Monthly Archives: March 2011

Tackling Care as Chronic Ailments Pile Up

No one said it was going to be easy and with the most recent figures coming to light, all will have to agree that it isn’t going to be an easy task…but clearly our older seniors are requiring care that ‘someone’ is going to have to pay for; ‘looking away’ is not an option.

Anyone seriously interested in improving the health of Americans and reducing the costs of health care must be willing to tackle a growing and under-appreciated problem: the vast number of patients with more than one chronic illness.

The problem is actually two problems: delivering more efficient care to these patients and helping them not to get sick in the first place.

Both tasks require the cooperation of patients and caregivers, as well as the providers of health care and the agencies that pay for it — and, at least as important, a public willing to take proven steps to reduce the risk of chronic disease.

The statistics, as reported in December in a strategy report from the Department of Health and Human Services, say it all. More than 25 percent of Americans have two or more chronic conditions — which, by definition, require continuing medical care, and often limit their ability to perform activities of daily living. (The conditions include heart disease, diabetes, obstructive lung disease, high blood pressure, kidney disease, osteoporosis, arthritis, asthma, H.I.V., mental illness and dementia, among others.)



Dementia: A Silent Crisis That May Bankrupt America

We all hope never to endure having our minds slowly diminished and devoured by dementia, but the odds of that are worse than you might know. In fact, there’s about a 40% chance that your brain will self-destruct while you’re in your 80s. Your chances of developing dementia increase steadily every year.

Almost 13% of those aged 65 and older already have Alzheimer’s disease, which is only one of many forms of dementia. As the Baby Boomers age, the number will increase astronomically.

This coming, unprecedented surge threatens to overwhelm individuals, families, medical systems and budgets. Years ago, we undertook a massive research campaign for HIV/AIDS, successfully developing treatment and prevention strategies. If we are to avert the looming catastrophe posed by dementia, we must increase research funding for it in the same way.

At the peak of the AIDS epidemic, 600,000 to 900,000 Americans had the disease. Now, more than 5.4 million Americans are known to be living with Alzheimer’s. Many more dementia sufferers go undiagnosed, and Alzheimer’s is the sixth leading cause of death in our country.

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Hearing Loss Linked To Dementia

Adults with hearing loss are significantly more likely than adults with normal hearing to develop dementia, according to a new study out today from researchers at Johns Hopkins and the National Institute on Aging. The study, which finds that the greater the hearing loss, the higher the risk, may open a new avenue of research into dementia and Alzheimer’s disease. Men and women in the study who experienced severe hearing loss were five times more likely to develop dementia than those with normal hearing. But even mild hearing loss doubled the risk of dementia.

The study followed 639 people ages 36 to 90 who initially did not have dementia, the insidious loss of memory, logic and language that interferes with daily living. The volunteers were tested for hearing loss and dementia every two years for nearly two decades.

Researchers found that those with hearing loss at the beginning of the study were much more likely to develop dementia by the end, even after taking into account age and other risk factors. The risk of dementia only began to rise once hearing loss began to interfere with the ability to communicate for example, in a noisy restaurant. The study also found that hearing loss increased the risk of Alzheimer’s disease, but the two were not as strongly linked as hearing loss and dementia.

Frank Lin, M.D., assistant professor in the Division of Otology at Johns Hopkins University School of Medicine and an author of the study, says this is the first large study to connect hearing loss to the development of dementia and should spur more research into this intriguing new relationship.

Lin says it may be that whatever causes dementia also causes hearing loss, but there’s no clear evidence. He thinks it’s more likely that the neurological stress of dealing with hearing loss contributes to dementia and Alzheimer’s disease. “If you are out to dinner with friends at a busy restaurant and it’s very, very loud, by the time you get home you’re exhausted, because you spend so much time trying to think about the words people are saying, to decipher everything,” he says. Then, too, it may be that the social isolation that comes with hearing loss contributes to the development of dementia.

People who have a hard time hearing can’t follow conversations or respond to questions. They feel frustrated and embarrassed and tend to avoid socializing. And previous research has linked isolation with a higher risk of dementia. Or, Lin says, it may be a combination of the neurological stress and social isolation.

Either way, this study may prompt men and women to pay more attention to hearing loss, a condition that affects more than 9 million Americans over the age of 65, according to the American Speech-Language-Hearing Association. Lin says people don’t tend to give hearing loss the same kind of attention they give high blood pressure or heart disease. Instead, they accept hearing loss as an inevitable part of aging. But, says Lin, it may be time to take a more serious look at the condition.

Luigi Ferrucci, M.D., chief of the Longitudinal Studies Section at the National Institutes on Aging and another of the study authors, says it’s not yet time to recommend widespread action, but researchers have important questions to answer, including: If we cure hearing loss, are we going to prevent dementia? And can hearing aids make a difference?

Even if treating hearing loss only delayed dementia, that alone could have enormous consequences, researchers say. This study didn’t find that hearing aids decreased the risk of dementia, but volunteers in the study only reported whether or not they had hearing aids, not how often they used them or how effective they were.

Thanks to Elizabeth Agnvall, a contributing editor at the AARP Bulletin.

More Prevalent Than You May Believe

The story below outlines the fact that senior abuse can and does happen in all walks of life. The rich and the powerful may be as susceptible to it as those living on median (or less) incomes. Abuse may be the result of family dynamics, stress, financial issues…whatever the cause…if you see it (or think you see it) please share your findings with someone who can help before a tragedy ensues. Actor Mickey Rooney has been the alleged victim of elder abuse at the hands of his own stepkids, according to restraining orders filed Monday. The 90-year-old actor, who, born into vaudeville has had one of the longest careers of any actor, was granted court protection from stepson Chris Aber and his stepdaughter Christina Aber, after he filed a case against them charging verbal, emotional and financial abuse, and for denying him such basic necessities as food and medicine. The court documents say that both Chris and Christina Aber have been keeping Rooney as “effectively a prisoner in his own home” through the use of threats, intimidation and harassment. Read More Here

Long Term Care Insurance

Surprise bills do NOT make us happy! So if you haven’t researched long-term care, now may be the TIME to do so. Please realize Medicare does NOT cover long-term care. Medicare does offer LIMITED skilled-care nursing home benefits under certain conditions (maximum of 100 days) and in home skilled care benefits under very LIMITED conditions (medically necessary and NOT daily). Most long-term care policies reimburse for custodial, non-medical care…a service that is NOT covered by Medicare, Medicare supplements or health insurance. Costs for long-term care policies vary in every state, but here are some nationally recognized figures:

A median rate of $24 per hour for custodial care/non-medical services; approximately $192 for an eight-hour shift

The median monthly rate for a one bedroom unit in an assisted living facility is $4550; approximately $54,600 annually

The median daily cost for a private room in a nursing home is $321; approximately $9764 per month; or $117,165 per year

In addition, consider that inflation WILL increase the cost of care over time. On the bright side…most long term care policies now offer built-in inflation riders or options to purchase more coverage in the future (regardless of your health).

If you already have a long-term care health policy be sure to review it periodically with your carrier and if you haven’t yet opted in…think about consulting an agent. TIP: Vet several agents and companies before signing on the dotted line…it is MOST important that you know exactly WHAT you are paying for and the options the policy is providing!

Seniors Driving Safely and Responsibly

An older driver does not necessarily mean an unsafe driver. Many older drivers compensate for declining abilities and continue to educate themselves on driving and traffic issues.

Regardless of age, certain functional abilities must be present in order to drive safely. Chief among these are:
· Cognitive-the mental process of acquiring knowledge by the use of reasoning, intuition, or perception
· Visual- basic and complex vision as well as depth perception and night vision
· Physical-being able to coordinate and move the body

As we age, these abilities naturally decline, and a majority of the time, medical issues and/or the medications taken can further decline these abilities. The changes are often subtle and not always recognized by individuals.

Get an evaluation of your loved ones driving skills or suggest they take a refresher course…
AARP Driver Safety Education Class

Elderly Veterans Almost Three Times More Likely To Be Homeless Than Non-Vets

Veteran care is an important, growing challenge for America’s aging population and new statistics show senior veterans from the Baby Boomer generation to be homeless more often than non-veterans. The U.S. Department of Housing and Urban Development (HUD) and the U.S. Department of Veterans Affairs (VA) recently published a study on the extent and nature of homelessness among America’s veterans as an adjunct to the 2009 Annual Homeless Assessment Report to Congress . The research finds that almost 136,000 veterans spent at least one night in a homeless shelter in 2009.

“With our federal, state and community partners working together, more Veterans are moving into safe housing,” said Secretary of Veterans Affairs Eric K. Shinseki. “But we’re not done yet. Providing assistance in mental health, substance abuse treatment, education and employment goes hand-in-hand with preventive steps and permanent supportive housing. We continue to work towards our goal of finding every Veteran safe housing and access to needed services.”

The study finds that veterans represent almost 12 percent of all homeless persons during the 2009 study. Other findings from the study include:

39 percent of homeless veterans are 51–61 years compared with 19 percent of homeless non-veterans

9 percent of homeless veterans are 62 years and older compared with 4 percent of homeless non-veterans

Veterans are fifty percent more likely to become homeless compared to all Americans

For the full report:

Medical Power of Attorney and Living Wills

A Medical Power of Attorney gives an individual the ability to make medical decisions for another person when they become unable to do so. This is an extremely important document to have as a parent ages, since their ability to make decisions about complex medical matters may change quickly.

Note that both a Living Will and a Medical Power of Attorney must be in the format of the state in which the parent lives to be accepted. Most attorneys advise that both documents are not necessarily needed and that there is a possibility they could conflict with each other. A Living Will can be interpreted by any member of the family and remember that most siblings and family members can rarely agree to a single decision, let alone multiple ones.

In Massachusetts the state has no provisions for a Living Will, but does have a Health Care Proxy, which is a simple document, legally valid in Massachusetts, which allows you to name someone (an “agent”) to make health care decisions on your behalf if you are unable to make or communicate those decisions. This Health Care Proxy document, provided free of charge, gives a clear explanation of the responsibilities of a health care agent, and simple directions on how fill out and sign the form. There are also instructions on how to revoke or cancel the document at a later date, if you choose to do so.

In the case of my Dad, he was mentally competent prior to being sent to the hospital one Sunday morning. But he would not sign any documents without at least one of his children present, and he was in Florida and we were all in Massachusetts. Since not one of us had the medical ‘surogate power’ (Florida standards), it was impossible for us to do anything until we arrived in Florida.

I could cite multiple horror stories from people who delayed too long in obtaining this document. The best advice is to find out how your parent’s state of residence treats this document and to talk about it with your parent before it is actually needed and then speak with a trusted attorney about exactly what is needed in your parent’s state of residence.

Paying Family Caregivers…Pros and Cons

Making a decision to PAY a family member for caregiving services can get complicated. However, one thing should be a definite…make sure the action is transparent.

An article last year in the Wall Street Journal stated, “Particularly in situations where a care recipient may eventually need to rely on Medicaid, attorneys say it is important to draft a written agreement—often called a “personal care contract”—that documents the caregiver’s responsibilities and hours and sets a rate of pay in line with that of local service providers.

The article goes on to mention different types of payment arrangements, identifying both the pros and cons.

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Be Sensitive to the Primary Caregiver’s Needs

Geriatric specialists note that no matter how many adult children make up a family, the responsibilities are not equally shared when parent care becomes necessary. Often one adult child emerges as the primary caregiver. If you are not the primary caregiver, maintain a sensitivity to the one who handles most of the responsibility.

Ann Landers, the advice columnist received this letter to her column…
“This is for all the sisters and brothers of caregivers who are `too busy’ with their own lives to lend a hand,” she begins. “A few years ago my life changed when my mother became ill with a progressive disease. I put all my plans on hold and little by little gave up visiting my friends, doing volunteer work, socializing, attending night school, and spending time with my husband. I now must use all my `free time’ to take my parents to their doctors’ appointments and tend to their needs. I am not complaining. My parents are wonderful people, and I consider it a privilege to care for them, but I am upset because my siblings do nothing to help me.”

Many times we are just not aware of the effort our sibling is putting into the care of our parent…we are most times too consumed with our own life and hence we just accept that the caregiver sibling is fine…I mean after-all she is not complaining …she hasn’t said anything. So a little advice to the ‘lesser’ caregivers…If another member of your family is carrying most of the load, do whatever you can to pitch in and help. If you are geographically distant, consider using some of your vacation time to provide care for the aging parent, giving the primary caregiver some time off. Or if you live nearby, call the primary caregiver and offer your services a few hours per week…if you are unable to physically help, consider calling in a service such as Home Instead Senior Care to help out.

Finally, as caregiver to an aging parent, be sure you know and respect your own limits. Otherwise you run the risk of becoming exhausted, sick, depressed, and burned out. In that condition you will not be helpful to aging parents or anyone else. Do make time for yourself and find ways to nurture your body and spirit.