Welcome ...

All too many times overwhelmed caregivers are physically and emotionally depleted and need to take time to rest and care for themselves. Believing in a holistic approach to caregiver stress and a strong commitment to helping our members find the right solutions, we created this blog to help you connect with others who, like you, may be facing the same eldercare issues and challenges. Feel free to comment, ask questions, and submit articles. Please forward the blog link to your family and friends. They'll be glad you did.

Warm regards,

Patricia Grace
founder & CEO
Aging with Grace

Wednesday, March 30, 2011

Study finds caring for an elderly parent not evenly distributed

Research conducted by the Home Instead Senior Care network found that 46% of family caregivers say their relationships with siblings have deteriorated from an unwillingness to provide help. Making decisions together, dividing the workload and teamwork are the three key factors to overcoming family conflict, according to the organization’s research.

“Senior caregiving can either bring families together or cause brother and sister conflict,” said Ingrid Connidis, Ph.D., from the University of Western Ontario. “In some cases it can do both. These issues can be very emotional.”

Family feuds often revolve around the following areas:

* Roles and rivalries dating back to childhood — Mature adults often find that they’re back in the sandbox when their family gets together. This tendency can grow even more pronounced under the strain of caregiving.
* Disagreements over an elder’s condition and capabilities — It’s common for family members to have very different ideas about what’s wrong with a loved one and what should be done about it. Take, for example, seniors and driving. You may be convinced that your family member is no longer capable of driving, while your brothers argue that he needs to maintain his independence. Your sister may not agree on the care that you and your mother have decided upon and be unwilling to assist as a result.
* Disagreements over financial matters, estate planning, family inheritance and other practical issues — How to pay for a family member’s care is often a huge cause of tension. Financial concerns can influence decisions about where the person should live, whether or not a particular medical intervention is needed, and whether he can afford a housekeeper. When aging parents need help with finances it can cause new conflicts – often fueled by ongoing resentment over income disparities and perceived inequities in the distribution of the family estate.
* Burden of care — Experts say the most common source of discord among family members occurs when the burden of caring for an elder isn’t distributed equally. “Usually one of the adult children in the family takes on most of the caregiving tasks,” says Donna Schempp, program director at the Family Caregivers Alliance. Research conducted for the Home Instead Senior Care reveals that in 43 percent of U.S. families, one sibling has the responsibility of providing most or all of the care for Mom or Dad.

Engaging parents in caregiving issues is important, Dr. Connidis said, and so are family meetings that involve a third party if necessary. A third-party resource, particularly a professional such as a doctor or or elder mediator, can provide an impartial voice of reason. “Talking before a crisis is best,” she said. “Talk to one another about perceptions of what happens if seniors need help, how available you would be, and the options that you and your family would consider.”

Monday, March 28, 2011

Workplace benefits are needed to meet family obligations to help aging family members.

The collision of the economy, the health care crisis, and a growing number of aging Americans has put many families in or near financial crisis according to a new report from Volunteers of America.

“Plurality of caregivers say the economy has made it more difficult to provide care to a family member,” said the report. ”Few—roughly one in 10—are paid for the care they provide.”

More than 46 percent report that the economy has made it harder to be able to provide care. Three quarters of caregivers state that the person to whom they provide care is 70 years or older.

“We have a potential catastrophe looming with the collision of a significant, and growing, aging population, the economic downturn, and the health care crisis,” said Rosemarie Rae, executive vice president with Volunteers of America.

The number of older Americans in the 65 or older age bracket is expected to reach more than 71.5 million people by 2030 says the report. This will be the largest senior population in U.S. history and almost double the approximately 37 million seniors today. “This is a large, emerging crisis in America,” Rae said.

“Medicare already pays out more in benefits than it brings in and will be insolvent by 2017,” Rae continued. “Social Security will pay out more than it collects beginning in 2016 and the system as a whole will be insolvent by 2037.” Medicaid statistics are equally alarming. In order to qualify, most people must bankrupt themselves before they can receive long-term care coverage.

“We are hopeful that healthcare reform will begin to shape this discussion and mitigate the negative impacts of the current system,” Rae said.

The study also found that an overwhelming majority—97 percent of women and 94 percent of men—believe that the elderly should be allowed to age at home, if they want to.

A majority of those interviewed reported that they were unable to make financial, career or family sacrifices in order to care for an older family member. More than 65 percent stated that they would be unable to take time off of work to care for an elderly loved one, and 86 percent of women interviewed and 81 percent of men agreed that better workplace policies are needed to meet family obligations to help aging family members.

View a copy of the report here.

Friday, March 25, 2011

Wednesday, March 23, 2011

Eliminating the confusion that surrounds end of life choices

Advance directives, which allow people to plan ahead for end-of-life care, can be too vague to cover many medical situations. Now, a growing number of states are promoting another program to help guide physicians with a patient's specific instructions.

The programs are known as Physician Orders for Life-Sustaining Treatment, or Polst. They are meant to complement advance directives, sometimes known as living wills, in which people state in broad terms how much medical intervention they will want when their condition no longer allows them to communicate. A Polst, which is signed by both the patient and the doctor, spells out such choices as whether a patient wants to be on a mechanical breathing machine or feeding tube and receive antibiotics.

Polst programs are currently in use in 14 states and regions, including California, Oregon and New York. Three states, Colorado, Idaho and Pennsylvania, adopted Polst programs recently, and another 16 states and six regions are developing programs. Besides providing documents that meet local regulations, the programs train health-care providers to discuss end-of-life treatment choices with patients with terminal illness or anyone wishing to define their care preferences.

Read full article

Tuesday, March 22, 2011

How will the growing issue of inflation affect older Americans

Prices are going up and Americans are already feeling the effects of higher food, property taxes and energy prices that are having a direct impact on their pocketbooks and the psyche. These rising costs and the fixed incomes of retirees are on collision course given the current trajectory of price increases.

Not only are are the costs of living rising rapidly but housing options are becoming increasingly more expensive for seniors through higher rents, higher property taxes and increased utility costs. Whether independent living at home or at a senior living facility, cost increases will threaten decisions as the effects of inflation compound on pricing increases. Besides inflationary pressures, the lack of supply and increasing demand will exacerbate cost increases creating challenges for retirement planning.

How will inflation show up in senior housing? Assuming a 10% growth in property taxes, home maintenance, heating and air conditioning, food, gas and other household expenses every five years, assets will be depleted faster or retirees will need to find a way to supplement their incomes, most likely through part-time work. Notice how the list does not address healthcare expenses?

Part-time employment for retirees will increase and will become competition for traditional demographics of part-time workers. Cost of Living Adjustments (COLA) cannot keep up with inflation in any scenario given the fiscal issues associated with the federal and state budget problems and investment returns cannot keep pace with inflationary trends.

The solution? It will be time to go back to work but are employers ready for a rise in part-time, senior workers coming back into the job market?

Monday, March 21, 2011

Alzheimer's takes increasing toll on healthcare system

Alzheimer's disease will take an increasing toll on the healthcare industry and entitlement programs, report USA Today and Reuters. Altogether, $183 billion is expected to be spent on professional caregivers in 2011, up from $172 billion a year ago, according to a new report by the Alzheimer's Foundation.
Those ever-increasing expenditures will take a huge toll on Medicare and Medicaid. By 2050 it is expected that Alzheimer's and dementia-related costs for Medicare will increase six-fold and for Medicaid, four-fold. Elderly individuals with Alzheimer's are about three times more costly to care for than other patients because they often require long and repeated hospitalizations.
Meanwhile, nearly 15 million Americans are caring for someone with Alzheimer's or age-related dementia--up more than 37 percent from a year ago. Those family caregivers provide 17 billion hours of uncompensated care, for a total of $202.6 billion.
"Stress is extremely high, and one-third (of caregivers) are experiencing depression," said Beth Kallmyer, the Alzheimer's Foundation's senior director of constituent services.

Sunday, March 13, 2011

Safety tips needed for planning foreign travel

The retirement years can be an exciting time to see the world, and travel is easier and safer than ever before for older Americans. With a little planning and some caution, seniors can safely visit almost any destination. But the Centers for Disease Control and Prevention urge older travelers to follow the simple tips below to ensure safe travel.

All travelers, including the elderly, should see a doctor for a pre-travel visit, ideally 4-6 weeks before planned trip, although even a last-minute visit can be helpful.

The doctor should be told about illnesses the traveler has and medicines he or she is taking, since this will influence medical decisions. In addition to providing vaccines, medicine, and advice for keeping healthy, a doctor can conduct a physical exam to assess a senior's fitness for travel.

Seniors should consider their physical limitations when planning a trip. Seniors with heart disease, for example, might choose an itinerary that does not involve strenuous activities. Seniors may also have a hard time recovering from jet lag and motion sickness, so they should take these factors into account when planning a trip.

Before travel, seniors should have information about their destination that could affect their health, such as the altitude and climate. They should be aware of whether the destination is prone to natural disasters, such as earthquakes and hurricanes, since seniors may have more problems in those extreme situations.

Vaccines - Before travel, seniors should be up-to-date on routine vaccines, such as measles/mumps/rubella and seasonal flu. Some of these may be considered "childhood" vaccines, but their protective effect decreases over time, and the diseases they protect against are often more common in other countries than in the United States. More than half of tetanus cases are in people over 65, so seniors should consider getting a tetanus booster before they travel.

Seniors should also receive other vaccines recommended for the countries they are visiting. These may include vaccines for hepatitis, typhoid, polio, or yellow fever. Recommended vaccines are listed by country on CDC's destination pages.

Use of some vaccines may be restricted on the basis of age or chronic illnesses. Yellow fever vaccine, for example, should be given cautiously to people older than 60 years, and it should not be given at all to people with certain immune-suppressing conditions. Seniors should discuss their detailed travel plans with their doctors and, if necessary, alternatives to vaccination.

Medication - A doctor may prescribe medicine for malaria, altitude illness, or travelers' diarrhea; seniors should make sure the doctor knows any other medications they take, to watch out for possible drug interactions. Travelers' diarrhea is common and may be more serious in seniors, so seniors should also follow food and water precautions.

In addition to medicine prescribed specifically for travel, seniors are likely to take other medicines regularly, such as medicines for high blood pressure, diabetes, or arthritis. They should plan to pack enough medicine for the duration of the trip, plus a few days' extra in case of travel delays. Counterfeit drugs may be common overseas, so seniors should take only medicine they bring from the United States.

Prescription medicine should always be carried in its original container, along with a copy of the prescription, and all medicine should be packed in carry-on luggage, in case checked luggage gets lost.

Injury Prevention
- Although exotic infections make the headlines, injury is the most common cause of preventable death among travelers. Seniors can minimize their risk of serious injury by following these guidelines:

Always wear a seat belt.
Don't ride in cars after dark in developing countries.
Avoid small, local planes.
Don't travel at night in questionable areas.

In addition, seniors should consider purchasing supplemental travel health insurance in case of injury or illness overseas. Many health plans, including Medicare, will not pay for services received outside the United States. Seniors who are planning travel to remote areas should consider purchasing evacuation insurance, which will pay for emergency transportation to a qualified hospital.

For more information on healthy travel, visit www.cdc.gov/travel.

Friday, March 11, 2011

Credit Card Debt That Outlives Mom

Following a recent post on the rising levels of credit card debt among the elderly, several readers raised an important question: What happens when borrowers die? Do they take their credit card balances to the grave, or are those left behind responsible for the debt?

Tom from Vancouver Island, British Columbia, offered an answer: “Excess debt over the value of the estate is considered insolvent and cannot be passed on to heirs.” He’s right, it turns out.

Experts say that unlike a mortgage or a car loan, credit card debt is unsecured, meaning that it isn’t tethered to an asset. When someone dies, credit card companies have to wait near the back of the line to receive payment. If what’s left over after settling the estate isn’t enough to pay the bill, credit card debt is written off. Read more...

Thursday, March 10, 2011

Americans Ready to Talk About End of Life Care

A new report indicates that American’s are ready for more discussions about palliative and end of life care. The study, released at yesterday’s summit held by National Journal LIVE entitled “Living Well at the End of Life: A National Conversation,” surveyed hundreds of adults on issues relating to palliative care.

According to the report, 96% of Americans surveyed thought that making palliative care a priority for the health care system was important. This percentage was even greater for those participants who had personal experience with palliative care. About 81% of respondents also believed that palliative and end of life care should be covered by Medicare. The survey demonstrated that opinions about end of life care were not shaped by political persuasion, but instead by whether participants had previous experience with end of life care.

A panel of experts in the field of health and public policy voiced their pleasure with the study’s results. “It is important to honor a patient’s wishes when it comes to care. It is impossible to do that if we don’t know their wishes,” reasons Dr. Allen Lichter, Chief Executive Officer of the American Society for Clinical Oncology. Representative Earl Blumenauer (D-OR) personally agreed with the results, “I am not planning on passing away in the next 6 months, but this is a vital conversation for me to have with my family.”cans Ready to Talk About End of Life Care

Tuesday, March 08, 2011

Family Care Arrangements to Pay the Cost of Home Care Services

Approximately 70% of all people receiving long term care in this country are in their homes.  This care is provided primarily by family members who are not paid for their services.  In many cases, family members are more than happy to provide unpaid care because that is what families do.  On the other hand, some family members go to great sacrifice to provide care for their loved ones.  In some cases they have to give up employment, move to a new location, give up spending time with a spouse or children and possibly isolate themselves from any normal pursuits other than caregiving.  In these cases, it would seem reasonable that children or other close members of the family should be reimbursed for their sacrifice.

Fortunately, for those veterans who served during a period of war, the Department of Veterans Affairs will provide funds to all those who qualify to help cover the cost of paying family members to provide care for their loved ones.

The veterans program is called Pension and it is commonly referred to as the "veterans aid and attendance benefit."  Pension can pay up to $1,949 a month in additional income to a veteran household to cover the cost of paying a child or a friend for providing care in the home.  A spouse providing this care would not qualify.

If the disabled veteran or the single surviving spouse of a veteran has been rated "housebound" or in need of "aid and attendance" by the VA, all fees paid to an in-home attendant -- this includes members of the family as well as friends or hired caregivers -- will be allowed as a deduction for determining Pension as long as the attendant provides some medical or nursing services for the disabled person.  The attendant does not have to be a licensed health professional.

A family member may be considered an in-home attendant, but that family member has to be paid for services rendered.  There is potential for fraud here where a family member may move into the home and ostensibly receive payment as a caregiver but not actually provide the level of care paid for.
Documentation for this care must be provided to the VA, and it is reasonable for the VA to question whether the services being purchased from someone living in the household are legitimate.
Because of this, the evidence for an arms-length, legally functioning care arrangement must be irrefutable.

It is important to note that claimants are responsible to ensure that any caregivers, including family, are compensated in accordance with federal and state guidelines, and that any appropriate taxes, social security and unemployment fees be paid by both the caregiver and the claimant. Claimants should contract with a payroll service to ensure compliance with necessary regulations.

In the case of VA Non-Service Connected Disability Pension for Housebound or Aid & Attendance, certain critical forms and documents must be submitted with the initial application in order to avoid delays in the claims process or even a denial.  It is almost impossible for a family member who wants to receive the Pension benefit to comply with all of the documentation requirements without knowledge of how the actual process of application works. 

Aging with Grace is available to provide pre-filing consultation* for families that wish to pursue establishing Family Care Arrangements.  In addition to sample documentation, AWG has secured discounted payroll and support services for its clients through HireFamily LLC (www.HireFamily.com), which enables claimants to pay caregiver(s) in accordance with all federal and state guidelines.  Assistance with preparing claim paperwork for VA Benefits is provided at no additional cost. **

To learn more, visit www.agingwithgrace.net




*AWG is not a substitute for legal counsel, tax advice or financial planning and a personal service contract created for paid family caregiving purposes should be reviewed by an attorney.

**AWG Veteran Services is a private practitioner and not connected with the Department of Veterans Affairs. This service is provided by a VA accredited Claims Agent. We comply with federal statutes and regulations governing the preparation, presentation and prosecution of any claim for veterans’ benefits with the U.S. Department of Veterans Affairs. Our Long Term Care Planning Consultation fee is for pre-filing services only. Membership in the Aging with Grace Program is not required. No additional fees are charged for assistance with preparing or filing a claim for VA benefits.

Monday, March 07, 2011

Actor Mickey Rooney tells Congress of abuse

"If elder abuse happened to me, Mickey Rooney, it can happen to anyone," the 90-year-old actor said in testimony to the Senate Special Committee on Aging.

In court documents, Rooney accused his stepson Christopher Aber of intimidating and bullying him and blocking access to his mail. The documents also alleged Aber deprived Rooney of medications and food.

"My money was taken and misused. When I asked for information, I was told that I couldn't have any of my own information," Rooney told the committee. "I was literally left powerless."

Rooney rose to fame as a child star in the 1930s and 1940s when he made more than a dozen Andy Hardy movies. He appeared frequently alongside Judy Garland and, in his heyday, was one of Hollywood's biggest stars, receiving a junior Oscar in 1938.

Rooney continued to work in movies and television into his late 80s, appearing in the 2006 film comedy "Night at the Museum," among other works.

Rooney told the Senate committee he suffered in silence for years because "I couldn't muster the courage to seek the help I knew I needed."

He urged elderly victims to speak out whenever they could.

"Please, for yourself, end the cycle of abuse and do not allow yourself to be silenced any longer," he said.

Rooney eventually won a court order handing control of his affairs over to a Los Angeles attorney and obtained a restraining order against his stepson, who was ordered by the court to stay at least 100 yards from Rooney and his home.

In testimony to the Senate panel, Rooney suggested Congress enact legislation strengthening the law enforcement response to allegations of elder abuse.

A study by the Government Accountability Office released at the hearing estimated 14 percent of elderly Americans experienced some form of abuse in 2009.

The abuse can range from financial exploitation to physical harm and neglect.

The actual level of elder abuse may be far worse than estimated because many seniors become socially isolated or feel shame about their situation, Dr. Mark Lachs, who heads an elder abuse center in New York, said in testimony to the committee.

Thursday, March 03, 2011

For Women, Age Often Brings Isolation


By Karen Stabiner, New York Times

Most elderly women today never worked outside the home, while most of their daughters did or still do. Members of these two generations approach the question of how to spend their days with very different skill sets.

An elderly woman may have successfully navigated life as a mother, wife and guardian of home and hearth. But liberation from those daily responsibilities later in life can be disorienting, said Deborah Tannen, professor of linguistics at Georgetown University.

To many women who have lived what she calls “a circumscribed life,” newness doesn’t always appeal, not after decades of a familiar and satisfying routine. Men who spent their lives in the workplace are familiar with new social situations and are less likely to feel unease, she said. A woman whose life has had a narrow, if intense, focus is likely to have more trouble branching out.

“It gets harder to make friends — most people find it harder when they’re older,” said Dr. Tannen. Many older women, she suggests, are simply more comfortable in a world they can control.

Read full article...

Tuesday, March 01, 2011

Story telling...a great communication tool

Nearly 16 million Americans will be diagnosed with Alzheimer's disease or another type of dementia by 2050, according to the Alzheimer's Association. Symptoms include mood and behavior changes, disorientation, memory loss and difficulty walking and speaking. The effects of anti-dementia drugs on patients' emotions and behaviors are inconsistent. Now, University of Missouri researchers have found that participation in TimeSlips, a drug-free, creative storytelling intervention, improves communication skills and positive affect in persons with dementia.

TimeSlips is a nationally recognized storytelling program for people with dementia that encourages participants to use their imaginations to create short stories as a group. Rather than relying on factual recall, participants respond verbally to humorous images presented by facilitators who record the responses and read narratives to further develop or end the stories.

"TimeSlips provides rich, engaging opportunities for persons with dementia to interact with others while exercising their individual strengths," said Lorraine Phillips, assistant professor in the Sinclair School of Nursing. "It encourages participants to be actively involved and to experience moments of recognition, creation and celebration. Meaningful activities, such as TimeSlips, promote positive social environments that are central to person-centered care."

The storytelling program is an easy and affordable activity for long-term care facilities to implement and allows caregivers to interact with multiple residents at a time, Phillips said.

"TimeSlips offers a stimulating alternative to typical activities in long-term care facilities," Phillips said. "It is an effective and simple option for care providers, especially those who lack resources or skills required for art, music or other creative interventions."

In the study, Phillips and her colleagues delivered the TimeSlips intervention in one-hour sessions, held twice weekly for six consecutive weeks. The results included increased expressions of pleasure and initiation of social communication. Improvements in participants' affect lasted several weeks following the final session. The intervention is acceptable for people with mild to moderate dementia, Phillips said.

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