It Takes a Village to Serve Elders

Mom's 90th Birthday  

Many seniors want to do everything they can to stay in their homes as they get older. But often they need help to handle various responsibilities including getting to medical appointments, shopping, socializing with friends, preparing meals, and managing things around the house.

They usually have two choices to get these services. First they can rely on family members to help them. This is often difficult if their children are working or are not in the immediate area. Second they can hire aides to come to the home. But this can be very expensive. Aides often cost $20 an hour or more and many seniors just can’t afford them.

But a new alternative is emerging. It is a volunteer nonprofit organization created by a community to allow neighbors to help other neighbors. Each senior pays a fee to become part of the network. Fees vary by community and services offered . They range from $175 to $900 a year. Community members volunteer to provide most of the services. Discounted fees are available to people with lower incomes.

Beacon Hill in Boston was probably one of the first neighborhoods to offer such a program. Beacon Hill Village was founded in 2001.( www.beaconhillvillage.org) in 2001

A group of friends in the neighborhood started to talk. What if they banded together and created a network of like-minded people who were aging, but who knew they didn’t want to go to a nursing home? They could help one another when they needed it, recommend plumbers and doctors and home-care aides to each other, and schedule social events so no one would be isolated at home. The network would mean they wouldn’t have to be a burden to their children, and they wouldn’t have to go to a nursing home, either.

Services offered to members include:

  • Referrals to discounted, vetted providers for everything from dog walkers to plumbers
  • A volunteer to assist you in your home or around town
  • Geriatric care management for you or your family members anywhere in the US
  • Rides home from a medical procedure that are required by the hospital/doctor
  • Personalized grocery shopping—we will drive you or deliver groceries to your home
  • Discounts to all providers: Electricians, plumbers, organizers, personal trainers, massage therapists, homecare specialists

A similar program was started on Cape Cod in 2011. It is called Nauset Neighbors (www.nausetneighbors.org) that states “One call does it all”. It is staffed by 320 volunteers and serves over 260 seniors in the lower Cape. Volunteers provide transportation, light home maintenance, technical support, and other support tasks

There are now eight open villages in Massachusetts. Each village is unique to its area and resources.  Nauset Neighbors is part of the Village to Village Network (http://www.vtvnetwork.org/) which now is composed of 190 open villages with another 185 in development around the country.

Have You Attended a Death Cafe?

Death CafeAt a Death Cafe people, often strangers, gather to eat cake, drink tea and discuss death.

Their objective is ‘to increase awareness of death with a view to helping people make the most of their (finite) lives’.

A Death Cafe is a group directed discussion of death with no agenda, objectives or themes. It is a discussion group rather than a grief support or counseling session.

Death Cafes are always offered:

– On a not for profit basis
– In an accessible, respectful and confidential space
– With no intention of leading people to any conclusion, product or course of action
– Alongside refreshing drinks and nourishing food – and cake!

Death Cafe is a ‘social franchise’. This means that people who sign up to the guide and principles can use the name Death Cafe, post events to the Death Café Website (www.deathcafe.com) and talk to the press as an affiliate of Death Cafe.

Death Cafes have spread quickly across Europe, North America and Australia. As of today, 803 Death Cafes have been offered since September 2011.

The Death Cafe model was developed by Jon Underwood and Sue Barsky Reid, based on the ideas of Bernard Crettaz.

Death Cafe has no staff and is run on a voluntary basis by Jon Underwood in Hackney, East London. Also Lizzy Miles who ran the first Death Cafe in the U.S. and Megan Mooney who runs the Death Cafe Facebook page have played a significant role in Death Cafe’s development.

People often ask why the Death Cafes are so popular. Everyone has their own reasons for getting involved in Death Cafe. – See more at: http://deathcafe.com/what/#sthash.eYN3ZxOa.dpuf

Major Breakthrough in Medicare Coverage for Chronic Illnesses

hands of old and youngFor years we have accepted the fact that Medicare will only cover physical therapy for patients who are continuing to improve. When my mother broke her hip the therapists informed her doctor that Medicare coverage for rehabilitation would cease after only three weeks of therapy. They told us that she would have to return to her assisted living residence even though she was still not able to walk. Their conclusion: She was no longer improving and it was likely she would never walk again.

Of course this was complicated by the fact that she had dementia and couldn’t remember the exercises they had prescribed for her a few minutes after she left the therapy room. But we accepted their conclusion without making a fuss and she has been in a wheelchair for the last five years.

But a major change has recently occurred in Medicare. One that has been kept very quiet but will have a huge impact on patients who have chronic illnesses. Medicare officials updated the agency’s policy manual in January. This is the rule book for everything Medicare does.  They stated that Medicare will now pay for physical therapy, nursing care and other services for beneficiaries with chronic illnesses like Multiple Sclerosis, Parkinson’s and Alzheimer’s disease in order to maintain their condition and prevent deterioration.

This dramatic change is due to the settlement of a class-action lawsuit filed in 2011 against Kathleen Sebelius , the Secretary of Health and Human Services by the Center for Medicare Advocacy and Vermont Legal Aid on behalf of four Medicare patients and five national organizations, including the National Multiple Sclerosis Society, Parkinson’s Action network and the Alzheimer’s Association. The settlement affects care from skilled professionals for physical, occupational or speech therapy and home health and nursing care, for patients in both traditional Medicare and private Medicare Advantage plans.

The change will have the greatest impact on seniors who want to avoid having to go into an institution to get care. People with chronic illnesses like Parkinson’s or MS may be able to get the care they need and stay in their own homes.

Existing eligibility criteria for Medicare rehabilitation benefits have not changed however. To be admitted to a rehab. facility or nursing home for covered care the patient must have spent three consecutive midnights in the hospital as an admitted patient and the patient must be referred by a Doctor’s order prescribing skilled nursing home care not custodial care.

For home health coverage, the beneficiary must have a Doctor’s order for intermittent care ( every few days or weeks) provided by a skilled professional or outpatient therapy, social work services or a visiting nurse. Beneficiaries receiving skilled services at home are also eligible for home health care aides for assistance with bathing, dressing and other daily activities.

The settlement also provides for a review of claims that were denied in the past three years solely because patients were not improving. Officials have posted a form on the Medicare site to repay beneficiaries for the care they paid for themselves. This form must be submitted by July 23, 2014 for claims that were denied from Jan. 18, 2011 to Jan. 24, 2014. Claims denied between Jan. 25, 2013 and Jan. 23, 2014 must be submitted by Jan. 25, 2015

Can Telemedicine Help Your Aging Parents?

TelemedicineWhat do you do if you can’t get your aging parent to a doctor’s office because of her disability? What do you do if your parent needs to see a specialist who may be hundreds of miles away? A new area of medicine known as Telemedicine may be the answer to your problem.

I first heard of this breakthrough  through the Parkinson’s Disease Foundation’s Newsletter, News & Review available at  www.pdf.orgThe newsletter described the advantages of Telemedicine for Parkinson’s patients. It offers them access to care, particularly to specialists, in locations that are remote or poorly served by medical resources. It also makes it easier for people with Parkinson’s to participate in clinical trials, which could speed up the development of new treatments.

A virtual medical appointment uses a computer, tablet or smartphone with technologies such as Skype or Facetime. These programs are available for free. Skype can be downloaded from www.skype.com. Facetime comes as a resident program on any Apple Computer, Iphone or IPad. Patients can communicate with and see their Doctor on the screen of the devise.

Early studies have indicated that the virtual visit may be more effective than seeing your doctor in person. It eliminates the hassle of travel to and from the doctor’s office and sitting in the waiting room. It also helps the doctor see you in your everyday environment. If your parent is prone to fall  it may help a doctor or therapist to identify risk factors and suggest ways to solve them.

Some studies have shown that during Telemedicine appointments, people are more relaxed, can communicate better with their doctors and can remember advice with greater accuracy. In a study done by the University of Rochester with people who have Parkinson’s Disease, researchers found that the quality of care was high and patients actually preferred the telemedicine visit.

According to the AmericanTelemedicineAssociation, www.americantelemed.org there are 3,500 sites around the US that offer telehealth in some capacity. More than 380,000 veterans received telehealth services from the VHA in 2011.

Telemedicine has demonstrated a significant impact on hospital admissions and emergency room visits, as well as, walk-in clinic visits. Ontario Telemedicine Network (OTN) conducted a trial program that involved more than 800 patients with one of two chronic diseases – Congestive Heart Failure or COPD. The results were:

  • 65% reduction in number of hospital admissions;
  • 72% reduction in number of Emergency Room visits; and
  • 95% reduction in number of walk-in clinic visits.

Telemedicine offers the possibility of shifting the delivery of many health care services from hospitals and other healthcare facilities to patient’s homes, thus reducing the load on the healthcare system and reserving hospitals for more critical cases.

One of the biggest hurdles for the expansion of Telemedicine is the patient’s ability to use the technology. We have probably all seen our elders wrestle with learning how to use email on their computers. But the use of a tablet or a computer with touch capability can make the communication almost as simple as dialing a phone.

Find out if your family doctor is familiar with the American Telemedicine Association (ATA). Ask them to check out the website, www.americantelemed.org to learn more about the exciting developments in this area. And see if it might work for them.

The Coming Caregiver Crisis

Caregiver CrisisOne third of the families in the United States provide long term care for a disabled or elderly family member. Two thirds of these caregivers are women. And one half of them are working.

These family caregiver are critical for the elderly to remain in their homes  when disability strikes. More than two- thirds (68 percent) of Americans believe that they will be able to rely on their loved ones to meet their long term care needs when they require help, but this belief may collide with the reality of dramatically shrinking availability of family caregivers.

According to an AARP study, in 2010, the caregiver support ratio was more than 7 potential caregivers for every person in the high-risk years of 80-plus.

By 2030, the ratio is projected to decline sharply to 4 to 1; and it is expected to further fall to less than 3 to 1 in 2050, when all boomers will be in the high-risk years of late life.

If fewer family members are available to provide everyday assistance to the growing numbers of frail older people, more people are likely to need institutional care—at great personal cost—as well as costs to health care programs. Greater reliance on fewer family caregivers to provide home- and community-based services could also add to costs borne by family members and close friends—in the form of increasing emotional and physical strain, competing demands of work and caregiving, and financial hardships.

The decades of the 2010s and 2020s will be a period of transition, as boomers age out of the peak caregiving years and the oldest boomers age into the 80-plus high-risk years.

The departure of the boomers from the peak caregiving years will mean that the population aged 45–64 is projected to increase by only 1 percent between 2010 and 2030. During the same period, the 80-plus population is projected to increase by a whopping 79 percent.

It is critical that families begin the conversation now to create a long term care plan for elderly family members. Do not wait for it to become an immediate crisis. The family must have a serious meeting to answer the following three questions.

  1. If mom or dad becomes incapacitated, where will they live?
  2. Who will take care of mom or dad if they need custodial care? 
  3. How will they pay for this care?

The answers to these questions will form the basis for a long term care plan. If family members disagree regarding the answers to these questions, compromises must be made. The entire family must come to a consensus that everyone can live with or risk the disintegration of the family.

Why have our Parents become targets for Elder Abuse?

Mom's 90th Birthday

Financial scams involving our elderly parents are becoming an increasing problem throughout the  U.S.  Surprisingly, 90% of these financial crimes are committed by people who have personal access to your parents. They could include, relatives, caregivers, healthcare workers and attorneys. Why is it that our parents have become such targets for financial abuse?

Reason #1 Wealth concentration. Scam artists go where the money is. Forty-four percent of all wealth in America lies with older Americans. In addition, the concentration of people in this category is growing by 8,000 people per day as the baby boomers—those born after 1945 and prior to 1965—enter this peak wealth stage of their life in record numbers beginning in 2011.

Reason #2 Mental Capacity. As people get older those high-level thinking abilities required to  differentiate between a fraud and a legitimate transaction diminish. Studies show that between 15% and 35% of older Americans experience some form of cognitive impairment and may not even be aware of it.

Reason #3 Desire to Stay Healthy Older Americans want very much to stay healthy and avoid chronic sickness. Some older folks will believe anything in an attempt to feel healthy again. They will pay a lot of money for cure-alls with little evidence of success.

Reason #4 Politeness People born in the 1920’s 1930s, and 1940s, were taught to be polite, and con artists will prey on these positive qualities. Politeness was taught at home; it was reinforced at school, church, and anywhere a young person went. It was an automatic response and was learned at an early age. Older Americans don’t like to question things and have a hard time saying ‘no’ to people. When aggressively approached by a con artist they are often willing to comply passively.

Reason #5 Less Likely to report abuse and fraud. Older folks are less likely to report fraud. They do not make good witnesses because of the memory issues and con artists know this. In addition, seniors fear losing care, physical harm, and embarrassment if the perpetrator is their caregiver. An older person may fear losing freedom if they complain too much—one more complaint could send them to the nursing home or cause them to lose driving privileges. They think “Maybe I should just stay quiet so I don’t lose my freedoms.”

What can you do to help your parents avoid financial abuse?

  1. Remind your parents that financial elder abuse is serious and they need to be on guard.
  2. Routinely offer to help review your parents’ transactions or discuss concerns about situations or people that may be on their mind. Make sure their important papers are safely locked away. Review credit card and bank statements looking for small transactions.
  3. If you are a significant distance from your parents consider having them set up a revocable trust with a corporate trustee—there is no better protection for a client. Corporate trustees are the most regulated financial entities in our industry; they’re regulated by the OCC, the FDIC, and the state banking commission.
  4. Durable power of attorneys are an important estate planning tool for your parents ( and you as well). But the person with that durable power has unlimited access to your parents’ finances. If you are not the person given that power make sure the individual with the power sends you copies of all transactions that they are involved in. Have them send you duplicate banking and investment statements each month..

Important Information You Must Save for Your Elderly Parents

Every time I speak before groups of babyboomers and their elderly parents I remind them of the importance of getting all their critical information down on paper or in a computer file that can be accessed by the family if there is an emergency.

What kind of information do you need close at hand? Copies of wills and trusts, durable powers of attorney, health care proxies and living wills should all be readily available. In addition the names and contact information for any family advisers(attorney, doctor, minister, banker etc.) should also be accessible.

Financial information such as the name and account numbers for bank and investment accounts should be listed. In addition the beneficiary statements for IRA’s, annuities and life insurance policies should be close at hand. Make sure these are up to date, and the beneficiary has not already passed on. Also make sure there are contingent beneficiaries listed if the primary beneficiary is deceased when the funds are released.

Last and perhaps more important than ever before. Make sure the internet addresses, usernames and passwords for any online financial accounts are readily available. When one of my clients passed away, his wife did not know the internet accounts he had utilized to manage his investments. The institutions would not give her any information about the accounts. She eventually had to hire an IT specialist to hack into his accounts and it took months!

A Guide for Babyboomers helping their elderly parents

A Guide for Babyboomers helping their elderly parents

Save info on important documents for your parents.There are a few ways to store all this information. One is a simple three ring binder. If you purchase my book “Can We Talk, A Financial Guide for Babyboomers Assisting Their Elderly Parents.” there is a section at the end of the book called the Lifefolio that has forms available for everything I have mentioned above. You can either tear those pages out or copy them and put them in the binder.

Another approach is to copy all the information digitally into a cloud system such as Dropbox or Google Documents. Then all family members who are authorized can access the information from any computer or tablet connected to the internet.

Whichever way you do it, do it now. You never know when there might be an emergency and you will need to access critical information for your parents.