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. 

Students Devise Products For Adults With Dementia

Students Devise Products For Adults With Dementia
Richard Eisenberg

 Anyone who has, or had, a loved one with dementia will want to say “thank you” to the seven student finalists of the inaugural Stanford Center on Longevity Design Challenge announced today. With any luck, caregivers and families will be able to buy their brilliant creations sometime soon.
 Stanford, in collaboration withAging 2.0 (an organization aiming to accelerate innovation to improve the lives of older adults), challenged graduate school and undergraduate students around the world to design products and services that would keep individuals with cognitive impairment independent for as long as possible.
Why Independence is a Worthy Goal
More than 80 percent of adults want to age in place and that the cost of 24-hour supervised memory care can run $10,000 a month, according to Stanford.
Each of the finalists will receive $1,000 and mentorship from the Challenge’s corporate sponsors, to help them refine their ideas. The Design Challenge winner, to be named at a ceremony on April 10, will receive $10,000; two runners-up will get $5,000 and $2,000. That’s also when Stanford will unveil the theme of its next Design Challenge.
  Stanford received submissions from 52 teams in 15 countries. Five finalists were from colleges in America, one was studying in Denmark and one in Singapore.
“Cognitive impairment affects people in such a personal way, the challenge brought out a lot of creativity,” says Ken Smith, Director of Mobility at the Stanford Center on Longevity.
The students who entered weren’t just studying design and engineering. They also came from fields such as nursing, psychology, fine arts and computer science. Dementia affects patients, families caregivers and health providers in a multitude of ways, so the inventions addressed the disease from a variety of angles.
The 7 Challenge Finalists
Memory Maps from Ritika Mathur at Copenhagen Institute of Design. Combining a small device with an RFID reader, a map of the patient’s neighborhood and GPS technology, Memory Maps lets someone with early-stage cognitive issues and his or her family record memories and then coordinate them to a map with the real-world locations where they took place.

“Our goal was not just to bring back what’s gone, but to find out what is still there and nourish and cherish that,” Mathur wrote in the entry.
Eatwell from Sha Yao at the Academy of Art in San Francisco. Inspired by her grandmother who had Alzheimer’s, she designed a seven-piece tableware set specifically designed for people with the disease. Its goal: to help users eat better and maintain their dignity while helping alleviate burdens of their caregivers.
Anti-slip bowls are designed to get food into spoons more easily, cups have rubber mats and extended handles that act as stabilizers, trays let caregivers clip aprons onto the edge to help catch food that may drop. Estimated retail price: $150 initially.
Taste+ from Huabin Kok at Singapore National University. Another product for meals, this is a spoon with a built-in electrical stimulation to make food more delicious if they have diminished taste sensation, as many with cognitive impairment do. The user taps a button on the spoon to deliver a salty or sour flavor, rather than actually adding salt, which could lead to heart problems. Estimated price: Under $40.
Caresolver from Arick Morton at Harvard University. This is a cloud-based, web/mobile/phone-based platform for “lay” caregivers to give them  support and help facilitate coordination with a larger caregiver team. Its CareLogic engine tracks and monitors caregiver and care-recipient wellness and delivers alerts, notifications and clinically-validated interventions when appropriate. Caresolver also connects users with online support groups, forums and mentors.
Confage from Ani Abgaryan at San Francisco State University . Abgaryan devised this engaging gaming experience after growing frustrated that she was unable to teach her grandmother how to read or write text messages on her mobile phone. Confage shows people with memory and hand-motorics issues the main gestures needed to use touchscreen devices.
ThermoRing from Kayvan Mojtahedzadeh at San Francisco State University. It’s a plastic ring placed around an electric stove burner that warns people the burner is on by changing from black to red.
Kitchen fires and burns are, of course, a significant safety concern for people with dementia and their families. Fear of fire accidents is actually a common reason why the elderly are moved into assisted living centers.
Automated Home Activity Monitoring from Guido Pusiol at Stanford University. This computer-based system, operated through cameras, would learn its user’s daily living behavior and then send an alert to the caregiver when “abnormal” activity occurs — such as a fall. A 24-hour test in an apartment found the system was 90 percent accurate in detecting eight daily activities including cooking and eating.
Will any of the Design Challenge ideas make it to market? No one knows, of course, but Smith says: “I was more encouraged about the possibility after we figured out who the finalists would be.”

 Source: Money & Security and Work & Purpose channels of Next Avenue

Blog Editor: 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.