Alzheimer's disease promotes isolation

Patients with Alzheimer’s disease, the most common form of dementia, and their caregivers say the illness leaves them feeling isolated and apart from family, friends and life’s typical connections, a report shows.

About a quarter of people with dementia hide or conceal their diagnosis because of the stigma surrounding the disease and 40 percent say they are excluded from everyday life, according to the World Alzheimer Report 2012 released today by London-based Alzheimer’s Disease International.

About 36 million people worldwide are living with dementia and the numbers will more than triple to 115 million by 2050, according to the report. The global cost of the disease is estimated at $604 billion. More education is needed about dementia, especially as seemingly healthy people are diagnosed earlier with the disease, said Beth Kallmyer, vice president of constituent services at the Alzheimer’s Association in Chicago.

More evidence that poor dental hygiene leads to dementia

Researchers who followed close to 5,500 elderly people over an 18-year period, found those who reported brushing their teeth less than once a day were up to 65 percent more likely to develop dementia than those who brushed daily.

"Not only does the state of your mind predict what kind of oral health habits you practice, it may be that your oral health habits influence whether or not you get dementia," said Annlia Paganini-Hill, who led the study at the University of California.

Inflammation stoked by gum disease-related bacteria is implicated in a host of conditions including heart disease, stroke and diabetes.

And some studies have found that people with Alzheimer's disease, the most common form of dementia, have more gum disease-related bacteria in their brains than a person without Alzheimer's, said Paganini-Hill.

It's thought that gum disease bacteria might get into the brain causing inflammation and brain damage, she told Reuters Health.

So she and her team wanted to look at whether good dental health practices over the long term would predict better cognitive function in later life.

The researchers followed 5,468 residents of a Californian retirement community from 1992 to 2010. Most people in the study were white, well-educated, and relatively affluent. When the study began, participants ranged in age from 52 to 105, with an average age of 81.

All were free of dementia at the outset, when they answered questions about their dental health habits, the condition of their teeth and whether they wore dentures.

When the researchers followed-up 18 years later, they used interviews, medical records and in some cases death certificates to determine that 1,145 of the original group had been diagnosed with dementia.

Of 78 women who said they brushed their teeth less than once a day in 1992, 21 had dementia by 2010, or about one case per 3.7 women. In comparison, among those who brushed their teeth at least once a day, closer to one in every 4.5 women developed dementia. That translates to a 65-percent greater likelihood of dementia among those who brushed less than daily.

Among the men, the effect was less pronounced, with about one in six irregular brushers developing the disease - making them 22 percent more likely to have dementia than those who did brush daily. Statistically, however, the effect was so small it could have been due to chance, the researchers said.

There was a significant difference seen between men who had all, or at least most, of their teeth, or who wore dentures, and those who didn't - the latter group were almost twice as likely to develop dementia.

That effect was not seen in women, though.

Paginini-Hill could only speculate on the reasons for the different outcomes among men and women. Perhaps women wear their dentures more often than men, and they visit the dentist more frequently, she suggested.

The new findings, published in the Journal of the American Geriatrics Society, cannot prove that poor dental health can cause dementia.

Neglecting one's teeth might be an early sign of vulnerability to dementia, for instance, or some other factor could be influencing both conditions.

Still, this report "is really the first to look at the effect of actions like brushing and flossing your teeth," said Dr. Amber Watts, who studies the causes of dementia at the University of Kansas and was not involved in the research.

The new study does have some limitations. Paganini-Hill and her team looked at behavior and tooth count as a kind of proxy for oral health and gum disease. They didn't carry out any dental exams so they couldn't determine if people had gum disease or not.

And tooth loss isn't always related to gum disease, Watts noted. Head injury and malnutrition are also important causes of tooth loss in adults, and any of those might increase risk for dementia, she said.

"I would be reluctant to draw the conclusion that brushing your teeth would definitely prevent you from getting Alzheimer's disease," Watts said.

Yet despite the limitations, Watts said the study is an important step toward understanding how behavior might be linked to dementia.

"It's nice if this relationship holds true as there's something people can do (to reduce their chances of developing dementia)," said Paganini-Hill. "First, practice good oral health habits to prevent tooth loss and oral diseases. And second, if you do lose your teeth, wear dentures."

Caregivers responsible for the bulk of elder abuse

A new study confirms that financial elder abuse has reached the point of epidemic,with 65% of more than 750 interviews with experts who work with older Americans revealing victims of investment fraud or financial exploitation.

Of those who commit elder financial fraud, family members and caregivers are among the most common offenders, followed by strangers.

“Our new survey shows that financial swindles targeting older Americans are a bigger problem today than ever before and that seniors need more help.” said Don Blandin, president and CEO, Investor Protection Trust. “…Of course, there is no ‘silver bullet’ that will end the financial abuse of America’s seniors. Putting a major dent in the problem will require new and innovative collaborative efforts by many different experts and organizations, both public and private.”

Education is seen as the No. 1 way to combat the problem, through counseling or personal finance management programs tailored to the needs of older Americans. These programs are most effectively delivered through local professionals, protective service workers, law enforcement agencies and health care professionals, as well as senior centers, the study finds.

The magnitude of the problem and lack of effective ways to identify elder financial abuse has led it to become a health issue in addition to a national concern, says Dr. Mark Lachs, Director of Geriatrics, New York-Presbyterian Healthcare System.

“Elder financial abuse is not only about financial exploitation: It is a major public health problem. When older Americans are financially exploited and there are no resources left for their care, these individuals effectively become wards of the state. In these cases, all Americans end up paying.

Read full study...

Top Ten Things a Caregiver Needs from a Health Care Provider

Excellent insight from our friend Gary Barg of Today's Caregiver.

1. Attention: The caregiver's loved one may be the 27th similar case you've seen today; but to the caregiver, this is Mom or Dad, Sister or Lover.

2. Compassion: Be diligent in its application.

3. Time: A few moments of your undivided time is some of the strongest medicine you'll ever administer—and it costs so very little.

4. Respect: The person pushing the wheelchair is also part-time bookkeeper, psychologist, dietitian, insurance and incontinence expert, and a full-time general in the war they are waging with this illness. They not only need your respect, they DESERVE it.

5. Dedication: Be relentless in your devotion to your craft. The caregiver has entrusted you with their most valuable asset—their loved one. You earn that trust with your skill, knowledge base and ability. 

6. Honesty: The caregiver is your partner in this endeavor; they deserve (and can handle) the truth.

7. Prudence: The graceful administration of the truth is a true test of a caring professional.

8. Advocacy: Never accept less than the best your system has to offer their
loved one.

9. Understanding: The caregiver plays a pivotal role in the well-being of your patient; understanding the needs, wishes and fears of the caregiver improves your patient's care.

10. Your well-being: Know your emotional limit and learn when to ask for help. Your loved ones as well as the caregiver's loved one need you to remain well.

Gary Barg
Editor-in-Chief
Today's Caregiver

After the heart attack...

If your parent has recently been hospitalized for a heart attack, the future may seem very uncertain. Now is the time to organize medical care and figure outhow to make the transition from hospital tohome as smooth as possible.

Ask your parent's physician (s) the following:
How serious was the heart attack?
Some heart attacks are worse than others. Knowing how badly your parent's heart was damaged will give you a clearer sense of his prognosis and timeline for recovery. The extent of damage will also determine any complications your parent might have.
What complications should we watch for?
If your parent suffered a very mild heart attack, you might not need to worry about complications at all. But if the attack was more severe, your parent could develop complications, such as an arrhythmia, congestive heart failure, or stroke. Ask the doctor about your parent's risk for these complications and how to recognize them if they develop.
How much care will my parent need -- and for how long?
If your parent will need more care than you can provide, now is the time to make plans. The doctors and nurses should be able to give you an idea of how badly and how long your parent will be disabled.
When can my parent resume normal activities?
How much and what type of activities your parent can do will depend on the condition of his heart. In most cases, heart attack survivors can get back to normal activities within a few months; others may need to take it easy for a longer period of time. Depending on his state's laws, your parent may be able to start driving within a couple of weeks. The doctor can help you and your parent set a realistic timetable for recovery.

What exercises should my parent do?
Physical activity strengthens the heart muscle and is important for overall health. Exercise can help your parent reduce his cholesterol level, lose weight, and lower his blood pressure. But it's important not to overdo it, especially soon after a heart attack. Ask the doctor if your parent could benefit from a cardiac rehabilitation program, in which an exercise specialist will help him develop a program he can continue on his own.

What kinds of dietary restrictions are necessary?
You probably already realize that your parent will need to make changes to his diet, but the thought of implementing those changes may daunt you. The doctors and nurses can help you figure out the best diet for your parent. Ask what foods are good for heart health, what foods he should limit, and how to control portion size. If you need more help, ask for a referral to a nutritionist who specializes in cardiac patients.

What medications will my parent need to take -- and what are the likely side effects?
The doctor has probably prescribed a bewildering array of different medications for your parent. Make sure you understand each medication and its potential side effects.

 For each medication, ask:

• What does it do?
• How often should my parent take it?
• Should my parent take this medication with food?
• Is there anything my parent should not eat or drink with this medication?
• What side effects might we expect?
• What doctors should my parent see?

If your parent's heart attack was fairly mild, he may be able to continue to see only his primary care physician. But if his heart was badly damaged, he'll probably need to see a cardiologist as well. Ask what doctors he'll need to visit and whether your insurance will cover those appointments.

 

What's my parent 's risk for another heart attack, and what signs should we watch for?
Most heart attack survivors are at a higher risk for a second attack. Ask the doctor how you can tell the difference between angina and a heart attack. Be aware that the second heart attack may not exhibit the same symptoms as the first. With that in mind, ask the doctor for a list of signs to watch for and what to do if you see them, including where you should seek emergency care.

Mom, what's wrong with Nana?

Alzheimer's can be baffling to anyone, but for young children and even teens it can be especially hard to grasp all that's happening to someone who has played a central role in their lives. But because Alzheimer's can have a profound impact on family life, it’s important to talk with your children about the disease as soon as possible and help them to understand how this disease will probably have to change the relationship they’ve previously shared with that loved one.
You should expect that your children will have a strong reaction to the news of their loved one's Alzheimer's diagnosis. "Both the five-year-old and the fifteen-year-old are going to be alarmed and stressed, and as grandpa or grandma drifts away they're going to face feelings of bereavement," says Richard Powers, MD, associate professor of neurology and pathology at the University of Alabama at Birmingham School of Medicine and spokesman for the Alzheimer's Foundation of America. "It's important to explain that while grandpa may not remember your name, he still loves you as much as the first day he laid eyes on you, and you need to reach out to the part of the person that's still intact."

To choose the right words to explain a loved one’s Alzheimer diagnosis to a child, first consider their age and modify the conversation to make it age-appropriate. The following tips can help you to do just that:

• Younger children - when talking to a younger child about a loved one's diagnosis, you won't necessarily want to use the term Alzheimer's disease. "I recommend parents say something like, 'Grandpa is having problems with his memory or he is unable to think as well as he used to think, so sometimes we'll have to help him with his thinking or his remembering,'" says Barry J. Jacobs, PsyD, a psychologist, faculty member of the Crozer-Keystone Family Medicine Residency Program in Springfield, Pa., and author of The Emotional Survival Guide for Caregivers. You should mention that the person with Alzheimer’s will get sicker over time. Then, if your child seems to have a good grasp of what's already been explained, you could prepare him for some of the changes he will see in the person with Alzheimer's by going over symptoms and how to handle them appropriately.
• Teenagers - will be capable of understanding more than young children, so you should share details of both the progression of Alzheimer's disease and the treatment options available. "For teenagers, we developed a more sophisticated program that actually gets into the brain pathology," says Dr. Powers. "Often, teenagers will end up playing a role in caring for grandpa or grandma, so it is important for them to know as much as possible up front."

Reassure children that Alzheimer's disease is not infectious as you answer their questions and acknowledge their feelings. Make sure they understand that the dementia patient still loves them and wants to see them, but don't force them to visit if they are very resistant or uncomfortable with the situation.

There are a number of emotions children and teens might experience after hearing of their loved one's Alzheimer's diagnosis, including:

• Sadness and a sense of loss
• Confusion or fear about behavioral changes
• Worry that Alzheimer's is contagious, or that their parents might develop the disease
• Anger or frustration because they have to repeat questions when interacting with the dementia patient or help with caregiving tasks
• Remorse over their anger or frustration
• Embarrassment and not wanting to have friends over if the Alzheimer’s patient lives at home with them

These emotions can also be expressed in ways that are less obvious. The child or teenager might act out by:

• Complaining of vague physical discomfort, like a stomachache
• Performing poorly at school
• Spending more time away from home
• Refusing to invite friends over

Parents should respond with unconditional love and support, allowing their children to work through their feelings and answering all of their questions as honestly as possible. Family-related activities like sorting through old photographs or making a family tree also might help by reinforcing the child's connection to their loved one.

Above all, don't force kids to do things they are not comfortable doing. This could include being present for medical exams, participating in daily care (like toileting), or making visits to a nursing home rather than visiting the person with Alzheimer's at a more neutral or familiar location.
Hearing of a loved one's Alzheimer's diagnosis is tough. Explaining it to kids can be challenging for you as well. But following these tips, and customizing them to your specific situation, can be a great step in the right direction. Opening the lines of communication will ease the transition for everyone, no matter

President Obama targets 2025 for effective Alzheimer's treatment

Effective treatments for Alzheimer’s by 2025? That’s the target the government is eyeing as it develops a national strategy to tackle what could become the defining disease of a rapidly aging population.

It’s an ambitious goal — and on Tuesday, advisers to the government stressed that millions of families need better help now to care for their loved ones.

“What’s really important here is a comprehensive plan that deals with the needs of people who already have the disease,” said Alzheimer’s Association president Harry Johns, one of the advisers.

Already families approach the advisory committee “reminding us of the enormity of our task,” said Dr. Ron Petersen, an Alzheimer’s specialist at the Mayo Clinic who chairs the panel.

The Obama administration is developing the first National Alzheimer’s Plan to address the medical and social problems of dementia — not just better treatments but better day-to-day care for dementia patients and their overwhelmed caregivers, too.

The plan still is being written, with the advisory panel’s input. But a draft of its overall goals sets 2025 as a target date to have effective treatments and ways to delay if not completely prevent the illness.

Some advisory members said that’s not aggressive enough, and 2020 would be a better target date.

“We want to be bold,” said Dr. Jennifer Manly of Columbia University. “We think the difference of five years is incredibly meaningful.”

Regardless, an estimated 5.4 million Americans already have Alzheimer’s or similar dementias — and how to help their families cope with day-to-day care is a priority, the advisory committee made clear Tuesday.

The disease is growing steadily as the population ages: By 2050, 13 million to 16 million Americans are projected to have Alzheimer’s, costing $1 trillion in medical and nursing home expenditures. That doesn’t count the billions of dollars in unpaid care provided by relatives and friends.

Today’s treatments only temporarily ease some dementia symptoms, and work to find better ones has been frustratingly slow. Scientists now know that Alzheimer’s is brewing for years before symptoms appear, and they’re hunting ways to stall the disease, maybe long enough that potential sufferers will die of something else first. But it’s still early-stage work.

Meanwhile, as many as half of today’s Alzheimer’s sufferers haven’t been formally diagnosed, a recent report found. That’s in part because of stigma and the belief that nothing can be done. Symptomatic treatment aside, a diagnosis lets families plan, and catching Alzheimer’s earlier would be crucial if scientists ever find a way to stall it, the advisory panel noted.

Among the goals being debated for the national plan:

Begin a national public awareness campaign of dementia’s early warning signs, to improve timely diagnosis.

Give primary care doctors the tools to assess signs of dementia as part of Medicare’s annual check-up.

Have caregivers’ health, physical and mental, regularly checked.

Improve care-planning and training for families so they know what resources are available for their loved one and themselves.

A training program in New York, for instance, has proved that caregivers who are taught how to handle common dementia problems, and given support, are able to keep their loved ones at home for longer.

Such programs “are dirt cheap compared to paying for nursing home care,” said David Hoffman, who oversees Alzheimer’s programs for the New York State Department of Health.

But hanging over the meeting was the reality of a budget crunch. The government hasn’t said how much money it will be able to devote to the Alzheimer’s plan, and states have seen their own Alzheimer’s budgets cut.

“We’re not going to fix this without substantial resources,” Hoffman said. “In New York, we’re hanging on by our nails,” he added.

2012 Best US Nursing Homes

Each year, U.S. News and World Report releases its list of “Best Nursing Homes,” determined by quarterly ratings from the Centers for Medicare and Medicaid Services (CMS), and it also issues an Honor Roll which consists this year of 39 nursing homes that earned the highest possible ratings in all four quarters of 2011.

The 39 nursing homes on the Honor Roll are the only ones out of more than 15,500 that U.S. News reviewed to receive the four straight quarters of perfect five-star ratings from CMS in all three areas of consideration: health inspections, nurse staffing, and quality of care.

View the list...

6 Time Management Tips for Caregivers

Caregiver stress is a popular topic these days, and for many caregivers burnout is a very real factor this time of year. I spoke with several people this week who are feeling that they can’t live up to what’s expected of them…that there simply aren’t enough hours in the day to take care of their children, their jobs, their ailing parents, their holiday plans etc.
In order to juggle caregiving responsibilities with all the other demands of daily life, time management strategies can be a life saver. Try these techniques next time you’re feeling overwhelmed:
• Unplug from technology: Laptops and cell phone with Wi-Fi are great, but they make us available to any and all who need us 24/7. Unless that’s part of your job responsibilities, it may be interfering with your ability to relax and enjoy whatever down time you have.
• Make a list: It’s hard to relax when you’re carrying around a mental “To Do” list. Before you go to bed each night, write down all the things you need to take care of the next day. That way you can put them on paper, and let the weight of responsibility go for the night.
• Mono-task instead of multi-task: Our brains can only focus well on one thing at a time. Trying to do too much at one time can cause silly mistakes that take time to correct.
• Start with the most dreaded task on your list: Avoiding an unpleasant task uses up a lot of emotional energy. Attack them first thing instead of worrying about them all day.
• Schedule time to recharge your batteries: Whether its 30 minutes with a cup of coffee and a good book, or 30 minutes at the gym, be sure you give yourself a little “me time” each day.
• Delegate what you can: No one can go it alone. Let your family, friends, and co-workers help when possible.

Technology is playing a greater role in caregiving.

The senior care industry is increasingly relying on technology to better meet the needs of elders both in senior living facilities and at home. Here are some gadgets, applications, and systems that might be on caregivers’ Christmas lists this year:

1. Memo Touch: The iPad for Seniors

This tablet, a tech gadget similar to the iPad, is designed for seniors with short-term memory loss and provides reminders for to-do lists, taking medication, or keeping scheduled appointments. The Memo Touch also allows seniors or their caregivers to coordinate calendars and schedules, and is marketed as easy-to-use even for those without computer knowledge or skills.

2. Presto: Elder 911 & Elder 411 Applications for the iPhone

Developed by a gerontologist and Presto Services, Inc., these apps provide convenient mobile access to a variety of advice and insights for those who provide care and support to the elderly. Elder 411 is a resource for on-the-spot caregiving information and for planning ahead, covering a full spectrum of caregiving issues including managing financial and legal needs, considering housing options, and keeping the home safe. Elder 911 is for emergency situations like a fall or sudden illness, and provides important information for navigating a variety of crises.

3. eCaring: Home Health Care Management System

eCaring LLC recently launched a home health care management and monitoring system that coordinates seniors’ information about care, conditions, activities, and status among family members, home care providers, and doctors. The system utilizes digital media to allow home care providers to quickly and easily track a patient’s comprehensive information and share it with others outside of the home.

4. Virtual Health: Remotely Monitor Patients’ Vital Signs

Virtual Health now provides subscription-based services that are available nationwide to assist family members caring for seniors who are living independently at home. The platform works directly with an individual’s primary care physician, and allows for monitoring a patient’s vital signs such as blood pressure, weight, and glucose; it also includes video-conferencing technology capabilities.

5. Verizon Wireless: Digital Healthcare Suite for Mobile Care Management

Verizon Wireless has released a virtual care solution that uses smartphones, tablets, and video technology to provide a tool that virtualizes a healthcare visit, eliminating the need to physically visit a doctor’s office for routine consults. It allows healthcare professionals instant access to patient health records, images, and clinical reference information, leveraging high-speed mobile networks and devices to enable greater efficiency and productivity among clinicians.

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.

Family caregiving growing in leaps and bounds...

Family caregiving is becoming a more and more common phenomena with the rise in numbers of American seniors, and a 2011 AARP study says the value of unpaid family caregiving reached $450 billion in 2009.

Recent data shows one in eight Americans are 65 or older, with the number of seniors doubling between 2000 and 2030; the number of senior household is expected to increase 35% by 2020 from 2010 figures. Many older Americans embrace their independence and prefer receiving care at home and aging in place rather than going to a nursing facility, says AARP; this has contributed to the rise in caregiving in general, as well as family caregiving and the costs associated with it.

To put the costs of caregiving in context, the AARP paper, Valuing the Invaluable: 2011 Update – The Growing Contributions and Costs of Family Caregiving, says that in 2009, approximately one in four adults gave care valued at an estimated $450 billion—more than Wal-mart’s total 2009 sales.

This figure represents a 21% increase from what was found in a 2007 study, and reflects the estimated 61.6 million Americans who provided care in 2009.

“We know most people want to remain in their own homes and communities as they get older. Family caregiving is key to making that possible,” says Susan Reinhard, Senior Vice President for Public Policy at AARP.

The AARP report comes after a 2010 MetLife study found that caregiving represents a $3 trillion drain on adult children’s wallets when factoring in lost wages due to missing work, and how that affects retirement and Social Security contributions.

AARP also mentions the levels and kinds of care offered by caregivers, which has grown more complex over the years, and the toll this care can take on the health and well-being of caregivers.

“Family caregivers are an essential part of the workforce to maintain the health care and long-term services and supports systems for the growing number of people with complex chronic care needs,” says the report. “Family caregiving has been shown to help delay or prevent the use of nursing home care.”

The rising cost of elder caregiving

When Maria and Bernie Staab laid out their retirement road map a while back, travel was priority No. 1: specifically, extended trips from their Baltimore-area home to visit their grandkids in San Diego and take them to the beach and on other adventures. The odysseys were supposed to kick in next spring, but now something else is at the top of their agenda: Bernie's mother's Alzheimer's disease. The couple says her condition has worsened, and they're now scrambling to finance the $3,800 monthly bill for her care. Not only has Maria questioned her plan to retire from her job as a human resources manager, but Bernie even came out of retirement to work part-time for a while. After all, it was that or blow through their nest egg.

The Staabs aren't the only ones being forced to choose between paying for their own golden years and paying for their parents'. Most people are well aware of the problem: As boomers reach retirement age, a growing cadre of Americans are finding themselves caring for aging relatives with increasing medical needs and dwindling financial resources. Indeed, more than 49 million Americans, or about 20 percent of the population, care for someone over the age of 50 who is ill or aging -- a number that has steadily increased over the past decade, according to the National Alliance for Caregiving. Caregivers take time off from work for doctors' appointments and to look for home health care. They also dip into their own savings to pay for expenses -- even more so now that state and local caregiving programs are facing budget cuts. For many, the question isn't whether they'll face higher costs, but how they'll manage them.

Such costs can be daunting, especially with many adult children still clawing their way back from the financial crisis. On top of out-of-pocket expenses, MetLife Mature Market Institute estimates that a person over the age of 50 will lose an average of $304,000 in total wages, benefits and accumulated wealth by caring for a parent. Of course, that stat is worth taking with a grain of salt: MetLife had until recently sold long-term-care insurance designed to address this financial bogeyman. But financial advisers agree that most caregivers will get stuck with some hefty expenses. Now they're scrambling to offer ideas -- from concrete steps for a portfolio to rather squishy advice about chats with aging parents. "You shouldn't sacrifice your future completely to support your parents, so it's a balance," says Steven Raymond, an adviser at Davis, Calif.-based Navion Financial Advisers, who has been dealing with the issue personally for a decade.

To try to cover extra costs, some caregivers have started investing more aggressively, but planners say that's a move where the risks outweigh the rewards. Instead, Diane Pearson, of Legend Financial in Pittsburgh, suggests caregivers set aside a chunk of their savings for these expenses -- and do so outside their 401(k)s or IRAs. Some advisers suggest concentrating caregiver funds in dividend-paying stocks and bonds, using the income for expenses rather than reinvesting it. And family members can stretch money by paying attention to taxes: Caregivers, for example, can pay medical expenses directly to a hospital rather than writing a parent a check, or they can lessen the burden of capital-gains taxes by giving an aging parent a gift of stock.

For those who have the luxury of time to plan, getting parents to sign up for long-term-care insurance early on can curb one of the biggest costs: assisted-living and nursing-home fees, which can easily top $50,000 a year. While relatives may be tempted to dodge those costs by leaving their jobs to help out, many planners discourage that. "In the long run, it can be less expensive to continue to work and hire someone" to care for family members, says Sandra Timmermann, director of the Mature Market Institute. After all, advisers say the biggest risk is ending up in the same shoes as your parents -- and passing a financial burden on to your kids.

The above article appeared in SmartMoney, 7/14/2010.

Physicians focus on the importance of mental health for the elderly

The Merry Widows, as they call themselves, were blinged out, Florida-style, to celebrate Elayne Weisburd’s 79th birthday at a sprawling community for seniors. Mylar balloons levitated above their table, and sparklers twinkled from a cake.

The guest of honor and her two friends were beaming when Dr. Marc E. Agronin, a geriatric psychiatrist and the director of mental health, arrived with a hug for everyone long after what would be normal office hours.

The Merry Widows moved to the community when their husbands developed Alzheimer’s disease and looked to Dr. Agronin to prepare them for what lay ahead. But while treating their husbands’ disease, he became their psychiatrist, too. He urged the women to attend therapy groups, made suggestions about medication for anxiety and encouraged new bonds of friendship.

Dr. Agronin calls them his graduates — a trio of success stories 3,700 patients he is responsible for, in what, by all accounts, is the largest geriatric in the nation, at the Miami Jewish Health Systems.

The doctor is a rare breed even in Florida, which has the highest proportion of people older than 65. There are only 17 board-certified geriatric psychiatrists in the state, and a mere six here in southeast Florida, where snowbirds from New York often come to perch. In March, acknowledging the crisis in care, the federal Institute of Medicine began a study of the shortage of geriatric mental health workers nationwide.

Caregiving and the Family Circle

Today’s guest post comes from SeniorsforLiving.com’s Michelle Seitzer.

Before committing to life as a full-time freelance writer, Michelle spent 10 years in the senior living and advocacy world, serving in various roles at assisted living communities throughout Pennsylvania and Maryland, and leading the charge for Alzheimer’s as a public policy coordinator for the Pennsylvania chapters of the Alzheimer’s Association. She has blogged for SeniorsforLiving.com since November 2008 and currently resides in York, Pennsylvania, with her teacher husband and two Boston Terriers. Follow her on Twitter and Facebook.

“When our relatives are at home, we have to think of all their good points, or it would be impossible to endure them.” - George Bernard Shaw

Ah, family. Even those of us with small families can identify with George Bernard Shaw’s words, can’t we?

And no matter how much you love them (or not), little else in life tests the family boundaries and challenges your sanity quite like caregiving.
Taking care of another human being is already difficult work for a number of reasons. It can be physically challenging, emotionally demanding, financially taxing, and psychologically draining to be a caregiver. The responsibility can take a toll on your relationships with co-workers, your spouse, friends, and other acquaintances. Throw in the family wrench, and things can really get ugly.
Becoming a caregiver changes things. Caregiving for a family member, and at times, doing so in coordination with other family members, takes this already life-altering change to the next level.

Before I go any further, I must offer this disclaimer: Caring for a family member in this manner isn’t always a recipe for disaster. In fact, if you and your relatives have the level of maturity, acceptance, flexibility, and compassion necessary to approach the situation with grace, then caregiving for a family member can be one of the most rewarding journeys your family has ever embarked on together. It can truly be a time of bonding, growth, and honor. Always keep this in mind as you embrace this new stage in your family’s development – especially in those tense moments that are sure to come.

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.