My elderly father recently underwent cataract surgery, and it has lead to a dramatic improvement in his vision. But the true benefits go far beyond better eyesight. Now that he can see more clearly, he is participating in activities at his Florida continuing care retirement community more. He is spending time in his building’s library, reconnecting with his lifelong love of reading that in recent years had become more of a strain than a joy. And he is spending more time outside going for walks with friends.

By improving his vision, the surgery has ultimately improved the quality of his daily life. And a new study indicates it may also have reduced his chance of developing Alzheimer’s disease, the most common form of dementia.

The  study, from the University of Michigan Health System, reports that elderly people with untreated vision disorders are significantly more likely to develop Alzheimer’s. The study used Medicare data and shows that those with poor vision who visited an ophthalmologist at least once for an examination were 64 percent less likely to develop dementia.

The findings may create a new way of looking at poor vision in the elderly: as predictor of dementia rather than as a symptom after the diagnosis.

For the study, Mary A.M. Rogers, Ph.D., and her colleague Kenneth M. Langa, M.D., Ph.D.,analyzed data from the nationally representative Health and Retirement Study and records from Centers for Medicare and Medicaid Services.

“Our results indicate that it is important for elderly individuals with visual problems to seek medical attention so that the causes of the problems can be identified and treated,” Rogers says. The types of vision treatment that were helpful in lowering the risk of dementia were surgery to correct cataracts and treatments for glaucoma, retinal disorders and other eye-related problems.

Proper vision is a requirement for many of the activities that previously have been found to lower the risk of Alzheimer’s disease. These include reading, playing board games, other mentally stimulating activities, social networking, as well as physical activity such as walking and routine exercising. A visual disorder may interfere with normal mobility and may also hinder a person’s ability to participate in such activities, as it was in my father’s case.

“Many elderly Americans do not have adequate health coverage for vision, and Medicare does not cover preventative vision screenings for most beneficiaries,” Rogers says. “So it’s not unusual that the elderly receive vision treatment only after a problem is severe enough to warrant a visit to the doctor when the problem is more advanced.”

According to a survey conducted by the National Eye Health Education Program, less than 11 percent of respondents understood that there are no early warning signs for eye problems such as glaucoma and diabetic retinopathy. However, vision problems and blindness are among the top 10 disabilities among adults and can result in a greater tendency to experience other health conditions or even to die prematurely.

“While heart disease and cancer death rates are continuing to decline, mortality rates for Alzheimer’s disease are on the rise,” says Rogers. “So if we can delay the onset of dementia, we can save individuals and their families from the stress, cost and burden that are associated with Alzheimer’s disease.”

The study was based on the surveys and medical information from 625 people compiled from 1992-2005. Only 10 percent of Medicare beneficiaries who developed dementia had excellent vision at the beginning of the study, while 30 percent of those who maintained normal cognition had excellent vision at the onset of the study. One in five Americans who are over age 50 report experiencing a visual impairment, according to the U.S. Centers for Disease Control and Prevention. Approximately 5 million Americans have Alzheimer’s disease and the number has doubled since 1980. It is expected to be as high as 13 million by 2050.

As I’ve watched my father’s relationship with his dear friend Ginny grow closer and closer over the last 20 months, it has demonstrated to me that love really can blossom later in life.  He and Ginny are just one of the many happy couples I see when I visit their Florida continuing care retirement community. So with Valentine’s Day coming up in a week, I wanted to share this contest sponsored by a national senior living provider. Following is the information from their website:

In honor of Valentine’s Day, Emeritus Senior Living, a national provider of assisted living and Alzheimer’s and related dementia care services to seniors, is holding a Facebook contest that encourages fans to share personal and family love stories.

Emeritus’ “Lifetime of Love” contest gives fans the opportunity to share their own love stories, or family love stories that have been passed down from parents and grandparents. Fans are encouraged to post their love stories as comments to the “Valentines Day Contest” tab on the Emeritus Senior Living Facebook page. One grand prize winner will receive a $500 American Express gift card. Twenty additional winners will receive a $100 American Express gift card. All winners will be announced via Facebook on February 15th, 2010.

The inspiration behind the Emeritus “Lifetime of Love” contest comes from sharing the personal stories and journeys of many of the residents who live at its 316 communities across the country. Among the residents who have shared their heartwarming love stories with Emeritus are four Garden Grove, CA couples who are scheduled to renew their wedding vows at Emeritus at Garden Manor community in a group ceremony on February 12th, 2010.

I remember when my father was trying to select a Florida senior living facility. The process was frustrating (which is in part why I created Florida Senior Living Advisor) and tiring – driving around from one senior facility to the next, trying to keep track of the different features, costs, options, etc. By the time he had made his decision, we were both a bit worn down and just ready to be done with it. In actuality, that was the time we probably should have been at our sharpest – focused on reading every bit of fine print before he signed on the dotted lines. Yes, we did read over the pages and pages of paperwork very closely; but I’m not confident that we truly scrutinized every point, and we certainly didn’t have it independently reviewed by an attorney.

Thus far, my father has not had any issues, and (knock on wood) I don’t foresee any in his future. But when I came across this article from The Washington Post about contracts at continuing care retirement communities, I figured it was worth sharing. It makes reference to a specific CCRC in Northern Virginia, but the concepts are universal.

Scrutinize any contract to avoid nasty surprises at continuing care community

By David S. Hilzenrath

If you are considering moving to a continuing care retirement community, you would do well to consult a lawyer and read the fine print of any contract to determine whether the potential benefits outweigh the risks. A “Residence and Care Agreement” for Ashby Ponds, an Erickson community in Ashburn, illustrates some of the trade-offs the decision could entail.

You might be drawn to Ashby Ponds by the potential to avoid another disruptive move when you are least able to cope with it, but there is no guarantee you would be able to move to an assisted-living or nursing facility on the same campus — even when those facilities are completed. If the assisted-living and nursing home beds at Ashby Ponds are full, management could arrange for you to go elsewhere.

Some delay in building those facilities is routine at Erickson developments, said Ronald E. Walker, chairman of a nonprofit group associated with Erickson campuses. Though Ashby Ponds opened in September 2008, the assisted-living and skilled-nursing portions were not expected to open until the end of 2011 or the beginning of 2012, according to a May report from the community’s management.)

The deposit you post to move in does not limit the amount you could be required to pay on a monthly basis; management can raise the monthly fees. In addition, the fees can go up as you move from one level of care to the next. At Erickson communities, the average monthly fees range from $1,750 for singles in independent living to $5,178 in assisted living and $307 per day — as much as $9,517 per month — in the nursing homes, Erickson spokesman Mel Tansill said.

Management can decide to transfer you to a higher level of care. If you refuse to go, management can kick you out and hold on to your deposit until 60 days after it finds a new tenant. To gain admission to the community, you have to pass financial and medical reviews. If you marry a nonresident, your new spouse would have to pass such a review before being allowed to move in.

To reassure management that you have the ability to pay expenses, you must agree not to give away any assets that would bring your net worth below a minimum requirement. Evan H. Farr, a Fairfax lawyer who specializes in issues facing the elderly, recommends putting any extra assets in an asset protection trust before you move in.

Unlike a real estate investment, the deposit you post to enter the community does not grow as property values rise. But it can shrink as property values fall. If it takes management a long time to replace you, you may be offered the option of accepting a smaller payout so that management can in effect cut the price of admission for the next tenant to occupy your apartment.

If an elderly family member suffers from hearing loss, here is something you need to know: Florida Telecommunications Relay, Inc., (FTRI) will provide specialized phone equipment for them at no cost. FTRI is a statewide non-profit organization that provides this equipment as mandated by the Florida Legislature. The program is funded by an 11 cent surchage on all landlines in Florida. And these phones can be used in private residences, or in Florida nursing homes, Florida assisted living facilities, and Florida continuing care retirement communities.

And now FTRI has added a cordless amplified phone to its mix of available equipment. The Clarity W425 Pro amplifies incoming sounds up to 45 db.

Clarity W425 Pro cordless amplified phone

Permanent Florida residents who are certified as having a hearing loss can easily obtain the W425 Pro by completing an application and visiting one of FTRI’s 22 conveniently located distribution centers throughout the state.  For more information, call FTRI at 1-800-222-3448 or visit www.ftri.org. 

“FTRI aims to provide individuals with hearing loss a telephone solution like the Clarity W425 Pro,” said James Forstall, FTRI’s executive director.  “The majority of the people we serve are senior citizens and the Clarity W425 Pro is a device that may assist them with communicating with others on the telephone.”

 FTRI estimates that nearly three million Floridians experience some degree of hearing loss. Along with amplification technology, the W425 Pro contains large backlit numbers, a bright visual ringer, and is hearing aid compatible. 

 “FTRI is an outstanding program which helps so many people throughout Florida,” said Carsten Trads, president of Clarity.  “Hearing loss is a serious, yet often overlooked issue.  Many people are not aware that solutions like amplified telephones even exist.  Thanks to FTRI, hopefully more people in Florida will take the necessary steps to address their hearing loss and consider using amplified telephones.” 

FTRI also offers equipment for Florida residents who are deaf,  blind or speech impaired. Many other states have similar free programs.  Visit the Telecommunications Equipment Distribution Program  Association to learn more.

Sunday, October 18, life threw me a curve. My elderly father fell in his Florida senior living apartment and dislocated his hip. That triggered a series of events – a trip to the ER to have it put back in place, his release that same night to come stay with me, a second hip dislocation followed by a  second re-location. Then six nights in the hospital to run tests,etc.  He is now back in his Florida continuing care retirement community apartment and gradually re-gaining his strength. So I thought I would share the top ten things I learned in this last week of helping my father recover from this fall:

1 – At any age, life can change in an instant.
2 – Healthcare workers are just like the general population – some are nice, some are not so nice; some are highly skilled, some are mediocre; some genuinely care, some are just doing a job. We shouldn’t make them “God-like,” nor should we start with the mindset they are all incompetent (like my dad is prone to do).
3 – Communication is critical when in the hospital – both from the patient to staff and from the staff to patient. I find nothing puts me, and my father, more at ease then feeling like the medical staff is keeping us up-to-date on his situation; and nothing was more frustrating then having to walk around begging someone to tell us what is going on.
4 – Nothing happens fast in the hospital. Patience is key.
5 – You must be an advocate for yourself, or for your loved one if you are their caregiver. Ask questions, ask for clarification, ask to see test results, ask “What would you do if this was your father?” Don’t be afraid to push a little. I had to call my father’s nurse to say “He would really like to shave, can you help him do that?” and “He has been lying in bed all day, can someone please get him up to walk the halls?” The squeaky wheel gets the grease.
6 – The whole experience of being hospitalized can be confusing and frightening, particularly for the elderly. In my elderly father’s case, anything outside of his normal daily routine causes some confusion. So suddenly being in a hospital, with no familiar faces, a different schedule for meals, none of his personal effects, etc., left him confused and a bit angry. I had to remind myself that his anger was just an expression of his confusion and frustration at the situation and at having to rely on everyone else.
7 – When caring for an elderly family member, remember to care for yourself too. It has taken me a long time to embrace this concept. When my father had a similar fall last year, and was hospitalized for a couple of weeks, I was constantly wracked with guilt if I was not by his bedside 24/7. I have finally learned that is not necessary for him , and not healthy for me. And actually I have found that by taking breaks, I have helped him re-gain confidence that he can do things for himself.
8 – Health insurance & Medicare rules are confusing and can sometimes be an overriding factor in determining care.
9 – When dealing with a variety of care providers (physical therapists, home health, rehab facilities, etc), don’t lose sight of the fact that they are all in business and that factors in to their recommendations.
10 – Getting old is not for sissies (credit goes to my husband for that one).

Most of Florida’s senior living facilities are concentrated around the state’s largest cities: Miami, Orlando, Tampa and Jacksonville. The Palms of Sebring is an exception – thriving for the past 50 years in the tiny town of Sebring, Florida. Located about 90 miles due south of Orlando, far from any interstate, Sebring is a small town in the middle of the state. And location is not the only thing that makes The Palms unique.

Tower apartments at The Palms at Sebring

The Palms of Sebring is Highlands County’s only retirement community offering three levels of living – independent living, assisted living and a nursing home. This senior living facility has approximately 70 units each in independent and assisted living, and 120 beds in the nursing home.

While many Florida continuing care retirement communities such as this require a large, up-front community fee, The Palms of Sebring only charges new residents a one-time fee of $750. After that, independent living residents choose whether to live in the full-service Tower apartments, where monthly rent starts at $1689 and includes utilities, all meals, housekeeping, and transportation; or the Poinsettia apartments, where monthly rents starts at just $901 and does not include meals or housekeeping. Recreational activities and wellness programs are included for residents in both buildings. Another unique feature of The Palms is that they do allow residents to have pets – cats and dogs in the Poinsettia Apartments and cats only in the Tower Apartments.

In addition, the dining room is open continually from 7am – 6pm. “So if you want a steak dinner at two in the afternoon, you can have it,” explains marketing director Janice Roberts. “Our executive chef is wonderful.”

Roberts also told me The Palms has a home health agency that provides services to residents in their Palms apartments, and also to individuals who do not live on property.

To learn about this Florida senior living facility, visit The Palms at Sebring. To search for other senior living facilities around Florida, visit Florida Senior Living Advisor.

Today’s “Friday’s Featured Facility” is The Veranda of Pensacola, a Florida continuing care retirement community. This means that The Veranda offers both independent living and assisted living options, which allows elderly residents to “age in place” – ie – transition from independent to assisted living as their needs increase.

According to their website, the apartments at The Veranda retirement community are spacious, modern and well-equipped one and two bedroom units with fully equipped kitchens.  Utilities and expanded cable TV are included. The amenities at The Veranda include common areas inside and out, an indoor heated pool, fitness center, and a own stadium seating movie theatre.

The Veranda provides housekeeping, linen and laundry service, scheduled transportation for independent residents and coordination of transportation for assisted living residents, a personal emergency response system and maintenance inside and out. The Veranda also has 24-hour camera surveillance.

The dining service provides a healthy breakfast, lunch (main meal of the day) and light meal in the evening. When it is time for community outings, shopping and personal appointments, the professional staff at The Veranda retirement community will schedule the necessary transportation.

The Veranda is just one of many Florida continuing care retirement communities. To see a complete list, searchable by region, visit Florida Senior Living Advisor. The database also includes assisted living facilities, nursing homes, adult day care centers, independent living communities, hospice and skilled nursing units.

The Florida Department of Children and Families is investigating an alleged case of sexual abuse of an elderly resident at a Jacksonville nursing home. The Jacksonville Sheriff’s Office arrested 35-year-old Anthony Mgugua Njorge early Sunday morning at Regents Park nursing home. He is charged with sexual battery on a mentally impaired and physically helpless victim.

The latest inspection report of Regents Park, conducted by the Florida Agency on Health Care Administration in August, gives the facility just one star out of five in most categories. According to the AHCA website, “The fewer stars a facility receives, the more the facility was found to be in noncompliance with the regulations governing nursing homes.” The Federal Centers for Medicare and Medicaid Services also publishes a Nursing Home Compare web site that provides additional information to compare nursing homes in Florida and the nation.

In this particular incident, a witness told police she heard something from one of the rooms, and when she went in she saw Njorge engaged in a sexual activity with a woman in the room. The woman is disabled.The witness told police she reached for her cell phone, but Njorge tried to stop her.She was able to make a call and someone else came into the room. That witness told police she saw Njorge cleaning up and then throw something in the disposal room.

DCF Spokesperson John Harrell says his agency has investigated eight allegations of abuse at Regents Park in the past year, though none have been verified.

“Of those eight reports, four showed no findings, but four had some findings, including inadequate supervision [of patients]. That happened a couple of times,” Harrell said.

Njorge also worked at Life Care Center, another Southside nursing home. DCF is now looking into whether the attack is an isolated incident.Police are withholding any further information due to the nature of the crime and the investigation. Njorge remains in jail on a $500,000 bond.

Florida Senior Living Advisor offers a complete searchable database of all senior living facilities in Florida, including nursing homes, assisted living facilities, adult day care centers, skilled nursing units, independent living, continuing care retirement communities and hospice. As part of your research on particular facilities, you can check their rating in the AHCA guide; of course, you should always visit and inspect a facility in person before making such an important decision.

I’ve heard from many people lately who are just beginning their efforts to help a loved one select a Florida senior living facility. They tell me they feel overwhelmed and are so afraid of making a wrong decision. While every situation is unique, there are some standard ideas and steps that I suggest, including:

• Determine what type of facility the person needs. You can read my definitions to learn the differences between nursing homes, skilled nursing units, assisted living facilities, continuing care retirement communities and adult day care centers. In general, most people hope to retain as much independence as possible. (An increasingly popular option is in-home care. I’ll write more about a great home care company located in Central Florida in one of my next blogs.)
• Decide what part of the state of Florida your loved one is interested or willing to live. I’ve divided my database into the following regions: Panhandle, North Florida, Central Florida, Central Gulf Coast, Southeast Coast, Southwest Gulf Coast, South Central Florida. You can also look at my map to understand where those regions are.
• Conduct a search of the Florida Senior Living Advisor database, based on your answers to the above two questions. If a facility has a website, I provide a direct link to it from the database. So look at the facility’s website to get more information. Of course, keep in mind that some of these Florida senior living facilities provide very detailed information on their websites, others do not. If a facility you are interested in does not have a website, you will need to call to get more information.
• Look at Florida Senior Living Advisor’s “Evaluating Facilities” page for a list of the questions that I asked – and some I wish I had asked – as I was researching facilities for my elderly father. The answers you receive can help you start to narrow down your list of options.
• Of course a big deciding factor is cost. This will vary greatly from facility to facility.

And don’t forget good, old-fashioned word-of-mouth. Talk to friends and neighbors. This is what lead me to help my father find the perfect facility – a casual conversation at a social event with an acquaintance I had not seen in several months. When she asked, “What’s new?” I proceeded to explain how I was immersed  in helping my father select a Florida senior living facility. She responded by telling me about a facility she had just visited with her elderly mother. And the rest, as they say, is history.

One more idea: if you feel like you need more help, someone to walk you through the process, consider hiring a senior care management company. I  recently met a wonderful woman named Patrice Antony who owns and operates Elder Advocates, Inc. in the Orlando area. Patrice is a Physical Therapist and Geriatric Clinical Specialist with more than 27 years of experience in working with the handicapped and the elderly. Patrice and her staff will do as much or as little as you need – from helping you research and select a senior facility, to consulting with medical staff on a client’s behalf, and negotiating with insurance companies. For more information, visit the Elder Advocates website.

I’d love to hear back from anyone currently going through this search process for an elderly family member. Comment on this blog or send  me an email at mitra@flseniorlivingadvisor.com.

There are two things I know my 84-year-old father will always have in his pocket: a toothpick and a wad of bills. Like many elderly people who grew up in a different era, his preferred form of payment is cold hard cash. Over his lifetime, he has used credit only sparingly and I don’t think he has ever had a debit card (no matter how hard I try to explain that it is like using cash, he doesn’t buy it). Since he moved into a Florida continuing care retirement community about a year ago, I have been a little concerned about him keeping too much cash on hand. Thankfully his building has a Bank of America branch right in the basement. Not only does it give him peace of mind to know that he has easy access to his money, but I think it also helps preserve his sense of independence and dignity, especially since he no longer drives. 

I got to thinking about this after reading last week that an employee of a West Palm Beach nursing home has been arrested for stealing more than $2300 from an elderly resident. The employee, Natasha Petit-Homme was an admissions clerk at Woodlake Nursing and Rehabilitation Center in West Palm Beach.  According to Florida Attorney General Bill McCollum, Petit-Homme gained access to the victim’s checkbook, wrote herself a check for $2,341 and deposited the funds into her personal checking account. Petit-Homme is charged with one count of exploitation of an elderly person, a third-degree felony. She faces up to five years in prison and a $5,000 fine if convicted.

I don’t know anything about this victim’s capabilities or her situation, but I have to wonder why a nursing home resident is keeping a checkbook. These are sensitive issues, I know. As I have seen with my father, control of one’s finances is an important part of maintaining dignity and holding on to some independence. And as I have also seen with him, things can change rapidly for the elderly. Someone who is sharp-minded and on top of things today can go downhill in a matter of weeks or even days. Maybe the best we can do for our loved ones who are in senior living facilities is to be aware of these issues, discuss personal security with them and look out for changes in their mental abilities that may warrant a change in their responsibilities.

The arrest in this case resulted from an investigation by the Attorney General’s Medicaid Fraud Control Unit’s Patient Abuse, Neglect and Exploitation (PANE) team. According to their website, the AG’s Medicaid Fraud Control Unit investigates fraud committed by health care providers, and it also investigates the abuse, neglect and exploitation of the elderly, ill and disabled residents of long term care facilities such as nursing homes and assisted living facilities. If you want to report fraud or abuse, you can call the statewide hotline number or contact the Medicaid Fraud Control Unit nearest you:
The statewide hotline number is 1-866-966-7226

Tallahassee (850) 414-3300

Orlando (407) 999-5588

Tampa (813) 287-7940

Ft. Lauderdale (954) 712-4600

Miami (305) 377-5441

Jacksonville (904)-858-6919

Ft. Myers (239) 338-2442

West Palm Beach (561) 837-5000

Pensacola (850) 595-6057

While I was on the AG’s website, I noticed that they also provide a link to a new brochure, “Smart Consumers Can Stop Fraud: A Guide for Seniors.” The information in the brochure provides valuable guidelines and steps for consumers to take to protect their interests, as well as information on tools designed to save money, especially in the important area of prescription medication.