Monday, December 15, 2014

Do FDA Approved Alzheimer's Drugs Raise False Hopes?

The Hard Truth About Alzheimer’s Drugs: 
"Most people who take them don’t experience a meaningful benefit."

Submitted by Bob O'Toole, Informed Eldercare Decisions, LLC. 

Big pharmaceutical companies have struggled for years to develop a drug that will halt the progression of Alzheimer's disease, a terrible neurological ailment that begins with memory loss and steadily robs patients of brain function, leading to dementia and death. Barron's ( has stated that "Success would have an enormous societal impact and help to contain the cost of an ever-increasing population of Alzheimer's patients, which number an estimated five million in the U.S. -- and 26 million worldwide."

But, as Barron's has noted, "Most medications prescribed for those diagnosed with Alzheimer's disease and other forms of dementia do little to help most people and pose risks..."

Over time, Alzheimer’s disease, the most common form of dementia, robs people of their ability to remember, learn, and reason, cutting them off from friends and family and eventually even their own sense of self. The companies that sell Alzheimer’s drugs peddle hope to people looking for a way to ease the pain and frustration. But a hard look through the research paints a far more disappointing picture.

Marketing for the Exelon Patch reassures people that the active ingredient “has been studied for over a decade in clinical trials” and that it has “been shown to benefit cognition, which includes things like memory, reasoning, understanding, and communication, as well as improve overall function.” Marketing for Aricept characterizes giving the drug to a loved one as an act of responsibility and caring. “I want to give to the man who gave me so much love,” says a woman as she kisses the cheek of an older man.

 It’s true that Alzheimer’s drugs have undergone extensive study. But the overall results are far less encouraging than the ads portray. Most people who take them don’t experience a meaningful benefit. More than half experience side effects. And they’re expensive, costing anywhere from $140 to more than $656 monthly.

 To clearly spell out the risks and benefits of these medications, Consumer Reports Best Buy Drugs commissioned Informulary, a company founded by Dartmouth professors,   to review the evidence for three drugs approved by the Food and Drug Administration to treat mild-to-moderate Alzheimer’s—donepezil (Aricept and generic), galantamine (Razadyne and generic) and rivastigmine (Exelon patch, Exelon capsules, and generic). 

Their research  revealed that after six months on the drugs, most of the patients show no improvement in mental functioning, based on their doctors’ assessments and tests of basic thinking skills. Among the few who do benefit, the improvement is typically slight. “The available studies have not shown that the drugs help achieve what we would consider major goals of dementia treatment, prolonging people’s ability to live independently or improving quality of life for either patients or caregivers,” Woloshin said.

    Even a small benefit or chance of improvement might be worth it if Alzheimer’s drugs were risk free. But they are not. They can cause side effects such as insomnia, nausea, muscle cramps, diarrhea, and reduced appetite, all of which can be troublesome for people with dementia. Rarely, the drugs may cause more serious side effects such as internal bleeding and a slowed heart rate that could be potentially dangerous. 

The decision on whether you or a loved one who is affected by Alzheimer’s disease should use a medication is a personal one. Patients and their families who decide to try a drug could start with generic donepezil, which is not more effective than other drugs, but is one of the less expensive choices and has a lower rate of side effects. If there’s no improvement in symptoms after a few months, it makes sense to consider tapering and stopping the drug.

If treatment is continued, people should be reluctant to tolerate a lot of side effects and should stop the drug when the disease has progressed substantially—for example, to the point that a patient requires institutionalization.

Bob O'Toole is president of Informed Eldercare Decisions, LLC. 
Dedham, MA
Providing services to elders and family caregivers
faced with difficult care planning decisions for more than 20 years

Wednesday, December 10, 2014

What to do if You Missed the Medicare Annual Enrollment Period

Each year, Medicare's Annual Enrollment Period (AEP) (Also known as the Medicare Open Enrollment Period) gives seniors the opportunity to enroll in a Medicare Advantage or prescription drug, change an existing plan, move to a new one or dis-enroll.

The AEP typically lasts about two months. But what if you miss the deadline? Does it mean you can't make any changes until next year? Changing your Part C or D coverage outside of AEP is difficult, but it's not impossible.

Here are a few tips to help you maximize your drug and health benefits in the coming year, and a few strategies for switching your plans outside of the enrollment period.

    Look for other drugs: If you missed AEP and you can't change your coverage, try to optimize the drugs you're taking to fit your current plan. 

Among the ten largest drug plans in the country, no single plan covers more than 79 percent of all available prescription drugs (as of 2012). PlanPrescriber surveyed people on their website and found that one-in-three (34 percent) took a drug that wasn't covered by their Medicare plan in the coming year. If these individuals didn't update their coverage in time, they'd not only pay full price for that drug, but their expenses wouldn't count toward getting them out of the "donut hole." If you're in the same boat this year, don't despair. The Medicare Modernization Act (MMA) requires every Medicare plan with prescription drug coverage to include at least two drugs in each category and class. Even if your plan doesn't cover the drug you take, it must cover another drug designed to treat the same problem. Talk to your doctor to find what other drugs exist to treat your illness and discuss the possibility of switching.
Ask about Medicare Supplement (MediGap) open enrollment periods: If your MediGap plan isn't working for you any longer and you can't enroll in a Medicare Advantage plan outside of AEP, you may be able to change your MediGap plan during select MediGap open enrollment periods. MediGap plans are usually medically underwritten, which means the insurance companies don't have to accept your application if you've been on Medicare Part B for more than three months. AEP is the best time to drop a MediGap plan and switch to a Medicare Advantage plan. But, some states and insurance companies have created open enrollment periods for MediGap plans as well. These open enrollments allow you to update or change your MediGap health coverage without medical underwriting. The specific rules vary by state so, if you want or need to make a change outside of AEP, investigate the MediGap open enrollment rules in your state by contacting a licensed agent.
Ask an expert about Special Needs Plans (SNPs): Special Needs Plans (SNPs) are available for people who are low-income, disabled and younger than 65. There are also 15 types of SNPs designed specifically for people with chronic health problems. If you qualify for a SNP you can enroll at any time, provided one is available in your area. SNPs designed for chronic conditions cover the following areas: chronic alcohol and other drug dependence; certain auto-immune disorders; cancer; certain cardiovascular disorders; chronic heart failure; dementia and Alzheimer's; diabetes mellitus; end-stage liver disease; end-stage renal disease requiring dialysis; certain hematologic disorders; HIV/AIDS; certain chronic lung disorders; certain mental health disorders like bipolar and schizophrenia; certain neurologic disorders; and stroke.
Investigate 5-Star Medicare Advantage plans: As of 2012, you don't have to wait for AEP to enroll in a 5-Star Medicare Advantage plan. The 2010 Health Care Reform law created a new ratings system for Medicare Advantage plans. Plans with a 5-star rating can enroll people at any time, even after AEP is over, however these plans are not available everywhere.
Medicare Annual Disenrollment Period (MADP) Starts January 1: Medicare's ADP lets you "disenroll" (cancel) from a Medicare Advantage plan if it fails to meet your needs. You can also add drug coverage at the same time. In 2015, ADP starts on January 1, 2015 and ends on February 14, 2015. If you decide to drop a Medicare Advantage plan, you will have the option to enroll in a stand-alone Medicare prescription drug plan so that you don't lose drug coverage. If you abandon a Medicare Advantage plan you're giving up benefits such as the network of providers who participate in that plan and a cap on your out-of-pocket spending for medical bills (provided those costs are approved by Medicare). These are two benefits original Medicare doesn't have. So, before you disenroll in a plan, do some homework to be sure you'll still have the coverage you need.
 Investigate Medicare Special Enrollment Periods (SEPs): Medicare also provides SEPs for people who need to change their coverage outside of AEP. A person may qualify for an SEP if they move permanently outside of their plan's service area; become eligible for a low-income subsidy due to a loss of income; receive incomplete information about what qualifies as creditable prescription drug coverage or lose that coverage through no action of their own; if they become eligible for Medicare and Medicaid ("dual eligible") but lose their dual eligibility status; if they live in, are moving into, or moving out of certain types of skilled nursing facilities; if they receive a retroactive Medicare entitlement determination; or if they qualify for other special enrollment periods that may be authorized by the federal government.

If you missed the Annual Enrollment Period, don't feel as though you're trapped in a plan that doesn't meet your needs.

If the cost of drugs, coverage or key benefits becomes more than you or a loved one can afford, there may be opportunities to make changes. The key is to be proactive. Reach out to an expert who can help you figure out what those opportunities are and how to take advantage of them.,%202014

Tuesday, December 9, 2014

Be Observant for Clues That Indicate Need for Help for Aging Parents During Holiday Visits

Reuniting at the holidays is a natural time for adult children to observe their elderly parents and help them organize for long-term care.

Many people go home ready to celebrate the family being together. Then they notice their parents have changing needs. Holidays are a good time to pause and check in on how your aging parents are really doing.

• Take Stock of Health and Wellness

Evaluate your loved one’s living situation including eating habits and look for weight loss or gain. Ask about their medical visits and call their doctor for another perspective. Take a photo of their prescriptions for your records. Inquire about their social life and listen for mental health concerns. Look for red flags that identify potential safety, mobility and health issues.

• Discuss Senior Living Choices

Families reuniting for the holidays enjoy reminiscing about past get-togethers. Turn on the video camera on and “interview” your parents on a variety of topics, such as growing up, their young adult years, favorite holiday traditions or whatever is of most interest to your family. This can ease you into the “tough conversation” on aging and different senior living options.

• Review Important Financial and Legal Documents

Families can find themselves in a crisis needing to make quick decisions about care for an elderly parent or relative. Set aside time to collect important documents to prepare for a parent’s elder care and health care. Knowing where to find insurance cards, birth certificates, wills and financial records can help families be prepared for hospital visits and making decisions about senior care for their loved ones.

Using your holiday visit for evaluating your aging parents is more effective than a phone call or short-term visit. Being proactive and engaging your parents about their future may seem awkward, but knowing how they feel and understanding their legal and financial realities, helps your family make better choices.

Thursday, December 4, 2014

New Census Bureau Report Underscores the Need for Senior Care

 A group of seniors smiling together while in a retirement home

The Baby Boom is now creating a Senior Boom. According to a new report from the U.S. Census Bureau, the number of individuals age 65 and older is projected to reach nearly 84 million by 2050, almost double the size from 2012. Another factor contributing to the boom is the fact that people are living longer: Currently, the average American is living to be almost 79 years old, up from about 71 years in 1970.

This raises the question of how we, as a country, plan on taking care of our aging citizenry. According to the Congressional Budget Office, about one-third of people age 65 or older report functional limitations of one kind or another—limitations that require assistance in dressing, bathing, preparing meals, managing medications, etc. Among people age 85 or older, about two-thirds report functional limitations. And experts project that two-thirds of all seniors will need assistance to deal with a loss in functioning at some point during their remaining years of life.

“Changes in the age structure of the U.S. population will have implications for health care services and providers, national and local policymakers, and businesses seeking to anticipate the influence that this population may have on their services, family structure and the American landscape," says Jennifer Ortman, chief of the Census Bureau's Population Projections Branch.

The aging population presents numerous challenges and great opportunities for agencies and companies that provide senior care. Home care and home health care services, community care facilities for the older population, and continuing care retirement communities are all expanding. All showed an increase of 20 percent or more in their number of employees between 2007 and 2011. Additionally, age-restricted communities are becoming more and more popular. One such community, The Villages in Sumter County, Florida, was the nation's fastest growing metro area from 2012 to 2013.

Fortunately, the Senior Boom wasn’t an unforeseen phenomenon. We’ve known for nearly 60 years that Baby Boomers would eventually grow old and need greater care. The associated industries caring for these individuals has, so far, been able to keep pace with demand, although occupancy at senior living communities is on the rise, reaching 89.9% in the second quarter of 2014. Fortunately, construction of new communities is also on the rise.

It’s safe to say that senior care will be a growing industry for many years to come.

Source: Informed Eldercare Decisions (
U.S Census Bureau and the Congressional Budget Office.
- See more at:

Tuesday, December 2, 2014

Your Siblings Can be Enormously Helpful and Your Best Support.

From Public Broadcasting

Caring for an aging parent alone is complicated. When your brothers and sisters are also involved, and when care, medical and financial decisions must be arrived at together as a team, caregiving can become even more complex. Your siblings can be enormously helpful and your best support. But in many families, they can also be a source of stress. No two families are ever alike.

A visit home. Often, around this time of year, adult children returning home for a visit realize for the first time that their parents are far more frail than they expected. Although Mom or Dad always report they are “just fine” when you make those weekly phone calls, during a visit, you realize that this is not the case. Your parents suddenly seem much older, and you see the memory lapses, or shortness of breath, wavering balance, multiple prescription containers, or other signals of waning health.

You and your siblings talk in whispers about what should to be done to ensure Mom’s safety and care. There is no money for assisted living, even if your mother would agree to it. Someone needs to step up, to see what can be done, to make decisions, to find some help, or even to live with your Mom to keep her as safe and healthy as possible. And it’s determined, often by default, that one person — perhaps the one who lives the closest, or doesn’t have kids, or is the oldest — will take on the role of primary caregiver.

Why sibling tensions can surface as parents need care

People are living longer — but not necessarily in good health. Their adult children may be caring for them for years or even a decade or more. Siblings or step-siblings are coping with a major emotional passage that stirs up childhood feelings and conflicts. But it’s made more challenging when there’s no model for working together as a team to handle the practical, emotional and financial issues that go with caring for someone who is no longer able to be independent. Some families are able to work out differences; many others struggle.

Consciously or unconsciously, needs arise for love, approval, or being seen as important or competent as a sibling. The disagreements now are over care for your parent: who does or doesn’t do it; how much; who’s in charge. At the same time, your parent is very aware — and most likely not happy — that he or she has become so dependent on you.

To help your family navigate through this situation, we offer this advice:

1. Think about, and talk about, family history and dynamics, and how they might affect caregiving. When we get together with our families, many of us tend to slip into our old roles. Maybe one person was the “responsible” one, one was the “social” one, one was the “helpless” one. But do those roles define you today? And more importantly, can you take a fresh look at who your siblings are now in the context of how these roles and assumptions can affect care for your parents?

2. Consider that care for a parent is a shared responsibility. A key concern is who will be the primary care provider(s) and what support other family members can provide. Since this is a role that can progress to more than a full-time job, this is an important decision. Rather than letting assumptions become default decisions (e.g., Barbara is oldest so she will be in charge, or Max needs a place to stay, so he’ll take care of mom), really consider who is most able, willing, skilled, and emotionally prepared to fill this role. Then consider what other family members can contribute in time or money.

3. To help reach the goal of effective shared decision-making, hold a family meeting. Family meetings are a way for siblings, parents and other concerned relatives or friends to try to clarify the situation, work out conflicts and set up a care plan that, ideally, all can agree upon. If the meeting is likely to be contentious, or if you want an experienced, objective voice to guide it, involve a facilitator such as a social worker, counselor, geriatric care manager or trusted outside party who will ensure that all participants have a chance to be heard. You may need more than one meeting. And although emotions might run high, it’s possible to conduct a productive meeting by following a few guidelines:

 4. Understand and respect that your brothers and sisters might have different ideas about the care your parent needs. It’s hard to accept that your parent now need your help. Unless there’s a sudden crisis like a stroke, adjusting to this new reality takes time. Some adult children have to work through their denial that anything serious is wrong. Others might feel reluctant to get involved, fearing they are “meddling” in their parent’s life.

Yet, to the primary caregiver, the person who is present day-to-day, it’s clear that his or her parent is less and less able to handle everyday needs. They see that Mom requires assistance with grocery shopping and cooking, that transportation and bill paying are problems, or advancing memory loss or fading eyesight or painful joints keep her from normal activities. Her needs are evident and most likely will become more intense.

Be straightforward about financial issues. Finances are a key component in long-term caregiving, affecting where your parent lives, whether paid outside help is available, whether placement in a facility is a suitable or desirable option, or whether home care is manageable with family support. Overseeing bill-paying and dealing with Medicare and other health care bills is a job in itself, and can be delegated as such.

Let your siblings know that their help is needed and wanted (if, in fact, it is — see below). Be direct and specific about what tasks you need help with. Even if they live far away, siblings can help with finances, can provide virtual companionship to your parent with frequent phone calls and Skype, or can provide occasional respite or substitute care.

Some caregivers really don’t want help, or can’t rely on help from siblings who are undependable or unavailable. If you’re in this situation, admit it to yourself, accept that you’re on your own, and work to make the care as efficient as possible while still attending to your own health and well-being. If other relatives or friends are willing, ask for help from them or from religious communities your parent might have been involved in. Check for resources in your community. When people offer to help, say yes.

With Durable Powers of Attorney or an Advance Health Care Directive, your parents can designate who will be in charge if they become incapacitated. Sometimes this creates tension among the adult children. If at all possible, this should be discussed at a family meeting and clarified for everyone concerned. An advance directive will outline the types of care that your parent desires at end of life. With this information in writing, a difficult situation is made a little more tolerable.Some families compensate the primary caregiver for their work, particularly if he or she has cut back on employment to care for their parent. How much the compensation is and who pays it can be covered in a Personal Care Agreement, which is a written contract. This can be reviewed periodically to ensure it reflects any changes in care.

National Association of Professional Geriatric Care Managers
3275 West Ina Road, Ste. 130
Tucson, AZ 85741
(520) 881-8008

Read the full article at:

Wednesday, November 26, 2014

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

 Obama Immigration Move May Aid  Eldercare Worker Shortage

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

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

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

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

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

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

Monday, November 24, 2014

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

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

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

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

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

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

Friday, November 21, 2014

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

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

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

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

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

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

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

They further found that:

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

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

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

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

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

Thursday, November 20, 2014

Hiring Caregivers Under the Table: What are the Risks?

Melanie Haiken

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

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

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

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

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

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

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

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

The Hard Truth About Alzheimer’s Drugs

Friday, November 14, 2014

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

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

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

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

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

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

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

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

Wednesday, November 12, 2014

US Family Eldercare Tops Half-Trillion Dollars

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

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

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

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

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

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

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

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

The study was funded in part by the California Health Care Foundation.
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One in Three Adult Children Today are Supporting Their Aging Parents Financially

By JosephF. Coughlin

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

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

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

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

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

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

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

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

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

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

Monday, November 3, 2014


Who is a caregiver?

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

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

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

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

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

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

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

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

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

Thursday, October 30, 2014

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


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

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

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

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

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

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

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

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

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

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

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

Wednesday, October 29, 2014

Tips to Remember During Medicare Open Enrollment

Tips to Remember During Medicare Open Enrollment

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

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

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

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

Tip 1: Be aware of enrollment periods.

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

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

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

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

Tip 2: Don't guess when picking coverage.

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

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

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

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

Be a Smart Shopper

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

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

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