Monthly Archives: November 2009

Taking Care of Your Aging Parent’s Spiritual Matters

Posted on November 25, 2009 by jpon| Leave a comment

Submitted by Richard Hetzler

My brother had worked with my mother many years before she came to Chicago to outline her desires for funeral services.  One of her requests was for me to do the readings at her funeral mass.  When mother moved near me, I contacted the local Catholic Church, and found that there is a book, “Through Death to Life,” which allowed me to plan all the readings and songs ahead of time.

I selected the passages I would read, then later selected songs and other readings.  I was able to determine her comfort with many songs and readings, without specifically referencing a funeral.  When her death came, being able to simply fax the printed outline to the church removed a burden during that difficult time.

Once mother was under hospice care, one of the services offered was a chaplain.  I was skeptical, but gave it a try.  These turned out to be very well qualified chaplains who are sensitive to individual religious preferences.  Ours was a Methodist minister who did an excellent job of meeting the needs of a Catholic person, even saying the rosary with her.  This turned out to be a valuable service, and they earned my greatest respect for how they handled the situation.

→ Leave a comment

Posted in Emotional Issues, Faith Issues, Family Issues, Outside Resources

Tagged , , , , , ,

Congress Debates Adding Long-Term Care to Health Bill

Posted on November 22, 2009 by jpon| 1 Comment

By Joe Ponepinto

Recently the House of Representatives voted to include a long-term care benefit in the pending health-care legislation. The Senate is still debating whether to include that option. Whatever they decide, a federal program would likely only cover part of the cost of long-term care for most people. That means the decisions about whether and when to purchase this coverage are still up the individual.

Long-term care insurance requires policyholders to pay premiums in advance of them needing a long-term care facility. Premiums vary widely depending on the insured’s age. According to Consumer Reports, a plan that costs a 50-year-old $1,625 annually will run a 60-year-old $3,100 and a 70-year-old $7,575. So it might seem that purchasing earlier would save money, and many insurance agents encourage people as young as 40 to buy at a lower monthly cost. But consider that you can’t actually use the policy until you qualify for what is defined in the policy as “long-term care,” which for many people isn’t until age 80 or beyond. That means up to 40 years of premiums, or more, with no return. Although there’s no perfect age to begin coverage, some experts say 60 is a good time to start. But also remember that it is harder to qualify for a policy as you get older. One out of four 65-year-olds flunk the physical; at 75, it’s one in three.

Whether you need it or not is another matter. Currently, average nursing-home costs for a semiprivate room are $198 a day, while home health aides get $21 per hour, according to a survey from MetLife Inc.’s Mature Market Institute. (A pdf file of the survey is here.) Those rates are bound to go up. The federal benefit being discussed would pay only $75 per day, according to the Congressional Budget Office. The costs can deplete an average person’s savings very quickly. Personal and family health histories can be factors in determining when you might need this benefit, but no one can predict this with any accuracy.

If you do decide to purchase long-term care coverage, one of the most important aspects to weigh is what, exactly, the policy considers to be the qualification for long-term care. Policies vary widely in what they will pay for. Many only pay 50 percent for in-home care, so at $10.50 per hour it adds up fast.

A federal option for long-term care would eventually change how much insurance each person needs, but it probably won’t eliminate the need to carry some additional insurance. It’s good to understand the options no matter what the government decides.

→ 1 Comment

Posted in Care Givers, Elder Heath, Family Issues, Financial Issues, Insurance, Outside Resources

Tagged , , , , , ,

Parents’ Level of Care Must Be Monitored

Posted on November 21, 2009 by jpon| Leave a comment

Submitted by Richard Hetzler

When the level of care for your aging parent must be increased, it’s important for caregivers to take a more active role in how that care is delivered.

When my mother moved to the Chicago area, she stayed in an assisted living facility with which we were extremely pleased. But after a stay in the hospital, she was required to move to the rehab facility on the same campus.  Since we were so happy with the assisted living facility, I made the mistake of assuming that she would be well cared for in the rehab facility.

They had made no effort to compare treatment plans from the adjacent building. For example, they had every pain medicine labeled “PRN” (Latin: pro re nata, which means taken as needed).  That meant that she would receive no pain medicine unless she asked for it, but she had been on a pain management regiment for years so never had to ask before, and now did not realize the change.  Once I saw the intense pain that she was in, I had to act, to get the facility to resume her pain management regiment, but it was a difficult process.

Most facilities have a certain level of care that they are prepared to offer, and sometimes do not recognize when residents require greater care.  It’s important for children and caregivers to get involved and stay involved in the decision making process before a parent is moved.

→ Leave a comment

Posted in Care Givers, Elder Heath, Emotional Issues, Family Issues, Hospitals

Tagged , , , , , ,

Medicaid Yields Hardships As Well As Benefits

Posted on November 19, 2009 by jstarkweather| 2 Comments

One of our readers has submitted  a guest column regarding his experiences with Medicare. The names have been withheld by request.

My mother was never very affluent. So when it came time for her to move into an assisted living facility for the treatment of Alzheimer’s disease, she was not financially prepared for it. Eventually, we had to turn to state Medicaid for assistance, but we were very surprised at the restrictions imposed on her finances.

In our state, at the time my mother applied for assistance, a person could have no more than $1500 to her name in cash and assets. Since my mother had more, we (believe it or not) had to sell off all her assets and give the excess to the state government for use in paying for Medicaid. The excess, and any income she had, including Social Security, was to be used first to cover costs before state help kicked in.

We were lucky in that her living facility had staff who were very helpful in navigating the state’s legal system. Other facilities may not be as prepared. But we realized while it was happening that my mother was essentially becoming a ward of the state—not that we expected her to recover, but in effect she no longer had an independent future.

In retrospect, we could have tried to have her “gift” the excess assets to her relatives (up to the federal tax-exempt limit) before applying for Medicaid, but even that strategy is difficult, since in our state, Medicaid looks back three years to figure net worth, to ensure the person is cognizant enough to understand what she is giving away. Who can say three years before Alzheimer’s care is needed that it is inevitable?

Think carefully about your parent’s future. It’s much better to be prepared for the possibility of having to use state Medicaid than to have to deal with it suddenly, as we did. If a long-term care insurance policy is an option, you should investigate it.

Keep in mind that Medicaid, although a national program, is also governed by individual state law and the requirements and services vary from state to state, sometimes greatly. But the best advice, if you anticipate that your parent might need it in the next few years, is to learn as much as you can about the program where you live, and prepare your parent’s finances so s/he gets the most help for the least impact.

→ 2 Comments

Posted in Financial Issues, General Information, Insurance

Tagged , ,

Mamita

Posted on November 19, 2009 by jpon| Leave a comment

Submitted by Carmen T. Bernier-Grand

I had left my Oregon home and family to take care of my parents in Puerto Rico. My brother had been their helper, but now that my father’s anemia had made him forgetful and my mother’s pulmonary fibrosis had thickened her lungs, it wasn’t fair for my brother to carry the full load. My sister had done her duty. She had spent over half a year with my parents. It was my turn. What an experience that was!

One morning at two I heard water running. For sure my father had forgotten to turn off the outside faucet. He often did, and water ran all the way from the backyard to the street. This was from a father who complained that water bills were too high.  I had to find the source of this running water.

I opened the back gate and found two tree frogs leaping to hide as if they had done something wrong. Their hundred friends’ Kokee-kokee songs muffled the running water. That sound didn’t come from the outside faucet but from inside.

The kitchen faucet! What hadn’t I thought of it? That faucet insisted to be turned a certain way or it wouldn’t close. I went in and turned on the kitchen light. Not a drop from the kitchen faucet.

I could still hear water.

Could it be the toilet?  This save-water toilet had to be flushed several times, using as much or more water than the old one. I listened by the bathroom door. I had misspoken about this toilet, but what about the toilet in Mamita’s bathroom?

I had to cross Mamita’s bedroom to get to it. In the dark I saw a figure. It couldn’t be Mamita. She had strict orders from the doctor not to get out of bed by herself.

“What’s happening?” Mamita asked.

I turned on the light. Mamita was sitting on the portable toilet. It had no bucket underneath it! I had taken it out.

At two-thirty I was mopping the terrazzo floors in Mamita’s bedroom. But later that morning, we gave others the gift of this memory wrapped in laughter.

Carmen T. Bernier-Grand is the author of many popular books for children, including Diego, an Oregon Book Awards Finalist. She is currently working on a children’s book about Supreme Court Justice Sonia Sotomayor. Her web site is at http://www.carmenberniergrand.com/

→ Leave a comment

Posted in Care Givers, Elder Heath, Family Issues, Humorous Incidents

Tagged , , , , , , ,

Becoming Your Parent’s Hospital Advocate

Posted on November 17, 2009 by jstarkweather| 1 Comment

If you’ve never been an advocate for an elderly person when they land in the hospital, there’s a learning curve.  I found this out the hard way when my Mom ended up in the hospital after a fall. What I thought would be a two-day ordeal at best, turned into seven challenging days.

I first discovered that since my Mom’s physician wasn’t associated with the hospital she was in, they assign an internal doctor called a “hospitalist” to manage her treatment. And if I didn’t catch him in the morning when he did his rounds, trying to get information from anyone else on the staff was nearly impossible! Shortly after she got out, we changed physicians to one that was associated with this hospital. Now she will manage her care if and when Mom has to go in again.

One morning when I walked into her room, a caring hospital worker told me that my mother needed more supervision. He said that she had gotten up early in the morning and walked over to sit down on a chair across the room! When I begged her not to do that again – we didn’t even know if she had a hip fracture yet – she calmly exclaimed, “Well, at least we know I can still walk!” 

It was then I noticed that only three of the four rails on the bed were up.  Her nurse informed me that I’d need to get orders from the doctor to put all four rails up. This totally baffled me, but I got the orders and put them up when I left that night. The next morning I found out that Mom had tried to climb over the side rails and fell out of bed in the process! Fortunately she wasn’t hurt. It was only then I discovered the reason for not putting all up at the same time – apparently it’s been proven that more people get hurt trying to crawl over the rails than if they actually get out of bed without them! The only thing left to keep her safe was to put her in wrist restraints at night.  I struggled with this one, but there was no other choice.

I also learned that if your parent suffers from dementia, it’s likely to get worse in the hospital, simply due to confusion that comes from being in such a different environment.  During the day, my mother’s manifested itself in a very sweet and humorous way. At one point she told me that the surgery (which she didn’t have) had gone well and they worked on her breasts while mending her hip and she couldn’t wait to get the bandages off to see the results! At night, she would become agitated and paranoid. I discovered that this is called “sundowner’s syndrome.” She refused to eat one evening, because she was sure that her food had been poisoned. It wasn’t until one of the nurses told me that this was very common, that I stopped wondering what was going on and accepted this as a temporary problem.

Ultimately it was determined that Mom hadn’t broken her hip and they were able to get her blood pressure back to normal so she went back to her assisted living home. Had I been armed with more knowledge on hospital procedure and the effects of a hospital stay on the elderly, it would have made a difficult situation much less difficult.

 

 

→ 1 Comment

Posted in Care Givers, Elder Heath, Hospitals, Medical Issues

Tagged , , ,

Reverse Mortgages Are Not the Easy Money They May Appear to Be

Posted on November 16, 2009 by jpon| 1 Comment

Despite the downturns in the housing market and the economy in general, one segment of the real estate loan industry that continues to grow is the reverse mortgage market—up 37 percent in 2008 according to Consumer Reports. In their advertising efforts, reverse mortgage lenders sometimes make these deals look like easy money for seniors. But there are many considerations that potential borrowers, and the adult children who help care for them, should be aware of before signing any paperwork.

The principle behind a reverse mortgage is simple. Seniors in need of money—to pay for medical expenses, mounting bills, to maintain a lifestyle; almost any reason is accepted—can borrow against the equity in their primary homes. But a reverse mortgage is not like an equity line of credit, in which the deal is based on income and the borrower must begin paying the loan back immediately. Instead, the lender pays the homeowner the equity in either a lump sum or regular payments, and no payment against the loan is due until the borrower(s) no longer use the home. When that event occurs, however, whether through the death of the borrower(s) or moving away, the loan becomes due in full. Usually the borrower(s) or their heirs pay off the loan with the sale of the home.

The good news is that even if the borrower(s) lives another 30 or more years, no payments are due and they get to stay in their home all that time. If that is the case, the value of the home will probably have gone up significantly and the loan balance will be no problem to pay off.

But if the borrower(s) pass away or move after only a few years, it could create a financial hardship. Here’s why: Reverse mortgages are very expensive loans, with many up-front and ongoing fees. The up-front fees can be included in the loan, but then they continue to accrue interest. Again, according to Consumer Reports, the up-front fees like mortgage insurance, origination fees and closing costs average about $15,000 on a $300,000 home. Another $15,000 in costs comes from ongoing insurance premiums and service fees. If the borrower(s) haven’t stayed in the home long enough for the value to go up, then they won’t have the means to pay the loan plus interest. Figure this means staying in that home for 10 years at least, but that doesn’t even include the possibility of a real estate devaluation, such as we are in now. People whose reverse mortgages have become due in the last two years may be having a very tough time paying them—that includes heirs who become responsible for their parents’ estates.

One particular scam to watch out for is unscrupulous reverse mortgage lenders who convince senior couples who have an age difference to apply for the reverse mortgage under the name of the older spouse only, to make it easier to qualify, by taking the younger person’s name off the title. But if the older spouse dies, then the younger one is left with the bill, and no claim to the home. Another scam caregivers should monitor is financial advisers who convince seniors to take equity money to put into “sure thing” investments. If the investment doesn’t work out, the borrower(s) still has to pay off the loan.

Considering the potential problems such an arrangement can cause, it’s best to be very, very careful before entering into a reverse mortgage. There are many online and local resources that can help you make a decision, and we recommend consulting a variety of them before moving ahead. Be careful about online sources, though. Many reverse mortgage lenders masquerade as unbiased sites designed to “guide” visitors to an informed decision about the product, but their information is often overwhelmingly one-sided about the benefits of reverse mortgages. If the site contains a “reverse mortgage calculator,” or a link to apply for a loan, chances are they are in the business of selling reverse mortgages and therefore their information is biased.

We especially urge children of senior parents to remain involved in their parents’ finances to guard against unnecessary spending and bad deals.

→ 1 Comment

Posted in Family Issues, Financial Issues, Insurance

Tagged , , , , , , , , , , ,

Many Options Allow You to Customize Wheelchairs for Parents

Posted on November 15, 2009 by jpon| Leave a comment

By Susan Melanie Levy

There are many devices designed to aid seniors physically, and of course many of these come in various levels of quality. During the seven years I helped care for my mother I learned just how important the differences can be.

My mother suffered from a form of polio when she was a child, and when she became older she had a great deal of trouble with her legs. Doctors prefer for people to try to stay on their feet as long as possible, so mom progressed from walking to the use of a cane, to a walker, but finally, after two falls, she needed a wheelchair.

When it came to selecting a wheelchair we were amazed at the level of options available. Mom first visited the Shepherd Spinal Center in Atlanta, where the technicians tested and measured her. Then they customized the wheelchair she would receive to make it as functional as possible, and give her freedom to move around. Although it took a couple of months to have the chair built, it was worth the wait. When the chair was delivered the techs also provided training so we both understood its uses and functions.

Her chair had a tilt that could be employed to take pressure off her spine. It also was designed to go anywhere in her facility, including the beauty shop, and it adjusted to the stylists’ height, so mother didn’t even have to switch chairs. It was a great help to her during some difficult times.

If your parent needs special equipment to support their physical needs, it’s definitely worth it to check out all the options available, so your mom or dad still has as much freedom as possible.

→ Leave a comment

Posted in Care Givers, Elder Heath, Family Issues, Medical Issues, Outside Resources, Safety

Tagged , , , , , , , , ,

Solving a Travel Dilemma for Your Aging Parent

Posted on November 13, 2009 by lisacochrane| Leave a comment

By Lisa Cochrane

I recently was told about a creative solution that a friend used when his aging mother could no longer drive. George’s mother lived in an assisted-living facility and she loved the independence and freedom that came with driving herself to doctor appointments and on errands. But George was worried, as he could tell her eyesight and reflexes weren’t what they used to be. When she had a small accident, he was finally able to convince her to give up her keys.

George then decided to sell her car and put the money into an interest-bearing account. He contracted with a local cab company to have a taxi available for his mom whenever she needed it, and instead of billing her, they sent an itemized statement every month to George (including a 20% gratuity). The cab company agreed to use only three drivers so his mom could get to know them. The drivers also agreed to carry her packages and groceries to the door and wait for up to a half hour at her destination.

It was a perfect solution to what could have been a difficult problem. George’s mom still had the freedom to go when and where she wanted and George didn’t worry nor need to take time off work to get her to doctor appointments. His mom even became the hit of the assisted-living facility — especially after she started inviting others to join her on her trips to the local department stores, the grocery and even the theater. Having a taxi available allowed them to venture out to more evening events and dinners.

The money in the interest-bearing account and the savings from not paying for car insurance, gas and upkeep paid for all the taxi rides. His creative solution also kept his mother safe and actually gave her a different kind of freedom — she could now bring along new friends and they could enjoy themselves without the worry of driving home!

→ Leave a comment

Posted in Emotional Issues, Financial Issues, General Information, Safety

Tagged , , , ,

Holidays Are a Great Opportunity to Check on Your Parent’s Health

Posted on November 11, 2009 by jpon| 1 Comment

By Joe Ponepinto

Many of us with senior parents have moved far enough away from our folks that the only time we see them each year is during the holidays. That’s the case with me—we’ll be seeing my mom over Thanksgiving and my wife’s mom during Christmas.

It’s great to get together, of course, but now that our moms are aging, it’s also a good opportunity to assess their mental and physical health. It’s certainly better than trying to do it over the phone and asking questions, since parents may not be completely truthful about health issues in order to keep from becoming a burden to their children.

Obviously I won’t be sitting at the Thanksgiving table, staring at mom. But over the course of our visit, I’ll be checking for indications that she may be having trouble performing functions that weren’t a worry before.

For example, my mom has always been someone who takes regular walks and never has any trouble with stairs, and I’ll want to make sure that is still the case. She wears a hearing aid and lately we’ve had some trouble over the phone, so I’ll be looking to see if there is a bigger problem than she admits when we talk.

If the opportunity arises, and you can sit down with your parent one-on-one, the personal setting may give you a chance to ask about such things as financial or legal issues, to make sure his or her affairs are in good order. If you are visiting at your parent’s home, you might also ask to see such things as bank statements or insurance policies, to make sure they are in order. Ask also about new purchases or agreements they may have entered into—as we’ve noted in previous posts, seniors are often the target of unscrupulous sales pitches. You can also check on medications—how many and whether they’re taken as prescribed.

And if you have a suspicion your aging parent is developing dementia or Alzheimer’s, here are a few signs to look for, courtesy of the Alzheimer’s Association (alz.org).

  • Memory loss that disrupts daily life
  • Challenges in planning or solving problems
  • Difficulty completing familiar tasks
  • Confusion with time or place
  • Trouble understanding visual images and spatial relationships
  • New problems with words in speaking or writing
  • Misplacing things and losing the ability to retrace steps
  • Decreased or poor judgment
  • Withdrawal from work or social activities
  • Changes in mood and personality

The holidays are a great time to relax and renew family bonds, but don’t pass up the chance to make sure your aging parent is in as good shape as you think s/he is.

→ 1 Comment

Posted in Alzheimer's, Care Givers, Elder Heath, Emotional Issues, Family Issues, General Information, Medical Issues

Tagged , , , , , , , , , ,