Wednesday, November 26, 2014

As Baby Boomers Age and Americans Live Longer, The Need for Health Care Workers Will Become Greater.

 Obama Immigration Move May Aid  Eldercare Worker Shortage

Advocates for the aging and their health care workers, particularly in the nursing home and long-term care industry, say President Obama’s move to grant work permits for up to five million undocumented immigrants and shield them from deportation may bring at least “some temporary relief’’ to seniors and people with disabilities.

If it weren’t for foreign-born health workers, older adults and people with disabilities wouldn’t be able to remain in their homes, “stay healthy and age with dignity,” said James Firman, chief executive officer of the National Council on Aging. Already, one-quarter of the nation’s home care workers are foreign-born, the council said.

As baby boomers age and Americans live longer, the need for health care workers is only going to become greater.  At the same time, more Americans can pay for their health care under the Affordable Care Act and are therefore seeking treatment, putting even more demands on the health care labor force.

“As our population ages, the number of Americans needing long-term care will more than double from 12 to 27 million by 2050,” Firman said in a statement. “There is a severe projected shortage of direct care workers such as nurse aides and home care aides, that common sense immigration policy could help address.”

While advocates for older adults are okay with Obama’s executive order issued last week, they still want bipartisan legislation that creates a pathway for citizenship for undocumented immigrants. Without it, they say, care for aging Americans is threatened.

“When one of eight home care workers live in fear of deportation, this hurts the families that rely on their care as well as the workers themselves,” said Sarita Gupta, co-director of Caring Access Generations who praised Obama’s action. “This executive order will bring peace of mind to millions of families, immigrant or not. But we need to keep pushing for a permanent solution – and one that includes all of those that have not been included – for a more stable workforce and a stronger economy.”

Monday, November 24, 2014

6 in 10 Adults Age 50+ Provided Some Financial Support to Family Members

Merrill Lynch, in partnership with Age Wave, released a study focusing on health in retirement. 

Many retirees say the key to a happy retirement is being healthy. Poor health can mean significant retirement challenges, so staying in top condition is important.

The study, Health and Retirement: Planning for the Great Unknown, explored several areas of concern in retirement. Topics of exploration included the impact of health and health care costs on quality of life during retirement, and how longevity is requiring pre-retirees to more closely examine how their health might impact their wealth.
Key insights from the Merrill Lynch/Age Wave study:
  • Retirees view health as the most important ingredient to a happy retirement, but also the greatest financial concern.
  • Most have not factored health care costs into their retirement planning, and most couples age 50 and over have not discussed how much money they may need to finance their healthcare during retirement.
  • Most retirees were forced to retire earlier than expected. The top reason for early retirement was a health problem.
Survey respondents of all ages said Alzheimer’s was a health condition of later life that scared them most. They feared this disease even more than cancer, strokes, heart disease, diabetes and arthritis combined.

For more retirement coverage, see The New Playbook for Retirement in the October issue of Black Enterprise.

Merrill Lynch. (2013). Family & retirement: The elephant in the room. U. S.: Bank of America. Retrieved from

Friday, November 21, 2014

Politicians Who Claim America Has "World's Best Health Care System" are in Denial

Commonwealth Fund: U.S. healthcare is most expensive, but last in quality

For the fifth time, the United States' healthcare system ranks last in quality compared to 10 other industrialized Western nations, according to a report from the Commonwealth Fund.

Not only has the U.S. remained in last place through the past decade, the healthcare system's per capita spending ($8,508) is far greater than that of the second-most expensive system, Norway's, which spends $5,669 per capita, according to the report.

"Although the U.S. spends more on healthcare than any other country and has the highest proportion of specialist physicians, survey findings indicate that from the patients' perspective, and based on outcome indicators, the performance of American healthcare is severely lacking," the report states.
Older American adults are sicker than those in 10 other countries, with nearly seven in 10 dealing with at least two chronic conditions, according to an international survey published in Health Affairs.

Researchers from the Commonwealth Fund, surveyed 15,617 adults 65 and older in the U.S., Canada, France, Australia, Germany, New Zealand, Norway, Sweden, Switzerland, the United Kingdom and the Netherlands.

In addition to finding that 68 percent of American respondents live with two or more chronic conditions, researchers found that a small majority--53 percent--take at least four medications, although at 83 percent, Americans also had one of the highest rates of respondents who said they could carry out their treatment plans in their daily lives.

They further found that:

    Only 57 percent of U.S. respondents could get same-day or next-day appointments for illness, which put the U.S. below France and New Zealand's 83 percent and Germany's 81 percent, but above Canada's 45 percent

    Americans scored better on the availability of specialty care appointments, with 86 percent saying they waited fewer than four weeks, putting them ahead of all surveyed countries except Switzerland

    At 23 percent, U.S. respondents were most likely to say test results or records were unavailable at appointments or that their doctor had ordered duplicate tests, but at 28 percent, they were among the least likely to have gaps in their plans after being discharged from the hospital

    In half of all countries surveyed, at least 20 percent of chronically ill adults were themselves in a caregiver position

As almost all U.S. respondents were covered by either Medicare or some other form of insurance, researchers were able "to compare more directly the performance of the U.S. healthcare delivery system with...other industrialized nations," according to the survey. A June report from the Commonwealth Fund found healthcare in the U.S. was the most expensive of 11 Western industrialized nations, but last in outcomes quality, FierceHealthcare previously reported.

Thursday, November 20, 2014

Hiring Caregivers Under the Table: What are the Risks?

Melanie Haiken

Can you save money in the short term by hiring a caregiver under the table?  Of course.  Is it worth all that can go wrong?  Probably not.
The client saves some time and hassle by paying an hourly wage without taking out taxes , known as paying “under the table” .   You, the client,  save more money while the caregiver takes home a bigger paycheck.  Simple and easy, right?  Well, consider the  numerous risks and hidden costs involved in paying a caregiver under the table.
Here are the dangers to consider before entering into an under-the-table arrangement.

1. You’re breaking the law
Employers who pay an employee under the table (or misclassify an employee as an independent contractor, do not pay their allotted taxes and avoid other payroll obligations) cause the loss of billions of dollars of  revenue to state governments.
When you hire an in-home caregiver, the IRS considers that person your employee if you pay her more than $1,800 in a calendar year. This means the IRS holds you responsible for withholding and paying taxes, which include income tax, Social Security, Medicare, and other state and federal taxes and benefits. Some families try to get around this by labeling a caregiver a “contractor,” in which case you file a W-9 recording the annual total of your caregiver’s wages, and she’s then responsible for paying taxes. However, few caregiver relationships meet the IRS’s definition of a contractor, and the government is cracking down on enforcing this issue. If you choose to go completely under the table, you and the caregiver together are defrauding the government of taxes and benefits. If you’re considering going this route, it’s a good idea to talk to an accountant or lawyer to learn about the legal and financial rules about hiring in-home help and the possible consequences of ignoring them.

2. You could pay more down the line.
As an employer, you were legally required to pay taxes for your employee. This means that if you get caught by the IRS, you’ll be responsible for paying back taxes, including interest and penalties. These taxes and penalties accrue each year, so if you hire a caregiver for several years, or if you get caught years later, or both, the penalties can be very steep. You might think there’s little chance of getting caught, but you’d be wrong. You can get caught during an audit of your taxes or as a result of a caregiver’s future actions, such as if she seeks unemployment compensation or in some other way reports the job.

3. An under-the-table caregiver is harder to verify.
Home-care agencies and most registries conduct background checks and use verification services to make sure caregivers don’t have a criminal history or any other issues you should know about. Often registries and agencies also check driving records and make sure caregivers have valid licenses. Many professional caregivers (who typically ask to be paid over the table) are also licensed and bonded, giving you the security of knowing that they’ve undergone professional training and that these checks have been performed. If you hire someone on your own, you’ll need to do all this yourself, and it’s unlikely the results will be as satisfying. Of course you’ll ask for and check references, but the less legal your arrangement, the greater the chance that your caregiver candidate could be padding her resume or faking references.

4. You’re not protected from disability claims.
Many professional caregivers are bonded and carry disability insurance in case of injury. Under-the-table caregivers are unlikely to come with these safeguards. If your caregiver is not bonded and insured, you could be liable if she gets hurt or disabled from an injury or accident she suffers on the job. By hiring under the table, you have little protection if she chooses to seek damages. Yes, it’s unlikely, since the fact that she agreed to an under-the-table agreement may prevent her from coming forward, but it has happened.

5. The risk of theft is higher.
Think about it — if your relationship with your caregiver is illegal, which means it’s in some sense secret, your caregiver knows there’s less chance that you’ll report abuse, theft, or other problems. The feeling of being able to “get away” with more can lead to serious problems down the line that you don’t want to deal with.

6. You may have to deal with high turnover.
According to geriatric care managers and other experts in senior care, caregivers hired under the table have much higher turnover than caregivers hired through agencies or registries, or even those hired independently but employed legally. It makes sense — there’s no paperwork to document the job, therefore no hassle to leaving and finding another. Without a contract or any legal agreement, you’re not protected from someone simply quitting with short or no notice. This is probably the least of your worries, given the seriousness of some of the issues above, but you don’t want a frail or ill loved one left without care available.
The cost of elder caregiving can be higher than any of us cares to pay.  But is it worth the fiscal and emotional punishments that can occur?  Probably not.

Melanie Haiken is a writer, editor, Web project manager, and national magazine journalist based in the San Francisco Bay Area.

The Hard Truth About Alzheimer’s Drugs

Friday, November 14, 2014

Daughters provide twice as much care for aging parents than sons do, study finds

Studies suggest that sons limit care for aging parents because they know sisters will do it, study suggests.

The new research found that in families with children of both sexes, the gender of the child is the single biggest factor in determining who will provide care for the aging parent: Daughters will increase the time they spend with an elderly parent to compensate for sons who reduce theirs, effectively ceding the responsibility to their sisters.

By foisting most of their care-giving duties onto women, men also shift the physical and mental stress of providing care, as well as the financial burden, the study’s author said.

The findings – which are to be presented later month at a meeting of the American Sociological Association in San Francisco – suggest that traditional gender roles are the most telling factor in providing care for the elderly. How much care women provide for an aging parent is often shaped by competing concerns such as their jobs or children. Men, in contrast, base their care for an aging parent on whether a sister or the parent’s spouse can handle those responsibilities.

Angelina Grigoryeva, a doctoral candidate in sociology at Princeton University,
 found that daughters provide an average of 12.3 hours of elderly parent care 
per month as compared to sons’ 5.6 hours.

“In other words, daughters spend twice as much time, or almost seven more hours each month, providing care to elderly parents than sons,” Grigoryeva said in a written statement. She said the data suggest that despite a shift toward more gender equality in the United States in the past few decades, the imbalance is “acute” when it comes to caring for aging parents.

The paper, “When Gender Trumps Everything: The Division of Parent Care Among Siblings,”used data from the University of Michigan Health and Retirement Study, which surveyed more than 26,000 people over the age of 50 every two years. The association said papers presented at ASA annual meetings are “typically working papers” that have not yet been published in peer-reviewed journals.

Wednesday, November 12, 2014

US Family Eldercare Tops Half-Trillion Dollars

A new study shows informal care for the elderly costs the US economy more than half a trillion dollars each year.

The study, conducted by the Rand Corp., was published last month in the journal Health Services Research. It uses data from the 2011 and 2012 American Time Use surveys.

The American Time Use Survey was launched in 2011 by the US Bureau of Labor Statistics (BLS). It asks respondents about the amount of time they spent helping elderly relatives, as well as questions about the respondents’ employment status. Researchers used the employment data in the American Time Use surveys to calculate the weekly wages of respondents. Demographic information was used to calculate the hourly costs to non-workers.

Because the survey is so new, the Rand study is believed to be one of the most accurate, up-to-date accounts of the cost of informal eldercare.

“Our findings provide a new and better estimate of the monetary value of the care that millions of relatives and friends provide to the nation’s elderly,” said Amalavoyal V. Chari, PhD, the study’s lead author. “These numbers are huge and help put the enormity of this largely silent and unseen workforce into perspective.”

Three out of five informal caregivers were employed, thus they may have lost work time to provide care. The vast majority of caregiving hours – 22 billion out of 30 billion – were given by people under the age of 65. The hours given by those working-age adults account for $412 billion of the total cost to the economy. The study notes that’s nearly double the cost of replacing those informal caregivers with unskilled caregivers ($212 billion). It’s somewhat less than the cost of replacing those caregivers with skilled caregivers ($642 billion).

Rand said other studies suggest about $211 billion is spent annually on formal long-term services for the elderly.

“Our findings explain the interest in workplace flexibility policies being considered by a number of states that provide paid time off from work for caregivers, as well as programs such as Medicaid’s Cash and Counseling program that allows family caregivers to be paid for their assistance,” said Ateev Mehrotra, MD, MPH, a co-author of the study.

The study was funded in part by the California Health Care Foundation.
- See more at:

One in Three Adult Children Today are Supporting Their Aging Parents Financially

By JosephF. Coughlin

We are all told to save. Save for a new home. Save for college. Save for retirement. Now there is a new financial priority – saving for your parent's retirement. Our parents may need more than just a hand in older age, they may also need financial support.

Greater longevity may strain even the best-planned retirement portfolio, resulting in lifespans outliving wealthspans. And, helping mom and dad manage their longevity risk is likely to be the most costly for younger baby boomers and Gen X families in their 40s and 50s — just when college expenses and retirement savings are converging and competing for limited dollars.

According to Pew Research, one in three adult children today are supporting their aging parents financially, and more than 70% who provide funding report that the money is for continuing expenses. Looking to the future, elderly baby boomers, with far less savings than their parents, may benefit from their millennial children's sense of duty. More than 80% of millennials report that providing financial support to an aging parent is their responsibility.

Consider the following costs that adult children may share or underwrite entirely in retirement:

Housing — Even if your parents choose to age in the family home, there are rising and unplanned costs. 

While the mortgage may be paid off, the old homestead's taxes may be outpacing retirement income. The oldest baby boomers live in homes that were, on average, built in the early 1970s. Surprise repair costs from replacing hot water tanks, or routine maintenance, such as, roof repairs, can drain mom and dad's liquidity.

 Technology &and home modification — Technology is offering ways to help elderly parents stay independent. It’s also a new expense. Home monitoring systems that give an adult child piece of mind, and an elderly parent a sense of security, are monthly costs. Aging parents managing disability may need to install a stair lift, modify a bathroom, or widen doorways, potentially costing thousands of dollars and involve recurring costs.
Caregiving — The cost of caring is more than physical and emotional. Taking time from work, or declining a promotion that may require significant travel, will impact income. Out-of-pocket expenses for transportation, medication, groceries, or even hiring a home health aide add up. Studies suggest that even modest assistance averages $200.00 a month nationally.
Long-Term Care —Living longer often includes periods of disability and intensive health care in later life. While some may try to coordinate their parent's complex care needs alone, others may need the services of a geriatric care manager, which may charge anywhere from $50 to $200 per hour. If staying home is no longer an option, Legg Mason research estimates that assisted living, skilled nursing and memory care facility costs an average $3,000 to $11,000 monthly.

The new retirement planning includes the realities of helping adult children as well as elderly parents.

Younger boomers and Gex Xers may want to ensure that they have the income they need for a lifetime and have identified the services they will need to support their future well-being — a retirement objective for themselves, but a gift that goes across the generations.

Joseph F. Coughlin, PhD ( is Director of the Massachusetts Institute of Technology AgeLab. His research addresses how individuals, families, businesses and governments make decisions and plan for the new future of old age. He was named one of Fast Company's "100 Most Creative People in Business," The Wall Street Journal's "12 Pioneers Inventing the Future of Retirement" and a featured "Game Changer" by Money Magazine.

Monday, November 3, 2014


Who is a caregiver?

You're a caregiver if you give basic care to a person who has a chronic medical condition. A chronic condition is an illness that lasts for a long period of time or doesn't go away. Some examples of chronic conditions are cancer, stroke, multiple sclerosis, dementia, diabetes and Alzheimer's disease.

If you're a caregiver, you may be doing the following things for another person:

  • Lifting
  • Turning him or her in bed
  • Bathing
  • Dressing
  • Feeding
  • Cooking
  • Shopping
  • Paying bills
  • Running errands
  • Giving medicine
  • Keeping him or her company
  • Providing emotional support
Why is caregiving so hard? The person you're caring for may not know you anymore. He or she may be too ill to talk or follow simple plans. This may make it hard for you to think of that person in the same way that you did before he or she became ill. This may be especially true if the person you're caring for suffers from dementia.

The person you're caring for may also have behavior problems, like yelling, hitting or wandering away from home. This behavior may make you feel angry and frustrated.

How can I tell if caregiving is putting too much stress on me?
Common signs of caregiver stress include the following:
  • Feeling sad or moody
  • Crying more often than you used to
  • Having low energy level
  • Feeling exhausted
  • Feeling like you don't have any time to yourself
  • Having trouble sleeping, or not wanting to get out of bed in the morning
  • Having trouble eating, or eating too much
  • Seeing friends or relatives less often than you used to
  • Losing interest in your hobbies or the things you used to do with friends or family
  • Feeling angry at the person you are caring for or at other people or situations
In addition, you may not get any thanks from the person you are caring for. This may add to your feelings of stress and frustration.

What should I do if I'm feeling overwhelmed and stressed? These feelings are not wrong or without reason. Caregiving can be very stressful. Because being a caregiver is so hard, some doctors think of caregivers as "hidden patients." If you don't take care of yourself and stay well, you won't be able to help anyone else.

Talk with your family doctor about your feelings. Stay in touch with your friends and family members. Ask them for help in giving care. Asking for help doesn't make you a failure.

Look for help in your community. Community services can include meal delivery, transportation, legal or financial counseling and home health care services such as physical therapy or nursing. You can also ask at your church or synagogue for services or volunteers who can help you. You can also ask for help from support organizations (see "Other Organizations") or join an online community.

"Elderlifeplanning in an Age of Scarcity" is brought to you by 
Informed Eldercare Decisions, LLC.
 Picture For more than 20 years, Informed Eldercare Decisions, Inc has been providing experienced and highly professional care management specialists to elders and family caregivers who seek assistance with the difficult care planning decisions. 

Thursday, October 30, 2014

Joan Rivers' Death Reinforces the Need to Prepare Advanced Directives Including a Living Will


Recently, Comedienne Joan River went in for what  was described by CNN as a "minor procedure" on her vocal cords. While on the operating table, she suffered cardiac and respiratory failure and was placed on life support.   It's perhaps the most difficult decision a person can make: deciding it is time to take a loved one off of life support.  But as difficult as the decision is, it's also one of the greatest acts of love a person can share with another.

Taking a loved one off of life support is played out privately countless times a day across the United States and around the world. Now imagine having to make that decision in the public eye. That's what Melissa Rivers did when she decided to take her mother, comic legend Joan Rivers, 81, off life support on September 4.

Before her death, Joan Rivers named Melissa as her power of attorney to make medical decisions, Communities Digital News reports. It's not currently known if Joan Rivers also had a living will or a do not resuscitate (DNR) order, but her death is a note of caution that your clients need to have these documents in order before these papers are needed.

 Her death is a reminder that there is no such thing as "minor" surgery. Opening up the human body - despite the advanced medical care and procedures used today - is inherently risky.

There are no guarantees, but there are ways for your clients to prepare for the unexpected. Their values will direct their decisions, and one of the most important decisions they make will be whether quality of life outweighs the quantity of life.

Just as your clients make their financial wishes known to their children, they also need to make their medical wishes clear as well.

In that living will, your clients can detail their wishes on a number of fronts, including: resuscitation, ventilation, feeding tubes, dialysis, and antiviral or antibiotic medications. The more detail they give, the closer their wishes can be followed.

Another document your clients could have is a "Do Not Resuscitate" DNR. This document, Newsmax Health says, tells medical personnel that your clients don't want them to try get their hearts beating again if it stops or is beating unevenly. Although these are often thought of as pertaining only to the elderly, they are useful in case of accidents or sudden-onset conditions.

The DNR can also include directives that ambulance personnel are not to resuscitate your clients. There are also forms your clients can fill out if they don't want CPR performed or if they do not want to be intubated.

Although death is inevitable, preparing for it can ease your clients' and their family members' minds when tough decisions have to be made. Our office is here to help clients navigate those decisions and create planning documents to ensure their wishes are carried out.

We hope this information was useful to you and helps your clients and their families. If you have a specific case or a question, don't hesitate to call our office.
Law Office of Frederick N. Pellegrini

Wednesday, October 29, 2014

Tips to Remember During Medicare Open Enrollment

Tips to Remember During Medicare Open Enrollment

Medicare's annual Open Enrollment Period runs October 15 to December 7. During this time, people with Medicare can join or switch prescription drug (Part D) and health care (Medicare Advantage) plans.

Every year, there are slight changes to plans and coverages — and this year is no different.  According to the Centers for Medicare and Medicaid Services (CMS), the average costs for a basic prescription drug plan and a Medicare Advantage plan are expected to go up slightly.

Finding the right Medicare plan matters. With hundreds of policies to choose from — and so many details to understand — most people guess when choosing a policy. The result? Paying too much for a plan that doesn't cover what you need.

Before you start shopping, review these four tips, courtesy of the National Council on Aging (NCOA):

Tip 1: Be aware of enrollment periods.

Everyone who currently has Medicare should take advantage of the Open Enrollment Period to review their coverage. This is the one guaranteed time each year in which you can change plans.

New to Medicare? Know that you have special windows of time in which to select your coverage. If you're about to turn 65, you will have an Initial Enrollment Period around your 65th birthday. NCOA's educational service My Medicare Matters® offers a free Medicare QuickCheck™ that will provide you a personal report with your initial enrollment date.

If you're still working when you turn 65, you can delay enrollment in Parts A, B, and D if your insurance meets certain requirements. Find the rules here.

To avoid long-term penalties, make sure you know what you have to choose — and by when.

Tip 2: Don't guess when picking coverage.

Choosing a Medicare plan — whether for the first or 15th time — is too important to leave to guesswork. Take the time to review your health insurance needs before every enrollment period. Think about:
  • Do you have health insurance from another source?
  • Do you have any chronic conditions?
  • Which doctors and hospitals do you use?
  • Which prescriptions do you need and what pharmacies do you get them from?
Tip 3: Check your policy every year.

Insurance companies can make changes to policies every year. Just because your doctors and medications are covered this year doesn't automatically mean they will be covered in the coming year. Make sure to confirm cost, co-pays, coinsurance, covered providers and prescription drugs. Here are a few things to consider:
  • Has your health changed in the last year?
  • How much have you paid out of pocket in the last year — and for what?
  • Is your current plan still meeting all of these needs?
Medicare's Plan Finder can help you assess the costs of different plans in your area.

Tip 4: See if you qualify for extra help with Medicare costs.

There are programs that can help people who are struggling to pay for their prescriptions and health insurance premiums, deductibles, and coinsurance. NCOA offers a free online BenefitsCheckUp® where you can see if you’re eligible for help. Or, contact your State Health Insurance Assistance Program (SHIP) to see what’s available to you.

Be a Smart Shopper

Navigating the Medicare maze is challenging — especially when you're bombarded with sales pitches. But by being informed, you can be a smart shopper.

Use these tips to get started. And get free, trusted, personal assistance at NCOA's  

Source: The National Council on Aging ( is a nonprofit service and advocacy organization whose mission is to improve the lives of millions of older adults, especially those who are vulnerable and disadvantaged. NCOA is a national voice for older Americans and the community organizations that serve them and works with thousands of organizations across the country to help seniors find jobs and benefits, improve their health, live independently and remain active in their communities.

Tuesday, October 28, 2014

"Caregiver Responsibilities for Those Over Age 50 Can Cost More Than $300,000 in Lost Wages and Benefits."

S. Kim DeVoss a Certified Financial Planner for Wells Fargo in Phoenix, AZ recently published an article about the financial stress that caring for an aging parent can create for adult children.

More Americans are facing rising caregiver costs, says DeVoss. and the financial challenge of caring for an aging parent can also add to the already stressful challenge of caregiver stress. 

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 MetLife Study of Caregiving Costs to Working Caregivers, June 2011).

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.

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 parent’s financial situation may even make 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 advisor 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?

Tuesday, October 21, 2014

Kentucky Will Revamp Services For The Elderly


More than 13,000 people remain on waiting lists at the Department for Aging for meals, transportation, home-based services and caregiver services, with some applicants waiting as long as five years.

Kentucky is overhauling its elderly services with the aim of stretching resources and helping aging baby boomers remain independent and live out their final years at home, rather than in an institution.The state has struggled to keep up with demand, forcing many elderly residents to remain on waiting lists for critical programs or enter nursing homes earlier than necessary.

Deborah Anderson, commissioner of the state Department for Aging and Independent Living, told The Courier-Journal that those challenges are only expected to grow as baby boomers advance in age.

"Nationally, I don't think anybody is prepared for what is going to happen with the boomers," Anderson said.

The agency spends about $857 million from Medicaid each year on institutional care, more than 81 percent of the total Medicaid dollars earmarked for the elderly and disabled in Kentucky. The rest, about $198 million, goes to the type of home and community-based services that can help people avoid nursing facilities at about one-third the cost.

"What we want is that when someone goes to the nursing home, then it is because they absolutely need skilled nursing, not because they don't have anyone there to help them take a bath," Anderson said.

More than 13,000 people remain on waiting lists at the Department for Aging for meals, transportation, home-based services and caregiver services, with some applicants waiting as long as five years.

By Associated Press Posted: September 21, 2014 - 6:30 pm ET

Thursday, October 9, 2014

Mass. Office of Elder Affairs "endangering the safety of residents living in assistant living facilities...."

Oversight Questions Raised on Mass. Office of Elder Affairs

Agency does little with incident reports

BY: Colman M Herman
 The state’s Elder Affairs office, which is charged with regulating some 200 assisted living facilities that care for more than 12,000 senior citizens, some of them suffering from dementia, appears to be asleep at the switch.

The agency receives about 6,500 reports a year of abuse, neglect, falls, and other incidents, but does very little with the information. Only recently did the agency start assembling the data electronically, which would allow for easier scrutiny. Even so, there is little evidence the agency is using the information to look for patterns, either in general or at specific facilities.

The agency has rebuffed repeated efforts by CommonWealth to review the incident reports and the agency’s process for handling them. The agency has also resisted entreaties from an advisory board for access to the reports.

Peter Antonellis, a compliance officer at elder affairs, said the agency does almost no analysis of the data it is gathering. He says the agency cannot say how many people have fallen down, wandered off, been abused, or exploited. He said there are no procedures in place on how to handle incident reports as they come in.

Antonellis contacted CommonWealth after noticing emails between agency officials and the magazine. He said the emails raised many of the same issues he had brought up a year ago in a memo sent to top officials at the elder affairs agency as well as John Polanowicz, the governor’s secretary of health and human services.

In his memo, Antonellis said he believed poor management at elder affairs was endangering the safety of residents living in assistant living facilities. He said the agency’s incident reporting program is “nothing more than a hollow and dangerous façade.”

Officials at elder affairs, who declined to be identified by name, said their regulation of assisted living facilities is rigorous and appropriate. They also noted that the residents of assisted living facilities negotiate their own service plans with the facilities and are capable of moving to a different residence if they are dissatisfied with the facility in which they are living.

Elder Affairs employs two ombudsmen to investigate and resolve grievances from residents at the state’s 224 assisted living facilities. Regulations governing elder affairs require the agency to operate a statewide network of ombudsmen who would visit at least one facility once a month.

Antonellis said two ombudsmen in Boston are not enough. “This is clearly not sufficient to tend to the needs of all the people who are living in assisted living residences spread throughout out the state,” he said.

Officials at elder affairs say the two ombudsmen are sufficient. One official said residents of assisted living facilities “have access to an ombudsman whenever they need it, and it provides the support that people need.”
Bob O'Toole

Tuesday, September 30, 2014

5 Mistakes to Avoid When Hiring a Caregiver for Your Parent

Finding an in-home caregiver for an aging parent can be a daunting task.

Senior woman with her home caregiver

You can't do it all, and when you realize that, you either hire someone else for the task or spread the work around. Or you just let it go.

But if part of doing it all is taking care of an aging parent, you can't let it go, and spreading the work among family and friends may be impractical or impossible. Depending on the type of care your parent needs, you may not be able to do much, even if you have the time. So if you’re considering hiring an in-home caregiver for your mother, father or a relative, here are five common mistakes you should avoid.
Putting it off. Tamar Shovali, an assistant professor of human development at Eckerd College in St. Petersburg, Florida, who specializes in aging and caregiving, says the No. 1 mistake people make in this situation is not hiring a professional caregiver.

Shovali says there's a lot of evidence that shows using a professional caregiver – whether in home health care or adult day care – improves the psychological well-being of nonprofessional caregivers, like you. Indeed, studies in publications like the Journal of Aging and Health have found that people often seek professional caregivers to alleviate stress and depression that results from taking care of a loved one around the clock.

If you keep plugging away, taking care of a parent who needs more than you realistically give, you're risking depression, anxiety and resentment, Shovali says. She urges anyone with a parent or relative in failing health to look into the services that are available in their community. "The sooner you do your research, the better, because most caregivers regret not starting this process sooner," she says.
Not vetting the caregiver or agency. This process can be intimidating, especially if a friend or family member recommended a caregiver. But just because it worked out for someone you know doesn't mean it will for you.
"Don't be afraid to ask for the professional caregiver's credentials and prior experience," Shovali says. "You want to make sure that the agency has hired the professional caregiver themselves, has conducted background checks, verified education and prior in-home care experience, and carries the proper insurance for workers' compensation claims."
Focusing on one factor to the exclusion of others. Maybe you're understandably panicking about the cost of in-home care. Or maybe you're wondering how your independent spitfire of a mother is going to take to someone coming into her home and cleaning or cooking.

"There are three kinds of elements to having in-home care – the financial piece, the skills that the caregiver brings and the personality of the caregiver," says Randy Brown, CEO of Quaker Gardens Senior Living, a nonprofit continuing care retirement community that offers in-home care in Stanton, California. "I think a mistake you can easily fall into is to only look at one of those elements and not equally weight all three. It's great if a caregiver has a wonderful personality and is honest, but if they have poor skills, that doesn't help your parent. Or if you focus so much on the financial side, you short yourself on the other two."

The Cost of Caring for Aging Parents

The American population is aging, with millions of people living well into their 80’s or 90s, creating a situation where many are outliving their savings. As a result, they are turning to family members for help. But that is costing the “help” a lot more than anyone expected.

According to a new study conducted by, nearly half of family caregivers spend more than $5,000 a year on expenses associated with providing care.  Of those spending more than $5,000, 16% are seeing costs of as much as $9,999 while 11% are spending as high as $19,999 and 5% are absorbing out of pocket expenses of as much as $49,999.

“People in their 50s and 60s are spending a significant part of their money caring for aging parents,” says Chief Executive Andy Cohen.  “People do a good job of saving for their kid’s college and their own retirement but they don’t know this is coming.”

No one can predict if or when a family member will get sick or need long term care. But you can prepare, just in case it does happen. Experts say one of the first things you need to do is have conversations with your parents’ about their finances. Not only do you want to know where your parents keep the financial documents, where they bank, who their financial advisor is and what type of long term insurance they may have -- but also the names of their doctors, how much they owe and how much they have in savings or other assets.

Monday, April 21, 2014

When Your Parent With Alzheimer's Goes Wandering

When Your Parent With Alzheimer's Goes Wandering
Caroline Mayer Caroline Mayer , Contributor

Washington Post reporter Tom Jackman was frightened when his 78-year-old father with Alzheimer’s went missing in northern Virginia last October. Fortunately, his dad was found about 20 hours after disappearing.
Jackman discovered some valuable lessons in the search for his father, which he wrote about in a touching Washington Post story.
Jackman reported that  his dad “spent most of his career as a spokesman for the airline industry and the American Automobile Association before retiring more than 10 years ago. Then he began working as a docent and information-desk guy at the Udvar-Hazy Center, the Smithsonian National Air and Space Museum annex near Dulles Airport. He had to stop doing that about two years ago, when he got lost coming home from the museum one day.”
 Jackman’s father was diagnosed with Alzheimer’s about two years ago but is in fine physical shape otherwise. As with many people with Alzheimer’s, his short-term memory is terrible, although his long-term memory is still reasonably good.
“He lives with my mother, who is a couple of years younger and quite active around their town.”
Until last October, the doctor said it was OK to allow Dad to continue to drive to the two places he visited regularly: A daily drive of about one mile to Starbucks and a Sunday drive of less than a mile to the church where he has long sung in the choir.
“To our knowledge, he had never experienced any problems going back and forth between those two places until a Saturday morning in October.”
What happened that morning?
“My mom went to meet some of her friends for a leisurely breakfast. Dad was asleep when she left; he typically goes on his daily Starbucks run around 11. Mom returned around 11:30 a.m., so she wasn’t concerned when Dad wasn’t home. But by 12:30, she began to be. At 1:30, she was extremely concerned and started calling me. Shortly before 2 p.m., she called the Fairfax County police.”
“The Police conducted an all-out search with more than 60 officers. One officer was assigned to stay with my mother, to get information from her and to be around in case Dad called or showed up. A helicopter searched the air over the town where they live.”

“The fire and rescue department took down all of Dad’s medical information in case he was found in distress. Officers were dispatched to any place we could think he might have visited. The phone company was contacted to try to locate his cell phone — an older model which had no GPS device in it.”
 The police released a Missing Persons poster at 4:30 a.m., and the local TV news began broadcasting it at 5:00.

“At around 7:30 a.m. on Sunday, an officer in Washington, D.C., found my father. His car had stalled outside a McDonald’s near the Capitol, about 25 miles from his home. Receipts in the car showed he had driven about 40 miles north to Baltimore, got gas, went to a McDonald’s there and then drove back to Washington. He had no memory of any of it. He was checked out at a hospital and released.”
  What were some of the lessons learned from this experience?
For one thing, cell-phone locator technology is far from perfect. The phone company was quite certain that his phone was in a particular neighborhood. Two months later, my mother found the cell phone under a couch in their house. He’d never taken it with him. For older phones without GPS capability, like my dad’s, phones pinging off cell towers can still be in a radius of many miles around the towers.
Another lesson was that many banks simply do not have the capability to access customers’ records immediately on weekends, particularly smaller banks such as the one my dad uses. Even for the police.
Can technology help find people with Alzheimer’s who are wandering?
There are devices that can be used to track missing adults. But in Fairfax County there is a waiting list to obtain one, from a program called Project Lifesaver, which is available in nearly every jurisdiction in the Washington, D.C. area.
“After I wrote the article, a local group stepped up and donated several thousand dollars to Project Lifesaver in Fairfax County, which will be used to purchase more GPS equipment so more people can be enrolled. The newly elected sheriff has indicated he hopes to expand the program.”
What advice would you give families who have loved ones with Alzheimer’s?
There are several things family members can — and should — do.
First, they should get their loved one a cell phone with GPS capability to help track them if they wander.
They should also sign up for online banking with their parent’s financial institution to be able to access the account and follow any transactions if he or she goes missing.
They should also sign up for Project Lifesaver or a similar program, if there is one.
And by all means, they should contact the local police and inform them that there is someone in your family who might some day wander.
Caroline Mayer is a consumer reporter who spent 25 years working for The Washington Post. Follow her on Twitter @consumermayer.

Bob O'Toole, MSW
Informed Eldercare Decisions, Inc.
Dedham, MA 02026
Home of the Elder Life Planning for Organizations program (ELPO) a nationwide, low cost, caregiver support program for employers, associations, banks, credit unions, labor unions and religious organizations.