Whenever I sit down with clients to plan ahead for Medicaid eligibility we spend a lot of time walking through the worst-case scenario of permanent nursing home placement, thereby triggering approximately $12,000 per month in nursing home fees (Connecticut is the 2nd most expensive state in the U.S. when it comes to nursing home care). But it's also important to at least consider the possibility that the client will never actually need to be placed in a nursing home.
There is no "crystal ball" to use and nothing can be guaranteed but there are factors to consider when trying to determine the odds that you will need permanent nursing home placement at some point in the future.
Is there a history of dementia and/or Alzheimer's Disease in family? It seems like these are the types of conditions that most often trigger the need for long-term, permanent nursing home placement and they are very hereditary. Other issues like diabetes, a heart condition, a bad hip etc. can usually be handled adequately at home.
Do children, grandchildren and other family members live nearby or are they beyond driving distance from your home? The larger the local support network (usually a family-based network) the less likely that you will need to be permanently institutionalized.
How extensive are your liquid assets? Even if you don't have long term care insurance in place, the more you have in investments, bank accounts, retirement accounts, etc., there is a greater possibility that you will be able to provide yourself with home health care and/or companionship to keep you in the community.
I always advocate for planning for the worst (in this context, permanent nursing home placement) and hoping for the best. However, you need to realize that future nursing home placement is not a "given", and if the chances of requiring institutionalization are remote based on your own set of personal circumstances then you should factor that into your planning.
DISCLAIMER: This blog does not offer legal advice, nor does it create an attorney-client relationship. If you need legal advice, consult with a lawyer instead of a blog.
This is something that I have observed with my own clients over the past 16+ years, but this is the first study that has backed it up with statistics: daughters of the elderly tend to provide the hands-on basic care. I'm sure there are all sorts of theories to explain this, none of which I am qualified to blog about.
My wife and I have three sons and no daughters, so I guess we're in serious trouble.
If you have a loved one in a nursing home then you will be invited to attend a quarterly meeting to discuss how your loved one is doing and determine what course her care should follow going forward. These meetings are usually called "care plan meetings/conferences" and they are required if the facility accepts Medicaid and/or Medicare.
These meetings should not be taken lightly. You should attend the meeting if at all possible and you should go there fully prepared with a list of specific questions for the nursing home staff. This is your best opportunity to voice your concerns and determine whether your loved one is getting the best possible care. This is also your chance to provide the staff with background information that could prove helpful in formulating the care plan.
I have been appointed many times by local probate courts to act as the conservator for seniors when family members and friends are unable to do so. This means I have attended innumerable care conferences and I usually pose the following questions to the staff:
Have there been any notable changes in the resident's condition since the last meeting? If so, what was the cause?
Is the resident participating in the facility's recreational/social events? If not, can steps be taken to facilitate his/her participation?
Have there been any visitors for the resident since the last meeting? If so, have those visits been helpful or detrimental to the resident's spirits?
What specific therapies are being provided?
Is the resident short on any personal items (toiletries, clothes, reading material, etc.)?
These are some of the standard questions I usually ask. However, every resident is different. So I suggest asking the above-mentioned questions as well as questions that are specific to your loved one's situation.
It's not too late to sign up for a 3-part webinar series on Alzheimer's Disease and Tools for Caregivers. This is being presented by the Administration on Aging (AOA), which is part of the Department of Health & Human Services.
The first webinar (5/9) goes over what, exactly, Alzheimer's disease is, as well as the latest updates on treatment and research.
The second webinar (6/13) reviews some helpful online tooks for Alzheimer's patients and their caregivers.
The third webinar (7/12) discusses how Alzheimer's patients and caregivers can participate in research opportunities.
I'm already registered for the first webinar. Click here to get all the details, including registration information.
People who commit to becoming the primary caregiver for a loved one are taking on an enormously important responsibility. To say that such a role takes its toll on the caregiver is an extraordinary understatement. I'm yet to meet a caregiver-client who hasn't mentioned that the responsibilities were well beyond what they ever imagined.
This is a reminder to caregivers that they need to focus as much as possible on themselves as well as their loved one. Otherwise, you simply won't be the best caregiver you can be.
This message was emphasized in a wonderful column by Jane Brody in the New York Times back in November titled, "Caring for Family, Caring for Yourself" and it's worth a read. It reminds the caregiver to do the basics in regards to personal care: take daily, weekly and annual breaks, get some regular exercise (walking is a great workout, and I'm a personal fan of running/jogging), get enough sleep and join a support group.
If you're a caregiver, please check out this article when you get a chance and make sure you don't create a situation where you need your own caregiver at some point!
First of all, my apologies for the long absence. A two-week trip to New Hampshire with the family, directing the Living Well Summer Racing Series in Glastonbury, CT and a very busy month at the law practice has forced a temporary blogging hiatus. But things are at least starting to settle down a bit...
Today I would like to sincerely thank Fiona King for directing me to a fascinating article on RNCentral.com which contains 50 tips for caregivers on how to effectively communicate with their loved one.
The article draws attention to the fact that the success of a caregiver's interaction with their elderly patient depends strongly on how well they communicate. Certainly, the elderly present a much different audience as compared to younger individuals. Therefore, dramatically adjusting your communication style becomes very important. Things like raising the normal volume of your voice, slowing down the speed at which you usually speak, minimizing distractions in the environment, a gentle touch on the arm to get attention...these are excellent ways to enhance the quality of communication with an elderly person.
The article is geared toward RN's, but it's still a fantastic resource for caregivers and children of elderly parents. And, although I'm not in either of those categories yet, I certainly plan to use these techniques when I chat with my next elderly client!
Click here to see the whole article and enjoy the read.
I often visit the Connecticut Senior Information website, which acts as a hub of important web-based information for seniors here in the Nutmeg State, and recently I ran across this thoughtful musing on loneliness and the elderly: Download Loneliness.doc. Unfortunately, there is no author provided.
This writing seems to assume a middle-aged audience and asks the reader to project forward to the future when the young kids you raised have struck out on their own to raise their own families, you are no longer working and you have reached a point where visits from friends are few and far-between because they can't get out easily or they have departed the earth altogether. The result: a deep sense of isolation and loneliness.
I appreciated the insight this writing provides since my wife and I are deep in the throes of raising three energetic young boys with their soccer games, cub scouts, educational issues and trying to keep the household at least somewhat in order. Oh yes, there's running the law practice as well! This leaves precious little time for visiting my parents, despite the fact that they are less than an hour away. Just making a phone call is a bit of a task since the 2 year-old and 5-year old apparently have a policy of climbing all over me and demanding a dozen different things whenever they see me reach for the phone.
So I think there's a lot of truth to this writing and it provides an insightful perspective on how a sense of loneliness can gradually creep up on members of our elderly population. So if you have seniors in the family I ask that you take five minutes out of your hectic day to give this a quick read.
If you have an elderly parent or parents, I highly recommend taking 20 minutes or so to read this New York Times article which came out on Christmas Eve (I finally found some time to read it!). It is an interesting yet disheartening depiction of a growing dilemma for the elderly in our society.
One of the biggest issues in regards to caring for the elderly, specifially those who are still competent and not suffering from dementia or some other debilitating disease, is protecting them from financial predators who attempt to take advantage of their generosity. Another big issue is helping the elderly maintain their independence and autonomy in making their decisions if they are still mentally competent. But trying to address both issues simultaneously can be extremely challenging.
This article chronicles the sad story of 81 year-old Robert J. Pyle of California who was financially comfortable before he was befriended by a single mother who was struggling to get by. Mr. Pyle then voluntarily loaned enormous amounts of money to her until nearly all of his money was gone, and now the matter is in court. The troubling aspect of the case is that Mr. Pyle is perfectly competent with no signs of dementia.
So...does his case get thrown out because he simply made some bad financial decisions? Or does his characterization as "elderly" mean that he is entitled to some type of legal protection, even if he is perfectly competent? The article compares the situation to a teenager being able to get out of a legal contract because she is underage, despite the fact that she was fully aware of the consequences of entering the contract.
This is a relatively new and fascinating legal question that will surface more often in the courts as the population continues to age. But if you're a caregiver on the homefront it's an enormously difficult balance for you and your family to strike between the competing issues of "automony" and "protection".
The State of Connecticut has launched a pilot program aimed at addressing the needs of those between the ages of 18 and 65 who suffer from neurological diseases, such as Parkinsons and Multiple Sclerosis by keeping them at home instead of subjecting them to expensive nursing home placements.
The $750,000 program will start off by providing visiting nurses, home health aides and other home care service providers to 50 disabled individuals. This Connecticut Home Care Program for Disabled is essentially an expansion of the Connecticut Home Care Program for Elders which has provided the same type of assistance for seniors.
This increased effort to keep the elderly and disabled at home, as long as it can be done safely, is a classic win-win arrangement. It's a win for the State since a nursing home placement funded by Medicaid dollars is enormously expensive, and it's a win for the individual who would choose the comfort of their own home over a nursing home ten times out of ten.
If an applicant's income exceeds $1,702 per month, then he/she may have to contribute partically for the care. Asset limits are $20,328 for individuals, $30,492 for married couples.
Click here for more information or call the Department of Social Services at 1-800-445-5394 toll free or 860-424-4904 in the Hartford area.