Waiting Lists Lengthening For Elder Care Services

Somerville Journal - Somerville, MA

There are more than 2,000 households across the state that have a disabled elderly person who is not receiving home care support.

According to Mass Home Care, which represents the 27 agencies that operate the home care program locally, the waiting list to get into home care has reached 2,002 people. This includes both the basic home care program (1,593 people waiting) and the Enhanced Community Options Program (409 waiting).

Mass Home Care projects that budget cuts enacted by the General Court and the governor will result in as many as 5,000 to 6,000 seniors waiting to get home care by the close of the fiscal year June 30.

“Families will be struggling to figure out how to take care of mom or dad this Thanksgiving,” said Mass Home Care executive director Al Norman, who said the 2010 fiscal year will go down as the worst on record for cuts since the home care program began in 1974. “The irony is that nursing home doors are wide open in most parts of the state, but the door to home care is closed.”

Norman said community programs like home care are a wise investment for the state, because home care has helped drive down institutional services by 20 percent since the year 2000, and two people can be helped at home for the cost of one nursing home placement. The state’s Medicaid program is required to provide care to the disabled in the “least restrictive setting appropriate to their needs,” but Mass Home Care said the community programs are some of the first to be cut.

Along with home care cuts, the administration has recently slashed rates to the adult foster care program — a residential alternative to nursing homes — and reduced access to the personal care attendant program. The group adult foster care program has also been pared back. Cuts to these three community services total $11 million. The home care cuts totaled more than $16 million, for a total of at least $27 million in lost services.

“It will take us years to get back what we have lost,” said Norman. “We are hurting some of the most vulnerable people in the commonwealth. These are people who will show up sooner or later in our institutions, costing the taxpayers much more in the long-term. Not only is this policy forcing people to be unnecessarily segregated from their community, but it’s fiscally short-sighted.”

While these programs are struggling for every penny, the commonwealth provides $1.2 billion in corporate excise tax breaks.

Podcasts Feature Advice For Senior Community Management

Earth Times

"Best Practices in Senior Care Management" podcast series from Horst Construction discusses trends and challenges facing CEOs, CFOs and executive administrators of senior living communities. Four episodes are now online, focusing on lending and financial issues and the new Five Star rating system for senior housing.

Lancaster, PA (PRWEB) December 6, 2009 -- A series of thought-provoking podcasts developed expressly for CEOs, CFOs, executive administrators and other top decision makers of senior living communities by Best Practices in Senior Care Management and sponsored by Horst Construction is available on iTunes or accessed as an XML feed at http://horstconstruction.com/podcast.asp.

Titled "Best Practices in Senior Care Management," the four-episode podcast series provides ideas, processes and new information from leading thinkers and doers in the field of senior care. Topics such as new regulations, financial measures and management, marketing ideas for increasing occupancy, and operations and planning are part of the podcast curriculum.

In the first two episodes, Steve Jeffrey, regional director of Ziegler Finance, reviews first quarter 2009 results and the present state of lending and then addresses the near-future of financing and acquisitions in the senior care industry. The final episodes are a two-part discussion on the Five Star rating system for senior care facilities in the U.S. Ron Barth, CEO of PANPHA, the largest trade association representing nonprofit providers of housing and health-related service options to Pennsylvania's elderly, and Pennsylvania Secretary of Aging, Mike Hall, debate the benefits of a nationwide rating system for senior care.

The information in the "Best Practices in Senior Care Management" podcasts was originally presented at the Horst Senior Living Conference in April. The 2010 conference is scheduled for April 8 at the Lancaster Country Club in Lancaster, PA. Keynote speaker is Jim Moore, president of Moore Diversified Services, a leading national consultant to the senior housing industry. More information on the 9th annual half-day conference is available by calling 717-581-9981.

Estate Planning: Never Too Early, Often Too Little, Too Late

Yakima Herald

Eric Gustafson has seen it too many times.

Families estranged or survivors forced to spend large sums of money in the absence of an estate plan or -- just as importantly -- a plan that hasn't been updated to account for changed circumstances such as divorces or deaths.

Such plans should include a durable power of attorney for health care and finances, a will, a community property agreement for a couple and, in some cases, a revocable trust.

"It can destroy relationships if it is not well thought out and planned. You can have family members who will never speak to one another again," said Gustafson, an attorney in Yakima for 36 years and a certified elder care attorney who focuses his work now on estate planning.

"My job as an estate planner is to plan for the worst and then hope for the best," he said.

Yet only a minority of people have taken the steps necessary to see that their wishes are carried out if they die or are incapacitated.

"It amazes me how few people have an estate plan," he said.

Gustafson's experience is borne out in a 2008 poll commissioned by AARP on end-of-life issues.

The poll of more than 1,000 respondents suggests that fewer than half of people have addressed the elements of estate planning. A last will and testament had been completed by 45 percent of those who responded. But for other elements of an estate plan, slightly more than a third had a durable power of attorney or a living will that guides decisions on health care in cases of incapacitation.

People between ages 35 and 49 have a much more spotty record when it comes to estate planning. Fewer than one in three have a will and even fewer -- one-fourth -- have a durable power of attorney for health care.

The percentage of those who have completed estate planning increases with age as people acquire assets. But for younger people with children, an estate plan is even more important.

"It's important for people with children to have a will because you need to provide for children even up to 30 years old," he said. "Clearly, before they are 18 you need that to designate who you want to be guardian and not have a judge do it who doesn't know your wishes."

He said a community property agreement between spouses in a first marriage allows co-owned property to go to the surviving spouse.

"All property co-owned by the parties passes under the contract to the surviving spouse. It avoids probate on the first death," he said. "You can virtually transfer all property under a community property agreement to the surviving spouse."

Estate planning attorneys advise consumers to avoid will kits with fill-in-the-blank forms. Such kits are made generic to try to fit various laws in various states, but they may be too broad to suit a person's needs or can leave questions that must be sorted out later.

"Planning an estate can be a very complex thing depending on what is going on," observed Steve Hartnett of San Diego, the associate director of education for the American Academy of Estate Planning Attorneys. "A proper estate plan integrates all aspects of a person's goals with their assets."

AARP advises against people sitting down at the kitchen table and writing out their own will because of the chance for errors that cause problems later. Few states recognize homemade wills, according to the organization.

But short of an estate planning attorney, there is help available online and the field is growing.

Bankrate.com, a personal finance Web site, reports that some sites offer users access to an attorney to check your work. Others don't.

Prices can range from as little as $20 to as much as $225.

But Bankrate.com discourages those who have significant assets, own a business, have children or are in a second marriage from going the online route.

Financial planners are great at helping clients develop an investment plan, but they lack the expertise to deal with estate plans.

If you use an estate planning attorney, anticipate preparation of an estate plan taking from a month to six weeks to complete.

Keeping the estate plan up to date to allow for changes is also important.

Gustafson recalls one case in which a client whose elderly aunt lived half a state away put her neighbor on her checking account to pay bills and purchase groceries. The aunt, suffering with health problems, also transferred funds from investments to cover medical bills.

When the aunt died, the neighbor received a substantial sum of money as a joint tenant of the checking account.

The money had been intended for Yakima relatives in the woman's will. But having the neighbor's name on the account trumped the will.

"We see it all the time where family members put someone on their bank account or trust account. It changes the legal consequences of where that asset goes," he said.

Beneficiary designations on life insurance and retirement accounts also prevail even if a will prepared years later names a spouse.

And if no estate plan exists, a person who dies intestate -- as the lack of a will refers -- will have the laws of the state determine what happens to their assets.

"You want to control where your assets go," Gustafson said.

Hartnett agreed, saying those who die without a will may have wanted assets to go to a domestic partner, a friend or a charity, none of which is accounted for in state law.

"The best solution is an estate plan that is tailored to your circumstances. While the intestate provisions may satisfy a small number of people, they don't accomplish the goals of the ordinary person," he said.

Based on his experience, Gustafson said he believes people delay taking action because they don't want to face their own mortality or are concerned about cost. But costs for a plan that covers all assets are often lower than buying annual homeowners and auto insurance.

He estimates an average couple can have a qualified estate plan -- with key documents included -- for $600 to $1,000.

"The least cost is when you do good planning," he added.

Choosing Appropriate Senior Care

Evansville Courier & Press

One of life's landmarks is choosing a nursing home. It should be carefully thought out, but typically the decision is made when a loved one is about to be discharged from a hospital, often with hours notice. Even on that deadline it's possible to make a good choice.

Lee Bowman, medical reporter for Scripps Howard News Service, talked to many top experts on nursing homes to come up with some guidance.

They recommend starting with the U.S. Centers for Medicaid and Medicare Services' Nursing Home Compare, a database that ranks 15,700 nursing facilities on a star system, from one star — "much below average" — to five stars — "much above average." Around 12 to 13 percent of nursing homes have the top rating; slightly more than 20 percent the lowest.

But the star system can be slightly misleading. In a study of the CMS database, Scripps Howard came up with a few general principles to help read between the ratings:

— Homes run by nonprofits, about two-thirds of all, generally score better than those run by for-profits and tend to have more nursing staff per patient.

— Homes with more than 100 beds tend to get lower scores in all categories.

Experts recommend finding a nursing home close to the patient's home because it's easier for family and friends to visit. He recommends meeting the home administrator and making several visits at different times to talk to staff and inspect public areas. Look for longevity among the key caregivers. If more than 25 percent of staff are recent hires, it can be a worrisome sign.

Plan early. Choosing a nursing home is difficult, but knowing the patient's preferences improves chances that the decision will be the right one.

Couties Considering Phase-Out Of Home-Health Care

the Daily Mail

CATSKILL — With Greene County looking to get through one of its most difficult financial times in recent memory, one program that is facing eventual elimination is the CHHA — certified home health agency — which is provided by the Greene County Public Health Department.

While a final decision has not been made, the Greene County Legislature is currently considering phasing out the CHHA, which provides in-home nursing care to recently discharged patients.

“The majority of our patients are Medicare patients, so they are over 65 and homebound,” said Public Health Director Marie Ostoyich. “They are referred to the certified home health agency through the hospital or nursing home upon their discharge, and they need assistance with things like medication management, dressing change, or some kind of skilled nursing care at home.”

Eliminating the CHHA would save taxpayers approximately $800,000 a year, once it has been fully phased out. The first year of the phase-out program would save around $400,000.

However, county officials say care for current patients would not be impacted, and that the program would be phased out slowly over a period of two to three years.

“It would probably take several years to phase out the CHHA,” said Interim County Administrator Dan Frank. “A lot of people are under the impression that if they are currently getting care under CHHA they would be cut off, but that is not true. We would probably slow down the intake of new patients, and eventually stop it.”

Referrals for care generally cover a sixty-day period, and then need to be reissued should the patient continue to have a medical need for home health care. They would not be affected by the change, should it go through.

“For patients who are getting care right now, their care would continue for as long as it is needed,” Frank said.

Another group of residents who would not be affected by the phase-out of the CHHA are seniors who receive services through the Greene County Department for the Aging. Day-to-day care provided to those senior residents is not part of the phase-out proposal.

One option the county is considering to continue offering in-home care post-discharge is having private nursing agencies take over. Currently, some patients already receive care through The Eddy Nursing Service.


“Another option we could look at would be to have private industry take over the CHHA and let them operate it,” Frank said. “We are very concerned that people have alternatives. A segment of the population is already being served by private industry, so we could look at privatizing it.”

One problem with that option is that The Eddy currently does not provide service to communities on the mountaintop, and the needs of those clients have to be addressed as well.

Frank said the slumping economy has presented the county with serious financial challenges this year, and that it’s expected that things will only get worse over the next year or two. Implementing changes to the CHHA — or any other county program — is one way officials are looking to trim costs, but it’s a balancing act.

“Before we make a decision regarding the CHHA, we have to consider the best interests of our residents,” Frank said. “This will be a very difficult year for the legislature to decide the budget because they will have to balance the financial needs of the residents with the service needs of the residents. We are getting crunched in every direction.”

With the economic stakes high, officials say they want to minimize the tax burden on already stressed-out taxpayers. Frank said they are doing that by cutting expenses as much as possible. Much of that was done in the 2008 and 2009 budgets, and now that the easy changes have been made, the legislature is left with making some tough decisions on programming and services.

“We understand our residents are under a lot of financial pressure — unemployment is high, tax delinquency is up — so adding more tax to that would be difficult,” he said. “The county is already making substantial cuts to staffing — we eliminated positions, and we are proposing more cuts. There are no pay raises, and we are asking our employees to do more but we aren’t giving them more. Now, we need the agencies to share in the pain.”

Mysteriously, Risk Of Stroke Shown To Have Geographic Determinants

eMax Health

A new study published in the December issue of Neurology reports on the strong influence of birthplace on stroke risk. A person born in the “Stroke Belt" will continue to have a higher risk of stroke even if they have moved away.

M. Maria Glymour, ScD, of Harvard School of Public Health, and colleagues evaluated stroke mortality rates for United States–born black and white people aged 30–80 years for 1980, 1990, and 2000. This data was defined by birth state, state of adult residence, race, sex, and birth year.

Four “Stroke Belt” (SB) exposure categories were defined: born in a SB state (North Carolina, South Carolina, Georgia, Tennessee, Arkansas, Mississippi, or Alabama) and lived in the SB at adulthood; non-SB born but SB adult residence; SB-born but adult residence outside the SB; and did not live in the SB at birth or in adulthood (reference group).

The researchers findings noted an elevated stroke mortality associated with both SB birth and, independently, SB adult residence. The highest risk was found to be in persons who were born in the SB and continued to live there as an adult.

For African-Americans born in the Stroke Belt and living there as adults, the odds ratio for stroke mortality was 1.55 in 1980, 1.47 in 1990, and 1.34 in 2000. For white individual in the same group, the odds ratios were 1.45 in 1980, 1.29 in 1990, and 1.34 in 2000.

For reasons that have eluded explanation, residents of the southeastern U.S. historically have had a 20% to 50% greater risk of stroke mortality compared with residents living elsewhere in the country. This influence of residence in the Stroke Belt has little association with conventional stroke risk factors, social resources, or access to medical care.

Future studies of stroke risk should include detailed information about movement from one region to another. Such information might show whether people who move have different risk patterns help identify more precisely the point in life when stroke risk begins to increase. That information could aid the development of risk-reduction strategies specific to different regions of the country, the authors concluded.

Senior Care Across The Miles

The Bend Bulletin

Our society has become increasingly mobile in the past few decades.

Kids move away from home and don’t come back. Parents retire to another state. Family members shift from place to place, looking for work, going to school, building their lives.

Often, adult children end up living some distance from their aging parents. While this leads to increased travel and decreased time spent together, it has another consequence as well. Distance makes it harder to help when a parent is in need. As a result, many adults are finding themselves playing the role of long-distance caregiver.

Raeann Hamon, a professor of family science and gerontology at Messiah College in Pennsylvania, says long-distance caregiving is absolutely a trend that is likely to increase.

“Certainly, as the baby boomers and their parents age, we can expect a large jump in the number of families dealing with such caring across miles.”

These adult children face challenges of trying to find the right role to play, staying involved while not becoming overly burdened.

Starting off

Nancy Turk co-owns Visiting Angels, a local service that connects in-home professional caregivers to older individuals. She says about half their clients have relatives in another region or state. They have been contacted by family members in Alaska, California and Australia who want to hire help for a local relative. Typically, Turk says, a family member realizes they need to step in after visiting. “They are shocked to see the condition their grandparents or parents are living in.”

These relatives, often adult children, believe their parents are doing fine, but the reality is somewhat different. They might find rotten food or dog feces. “It’s traumatic for the kids.”

Turk says oftentimes the family members feel guilty and then hire staff to come in and assist, particularly in cases in which the parents don’t want to leave their own home.

Marion Somers, a geriatric care manager and author of “Elder Care Made Easier,” suggests adult children think about what they can and cannot do. She encourages them to set limits and to delegate. “You have to be honest about your time and resources.” She thinks of it this way: It’s like being on an airplane when passengers are supposed to put on their own air masks first before helping anyone else.

“You have to be organized, you have to prioritize, you have to delegate,” Somers said.

Challenges

Trying to assist a relative living far away can be quite complicated. Hamon says many adult children feel guilty about not being able to help more, while also feel angry about the imposition and feel anxious about future needs. She says many individuals feel guilt because of the “norm of reciprocity.”

“There’s the notion that you should be good to those who have been good to you,” Hamon said.

Figuring out when to visit and to allot resources — both financial and time — is another big issue. Sometimes, resources are better spent hiring someone to help than flying out to visit for a week. Somers point out that a $600 plane ticket could be used to hire someone to come in once a week to help out for a couple weeks or more.

Robert Sachs knows about this challenge from both sides. He has been a caregiver working with adult children who live in another state. And he has been the son, living far from his dying father. His experiences are chronicled in his book “Perfect Endings.”

“We’ve created this kind of quandary for ourselves.”

When Sachs worked in a hospice in New Mexico, he saw many negative reactions from staff to adult children living far away. He says staff members frequently looked on these individuals negatively, thinking, “If you really cared, you would live here and be here all the time.”

Sachs felt these assumptions were unfair. That said, he recognized why it happened. Sometimes, the professional caregiver felt as if the relatives living away were serving as armchair quarterbacks, questioning decisions and making recommendations without really knowing the situation.

Sachs says relatives’ top priority should be to develop a relationship with the primary professional caregivers.

Hamon says it’s also not good to assume an older parent will naturally move to where adult children live. She believes part of it is generational because many older individuals have lived in one place for many years. They can also be entrenched in the community and have social support. “To ask them to move, it’s a challenge.”

Practical steps

Hamon suggests adult children start regular rituals and routines, for instance calling once a week at the same time and day.

Somers agrees, saying, “The voice tells so much. Most older people don’t have the energy to fake it.”

When the son or daughter does visit, they need to really get to know the area. Hamon suggests they learn about the neighborhood and meet the neighbors. Who does the older relative have regular contact with? She suggests the child hand out his or her phone number and ask for theirs. Then if neighbors see anything of concern, they will know who to call. She also thinks adult children should try to assess their parents’ needs, such as help with household tasks, personal care and transportation.

Somers suggests adult children take a “look at the house or apartment with fresh eyes.” What is the lighting like? How is it at night? Are any light bulbs burned out? How easy is the bathroom to navigate? Are there any throw rugs? What about the outside, including the garage and porch? She strongly encourages installing grab bars in bathrooms, putting in sensor lights outside and getting rid of all throw rugs. Somers also believes all kitchen items should be at eye level. She says to banish footstools. She will hire a neighborhood kid to mow the lawn or shovel snow. She also encourages family members to get in touch with the parents’ church, if applicable. Getting the grocery store to deliver is another good option.

Hiring help can bring relief. Turk says many adult children appreciate being able to talk with someone who serves as their eyes and ears.

Turk says sometimes the older individuals may resist outside help, saying, “We don’t need it; we’re fine.” They see help as a sign of the end. Sometimes, however, they “respond better to someone who is not a loved one,” said Turk. With family, older individuals may feel more comfortable saying no or getting angry.

Adult children need concrete information should anything go wrong. This includes a list of their parents’ doctors, medications, insurance information and more. Knowing what they are allergic to, past surgeries, medical issues and what vitamins and over-the-counter items they take are also good ideas.

Not all parents expect their children to be there to provide physical care for them, says Hamon. “Most expect their children to be emotionally supportive.” That is the most important piece. And the good news, according to Hamon, is being a good listener and offering support “is something that’s a bit easier to do at a distance.”