Senior Fall Prevention

Older Americans Act Reauthorization

Falls among seniors are incredibly common, and can cause serious injuries. According to the Centers for Disease Control and Prevention (CDC), some 2.5 million adults aged 65 and older in the United States are treated for fall injuries every year. Each year, three million older adults go to the ER for injuries due to falls.

And in a2015 Caring.com survey of 2,000 adults, the more than 500 respondents with a parent or grandparent living alone or with a spouse said they were concerned for those aging relatives’ safety.

Senior Fall Prevention

Source: Centers for Disease Control and Prevention

Falls can have serious consequences for the elderly. They can cause injuries such as broken wrists, arms, ankles, or hips, and are a leading cause of head trauma. At least 300,000 older adults go to the hospital each year for hip fractures – most of which are due to falling, according to the CDC, and the majority of which will not health well if at all. In 2015, falls cost more than $50 billion, most of which is paid out through Medicare and Medicaid.

Even if your aging parent falls with no injury, they (and you) may become more afraid of falls – which can lead to a decrease in necessary activities such as walking, exercising, and going out with friends and family. This decrease in activity can actually lead to muscle weakness – and increase fall risk.

To help you protect your elderly loved ones from these effects, we’ve put together a helpful guide to help you understand how and why older adults fall, how to prevent falls and what to do after a fall.

  • Causes of Falls Among Elderly Adults
  • Common Consequences of Falls
  • Lifestyle Changes That Can Help Prevent Falls
  • Home Safety Measures for Fall Prevention
  • Medical Alert Systems and How They Can Help After a Fall
  • What to Do in the Event of a Fall

Causes of Falls Among Elderly Adults

Risk factors for falling include:

  • Weakness, especially in the lower body
  • Loss of bone mass that can weaken bones
  • A lack of vitamin D
  • Challenges walking and balancing
  • Using medications that affect balance or may cause dizziness
  • Difficulty seeing clearly
  • Difficulty seeing at night
  • Painful feet or shoes
  • Neuropathy in the feet
  • Blood pressure dropping as an older adult moves from sitting to standing
  • Dementia
  • Hazards around the home, including broken steps, broken or missing handrails, lack of lighting, and tripping hazards
  • Alcohol consumption

Many people have a combination of these risk factors which can lead to falling.

Common Consequences of Falls

When older adults fall, they and their loved ones may be surprised by the severity of the consequences. Falls that once might only have left a bruise and wounded pride can lead to serious injury, fractured or broken bones, or brain injury in your aging loved one. Consequences of falling include:

  • Scrapes, sores, and other wounds
  • Fractured bones
  • Broken bones
  • Head injury
  • Fear of future falls

Unfortunately, injury from a fall can lead to a cascade of events which reduce an older adults independence. The majority of hip fractures in older adults do not heal, according to the American Academy of Orthopaedic Surgeons, and can lead to a move to a residential facility. Prevention of falls, and thorough care after a fall, can help aging loved ones maintain their independence longer.

Fear of a fall can lead to a separate set of challenges. Once your aging parent becomes afraid of a fall, she may avoid many situations that seem dangerous. She may cut back on exercise, socializing, or leaving the house. Although these actions may seem like the safest choices, they can make your loved one weaker so that a fall becomes even more dangerous.

Lifestyle Changes That Can Help Prevent Falls

While the risk of suffering a fall increases with age, that doesn’t mean it’s unavoidable. In fact, there are a number of lifestyle changes older adults can make to lower the risk of a potentially life-altering spill.

Senior Fall Prevention

1. Staying Physically Active

Your aging loved one should be engaged in regular, daily exercise that is appropriate for their physical condition. Exercise helps to build muscle strength and can improve flexibility. Aim for a mix of aerobic activity, such as walking, and weight-bearing activities, to keep muscles conditioned. Learn more about chair-based activities, water-based activities, and group fitness activities that not only strengthen the body but keep individuals socially connected.

2. Maintaining a Healthy Weight

Many older adults find their appetite decreasing, and they become underweight. Losing too much weight puts their bones at risk.

3. Quitting Smoking

Smoking cigarettes is correlated with losing bone mass more rapidly. Encourage your aging parent to protect their bones strong by giving up cigarettes.

4. Eating for Healthy Bones

Make sure your loved one is eating a healthy, varied diet and getting plenty of vitamin D and calcium. Talk to his doctor about whether he needs supplements to bolster bone health.

5. Staying Hydrated

Dehydration can make older adults weak and dizzy. Provide plenty of fluids in beverages, soups, fruits, and treats such as popsicles.

6. Limiting Alcohol

As people age, alcohol can have an even greater impact on blood alcohol levels than in the past. Research shows that the more alcohol older adults drink, the greater their risk for hip fractures. Drink minimally if at all, and make sure your aging parent is in a safe situation where she will not be at risk for falling.

7. Getting Enough Sleep

Your aging relative’s sleep needs change with age, but sleep deprivation always increases risk of falling. If your loved one is having difficulty getting the sleep he needs, talk to your doctor.  

Home Safety Measures for Fall Prevention

Despite their concerns, more than half of respondents to Caring.com’s 2015 Fall Prevention Survey said that their senior loved ones living alone lack a number of basic in-home safety items. Features such as raised toilet seats, entrance ramps and shower grab bars can help prevent unintentional falls, while emergency response systems make it easier for seniors to call for much-needed help in the event of a fall.

Senior Fall Prevention

Source: Caring.com Senior Fall Prevention study, 2015

1. Understand what you’re dealing with

Identify, with a doctor’s help, which risk factors for falls your loved one has, besides dementia (which is itself considered a risk factor). The list varies by individual, but for many people with dementia these include such common problems as poor eyesight, poor balance, arthritis, and generalized frailty. People with dementia may also have a shuffling gait, muscle weakness due to past stroke, or neurological problems.

2. Minimize or avoid medications that have been linked to increased falls

Review a complete medication list with the doctor, and ask which ones might cause increased confusion or worse balance in a person with dementia. Medications to especially look out for include drugs from a class known as anticholinergics, which includes drugs for overactive bladder, itching/allergy, vertigo, nausea and certain drugs for nerve pain or depression.

Diphenhydramine, or Benadryl, is a commonly used anticholinergic that’s often included in over-the-counter sleep aids and PM-version painkillers. People with dementia are also more likely to fall when taking sedatives, tranquilizers, and antipsychotics. Finally, blood pressure medicines can sometimes work too well and cause blood pressure to fall when a person stands.

3. Ask the doctor about leg strength, gait, and balance evaluations

These tests help determine physical risk factors. A doctor (or a physical therapist, to whom you may be referred for testing) will watch whether your loved one uses both hands to rise from a chair, for example, which indicates muscle weakness.

4. Ask about vitamin D supplementation

Many (but not all) older adults are deficient in vitamin D. Studies have found that treating vitamin D deficiency does reduce the chance of future falls. The doctor can help identify the right supplemental dose

5. Ask about osteoporosis

Senior Fall Prevention

Whether or not they also have dementia, adults with osteoporosis are more likely to suffer injuries if they do fall. Note: Both older men and older women can suffer from porous bone. But since osteoporosis is more common in women, all women over age 65 should be screened at least once.

6. Consider asking for a referral to a physical therapist or occupational therapist

These experts can work with your loved one to develop exercises that shore up weak spots. They can also evaluate the use of a cane or walker to see if the device (as currently being used) is more help or hindrance. Because forgetting to use devices is a common problem with dementia, a therapist may suggest ways to get around this.

7. Make sure your loved one has an annual eye exam

Low vision is a huge risk factor for falls, and many vision problems come on gradually but steadily. Some, like cataracts, are easily treatable. Also be cautious with bifocal glasses; although they’re convenient, one study found increased falls when people wore bifocals compared to monofocals, possibly because bifocals can make it harder to gauge depth and steps properly.

8. Keep up with foot care

Trimmed nails help people walk more comfortably and therefore properly, yet this is an often-overlooked aspect of eldercare. A podiatrist can also check out other foot-pain issues that may be affecting gait and balance.

9. Get a home-safety assessment

Social workers and geriatric care managers routinely perform these. An expert comes to the person’s home and targets danger spots (including fall risks) and suggests easy improvements. This assessment can focus specifically on the needs of someone with dementia.

10. Consider exercise classes

If your loved one is capable, consider an exercise class to improve strength and balance, such as tai chi or yoga for seniors. Even people with dementia can benefit. Bonus: It might be something you can do together, getting you out of the house.

11. Make sure slippers and shoes are safe and stable

Discourage walking around in stocking feet, loose slippers, or flimsy open-heel styles. Overlooked footwear dangers include new shoes with smooth, unscuffed soles and walking shoes with heavy treads that “catch” on carpets.

12. Remove tripping hazards around where the person walks

Scatter rugs are a top tripper, for example. In the bathroom, you can lay a towel or rug in front of the tub or shower when the person is exiting, if the floor is cold; then pick it up right away.

Also tame unruly extension cords. Better than taping them to the floor is to remove them altogether. Remove piles of old newspapers and magazines and other clutter.

13. Maintain good household lighting

Poor vision is a leading fall-maker. Watch for darkened hallways and stairs that might need more light. Replace burned-out bulbs.

Don’t forget night lighting. Keep the night path to the bathroom lit. Consider using holiday lights, spaced nightlights, motion-detector lights, or simply leaving the hall or bathroom light on.

14. Install grab bars in showers, bathtubs, and near toilets

These allow your loved one to catch him or herself in a fall. Regular towel bars are insufficient; they can be pulled off the wall if grabbed during a fall, often worsening the accident.

15. Brainstorm ways to limit the potential hazard of pets that cause falls

For example, you might consider whether a pet could be limited to one area of the house, or let it wander freely only under supervision. Beware of chew toys and bones that get scattered on the floor, too. Children’s toys can be another hazard.

Medical Alert Systems and How They Can Help After a Fall

Senior Fall Prevention

Your aging parent has a number of options for medical ID and medical alert systems that could facilitate them getting help quickly after a fall. At the most basic level, an older adult may want to wear medical ID jewelry that provides first responders and others information about their medical condition, in the event of an emergency or loss of consciousness in public.

A smartphone is an option in a pinch, however your aging parent might not have their smartphone with them when they fall or a fall might either break the phone or cause your loved one to be unable to use the phone. So you may want to consider other options that can either sense a fall or be as easy to use as pressing a button in the event of a fall.

If you are concerned about falls, your family may want to move to more advanced monitoring systems. You have a number of options in this category, and you will have to answer a number of questions in order to find the best possible system for your family:

  • What is your budget? Each service offered by a medical alert system may have an added monthly fee.
  • Do you want home monitoring or mobile monitoring, or both? If your aging parent needs a device to carry with them while they are out and about, that will be additional to home monitoring. However, an older adult who is homebound might not need a portable option.
  • Do you need a system that works well for the hearing impaired? If your loved one has hearing impairments, make sure the system you need works well for those who do not hear well.
  • Do you want 24-hour monitoring? This is particularly useful if you are concerned that your loved one may fall at night and will need an immediate response. Unmonitored systems are set up so that when your loved one signals that they need assistance, select friends and family will be called automatically to come to their aid.
  • Do you want a fall-detection option? Medical alert systems may not automatically include fall sensing equipment. You might have to ask for – and pay for – this added option.

Comparison shop to find the option that suits your aging loved one best. If possible, involve them so that they can let you know what device they will be most comfortable using.

To help you in your search, visit our comprehensive guide to the Best Medical Alert Systems for Seniors.

If your aging loved one lives independently, you also may want to check in with them daily – or ask friends, neighbors, postal workers, health aides, members of their faith community, or others who are in their neighborhood frequently to check on them regularly. If your loved one lives in a residential facility, talk to the facility managers about how they find out about falls that happen in their residents’ personal living areas.

3 Crucial Steps to Take After a Fall

Senior Fall Prevention

Your decision about what to do after an elderly loved one experiences a fall will depend on the situation. First, encourage your loved one not to try to get up immediately after a fall. It’s best to try to sit up slowly and possibly crawl to either a chair to pull themselves up, or to a phone to call for help.

1. Call 9-1-1

Certain signs indicate a medical emergency that requires immediate attention. Call 911 if:

  • The person is unconscious.
  • The person is having difficulty regaining consciousness.
  • There’s an obvious fracture.
  • The person is in a lot of pain.
  • Something about the nature of the fall warrants concern about spine or neck injury (for example, falling down the stairs or an inability to move).
  • You notice signs of an acute medical problem that could have caused the fall, including chest pain, shortness of breath, or signs of stroke.

2. Visit the Doctor the Day of the Fall

Some falls don’t warrant an ambulance but require medical care because they may lead to complications if not treated.

Get same-day medical treatment from your doctor or a walk-in clinic if:

  • The person has hit his or her head. Older adults are at higher risk for bleeding between the brain and the skull after a head trauma. A CT scan of the head is therefore wise after any head injury. This is critical and requires immediate medical attention if there’s also a worsening headache, nausea, vomiting, or a change in mental status or neurological abilities.
  • There’s been a cut that might require stitches or additional attention. A more minor abrasion can be treated the same way you’d treat one in a child: Wash it, apply antibiotic ointment, and cover the wound.
  • The person reports significant pain in any bones or joints, which could be signs of fracture or bleeding in a joint.
  • The person is no longer able to walk (but could before the fall).
  • The person has less mental or physical function than before the fall (for example, is more confused than usual or has a reduced range of motion).

3. Get a Medical Evaluation

You will likely need a medical evaluation after a fall. If a person is hurt in a fall, the first medical evaluation will probably focus on assessing the injury. Make sure a prompt follow-up appointment is scheduled to further evaluate the possible causes for the fall and to talk about how to prevent future falls.

Here’s what a thorough medical evaluation will likely cover. If the doctor overlooks certain points, don’t be shy about asking why. You can expect:

  • An assessment for underlying illnesses
  • A blood pressure/pulse reading when standing and sitting
  • Bloodwork
  • Review of medications
  • Gait and balance assessments
  • Physical exam to look for underlying heart or neurological condition
  • Vision exam
  • Foot exam
  • Home safety assessment

These evaluations may lead to some solutions that can help prevent future falls. For example, treating illness, giving supplements to address a nutritional deficiency, or adjusting medication can help your aging parent be steadier on their feet.

Some of these evaluations may require visiting more than one medical professional, such as an eye doctor or a podiatrist, or inviting a physical therapist into your home to help make your surroundings safer.

Source: Caring.com

Create Your All-Star Care Team in 5 Steps

In this country, there is a growing problem regarding a lack of supportive resources for family caregivers. There are government programs, charities and nonprofits that might be able to help intermittently, but what caregivers often need most is sound advice, regular respite and an extra set of hands.

Friends may scatter when one begins caring for a spouse or parent, and not everyone has siblings or other family members they can depend on to share the load. It is crucial for each caregiver to take inventory of their personal supports in order to utilize their help as efficiently as possible. A carefully selected care team is a necessary complement to a loved one’s plan of care. Use these five steps to build your team.

Step 1: Draft a List of Prospective Team Members

Write down the name of each family member, friend or neighbor that you interact with on a regular basis. Forego any initial judgements or doubts about their usefulness in your care plan. You want to avoid limiting any potential sources of assistance from the very beginning, so just let the ideas flow.

Step 2: Assess Each Individual’s Strengths

Now is the time to assess the strong suit of each person on your list. Is your best friend financially savvy? Can your cousin listen to you vent without interrupting or casting judgement? Does your neighbor offer to keep an eye on Mom when she’s tinkering outside in the garden? Each of these people has specific talents or capabilities that can help you execute your care plan, and most have something to contribute, whether big or small. However, be sure to factor in each person’s attitude before asking them to join your team. Your sister may have plenty of free time to drive Dad to and from doctor’s appointments, but if she brings negativity or criticism to your regular routine, then the drawbacks may outweigh the benefits of her involvement.

Step 3: Create Your All-Star Care Team

Revise your remaining list to create a foolproof roster of people who will assist you with hands-on care and day-to-day tasks. Do not include anyone who may make your duties more difficult. This is your go-to tool for getting outside help, whether it is planned well in advance or needed at the last minute. Include each person’s contact information and, if possible, an outline of their weekly schedule. This will help you quickly reference when a team member is available to pitch in.

Step 4: Assign Roles for Each Member

Once you have narrowed down your list to reliable, positive individuals, identify specific tasks in your care plan that would be a good fit for each one. Friends and family often wish they could help, but they are usually unsure of what would be useful to contribute. Individuals who have never walked in a caregiver’s shoes tend to have a difficult time understanding all of the responsibilities that are involved.

It is best for caregivers to be very specific about the kinds of assistance they would appreciate. For example, if your son lives nearby, ask if he can tend to yardwork or any home maintenance projects once or twice a month. If you struggle to prepare dinner on Wednesdays (your busiest day of the week), see if Mom’s friend from church can pick her up for a weekly dinner date. The goal of creating this team is to be able to meet your loved one’s needs (as well as your own) without every single responsibility falling solely on your shoulders. A care plan that lacks meaningful support and respite time is not viable over the long term.

Step 5: Add Some Pros to Your Team

Relatives and friends aren’t the only ones to recruit for your care team. You may feel most comfortable with these people helping out because you know them personally, but remember that not everyone has the personality, time or resources to be even a part-time caregiver. Fortunately, there are a number of professionals who can facilitate the technical aspects of providing care. A financial planner can assist with complicated fiscal decisions, an elder law attorney can ensure that you and your loved one are legally prepared for the future, and a geriatric care manager can coordinate the care your loved one deserves. A social worker or advisor at your local Area Agency on Aging (AAA) can help you find and apply for federal, state and local resources that can assist you in your caregiving duties.

Any remaining gaps in your care plan can be filled by paid caregivers and other services. For example, in-home care and adult day care services can provide supervision and stimulation for your loved one when you need to run errands, attend your own doctor’s appointments, enjoy some respite time or go to work. If housekeeping rarely fits into your daily or weekly routine, then hire a cleaning service or arrange to have these tasks added to your home care professional’s responsibilities. Healthy meal delivery, pre-sorted prescription medications, and transportation services are some other options that can simplify your schedule and reduce your workload.

A comprehensive team assists with daily duties and can provide valuable back-up care in instances when the primary caregiver cannot see to their responsibilities. The more support a caregiver has, the less likely they are to experience burnout and the more sustainable the care plan will be.

Who Should Join Your Care Team?

  • Family and Friends
    • Siblings
    • Significant Other
    • Adult Children
    • Close Friends
    • Neighbors
    • Members of Local Community or Religious Groups
    • Grandchildren
  • Professionals
    • Physicians (Primary Care and Specialists)
    • Elder Law Attorneys
    • Geriatric Care Managers
    • Social Workers
    • Financial Advisors
    • Pharmacists
    • Home Care Agencies and Professional Caregivers
    • Adult Day Care Centers
    • Charities, Organizations and Support Programs
    • VA, Medicare and/or Medicaid Advisor(s)

See also: Care Plan 101: Set Yourself Up for Success As a Caregiver

Source: AgingCare by Ashley Huntsberry-Lett

Forming Your “Circle of Help”

Forming Your “Circle of Help”

Never go it alone. The best way to stand up to Alzheimer’s is to gang up on it.

The best way to defeat Alzheimer’s is to come together and gang up on the disease. If you or your spouse have been diagnosed with Alzheimer’s, please know that you are not alone. Right now, thousands of Alzheimer’s researchers, doctors, nurses, caregivers, support groups, and long-term care facilities are fighting for you on many fronts.

One of the most important fronts, of course, is the home front. My new book, Mike & Me, is one of several new books to chronicle the changing face of home care among Alzheimer’s couples and caregivers. Together, we are learning how the astonishing power of love, patience, compassion, and stay-at-home care can be mobilized by virtually every couple to help Alzheimer’s patients defy the old statistics and live a longer, fuller life.

My Husband and I Made A Deal

Early in my husband Mike’s 10-year journey with Alzheimer’s, we made a mutual commitment: As long as it was safe for him and me, Mike and I would live together in our home and make the Alzheimer’s journey together. Our goal was to keep Mike’s life as normal as possible for as long as possible, and that would entail staying in our home and community. It turned out that keeping that commitment to Mike was only possible because of a circle of friends and family who gradually formed around us and helped us every step of the way.

Looking back, I now realize that one of the most important things Alzheimer’s couples must learn in the early going is to simply reach out for help from friends and family. That probably sounds too obvious to mention, but you would be surprised to learn how many Alzheimer’s couples try, initially, to go it alone in their care. My husband Mike and I were one of those couples in the beginning. You see, we weren’t accustomed to asking people for help or bothering others with our difficulties. In the past, whenever a problem arose, Mike and I had always turned to each other for help, and, at first, that’s how we tried to deal with Alzheimer’s too.

Forming Your Circle of Help 

So why do I tell you these things? I tell you because I want you to believe that your “circle of help” – your friends, family, neighbors, and community – is waiting for you, too, if you will only let yourself reach out.

Perhaps like you, my challenge in the beginning was to simply open up to the idea of accepting help from others. But once I opened up, I quickly learned two things.

First, I was surprised at how many people were more than willing to help Mike and me. And second, I didn’t have to accept everyone’s help; I could still be selective about who I would let into our circle.

As time went on, I eventually built a small team of people – kindred spirits – who were helping me care for Mike. I like to think of them not just as a team, but as a “circle” of thoughtful people who surrounded us and helped care for our physical, emotional, and spiritual needs. It felt like such a natural process. One by one, along came certain friends and neighbors who thoughtfully recognized that we had a need of one kind or another and offered to help, each in his or her own way.

You may not know it yet, but you, too, have a circle of support quietly waiting for you. Watch for it, welcome it, be thankful for it. Yes, it’s a little scary at first to allow people in when you feel most vulnerable. But if you do plan to stay in your home together, rather than go to a care facility, then you too will have to turn to a circle of caring people who can help you.

Source: UsAgainstAlzheimer’s by Rosalys Peel

Should You Quit Your Job to Care for Your Elderly Parent?

As parents age and need more assistance, most adult children do what they can to help. For many, the first step is a weekly stop by Mom and Dad’s home to assess the situation and perhaps help with some chores and errands. Often, these check-ins increase in frequency until it becomes a routine part of each day.

Family caregivers typically look into community services and in-home care for assistance. They research adult day care centers and assisted living communities. However, most seniors are adamant about wanting to remain in their own homes and receive assistance from their own children. They don’t want “strangers” in their house or driving them to engagements.

Sick days and paid time off begin to dwindle. Performance suffers and unpaid leave becomes the only option for taking time away from work to handle emergencies and doctor’s appointments. Eventually, like so many other family caregivers, you consider quitting your job, putting your career on hold. While it won’t be easy, it’ll just be a temporary solution, ideally with minimal impact. Right?

The Benefits of Leaving Work to Care for a Family Member

You already know what may be gained by giving up your job and becoming the primary full-time caregiver for your parents. You would benefit from knowing firsthand how they are faring day and night. You could save them from paying for in-home care or adult day care. You wouldn’t have to worry about the quality of care they are receiving from outside sources. You could likely delay, if not eliminate, their need for nursing home care. You may be able to deepen your relationship with your parents and grow closer to them.

Keep in mind that every family is unique. For some, these benefits are realistic yet short-lived. For others, these benefits are simply unattainable ideals. Caregiver burnout, financial strain and changes in health and relationships can severely undermine even the best laid care plans.

The Costs of Quitting a Job for Caregiving

While the benefits seem straightforward enough, the true costs of deciding to quit your job to care for Mom or Dad are much more complex.

A deficit in or loss of monthly income is likely the biggest factor in this decision, and that change can usually be tolerated on a temporary basis. However, caregiving can drag on for months and even years. Many caregivers do not think about the long-term effects of this choice, but it’s crucial not to forget about or ignore your own financial future.

Yes, stepping in to help your aging parents may feel good and help them save money. If they have significant assets and don’t outlive their savings, you may even recoup some of the financial resources you gave up by inheriting part of their estate when they die. But, my best advice to family caregivers is never to rely on that outcome.

It is highly likely that your parents will still need care in a senior living facility at some point, regardless of whether you embrace unemployment to personally spearhead their care. When the time comes for placement in long-term care, their financial resources will dwindle quickly unless they are fortunate to have a very good long-term care insurance policy or abundant savings. Therefore, assuming that you will financially recover after “it’s all over” is very risky. Even if a personal care agreement is put in place very early on to compensate you for your services, there is still no guarantee that your parents’ funds will see them through.

Obviously, this decision involves giving up a paycheck for a certain amount of time, but that’s not the only thing that’s on the line. Consider the following implications that may not initially occur to family caregivers who are contemplating quitting their jobs.

  1. Social Security Benefits: Even though family caregivers work very long, hard hours, these work hours do not show up on one’s Social Security record. Depending on the number of years you spend officially unemployed, you not only lose your take-home wages, but you also lose the opportunity to work toward earning hundreds of dollars a month in Social Security retirement benefits.
  2. Retirement Savings Plans: Without a job, you’ll miss out on the ability to participate in an employer’s retirement plan or 401(k) match. Unless you had a healthy retirement plan before you quit your job, your financial future is likely to be bleak. In fact, most family caregivers who give up their jobs end up withdrawing funds from their savings and retirement accounts prematurely to offset their lost income and cover monthly expenses.
  3. Job skills: As other colleagues in your field move up and gain experience, your skills are likely to wane during your unemployment. Countless people have left the workforce and been unpleasantly surprised to find that new educational requirements, technological expertise and training are now required for jobs similar to the ones they held before.
  4. Re-entering the Workforce: It’s easier to get a new job when you already have one, compared to job hunting while unemployed. In today’s tight job market, re-entering the workforce may not be easy, especially with a significant gap in employment on your resume.
  5. Ageism: As your parents age and you care for them, you, too, are growing older. Age discrimination is illegal, but when you’re finally able to work again, potential employers can find other ostensible reasons for not hiring you, such as out-of-date skills.
  6. Caregiver Isolation: Not everyone is cut out to be a full-time caregiver. You may find that, while you are glad not to be juggling a job and caregiving responsibilities, you miss the work atmosphere, your paycheck and the social interaction you had as an employed person. Caregiving can be a profoundly lonely job.

As with all issues in caregiving, there is no black and white answer. For some, leaving work for caregiving is the only right thing to do. For others, it can lead to financial ruin and a lost sense of purpose and identity outside of providing care. As a nation, we need more affordable elder care resources and better support from employers so that gainful employment, financial security and dedication to family are attainable goals that can coexist. Until more options are made available to Americans, adult children who wish to care for their aging parents will continue facing heartbreakingly difficult decisions like this one.

Source: AgingCare Carol Bradley Bursack

Scams to Watch Out for in 2019

Scams to Watch Out for in 2019It is estimated that older adults lose billions of dollars to scammers each year. But there is good news—last year the Federal Trade Commission noted that older consumers are more likely to report they’ve been victimized by financial exploitation than their younger counterparts.

Here are three scams that are notably making the rounds.

1. Beware of Social Security spoofing calls

There’s been a significant uptick in fraudulent telephone calls from people claiming to represent the Social Security Administration (SSA). In them, unknown callers threaten victims that they face arrest or other legal action if they fail to call a provided phone number or press the number indicated in the message to address the issue. Sometimes the scammers switch tactics and say that they want to help an individual activate a suspended Social Security number. They may even “spoof” the actual Social Security hotline number to appear on the recipient’s phone: 1-800-772-1213.

If you receive one of these calls, hang up. Know that Social Security rarely contacts persons by phone unless you have ongoing business with them and they never make threats about arrest or legal action.

Report suspicious calls to the SSA Office of the Inspector General by calling 1-800-269-0271 or submitting a report on the OIG website.

2. Watch for a new twist on the old grandparent scam

The grandparent scam has been around for several years. In this approach, a person calls an older adult pretending to be a grandchild who’s been involved in an accident or legal trouble and needs money immediately.

Recently, the Federal Trade Commission (FTC) found that instead of using wire transfer or gift cards, an increasing number of older adults are mailing cash to these fraudsters, with a median individual loss of $9,000. According to reports, the scammers often ask seniors to divide the bills into envelopes and place them between the pages of a magazine, then send them using various carriers, including UPS, FedEx, and the U.S. Postal Service.

The FTC warns that if you or a loved one receives one of these calls, don’t act right away. Call that grandchild back on a correct phone number and verify their whereabouts. If you’ve mailed cash, report it right away to the Postal Service or shipping company you used. Some people have been able to stop delivery by acting quickly and giving a tracking number. Be sure to also file a complaint to the FTC at FTC.gov/complaint.

3. Only work with reputable agencies after a natural disaster

Wildfires, earthquakes, tornadoes, hurricanes—these unpredictable forces of nature can be devastating to those living in affected areas. Even those not directly affected may want to lend support in whatever way they can.

Unfortunately, natural disasters are a golden opportunity for scammers, who target both those who’ve been directly affected and those who want to offer their support. Natural disaster scams typically start with unsolicited contact by telephone, social media, e-mail, or in person. Scammers may:

  • Impersonate charities to get money or private information from well-meaning consumers.
  • Set up fake websites with names that mimic legitimate charities to trick people into sending money.
  • Pretend to be from the IRS and collect personal information under the guise of helping victims file loss claims and get tax refunds.

To find reputable charities to support victims of natural disasters, use the IRS’s tax exempt organization search or look for an organization’s charity rating on places such as Guidestar and Charity Navigator.

If you’re a disaster victim, use NCOA’s BenefitsCheckUp® disaster assistance tool to find legitimate help with relief and financial assistance.

Pass it on!

One of the most important ways to avoid becoming a victim of a scam is to pass along information about scams that are making the rounds. Through the Pass It On campaign, the FTC offers free materials you can download or order and share in your community to protect older adults from scams.

Source: NCOA – Nationa Council on Aging

6 Ways to Get Vision Coverage When You Retire

6 Ways to Get Vision Coverage When You RetireAbout 1.3 billion people in the world live with some form of vision impairment. The reasons vary but the fact is, your risk of developing vision problems drastically increases as you age. Over 91% of people age 55+ use some form of vision correction, so having access to quality vision care is critical as you get older. Issues with vision can increase the risk of falls, driving incidents, and impacting quality of life.

Medicare plans cover a wide variety of services including doctor visits, home health care, and a range of preventive screenings and treatments, but when it comes to vision coverage, beneficiaries’ options are extremely limited. So, what are the available options when you retire?

Original Medicare (Part A and Part B)

Vision coverage through Original Medicare is limited to mostly preventive and emergency services. Original Medicare generally doesn’t cover routine eye exams for eyeglasses or contact lenses. Medicare Part A covers medical emergency related to your vision if you are admitted to the hospital and Medicare Part B covers preventive treatments and screening related to diseases affecting your vision.

Medicare Part B covers annual glaucoma test for at-risk individuals which includes those with diabetes, African-Americans aged 50+, Hispanics aged 65+, and/or those with a family history of glaucoma. Annual exams to test for diabetic retinopathy among diabetics, diagnostic tests and screenings for macular degeneration, cataract surgery and one pair of post-surgery eyeglasses or contact lenses are also covered. Medicare will only pay for contact lenses or eyeglasses from a supplier enrolled in Medicare. For each of these services, the out-of-pocket costs is the 20% Medicare-approved amount, and Part B deductible.

Medicare Advantage (Part C)

One of the easiest options for vision coverage when you retire is Medicare Part CPart C includes the same emergency and preventive benefits included with Original Medicare, but some Part C plans may also offer additional benefits that include a yearly eye exam, eyeglass frames and lenses, or contact lenses. The cost and coverage for these services vary from plan to plan. The best way to find a Medicare Advantage plan that covers all the services you need is to compare plans online or speak with a licensed benefits advisor.

Vision Programs

Enrolling in a Medicare Advantage plan to receive vision coverage is not necessarily the best option for everyone, but that doesn’t mean you should not be able to get adequate vision coverage. There are national and local programs available that can provide vision care for little to no cost, but there may be additional requirements to participate and resources may be limited.

  • EyeCare America®, a service from the Foundation of the American Academy of Ophthalmology, provides free eye exams and up to one year of care for low-income individuals who qualify.
  • Local Lions’ Club chapters often have programs to assist those with severe vision impairment. Local chapters will be able to provide more information on how to get assistance.
  • Vision USA, a program of the American Optometric Association and Mission Cataract USA both offer vision services for those without insurance including Medicare or Medicaid. Vision USA provides free eye exams for low-income Americans and Mission Cataract USA offers free cataract surgery to those who qualify.

As you begin to research your Medicare options keep in mind the enhanced services you may need to maintain, or maybe even improve your quality of life. Having yearly eye exams and updated prescriptions or dental cleanings and fillings may not be the things you consider when choosing a Medicare plan, but they should be.

To get help discovering a plan that covers your needs try taking our Medicare Questionnaire, which allows you to compare plans online or connects you to free professional advice from licensed benefits advisors. You can also contact your local State Health Assistance Insurance Program (SHIP) for access to federally-funded Medicare counseling from trained staff members.

By: The My Medicare Matters Team

Source: My Medicare Matters

How to Use a Miller Trust for Medicaid Eligibility

A senior’s income and assets must fall below certain levels to qualify for Medicaid coverage of their stay in a skilled nursing facility. If their countable assets exceed $2,000, they will not qualify until the excess is spent down or converted to an asset that is not countable.

For income, the 2018 federal limit for eligible applicants is $2,250 per month. However, many states allow Medicaid applicants to spend down their income on medical expenses to get below the $2,250 limit and thus qualify. These states are known as “medically needy” or “spend-down” states. But what can an applicant do if they live in a state that has a hard income limit and doesn’t allow spend-down? Say their assets are below the eligibility limit, but their countable monthly income is $2,275. In this scenario, the senior has too much income to qualify for Medicaid, but they certainly do not have enough money to pay for a nursing home or other long-term care facility!

It was this very situation that led to the 1990 case of Miller v. Ibarra in Colorado. As a result of the decision in this case, those states that do not permit an income spend-down all offer Medicaid applicants the ability to set up a simple irrevocable trust to hold their excess income. Funds in this trust can be used to pay the Medicaid recipient a monthly personal needs allowance (approximately $60, but this varies by state) and, if applicable, pay their community spouse a minimum monthly maintenance needs allowance (MMMNA). From there, any funds that are left over are used to pay the Medicaid recipient’s nursing home bill. The difference will be covered by Medicaid, assuming the applicant otherwise qualifies. Such a trust is called a Miller Trust (after the court case mentioned above), but it can also be referred to as a Medicaid Income Trust, a (d)(4)(B), an Income-Only Trust, an Income Diversion Trust or a Qualified Income Trust (QIT).

Each state has different rules, but in “income-cap” or “categorically needy” states that don’t allow spend down, at least the excess over the income limit amount must be placed into the trustThe Medicaid applicant cannot be the trustee of this account since they are essentially giving up their rights to the money it contains. The trustee is typically a family member, and each month they use money from the trust to pay the Medicaid recipient’s share of cost (SOC), personal needs allowance, their spouse’s MMMNA, and other medical costs and premiums not covered by Medicaid and Medicare. Assuming some basic rules are followed regarding this process, excess income will not prevent an applicant from qualifying for Medicaid, unless their income is so high that it exceeds the amount that Medicaid would otherwise pay to the nurs­ing home each month for their care.

Keep in mind that a Miller Trust can only be used to hold income going to the individual who is trying to qualify for Medicaid, and many states require this income to be direct deposited into the trust account. Applicants cannot put only portions of certain income sources into the account. For example, you cannot put part of your pension or social security check into the trust—it’s all or nothing. Assets and income sources that do not count towards eligibility limits should not be placed in this account either. This includes a community spouse’s income, VA benefits like Aid and Attendance and housebound pensions, income tax payments and some annuity payments.

At the time of publication, these 24 states are “income-cap” states that permit Miller Trusts:

  • Alabama
  • Alaska
  • Arizona
  • Arkansas
  • Colorado
  • Delaware
  • Florida
  • Georgia
  • Idaho
  • Indiana
  • Iowa
  • Kentucky
  • Louisiana
  • Mississippi
  • Nevada
  • New Mexico
  • New Jersey
  • Oklahoma
  • Oregon
  • South Carolina
  • South Dakota
  • Tennessee
  • Texas
  • Wyoming

If your state is listed above, check to see if it publishes a standard short-form trust document that is essentially a “fill-in-the-blank” form. In some cases, this form may even be available on the state’s Medicaid website. Using such a form means you do not have to hire an attorney to draft a customized trust, but it is still advisable to consult with an expert to assist with Medicaid and estate planning. These are complex matters that can have serious and long-lasting ramifications if done improperly.

Source: AgingCare.com By K. Gabriel Heiser

Check Your Mail: Changes to the 2018 Medicare Open Enrollment Period Mailings

Changes 2018 Medicare Open Enrollment PeriodIt’s time a year again! Medicare’s Open Enrollment Period (OEP) is almost here, starting October 15th and ending December 7th. If you’re already enrolled in a Medicare plan this is the time of year where you can re-evaluateyour coverage to make sure you are still enrolled in the best plan for your needs.

Over the next few weeks, leading up to and during the Medicare OEP you’ll receive notices from your current Medicare plan, the Centers for Medicare and Medicaid Services (CMS) and advertisements from other Medicare companies claiming to offer the best plans. All this information can be overwhelming and as tempting as it may be to lump is with the junk mail and throw it away, that may not be the best idea. There are a lot of changes occurring with Medicare this year and to stay informed you need to review all the notices provided by your insurance company and CMS.

One of the most immediate changes impacts the Medicare Advantage and Medicare Part D plan notification policies. Plans will no longer mail copies of the Evidence of Coverage to beneficiaries. Instead, the Evidence of Coverage will be available online and a hard copy must be requested. Here’s a list of notifications and resources which you should review and/or request as you prepare for Medicare Open Enrollment:

  • The Annual Notice of Change (ANOC), a 10+ page document sent out to people enrolled in a Medicare Advantage and/or Medicare Part D The ANOC is sent by your Medicare plan and includes any changes to your current plans coverage, costs, or service area effective January 2019. Insurance companies can make changes every year that may increase your out-of-pocket cost or decrease your benefits, so it’s important to review this document thoroughly. You should receive this notice by September 30, if not contact your plan directly.
  • The Evidence of Coverage is 140+ page document that contains a detailed overview of what your current plan covers, cost, and more.  Beginning in 2018, Medicare Advantage and/or Medicare Part D plans are no longer required to mail hard copies of the Evidence of Coverage to Medicare plan enrollees.  Instead, Medicare Advantage and Medicare Part D plans are required to publish the EOC on their website by October 15.
  • Plans are required to mail a printed notice called the Notification of Electronic Materials to all enrollees explaining how to obtain hard copies of plan materials routinely available on the plan’s website (EOC, provider directories and formularies). The notice must list the plan’s website, the date the documents will be available on the website, and a phone number to request hard copies of the EOC, plan provider directories and/or plan formularies.
  • Medicare & You Handbook is sent by The Centers for Medicare and Medicaid Services (CMS) in late September. This handbook contains lots of useful information about when Medicare covers certain services, including preventive care, medical equipment and supplies and much more. If you don’t receive one by the second week in October, call 1-800-Medicare to get another copy with your state’s specific plan information, or go to the Medicare site to view the general information online.

Additional Medicare Notifications

  • Notice of Plan Termination/Reassignment Notice. If your Medicare Part D or Extra Help plan will no longer be available in 2019, the CMS will send you this blue notification. You will have the option of selecting a new drug plan for the new year or being reassigned to one by CMS. Your decision must be made before December 31st.
  • The Consistent Poor Performer Notice is sent to individuals enrolled in a Medicare plan that has received an overall star rating of less than 3 stars for at least three years. Plans with less than 3 stars are considered poor quality and it’s recommended that you switch to a 4.5 or 5-star rated plan during the Medicare OEP. If you choose to remain enrolled in your plan during the OEP you can switch any time of the year using a Special Enrollment Period for lower rated plans.

All of these documents should be reviewed thoroughly to help you decide if your current plan still meets your needs for the upcoming year. If you haven’t already done so, consider going paperless this year. You can start by creating a Medicare.gov account to receive all notices via email. Then, call your plan to learn about their paperless options. You can find their customer service phone number on your insurance card.

To get help finding a Medicare plan that fits your needs try taking our Medicare Questionnaire, which can connect you to free professional advice about Medicare from a licensed benefits advisor.

MEDICARE GUIDE

Source: MyMedicareMatters.org  By: The My Medicare Matters Team

Why a Letter of Competency Should Be Part of Every Senior’s Legal File

Dementia and other health issues that affect one’s mental capacity are devastating in many ways, but they can also complicate the basic legal planning that is recommended for all seniors. Countless members of the AgingCare Caregiver Forum have shared stories about bitter disputes between family members over whether an aging loved one’s will, powers of attorney and other legal documents were valid.

The perfect storm of questionable mental capacity and preparing for the future can breed suspicion and jealousy, often pitting family members against one another. However, adding one very simple step to a senior’s legal planning process can reduce the potential for unnecessary stress and familial discord down the road.

How a Letter of Competency Works

Encouraging a loved one to obtain a letter of competency at the time their will, power of attorney forms, advance directive and any other legal documents are drafted and signed will help dispel any notions that these documents were created while they lacked the mental capacity to make medical, financial and legal decisions.

While attorneys are prohibited from helping incompetent individuals to change or create legal documents, the legal definition of incompetence differs slightly from the medical definition of mental capacity. Ensuring that a person is both legally and medically capable of making decisions about their health care, finances and estate should eliminate any doubt about the validity of their documentation.

How to Obtain a Letter of Competency

Most people request this letter from a primary care physician who has seen the patient over the course of several years and is familiar with any changes in their baseline mental and physical health. In some cases, though, obtaining this letter from a doctor who specializes in mental health and cognition, such as a psychiatrist or a neurologist, is a good idea.

For example, if your mother is already experiencing mild memory loss and has not had a primary care doctor for a decade, then a complete mental evaluation conducted by a specialist would be more credible compared to a mini-mental exam conducted by a new family doctor who is seeing her for the first time.

The attorney you’re working with should be able to recommend which of a loved one’s physicians would be able to provide the most accurate statement.

What a Letter of Competency Should Include

A generic letter from a doctor attesting to a patient’s mental capacity should be printed on the physician’s letterhead and include the following fundamental pieces of information:

  • Patient’s name
  • Patient’s date of birth
  • Date the patient-physician relationship was established
  • Physician’s statement testifying to the patient’s ability or inability to make independent decisions regarding healthcare, finances and legal matters
  • The patient’s relevant medical diagnoses (e.g. Alzheimer’s disease, stroke, mental illness, developmental delay, etc.)
  • Date of diagnosis for each relevant medical issue
  • Physician’s contact information

While the above pieces of information are typically included in a basic statement of mental capacity, it is wise to work with an attorney to determine if any other facts or supporting evidence should be included. File the original letter(s) of competency away with the corresponding legal documentation in a safe place, such as a locked file cabinet, a safe deposit box or with an attorney. It’s wise to have the physician keep a copy in the patient’s medical file as well.

Documentation is Key

It is impossible to predict whether a sibling, grandchild, stepparent or other family member may contest the validity of an aging loved one’s legal documentation, but it happens all the time. Some of these cases even end up in expensive and lengthy guardianship proceedings. Others result in lawsuits where a loved one’s will is contested. These squabbles can divide families and destroy relationships.

It may seem excessive to seek additional proof of mental capacity when changing or creating any legal documents, but it’s better to be safe than sorry. The time and energy involved in attending a doctor’s appointment and obtaining a letter of competency is minimal compared to the emotional turmoil and legal fees involved in a lawsuit or an investigation conducted by Adult Protective Services (APS).

It isn’t easy but encouraging your loved one to make sound legal preparations, acting in their best interest, and taking every precaution to carefully document changes in their health and financial status will ensure that your caregiving journey goes as smoothly as possible.

Source: AgingCare

How to Get Rid of Junk Mail and Telemarketing Calls for Good

As a child, I used to get so excited when I received something in the mail. Maybe it was because the only time I would get mail was either around my birthday or Christmas and it usually contained a check from my grandmother. Now, as an adult, my relationship with mail is quite the opposite. The only correspondence I receive is either bills or junk, neither of which I look forward to receiving.

While there is not much anyone can do to eliminate their bills, there are a few things you can do to get rid of junk mail. In fact, scams and spam seem to be on the rise via most methods of communication these days. Taking steps to declutter your mailbox and protect your phone number(s) can greatly minimize your frustration and reduce your vulnerability to fraud and identity theft.

How to Opt Out of Junk Mail

The first step toward eliminating a large portion of one’s junk mail is to participate in the DMAchoice program from the Data & Marketing Association (DMA). This program was created to give you control over what mail you receive and help the DMA’s more than 3,600 members avoid mailing to uninterested customers.

The categories of mail you may opt out of receiving include credit card offers, catalogs, magazine offers (such as subscription offers, newsletters, periodicals and other promotional mailings), donation requests, bank offers, retail promotions and more. You can choose to opt out of specific direct mail categories like the ones above or all of them. Once registered, the DMA forwards your preferences to the appropriate members.

To register, visit www.dmachoice.org and enter your information. There is a $2 fee to register online, but this registration lasts for 10 years. Caregivers also have the option to register on behalf of their care recipients to prevent them from receiving junk mail as well. Just visit the DMA website’s Do Not Contact for Caretakers page and follow the instructions. There is no cost for removing a vulnerable senior from the DMA’s databases.

Cancelling Pre-Approved Credit Offers

In the same way that DMAchoice works with member organizations to streamline marketing and promote consumer satisfaction, the OptOutPrescreen program works directly with the credit bureaus Experian, Equifax, TransUnion and Innovis to allow consumers to opt out of pre-approved and pre-screened credit and insurance offers.

To register for the program, visit OptOutPrescreen.com or call 888-567-8688. If you register online or by telephone, your registration is valid for five years. To opt out permanently, you will need to print, sign and mail back a permanent opt out election form. This form will be emailed to you when you register online or be mailed to you if you register by telephone.

Doing Away with Unsolicited Mail

In order to opt out of generic mail (the type that says “Dear Occupant” or “Current Resident”), you must directly contact the organization that sent you the solicitation. If you’d like to send a written request, provide your name and mailing address and state clearly that you wish to opt out from receiving future mail.

“Junk” Can Overwhelm Your Phone, Too

While junk mail is a nuisance that can literally pile up, unsolicited telephone calls can be equally as annoying but even more dangerous. Scammers will often call pretending to be from a legitimate organization in an attempt to get you to send them money or share your sensitive financial or identifying information.

One common scam is where the caller pretends to be from the IRS. He or she states that you owe money and if you do not pay within a certain timeframe you will be arrested. They use fear and intimidation to get the victim to do what they want.

But how can you tell which calls are legitimate and which are scams? It is often difficult to make that determination based on the call alone. One way to reduce, if not eliminate, legitimate solicitation calls is to register both your home and cell phone numbers on the Federal Trade Commission’s national Do Not Call Registry. Once you have registered, solicitors are prohibited from contacting you.

However, this does not apply to organizations with which you currently conduct business (known as established business relationships or “ERBs”) or tax-exempt organizations. You will still receive calls from entities you have given permission to contact you, like your bank, charities soliciting donations and—everyone’s favorite—political calls.

To register for this free service, call 1-888-382-1222 from the telephone number you wish to register. You can also register online at www.donotcall.gov. Keep in mind that this registration does not expire, so there is no need to ever re-register.

Telemarketers have 31 days from your registration date to remove your information from their call list and cease contact. If you receive a call after this 31-day period, notify the caller that you are on the national Do Not Call Registry and ask to be removed from their contact list. If they continue to call you, then you can report them online at the FTC’s complaint website. By law, organizations that are not tax exempt must remove a consumer’s contact information from their call list upon request.

This will not eliminate all calls, but it will greatly reduce the number of legitimate, unsolicited calls. You should be wary of whatever calls continue to come in from unknown sources. Here are a few indications that you’re talking to a scammer on the phone:

  • Caller is asking you to provide sensitive information
  • Caller is threatening or bullying you
  • Caller demands money, especially in the form of a money order
  • Caller refuses to remove your information from their call list
  • Caller claims to be from the IRS or another “official source” and demands money or sensitive information
  • Caller threatens your arrest if you do not comply
 Also, don’t be fooled by what appears on your caller ID. Caller ID can easily be manipulated using free online tools. This process is called “spoofing.” I could call you and have the caller ID read “IRS” or “police station.” It really is just that simple.

Read: Fake Caller ID: Don’t Fall for Spoofing Scams

If you are in doubt when you receive an unsolicited telephone call, simply hang up the phone. If you get a call from someone claiming to be from your bank or credit card company, hang up and call the official telephone number printed on your bank statement or the number printed on the back of your credit card. If they claim to be from the IRS, you can visit the IRS website (www.irs.gov), and call them at the telephone number listed there. You get the idea. It’s always better to be safe than sorry.

Tackling Unwanted Text Messages

If you receive spam-type text messages on your cell phone, you can typically report it to your carrier by forwarding the text message to 7726. This works for AT&T, T-Mobile, Verizon, Sprint and Bell customers. They will then add this to their identified spam messages list and attempt to block the sending number. This process is similar to identifying an unsolicited email as spam or junk mail. Once you have labeled it as such, your email provider will block future emails from that sender from getting into your inbox.

The same handling rules for spam emails apply for text messages as well. Don’t reply to the sender, click on any links in the messages or provide any personal information. Legitimate businesses will not ask for your account or login information via text. The next safest thing after reporting the message to your carrier is to delete it immediately.

While you may not be able to block all potential frauds and scams, these tools will help you to eliminate most legitimate solicitors, making it easier for you to identify the remnants as fraudsters and scammers. At that point, you can simply toss the mail, hang up the telephone or delete the text.

Source: AgingCare.com by Carrie Kerskie