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.

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).

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.

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.

The operators of three separate assisted living facilities in Florida have been arrested, all on charges of operating without licenses. One of the arrests was in Volusia County, the others in Duval County.

In Volusia, officers from the state’s Medicaid Fraud Control Unit arrested Marjorie Nelson, owner and operator of Helping Hands Manor I and II in Edgewater. According to the Attorney General’s office, Nelson told investigators she had not licensed the second location because upgrading the septic system and fire suppression systems would cost too much. Those upgrades were necessary to qualify for a license. Nelson is charged with operating an unlicensed assisted living facility, a third-degree felony. If convicted, she faces up to five years in prison and a $5,000 fine.

In Duval County, officers arrested Tommy Teague and Roberto Gallegos on charges of operating an unlicensed facility at 2198 Mossbrook Court in Jacksonville. Teague and Gallegos face third-degree felony charges and could each face up to five years in prison if convicted.

At the third facility, Medicaid fraud investigators determined through a routine spot-check that Torina Brooks had exceeded the capacity of her licensed facility, Pauline’s House in Jacksonville. Brooks placed the extra clients in an unlicensed facility across the street and requested Medicaid reimbursement for their care. She faces one count of operating and/or maintaining an assisted living facility without a license, one count of Medicaid fraud and one count of grand theft, all third-degree felonies, and could face up to 15 years if convicted of all charges.

To legally and properly operate an assisted living facility in the state of Florida, there are various administrative and operational requirements which must be met. These include licensing procedures, staffing requirements, compliance with county health and local fire authority regulations and the safe management of medication by trained staff personnel.

For a searchable database of licensed assisted living facilities throughout Florida, visit Florida Senior Living Advisor. Licensing status can change, so be sure to ask for proof of licensure when visiting a facility. For more information on the Florida’s licensing process for senior living facilities, visit the Florida Agency for Health Care Administration (AHCA).

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.

The nationally renowned advocacy group, Americas Watchdog, has created the Nursing Home Complaint Center to draw attention to senior citizens suffering wrongful death, abuse and neglect. America’s Watchdog describes itself as a “National Advocacy Group for Consumer Protection and Corporate Fair Play.” It’s the same group that has been helping to lead the charge against allegedly toxic Chinese drywall. They have also received attention for their Mortgage Inspection Service, intended to keep consumers from being cheated or overcharged when they finance or refinance their home.

According to America’s Watchdog,”once our legal team is in place, the Nursing Home Complaint Center will focus weekly press releases on elder abuse, Medicare or Medicaid fraud, Class Actions, or Wage and Hour investigations.”

They are interested in the following issues:

• Nursing homes not providing patients with minimum time per day.
• Nursing homes over billing Medicare for testing that was never done.
• Nursing homes not changing patients for a 24 hour period of time. (the patient then gets septic infections and then they often die)
• Nursing-home care firms that, instead of sending an actual nurse, send a undocumented worker to spend the day with the patient.
• Nursing homes not paying overtime to their employees, or abiding by fair labor laws.
• Possible class issues related to standard of care, drug costs, testing schemes, etc.

I will be interested to see what develops from this group. Unfortunately, I suspect they won’t have any trouble finding complaints against nursing homes to try to splash all over the evening news. Certainly there are many wonderful nursing homes throughout Florida and the entire country that are providing quality care and service to patients. But I also think that in many of these facilities, employees are overworked, underpaid and not monitored closely enough. Maybe just the creation of this complaint center will be enough to get some nursing homes to pay closer attention to safety, quality and customer service.

We’ll see. I’ll report back as I learn of updates from America’s Watchdog.

If you are trying to select a Florida nursing home for yourself or a loved one, here is an information-packed website that you will want to check out – www.medicare.gov/NHcompare/Home.asp

This is the federal government’s Medicare website. One of the most useful tools they provide is their Nursing Home Compare database. This tool has a Five-Star Quality Rating System about every Medicare and Medicaid-certified nursing home in Florida and throughout the country. There are 677 Florida nursing homes in the database.

Here is a description of the rating system for nursing homes from the website:
The Five-Star Quality Rating System helps consumers, their families, and caregivers compare nursing homes more easily and to help identify areas about which you may want to ask questions.

The Nursing Home Compare Web site now features a quality rating system that gives each nursing home a rating of between 1 and 5 stars.  Nursing homes with 5 stars are considered to have much above average quality and nursing homes with 1 star are considered to have quality much below average.  There is one Overall 5-star rating for each nursing home, and a separate rating for each of the following three sources of information:

Health Inspections – The health inspection rating contains information from the last 3 years of onsite inspections, including both standard surveys and any complaint surveys.  This information is gathered by individuals who go onsite to the nursing home and follow a specific process to determine the extent to which a nursing home has met Medicare’s minimum quality requirements.  The most recent survey findings are weighted more than the prior two years.  More than 200,000 onsite reviews are used in the health inspection scoring nationally.

Staffing – The staffing rating has information about the number of hours of care on average provided to each resident each day by nursing staff.  This rating considers differences in the level of need of care of residents in different nursing homes.  For example, a nursing home with residents who had more severe needs would be expected to have more nursing staff than a nursing home where the resident needs were not as high.

Quality Measures (QMs) – The quality measure rating has information on 10 different physical and clinical measures for nursing home residents – for example, the prevalence of pressure sores or changes to resident’s mobility.  This information is collected by the nursing home for all residents.  The QMs offer information about how well nursing homes are caring for their residents’ physical and clinical needs.  More than 12 million assessments of the conditions of nursing home residents are used in the Five-Star rating system.

On the Web site people will be able to arrange the order of the nursing homes according to any of the three aspects above, as well as an overall quality rating based on those three sources of information.