insurance and financial resources, your personality and preferences, and your social support system. As a result, you are more likely to get a match that will help you maintain good spirits and enjoy a speedy recovery.

Review all your options
Unlike “free” referral agents, an Aging Life Care Manager will present all the choices that make the most sense for your needs and personality. Not just the communities that are willing to pay a kickback referral fee.

Such independence is even more important for long-term living situations
Choosing an assisted living community, a CCRC, or a memory care facility is a big decision. You want to get a good match from the start.

Touring these communities can be daunting
A Google search delivers a dizzying array of choices. They all put their best foot forward. But architectural features and social amenities are only superficial measures of quality. An Aging Life Care Manager has had other clients who live in these facilities. He or she has a firm grasp on deeper metrics, such as the tone of the administrative leadership, the training and stability of the staff, the solvency of the company, and the overall personality of the community.

An Aging Life Care Manager also knows current conditions in the market that can save you money. For instance, if a community happens to have a lot of openings, a lower monthly rate or entry fee could be negotiated. A “senior housing advisor” paid a commission by the community would not be able to serve as your advocate in this regard.

Looking for unbiased recommendations based on all your options?
Give us a call at (208) 321-5567.

Learn more about our aging life care planning services.

Assembling your support team

Assembling your support team

Much as we would like to imagine an elderhood free from troubles, the truth is, we are all likely to need help eventually. And on several levels.

Informal support. This is the kind of help that friends and family members can provide short term. Someone to run errands or mow the lawn, etc. Make a list of the

  • people you feel emotionally close to
  • people who live close by who are reliable

When the going gets tough. If you were hospitalized, who would you call to

  • make medical decisions for you if you were unable to speak for yourself
  • pay bills or perhaps even manage your financial affairs long term

Your health care team. Medically trained support:

  • Your primary care provider and any specialists
  • Your pharmacist
  • Allied health providers (e.g., therapists, home health)

Professional advisors

  • An elder law attorney for important documents. You will need an attorney to set up a trust or will for dispersing your assets after you are gone. Or, if you have no relatives, to arrange for a guardian to make medical and financial decisions for you when you can no longer do so yourself. In addition, an attorney can review contracts and catch important details about senior housing. And an attorney’s advice is critical if you are considering a reverse mortgage or spending down your assets to be eligible for Medicaid.
  • A financial planner to manage assets and strategize to liquidate them to pay for care.
  • A CPA to highlight the tax implications in any of the above situations.
  • An insurance broker for prescription, Medicare supplemental, life insurance, etc.

An Aging Life Care™ Manager. The choices are boggling when it comes to assembling your team. It’s difficult to assess quality of professionals or compare pricing. An Aging Life Care Manager is a “meta-advisor” whose experience can help you choose your team wisely and coordinate whom to call when.

Want help assembling your team? Give us a call at (208) 321-5567.

Learn more about our aging life care planning services.

Paying for care at home

Paying for care at home

How you pay for care at home depends on whether the service is by medically trained staff or by nonmedical caregivers. Also, what you can mix and match in terms of community programs and help from friends and family.

Medicare pays only for care in the home that requires the skills of a nurse, nursing assistant, physical therapist, or other medically trained professionals.

Home care $$–$$$$
The cost of nonmedical home care is NOT covered by Medicare. As a result, you must contract directly with providers. Fees depend on how many hours a week your care requires.

Consider that caregivers coming to your home need a livable wage. Add to this agency costs of staff recruitment, vetting, training, and scheduling. The price can mount up quickly.

  • Long-term care (LTC) insurance. These policies can be purchased privately and are the least expensive when begun in middle age. Typically, to draw upon the insurance, you must pay for home care services out of pocket for a waiting period. Insurance will contribute afterwards and pay up to the lifetime cap. Check policy details.
  • Veterans assistance. For qualifying vets who saw active duty with at least one day during a war, there may be benefits available to help with the costs of home-based care.
  • Personal savings. Consult with a financial planner and elder law attorney to determine the best strategy for liquidating assets to cover your care.

Adult day care $–$$$
You must pay privately. Many programs are run by nonprofits so are underwritten by donations and grants. Medicaid, LTC insurance, and veterans benefits may also help.

Home health and hospice $

  • Medicare. This is typically deducted from your Social Security check and will cover home health services (80%) and hospice (often 100%).
  • Supplemental insurance. This is insurance you buy to cover the 20% balance not paid by Medicare.
  • Medicaid. Those with VERY low income and minimal assets may qualify for state government support. The eligibility requirements are stiff. Coverage includes 100% of most medically trained care, with some restrictions. Coverage for nonmedical care is spotty and varies by county.

We can help you sort out your options.
Give us a call at (208) 321-5567.

Learn more about our aging life care planning services.

Age-friendly bathroom remodels

Age-friendly bathroom remodels

Activities that are easy now may become more difficult in the future: Going up and down stairs, standing up from sitting, getting in and out of the tub, catching your balance if you start to slip. . . . As you consider aging in place, it is wise to keep these issues in mind, particularly about the bathroom.

Structural considerations. To eliminate the need to climb stairs, the ideal is a full bathroom on the main level of the house. In addition, as we age, the likelihood of needing support increases. Whether a wheelchair or walker, or a spouse or paid caregiver is providing assistance, a spacious room is best.

Did you know the bathroom is the most dangerous room in the house? Eighty percent of falls occur in the bathroom on hard, sometimes slippery surfaces. Most falls occur in the process of sitting down on or getting up from the toilet, or getting in/out of the bath/shower.

Bathtub or shower? The most versatile design involves a water-friendly, nonslip floor with a drain, and no hard curb around the shower area. This allows for rolling a wheelchair into the shower and provides room for a helper. Even without such a radical makeover, it’s easy to install a handheld showerhead and a built-in or portable bench in an existing bathroom to create a seated shower option.

If you need to soak—great for achy arthritic joints—consider a walk-in tub. These tubs have a watertight seal on a side door that allows you to walk in, sit on a bench, and then fill the tub to the desired height. Or have a dip cut into the side of an existing tub to lower the height for ease of stepping in and out.

Toilets and bidets. Purchasing a high toilet or adding an extender that raises the sitting surface greatly reduces the physical challenges of sitting down and getting up. Many people find a bidet adds to convenience and cleanliness. (Twisting to wipe our nether regions becomes more difficult with age.) Rather than ask for help, cleaning with water can improve hygiene while preserving dignity.

Other fall prevention strategies. You don’t need a full remodel to improve safety. Installing grab bars beside the toilet and within and outside the bathing area is an easy and effective modification. Grab bars must be attached securely to the studs of the wall and be able to support 250–300 pounds. Installing nonslip flooring or applying antislip floor coatings for higher traction is also wise. Increased lighting will help visibility and reduce falls. In addition, lights installed on the wall instead of on the ceiling reduce the need to get on a ladder, and possibly fall, when changing a bulb.

How age friendly is your bathroom?
Give us a call at (208) 321-5567.

What is an Aging Life Care™ Manager?

What is an Aging Life Care™ Manager?

Imagine your life as a movie. If you are the director, an Aging Life Care Manager is your production manager.

He or she is a deeply knowledgeable guide (usually a nurse, social worker, or allied professional) who finds you high-quality help, arranges care “locations,” and advises you about needed services.

Aging Life Care Managers are part of a national organization with training requirements, codes of ethics, and a nationwide network of experienced colleagues in case you need to move to a different part of the country.

Specialized knowledge and skills
Aging affects all aspects of life, so an Aging Life Care Manager draws upon many areas of expertise:

  • Advocacy. Communicating with doctors and navigating the very confusing eldercare network to get you the care you want.
  • Health and disability. Conducting an assessment and making recommendations so you and your family members can rest assured that a plan is in place if you need extra help.
  • Local resources. Recommending area service providers. Anyone can Google. But an Aging Life Care Manager intimately knows quality and reputation and can match best services for your budget and priorities.
  • Family. Helping relatives understand their role and work together to support your wishes.
  • Housing. Providing independent recommendations for the best fit based on your needs, priorities, and resources. No kickback referral fees that limit your choices.
  • Legal. Assembling needed paperwork and referring you to reputable attorneys as needed so you are well covered by a professional team.
  • Finances. Reviewing your options to identify eligibility for programs and ways to stretch your dollar wisely.
  • Crisis support. Helping you create a safety net you can depend on in emergencies.

As the director of your later years, how do you want your story to unfold? While not all of it is within your control, you do have agency. With planning, there is much you can do ahead of time to prepare for the elderhood you want and create a network to support it.

Would you like a guide for aging well?
Give us a call at (208) 321-5567.

Learn more about our aging life care planning services.

Social Security and the newly single

Social Security and the newly single

Life has a way of throwing us curveballs.

The unexpected death of a spouse—or a divorce—can certainly wreak havoc on your emotions. It can also throw a wrench in your finances.

If you are age 62 or older, here are some Social Security basics to bear in mind as you regain your financial footing or make contingency plans.

Survivor benefits. If you find yourself widowed after at least one year of marriage, then you are eligible to receive monthly survivor payments.

Did you also work outside the home? If so, you can choose the higher of the two benefits: yours personally; or as a surviving spouse.

Before deciding, confirm the amount for each one for three points in time: collecting now; waiting until age 70; or at your designated retirement age (as determined by Social Security). While you cannot receive both benefits at the same time, you can strategically claim the highest one now and then switch to the one that becomes higher later.

Spousal benefits. A divorce does not erase the contribution you made to the household. As a formerly married spouse, you are eligible for Social Security benefits based on the earnings of your breadwinning partner. As long as you were married for 10 years or more, you have earned spousal benefits.

Receiving spousal benefits does not affect what your ex will receive from Social Security. What’s more, your ex does not need to know, give permission, or sign any papers. All you need to provide is the marriage certificate, divorce papers, and your ex’s full name.

If you were also employed and are eligible for your own Social Security benefits, investigate which benefit will pay more: now; when you turn 70; or at your designated retirement age. Unlike survivor benefits, you cannot switch benefits at a later date. Decide when is the best time to apply, and choose the larger amount.

It’s important to make a fact-based decision. The difference in monthly payments, added up over many years, could mean there are thousands of dollars at stake. There are many more details than we can cover here, including information about benefits in same-sex marriages. Consider working with a certified financial planner who can run the various calculations for you and suggest the wisest strategy. There’s too much to lose to depend on Social Security staff for detailed guidance.

Find yourself suddenly single?
Let us help you get reoriented. Give us a call: (208) 321-5567.

Learn more about our services for aging well.

What Services Do In-Home Caregivers Provide?

What Services Do In-Home Caregivers Provide?

In-home caregivers come to the home to help with activities daily living, such as light housekeeping, grocery shopping, meal preparation, medication reminders, and grooming. And while home health care aides can also provide personal care assistance, the opposite is not true (personal care assistants can not provide in-home health care).

Some of the options for in-home care and home health care services can be found below. 

Home Care Services

Personal care assistants do not provide medical care, but otherwise, care can be tailored specifically for each individual’s needs. Available services include: 

  • Assistance with ADLs
  • Assistance with mobility
  • Grocery shopping and meal preparation
  • Housekeeping and cleaning services, including laundry
  • Transportation to doctor’s appointments, social activities, and more
  • Companionship, social engagement, and cognitive stimulation 
  • Medication management (but not administration)
  • Respite for family caregivers

Home Health Care Services

Home health care aides provide more skilled medical care than personal care assistants. The care one receives will depend on their own medical needs, but available services include: 

  • Skilled nursing, first aid, and wound care 
  • Post-surgery recovery care
  • Physical therapy
  • Occupational therapy
  • Respiratory therapy and assistance with oxygen tanks and tubing
  • Assistance with maintaining and cleaning feeding tubes, catheters, and other medical devices
  • Medication administration, including injections 
  • Assistance managing and monitoring chronic conditions
  • Blood withdrawals

How Much Does Home Care Cost? 

According to the Genworth Financial Cost of Care Survey, in-home care costs about $24 an hour. That comes out to $1,950 per month for 20 hours of care a week, or $3,900 per month for 40 hours of care per week. Home health care is slightly more expensive at an average rate of $25 an hour. 

These figures are the national average, so average costs in your state or city may be quite different. For example, in Vermont, where senior care tends to be more expensive than the national average, 20 hours per week of in-home care costs an average of $2,362 per month, about $400 higher than the U.S. average. Meanwhile, in Louisiana, the same amount of in-home care costs just $1,463 per month, on average.

Financial Assistance for In-Home Care

It’s always an option to pay out-of-pocket for in-home care, but many people utilize some form of financial assistance to make the cost more manageable. Below are some of the most commonly used resources available to pay for home care. 

  • Long-Term Care Insurance: Standard health insurance will not pay for personal care assistance, but some long-term care insurance policies may. While long-term care (LTC) insurance policies are specifically designed to cover senior care, the exact coverage details can vary depending on several factors, most notably the age of the beneficiary when they signed up for their policy. LTC insurance oftentimes will not cover in-home care until the client needs help with at least two ADLs. Check the details of your loved one’s policy to see if in-home personal care assistance is a covered benefit.

  • Medicare: Original Medicare does not cover standard in-home care as it is considered “custodial care” and not medical. However, it may cover personal care assistance if it is delivered with home health care services from the same provider. Additionally, some Medicare Advantage and Medicare Supplement plans may cover in-home care services.

  • Medicaid: Medicaid does not cover custodial care, which includes standard in-home care. However, many states have some form of Home and Community-Based Services (HCBS) waiver, designed to expand the state’s Medicaid benefits to cover additional services such as personal care assistance. Medicaid does always cover home health care for those who meet both medical and financial eligibility requirements.

  • Life Insurance: Though one’s life insurance benefit is intended to be accessed after they pass, in some cases it makes more financial sense to access the funds early and use the life insurance payment to finance long-term care. This may be in the form of an “accelerated death benefit” from the insurance provider, or you may look into selling the policy to a third-party for a cash payment. Look into the specifics of your loved one’s policy to see if this option makes sense for your situation.

  • Veterans Benefits: In addition to a VA pension, some veterans are eligible for the Aid and Attendance (A&A) benefit, an additional monthly payment intended to be used towards paying for long-term care. One of the eligibility terms is needing help with one or more ADLs, so most veterans in need of in-home care will likely qualify. You can learn more about the benefit and apply directly on the VA website, or apply in person at your local VA office.

  • Reverse Mortgage Loans: Reverse mortgages are a loan that one can take against the value of their home, essentially converting part of their home’s value into a cash payment while they continue to live there. The only federally-insured, and thus most reliable, form of a reverse mortgage is the Home Equity Conversion Mortgage (HECM), available to adults age 62 and over to help finance long-term care or other expenses. No matter which type of reverse mortgage one chooses, the loan will need to be repaid with interest once the home is eventually sold. 

Source: Caring.com

THE ART OF ACHIEVING BALANCE

While we all know there is no such thing as a unicorn, that does not stop us from writing stories, creating cartoons, and other fairy tales about them.  Nor is there concrete evidence that the Loch Ness Monster exists, and yet that tale persists. I have a friend who believes that he has seen Sasquatch. I would also add the concept of Time Management to this list of things that do not exist, yet people continue to dwell on it.

I firmly believe that time management is an illusion that a great many people pursue, but like a cloud in the sky, can be seen but never touched. I state this as an affirmation because I know that time simply cannot be managed. We can prioritize and micro-schedule, but we all receive the same 24 hours each day, the same 168 hours each week. Sixty seconds to each minute, sixty minutes to each hour. It is a law, and like all laws of nature and man, needs to be respected. Success follows when we are obedient to laws over which we have no control.

I recently had a conversation with a producer who spent twenty five minutes lamenting at how poor he is at time management. After listening to him ramble (his choice of words) for those twenty five minutes, he ceased, and it was my turn. I immediately pointed out to him that he had referenced ‘time management’ some seven times in those twenty five minutes, and that he should not be so self-deprecating because of an inability to manage something as illusory as time. I shared with him that we have as much chance of managing time as we do of touching a cloud. Just last week, I sat on the modern miracle of jet planes, looked out the window at approaching cloud banks, and realized that as we were flying into them and through them, that there is never any tangible contact. Yes, there is condensation on the outer surface of the plane, but for the passengers, it is largely an illusion.

At the conclusion of my agent session, I made that suggestion to him that rather than attempting to manage something that is simply unmanageable, that he would be better served if he focused his efforts to achieve happiness and success by attaining balance in his life, and being proactive rather than unbalanced and reactive.

A series of conversations with this same producer as well as several others led me to share that achieving balance in one’s life is really a series of choices that we must make every day, to wit:

  • It is about organization, not about making excuses.
  • It is about exercising discipline and being diligent.
  • It is about avoiding a state of inertia and rising above it.
  • It is about prioritizing our activities, not managing the time.
  • It is about never uttering “I’m sorry” when it comes to owning your business.

A long term care advocate can be successful by working an honest 40 hours per week. Yes, you heard it right. Not sixty or eighty hours, but only 40. An honest, yes, there is that word again, forty hours WILL make an advocate successful at the Leading Producer level if he or she employs the above tools.

  • It is about working smarter not harder.
  • It is about creating and maintaining balance in the various spheres that comprise our lives — family, professional, personal, spiritual, physical, recreational.
  • It is about maximizing — not managing — the 168 hours that we are granted each week.
  • It is about focus.

Some life lessons gleaned over the years.
More than a few years ago, I learned “Focus on everything is focus on nothing.” You simply cannot spread yourself so thin and expect to remain focused enough to accomplish anything at a level equating to success. That is a formula for mediocrity.

Second, what is your time worth? Only you can assess this and assign a value. It is important to remember and to discipline yourself so as not to chase meaningless opportunities.

Third, it is about answering the question: “Am I investing my time, or merely spending it?” Time invested in an activity such as reading to your grandchildren or family history and genealogy would surely trump the time spent playing Fortnight or spending hours on Facebook or Pinterest. Sorry, I am neither a gamer nor a social media junkie.

Simple math:

  • 40 hours of work (five 8-hour days or 4 10-hour days — it does not matter) broken down as follows:
    • 4 hours education (workshops, webinars, conference calls, self-study)
    • 5 hours marketing
    • 8 hours scheduling appoints
    • -20 hours of appointments
    • 3 hours of administration
  • 49 hours of sleep (achieving the optimal 7 hours per night)
  • 6 hours of physical exercise (six 1-hour sessions Monday-Saturday)
  • 7 hours of personal spiritual time (1 hour daily – scriptures, prayers)
  • 3 hours of church worship
  • 7 hours of service (extended family, neighbors, friends,)
  • 14 hours of recreation (2 hours daily).
  • 8 hours date night with significant other (Friday and Saturday)
  • 21 hours of family time (for those who do not have immediate family, this could be phone, Skype, FaceTime, letter writing, etc.)
  • 4 hours of maintenance and housekeeping

Leaves a reserve reservoir of 9 hours, and we were generous with some of the above allocations.

These categories can be combined; a family activity that involves hiking or skiing would encompass family time, recreation, physical exercise, etc.

You work for yourself, which means that you are primarily accountable to yourself. To this end, the first question that you must ask, and answer is “Would you have hired you in the first place?” Follow up questions should then include, “Are you measuring up?” “Would you not fire you based on your current performance if it was coming from someone else?”

Remember that when performance is measured it improves. When it is measured consistently, it improves exponentially. So, stop managing something that is not manageable and focus on the greatest resource you have in your possession: YOU.

“All good performance starts with clear goals.” – Ken Blanchard.

Source: Age Gracefully America  Written by: Don Levin