Christopher Williams, Senior Solutions

The words “long term care” usually bring to mind images of nursing homes and elderly people living in them who can no longer care for themselves. In truth, long-term care (LTC) comes in many different forms, is provided in many different settings, and can refer to people of all ages.

In 2008, the average annual cost of a stay in a private room in a nursing home was more than $76,000. A stay in an assisted living facility was $35,628. Yet the majority of long-term care services aren’t paid for at all. They are provided by 52 million unpaid caregivers – primarily family members and friends of those needing the care.

According to the Alliance for Health Reform, two-thirds of Americans age 65 will need some type of long term care in their lifetimes. For those who do not have family members to provide it, or those who do not want to be a burden financially (or emotionally) on their relatives, the out-of-pocket cost can be substantial. These costs vary widely from region to region, ranging from $25 per day to $500 per day, with the highest rates in the Northeast, Texas, and Florida. The average cost of a nursing home here in Florida is near $140 per day.  With the average stay in a LTC facility being two and a half years, that adds up to $127,700.

The question that needs to be addressed is whether someone has enough income or assets to handle these costs over time.  Typically, a senior’s income will not cover the costs, but their savings may be enough to handle the expenses. Unfortunately, however, there is no way for anyone to estimate the total of their future LTC expenses.

In making these decisions, one should consider all of the options. Many elderly people who do not have the assets to sustain the high costs of LTC may eventually qualify for Medicaid assistance. In order to qualify, though, they will have to spend down their own assets first before Medicaid steps in. Medicaid accounts for 49% of the total spending towards LTC in America. Another option is to purchase a Long Term Care insurance policy. These policies can be expensive, with costs varying greatly depending on the age and medical history of the insured. But the cost of these polices pale in comparison to the out-of-pocket potential of using one’s own assets. Before making any decision, it is a good idea to sit with a state licensed insurance agent to estimate the cost of a policy. This may be the agent who sold you your life or auto policy, or you may need to find a specialist. Either way, be sure the person fully understands your needs and is active enough to be selling at least a dozen policies a year.

In 1987, the Robert Wood Johnson Foundation initiated the Program to Promote Long-Term Care Insurance for the Elderly. This program is available in eighteen states, including Florida. The program involves a partnership between Medicaid and private LTC insurance.  It allows nursing home patients with state-approved long-term care insurance policies to be eligible for Medicaid with substantially higher levels of assets than are normally allowed. This would permit them to receive nursing care but still have enough to live on and to bequeath to their children.

Whatever decision you make, you may want to make it sooner rather than waiting. The cost of an insurance policy is partly based on age, but you will also want to make arrangements with friends or family members should you choose to “self-insure” or to receive care from a relative. It’s never easy to discuss or think about, but definitely needs to be addressed before it’s too late.

Funny how life gets in the way. It’s been several days since I posted on this Florida Senior Living Advisor blog. There are two reasons: first, I was busy helping my elderly father address some issues he is having with his eyes. Looks like cataract surgery is in his future. First he has to see a retina specialist, to make sure there are no underlying issues with his retina. I don’t mind taking him back and forth to doctors, but the fact is it is very time-consuming.

In addition to those obligations, I was busy on Friday and Saturday attending an amazing conferenced about social media and blogging. It was called “Izeafest” – a reference to the company that organized it, Orlando’s Izea, Inc. I learned so much and met so many wonderful people. I’m still going through all of my notes, mapping out next steps for this blog and for the Florida Senior Living Advisor website. But I know one my priorities needs to be to find other websites and blogs to link to me. So this is my first shout-out: if you know of a useful blog that focuses on issues such as senior care, senior living facilities, nursing homes, assisted living facilities, Alzheimer’s disease, Medicare, really ANYTHING of interest to seniors, please tell me about the site in a comment below. I also want to know about these sites so I can add them to my “Helpful Links” section of Florida Senior Living Advisor.

My elderly father used to be quite the world traveler. Whether for his job with the U.S. Government, or for pleasure, he visited more corners of the earth than I will ever see. As I recall, his last overseas trip was to Paris about five years ago with my nephew. Now, at 84-years-old and a bit unsteady on his feet, he rarely leaves the grounds of his Florida senior living facility, much less travel out of the country, or even out of state. But I think with enough planning and accommodations, he could easily have some adventures in his future.

I recently came across this list of travel tips for wheelchair users and slow walkers. It is provided by Connie George Travel Associates, based in Pennsylvania. These tips are specifically tailored to a cruise vacation, but I think they can help to ensure a safe and enjoyable vacation of any kind.

• Be clear about what you need. Whether you are dealing with a travel consultant or directly with a cruise line, keep in mind that not everyone has exactly the same needs. A cabin feature that works well for most others may not meet your requirements. You are the best judge to know what works best and you need to relay that information rather than assume what you need is the norm.
• Think about all aspects of the trip. As well as an accessible cabin on an accessible ship, you may need accessible airport and pier transportation, an accessible hotel room before and/or after the cruise and accessible sightseeing options in the ports.
• Consider whether you need adaptive equipment in your cabin to be more comfortable. Some items may be offered by the cruise line while other equipment is available for rent from third party companies. If renting a transfer lift would make mornings and evenings easier for you and your traveling companion, consider adding it to your cruise plans.
• Check the itinerary for “tender” ports. Tendering means the ship will anchor in a bay and use a boat to shuttle guests into the port. Success in tendering depends on the cruise line’s policies on allowing and assisting guests who use wheelchairs to tender, the size and weight of your “wheels”, and sea conditions.
• Consider riding. If you are a “slow walker” with limitations on how long you can be on your feet in time or distance, consider renting a scooter. If it helps increase your stamina or gives you more flexibility to get around your large ship, it may make your vacation more enjoyable and relaxing.
• Consider downgrading your ride. If you use a scooter or power chair full-time and are able to use a manual wheelchair and perform transfers, you might want to consider bringing or renting a manual wheelchair for ports. Many ports don’t have accessible vehicles with ramps or lifts. In those cases, using a manual wheelchair and transferring onto the seat of a car can give you access to more sightseeing.
• Request a table location. Like banquet seating, tables can be a bit close. Request your dining table to be located near an entrance or pathway for ease in navigating to your table.
• Send a report. If your disability involves a chronic medical condition, consider obtaining a brief summary report from your physician. Request that the cruise line send a copy to the ship’s infirmary and carry an additional copy for you to have on hand. Ship physicians are hired from around the world so the report should use terms most used worldwide.
• Plug in. If you are traveling with a power chair, scooter, c-pap or other electric equipment, bring a power strip and an extension cord. Most cabins have only one outlet and it’s located at the vanity.
• Hire an advocate. That’s what you’re doing when you book through an agent who specializes in accessible travel. They have dedicated a lot of time and energy into learning about accessibility and have developed rapports with suppliers. They also devote a lot of resources to teaching suppliers about accessibility and in advocating for travelers who have disabilities. A specialist will go to bat for you, saving you time and concern so that you can look forward to your vacation with the same excitement that nondisabled travelers enjoy.

Today, on World Alzheimer’s Day, new data released estimates 35 million people worldwide – a 10% increase over 2005 – are living with Alzheimer’s and dementia, highlighting the urgent need for action and response. With 77 million American baby boomers reaching the age of greatest risk, it is clear that the crisis of dementia and Alzheimer’s cannot be ignored. Left unchecked, dementia and Alzheimer’s will impose enormous burdens on individuals, families, health care infrastructures and the worldwide economy. The impact is already being felt here in Florida, where 25% of our population is 65 or older. Individual families and senior living facilities are struggling to provide care to the growing number of people dealing with Alzheimer’s and dementia.

According to the 2009 World Alzheimer Report, newly released today from Alzheimer’s Disease International (ADI), a London-based nonprofit, international federation, the number of people with Alzheimer’s or another dementia is expected to nearly double every 20 years, to 65.7 million in 2030 and 115.4 million in 2050.  It is estimated that there is a new case diagnosed every 70 seconds.

Much of the growth will be fueled by longer life spans and population growth, especially in developing nations.

“The number of people affected by Alzheimer’s is growing at a rapid rate, and the increasing personal costs will have significant impact on the world’s economies and health care systems. We must make the fight against Alzheimer’s a priority here in the United States and worldwide,” said Harry Johns, President and CEO of the Alzheimer’s Association.

According to Johns, some other countries, like the U.K., have a national Alzheimer’s plan in place. But in the United States, federal spending on research for Alzheimer’s is far lower than some other diseases, like cancer and AIDS. And, there’s no national plan in place that deals with long-term care for people with dementia, as well as “care coordination” of the many different health-care professionals who are often needed to care for patients with Alzheimer’s.

Although there is no cure, experts say that patients who receive active, early medical care may be able to delay progression and experience a higher quality of life. Also, caregivers who receive supportive services early on are better able to manage their loved ones’ illness at home and reduce institutionalization.

The Alzheimer’s Association website provides this very interesting interactive tour that shows how Alzheimer’s affects the brain. Inside the Brain: An Interactive Tour.

If you are trying to find care for a loved one with Alzheimer’s or dementia, many of the nursing homes and assisted living facilities in the Florida Senior Living Advisor database offer memory care services. Visit the individual websites or call for more information. Another option is in-home care, which I wrote about on this blog last week.

This week’s “Friday’s Featured Facility” is actually not a facility but a senior living option that provides services to the elderly in their own homes. There are two different types of services:

• home health agencies, which are licensed to send both skilled (RN’s, Therapists, Social Workers) and unskilled (home health aides, certified nursing assistants, homemaker/companions) staff into a patient’s home. These services are usually covered by Medicare.
• home care/companion agencies, which employ individuals to do housekeeping, cook, run errands and provide companionship. These types of services are private pay, and not covered by anything except some long-term care insurance policies and veterans benefits.

There are hundreds of both types of agencies throughout Florida. If you are considering this type of care for yourself or an elderly family member, you should review this Home Health Guide  provided by Florida’s Agency for Health Care Administration.

Jennifer Campbell, Age Advantage Home Care

I recently met Jennifer Campbell, who owns Age Advantage, a home care agency serving Orange, Seminole and Osceola counties. Jennifer says she currently has about 60 employees that serve her elderly clients for as little as four hours at a time up to live-in care. Jennifer’s agency employs companions, home health aides and certified nursing assistants, so she can provide a wide range of services.

“We basically do anything a family member would do but can’t,” she explained. Jennifer believes as the baby boomer generation continues to age, more and more of them will opt for in-home services. “I think it is a trend. The baby boomers are not going to go to facilities. And people are living longer than they ever were so they will need this type of assistance.”

Jennifer says that the benefits of hiring an agency such as hers include: back-up caregivers, caregiver replacement, bonding, insurance and licensing, supervision of staff, background checks, worker’s compensation, and experienced caregivers. Caregivers are available 24 hours a day, 365 days.

Before selecting a home care agency, Jennifer suggests you ask these questions:
1. Are your caregivers employees?
2. What are your hiring requirements?
3. Are your caregivers supervised? How often? 
4. How do you know if your caregiver has reported to work?
5. How long does it take you to replace a caregiver who has not shown up to work?
6. Can you be reached outside of business hours?  How quickly?
7. Do you develop a comprehensive care plan with the patient prior to services? Is this information shared with the caregiver?
8. What benefits do you offer your caregivers? (caregivers with benefits are long term caregiver’s)
9. Do you require the client’s to sign a service agreement? Do you require a deposit?

To understand all the different types of senior care options available in Florida, visit the definitions page on Florida Senior Living Advisor.

The old keep getting older. No wonder many Florida senior living facilities and businesses that serve the elderly tell me they are continuing to do steady business, even in these tough economic times. Life expectancy in the United States has reached an all-time high: 77.9 years. The increase is due mainly to falling death rates in almost all the leading causes of death.

The new statistics come from the National Center for Health Statistics, part of the Centers for Disease Control and Prevention. Men now have a life expectancy of 75.3 years. For women, it’s 80.4 years. The numbers are for the year 2007, and are based on 90 percent of death certificates in the United States.

I never really thought about where these life expectancy figures come from. Now I know: the CDC analyzes figures on the death certificate that are completed by funeral directors, attending physicians, medical examiners, and coroners. They use these figures to estimate how long a baby born today will live, assuming mortality trends stay constant. U.S. life expectancy has grown nearly one and a half years in the past decade, and is now at an all-time-high. The average life expectancy for babies born in 2007 is nearly three months greater than for children born in 2006.

One reason for the increased life span is that there were sharp drops in mortality rates for several leading causes of death, including: influenza and pneumonia; homicide; accidents; stroke; diabetes; and hypertension. The latest numbers also reflect a decline in the two leading causes of death in the United States: heart disease and cancer. Together, heart disease and cancer accounted for just under half of all the deaths.
Other interesting tidbits from the report:

• For the first time, life expectancy for black males reached 70 years.
• Alzheimer’s disease became the sixth leading cause of death, surpassing diabetes, which now ranks seventh. The number of deaths from Alzheimer’s remained steady, but there was a 3.9 percent drop in the number of deaths by diabetes. Also, as people live longer, more develop Alzheimer’s.

So what does this trend mean for the senior services industry? How do we grow and adapt while continuing to offer high quality services to the elderly in our senior living facilities. What about implications for Social Security and Medicare? Share your thoughts below.

There is a crisis looming in our ability to care for the elderly in this country. I’m not talking about the healthcare debate or the solvency of Medicare. I’m talking about a growing shortfall in the number of doctors trained to care for the special health problems of the elderly. These doctors are known as geriatricians. And with our nation’s senior population due to explode in the next few decades thanks to the  aging of the Baby Boomer generation, this could present a serious problem.

According to the American Geriatrics Society, there are currently 7,590 certified geriatricians in the US — one geriatrician for every 2,500 Americans 75 or older. Due to the projected increase in the number of older Americans, this ratio is expected to drop to one geriatrician for every 4,254 older Americans in 2030.

One reason geriatrics does not appeal to medical students: money. According to the AGS, the median salary for a geriatrician in private practice in 2006 was $161,888. This was $2,133 less than the average family physician’s salary, and $15,171 less than the average general internist’s. Geriatricians train at least one year longer than their primary care colleagues, and yet they are compensated at a lower level. In many parts of the U.S., Medicare payment rates for physicians are lower than commercial insurance rates. Medicare reimbursement is the major source of income for most geriatricians and, as a result, community-based geriatricians have lower incomes than most other physician specialists.

The University of New England has created a unique program to give its medical students first-hand experience in a nursing home. UNE’s college of Osteopathic Medicine operates the “Learning by Living” project, which places a medical student in a nursing home to live the life of an elder resident for two weeks, 24/7. The goal is to equip the students to become more effective physicians, and also to offer a fresh perspective to nursing home administrators.

I came across an interesting article that I want to share with you. It comes from ww.medicalnewstoday.com, and I am using parts of it with the site’s permission. The article is titled  “Baby Boomers Face Down Aging: 10 Most Common Medical Challenges.” It offers a snapshot of the ten challenges that baby boomers will face in the coming years as more and more of them hit 65. And since the US Census Bureau estimates that nearly a quarter of the US population will be 65 or older by 2030 (today that group is around 13% of total), this means these are issues that will balloon in scope and impact in coming years.

Of course, these are also issues that today’s elderly population is dealing with. So whether you are caring for an elderly loved one right now, or looking toward your future as a senior citizen, I think this list provides some valuable information to keep in mind. It comes to use from researchers and clinicians in the Division of Geriatric and Palliative Medicine at The University of Texas Medical School at Houston.

10 Most Common Medical Challenges Facing Baby Boomers

1. Functional decline: According to the U.S. Department of Agriculture, the body loses one percent of muscle mass a year beginning at age 45, which can result in sarcopenia as skeletal muscle is eventually replaced with fat and the body becomes weaker. Some research has linked protein deficiency with sarcopenia. For every week spent in the hospital, it takes an aging body a month to recover muscle strength with daily rehabilitation, says geriatrician Liliana Andrade, M.D., assistant professor of internal medicine at the UT Medical School at Houston. Exercise, including resistance and strength training, is absolutely essential for retaining muscle mass and strength. “For balance, tai chi is good,” she says. “We also encourage patients to rent ’sit and be fit’ videos that use hand and leg weights.”

2. Depression: Considered as prevalent as the common cold in the elderly, depression can be the result of major life changes, including retirement, losing loved ones and loss of mobility and independence. It can show up differently in older people, says geriatrician Nasiya Ahmed, M.D., assistant professor of internal medicine at the UT Medical School at Houston. “There’s not as much of a tendency toward tearfulness or feelings of hopelessness,” she says. “Instead they have vague somatic complaints, increased pain, not sleeping or eating well or general apathy.”

3. Disease: Chronic diseases associated with the aging process, including high blood pressure, stroke, cardiovascular disease, osteoporosis, chronic obstructive pulmonary disease, hypothyroidism, constipation, incontinence and arthritis, can take their toll. Preventive measures taken now such as quitting smoking, eating healthy food and exercising are all important steps toward a better quality of life. “Even quitting smoking at age 60 is better than not quitting at all,” Andrade says.

4. Polypharmacy: A term geriatricians are using for the number of prescription and over-the-counter medications that elderly people are taking in alarming numbers is polypharmacy. “People go to five different doctors and none of the others know what is going on,” Ahmed says. In some cases, seniors who wind up in the hospital may be prescribed a different medication for an existing condition such as high blood pressure because the hospital doesn’t stock the particular one they’ve been taking in the past. The patient returns home with a new prescription from the hospital physician and continues taking the other medication as well, which can be deadly. “I’ve had patients come in who are taking 20 different medications,” Andrade says. “A lot of them also take vitamins and herbal supplements that they don’t need and that can interfere with medications.” The solution, they say, is to have a written record of all prescriptions, supplements and vitamins that they can bring to their appointments and have a family practitioner or geriatrician who can be the lead physician in managing their care.

5. Falls: Low blood pressure, which can be a result of poorly managed hypertension or dehydration, can lead to dizziness. That dizziness, combined with a decreased ability of the vascular system to compensate for changes in position such as standing up, is the largest cause of falls, they say. “So many patients have told me that they take blood pressure medication when they feel like it’s high instead of taking it as it is prescribed,” Ahmed says. “I ask them how they know it’s high and they give vague signs such as their nose tingles or their tremor worsening.” Taking medications for sleep can also be dangerous. “Some take Benadryl to help them sleep and as people get older, that’s not such a good thing because it causes confusion and they can fall because they’re sleepy,” Andrade says.

6. Abuse and neglect: These two problems, including self-neglect, will continue to afflict the elderly, says Carmel B. Dyer, M.D., professor and director of the geriatric and palliative medicine division at the UT Medical School at Houston and co-author of the book, “Elder Abuse Detection and Intervention.”

7. Financial exploitation: Vulnerable elderly people can easily become victims of family members or caregivers. “We see cases where grown children have moved back in with them and are depending on them financially. They use their resources, borrow the car, rely on them to baby sit, and it upsets the senior’s ability to function,” Ahmed says. “I had one patient in her early 80s whose leg had just been amputated and she was still babysitting her 11- and 12-year-old grandchildren, who were taunting her.”

8. Dementia: Alzheimer’s disease is the most common form of dementia, a gradual decline in a person’s mental functioning, and is the fifth leading cause of death for Americans over age 65, according to the National Center for Health Statistics. The Alzheimer’s Association reports that Alzheimer’s disease and dementia triple healthcare costs for people over 65. But education about dementia and possible treatments including medications is lacking, Ahmed and Andrade say. “There are now more medications that are helpful. They can’t cure it, but they can help,” Andrade says. “Unfortunately, a lot of people are in denial. I had a 78-year-old patient who I knew was suffering from dementia because of the way he was managing his medications and health. But his son got upset when I started talking about it and they left the room.”

9. Caregiver burnout: As baby boomers age, many will also be taking care of their own aging parents. That brings caregiver burden, which can lead to a higher risk for depression and other stress-related illnesses. Ahmed says caregivers should solicit health resources, such as daycares for seniors, to help them shoulder the stress. They should take advantage of support groups and ask social workers regularly about available community resources. Special units for acute care for the elderly (ACE units), can help make hospitalizations less stressful for the patient and family.

10. Death and dying: Baby boomers will have to decide how they want to live out the end of their lives and how they want to die. Cultural and religious beliefs will impact these decisions and physicians will need to be sensitive to that, Ahmed says. As patients age, the physician begins to play a larger role in a patient’s life and strong physician-patient relationships will be important in determining a patient’s wishes. People should make those wishes known to family members and caregivers and put them in writing.

Source: www.medicalnewstoday.com

GPS-fitted shoe by Aetrex & GTX

We hear about it far too often- an elderly person with Alzheimer’s or dementia who is missing. In the past few days, I’ve come across these news stories online:

• Virginia State Police are searching for a woman with early stage Alzheimer’s who wandered away from her Eastern Shore home overnight…
• Police are looking for a Georgia woman with Alzheimer’s disease who went missing Saturday afternoon in New Orleans…
• Authorities asked for the public’s help in locating an elderly Millard County man with Alzheimer’s Disease…
• Search is on for woman, 87, with mild dementia…

It’s a frightening situation for caregivers, and an unsafe and sometimes tragic one for the patient. But recently I heard about a new device that could truly be a lifesaver: a shoe outfitted with a GPS tracking system that can locate the wearer instantly.

According to the Alzheimer’s Association, as many as 5.3 million people in the United States are living with Alzheimer’s. Patients of Alzheimer’s, the leading cause of dementia, can easily become confused or disoriented, and it’s common for them to wander from their home or senior living facility and not be able to find their way back. The tracking device in this shoe is intended to be totally unobtrusive. In addition to providing real-time information on the elderly person’s location, caregivers will also have the option to subscribe to a GTX service that automatically alerts them when the wearer of the shoe leaves a designated boundary.

Of course one of the stumbling blocks here is whether your loved one is willing to wear such shoes. There are all sorts of issues of privacy and consent. No one is more stubborn than my elderly father. He still lives independently in a continuing care retirement community, but in recent years  I have noticed that he is more accepting of his limitations and maybe even a little scared at times. As I’ve written before, he suffered a terrible fall in his apartment last September and nearly 32 hours passed before he was found. He is now fully recovered, but that tragedy scared him into agreeing to wear an “alert” necklace that he can use to signal if he is ever incapacitated in the future. I’d like to think that if he started to develop dementia, he might be willing to wear a shoe such as this, if not out of concern for his own safety than maybe out of concern for my peace of mind.

Of course, my husband reads this and his first thought is, “Can’t we get those shoes for our daughters?” That’s a topic for a different blog!

The shoe is a collaboration between GTX Corp., a firm that specializes in miniaturized GPS tracking devices, and footwear company Aetrex. Details are still being worked out, but GTX expects the shoe to retail for around $200 to $300 and be available some time next year.

The latest research on dementia gives new meaning to the phrase “food for thought.” A study released yesterday indicates that individuals with even borderline to moderately high cholesterol levels in their 40s have a much greater chance of developing dementia later in life.

Researchers tracked nearly 10,000 people for four decades, starting when the participants were between 40 and 45. After controlling for weight, hypertension and diabetes, researchers discovered a significant link between borderline-high cholesterol and dementia, according to the study.Participants who had high cholesterol (240 or more) had a 66 percent greater risk of developing Alzheimer’s disease later in life. People with borderline-high cholesterol (200-239) had a 25 percent spike in risk.

Although previous studies have linked heart and brain health, researchers said this study is the first to examine the association between borderline cholesterol levels and dementia. And although dementia does not typically strike until later in life, “it’s a disease of a lifetime,” said Rachel Whitmer, Ph.D., a research scientist at Kaiser Permanente and senior author of the study. “We need to think about it like we do for cardiovascular disease.”

Experts agree that a three-pronged approach of daily exercise, stress reduction and nutrition can naturally lower levels. A diet rich in olive oil, nuts, whole grains, fiber, fresh fruit, vegetables and a limited amount of red meat is best, according to the Mayo Clinic.

“Our study shows that even moderately high cholesterol levels in your 40s puts people at greater risk for Alzheimer’s disease and vascular dementia decades later,” said Whitmer. “Considering that nearly 100 million Americans have either high or borderline cholesterol levels, this is a disturbing finding. The good news here is that what is good for the heart is also good for the mind, and this is an early risk factor for dementia that can be modified and managed by lowering cholesterol through healthy lifestyle changes.”

The study appears in the journal Dementia & Geriatric Cognitive Disorders.