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Tag: alzheimers
If You Become Incapacitated, Will Your Family Know What to Do?

If You Become Incapacitated, Will Your Family Know What to Do?

Dear Carrie: My friend’s 90-year-old mother was just diagnosed with early stage dementia. Unfortunately, she never provided any written or verbal guidance about her wishes for care, so my friend finds herself in a very tough spot. I want to make sure this never happens to me or to my loved ones. What do we need to do to prepare? — A Reader

Dear Reader: Contemplating the possibility of dementia is tough, whether you’re talking about yourself or a loved one. We want to think that it only happens to the very elderly, someone in their 90s such as your friend’s mother. And so we put it off. But according to the “2014 Alzheimer’s Disease Facts and Figures, Alzheimer’s & Dementia” report by the Alzheimer’s Association, one in nine Americans age 65 or older have some form of dementia. And the annual number of new cases of Alzheimer’s and other dementias is projected to double by 2050. It’s scary. It’s sobering. And to me, it means there’s a real need to confront this possibility — and prepare for it — when we’re young and clear-headed enough to look at financial and healthcare decisions from a practical as well as an emotional perspective.

Your friend’s situation is a heartbreaking example, and you’re very wise to take steps now to prevent this from happening to you and your family. But no matter how forward-thinking you are, it won’t be easy. You may be willing to face the possibility of incapacity, but others may not be so comfortable with the idea, either for you or for themselves. So you may have to tread gently. Here are some thoughts on how to go about it.

Think Realistically About Care Options

Exploring care options for someone with dementia is more of a challenge than with other diseases. That’s because, while there is certainly the need for doctor’s visits and medications covered by insurance, a lot of the care required by people with Alzheimer’s or other forms of dementia involve more personal care, called the activities of daily living (ADLs). Where do you turn for help with eating, bathing, dressing or just making sure you don’t injure yourself? These things aren’t generally covered by health insurance.

Again, according to the report from the Alzheimer’s Association, unpaid caregivers such as family members provide billions of hours of care. Professional care is available, such as assisted living, in-home care or adult daycare centers, but the costs can be a challenge. For instance, basic assisted living services average about $42,000 per year according to alz.org as of 2015. And that’s just the estimated average. I recently spoke with someone who was paying $12,000 a month to have both parents in assisted living with full care.

Your own family and financial circumstances may well determine what care might be available to you or to a loved one. But whether you’ll have to rely on professional assistance or you have a supportive family network that can provide help, be aware that you’ll be dealing with potentially significant emotional as well as financial costs.

Plan for the Financial Side

There’s a whole list of costs you may have to deal with from ongoing medical care, to home safety related expenses to full residential care.

Most insurance policies don’t cover nursing home care or help with ADLs. And while Medicare covers some skilled home health care such as skilled nursing care, long-term care isn’t covered. Medicaid is a possible solution, but it’s only available when an individual has depleted most of their personal assets.

Unless your family has significant assets to self-insure, you may want to look into long-term care insurance. Here, too, you have to be cautious. Not every LTC policy covers Alzheimer’s. And you want to make certain that a policy covers things like assisted living, skilled nursing home care and licensed home care.

There are, of course, other financial options. People with a lot of equity in their homes may see that as a potential source of funds. Others may max out a health savings account (HSA) every year and keep it in reserve for this type of care. Your retirement funds can also be a significant resource.

Talk to Your Family About the Emotional Side

Once you’ve thought through potential practical solutions, talk to your family. Be upfront about why you’re bringing up the subject. Your friend’s story could be a good starting point.

If you’re talking to your parents, they may welcome the chance to discuss their own fears and desires. Your children may be more resistant, but make it clear that you’re not being morbid, just realistic. And no matter what response you get, be willing to listen to everyone’s concerns.

Put Your Paperwork in Place

Basic paperwork includes an advance healthcare directive, power of attorney for healthcare, a will and/or trust, and a durable power of attorney for finances. You’ll find more specific information on legal documents for someone who’s incapacitated at alz.org.

There’s no one solution for every family. But thinking about it and planning ahead is something everyone should do. It also would be a good idea to consult with your financial advisor about the best way to prepare financially given your personal circumstances. I applaud you for being willing to tackle this very difficult subject.

Carrie Schwab-Pomerantz, Certified Financial Planner, is president of the Charles Schwab Foundation and author of “The Charles Schwab Guide to Finances After Fifty,” available in bookstores nationwide. Read more at http://schwab.com/book. You can email Carrie at askcarrie@schwab.com. This column is no substitute for individualized tax, legal or investment advice. Where specific advice is necessary or appropriate, consult with a qualified tax adviser, CPA, financial planner or investment manager. To find out more about Carrie Schwab-Pomerantz and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate website at www.creators.com. COPYRIGHT 2015 CHARLES SCHWAB & CO., INC. MEMBER SIPC. DIST BY CREATORS SYNDICATE, INC. (1215-7257)

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This Week In Health: Tipping Point With ‘Superbugs’

This Week In Health: Tipping Point With ‘Superbugs’

“This Week In Health” offers some highlights from the world of health and wellness that you may have missed this week:

  • Experts say we are at a tipping point with antibiotic-resistant bacteria — so-called “superbugs.” Due to the massive overuse of antibiotic drugs, pathogens are becoming increasingly immune to available treatments, posing a huge potential public health risk. The Food and Drug Administration is taking steps to curb the widespread use of antibiotics in livestock in an effort to mitigate the spread of these unkillable microbes.
  • A link between obesity and Type 2 diabetes has already been quite well established for some time. A new study published in mBio sheds new light on the precise mechanism: Type 2 diabetes is possibly caused by bacteria that become more prevalent in the bodies of people who gain weight. What this means in practice is that doctors may have a way to intercede and affect the course of Type 2 diabetes, by targeting the bacteria.
  • New research suggests that poor sleep in old age may be linked to the development of Alzheimer’s Disease. The findings imply that insufficient deep sleep contributes to “a reduced ability to cement memories in the brain over the long term, resulting in greater memory loss,” according to researchers.
  • The tragic loss of 46-year-old Beau Biden to brain cancer has brought renewed attention to brain tumors, an often lethal and not fully understood form of cancer, and to developing new and more effective treatments in the fight to cure them.

Photo: NIAID via Flickr

Take Time To Pick The Right Long-Term-Care Facility For A Parent

Take Time To Pick The Right Long-Term-Care Facility For A Parent

By Kimberly Lankford, Kiplinger Personal Finance

When Donna Braley was 79, her family started to notice she was having trouble doing things that she’d always loved to do — crocheting, cooking, doing crossword puzzles. Because her children lived in different states, it took a while for them to piece together their stories and realize that their mother needed help.

The family hired a geriatric care manager, and “her assessment made it obvious to us that Mom would soon no longer be able to live at home without full-time caregiving,” says daughter Kathi Dunn.

The family moved Braley to a semi-independent apartment in a locked Alzheimer’s facility in Roseville, California, near her son Scott and his wife, Amy. But after she was there for a few months, she became combative and difficult to manage. They found another Alzheimer’s facility, “but it was too large,” says Amy. Braley would roam the hallways and go in and out of other people’s rooms, disturbing their belongings.

When money started to run short, the family searched for another option. They heard about a 15-person facility that focused on dementia, which seemed like a better fit and was less expensive. The third time was the charm.

For the past two years, Braley has required total care and uses a wheelchair full-time, but staff at her new home have found ways for her to be as active as possible. When her grandchildren visit, they play in the backyard as if it were Grandma’s house, and the residents’ families watch out for one another.

Start the search

When it’s time to get extra care for your parents, you may be forced to decide quickly, especially if your parent has been in the hospital and needs extra help as soon as he or she is released.

“You’re making a traumatic and important decision under pressure,” says Byron Cordes, a geriatric care manager with Sage Care Management, San Antonio, Texas. “The hospital may say you need to move your dad by the end of business today, then just hand you a magazine about senior-living options and say, ‘Good luck finding a nursing home.'”

Cordes recommends taking the time to find out exactly what your parent needs. That often means talking to the staff doctor, social worker, nursing personnel, case manager and discharge manager. It may mean hiring a geriatric care manager to help coordinate the various care providers.

It can be challenging to balance quality and cost. The median price of a private room in a nursing home tops $6,900 per month, and assisted-living facilities cost more than $3,400 per month, according to the Genworth 2013 Cost of Care Survey. So unless your parents have long-term-care insurance, they — or you, if you’re helping pay the bills — may not be able to afford the ideal setting for long. Medicare covers very little long-term care, and most people aren’t eligible for Medicaid until they’ve spent most of their money.

Now new resources can help you make the decision.

“The landscape has changed for senior housing,” says Andy Cohen, CEO of Caring.com, where people share reviews of nursing homes and assisted-living facilities. “Some are more like college dorms for seniors, with good food, transportation and activities. A lot of children feel guilty, but after they visit these places, they say that Mom’s healthier and happier.”

Assisted living in many cases can take the place of nursing-home care, at least in the early stages of care, says Sandra Timmermann, a gerontologist in Fairfield, Conn. Some facilities have continuing care, and residents can move to another wing in the same facility if they need more supervision.

You can also hire a caregiver to provide extra assistance in an assisted-living facility so you don’t have to move your parent to a nursing home. People with dementia and Alzheimer’s have many options for memory care.

Medicaid generally covers nursing homes but not assisted-living facilities, so your parents can usually choose assisted living only if they have enough savings or long-term-care insurance. (A few states have Medicaid voucher programs, which allow a limited number of people to use Medicaid money for assisted living; see Medicaid.gov for each state’s rules.)

The Medicare Nursing Home Compare tool assesses more than 15,000 nursing homes throughout the U.S. based on inspections, complaints and staffing ratings. But it doesn’t include most assisted-living facilities, which have different licensing requirements in each state.

You can go to the Eldercare Locator or a local Area Agency on Aging for help finding assisted-living facilities, but these resources don’t assess the services. Review sites, such as Caring.com, let you see others’ experience with the facilities.

Several services can help you with your search. CareScout includes ratings and profiles for more than 90,000 assisted-living facilities, nursing homes and home-care providers. For $495, you can work with a care advocate, who helps assess your needs and narrow the list to three or more facilities to visit; the advocate can also negotiate discounts at the facilities. Many Genworth policyholders get free access to CareScout for themselves or their parents, and some employee-assistance programs include access to similar services.

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Hire a pro?

A geriatric care manager can help you explore your options. Care managers are also familiar with local facilities and benefits programs, so hiring one can be a good idea if your family has multiple siblings or if you’re researching care options from a distance. Go to www.caremanager.org to search for care managers throughout the U.S. They generally charge $100 to $180 per hour and are not allowed to accept finder’s fees from facilities.

Geriatric care managers have made a big difference for Jennifer Russell, of Tampa. Her mother, Margie Yeagley, who lived in San Antonio, seemed to be doing fine living alone after her husband died. But four years ago, Russell realized she needed more help.

Russell asked Byron Cordes, the geriatric care manager, to have Yeagley evaluated and discovered that she had significantly progressed dementia. Cordes found an assisted-living facility in San Antonio with a memory-care unit, and they moved her mother right away. After two years of traveling back and forth between California, where Russell lived then, and Texas, Russell decided it would be easier to move her mother out to California.

Her first step was to find a care manager in California, who helped identify the best facilities and doctors. When Russell’s husband got a new job in Tampa, they repeated the process again. Russell’s mother is now in a memory-care wing of a large assisted-living facility nearby.

What to look for

After you narrow the list to two to five places, visit and ask a lot of questions. And don’t just talk with the marketing people; seek out those providing the care.

“Go completely unannounced and walk in at whatever time of day you can,” says Cordes. “I’ve been in nursing homes when they’ve announced that a tour is coming in. You see the housekeeping staff spraying the halls with Febreze and closing the doors to patients’ rooms.” See how people are treated at mealtime and how they’re treated at 8 p.m.

Next, schedule a meeting with the marketing director to get more details about how the facility cares for residents. Every nursing home is required to have a care plan. What would be in the care plan for your parent? What activities would the facility offer to your parent? How are the residents’ physical needs monitored? Ask about the patient-to-staff ratio (Cordes usually recommends 18-20 patients per caregiving staffer.) What type of specialized training do the staff have in dealing with your parent’s medical condition?

Ask if your parent will get any time outside the facility, especially if he or she is in a locked memory-care wing of a long-term-care facility (some have courtyards).

Ask for a list of the costs, especially for assisted living. In some facilities, you may get a set number of hours of personal care, and you may be charged extra if your parent needs more. After your visit, ask yourself: Is this a place where you would want to spend time? Is it clean? How does it smell? Are the residents showered, with clean clothes? Is the food healthy and tasty? How would your parent fit in with the other residents?

“Does the staff treat the residents with respect or, better yet, like beloved grandparents?” adds Amy Braley.

Things change

Your parent may start out in assisted living but eventually need care in a nursing home. No matter what, monitor your parent’s care with the same critical eye you brought to the selection process. If the place isn’t a good match, don’t be afraid to move your parent to one that feels like home.

(c) 2015, Kiplinger. All rights reserved. Distributed by Tribune Content Agency, LLC.

Photo: More Good Foundation via Flickr

Quick & Healthy: A 1,000-Year-Old Medical Marvel

Quick & Healthy: A 1,000-Year-Old Medical Marvel

“Quick & Healthy” offers some highlights from the world of health and wellness which you may have missed this week:

  • It’s another win for java-junkies: The World Cancer Research Fund found in a recent study that each cup of coffee consumed is correlated with a 14 percent decreased risk for liver cancer.
  • Eating well can halve your risk for Alzheimer’s Disease. That’s the conclusion of a new study that tracked participants’ adherence to one of three diets; those who stuck with healthy eating regimens were less likely to develop Alzheimer’s later in life.
  • An apple a day does not diminish one’s need to seek medical attention, according to a report in the journal JAMA Internal Medicine. That matter settled, researchers are currently refocusing their efforts on understanding whether or not a pot of water being surveilled can, in fact, be brought to boil.
  • A concoction of garlic, wine, and bile, taken from a 10th-century apothecary’s textbook, was found to be effective at stopping an antibiotic-resistant pathogen. These so-called “superbugs” are expected to be one of the major health hazards of the next century; the potion, derived centuries before the development of germ theory, shows promise for combating them.

Photo: Paul Morriss via Flickr