Health and wellness concerns for the elderly

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.

Learn more about our aging life care planning services.

Choosing a home care provider

Choosing a home care provider

Frank knows they need help at home. His wife’s dementia is getting worse, and he has his own health problems. She can’t be left alone anymore.

Doing all the cooking and cleaning, and now helping with bathing … it’s just too much.

Frank needs to take breaks. But a Google search reveals a dizzying array of home care providers. How to choose?

Allowing a stranger into your home can leave you feeling quite vulnerable. It’s important that you trust the individual and the company that does the background checks, verifies training, and puts together the schedule.

You also need to interview each company to find out pricing and minimum number of hours, and to see if they have independent quality ratings.

How do you know which one to trust?
This is where an Aging Life Care™ Manager can help.

On the basis of past experience with other clients, he or she knows which companies put an emphasis on training. Which have difficulty filling a shift if a caregiver calls in sick. Which have high staff turnover resulting in the need for you to orient a new employee every few months. Which have a strong team, with employees who love their work.

Wise home care companies will let you and your Aging Life Care Manager interview several caregivers before making a choice. They know that an Aging Life Care Manager understands you as the client and understands what will result in an optimal match.

Both you and the provider and the caregiver want a good fit the first time so all of you can work together positively for the duration of your need. It makes the difficult transition to home care that much easier if a knowledgeable advocate can set expectations and provide an objective viewpoint.

Even with adult day care and medically trained services, such as home health and hospice, not all providers are alike. An Aging Life Care Manager knows the reputation and the management style of each company. He or she can look up Medicare reviews and complaints.

An Aging Life Care Manager can also coordinate care across multiple service providers and work with your physician to ensure that all the different players are aware of your changing needs.

Want to find the best fit the first time?
Give us a call at (208) 321-5567.

Learn more about our aging life care planning services.

What is “elder law”?

What is "elder law"?

Elder law focuses on the special rights, needs, and challenges that arise in the context of simply growing older and planning for possible care needs.

Attorneys specializing in elder law take a holistic perspective.

They acknowledge the interplay of health, family, disability, and housing, as well as emotional and financial issues. Consider a consultation for:

  • Estate planning. Within elder law, estate and trust attorneys advise on the best strategy for organizing and managing your assets now that also ensures ease of transfer upon your death. This may involve a will. Or a living trust. There are pros and cons to each. And, if you have a dependent adult in your life, an attorney can draw up a special needs trust to provide for care when you are no longer alive.
  • Decision-making plans. With advancing age, many of us lose the ability to manage our finances or make complex healthcare decisions. Especially if you do not have relatives to step in, you will need legal assistance to locate and contract with trustworthy professionals to fill these roles.
  • Paying for care. An elder law attorney knows about the many programs designed to assist with the cost of care. You may, for instance, be considering a reverse mortgage, but there are significant “gotchas” with this arrangement. If Medicaid is your fallback should you need a nursing home long term, you will want to work with an attorney to be sure your spouse is not left without resources when you die. Long-term care insurance is another payment option worthy of an attorney’s review.
  • Housing contracts. Before moving into an assisted living or continuing care retirement community (sometimes called a “life care” community) or a nursing home, have an elder law attorney review the paperwork. They can clarify tax implications and advise you regarding your rights and how or when you can cancel a housing contract.
  • Claims and appeals. You may have disagreements with Social Security, Medicare, your pension fund, or other insurance or benefit programs. An elder law attorney can help you navigate the appeals process and increase your chance of a successful resolution.
  • Grandparent visitation rights. Whether the schism is due to a divorce, the death of your child, or estrangement from your son or daughter, you do have rights to see your grandchildren. An elder law attorney can help you stay connected.
  • Age discrimination in employment. Have you been turned down from a job, a promotion, or fired because of your age? An elder law attorney can help you rectify the situation.

Looking for an attorney specializing in elder law?
We network with the best. Give us a call at (208) 321-5567.

Learn more about our services to help you age well.

Medical emergencies: Are you prepared?

Medical emergencies: Are you prepared?

Judy fell and broke her hip. She calls 911. She lacks a medication list. As a result, the hospital team is unaware of her chronic conditions. Her daughter lives far away and doesn’t know if she should fly in.

Accidents by their very nature are unplanned. That doesn’t mean you need to be unprepared for a fall or a serious incident (e.g., a heart attack or stroke).

Those who are prepared and have a professional advocate, such as an Aging Life Care™ Manager, are more likely to get the care and the outcomes they desire. Plus, they can recuperate in a setting most in line with their personal needs and preferences.

To be prepared, you need

  • current documents. Key to avoiding problems is the ability to give emergency and hospital personnel a list of current medications, your medical history, and an up-to-date list of your doctors and their phone numbers. Copies of all your insurance cards will speed the clerical side of the process. You will also need an advance directive that names your health care decision maker(s) and your preferred treatments.
  • up-to-date decision makers. Does the person you have chosen know and understand your treatment preferences? Does the rest of the family know and respect that he or she “speaks for you”? Does your decision maker have a medical background? Is he or she nearby enough or able to drop everything and come to your side?
  • a professional advocate. Often family or trusted friends cannot be present at a moment’s notice. And most people are not conversant with medical procedures. A professional advocate, such as an Aging Life Care Manager, has met with you prior to the emergency. He or she can fill in the medical team and communicate your personal priorities. An Aging Life Care Manager can advise decision makers by providing insight about treatment choices: Pros and cons and likely outcomes vis-à-vis your values. An Aging Life Care Manager can keep long-distance relatives informed and make recommendations regarding the need to travel. When it’s time to leave the hospital, an Aging Life Care Manager can recommend the best support facilities on the basis of your resources and personal preferences. As you plan ahead for emergencies, you will want to make decisions about hiring a professional advocate. Some Aging Life Care Managers offer the option of 24/7 emergency, on-call coverage. Others do not.

Ideally, all this information is available on your person or is readily accessed should you get into an emergency situation.

Want help getting prepared for a medical emergency?
Give us a call: (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.

Types of long-term care

Types of long-term care

While “aging in place” has its benefits, it is expensive to get such individualized care. Plus, it’s rather isolating. Group options require a move, but are more social and cost effective.

  • Assisted living. People move to assisted living when they are ready to stop cooking, cleaning, and maybe even driving. They enjoy social activities but need more help than an independent retirement community might offer. Though not a setting for people with advanced dementia, a portion of assisted living residents may have memory problems.
  • Memory care. With activities specifically for people with significant dementia, memory care may be housed in a wing of assisted living or operate as an independent facility.
  • Skilled nursing or “rehab.” Geared for short stays—several days to several weeks—a skilled nursing facility can be thought of as a place to get stronger or learn to do things in new ways after a setback. Then you move to a more homelike environment.
  • Nursing home. This setting is a long-term version of rehab but for those with complex conditions who don’t need a hospital, yet aren’t independent enough for assisted living.
  • Continuing care retirement community (CCRC). This large “campus” offers all of the above and more. Move in while fully independent and able to enjoy the pool, golf course, etc. As care needs change, residents move to the different care buildings yet stay on the same property. Ideal for a couple when one needs more support than the other.

Let us help you understand the different options.
Give us a call at (208) 321-5567

Learn more about our aging life care planning services.

Home care

Home Care

Support is available for those who wish to stay at home. However, one-on-one care is expensive. And it’s not always easy to find caregivers. Community services can sometimes be patched together.

To stay at home, it helps to have a knowledgeable person check in periodically who knows eligibility requirements and can supervise and coordinate all the players.

  • Home care. People who do not need medical attention, but simply help with household activities, running errands, or light companionship, benefit from home care. The key to success is finding a good match between the caregiver’s personality and your own.
  • Adult day care. If someone is available for nighttime care of a person with dementia or light medical needs, then adult day care can provide engaging daytime activities, meals, and relief for the caregiver. Ideal for working families or a spouse who needs a break.
  • Home health. Patients are able to leave a skilled nursing facility yet continue receiving needed therapy through visits at home. This is a short-term service, ending when the patient has improved as much as can be expected.
  • Hospice at home. Hospice is for people with a life expectancy of up to six months who opt for improved quality of life over the hardships of treatment. Nurses visit at home a few times a week to monitor pain and comfort and to support families as nature takes its course.

Call us at (208) 321-5567 to start
the planning process for aging in place.

Learn more about our aging life care planning services.

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

Getting the most from video chat

There is no doubt that video chat tools such as Zoom, FaceTime and Amazon Echo Show have made the isolation of older adults much more bearable. While not the same as an in-person visit, video chatting has been demonstrated to reduce depression in older adults by 50% when compared with other forms of connecting.

Video chatting with grandchildren is an art. Keeping their attention is a challenge, along with finding a “good time” to talk. Here are some tips you may want to go over with your loved one to help make video visits a positive exchange for all involved:

The physical environment. Pick a spot where the lighting is in front, not behind. “Backlighting” creates more of a silhouette, making it harder to see faces. Reduce background noise. (Turn off televisions. Move to a quiet room.) Mount phones or tablets on a tripod to free up both hands for gestures or showing off objects.

Create a routine. Make storytime with grandpa a regular activity before bed. Or maybe have grandma call while you are cooking dinner so the kids are entertained while you prepare the meal. Agree on a mutually convenient time that works for all three of you.

Prepare for the call. As the parent, ask your child what they want to share with grandma or grandpa and bring it to the phone station. Before handing the phone over to your child, give your parent a quick run down of interests in the last hour or day so they can be sure to inquire about activities that are top of mind. As the grandparent, have a favorite book or object at the ready that you want to share in return.

Bring out the inner hambone. The joy of video chats comes in the ability to interact. Kids love movement, silly faces and gestures that can be done together. Babies enjoy patty cake and peek-a-boo on video. And blowing kisses. Older children enjoy activities such as “Freeze Dance”—like musical chairs except the players freeze like statues until the music starts again.

Start with short, 5 minute visits. Work up gradually to longer visits as you all get used to this new medium.

Will we ever hug again?

Hugs are more than a symbolic display of affection.

They have actually been shown to release oxytocin, the bonding hormone, which calms our nerves and reassures us that we are loved and we belong. Like everyone, older adults have a basic need to hug and be hugged. And grandchildren are often the joyful purveyors of sweet, soul nurturing embraces. One reason hugging is so dangerous now is that close proximity means we breathe into each other’s air space. Since the virus is spread by tiny droplets in aerosol form, face-to-face hugs are especially risky.

Imagine that every exhale is like smoke. It wafts in the air, even from children, dissipating gradually over time. You can see why we wear masks! According to aerosol specialists at Virginia Tech, there are things adults can do—and teach children to do—so that grandma and grandpa may feel safe enough to be back on the hug circuit.

  • Always wear masks. They seem to protect both the wearer and the person on the receiving end of the hug.
  • Keep your hugs brief. 10 seconds, and then step away to a six-foot distance.
  • Look away from each other. Head-on or cheek-tocheek hugs put you right in each other’s jet stream. Instead, turn your heads so you are facing different directions.
  • Hold your breath. From the time you approach to the time you step back. Another reason or cue to keep the hug short.

A hug around the knees or waist from a little one is fine. The adult should turn their head away so they aren’t breathing down on the child.

An affectionate kiss on the back of the head is also relatively safe. Hold your breath and try not to exhale until you are appropriately distanced again.

Source: Dee Childers, Life Changes Elder Care, LLC

Grandparenting in the time of COVID

“COVID EXILE”

The “COVID exile” has hit older adults particularly hard, adding isolation and depression to their high risk of dying from the virus.

This is especially so for the 70 million grandparents who have suddenly been cut off from their grandchildren, a major source of joy and affection.

Not only are daily lives diminished, but time is ticking. Children grow and change. No contact means missing out. And many older adults, especially those already in frail health, fear they could never see their grandchildren again.

If quality of life—having access to true delight—is more important to your loved one than safety, consider together the relative risks of in-person contact. Here are some guidelines:

Maximize safety. The safest are short visits, preferably outdoors, with masks, handwashing, and maintaining a six-foot distance. As bad weather increases, indoor visiting may be necessary. But it increases the risk. The fewer the number of people and the larger and more ventilated the room, the safer the visit.

 Health and age of the older adult. Those over 85 are most at risk. The CDC reports added risk for those with cancer, chronic kidney disease, COPD, diabetes (Type 2), heart disease, obesity, sickle cell anemia, and compromised immune systems. Asthma and high blood pressure also increase the risk of getting sicker with COVID.

Health and exposure of the child. What makes interacting with grandchildren risky is that they can be infected without showing symptoms. Absolutely forego a visit if the child has a fever, sore throat, cough, runny nose, headache, diarrhea, vomiting, or body aches. Children can bring other illnesses, such as cold or flu. Make sure they are current on their immunizations. Children are typically exposed to more people. If a child is attending in person school or day care, a visit is riskier than if a child has had little to no outside contact in the previous 14 days. Children are also less able to follow guidelines. Social distancing is hard for all ages, especially teens. Masks are impractical with children younger than two years.

Is travel required for a visit? If so, check out the viral transmission rates in both communities. If one is high, reconsider the visit. Avoiding airports is wise. Car trips are safer. But hotels, restaurants, and public restrooms require extra care. Consider quarantining for 14 days before the journey so everyone’s exposure is low. A negative test before a visit may ease anxiety, but a test is only a snapshot in time. A person can get infected an hour later.

Source: Dee Childers, Life Changes Elder Care, LLC