Sunday, March 16, 2014

Financial Abuse of Elderly on the Rise, New Survey by NAPGCM Finds


New survey of geriatric care managers finds that financial abuse and exploitation of older Americans is increasing. Most common form of financial elder abuse encountered is theft by family, friends, neighbors and caregivers.


Survey Finding: Most Common Forms of Financial Elder Abuse

"Financial abuse of seniors is a growing problem. Families with older relatives need to know the warning signs of this all too common and often hidden form of elder abuse." - NAPGCM President, Emily Saltz.

Tucson, AZ (PRWEB) March 12, 2014

Financial abuse and exploitation of older Americans is on the rise, according to a new survey released today by the National Association of Professional Geriatric Care Managers (NAPGCM). The survey, which also identified theft of money by family, friends, neighbors and caregivers as the most common types of abuse, comes on the heels of President Obama’s call last week for a new $25 million initiative to combat elder abuse as part of his budget.

NAPGCM surveyed 325 professional geriatric care managers nationwide about their experiences with financial abuse in their work with seniors. Major findings of the survey include:

        71 percent of the care managers reported that financial abuse and/or exploitation of the elderly is a growing problem in their communities.
         The top 5 types of financial abuse most commonly encountered are:

-Theft of money or property by family/friend/neighbor (79%)
-Theft of money or property by caretaker/ in-home care provider (75%)
-Investment/securities schemes through the mail or phone (52%)
-Home Repair scams (45%)
-Getting senior to sign a deed, will, power of attorney through deception (43%)

“Financial abuse of seniors is a growing problem. Families with older parents need to know the warning signs of this all too common and often hidden form of elder abuse,” said NAPGCM President, Emily Saltz. “Our survey shows that close oversight of vulnerable adults by family members or qualified professionals is crucial,” added Ms. Saltz.

According to the National Adult Protective Services Association (NAPSA) 1 in 20 older adults indicated some form of perceived financial mistreatment occurring in the recent past. Most financial abuse goes undetected, as NAPSA estimates only 1 in 44 cases are reported. So it is crucial that family and loved ones know the warning signs. The NAPGCM survey asked professional geriatric care managers to identify the most reliable “red flags” that a senior might be the victim of financial abuse or exploitation. The top five red flags identified are:


You and/or their bank notice unusual activity on bank accounts and/or credit cards that they can’t explain
        A new “best friend” has appeared who is becoming heavily involved in personal activities
        A friend, paid caregiver or trusted employee/vendor is isolating senior from others
        Another family member becomes secretive or defensive about parent’s finances
        Missing belongings or property are apparent

The survey, which was conducted March 4-8, 2014, also identified a number of emerging schemes professional care managers are seeing more frequently now in their communities, including:

 A new version of the "Jamaican lottery" scams in which someone posing as a new friend of the senior, often pretending to have romantic interests, tricks them into purchasing cash cards supposedly to send payment in order to receive their lottery “winnings.
        A rise in “caregivers” marrying seniors and then financially exploiting them.

Financial abuse of the elderly carries a major and direct cost to taxpayers as almost 1 in 10 financial abuse victims will turn to Medicaid as a direct result of their own monies being stolen from them. And President Obama’s budget plan released last week contains a new $25 million effort to reduce elder abuse, neglect and financial exploitation. The initiative would fund grants to States to pilot a new abuse reporting system and improved research to understand and prevent elder abuse.


About NAPGCM

The National Association of Professional Geriatric Care Managers (NAPGCM) was formed in 1985 to advance dignified care for older adults and their families. Geriatric Care Managers are professionals who have extensive training and experience working with older people, people with disabilities and families who need assistance with caregiving issues. They assist older adults who wish to remain in their homes, or can help families in the search for a suitable nursing home placement or extended care if the need occurs. The practice of geriatric care management and the role of care providers have captured a national spotlight, as generations of Baby Boomers age in the United States and abroad. For more information please visit http://www.caremanager.org. You can also find a listing of professional geriatric care managers in your community at the NAPGCM website: http://www.caremanager.org and click on “Find a Care Manager”

Tuesday, March 4, 2014

Elder-care Provider: ‘We Want Respect and a Living Wage’

 Elder-care provider: ‘We want respect and a living wage’

Underpaid, overworked and barely making ends meet 
 More Americans live longer and longer, 79 percent of people who need long-term care live at home or in community settings. By 2050, the number of elderly people who will receive long-term care is expected to reach 27 million, up from 13 million in 2000.

So, who's providing all this caretaking?

Many of the people who care for all these seniors receive low pay, often below their state’s minimum wage. Few receive health benefits, and most states offer no protections for harassment, abuse or unsafe and unsanitary conditions. Hours can be long and irregular, and client turnover may suddenly cut off their incomes. The need for caretakers is urgent, their work intimate and demanding, but the median pay is just $16,800 a year.

On Tuesday, America Tonight’s special series "Aging America" continues with a profile of Marlene Champion, a 68-year-old Barbados native who has worked as a caregiver for the elderly for more than 30 years, and in domestic care since the age of 14.

"I cook, wash, clean, vacuum, shopping, [help with] doctor visits," she said. "If there's a nail to nail, I'll nail it. If something's being undone, I'll try to fix it."

Working with the elderly can be a huge challenge, she said, as the people under her care have early dementia, Alzheimer’s, or both.

"Some of them spit on you. Some of them hit you. Some of them deliberately do dirty things,” she told America Tonight. “You have to put yourself in the same frame of mind as they're in, because if you are not strong enough as a caregiver – mentally you're not strong enough – you'll break."

Champion's first job in the U.S. was caring for an 89-year-old doctor. By the time the man died seven years later, she could barely get by on her salary.

"You cannot save anything," she said. "It's like that cup of coffee, if you're cold in the morning, you cannot afford to buy. I cannot do the things that some people do. Very seldom I go to a restaurant. Maybe for my birthday I go for breakfast at IHOP.”

Champion doesn’t have the money, or the time, to go out anywhere, like a movie. She goes from home to work, and then straight to church. Caregiving can be strenuous and the hours are long, yet clients often undervalue it, she said.

"People have to learn that one of the greatest things for a caregiver is respect – and a decent salary," she said. "They want to pay you $5 an hour, and they want you to work 10, 12 hours a day for that.”

Champion’s hopeful that she’ll be able to enjoy retirement of her own someday.

"At this stage of my life, I shouldn't have to be working so hard to make ends meet," she said. "But when I get things together, I'm out of here. I want to enjoy a little bit of life before the good Lord decide to take me home."


Editor's Note: The complete 3 -part series with video is available at the following link:
http://america.aljazeera.com/watch/shows/america-tonight/america-tonight-blog/2014/2/25/eldercare-providerwewantrespectandalivingwage.html

Wednesday, February 26, 2014

Shortage of Workers in Long-term Care May Improve With Immigration Reform

Nursing homes and operators of agencies providing home-care services already are straining to find enough so-called direct-care workers, who help the elderly or disabled with such things as eating and bathing. They also face looming retirements in the current workforce, in which one-fifth of workers are 55 years old or older.


The reasons for the shortage: pay is low, typically less than $12 an hour, injury rates are high, and the work can be unpleasant and physically draining.

Nursing aides say they often are being asked to work double shifts at short-staffed nursing homes. Indeed Inc., which runs an employment website, says the number of U.S. nursing-home-aide jobs advertised in December was 10,922, up 120% from a year earlier

With the number of Americans aged 65 and older projected to reach 73 million in 2030, the demand for nursing aides will continue to grow. But high demands have led to high labor turnover.

Between 43% and 75% of nursing aides turn over each year, studies have found, compared to a 27% rate for all healthcare and social-assistance jobs in 2012, notes WSJ.

Immigration reform has been one of the hottest topics on the political agenda in Washington. Depending on the final shape it takes, it could be a boon for the long-term care industry.

The long-term care industry has struggled with labor shortages in recent years. "As a result," wrote Walter Leutz in a report for the Immigration Policy "immigrants will continue to play a significant role in the growth of the U.S. labor force in general and the direct-care workforce in particular."

The Bureau of Labor Statistics projects that the direct-care workforce will be one of the fastest growing, increasing to about 6 million by 2050. In 2005, Leutz noted in his report, there were 2.5 million direct-care workers age 18 and older in the U.S. labor  

"By 2020, we need an additional 1.6 million direct-care workers. There are not sufficient numbers of women entering the workforce to fill these jobs," said Karen Kahn. "Immigrants will help us meet this challenge." 

Between 43% and 75% of nursing aides turn over each year, studies have found, compared to a 27% rate for all healthcare and social-assistance jobs in 2012.

"We're going to have a healthcare worker shortage as people live longer. There's no question about it," said Harlan York, a New Jersey-based immigration attorney. "Immigration reform, I think, cures, no pun intended, that problem."

In some situations, injury rates have forced nursing aides away from work. It is not just the toll that heavy lifting takes on an aide's body that deters workers, but the daily stress of caring for patients who are often gravely ill and suffering from dementia creates a stressful work environment.

Better pay and working conditions for aides would help reduce turnover and workers' compensation claims for injuries, says Dore Seavey, an economist at Paraprofessional Healthcare Institute.

However, not all experiences are negative for nursing aides; the WSJ article clarifies, as many aides feel a sense of companionship with the patients they serve.

"You have to be ready physically and mentally," says Sonia Dhaliwal in the article, a 27-year-old aide. "They're our family. We really do love them."

—Robert E. O'Toole, President, Informed Eldercare Decisions

- See more at: http://caregiversupportenews.enewsworks.com/#sthash.1Qt6S0OF.dpuf 

   

Friday, February 14, 2014

How Are Today’s Seniors Adapting to Disability?

Man in wheelchair cooking

Only about a third of Americans ages 65 and older are fully able to take care of themselves and go about their daily lives completely independently, according to a recent study published online in the American Journal of Public Health.

Understanding that there are different ways older adults adapt to disability is a big step in developing public health policies that maximize the quality of life for all older Americans, said the study's lead author, Vicki Freedman, a research professor at the University of Michigan Institute for Social Research.

Freedman and colleagues analyzed data on a nationally representative sample of 8,077 older men and women, part of the National Health and Aging Trends Study. The National Institute on Aging, part of the National Institutes of Health, funded the research.


Among the findings:

  • About a quarter succeed in accomplishing what they need to do on their own by using walkers or other assistive devices. Another 18 percent say they have trouble even when using these devices.

  • Six percent cope by reducing their activities—bathing or going outside less often, for example.
  • Twenty-one percent manage by receiving help from others.

The study is the first to provide national estimates of ways the Medicare-age population adapts to limitations in daily life.

"Nearly 80 percent of all older adults find ways to manage on their own without assistance from others," Freedman said. "The group using devices on their own without difficulty is especially interesting. They seem to be able to participate in activities they enjoy and report well-being as high as those who are fully able to care for themselves."

The researchers asked about seven activities of daily living: going outside, getting around inside, getting out of bed, eating, getting cleaned up, using the bathroom and dressing.

During face-to-face interviews, study participants were first asked whether they used devices or environmental modifications including canes, walkers, wheelchairs, scooters, grab bars, and bath/shower seats and whether they received help from another person in the last month.

Then they were asked whether they experienced any difficulty doing any of the activities even when they used modifications, and about whether they had changed how often they performed any basic activities over the last year.

According to Freedman, the proportion of older adults able to function independently varies greatly by activity and by age. For example, 90 percent of older adults are fully able to eat by themselves, while only 54 percent are fully able to bathe by themselves. About 45 percent of those ages 65 to 69 are fully able to carry out all activities independently, compared with only 4 percent of those ages 90 and older.

Women are more likely than men to do things on their own by using devices to assist them (26 percent compared to 23 percent). But African Americans and Hispanics are much less likely than whites and Asians to do so. Older adults with low incomes are also less likely to successfully accommodate declines in their functional abilities.

"Two groups that we identified may be especially important targets for public health intervention," Freedman said. "These are the seven million older adults who have difficulty carrying out activities alone with whatever accommodations they have already made, and the additional 2.1 million who have reduced their activity levels but do not experience or acknowledge that they are having difficulty."

Source: University of Michigan Institute for Social Research (http://home.isr.umich.edu)


- See more at: http://caregiversupportenews.enewsworks.com




   

How Are Today’s Seniors Adapting to Disability?

Related topics: Safety, Senior Lifestyles

Man in wheelchair cooking
Only about a third of Americans ages 65 and older are fully able to take care of themselves and go about their daily lives completely independently, according to a recent study published online in the American Journal of Public Health.
Understanding that there are different ways older adults adapt to disability is a big step in developing public health policies that maximize the quality of life for all older Americans, said the study's lead author, Vicki Freedman, a research professor at the University of Michigan Institute for Social Research.
Freedman and colleagues analyzed data on a nationally representative sample of 8,077 older men and women, part of the National Health and Aging Trends Study. The National Institute on Aging, part of the National Institutes of Health, funded the research.
Among the findings:
  • About a quarter succeed in accomplishing what they need to do on their own by using walkers or other assistive devices. Another 18 percent say they have trouble even when using these devices.
  • Six percent cope by reducing their activities—bathing or going outside less often, for example.
  • Twenty-one percent manage by receiving help from others.
The study is the first to provide national estimates of ways the Medicare-age population adapts to limitations in daily life.
"Nearly 80 percent of all older adults find ways to manage on their own without assistance from others," Freedman said. "The group using devices on their own without difficulty is especially interesting. They seem to be able to participate in activities they enjoy and report well-being as high as those who are fully able to care for themselves."
The researchers asked about seven activities of daily living: going outside, getting around inside, getting out of bed, eating, getting cleaned up, using the bathroom and dressing.
During face-to-face interviews, study participants were first asked whether they used devices or environmental modifications including canes, walkers, wheelchairs, scooters, grab bars, and bath/shower seats and whether they received help from another person in the last month.
Then they were asked whether they experienced any difficulty doing any of the activities even when they used modifications, and about whether they had changed how often they performed any basic activities over the last year.
According to Freedman, the proportion of older adults able to function independently varies greatly by activity and by age. For example, 90 percent of older adults are fully able to eat by themselves, while only 54 percent are fully able to bathe by themselves. About 45 percent of those ages 65 to 69 are fully able to carry out all activities independently, compared with only 4 percent of those ages 90 and older.
Women are more likely than men to do things on their own by using devices to assist them (26 percent compared to 23 percent). But African Americans and Hispanics are much less likely than whites and Asians to do so. Older adults with low incomes are also less likely to successfully accommodate declines in their functional abilities.
"Two groups that we identified may be especially important targets for public health intervention," Freedman said. "These are the seven million older adults who have difficulty carrying out activities alone with whatever accommodations they have already made, and the additional 2.1 million who have reduced their activity levels but do not experience or acknowledge that they are having difficulty."
Source: University of Michigan Institute for Social Research (http://home.isr.umich.edu)
- See more at: http://caregiversupportenews.enewsworks.com/en/1051314/1/1267/How-Are-Today%E2%80%99s-Seniors-Adapting-to-Disability.htm#sthash.y0Ivng7m.dpuf

How Are Today’s Seniors Adapting to Disability?

Related topics: Safety, Senior Lifestyles

Man in wheelchair cooking
Only about a third of Americans ages 65 and older are fully able to take care of themselves and go about their daily lives completely independently, according to a recent study published online in the American Journal of Public Health.
Understanding that there are different ways older adults adapt to disability is a big step in developing public health policies that maximize the quality of life for all older Americans, said the study's lead author, Vicki Freedman, a research professor at the University of Michigan Institute for Social Research.
Freedman and colleagues analyzed data on a nationally representative sample of 8,077 older men and women, part of the National Health and Aging Trends Study. The National Institute on Aging, part of the National Institutes of Health, funded the research.
Among the findings:
  • About a quarter succeed in accomplishing what they need to do on their own by using walkers or other assistive devices. Another 18 percent say they have trouble even when using these devices.
  • Six percent cope by reducing their activities—bathing or going outside less often, for example.
  • Twenty-one percent manage by receiving help from others.
The study is the first to provide national estimates of ways the Medicare-age population adapts to limitations in daily life.
"Nearly 80 percent of all older adults find ways to manage on their own without assistance from others," Freedman said. "The group using devices on their own without difficulty is especially interesting. They seem to be able to participate in activities they enjoy and report well-being as high as those who are fully able to care for themselves."
The researchers asked about seven activities of daily living: going outside, getting around inside, getting out of bed, eating, getting cleaned up, using the bathroom and dressing.
During face-to-face interviews, study participants were first asked whether they used devices or environmental modifications including canes, walkers, wheelchairs, scooters, grab bars, and bath/shower seats and whether they received help from another person in the last month.
Then they were asked whether they experienced any difficulty doing any of the activities even when they used modifications, and about whether they had changed how often they performed any basic activities over the last year.
According to Freedman, the proportion of older adults able to function independently varies greatly by activity and by age. For example, 90 percent of older adults are fully able to eat by themselves, while only 54 percent are fully able to bathe by themselves. About 45 percent of those ages 65 to 69 are fully able to carry out all activities independently, compared with only 4 percent of those ages 90 and older.
Women are more likely than men to do things on their own by using devices to assist them (26 percent compared to 23 percent). But African Americans and Hispanics are much less likely than whites and Asians to do so. Older adults with low incomes are also less likely to successfully accommodate declines in their functional abilities.
"Two groups that we identified may be especially important targets for public health intervention," Freedman said. "These are the seven million older adults who have difficulty carrying out activities alone with whatever accommodations they have already made, and the additional 2.1 million who have reduced their activity levels but do not experience or acknowledge that they are having difficulty."
Source: University of Michigan Institute for Social Research (http://home.isr.umich.edu)
- See more at: http://caregiversupportenews.enewsworks.com/en/1051314/1/1267/How-Are-Today%E2%80%99s-Seniors-Adapting-to-Disability.htm#sthash.y0Ivng7m.dpuf

How Are Today’s Seniors Adapting to Disability?

Related topics: Safety, Senior Lifestyles

Man in wheelchair cooking
Only about a third of Americans ages 65 and older are fully able to take care of themselves and go about their daily lives completely independently, according to a recent study published online in the American Journal of Public Health.
Understanding that there are different ways older adults adapt to disability is a big step in developing public health policies that maximize the quality of life for all older Americans, said the study's lead author, Vicki Freedman, a research professor at the University of Michigan Institute for Social Research.
Freedman and colleagues analyzed data on a nationally representative sample of 8,077 older men and women, part of the National Health and Aging Trends Study. The National Institute on Aging, part of the National Institutes of Health, funded the research.
Among the findings:
  • About a quarter succeed in accomplishing what they need to do on their own by using walkers or other assistive devices. Another 18 percent say they have trouble even when using these devices.
  • Six percent cope by reducing their activities—bathing or going outside less often, for example.
  • Twenty-one percent manage by receiving help from others.
The study is the first to provide national estimates of ways the Medicare-age population adapts to limitations in daily life.
"Nearly 80 percent of all older adults find ways to manage on their own without assistance from others," Freedman said. "The group using devices on their own without difficulty is especially interesting. They seem to be able to participate in activities they enjoy and report well-being as high as those who are fully able to care for themselves."
The researchers asked about seven activities of daily living: going outside, getting around inside, getting out of bed, eating, getting cleaned up, using the bathroom and dressing.
During face-to-face interviews, study participants were first asked whether they used devices or environmental modifications including canes, walkers, wheelchairs, scooters, grab bars, and bath/shower seats and whether they received help from another person in the last month.
Then they were asked whether they experienced any difficulty doing any of the activities even when they used modifications, and about whether they had changed how often they performed any basic activities over the last year.
According to Freedman, the proportion of older adults able to function independently varies greatly by activity and by age. For example, 90 percent of older adults are fully able to eat by themselves, while only 54 percent are fully able to bathe by themselves. About 45 percent of those ages 65 to 69 are fully able to carry out all activities independently, compared with only 4 percent of those ages 90 and older.
Women are more likely than men to do things on their own by using devices to assist them (26 percent compared to 23 percent). But African Americans and Hispanics are much less likely than whites and Asians to do so. Older adults with low incomes are also less likely to successfully accommodate declines in their functional abilities.
"Two groups that we identified may be especially important targets for public health intervention," Freedman said. "These are the seven million older adults who have difficulty carrying out activities alone with whatever accommodations they have already made, and the additional 2.1 million who have reduced their activity levels but do not experience or acknowledge that they are having difficulty."
Source: University of Michigan Institute for Social Research (http://home.isr.umich.edu)
- See more at: http://caregiversupportenews.enewsworks.com/en/1051314/1/1267/How-Are-Today%E2%80%99s-Seniors-Adapting-to-Disability.htm#sthash.y0Ivng7m.dpuf

Thursday, February 6, 2014




From: LAW OFFICE OF ATTORNEY FREDERICK PELLEGRINI
Help Clients with the 'Inheritance Talk'

It wasn't easy for your clients to talk to their kids about sex, drugs and being safe on the Internet, but they managed - whether with red faces or not. But when the subject turns to inheritance, many clients would rather have a root canal than talk about family money.

Telling children how much they stand to inherit is fraught with what The Wall Street Journal calls "emotional land mines." Parents who came from much more modest means might feel guilty about their wealth. They worked hard for their money and don't want their children to lose their work ethic. (http://tinyurl.com/lhfnju7)

There's also the thorny subject of who inherits what, and how much. Not talking about it can lead to confusion, mistrust and heirs ill equipped to manage wealth.

Despite these obstacles, experts interviewed by The New York Times say it's important for parents to talk openly to children about money because failing to do so brings with it its own set of problems. (http://tinyurl.com/o8khljn)

Etiquette in discussing money with family

Is there a "best way" of approaching the conversation about wealth with your client's family? We found an interesting article in AARP interviewing etiquette expert Peggy Post of the Emily Post Institute about this issue. (http://tinyurl.com/mnn2nhm).

Post says there is no set "blue print" to follow for every family. Before money is left to heirs, Post suggests having one-on-one conversations with the children. It's also important to have group meetings so everyone is on the same page.

Dropping the news all at once can overwhelm and dumbfound heirs who had no idea of the scope of their inheritance. Sudden wealth can be a burden.

Developing a family mission statement can help heirs know what a family's values are regarding money. Also, holding regular family meetings can reinforce those ideas. Sharing stories about how the wealth was created lets the kids know the money didn't come out of thin air.

There's going to be a lot of money transferred in coming decades. Baby boomers will leave their children more than $30 trillion in the next 30 to 40 years, The Times says.

The "blank check" exercise

Parents need to assess their children before revealing too much information, The WSJ says. What is their level of financial responsibility, ability to think in an adult way and adjust to a potential large inheritance?

Hand them a sheet of paper and tell them to pretend it's a blank check and to write down what they would buy if they had the money now. If they say a sports car or a wardrobe from Mercedes-Benz Fashion Week, then clients know more mentoring and teaching is called for.

It is all about communication and planning

Deciding how assets will be divvied up can be a chore. Should everything be equal? What if one child is active in a parent's business working for below market salary with the implied understanding that the business will be "left" to him or her? What if it's a blended family? This is why working with a professional team of advisors is critical in thinking these issues through. Unique family dynamics call for unique planning strategies. In the end, it comes down to great communication within a family and thoughtful legal planning.
  Frederick N. Pellegrini, is a  Dedham, MA estate planning attorney specializing exclusively in estate planning for individuals, small business owners, and families throughout Norfolk County, Massachusetts.  Attorney Pellegrini, has numerous awards and honors, including:
  • National Directory of Who's Who in Executive and Professionals
  • National Directory of Who's Who in Finance and Industry
  • Strathmore's Who's Who Registry of Business Leaders
  • Marquis Who's Who in American Law
  • International Who's Who of Professionals
He is also a member of several professional associations, including the Massachusetts Bar, the Boston Bar Association, the Norfolk and Plymouth Estate Planning Council, the National Network of Estate Planning Attorneys, and the Neponset Valley Chamber of Commerce.

Law Office of Frederick N. Pellegrini
Located at 30 Eastbrook Road, Suite 401, Dedham, MA 02026
Toll Free: (888) 743-7671
Phone: (781) 329-1060
Website: .
Probate.com
  

Wednesday, February 5, 2014

Aging Americans Have More Care Options than Ever, But Few Have the Funds to Pay For Them
Bob O'Toole, President, Informed Eldercare Decisions, LLC

While many Americans still think of nursing homes as a primary provider of care for frail elders, few older Americans ever require nursing home placement.

Nursing homes are the most intensive form of long-term care and are sometimes the alternative best suited for those who need round-the-clock medical supervision. But whether that level of care is provided in a nursing home, or at home by home care aides, it comes with a steep price tag.

In last month's issue of the Caregiver Newsletter, (for a free subscription write to me at bob@elderlifeplanning.com), I discussed the high cost of home care which typically runs between $16.00 and $24.00 per hour depending on what region of the country you live in. The cost of care in a nursing home also varies in different regions of the U.S. ranging from $75,000 to $140,000 per year, with the most expensive being on the east and west coasts

Fortunately, most seniors won't require extended nursing home care. Only 5 percent will need five years or more in a nursing home.

Less intensive alternatives include home-care services that offer help with meals and household chores, assisted living facilities, and in some states, board and care homes provide a less intensive level of care, but are usually less costly per month than a nursing home. There are also such community-based alternatives as adult day care programs, which provide care, recreation and meals for a few hours per day, to full day programs 5 days per week. In some states, the services are subsidized by state funding and can be paid for on a sliding scale based on the income of the elder.

The average rate for adult day care last year was $70 a day, or about $18,000 annually. Licensing and certification requirements vary by state and county. More than 5,000 centers run programs across the country and can be found through groups like the National Adult Day Services Association. The group recommends visiting potential centers and going through a checklist of options and amenities, including door-to-door transportation and accessibility. For more, visit: www.nadsa.org/consumers/site-visit-checklist.

About 10 million seniors currently rely on others for daily care, such as help getting dressed, preparing meals or taking medication, according to a recent article by Matthew Perrone, of the Washington Post. That number will only increase as more of the nation's 78 million baby boomers enter old age. Nearly 7 in 10 people will need some form of long-term care after turning 65, according to the Georgetown University Public Policy Institute.

"Nobody wants to go to a nursing home; it's the last resort," said James Firman, president of the National Council on Aging. "People want to stay in their own home, and if they can't, they want to go to a place where they can get assistance but that still feels homelike."

"The issue is that these are long-term costs and almost all of it comes out of pocket," said John Migliaccio, director of research for Metlife’s Mature Market Institute. "It's important to have some idea about what it will cost dad, mom or your husband to get the care they need."

Insurance policies for long-term care are available, but only about 5 percent of U.S. adults have them. Most families don't plan for long-term care because often the need comes unexpectedly: an elder takes a bad fall or suffers a stroke. Cost is another issue, because policies can run $1,000 to $8,000 a year, depending on the seniors' age, health and other factors.

"The people who can really afford long-term care insurance often have enough fixed income that they don't really need it," said Bradley Frigon, vice president of the National Academy of  Elder Law Attorneys. Groups like the National Association for Professional Geriatric Care Managers recommend that families discuss various options for long-term care and how to pay for them — before they become necessary.

"Once you're already sick, that's not the time to start changing doctors, moving to a new place and depending on your kids," said Bunni Dybins, a senior care adviser with LivHome in Los Angeles.

Here are some other senior care services to consider:


  • Medical alert systems: Perhaps the cheapest and least intrusive option, seniors can use medical alert systems to get assistance in the event of an emergency. Services like Philips Lifeline and Life Alert consist of a necklace or wristband with an emergency button. When pressed, a dispatcher who has access to the senior's profile and medical history is called. Depending on the situation, he or she will call a neighbor, family member or medical center. Services generally cost between $30 and $50 a month.
    Some companies also offer extra motion-sensor technology that automatically contacts a dispatcher if it detects the user has fallen. For more, visit: www.lifelinesys.com/content/home.
  • Adult day care: Much like day care for children, adult day care generally operates during business hours Monday through Friday, providing activities and meals for seniors. Perhaps most importantly, these facilities enable caregivers to go to work, run errands or simply take a break (see link to National Adult Day Services on page 1).
"Three-fourths of the care people receive in this country comes from spouses, kids and other relatives," said Firman. "The challenge there is to make sure those caregivers doesn't burn out, and adult day care becomes an important respite during the day."

Tuesday, January 7, 2014

10 Warning Signs That an Elderly Loved One May Need In-Home Private Care. Where to Find Caregivers


  After millions of Americans gathered with their loved ones this holiday season and had an opportunity to interact with each other more than they normally do, elder care experts advise to reflect on the behavior of elderly friends or family members in order to identify potential signs of deteriorating health.

"We all want to feel like the time we spend with our elderly loved ones is of value and not a burden, but the truth is they tend to have set routines that help keep them stable day to day and it's natural for our presence over the holidays to cause some different behavior from them when we disrupt those routines," said Amy Natt, a certified geriatric care manager and owner of Aging Outreach Services in North Carolina. "However, if we observe a number of these behaviors over the holidays and their personal safety in the home becomes a concern, we may need to explore options for how we can obtain in-home assistance for them."

According to Natt, it would behoove family members who are concerned about behaviors they observed over the holidays to reflect on 10 prominent warning signs that their elderly loved one may need help
:

1. Experiencing a change in memory
2. Bills not being paid on time or mail piling up
3. Missed doctor appointments
4. Personal hygiene (e.g., clothing, hair, etc.) becoming difficult to maintain
5. Kitchen problems, such as scorch marks on pots or other signs of fires from cooking
6. Grocery supply (e.g., limited food or lots of expired food)
7. Weight loss or gain
8. Home repairs and yard work not being maintained
9. Isolation or skipping activities formerly of interest
10. Driving issues, such as accidents, tickets or car repairs not being addressed


"If a family member reflects back on what they saw over the holidays and several of these warning signs jumps out at them, it's a good idea to have a conversation with the loved one, ask some open-ended questions and just listen," advises Natt. "If your gut tells you that it's time to get your loved one some dedicated help in the home, there are some wonderful resources available to help you do that without breaking the bank."

Natt advises that a good place for consumers to start their research for in-home care is to consult the Private Care Association (PCA), the national association for private duty home care registries and referral agencies since 1977.

PCA member registries conduct background checks, verify credentials and check the professional references of caregivers before they are referred to consumers on a private basis, for care needed anywhere from a few hours at a time up to 24 hours a day. This ensures that caregivers referred to consumers are pre-screened prior to entering the client's home and are only the very best, qualified caregivers suited for the consumer's needs. At the same time, since the caregivers are self-employed, a caregiver registry can save families anywhere from 10 to 30 percent on their in-home care expenses.

Source: http://www.digitaljournal.com/pr/1663219


For more information about private duty home care registries and how to find in-home caregivers at an affordable price, please go to www.privatecare.org.

"Eldercare In An Age of Scarcity: Who Will Care and Who Will Pay is sponsored by Informed Eldercare Decisions, LLC
http://www.elderlifeplanning.com                       

Bob O'Toole is the editor of this blog. Your comments are welcome. They will be published as long as they are not "anonymous"
Bob can be reached at bob@elderlifeplanning.com

Informed Eldercare Decisions, Inc. is a private company serving dedicated to helping our clients make the best care choices for parents and relatives.

We can provide a thorough assessment of each situation and create a care plan that addresses the full range of medical, emotional, financial and legal needs. For long-distance caregivers, we can also help to implement the care plan and monitors its effectiveness

The Aging of the Long-term care Work Force

Among the overall population of direct-care workers, 29 percent are projected to be 55 or older by 2018, up from 22 percent a decade earlier, according to an analysis by the Paraprofessional Healthcare Institute, or PHI, a New York-based nonprofit advocating for workers caring for the country's elderly and disabled. In some segments of the workforce, including personal and home care aides, those 55 and older are the largest single age demographic.


"I think people are surprised that this workforce is as old as it is," said Abby Marquand, a researcher at PHI. "There's often people who have chronic disease themselves who have to muster up the energy to perform these really physically taxing caregiving needs."

Warren Manchess a 74-year-old caregiver came out of retirement to work for Home Instead Senior Care after caring for his mother-in-law, who, too, had Alzheimer's and whom he regarded as his hero. The experience, though taxing, inspired his new career.

Three days a week, he arrives at the home of a retired electrician to give his wife a needed break. He carefully shaves and dresses his client, prepares breakfast and lunch, cleans the house and quickly remedies any accidents. He does the laundry and swaddles Gregoline in a warm towel from the dryer, reads him the sports page to keep him updated on his beloved Bears and sometimes pulls out dominoes or puzzles to pass the time.

 Manchess has worked for his client for about a year, and the men are at ease around each other. Past aides to Gregoline have been in their 20s, but Manchess says he thinks his age is an asset.

"Age can be an advantage," he said, pointing to the common conversation points and life experience, including his own health troubles and aches and pains that can come with age. "We hit it off pretty well. Maybe I didn't seem to be too much out of the ordinary."

Around the country, senior service agencies are seeing a burgeoning share of older workers. About one-third of Home Instead's 65,000 caregivers are over 60. Visiting Angels, another in-home care provider, says about 30 percent of its workers are over 50. And at least one network, Seniors Helping Seniors, is built entirely on the model of hiring older caregivers.

Like most occupations, some of the growth in older caregivers is driven by the overall aging of the population and the trend of people working later in life. But with incredibly high rates of turnover and a constant need for more workers, home care agencies have also shown a willingness to hire older people new to the field who have found a tough job market as they try to supplement their retirement income.

The jobs are among the fastest-growing positions in the U.S., but are also notoriously physically demanding, with low pay and high rates of injury. Manchess has had spinal surgery and says he's especially careful when vacuuming. He's not sure how many years he'll be able to continue this work, and he acknowledges it can be tough.

"Halfway through my shift, I'm a little weary myself," he said. "It takes its toll."

Manchess had worked as an Air Force pilot, then in real estate, then as a school bus driver, before becoming a professional caregiver. As Gregoline contentedly nibbles on his ham sandwich, Manchess wraps up his shift, turning reflective when considering his life's careers.

"I think this is about as rewarding, if not more rewarding, than any of them," he said.

Source: http://latino.foxnews.com/latino/health/2014/01/06/seniors-looking-after-seniors-growing-trend-as-demand-for-elder-care-swells/


Monday, January 6, 2014

Costs of Care NOT covered by Medicare



Medicare only covers medically necessary care and focuses on medical acute care, such as doctor visits, drugs, and hospital stays. Medicare coverage also focuses on short-term services for conditions that are expected to improve, such as physical therapy to help you regain your function after a fall or stroke.

Medicare does not pay for long term custodial care. This may result in the largest single expense faced by those who live a long life but require hands on care for an extended period of time, also known as "long-term care"

What is Long-Term Care?
Long-term care is a range of services and supports you may need to meet your personal care needs. Most long-term care is not medical care, but rather assistance with the basic personal tasks of everyday life, sometimes called Activities of Daily Living (ADLs), such as:

    Bathing
    Dressing
    Using the toilet
    Transferring (to or from bed or chair)
    Caring for incontinence
    Eating

Other common long-term care services and supports are assistance with everyday tasks, sometimes called Instrumental Activities of Daily Living (IADLs) including:

    Housework
    Managing money
    Taking medication
    Preparing and cleaning up after meals
    Shopping for groceries or clothes
    Using the telephone or other communication devices

Some average costs for long-term care in the United States (in 2010) were:

    $205 per day or $6,235 per month for a semi-private room in a nursing home *
    $229 per day or $6,965 per month for a private room in a nursing home*
    $3,293 per month for care in an assisted living facility (for a one-bedroom unit)*
    $21 per hour for a home health aide
    $19 per hour for homemaker services
    $67 per day for services in an adult day health care center


*Higher on East and West Coasts

The cost of long-term care depends on the type and duration of care you need, the provider you use, and where you live. Costs can be affected by certain factors, such as:

    Time of day. Home health and home care services, provided in two-to-four-hour blocks of time referred to as “visits,” are generally more expensive in the evening, on weekends, and on holidays
  
 Extra charges for services provided beyond the basic room, food and housekeeping charges at facilities, although some may have “all inclusive” fees.
   
Variable rates in some community programs, such as adult day service, are provided at a per-day rate, but can be more based on extra events and activities

Thursday, December 26, 2013

China Faces Enormous Problems Due to Growing Aging Population

As is the case in most countries, people are living longer in China. But momentous demographic changes are conspiring to make it more difficult for the Chinese to look after their seniors.

China has the world’s largest elderly population. Nearly 200 million Chinese are now over 60, or more than 14 percent of the overall population. 

It is estimated that as many as one in four Chinese will be above 65 by 2050—probably more than the entire population of the United States.

In the late 1970s the Chinese government felt that unrestrained population growth would eventually become a liability, and it put in place its infamous one-child policy.

Migration patterns have compounded the eldercare problem. Over the past decade, China’s flourishing industrial centers on the eastern coast have drawn hundreds of millions of workers away from their aging parents in the poorer rural areas of western China. This mass migration, engineered in part by the government to speed up the process of urbanization in order to sustain industrialization, has eroded traditional practices of familial support. Two-thirds of China’s elderly remain in the countryside. While many receive money from their children in the cities, they increasingly need more than only financial help. As they grow older, they need assistance with basic daily activities as well as companionship, which for many is currently provided by fellow seniors.

In July, China introduced an amended national law requiring the children of parents over 60 to visit them “frequently” and attend to their financial and spiritual needs. The Law of Protection of Rights and Interests of the Aged is intended prevent patent neglect and abuse of the elderly. It is part of a national campaign to raise awareness of the plight of seniors, which includes the creation of an Elderly Day that will be celebrated each autumn. While the law does not stipulate the number of required visits or penalties for violators, Chinese courts this year have heard numerous cases of elderly parents suing their adult children for neglect.

The government at all levels remains ill-prepared to cope with the burgeoning number of senior citizens. It has not fully developed a comprehensive and robust national healthcare and insurance program, which in the United States accounts for more than 10 percent of GDP. More than 90 percent of China’s elderly are now covered by health insurance, but the quality of healthcare generally remains low and out-of-pocket expenses high. The burden of caring for the elderly still falls largely on family and friends.

Simple mathematics suggests the magnitude of the crisis. Despite the proliferating number of private independent or assisted-living homes, China estimates that there are only 21.5 beds currently available for every 1,000 elderly in the nation’s nursing homes, most run by the government. China would like to increase this to 30 beds for every 1,000 by 2015. This modest increase will not be as easy to achieve as it might seem, for the national social security fund already faces a US$2.9 trillion deficit and is expect to balloon in coming years.

Lacking the experience needed to build a viable national eldercare system, and recognizing that the undertaking could outstrip public resources by 2020, policymakers are proposing that China tackle the problem in the same way it reformed and revitalized its economy after decades of self-imposed isolation—by opening it up to foreign investment. Direct foreign investment in the eldercare market (including nursing, geriatric and insurance services) will, they think, bring invaluable management expertise and technological know-how.

China will continue to feel the increasing weight of its aging population. The most innovative approaches to caring for its seniors may not be the most viable. The country may have to find a way back to more traditional practices of familial eldercare. These will necessarily have an impact on the economy, but what China loses in productivity and growth, it will no doubt regain in social coherence.


This is an abridged excerpt from an article originally published in the Diplomatic Courier's November/December 2013 print edition.
You can read the full article here: http://www.diplomaticourier.com/news/regions/brics/1938-china-s-eldercare-predicament

Thursday, December 19, 2013

Innovative New Service Allows Caregivers to Monitor Homebound Elders

Adult children worry about Mom or Dad living alone. This is a big added stressor especially for those taking care of parents and children at the same time. Most seniors want to live in their own home as long as possible - and outside senior care is very expensive.


Enter SafeinHome, a real time smartphone enabled service that uses small sensors in the senior's home to send information about their activity securely to family members' mobile device or computer. Adult children can easily check on their Mom or Dad any time which saves time and reduces stress.

"Ten million seniors age 75 and over live alone at home," explained Denise Yarmlak, director of marketing for the SafeinHome company based in Walnut Creek, California. Nearly 40% of adults face daily concerns about the wellbeing of their aging parents and cannot always be there to check on them in person.

SafeinHome can be used by multiple family members and keep them in the loop with real time alerts for common daily routines such as was the door left open? Did Mom return home and settle in for the night? Is she up and about as usual?

Family members and professional caregivers are benefiting from this new technology. At $99 a month, it is an affordable supplement to paid care which runs in the thousands of dollars per month.

When the SafeinHome system became available, senior care agency owners responded positively. Director Geneva Knoles who manages two senior care Visiting Angels offices in Valencia and San Luis Obispo stated, "We recognized the need for senior home care beyond companionship, meal delivery and attending to basic needs. Our mission very clearly aligned with the SafeinHome goals to provide peace of mind and independence for seniors."

I have always been interested in technology and the SafeinHome solution shows promise in their product. Big changes are headed our way January 1(st) and 24 hour in-home care may no longer be affordable for some families. SafeinHome provides an information safety net with their caregivers and families. We were completely impressed by their product which offers more functions than anything we have seen."

After many years working as a nursing home administrator and a career nurse my whole career, I found the greatest satisfaction was providing comfort and independence by letting seniors stay in their own home.

While the statistics reveal that 53% of most seniors who move into a nursing home unfortunately pass within 6 months, the goal of Visiting Angels has always been to keep a senior in their own home and preserve their comfort and independence as long as possible. SafeinHome allows us to complement our mission."

Barbora Soltys' Comfort Assisting, Inc. in the San Francisco Bay Area took notice immediately and signed up recognizing the value this real-time information and alerts could provide to family members who wanted to stay connected to their senior every day.

A relieved caregiver calls their family's SafeinHome system "life changing and a life saver; a cost-effective alternative that keeps home care costs low. It's an extra measure of security; a proven technology designed to keep seniors safe and families worry free."

"We are rolling out SafeinHome in Santa Barbara, San Luis Obispo, Santa Maria, and other parts of California. During the holiday season, many people visit their aging parents and recognize the need for more help.

SafeinHome is an easy and affordable way for adult children to check on aging parents when they can't be there in person," explained Denise Yarmlak, and it gives you peace of mind knowing Mom is OK.


Web Site: http://www.SafeinHome.com
 Source:HealthNewsDigest.com

Tuesday, December 17, 2013

Managing Aging Parent Care From A Distance

How to Manage Your Parents’ Care From Afar


Seven million or so people playing the role of long-distance caregiver, defined as someone who helps a parent or relative living an hour or more away. The job can involve anything from visiting more often to orchestrating services and taking on financial and legal responsibilities on behalf of a parent.

Start the conversation. Persuading your parent that he or she needs help requires tact and patience, says Christina Irving, of the Family Caregiver Alliance. “Bring up what you’re noticing and let them know you’re concerned and would like to help as much as you can.” If the problem involves finances, such as racking up overdraft fees, appeal to your parent’s practical side, says Cal Brown, a financial adviser at Savant Capital Management, in McLean, Va. “Point out the errors and say, ‘Look, you can’t do this anymore. It’s costing you too much money.’ ”

Consider including a trusted adviser in the conversation, such as the family doctor or lawyer, for support.

Set up the team. Usually, one family member becomes the point person in long-distance caregiving, says Irving. If that’s you, discuss with your siblings and other interested parties what roles they can play. “Focus on the strengths of different family members. The person who is good with money can manage the finances. The person who lives closest can work on getting in-home help. If one person has a medical background, that person can take on the medical piece.”

Or, if the roles don’t break down neatly, divvy them up according to who has time to make arrangements and who has the money to help pay for services. Also ask family friends, neighbors and perhaps church members to help -- say, by providing an occasional ride. Tools such as CaringBridge can help you organize tasks and keep everyone informed.

Whatever your plan, remember that you don’t have to go it alone, says Jody Gastfriend, vice-president of senior care services for Care.com, which helps families find caregivers. “In most cases, one person, usually the daughter, bears the brunt of work. It’s a mistake for that person to shoulder it all.”

Gather information. Put together a file or notebook that includes the names and contact information of your parent’s doctors, lawyers, financial advisers and other key players, including the friends and neighbors who have agreed to help out. Make a list of all medications, and find out where the prescriptions are filled.

Gather information about your parent’s income and assets. Identify bank, investment and credit card accounts and passwords, and know where insurance policies, legal documents and tax returns are kept.

Get authority. One of you will also need your parent’s durable power of attorney, which lets you make legal and financial transactions on your parent’s behalf. With this document, anything the person giving authority can do, the agent should be able to do, “no matter what the situation,” says Howard Krooks, president of the National Academy of Eldercare Attorneys. That agent (presumably, you or a sibling) can set up automatic payments for recurring fixed expenses, such as the mortgage, and pay other bills online.

One of you will also need a durable power of attorney for health care, which allows that person to make health care decisions on your parent’s behalf if your parent cannot. Also have your parent complete a release form that gives doctors permission to share medical information. (For more on elder-care documents, see Get the Documents in Order.)

The family member who is coordinating medical care should be the one to communicate with the doctors, says Gastfriend. “There’s nothing more frustrating for doctors and nurses than to talk to five different siblings who have five different opinions.”

Line up home services. If your parent is recovering from an illness or injury or is having trouble with basic activities such as dressing or bathing, he or she may need home health care. Home health aides, who are often nurses, can supervise medications and provide physical or occupational therapy, as well as skilled nursing. The average cost runs $21 an hour. Medicare covers home health care under specific, limited circumstances; private insurers generally follow the same criteria Medicare does. 

For nonmedical assistance, look to home-care franchises, such as Home Instead Senior Care and Comfort Keepers Home Care. Aides from agencies such as these will help with meals, light housekeeping, personal care and transportation, typically for about $20 an hour. Keep in mind that you’re introducing a stranger into the household, says Irving. “It can take work to find the right person, with the personality fit and the skills, who you trust and feel comfortable with.”

Enlist volunteers. The National Volunteer Caregiving Network (some chapters continue to use the name Faith in Action) lists about 500 programs in communities across the country whose volunteers provide free services, including transportation, yardwork, light housekeeping, respite care and friendly visits. Not every program provides every service, but most at least offer transportation, says Rhonda Anderson, executive director of the network, “because that’s the biggest need.” Programs usually run a background check and vet the driving records of volunteers, she says. To find services near you, use this interactive map.

Hire a geriatric care manager. If your parent’s medical situation becomes more complicated than you can handle, or you simply need guidance, hire a cer­tified geriatric care manager. Such professionals will assess your parent’s needs, help identify services and, if necessary, provide ongoing care management.

The cost: $100 to $200 an hour, depending on the location, says Jullie Gray, president of the National Association of Professional Geriatric Care Managers. That’s pricey, but it may take only one or two meetings to come up with a plan you can execute yourself, says Gray. “It’s an affordable way to get on track.” Care management can also be cost-effective if you live across the country or abroad and would otherwise face out-of-sight travel expenses. And sometimes, having boots on the ground is worth any price. “If Mom or Dad ends up in the hospital, we talk to doctors, coordinate care and make sure everyone knows what’s happening,” says Gray.

Source:
By Jane Bennett Clark, From Kiplinger's Personal Finance, January 2014
Read more at http://www.kiplinger.com/article/insurance/T013-C000-S002-how-to-manage-your-parents-care-from-afar.html#2M4X125lK3WTfFdL.99

Tuesday, December 10, 2013

Trusts should be reviewed every few years to make sure that they are up-to-date with the law and meet your goals today

Harry Margolis is a nationally prominent attorney and elder law specialist who is also a prolific writer about legal issues of interest to older Americans as well as to the adult children of aging parents.

He recently wrote an important article that anyone who thinks they have already done the critical legal planning steps necessary-including setting up a trust should read.

9 (Potential) Problems with Your Trust - Massachusetts

  All trusts should be reviewed every few years to make sure that they are up-to-date with the law and meet your goals today. Following is a checklist of trust features you can review yourself. But be aware that these only refer to revocable "living" trusts, not to irrevocable trusts.
  1. Do you have the right successor trustees? Typically you will be the trustee of your own revocable trust with your spouse as co-trustee (if you're married). Trusts should name one or more successors in the event the original trustee or trustees are unable to serve. Make sure that you still want the successors you originally named. Also, do you want them to come on and begin acting as trustee now? And if you and your spouse are co-trustees, do you want the successor or successors to step in when the first of you becomes incapacitated or passes away or not until neither of you can serve?
  2. Who can remove trustees? You can always change the trustees of your revocable trust. But do you want your heirs to have this right after you pass away? This can often avoid problems if there are communication problems or disagreements with the trustee. On the other hand, you might want to limit this to some extent to make sure heirs aren't just looking for a trustee to do whatever they say.
  3. Can your spouse change the ultimate distribution of trust assets after you have passed away? Many trusts give surviving spouses a so-called power of appointment to redirect trust assets at their death. This can be important to provide for flexibility to respond to changes in family circumstances. However, this usually doesn't make sense in second marriages. In a Massachusetts court case, the second wife used her power to give everything to her children instead of the original beneficiaries: her deceased husband's children. Even in the case of a first marriage, removing this provision from the trust can provide protection for children and grandchildren in case the surviving spouse remarries and becomes estranged from his family.
  4. Does your trust protect your children and grandchildren from lawsuits and divorce? You have the option of drafting your trust to continue for your children's lives to provide creditor and divorce protection.
  5. Have you funded your trust? We often see great trust documents that don't do all that's intended because the clients' assets are still titled in their names. You can avoid probate and make sure that the estate tax protections in your trust operate as planned through retitling assets in the name of the trust.
  6. Who is named as beneficiary of your retirement plans and other investments? Often clients spend hours with their attorneys crafting an estate plan to match their goals and them circumvent it through naming individuals as beneficiaries of retirement plans and investment accounts. Make sure these are all coordinated.
  7. At what age from children and grandchildren receive their inheritance? Most trusts provide that funds will remain in trust until those inheriting reach a certain age, often 21 or 25. But you can set any age you choose and even permit them to withdraw a portion of the trust at set ages, say half at 25 and half at 30, or a third each at 25, 30 and 35. This doesn't mean that they can't benefit from the trust assets in the meantime, but that distribution decisions are made by the trustees until children and grandchildren have more financial experience.
  8. Does your trust have provisions providing for maximum tax deferral if it is named the beneficiary of a retirement plan? While you may choose to have your retirement plans go directly to your heirs -- and often this is the simplest approach -- if they are going to your trust, it must have special provisions to stretch out the annual required distributions for as long as possible.
  9. Is your trust up-to-date for estate tax purposes? Congress and many states have changed the estate tax laws several times in recent years. If your trust is more than five years old, or if you lived in a different state when it was drafted, it should be reviewed by an estate planning attorney to make certain it is still current.
You can check many of these questions on your own. In fact, it's a useful exercise to make sure that you understand what is in your trust. Others, particularly those related to tax issues, will require consulting with an estate planning professional. Let us know if you have any questions about your trust.

Margolis & Bloom, LLP, practices estate, long-term care and special needs planning in Boston, Dedham, Framingham and Woburn with a strong commitment to client service.  If you have questions about these or other legal matters, do not hesitate to contact us by e-mail by clicking here or by calling us at 617.267.9700.

http://www.margolis.com/Our-Blog/bid/103741/9-Potential-Problems-with-Your-Trust-Massachusetts

Sunday, December 8, 2013

Geriatric Care Managers Help Elders and Families Navigate Available Health Care Options.

 Geriatric Care Managers Help Elders and Families Navigate Available Health Care Options.

There had been telltale signs of dementia -

repeating conversations, getting lost in stores, forgetting things.

But then came the day in February when Clare Day's 82-year-old father dropped her 82-year-old mother off at the supermarket. By the time her sister had picked up her mother as planned and returned her to their Logan home, their father had vanished.

He had driven from Logan to Hulmeville in Bucks County, where "he ended up at the fire station," says Day, 52, of South Philadelphia, who went with family to get him. "I took his car keys and drove the car home and have had it ever since."

The sixth of eight children, Day had researched a care plan for her parents as their dementia worsened. But the family couldn't reach a consensus. Finally, they approached geriatric care manager Joyce Gray of GrayCare in Lower Merion to help plan the next steps.

The demand for such geriatric care managers "will only grow," says Kaaren Boothroyd, executive director of the National Association of Professional Geriatric Care Managers, the profession's largest group, which saw a 5 percent increase in members from 2011 to 2012.

Driving the trend, she said, are the growing number of baby boomers nearing retirement, the byzantine world of health care, and new technology that can help elders stay in their homes.

"We're often called in during a crisis," says Helene Feldman of Helene Feldman Elder Care Management in Philadelphia, a 14-year veteran of the field. "I'm a resource and advocate to help people reduce stress, save time, and reduce time away from work. My role is to educate and find a balance for the family and for the designated person who needs the help."

Although some long-term health insurance plans may pay for these services, it's mainly a fee-for-service business with rates from $95 to $200 an hour. For some clients, a single consultation to review options may be all that's needed, while others may remain with the care manager for a decade or longer.

"We offer care managers that assess needs, develop a plan of care, assist with the plan and do follow-up care," says Steve Touzell, director of long-term care at the Philadelphia Corporation for Aging. "Most of our public services are paid either by state or federal subsidies" or on a sliding fee scale.

Touzell recommends that people seeking private management look for reputable agencies and experienced staff with graduate degrees in social work, proper accreditation and experience.

Hiring a manager doesn't always involve moving an elder person from home. "Most people don't want to leave their homes," Gray says. "And for some people with enough financial resources who can tolerate having people working and living in their homes, that can work out very well. . . . But when individuals can't tolerate a revolving cast of people, we can also help with plan B."

One job of a manager is to be "in the trenches," Gray adds. "Some families with long-distance caregivers may need someone on the ground to see how a person is functioning: Is there food in the refrigerator? How is their personal hygiene?"

"This is intimate work," Gray says. "We become very close with families and the older person. Older people with dementia can be very vulnerable, attach quickly and be free with information, no boundaries. You have to be careful who you let into that situation."

Personalized care may also include attending visits to doctors as an advocate and to make sure the doctor is aware of all symptoms; arranging drugs; and overseeing the care of residents who live outside the home.

"Psychologically, it's like having a partner," says Gray. "You can get so caught up in the day-to-day minutiae of caring for the person that it's hard to step back and look at the diagnosis and what are the long-term scenarios that I need to prepare for."

For Day's family, the first step was a consultation to decide if they needed a care manager. "We also wanted some expert input on what kind of facility we should be looking for. There are so many choices of type, style, cost, and location," she said.

Gray was able "to help us name the things most important to us and narrow down our choices."

The result is that Day and her siblings have made an application to an assisted living facility.

"The whole process is so emotionally fraught to begin with and the added element of adult siblings having to come together and make a decision makes it more so," Day said. "Having an agreed upon expert to turn to has been quite helpful."


Source: www.inquirer.com/health_science (By Ilene Raymond Rush, For The Inquirer/Posted: December 02, 2013)
To Find a Geriatric Care Manager anywhere in the U.S. a directory of care managers can be found at www.caremanager.org.

Tuesday, December 3, 2013

Recent Studies Reveal that Nurse Understaffing Results in Fatigue that Threatens Patient Safety

Recent Studies Reveal that Nurse Understaffing Results in Fatigue that Threatens Patient Safety. Improved Work Environments for Nurses Result in Better Outcomes

Fatigue leaves a majority of nurses concerned about their ability to perform safely, with two-thirds of nurses reporting they had nearly made a mistake at work because of fatigue and more than a quarter saying they had made a fatigue-related error, according to a survey commissioned by Kronos Incorporated.

The "Nurse Staffing Strategy,"  released in March 2013 at the American Organization of Nurse Executives conference in Denver, found nurse fatigue also can negatively affect operational costs, as well as patient and employee satisfaction, according to the research announcement.

Among the findings:

  • 39 percent of respondents found current staffing levels inadequate, while 38 percent found them unsatisfactory 
  •  57 percent said workloads were not distributed evenly in the previous year, with 54 percent saying they had an excessive workload
  • 77 percent said their organization had 12-hour nursing shifts
  • 96 percent reported feeling tired at the beginning of their shift, and 92 percent while driving home after work
  • 63 percent said vacancies affected scheduling and overtime staffing "more often than anticipated"
  • 56 percent said their hospitals disregard required rest periods, and 65 percent said their hospitals do not have policies regarding cumulative days of extended shifts
  • Sixteen states have rules regarding staff-to-patient ratios, but California is the only  state setting minimum hospital staffing levels, according to the report.
"I don't think people realize that when your nurse is handling far too many patients, or working a double-shift or been mandated to stay over, it's probably because the hospital wants it that way," Scott Nesbit, R.N., told Michigan Radio.

Meanwhile a study published in May 2013 says improved work environments for nurses results in better outcomes. Investments in nurse staffing, education and work environments help magnet hospitals achieve better patient outcomes and lower mortality rates, a study in the May issue of Medical Care found.

Surgical mortality was 20 percent lower at magnet hospitals, after adjustments are made for clinical factors, research by the University of Pennsylvania School of Nursing showed. Mortality among patients experiencing complications also was lower, by about 12 percent, according to a research announcement. Surgical patients in magnet hospitals also were 14 percent less likely to die in the hospital within 30 days.

Magnet hospitals are recognized for nursing excellence and quality of care, and are generally successful at attracting and retaining nurses, the authors noted. The hospitals have higher proportions of nurses with bachelor's degrees and specialty training and certification than typical hospitals.

"Our findings reinforce that better work environments for nurses are the distinguishing factor between Magnet and non-Magnet hospitals and are key to better patient outcomes," according to the report.

The American Nurses Credentialing Center confers magnet recognition. About 8 percent of U.S. hospitals have status as magnets.

"Magnet recognition likely stimulates positive organizational behavior that improves patient outcomes," lead author Matthew D. McHugh, Ph.D., said in a statement.

A separate study published in the April issue of Medical Care found that payment reform likely strengthens the business case for investing more in nursing care. The study found that the existing business case for nursing investments is probably understated because of "the inability of most studies to capture spillover and long-run dynamic effects, thus causing organizations to forfeit potentially viable nursing investments that may improve long-term financial stability."

Sources:
1. http://www.pymnts.com/news/businesswire-feed/2013/march/20/kronos-survey-reveals-nurse-fatigue-is-pervasive-in-the-healthcare-industry-and-directly-linked-to-on-the-job-errors-20130320005124
2. http://journals.lww.com/lww-medicalcare/Abstract/2013/05000/Lower_Mortality_in_Magnet_Hospitals.2.aspx
3. http://www.fiercehealthcare.com/story/study-credits-nurse-work-environment-better-outcomes/2013-04-19#ixzz2mRu8QSzO

Sunday, November 24, 2013

Increasing Percentage of Working Caregivers are Men




Increasing Percentage of Working Caregivers are Men

Although the traditional stereotype of a family member taking care of an elderly relative is a wife, daughter or daughter-in-law, 45% of Americans in that role are men, according to a Pew Research Center report.

Lost wages from caring for parents will cost men who are 50-plus an average $89,107 in 2011 dollars over their lifetime.


Why more men? Social norms are changing.  The aging of the population means more elderly parents and spouses to care for with fewer children to help. And those children often are more geographically dispersed.

Male caregiver tasks differ, in many instances, from tasks performed by female caregivers who are more likely to manage personal care tasks such as bathing, grooming and toileting.

Male caregivers are more likely to handle such tasks as mowing lawn, doing general maintenance and helping to clean up after their elderly dog. But males are increasingly involved in such management tasks as hiring in-home caregivers and managing frail parent’s finances.


Caregiving Responsibilities Can be Costly

Lost wages from caring for parents will cost men who are 50-plus an average $89,107 in 2011 dollars over their lifetime, according to a study last year conducted for the MetLife Mature Market Institute. They also stand to lose an estimated $144,609 in Social Security benefits and $50,000 in pension benefits.

Men are less likely to be aware of or seek out help.  As men are increasingly assuming the role of caregiver for aging parents while working full-time jobs, those male caregivers may unfortunately face a tougher time than women from employers who may be more accepting and flexible with women who assume these responsibilities.


As the population ages and retirement age increases, greater numbers of working Americans – many of them men — will be caring for aging family members. As more men become caregivers they are becoming more vocal about the need for caregiver benefits and flexibility.


According to the Center for WorkLife Law roughly 12 percent of lawsuits alleging family responsibilities discrimination in the workplace are filed by men; between 2006 and 2010, the number of cases brought by male plaintiffs was three times higher than the number filed by men during the previous five-year period.

Sources: http://pewinternet.org/~/media/Files/Reports/2012/PIP_Family_Caregivers_Online.pdf/February 28, 2013

Kelly Greene, The Wall Street Journal

MetLife Mature Market Institute

Center for WorkLife Law

"Eldercare In An Age of Scarcity: Who Will Care and Who Will Pay is sponsored by
 Informed Eldercare Decisions, LLC
http://www.elderlifeplanning.com                        781-461-9637
 
Bob O'Toole is the editor of this blog. Your comments are welcome. They will be published as long as they are not "anonymous"    Bob can be reached at bob@elderlifeplanning.com

Informed Eldercare Decisions, Inc. is a private company serving dedicated to helping our clients make the best care choices for parents and relatives. We can provide a thorough assessment of each situation and create a care plan that addresses the full range of medical, emotional, financial and legal needs. For long-distance caregivers, we can also help to implement the care plan and monitors its effectiveness.