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Money & Legal

May 2, 2017

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For most people, legal and financial matters are overly complex and not particularly riveting (we hear you). All too often, though, entire families are caught off guard when a loved one suddenly falls ill, has an accident or develops noticeable cognitive problems. 

Understandably, their wellbeing is the number one priority, not determining whether they have named a health care proxy, composed a living will or put aside money for long-term care or a funeral. The vast majority would rather not discuss sensitive issues like money or end-of-life care with their loved ones. In the rare instance when a caregiver knows exactly what their parent or significant other wants, the proper legal and financial documentation must already be in place for them to see these wishes through. Without it, they have no authority to rule on these matters or even gain access to relevant information.

Making sure your family members have covered all of their bases takes careful planning and consideration. Although many people are not keen on paying attorney fees, obtaining a few basic documents, like medical and financial powers of attorney, a will, and an advance directive, in a timely manner can help you avoid major headaches down the road. The same principles apply to financial preparedness. The earlier you and your family save and plan for the unknown, the more security you will be able to enjoy. Each situation is different, but preparing for the worst and hoping for the best is the recommended approach for these intricate matters.


Veterans Pension Helps Pay for Long-Term Care and Home Care

May 2, 2017

BY MARLO SOLLITTO


Over 1.5 million wartime service veterans and their surviving spouses are eligible for billions of dollars a year in VA pensions to help pay for long-term care such as assisted living, nursing home and home care. The pensions are called "Aid and Attendance" and "Housebound." Many are not getting the benefits they are eligible for, because they lack the knowledge of what programs are available and don't know how to file for pension benefits.


Although many veterans are eligible for pensions, filling out the necessary forms and understanding the filing process can often be overwhelming and frustrating.

In an interview with AgingCare, Joseph Scott McCarthy, a veteran advocate answers some common questions about veteran pension and financial assistance.


Can Caregivers Get Financial Assistance for Caring for a Veteran?

Yes, spouses or family members of veterans may get tax-free money for caring for veterans or surviving spouses. The VA program is called Aid and Attendance or Housebound Pension and requires the claimant to meet eligibility requirements to receive the money. A veteran with a dependent, for example, may receive as much as $25,525 per year to pay for un-reimbursed long-term care.

Do VA Benefits Cover Nursing Homes or Assisted Living?

Yes, VA pension benefits can cover a portion of nursing home care if the veteran or surviving spouse is paying for the care out-of-pocket. Since with some exceptions, assisted living is un-reimbursed by insurance, the money from the VA pension can be the difference that allows the veteran or surviving spouse to afford the cost of assisted living.

When you add the social security income sources to the VA pension, many veterans can afford the monthly bill for assisted living. For example, if a veteran has $1,400 per month in social security and pensions and receives the maximum pension (approximately $1,794 per month, with no dependent) the total money available is $3,194 per month and should cover most of the monthly bill for assisted living.

Does Long-Term Care Have to Be Provided at a VA Facility, or Can They Choose any Nursing Home?

The vet can choose any assisted living, home care provider or nursing home they want. It does not have to be a VA facility. The provider does not have to be VA certified and any physician can document the care needs of the claimant.

Do any VA Programs Cover the Cost of Home Health Care?

Yes, the Aid and Attendance and Housebound Pensions can cover care provided in the home as long as all eligibility criteria are met. The pension can pay for the care in the home, and in assisted living, independent living, and nursing facilities.

What Is the Difference Between Aid and Attendance and Housebound Pensions?

The care needs and the rates of payment are the main difference. For an Aid and Attendance pension, the veteran must need activities of daily living such as dressing or bathing. For the Housebound pension, the veteran must be substantially confined to his or her immediate premises because of a permanent disability.

For example, your sister, a veteran of the Korean War, is a widow, is confined to her home due to a permanent disability, but is able to provide her own activities of daily living care. Because of her disability, she requires oxygen therapy, has difficulty walking for which she uses a wheeled walker, and her physician ordered her driver's license taken away. She is paying out of pocket for transportation services in order to go food shopping and to keep doctors' appointments. Since her disability caused her to lose her driver's license, and she now needs transportation services to leave her home, she satisfies the care-needs qualification for Housebound benefits.

How to Evaluate Senior Living Options

May 2, 2017

Knowing where you would like to live is easy. Most of us want to live in the home we are already in and few of us want to find ourselves living somewhere unexpectedly or as a last resort.


Unfortunately, wisdom isn't the only thing that aging brings. It also brings challenges that can sometimes make staying in the home you love difficult, if not impossible. When a person faces these challenges, knowing where you need to live is not easy to decipher. 


As a director for an agency whose mission it is to help seniors facing these challenges stay in their home for as long as possible, I know that sometimes despite valiant efforts, the decision to move a person into a setting that is better equipped to meet that person's needs has to be made.


On many occasions it is not the individual, but rather a caregiver, that is making the decision to move their parent from the home that they have lived in for so long and where they have created many memories. This is certainly not any easy decision for the caregiver, particularly when they have made a promise to "never put them in a home." The feelings of guilt and the belief that they failed to keep this promise can be overwhelming. 


The decision for a person to move out of their home into another setting will never be an easy one, but it can be made less difficult. As with many things in life, things usually go much smoother when you plan and do your research. Plan, plan, plan—it can't be said enough. Some may be asking themselves, "What am I supposed to be planning for?" The answer is aging. Although we may joke about getting older, very few of us actually plan on it happening.

It is similar to a hurricane. I live in Florida where we experience these devastating storms. It is remarkable how many people are not prepared for these events. The main distinction between hurricanes and aging, though, is that the latter affects everyone. So, I say again, you cannot plan enough.

Where should we start the planning process for deciding where we should live or where we will place a loved one should it become necessary? One of the greatest fears expressed by the elderly is placement in a nursing home facility. It is not uncommon to hear, "I don't want to end up in a nursing home" or "promise me you won't put me in a nursing home." People tend to believe that nursing homes are the only option for seniors when they can no longer safely remain in their own residence. The reality could not be further from the truth.

The living options for seniors needing assistance grows every year. There are assisted living facilities, family group homes, independent senior living communities, skilled nursing facilities, and many more, including home care, intentional communities, and continuing care retirement communities. The first part of planning for an alternate living situation is to become aware of the various options available in your community.

The second is to understand that people have different needs and that certain living options are dependent upon individual needs. Living options are not "one size fits all." Take a good look at your loved one's care requirements so that you will have a clearer idea of which levels of care would be the best fit for them.


The third part of planning is researching each type of facility. There are several things to bear in mind when researching facilities. Caregivers must understand the term "least restrictive setting." The least restrictive setting is the one where the person maintains as much of their independence as possible. A person's own home would be the least restrictive setting possible. A skilled nursing home would be considered the most restrictive settings.

When you are thinking about the least restrictive settings you also need to consider future needs. You want to make sure that the setting is one that will be able to accommodate the person's current and future needs. It is tragic when a person is placed in an environment that is too restrictive and unnecessarily loses years of independence. It is equally tragic when a person is placed in a setting that is very unrestrictive but incapable of meeting that person's developing needs. Ultimately the person ends up having to move yet again.

There are three primary senior living options: independent senior living, assisted living facilities and skilled nursing facilities.


Independent Living Facilities

Independent living facilities are exactly what they sound like. They are usually set up like an apartment complex and house large numbers of seniors. These unrestrictive facilities allow a person to maintain complete autonomy. This type of facility is a very good option for those individuals who can still do most things for themselves, but prefer contact with other people of their age. Senior communities usually have on-site staff members that provide minimal supervision for safety and security purposes. Many independent living facilities also offer a wide variety of activities and events for their residents.


Choosing Senior Housing Care Based on Your Parent's Needs

May 2, 2017

BY CAROL BRADLEY BURSACK


As our population ages and more of our national focus is on senior care, we can find ourselves in a muddle over confusing choices. How do we decide what care our elderly mother or father needs and when do we start looking for it?



Choosing senior housing care

If Mom is still living in her original home, with no one to look in on her regularly, she may be at a turning point. Many people choose to start getting help from in-home care agencies, since Mom can stay in her home longer with this help. Others feel it's time for Mom to move to assisted living. There are several things for you and your mom to look at while you consider the options.

  • Are there still people in her neighborhood she knows and does she get out and about to visit friends? If she is stuck at home and there's no one nearby, she may become socially isolated in her home. In-home help can alleviate some of this loneliness and isolation, but Mom may be better off in a senior living center or even assisted living, depending on her needs.
  • Companion care may even be enough. This is someone who is paid to keep an elder company. Be careful who you hire, however, since seniors are vulnerable. A good place to find senior companions, and it's often free, is to call your local Retired Senior Volunteer Program, known as RSVP. They offer senior companions, who are healthy seniors who make great friends for more frail seniors. Whether hired or volunteers, people who are only senior companions aren't going to be cooking, cleaning and giving baths. They are there to provide company.
  • Senior living centers are aimed at fairly healthy seniors, but they generally offer more socialization than an elder gets if he or she lives in a home where the neighborhood has drastically changed, as so often happens. In a senior living center, Mom would probably find it easy to socialize.
  • However, if mom is showing signs of needing assistance with her meals and transportation, I'd recommend looking around at assisted living centers. Assisted living centers do not generally offer nursing care, and if help with dressing and other activities of daily livings (ADLs) are needed, she'd likely still have to have the help of an in-home care agency. The advantage of assisted living over a senior living center is one of watchfulness. The staff is on alert for medical emergencies. Plus, they generally serve meals in a central dining room. Often, assisted living centers will make transportation arrangements to doctor appointments, and some of them take groups shopping. Assisted living centers are not all cut out of the same mold, so make sure you understand what services they do and don't offer per contract, and what services may be available, but would cost extra. These centers range in size from community homes with four to six residents, to large complexes.
  • Many people never need more care than an assisted living center can provide, with perhaps some help from an outside in-home care agency for daily care. However, many people do need more nursing care. Diabetics often need nursing home care, as they must have their blood sugar checked often and generally only medically trained people can draw blood. People who fall often or need help to get from a bed to a chair may also need to make the move to a nursing home. Alzheimer's patients also require the medical care and supervision that a nursing home provides. The line between the two is fuzzy, as some assisted living centers can care for people longer into their frail years than others. However, the day comes for many when the assisted living center won't be enough. Nursing care is needed and the move to a skilled nursing home is next.
  • At this time, you would drop the in-home care agency, as the nursing home would handle all of the needs of the elder.

Everyone has their own personal checklist for finding good housing for their elderly parent. We want them safe, well cared for and happy. Happy depends a great deal on the individual, but safe and well cared for should be part of the bargain. So, what do you look for when you tour a center?

  • First, don't just take a tour with an administrator and say, "all done." Yes, you will want a tour with an official guide and you will want to talk about options and contracts.
  • Then, go back at a different time. If you can manage it, go back several times - once early in the morning while they are getting people up, especially if you are looking at nursing home. Assisted living centers will not be hustling people out of bed, but it's still a good time to get a feel for how mornings generally go.
  • Expect to have some unpleasant smells, especially in a nursing home. This is unavoidable, but the home should be equipped to hand these issues quickly and efficiently.
  • Watch how members of the staff treat each other, and the elders. Are they a cheerful bunch, working together and treating each other and the residents with respect? Do the hands-on caregivers in a nursing facility - generally Certified Nursing Assistants - seem to know "their" elders? Do the elders, in general, seem happy to see the CNAs? Please understand that some elders won't be happy - ever.
  • Visit again mid-day. Residents should have meaningful activities. One reason to move from the old home into assisted living or a nursing home is for socialization. Many studies have proven that being socially active is good for the health - mental and physical.
  • If you can, visit again in the evening. Security is more of an issue -- and that is a good thing. But it makes unannounced visits more difficult. Arrange to get past for evening visits.
  • In any setting, are people treated as individuals with their personal likes and needs addressed? Or are they just like a little chain of beads, pushed along to conform to the efficiency standard of the home? This is an important aspect of care that is now called "person centered care." and you want to see respectful person centered care in action.
  • Look for cleanliness. Look for attention to healthy detail.
  • Make sure the facility is licensed and has no history of abuse. Read contracts carefully to see what is covered and what is extra.

You can go to the Medicare Nursing Home Compare Guide at http://www.medicare.gov, and find a ranking for most homes. This can be useful, but the number of "stars" is only a guide. Most of these categories are self-reported, so many nursing homes may fudge. Also, this is a snapshot based on locality. In some states nursing homes are held to fairly high standards and others are pretty lax, therefore a two star home in one state may be far better than a five star home in another. Certainly, the Medicare ranking is useful, but only as one tool.

Bottom line, go with your gut. Check with families who have loved ones in the home. Don't go by just one recommendation (or condemnation). People have different expectations and even grudges. But do check with families you see who are visiting their loved ones. Several opinions should give you a fair idea of what families think. And what families think is far more important than the fluffy pillows on the couch and the smiling guide. Trust your instincts and word of mouth before you trust glitzy marketing strategies.

Should Your Elderly Parent Move into Independent Living?

May 2, 2017

BY EMILEE SELTZER


As people age, they often look into relocating. When an elderly person still has the physical and mental capacity to live independently, but wants companionship with others who are their age, independent living could be a good option. Independent living communities promote seniors' active lifestyles while offering a secure environment and providing specific services and amenities related to elderly people's needs.


Before spending time finding the right independent living community for your senior parent, first determine if your parent is a good candidate for independent living. Ask these questions:

  • Are they in good health?
  • Can they manage medications and doctor appointments on their own?
  • Would they enjoy living in a community with their peers?
  • Do they want "hassle-free" living?
  • Would they prefer the extra security provided by these communities?
  • Can they afford the costs for this kind of living? If not, are they willing to live in low-income senior housing?

If your elderly parent is not in good health, or cannot care for themselves without assistance, they are not a candidate for independent living. Assisted living or a nursing home, which provide access to healthcare and emergency medical services, would be a more suitable living option.

Seniors have options when looking for independent living communities. There are three major types and although they are somewhat similar, there are key differences in each option.


Retirement Communities

There are other names for these communities. Look for these:

  • Retirement Community
  • 55+ or 62+ Community

These housing communities usually offer the least in services and amenities and as a result, this is the most "independent option" in independent living. These communities are called retirement communities because they are just that; homes for independent and active retirees who want to live among peers.

Grounds maintenance is usually the only service provided, while things like cooking and cleaning are still done by the elder. Social activities are usually organized by the residents. Homes can be single-family houses, condominiums or modular. Although it depends on the particular community, usually seniors own their home individually. If renting is an option in the retirement community, it is usually done by renting from an individual owner, or renting as part of a co-op.

Independent Living Options for the Elderly

Senior Apartments

There are other names for these communities. Look for these:

  • Independent Living Community
  • Independent Living Facility
  • Senior Living Facility
  • Senior Living Community

Senior apartments, or senior housing, offer the same services as retirement communities; however, senior apartments offer a bit more. They are usually a part of a facility that provides varying levels of care, ranging from independent living to assisted living, and sometimes dementia units and skilled nursing. Services such as cleaning and transportation are usually offered and residents even have the option of eating in the community dining room, rather than cooking for themselves. Also, additional safety and security is inherent in senior housing facilities, simply because staff is generally available around the clock. According to Connie Hamin, marketing director of Heritage Woods in Winston, North Carolina, many of these senior apartments have emergency pull-cord systems, which are emergency devices, usually set up in every room of the apartment, that allow for the resident to alert the front office of an emergency or if they need assistance.

Senior apartments can be an ideal choice for active seniors who desire a "maintenance-free" lifestyle. They are still able to maintain their independence while having the added luxury of services and amenities that independent living provides.

Senior apartments are similar to assisted living, but have two key differences. Hamin explains, "For someone to live in independent living, they must be able to dress and bathe themselves, do their own laundry and are responsible for handling their medications. Seniors who live in assisted living also get the added bonus of 24 hour monitoring services." If an elder needs assistance with medications and/or personal care, but wants to maintain independent living status, they can use outside sources to receive this extra care. Usually this is done by hiring private-duty caregivers. Ultimately, the senior then is not really capable of independent living, but they still maintain the independent living status in their community.


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