The Telegraph reports on research in the British Journal of General Practice on Anticipatory Care Plans (ACPs) and their effect on hospitalization and duration of hospital stays. General practitioners in Scotland who asked elderly patients to write ACPs reported unplanned admissions falling by 43%, and the length of hospital duration was 52% lower as compared to patients who had not been asked to write an ACP. The authors explain that the associated costs were also cut in half. For more information, visit: The Telegraph: “End-of-life plans halve unplanned hospitalizations”

British Journal of General Practice: “Anticipatory care planning and integration: a primary care pilot study aimed at reducing unplanned hospitalization” (article is free)

From the National Care Planning Council, January 11, 2012

A recent USA Today article states that there is an increase in seniors living over the age of 90. According to author Haya El Nasser “The number of people living to age 90 and beyond has tripled in the past three decades to almost 2 million and is likely to quadruple by 2050”.

Seniors who live longer generally have some sort of disability or need help at some level of living. Sandy Markwood, CEO of the National Association of Area Agencies on Aging, indicates that the focus needs to be on being able to help these seniors live at home as long as possible as nursing home cost could rise to average $72,000 a year.

Long Term Care at any level, in the home, assisted living or nursing home can add a tremendous cost to seniors and their families.

Government Programs Only Pay For About 16% Of Long Term Care

Government programs such as Medicare, Medicaid and the Veterans Administration will cover the cost of long-term care under certain conditions. Medicare will cover rehabilitation from a hospital stay or limited care at home if there is a skilled (medical) need. The Veterans Administration will cover the cost of nursing home care indefinitely if the veteran is at least 70% service-connected disabled. The VA will also cover other forms of home-based or community-based care if there is a medical need.

Medicaid will cover both medical and non-medical related long-term care but in order to qualify for Medicaid a person has to have less than $2,000 in assets and income that is insufficient to pay the cost of care.

Funding Long Term Care with your Life Insurance Policy

Drawing cash from life insurance or changing a life insurance policy should only be done after reviewing with an expert advisor. Loss of the policy and death benefit could prove to be a detriment. If, however you have accumulated cash in a life insurance policy and no longer need the coverage you may consider using the cash for long term care or purchasing a LTC rider to your current policy.

New insurance products are being developed to cover both life insurance and long term care insurance. ElderLawAnswers reports:

“A new law makes the purchase of products that combine annuities or insurance policies with long-term care insurance more attractive. These “hybrid” products are gaining in popularity due to a law that went into effect January 1, 2010, making distributions from life insurance and annuities tax-free when used to pay for long-term care. The same law also allows owners of annuities or life insurance policies to exchange their old policies for long-term care insurance or hybrid policies without being taxed.”

Combination sales which include life insurance, annuities and traditional long-term care coverage are becoming popular with insurance companies and may prove a method of financing long term care. Investigate closely, however to find what exactly will be covered. Some policies do not cover home care costs or complete costs of nursing homes.

Long Term Care Insurance Funding for All Long Term Care Needs

The first long-term care policies were offered about 40 years ago. These were primarily nursing home-only policies designed to take over when Medicare rehabilitation ran out. They were not the comprehensive benefit policies we see today.

Long Term Care Insurance policies today are greatly diversified in their coverage. Home care, nursing home costs, adult day care, physical therapy, skilled and non-skilled nursing care are some of the services covered. Policies vary in price and what they cover. There is also a very restricted qualification of physical and mental heath to get a policy. Purchasing a policy at a younger age makes it easier to qualify and also provides cheaper premiums. It is best to consult with a long term care insurance professional about the type of policy that fits your needs and budget.

Veterans Aid and Attendance Pension Benefit

Though not an insurance policy, the VA Pension Benefit should be mentioned as a way to pay for long term care needs. A veteran or spouse of a veteran who served during a period of war can receive money, up to $2,019 a month, to pay for long term care medical expenses, home health care, and assisted living cost. A qualified Veteran Consultant can help you determine if you qualify for this benefit.

Pre-Need Burial Insurance

One might ask what Pre-need burial insurance has to do with long term care. The purpose of preneed life insurance is to set aside funds for your funeral, before the need arises.
It is an insurance policy that covers the cost of the predetermined expenses of a funeral, cremation or burial. It gives the purchaser the opportunity to preplan the services and peace of mind in having it paid for. This is usually an insurance policy that pays at time of death for these expenses. There are many insurance companies that offer these packages as well as funeral homes.

The saddest cases of long term care needs we hear are:

“Mother can no longer live alone and she has no money to go live in a care facility.”

“ Is there someone that can come help me take care of my wife? We live on our Social Security and I can not pay what home care costs.”

“Father died last night and we have no money to bury him, what do we do?”

It is important to make the necessary arrangements to cover long term care and end of life costs. There is no government program that will cover all those needs. The National Care Planning Council at www.longtermcarelink.net strives to educate people about long term care services and encourages the planning that needs to be done to prepare for future costs and needs.

What do you need in an emergency? Here’s a list compiled from an informal poll;

1. Full tank of gas in the car

2. Tub of water (for flushing and hygiene)

3. Pots/containers of water (for drinking)

4. Plug in phone (corded land line) May not work unless your service uses standard wires

5. Cell phone May not work

6. Cell phone car charger

7. Radio and batteries Hand crank version available and saves batteries

8. Flashlight or small lanterns and batteries Hand crank version available and saves batteries

9. Matches, candles, long stove/fireplace lighter—Though flashlights are safer

10. CO2 monitor with batteries if power is out

11. List of medications, allergies, medical conditions

12. Three (3) weeks supply of all medications 1 week at a minimum

13. Three (3) days supply of Bottled water 1 gl per person per day plus animal water

14. Three (3) days supply nonperishable food. Food you can eat without cooking. Protein from peanut butter, canned tuna, canned salmon, carbohydrates from crackers canned fruit, dried fruit, trail mix…

15. Paper plates, cups, plastic utensils

16. Hand operated can opener

17. Pet food if you have pets

18. Pet carriers accessible if they need to be evacuated with you

19. Standard first aid kit including a thermometer and basicmeds (anti-inflammatories…)

20. Hygiene items, hand sanitizer & personal care items Wash cloths, soap for sponge baths, toothpaste and brush

21. Cash—small amount. ATMs don’t work without power

22. Coolers /ice for food

23. Shovels and car ice scrapers/brushes

24. Warm clothing & blankets

25. Propane for gas grill TO BE USED OUTDOORS FOR GRILLING FOOD ONLY

26. Water filtration system—which might be as simple as a pitcher with a filter in it.

27. Wood indoors if you have a wood stove. Pellet stoves have an electric pellet feeder which won’t work without power

28. Plan for oxygen and other medical needs that require power

In an easy to find location:

1. Name, address and phone of a local emergency contact list ofother necessary phone numbers (doctor, vet…)

2. List of medications

3. Extra medications (1-3 weeks worth)

4. Copy of photo id and health insurance info

5. House key

6. Car key

7. Town emergency number in case evacuation from home is needed. Contact your town to find out where to call.

In Case of Evacuation:

An evacuation “Go Bag”— duffle or small bag with some food,water, emergency contact names, address and phone numbers, clothing, personal essentials, 1 week’s worth of medications, list of all medications, few basic first aid supplies.

You may need/want to adjust the list to your specific needs but it’s a good place to review and start your emergency plan.

When Bill Stevens realized that caring for his wife was taking a toll on his own health, he turned to adult day care.

Stevens, who lives in southern Franklin County, found a day program that can care for patients with Alzheimer’s disease and made arrangements for his wife, Marilyn, to go there two days a week.

The break was good for both of them, said Stevens, whose wife was diagnosed with the progressive brain disease seven years ago. He recently placed her in a group home that provides round-the-clock care to its residents.

“I firmly believe, looking back, that (day care) gave me a chance to keep my wife home a year longer.” the 68-year-old said.

Finding the right adult day care center can offer respite to caregivers while offering their loved one a chance to socialize and take part in supervised activities. Facilities vary from those that focus on medical care to those that are recreational, offering games, gardening or crafts.

There are over 3,500 adult day care providers across the country, according to industry experts, who say the number grows annually. In recent years, towns, churches, nursing homes, home health agencies and national franchises have opened adult day care centers.

In this area

Sugarloaf Adult Day & Respite program  has been operating in Sunderland for over 6 years. It offers a home-type environment and a great ratio of staff to clients. But, (there’s always a ‘but’) the need for Adult Day Care is growing and as ‘Baby Boomers’ age, the need grows larger.

For Sugarloaf Adult Day & Respite, that growth meant a change needed to happen. The original space was too small for the growing number of clients; requiring more services and more staff. A new executive director took over in January with the charge, from the board of directors, of finding a solution.

The Solution

A brand new, larger space was found in Hatfield and building plans commenced. Despite all attempts to make the transition to a larger facility work financially, the small not-for-profit did not have the resources to accomplish that goal. So another transition is about to take place. Elite Home Health Agency, in Amherst, has had an ongoing relationship with Sugarloaf through mutual clients and support of  the Sugarloaf program. In talks with Tom Porter, Elite’s president, it was apparent Elite could develop an Adult Day Care & Respite Program that filled the needs of Sugarloaf.

Sadly, Sugarloaf in Sunderland will close. The staff and clients will move to Elite’s new larger location at 10 West Street in Hatfield, just off the I-91 Hatfield exit. The facility is scheduled to open its 2400 square foot space in January 2012 and Sugarloaf Adult Day will end their services by the end of February 2012.

Chris Westerholm, Sugarloaf’s Program Director will continue with Elite in the same capacity. In December 2011, Elite Home Health Agency will move their offices from Amherst to the new space and continue to provide adult in-home care to clients in Franklin and Hampshire Counties.

For more information on the transition you may contact Sugarloaf Adult Day & Respite (665-9675) or Elite Home Health Agency. (256-4663)

Worried About Getting the Flu from the Flu Shot?

Rest assured, it’s impossible to get the flu from the flu shot because it contains an inactivated (killed) form of the virus. Since it takes two weeks for the shot’s antibodies to build up and provide full protection, some people who have gotten the flu during this time may think they got it from the shot. And of course that’s simply not true. In any case, it’s better to get your flu shot early to be protected before peak flu season, usually occurring in January and February. So be sure to get your flu shot now!

CELEBRATING FAMILY CAREGIVERS

November 9, 2011

Debbie turned the ringing alarm off. It was 6:00AM and time to get herself ready for the day. Her son would be there soon to help her shower and dress her husband Jim. Her son came every day before work to help because Debbie, at 75 years old and suffering with arthritis, could not lift Jim out of bed or help him to the shower. This has been the daily routine since Jim’s stroke a year ago. When her son leaves for work, Debbie spends the day caring for Jim’s needs.

President Barack Obama, in his Presidential Proclamation of National Family Caregivers Month -2011 states:

“Across our country, millions of family members, neighbors, and friends provide care and support for their loved ones during times of need. With profound compassion and selflessness, these caregivers sustain American men, women, and children at their most vulnerable moments, and through their devoted acts, they exemplify the best of the American spirit.”

Statistics from the Administration On Aging show that the population 65 and older is expected to grow from its current 13% to 19% of the total population by 2030. With the older population increasing, the need for elder caregiving will continue to increase. Family caregivers play a vital role in filling these caregiving needs. Who better than family can understand the needs and ensure the best care of their loved ones.

Caregiving can be very stressful and demanding. In the case of a healthy spouse or a child living with the disabled person at home, caregiving can be a 24 hour, 7 day a week commitment. But even for the caregiver not living in the home, looking after a loved one or friend can consume all of the caregiver’s free time.

Surveys and studies consistently show that depression is a major problem with full-time informal caregivers. This is typically brought on by stress and fatigue as well as social isolation from family and friends. If allowed to go on too long, the caregiver can sometimes break down and may end up needing long term care as well.

A typical pattern may unfold as follows:

1 to 18 months--the caregiver is confident, has everything under control and is coping well. Other friends and family are lending support.

20 to 36 months–the caregiver is taking medication to sleep and control mood swings. Outside help dwindles away and except for trips to the store or doctor, the caregiver has severed most social contacts. The caregiver feels alone and helpless.

38 to 50 months–Besides needing tranquilizers or antidepressants, the caregiver’s physical health is beginning to deteriorate. Lack of focus and sheer fatigue cloud judgment and the caregiver is often unable to make rational decisions or ask for help. It is often at this stage that family or friends intercede and find other solutions for care. This may include respite care, hiring home health aides or putting the disabled care recipient in a facility. Without intervention, the family caregiver may become a candidate for long term care as well.

Since most family members go into informal caregiving without training or counseling, they often aren’t aware of the possible outcome described above. It is therefore extremely important to seek counseling and to formulate a plan of action prior to making a caregiving commitment.

According to the National Care Planning Council:

” In 1965, Congress passed the Older Americans Act which provides guidance and funding to the States to give help to caregivers. All states offer programs at no cost or very low cost which might include: counseling, caregiver training, respite care, adult day care, meals, support groups and much, much more. It is vital for the health and longevity of all caregivers to make use of these services.”      (www.longtermcarelink.net)

In 1994 President Clinton proclaimed a week in November as National Family Caregivers week to be observed with appropriate programs and activities. It has since been changed to the whole month of November with each President giving a yearly proclamation for its observance.

Government assistance is available all over the country. Area Agencies on Aging and local senior centers give aid and support to family caregivers. Numerous religious and community organizations also lend their support.

This month of November, as individuals, we can take note of those around us, in our families and community, who are family caregivers. A note of acknowledgement of their service, a gift of thanks or even an offering of our time to give them a needed break would let them know their service is recognized and appreciated.

Many people use the terms Alzheimer’s disease and dementia interchangeably, but they have very different meanings. Although dementia is a group of symptoms that include memory loss, the term itself doesn’t explain what is causing the symptoms. Alzheimer’s disease is the leading cause of dementia, but there are many other causes.

Dementia is a general term for memory loss that is severe enough to interfere with daily life. The signs of dementia may include forgetfulness, difficulty making plans, thinking ahead, or using language, as well as changing character traits, among other symptoms. Alzheimer’s disease accounts for 50 to 80 percent of dementia cases according to the Alzheimer’s Association, but there are other causes, including vascular dementia, Lewy body dementia, frontotemporal dementia, and Wernicke-Korsakoff syndrome. For a list of the different causes of dementia, click here. Some causes of dementia are treatable, so it is important to understand the cause.

Alzheimer’s disease is a partially hereditary disease that causes a loss of brain cells. The symptoms start out mild but grow progressively worse over time. There is no cure, but there are medications that can treat the symptoms and slow the disease’s progress. An early symptom of Alzheimer’s is difficulty learning new information. It can then progress to more severe symptoms such as forgetting names and places, disorientation, mood and behavior changes, and an inability to relate to others. Eventually, it can lead to the inability to talk, walk, or eat. For more information on Alzheimer’s disease from the Alzheimer’s Association, click here.

Dementia, whether caused by Alzheimer’s disease or some other underlying disease, is not a normal part of aging. If someone you love is exhibiting signs of dementia, they should get immediate medical attention to understand what is causing it.

Published by ElderLawNet, Inc.

Tuesday, November 15, 2011 7:00 PM – 8:00 PM EST

More exciting webinar news from the Private Duty Homecare Association (PDHCA)!

To register, please click here. As our population of families dealing with caregiving for a loved one with Alzheimer’s increases, more information is needed about options to keep loved ones comfortable & safe in the home. Join PDHCA & the Alzheimer’s Association to learn warning signs, how to approach caregiving, signs of caregiver stress, respite care options & caregiving resources.

There are many decisions to be made when imminent death is approaching for a loved one. Questions regarding what type of care, medical assistance and even physical location for their last days confront us.

If care at home has been given, should loved ones be moved to a facility or remain at home? If in a care facility should they be moved home for their last days? Will 24-hour care become necessary and more medical assistance be required?

If you are asking these questions, a Hospice service might be a good solution. Hospice can be provided to a person who has a life-limiting illness wherever that person lives. A nursing facility or long-term care facility can receive visits from hospice personnel in addition to the other care and services provided by the facility.

Hospice care is a special way of caring for a patient who is in the last stages of life. Hospice provides a team of professionals who aid the patient and family caregivers. This could include nurses, social workers, physicians, clergy and aides who all work together to plan and coordinate care, 24 hours a day or as needed.

The Hospice Foundation of America outlines the following services of hospice:

• Hospice is a special concept of care designed to provide comfort and support to patients and their families when a life-limiting illness no longer responds to cure-oriented treatments.
• Hospice care neither prolongs life nor hastens death. Hospice staff and volunteers offer a specialized knowledge of medical care, including pain management.
• The goal of hospice care is to improve the quality of a patient’s last days by offering comfort and dignity.
• Hospice care is provided by a team-oriented group of specially trained professionals, volunteers and family members.
• Hospice addresses all symptoms of a disease, with a special emphasis on controlling a patient’s pain and discomfort.
• Hospice deals with the emotional, social and spiritual impact of the disease on the patient and the patient’s family and friends.
• Hospice offers a variety of bereavement and counseling services to families before and after a patient’s death.

To be eligible for hospice a physician must certify the patient to be terminally ill with a life expectancy of six months or less and treatment for a cure is no longer provided.
The focus for the patient has changed to supportive care and quality of remaining life.

Hospice is paid for by private insurance, Medicare or Medicaid Hospice Benefit or personal funds.

Here are the conditions that apply for Medicare Hospice Benefits:

• You are eligible for Medicare Part A (Hospital Insurance)
• Your doctor and the hospice medical director certify that you’re terminally ill and have 6 months or less to live if your illness runs its normal course.
• You sign a statement choosing hospice care instead of other Medicare-covered benefits to treat your terminal illness.
• You get care from a Medicare-approved hospice program
• You understand that Medicare will still pay for covered benefits for any health problems that aren’t related to your terminal illness. Medicare.gov

Special benefit periods apply to Medicare hospice care and some services do not apply.
Be sure to understand the rules and requirements of Medicare payment before you commit.

Hospice is available to anyone, regardless of age or illness. If Medicare or private insurance is not available, hospice services may be available for low income individuals through grants or charitable donations. Many hospices are non-profit and will provide services to anyone in need.

“Many families or their loved ones’ doctors often wait too long to order hospice. Hospice is a very valuable service and should be ordered at an earlier stage of illness. Many do not consider hospice for Alzheimer’s, degenerative old age or other debilitating illnesses where a person is going downhill fast. They should.

It is unfortunate that many people who died in a hospital emergency room or who received heroic treatments to prolong life in a hospital may have had the alternative of dying at home in familiar surroundings, with family or other loved ones at their side.When someone is in crisis or appears to be going downhill fast but there really is no hope for recovery, family often call 911 and start a process which can result in great stress and great emotional discomfort. The loved one who is dying ends up in a hospital and may die there or be transferred to a nursing home where death eventually occurs.When there is no longer hope for prolonging life, especially when this decision is made months in advance, hospice is usually a better alternative to other medical intervention”. National Care Planning Council

The days leading up to the moment of death of a loved one can be rich with meaning and expressions of love. Family and caregivers should allow others to help with the care and daily responsibilities. They need to free themselves from the details of caregiving and instead need to use hospice to allow more time to reminisce, give thanks for a life shared and say goodbye.