Category Archives: Nursing Home
There are treatments available now that most families coping with Alzheimer’s or other dementia never hear about that can significantly improve their quality of life.
Called non-pharmacologic therapies (NPTs), these treatments do not come in a pill. Instead, NPTs such as personal counseling and occupational therapy-based strategies are proven to improve the quality of life for people with dementia and their families. NPTs support families and teach them the skills they need to protect their own health and cope with the intense demands of caregiving and help people with dementia stay independent and safe for as long as possible. Some of the NPTs currently used are proven programs that are actually more effective than any known drugs for Alzheimer’s disease.
One example of an NPT, developed at NYU, includes individual and family counseling to reduce conflict and improve communication among family members. Those caring for a spouse with dementia who received the NYU Caregiver Intervention were more satisfied with social support and less depressed, less bothered by difficult behaviors, had better physical health and were able to keep their ill spouses at home longer than those receiving usual care.
Another model developed at Thomas Jefferson University in Philadelphia, employs occupational therapists to assess the patient with dementia and identify preserved capabilities as well as the caregiver’s needs. Families are then provided with strategies to manage day to day care, such as communication techniques, safe-proofing the home, establishing daily routines and engaging the individual with dementia in meaningful activities. Families who participated have reported feeling more confident and less upset, and found that their ill family member functions better and exhibits fewer challenging behaviors.
Another NPT that is now being used is a stimulator device surgically implanted into the brain of a patient in the early stages of Alzheimer’s disease. The implanted device is seen as a possible means of boosting memory and reversing cognitive decline, and has already been used in thousands of people with Parkinson’s. The surgery involves drilling holes into the skull to implant wires into the fornix on either side of the brain. The wires are attached to a pacemaker-like device, which stimulates the brain with tiny electrical impulses generated 130 times a second. The patients don’t feel the current.
Lastly, another effective non-drug Alzheimer’s treatment used to jog memory is music. In nursing homes that use music, the personalized playlists are often meaningful songs chosen by loved ones. According to Alzheimer’s experts, music helps patients become more alert, more cooperative, more attentive, and more engaged. In many cases, even if they can’t recognize loved ones and they’ve stopped speaking, when the patients hear music, they “come alive”.
Geri Hall, a clinical nurse specialist at the Banner Alzheimer’s Institute, explains how music activates a part of the brain that stays active despite the dementia. “There is something about music that gets through to Alzheimer’s patients right up until the very end of the disease,” she said, adding that “familiar music from the past can help people with dementia feel at home. It calms them, increases socialization, and even decreases the need for mood controlling medications.” Read our blog post about Alzheimer’s and Music.
Alzheimer’s slowly robs its victims of a lifetime of memories and the ability to perform simple daily tasks. Instead of focusing on drug treatments, many of which have failed in clinical trials, it may be a good idea to try non-drug treatment options. These programs have been proven effective in randomized controlled trials. And, unlike drug therapy, there are no adverse side effects. There is also an economic argument to be made for better caregiver support. Nearly 11 million family and other unpaid caregivers provided an estimated 12.5 billion hours of care to people with dementia. This care is valued at nearly $144 billion. The country can’t afford the consequences of these caregivers becoming too burned out or sick to carry on. See our recent blog post about the rising cost of dementia.
Moving a person with dementia to a nursing home, while sometimes unavoidable, is expensive. The NPTs described have helped to delay nursing home placement for more than a year. Unfortunately, you cannot delay the inevitable forever, but what you can do is plan ahead for you and your loved ones. Do you or a loved one need nursing home care in the near future or are you looking to plan ahead? Call 703-691-1888 to make an appointment for a no-cost consultation at The Fairfax Elder Law Firm of Evan H. Farr, P.C. We can meet with you, access your situation and determine strategies for your long-term care plan.
As the Baby Boomer generation ages, more and more families are struggling to live with a loved-one suffering from Dementia or Alzheimer’s disease. While memory loss can be a frightening experience for an aging parent or grandparent, its’ impact on the family can be equally frightening, particularly when there are young children in the home.
There are a host of reasons why people invite an aging parent or grandparent to move in with them and their family. It might simply “feel” like the right thing to do; the home could be old and in need of serious repair, and perhaps they have fallen or have been injured as a result of the conditions of the premises.
It might be easy to dismiss occasional forgetfulness as normal – the elder may even laugh at, or make fun of their own inability to recall something. However, when living with someone suffering from a progressive form of dementia, it does not take long to realize the differences between it, and mere forgetfulness.
The transition can be even more difficult when children are part of an active household. When an aging relative has lived alone for many years, this can be especially pronounced.
Unfortunately, it can get to the point that it is not possible to care for one’s own children as well as an aging parent or grandparent at the same time. The needs of one are often diametrically opposed to the other.
Individuals placed in an environment catering to the specific needs of those with cognitive impairments such as dementia, quite often are truly better off. Age-appropriate activities and companionship with people one’s own age is an important aspect not to be overlooked. While it can be a painful reality to accept, quite often others are far better equipped to provide the care a patient with Alzheimer’s or other forms of dementia.
As our population ages, and people live far beyond the life expectancy of even 20 years ago, more and more families will be forced to acknowledge their limitations. Choosing to place a family member in a nursing home is not an admission of failure, but an acceptance of the fact that prolonged life expectancy carries with it a need for more complex care than the vast majority of us can ever hope to provide.
While placing a loved one in a nursing home is a difficult decision, there may come a time when it is the right one. It will help if you do your homework and trust your instincts.
According to the Department of Health and Human Services, the nation’s nursing homes provide care to over 1.5 million people. Over 90% of these residents are over age 65. Most of the residents are frail and require round-the-clock supervision due to dementia.
Things You Need to Know
A nursing home is a residence that provides room, meals, nursing and rehabilitative care, medical services and protective supervision to its residents. While someone coming from the hospital may require the services of many long-term care professionals such as nurses, therapists and social workers, a nursing home is not a hospital (acute care) setting. The goal at a nursing home is to help people maintain as much of their independent functioning as possible in a supportive environment.
Choosing a Facility
One of the first things to consider when making a nursing home choice is the needs of the individual for whom you’re providing care, suggest experts at the MetLife Mature Market Institute®. Make a list of the special care they need, such as dementia care or various types of therapy.
If the person is hospitalized, the discharge planner and/or social workers can assist you in assessing the needs of the individual and locating the appropriate facility.
If you are choosing a nursing facility for someone who is presently at home, ask for referrals from your physician, Area Agency on Aging, friends, and family.
Other factors such as location, cost, the quality of care, services, size, religious and cultural preferences, and accommodations for special care need to be considered.
When you’ve located a few facilities that you’d like to consider more thoroughly, plan on visiting each one, both with scheduled and unscheduled visits, and at different times and on different days of the week.
As you are walking around, take note of what you hear and don’t hear. Is it silent? Is there activity? How clean does it look? Are the residents dressed appropriately for the season? Most importantly, find out the ratio of nurses to residents is and what is the staff turnover rate?
When you’ve finally decided on a facility, you should know your rights and those of your family member. Before you or the resident sign the admissions agreement, understand what you’re signing, and do not sign any paperwork unless everything has been fully explained.
The admissions contract should, at a minimum, contain the daily room rate, reasons for discharge and transfer from the nursing home, and the policy regarding payment of the daily room rate if the resident goes to the hospital or the family brings the resident home for a short period of time.
You may question if you’re really making the right decision to place your loved one in a facility at all. Remember, you can do no more than your best, and if you’ve done that, neither you nor your family member can ask any more of you.
Medicaid complexity is a real problem. For those not familiar with program specifics, Medicaid – not Medicare – is the program Americans rely on to receive their long-term care. Long-term care is extraordinarily expensive – in fact, it is the single most expensive creditor Americans are likely to face. Unfortunately, understanding the various Medicaid rules is a monumental task for the average layperson, and to properly qualify for the program and protect one’s assets, it often it takes an experienced professional and a complicated asset protection plan.
Why is Medicaid so complex? One reason may be due to the fact that Medicaid is a joint state and federal program, and planning to receive (either for you or for a client) this public benefit often involves tax planning, too. Proper Medicaid planning requires an understanding of several complex bodies of law.
While some of these quotes are humorous, it is no laughing matter that Americans, by and large, do not realize that Medicaid is available to the middle class. Protecting assets from long-term care expenses can enable a family to pass an inheritance on to their children that otherwise would not have been available; it allows for the recipient to enjoy an enhanced qualify of life while alive; and it gives peace of mind and security to the family members.
Here is a glance at what the courts have had to say about Medicaid complexity over the last thirty-five years.
The Second Circuit commented the absurdity of any law or regulation 7 subsections deep. For example:
The United States Supreme Court has called the Medicaid laws:
The Second Circuit calls the Medicaid statute one of:
In a case arising out of Maine, the District Court called Section 1396a(a)17) of the Medicaid statute:
The Fourth Circuit called the Medicaid Act:
Medicaid complexity is a problem for all Americans. Most Americans will need some form of long-term care, and of those that do, such care may be a nursing home stay. The average private nursing home room costs nearly six-figures every year, and the average nursing home stay is close to three years. Medicaid is available to anyone who can qualify; unfortunately, there are many public misperceptions when it comes to Medicaid. Contrary to public belief, a person does not need to be “poor” to qualify.
At this point in time, the laws are so complex that it is recommended that any person contemplating long-term care speak with an experienced elder law attorney.
Image: Master isolated images / FreeDigitalPhotos.net Evan H. Farr on Google +
When older adults think of estate planning, many actually have asset protection in mind. What they want is the peace of mind of knowing that the nest egg they’ve been saving for that proverbial “rainy day” will actually be available for them when that rainy day comes. The rainy day, for most people, is when they or their spouse enters a nursing home. But estate planning and asset protection are two very different fields of law. Estate Planning documents do nothing to achieve asset protection, as Estate planning deals with distribution of assets upon death. If you wind up going broke in a nursing home before your death, your Estate Plan will wind up being a worthless pile of paper.
These days most older adults use the Revocable Living Trust (RLT) as their primary Estate Planning document in order to minimize delays and expenses and avoid the “nightmare of probate.” A Last Will and Testament is designed to put your estate into probate – an expensive and complex process that most people want to avoid at all costs. Although the RLT can achieve this important goal of avoiding probate, a major limitation of the RLT is that it cannot accomplish asset protection. The RLT can’t shield your assets from nursing home expenses. With the average cost of a nursing home room in the DC Metro area at around $9,000 per year, this is an important limitation of the RLT that every older adult needs to understand.
Is there a living trust that actually does protect assets in contemplation of future nursing home expenses? Yes. You can protect your assets legally and effectively by using the Living Trust PlusTM (LTP). As opposed to the RLT which only avoids probate, the LTP is designed to protect your assets from the expenses and complexities of probate PLUS lawsuits PLUS nursing home expenses. The LTP functions very similarly to the RLT and maintains much of the flexibility of the RLT, but in addition to serving as your primary estate planning document, the LTP allows you to actually protect your nest egg from having to be “spent down” to pay for the catastrophic expenses often incurred in connection with nursing home long-term care.
If you’re over the age of 65 and you’ve been holding on to a nest egg for a rainy day, the time to get out the umbrella and protect the nest egg is now, while you’re still relatively healthy and living independently. To find out more, you can sign up yourself and your family to attend a free seminar on the Living Trust PlusTM.
If you are an attorney and are interested in learning how you can offer your clients true asset protection, visit LivingTrustPlus.com and join the dozens of attorneys across the U.S. who have already educated themselves and embraced the LTP!
Today’s women are decision makers. For some couples, the woman is THE decision maker, and there’s nothing wrong with that. For example, in nearly 8 out of 10 cases where married couples purchase a vehicle, it is the woman who makes the final decision. And because women outlive men by 5.4 years on average, women frequently make decisions that have long lasting effects upon their children, their spouse, and even their parents.
Today, I want to offer 3 tips to help open the lines of communication between parent and child when it comes to the difficult subject of long term care.
Tip 1: Explain that Elder Law Attorneys are Passionate About Their Clients – Elders!
Elder law attorneys have deliberately chosen a career in a specialized area of law to serve elders. Moreover, Virginia Rules of Professional Conduct require lawyers to act in the best interests of their clients. The client of an elder law attorney is the elder. Not the child.
Elder law attorneys are equipped to facilitate familial harmony; they place the client’s concerns at the forefront of any discussion, and they orchestrate a plan that can protect a nest egg from the catastrophic expenses of long term care and improve quality of life. An inheritance is nice – and usually a much larger inheritance is a by-product of the plan devised by an excellent elder law attorney – but the first thing I explain to families I meet with is that the inheritance is not the focus. My client’s quality and dignity of life is priority #1.
Tip 2: Gather Information with Parents in No-Pressure Environment
Parents love to do things with their kids, and adult children likewise value the time they have with their aging parents. One easy way to spend time with your parents while gathering information is to attend a free seminar hosted by a local elder law attorney. Don’t be afraid to research, communicate and explain important statistics to your parents.
Tip 3: Use Easy to Understand Statistics to Convey Your Message:
Did you know that if you are over age 65:
- you have a 7.2% chance of having an auto accident every year;
- a 6.15% chance of needing to file a homeowner’s insurance claim; and
- a 70% chance of needing long-term care?
Over half of those who need long-term care will require a nursing home.
Here is the statistic you must be concerned with:
- 13% of drivers are uninsured;
- 15% of homeowners are uninsured; but
- 90% of senior citizens are uninsured and unprotected against long term care needs.
87% of people insure themselves against an event that has a 7.2% annual probability;
85% of individuals protect themselves against an event with a 6.15% annual probability; but
Only 10% protect themselves from an event with a 90% probability!
Why is it important to plan for long term care? Primarily because the expenses of long term care are catastrophic and can wipe out a nest-egg in less than a year. 50% of couples and 70% of singles are impoverished (broke) after one year of entering a nursing home.
Medicaid is a government program meant for those who plan for it. I encourage you to attend a free seminar on the subject, as it is shocking that so many smart people do not realize that Medicaid – not Medicare – can be used to pay for long term care.
One common misconception is, “We don’t need to plan for our long term care yet, we’re only 65.” Almost half of all long-term care claimants are under age 65 at the time of disability. Every day that goes by without a plan, the family is risking possible delay or even forfeiture of government benefits that are meant to pay for catastrophic long term care costs.
Talking to your parents about their long term care options can be understandably difficult, and no other generation has had to simultaneously balance so many familial responsibilities at one time. But there is a new breed of estate planning and elder law that takes a family-friendly, solution-based approach making it easier to discuss difficult subjects.Photographer: graur razvan ionut
While it’s no secret that Alzheimer’s Disease can cause confusion in the estimated 5.1 million Americans directly affected by the disease, both researchers and the general public have spent years perplexed by the disease as well. For a look at some of the most common misconceptions about Alzheimer’s Disease, see the Alzheimer’s Association‘s list of the top 8 Alzheimer Myths.
The Alzheimer’s Association, which calls Alzheimer’s Disease “the defining disease of the baby boomers,” points out that “too many of America’s baby boomers will spend their retirement years either with Alzheimer’s or caring for someone who has it.” The Alzheimer’s Association also points out that although death rates for other major diseases — HIV, stroke, heart disease, prostate cancer, breast cancer — are declining, “Alzheimer’s is the only top 10 cause of death without a way to prevent, cure or even slow its progression.”
There is no question that Alzheimer’s Disease is a growing concern, especially as the number of America’s baby boomer and elders continues to rise. But despite the disease’s prevalence, there are already two positive developments in 2011. First, researchers seem excited about a new means to predict — and perhaps one day to diagnose — the disease with certainty in the living. Second, an unlikely team of players has unified on the front lines…from an NFL superstar to some of America’s largest pharmaceutical companies.
Three Recent Studies Suggest ‘Biomarkers’ Could Play Pivotal Role in Predicting Alzheimer’s Disease
What is a biomarker? AstraZeneca defines the term as:
“a characteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes, or pharmacological responses to a therapeutic intervention.”
In essence, a biomarker is an identifiable variable that can be measured in humans. While this may sound like a very broad definition, the breadth of the concept is what makes it so promising.
A recent study, published in the Journal of the American Medical Association (JAMA) and reported by Senior Journal, aimed to investigate a potential relationship between “plasma beta-amyloid 42 and 42/40 levels and cognitive decline in a large group of community-dwelling older adults without dementia.”
The study found that older individuals who do not suffer from dementia, but have lower levels of “blood plasma and biomarkers beta-amyloid 42/40 (protein fragments),” may be at an increased risk for experiencing cognitive decline later in life:
“[The use of] biomarkers to identify elderly persons at risk of developing dementia could be useful for early prevention, if and when such interventions are available, and treatment.”
In a different study, three specific proteins in cerebrospinal fluid were found to potentially “spot” Alzheimer’s disease. That study appeared in The Archives of Neurology. The BusinessWeek article on this study is available here. Of note, the Senior Director of Medical and Scientific Relations at the Alzheimer’s Association had this to say:
“This just reinforces the recommendation by [Alzheimer's working groups] saying that biomarkers can actually be incorporated today into clinical practice in order to add a certain piece to the diagnosis if patients are already presenting with something that looks like Alzheimer’s.”
Still another study carried out by the Texas Tech University Health Sciences Center and the Texas Alzheimer’s Research Consortium, reported by Ivanhoe Newswire, found that blood serum biomarkers PLUS other clinical information could be used to more accurately classify patients with Alzheimer’s. Commenting on the importance of such studies, the authors say:
“There is clearly a need for reliable and valid diagnostic and prognostic biomarkers of Alzheimer’s disease, and in recent years, there has been an explosive increase of effort aimed at identifying such markers.”
The Texas Tech study authors are optimistic:
“With the rapidly evolving technology and the analytic techniques available, Alzheimer’s disease researchers now have the tools to simultaneously analyze exponentially more information from a host of modalities, which is likely going to be necessary to understand this very complex disease.”
Pharmaceutical Companies are Uniting to Fight Alzheimer’s Disease
CNN reported recently on Big Pharmaceutical companies uniting to share data in an effort to better understand the disease:
Numerous Celebrities Help Raise Awareness of Alzheimer’s Disease
Dozens of national celebrities have been helping to raise awareness of the devastating toll that Alzheimer’s Disease takes on our society. Here’s a “Behind the Scenes” look at some of the Alzheimer’s Association’s Celebrity Champions:
This CNN story (and the video below) highlights the emotional toll that Alzheimer’s disease has had on one such Celebrity — NFL star Terrell Owens. Mr. Owens’ battle against the disease on behalf of his mother has touched hearts and inspired many:
Recognizing Early Symptoms is Important: Top 10 Signs
- Memory loss that disrupts daily life
- Challenges in planning or solving problems
- Difficulty completing familiar tasks at home, at work or at leisure
- Confusion with time or place
- Trouble understanding visual images and spatial relationships
- New problems with words in speaking or writing
- Misplacing things and losing the ability to retrace steps
- Decreased or poor judgment
- Withdrawal from work or social activities
- Changes in mood and personality
Have you Heard of Alzheimer’s Planning?
Many people are unaware that Alzheimer’s Planning is a sub-specialty of Elder Law. It involves a unique and complex combination of estate planning, long-term care planning, asset protection, Medicaid planning, and nursing home planning, and requires a specialized knowledge of the legal and financial problems and issues that are unique to families dealing with this devastating illness. We at the Farr Law Firm routinely assist clients with all of the financial and legal issues surrounding Alzheimer’s Disease.
One of the primary goals of Alzheimer’s Planning is to ensure the highest possible level of personal dignity and quality care for the remaining lifetime of the Alzheimer’s patient. To achieve this goal, it is often necessary to protect assets as quickly as possible, so that if the Alzheimer’s patient must enter a nursing home, Medicaid can be obtained as soon as possible. Money that is protected through Alzheimer’s Planning can often be used to provide the Alzheimer’s patient with an enhanced level of care and a better quality of life while in the nursing home and receiving Medicaid benefits.
There is still a long way to go in predicting, diagnosing, and ultimately preventing Alzheimer’s disease. But with help coming from all directions – the steady fight of the Alzheimer’s Association in leading the global fight for a world without Alzheimer’s, new research methods and tools, consolidated efforts from Pharmaceutical Companies, and the increased awareness created by dozens of celebrities who have been personally touched by this destructive disease — hopefully greater strides for combating this disease are in store in 2011 than ever before.
The Alzheimer’s Association, mentioned several times in this article, is the leading voluntary health organization in Alzheimer’s care, support and research. The Association’s mission is to eliminate Alzheimer’s disease through the advancement of research; to provide and enhance care and support for all affected; and to reduce the risk of dementia through the promotion of brain health. If you have a question about Alzheimer’s disease, if you’re providing care for someone with memory loss, or if you’re experiencing memory loss yourself, the highly trained and knowledgeable staff of the Alzheimer’s Association can assist you at any time — just call their 24/7 Helpline at 1-800-272-3900.
Lastly, don’t overlook the quality of life and dignity that can be preserved through Alzheimer’s Planning. Until there is a cure or vaccine for Alzheimer’s disease, the focus for many families is on ensuring the quality of life and dignity of those suffering with this disease. For more on Alzheimer’s Planning, please visit us at http://AlzheimersPlanning.com.
Abuse can come in many forms, and can affect a variety of individuals. Whether it be a child, nursing home resident, or incapacitated person – there is a common thread in most cases. Usually, the abused is a disadvantaged person in that they have some physical, emotional, or cognitive disability. In the case of children, the abused may not have any disability at all, but rather, their young age and naivety are taken advantage of. Children and the Elderly are similar in this regard; both groups are potential abuse-targets due to age and not necessarily disability.Health reform laws recognize the widespread issue of elder abuse. Read a popular article here, for information on this subject. According to “Health Reform: Changes in Store for the Elderly,”new laws contain
“[p]rovisions that will help protect nursing home residents and other long-term care recipients from abuses, and give families of nursing home residents more information about the facilities their loved ones are living in or considering moving to.”
Many cases involving abuse involve heart-wrenching facts that quickly gain media attention. The harsh penalties, public attention, and shame accompanying charges of abuse should be motive enough to deter such behavior. Since abuse is such a reputation-damaging charge or allegation, the public must not immediately judge every case reported by the media.
Individuals who are living in long term care facilities are susceptible to mistreatment. Many older people develop dementia and/or other physical disabilities towards the end of life. This can stress-out workers at care facilities, which can lead to frustrations being taken out upon the defenseless patient or resident.
What to look for? If you suspect a loved one is being, or has been victimized – there are things you can look for to ensure you don’t miss telltale signs. Look for physical signs like bruises, burns, bed sores, and puncture holes. Also, don’t ignore uncomfortable subjects like the presence of a sexually transmitted diseases, lowered self-esteem, or unexpected mistrust. If you have a parent or loved one who lives in a nursing home or assisted living facility, keep a mental note (or hard copy if you are already suspicious) of possessions and valuables. Then, check each month to be sure those items are still where they are supposed to be.
In addition to physical and emotional signs of abuse, more obvious financial red flags should be examined carefully. For example, if you notice your loved one spending an excessive amount of funds he or she controls, make an inquiry. Look for transfers of funds or property that “don’t seem right.” Trust your instinct and remain diligent.
Do I HAVE to Report Abuse or Neglect?
Depending on your job or title, you may have an obligation to report abuse. If you are uncertain, contact your attorney.
State laws may vary slightly, but in no state is it legal to abuse a person. One state-to-state variable is the age which one is classified as a senior citizen.
In Virginia, you may have a duty to report abuse of elders or incapacitated individuals. Virginia Code 63.2-1606 mandates that certain people report abuse. Included in this group are licensed and registered nurses, doctors, pharmacists, dentists, funeral service providers, psychologists, and numerous others. Virginia law requires the person reporting to do so “immediately.”