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

Keys Can Kill

Perhaps the second most common complaint I receive (problems is residence is first) is about elders and driving. The scenario begins

"I don't think dad should be driving anymore. his eyesight is not so good and his reflexes are defintiely too slow. but he won't give up his car! How can I make him stop before he kills somebody or gets hurt himself?"

First off - take comfort in knowing you are not alone in your delima. While there are 95 year olds still driving and doing so quite well, chances are your Dad or Mom are not included in their number. to make matters worse, the DMV (Dept, of Motor vehicles) only requires an eye test in order to renew their driver's license for 2 years!

Driving is both a skill and a privilidge. Individuals who have been excellent drivers all their lives can lose the cognitive and physical functions that enabled them. And when they do not recognize their limitations or refuse to acknowledge them, they become a danger to everyone else on the road. An example of just unrealistic they can is with Mr. X.

Mr. X was 87 years old when his son called me asking for help. Dad was still driving but could not see the curb when parked and kept climbing onto the sidewalk. He frequently got lost just going to the store 2 blocks away and recently a policeman had stopped him thinking he was drunk! Mr. X's son told his dad "you are going to end up hitting someone, maybe hurting them or killing them!" In a very uncharateristic response his Dad said "that's what I have insurance for!"

For a more in-depth look at how to handle the cars and keys problem click here. Below are a few fast tips that might help you right now!

1. Arrange for your loved one to have a physical therapist test his ability to drive. Theoretically,

if he does not pass that test, the therapist will notify DMV who is then supposed to rescind his driver's license.

2. Dad's car can develop "mechanical" problems. Take it in for a tune up and have the mechanic create a disabling event that take a VERY long time to repair.

3. The car can get "stolen".

4. Have the insurance triple. (You pay the regular bill and create a mock bill for a much higher amount - convince dad it is not worth spending the money just to keep driving)

5. Bite the bullet and take away the keys, remove the car and refuse to budge on the issue. Dad or mom will be furious but eventually will settle back downand may even use you as an example of "my kid really watches out for me" to their friends.

You have a moral responsibility to society-at-large that trumps your desire to have calm, peaceful relations with your loved ones. Just like your parents said when you were growing up "sometimes doing the right thing is hard.

Thursday, December 17, 2009

When Home Won't Work

"Telling Mom she was moving to a nursing home is the hardest thing I have ever done"

These words from a veteran green beret officer were accompanied by a glistening of tears as he recalled the day, 11 years ago, he prepared his 86 year old, invalid mother for the last move of her life.

Making the choice to move a love one to a nursing home produces a host of emotions for everyone involved. Your loved one may feel he or she is being abandoned, unloved, rejected. You may be faced with angry accusations and emotional please. You may feel guilt, sadness, anxiety and frustration. And you will have well-meaning individuals and professionals tell you “Don’t feel guilty” as though you can just make life altering decisions for your loved ones and then walk away whistling.
read more

The Caregiver Foundation of America exists to help Caregivers survive their journey. We help you help those you love. For more information visit www.thecaregiverfoundation.com or contact us at thecaregiverfoundation@yahoo.com

Senior Housekeeping and other torture

Caregivers are often see as people who have an easy time staying home and doing a little cleaning, sitting on the couch with mom or dad and watching TV or running around town doing a few errands here and there.

Yeah! Right! If you know any Caregivers or are a Caregiver yourself you know that the idea of a glorified homemaker is so far from the true work of a Caregiver that it is laughable. In fact, when it comes to housekeeping anyway - that is often the last thing that gets done - if it gets done at all.

And that brings me to the topic of today's blog! Senior Organizing Services.

Everyone ages and as we do the day-to-day tasks that were once fairly easy to do (even those we would have preferred not to do) become more and more difficult. Backaches, arthritis, and other conditions make the physical aspects of day-to-day cleaning challenging and for some the cognitive and emotional factors of maintaining things can start to overwhelm. I am often called to the homes of aging loved ones who have not wanted to have others butting into their affairs but have themselves been unable to keep up with the cleaning, organizing and other tasks that make life function smoothly. Their homes are sometimes just cluttered, bills unopened and refrigerators needing to be cleaned out and freshened up. Other homes have reached a point where just getting in the front door can be an adventure and actually living in the home has reached an impractical, unsafe of unhealthy state.

No matter the condition of the home, the state of financial disarray or the real need to organize, inventory and restore a home to a livable state - I am almost always able to create a plan that will keep your loved one at home. It is not easy and it is not inexpensive. Although The Caregiver Foundation is a not-for-profit organization, there are fees for various services. The most common fee is for daily financial management.

With daily financial management The Foundation actually becomes the financial authority for an aging person. Income is received into properly maintained and documented checking accounts or other accounts as needed and bills are paid by The Foundation from these accounts. Most mail is re-routed to the Foundation and notices go out to all suppliers, repairman, landlords, finance companies, physicians etc. to inform them of the new arrangements and provide them with copies of the authorization allowing us to perform these tasks. This service reduces the possibility of senior exploitation and abuse and helps to preserve family harmony by taking the responsibility of this area off the shoulders of family members.

Another common service that The Caregiver Foundation of America provides is household organization. This extensive cleaning and organizing sorts through papers and files and organizes them. Kitchens are rearranged to allow commonly used items to be at a reachable height with only storage items being housed in overhead cupboards. Outdated food items are cleaned up and inspection of appliances and equipment reduces the potential for bodily harm. When substantial repair is need to structures, electrical systems, plumbing and refrigeration systems, TCFOA arranges for licensed, insured contractors to perform the repairs under our supervision and guidance. When we are finished "restoring" a home it is in a livable, neat and clean condition. We then often arrange for on-going service to be provided for your loved one to keep the home maintained and provide supplemental services such as laundry, meal preparation, errand running and other tasks. 

If you would like us to take a look at your loved one's situation, call us or email today and let's get together and see what can be arranged to keep your loved one at home and happy! call 808-625-3782 or 808-722-1903 or email thecaregiverfoundation@yahoo.com

Posted by The Caregiver Foundation of America at 11:32 AM

Fly Away, Fly Away Home

Modern Society makes life better for many people - while they are young, able to travel and don't have to concern themselves too much with the health and welfare of others. Living apart from family - separated by thousands of miles is no big deal. But the day comes all too soon when living apart means you are unable to see if Mom is OK, if Dad is taking his medicine, if the house is being kept clean and safe....

Long distance caregiving has a different kind of stress. Day-to-day caregiving is full of hands-on stress and emotional struggles an long distance caregiving is a state of constant worry and concern. Both the hands-on and the long distance caregiver deal with stress.

If you are a long distance caregiver, there are some practical steps you can take to make life a little easier for yourself and insure better care for your loved one.

1. Have a surrogate presence.
2. Know the medical professionals who care for your loved one.
3. Schedule visits carefully.
4. Don't expect gratitude.
5. Be knowledgeable about your loved one's conditions, residence, finances and legal affairs.

Read more about this here - click on "long distance caregiving tips"

On-line resources

Finding Caregiving supplies and equipment can be an adventure in frustration. The Caregiver Foundation of America scours the internet for items that are of real value to Caregivers. A recent addition to the selections is a simple swivel seat that makes getting in and out a car so much easier.

Blackberry phones and cell phones are hard to use - those tiny buttons give even well-sighted people trouble. Home phones are a little better but the big button phone can be a lifesaver!

You can even find specialized clothing that still looks nice - like these side opening velcro closure pants. Finding resources like these can help your loved maintain independence.

Take a look around the store - items change and come and go so if you see something you cannot order - let me know and we will try to find a new source!

Caregiving can be easier with tools and resources designed to help both you and your loved one. Don't hesitate to ask us about other resources that can help.

Potential Savings for Seniors!

The Social Security Administration has a program to help subsidize Medicare Part D prescription drug premium payments. While this is not a new program, what is new is the expansion of qualified low-income seniors eleigible for the help.

Called the Extra Help program is estimated to have an average annual benefit of $3900 for Seniors whose income is no greater than $16,245 (for singles) and $21,855 for married couples living together. Add to those figures the value of stocks, bonds, bank accounts etc. which cannot exceed $12,500 for singles and $25,010 for couples. Homes and automobiles are not factored in this equation. Now - 2 other asset bases are not counted against low-income Seniors. Cash value life insurance is not counted and neither is assistance received from family and friends if used to pay for ordinary household expenses.

If you have not qualified in the past or have a loved one or friend who you think might benefit from this - apply. The potential benefit is nothing to dismiss lightly. Apply at the Social Security Administration website.

Contact The Caregiver Foundation of America at 808-625-3782 for more information or help in investigating this benefit. Visit www.thecaregiverfoundation.com

Remembering - ?

"I can't remember where I put the car keys!"
"What is that person's name?"
"I had an appointment today?"

These words can be heard from almost anyone but they become more and more frequent as people age. For Caregivers, these issues present situations that can frustrate and irritate and often we try to "fix" the situation.

We remind
We scold
We encourage

and none of them work. Much better are the practical helps like lists, designated spots for keys and other important items, automated reminders, and a host of other ways to help compensate for memory loss and confusion.

For many Caregivers, memory issues become more and more debilitating as our loved one moves from losing keys to not remembering if he ate breakfast, forgets to take a bath, leaves medications untouched, or wanders off and gets lost. It is frightening to see our loved one forgetting past times and the faces of people that were in his life. It is as if our existence in his memory is threatened - and in the case of severe dementia, like Alzheimer's disease, this is a real possibility.

As Caregivers we have to become confident in our memory of the loved we care for. It is a good idea to have photographs of friends and family and review them with our loved ones. This helps them to connect, however breifly, with memories that scamper all over their minds. Old songs are frequently recalled in part and can connect events with music. Anything you can do to provide keys to the past will help your loved one. But you must do this in a way that is not pushy and where you do not become impatient and irritated that the picture you just showed him has already been forgotten and you have to go through the same routine of memory tugs that you did less than 5 minutes ago.

What issues are you having with memory care? post them here and I will answer them.