Monday, May 14, 2012

Technological Transitions

Last month I made a decision to change website hosts. My oldest son recently graduated with a technical degree in artistic and graphic design and internet marketing and well, you know... nepotism is alive and well in small businesses. [In fact I think family small entrepreneurships are the wave of the future - but that's another topic] Having seen the computer world explode unimaginably from giant room-sized key-punch card monsters to the tiny laptop I peck on just now, I would have thought that changing website servers would be a seamless operation. Long story short, my professional e-mail is currently down, so I'm directing my readers to use my ever-reliable G-mail account: droidl316@gmail.com -- for the time being. Meanwhile, I'll just have to blog more so that website traffic doesn't suffer seriously. In fact, luckily my website has been searched for so frequently in the past week, it comes up first on the search engines and I received a new client from just what Google has on the search page about me! Map and everything. I like Google. And I'm still glad to be switching to a more modern approach to my website management. Sometimes it takes a new dog to do new tricks that help get the message out that there is help out here for your aging parents. Stay tuned....

Friday, February 24, 2012

ARE YOU LISTENING?

Recently the National Care Planning Council published an article discussing the old adage as we did not listen to our parents when we were teenagers, we are now concerned with convincing our parents to listen to US regarding their present and future care needs.

The article stated, “[Adult children] are finding themselves concerned about their aging parents and what their needs will be as their health and mental abilities fail them. In some cases the children must take the role as parent in securing the safety and well being of an elderly family member.”

I respectfully disagree. Although we are facing a reverse situation wherein our aging parents may not be using what we feel is good judgment, we should never presume to take a parental authoritarian attitude or approach toward our parents. In my experience, you will run up against a very thick brick wall.

While we need to ensure the safety and well-being of our parents and other vulnerable disabled persons in our lives, we should also defend their autonomy and right to self-determination to the furthest extent possible. Approaching an elder with concerns can be done in such a way as to accomplish this. If we try to force our authority and wishes on elders, they will dig their heels in further and become more wary and suspicious of any proposed intervention.

Elders are usually aware to some extent that their functionality is deteriorating. Fear of losing their autonomy can cause them to be very creative in their ability to hide their disabilities. When we call our parents, the conversation frequently sounds like this:

“How are you doing today Mom,” Julie asks? 
“Everything’s fine”, Mother replies. 
“Are you taking your pills?”
“Yes, everything’s fine.”
“Do you need anything?”
“Everything’s fine.”

Julie does not get much more conversation from her mother. Perhaps everything is fine, or perhaps Julie’s mother just wants Julie to think she can take care of herself. Even worse, mother could think all is fine and be forgetting her medication and not eating properly.

Is Julie really listening? ARE YOU LISTENING?

It may be time to put your face in front of your parent and listen. Assuming all is well and your elderly family member knows and does what is best for them, may be putting them at risk.

Rather than becoming authoritarian and considering yourself in a role reversal with you as the parent and they as children, become a partner with them in their care. The best time to form the partnership is before a crisis happens.

Donna Schempp, a licensed clinical social worker and program director at the Family Caregiver Alliance, states when talking with your parents, "The sooner, the better." If you bring up the subject before your parents need any extra support, "then it's not crisis driven," she explains. "It's not a way of saying, 'Mom, Dad, there's something wrong with you.”

A good way to begin this relationship is to sit with your parents and ask questions like, what are your concerns for the future. Do you want to remain in your home? Are you worried about losing your independence? Listen to their answers. You might relate your concerns as well, or your desire to be of help. LISTEN to what is behind their answers. Many elders will not come right out and list their fears; some do not really know what it is they fear. In their generation, most fears have to do with “being put in a home”. Their experience of long term care settings is rooted in the way nursing homes looked and operated several decades ago. They need to be educated about the options now available, and the cost affiliated.

The other part of forming this relationship and becoming a real partner in your loved one’s care planning is to understand what legal and financial arrangements are in place. Begin by asking, “What if you had a stroke, Mom? I need to know where your medical and insurance documents are and what you would have me do on your behalf.”
The next step might include accompanying them to their doctor appointment(s) so to understand the full scope of their medical needs and to be a part of creating a successful plan for future needs.

The National Care Planning Council's book “The 4 Steps of Long Term Care Planning” gives the following list of most common services family care givers will provide for their parents.

Feeding, walking, lifting, bathing
Using the bathroom, incontinence
Pain management
Preventing unsafe behavior, wandering
Providing comfort, assurance, professional counseling
Arranging therapy, meeting medical needs and appointments
Maintaining the household, laundry, phone
Shopping, errands, writing letters/notes
Providing transportation
Administering medications
Managing money, paying bills
Personal hygiene, grooming
Home repairs, yard maintenance

There are many resources available to help families in caring for their elder parents, including your local Area Office on Aging at 419-382-0624. Two great websites include www.longtermcarelink.net/8profiles.htm and www.caremanager.org. As you become involved you will know when it is time to include professional services or when the need to find new living arrangements is necessary. If you are not an expert in long term care planning and, or are having difficulty approaching your parents to begin these discussions, reach out to experts for assistance. Long term care expertise is fast becoming more complex and expansive and without professional involvement you may overlook important available resources.

Plan now to talk, listen and work together, but especially LISTEN – not just to the words that elders use, but to the potential hidden needs and fears that need to be addressed. Education and compassion are essential to promoting good decision-making with regard to long term care planning.

Monday, January 16, 2012

Is Insurance the Answer to Long Term Care Planning?

A recent USA Today article states that there is an increase in seniors
living over the age of 90. According to author Haya El Nasser “The
number of people living to age 90 and beyond has tripled in the past
three decades to almost 2 million and is likely to quadruple by 2050”.

Seniors who live longer generally have some sort of disability or need
help at some level of living. Sandy Markwood, CEO of the National
Association of Area Agencies on Aging, indicates that the focus
needs to be on being able to help these seniors live at home as long
as possible as nursing home cost could rise to average $72,000 a
year.

Long Term Care at any level, in the home, assisted living or nursing
home can add a tremendous cost to seniors and their families.

Government Programs Only Pay For About 16% Of Long Term Care

Government programs such as Medicare, Medicaid and the Veterans
Administration will cover the cost of long-term care under certain
conditions. Medicare will cover rehabilitation from a hospital stay or
limited care at home if there is a skilled (medical) need. The Veterans
Administration will cover the cost of nursing home care indefinitely if
the veteran is at least 70% service-connected disabled. The VA will
also cover other forms of home-based or community-based care if
there is a medical need.

Medicaid will cover both medical and non-medical related long-term
care but in order to qualify for Medicaid an Ohio resident has to have
less than $1,500 in assets and income that is insufficient to pay the
cost of care.

Funding Long Term Care with your Life Insurance Policy

Drawing cash from life insurance or changing a life insurance policy
should only be done after reviewing with an expert advisor. Loss
of the policy and death benefit could prove to be a detriment. If,

however you have accumulated cash in a life insurance policy and no
longer need the coverage you may consider using the cash for long
term care or purchasing a LTC rider to your current policy.

New insurance products are being developed to cover both life
insurance and long term care insurance. ElderLawAnswers reports:

“A new law makes the purchase of products that combine annuities
or insurance policies with long-term care insurance more attractive.
These "hybrid" products are gaining in popularity due to a law that
went into effect January 1, 2010, making distributions from life
insurance and annuities tax-free when used to pay for long-term
care. The same law also allows owners of annuities or life insurance
policies to exchange their old policies for long-term care insurance or
hybrid policies without being taxed.”

Combination sales which include life insurance, annuities and
traditional long-term care coverage are becoming popular with
insurance companies and may prove a method of financing long
term care. Investigate closely, however to find what exactly will be
covered. Some policies do not cover home care costs or complete
costs of nursing homes.

Long Term Care Insurance Funding for All Long Term Care Needs

The first long-term care policies were offered about 40 years ago.
These were primarily nursing home-only policies designed to take
over when Medicare rehabilitation ran out. They were not the
comprehensive benefit policies we see today.

Long Term Care Insurance policies today are greatly diversified in
their coverage. Home care, nursing home costs, adult day care,
physical therapy, skilled and non-skilled nursing care are some of the
services covered. Policies vary in price and what they cover. There
is also a very restricted qualification of physical and mental heath to
get a policy. Purchasing a policy at a younger age makes it easier to
qualify and also provides cheaper premiums. It is best to consult with
a long term care insurance professional about the type of policy that
fits your needs and budget.

Veterans Aid and Attendance Pension Benefit

Though not an insurance policy, the VA Pension Benefit should be
mentioned as a way to pay for long term care needs. A veteran or
spouse of a veteran who served during a period of war can receive
money, up to $2,019 a month, to pay for long term care medical
expenses, home health care, and assisted living cost. A qualified
Veteran Consultant can help you determine if you qualify for this
benefit.

Pre-Need Burial Insurance

One might ask what Pre-need burial insurance has to do with long
term care. The purpose of preneed life insurance is to set aside funds
for your funeral, before the need arises.

It is an insurance policy that covers the cost of the predetermined
expenses of a funeral, cremation or burial. It gives the purchaser the
opportunity to preplan the services and peace of mind in having it
paid for. This is usually an insurance policy that pays at time of death
for these expenses. There are many insurance companies that offer
these packages as well as funeral homes.

NOTE: If a person anticipates needing to apply for Medicaid after
all is said and done, it is unwise to start spending down assets until
having at least a consultation with a Medicaid specialist. In order to
retain the maximum assets for the community spouse, application
needs to be made first.

The saddest cases of long term care needs we hear are:

“Mother can no longer live alone and she has no money to go live in a
care facility.”

“ Is there someone that can come help me take care of my wife? We
live on our Social Security and I can not pay what home care costs.”

“Father died last night and we have no money to bury him, what do
we do?”

It is important to make the necessary arrangements to cover long
term care and end of life costs. There is no government program
that will cover all those needs. The National Care Planning Council at
www.longtermcarelink.net strives to educate people about long term
care services and encourages the planning that needs to be done to
prepare for future costs and needs.

The National Association of Professional Geriatric Care Managers at
www.caremanager.org has lots of good information as well as a list
of professionals around the country who specialize in long term care
planning and follow-through with families.

Debra Roidl, MSW, CMC
Care Manager, Certified

Wednesday, May 11, 2011

Downsizing and accessibility for seniors

Downsizing, Organizing, Handicap Remodeling or Relocating
May 10, 2011

When Robert and Anne bought their family home thirty years ago, their plan was to live through retirement in this home. They had furnished their home with refurbished antiques acquired from their many trips together. It was one of their cherished antique coffee tables that Robert tripped over, breaking his hip. Now with his return from the hospital in a wheelchair, the overwhelming task of making their home accessible for Robert’s wheelchair and safe for both of them faced Anne.

Remodeling for wheelchair access, organizing home furnishings and daily living items or downsizing and relocating to a smaller living area are monumental tasks that are many times thrust on senior home owners. Sometimes the need to do this is brought on by injury or age related illness. Home and yard maintenance can become a daunting chore for even the healthiest of seniors, requiring them to make a downsizing decision.

There is a large and growing industry of specialists who understand these challenges of elderly homeowners and are ready and willing to help with remodeling, organizing or the sale of the home and with the move to a new location.

A professional organizer provides skills in making the home safe and manageable. Relocating furniture, removing hazards such as electrical cords, throw rugs, heavy objects on shelves that might fall are some of the ways they make a home more senior friendly. They specialize in helping seniors part with items that clutter or have no valued use, so to make rooms less crowded or to make ready for a move to a smaller living space.

Handicap remodeling services and senior safety services offer help in adding wheelchair ramps and widening doorways. Bathrooms are made more accessible and safe, with hand rails, walk-in bath facilities and easier access to toilets.

If moving to a smaller retirement home or care facility is the best solution there is another senior specialty provider to call on called a Seniors Real Estate Specialist.

The Senior Real Estate Specialist concentrates more on a complete service package for the sale of the property and/or the purchase of a new living arrangement. The specialist also arranges for the services of a relocation specialist or Senior Move Manager to provide a complete, stress-free package for the elderly homeowner.

A move often requires downsizing and getting rid of a tremendous number of acquired possessions. The relocation specialist or Senior Move Manager, as they are often called, will typically provide a turnkey operation that includes assessing and identifying items to keep, arranging for auction or other disposal, cleaning the home, moving the belongings and setting up the new residence. The manager may also work closely with a real estate agent to arrange for the sale of the home and may also be involved in the financial transactions necessary to move into a new living arrangement.

All the help available to seniors may in itself be overwhelming. How do seniors choose the right service provider for their needs? How do they know they will hire someone qualified, responsible and honest? Area Agencies on Aging and State Better Business Bureaus are good resources to check out available service providers.

Family, friends and religious leaders can be valuable resources to seniors in referring service providers and helping to manage the hiring and supervision.

The National Care Planning Council’s website www.longtermcarelink.net provides educational articles and information on eldercare providers throughout the nation.

Wednesday, April 20, 2011

Using Your Home Equity for Long Term Care

In my business as a Professional Geriatric Care Manager, many seniors and their families come to me with questions about how to pay for long term care. Most seniors want to stay in their own homes, and some may be able to if they can afford the care that they require now, and in the future. For many seniors the equity in their home is their largest single asset, yet it is unavailable to use unless they use a home equity loan. But a conventional loan really doesn't free up the equity because the money has to be paid back with interest.

A reverse mortgage is a way of tapping into home equity without creating monthly payments and without requiring the money to be paid back during a person's lifetime. Instead of making payments the cash flow is reversed and the senior receives payments from the bank. Thus the title "reverse mortgage".

Many seniors are finding they can use a reverse mortgage to pay off an existing conventional mortgage, to create money to pay off debt, make home repairs, or for remodeling.

For those seniors who are in need of long term care and want to stay in their home, a reverse mortgage can create the money needed to pay for in-home personal and medical care. They can also pay for needed medical equipment and handicap adaptation to their home.

There are no income, asset or credit requirements. It is the easiest loan to qualify for. You must be at least 62, own and live in, as a primary residence, a home [1-4 family residence, condominium, co-op, permanent mobile home, or manufactured home] in order to qualify for a reverse mortgage.

A reverse mortgage is similar to a conventional mortgage. As an example:
• The bank does not own the home but owns a lien on the property just as with any other mortgage
• You continue to hold title to the property as with any other mortgage
• The bank has no recourse to demand payment from any family member if there is not enough equity to cover paying off the loan
• There is no penalty to pay off the mortgage early
• The proceeds from a reverse mortgage are tax-free and can be used for any legal purpose you wish

False Beliefs Regarding Reverse Mortgages
• "The lender could take my house." The homeowner retains full ownership. The Reverse Mortgage is just like any other mortgage; you own the title and the bank holds a lien. You can pay it off anytime you like.
• "I can be thrown out of my own home." Homeowners can stay in the home as long as they live, with no payment requirement.
• "I could end up owing more than my house is worth." The homeowner can never owe more than the value of the home at the time the loan is due.
• "My heirs will be against it." Experience demonstrates heirs are in favor of Reverse Mortgages.

There are some things to be aware of when thinking of using a reverse mortgage. According to Walter Updegrave, a senior editor at MONEY Magazine and author of "Investing for the Financially Challenged," closing costs and other fees can run into thousands of dollars. If the borrower remains in their home for many years after taking the reverse mortgage, and uses the money to stay independent by paying for caregivers, for example, then the costs may be worth the risk. If, however, the borrower dies or has to move to a more protected environment within a few years, the fees may not be worth it. (http://money.cnn.com/2004/03/30/pf/expert/ask_expert/)

The amount of reverse mortgage benefit for which you may qualify, will depend on
• your age at the time you apply for the loan
• the reverse mortgage program you choose
• the value of your home
• current interest rates
• and for some products, where you live

As a general rule, the older you are and the greater your equity, the larger the reverse mortgage benefit will be (up to certain limits, in some cases). The reverse mortgage must pay off any outstanding liens against your property before you can withdraw additional funds.

The loan is not due and payable until the borrower or borrowers no longer occupy the home as a principal residence (i.e. the borrower sells, moves out permanently or passes away). At that time, the balance of borrowed funds is due and payable, all additional equity in the property belongs to the owners or their beneficiaries.

Other considerations regarding reverse mortgages are that interest rates and fees can vary widely among reverse mortgage lenders. Mr. Updegrave states, “… it can be very difficult to compare the true costs of different loans from different lenders. The best way to do that is to compare each loan's ‘TALC,’ or total annual loan cost.
This figure, which reverse mortgage lenders are required to disclose by federal truth-in-lending laws, takes all loan costs into account as well as the timing on the payments you're projected to receive.”
( NEW YORK (CNN/Money) - What are your feelings pro and con about reverse mortgages?
-- Josephine Amato, Wyckoff, New Jersey) (http://money.cnn.com/2004/03/30/pf/expert/ask_expert/)

The most popular reverse mortgages are the so-called HECM loans. HECM loans require that the applicant meet with a government approved counseling agency to be sure the applicant understands the reverse mortgage process.

The Federal Trade Commission states:
“Before applying for a HECM, you must meet with a counselor from an independent government-approved housing counseling agency. Some lenders offering proprietary reverse mortgages also require counseling. The counselor is required to explain the loan’s costs and financial implications, and possible alternatives to a HECM, like government and nonprofit programs or a single-purpose or proprietary reverse mortgage. The counselor also should be able to help you compare the costs of different types of reverse mortgages and tell you how different payment options, fees, and other costs affect the total cost of the loan over time. Most counseling agencies charge around $125 for their services. The fee can be paid from the loan proceeds, but you cannot be turned away if you can’t afford the fee.”

A Reverse Mortgage Specialist in your area can answer your questions, calculate the amount of loan you can receive and advise the type of loan for your needs. The National Care Planning Council (http://longtermcarelink.net/a7reversemortgage.htm) has a list of Reverse Mortgage Specialists in your area. Also, the AARP website has a section on reverse mortgages at http://www.aarp.org/money/credit-loans-debt/reverse_mortgages/. Do your homework and make sure that you also consult with your own financial advisor about whether a reverse mortgage is the best way for you to utilize the equity in your home.

Sunday, February 13, 2011

Planning Ahead for ElderCare

I've received more requests than usual recently for assistance with planning ahead for aging parents. This is an indication that more people are seeing what is happening around them with long term care. The general population has no idea what services are available, appropriate, affordable to alleviate stress and improve quality of life as we age.

Take a look around. Talk with your friends and neighbors. Notice how many people are engrossed in the task of caregiving. Tell them there is hope. There are resources. And there are experts in the field that can guide and assist them through their journey.

Make sure you are educating yourself about what your parents need, what they have, and what they do not have. Where are their finances? Who are their doctors? What hospital do they prefer? What legal documents have they updated (healthcare Powers of Attorney, financial POAs, Trusts, Living Wills, etc.).

Don't wait for the crisis. Plan ahead. You will be much more prepared and experience less stress if you take your head out of the sand and look around to prepare.

Thursday, October 7, 2010

Phobias

October 7, 2010



People love their phobias. Withn the anxiety and the trepidation, there is something that makes us hold on to them.

For example, just now, thinking about really trying to desensitize myself with regard to my arachnophobia, I actually felt kind of … sad. Like I would miss the drama, the attention that I make to myself of this inordinate fear of spiders. I would actually miss the fear?

Or am I just talking myself out of trying to desensitize myself.

I truly am afraid of spiders. No reason, really. No memory of a traumatic event. Maybe it’s a past-life thing. Actually, yes, come to think of it, there is an early memory of being in bed, waking up sleepily, and with every stuffed animal I owned having a sleepover that night. A spider. Small but large to my young eyes (4 year old, maybe? 6?), crawling relentlessly, and rapidly – startlingly – across my bed, and under my bunny rabbit. I could not save my bunny rabbit. Stuffing 12 other beloved toy animals in my two little arms, screaming bloody murder for my other - is my next memory. And my mother, so calm, so comforting. I will always admire mama for her lack of fear and the chivalry of her nestling it into a tissue to set it free outdoors.

Today, they get in my house, they're dead. Sorry. Outside, i avoid you, spider. Inside, you weren't invited and you scare me!

Spiders are always running, rapidly, startlingly, across one’s vision. Often towards me, it seems. Coming right at me. Relentless. Purposeful. Driven. Because it knows I’m afraid of it and is coming to scare me.

I really don’t think they’ll bite me – unless I provoke them, of course, the spiders “are just afraid of you as you are of them” (yeah, right). It’s just that they startle me, and they seem to do it on purpose. "BAH". “I am in front of your face you stupid human and you didn’t see me coming and I might TOUCH you.”. Their tickling touch – ick!

Okay, I’m changing the subject now. Thanks for listening.

Rantings of an aging baby boomer.


Happy Halloween, everyone.