Adult day care...the best kept secret in eldercare

Submitted By: Patricia Grace

Adult day care allows caregivers to continue working outside the home, receive help with the physical care of a loved one, avoid the guilt of placing a loved one in institutional care, and have respite from what can be a "24/7" responsibility. Sounds like an ideal option for those caring for a frail or cognitively impaired loved one…then why is it the most under-utilized service in the continuum of senior care services?

There are three models of adult day care: social, medical and Alzheimer’s.

• Social - provides social activities, meals, recreation, and some health-related services.
• Adult day health care - offers more intensive health, therapeutic, and social services for individuals with severe medical problems and for those at risk of nursing home care.
• Alzheimer’s specific - social and health services only to persons with Alzheimer’s or related dementia.

The purpose of an adult day center is primarily:

• To provide older adults an opportunity to get out of the house and receive both mental and social stimulation
• To give caregivers a much-needed break in which to attend to personal needs, or simply rest and relax
Good candidates for adult day care are seniors who:
• Can benefit from the friendship and functional assistance a day care center offers,
• May be physically or cognitively challenged but do not require 24-hour supervision,
• Are in the early stages of Alzheimer's disease.
Participants need to be mobile, with the possible assistance of a cane, walker or wheelchair, and in most cases, they must also be continent.

A social adult day care setting differs from adult day health care, which usually requires a health assessment by a physician before someone is admitted into the program. Adult day health centers, which typically use the term "Adult Day Health Care" (ADHC) in their names, often provide physical, occupational, and speech therapy, and are usually staffed with an RN and other health professionals. A third type of day care provides social and health services specifically for seniors with Alzheimer's or a related type of dementia.

Costs and financial assistance for adult day care:

The national average cost for an adult day care center is $55 per day, depending on the services provided (e.g., meals, transportation, nursing supervision) compared to the national average cost of assisted living which is $100 per day. Centers that provide professional health care services will mean higher fees. Dollar for dollar adult day care is the most cost effective long term care service available at this time.
Medicaid will pay most or all of the costs in licensed adult day health care settings and Alzheimer's focused centers, for participants with very low income and few assets. Due to Medicaid funding requirements many social adult day care programs have transitioned to the ADHC model. Many centers offer services on a sliding fee scale and possible financial assistance or scholarships. Long-term care insurance may also cover services for adult day programs. Additionally, dependent-care tax credits may be available to you as caregiver.

The goal of adult day programs is to improve the well being of the participants, with a wide variety of activities such as:

• Arts and crafts
• Musical entertainment and sing-a-longs
• Stretching or other gentle exercises
• Interactive games such as Wii
• Discussion groups (books, films, current events)
• Holiday and birthday celebrations
• Local outings
• Intergenerational programs that include children of all ages are regularly included especially for arts and crafts programs.

Adult day care offers a win/win situation for everyone in the family—not only the senior who attends the program, but also for the family member who more than likely is working a full time job as well as being the primary caregiver. Adult day care provides a much-needed respite for the caregiver, affording a break from the physical demands and stress of providing round-the-clock care while providing much needed socialization for the older adult.

For the participant, adult day care's benefits can be extensive:

• a safe, secure environment in which to spend the day
• enjoyable and educational activities
• improvement in mental and physical health
• enhanced or maintained level of independence
• socialization and peer support
• nutritious meals and snacks

National Adult Day Service Association suggests asking the following questions when choosing an ADC or ADHC:

• Is it licensed or certified? (If required in your state)
• What are the days and hours of operation?
• Is transportation to and from the center provided?
• Which conditions are accepted (e.g., memory loss, limited mobility, incontinence)?
• The ratio of staff to participants?
• What activities are offered? Are meals and snacks included? Are special diets accommodated?

It is always a smart idea to spend a day at the center before you enroll your family member, so that you can get a "feel" for the people and environment. It’s also advisable that you visit at different times and days to confirm your initial impressions.

Are you still asking yourself why adult day care is the most under-utilized eldercare service? The answer is the misperception that adult day care is baby-sitting for old people. However, with the cost of long term care skyrocketing and Aging in Place becoming the aging choice for many, adult day care will finally take its seat at the table of eldercare services.

Reverse Mortgage Fact vs. Fiction

Submitted by: Onisha Williams

“There’s no place like home, there’s no place like home, there’s no place like home” ~ Dorothy in The Wizard of OZ

In life we learn that there is fact and there is fiction, and then there is fiction that sounds like fact! Ultimately, the FHA Home Equity Conversion program is a tool that was designed to help Older Adults who want to age and receive services in their home. Over the years the term “Reverse Mortgage” has become a topic that will garner mixed responses to any random survey of passersby’s. So let’s walk down the Yellow bricked road to find out if the Reverse Mortgage will lead to
ruby slippers or rotten apples!!

Fact or Fiction?

My children will have to repay the money I borrowed plus interest.
– This is a Fictional Fact

Interest compounds daily on the initial loan balance. At the time of repayment the amount borrowed, accumulated interest, service fees, mortgage insurance premiums, and settlement costs that were financed into the loan are included in the pay off balance. The loan is typically repaid at the time of sale of the property. If the pay off balance exceeds the amount of money that can be obtained from the sale of your home, the FHA mortgage insurance kicks in to cover the difference- ultimately limiting the liability of paying back the loan balance to the amount of money that your home could be sold for.
If your family wanted to keep your mortgaged home, the payoff balance would be repaid by either refinancing into a new loan or through an alternative pool of assets (i.e. life insurance benefit, private funds)

I’m selling my home to the Bank/Government for less than it is worth
~This is fiction

Your lender and the Department of Housing and Urban Development would have a mortgage, also known as a lien, on your property. The amount of money you receive would only be a portion of your home’s value. The remaining equity would remain available to you subject to the terms of your agreement, typically the accumulation of interest & related fees over time. You retain the ability to sell, refinance, or will your property to any entity you choose at any time during the life of the loan. You also will be living in your home - if you sold the home you would give up title and relocate, or pay rent to stay in the property after the deed was transferred. At the time that you or your family does sell your home, the Reverse Mortgage balance would be paid at that time and any remaining equity would be dispersed to you and/or your heirs based on your choices.

This loan is only for people who have no other choice, it’s a loan of last resort.
~This is Fiction

There are always people who are making difficult choices in regards to elevating or maintaining their quality of life, but at this time there are no restrictions on the use of the funds beyond the basic eligibility requirements. CPA’s and Financial Advisors recognize the program as a financial tool that many families are taking advantage of while rates are low and many other credit based programs are being eliminated or are inaccessible to many potential borrowers. The Reverse Mortgage is a product that can facilitate a broad spectrum of financial goals and needs.

Do you have a fact or fiction question, or just need clarification? Email me your questions to be included in the next Fact or Fiction post!

Rocking the Joint: a “STRIVE Sources” post

Submitted by: Dr. Wayne Phillips, FACSM

As Sting famously sings, ”every step you take, and every move you make …” , there is a joint involved (Ok, Sting didn’t sing about joints but I couldn’t resist the reference). Joints are an always switched on, always active and always essential part of daily living. In fact we don’t leave home without them! Perhaps in part because of this nonstop motion, they are also one of the most frequent reasons for doctors visits – up to a third of which are for muscle and joint (or ‘musculo-skeletal’) pain. Joint pain, much of which is generally the result of osteoarthritis, can affect anyone and typically starts as our bodies begin to show the effects of aging. Its effect is all the more noticeable with ‘Usual Aging’ which I have discussed in this blog many times before. Here we go ….

Congress Tackles Long-Term Care

Generally overlooked in the debate over health care reform, and of particular interest to New Old Age readers, is the C.L.A.S.S. Act, a bill introduced by Senator Edward M. Kennedy, Democrat of Massachusetts, that would establish a national long-term care insurance program. The idea has circulated for years, but now advocates think there’s a real possibility such a plan will be incorporated into whatever health care bill emerges from Congress.

The C.L.A.S.S. Act (short for Community Living Assistance Services and Support, if you’re wondering) could transform the way people pay for long-term care. Participants would receive daily benefits — money they could use to pay for home care, adult day programs, assisted living or nursing homes — whether they’re elderly or young and disabled. Read the full article...

Eldercare...it isn't all about stress

Eldercare...it isn't all about stress

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Safer Homes for Seniors

By Lesley Alderman

When we moved into our row house in Brooklyn, N.Y. — with steep staircases, floor-to-ceiling windows and a working fireplace — my 15-month-old son was just learning to walk. Needless to say, we soon realized the house was a four-story danger zone. So my husband looked up “child-proofing” in the Yellow Pages and called in the installers. For a few grand, the service added stair gates, window guards and drawer locks throughout the house. And we had peace of mind.

When I was researching the story “A Safer Home for the Golden Years, Without a Golden Budget,” I expected to find similar services that would help seniors safeguard their homes. It turns out there are very few companies that perform this home-safety service for the elderly.
Read the full article

Law passes requiring insurance companies to inform policy owners about their legal right to a life insurance settlement

Submitted by: Chris Orestis

The Governor of the state of Maine signed into law a bill requiring life insurance companies to inform citizens of the state their legal right to engage in a life settlement instead of allowing a policy to lapse or be surrendered. Maine and Washington State are now the first two states to pass this important consumer protection law. Many more states, including Kentucky and Indiana, are currently considering the laws adoption.

The consumer protection law also prohibits insurance companies from engaging in anti-consumer activities. It will now be illegal for insurance companies to stand in the way of people who would be better off to sell their insurance policy through a life settlement, instead of surrendering it back to the insurance company for much less money or allowing it to lapse. As much as 90% of life insurance policies issued are allowed to lapse every year, and to date, life insurance companies do not inform people of life settlements as an alternative option. This law will begin changing that intentional oversight around the country.

"These new consumer disclosures and consumer protections represent a substantial step forward in ensuring that seniors who are faced with the lapse or surrender of unaffordable or unwanted life insurance policies can sell their policies and are not prevented from doing so by the acts of big insurance companies," said Doug Head, Life Insurance Settlement Association (LISA) Executive Director. "These measures respond to the documented evidence of carriers trying to block life settlements through threats to insurance agents and providing misleading information to seniors."

With seniors and baby boomers facing economic challenges and shrinking government dollars to help pay for the costs of senior housing and long term care, the need for alternative financial options is at an all time high. Options such as life insurance settlements, which can pay out as much as 500% more than the cash surrender value of a policy, have been suppressed by the life insurance industry because it cuts into their profits. But now, instead of allowing a life insurance policy that has re-sale value to just terminate, seniors can tap into that value through a life settlement. With this law passing, the citizens of Maine and Washington will now be informed of the life settlement option as a legal right to raise the most money possible through their valuable asset-- and soon many more states around the country will benefit from this important consumer law.

Chris Orestis, president and a principal with Life Care Funding Group, is an acknowledged national expert on insurance and long term care issues. His Blog on senior living issues has become one of the more popular forums on the internet about the impact of the economy and politics on seniors and their housing and long term care needs. Learn more about senior funding alternatives and life settlements on the Life Care Funding Group web site.

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When The Bottom Falls Out Mind Map ™

By David Solie

Here is the When The Bottom Falls Out Mind Map ™ that I created for a family where the aging parents told their adult children they were going to wait until they “needed to plan” The goal was to provide the adult children with a way to visually ...read full article


Listen to David's most recent Aging with Grace radio podcast

Have you ever felt powerless to help someone during a medical emergency?

"Fear is palpable...make no mistake, I saw it on the faces... heard it in the voices, as I approached my daughters school. Can someone help?...help!... we need some help! A crowd had gathered...does anyone know anything about this woman? someone asked. Look in her purse...a quick search from a bystander revealed nothing. There, just outside the middle school entrance, lay an elderly woman, unconscious, experiencing a medical emergency, and all of us just stood there...helpless."

Have you ever felt powerless to help someone during a medical emergency? To provide even the slightest bit of information that might make a difference in a victims outcome or possibly save a life. Well you're not alone. Most of us who've ever witnessed a medical emergency up close rarely forget it.

Its a shock to our system - its grounds us...makes us realize our vulnerability and cherish the ones closest to us. Medical emergencies happen every day, without warning. Whether we want to accept it or not, the possibility of an unexpected medical event hangs over all of us, our loved ones, our friends.

But for older adults the possibility of a medical emergency dramatically increases. Age brings with it many things, knowledge, maturity and wisdom, but it also brings chronic disease, deteriorating cognitive skills and reduced physical strength. A broken hip, annoying to a youthful generation can have life threatening consequences for an older adult.

That's why its vitally important that all of us - particularly older adults, create and carry some form of medical ID. Medical Information cards are inexpensive and easy to fill out and they keep our unique medical history relevant and available to emergency medical personnel when we need it most.

"Critical decisions about your health are made in the first few minutes of your emergency care," says James Kelley an ER physician and Co-Founder of miCARD, a medical information solution that combines a wallet card and online PHR, "If you are unconscious or incapacitated, emergency personnel have no knowledge of existing medical conditions, critical medications or other important details which could improve your care or possibly save your life."