Why Bankrutcy Filing for Senior Citizens is on the Increase

Seniors are living longer today than ever before, so how could this ever be a problem. The longer seniors live the problem begins when more and more outlive their money. Plus any catastrophy can change long range retirement planning irreversibly no matter how well thought out they may be. The what-ifs in life, and for seniors in particular, are always ready to pop up their heads and scare the tar out of us. But for seniors it could be a catastrophy simply because time and money are in short supply for us,or at least, spoken for.

What are these what-ifs.

They range from the need for long-term-care to the death of a spouse. These what-if’s could keep you awake at night and are hard to plan for. According to the AARP, 60% of thoes over 65 will need some kind of nursing home or home health care services at one time or another. These costs can range between $150 to $170 per day with an average need of just over 3 years. How well can you plan for that when the cost of health care is going up at about four times the rate of inflation.

What happens if one spouse dies after that. Its been said the average couple is broke after 13-14 months of nursing care. This means the surviving party has now lost their independent living ability and must depend on friends or family and sometimes charity to survive.

What do we do? Well at this rate, the job application for Wal-Mart and McDees will be as competitive as trying to get into some collage. As per a survey done by “Financial Literacy Survey” 1 in 5 people felt they would have to work till they drop. They fear they will never be able to retire.

Now, I don’t really think that not wanting to retire is a bad thing, as long as its your choice. Looking at seniors who have had a long life, I think you would find that most have been working long after retirement age. To keep going, we need a reason to get up and get out to maintain that feeling of self worth. We need to stay active. But I don’t want to wait in line for that Wal-Mart job application.

This is why myself, and many seniors are turning to the computer and the internet. Even Blogging among seniors is on an increase. We can be 80+ and in a wheelchair but if we can still roll that sucker up to a computer, can see the keys, and have at least one finger to shake at the world, we can be in business.

Now, normally it can take years to create a profitable business,online or offline. You need to create an audience and that can take time. There is just no way around that. The old way of doing it took a ton of time and money which is in short supply for us. Many senios are on fixed incomes and time speaks for itself. But it’s a fact. I have had two open heart operations plus a pace maker. So, how much time do I have, I thank God for whatever it is. But, I will be sitting at this computer at the end and that’s just fine with me. Plus you can build your business on a strict budget.

This thing called “Attraction Marketing” has made all that I am doing possible. Why? because this system does not take a ton of either time or money to be successful with. Most of what you are taught is free or very low costs. When done properly, you can be well on your way to your goals within a very short time. Whatever your goals are and that’s within months and not years trying to do things any other way.

You are taught how to create that audience of people interested in what you are doing and what you have to say. People will be looking for you. You will be the hunted and not the hunter. Can you imagine how much quicker your business and income will grow if you only need to spend your time and money on people who came to you and said “I like what you are doing and want to join you”. This is what attraction marketing will do for you.

If you’re anything like me and want something to suppliment your income or want to create a new business, something you can show your family and pass on, then you need to learn attraction marketing and get started.

It may look overwhelming at first. Just remember you don’t need to know everything. Pick something out and learn it and get started. The rest can be learned on the job at your own pace. Don’t forget, by using the attraction marketing system, people will be looking for you and not you looking for them.

Thank You!

Jerry

Senior Apartments and Assisted Living Facilities May Want to Offer Baby Boomers In-house Medi-spa Tr

Baby boomers are lining up to pay hundreds of dollars to remove unwanted wrinkles, blemishes and hair. With so many of them eager to pay for these services perhaps there is an untapped market in the <a rel=”nofollow” onclick=”javascript:pageTracker._trackPageview(‘/outgoing/article_exit_link’);” href=http://www.greatplacesinc.com/features/NursingHomes.aspx>senior apartment</a> and <a rel=”nofollow” onclick=”javascript:pageTracker._trackPageview(‘/outgoing/article_exit_link’);” href=http://www.greatplacesinc.com/features/AssistedLivingFacilities.aspx>assisted living industry</a>.

Several medical spas claim that baby boomers make up a good portion of their business. CNN stated that In 2004, there were about 750 medi spas in the United States, but by the end of 2006 there could be as many as 2,500.

Removal of Wrinkles, Sunspots, Unsightly Veins and Unwanted Hair Along with Your Weekly Physical Therapy

Besides offering physical therapy and 24-hour nurses and physicians, the senior living industry could benefit from having a medi-spa on site.
Since many people are working past their 60s and living longer these days, it’s no wonder that many baby boomers want to continue looking their best. They perhaps don’t feel “old” so why should they look it.

A medi-spa can include laser treatments usually take between 30 and 40 minutes and range from laser hair and vein removal techniques to wrinkle-reducing Juvederm or Restylane injections to chemical skin peels that restore sun-damaged skin. Prices for services generally range from $50 to $500. When you think about your average doctor’s appointment cost, a medi-spa treatment is at least twice that amount.

Many seniors looking to lead active lifestyles and still look great would think twice about having a senior living facility with a medi-spa on site verses without.

Baby boomers are not ready to be considered “old” and are moving towards healthy lifestyles in so many ways, be it exercise, nutrition and overall appearance.

Emeritus Senior Living featured on Living in Style!

Watch Deborah Howard of Emeritus Senior Living explain the benefits of residing at an Emeritus community! Services include Assisted Living, Independent Living, Retirement Living, Hospice Care, Skilled Nursing Care, and many more! Check out Emeritus at www.emeritus.com

Seniors And Social Life – Where To Find Friends

To determine whether a senior is socially isolated or enjoys an active social life, we must first see where the senior resides, the organizations the senior belongs to and the activities she participates in.

Retirement Communities – Seniors residing in retirement communities can participate in a wide range of community organized activities that can help minimize isolation.

Apartments with gyms – Seniors living in apartments with gyms can exercise regularly and get to know the neighbors while doing so.

Golf or Tennis Clubs – Some golf clubs and tennis clubs provide these elder people with a social network as well as the opportunity to exercise.

Groups based on common interests – Some seniors enjoy meeting with others who share common interests such as gardening, knitting, sewing, discussing foreign policy, writing etc.

Are you a socially isolated senior citizen? Want social connections but don\’t know where to start? Here are some suggestions:

·         One can visit to the local senior center, where they offer lectures, classes and meals.

·         The local library is a wonderful meeting point for the seniors. The local library can provide book discussion groups as well as lectures and concerts.

·         Some local colleges and universities have special classes, concerts or other social activities for seniors. If seniors attend such classes, their minds will be occupied and they will not feel any sort of isolation from the society.

·         The local YMCA has movement classes for seniors.

·         One of the safest places where a senior member can engage himself are the health clubs. These health clubs have exercise and yoga classes for seniors.

·         Many civic, medical, educational and arts organizations look for volunteers. Senior members can act as volunteers to these organizations where they can meet a lot of like-minded people.

·         Affinity groups such as organizations or clubs for guitar players, singers, environmentalists, theatre actors can help the senior members to increase their social interactions.

·         The senior members can act as volunteers for churches, mosques, synagogues or any other religious organizations that offer adult education.

·         Widowed or divorced seniors who want companionship could consider online dating, which has connected more than one happy older couple. But don\’t always believe what you read in a profile. And it is helpful to follow your instincts — if something about the person doesn\’t feel right, don\’t pursue it.

It\’s never too late to get socially connected. Social interactions help with physical health as well. People with social connections tend to stay healthier. In home companion care is another great option for senior care, but both the persons are confided in a home, which prevents from any social interactions.

An Overview Of Assisted Living

Assisted living facilities are meant for senior citizens and the disabled who require housing, and assistance with activities of daily living (ADLs) such as bathing, dressing, and assistance with taking medicine. These facilities enable people to follow an independent lifestyle and at the same time provide the right type of assistance needed in day-to-day activities. Occupants of assisted living facilities are generally unable to live independently but are also not in need of full-time care. Thus, an assisted living facility offers an alternative to nursing homes that are more suitable for senior citizens with a greater need for care.

Assisted living facilities are sometimes referred to as residential care, personal care, adult congregate living care, domiciliary care, retirement residences, adult homes, etc. Assisted living facilities often operate in conjunction with nursing homes and independent living residences. Together, the three constitute Continuing Care Retirement Communities. Thus, an individual can start by shifting into an independent living residence and move on to assisted living facilities or a nursing home depending upon his requirements as he ages.

Housing facilities can be private single rooms or private suites. Assisted living residences often have ensuite bathrooms and common dining facilities. The occupant and housing facility are expected to enter into a written occupancy agreement. Assisted living facilities can provide housekeeping, meal services, laundry, and round-the-clock emergency services.  

The personal assistance provided at assisted living facilities ensure that the dignity and self-respect of the occupants are upheld and that they get ample opportunities to socialize, make friends, and also keep in touch with their family. The assistance can be either routine or intensive. The personal assistants are trained to be mindful of the requirements and values of senior citizen. They usually hold a college home support/resident care aide certificate or have the required balance of experience and learning. Personal assistants may operate under the supervision of professionals such as registered nurses.

The key points to be borne in mind while selecting an assisted living facility should include :

-    Atmosphere – This would include the size of the facility, visiting hours, opportunities for socialization, and meal-related information.  

-    Activities – Factors such as flexibility of schedule, presence of lounge areas, and chance of interacting with neighboring communities should be considered.

-    Amenities – Presence of exercise facilities, availability of equipment for supporting patients with special needs, religious facilities, and storage space are the amenities that should be present.

-    Costs – Costs of staying at the facility, rate at which expenses fluctuate, as well as services and utilities included in the costs are some of the features that should be considered while checking out the costs.

A facility should be visited and the opinions of staff and residents should be taken into consideration. In order to get a complete picture, the facility should be visited on multiple occasions at different times of the day over a period of time.

Senior Assistance-Care Options

Locating appropriate senior assistance for your elderly loved one can be a daunting task. This can be especially true when you are not familiar with your care and housing options. It can be overwhelming when you hear senior care related terms such as sub-acute care, independent living, assisted living, residential care, or continuing care facility.

Understand the variety of senior care options and related terminology can ease your way as you navigate your way. The following are some of the common terms and service options you may encounter and want to become familiar with.

Adult Day Care/Medical Day Care-a protective environment for seniors needing a structured program. Adult day care services vary from custodial care, offering stimulating activities for independent seniors along with meals, to an adult medical day care setting which provides activities to seniors with medical needs. Seniors are usually brought to an adult day care program in the morning and leave in the evening. Often times, transportation to and from the center are available.

Assisted Living- is a combination of housing and personal health support services for seniors. Such services usually include:

Private or semi-private apartment Emergency call system Daily meals served in a common dining area Recreational and social activities Transportation Personal care assistance Staff available 24 hours Laundry and housekeeping services Secure unit for memory impaired residents (at some assisted living communities)

Continuing Care Retirement Community (CCRC)- a community that offers multiple levels of assistance to seniors. Levels of care range from independent living apartments, assisted living and nursing home care. A CCRC provides a continuum of housing and health care options on one central campus. Seniors who opt for CCRC living usually sign a long term contract such as the length of the resident’s life. The benefit of this type of care is that it can provide peace of mind that housing and medical assistance will continue to be provided at one site as needs increase.

Home Care- also known as senior in home care or home health care. This type of service provides a range of services that include assistance activities of daily living such as bathing, toileting, dressing, and ambulation. Home care can also include meal preparation, light housekeeping and laundry services. In-home care can be provided for a few hours per day or on a 24 hour basis.

Nursing-Convalescent Home/Skilled Nursing Facility- for those with a need for more acute care, a nursing home provides patients with 24 hours care. This type of facility is generally for patients that will require skilled care ongoing. This type of facility provides medical supervision, rehabilitation as well as bathing, toileting, dressing, and assistance with ambulation.

Difficulties Facing the Senior Housing Market

The Industry Today

 

 

The seniors’ housing market has become soft, the gap between buyer and seller expectations has grown wider making it hard to get deals done, valuations have contracted and will be driven by fundamentals instead of by cheap capital, cap rates are rising, the debt markets have become very conservative, and some lenders have been changing their terms or just getting cold feet. These factors combined or separately, are impacting participants on both sides of the table.

 

 

Proceed with Caution

 

The troubles in the subprime mortgage sector have sparked concerns about credit quality. However, some industry professionals are saying that the changing climate is not necessarily a bad thing. The seniors’ housing market was getting far too overheated, with easy money spiking up the price of assets and lenders going higher and higher up the risk spectrum in order to put their dollars into play. A fast adjustment was needed. This meant that on the debt side, borrowers could forget about high loan to values and lengthy interest-only periods. The capital has become more expensive and harder to come by. As a result, an increasing number of deals are being re-priced or scrapped altogether. So what does it all mean? According to Real Estate Forum, it really depends on who you talk to. Some in the business are holding on tight in hopes of weathering the storm while others are looking closely at the potential for profit. But there is one thing that everyone seems to agree on – it won’t be a smooth ride. The economy is showing signs of weakness, oil is approaching $100 a barrel, the housing market is in a slump, Wall Street bonuses were lower this year, job growth is tapering off and consumer confidence continues to decline. It means that it’s too early to tell just how wide and deep the impact will be.

Financing – A Return to Normal Conditions

 

Spillover from the sub prime mess has pushed conduit lenders to the sidelines, causing a temporary slowdown in velocity. Commercial banks, credit unions, life insurance companies and agencies have stepped in, and senior’s housing investment activity is holding its own as a result. Tighter lending standards, particularly lower loan-to-value ratios, higher debt-service coverage ratios and focus on actual financials are here to stay, but should be characterized as a return to normal conditions rather than a credit crisis. More lender scrutiny and capital discipline bode well for the long-term health of the sector by limiting speculative investment and development.

New Ways are In, Old Ways are Out

As medicine and health sciences advance, seniors are, on average, healthier and more active than ever before, and their demands have evolved accordingly, according to Commercial Property News. While the implications are far reach ing, the major effect has been an overarching shift away from sterile, institutional-feeling facilities toward a more independent, amenity-rich and home-like environment. Seniors are demanding internet access, larger units, full-size kitchens are becoming standard, and apartments are starting to contain additional bedrooms, half-bathrooms and dens.

 

The Flood Begins

 

In October, the nation’s first baby boomer filed for Social Security benefits, with an estimated 78 million to follow. The number of beneficiaries will nearly double by 2040, while the work force that supports Social Security will grow by only about 16 percent.

 

New Development

 

There has been a 28% increase since last year in the total number of units under construction in the top 75 metro markets. The NIC/ASHA report indicated that Seattle (with 2,347 units) had the greatest amount of new construction started in the survey year (April ’06 through March ’07). The next four metros, in order, were Dallas, New York, Houston and Chicago.

 

Alzheimer’s

 

With more and more people living into their 80s and 90s, Alzheimer’s disease is more common today than it was 100 years ago. Estimates of its frequency vary, but it strikes one out of every 5 people between ages 75 and 84, and 42% of those over age 85, according to the Alzheimer’s Association. More than 26 million people worldwide have the disease, and a forecast says the number will more than quadruple by 2050. The biggest jump is projected for Asia, home of almost half of the current Alzheimer’s cases, or 12.6 million cases. By 2050, Asia will have 62.8 million of the world’s 106 million Alzheimer’s patients. A new study suggests that America’s Alzheimer’s toll will rise to 8.8 million by 2050 from 3.1 million today. Among estimates for other regions are: Africa, 1.3 million cases today and 6.3 million in 2050; Europe, 7.2 million and 16.5 million; Latin America and the Caribbean, 2 million and 10.8 million; and Oceania, 200,000 and 800,000.

 

What Other Experts are Saying

 

“The seniors housing and care market is going through what we believe will be a much-needed market correction. While this may be mildly painful to some in the short term, in the long term it will benefit the industry and bring more stability.” – Steve Monroe, SeniorCare Investor

“When real estate finance finally settles down after this year’s subprime turbulence, underwriting for seniors housing will seem downright bland compared with the recent past. Seniors housing cap rates are going up for now. The availability of capital has been curtailed – there’s still some debt financing available, but the extra-high leverage available through CMBS and CDO products for all types of real estate classes is over, so we’ve seen a peak in prices for a while.” – Craig S. Jones, Sr. Managing Director of RED Capital

“Today’s sellers are living in yesterday’s world and today’s buyers are afraid of overpaying if they no longer have to. When determining value in the acquisition market, 65% of the respondents to a survey said they will use trailing net operating income while 35% will use projected net operating income. Nine months ago, these percentages were probably reversed.” – Steve Monroe, SeniorCare Investor

“There are fears about the economy, but there’s not a whole lot of fear about health care demand.” – Louis W. Taylor, Managing Director at Deutsche Bank Securities

“The seniors housing industry is changing from a need-driven model to a more choice-driven model. Today’s seniors are more active and independent. They expect a lot more choices. They’re going to demand the best of all worlds.” – Steve Gilleland, Director for CapitalSource’s Healthcare Real Estate Finance Group

Average entrance age is 82, up from 78 just 10 years ago. – Larry Cohen, CEO of Capital Senior Living Corp.

“Capital is more expensive and the terms of the loans are stricter, but investors have adjusted to the new lending environment pretty quickly.” – Robert Kramer, President of NIC

“Rather than focusing on the long-term baby boomer demographics which are still many years away, the focus needs to be on customer outreach and penetration of the existing demographics. The perception of senior housing is still generally negative, viewed by many as institutional buildings where senior go to die. The challenge for the industry is to explain the product and change that perception. A strong advocate for the industry is needed.” – Dr. Peter Linneman, a keynote speaker at this year’s NIC Conference

When Staying at Home is No Longer an Option

Let’s call it like it is- most people don’t like to move and most older individuals certainly do not want to leave the family home and move into an assisted living environment.  There are of course many reasons that make a move so difficult, not least of which, is the overwhelming thought of emptying cupboards, basements and bedrooms.  When the ‘home’ is no longer safe- is usually the determining factor of when a move should be made.  But sometimes it is hard to determine when a move to a higher level of care is appropriate.   For older couples it is sometimes advisable to plan a move while the couple is still well enough to adjust to a new setting.   However many will only consider a move after a spouse dies.  

 

Once it has been decided that a move is necessary, there are several options to consider. Most seniors strongly resist moving into an “old folk’s home” for fear of the negative images they hold.  There are several options available in today’s marketplace including: condominiums, life lease apartments, senior’s apartment buildings, supportive housing, retirement residences, and long term care facilities.  An open discussion about what the senior would like and their current and future care needs is a great place to start.

 

When making a decision about a move, it is important to remember that each living arrangement has benefits and drawbacks. A condominium might be a good fit for someone who is finding the outside maintenance of their home to be a challenge and who wants to maintain complete independence- as no services are typically offered.  Many have a doorman or concierge who can provide some level of security and assistance.  These buildings also can allow the senior to stay in a community of people of varying ages. Seniors living in condominiums still need to prepare their own meals and take care of their own household chores. Perhaps the largest drawback to this type of move is that it is likely that the senior will have to move again as their care needs increase, unless there is space and interest in hiring private home support assistance and/or a live in caregiver.

 

A senior’s apartment building is a rental option for seniors who, much like those who purchase condominiums, find outside maintenance of their homes to be difficult to manage but in every other way would like to maintain complete independence. These apartment buildings have an age requirement and do not allow children or younger families to rent. Seniors who chose a facility like this to call home may find that they meet more people who share similar interests and activities. Like the condominium, however, the largest drawback to this type of facility is the need to move again to higher levels of care when health begins to decline and the need for assistance with tasks of daily living increase unless there is space and interest in hiring private home support assistance and/or a live in caregiver.

 

Supportive housing provides affordable housing designed to help seniors re-establish connections to the community. The housing is linked to voluntary and flexible support services designed to meet the seniors’ needs and preferences. It is designed for people who only need minimal to moderate care, such as homemaking or personal care and support, to live independently. The level of support may vary, and some support services are provided by on-site staff, while in other instances may be delivered on an outreach basis. This may include adult day programs or medical/physiotherapy clinics coming into the apartment building. Staff working in these facilities try to help seniors in their building get linked into other services offered out in their community, such as senior’s centres. These staff, however are not medically trained, some are Personal Support Workers (PSW’s) while others have certifications in recreation planning. In many facilities, no one is on staff during the night in case of emergency.  Supportive housing buildings are owned and operated by municipal governments or non-profit groups including faith groups, seniors’ organizations, service clubs, and cultural groups. Accommodations, on-site services, costs, and the availability of government subsidies vary with each building.

 

Accommodation costs are based on market rent for similar apartments. Seniors wishing to live in this environment need not have a certain income level however subsidies are available for seniors with limited financial means. If eligible, the government may subsidize the rent so that the senior only pays up to 30% of their household’s monthly income. To be eligible for a rent subsidy, the senior must be a Canadian citizen, landed immigrant or refugee claimant. If they own their home they are obliged to sell it within six months of moving into supportive housing. Local governments may set additional eligibility requirements for rent subsidies. There is usually a waiting list for subsidized units. Seniors may have to pay an additional fee for optional services such as transportation, recreational outings or hairdressing.

 

To find out what the further eligibility requirements for subsidy are for your province, and to find out where there is a supportive housing unit in your area, contact your local CCAC or Community Care Association who have application information as well as a listing of all supportive housing locations in the area.

 

A retirement residence is another option. Many are geared to modestly well and independent seniors. These rental facilities, can range in price and service delivery.  Many offer dining room settings, pools, exercise rooms, supervised outings and bus services.  Units can include a bachelor, one or two bedrooms and some have kitchenettes that allow residents to opt in or out of some of the meals.  These retirement residences have the benefit of having staff (typically Personal Support Workers) available to residents as well as nursing and recreation planning staff. This provides the senior and their family a feeling of security in knowing that there is always someone close by in case of emergency. These facilities often become a community unto themselves, with meals offered and activities and events pre-organized by the staff.  Many even have visiting physicians and other health practitioners and can arrange for medications to be delivered right to the resident’s door.

 

Within many retirement communities varying levels of assistance for personal care are available (assisted living) and can be purchased as needed for an additional fee. These programs are offered as a means to help seniors ‘age in place’ so another move will not be necessary. Additional levels of care may be referred to as ‘assisted living’ which includes some hands on assistance from a Personal Support Worker for bathing and/or dressing and may include medication monitoring.  If the individual requires more assistance during the day and evening, or are dealing with significant cognitive issues that result in the need for full time supervision or a secured floor, while some facilities may be able to accommodate others would deem them ready to move to long term care or to require extra help from private service providers.

 

A life lease apartment is much like a condo – but includes access to all the services of the retirement home. These facilities may be within a retirement residence or a separate facility. The benefit to these types of apartments is that the resident maintains a bit of equity –they own their apartment and when they pass away, the money from the sale of the apartment will act as an inheritance or be available to pay off any remaining debt. If a retirement residence has life lease suites along with apartments, assisted living programs and long term care, the senior could move once and not need to move to another facility. Rather, they would move within the facility as the need arose for higher care levels.

 

One of the major drawbacks to moving to a retirement setting is the need to adjust to a communal setting. In these facilities there is a set menu, a set meal time and bus trips and outings are set according to a pre planned schedule. It can also be a shock for a senior first moving into one of these facilities to see “all the old people”. Discussing what to expect and getting tours of possible residences will help make the decision as to whether the facility will be a right fit. Some locations will offer trial stays so that seniors can see what daily life will be like, get to taste the food and meet other people who live there.  Respite and convalescent care is also offered in many retirement residences and may be another good way to introduce an alternate setting.

 

A long term care facility is available for those who require more assistance than what is offered by the retirement residence. These facilities are funded by the government so that no person who requires this level of care will be turned away for lack of funds.

 

These facilities have 24 hour nursing care and residents receive help with all activities of daily living- eating, dressing, bathing, grooming, as well as having provision for laundry and housekeeping.

 

In the Province of Ontario, long term care facility admission is accessed through the Community Care Access Centre (CCAC). The CCAC will send a case manager to your home to help you to select 3 facilities that you would be willing to move to, in order of preference. Much like Ontario, British Columbia, Alberta, Quebec and Prince Edward Island have agencies (Home and Community Care Services, Community Care Access Capital Health, “Centres locaux de services communautaires”(CLSC) (Local Community Services Centre in English) and Home Care Office respectively) through whom residents of the Province access admission to long term care. These government agencies assess applicants for eligibility, assist with completing applications, monitor the waiting lists, and advise residents of their admittance to a particular home. Initial contact with any of these agencies can be completed by either the senior themselves or a family member. To ensure that you make an informed choice, it is always good to book a tour of each facility, enjoy a lunch and speak with other residents and family members prior to making any decisions on your application.

 

If you are still unsure of what setting would be right for your parent, a Geriatric Care Manager can help assess your parent’s care needs and can assist with outlining the various local options available. They can help the senior to make a decision that will optimize their health and lifestyle for the immediate and long term.

 

Home Health Care v.s. Facility Placement : Options in Elder Care

It always makes me sad to hear the families of an elder say “Mom made me promise to never put her in a nursing home”. That is simply a promise that most families today cannot keep. If a caring son or daughter finds that they have to break that promise, they may feel guilty for the rest of their lives. Mom probably asked for that promise because the nursing homes she remembers were dark, institutional places which would be considered substandard in America today. Today’s family structure and the financial challenges of elder care, make facility living a very common choice. When an elder shows signs of not being able to perform the basic activities of daily living, families or concerned professionals must step in. It is actually against most state laws for a professional to be aware of an elder in trouble without taking some reasonable action to secure their safety. There are many indicators that an elder is no longer safe at home alone. The basic litmus test is to ask yourself is: “Could this person save him or herself if their home were on fire? Would they be able to call 911 and communicate their exact location? If left alone for any period of time are they at risk for physical abuse or financial exploitation? Do they have the skills and resources to meet their daily hygiene and nutritional needs? The answer is “NO” for many American elders who live home alone.

Independence vs. Isolation

Many of my elderly clients who were trying so hard to maintain their independence by living alone at home actually maintained nothing more than an isolated existence punctuated by the occasionally call or visit from friends and family. This type of isolation was also coupled with medication errors or abuse, self neglect and unsanitary housekeeping. A person living in this situation will often “bloom like a flower” in the right retirement facility environment. It is amazing what three hot meals a days, social interaction, clean sheets and regular administration of medications can do for a person’s mind, body and spirit. A person who lives alone is more likely to fall and lay alone on the floor for days without being found. A person, who lives alone may make poor choices such as keeping, (or worse,) spoiled food in the refrigerator. If a person lives alone, there are many signs of illness that no one will notice during sporadic short visits. Medical appointments may be missed and prescriptions left unfilled. Many people feel that they are honoring their aging loved one by letting them live alone, even though all the tell tale signs of self neglect are apparent. There is no honor or dignity in being found on the floor after one has laid in their own excrement for three days. Unfortunately, many families will wait for this type of incident before insisting on either home health care or facility placement. If an elder is physically or verbally abusive to family and care givers, they are much more likely to be left alone to make their own decisions, regardless of how dysfunctional their situation may be. Elders with difficult personalities are many times more likely to be abused by caregivers. They need more supervision, not less.

American Family Dynamics and the Pressures of Today’s World

I hear people say “Americans don’t take care of their elders like other countries do”. Well that is not my experience. The adult children who consult with Geriatric Care Manager or other eldercare professionals are very concerned about their parents. They love them and they want the best care their money can buy. That’s the clincher: what their money can buy. In America, caregivers, maids, etc,, are expensive. Perhaps in another country where slave labor is commonplace, people can afford plenty of care. But in this country it costs $12.00 per hour (or more) for a home health aide. At eight hours per day, that is $96.00 per day. That is $2,880 per month or $34,560 per year – more than the average working American earns per year. The average woman gets a social security check of less than $500.00 per month. Do the math and you will soon see that unless you are wealthy, many people cannot afford to keep their elders in their own home with a part time caregiver or even in their children’s home with a caregiver.

Now couple this financial problem with another very real problem. Most middle income women in their fifties, who are caring for their elderly parents, are also trying to hold down a job, help their young-adult children and maintain a marriage. If a middle income woman stops working to care for her parents, she and her husband either cannot pay their bills or they must significantly reduce their standard of living. I know a few husbands who are fifty-something and feel they have worked too hard and too long to have their dreams of retirement evaporate because someone else’s needs are suddenly more important than their own. Now that Americans have come to grips with the concept that it takes two incomes to live well in this country, they are more determined than ever to have a retirement. Paying $35,000 per year for a caregiver can take a huge chunk out of the retirement savings. Frankly, most people couldn’t afford to do it even if they wanted to. Because most Americans’ net worth is in the equity of their home, selling the family home is the most common way to finance elder care services. If the family home sells for $100,000.00 and the average cost of an Assisted Living Residence is $36,000.00 per year, an elder can afford to live in that Assisted Living for 2.7 years. Coincidently, the average amount of time a person lives in an Assisted Living before moving on to a nursing home is 2.5 years.

Many adult children, who do have the desire and financial means to bring their elders to live with them, still cannot. They cannot because the medical or psychological needs of the elder are beyond their capacity to manage. For example, if Grandma is sweet and docile by day, but “sundowns” or grows agitated as evening falls, this poses a difficult problem for the caring family. When some people experience dementia or other medical issues, they may stay awake all night. They sometimes wander out of doors or rummage through drawers and closets. This behavior will keep the whole family awake at night. If a working family cannot sleep at night, this situation will become intolerable very quickly. Some adult children have been raised by violent, aggressive parents who are now violent aggressive elders. Children who have been raised under these conditions need not feel obligated to bring their parents to live with them, despite the pressure they may get from outsiders who do not know the real story.

Elders and their families who are trying to make difficult choices about elder care benefit from a professional assessment from a geriatric specialist. Professional care managers can offer an objective opinion based on a clinical evaluation of the physical and cognitive status of the elder. Physicians, hospital case managers, facility admissions coordinators and social workers can also offer advice about appropriate placement of an elder or even suggest how to set up services in the home to best meet the elder’s needs.

Home Health Care – Stay Home without Being Alone

At the very least, any elder living alone should have a medical alert system. This is a necklace or wrist band with a panic button that can be pushed in case of emergency. If the button is pushed a dispatch center receives the signal and makes and attempt to communicate with the elder through a speaker placed in the home. If the elder needs help or does not respond to attempts to communicate, emergency services will be dispatched to the home. Many services will also contact friends and family to notify them that assistance is needed. A good candidate for this device is one WHO DOES NOT have memory loss as memory loss makes it difficult to learn to operate new appliances.

There are two basic types of home health care services: Medicare and Private Duty:

Medicare Home Health is free but can only be accessed if ordered a physician. Medicare will only authorize the free home health services if specific events have happened such as a recent hospitalization lasting three or more days, or a recent change in health status, etc. Medicare will send a Registered Nurse to evaluate the elder and that nurse decides if other professionals such as physical therapists, social workers, dieticians, etc. should perform evaluations. Each professional will determine what services they will render and for how long. Medicare services are temporary in nature and are not offered on a full time basis. The average visit by the nurse, aide and therapist is less than one hour each. Even Medicare home health aides only stay long enough to bathe and dress the patient.

Private Duty Home Health can be arranged on a full time, part time or live- in basis. Many Long Term Care Insurance policies will pay for home health care. The amount of care one can get and the duration of the services varies depending upon which policy they purchased. If someone does not have insurance, they must pay out of pocket (or private pay) for any services. Typically a private home care agency will offer services at a minimum of four hours per day. Typical eight hour shifts are 7am-3pm, 3pm-11pm and 11pm – 7am. Many elders complain that an agency sends them a different caregiver each day. In order to avoid having the same aide, that as much as possible, order care every day for at least eight hours. This will allow the agency to schedule the same person for all your shifts. Because labor laws do apply and the agency would have to pay overtime for time which exceeds 40 hours per week, you will most likely have at least two to three caregivers on a full time case. The average hourly rate is $14.00 per hour. A live-in will cost about $150.00 per day. A live-in lives in your home and drives your car (or theirs for a mileage fee) and you are expected to feed them as well, even if you go out to dinner. By law, a live- in is entitled to two hours per day of free time. They can do what ever they like, including leaving the house during their break. If this arrangement will not work for your situation, consider hiring an aide around the clock. Around the clock care is typically delivered in two twelve hour shifts which are done by two different caregivers.

One aide comes to the home from 8am until 8pm and is relieved by the second caregiver at 8pm until 8am. Around the clock care can be delivered in many schedule formats. A live- in is expected to have their own private bedroom and bathroom although many agencies are flexible on this issue. The live- in is expected to be awake all day and have at least 7 hours of sleep at night. If the elder does not sleep at night, a live- in arrangement will not work. One option is to have the live in ($150/day) plus hire a caregiver to come to the house and stay up all night with the elder ($14.00. hour for eight nighttime hours). This costs $112 + $150= $262.00 per day. The only other alternative is to have around- the- clock care which will cost $14.00/hr X 24 hr=$336/day. Adding the eight hour night shift to the live in, saves about $3,000 per month. The Veterans Aid and Attendance Pension is available to qualified veterans who need a caregiver in their home on a regular basis.

Types of Adult Housing and Facilities:

Independent Living Facilities usually offer small apartments with some meals included in the price. A person who lives in an Independent Living Facility is expected to manage their daily care needs on their own, but the staff would readily recognize if needs increased and assist the resident in obtaining the needed help. Some facilities have extra care services available for additional charge to help the resident “age in place.” Others may ask a resident to move out if their needs exceed the scope of that particular facility. Limited transportation is usually provided although many residents are still driving when they enter an Independent Living Facility. These facilities may cost anywhere from less than $1,000 per month to over $5,000 per month depending upon the luxury amenities and location.

Assisted Living Facilities usually offer hotel size rooms with the option to share a room or pay extra for a private room. Three meals and snacks are usually provided as part of the price. Residents are expected to need some assistance with their daily care needs. Medication administration is strictly supervised. The State laws dictate who can live in an Assisted Living. The State does not want Assisted Living facilities to house nursing home candidates or Nursing Homes to admit people who could function just as well in an Assisted Living Facility. Assisted Living residents must be able to walk and transfer ( from bed to chair or chair to standing) with the assistance of only one other person. An Assisted Living resident can be left alone in their room for two hours or more. Nurses aides are on duty around the clock. Registered nurses or Licensed Practical Nurses are on duty at least during the daytime. Many medical services may make rounds and visit residents at least monthly. It is not uncommon for an Assisted Living resident to never have to leave the building for a medical or beauty appointment. Prices may range from under $1200/month to over $8,000/ month, once again depending upon the amenities. Medicaid has a program called the Medicaid Waiver which can pay part of the cost of the Assisted Living. However, funds have been historically limited and waiting lists can be long. The Veteran Aide and Attendance Pension is designed to financially assist qualified veterans who need the services of an Assisted Living facility

Dementia Specific Facilities are designed especially for the memory impaired resident. The building, floorplan, furnishings, décor, activity program and even the lighting have been scientifically engineered to enhance the lifestyle of residents with dementia. Many Assisted Living Facilities and Nursing Homes offer a dementia program or dementia unit, but there are entire facilities which specialize in this unique population. Dementia Specific Facilities can be either Assisted Living Facilities or Nursing Homes. They are secure in order to prevent residents from wandering off the property and getting hurt or lost. The price for this extra level of care is usually about $1,000 to $2,000 more per month than a non-specialty building.

Nursing Homes are State regulated and are inspected at least annually. A person who needs a nursing home generally cannot live safely in an Assisted Living environment. A typical resident is either wheelchair bound or bed bound. Those who can walk around freely may need the nursing home environment because they need constant medical supervision. The medical component of this environment is similar to a hospital or hospice setting. The emphasis is on rehabilitation or custodial care rather than socialization and activities. The ICP Medicaid Program (institutional care program) will pay for the room, board and medical costs of those residents who meet the financial and medical criteria. It is possible to plan in advance to help an elder meet these strict criterion.

Financial Realities

Keeping an elder at home with a caregiver can be the most expensive option of all. Many families feel keeping their loved one in the comfort of their own home is priceless. If a paid caregiver cost $14.00/hour, eight hours per day is equal to $2,880.00 per month. Around the clock care exceeds $10,000 per month. Independent Living Facilities cost an average of $2,300.00/ month and provide no personal assistance. Assisted Living Facilities range from about $2,500/month to $5,000/month and provide limited care. A Nursing Home (without ICP Medicaid assistance) can cost from 5,000.00 to $7,000.00 per month and will provide total care.

Anyone considering hiring home health or moving an elder into a care facility of any type should have their elder’s current needs assessed by a qualified professional who can ascertain the elder’s current medical/psychological and financial needs and anticipate future needs/solutions. With careful, realistic planning, caring for an elder does not have to be a financial or emotional nightmare. Making the right choices for you and the elder you care about is easier when you enlist the help of people who know the eldercare community and all that it has to offer.

Healthy Aging: What role does socialization play?

Educating care providers and informing families currently caring for loved ones is one way Always Best Care Senior Services is insuring homebound seniors are receiving the quality care they deserve.  With this in mind, Ryan Engar, a Licensed Clinical Social Worker for Always Best Care, teamed up with Fran Wilby, PhD, Assistant Professor, Executive Director of the W.D. Goodwill Initiatives on Aging and O. William Farley PhD, Professor at the College of Social Work University of Utah to write an article and training guideline for Always Best Care Senior Services care providers and family members on the importance of socialization.

 

The aging population, nationally and worldwide, is at the forefront of people’s thoughts today.  Developed nations worldwide are experiencing an “aging boom” as people are living longer.  Nationally, estimates are that the number of people aged 65+ will grow to 80 million by the year 2050 with the fastest growing group being those aged 85+ ( U.S. Census Bureau, 2004).

 

With increased longevity comes increased number of years in retirement.  As the demographics of our nation shift, family members caring for their aging loved ones will no longer be enough help to adequately care for our senior population.  More and more families will begin to invite caring professionals into their homes for assistance.  It is for this reason Always Best Care Senior Services exists.   For the past 14 years Always Best Care has been welcomed in many homes in effort to improve not only the quality of life of the individual receiving the care, but the quality of life of the family members as well.  By the year 2040, people who live until 65 years old can expect to live an additional 15 to 20 years—thus spending 21% to 23% of their total life span in retirement (Smeeding, 2010).  If these numbers seem astounding—it is even more astounding to wonder what people will do with this time.

 

With retirement comes withdrawal from normal work cycles and work relationships.   Although many older adults handle the transition from work to retirement well, others experience emotional difficulties during this phase of life.  The loss of contact with close colleagues and the loss of a sense of purpose in life can lead to increased social isolation and bouts of depression.   Additionally the burden of chronic disease can make normal routines difficult and strain financial resources.  So what roles does socialization play in maintaining health and wellness through retirement and beyond?

 

Socialization plays a large role in maintaining quality of life as one ages.  Research has shown that those older adults, who have strong social networks, seem to have a higher quality of life, live longer and are healthier compared to those with little social support (Glass, Mendes de Leon, Marottolie & Berkman, 1999).  Also, studies have shown that strong social support seems to protect against cognitive decline and self-reported disability (Mendes de Leon, Glass, & Berkman, 2003).  The “use-it or lose it” theory seems to be true—social engagement may stimulate multiple body systems including the cognitive, cardiovascular, and neuromuscular systems.

Social engagement also seems to be an active coping strategy as well as reinforcing life long patterns of connections to other people and resources (Barnas, Pollina, & Cummings, 1991).

 

Given the importance of socialization to healthy aging—what happens to those older adults who do not have strong social networks and social support?  Numerous factors can impact the social networks of older adults—smaller family sizes and mobility of family members—leaves many older adults isolated from family help and resources.  Those older adults who live past 80 years old find that many of their friends and in some cases family members have passed away—leaving them more isolated and alone.  Chronic disease can affect an older person’s ability to leave the home to engage in social activities.  Limited transportation options for those who no longer drive can leave them isolated in their homes. It is in these cases where the many services that Always Best Care  provide mesh perfectly to provide not only vital assistance to maintain their clients health and safety, but also addressing problems caused by isolation.  Always Best Care provides an opportunity for friends and family to reunite through transportation as well as an opportunity to socialize and form meaningful relationships with people who genuinely care for them within the walls of their own home.

 

As a society we are poorly equipped to deliver help to older adults who are isolated in their homes.  The creation of community based programs is a dire need now and will become more essential as the aging population strains social programs.  One such program, developed at the University Of Utah College Of Social Work by Wilford Goodwill and O. William Farley, is the Neighbors Helping Neighbors program (NHN).  NHN is a non-profit organization whose mission is to improve the health, safety and quality of life for community-dwelling seniors through the promotion and maintenance of independent living.  NHN strives to enable older adults to reside in the community for as long as possible while training social work students and community volunteers.

 

In Utah, as well as in many other communities throughout the nation, caring individuals have responded to our aging population’s cry for help.  In many cases it only takes a little help from an outside source to keep an older adult at home whether that outside source is a family member or a care provider from one of the many home-care agencies created to address such needs.  In the growing number of cases where family member’s responsibilities pull them away from hands-on service to their loved ones, agencies such as Always Best Care are able to customize the amount of involvement they have in an individual’s life in effort to maintain their quality of life.  Remaining within the home where memories were formed, with a little assistance from a care provider, enables an older adult to remain in the community with dignity and without suffering from the consequences of social isolation.  It is up to our society to step-up and create the kind of services that will enable older adults to remain in their homes, without isolation, if that is what they chose.

 

 

 

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