Archive for the ‘Senior Care’ Category

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Keeping Mom and Dad Safe at Home

Thursday, September 17th, 2009

Elderly parents generally prefer to remain living in their own homes as long as possible. However, remaining in their homes becomes a concern when children see their parents slowing down or starting to have trouble with handling stairs and doing general daily activities.

This is the time to evaluate the home to make it safe and secure for your loved ones — now and in the near future — in anticipation of age-related disabilities that may occur. Help and support are available. The nation as a whole is more aware of elderly needs and services and products are becoming available at an accelerating pace.

The Bureau of Labor Statistics states:

“Employment of personal and home care aides is projected to grow by 51 percent between 2006 and 2016, which is much faster than the average for all occupations. The expected growth is due, in large part, to the projected rise in the number of elderly people, an age group that often has mounting health problems and that needs some assistance with daily activities.”

Bureau of labor Statistics – Occupational Outlook Handbook, 2008-09 Edition.

This growing need for aides and home services also includes related services such as:

• home remodeling services — making a home more serviceable to the elderly;
• safety alert systems and technology;
• motion sensors to monitor movement;
• telehealth services — using home-based computer systems to monitor vital signs;
• pill dispensers that notify when it is time to take medication.

If you have an aging parent still living at home, where do you begin to make sure your elderly family member is safe and managing well in his or her home?

Visit often and at different times of the day and night. Make note of daily activities that appear challenging and where changes might be made to add safety and convenience. Remove rugs that slide — creating a fall risk — and move furniture with sharp edges. Be sure smoke detectors and carbon monoxide detectors are in place.

Bathrooms can be a hazardous area for the elderly. Set the water heater at a lower temperature to protect skin from scalds and burns. Grab bars by the toilet and shower are a must to help prevent falls. Another important item is a shower stool or chair.

If you’re not sure what needs to be done, consider hiring a professional. There are dozens of Geriatric Care Managers in our area who can do a home safety evaluation and make recommendations. There are also home remodeling contractors that specialize in retrofitting homes to add special safety and convenience features for seniors so they can age in place. The National Association of Home Builders even bestow a CAPS designation to home remodeling companies that have met the criteria to become a Certified Aging in Place Specialist.

Home safety or medical alert companies provide GPS-based bracelets or pendants to track those who tend to wander – a common side-effect of Alzheimer’s disease. Numerous companies provide alarm devices such as pendants and bracelets that allow the elderly to alert someone if there has been a fall or a sudden health-related attack. In the event an alarm has been triggered, a 24-hour monitoring service will alert the family or medical emergency services or call a neighbor depending on previous instructions. In addition, there are companies that will install motion sensors in the home to monitor the elderly on a 24 hour basis.

Don’t forget your parents’ community as a valuable resource for helping them stay in their home. Many elders are able to stay in their homes longer with the help of their local senior services.
Neighbors, local church groups, senior centers and city centers are some places to look for assistance. Most of the time there is little or no cost for these services.

For Virginians, the easiest way to find senior assistance services is the the Senior Navigator at www.seniornavigator.com. A quick search of the word “home” in my zipcode results in numerous assistance services designed to help seniors stay in their homes, including:

• Home Delivered Meals: Meals for homebound persons sometimes called “meals on wheels”
• Home Health Care: Certified skilled nursing care such as IV therapy or wound management provided in the home and coordinated with a physician’s direction. Services may also include therapy for physical, occupational or speech improvements by certified therapists
• Home Modification & Safety: Modifications and repairs done to make homes safer and more accessible
• Medical Equipment and Supplies: Equipment and supplies for medical, functional and mobility needs
• Medication Management: Assistance with taking medications properly including assessments and reminders
• Chore Services: Programs that provide assistance in performing routine household and yard activities
• Assistive Technology: Also referred to as adaptive technology it includes programs, devices and resources that help individuals with disabilities
• Household Organizing: Services that provide or coordinate the organization of households items for an individual or family
• Companion Services: Services that assist adults in the community including telephone reassurance, friendly visitors and companionship
• Personal Care: In-home assistance with activities of daily living such bathing, grooming, toileting and mobility support that is provided by paraprofessionals. Food preparation & housekeeping services may or may not be provided by personal care assistants
• Geriatric Care Management: Assessment of needs and coordination of services for seniors provided by a social worker, certified geriatric care manager or other professional

A few thoughts on hiring home care aides or live-in care givers:

The classifieds are filled with people looking for work as aides to the elderly. Many of these aides are well-qualified, honest people who will do a good job; however, there will be some not so reputable. If you are looking to directly hire an individual, be sure you interview and check references and qualifications. You will also be responsible for scheduling that person and doing payroll and taxes and insurance, including worker’s compensation insurance in case the person is injured on the job, although there are tax services that can assist you with the required tax payments and filings. Be very sure you hire someone trustworthy, as the elderly often develop trust in these helpers beyond what they should, and therefore can easily be taken advantage of.

A professional home care service will eliminate most of these concerns. Professionally-provided aides are usually insured and bonded, and substitute aides can be provided in the event that the primary aide becomes unavailable. Home care companies take care of the scheduling and payment of their employees. Home care companies cater to the elderly in their homes by offering a variety of services.

These providers represent a rapidly growing trend to allow people needing help with long term care to remain in their home or in the community instead of going to a care facility. The services offered may include:

• companionship
• grooming and dressing
• recreational activities
• incontinent care
• handyman services
• teeth brushing
• medication reminders
• bathing or showering
• light housekeeping
• meal preparation
• respite for family caregivers
• errands and shopping
• reading email or letters
• overseeing home deliveries
• dealing with vendors
• transportation services
• changing linens
• laundry and ironing
• organizing closets
• care of house plants
• 24-hour emergency response
• family counseling
• phone call checks and much more.

Unfortunately, many people fail to think about the issue of long-term until an emergency occurs, at which point there may be fewer options for care and care in a facility may be the only choice. Additionally, as I mentioned in an article in July – Putting Home Care in Perspective – lack of significant wealth and lack of pre-planning means that most people do not have the luxury of remaining in their homes when the time comes.

Fortunately, Medicaid is available to pay for nursing home care to finish out the rest of their lives. Every day, our firm helps families with loves ones needing nursing home care protect significant assets and still qualify for Medicaid. Please call us if we can assist you or your family with your long-term care planning.

Posted in Asset Protection, Medicaid Planning, Other Elder Law Blogs, Senior Care, health care | Comments Off

Myths about Obama’s Health Plan

Wednesday, August 12th, 2009

Lots of clients have been asking my opinion on Obama’s new health care reform plan.

I’m not at all a political pundit, and I have not read the entire Bill, but
I have seen and heard what appears to be a great deal of misinformation out there in the popular press. Here’s a slightly left-of-center article explaining the current status of the Bill and summarizing and rebutting some of the seemingly more outrageous claims that are out there:

MAKING LAW REALLY IS LIKE MAKING SAUSAGE!

Lots of clients have also been asking me whether Obama’s health care reform plan will affect Medicaid. Medicaid is the federal program that pays for approximately 70% of people residing in nursing homes.
It is my understanding that the current Bill does not change the Medicaid long-term care program at all. Long-term care is essentially “custodial care” — it does not fall under the umbrella of health care or under Obama’s new health care reform.

So for now, Medicaid is alive and well. If you have a family member who is in a nursing home or who you think might need to enter a nursing home in the near future, please contact us, as there are dozens of Medicaid Asset Protection strategies that we can use to help clients protect assets and get better long-term care in the process.

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Posted in Medicare, Senior Care, health care | 1 Comment »

Putting Home Care in Perspective

Thursday, July 16th, 2009

The Evolution of Home Care

In the first century of our country’s history there was no such thing as nursing homes or assisted living. Society was mostly rural and people lived in their own homes. Families cared for their loved ones at home till death took them. In the latter part of the 1800’s because of an increasingly urban society, many urban families were often unable to care for loved ones because of lack of space or because all family members including children were employed six days a week for 12 hours a day. During this period many unfortunate people needing care were housed in County poor houses or in facilities for the mentally ill. Conditions were deplorable. In the early 1900’s home visiting nurses started reversing this trend of institutionalizing and allowed many care recipients to remain in their homes. Nursing homes or so-called rest homes were also being built with public donations or government funds. With the advent of Social Security in 1936, a nursing home per diem stipend was included in the Social Security retirement income and this government subsidy spurred the construction of nursing homes all across the country.

By the end of the 1950s it was apparent that Social Security beneficiaries were living longer and that the nursing home subsidy could eventually bankrupt Social Security. But in order to protect the thousands and thousands of existing nursing homes Congress had to find a way to provide a subsidy but remove it as an entitlement under Social Security. In 1965 Medicare and Medicaid were created through an amendment to the Social Security Act. Under Medicare, nursing homes were only reimbursed on behalf of Social Security beneficiaries for short-term rehabilitation. Under Medicaid, nursing homes were reimbursed for impoverished disabled Americans and impoverished aged Americans over the age of 65. It has never been the intent of Congress to pay for nursing home care for all Americans. The nursing home entitlement for all aged Americans was now gone.

Over the last 40 years, there has been a gradual change away from the use of nursing homes for long-term care towards the use of home care and community living arrangements that also provide in-house care.

With Proper Planning People Could Remain in Their Homes for the Rest of Their Lives
We are seeing a trend towards working conditions like those in urban America in the early 1900’s where both husband and wife are working and putting in longer hours. We are also seeing a return of the trend in the early part of the 20th century where outside visitor caregivers are becoming available to replace working caregiver’s and allow the elderly to receive long-term care in their homes. In addition there is a significant trend in the past few years for Medicaid and Medicare to pay for long-term care in the home instead of in nursing homes.

Given enough money for paid providers or government funding for the same, a person would never have to leave his home to receive long-term care. All services could be received in the home. Adequate long-term care planning or having substantial income can allow this to happen.

We only need to look at wealthy celebrities to recognize this fact. Christopher Reeve, the movie star, was totally disabled but he had enough money to buy care services and remain in his home. President Ronald Reagan suffered from Alzheimer’s for many years but received care at his California ranch. He was also wealthy enough to pay for care when needed. Or what about Annette Funicello or Richard Pryor? Income from their movie careers allowed them to receive care with their multiple sclerosis at home. We will be willing to bet that Mohammed Ali, who is severely disabled with Parkinson’s disease, will probably never see the inside of a care facility, unless he chooses to go there to die. With the proper planning and the money it provides, most of us could remain in our homes to receive long-term care and we would never have to go to an institution or a hospital.

The Popularity of Home Care
Most of those receiving long-term care and most caregivers prefer a home environment. Out of an estimated 8 million older Americans receiving care, about 5.4 million or 67% are in their own home or the home of a family member or friend. Most older people prefer their home over the unfamiliar proposition of living in a care facility. Family or friends attempt to accommodate the wishes of loved ones even though caregiving needs might warrant a different environment. Those needing care feel comfortable and secure in familiar surroundings and a home is usually the best setting for that support.

Often the decision to stay in the home is dictated by funds available. It is much cheaper for a wife to care for her husband at home than to pay out $2,000 to $4,000 a month for care in a facility. Likewise, it’s much less costly and more loving for a daughter to have her widowed mother move in to the daughter’s home than to liquidate mom’s assets and put her in a nursing home. Besides, taking care of our parents or spouses is an obligation most of us feel very strongly about.

For many long-term care recipients the home is an ideal environment. These people may be confined to the home but continue to lead active lives engaging in church service, entertaining grandchildren, writing histories, corresponding, pursuing hobbies or doing handwork activities. Their care needs might not be that demanding and might include occasional help with house cleaning and shopping as well as help with getting out of bed, dressing and bathing. Most of the time these people don’t need the supervision of a 24/7 caregiver. There are, however, some care situations that make it difficult to provide long-term care in the home.

Please note from the first set of numbers below that a great amount of home care revolves around providing help with activities of daily living. Note from the second group of numbers that the average care recipient has need for help with multiple activities of daily living. Finally, it should be noted from the second group that well over half of home care recipients are cognitively impaired. This typically means they need supervision to make sure they are not a danger to themselves or to others. In many cases, this supervision may be required on a 24-hour basis.

The following numbers were derived from the 1999 national caregivers survey:

Percent of Elderly Home Care Recipients Needing Help With Selected Activities of Daily Living:

Bathing 42%

Dressing 37%

Transferring 32%

Doing Light House Work 22%

Toileting 21%

Medication Reminders 19%

Preparing Meals 12%

Eating 11%

Shopping 6%

Using the Phone 2%

Managing Money 1%

Functional and Cognitive Impairments of Care Recipients as Reported by Their Informal Caregivers:

0 to 2 Activities of Daily Living (ADL) Limitations = 40%

3 to 4 ADL Limitations = 30%

5 to 6 ADL Limitations = 30%

Percent of Recipients with Cognitive Impairment = 54%

It is precisely the ongoing and escalating need for help with activities of daily living or the need for extended supervision that often makes it impossible for a caregiver to provide help in the home. Either the physical demands for help with activities of daily living or the time demand for supervision can overwhelm an informal caregiver. This untenable situation usually leads to finding another care setting for the loved one. On the other hand if there are funds to hire paid providers to come into the home, there would be no need for finding another care setting.

Problems That May Prevent Home Care from Being an Option
Caregivers face many challenges providing care at home. A wife caring for her husband may risk injury trying to move him or help him bathe or use the toilet. Another situation may be the challenge of keeping constant surveillance on a spouse with advanced dementia. Or a son may live 500 miles from his disabled parents and find himself constantly traveling to and from his home, trying to manage a job and his own family as well taking care of the parents. Some caregivers simply don’t have the time to watch over loved ones and those needing care are sometimes neglected.

The problems with maintaining home care are mainly due to the inadequacies or lack of resources with informal caregivers, but they may also be caused by incompetent formal caregivers. These problems center on five issues:

• Inadequate care provided to a loved one

• Lack of training for caregivers

• Lack of social stimulation for care recipients

• Informal caregivers unable to handle the challenge

• Depression and physical ailments from caregiver burnout

In order to make sure home care is a feasible option and can be sustained for a period of time, caregivers must recognize these problems, deal with them and correct them. The responsibility for recognizing these problems and solving them is another function of the long-term care planning process and the team of specialists and advisers involved, such as the Farr Law Firm.

Adequate Funding Solves Most Problems Associated with Providing Home Care
None of the problems discussed in this article would be an obstacle if there were enough money to pay for professional services in the home. These services would be used to overcome the problems discussed in the previous section. If someone desires to remain in the home the rest of his or her life and is not extremely wealthy, adequate pre-planning can often provide the solution.

Such pre-planning involves asset protection, and should ideally be done as early as possible. One type of asset protection is to purchase a long-term care insurance policy when you are still healthy and able to afford the premiums, being sure to get a policy with a good home care benefit. There is also significant financial assistance available in the form of the Veteran’s Aid and Attendance benefit for qualified veterans. If long-term care insurance is not an option and Veteran’s Aid and Attendance is not available, another possible option is to put money aside to pay for home care in the future. If putting money aside, you should consider putting it in a special type of irrevocable asset protection trust called the Living Trust Plus™, that is designed to protect assets from probate and from the expenses of long-term care. If Medicaid assistance is needed to pay for future long-term care, whether at home or in a nursing facility, the assets in the Living Trust Plus™ Asset Protection Trust will be exempt assets for Medicaid eligibility and will not be counted against you.

Unfortunately, not enough people think about the issue of needing long-term care when they are older. This lack of planning leads to fewer options for elder care when the time comes. Lack of significant wealth and lack of pre-planning means that most people do not have the luxury of remaining in their homes when the time comes. Fortunately, Medicaid is available to pay for nursing home care to finish out the rest of their lives. Every day, the Farr Law Firm helps clients needing nursing home care protect significant assets and still qualify for Medicaid when needed.

Posted in Medicaid Planning, Other Elder Law Blogs, Senior Care | 1 Comment »

Ten Affordable Gifts for Elderly Parents

Thursday, December 18th, 2008

Finding the right gifts for family members is an annual challenge, especially this year when everyone is feeling economic uncertainty. Gift giving is more meaningful when you know that the item you’ve chosen will have personal significance to the recipient.

What many elderly parents want more than material goods is the physical presence of their loved ones. Most want to feel the connection to loved ones and to uphold the traditions they have become accustomed to for half a century or more. They want to be surrounded by people they know and love, allaying the underlying feelings of being isolated from the warm customs they have known in the past. However, with families often living long distances from each other, being able to share the holidays in person may not always be practical or feasible given financial constraints. So, what options are available to maintain the connection and bring joy into the hearts of the older person while feeling good about the gift choices you make? Below are ten suggestions for holiday gifts to consider that are easy to find, inexpensive to send, take nominal space, if any, and can fit most cost conscientious shoppers of any age.

1) Holiday decorations: Most communities will decorate the common areas of the independent living, assisted living or nursing home with a Christmas tree, lights and a menorah for those who celebrate Chanukah. It’s not uncommon to see wrapped gifts under a tree and beautiful plants in the entry way of most senior housing settings. Most residents still want to adorn their private space with their own holiday accoutrements. Most residents typically don’t have access to transportation to buy their own decorations, store them throughout the year or to dispose of a real tree after the holiday. Using real candles for the menorah can be a fire hazard along with tree lights. There is always the electrical candle option, but it’s a good idea to check with the community first in any case regarding their safety policies. A seasonal gift might be a few small poinsettia plants to liven up their apartment, a decorated wreath for the entry door, ornaments to hang by the window or nutcracker soldiers to place on a shelf or table. Even stockings with little gifts such as reading lights with batteries, toiletries or customized stationery with a new personalized pen would be welcomed additions.

2) Food items: Most families have traditional foods specific to the holidays. Remember, some places may not have refrigeration or adequate space for larger food items. Consider items that are not difficult to chew and have a relatively long shelf life. An example could be cookies, fruitcake or an assortment of holiday candies such as candy canes or chocolate kisses to have on hand when friends of the grandkids visit. A festive holiday basket filled with jams, jellies, crackers and cheese could be a gift shared with fellow residents. Who doesn’t love to receive a surprise package, knowing that someone cares about them enough to send a thoughtful gift? Don’t forget the personalized note so they know who sent it. The cost can be kept under $50, depending on whether you prepare the food yourself or order a package from a distributor.

3) DVDs of Classic Movies and/or TV shows: Re-experiencing the old days is a favorite pastime for seniors with long term memory usually more intact than the short term. Whether it’s the “Best of Lawrence Welk,” western movies, or Hollywood classics with the “Brat Pack,” these films could bring smiles and stimulate fond times of younger days. Two DVDs or CDs can be found for under $30 including tax.

4) CDs of their favorite music: Music from the senior’s years of youth, such as big band, jazz or classical tunes, could bring many hours of pleasure and be a gift that keeps rekindling old memories.

5) Digital Photos: Having an assortment of family rotating shots of the grandkids in action smattered with older and more recent photos of family and friends available for them to look at any time would delight their living space while they muse at the latest technology. A digital photo frame is far more likely to be viewed than the traditional photo album which tends to gather dust. You will likely have to load the photos for them, but seeing the expression on their face is well worth the time and effort. Most come with a memory card slot, which makes it easy for you to update photos from far away. Depending on how many photos you want to hold, the cost typically runs between $25 and $50.

6) Magazine subscriptions: There is a magazine for practically every hobby and interest. Purchasing a one or two year annual subscription can be a personalized gift that can bring ongoing pleasure to the individual, knowing that you cared enough to remember their particular area of interest. In addition, it stimulates their mind to read and stay current on hot trends related to their favorite subject matter. An annual subscription for most magazines will be under $36.

7) Books on tape: For many seniors with compromised eyesight, having interesting new novels on tape read by an eloquent narrator can bring hours of entertainment. It can also give the senior a reason to engage in conversation about the latest written works with extended family and friends making them feel able to contribute in contemporary works of art.

8 ) 2009 calendar with family photos: Select twelve of your special photos and make a calendar on your own home computer, or have it done at Kinko’s or an equivalent print shop. This gift shows the extra care to tailor a gift for the senior. Go the extra mile and note the birthdays of all close family members on the calendar as a reminder for them throughout the year. You can also buy a box of birthday cards for them to send to family members throughout the year since getting out to the store to buy cards in a timely manner is difficult for most senior residents. Our family prepared the calendar at a local print shop for less than $20.

9) Snugglies: Room temperatures tend to vary from room to room in senior housing so having your own personal blanket or cover-up from head to toe may be ideal for winter comfort. It can also be of ideal for watching TV or listening to good music with air conditioning in the summer months. For less than $30, the fabrics can range from fun fur, fleece, cotton or polyester. We encourage you to consider machine washable fabric, which means avoiding wool if possible. There are new products which are blankets with sleeves to enable use of your hands for reading, knitting or cuddling a pet or grandchildren while maintaining that cozy feeling.

10) Membership in Medic Alert: The non-profit organization, online at www.medicalert.org, offers a bracelet or necklace with a toll free number inscribed along with the senior resident’s name and other essential information (e.g., allergies, medical conditions such as diabetes) on the back to a 24-hour emergency response service. The family member who takes out the annual subscription can access and update the personal health information for the senior resident any time. The service includes family notification, medical profiles with medication dosages and medical device information. If you are a caregiver living near or far, you can have peace of mind knowing that this inexpensive service, typically less than $50 per year, will provide access to current pertinent information to help the senior during a medical emergency or natural disaster. No longer are paper records, often out of date, necessary to get timely key information into the hands of those who need it to respond accordingly. Even the Alzheimer’s Association uses this service for their Safe Return program for those afflicted with dementia or Alzheimer’s disease who can lose their whereabouts and become disoriented.

The Farr Law Firm sends you our warm holiday greetings, and we hope these ideas lighten your burden of finding the right gift for the older special person in your life.

This article is provided by SNAPforSeniors®, the most current and comprehensive senior housing resource in the nation, which has recently partnered with the National Academy of Elder Law Attorneys to provide the NAELA Senior Housing Locator. If you or a loved one are in need of senior housing, you can start a search by clicking here.

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Holiday Blues: Depression in the Elderly

Thursday, November 13th, 2008

The holiday season is quickly coming upon us. If you are a caregiver for an elderly loved one, you may notice a change in your loved one’s mood as the holidays approach. Perhaps you are one of many who live a distance away and visit elderly parents and family during the holidays. When you visit, you may notice that your loved one is not as physically active, or is showing symptoms of fatigue or sadness and has no interest in the holiday or in their surroundings.

According to the National Institutes of Health, of the 35 million Americans age 65 or older, about 2 million suffer from full-blown depression. Another 5 million suffer from a less severe forms of the illness. This represents about 20% of the senior population — a significant proportion.

Depression in the elderly is difficult to diagnose and is frequently untreated. The symptoms may be confused with a medical illness, dementia, or malnutrition due to a poor diet. Many older people will not accept the idea that they have depression and refuse to seek treatment. 

What causes depression in the elderly?

It is not the actual holiday that causes depression, but the fact that holidays tend to bring memories of earlier, often happier times. Additional contributing factors that bring on depression may be the loss of a spouse or close friend, or a move from a home to assisted living, or a change with an older person’s routine.

It is not the actual holiday that causes depression, but the fact that holidays tend to bring memories of earlier, often happier times. Additional contributing factors that bring on depression may be the loss of a spouse or close friend, or a move from a home to assisted living, or a change with an older person’s routine.

Depression may also be a sign of a medical problem. Chronic pain or complications of an illness or memory loss can also cause depression. In addition, diet can also be a factor when proper nutrition and vitamins are lacking.

Symptoms to look for in depression might include:

- Depressed or irritable mood
- Feelings of worthlessness or sadness
- Expressions of helplessness
- Anxiety
- Loss of interest in daily activities
- Loss of appetite
- Weight loss
- Lack of attending to personal care and hygiene
- Fatigue
- Difficulty concentrating
- Irresponsible behavior
- Obsessive thoughts about death
- Talk about suicide

How do you know if it is depression or dementia?

Depression and dementia share many similar symptoms. A recent article on Helpguide gives some specific differences.

In depression there is a rapid mental decline, but memory of time, date and awareness of the environment remains. Motor skills are slow, but normal in depression. Concern with concentrating and worry about impaired memory may occur.

On the other hand, dementia symptoms reveal a slow mental decline with confusion and loss of recognition of familiar locations. Writing, speaking and motor skills are impaired and memory loss is often not acknowledged by the person suffering dementia.

Whether it is depression or dementia, prompt treatment is recommended. A physical exam will help determine if there is a medical cause for depression. A geriatric medical practitioner is skilled in diagnosing depression and illnesses in the elderly. If you are a caregiver of an elderly person, it may be beneficial for you to seek out a geriatric health care specialist.  

Treating depression in older people.

Once the cause of depression is identified, a treatment program can be implemented. Treatment may be as simple as relieving loneliness through visitations, outings and involvement in family activities. In more severe cases antidepressant drugs have been known to improve the quality of life in depressed elderly people. Cognitive therapy sessions with a counselor may also be effective.

Once the cause of depression is identified, a treatment program can be implemented. Treatment may be as simple as relieving loneliness through visitations, outings and involvement in family activities. In more severe cases antidepressant drugs have been known to improve the quality of life in depressed elderly people. Cognitive therapy sessions with a counselor may also be effective.

As a caregiver or family member of a depressed older person, make it your responsibility to get involved. The elder person generally denies any problems or may fear being mentally ill. You can make the difference in and remove the Holiday Blues from seniors suffering from depression.

The Geriatric Mental Health Foundation offers a “Depression Tool Kit.” To read more about the tool kit and depression in the elderly go to:

http://www.gmhfonline.org/gmhf/consumer/depression_toolkit.html

For more information on senior health services, see the following lists from Evan Farr’s book, the Virginia Nursing Home Survival Guide:

List of Geriatric Physicians
List of Geriatric Care Managers

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Celebrating Our Family Caregivers

Wednesday, October 15th, 2008

November is National Family Caregiver’s Month. Most family members who help their older loved ones don’t see themselves as caregivers. Yet a caregiver is anyone who helps an older person with household chores, errands, personal care, or finances. Most caregivers also don’t realize that caring for themselves is an important part of providing care for someone else. Among all the hardships of providing care to another, a caregiver faces time restraints and stresses that might be physical and/or psychological in nature. Particularly today, given the current economy, a caregiver may also feel the burden of financial stress. The simple truth is you can’t be a good caregiver if you don’t take care of yourself. The following advice comes from my book, The Virginia Nursing Home Survival Guide, which you can obtain from our firm or from Amazon.com.

What You Can Do

Take charge of your life. Don’t let your loved one’s illness or disability always take center stage. While you might fall into a caregiving role because of an unexpected event, somewhere along the line you need to step back and consciously say “I choose to take on this caregiving role.” It goes a long way toward eliminating the feeling of being a victim.

Set realistic goals. Caregiving creates many conflicting demands on your time; it is vital to set realistic goals. Recognize what you can and cannot do. Define your priorities and stick to them as much as you can. You have the right to set limits and, though it is hard, it is okay to say no.

Seek out help from family and friends. When others offer assistance, accept it and suggest specific things they can do. Some caregivers see asking for help as a sign of weakness, failure or inadequacy, when in fact it is just the opposite. Reaching out for assistance before you are beyond your limits is one characteristic of a strong person. While they might not be comfortable helping with bathing and dressing needs, friends and family can help by running errands, shopping for groceries, preparing meals or just visiting. They can call regularly, taking some pressure off you to be the primary social outlet.

Seek out appropriate geriatric medical professionals. A geriatrician is a medical doctor who is specially trained to prevent and manage the unique health concerns of older adults. Older persons may react to illness and disease differently than younger adults. Geriatricians are able to treat older patients, manage multiple disease symptoms, and develop care plans that address the special health care needs of older adults. Geriatricians are typically primary care physicians who are board-certified in either Family Practice or Internal Medicine and have also acquired the additional training necessary to obtain the Certificate of Added Qualifications in Geriatric Medicine.

National Family Caregiver’s Month

The National Family Caregivers Association (NFCA) provides education and support to those who are caring for a loved one. Founded in 1993, their motto is “Believe in Yourself, Protect Your Health, Reach Out for Help and Speak Up for Your Rights.”

Fairfax County has regular Free Seminars for Family Caregivers. The seminars take place in October and November and are all geared towards educating the Family Caregiver. Some of the titles include: Planning Quality Time for the Person with Dementia (10/22), End of Life Decisions: What Families Need to Know (10/28) and When Do I Step In (11/5). You can click here to register for any of these free seminars.

The Farr Law Firm is dedicated to helping caregivers by providing outstanding legal services that help preserve assets in order to protect the dignity and integrity of their loved ones.

Free Seminars for Family Caregivers:
http://www.fairfaxcounty.gov/aaa/pdf/cgsemfall2008.pdf

National Family Caregivers Association:
http://www.nfcacares.org/

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Transportation Options for Seniors in Fairfax County

Tuesday, September 16th, 2008

The Americans with Disabilities Act (ADA) became law in 1990 and since then has improved transportation options for seniors and disabled persons living in Fairfax County and beyond. The ADA is a federal civil rights law prohibiting discrimination against persons with disabilities in a wide range of categories, one being transportation. Before the ADA, many fixed-route bus systems did not provide transportation options for disabled persons. Under the ADA, public transportation systems across the board were made more accessible. Most buses or vans today provide what are termed paratransit services, that is, they are specifically equipped with ADA approved wheelchair lifts or ramps to facilitate access for disabled persons.

MetroAccess

In the Washington D.C. metropolitan area, MetroAccess is the name for the paratransit service that was built specifically to comply with ADA standards. All those participating in this program are unable to use fixed-route bus or rail services due to a physical or cognitive disability. To those who are qualified, MetroAccess provides door-to-door transportation to any location in the District of Columbia; to Montgomery and Prince Georges counties in Maryland; and to Arlington and Fairfax counties, the cities of Alexandria, Fairfax and Falls Church in Virginia that is within three-quarters of a mile of any fixed-route service operated by Metrorail, Metrobus or any of the above local jurisdictions. MetroAccess uses the same hours as any regular fixed-route transit.

Only riders who meet certain criteria specified by the ADA and who have been certified as eligible can use MetroAccess. A two part application is required; Part A is completed with one’s own doctor while Part B is completed only by a scheduled appointment with a physical therapist who works specifically with MetroAccess. According to a representative at MetroAccess, the current wait time for an appointment to complete Part B is three months. In the meantime they can issue a temporary pass that is good for 21 days.

MetroAccess fares range between $2.50 and $6.50 each way, depending on the distance (measured in “zones”) traveled. The price is based on how far a pick up is from a fixed route. For more information about MetroAccess please call 1-800-523-7009.

Fastran

On a more local level, Fairfax County offers paratransit options for those who are either disabled or 65 years of age or over. One such service is Fastran, which offers specialized transportation services for residents of Fairfax County and the Cities of Fairfax and Falls Church. All Fastran riders must be certified by a participating agency before utilizing the service (with the exception of companion riders). Fastran only travels within Fairfax County for a pick up but they will travel as far as Arlington County or the City of Alexandria for a drop off.

Fastran has three programs. The Dial-a-Ride Program (DAR) is for residents who are certified by Fastran to be transported to and from medical appointments and essential shopping needs; all of these vehicles are equipped with wheelchair lifts. DAR trips are available between 10:00am and 2:00pm weekdays. According to a manager at Fastran, they are usually booked for going to the grocery store, doctor or physical therapist. DAR is an income-based program.

Secondly, the Critical Medical Care Program (CMCP) offers transportation for residents who are undergoing dialysis, cancer treatments or rehabilitative services. This program operates on a space available basis and only between the hours of 6:00am and 6:00pm Monday through Friday. On the weekends, riders are encouraged to use MetroAccess.

Lastly, Fastran offers charter buses for the county, Monday through Friday from 10:00a.m. until 2:00pm. Often, Senior Centers rent these and pay the fare for transportation to and from their facilities.

The fees for DAR and CMCP are minimal. Dial-a-Ride users deposit $1.00 to $2.00 in the farebox each way, depending upon the length of the trip while CMCP riders pay $0.00 to $5.00 per one-way trip depending upon their income.

The differences between Fastran and MetroAccess are three. With a $2.50 base pay and what can be a fare of $6.50 per trip, MetroAccess is far more expensive than Fastran. If you are a senior citizen of Fairfax County and need rides during regular weekday times, Fastran makes sense. A benefit, however, of MetroAccess, other than the obvious fact that it has a greater client base, is that it operates on the same schedule as Metrorail and Metrobus and this gives seniors more flexibility for their appointments whether they be on a weekday or weekend.

Fairfax Connector

Fairfax County also offers bus and tax cab services for seniors and those with disabilities. One such bus service is the Fairfax Connector, which began in September 1985 as a cheaper alternative to Metrobus. It now serves Fairfax County and includes the Dulles Corridor and the Reston Internal Bus System (RIBS). It provides service to all Metro Stations in Fairfax County and various points in between.

Priority seats for seniors and passengers with disabilities are located behind the operator. Buses in Reston and Herndon all have wheel chair lifts while most others outside this area, are similarly equipped. In order to be sure that your area has wheelchair equipped buses, call (703) 339-7200.

Besides the already low cost, the Fairfax Connector reduces its fares to 50 cents for those 65 years of age and older and for disabled persons. Also, as is true with Metrobus, any passenger may ride for free on Code Red air quality days.

According to a representative, another benefit of the Fairfax Connector besides the reduced fare is that upon boarding, passengers have the option to ask for a transfer slip that enables them to ride multiple busses for up to two hours on the same fare. Senior citizens can obtain an ID application at all Fairfax County libraries. Persons with disabilities can arrange to obtain an ID by calling (202) 962-1245.

Fairfax County also provides taxi cab services for seniors who are residents. Two such programs are Seniors on the Go! and City Wheels.

Seniors on the Go!

Seniors on the Go! allows senior residents of Fairfax County who have an annual income of $40,000 or less for a family of one and $50,000 or less for a married family of two to purchase taxicab coupon booklets worth $30 at a cost of only $10 per booklet. Once qualified, seniors may purchase up to $480 worth of taxicab coupons (16 coupon books) within a 12-month period; this works out to a yearly savings of $320 on taxicab fare! There are no restrictions to where a rider may go.

City Wheels

Another service and one that some of our clients who live locally use is City Wheels This service provides disabled Fairfax City residents alternative transportation within the City of Fairfax, to George Mason University, to the Vienna/Fairfax-GMU Metrorail Station, to Fair Oaks Hospital and to the Farr Law Firm. All services are provided through private taxicabs. A Photo ID or Proof of Disability is required and fares are $1.50 a trip.

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Federal Nursing Home Site Now Notes Troubled Facilities

Wednesday, May 14th, 2008
The federal Centers for Medicare & Medicaid Services (CMS) announced recently that its Web site comparing nursing homes will now identify listed facilities that have a history of poor performance.From now on, the CMS Nursing Home Compare site will label nursing homes it calls Special Focus Facilities — those that have repeatedly violated state and federal health and safety rules and that rank in the worst 5 to 10 percent of all inspected facilities in a given state. CMS released the names of the 131 SFF facilities earlier this year, but this is the first time they will also be included on the Nursing Home Compare site.The troubled facilities are identified by a small “2″ in superscript next to a facility’s name.

A Wall Street Journal article on the CMS decision notes that “consumer groups and nursing home officials warn, however, that nothing can substitute for visiting a nursing home in person.” Evan Farr makes this same recommendation in his book, The Virginia Nursing Home Survival Guide, which contains a Nursing Home Evaluation Tool to help consumers compare nursing homes during personal visits. You can also find this tool on our Web site by clicking here.

The Journal article also highlights a free Web site MemberoftheFamily.net, that features easy-to-read, color-coded assessments of nursing homes nationwide.

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Understanding a Caregiver’s Stress

Wednesday, February 6th, 2008

A 2003 study of caregivers has proven that the off-repeated adage “stress can kill you” is true. The focus of the investigation was the effect the stress of caregiving had on caregivers.

A team of researchers at Ohio State University Medical Center has found a chemical marker in the blood that shows a significant increase under chronic stress and is linked to an impaired immune system response in aging adults. The team, led by Dr. Janice Kiecolt-Glaser, reports in the June 30, 2003 issue of Proceedings of the National Academy of Sciences on a 6-year study of elderly people caring for spouses with Alzheimer’s Disease. With the caregivers, the team found a four-fold increase in an immune system protein — interleukin 6 (IL-6) — as compared to a control group of non-caregivers. Only the stress of caregiving correlated to the marked increase of IL-6 in the caregiver group. All other factors, including age, were not significant to the outcome. Even the younger caregivers saw an increase in IL-6.

The study also found that the caregivers had a 63% higher death rate than the control group. About 70% of the caregivers died before the end of the study and had to be replaced by new subjects. Another surprising result was that high levels of IL-6 continued even three years after the caregiving stopped. Dr. Glaser proposes that prolonged stress may have triggered a permanent abnormality of the immune system.

The problem is if this response is initiated repeatedly over a long period; it can have a dangerous effect on the body. This repetitive initiation of the stress response is common among caregivers — especially those caring for loved ones with dementia. Providing supervision or physical assistance many hours a week and over a period of years turns out to be extremely stressful. This type of stress is often unrelenting, occurring day after day and week after week. And the long-term effects of this stress are more pronounced in middle-aged and older people who are precisely the group most likely offering long-term care to loved ones.

If you are a caregiver, please give us a call.  Through a properly-designed Life Care Plan for your loved one, the Farr Law Firm can help you minimize or eliminate much of your stress.

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Caregivers Take Care

Tuesday, November 13th, 2007

Caregiving can be very stressful and demanding. In the case of a healthy spouse or a child living with a disabled person at home, caregiving can be a 24 hour, 7 day a week commitment. But even for the caregiver not living in the home, looking after a loved-one or friend can consume all of the caregiver’s free time.

Surveys and studies consistently show that depression is a major problem with full-time informal caregivers. This is typically brought on by stress and fatigue as well as social isolation from family and friends. If allowed to go on too long, the caregiver can sometimes break down and may end up needing long-term care as well.

Since most people go into informal caregiving without training or counseling they often aren’t aware of the possible outcome. It is therefore extremely important to receive counseling and to formulate a plan of action prior to making a caregiving commitment. In 1965, Congress passed the Older Americans Act which provides guidance and funding to the States to give help to caregivers. All states offer programs at no cost or very low cost which might include: counseling, caregiver training, respite care, adult day care, meals, support groups and much, much more.

For example, one such resource that is readily available is to join a support group.  The Department of Family Services’ Fairfax Area Agency on Aging has put together a useful flyer that highlights some of the support groups available for caregivers in Fairfax County.

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