Take a Break!

Lately, I have been working almost non-stop organizing the financial and legal matters for several new clients.  It is hard for them to face this point and I try to make the transition from independently handling their own affairs to allowing The Caregiver Foundation to manage and control things as easy and dignified as possible.  Often our Daily Money Management can mean the difference between some form of continued independence having to place their whole lives in the hands of a care facility.  I took a short break just now and it dawned on me that this is a perfectly good analogy for Daily Money Management.

Most adults have to manage their own legal and financial affairs and the great majority of us do so with not a little irritation and anxiety.  Tax season can weaken the knees of the strongest man and confound the most competent woman.  Wouldn't you love to have someone step up to your checkbook and say "I'll do this for you!  Take a break!"  That is exactly what we do for Seniors and those adults who for other reasons find these tasks difficult.  We come in and organize their records, identify critical documents, eliminate inappropriate spending and giving and help establish a budget that can be used to project their needs against their resources.  We are saying to them "Take a Break!" 

Aging brings with it changes, often some form of cognitive change.  For a former bank president or a former farmer it can seem very demeaning to be told they are no longer capable or competent to manage their affairs.  But if we approach them more gently, assuring them that our help allows them to "Take a Break", maybe the transition can seem less of a blow and more like a helping hand.

Medicaid for Long Term Care

The cost of Long Term Care is staggering.  A private facility can reach as much as $10,00 a month for a private room and even a multiple bed setting facility is often several thousand dollars a month.  In the ideal world everyone would have Long Term Care insurance and be able to collect the daily benefit without any trouble. - Unfortunately, less than 10% of the US population even has this insurance.  Most people have the naive idea that they will pass on before needing to incur such expenses.

For most families, the initial costs of Long Term Care are met from personal resources.  When that care becomes significant, those costs escalate and resources are quickly depleted.  At some point, many families have to turn to government help in the form of Medicaid.

Medicaid is a Federal program that is State administered.  Medicaid benefits do not follow you across State lines and each State has their own set of rules and procedures in administering the benefit.  But there are some basic qualification guidelines that apply to Medicaid benefits for nursing home placement. 

First of all - understand that not all facilities qualify for Medicaid benefits.  Ask the facility if they accept Medicaid as a form of payment.

The basic requirements for Medicaid benefits are in two groups:  Assets and Income.
Assets
Documenting from the 1st day of each month and individual's total assets cannot be more than $2000.  If a person is married (but only one person is applying) the asset level is $109,560.00 + the individual $2000.  If both spouses are applying the limit is $2000 each.  (NOTE - there are special rules regarding the ownership of a home - potential exemption can be as much as $750,000 depending on State defined limits)

Income
While there is no limit to the amount of income a person can have, depending on the circumstances, some or all of it will be owed to the nursing facility. Except for a personal monthly allowance of $50, the "cost share" portion of the nursing home bill will be the rest of the monthly income.  NOTE - special rules apply to a spouse who is not applying for benefit.  Very often, if a person has private health insurance, the premium amount for that insurance will be deducted before the "cost share" amount is calculated.

Medicaid Planning
A thriving legal practice a few years ago was the practice of moving assets and income around to make it possible to qualify for Medicaid benefits without really spending your own funds on care first.  Today this is much harder to do and Medicaid analyzes the financial transactions in your life back 5 years and will disqualify you for the length of time they determine your own care could have been financed if you had not disposed of assets and/or income.  This can result in you being in quite a jam - no assets and income and no medicaid as well.  Talk to your local Elderly Affairs Office before acting on any Medicaid Planning Advice.  In Hawaii that number is 808-768-7700

The application process for Medicaid requires a number of documents and there are professionals who will go through the process with you for a fee.  There are also non-profit organization who can help (most hospital social workers have contacts with free services) and the State or County agencies on aging are usually able to help.  For a list of the documents you will need to provide email me at thecaregiverfoundation@yahoo.com and ask for the Medicaid Checklist.

Plan ahead for your aging years and plan today for the needs of those you love and care for.

Is it Depression or Something Else?

Depression among older adults is far more common than we freely admit. Some estimates place the condition in 8-20% of older adults nationwide. Here in Hawaii the estimates are lower – 4-8 % but for those residents in nursing homes the estimate jumps to 70%! It’s not hard to imagine why. They have lost much of their personal dignity to physical conditions they have little or control over. They are not able to make many personal decisions concerning schedules, activities or even what they will eat and drink. And on top of all that – they are living somewhere unfamiliar, among other people they usually do not know and sometimes cannot even communicate with.


But, it is important for caregivers to understand that while we may be able to identify factors that can promote depression; the condition itself is NOT a normal condition of aging. It is a treatable in 90+% of those affected.

Depression is linked to suicide. Depression increases with age (especially in men)Adults over the age of 85 commit suicide at almost twice the rate of all ages combined.

 Depression contributes to premature death from numerous illnesses and conditions.

 Some symptoms of depression:

 Feeling sad for a period of time

 Inability to enjoy life

 Lack of interest in favorite activities

 Sleeping too much or too little

 Changes in appetite or weight

 Trouble concentrating, slowed thinking and memory problems

 Thoughts of death or suicide

 Irrational thinking, hallucinations, or paranoia

 Lack of energy, fatigue, slowed movement

 Agitation or restlessness

 Feelings of hopelessness or helplessness

 *Feeling of worthlessness or excessive guilt

 *Physical complaints or pain

 *Social isolation

 *Irritability, criticalness

 *Excessive anxiety or worry

read on

American Geriatrics Association

www.americangeriatrics.org/education/forum/alzcare.shtml

National Institute for Complimentary and Alternative Medicine
http://www.nccam.nih.gov/

National Institute of Mental Health
http://www.nimh.nih.gov/

National Alliance for the Mentally Ill
http://www.nami.org/

National Mental Health Association
http://www.nmha.org/

National Library of Medicine
www.nlm.nih.gov/medlineplus/druginformation.html

The Value of Caregiving

Caregivers are an interesting bunch. Either we are not paid at all, are paid too little or we are just simply ignored by society in general. Whatever the outlook others may have of us, those who know us in a caregiving situation begin to understand the value that caregivers actually bring to our world.
I am not speaking of the economic value – although there is certainly that aspect. Recently the Honolulu Star Buletin estimated the un-paid value of family caregivers in Hawaii to be in excess of 1 billion dollars annually.
But the value caregivers bring to our world is so much more. I want to tell you about just 5. 5 areas that maybe you have not stopped to really think about. 5 that might pretty accurately describe you – the family caregiver.
Caregiver’s Promote Civilization
The human species is not completely unique in its dealing with the elderly and disabled in our midst. But we are totally unique in the complexity of the care that we render.
We don’t abandon our sick or injured or elderly as many species do and even some human societies have done. The result is a refinement of civilization that promotes responsible care of those less fortunate.
We value the contributions made by those who now need care. Rather than focus solely on current contributions and future possibilities, a civilized society looks to its founders and those who have contributed to its development – and it honors them. We prepare younger generations to care for older ones. As a result of placing values in context, we pass on the responsibility and obligation to ever younger generations.
Caregiver’s Promote Continuity
By providing a link between generations, Caregivers facilitate the preservation of life as we know it.
We encourage the transfer of wisdom and knowledge. Through interaction with our charges, we are able to open windows for sharing of experience and knowledge. Rather than simply feed, bathe and bed those we care for, we must take the time and effort to interact at whatever level possible and allow for the expression of life to be passed on. We create needed bridges from independence to dependence. Through our caregiving we can provide the bridge for individuals to use as they age. Instead of wanting to give up and check out as age begins transforming us, through caregiving an awareness of what is happening and a more realistic acceptance of change makes it possible to view this transformation of life – not as a desperate sentence of doom but more as a marker that tells us it’s time to pass things along. We allow for aging in place. Even though we went through a stage of institutionalizing our disabled and elderly, we are returning to the home model again and looking for ways to allow again in place. Providing a continuity in environment as well as care.  (There's a lot more to read - here)

Home is Where The Heart Is - or Is Not!

For almost anyone, changing a residence is not just a physical upheaval but an emotional one as well.  In fact, medical professionals rate it as one of the highest contributors to stress.  So we try to make these moves as infrequent as we can and often do them in order to improve living situations, neighborhoods, or to begin new experiences in our lives.  For the Elder, or disabled adult, changing a residence is usually

1. not wanted
2. not voluntary
3. a downgrade
4. permanent

factors that combined can devastate their emotional lives.

In spite of all the negatives involved, a move is often absolutely necessary.  It may be needed to prevent self-neglect or to provide a higher level of physical care than a family or other caregiver is able to provide.  It may be needed to allow for personal finances to last longer or provide a more affordable level of care.  It might even be needed to remove someone from an actual or potentially abusive environment.  While all these reasons may be justified, they do not remove the emotional toll that is suffered.  How you as a caregiver respond to all aspects of moving a loved one will have a significant impact on the degree to which your loved one suffers emotional distress.   Read More
visit www.thecaregiverfoundation.com

Who are Caregivers?

Caregivers come in all shapes and sizes - Friends helping friends who are aging or disabled. Spouses providing care as their partner moves from capable to needing assistance with routine activities. Kids helping their parents or siblings. Caregiving is the task of providing for the phsyical and emotional needs of an individual who can no longer perform daily tasks independenly.

Do you help with rides to the doctor, shopping, meals, bill paying, bathing, grooming, dressing, walking or transferring to a wheelchair, housekeeping, managing medications, or arranging services to be provided by others? If you provide services like these, whether or not you live with the person you are helping, you are a caregiver.
Whatever your role in caregiving, you are among the thousands of dedicated and concerned individuals who carry our loved ones forward in their lives and help them maintain as much quality of life as possible. And it is not an easy job.
This blog is presented by The Caregiver Foundation a non-profit organization that supports Caergivers with educational resources, counseling, bill paying services, home restoration services and support groups.
I am encouraging you to submit your questions, stories, comments - anything that you need help with or have that you think would help other caregivers. And pass this blog along to everyone you know involved with caregiving!
Thanks for caring,
Gary

Posted by The Caregiver Foundation at 12:02 PM 0 comments

Detecting Financial Incapacity in Seniors

Recently the SEC, NASAA and FINRA published a report to help advise financial professionals in detecting signs of diminished capacity among older investors.
Some of the "red" flags they noted are

•  The Senior seems unable to process simple concepts
•  The Senior appears to have memory loss
•  The Senior appears to have difficulty speaking or communicating
•  The Senior appears to be unable to appreciate the consequences of decisions
•  The Senior makes decisions that are inconsistent with his or her current long-term goals or commitments
•  The Senior’s behavior is erratic
•  The Senior refuses to follow appropriate financial advice
•  The Senior appears to be confused about missing funds when reviews suggest there have been no unauthorized money movements at all.
•  The Senior is unaware of, or does not understand recently completed financial or legal transactions
•  The Senior appears to be disoriented with surroundings or social setting
•  The Senior appears uncharacteristically unkempt or forgetful.
•  The Senior appears frightened or nervous around family or friends who are helping with finances.

Reacting to these signs requires compassion and a complete understanding of the financial, social and physical environment surrounding the Senior. Seniors with no responsible family support should be referred to an appropriate government agency such as Adult Protective Service or the Office of Public Guardian. Seniors with responsible family support need for you to discuss your observations with the responsible family member and recommend steps to take in protecting the financial well-being of the Senior. Always carefully document your observations and retain that information to protect yourself and your practice.

Very often a Senior will turn a trusted person, in an attempt to preserve their financial independence and personal dignity. You must be able to observe compassionately but with wisdom and always try to do what is right for the Senior. In many cases it is best to involve the professional services of a Daily Money Manager - like those provided by The Caregiver Foundation of America.

For more information on protecting the financial lives of Seniors contact

The Caregiver Foundation

at thecaregiverfoundation@yahoo.com or telephone 808-625-3782
The Caregiver
Foundation of America - a 501(c)3 charitable organization helping you help those you love.
Helping you help those you love

Saturday, January 3, 2009