Live independently at home with the help of experienced Homecare California caregivers.
Tuesday, May 15th, 2012
One of the hot-button topics in retirement planning is the issue of long-term care insurance. In a recent article in the Wall Street Journal, a health administration wonk and a nursing home reform advocate debated the pros and cons of long-term care insurance, and they both made some worthwhile points.
Having long worked in the field of in-home care, we have frequently seen families struggle with the best way to meet the needs of an older loved one. Financial realities are often a significant part of their concerns. The right health insurance can be a godsend, but long-term care insurance is not a one-size-fits-all proposition.
The Long-Term Care Insurance Debate
In the Wall Street Journal debate, the argument for long-term care insurance can be summarized as follows:
Most older individuals will need some type of long-term care eventually. Costs of long-term care can run up to $250 or more per day, and an individual’s lifetime savings can be depleted within a short time. If care is needed for several years, expenses can no longer be paid out of pocket. Long-term care insurance provides coverage for as long as needed. Most middle-income families need the safety net that long-term care insurance can provide.
The argument against the value of long-term care insurance is, in summary:
Long-term care insurance is too much of a gamble, and the industry uses fear tactics to generate demand. Most people who need long-term care only need it for a short period of time, and they are better off boosting their savings rather than paying premiums. The long-term care insurance industry bases its model on high costs, low risks, and relatively low benefits.
Determining What Is Best for Your Family
Based on research found in the above article and our own experiences in the senior care field, we offer a few suggestions for making a decision. First, start with a basic cost-risk-benefit analysis:
Cost of care. Depending upon the type of care needed, annual costs may vary significantly. Nursing home costs can run over $80,000 per year, while adult day care costs are closer to $15,000 per year. At-home care costs are not insignificant, with daily home health care costing over $40,000 per year, for example.
Degree of risk. What is the likelihood that you or a loved one will eventually need long-term care? Some data indicates that about 70% of individuals who reach the age of 65 will need it at some point. Regarding skilled nursing care, however – the most costly long-term care option, only around 3.7% of older Americans live in nursing homes. And only about 6% of older adults remain in a nursing home for more than two years.
Benefits provided. Consider the types and amount of coverage offered, as well as any exclusionary periods. The majority of long-term care policies exclude nursing home coverage for the first 90 days of care—luckily, around 60% of older adult nursing home admissions receive discharges within 90 days. Most policies don’t pay 100% of the daily rate for nursing home care, either, leaving an average gap of around $100 per day.
Now take a closer look at your own individual situation before you make a final decision about coverage, and be prepared to answer the following questions:
Finally, after you’ve weighed the facts, discuss your decision with a financial planning specialist or attorney. With the proper due diligence, you’ll make the decision that’s right for your needs.
Friday, April 20th, 2012
We’ve just noted that April is National Gardening Month, so it seems timely to make our pitch for gardening as a wonderful tool to promote good health and reduce stress in older adults. Gardening has been found to have a number of benefits for seniors, as those of us who work in senior care can attest. For those who have enjoyed gardening over the years, simple adaptations can keep the gardening experience comfortable and accessible. For others, gardening can become a new source of recreation and enjoyment.
To make gardening a worthwhile experience for older friends or loved ones, consider the following tips before you help cultivate their interest.
Staying Fit in the Garden
For seniors, the health benefits of gardening are many:
Make gardening a treat for all the senses. Edible gardens can contain vegetables as well as delicious herbs and berries. Have a cutting garden, too, in order to enjoy the sights and fragrance of flowers in bloom. Combine gardening time with good companionship for the best natural medicine!
Staying Safe in the Garden
For all its health benefits, gardening can create health risks for older adults if some precautions aren’t taken. Before venturing into the garden with a senior friend, follow some practical advice:
Staying Comfortable in the Garden
To increase accessibility and comfort, look at ways to modify garden equipment, beds, and other work areas, such as the following:
To find helpful information on planting a garden, contact your local garden club or country extension office. Now would be a great time to start! And if your loved (or you) can’t garden anymore, consider a trip to a local farmers’ market or rose garden.
Tuesday, April 10th, 2012
One conversation with local geriatric dentist Dr. Indira G. Sahiwal, and an individual walks away with a completely different perspective on oral care for the elderly. As senior care providers, we are certainly aware of the need for maintaining good oral hygiene in older adults. But our appreciation of this fact has increased significantly, after hearing Dr. Sahiwal’s perspective on caring for the aging mouth. In local practice at the Atherton Center for Advanced Dentistry since 2002, Dr. Sahiwal has focused much of her practice on geriatric dental care.
“I like to think of myself as practicing ‘additive’ dentistry,” she notes. “I try to build on what is already there and make it better.” This practice may include restorative dentistry, such as caps, bridges, and veneers; removable partial dentures, or dental implants. A practicing prosthodontist, Dr. Sahiwal specializes in replacement and restoration of teeth and related jaw structures.
In recent years, public awareness has increased about the relationship between oral health and overall medical health. However, Dr. Sahiwal sheds additional light on two less familiar aspects:
– Blood-based diseases such as anemia or leukemia
– Arthritic diseases such as lupus
– Immune system abnormalities
– Endocrine diseases such as diabetes or thyroid problems
– Kidney disease
– Gastrointestinal diseases such as Crohn’s disease or ulcerative colitis
– Pulmonary conditions
Dr. Sahiwal frequently consults with specialists about patients’ medical findings, and she attends training that addresses not only oral health but overall health and well being in the elderly.
Unfortunately, dental care is a frequently overlooked aspect of healthcare among older adults. Reasons range from high costs for people with limited incomes to decreased ability to access treatment. For example, one study found that less than 20% of nursing home patients received regular dental care. Overall, about 30% of older adults report difficulties in getting to dental offices, often due to being homebound. The implications are significant: Consider these facts:
The greatest irony in these findings is that the point at which individuals have the least access to dental care coincides with the time in their life when they are most vulnerable to the likelihood and effects of poor dental care. The reasons for this are many, but include such factors as:
Luckily, providers like Dr. Sahiwal practice in the San Mateo County area. As she summarizes: “My commitment to older patients means that I must take the time necessary to evaluate their overall wellness. Then I look for dental solutions that will promote their total health and well being.”
If you’d like further information, visit her website or contact Dr. Sahiwal at:
Atherton Center for Advanced Dentistry
3391 El Camino Real, Suite 102
Atherton, CA 94027
Phone: (650) 299-1482
A DMD graduate of the University of Pennsylvania in Philadelphia, Dr. Sahiwal received the Warner-Lambert scholarship for excellence in preventative dentistry. A board-certified prosthodontist, she earned her Masters in Prosthodontics at the Baylor College of Dentistry in Dallas, Texas, where she was awarded a scholarship from the American College of Prosthodontics Education Foundation. Dr. Sahiwal previously practiced in the Bay area, where she also served as an Assistant Clinical Professor at the UCSF Dental School/Graduate Prosthodontics program. She is a current member of the American Dental Association, California Dental Association, American College of Prosthodontics, and the Academy of Osseointegration.
Wednesday, April 4th, 2012
Los Altos area baby boomers recently had a special opportunity for learning and networking. On Saturday, March 24, The Los Altos Rotary Partners for Elder Generations (PEG), in conjunction with the Los Altos Recreation Department, sponsored a free, interactive community event, Encore! Investigate Your Passion and Get Involved.
A large turn-out of local “junior-seniors” first enjoyed a morning of interactive non-profit displays at the Los Altos Youth Center. More than 25 exhibits from local community organizations provided information on community and career engagement. The highlight of the day was a lunchtime panel discussion on the topic of encore careers in the second half of life. The panel featured three speakers who were representative of such mid-life career changes. These encore career trailblazers included:
As you can see from the photos below, the event was enthusiastically received, as many participants received inspiration for the next chapter of their professional lives. Events such as this are in keeping with the mission of PEG, a project of the Los Altos Rotary Club (of which yours truly is a proud member). The committee promotes activities that support the quality of life of 50+ individuals who are living in their chosen environment. One way it seeks to meet its mission is through motivating individuals to become more involved in their local communities.
Events such as Encore! can help to remind us, both as aging service providers and individuals, that the second half of our lives can be equally – or even more –rewarding.
Thursday, March 8th, 2012
The following article appeared in the March 7, 2012 edition of the Los Altos Town Crier.
Once or twice a month I speak to groups of older adults about remaining in their homes as they age. I usually share a little folk wisdom, saying, “You know you’re getting old when you stop blaming your parents and you start blaming your kids.”
At 47 years of age, I know I’m getting older because I’m not ready to stop blaming my parents, but I am starting to blame my kids as well. I usually get a few laughs and many nods of agreement, because the audience is experiencing the changing dynamics of their relationship between themselves and their parents or adult children.
Changing family dynamics
For the most part, today’s older adults are able to live relatively independently as parents and grandparents into their 70s, 80s and 90s. But at some point, a medical crisis comes along that quickly changes the relationship between parents and their adult children. It marks the beginning of a strange role reversal when our children begin to take on more responsibility for caring for us.
This family dynamic is becoming more pronounced with the complex world of financial and legal issues, medical options and long-term care needs. And because we’re living much longer, often with chronic diseases and debilitating conditions such as Alzheimer’s disease, the length of time older adults need significant support can last for decades.
But initiating a conversation between parents and children on these issues ranks right up there with that talk about the birds and the bees that took place decades earlier.
Options for in-home care
A while back, the adult daughter of a prospective client came to me to inquire about options for in-home care for her parents. Sharon had tried to discuss hiring in-home care with her parents, a conversation that was generating conflict with her mother. So she decided to do some homework before approaching the topic again, hence her call to me.
When she explained her situation, I came up with a suggestion. Rather than push the issue of home care just now, why not take a step back? I had just gone through the process of creating my own advance directive through a program at El Camino Hospital’s Health Library, and it had a huge impact on me.
I recommended that she ask her mother for a gift and also tell her she wanted to give that same gift to her own children. Would she be interested?
Sharon took my advice and started by explaining to her mother that she herself was reaching that age where she felt her college-aged children needed to know her wishes regarding medical decisions, mental incapacitation, etc. She felt the gift of making her wishes known would help ease those decisions when the time came to make them on her behalf. It would provide comfort at a time her children would most need it.
So they sat down one afternoon at her mom’s house and discussed it together. For the first time, it felt more like they were walking the path together. Not only did it achieve its purpose of their both filling out their advance directive, but also, perhaps most importantly, they got the overall conversation started regarding future care needs.
Resolution
Since then, they’ve been able to move on to other matters related to both of their wishes and desires for later life – the very decisions that seemed so hard to talk about before.
A few months later, Sharon’s parents made the decision to ease into getting care at home a few days per week. It was a positive step forward that allowed them to maintain flexibility to make other long-term care arrangements down the line. In the meantime, it provided a greater degree of independence and maintenance of their quality of life.
If you or your parents have estate planning documents in place that may already include an advance directive, ask your attorney how this may affect any living wills or other legal documents. This can be a time to have your parents review and update theirs in tandem with yours.
If you would like to explore this with your parent or children, I’ve posted several links to advance directives on my website at http://www.homecare-california/advancedirective.
Greg Hartwell is managing director and CEO of Home-care California, a Los Altos-based in-home caregiving agency. For more information, call 324-2600, email greg@homecarecal.com or visit the Homecare California website.
Wednesday, February 29th, 2012
Sunnyvale Senior Caregivers Conference to Provide Families with Resources and Support
Families of older adults with healthcare issues need all the support and information they can receive. If you would like the opportunity to get some excellent training on caregiver issues with seniors, I encourage you to mark your calendars for an upcoming conference. On Saturday, March 17, the Aging Services Collaborative (ASC) of Santa Clara County will be hosting an all-day training for families.
“Caregivers Count!” is the apt title for the event, which promises to cover a range of relevant caregiving issues for area families, including:
· Self-care and stress management
· Legal issues
· End of life and palliative care
· Navigating community resources
Major sponsors of the event include the Silicon Valley Council on Aging, HealthTrust, and several local healthcare organizations. Hosting organization ASC has been a moving force in Santa Clara County for the last five years. The collaborative of over 87 organizations promotes the well-being of older adults through leadership initiatives, capacity building, and information exchange.
At Homecare California, we work daily with families who are struggling with the demands of caring for an older loved one. Often the transition is sudden, and information and support are needed – often for the entire family. We encourage area residents to take advantage of this free training opportunity.
TIME and DATE:
Saturday, March 17, 2012, 9:00 a.m. – 3:30 p.m.
LOCATION:
Sunnyvale Senior Center
550 East Remington Drive
Sunnyvale, CA 94087
COST:
Free
REGISTRATION:
Registration is required, as seating is limited. You can register using this online form.
For additional information, go to the Aging Services Collaborative or HealthTrust website.
Wednesday, February 22nd, 2012
When Menlo Park attorney John C. Martin was younger, a favorite aunt worked as an estate planning attorney. She clearly enjoyed her work and shared stories of how she had saved families from various financial legal and financial nightmares. Martin also watched the lack of proper estate planning hit close to home. After his grandfather impulsively tore up his will, he died a few months later. With no will or estate plan in place, settling the estate was indeed a nightmare. Today Martin cites both these family influences as being professional inspirations for his work as an estate planning attorney.
“I enjoy counseling individuals one on one,” Martin says. “And I try to save them from their own family nightmares when I can.” As lead attorney in the Law Offices of John C. Martin, he works exclusively in the areas of legacy planning, estate and business succession planning, wealth preservation, and estate administration.
A key component of his work is incapacity planning. Martin notes that up to 44% of individuals will face a disability of more than two years’ duration during their lifetimes. When a person’s mental or physical condition affects the ability to make financial or legal decisions, the results can be far-reaching. He or she may become subject to state oversight and may face expensive legal proceedings such as conservatorship or guardianship. Decisions about health care may not be made according to one’s own preferences. And the planned legacy for an individual’s estate can also be impacted, as assets may not be adequately protected or probate disputes may arise.
When asked about the most critical elements of incapacity planning, Martin notes the importance of the right documentation, particularly for powers of attorney, advance health care directives, and revocable trusts. He offers the following tips:
Powers of attorney – Not all powers of attorney (POAs) are created equal, Martin states. Most individuals first need a basic document that assigns an agent to function in their behalf. However, many individuals may also need a more prescriptive one. Martin advocates “beefing up” a boilerplate POA with language that covers specific eventualities; e.g., the agent’s power to enter into long-term care contracts, such as agreements with in-home care facilities or providers. California law now requires the POA to state whether an agent may consent to resolving disputes by arbitration in a nursing home contract, for example, so he recommends that the POA explicitly empower the agent in this regard.
Health care directives – For most individuals, Martin finds that a standard template will suffice, such as the California Medical Association’s form. The advantage to a standardized form is that it can be readily reviewed in an emergency situation without delay. However, sometimes a more detailed directive is needed, depending upon the unique needs of the individual. For example, A Christian Scientist might elect to spell out the types of medical treatment that are acceptable for her care. An individual newly diagnosed with Alzheimer’s disease might want to outline the level of care that she would prefer at each stage of the progressive illness.
Revocable trusts – A key difference Martin notes between a revocable trust and a power of attorney is that a trustee has actual title on assets. Because POAs do not create a change of title, agents may be required to submit documentation over and over again to demonstrate they are authorized to take certain actions. A revocable trust can be an important tool for specifying an individual’s wishes over the later years in life. In addition to protecting estate assets, the revocable trust can better position an individual to receive and finance the best health care options; e.g., laying the groundwork for a special needs trust or establishing alternative ways of producing income to fund later elder care needs.
In the arena of incapacity planning, Martin addresses everything from drafting HIPAA-compliant release authorizations (“What is the value in having a health care agent if your health information can’t be released to them?”) to establishing special needs trusts. His firm offers convenient and cost-effective client care programs, set up to deal with changing financial, legal, or health issues. Periodic checks are made to ensure that clients’ directives are up to date and relevant, and basic document changes are made as needed.
“I work with both seniors and their family members, “Martin says. “But I always remember that the client’s own wishes must be my first priority.” By ensuring that these wishes are protected through the right legal planning and documentation, he also hopes to reduce the likelihood of an estate nightmare for another family.
Based in Menlo Park, the Law Offices of John C. Martin provide legal consultation to individuals and businesses throughout the Silicon Valley and San Francisco Bay areas. A magna cum laude graduate of UCLA, Martin received his J.D. from Boston College Law Schools and a Diplôme from L’Institut d’Etudes Politiques in Paris, France. He is a 2010 recipient of the State Bar of California Wiley W. Manual Award. For additional information on incapacity planning, please visit his website.
Friday, February 10th, 2012
For Minda Cutcher, Financial Advocate for Seniors, her work is her passion. “My goal is to lift the burden of money management and household planning from seniors and/or their adult children so their visits together can be about quality of time vs. quantity of tasks.” The service she provides is equal parts daily money manager and professional organizer.
A few short years ago, she was serving as a financial manager of a very different sort. An MBA with degrees from Cornell and Northeastern and a background as a civil engineer, Cutcher was blazing trails in the corporate world. She managed multi-million dollar budgets, led teams of several hundred employees, and handled billing and collections for companies with more than half a billion dollars in annual revenue.
Today, her work is not always so glamorous. Cutcher often finds herself sitting across the table from an elderly client, helping balance a checkbook. In a typical day, she may pack boxes for a client’s cross-country move or scrutinize the fine print in a set of insurance claims.
What changed? The timely intersection of a tanking economy and her 93-year-old father’s need for more hands-on care led to a reassessment of priorities, both personal and professional. Around the time she was laid off from her finance manager position, she realized that her widowed father, living 3,000 miles away, needed her to apply her organizational expertise to his life. When she discovered that his cleaning lady was helping him pay bills, she rolled up her sleeves. One startling discovery: her father was eligible for veteran’s benefits for which he had not even applied. And after his death, she was struck by the accumulated “business” of death – obtaining death certificates, contacting Social Security, stopping pension checks, and disposing of his estate.
Her epiphany came when she realized that other adult children as well as seniors needed assistance in navigating what she describes as the “financial challenges of aging.” She established the office of Minda Cutcher, MBA, Inc. — and never looked back.
As a Daily Money Manager and professional organizer, she applies her professional skills to four assistance areas for seniors:
You can find further details about these services at Minda Cutchter’s website and blog.
Cutcher estimates that about half of her referrals are from seniors who contact her directly when they realize they need questions answered, records organized, or financial decisions made. Often seniors will turn to a provider such as herself, rather than allowing themselves to appear vulnerable to their children. The other half of her client base comes from adult children, who realize a parent needs assistance that they are unable to provide, due to lack of expertise, geographical distance, or other factors. Cutcher notes that relieving an adult child of a managerial role with an older parent allows both parties to enjoy the familial relationship more.
Cutcher enjoys the support of a broad network of other service professionals to whom she can refer her clients. She has worked closely with organizations such as ours, and her assistance and expertise often make a difference in the degree of independent living a senior can maintain, as well as their overall quality of life.
“What drives my passion,” Cutcher says, “and what is most rewarding to me, is to see the concern drain from the face of a worried son or daughter—to see them relax when they realize that things are taken care of. Now they can focus on spending time with, and caring about, rather than caring for their parents.”
A recent comment from a client validates these words. Cutcher was hired by an older woman’s daughter to downsize her mother’s household possessions and then move her from California to Pennsylvania. As Robin S. describes: “Minda’s role in my mother’s life has been transformative. When I moved 3,000 miles away from my mother… I carried great anxiety over my ability to complete the organizational work I had started for her. When I hired Minda, she worked a total transformation on my mother’s home the first week of her involvement. Minda has been instrumental in transferring responsibility for my mother’s finances and personal administration to me, allowing me to secure my mother’s future. Minda has my deep and lasting gratitude.”
For Minda Cutcher, she’ll take the transformative work of changing people’s lives by helping seniors over the corporate world any day.
Minda Cutcher, MBA, is a member of the American Association of Daily Money Managers and the National Association of Professional Organizers. She is a past Chair of the Board of Directors for Pathways Hospice Foundation and on the Board of Director for Senior Housing Solutions.
Tuesday, January 24th, 2012
In a recent New York Times Opinion Pages essay, Dr. Jack Resnick, an internal medicine physician, describes his experience with a patient over a decade ago – an experience that changed his perception of hospital vs. home-based care. He admitted a 48-year-old patient with quadriplegia to the hospital, suffering from a urinary tract infection. Although his UTI was treated successfully, the patient developed a pressure sore, and became infected with a bacterium common in hospitals. It was, unfortunately, resistant to antibiotics. The patient, who had survived a gunshot wound during a robbery several years before, was felled by a common bedsore and died before he could leave the hospital.
Resnick describes how his practice has become one in which patients are treated in their homes whenever possible. He cites findings from a veteran’s affairs study which found that patients participating in a home-based primary care program were able to reduce their days in the hospital by 62% and their nursing home stays by 88%.
The recent health care reform act does include provisions for the establishment of Independence at Home Organizations, in which physician and nursing groups provide home-based care. Resnick notes, however, that Medicare has not yet even issued the rules or application procedures that will begin the process. The program was slated to begin January 1, but implementation is clearly not ready.
Resnick advocates that the medical community turn away from its “more is better” approach to health care. Often the simplest treatment, at a patient’s bedside at home, is the best and safest care. In the Santa Clara and San Mateo Counties area, Homecare California is a strong advocate for home-based care, as is the network of healthcare and elder care providers with whom we work. We encourage you to learn more about the provisions of the healthcare reform that pertain to independence at home organizations. Then let your voice be heard in support of the program’s speedy implementation.
Thursday, January 12th, 2012
The following article appeared in the January 11, 2012 edition of the Los Altos Town Crier.
“Who’s got it better than we do?” “Nobody!”
If you’ve been following the San Francisco 49ers this season, you know that’s the familiar dialogue between new coach Jim Harbaugh and his players. Harbaugh knows that winning in the NFL starts with a great defense. But as a former NFL quarterback, he knows the team won’t dominate until it has a top-five offense to match.
If you are an older adult, 2012 is a new season. It’s a time when you can develop offensive and defensive practices that will allow you to live safely at home for many years to come.
And in our later years, having a winning season may simply mean staying healthy and active for as long as possible. Unfortunately, an injury caused by an unnecessary fall can sideline you for many months. Often it’s that first injury that ultimately keeps you from maintaining your ability to live a normal, everyday life.
Defense
So to stretch the football analogy, basic home-safety adjustments are much like focusing first on a strong defense. Making simple modifications and minor investments to your home environment can prevent injury. Many such accommodations are simple:
• Eliminate fall hazards including loose cords, hallway or stairway obstructions like piles of old magazines, throw rugs or bathroom mats that don’t have slip-resistant rubber on their bottoms.
• Improve night lighting in bedrooms and halls, and remove obstructions between the bed and bathroom for nighttime visits to the restroom.
• Replace old house slippers with ones that provide better support and traction.
• Manage medications more closely to prevent improper dosages that can contribute to symptoms like grogginess or low blood pressure, which could cause fainting.
Offense
After shoring up defensive measures for safety, turn your attention to a more aggressive offensive strategy to make your overall home more accessible. This will help maintain not just safety, but also your quality of life by enabling you to continue to perform your daily activities independently.
Home accessibility upgrades range from moderate to more expensive in cost and can be scaled to your specific desires. A few affordable home modifications include:
• Place furniture risers under chairs, couches and beds to make standing or sitting easier and safer.
• Install proper handrails or a small ramp for steps and stairs that allow access for all areas of the house, the garage and outside areas.
• Replace existing toilet with an elevated Americans with Disabilities Act-height toilet.
• Add a handheld wand to a bathtub or shower as well as a proper shower chair for safe bathing.
• Replace existing knob-style door handles with lever-style handles.
Bigger-ticket upgrades
Because many Los Altos houses were built more than 50 years ago, you may need to invest more to reach modern accessibility standards.
The most common, more significant investment in home modification usually comes in the bathroom through:
• Widening the entrance and using pocket doors for wheelchair access.
• Remodeling the floor plan for transfer access between sink, toilet, bathtub and shower.
• Replacing a bathtub or shower that can facilitate a variety of disabilities, including full wheelchair walk-in access.
Like all good investments, such renovations cost a bit more up front but could pay dividends in the form of quality of life for years to come as you age at home.
For more information and a checklist of ideas for home safety and accessibility, visit www.homecare-california.com/homesafety.
Greg Hartwell is managing director and CEO of Homecare California, a Los Altos-based in-home caregiving agency. He is a frequent guest speaker on elder-care issues. For more information, call 324-2600, email greg@homecarecal.com.
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