Thursday, March 26, 2015

About 70% of people turning 65 today can expect to use long-term care of some kind in their lives.

Cliff N. Goldstein is a member of the personal finance team at NerdWallet, an unbiased source of tools and information aimed at helping consumers make smarter financial decisions. He previously worked as a financial investment professional in the Private Wealth Management division at Goldman Sachs, where he provided comprehensive financial solutions to high net worth individuals, families and foundations. Cliff's efforts are currently focused on building tools and writing articles to help people better understand the complex financial advisor landscape. He helps manage NerdWallet's "Ask an Advisor" platform, which enables people to receive professional answers to their financial questions while also streamlining their search for a financial advisor ideally suited to their unique needs. Cliff holds a bachelor's degree in International Economics from Georgetown University's Walsh School of Foreign Service and received an honors certificate in International Business Diplomacy. Follow Cliff on Twitter @CliffNerdWallet.

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As people live longer, it becomes more likely that many of us will need long-term care one day.
About 70% of people turning 65 today can expect to use long-term care of some kind in their lives, according to the Administration on Aging.
And with demand growing and health care costs rising, paying for that care requires some forethought. That's where long-term care insurance comes in.
"Most of us want to have a healthy, active retirement. But as you get older, the risk is greater that you may need extended care," says Nadia Allaudin, senior vice president of wealth management for Merrill Lynch in Century City, Calif. "Whether you are in an assisted living home for an extended period, or even in a convalescent center for a shorter time frame, a long-term care insurance policy is a valuable option to help cover incurred costs."
Long-term care insurance can be used to pay for various services that may be provided in a care facility or at home — for example, adult day care, skilled nursing, physical therapy and help with personal care, such as bathing. While Medicare and other health insurance cover immediate medical expenses, they fall short on long-term care related to chronic conditions. Medicaid can cover some services, but has very strict conditions that must be met before coverage kicks in.
How it works
With a long-term care insurance plan, you'll have to pay a monthly premium determined by factors such as your age, health and what you need in a policy. Your policy will usually include a list of what are called "Activities of Daily Living" (ADL) — for instance, bathing, dressing, eating and using the bathroom. Coverage, in the form of a daily benefit, starts when you are unable to manage a specified number of such activities on your own.
You can apply for long-term care insurance at any time, but since premiums rise as you age, it's best to buy between the ages of 55 and 64. Securing coverage when you're in good health can ensure a lower premium, and insurance carriers may reject applicants with pre-existing conditions or those who have undergone medical procedures.
When considering a long-term care insurance policy, look carefully into which benefits are covered; the process of getting paid; whether there are any blackout periods; what the monthly long-term benefits are; whether it includes inflation protection; and whether premiums can rise unexpectedly.
Take a longer view
Don't make the mistake of thinking long-term care insurance is only for retirees and seniors to worry about, says Mark Sullivan, a general agent for Genworth Financial and the president of the New England Long-Term Care Planning Group in Massachusetts.
"Many people often think 'that will never happen to me' when discussing someone else's health issues, but frankly, it can happen to anyone," says Sullivan. "Costs of nursing home care, as with other medically related services, are skyrocketing, and the family's retirement savings can quickly be exhausted if an insurance policy isn't in place."
Indeed, health care costs are rising among all sectors, including long-term care services. The average cost of a private room in a nursing home is around $240 daily, an increase of 4.35% over the year before, according to Genworth Financial's 2014 Cost of Care Survey. From 2013 to 2014, assisted living facility costs rose 1.45%, to $3,500 a month. In the same period, costs for home health aide services increased 1.59%, to $20 per hour.
"Knowing that you are protected may help ease the worry of having to depend on family members to provide care or financial support in the future," says Laura Knolle, a certified financial planner at Ballou Plum Wealth Advisors in California. "Having a policy also helps prevent depleting your estate if you would like to leave assets to loved ones when you pass."

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Wednesday, March 25, 2015

Planning Ahead When a Family Member Has Alzheimer’s Disease

When a loved one is diagnosed with Alzheimer’s disease (AD), you need to start getting his or her health, legal, and financial affairs in order.

You want to plan for the future, if possible, with help from the person while he or she can still
make decisions. You need to review all of his or her health, legal, and financial information to
make sure it reflects the person’s wishes. Here is a planning checklist from the National Institute
on Aging’s Alzheimer’s Disease Education and Referral Center:

Update health care, legal, and financial information
• A Durable Power of Attorney for Finances gives someone called a trustee the power to make legal
and financial decisions for the person with AD.
• A Durable Power of Attorney for Health Care gives someone called a proxy the power to make
health care decisions for the person with AD.
• A Living Will states the person’s wishes for health care at the end of life.
• A Do Not Resuscitate (DNR) Form tells health care staff how the person
wants end-of-life health care managed.
• A Will tells how the person wants his or her property and money to be divided among those
left behind.
• A Living Trust tells someone called a trustee how to distribute a person’s property and money.

Check for money problems

People with Alzheimer’s disease often have problems managing their money. As the disease progresses, a person may try to hide financial problems to protect his or her independence. Or, the person may not realize that he or she is losing the ability to handle money matters.

Someone should check each month to see how the person is doing. This person might be a family
member or the trustee.

Protect the person from fraud

Scams can take many forms, such as identity theft; get-rich-quick offers; phony offers of prizes or
home or auto repairs; insurance scams or outright threats. Here are some signs that the person with
AD is not managing money well or has become a victim of a scam:
• The person seems afraid or worried when he or she talks about money.
• Money is missing from the person’s bank account.
• Signatures on checks or other papers don’t look like the person’s signature.
• Bills are not being paid, and the person doesn’t know why.

 "Eldercare in an Age of Scarcity" is a service of Informed Eldercare Decisions,
Dedham, MA 02027

Providing services to elders and family caregivers
faced with difficult care planning decisions for more than 20 years

Friday, March 20, 2015

Elder Care in Norway is Worse than in U.S

Norway’s much-vaunted cradle-to-grave security was under legal scrutiny this week after the City of Oslo went on trial over its often-criticized elder care. At issue is whether the city was negligent and ultimately responsible for the deaths of two elderly women who police believe should have been placed in nursing homes.
Human rights violations
"While clean, well-functioning nursing homes are found, the standards of some elder care in Norway can be so low that the Norwegian Center for Human Rights recently released a report claiming that the human rights of the elderly were regularly violated at Norwegian nursing homes."

Many elderly simply need a hand to hold, others extensive care and help. The City of Oslo is on trial after two elderly women died because of what police believe was negligence. PHOTO: Sarpsborg kommune
Many elderly simply need a hand to hold, while others require extensive assistance. The City of Oslo is on trial after two elderly women died because of what police believe was negligence. PHOTO: Sarpsborg kommune
Jorunn Marie Bukkøy, age 83, was found in a snowbank outside her apartment in downtown Oslo in March 2010. Police said Bukkøy froze to death after she had wandered outside in the middle of the night. A month later, another elderly woman, Gunhild Bringaker, was found dead in her Oslo apartment. Police determined she’d died at least two weeks earlier, and had been unattended.
Both women were supposed to be receiving hjemmehjelp, the help offered at home to those who aren’t granted or don’t want a room at a local nursing home. Oslo, along with many other communities in a country where elder care is administered through local governments, has a chronic shortage of nursing home capacity. Help at home is often the only form of help available.
“It’s very serious when two women die in the way they did,” prosecutor Pål Fredrik Hjort Kraby of the Oslo Police District told Norwegian Broadcasting (NRK). “It was important that we determine what happened here.” After a lengthy investigation, and state regulatory review, police noted that Bukkøy was dement, incontinent and suffered from various pain and infections. She also had a tendency to fall, yet the city region where she lived, Bydel Gamle Oslo, did not place her in a nursing home and its so-called “round-the-clock” care only amounted a short visits by city health care staffers totaling around two hours a day. It did not prevent Bukkøy from wandering outside on a cold late winter night and freezing to death.
Oslo has a chronic shortage of nursing home capacity. Pictured here, the Langerud Sykehjem on Oslo's east side, built in 1976. PHOTO: Wikipedia
Oslo has a chronic shortage of nursing home capacity. Pictured here, the Langerud Sykehjem on Oslo’s east side, built in 1976. PHOTO: Wikipedia
The police thus fined the city NOK 500,000 for negligence, but the city refused to accept blame or pay the fine. That’s why the case involving the two deaths has finally landed in court, five years after the deaths occurred. 
Elder care ‘not good enough’
While hospitals in Norway are funded and run by the state, nursing homes are administered through municipalities. When an elderly patient is ready to be released from the hospital, their local authorities are supposed to provide nursing home care. All too often the local authorities fail to do so, meaning the patients linger at the hospital on the state’s bill or are sent home and can’t care for themselves. Families generally step in, and private options are available to those who can afford them, but many elderly are single with no family in the vicinity, and thus are on their own
Human rights violations
While clean, well-functioning nursing homes are found, the standards of some elder care in Norway can be so low that the Norwegian Center for Human Rights recently released a report claiming that the human rights of the elderly were regularly violated at Norwegian nursing homes. Residents were seldom taken outdoors in the fresh air, for example, or weren’t helped to the toilet, were forced to use diapers and showered too infrequently, according to the report. No one made sure elderly residents were eating properly, or getting enough fluids. Nursing home management blamed a lack of staffing, while the elderly themselves are a vulnerable group who often are unable or unwilling to complain or demand their rights. Berglund

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faced with difficult care planning decisions for more than 20 years

Wednesday, March 18, 2015

More Americans are Facing Rising Caregiver Costs


More Americans are facing rising caregiver costs. The financial challenge of caring for an aging parent can also create caregiver stress. Don’t allow caring for an aging parent or spouse to become a crisis. by Dustin Schofield

Nearly 10 million adults over the age of 50 provide care or financial support for aging parents. Their ranks have swelled significantly over the last decade and will continue to grow, according to a study on caregivers by MetLife.*
The cost of providing care for a loved one — whether an ailing spouse or elderly parent — can be daunting. Beyond medical expenses, such as in-house or nursing home care, it can also include lost income due to the large time commitment.
The MetLife study estimates caregiver responsibilities for the average person age 50 and older can result in a total of more than $300,000 in lost wages and benefits.
There is some good news. There may be ways to provide for an aging parent or loved one without jeopardizing your finances now or in the future. Here are some strategies to consider.
Talk to your employer
Caring for a family member can be a 24-hour-a-day responsibility. The demands of a full-time job can make taking care of an aging parent or spouse difficult. Discussing the situation with your employer as soon as possible may help create a better position for yourself.
For example, you may be able to negotiate flexible work hours that allow you to take time away for doctor appointments. Your employer may also be willing to allow telecommuting options. Working from home might allow you to stay productive while meeting the needs of your ailing spouse or parent.
Review your parent’s finances
While your parent is still healthy, sit down to discuss his or her financial situation. Talk about everything from retirement savings and monthly Social Security benefits to current health care premiums and housing costs.
These discussions can give you a better handle on just how much financial support you may be expected to provide.
Your financial adviser can help you weigh your options, and may be able to serve as a neutral third party during conversations with your parent about financial matters.
Your parent’s financial situation may even make him or her eligible for certain benefits. One example is income. If your parent’s annual income is relatively low, you may be able to claim him or her as a dependent on your tax return. This may defray the cost of care. Talk with your tax adviser before doing this to see if your situation qualifies.
Make sure your parent has an up-to-date estate plan. Be sure to review financial powers of attorney and health care proxies. You should understand what is included in these documents. Is an appropriate person named who has the authority to make critical financial or health care decisions if your parent becomes incapacitated?
These meetings should make your parent’s wishes clear.
Get (free) help
If your parent lives with you and needs periodic care during the day, hiring an in-home nurse can be expensive. It is likely not covered by Medicare.
Check on alternatives in your community. Many religious groups and local social service agencies provide free or low-cost care or companionship for elderly adults. These can help reduce your out-of-pocket caregiver costs.
Also check with your family. Other members may be able to participate in your loved one’s care and provide scheduled breaks for the primary caregivers.
To avoid surprises and reduce stress, talk to your loved ones about their wishes well in advance. Discuss what will happen when they reach the age when they need additional help caring for themselves.
This article was written by Wells Fargo Advisors and provided courtesy of Dustin Schofield, vice president of The Schofield Group Investment Management. Contact him at 435-674-3601 or

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Maria Shriver and Rob Lowe Discuss Their Personal Experiences Caring for Aging Parents (2 Minute video)

 Rob Lowe
Rob Lowe just completed an educational video series with Maria Shriver for Genworth Financial that focuses on families having conversations about later-life issues, specifically around the need for long-term care.
Barely a boomer, Lowe at 50 years of age is like so many of us; he's thrived, struggled and re-created himself. As successful as Rob Lowe has been, he has encountered many of the situations that we all have. That includes the need to speak with both our own children and our aging parents about their financial matters, as well as ensuring that our own financial situations are sound.
It was Lowe’s personal experiences that led him to sit down with me and discuss the need for families to have the "conversations that matter" about topics of later life, including long-term care.
You can view the introductory video at

 "Eldercare in an Age of Scarcity" is a service of Informed Eldercare Decisions,
Dedham, MA 02027

Providing services to elders and family caregivers
faced with difficult care planning decisions for more than 20 years

5 Steps to Avoid The "Sandwich Generation" Squeeze

These are the five steps every family should take to avoid or, at the very least, help alleviate the pain of becoming part of the sandwich generation. Preparing for illness and taking care of a sick loved one, is never an easy task. However, if you don’t plan or help your parents to plan, you could find yourself sandwiched between guilt and confusion.
The “sandwich generation” is a term coined for families squeezed between taking care of an aging parent and raising young children or supporting adult children.
1. Family meeting
The family meeting is simple, but effective. Many families hold financial affairs close to their chests. As a result, when a loved one becomes incapacitated or dies, family members are forced to scramble to determine final wishes and wrap up financial matters. Transparency is essential. A family meeting is the perfect time to decide who will handle what decisions.
2. Updating legal documents
A good rule of thumb is to dust off legal documents and update every five or so years. If an aging parent has an incident, or is in failing health, it is a very good time to review these documents with your parents. Laws change and life has a funny way of changing situations. The basic legal documents you should have are an updated last will and testament, living will, health-care surrogate, power of attorney, and potentially a living trust.
3.Taking financial inventory
 Many families have believed for decades that their parents were well off financially, only to discover they were broke and that they had unknowingly become their parent’s financial plan.
The following is a short list of information you should store in a safe place:
  • Incomes and survivor benefit options on these incomes if both parents are living
  • Monthly operating expenses
  • Long-term care policies
  • Death and marriage certificates for previous spouses
  • DD2-14 (discharge paperwork) to research potential benefits for seniors
  • Financial information: Checking accounts, CDs, brokerages, qualified accounts, and annuities
  • Real property including land, primary residences and other property
4. Take tours and research options
Do we move our parents into assisted living or hire caregivers? Remember there is no right or wrong answer. Facilities have come a long way since their initial creation and establishment. Home health care can be a great option as well, but families should understand that it can be a luxury to stay in one’s home. Home care may initially be cheaper but it can gradually become more expensive than a facility and taxing on family members acting as caregivers.
5. Build a long-term care plan
A long-term care plan is not a product. It’s not something someone can sell you. A long-term care plan is a strategy with an established timeline and predefined milestones. It is built upon one fundamental discovery question: “If today you became ill or injured in an accident and could no longer take care of yourself independently, how would you like to be taken care of?“

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Providing services to elders and family caregivers
faced with difficult care planning decisions for more than 20 years

Thursday, March 12, 2015

Tennessee Legislators Try to Protect Eldercare Facility Owners Who Abuse Residents in their Care

MEMPHIS, Tenn. — One patient choked to death, another claimed he was raped. Channel WREG has uncovered new and very disturbing details about problems at a local nursing home. The “On Your Side Investigators” at Channel 3 in Memphis also discovered these same details could be kept secret.

An inspection report from federal and state health surveyors shows Signature Healthcare at St. Peter Villa in MidTown Memphis was hit with more than 20 deficiencies in August of 2014. The survey shows one resident choked to death after the facility failed to provide the proper diet, neglected to monitor the patient during meals, and never even attempted a maneuver to stop the choking.

It also reveals Signature Healthcare at St. Peter Villa “failed to thoroughly investigate” an alleged rape. The resident wasn’t sent to the ER for a rape kit, and the nursing home never even notified police. The local television investigators recently uncovered problems at another Memphis nursing home owned by the same company.

 Several viewers of the TV report confirmed the horrific details and encouraged the station to continue to inform the public but now some members of the Tennessee state legislature are trying to make it illegal for the public to be informed of dangerous and abusive conditions in the state’s nursing homes. The surveys that reveal the details of poor quality care for frail elderly patients revealed by WREG could soon be kept secret, if a bill sponsored by Tennessee State Senator Brian Kelsey and Representative Leigh Wilburn becomes law.

Senate Bill 889 would prohibit survey and investigation results from being used as evidence in malpractice cases.

You can read a copy of this legislation at the TV station’s Web site

 Cameron Jehl is a Memphis Attorney who has sued nursing homes before. He opposes the proposed legislation.“If the nursing homes violates federal law and federal regulations, they’re required to comply with in order to keep and take care of the elderly, then they should be held accountable for their actions,” Jehl said.

However, Senator Kelsey says attorneys will sometimes misuse negative survey results to paint nursing homes with a broad brush, rather than focusing on a single incident that led to a injury or fatality.

 "Eldercare in an Age of Scarcity" is a service of Informed Eldercare Decisions,
Dedham, MA 02027

Providing services to elders and family caregivers
faced with difficult care planning decisions for more than 20 years

Sunday, March 8, 2015

The Worst States in America to Grow Old In
By Thomas C. Frohlich and Alexander Kent January 26, 2015 

HelpAge International evaluates the social and economic well-being of the elderly in its annual Global AgeWatch Index. Last year, the United States was among the better places to grow old in the world, at eighth place. However, domestically, each state offers a very different quality of life for its older residents. Based on an independent analysis by 24/7 Wall St., which incorporated a range of income, health, labor, and environmental indicators, the following states are the 10 worst in which to grow old. 

1. Mississippi
The median income among elderly households was less than $30,000 in 2013, the lowest in the country. Nearly 15% of residents 65 and older lived in poverty that year, also the worst rate. Perhaps as a result of financial burdens, elderly residents had worse health outcomes. More than 45% had a disability, the second highest rate in the country. In addition, accessibility to services in Mississippi was rated worse than in any other state by the OECD.

2. Louisiana
 Older Louisiana residents are among the nation’s most financially insecure. A typical household with older occupants had an income of $31,230 in 2013, second only to 

 3. West Virginia
 Among the state’s senior citizens, a typical household earned $31,542 in 2013, the third lowest figure in the country. Additionally, West Virginia’s elderlies were the most likely in the country to have some kind of disability in 2013, with nearly half indicating they were disabled.  

4. Arkansas
 More than 94% of elderly Arkansas residents received social security benefits in 2013, the highest rate among all states. Yet, this income frequently did not meet the financial needs of many older Arkansans, as nearly 13% did not have adequate access to nutritious and affordable food in 2011, the highest rate in the nation. 

5. Nevada
 The collapse of Nevada’s economy as a result of the housing crisis in 2009 is likely still having an effect on the state’s residents, including its elderly population. Only 91% of Nevadans aged 55 to 64 were employed in 2013, the lowest rate in the country. Additionally, Nevada had the country’s highest rate of residents 65 and older who did not have health insurance, which may have contributed to only 66.1% of all residents having a personal doctor, the lowest rate in the country.  

6. Tennessee
 In 2011, nearly 12% of Tennessee seniors did not have adequate access to nutritious and affordable food, the second-highest percentage in the nation. Low educational attainment rates likely explain in part the poor income security among older state residents. Less than 20% of Tennessee residents 65 and older had at least a bachelor’s degree, one of the lowest figures in the country. 

7. New Mexico
 The state’s elderly population was among the most likely to live in poverty in 2013. Nearly 12% of residents 65 and older lived in poverty, the third highest nationwide. Poor income insecurity likely contributed to similarly poor health outcomes. Nearly 42% of residents 65 and older had a disability in 2013, one of the highest rates. In addition, access to services in New Mexico worse than access in nearly every other state.

8. Alabama
 At 75.4 years, Alabama’s life expectancy at birth in 2011 was lower than that of all but two states. Low life expectancy may result from not eating healthy foods. In 2011, 11.2% of senior citizens in the state did not have easy access to nutritious foods, the fifth highest share in the country. The high degree of food insecurity may also be related to low incomes.  

9. Kentucky
 Older Kentuckians have relatively poor income security. Older households had a median income of less than $33,000 in 2013, one of the lowest figures in the country.   11.2% of Kentucky’s elderly population live in poverty, one of the highest poverty rates among state elderly populations.

10. South Carolina
 Based on a range of factors, including income, health, labor, and environmental indicators, South Carolina is the 10th worst state in which to grow old. Older Americans are often targets of scams, financial crimes, and violence. With nearly 500 violent crimes reported per 100,000 people in the state in 2013 — one of the highest rates — South Carolina is not especially safe.  

For more than 20 years, Informed Eldercare Decisions, Inc has been providing experienced and highly professional care management specialists to elders and family caregivers in Massachusetts who seek assistance with the difficult care planning decisions.
As parents age, they may need assistance with tasks such as home maintenance, getting dressed, personal hygiene, mobility, transportation and nutritious meals. And if a medical emergency occurs without a contingency plan in place, it adds to the burden of guilt and anxiety over what could happen in the family caregiver's absence. 
Our highly accomplished professionals conduct in home or hospital based evaluations and needs assessments in order to develop a comprehensive care plan that addresses the full range of medical, emotional, financial, and legal needs. Plans are customized to meet the specific needs of each family. We also provide optional, ongoing monitoring of the care plan when family members are unable to do so due to work, distance, or other conflicting responsibilities.  

Informed Eldercare Decisions, Inc.781-461-9637

Monday, March 2, 2015

Compound found in grapes, red wine may help prevent memory loss

Adapted media release

A compound found in common foods such as red grapes and peanuts may help prevent age-related decline in memory, according to new research published by a faculty member in the Texas A&M Health Science Center College of Medicine.

Ashok K. Shetty, Ph.D., a professor in the Department of Molecular and Cellular Medicine and Director of Neurosciences at the Institute for Regenerative Medicine, has been studying the potential benefit of resveratrol, an antioxidant that is found in the skin of red grapes, as well as in red wine, peanuts and some berries.

Resveratrol has been widely touted for its potential to prevent heart disease, but Shetty and a team that includes other researchers from the health science center believe it also has positive effects on the hippocampus, an area of the brain that is critical to functions such as memory, learning and mood.
Because both humans and animals show a decline in cognitive capacity after middle age, the findings may have implications for treating memory loss in the elderly. Resveratrol may even be able to help people afflicted with severe neurodegenerative conditions such as Alzheimer's disease.
In a study published online Jan. 28 in Scientific Reports, Shetty and his research team members reported that treatment with resveratrol had apparent benefits in terms of learning, memory and mood function in aged rats.

"The results of the study were striking," Shetty said. "They indicated that for the control rats who did not receive resveratrol, spatial learning ability was largely maintained but ability to make new spatial memories significantly declined between 22 and 25 months. By contrast, both spatial learning and memory improved in the resveratrol-treated rats."
Shetty said neurogenesis (the growth and development of neurons) approximately doubled in the rats given resveratrol compared to the control rats. The resveratrol-treated rats also had significantly improved microvasculature, indicating improved blood flow, and had a lower level of chronic inflammation in the hippocampus.

"The study provides novel evidence that resveratrol treatment in late middle age can help improve memory and mood function in old age," Shetty said.
This study was funded primarily by the National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health. Shetty's lab is now examining the molecular mechanisms that underlie the improved cognitive function following resveratrol treatment. He also plans to conduct studies to see whether lower doses of resveratrol in the diet for prolonged periods would offer similar benefits to the aged brain.
Written by Ellen Davis

 "Eldercare in an Age of Scarcity" is a service of Informed Eldercare Decisions,
Dedham, MA 02027
Providing services to elders and family caregivers
faced with difficult care planning decisions for more than 20 years