You're never too old to quit

Perhaps you’ve heard of the “damage is done” scenario. An elderly family member started smoking as a young person, maybe a teenager, tucking a pack of cigarettes into his rolled-up shirtsleeve or into her purse. Decades later, despite wall-to-wall anti-smoking ads, despite smoking being outlawed in nearly every public space, perhaps despite family pleas or doctors’ admonitions or even a heart attack, that person remains a smoker.

What’s the point of stopping now, he or she figures, when my body has already suffered the consequences of a lifetime of tobacco addiction? The damage is done, isn’t it?

So while the rate of smoking in those over age 65 is smaller — a bit over 8 percent — than it is in the younger population, more than 22 percent of whom smoke, older smokers are much less likely to try to stop. More than half of smokers ages 18 to 24 have tried to quit, the Centers for Disease Control and Prevention has reported, but only about a quarter of those over age 65 have. In the three decades following the first report by the surgeon general’s report on smoking and health in 1964, smoking rates dropped much more among younger adults than among older ones.

“They’ve been smoking longer, so they might be more nicotine-dependent,” said Bethea Kleykamp, a postdoctoral fellow in nicotine pharmacology at the National Institutes of Health, trying to explain those differences.

But in their article, “The Older Smoker,” recently published in The Journal of the American Medical Association, Dr. Kleykamp and Stephen Heishman, a nicotine researcher at the National Institute on Drug Abuse, argue that the damage isn’t done.

The good news for older smokers is that under the Affordable Care Act, Medicare now covers smoking-cessation counseling for any beneficiary who wants to stop. A quarter of older smokers have already made an attempt. (Previously, Medicare covered such programs only for those who already had a smoking-related disease.)

And Part D drug plans cover medications — patches, gum, pills — in most states. “We know that the best treatment is a combination of pharmacology and counseling,” Dr. Kleykamp said. You’d think that reducing smoking among the elderly population would save Medicare a boatload of money.

And the winner is...Sami Peterson, Caregiver of the Year

National Family Caregivers Association, announced Sami Peterson, 50, of Fort Collins, Colo., as the grand prize winner of the third annual National Family Caregiver of the Year award. As the winner, Peterson received $10,000 from Homewatch CareGivers, eight hours of respite care, and a scholarship to Homewatch CareGivers University, which offers courses geared to help caregivers increase their knowledge and skill sets.

Sami Peterson represents the spirit of this award, said Leann Reynolds, President of Homewatch CareGivers. The magnitude of care Sami provides for her son and her father is astounding. The fact that she can provide this level of care while holding down a career is an inspiration and a top reason why our judges voted Sami the National Family Caregiver of the Year.

The National Family Caregiver of the Year award was created by Homewatch CareGivers in 2009 to create awareness around the issues faced by family caregivers, and to nationally recognize one caregiver from the community each year whose story is judged the most compelling by a 10-member industry panel.

Caring for Will and Rob has provided me with many of life-enriching opportunities. It has touched those around me. While it is not always easy, it has truly enriched my life, says Peterson. I want to thank my sister, Lana, for her love and support – and for nominating me for this award. I owe this award to all the people who have been there for me along the way to help me not only survive, but to thrive. I am so very grateful to the National Family Caregivers Association and Homewatch CareGivers for this award and for all the work they do in helping family caregivers.

Peterson provides in-home care for her husband, Rob, 66, who has Huntington’s disease, as well as her developmentally disabled son, Will, who is 17. She also works full time and is active in the weekly Huntington’s Disease Support Group of Northern Colorado.

Reviewing Sami’s story was heartbreaking on the one hand and inspiring on the other, said Susan Lutz, Senior Project Manager, Health and Family Team for AARP. All of the finalists for the award faced intense caregiving situations, which made the final selection difficult, but Sami’s situation was perhaps the most intense. How she manages her husband’s Huntington’s disease while at the same time raising a developmentally challenged teenager is beyond most people’s threshold. She is a deserving winner.

Sami Peterson says that her quest to help her husband and son live better lives has been a challenge especially with regards to the relatively unknown Huntington’s disease. Huntington’s disease is a genetic disorder that affects muscle coordination and ultimately leads to cognitive decline and dementia. Rob Peterson, whose mother also had Huntington’s, is currently experiencing the full range of Huntington’s symptoms, including dementia. Sami Peterson is determined to find medical answers.

Sami is amazing, says sister Becci McCormack. She has had to fight the system of education, healthcare, insurance and employment to provide an affordable and viable situation for her family. And in doing so, she has tapped into resources others didn’t even know existed.

Best US Cities for Oldsters

Minneapolis is the best city in the United States for senior living, with Boston, Pittsburgh, Cleveland and Denver rounding out the top five, according to a new survey conducted for the Bankers Life and Casualty Company Center For a Secure RetirementSM.

Criteria in the areas of senior issues and gerontology identified the qualities for optimal senior living. Major categories were: healthcare, economy, health and longevity, social, environment, spiritual life, housing, transportation and crime. Each category was statistically weighted to reflect the needs of the senior population.

“Most surprising is that the survey results contain many cities we don’t often associate with senior living,” said Scott Perry, president of Bankers Life and Casualty Company, the national life and health insurer. “We weren’t interested in another study on where to enjoy your retirement, but instead wanted to find cities that did the best job in providing the services and support that seniors need. The top ranked cities aren’t what come to mind when you think about where to spend your golden years, but they scored high in the criteria most important to the 65 and up bracket.”

The Categories

The Healthcare category includes physicians per capita, gerontologist to senior ratio, hospitals per capita, hospitals with special care, nursing homes per capita, nursing home beds per capita, continuing care retirement communities per capita and average nursing home rating.

Economy includes consumer price index, sales tax rate, the unemployment rate and the stability index.

Health and Longevity includes life expectancy, age 85 expectancy, depression rate, heart mortality and cancer mortality.

Social includes percentage of seniors, social and emotional support, satisfaction with life rating, art and museums, education level, recreation, four-year colleges and libraries.

Environment includes number of sunny days, clean air levels, clean water measurement, natural disaster risk index, ocean coastline miles, river and lake square mileage, and local/state park number and size.

Spiritual Life includes percent of population belonging to organized religions and the number of religious congregations.

Housing includes cost of living index, housing price, property taxes and apartment rentals.

Transportation includes public transportation, special access and mass transit percentage.

Crime includes violent crime rate and property crime rate.

Methodology

The Bankers Life and Casualty Company Center for a Secure Retirement Best Cities for Seniors 2011 was conducted in July of 2011 by the independent survey administrator Sperling’s Best Places and identified the top 50 metro areas in the U.S. The complete report may be viewed at www.CenterForASecureRetirement.com.

Finally, a raise in social security.

Social Security retirement benefits for nearly 55 million people will rise 3.6% in 2012, the first cost of living increase since 2009 said the U.S. Social Security Administration on Wednesday.

Some other changes that take effect in January of each year are based on the increase in average wages. Based on that increase, the maximum amount of earnings subject to the Social Security tax (taxable maximum) will increase to $110,100 from $106,800. Of the estimated 161 million workers who will pay Social Security taxes in 2012, about 10 million will pay higher taxes as a result of the increase in the taxable maximum.

“Over the past two years, costs for food, utilities and health care have continued to increase while Social Security benefits have not,” said Nancy LeaMond, AARP Executive Vice President. “This first increase in three years will provide much-needed relief to millions, and underscores the importance of Social Security as the only guaranteed, lifelong, and inflation-adjusted source of retirement income for most Americans.”

Monthly Social Security payments average $1,082, or about $13,000 a year. A 3.5 percent increase would amount to an additional $38 a month, or about $455 a year.

Most retirees rely on Social Security for a majority of their income, according to the Social Security Administration. Many rely on it for more than 90 percent of their income.

Even a mild stroke can cause serious side effects

Even mild strokes can result in serious but unrecognized disabilities, such as depression, vision problems and difficulty thinking, according to a new study.

The findings, released Monday at the Canadian Stroke Congress in Ottawa, suggest new guidelines are needed on the treatment and management of mild strokes, the researchers said.
"There is no such thing as a mild stroke," said study co-author Annie Rochette, of the University of Montreal, in a news release from the Heart and Stroke Foundation of Canada. "These patients face huge challenges in their daily lives."

After interviewing 200 stroke victims within six weeks of having their first stroke, the researchers found a high rate of sleeplessness and depression among the participants. Nearly 25 percent were clinically depressed. The stroke patients also reported a significant drop in their perceived quality of life, the study revealed.

The researchers said treatment for symptoms of depression, such as fatigue, loss of appetite, lack of concentration, disturbed sleep and thoughts of suicide, should be an important part of recovery for mild stroke patients.

The participants' average age was 62 years -- younger than the typical age for a severe stroke, which is over 65. About 40 percent still worked before they had their stroke and they were worried about returning to their jobs.

Other mild stroke patients interviewed were concerned about caring for their families and being able to drive. Many feared another stroke and felt uncertainty about the future, the researchers found.
"People who have had a mild stroke are five times more likely to have a stroke over the next two years than the general population," Dr. Michael Hill, Heart and Stroke Foundation spokesperson, said in the news release. "Proper treatment and management of risk factors can help prevent another stroke."

Despite these worries, few of the mild stroke victims were screened for problems with their vision or mental abilities, which are often less obvious than problems with movement. The authors noted that nearly 25 percent of mild stroke patients are only treated in an emergency room and not seen by occupational therapists, neuropsychologists or speech therapists.
"Patients are told to see their family doctor, but given no other tools or rehabilitation," added Rochette. "When they go to drive again, some people are too afraid to get behind the wheel."

New treatment guidelines, including more accessible rehabilitation services, would help more people get needed care, the researchers concluded.

More information
The U.S. National Institute of Neurological Disorders and Stroke provides more information on stroke rehabilitation.

Decisions, decisions, it's that time of year again....

Navigating the Medicare maze is confusing enough, but the added pressure of the looming open enrollment deadline can be overwhelming. The following are 10 things you should know for enrolling in Medicare this year.

1. Open enrollment runs from October 15 to Dec 7, 2011

This window is the time that seniors can sign up for Medicare Advantage (Part C) or Medicare Prescription Drug Coverage (Part D) or they can make changes to an existing plan, move to a new one, change drug coverage benefits or dis-enroll.

2. There are two ways to get Original Medicare (Part A and Part B)

Choose Original Medicare on its own, with the option to add Medicare Part D prescription drug coverage. If you collect benefits from Social Security or the Railroad Retirement Board (RRB), you will automatically get Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance). There is a premium for Part B. If you don't want to keep Part B, you must follow the directions when you get your Medicare card, indicating you don't want it. Otherwise, you will be charged.

Or choose a Medicare Advantage (Medicare Part C) plan that bundles Original Medicare with extra benefits and may include prescription drug coverage in one plan. Medicare Advantage Plan is like an HMO or PPO. You may have to go to doctors within their service network or pay higher co-pays for going out of network.

3. Your share of the Medicare costs may be larger than you expect

Medicare, the traditional benefit provided by the government, doesn't cover all medical expenses. For example, approximately of 20% of physician fees are paid by the Medicare beneficiary. Seniors often find themselves paying out-of-pocket for many of their healthcare expenses.

4. Medicare Advantage Plans pick up where Medicare leaves off

A Medicare Advantage Plan (like an HMO or PPO) is another Medicare health plan choice you may have as part of Medicare. Medicare Advantage Plans, sometimes called "Part C" or "MA Plans," are offered by private companies approved by Medicare. This insurance provides your Part A, Part B and oftentimes, Part D coverage. You use a Medicare Advantage card for health care.

Medicare pays a fixed amount for your care every month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare. However, each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how you get services (like whether you need a referral to see a specialist or if you have to go to only doctors, facilities, or suppliers that belong to the plan for non‑emergency or non-urgent care). These rules can change each year.

5. Timing matters

Timing matters when you're joining Medicare. When you turn 65 or otherwise become eligible for Original Medicare (Parts A and B), enrollment windows open. But some of these windows will close quickly. If you wait until later to sign up, you may have fewer choices, and you may pay more. During Open Enrollment Period, you can:
•Change from Original Medicare to a Medicare Advantage Plan.
•Change from a Medicare Advantage Plan back to Original Medicare.
•Switch from one Medicare Advantage Plan to another Medicare Advantage Plan.
•Switch from a Medicare Advantage Plan that doesn't offer drug coverage to a Medicare Advantage Plan that offers drug coverage.
•Switch from a Medicare Advantage Plan that offers drug coverage to a Medicare Advantage Plan that doesn't offer drug coverage.
•Join a Medicare Prescription Drug Plan.
•Switch from one Medicare Prescription Drug Plan to another.
•Drop your Medicare prescription drug coverage completely.

6. Know what you're paying

When you're deciding whether or not to add, change or drop plans, pay attention to what you're paying. Look at your total out-of-pocket healthcare expenses from last year. It's not just the premium, but check to see what may have changed with the deductible, co-pays, prescription drug costs.

7. Doing nothing is an option

If you don't make any changes during Medicare Open Enrollment, your existing plans will rollover at the end of the enrollment period with no changes and your existing coverage will remain in effect throughout 2012.

8. If you miss the deadline, there may still be hope

If you missed the deadline, you may have to wait until next year before you make changes, or you will pay penalties and higher premiums.

However, there is a second enrollment period from January 1 to February 14. During this time, you can:
•If you're in a Medicare Advantage Plan, you can leave your plan and switch to Original Medicare.
•If you switch to Original Medicare during this period, you will have until February 14 to also join a Medicare Prescription Drug Plan to add drug coverage. Your coverage will begin the first day of the month after the plan gets your enrollment form.

9. Sometimes it's not so easy to "just switch back"

An insurance agent might say that "if you don't like the Medicare Advantage plan, you can just switch back." But it's not that easy. You can get stuck in a plan. You can only drop Medicare Advantage during certain time periods. In recent years, a new "disenrollment period" for Medicare Advantage plans is offered. From January 1 through February 14, a senior can disenroll if they are unhappy with the Medicare Advantage Plan they purchased. They can go back to regular Medicare coverage and, if they wish, pick up a prescription drug plan. (But beware: Medigap is different. Once you give up a Medigap plan, you might not be able to get it back.)

10. Get help if you need it

Don't go it alone. If you don't understand something, ask for help. For information on Medicare and/or personal assistance with signing up for Medicare Advantage Plans (Part C) or Medicare prescription drug coverage (Part D), including instructions on how to join, contact Medicare Marketplace or SGIA Retiree Support Center.

Cuts in Medicare and Medicaid major concern for nursing homes

The following is an article written by Alyssa Gerace for Senior Housing News.

In the past 10-plus years, there has been a trend away from nursing homes and to other, more home-like forms of long-term care for American seniors. Most say the shift is due to nursing homes’ high costs, but also some of the traditional qualities that nursing homes have represented over the years and the rise of alternative options.

Between 1998 and 2008, the number of Americans living in nursing homes shrank 6.1% to slightly more than 1.2 million, says a Brown University study published in the July 2011 edition of Health Affairs. During this same time frame, there was 18.1% increase in the number of Americans aged 65-69, and 8.7% rise in those aged 70 and older, according to U.S. Census Bureau estimations. MetLife estimates that today’s nursing home care costs upwards of $83,000 per year for a private room, on average.

Jodie Spiegel, a lawyer for consumer advocacy organization Bet Tzedek, says in her experience from speaking with clients, the nursing home population is decreasing because there are so many other options available, like assisted living, which has experienced rapid growth. There are more than one million people living in assisted living facilities, according to the Assisted Living Federation of America, even though it’s a relatively new concept that was developed about 25 years ago.

“Previously, when someone required care outside of their home, their only choices were hospitals or nursing homes,” says Spiegel. “Now, there’s assisted living, continuing care, adult day healthcare, senior centers, receiving care at home—there are more choices, and choices are more home-like, which in general is more appealing to people.”

Something else that may be keeping seniors out of nursing homes is the multitude of stigmatized issues attached to those establishments. As a consumer advocate, Spiegel encounters many recurring complaints regarding nursing homes, many of which she says are due to staffing shortages.

“Nursing homes are businesses and they’re trying to make a profit,” says Spiegel. “In a perfect world, nursing homes would be hiring more staff to provide better care, but unless they’re required to do so, they’re unlikely to do so.”

Missouri-based Cheryl Parsons, who’s a registered nurse and a licensed nursing home administrator and consultant, admits staffing can be a major issue for some facilities.

“The problem is, the acuity level has gotten a lot higher in the long term care setting,” says Parson, referring to the level of severity of a resident’s illness. “Hospitals just are not keeping patients, so we’re seeing higher acuity levels,” which translates to higher levels of care and attention being needed. “Couple that with reimbursement issues, owners are having a hard time keeping the bills met, and the staff paid, in order to keep that staffing where it needs to be,” she says. “It is a concern, it’s a big issue.”

Now that nursing homes are facing an 11.1% cut to Medicare payments, the challenges abound. Although both Medicaid and Medicare programs apply to nursing home residents, reimbursement rates from the government-funded programs aren’t as high as what a nursing home could receive from a private pay resident, says Spiegel.

Since many nursing homes have a high population of Medicare- and Medicaid-eligible residents, these facilities could be especially affected by funding cuts, since it will affect their ability to subsidize lower Medicaid reimbursements with Medicare funds.

“You need to pay the bills to keep the doors open and let patients in,” Parsons says. “It weighs heavily on those of us who are committed to the industry and to our residents. Most facilities work very hard and diligently to do so, but it’s always a challenge because of the reimbursement issue.”

Greg Crist, the Head of Affairs for (AHCA) says the important thing to remember is that nursing homes want residents to be in the least-restrictive setting. They’re not trying to pull in large numbers of residents to give them lesser-quality care for a profit, if those residents are better off living at home or at an assisted living facility.

“There will always be a need for long term care,” he says.”We just want to make sure there’s a cost-effective, and least-restrictive method as well. We only want them in our facilities if that makes the most sense.”

The Challenge of Mental Illness in the Elderly

Mental illness presents stresses and challenges at any age or stage of life, but seniors who must deal with issues of aging in addition to a long standing or newly diagnosed mental illness often face overwhelming issues. In addition, most elderly people who have long term mental illness never sought medical attention and treatment for their conditions due to societal attitudes towards mental illness years ago. And those with acquired mental illness remain reluctant to seek psychiatric care, again due to old stigmas about mental illness.

Seniors with age-acquired mental illness

It is not unusual for people to acquire certain mental illnesses after age 65. Depression, for example, is quite common in older persons due in part to the inevitable losses which occur with aging. Also, changes in brain chemistry can cause profound depression in older adults. Several physical problems, including transient ischemic attacks (TIAs), strokes, Alzheimer’s disease and related dementias often cause paranoid thoughts, delusions, hallucinations and aggressive actions. These acquired mental illnesses are often very frightening to the individual and to his or her family members. While symptoms of depression may be – unfortunately – very subtle, the delusional and paranoid behaviors are very distressing to families who previously enjoyed positive relationships with the senior. The senior may accuse his children of trying to take his money, his wife of having an affair, the government of beaming messages to him via the TV, and other such misperceptions. The result of the senior’s delusions is usually increased isolation from those trying to provide care and assistance.

Mental health treatment options for seniors

Effective treatment is available for mental illness of seniors. The first step to obtaining quality mental health care is to have a thorough history and physical exam by a qualified internal medicine physician or geriatrician. The purpose of this exam is to identify any physical problems which need treatment or which may be causing symptoms of mental illness. Help in arranging for treatment of any physical problems may be needed if the senior is unable or unwilling to make necessary arrangements.