One of the hottest debates currently happening in elder law and nursing home care is whether video cameras should be allowed in nursing home rooms. Many residents of nursing homes and their children believe that installing surveillance will benefit everyone involved; however, many nursing home facilities are attempting to block the installation of video cameras in their communities.
Nursing Homes Banning Use
The most common reason that nursing home facilities give to the children of residents about why video surveillance is not allowed is that the video recording violates federal privacy laws under the Health Insurance Portability and Accountability Act (HIPAA). However, that is not the case as long as the video cameras and recordings are owned by the families. Still, that reason remains commonplace for many nursing home providers.
New Video Surveillance Legislation
Illinois Attorney General Lisa Madigan has heard multiple complaints about the lack of accountability and ability to monitor residents in nursing homes. Her office has begun drafting legislation that would allow residents and their families to put cameras in the rooms of Illinois' 1,200+ nursing homes. The families of the residents would own and install the cameras; the facilities would not have access to them.
Ms. Madigan hopes that the law could be passed and implemented as soon as 2016. In Illinois, video cameras are not illegal in nursing home rooms, but the facilities can ban them. To protect the privacy of the residents, the resident or their healthcare proxy will have to request the cameras, and any roommates would also have to consent to their installation. The law would also require some type of notice to let people know that they are being recorded.
Four states: Texas, Oklahoma, New Mexico, and Washington all already have laws on the books that explicitly allow video cameras in nursing home rooms. With the passage of the law in Illinois, the hope is that other states will soon follow suit with their own laws allowing video cameras in nursing home facilities.
Benefits of Video Cameras
Deterring elder abuse in nursing home facilities is the main benefit that video camera advocates are arguing for the passage of these camera laws. When possible abusers know that they are being watched, most will behave properly. And if the cameras do not deter the abuse, it can at the very least provide proof of the crimes that can be admissible in court.
Another benefit of video cameras in nursing home rooms is that family members of the resident can monitor for inactivity on the part of the staff. Family members can ensure that their loved one is being turned to prevent bed sores, is being properly fed, and can ensure that all of their needs are being met.
Video cameras can also be valuable when patients have dementia or are otherwise unable to report mistreatment at the hands of the nursing home staff. However, elder law advocates remind family members that a camera is not a complete substitute for being there, communicating with staff, and seeing things with your own eyes.
One of the hottest debates currently happening in elder law and nursing home care is whether video cameras should be allowed in nursing home rooms. Many residents of nursing homes and their children believe that installing surveillance will benefit everyone involved; however, many nursing home facilities are attempting to block the installation of video cameras in their communities.
According to the National Center on Health Statistics annual report, in 2012 the average life expectancy of our older U.S. citizens continued to increase. Seniors who reach the average of 65 can now expect to live another 19.3 years, an all-time high. Men on average live another 17.9 years, while women live an average 20.5 years after 65.
Life Expectancy Trends
The number inched up only slightly from 2011, and seniors gained an extra five weeks or so on average. However, the long-term trends of life expectancy have been dramatic. There has been a fairly substantial increase even over the last decade, let alone multiple decades past. In 1960, the average 65 year old America had another 14.4 years of life expectancy. Between 1970 and 1980, that number jumped to 16.5 years.
The life expectancy jumped to 17.3 years after the age of 65 in 1990 and 17.8 in 2000. But in the twelve years reported after that, the number has increased an entire year and a half. In addition, the disparities related to race and ethnicity has also narrowed. Statistics from 2011 show that among 65 year old seniors, life expectancy was 20.7 years for Hispanics, 19.2 years for Caucasians, and 18 years for African Americans.
Reasons for the Increase
The latest report points to some common causes for an increase in the average lifespan. Age-adjusted death rates have significantly declined for cancer, heart disease, stroke, respiratory disease, diabetes, flu and pneumonia. Even the rates of Alzheimer's disease have decreased, despite there being few effective treatments for the ailment. In fact, of the leading causes of death, the only one that showed any kind of increase was elderly suicide.
How Long will the Trend Continue?
Experts agree that it is impossible to predict how long the life expectancy rates will continue to increase before leveling off. Many people once believed that the average age would never top 80 years, but the report for 2012 puts the average expected lifespan now at 78.8 years old. As a result, those who were once naysayers have admitted that there seems to be no discernable reason why the average age shouldn't continue to climb.
Less smoking among the younger and middle aged could help increase the average lifespan in years to come. In addition, the levels of obesity in the U.S. seem to be leveling off. However, Alzheimer's disease, not even a top 15 cause of death in 1990, is now the sixth leading cause of death in the U.S. Experts are now debating whether the increase in Alzheimer's is simply a case of competing risks - now that the average lifespan is higher, there is a greater opportunity for seniors to develop the disease.
What This Means for Seniors
For some elderly people, the extra few years represent nothing but a bonus to spend with their family and loved ones. They have remained healthy or are coping well with their chronic illness or disability. In other cases, an extended lifespan is not necessarily welcome for some seniors who are dealing poorly with their health and are still around only because of medical intervention.
Many people whose love ones are part of the latter group can often be frustrated at the sight of the slow decline and don't know where to turn. The authors of this latest report understand and realize that as a society we have never been this old before, and caregiving will have to change with it accordingly.
A U.S. nursing home chain has agreed to pay $38 million in a settlement to end a federal government investigation into whether its nursing homes billed Medicare and Medicaid for poor care for its elderly residents. The settlement was specifically with a subsidiary of Extendicare Inc., Extendicare Health Services.
Extendicare Nursing Homes
The investigation focused on 33 of the company's nursing home facilities in eight states: Ohio, Pennsylvania, Wisconsin, Indiana, Kentucky, Michigan, Minnesota, and Washington. Extendicare provides post-acute and long-term senior care services. The company has in total 251 different care facilities across the country and the capacity to care for 27,600 residents. It is the seventh largest nursing home chain in the country.
Nursing Home Allegations
The Justice Department claimed that Extendicare understaffed its nursing homes, alleging in some instances of improper catheter care in addition to failure to follow proper procedures that led to falls and bed sores. The company was also under investigation for improper billing of Medicare and Medicaid for things like physical therapy and other senior services.
The care at some of Extendicare's facilities was so inadequate that some patients became dehydrated and malnourished. They developed infections that led to unnecessary hospitalizations. The company also inflated the number of residents receiving physical therapy and other services in order to bill more to Medicare.
Nursing Home Settlement
According to the U.S. Justice Department, the company has denied any wrongdoing in its billing practices or care of its residents. It agreed to the settlement on the condition that there was no admission of wrongdoing, and the company agreed to be subject to a compliance program that would monitor its residents' care.
The compliance program is a five year corporate integrity agreement. It requires an independent monitor to check staffing levels and other quality measures to ensure the level of care that its residents are receiving. The agreement applies to every facility owned by Extendicare, not just the 33 sites that were the subject of the investigation.
A lawyer from the Justice Department's civil division went on record as saying that Extendicare's program between 2007 and 2013 was driven more by profit and less by quality of care. As a result of the $38 million, two whistleblowers from inside Extendicare's company will receive awards. One person will be getting $1.8 million and the other over $250,000.
Other Cases of Nursing Home Negligence
This is not the first time that a nursing home company has been accused of fraudulent or negligent practices with their residents. In 2012, the federal government agreed to a $48 million settlement with the nursing home chain Ensign Group due to exaggerated billing to Medicare and Medicaid.
Advocates for nursing home residents have criticized the federal government for failure to look into other claims of negligence and abuse in nursing home facilities. Officials stated that they are planning on investigating more claims of nursing home negligence and would use the False Claims Act to do so. In the case of Extendicare, the government stated that the quality of care was so substandard or nonexistent in some of their facilities that Medicare and Medicaid should not have to reimburse them.
For too many seniors and their families, the concept of falling victim to a financial scam seems improbable. Many believe that even in their retirement years they will be able to recognize when they are being scammed. Unfortunately, research shows that people over the age of fifty are the most likely to be the targets of scams, and they are making for even more attractive targets given their retirement funds.
Types of Senior Scams
There are a variety of scams that people perpetrate on seniors. Most are geared towards draining them financially or to secure their information for identity theft. There are some of the most common frauds being performed on seniors:
Medicare and Healthcare Scams: Also known as a Medicare discount-drug card scam, these people will call, email, or even go door to door selling fraudulent discount Medicare drug cards. It is important to note that any situation like this is always a scam - legitimate prescription drug benefit companies are not allowed to make unsolicited sales pitches.
Free Contests and Magazine Subscriptions: This type of scam is one of the oldest in the book. Almost always done by mail, and now sometimes through email, a scammer will claim that the senior has won a free contest or can have a free subscription to a magazine if they provide enough personal information to verify that it is them.
Grandparent/Grandchild Scam: This type of scam is done over the phone or through an email. A scammer will pretend to be the senior's grandchild, asking for money. Usually the "grandchild" is in some dire or embarrassing situation and asks the grandparent not to tell the grandchild's parents. This prevents the grandparent from checking on the situation first before sending the money.
Charity Email: This scam tends to be more prevalent during the holidays. Scam artists send out emails soliciting contributions, usually using the name of a legitimate charity, with a link to send money. Seniors will give out their bank account information and other personal information through the link.
How to Prevent Scams
The best way to help prevent someone from scamming your elderly loved one is to have a conversation with them about the risks and warning signs of fraud. For seniors that are less capable of making sound decisions, it is up to family members to be more vigilant in their watch for scams.
Sadly, seniors in the early stages of dementia or Alzheimer's are more likely to become the target of fraud. It is difficult because the senior still believes that they are capable of making financial decisions even though they may no longer be able to do so on their own. An easy way to protect your loved one from scams is to add an adult child to the senior's bank accounts to help look for suspicious withdrawals or payments.
If there is a concern that your elderly loved one has been taken advantage of in a scam, the first thing you should do is call a credit reporting agency and put a freeze on any compromised accounts. Adding a lock to the mailbox and taking the senior's name off of subscription lists can also decrease the chances of a scam.
For More Information
State and federal agencies have resources to help identify and prevent people from scamming your senior loved ones. The National Council on Aging has a list of the top ten most common frauds. The FBI and AARP also have web pages specifically dedicated to helping prevent fraud against seniors.
Many seniors plan ahead for their final days and include in their estate plan funeral directives as well as other wishes. However, more seniors are adding unique and unusual requests regarding their final wishes, including donating their bodies to science. The elderly are choosing to donate for a variety of reasons: some were involved with the profession, some wish to contribute to science, and others want their bodies to contribute to society in some way.
However, donating your loved one's body can be more difficult than you think, and it is important to know what to do beforehand in order to fulfill their final wishes.
Body Donation Issues
One couple in California recently went through the struggle of fulfilling one father's dying wish to have his body donated to science. When the husband went into hospice care, his daughter attempted to find a suitable place to donate the body.
She found that some places require that you be within a certain driving distance or number of miles away. Other places required that the donor sign a number of forms, which her father was unable to do in his condition. Some donation sites require that the donor sign the form, and not a family member or even someone with the power of attorney.
Finally, his daughter found a medical school that emailed over a simple document, collected her father's body, and asked what his widow's wishes were for his remains once the school was finished using his body. However, knowing the requirements ahead of time would have saved the family a lot of scrambling during his final days.
The Need for Body Donation
Many people ask why it is still necessary in this day for medical professionals to continue to need cadavers. Although most of the 170 medical schools across the country have implemented digital instruction into their anatomy labs, every single one of them still uses cadavers in some way in their instruction.
Dentists, physical therapists, and nurse practitioners all use cadavers in their training, as well. So do technicians and surgeons who need to practice or are working on developing new techniques. And although the need for donated bodies continues, the actual process of donating the body of an elderly loved one takes time, planning, and documentation.
Body Donation Law
Body donation is governed by the Uniform Anatomical Gift Act, first introduced in 2006. It has been adopted by 48 states, and it allows any individual to sign a "document of gift" that donates organs, tissue, or the full body for transplantation, therapy, research, or education. The law also provides that if the donor did not make arrangements during his life to donate his body, family members or a person with the power of attorney can do so for him. The list of family members allowed to donate the body is inclusive: parents, children, grandchildren, and spouse. The only exception is if the donor signed a form refusing donation.
Organ donation typically receives the most press, partially because everyone has heard of how organ transplantation can help, but also because of the federal law that requires hospitals to refer families to the federal organ procurement organization.
However, if your elderly loved one wishes to donate his body to science, arrangements must typically be made with a specific school. Each school has wide latitude to set its own policies regarding acceptance of donated bodies. Some schools have requirements beyond the Uniform Anatomical Gift Act regarding who can agree to donate, how far away the body can be, and even down to the specific body type that they will take.
Thankfully, a few states: Indiana, Florida, Maryland, and Illinois have set up state anatomical boards to make the process easier. The board intakes all donated bodies and distributes them to the schools in that state as they are needed.
More than one dozen U.S. senators from both sides of the aisle are pushing the Obama administration to broaden the Medicaid program for the nation's frailest seniors. They are pushing the idea as a proven alternative to pricier nursing home options, as states are looking to minimize long term medical costs. The senators released a statement to the Centers for Medicare and Medicaid Services to follow through on plans to loosen restrictions on the Program of All Inclusive Care for the Elderly (PACE).
Broadening the PACE Program
The PACE program is offered to Medicaid eligible seniors and people with disabilities who need nursing home care. The program offers an alternative to nursing homes that allows the elderly to stay in their homes and receive coordinated care from a team of doctors, nurses, and social workers at an independently operated day center. However, enrollment in this program has been small due to the limiting federal regulations and a push by states to move patients into more cost-effective health care plans.
Currently, the PACE program has enrolled 31,000 Americans aged 55 or older that are served by 196 PACE centers in 31 states. Pennsylvania has the most centers at 32, with California, New York, Massachusetts, Virginia, and North Carolina following right behind. Spokespeople for Medicaid Services stated last year that it would propose changes to the PACE program that would allow for more flexibility and the option for more seniors to enroll. However, they have yet to do so.
The letter released by the senators states that the PACE program is in a unique position to help Medicaid achieve "its goals of better care, better health, and increased cost-effectiveness." The senators are asking the Centers for Medicare and Medicaid Services to allow PACE in a wider range of community settings like adult day centers or senior centers in order to increase access to the program. They also asked for a quicker application process and to allow the elderly to keep their own doctors instead of a PACE physician.
PACE versus Nursing Home Care
Many seniors that have used the PACE program are happy with the freedom and independence that it provides. For one participant who suffered a stroke five years ago, instead of going into a nursing home she chose to enroll in PACE. She is picked up five days per week and taken to a day facility where she is monitored by doctors, fed, and can participate in daily activities before returning home. The costs are all picked up by Medicare and Medicaid.
Nursing homes cost on average $75,000 per year per person, not including the charges made separately to Medicare for medication, emergency services, and hospital stays. On average, PACE enrollees spend 14% less on costs than they would in a nursing home. While patient satisfaction and health outcomes in PACE have been positive so far, no long term studies have been done on the effectiveness of the program. Regardless, senators are pushing for Medicare and Medicaid to follow through on their promise to make this program available to more seniors as soon as possible.
The medical journal BMJ recently released the findings of a new study that links long term use of anxiety drugs to Alzheimer's disease. Previously, reports have been released that tie the long term use of drugs in the sedative-hypnotic family, which includes benzodiazepines like Xanax, Valium, and Klonopin in addition to related "z-drugs" like Ambien and Lunesta, to issues of dementia in elderly patients. The most recent study focuses specifically on benzo-drugs use in seniors and the rates of Alzheimer's disease.
Sedative-Hypnotics and Elderly Accidents
Doctors and health organizations have been concerned about benzodiazepines and its interaction with seniors for years. They point to much higher rates of falls, fractures, auto accidents, and cognitive problems in older patients taking these types of drugs as compared to seniors that do not. There is also a higher rate of emergency room visits and hospital admissions.
Recently, the American Geriatric Society included a long list of anxiety drugs on its "Choosing Wisely" list of treatments that doctors and patients should question. Now, French and Canadian researchers are reporting that benzodiazepine use can be directly linked to a higher rate of Alzheimer's disease, and that the association strengthens with a higher use of these drugs.
Benzodiazepine Use and Alzheimer's Study
Experts reviewed medical records of almost 1,800 older people diagnosed with Alzheimer's in the public health insurance program in Quebec and compared them to around 7,200 control subjects most of whom were over eighty years old. Almost half those with Alzheimer's and forty percent of the control subjects had used benzodiazepines that translated to a 51% increase in the odds of a subsequent Alzheimer's diagnosis among the benzodiazepine users.
Short-term use of the drugs had no increased risk for seniors, but elderly patients who took the drugs longer were more likely to be diagnosed with Alzheimer's. In older patients who took daily doses between 91 and 180 days the risk rose 32% compared to seniors who did not use the drug. In those who took daily doses for more than 180 days, the risk was 84% higher.
The association persisted whether users took 180 doses over six months or over five years, and it also remained constant even after the researchers controlled for health and demographic factors, including conditions like anxiety, depression and insomnia. The connection to Alzheimer's was stronger to longer-acting forms of the drug like Valium than to shorter-acting drugs like Xanax.
Raising Awareness about Alzheimer's
Dementia affects roughly twenty to thirty percent of seniors over the age of eighty, and Alzheimer's disease accounts for 70% of that. The search for drugs, treatments, and root causes of this debilitating disease has been discouraging. However, the results of this study not only show a correlation between anxiety drugs and Alzheimer's but could also point towards prevention.
Stopping these medications for seniors could be an easy, cost-effective method of reducing the chances of Alzheimer's. At the very least, it could help seniors who are considering going on these types of medications make an informed decision about the risks involved and the association between it and Alzheimer's.
In part one of this article the statistics and reasoning behind an increased possibility of LGBT elder abuse was discussed. The second part of this article concludes the reasons why LGBT seniors are at a higher risk of elder abuse and what to look for to prevent elder abuse against LGBT seniors that you care about.
In addition to an abuser threatening to out an individual, telling a senior that the authorities will not believe them, gaining control of finances, fear of spending the rest of their lives alone, and being easier to isolate the following are reasons why LGBT seniors are at more risk for elder abuse.
Abuser says that "this is what it means to be LGBT"
Because there are so few examples of healthy LGBT lives for seniors, it is still possible for LGBT seniors with limited experience within their own community to believe abusers who claim whatever is going on is "what LGBT people do." This applies particularly in sexual elder abuse situations.
Society believes that this is best that LGBT senior should expect
Internalized homophobia, biphobia, or transphobia occurs in elderly LGBT people when they believe the social message that an LGBT lifestyle is not normal, lesser, sinful, or worse than a non-LGBT lifestyle. When an elderly LGBT person believes this they are much more likely to put up with being abused, neglected, or exploited. In addition, elderly LGBT people who have been abused in the past are far more likely to believe that this type of behavior is normal.
Victim has history of self-reliance and fears authority
Many LGBT seniors have faced rejection from family members and disrespect from social institutions. It leads many in the LGBT community to form a strong belief in self-reliance as a survival tactic. This leads to a common setup for self-neglect if LGBT seniors become frail and unable to care for themselves, yet unwilling to seek help from others.
Tips for Preventing LGBT Elder Abuse
Despite the heightened opportunities for LGBT elder abuse, there are measures that you can take to lower the chances of you or a loved one in the LGBT community from being abused, neglected, or exploited. These measures include:
· Get and stay actively involved
· Do not live with someone who has a history of abusive or violent behavior
· Do not give others access to your finances, and automate what you can
· Plan for incapacity, and do it carefully
· Practice safe dating
· Be wary of new friends with financial problems
· Thoroughly screen caregivers
· Be wary of stereotypes regarding gender, orientation, and abuse
· Ignore all unsolicited offers of money, jobs, and financial deals
· If you live in a nursing home facility, know and assert your rights
· Help other LGBT seniors stay active
· Do not take "no" as an answer from friends forever
· Try to keep all topics on the table
· Help victims safety plan
· Know the signs and remain observant
· Be willing to "go with"
· Be resourceful
Between two and ten percent of seniors experience some type of elder abuse, and LGBT seniors have additional vulnerabilities that open them up to further opportunities for abuse. As discussed by the National Resource Center on LGBT Aging (led by SAGE), many people believe that elder abuse only pertains to bruises, broken bones, or other physical injuries; however, experts define elder abuse as physical abuse, sexual abuse, emotional or psychological abuse, neglect, abandonment, and financial exploitation.
For the most part, LGBT seniors face the same types of abuse as non-LGBT elders. However, LGBT elders can be victimized in additional ways, and more reasons exist why people are so accepting of this type of victimization. The National Resource Center on LGBT Aging notes that these additional factors for LGBT seniors include:
Abuser threatens to "out" the senior
Despite the recent legal advancements for LGBT individuals, people still discriminate and are prejudiced against LGBT society. Many seniors in the LGBT community still feel safer keeping their sexual orientation a secret. Abusers who discover this fact threaten to "out" these seniors unless they submit to abuse. Many LGBT elders feel that it is easier to take the abuse than be outed, especially if they are LGBT grandparents whose children and grandchildren are unaware of their sexual orientation.
Abuser tells senior that authorities will not believe him
Abusers often tell their LGBT victims that the authorities will not believe them if they try to report the abuse. If the victim is known as LGBT or has to come out in order to fully report the abuse, they may keep silent for fear of facing police prejudice or violence.
Abuser gains control of finances/assets
Most LGBT partnerships are not protected by marriage or community property laws. As a result, it is much easier for abusers to take advantage of LGBT seniors' finances or assets. This means that victims would be homeless or penniless if they leave their abusers. The same can happen if their report leads to the abuser being jailed or otherwise removed.
Victim fears "spending the rest of my life alone"
Older LGBT seniors have been told for decades that they will "end up alone" and ageism within this community seems to confirm this assumption. The threat of spending the rest of their lives alone or without meaningful human contact is another way that abusers keep their LGBT victims close. It also makes LGBT seniors particularly susceptible to "sweetheart scammers" that get form relationships with people in this community specifically to gain access to their financial resources.
Victim is easier to isolate
It is incredibly common for abusers to isolate their victims so that they become completely dependent on their abusers and so no one else will notice the abuse. Isolating an LGBT senior can be easier than isolating a non-LGBT senior because many are already estranged from their family. In addition, many LGBT elders do not feel comfortable in settings that cater mostly to non-LGBT people. Besides avoiding senior centers and meal sites, some LGBT seniors go as far as avoiding healthcare professionals for fear of discrimination or prejudice.
A new study shows that many sick elderly people, with advanced dementia or near death, are still being prescribed drugs that cause uncomfortable side effects or adverse reactions. The question among doctors is how sick and disabled, how far into dementia, how close to death, must a nursing home patient be before stopping drugs that cause these unfortunate side effects but show scant evidence of actually helping?
New Study on Overmedication
The Journal of the American Medical Association (JAMA) released a report last week that measures the amount of medication being overprescribed to near death nursing home patients when the evidence that such medication is helping is slim. The report took a nationwide sample of 5,406 people with a diagnosis of advanced dementia that spent at least 90 days in a nursing home between 2009 and 2010. Most of the participants were over the age of 85 and had other ailments, as well. The majority, over seventy percent, had a "Do Not Resuscitate" order.
By definition, dementia is terminal, degenerative disease. Seniors stricken with dementia no longer recognize family members, can no longer walk, bedridden, with an inability to feed themselves or communicate with others. Many victims of dementia also face swallowing issues, and the mortality rate within six months is high.
Yet, the study revealed that over 54% of patients received at least one medication considered "of questionable benefit." The types of drugs given to these patients are considered never appropriate for palliative care patients with advanced dementia. Even with patients that have mild to moderate dementia these drugs only bring small improvements to cognitive abilities but the clinical significance is uncertain.
Effects on Elderly Patients
If the only problem with giving these patients unnecessary medications was cost, averaged at around $816 per person per quarter, this study would be less of an issue. However, that is not the case. There is also a personal cost to administering these medications to patients with advanced dementia or near death.
Two of the most commonly overprescribed medications are known to cause nausea, fainting, and uncomfortable urinary retention. They can also cause heart arrhythmia, which can lead to implanting a pacemaker. People with severe dementia are more likely than seniors with normal cognition to receive pacemakers.
People with advanced dementia cannot verbalize to their family members or doctors the pain or discomfort that they may be feeling. And when they lash out, it can cause another round of medication to be administered instead of signaling that something is wrong. Discontinuing the drugs can help patients remain alert and relaxed; however, there is no published research either way.
Reasons for Overmedication
There are a variety of reasons why advanced dementia patients are continuing to be overmedicated in nursing homes. Geography plays a role in some of the decision making. Geographic areas like Mid Atlantic and South prescribed more often than in other areas. In addition, nursing homes, hospitals, cities, and regions have their own culture and practice patterns that lend more to overprescribing these drugs.
Emotions play a large part, too. Family members try to do everything for their ailing loved one and that includes giving them every drug despite warnings from professionals. Stopping medication is a fairly radical concept for many people, despite the full blown campaign asking people to weigh the pluses and minuses of continuous medication.
A large scale study recently published by The Gerontologist looked at the effects of the fuzzy concept, resilience, and how it impacts the lives of seniors. The surprising results of the study showed that this intangible concept can have a major effect on aging seniors' lives.
What is Resilience?
Resilience is a concept that is difficult to define. The study's lead author described resilience as "how people manage adversity and hardship over the life course." As one U.S. Supreme Court Justice once said about pornography, we know it when we see it.
The effects of resilience are easy to point out. Many elderly people deal with illness or loss in their later years. Some withdraw into isolation and inactivity even though they physically remain strong. However, others maintain a bright and sunny attitude despite the challenges, and they continue to be active physically as well as socially. Age, health, and finances cannot fully explain the differences in people, and the study focused on how that intangible, resilience, plays a role.
The Gerontologist Study
Scientists have been discussing and studying the concept of resilience for years. In this latest study, 10,753 people at an average age of 69 were drawn from three waves of the National Health and Retirement Study. The team of researchers created twelve items and asked each participant to rate the statement on a scale based on how strongly they agreed or disagreed.
These statements included things like "when I really want to do something, I usually find a way to succeed at it," and "I have a sense of direction and purpose in life." The study also included statements like, "if something can go wrong for me, it will," and "there is really no way I can solve the problems I have."
Over the course of two years, eleven percent of the participants developed a new chronic condition, yet the higher that the person scored on the resilience scale the less likely this new ailment disabled them. The study found that most of the seniors developed their resilience and ability to negotiate obstacles by overcoming tough experiences in their lives.
Effects of Resilience
The study looked at participants' ability to do daily living activities. It found that when a new ailment or challenge struck, those with the least amount of resilience had three times the amount of daily living activity disabilities than the most resilient seniors. The effects of resilience seem to create a "moderating effect" in seniors' lives. Even among the youngest participants in the group, when a new illness hit the amount of daily living activity disabilities among the least resilient were two times as many as the most resilient. The seniors with the most resilience are able to bounce back better and faster than those with less resilience. They are able to maintain function better and for a longer period of time.
Other Intangible Studies
Resilience is not the only amorphous concept being studied by researchers. Other reports that have been published show that a sense of purpose correlates to a lower rate of Alzheimer's disease, and volunteering in schools is linked to better cognitive ability.
Even the concept of religiosity, regardless of what specific religion, appears to help lower rates of depression and certain physiological problems. Self-efficacy, mastery, and gratitude have all also been shown to have real world effects on the lives of seniors, and it's becoming clear that health in old age is more than just medication and exercise.
While more people are beginning to draft estate planning documents like a will, trusts, and power of attorney forms they forget that estate planning can also be utilized to make more immediate changes in your life. One of the biggest changes that people in retirement go through is downsizing their home and belongings from a large, family-sized home to something smaller. The following includes tips that you and your loved ones can use to make the process of downsizing easier and more efficient.
Reasons to Downsize
There are many reasons why people in retirement choose to downsize. Some couples realize that they no longer need such a large home once all of their children are grown. Others wish to save money in retirement and move to reduce bills or eliminate a mortgage. Many more downsize because one or both spouses are in declining health and want to live closer to family, medical professionals, and have services included in their new home (maintenance, lawn care, etc.) to alleviate the amount of work that needs to be done.
Tips for Downsizing
· Plan Ahead of Time
Downsizing can take a long time, so planning ahead can take a lot of stress out of the experience. Take time to think about the lack of storage space going from a large home to a smaller one, or how you can take advantage of what space there is to organize what you want to keep.
· Scan It and Digitize It
Scanning all important documents like diplomas, pictures, and certificates can allow you to keep these important items without taking up wall space. After scanning and digitizing the items you can send them to family members, keep them on a hard drive, or put them on an internet cloud like Dropbox. The originals can be taken down, the frames sold, items stored in a book, and they can be reprinted by anyone from the digital form.
· Give Away to Family
Everyone has a lot more stuff than they think, and attempting to downsize from a larger home to a smaller one can really illustrate that fact. When getting rid of all of the unnecessary stuff, give your children and extended family first dibs on what they want. That way some of your belongings will remain with the family before giving the rest away.
· Give Away to Charity
If you still have a lot to get rid of consider about giving it to a worthy charity. Habitat for Humanity, Goodwill, the Salvation Army, and other charities are in constant need of furniture, home goods, clothing, and more to help others.
· Consider One Floor Living
If one or both spouses are facing a chronic illness, or just to combat the process of aging, consider living in a one floor home. Look for even floor surfaces without steps or sills between rooms to reduce the chances of tripping and falling.
· Consider Accessibility
This area goes beyond wheelchair accessibility. Make sure there is room to place stools, chairs, and benches around the home and in the bathroom. Also look to see if the garbage drop-off is nearby or included in concierge services.
· Ask About Concierge Services
Any services that are included in your new place mean that there is less that you have to do. Ask about whether there is maintenance, lawn care, housekeeping, security, and similar services for your new place.
· Automate It
Consider automating as much of your new place as possible when downsizing. Systems can be installed that easily controls the lighting, temperature, security, garage doors, and even the stove. In addition, bills can be automated as well to eliminate the need to remember to pay every month.
For the last four years, doctors, pharmacies, and medical clinics have all offered seniors a higher dose version of the annual flu shot. At the time that the vaccine was released the science was lacking but the hope from medical professionals was that the higher dosage would provide better protection for the elderly. Now, the first studies on this version of the flu shot are in, and the results are looking positive.
Higher Dose Flu Shot
The annual flu shot for seniors, known as Fluzone High-Dose, contains up to four times the amount of antigen found in the typical flu shot. Antigens are chemicals within the shot that stimulate the immune system. Previous research has shown that the increased antigens in the Fluzone produced a greater antibody reaction in seniors. This is significant because as the body ages the immune system becomes less effective.
When Fluzone High-Dose was approved by the FDA in 2009, the administration also asked for further testing to provide more rigorous proof of effectiveness for seniors, specifically for those ages 65 and older. The organization wanted proof that the higher dosage reduced the number of flu cases in the elderly. Since releasing the vaccine in 2009, the manufacturer of Fluzone has distributed nearly 21 million doses of the vaccine, and between eight to ten million more doses are expected to be delivered this season.
Flu Shot Study
The most recent study was published in the New England Journal of Medicine, and researchers have found that the higher dose flu shot had reduced cases of flu in the elderly by twenty-four percent when compared with the normal dosage. Scientists worked with the manufacturer of Fluzone to compare the number of flu cases reported from seniors with the higher dose vaccination and seniors who received the normal dose.
The result was a statistically significant difference between the two groups, with seniors taking the typical vaccine getting the flu more often than those taking the higher dose. These results have led experts to continue their research on flu shot vaccines. The next big task is to compare how often seniors get the flu after being vaccinated with a high dosage shot and seniors who get no flu shot at all.
Importance of Flu Shots
Experts believe that the standard flu vaccine prevents the illness around 50% of the time in older adults; however, that figure is old and more recent research has not been done on the topic. In 2012-13, the Centers for Disease Control found that the standard flu vaccine was effective for adults ages 65 and older around 27% of the time. In the 2013-14, the effectiveness for the same age group was closer to fifty percent.
Because seniors' immune systems worsen with age, it is incredibly important to receive a flu shot every year. Medicare covers one shot of Fluzone per year, but the cost of one shot is only $28.65 per dose. The Centers for Disease Control encourages seniors to get the higher dose flu shot when they can. There have been no reports of unusual side effects from the vaccine, and all studies point to this option being more effective for older adults.
Only one-fifth of all 15,000 nursing homes in the nation hold the distinction of a five star rating by the Medicare system, but an examination into the process has found that many top ranked nursing homes have been given their rating due to incomplete information regarding the conditions at their homes. This misinformation has an effect on the facilities' residents, potential consumers, and investors regarding the communities.
Medicare Nursing Home Ratings
The Medicare ratings system is considered one of the best ways to evaluate nursing homes in the country. When nurses and doctors discharge patients from the hospital, they often use the ratings in referral decisions. Insurers also look at the ratings when creating preferred insurance networks. Medicare ratings are also the first metric that investors and lenders look at when deciding whether a nursing home is a safe bet.
However, these ratings are accumulated through self-reported data given by the facilities that the government does not verify. In fact, only one of the three main criteria for rating a nursing home, the result of the annual health inspection, is verified by an independent source. Other criteria such as staff levels and quality statistics are reported by the nursing homes and accepted by Medicare at face value.
In addition, the Medicare ratings system does not take into account a variety of negative factors and information about the nursing home communities. Fines, enforcement actions by the state, and complaints filed against the facilities are not factored into the ratings system.
Gaming the System
Many nursing homes are now taking advantage of the rampant self-reporting and using it to their advantage in order to raise their rating in the Medicare system. Nationally, the number of nursing homes with above-average ratings has risen steadily. In 2009, around 37% had above-average marks, and by 2013 that percentage was closer to half.
Even nursing homes that have a history of poor care rate highly in the areas that rely on self-reporting. Of the more than fifty nursing homes in the country on a federal watch list for quality, nearly two-thirds of those communities have four or five star ratings in the Medicare system for self-reported staff levels and quality metrics. The worst facilities in the country can still self-report that their quality is the best while simultaneously being on watch lists for failing state health inspections.
Using the System as an Elder Care Resource
Some advocates agree that the current Medicare ratings system is the best option available, but other experts believe that the ratings are so inflated their only remaining purpose is to weed out the worst homes. A provision in the Affordable Care Act requires that Medicare use payroll data in order to ensure that nursing homes are not padding their staffing around inspections to receive a better rating, but Medicare has not implanted the system yet. The agency has said that it is still working on the verification system and hopes to have it running soon.
Until a better ratings system is introduced, experts encourage people looking into nursing home care to do their research and rely on more than just the Medicare rating. Check annual health inspection records, visit the facilities multiple times, talk to residents, and make sure that you are getting the true picture of the place before making a decision.
Elderly couples are divorcing at a higher rate than ever before for a surprising reason: soaring medical and long-term care costs. These expenses are being aggravated by longevity and uninsured risk from a lack of long-term care insurance. Although these senior couples still care for each other very much, the cost savings from divorce are inflicting the least amount of damage when compared to other financial options.
Medicare and Medicaid
Seniors are now turning to divorce to stave off financial ruin trying to qualify for Medicare and Medicaid coverage. In terms of Medicare coverage, the program only covers 100 days of nursing care. If you or your spouse needs long-term nursing care you must either pay out of pocket until your assets fall beneath a certain threshold or tap into your long-term care insurance if you have it.
If you do not have long-term care insurance, you must pay out of pocket as a couple until your assets are spent down and Medicaid steps in as a last resort. If you're married, all liquid assets must be tapped regardless of which spouse's name is listed on the asset. However, once Medicaid steps in the spouse is guaranteed care for the remainder of his or her life.
Divorce as a Financial Option
The divorce rate for seniors has doubled since 1990, and now over 28% of people divorced in the last year were over the age of fifty. According to the Census Bureau American Community Survey, in 2011 a total of 15.4% of seniors were divorced and another two percent were separated. There are a number of reasons behind the rising divorce rate, but one of the main causes cited was an increase in long-term health costs.
Considering divorce as a cost-saving option can be an emotionally fraught issue for loving couples. For the healthy spouse, it can feel profoundly wrong or immoral to divorce an ailing spouse despite the good intentions behind the decision. However, it is important to remember that a paper divorce does not mean that the healthy spouse is any less present in the ailing spouse's life.
An Example of Elderly Divorce
Take for example the hypothetical situation of an elderly couple, married but with separate assets and dealing with the ailing health of one spouse. For years, they have engaged caregivers to help, but now the costs are reaching over $3,000 per month for care. The ailing wife's resources are completely depleted, and the husband's separate assets are dwindling as he pays for her care.
For this couple, one of the best options for her care and his assets would be to get a paper divorce. With her assets depleted, the ailing wife will qualify for Medicaid, and his resources will remain intact in case he requires care in the future. If they remain married, he will be forced to continue to spend his assets on her care until they are both left with nothing, and he will have very little to cover his own living expenses or future care.
A paper divorce does not interfere with his responsibilities for her, and he can still oversee and coordinate her care through the use of a healthcare proxy and power of attorney. While the husband may feel like he is betraying his wife and taking advantage of the system, he also realizes the logic of divorce and how the decision is the best for both of their interests and long term care.