The Elder Care Reality Check

Debt Ceiling Cuts May Cause a Problem for Seniors

The recent debt ceiling cuts are expected to hit doctors, hospitals, nursing homes, and home health care agencies. According to the latest information, there may be up to a 2% cut to service providers.The idea seems to be that the cuts will hit the providers as opposed to cutting out actual benefits to seniors. If your doctor decides to quit taking Medicare for insurance, what will you do?

Here are a couple of questions to ask your doctor: 

1. Will you be willing to keep me as a patient under Medicare if you quit taking new Medicare patients?

2. If you are thinking about cutting out all Medicare patients, how much notice will you give me?

You should also plan to write letters to the soon-to-be established bipartisan Congressional committee members. They are supposed to make even more cuts by Thanksgiving, and they may will impact Medicare consumers directly. Write and give them a piece of your mind.

Most federal employees have benefits other than Medicare, so they may not be quite as sympathetic as you may expec; they don't have to worry about it in the same way. Here's a graphic portrayal of this information gap, from the Kaiser Family Foundation: Reality for Seniors. 

A good site to help you keep up on things is The Kaiser Health News Daily Policy Report.

Speaking Up for Elder Abuse Victims and My Trip to Washington, D.C.

On June 15th, I was honored to be invited to speak about elder abuse issues along with several other notable speakers from around the nation, including Kathy Greenlee, assistant secretary for aging, U.S. Department of Health and Human Services; Joye Frost, acting director of the office for victims of crime, U.S. Department of Justice; Robert Blancato, national coordinator, Elder Justice Coalition; and Latifa Ring, founder, National Elder Abuse and Guardianship Victims Taskforce for Change. The bipartisan Congressional Victims' Rights Caucus hosted the event at the U.S. Capitol Visitors Center in honor of World Elder Abuse Awareness Day.

Congressman Poe (R-Texas), co-chair of the caucus, acknowledged the growing incidence of elder abuse and the importance of increasing awareness and responsiveness. The briefing examined how elder abuse is being addressed, its substantial cost and what steps need to be taken to more effectively prevent elder abuse and address the needs of elder abuse victims.

At a time in our world when many people are suffering from natural disasters, oppression by their own governments, painful poverty,threatened financial security and overall great uncertainty, I must commend Congressional Representatives Ted Poe (TX) and Jim Costa (CA) for formally and respectfully making such a special effort to keep Elder Abuse on our radar. It was clear by the completely filled room, that there is a lot of interest in ending elder abuse and that is very meaningful to those of us that spend our careers trying to make a difference in the lives of others.   

On Tuesday, June 14^th I participated in coordinating a listening session at the Rayburn Building where 30+ individuals spoke skillfully, truthfully and poignantly about their dreadful experiences within the probate courts around the nation. The theme that was consistent throughout all of their cases was that professionals (Attorney & Fiduciary types) are making millions while violating the rights of the most vulnerable, while the Judges condone these activities and that crimes are being committed without accountability. 

Their testimony was shocking and compelling and I was glad to be part of the effort to further expose the need for national attention to be brought to these tragic stories. People came from 17 different states to tell their stories and the session was well attended by legislative staffers. As a result, Rep. Poe is calling for national attention on this issue. Take a look at this article to get a sense of what was happening last week with this group. http://blog.chron.com/txpotomac/2011/06/rep-ted-poe-texas-advocates-urge-guardianship-reform-to-prevent-elder-abuse/.

For more information on the National Organization to End Guardianship Abuse: http://www.stopelderabuse.net/index.htm. Here is the link from the Office of Public Engagement, which talks about the perspective from the White House.http://www.whitehouse.gov/blog/2011/06/13/taking-stand-against-elder-abuse.

 

 

 

Understanding the Long Term Care Insurance Market

Featuring our guest blogger Leslie Whiting

Right around age 50 we start to have the inevitable experience of a declining parent or loved one. It wakes us up:  

What am I going to do when that time comes?

Who will take care of me?

How will I pay for it?

Will the government help?

What about long term care insurance?

Let's face it, there is much uncertainty these days. How can we feel secure in today's insurance climate? Long Term Care (LTC) insurance is only popular because it is the lesser of all evils. The last thing we want to do is buy more insurance. However, if we want to ensure that we don’t deplete our life savings and wind up on MediCal, that we will be able to keep our homes, to receive quality care in our homes when we need it, and not burden our loved ones, LTC insurance can be the best solution…that is, if it is affordable and you buy the right plan.

Most companies offering LTC insurance are life insurance companies, with names that are probably very familiar. But just because we have heard their name is not enough—they may have been selling life insurance for 100 years, but that does not mean they are qualified to sell LTC policies. Here are some things to watch out for:

Make sure the company (or risk pool) has been offering LTC insurance for 20 to 30 years, long enough to actually have claims experience—not just experience signing people up.

Make sure they are "A" rated, by any of a variety of rating organizations.

Make sure they do not have a history of raising rates to existing policy holders.

Ask your agent (if you have a good relationship with one) how conservative the company (or risk pool) has been in underwriting applicants on a health basis.

Ideally, buy your plan as young as possible (40's and 50's) before you have any health conditions that preclude or limit who will insure you. Then you can choose the better risk pool to insure with. Every additional year you wait, you are not only older and have more health conditions that make the insurance more expensive, but the cost of care has also gone up. That means you will need to buy more coverage initially. Also, every year or so, the leaders in the industry put out new products that are more expensive for new applicants. This is a way to keep the premiums stable for existing policy holders.

Good solid Long Term Care insurance carriers have decades of knowledge of what conditions lead to claims; they have their own statistics. They are looking for healthy younger people who hopefully will pay for a long time, a smart and healthy strategy for them and for you: you want your insurance company  to be around when you need care. If you pay premiums for 30–40 years and don't need care for a long time, you are actually fortunate. And if you buy inflation protection, the value of your policy will keep up with the cost of care—those 30 years of premiums could equal less than a year of care.

Of course one would not buy LTC insurance only for these reasons. Most people only buy if they think they can save money over the long haul. Furthermore, people realize they risk being uninsured in case of a disablement or a health condition they were not planning on. This can be hard to swallow when we are all accustomed to thinking ‘It won't happen to me.’

To sum up, sit down with an experienced LTC adviser who represents more than one company, an adviser who will take the time to understand your financial situation, in order to help you look at it squarely so you can see how the insurance can remain affordable as time goes by.

The good news is that good quality LTC insurance does not restrict where you receive your care or dictate where you go. It gives you a pool of money to spend where you choose. The ideal is to buy enough insurance that will handle the cost of care in 30 years without over-insuring in the meantime. An experienced agent who takes the time to get to know you, understands your situation, and with whom you have a trusted dialog can be one of your most needed advisors.

Leslie Whiting has been counseling clients on long term care issues, insurance and annuity products since 1997. She lives in Corte Madera, and helps people all over California. She can be reached at 866-446-5824.

 

 

 

Living with Alzheimer's - caretaker perspectives

Thanks to the Alzheimer's Association for alerting us to a great news package in USA Today on Alzheimer's.  Here's a couple of excerpts: 

For the nearly 11 million family members and friends who, according to the Alzheimer's Association, now care for a loved one with the disease, coping with a diagnosis differs greatly from family to family as the disease progresses, says Beth Kallmyer, senior director of constituent services for the Alzheimer's Association in Chicago.

"The reality is it's different for everybody. The way it impacts caregivers depends on the relationship they had with that person before," says Kallmyer, who adds that the non-linear progression of the disease is most challenging.

More insight into caregivers' challenges: 

Kathy Hatfield, 40, lives outside Winston-Salem, N.C., and cares for her father, Lyman, 81. She says humor and patience help her navigate the ups and downs of living with a dad who has had Alzheimer's for 11 years.

..."The patient can't choose whether or not they get the disease, but the caregiver can choose his or her attitude. I truly do believe that. Everyone has some 'down' times, but if you let the down times in too frequently, then Alzheimer's wins."

Along with all this great information, let's not forget that Alzheimer's is only one of many kinds of dementia that can afflict aging family members, and an accurate diagnosis by a physican trained in geriatric medicine and/or neurology is essential. Too often, Alzheimer's is used as a catch-all diagnosis for conditions that can actually require very different treatment and care.

 

Stimulus funds to help with elder care may be on the way.....

When I speak to families who are doing their best to care for their older loved ones, there are two major factors that keep them up at night: The amount of time required to take very good care of their parent(s) and their ability to balance that with the rest of their life responsibilities. Then there is the monetary cost of taking very good care of elderly parents.

If they have to deal with only one of these issues at a time they are lucky. One of my clients has been caregiving for both parents for more than five years and has not been able to work the entire time. She has been living on her savings to do this. Most people cannot afford to quit working in order to become a caregiver.

The costs to care for someone in their own home, which most people want, may run $10,000 a month for 24/7 care through an employee-based homecare agency. The cost of assisted living,  depending on need, or a skilled nursing facility may be just as much, although usually a bit less. I don’t know too many people who have that kind of money, month in and month out, year after year, available for their parents, no matter how much they love them.


If a family wants professional and moral support, geriatric care managers (GCM) are a smart choice as long as you have the money to pay for their services. A good care manager will definitely help you sleep at night by reducing the worry and stress that comes with the day-to-day care for loved ones by shouldering these issues themselves. If a family can’t afford private on-going care management services they would be wise to arrange at least a consultation with an experienced GCM or eldercare consultant, of which there are many in the Bay Area.  They also need to become educated about the huge, complex systems they have to navigate, and look for benefits that may help pay for services for their loved ones.


Currently in California caregiver support services have been drastically cut and it is possible under the Schwarzenegger administration that they may be eliminated completely. President Obama’s recognition of this particular stress on middle-class families, until now virtually unnoticed, stands in stark contrast.

One lesson to be learned for baby boomers is that they should seriously consider long-term care insurance for their own aging future.

Greedy Son-Chapter 3-What happened to the money?

Chapter 3

In Chapter 2 the greedy son had just submitted his accounting to the courts for their review. None of it made sense and there was still a lot of paper to get through and analyze. After several more months, the law enforcement chose not to prosecute the greedy son, so they started negotiating a settlement agreement.The point of the settlement agreement was to get the greedy son to agree to terms that would would not allow him to get involved in his mother's estate or financial matters.

You might think that by then would have been relieved that he wasn't going to jail and may have behaved himself, but that wasn't the case.

During this time we were helping mom with all her medical needs, paying her bills and trying to get all of her accounts back into her name and the Trust.

During a short period of time when we had to transfer his still competent mom to a skilled nursing home for rehabilitation for a couple of weeks the son started again. I had reason to believe that the son was trying to gain control of his mom's estate again so I asked our Nurse Care Manager to visit our client and specifically review her medical chart. When she did she found a copy of that original letter from the doctor (which had been deemed invalid two years prior by a Judge) in the chart (as submitted by the son) along with a new doctor's note that the son had requested new medication because his mother's Alzheimer's condition had been worsening. The doctor started her on new medication based on the letter and the son's request.The son also wrote up a letter to terminate our services and had his mom sign it, so that we no longer had the authority to act on her behalf.

I notified all authorities immediately and pushed everyone to intervene. Their response was pathetic. The facility itself recognized what was happening, but since the Ombudsman didn't act and the law enforcment  didn't act, nothing more happened. Then she disappeared....

Look for Chapter 4 tomorrow-What Happened to Greedy Son and His Mom?

Greedy Son-Chapter 2-Will he go to jail for doing bad things?

Chapter 2

In Chapter One our client was trying to move into a more appropriate living situation like assisted living. While taking our client to see a new apartment she confessed to me that every night she was in the Alzheimer's facility that she willed herself to die every night before she went to sleep. You need to understand that the type of people she was living with were in moderate to severe stages of Alzheimer's disease, which is why the facility was a secure unit. I couldn't blame her for wishing to die every night.

So our client was now living in a lovely apartment in an assisted living building and getting adjusted to her freedom and enjoying different activities. Her son had been restricted to only have limited involvement with his mom and was forbidden to handle her estate, etc.

Remember that law enforcement had an open investigation on the son. All the evidence was there to show what he had done. Even during my initial meeting with the son, he told me everything he had done and I had taken very good notes to support what he told me directly, so from a prosecution point it was really a matter of a paper trail.

Well, paper trail schmaper trail. The son refused to spend his time and money to obtain all the relevant documents, so his mother had to rely on law enforcement and pay for our time to get copies of this evidence. One might have thought that the son would have been pretty worried about going to jail and would cooperate fully. Not the case and the courts let it happen.

So, we spent months and months and months gathering the documents as did law enforcement. An analysis of the accounting still needed to be submitted by the son. It  was finally submitted and it was worthless. Hmm, so maybe the son was going to go to jail for doing bad things?

Stay tuned for Chapter 3

Is it really Alzheimer's?

Adult children should know there's a strong tendency among general physicians these days to call everything even remotely resembling dementia "Alzheimer's." The fact is Alzheimer's is one of a variety of different kinds of dementia, all with different manifestations -- if subtle ones -- and different treatments. Even if they get the diagnosis right--and many miss it altogether -- do they know what to do? Usuallly not. Usually, they just prescribe ever-stronger doses of depressants to keep the patient quiet.

This issue was articulated well in a story on dementia on Wednesday's News Hour with Jim Lehrer on PBS. The patient (in his 50s) featured in the story went for two years without a correct diagnosis. One of the country's best known researchers in the field, Dr. Bruce Miller of the University of California San Francisco's Memory and Aging Center, (who correctly diagnosed the patient) put it this way: "In U.S. medical schools there are places where they don't even teach about the frontotemporal dementias and that have minimal teaching about Alzheimer's. These are the most costly diseases in our society, so these really have to be emphasized." There are probably far more cases of dementia than the 5 million currently diagnoses in this country, Miller says. You can download the story as a Quick Time movie, MP3 file, or podcast from the link above.