Florida Elder Law Blog - ElderLawAssociates.com

Nursing home coverage for veterans is available from two sources within the Department of Veterans Affairs -- the veterans health care system and the state veterans homes system. As always, if you are making elder care plans for a veteran, consult with a Florida elder law attorney.

Nursing Home Coverage through the VA Health Care System
Nursing home coverage along with other long term care services such as home care and assisted living as well as geriatric care management are available through the Veterans Health Administration for qualifying veterans.

In order to get into the veterans health care program, the veteran must have service-connected disabilities, or be below a qualifying income level or be receiving Veterans Pension income. Once in the system, veterans are not guaranteed long term care services, including nursing home care, unless they meet specific requirements. Here is a list of these requirements for nursing home coverage.

Who is Eligible for Nursing Home Care

• Any veteran who has a service-connected disability rating of 70 percent or more;
• A veteran who is rated 60 percent service-connected and is unemployable or has an official rating of "permanent and total disabled;"
• A veteran with combined disability ratings of 70 percent or more;
• A veteran whose service-connected disability is clinically determined to require nursing home care;
• Nonservice-connected veterans and those officially referred to as "zero percent, noncompensable, service-connected" veterans who require nursing home care for any nonservice-connected disability and who meet income and asset criteria; or
• If space and resources are available, other veterans on a case-by-case basis with priority given to service-connected veterans and those who need care for post-acute rehabilitation, respite, hospice, geriatric evaluation and management, or spinal cord injury.

VA's nursing home health system programs include VA-operated nursing home care units and contract community nursing homes. Many VA hospitals operate nursing home care units located in or near the hospital. Other hospitals, without adequate nursing home beds, contract with approximately 2,500 community private nursing homes nationwide to provide services.

State Veterans Homes
State veterans homes fill an important need for veterans with low income and veterans who desire to spend their last years with "comrades" from former active-duty. The predominant service offered is nursing home care. VA nursing homes must be licensed for their particular state and conform with skilled or intermediate nursing services offered in private sector nursing homes in that state. State homes may also offer assisted living or domiciliary care which is a form of supported independent living.

Every state has at least one veterans home and some states like Oklahoma have a number of them. There is great demand for the services of these homes, but lack of federal and state funding has created a backlog of well over 130 homes that are waiting to be built.

Unlike private sector nursing homes where the family can walk in the front door and possibly that same day make arrangements for a bed for their loved one, state veterans homes have an application process that could take a number of weeks or months. Many state homes have waiting lists especially for their Alzheimer's long term care units.

No facilities are entirely free to any veteran with an income. The veteran must pay his or her share of the cost. In some states the veterans contribution rates are set at a certain level and if there's not enough income the family may have to make up the difference. Federal legislation, effective 2007, also allows the federal government to substantially subsidize the cost of veterans with service-connected disabilities in state veterans homes.

State Veterans Homes Per Diem Program
The Veterans Administration pays the state veterans homes an annually adjusted rate per day for each veteran in the home. This is called the per diem. The 2008 nursing per diem amount is $74.42 and for domiciliary care it is $34.40. Adult Day Health Care – up to one-half of the cost of care -- cannot exceed $66.82 per day. The goal of state veterans homes is to get Congress to increase the per diem rate for nursing care to 75% of the state private nursing rates. In most states the per diem falls well short of this goal.

The per diem program and construction subsidies mean that State veterans homes can charge less money for their services than private facilities. Some states have a set rate, as an example $1,400 a month, and they may also be relying on qualified veterans receiving the Pension benefit with aid and attendance plus the per diem to cover their actual costs. Other states may charge a percentage of the veteran's income but be relying on other subsidies to cover the rest of the cost. Some state homes can receive Medicaid support as well.

Most of the states with income-determined rates are selective about the veterans they accept. These states may rely on a variety of private and public sources to help fund the cost of care.

Eligibility and Application Requirements for State Veterans Homes
From state to state, facilities vary in their rules for eligible veterans. And even in the same state it is common, where there is more than one state home, for some homes to have very stringent eligibility rules and others to be more lenient. These differing rules are probably based on the demand for care and the available beds in that particular geographic area.

Some homes require the veteran to be totally disabled and unable to earn an income. Some evaluate on the basis of medical need or age. Some evaluate entirely on income -- meaning applicants above a certain level will not be accepted. Some accept only former active-duty veterans, while others accept all who were in the military whether active duty or reserve. Still others accept only veterans who served during a period of war. Some homes accept the spouses or surviving spouses of veterans and some will accept the parents of veterans but restrict that to the parents of veterans who died while in service (Goldstar parents).

Federal regulations allow that 25% of the bed occupants at any one time may be veteran-related family members, i.e., spouses, surviving spouses, and/or gold star parents who are not entitled to payment of VA aid. When a State Home accepts grant assistance for a construction project, 75% of the bed occupants at the facility must be veterans.

Domicile residency requirements vary from state to state. The most stringent seems to be a three-year prior residency in the state whereas other homes may only require 90 days of residency.

All states require an application process to get into a home. Typically a committee or board will approve or disapprove each application. Many states have waiting lists for available beds.

Labels: elder care, Florida Elder Law Attorney

The appliance market is responding to the demands of boomers who want appliances that help them cope with the aches, pains and other infirmities they confront as they grow older, reports an article in the Wall Street Journal.

Some examples of the "senior-friendly" features for washing machines include pedestals that raise the height of the machine for easier access, large knobs that make a louder-than-usual noise when they're set, and musical chimes to indicate washing temperature.


Click here to read the entire article.

Labels: elder care

If you are a primary caregiver for a loved one, you are well aware of the daily stress and emotional and physical impact it can have on your health. As Florida elder law attorneys, we see this every day, as our clients come into our office.

Susan learned this first hand when she and her husband, Tom, brought his Mom home to live with them. Mom suffered from dementia and had to be watched constantly. Susan found that when you become a caregiver, you start by giving up a few things you usually do for yourself to make up for the time needed for caregiving. Even though your service is one of love and you are willing to do the sacrifice on behalf of your loved one, you find yourself giving up a lot more as time goes on.

“As a caregiver,” Susan laments, “You are often frustrated that you can’t do enough for your loved one and so guilt and feelings of inadequacy set in. Couple that with feelings of being unduly burdened, of resentment, of stress and then of more guilt at having those feelings."

She continues, "Now don’t get me wrong, I am very glad that I spent those years in caregiving. There were many cherished moments with Mom that only I experienced.”

In order to enjoy those moments and sustain your caregiving momentum, a little respite is essential.

An article posted on About.com by Carrie Hill, PhD states:

“Caregivers who use respite care often tell me that although caregiving is one of the hardest jobs they've ever had, they wouldn't trade the experience for anything. Helping a family member or close friend who has Alzheimer's disease can provide a sense of purpose and great satisfaction. Still, the emotional and physical demands of caregiving make it hard to be a caregiver 24 hours a day, 7 days a week. Without respite care -- a temporary break from the demands of caregiving -- you may be more susceptible to the effects of caregiver stress, such as depression, exhaustion and other health problems.

Carrie Hill, PhD, About.com “Why Caregivers Need Respite CareGiving Yourself a Break Helps You and Your Loved One” Updated: August 3, 2008

Be on the lookout for caregiver burnout. It can creep up on you without your noticing it. Caregiver burnout symptoms can include:

• depression
• anxiety, irritability, or anger
• feelings of exhaustion
• self-criticism
• Withdrawal from usual activities
• trouble with handling caregiving responsibilities
• substance abuse

The need for support for caregivers at home has received national recognition. State Human Resource Departments and Area Agency on Aging Services are offering more counseling and respite services for caregivers. The ARCH National Respite Services is also an organization that is reaching out to educate and support caregivers in many states. There is, however, one service that is highly valuable but very underused:

Adult Day Care to the Rescue!

Adult Day Care respite is two-fold. It gives the caregivers much needed time to themselves and gives their loved ones social and interactive therapy with their peers.

Many adult day services offer such things as:

• Social activities; music, movies, crafts, excursions
• Meals
• Fellowship support
• Assistance with daily living
• Nursing care
• Help with activities of daily living
• Medications
• Physical therapy
• Transportation

Finding an Adult Day Services provider takes a little investigating on your part. It is important to know what you are getting and that your loved one is comfortable with his or her new surroundings.

First: Ask for recommendations.

Check with your local Senior Center, Area Agency on Aging Services, Mental Health Centers, Doctor, Clinic, Family, Friends and neighbors. The best recommendation is by someone who has used the adult day services or is familiar with those who run it.

Second: Call and ask the facility to send you information.

Ask specifically to be sent the application, eligibility requirements and payment information.

Ask to see the calendar of activities, menus, hours and days of operation are needed to be sure to fit your schedule.

Ask about availability of transportation to and from the location and what is the cost.

Ask who runs the facility. Is it private, non-profit or a franchise or part of an assisted living facility or a nursing home?

Third: Visit the Adult Day Care facility.

Go visit the provider location along with the person you are caring for.

See if the staff is friendly.

Check that it is clean and odor free.

Ask about the experience of the staff.

Request a list of references.

Fourth: Find out the cost and payment requirements.

A survey from NCOA/NADSA provides the following information on fees:

“Fees for Adult Day Care providers range from $25 per day to $70 per day, with the average around $50 per day. Many facilities provide services with a sliding fee scale.”

One last word of advice. Don’t feel guilty about taking your loved one to adult day care.

Susan’s mother-in-law complained bitterly about leaving home and going to the adult day care facility, expounding on how Susan just didn’t want her around anymore. This only increased the guilt Susan was already feeling, but Susan was also determined that she needed the respite time the day care would provide and they pressed forward. That evening as Susan picked up Mom and helped her into the car, Mom -- who suffered from dementia -- exclaimed, “That was the nicest resort I have ever been to!”

To learn more about the AOA National Caregiver Support Program go to:

http://www.aoa.gov/prof/aoaprog/caregiver/caregiver.aspx

Labels: elder care, Florida Elder Law Attorney

Plan and consider before you jump.

Bringing a stranger into an elder's home is a big step and thought and consideration will go a long way in helping this big change be a success. First and foremost the elder needs to be involved as much as possible. How would you like having someone else arrange to bring a stranger into your home?

Start by making a list of which areas the elder needs help, such as cleaning and meal preparation, personal care like bathing and toileting or medical attention for medications, therapy, skin care, etc. A different type of aide is needed for the different levels of care. Will they need to drive and if so will the aide need to have her own car?

Next, how much help is needed, 4 hours twice a week, every day all day, or day and night? If someone needs to be on hand for 24 hours, will they be able to sleep through the night or must someone be alert at all times. This will determine whether you can have a live-in or if you will need shifts. A live-in is much less costly than shifts and helps to maintain a more stable situation.

Also critically important is the need to define a compatible personality that will interact well with your elder. Will the aide need to be able to keep control and be assertive, need to be tolerant of mood swings, need to play cards, or discuss current events, etc? With the needs defined you are now ready to start your search.

There are some community resources available for home care which may meet your needs. You can call the Eldercare Locator at (800) 677-1116 to learn what public agencies are in your area and how to contact them. However, most of these agencies are stretched to the breaking point and often will be unable to provide you with the level of care required, if they can provide any care at all.

Most areas have multiple private home health agencies available which you can find online, in the phone book and by asking for referrals. It is possible to save money by hiring someone directly, but if you have not had experience doing that, the choice can be fraught with obstacles such as medical screening, criminal background checks, payroll tax issues and more which you will have to handle yourself. You definitely do not want to have someone come into the house without the medical and background checks being made. If you do not have that experience, I strongly recommend you use an agency. Contact two or more different companies so that you will get more than one input about pricing, the amount of care needed, what type of aide, Home Health Aide (HHA), Certified Nursing Assistant (CNA), License Practical Nurse (LPN), etc. is required. Have them provide you a copy of their agency license, and referrals which you should call.

Determine whether the same person or persons will be providing the care. A revolving door of different aides is a prescription for problems. If it is a live-in will they really be there every day, or do they have obligations to a family and home. You may need two live-ins so they will they both be able to maintain a consistent schedule. If they will be driving get a copy of their driver's license and if they will be using the elder's car, make sure the insurance will cover them. Interviewing aides from more than one agency will give a wider choice of candidates. The first person you hire, or even the second or third person may not be the right one. Don't get discouraged, the right match is out there. Do not settle for someone that does not meet all your expectations.

It is also critical that you provide adequate supervision during the start of the process. If you do not live near by, you should get the help of a friend or relative. If there is no one, give serious consideration to getting a Geriatric Care Manager to help, at least in the beginning. Be sure to also ask your elder's opinion about the aide, but only when the aide is not present.

If you are not using a Platinum LifeLedger you will need to collect and make a copy available for the aide and the agency of all the many things they will need to know

Bringing help into the home is big project and you will need to be prepared for these new, added responsibilities. Do the best you can - perfect is not going to happen.

Labels: elder care

Elder care includes resolving family conflicts, a situation as Florida elder law attorneys, we're unfortunately very familiar with.

"My daughter is insisting I move in with her," complains Martha. "She just wants to control my life and take away my freedom," she continues.

Jenny, Martha’s daughter worries that her mother keeps falling, and fears one day she will break her hip or hit her head.

"I’ll take my sister to court before I will let her get control of mom and my inheritance," exclaims Jim about Jenny’s desire to move her mother in with her.

It is amazing how quickly formerly cordial relationships between family members will sour when the family has to deal with care of elderly parents or inheritance at their death. Sometimes the consequence of dealing with the final years of elderly parents can break families apart and create long-lasting animosity.

The National Care Planning Council has seen an increase in requests from caregiving children for help in solving disputes with siblings. In one case, the caregiver was being sued by her sister for abusing their parent and stealing the Social Security checks. In another, the caregiving child would not allow siblings to see their mother, claiming they would take advantage of her.

A lot of times it is a “she said,” “he said” situation with neither party really understanding what the elder person needs or wants.

Some families find it hard to communicate with each other when their parent is in need of care. Perhaps when they grew up together they were not accustomed to come together as parents and children to work out problems. And now those children are older and taking care of parents and they don't have this family council strategy to rely on. It may seem unnatural to them. But that is often exactly what is needed, especially in situations where perhaps one child is caring for the parents and the others are left out of the loop.

Children all have a common bond to their parents and as a result a common obligation or responsibility to each other. When disagreements arise, suspicions begin to grow. Suspicions or distrust often lead to anger and the anger often leads to severing the channels of communication between family members. This can occur between parent and child or between siblings or between all of them.

It is often at this point that a neutral third party can come in and repair the damage that has been done and help correct the problems that have come about because of the disagreement.

A practitioner experienced in elder mediation is a perfect choice for solving disagreements due to issues with the elderly.

WHAT IS ELDER MEDIATION?

Mediation is a non-adversarial approach to solving disputes. Mediation is a process of bringing two or more disputing parties together and having them mutually negotiate a solution to their disagreement. The mediator is not a judge and does not render a decision but is there to make sure that communication flows freely between the disputing parties. Elder Mediators are trained in the art of negotiating resolutions between elderly parents and family members.

Mediation can achieve results that the family by itself may not be capable of realizing or have the expertise of achieving. Here are some reasons that make Elder Mediation so valuable.

• A trained expert on communication gives the family a perspective it could not gain by meeting together on its own;
• All family members involved meet and prevent problems from arising by anticipating situations that may cause disputes;
• Allows for the mediator to invite experts such as care managers or other care providers into the meeting to educate the family and give them a new perspective;
• Allows parents to focus on their abilities rather than their limitations;
• Allows children to come up with and consider options not thought of previously;
• Encourages uninvolved family members to become involved;
• Allows parents to express wishes and desires that had previously gone unuttered;
• Allows for a neutral third party to challenge family members and make them take responsibility for their actions;
• Promotes consensus of all involved which in turn creates a much higher rate of compliance with the plan than with any other process; (the success rate for compliance with elder mediation is estimated to be about 80% to 85%)
• Requires a written plan with specific responsibilities which makes compliance feasible.

There are many organizations and companies throughout the country providing expertise in "Elder Mediation" to help seniors and their families. You will also find that mediators often have many coincident professional accreditations such as, Professional or Geriatric Care Manager, Elder Attorney, Clinical Social Worker or Certified Mediator.

In choosing a mediator, consider your needs. Is there a need for a medical assessment to determine the type of care? Are legal concerns with inheritance or family business or power of attorney, the main need? Perhaps, just bringing the family together to communicate on what needs to be done and who will do it is the agenda for now.

In one case, after months of dispute with her parents over their health and safety issues, Connie enlisted the service of a professional care manager mediator.

“Bringing a neutral person with a professional and compassionate attitude into our disputes was the best thing for all involved,” Connie recalled. “My parents shared their concerns and listened with acceptance to mine. All of a sudden we could communicate and work out a plan that they could live with and I could relax knowing they were safe.”

Seniors Use Mediators to help the family plan for long term care.

In the National Care Planning Council's book, “The 4 Steps of Long Term Care Planning,” the process of creating your own “Care Plan” before you need it is introduced. Quoting from the book:

“If the current or future caregiver wants the other persons attending the meeting to give support with respite care, transportation to doctors, etc., everyone needs to be aware of this and in total agreement to do it. All must also be willing to work with the member of the family, friend or professional who is designated as the Personal Care Coordinator.

If you feel the communication will be strained, consider having a professional mediator present. The mediator will be able to keep things calm and running smoothly
and help work out each person's concerns.”

“The 4 Steps of Long Term Care Planning” book can be found at http://www.longtermcarelink.net/a16four_steps_book.htm

Where to Find an Elder Mediator

• In your local phone book, on the internet or with your community senior services.
• References from friends and neighbors
• Contact the local area agency on aging
• Contact your state bar association
• Contact a local university or college and asked to speak to the department that provides mediation training and ask for a referral.
• On the internet look up mediation in your area
• Yellow pages in local phone books

Labels: elder care, Florida Elder Law Attorney

Eight Unselfish Ways to Put Yourself First

1. Eat a well-balanced diet
When you’re stressed out, you may tend to overeat. When you’re exhausted, it’s easy to resort to whatever is handy; quick snack foods, tea and toast, cheese doodles and soda. You need high quality food to perform well.

2. Get regular exercise
Exercise is the original “feel good” tonic. It helps you sleep better and wake up refreshed and ready to face another arduous day. Regular exercise improves both your mental and physical well-being, keeping your mind alert and body fine-tuned and energetic.

3. Get enough rest
This may be easier said than done, especially if you’re caring for someone who tends to wander at night. Still, most people need six to eight hours of sleep a night to maintain good health. Catch up with cat naps if necessary, early in the day.

4. Look after your own health
When you’re preoccupied with someone else’s health, it’s all too easy to neglect your own. Caregiving can be physically and emotionally exhausting, leaving you at risk for serious illness.

5. Get organized
It is very important to get an early diagnosis of your loved one’s illness, and then learn everything you can about it. That way you’ll know what to expect, and you can plan for it. (It also pays to have your legal plans well mapped out. Consult a Florida elder law attorney to do just that.)

6. Plan for emergencies
Who will take over if you do get sick? How will you cope if your loved one has a medical emergency? Be prepared. Keep a file or notebook with names and phone numbers of people you might need. In a crisis, you’ll be less likely to panic if you’re organized down to the last detail.

7. Take time out for yourself
Whether you’re caring for a parent, spouse, or other relative or friend, you need time for yourself. You need outside interests, other people, and a way to escape from the constant pressure of caregiving. You need to get away from time to time. Keep up your friendships. It’s easy to let friendships lag when you have “more important” things to do. But friends can get you through some tough times, just by being there.

8. Consider joining a support group
If you feel alone and isolated in your role as caregiver, talk to other caregivers. They’ll know what you’re up against; they’ll understand where you’re coming from. Think of it as therapeutic socializing — while you’re not actually escaping from your role as caregiver.

From the Saskatchewan Health Wellness and Health Promotion Promotions Branch
3475 Albert Street
Regina, Saskatchewan, S48 6X6

Labels: elder care, Florida Elder Law Attorney

A 2008 study by the Harvard School of Public Health found evidence that seniors in the United States with active social lives may have slower rates of memory decline and lower mortality rates. In fact, memory decline among the most integrated of the study subjects was less than half the rate among the least integrated (findings were independent of age, gender, race and health status).

Click here to read the entire article.

Of course, it's always prudent to make sure that elder care documents are in order. Please consult a Florida elder law attorney to make sure your loved ones are taken care of.

-- Ellen Morris, JD

Labels: elder care, Florida Elder Law Attorney

The holiday season is quickly coming upon us. If you are a caregiver for an elderly loved one, you may notice a change in your loved one's mood as the holidays approach. Perhaps you are one of many, who visit elderly parents and family during the holidays who live a distance away. When you visit you may notice that loved ones are not as physically active, or they show symptoms of fatigue or sadness and have no interest in the holiday or in their surroundings.

According to the National Institutes of Health; of the 35 million Americans age 65 or older, about 2 million suffer from full-blown depression. Another 5 million suffer from less severe forms of the illness. This represents about 20% of the senior population -- a significant proportion.

Depression in the elderly is difficult to diagnose and is frequently untreated. The symptoms may be confused with a medical illness, dementia, or malnutrition due to a poor diet. Many older people will not accept the idea that they have depression and refuse to seek treatment.

What causes depression in the elderly?
It is not the actual holiday that causes depression, but the fact that holidays tend to bring memories of earlier, perhaps happier times. Additional contributing factors that bring on depression may be the loss of a spouse or close friend, or a move from a home to assisted living, or a change with an older person's routine.

Depression may also be a sign of a medical problem. Chronic pain or complications of an illness or memory loss can also cause depression. In addition, diet can also be a factor when proper nutrition and vitamins are lacking.

As an example, Selma’s husband passed away, a few months before Christmas. Her family lived close by and would call or drop in often to check on her. Selma seemed a little preoccupied and tired, but this was to be expected as she had been the caregiver for her husband for many years. It wasn’t until the family noticed that her holiday decorations were not out and her yearly routine of Christmas card writing was not happening that they began questioning her mental and physical well being.

A trip to her physician confirmed depression, caused by not only the loss of her spouse, but a vitamin B12 deficiency. There were both mental and physical reasons for her depression.

Symptoms to look for in depression might include:

* Depressed or irritable mood
* Feelings of worthlessness or sadness
* Expressions of helplessness
* Anxiety
* Loss of interest in daily activities
* Loss of appetite
* Weight loss
* Lack of attending to personal care and hygiene
* Fatigue
* Difficulty concentrating
* Irresponsible behavior
* Obsessive thoughts about death
* Talk about suicide

How do you know if it is depression or dementia?
Depression and dementia share similar symptoms. A recent article on Helpguide.org gives some specific differences:

In depression there is a rapid mental decline, but memory of time, date and awareness of the environment remains. Motor skills are slow, but normal in depression. Concern with concentrating and worry about impaired memory may occur.

On the other hand, dementia symptoms reveal a slow mental decline with confusion and loss of recognizing familiar locations. Writing, speaking and motor skills are impaired and memory loss is not acknowledged as a being problem by the person suffering dementia.

Whether it is depression or dementia, prompt treatment is recommended. A physical exam will help determine if there is a medical cause for depression. A geriatric medical practitioner is skilled in diagnosing depression and illnesses in the elderly. If you are a care taker of an elderly person it may be beneficial for you to seek out a geriatric health care specialist. For more information on senior health services go to http://www.longtermcarelink.net/about_senior_health_services.htm

Treating depression in older people.
Once the cause of depression is identified, a treatment program can be implemented. Treatment may be as simple as relieving loneliness through visitations, outings and involvement in family activities. In more severe cases antidepressant drugs have been known to improve the quality of life in depressed elderly people. Cognitive therapy sessions with a counselor may also be effective.

As a care giver or family member of a depressed older person, make it your responsibility to get involved. The elder person generally denies any problems or may fear being mentally ill. You can make the difference in and remove the Holiday Blues from seniors suffering from depression.

The Geriatric Mental Health Foundation offers a “Depression Tool Kit.” To read more about the tool kit and depression in the elderly go to http://www.gmhfonline.org/gmhf/consumer/depression_toolkit.html

-- Ellen Morris, JD

Labels: elder care, Florida Elder Law Attorney

Eldercare providers and advisers who deal with the public know from experience that the need for long term care can often arise without warning. In many cases, desperate caregivers are frantically trying to find services, advice or care funding sources to help their loved ones with unexpected long term care needs. This sudden need for help often occurs when the loved one needing care has recently demonstrated unsafe behavior, or there has been an injury or sudden illness or there is a pending release from nursing home rehab or the current caregiver can no longer cope. Help must be found right now.

Unfortunately, many of these caregivers -- who are typically operating in crisis mode -- don't know where to turn for help. It's not that there aren't advisory services out there to help them, it's just that the caregivers often don't know where to find these services.

Government caregiver resource services such as area agencies on aging and related ADRC pilot programs typically reach out to caregivers through referrals from hospitals, discharge workers, doctors, home health agencies and nursing homes. Caregivers seeking help outside of this referral network generally aren't aware of government advisory services. In the private sector, help with caregiving issues is generally provided when a caregiver calls a specific agency, nonprofit organization or an advisor. There is no nationwide, private sector one-stop shopping source of help for all the types of care provider services that are available in the community.

The national care planning Council has discovered an answer to help desperate caregivers find the one-stop shop support they need. A 2004 study by the National Alliance for Caregiving and AARP estimates nearly six in ten (59%) caregivers are currently employed. Many of these working caregivers will use their Internet access at work to find the caregiving support they need.

The National Care Planning Council is in the process of developing websites in every state that contain the Internet resources employed caregivers are looking for. Currently, results from websites operating in 10 states indicate that harried caregivers will indeed search out these state care planning council websites for help. For example, one state website sponsored by the National Care Planning Council -- the Utah Eldercare Planning Council website, www.careUtah.com-- last year produced over 1,000 inquiries for help primarily from younger family caregivers. Additional requests for help were also received by Utah Eldercare Planning Council members through traditional outreach networking channels such as eldercare advisers, eldercare service providers, government agency referrals, associations, brochures and community presentations.

The National Care Planning Council is currently seeking qualified individuals to be Directors and oversee geographic service areas of state care planning councils. The Director's job is to coordinate local requests for help from the community and provide needed eldercare services. If you are a professional care provider or eldercare advisor please contact us about this opportunity to help the community and at the same time expand your services by becoming a Director of a Service Area. Or you may simply want to become a member of your local state care planning council.

-- Ellen S. Morris, JD

Labels: elder care, florida elder law

A large majority of the American public still believes that the government will provide long term care when needed. It is this misconception that most likely prevents people from doing any planning at a younger age for the future need for care. According to the National Care Planning Council, many people believe they can give away assets prior to the need for long term care and qualify for Medicaid. The Council suggests that this belief prevents people from considering other ways to fund the cost of future care.

As a matter of fact, it may be possible to use the system and allow Medicaid to cover care but at what cost? Why would anyone want to plan to spend his remaining years in a nursing home--which is the preferred living arrangement for Medicaid. Why go through the expense and effort of trying to manipulate the system to get welfare care, when a little preplanning at an earlier age would be a better option?

In our Florida elder law attorney practice we hear frequent objection to long term care planning from people who think Medicare or the Veterans Benefits Administration will take care of them. While this is true to a certain extent, these people simply don't understand the limitations of these government programs.

Below are quotes taken from individuals who, over the years, have voiced misconceptions about long term care planning.

"Uncle Jim got along just fine with the government paying his care"

"I can give away my assets and have the government pay for it"

"We have a trust and all of our assets will go to our family so the government will pay for our care"

"I'm not interested in home care or assisted living, just stick me in a nursing home and Medicaid will pay the bill"

"Long term care insurance is too expensive"

Government could be more involved in providing care but our constipated system of delivery prevents this from happening. The National Aging Network, a government-sponsored program, is in the best position to help people receive long term care in their homes. And studies have shown that the cost of providing this kind of care is significantly less than the cost of providing nursing home care through government programs.

Unfortunately, for every dollar that supports a person through the Aging Network the government spends about $270 supporting a person in a nursing home. Because it has inadequate funding, the National Aging Network must confine its valuable services to people who have little income or for social reasons are disadvantaged. Moderate and middle income Americans can receive some services from the network but are mostly excluded from the more valuable caregiving services.

We believe the public's misunderstanding of Government long term care programs is an impediment to proper long term care planning. When people understand the limitations of relying on government programs they are most likely to be more motivated to plan for the future by making provisions in advance and providing advance funding to pay for care. Prior planning also allows people to have a choice in their care setting and in the type of services they receive.

--Ellen Morris, JD & Howard Krooks, JD CELA

Labels: elder care, long term care, medicaid

I just read this great article on the bias of medical care providers toward the elderly and aging:

"In many cultures in the world, elderly people are revered and their advice is sought and respected. In our culture, the wisdom, the knowledge and the social skills of the elderly are often overlooked and instead we focus on the mental and physical deficits of our older generation....

"Because of this prevailing attitude, older people in our society are generally regarded as less valuable than younger people....It is inevitable that many medical care providers will unconsciously have this same attitude towards their older patients.

"As a result, if an older person has a medical complaint and the cause is not readily apparent, a medical practitioner is more likely to accept the condition as a consequence of old age. This attitude causes practitioners to focus treatment on making the elderly more comfortable in their old age as opposed to finding a cure. In younger people, if the medical complaint is interfering with normal daily function, typically a more concerted effort will be made to identify and correct the problem."

Click here to read the entire article.

-- Ellen S. Morris, JD

Labels: elder care

A change in the daily routine including an unfamiliar environment filled with new sights, odors and sounds, medications and tests, and the disease process itself can all be factors that increase confusion, anxiety and agitation in a hospitalized individual with Alzheimer's disease.

Alzheimer's Disease Education and Referral Center has published a booklet that will help you meet the needs of these individuals. Containing facts about Alzheimer's disease, communication tips, personal care techniques, suggestions for working with behaviors and environmental factors to consider in the ER and in the hospital room, this guide is a must have for any caregiver of a person with a memory disorder.

When hospitalization occurs, the best option for the individual with Alzheimer's disease is the constant presence of a family member or a trusted friend. Because this may not always be possible, this booklet hopes to prepare you for the unexpected and the expected.

To learn more about Acute Hospitalization and the Alzheimer's Patient, click here!

--Ellen S. Morris, Esq.

Labels: Alzheimer's, elder care

I just read an interesting article in The New York Times' Science Times, "Doctors Say Medication Is Overused In Dementia."

It reminds me of a Guardianship case I handled a few years ago. I represented a gentleman who had been assigned a guardian due to his apparent lack of ability to manage his own affairs. With further investigation, it was discovered that he had been prescribed an excessive amount of Haldol, one of the antipsychotic medications mentioned in the article.

When my client's medications were re-examined and his regiment changed, he became a different man, capable of taking care of himself and his affairs. If you have a loved one who appears to be suffering from dementia, scrutinize his or her prescriptions and dosages and have a doctor who is an independent party review the regiment for appropriateness. You, too, may be surprised.

--Howard S. Krooks, Esq.

Labels: Dementia, elder care, Guardianship

On May 28, I attended an Aging Policy Forum for aging network leaders conducted by The Florida Association of Aging Services Providers, through funding from the Florida Department of Elder Affairs. The purpose of the Forum was to identify key topics and share insights, expertise and experiences on emerging aging-related issues. Strategies for communication and collaboration on advocacy on behalf of older Floridians were also discussed.

The central theme of the session was for those involved in the senior community to become more active in grassroots lobbying for increased funding of programs for seniors and persons with disabilities.

Given the opportunity to address the group, I spoke about estate planning and Medicaid planning in regard to the serious lack of resources available to our clients and the almost desperate need to increase funding. Everyone in attendance agreed that the value of waiver programs which keep seniors at home or allow them to go to an interim facility is unparalleled. In comparison to a senior entering a nursing facility, waiver programs save everyone involved (the senior, the State, and the federal government) tremendous amounts of money while preserving the senior’s dignity. Hopefully the increased lobby efforts of leaders in the aging advocacy community will help achieve this most important and common sense goal.

- Ellen Morris, Esq.

Labels: elder care, medicaid