The Jewish Home Lifecare nursing home is starting a new program later this month geared towards patients suffering from both elderly ills and addiction issues. This unusual rehabilitation program is the first of its kind in the country. Traditionally, nursing home patients that have the complication of alcohol or prescription pill addiction are considered "undesirable admissions" and have been a population that nursing home communities have shied away from.
Why Elderly Addiction is Dangerous
Elderly adults often have addiction issues that go unnoticed. It can stem from a lifetime of drug and alcohol abuse or come from a recent misuse of doctor prescribed pharmaceutical drugs. Alcohol abuse can be particularly dangerous because as a body ages it metabolizes alcohol differently. In addition, it can cause serious interactions with any medications that a senior may be taking. A general stigma surrounding the subject also prevents people from discussing the mental illness in the elderly that can come with substance abuse.
The Nursing Home Rehabilitation Program
This program will deal specifically with patients suffering from alcohol or prescription drug addiction. The nursing home decided that until the program is more developed it will not admit seniors with addictions to illegal street drugs. Jewish Home Lifecare hired a director and procured multiple grants to set aside forty beds in the nursing home for these patients. The facility hopes to treat as many as 480 addicted seniors per year. Medicare and Medicaid are expected to cover the costs of the program.
The elderly participants will get a thorough screening, individual and group therapy, participate in a twelve step program, and get counseling to prevent relapses. When they are ready to leave the facility, the nursing home will connect them with community programs and professionals to aid in the continuation of their recovery.
Challenges to the Program
The first question most skeptics have about the program is whether a twenty-five day stay is long enough to make progress? The director of the program believes that if the patient seeks outside community programs and help that the program will be long enough. Another major issue is family support. Some families are convinced that their loved one is simply too old to change their ways and as a result the family can be obstructive or indifferent to the treatment program.
One of the largest questions is how to treat seniors suffering from addiction while simultaneously helping them recover from other elderly ills, most of which require some level of pain management. Steve Wollman, the director of the new rehab program, has few illusions about the task. He has discussed the strategies necessary to wean seniors off of certain addictive substances while still treating their pain from other ailments. He has also talked about the additional training that the staff will need to deal with these issues.
Denial and evasion are the two most commonly seen tactics used by addicted seniors. If they are newly addicted they do not believe that they have a problem, or they think that because their doctor prescribed the medication it is okay. Seniors suffering from long-term addiction often have multiple doctors and pharmacies where they get their drugs, and most of the time the doctors are unaware that their patient is getting multiple prescriptions. But regardless of age, Mr. Wollman believes that anyone can recover from alcohol and prescription drug addiction if they want to and have the guidance.
The Jewish Home Lifecare nursing home is starting a new program later this month geared towards patients suffering from both elderly ills and addiction issues. This unusual rehabilitation program is the first of its kind in the country. Traditionally, nursing home patients that have the complication of alcohol or prescription pill addiction are considered "undesirable admissions" and have been a population that nursing home communities have shied away from.
With the name "nursing home" most people assume that registered nurses are always on the premises. However, some of the time that is not the case and in certain nursing home facilities, most of the time. This is because of an old law from 1987, and lawmakers today are attempting to rectify the situation.
Old Registered Nurses Law
In 1987, a federal law was enacted that required registered nurses to only be on-site at nursing homes for eight hours per day. This rules applied regardless of the size of the facility. Supporters of the law at the time realized that in a building of sick and ailing elders a health crisis could arise at any time, but the legislation required compromises to be passed that included reducing registered nursing hours.
Since the passing of that law, certain legislators have been working to increase the number of hours that registered nurses should be required to be on-site at nursing home facilities. Most feel that their constituents would be shocked to learn that their loved ones are only cared for by registered nurses a fraction of the time.
Proposed Registered Nurses Law
Representative Jan Schakowsky, a Democrat from Illinois, was completely shocked when she learned of the few hours required by registered nurses in nursing home facilities. As a result, on July 31st she introduced a bill bluntly entitled "Put a Registered Nurse in the Nursing Home Act," otherwise known as House Vote 5373. This law would require that a direct-care registered nurse, not an administrator, be present in a nursing home facility 24 hours per day, seven days a week. It would apply to all 16,000 nursing home facilities across the country that receives Medicare or Medicaid reimbursement.
Implications of the New Law
It is difficult to determine how many nursing home facilities would be affected by the new law. Thirteen states already have some level of requirement for registered nurses to be on staff 24 hours per day. In Tennessee, Rhode Island, Hawaii, and Connecticut the rule is absolute. However, in other states like California the rule only applies to nursing homes that have more than 100 beds. There is little published research on this subject, but some experts believe that around eleven percent of all nursing homes around the country do not have the current staff to support 24 hour care.
Necessity for Registered Nurses
The new law specifies registered nurses for a reason. Unlike licensed practical nurses or aides, registered nurses are trained and licensed to evaluate a patient's care and conduct assessments when rapid condition changes occur. Multiple studies have proven the importance of registered nurses in nursing home communities. When more registered nurses are staffed, patients have fewer bed sores, urinary tract infections, and catheterizations. Patients also stay out of hospitals longer, the nursing homes get fewer serious deficiencies from state inspectors, and cares improves but costs less.
Registered nurses also do not come as a large expense. The average salary for a registered nurse is around $68,000 per year. However, rural nursing home facilities worry about finding enough nurses when they typically prefer working for higher pay in urban or suburban hospitals. Adding registered nurses all day in nursing homes will not solve every problem, but it is a great start to improving the overall quality of care for every nursing home resident across the country.
Whether it is moving to a retirement community, nursing home facility, or simply closer to the kids the changes associated with moving an elderly parent or relative can be fraught with stress and logistically challenging. There are few transitions in life more difficult for a person than when a senior needs to give up their home and independence. Giving up a house and friends of many years is an emotional and difficult experience for everyone involved.
Easing the Transition
There are many different ways to ease the transition for your loved one, but the most important is giving the older adult the opportunity to make their own choices about the decision. In addition, planning ahead for this type of transition is also a big help for everyone involved. Making plans early, instead of waiting for an emergency to hit, goes a long way in minimizing the stress for everyone.
Initiating these types of discussions can take a lot of effort, and the reluctance to talk can cut both ways. Of course, some elderly parents simply refuse to discuss the idea of losing their independence at all, and it is not difficult to see why. The best way to deal with a situation like this is to explain that the reason why the talk needs to happen is because you value their input as your parent or elderly loved one.
Making a Plan
Some seniors take issue when their children say that they want their input for this type of decision. Seeking input can sometimes be misconstrued as saying that the child has the final say in their parent's independence and living arrangements. Another way to approach the situation is to tell your loved one that you want to carry out their wishes as best as you possibly can.
The adult children also need to sit down and discuss the plan amongst each other. Families need to sit down and discuss who will play what role in the transition. You need to decide who will help with the move, help with the finances, and who can visit when. The children should also do the majority of the legwork in seeking out homes, retirement communities, or nursing home facilities for their parent to choose from.
During and After the Move
When it comes time for the actual move to occur, make sure that your senior loved one is still involved in the decision making process. Make sure that they have a say in what furniture and other personal belongings will be coming with them. If help is needed, there are a number of companies that help with senior moves, including the National Association of Senior Move Managers.
Another way to ease the transition during and after the move is to have the new home or living space completely unpacked before the first night, making the new space as homey as possible. In addition, try to spend as much time as possible with your elderly loved one in their new space over the next few weeks until they get acclimated with their new living arrangements. By following these tips, hopefully you and your elderly loved one can make the transition with as little stress as possible.
The California Supreme Court ruled that people suffering from Alzheimer's disease are not liable for injuries that they may cause to paid, in-home caregivers. The court ruled in favor of a couple sued by their in-home caregiver when she was hurt by the wife, who suffers from Alzheimer's disease.
Facts of the Case
In the California case, Gregory v. Cott, the facts were undisputed. In 2005, Bernard Cott hired Ms. Gregory as a paid, in-house nurse to help care for his wife, Lorraine, who was suffering from Alzheimer's disease. Ms. Gregory had worked with other Alzheimer's patients in the past and was specifically warned that Ms. Cott could be combative by biting, scratching, flailing, and kicking.
In 2008, when Ms. Gregory was washing dishes Ms. Cott came up behind her at the sink and bumped into her. As Ms. Gregory tried to restrain Ms. Cott she dropped the knife that she had been washing, striking her in the wrist, and ultimately causing her to lose feeling in multiple fingers. Ms. Gregory received workers' compensation for her injuries, but she also sued the Cotts for negligence, premises liability, and battery specifically against Ms. Cott.
The Court's Ruling
The California Supreme Court ruled 5-2 that people hired to take care of Alzheimer's patients should know that the disease commonly causes aggression and agitation in later stages. The court concluded that it would therefore be inappropriate to allow in-home caregivers who get hurt while caring for Alzheimer's patients to sue their employers.
Writing for the majority, Judge Carole Corrigan stated that "It is a settled principle that those hired to manage a hazardous condition may not sue their clients for injuries caused by the very risks they were retained to confront." However, the two dissenting judges argued that it was unfair to bar private caregivers from suing because of the dangers of their work. They unsuccessfully argued that the families of people suffering from Alzheimer's should bear the responsibility and "weigh the benefits of in-home care against the costs that it may impose on others."
The law in California and other states already prohibits caregivers in institutional settings like hospitals and nursing homes from suing Alzheimer's patients that injure them. The court concluded that by applying a different standard to in-home caregivers the families would only be benefitted financially by putting their loved one in a nursing home.
Effects of the Ruling
The effects of the case in California have far reaching implications across the country. The California Supreme Court case can now be cited by other families of Alzheimer patients who have injured their in-home caregiver and are facing repercussions. With the growing number of seniors and elderly people who are developing symptoms of Alzheimer's this case serves as protection for those suffering from the disease as well as their families.
However, there are limits on the ruling in the Cott case. It does not preclude future lawsuits by private caregivers who are not warned in advance that the patient could be violent and are injured as a result. In addition, in-home caregivers who are injured by their clients when it is not related to Alzheimer's disease are also still allowed to file claims for damages.
One of the most confusing aspects of the Medicaid program is the look back period for asset transfers and how it can affect the eligibility for applicants to the program. The Medicaid program is different than the Medicare program, although people often think of the two terms as interchangeable. Medicare is an entitlement program paid for through withholdings in paychecks. Medicaid is a social welfare program designed for people who need medical care and cannot afford it. Medicaid is administered by each state, which means that the rules and benefits can vary from place to place.
The Medicaid program goes into effect once a person no longer has the money to pay for medical care on their own. This means that as long as you have assets that you can sell you are not eligible for the Medicaid program. Long-term planning can protect some portion of savings and assets for a spouse or children while still allowing you to qualify for Medicaid coverage. One way to keep assets and still qualify is to transfer assets to family before applying to the Medicaid program, but you must beware of the Medicaid look back period.
Medicaid Look Back Period
When you apply for Medicaid, the program looks back five years (sixty months) from the date of the application for any transfers of gifts or assets. Any gifts or transfers made within the five year window are subject to penalties under the Medicaid program, but any transfers made outside of that window are safe.
For example, if you made gifts of a few thousand dollars to your child over the last three years each gift would be subject to a penalty under Medicaid. This is why long-term planning for Medicaid is so important and should be done long before the need to apply for Medicaid arises.
Consequences of the Look Back Period
The penalty for transferring assets within the five year window can be very harsh. Typically, a person is barred from the Medicaid program for the amount of time that the assets transferred would have paid for care. The penalty period is measured by dividing the value of the asset transferred by what Medicaid determines to be the average cost of care for a private nursing home in your state. There is no set limit for how long a person can be barred from Medicaid coverage due to gift or asset transfers.
The rules do allow for an escape hatch from the penalties incurred by transferring assets within the five year look back period. The penalty is considered "cured" if the transferred asset is returned in its entirety. Some states will also allow a partial reduction in penalties if part of the asset is returned; however, not all states allow partial returns and your state's rules should be examined first.
Exceptions to the Look Back Period Rules
Certain assets and gifts do not apply for the Medicaid look back period rules. Therefore, if transfers are made to these people within the five year window you are still eligible for the Medicaid program. These exceptions include the following:
· A spouse (or for a spouse's benefit)
· A blind or disabled child
· Trust for the benefit of a blind or disabled child
· Trust for the sole benefit of a disabled person under the age of 65
Special exceptions also apply for the transfer of an applicant's home within the window, but the transfer can only be to specific people within the family. These people include the spouse, disabled child, a trust for a disabled child, a sibling, or a caretaker child who meets certain qualifications for the role.
One of the main topics of conversation among the Baby Boomer generation is caring for their aging parents. One of the benefits of increasing medical technology is that our elders are living longer lives. However, one of the detriments of providing this type of long-term care is affording it. Arguably one of the biggest concerns about long-term care for elderly parents is cost and what to do when the money runs out.
Talking about affording parents' care is often seen as a taboo subject. People do not want to look like they are wishing that their parents' lives will end soon or that money is more important than family. But the truth is, the longer that parents live the more expensive it becomes. With six million Americans over the age of eighty-five, a number expected to hit fourteen million by 2040, the issue of affording parents' care is only going to increase with time.
Issues With Affording Parental Care
Every expert on the issue agrees that there is no one solution to affording the long-term costs of parents' care. The more complicated issue when dealing with this problem is trying to plan for the unknown. Financially planning for a child is much easier because you can predict the costs of education and care. But it is incredibly difficult to try and predict how long your parents will need money or for what kind of care, especially as the average lifespan continues to increase.
Recommendations for Planning the Costs of Care
One point that most experts agree on is that you need to put yourself first, and do not assume that you will need to tap into your own savings to deal with this problem. Even if it feels selfish, you need to consider your own needs and costs like retirement, children, education, and the like. Other tips for planning to afford parents' long-term care include:
Talk to your parents about your concerns
The sooner this discussion occurs the better off everyone will be. It gives your parents the opportunity to discuss their wishes and allows you to weigh them against the financial considerations.
Meet with professionals who can offer sound advice
An estate planning or elder law attorney can sit with you and your parents to discuss what options are available and how best to structure your assets to pay for elder care. Speaking with your parents' doctors can also give you an idea about what care will be needed down the road.
Look for money saving benefits for your parents
The government provides a wealth of information on this topic. Try looking at The National Council on Aging's BenefitsCheckUp.org, the federal Benefits.gov, or The U.S. Administration on Aging's Eldercare.gov
Improve your parents' financial situation
You can think creatively about ways to improve your parents' current financial situation. Consider getting a renter, moving to a smaller home, selling unwanted personal belongings, or looking into getting a reverse mortgage on the home.
When moving into long-term care, see if the cost is negotiable
Some nursing homes won't consider taking an applicant who is already on Medicaid because of the low returns by the government, but other facilities can be a lot more willing to negotiate the costs of care. Some places will agree to upfront payment for multiple months or years of care in exchange for a deal on long-term care later on.
Instead of paying outright for care, make it a loan
As an alternative to paying directly out of your own pocket for your parents' care you can structure it as a loan. The money can be repaid from the proceeds of the sale of the house upon your parent's death, or it can be taken from some other asset in the estate.
With the demand for expensive senior care options rising quickly, researchers are exploring new ways for technology to help healthcare providers and caregivers to remotely monitor seniors in their own homes at a lower cost. According to the Bipartisan Policy Center, around thirteen million Americans require some level of assistance with daily living activities, and most of these people are seniors. The demand for living assistance is expected to more than double over the next few years as an estimated twenty-seven million Americans will need care by 2050.
The cost for nursing homes and assisted living communities is incredibly high. Nursing home rooms can cost as much as $90,000 annually, and long-term care costs rise on average almost five percent every year. And while cost is a major factor driving the push for new assisted care technologies, it is not the only one. Over ninety percent of all seniors want to stay in their homes for as long as possible, but many are unable to do so because their homes cannot accommodate their living needs.
Assisted Living Care Technologies
Right now there are a few medical technologies available to help seniors and serve as medical alert systems. Special bracelets or pendants can be used that serve as communication devices if a senior falls or in an emergency like a fire. However, researchers are now working on a new technology - advanced sensor networks and smart homes.
These sensors give healthcare workers real time information about a senior's health and wellbeing while in the home. The sensor enabled homes learn to recognize behavior and activity patterns. It then learns to report any signs of illness or cognitive impairment over the internet to healthcare specialists or caregivers. The sensors can also send information to doctors and allow them to catch any medical issues before they become a serious problem. Having a sensor enabled home will allow the elderly to stay in their homes longer while maintaining a sense of independence and safety.
In addition, the sensor enabled homes cut costs dramatically on senior care. Compared to the costs of nursing homes, the sensors only cost around $2,500 on average to install in a home, plus a modest monthly fee to analyze the data. By some researchers' estimates, states could save up to $9 million per day in elder care costs if only ten percent of the state's seniors had sensors in their homes. While it will not eliminate the need for nursing homes and long-term care facilities, this new technology will allow seniors to safely stay in their homes for longer as well as save on cost.
Impediments to New Technology
While the sensor enabled homes show a lot of promise for the health, happiness, and financial wellbeing of seniors there are still some hurdles to overcome before there is wide acceptance of the product. In terms of payment, currently insurance plans do not cover the cost of installing the sensors in the home. Additionally, as more companies grow the vendors will need to set technological standards for interoperability. Finally, the acceptance of technology in general with most seniors is the largest obstacle.
Many of the elderly are uncomfortable with new technology and may be resistant to learning how this new system will work inside their homes. However, given that the sensors will allow them to live in their own homes for longer and avoid nursing home care it may be enough to trump any nervousness of accepting this new type of care.
Over 1.4 million seniors are currently living in a nursing home in the United States. While most dislike or fear nursing homes, it is usually the best option for a senior that needs 24-hour care. Nursing homes typically have a reputation for being smelly, unfriendly, and indifferent places where the elderly is left to spend their final years until they die. However, there are plenty of nursing home facilities that can be even better than home care, and good facilities outnumber the bad when it comes to nursing home and long-term care.
Preparing to Choose a Nursing Home
One of the biggest mistakes that can be made when choosing a nursing home facility is waiting until the last minute. Especially when faced with a medical or financial crisis, being forced into an impulsive decision is never the best option. When choosing a nursing home you need to do the research, start looking around, see what services are available, and figure out what will be best for your loved one.
Three of the simplest ways to begin your nursing home search is through cost, location, and report card. If your loved one qualifies for Medicaid then most of the cost will be absorbed. However, if Medicaid does not apply you can expect costs between $10,000 and $15,000 per month. Location is also a great way to narrow the search for a good nursing home. Finally, the government gives a report card for every nursing home facility in the country, and you can review their reports online.
Nursing Home Specifics
Once you have a list narrowed down start to look at the specifics of each facility. Check to see what specialized services it provides as well as whether your loved one's health needs can be accommodated. If English is not your loved one's first language, see if there are staff members who speak the language. Also check to see what activities are available at the facility and how often they can interact with other members at the home.
Do not rely on brochures to choose a nursing home. Be sure to take a tour of the facility and try to come at different times of the day. Observe how the seniors are treated by the staff, and ask around about the quality of care at the facility. If it helps, come in with a prepared checklist of questions to ensure that every aspect of care is covered by you in your tour.
After Choosing a Nursing Home
Once you have chosen a nursing home and your loved one has been admitted your job does not end. Monitoring the care provided to your loved one is critical. You should expect resistance, and you should try to visit as often as possible. In addition, you or someone that you trust should be appointed as a healthcare proxy for your loved one so that critical medical decisions can be made at a moment's notice.
Additionally, make sure that you are there at times when your loved one is being dressed or changed so that you can look for any signs of abuse. Have access to medical records, and be present when they are examined by the doctor. It is also helpful to have the names of all of the employees who are tasked with your loved one's care. Keep notes of any concerns and speak with the nursing home staff about it. By checking in after your loved one is in the home you can ensure that it is a good fit for them and that they are getting the care that they need.
The first segment of outsmarting scam artists focused on how to spot common schemes as well as advice for avoiding falling prey to their scams. That segment looked at what to do when you are already faced with potential scam scenarios; however, there are other steps that you can take to help avoid scams before they can occur.
The FBI cites senior citizens as particular targets and victims of scam artists. They stated that the most common types of schemes that focus on the elderly include healthcare fraud, counterfeit prescription drugs, funeral and cemetery fraud, fraudulent anti-aging products, telemarketing fraud, internet fraud, investment schemes, and reverse mortgage scams. However, you can stop the majority of these scam attempts on your loved ones by taking the following steps.
Cutting Down on Scams and Solicitations
In order to cut down on the number of phone, email, and paper letter solicitations for scams that are geared towards the elderly, you should try the following:
· Adding phone numbers to the National Do Not Call Registry
You can add the number of your loved one to the registry by going on donotcall.gov or by calling the hotline number. The phone number remains on the registry until you remove it or it is disconnected.
· Get Caller ID
The Do Not Call registry eliminates most telemarketers from making calls to the home, but politicians, charities, and companies that you already have an existing relationship are allowed to still call the home. Caller ID can help identify who is calling and you can explain to your older loved ones that they should not answer unless they recognize the caller.
· Visit the Direct Marketing Association (DMA) website
Visiting the DMA website can help you cut down on the number of direct mailings and commercial mail received to the home. You can specify what you do and do want mailed to the house, and these preferences are saved for three years. However, you need to remember that organizations not affiliated with the DMA as well as any company that you have an existing relationship with can still send you mailings.
· Opt out of unsolicited pre-approved credit offers
By visiting optoutprescreen.com you can request that major credit bureaus do not share your credit information or the information of your elder with creditors and insurance companies for promotional purposes. You can get your loved ones opted out for five years or taken off of the list permanently.
· Protect information online
Additionally, in order to cut down on in person scams share a calendar with your elderly loved one. That way you can see where they are going every day and who they are in contact with. Also, tell your loved one not to answer the door if it is someone that they do not know. Hopefully, by abiding by these and the other tips provided in these segments you can cut down or eliminate scam artists targeting you and your elderly loved ones for scams.
Protecting your loved one from scams is one of the biggest responsibilities you have as a caregiver for someone in their elder years. With a growing number of seniors every year, scams and scam artists abound. Even if you are careful, savvy consumers can still fall victim, and older individuals in particular are frequent targets of these plans because they are more likely to trust and act politely towards strangers. However, just because more people are attempting to take advantage of your older loved one does not mean that it will necessarily occur. You can take steps that can help prevent scam artists from taking advantage of your elders and protect the ones that you love.
Learn to Spot Common Scams
Scam artists use a variety of different schemes to try and trick seniors into giving up their money or personal information. Internet-based scams, phone calls, direct mailings, broadcast and print advertisements and door-to-door solicitations are all common ways of tricking unsuspecting victims. Having a healthy dose of skepticism when encountering all of these types of circumstances definitely helps, but in particular look out for these common schemes:
· Living trust kits and seminars
If you want to know what types of legal estate planning options are right for you, seek the advice of an estate planning or elder law attorney. Especially be wary of seminars "endorsed" by entities. One common ruse is saying that the seminar is endorsed by the AARP, when in fact they do no such thing.
· "Free meal" financial seminars
Regardless of the product they are selling, these free lunch or free meal seminars always involve very high pressure selling tactics that seniors often fall prey to.
· Unsolicited reverse mortgage offers
Very few, if any, legitimate reverse mortgage company will send you unsolicited information. Do your homework about the company before responding.
· "Free" or "Low cost" vacation deals or prizes
Typically, the scam artist will make you give out your personal information or attend a high pressure sales meeting before receiving your prize, and often those prizes are actually fake or worthless.
· Investment opportunities
Abide by the maxim, "If it sounds too good to be true it probably is."
Other Advice for Avoiding Scams
Never let anyone pressure you or your elderly loved one into making any type of immediate decision. Either tell them no thank you or say that you need time to consider it. If a scam artist is making a phone solicitation, simply hang up or install caller ID to screen for unfamiliar numbers. You can do this both for yourself as well as your loved one and explain that they should only answer for people that they recognize.
There are other ways of determining whether or not someone is trying to trick you into a scam. Always ask for information about the product or entity before giving away money or personal information. Never give out credit card information, Social Security numbers, or bank account information to anyone that you do not know, and independently verify who a person is as well as why they want your information.
The next segment of outsmarting scam artists focuses on ways that you can cut down or eliminate scams before they can even get to you or your elderly loved ones.
This summer, one nursing home settled a massive class action suit against the facility for using powerful and dangerous drugs on its residents without their informed consent or consent from family members. One member of the suit was a daughter whose mother entered the facility for eighteen days for physical therapy for a broken pelvis. The nursing home had given her heavy medication, including many dangerous antipsychotics, and within a matter of weeks she was dead. This class action lawsuit was the first of its kind in the country, and with a growing issue of drug abuse in nursing homes it will most likely not be the last.
A Growing National Issue
Sadly, this case is not an isolated event. Researchers estimate that as many as one in five elderly patients in nursing homes are given powerful antipsychotics and other drugs that are wholly unnecessary. This growing trend comes from a variety of sources, including but not limited to inadequate training of staff, understaffing of facilities, and aggressive selling by pharmaceutical companies. The Center for Medicare Advocacy has been quoted as saying that "The misuse of antipsychotic drugs as chemical restraints is one of the most common and long-standing, but preventable, practices causing serious harm to nursing home residents today."
Antipsychotic drugs are meant to help people with severe mental illness such as schizophrenia or bipolar disorder. The FDA specifically states on the boxes of these medications that they are not intended for the elderly population. Using these drugs on seniors can cause agitation, anxiety, confusion, disorientation, or even death.
Kickbacks for Doctors and Being Kept in the Dark
Multiple pharmaceutical companies, including giants Johnson & Johnson as well as Omnicare, have been fined billions of dollars for marketing drugs to nursing homes that were not approved by the FDA or deemed suitable for the elderly. Additionally, doctors were given kickbacks for prescribing these medications to their patients in nursing homes. Considering that so few doctors ever actually visit the facilities or are there so little, they do not see or care about the effects of the drugs on their patients.
Another reason for this growing problem is the law requiring informed consent is not being followed. Neither the patient nor their families are being told about the use of these drugs in the nursing homes. One reason is because of the lack of training for nursing assistants. With only seventy hours required for training, these staffers typically do not know that consent is required before administering these drugs. Because nursing homes are chronically undertrained and understaffed, so-called behavior problems can arise with the patients. The pharmaceutical companies market these drugs to nursing homes as a way to deal with that issue.
Searching for a Better Way
Thankfully, more nursing homes are now looking for a way to combat the issue of overmedicating its patients. One way nursing homes are dealing with this problem is by providing additional training for staff - both in requirements for federal regulations as well as how to deal with problem patients. Another way this issue is being addressed is by public outreach and advocacy. If more family members of nursing home patients know about the issue they can inquire with the nursing home about their loved one's care. And now that one lawsuit has been successfully brought against a nursing home for drug abuse, hopefully it will serve as a deterrent to other facilities that misuse the same practice.
The Massachusetts Senate just passed through a bill adopting the model set of rules for the Uniform Adult Guardianship and Protective Proceedings Jurisdiction Act (UAGPPJA). The bill now goes to the state House of Representatives, and if it is passed then Massachusetts will be the thirty-ninth state in the country to adopt this act. This model set of rules makes it easier for family caregivers to provide care for their loved ones across state lines.
A court will appoint a guardian to a person when someone is incapable of managing personal decisions or property. The guardian then makes decisions about personal property, medical choices, living arrangements, and financial issues. Appointing a guardian in court can be difficult and time consuming; however, they are a great way to prevent elder abuse, neglect, or exploitation.
If an elderly person is in need of a guardian in one state and the family is located in another, jurisdictional issues can arise. The tangles of figuring out which court gets say over what can take time and money to sort out. That is why many states have enacted or introduced the UAGPPJA in order to simplify the process of determining jurisdiction for guardianship.
What is the UAGPPJA?
The UAGPPJA is an act that addresses the issue of jurisdiction over adult guardianships, conservatorships and other protective proceedings, providing a mechanism for resolving multi-state jurisdictional disputes. The goal is that only one state will have jurisdiction at any one time. The act designates the individual's home state as primary jurisdiction, followed by a state that the individual has a significant connection, which then gives the court a clear process for determining which state has jurisdiction to appoint a guardianship or conservatorship if there is a conflict.
By enacting this set of rules, many states have saved time and money for guardians and conservators of the elderly, which in turn allows them to make decisions for their loved ones more quickly and with less hassle. The UAGPPJA provides a set of rules that explain how one court can transfer the guardianship procedure to another state as well as how to accept the transfer in a second state. This act helps to facilitate better enforcement of guardianship proceedings as well as protective orders for seniors that come in from other states.
If Massachusetts passes the act in the House of Representatives, it will become the thirty-ninth state to enact the legislation. Already this year Mississippi and New York passed the act, and in addition to Massachusetts the law has been introduced in California, Michigan, Rhode Island, and the U.S. Virgin Islands. As of July, the only states in the nation that have not either passed or introduced this legislation are Texas, Louisiana, Kansas, Florida, Georgia, North Carolina, Wisconsin, and New Hampshire. As more states enact this law, it will become even easier to provide guardianship and care for our elderly loved ones nationwide.
One of the most important parts of elder care is ensuring that you or your loved one is financially secure in later years. A wide variety of financial tools and plans are available to help structure this care for seniors, but as of July a new tool has been introduced for retirement planning that has not been widely available before - longevity insurance.
What is Longevity Insurance?
Longevity insurance is also known as a deferred-income annuity. You pay a lump sum of money as a premium to an insurer in exchange for a lifelong stream of income that begins years later, even as late as your 70s or 80s. Before July, longevity insurance could not be widely used in 401(k) or other individual retirement plans because those types of plans require that the holder start making withdrawals at age 70½. The rules have now been changed that allow workers to purchase these annuities if they use a portion of their retirement money and begin to make withdrawals by age 85.
Why is Longevity Insurance Available Now?
The federal government announced these changes to longevity insurance as part of its plan to broaden the options available to seniors and provide Americans with more financial security in retirement. The administration believes that this will help seniors plan for retirement and ensure that there is a constant stream of income available for as long as they live.
Before July, less than twenty percent of all 401(k) retirement plans offered any type of deferred-income annuity, and few people ever elected to exercise the option. The administration is hoping that by changing the rules more people will take advantage of this retirement tool. The Treasury department has stated that workers will have some flexibility in choosing their longevity insurance plan. If you purchase an annuity later in life you can start making withdrawals later, as well.
Specifics of Longevity Insurance Plans
In order to partake in the new option of longevity insurance a worker can use no more than twenty-five percent of their retirement balance or $125,000 to purchase the plan, whichever is less. If you accidentally exceed the limit for purchasing a plan you will be allowed to correct the error without penalty. In addition, the annuity plan must be relatively basic and cannot come with many of the special features that insurance providers sell with other plans. However, one feature that will be allowed is a rider that guarantees the beneficiaries of the account the original premium paid, minus any distributions. Another option that is available is to have the longevity insurance continue to pay out to a beneficiary after the original holder's death.
The reason for the limited options on the longevity insurance plans is that the government does not want it to be too difficult to compare the prices of the plans. Having fewer options also decreases the chance of insurers selling plans with so many extras that the income stream is greatly reduced. However, by allowing a couple of extra options on the annuity plans participants can purchase longevity insurance with some level of guarantee on the payout and the security of knowing that they or their loved ones will be taken care of in their senior years.
Some of the leaders in providing shelters for victims of elder abuse are meeting for the first time at a conference in an effort to combine forces and give more refuge to seniors in need. Eight shelters have formed an alliance that are meeting in suburban Cincinnati to discuss the growing problem of elder abuse as well as ways to better combat the issue. The shelters in the alliance have been participating in monthly conference calls to discuss their programs, and this is the first time that they will all be meeting in person to talk about their elder abuse shelters. They plan on sharing best practices, are bringing in expert guest speakers, and work together to create an even better network of elder abuse shelters.
Elder Abuse and Prevention
Estimates from leading researchers are that at least two million seniors are abused, exploited, and neglected every year in the United States alone. In addition, nearly everyone agrees that many more cases of elder abuse go unreported or undetected. The number of seniors over the age of seventy is expected to more than double to about 64 million people by 2050. Elder abuse occurs most often at the hands of a family member or other people close to the victim.
As a result, elder abuse advocates encourage bank employees, other service providers, neighbors, and anyone else close to someone in their senior years to be alert for signs of physical and mental elder abuse. Prevention training has begun in states like New York to certain groups that see the elderly often like doormen and apartment workers.
Elder Abuse Shelters
The elder abuse shelters are designed as a safe place for victims to receive emergency care, counseling, and legal help for their abuse issues while they stay among their fellow peers in the senior community. The leader of the Weinberg Center for Elder Abuse Prevention that opened in 2005 at New York City's Hebrew Home has found that engaging with victims of elder abuse in an environment where their dignity is a priority and they can be in an established community has been the most effective way to begin the healing process for these victims. Typically, the shelters provide ninety to 120 day programs in the community for free with a range of services aimed at giving the victims of elder abuse a way to resume their lives in a safer location.
The Weinberg Center has helped other nonprofit organizations around the country form their own elder abuse shelters. Most of the shelters outside of New York are operating in Connecticut, Rhode Island, Minnesota, and Ohio but other shelters are opening in various states. Additionally, states and private entities that are interested in opening their own elder abuse shelters were also encouraged to come to the conference in Ohio in order to learn more about the shelter programs. "I felt it was really important that we have conversations, that we create best practices and that we share successes and challenges," the leader of the Weinberg Center said, in order to help the shelter movement grow.
Casey Kasem was known mostly for his long and illustrious career in radio. Almost everyone remembers his years on "American Top 40" or hearing him as the voice of Shaggy in the cartoon, Scooby Doo. However, his final years on earth also left his fans with a cautionary tale about caregiving and the problems that can arise.
During the last couple of years of his life, Casey Kasem's family was torn about his caregiving needs. On one side were his children from his first marriage, and on the other side was his second wife. Their bickering led to very public court battles, and it culminated in his wife moving Kasem without telling his children of his location. In the end, one of his children was appointed his custodian, and thankfully his entire family was able to see him before he passed.
Family Conflict and Caregiving
Family conflict over issues of caregiving is a common problem in estate planning and elder law offices. Typically, most conversations regarding caregiving occur too late, and they only happen after a person in the family is in need of serious care. When the caregiving conversation happens too late oftentimes the person in need is no longer in the position to contribute to the decision making process about their own care.
As a result, family battles arise and questions about long-term financial needs are often at the forefront of the conversation. In most cases, the spouse is considered the primary decision maker for medical and financial choices; however, without certain documents like a medical and durable power of attorney, living will, and advance directive family members will fight for the right to make caregiving decisions.
Having the C.A.R.E. Conversation
The 40/70 rule, also known as the caregiving conversation rule, states that when a child reaches forty years old or a parent reaches seventy, whichever comes first, the conversation about long-term care and end of life decisions needs to occur. The C.A.R.E. acronym is a step by step instruction on how to have the caregiving conversation:
· C: Create the conversation. Using stories such as Casey Kasem can be a great icebreaker when bringing up long-term care wishes.
· A: Acknowledge wishes. While as the caregiver you may think that you know best it is important to acknowledge the long-term care and end of life wishes of your loved one. The conversation goes best when it is approached as a partnership or collaboration for what the parent wants and needs.
· R: Review all documentation. Review all legal, financial, and personal documents for your parent. Ensure that all of their wishes are fully documented and that all documentation is up to date.
· E: Engage the entire family. Make sure that all family members are involved in the conversation about the long-term care and end of life wishes of your loved one. Explaining why certain choices were made and ensuring that everyone feels included in the process can avoid future problems before they happen.
The added trauma of family squabbles can hasten a loved one's demise by causing undue stress in an already difficult situation. Casey Kasem's legacy has taught us that it is important to have the caregiving conversation, and have it early, to ensure that the issues faced by his family do not happen to ours.