VA Disbursements have increased!​​​​​​​

Are you a War-Time Veteran or Widow of War Time Veteran?

There are Financial Benefits available for War Time Veteran and Widow of War Time Veteran to help defray the cost for senior placement Assisted Living Facilities, Board and Care Homes, and In-Home Care. There is a non-service connection pension cal Aid and Attendance Pension Plan. This was established in 1954 under Section 38 USC to assist qualified veterans and their surviving spouses.
 

And the amounts have just increased:
Current Maximum VA Monthly Benefit Amounts

Two Veterans/ Spouses: $2,903 per month / $34,837 annually

Married Veteran: $2,169 per month / $26,036 annually

Single Veterans: $1,830 per month / $21,962 annually

Widow: $1,176 per month / $14,113 annually
 

What are the qualification?

  • The Veteran Must:
    Be aged 65+ or Unemployable
  • Be Honorably Discharged having 90 days or more of active duty service with at least one of those days during a period of War. This does not mean they needed to be in War Country.
    Have Cost of Care that is 5% greater than their fixed income.
  • Eligible Veterans must show active duty service for a minimal 90 days during a time in which the US was involved during a declared conflict (from 1980 forward the veteran needs to serve 2 years active duty).
  • You must need assistance with activity of daily living (ADLs) (bathing, eating, dressing, hygiene, transferring, and medication management). Your doctor will provide a report that you need assistance with at least of two ADLs.

Advanced Wellness Geriatric Care Management and a VA Accredited Claim Agent is providing a service to the community for assistance to veterans and surviving widows of War Veterans. We provide a comprehensive seminar to educate families on this benefit. It’s a FREE Seminar. Click Here and register for the next one. This seminar will provide information on all public benefits. We will help with all the paperwork and current claim forms available from the Veterans (VA) Benefit Pension Program. We are available to assist you in filing a claim with the VA after you attend Family Training. THIS SERVICE IS FREE.

Find out more here:

Seminar: Family Training Workshop

Medical Tax Deductions

The deduction for qualified medical expenses has survived yet another round of tax reform.  The IRS will allow a tax payer to deduct expenses that exceed 7.5% of their adjusted gross income for 2017 and 2018.  Beginning in 2019, all taxpayers may deduct only the amount of the total unreimbursed allowable medical care expenses for the year that exceeds 10% of their adjusted gross income.

 

For example, if you have a modified adjusted gross income of $50,000 and $5,470 of medical expenses, you would multiply $50,000 by 0.075 (7.5 percent) to find that only the expenses exceeding $3,750 can be deducted. This leaves you with a medical expense deduction of $1,720 (5,470 – 3,750).

 

Many elders who have been ordered into a professional care environment such as assisted living, may have qualified care expenses of $30,000, $40,000 or more annually.  Often times, the elder relies on other parties such as their children to supplement their care expenses.  Regardless of the amount, “anyone” who is contributing to the direct care expenses of themselves or a loved one, should seek qualified tax services from an Enrolled Agent or CPA to determine if those expenses are deductible.  Considering the a mount of money and complexity of claiming these expenses, I do not recommend using on-line Internet Tax or Shopping Mall type tax preparation services.  Many of these face to face data collection persons are customer service agents with minimal, if any, actual tax training or credentials.  You have the right to claim these deductions – if it is done properly!

 

Also, for those who used an Irrevocable Trust to reposition assets, you should meet with an Enrolled Agent or CPA to discuss if you will be required to file a 1041 tax return.

 

One big tip for those receiving VA Aid and Attendance.  I would strongly recommend you file a 1040 and claim your care expenses – even if you are exempt from filing!  Remember, the VA is tasked with verifying your care expenses exceed your income annually.  By filing the 1040, it makes their job easy.  By not filing a 1040, make certain you keep a close eye for any correspondence from the VA.  If you fail to respond timely, they may terminate your monthly benefit!

 

-By Edward Cotney

Mistakes when Applying for Public Benefits

7 Biggest Mistakes when Applying for Public Benefits

When you are applying for public benefits you may be eager to get started, downtrodden with the process or fearful of the results. As you move through the process of the application it is so important that you understand the 7 Biggest Mistakes most people make when applying for public assistance or Government issues benefits. By making these big mistakes, the application results can be delayed, require more information or be denied all together.

 

Obviously, your goal is to get approved and start your benefits as soon as possible. However, don’t let your emotions, doubts or fear of a negative outcome, create a situation where you have a negative outcome. Here are the 7 Biggest Mistakes people make when applying to receive public benefits, including Medicaid, Medicare, Veteran or VA benefits or other government assigned assistance.

 

#1 Simple errors when trying to go to quickly through the application process is the first mistake made by a majority of applicants. Today, there are many ways to apply for benefits and the transition has been toward electronic filing. The entire action of filing for the age group of 50 and above has proven to be a hardship. When you begin your online application take time to read every question very carefully and if you do not know the answer, find someone to help you understand the question so you don’t go too fast and mess up on things such as income or health related questions.

 

#2 Fear of being denied the benefits you are requesting is the 2nd mistake many applicants make when applying for public benefits. It is an emotional issue when you are applying for help, and often the need for help is one that creates embarrassment and fear. The mere fear of being denied, is responsible for mistakes and errors in the application process. Before applying, check in with yourself to ensure that you are confident that you will be approved based on your true and authentic need.

 

#3 Misunderstanding income reporting requirements when you have received payments for miscellaneous reasons such as babysitting or caring for someone’s home. When you are applying for public benefits one of the questions you are asked is how much money you made. Be very honest when you claim the amount of money you earned even if it was a small amount from simple things. The more clear you are, the easier it will be for your claim to be reviewed.

 

#4 Do your homework when applying for SSI or Social Security benefits. If you are disabled, you have something preventing you from working. Before you apply, be sure to do your homework and learn about the options for you, your state’s requirements and the disability you believe is keeping you from working.

 

#5 Understanding VA benefits and SSI. Veterans often will believe if they are injured in war or in duty and become disabled, that they are only qualified for one benefit. However, the applications are separate and so are the benefits. So, if you are applying for benefits as a disabled Veteran then you may be also qualified to receive SSI for your disability.

 

#6 Not completing the application. While this sounds a bit enormous, many people who are applying for benefits for the first time, will start the process and not finish it. Whether you are filing paper forms or electronically, make sure that you have confirmation that the application process was complete.

 

#7 Finally, giving up after the first denial is a critical mistake most applicants for public benefits will fall into. Remember, there are appeal opportunities for you, if you believe you have been wrongly denied a public benefit so get with a professional consultant for legal guidance on the appeal process.

 

Copyright 2017 –  Helen Justice GCM – Elder Care Navigator and Advocate – Advanced Wellness GCM, Inc

 

Known by many as “The Elder Care Navigator”, Helen Justice is a Certified Geriatric Care Manager trained to assist elders and their families with the process of aging with dignity and grace.  Her knowledge and experience insures elders obtain quality care and transitional preparation for their future.  More important than the financial aspect of aging is the social and emotional component that elder care places on the family.  Go to www.advancedwellnessgcm.com for information on no fee seminar. 

Ten Steps to Moving into Assisted Living

Ten Steps to Moving into Assisted Living

Aging parents and grandparents begin to need constant care both physically and emotionally. Choosing to move your loved one into an assisted living facility is not easy at all, for you or your loved one. However, the move can be easier with these 10 steps to moving into an assisted living facility.

 

The first area that will need to be addressed is what items can be taking into the room where your loved one will be living. Followed by the visitation schedule, if any, and what situations trigger the need for a family member to be present. We are going to discuss a 10-Step checklist for moving your loved one away from their home and into an outside facility so you can feel good about your decision.

 

  1. Decide what to do with the current home and/or living space. The first thing you must decide when you are considering moving your loved one into an assisted living facility, is what to do with the current location. If, for example, your aging parent, grandparent or loved one, has been living in their own residence up until the time they will be moving out, you must decide who will stay in the home or of no one will stay in the home, but rather take care of the residence. Again, have this conversation as early as possible because this is a critical decision at this juncture. Ask your family member what they would like to see happen with the residence, if this is a dwelling such as a lifetime home. If they are moving out from an apartment, the issue is where to store the items that cannot be taken to the assisted living facility.
  2. Decide the move in strategy and discuss this with family members. Moving out from a home into a facility carries many possibilities of rejection by the loved one so a good idea in strategy #2 is to plan this move to be a fun day with lots of love and support. Discuss the plan with all family members who may be involved in support so the day happens with ease and dignity.
  3. Visit the facility at least 10 times before deciding which assisted living home will be the best for your loved one’s situation. If your loved one is still able to do physical activities, a facility with more outdoor options may be the best choice. However, if your loved one has a condition that will quickly degrade health, a facility near a hospital may be the best choice. Use your best judgement during your visits to the assisted living facility.
  4. Ensure that you have a good checklist of current medications and any medications your loved one may be allergic or sensitive to so the care givers will know this up front. Even if your loved one has an emotional tendency such as self-harm or acting out, inform the assisted living facility of this as well.
  5. Have all documentation ready in advance of enrolling your loved one into an assisted living facility. These documents include a living will, do not resuscitate directive and complete will. Your loved one most likely is going to this facility to complete his or her life cycle so this part is important.
  6. Ensure there is a clear list of phone numbers for the facility to call if there is an emergency, and the presence of a family member is needed. If you are putting phone numbers on this list ensure the family member is well aware that they may be contacted by the assisted living facility in case of an emergence. Remember to update this list with the facility administration if there are changes to the contact source.
  7. Move only the necessities at first. Although your loved one may be a pack rat and want to take everything, there often is simply not enough room for all of their desires so start off with the basics of home plus plenty of things to do such as crossword puzzle books, crocheting things and activity materials that will be there for your loved one.
  8. Spend quality time with your loved one before its time to move them into an assisted living facility. Go fun places and take vacations they may have dreamed of. This helps them feel loved, appreciated and secure in the move.
  9. Gather the family for a pre-death planning session. While this certainly is the hardest part of putting a family member into assisted living, it is a piece that must be discussed. Too many people pass away with confusion within the family.
  10. Finally, whatever you decide, know that you have taken the needed steps in doing the best thing for your loved one. Take some time to treat yourself good for being a decision maker and for doing what is needed and best for your loved one.

 

Home care, adult daycare and assisted living options are all decisions that require a lot of energy and love. Believe in yourself to make the right choices and know that your love – is what makes your loved one – feel loved.

 

Copyright 2017 –  Helen Justice GCM – Elder Care Navigator and Advocate – Advanced Wellness GCM, Inc

 

Known by many as “The Elder Care Navigator”, Helen Justice is a Certified Geriatric Care Manager trained to assist elders and their families with the process of aging with dignity and grace.  Her knowledge and experience insures elders obtain quality care and transitional preparation for their future.  More important than the financial aspect of aging is the social and emotional component that elder care places on the family.  Go to www.advancedwellnessgcm.com for information on no fee seminar. 

Adult Day Care

Adult Day Care as an Alternative to In-Home Care

When your mother, father or grandparent starts to age, he or she may develop mental or physical problems that prevent them from being left alone. Dementia is the leading cause of loss of cognitive function and leaves your aging family member vulnerable to harming themselves because of the loss of mental faculties. Some physical problems also prevent the person from getting around a lot and provide danger to them when left unattended.

 

Traditionally, In-Home care has been used to fulfill this need so the functioning member (child or grandchild) can leave the home to participate in their own life. Nurses would come in and sit; thus their title “sitter”. This method, although traditional, has been challenged as causing more damage to the person than good in some cases where their independence has been challenged. The emotional damage to the loved one, may outweigh the positive benefits of having someone watch over them.

 

Adult daycare is pretty new but seems to be becoming popular to families who want their mom, dad or grandparent (or disabled person) to have a full life for as long as possible. Adult daycare centers are much like daycare for children where they have fun activities, get exposure to nature and being outside, and have friendly and fun interaction with others in their same condition, whether that is handicapped, aging or injured for a time.

 

When deciding which option to choose for your family member you must use common since and decide which is best for your loved one based on many factors such as affordability, transportation and practicality.

 

Here is a short checklist to help you decide whether to hire someone to come to your home or their home, to sit with your loved one, or to enroll them in an Adult daycare program.

 

  1. Affordability – If cost is the problem, the first thing you should do is start to see if it is financially feasible for your loved one to be enrolled into a daycare as opposed to receiving home care. Insurance may cover a nurse to come in and sit with your loved one in their home or yours, and may not cover any cost of Adult daycare. If money is no issue, then you may want to strongly consider the daycare option but not without the next two items on this checklist.
  2. Reputation of Nearby Facilities – Elder abuse and abuse of the disabled is on the rise. Even an adult day care center may be staffed with inappropriate people who have tendencies toward anger or impatience. This is a critical area in deciding what type of care your aging parent, disabled child, injured grandparent or other loved one receives. While there is no one single way to project the type of person caring for your loved one is or will be at any time, simply asking questions that spark answers will cause you to feel one way or the other so don’t hesitate to ask.
  3. Opinion of your Loved One – Simply ask them their opinion, if they have the mental faculty to answer. Often dementia sufferers cannot give you a right answer, although their body language may provide an indication. When you are talking with them, rather than saying “adult daycare” say something like “Would you enjoy going to town and hanging out with some friends your age for the day?”, or “Can we go check out the adult daycare down the road and we will get some lunch?”. Remember inside, your loved one is still a human and is entitled to take part in their own care for as long as possible.

 

Making these decisions for someone you love is not easy. Deciding to choose adult daycare over in home care is an emotional decision and should be planned out properly so the experience is the best it can be in any given situation. Always have the talk.

 

Copyright 2017 –  Helen Justice GCM – Elder Care Navigator and Advocate – Advanced Wellness GCM, Inc

 

Known by many as “The Elder Care Navigator”, Helen Justice is a Certified Geriatric Care Manager trained to assist elders and their families with the process of aging with dignity and grace.  Her knowledge and experience insures elders obtain quality care and transitional preparation for their future.  More important than the financial aspect of aging is the social and emotional component that elder care places on the family.  Go to www.advancedwellnessgcm.com for information on no fee seminar. 

Safety Checklist

Safety and Fall Prevention Checklist

These 3 Simply Steps can Prevent Falls and Accidents

When your parents, yourself or a loved one begin to age, certain faculties cause a rise in the increase of falling. Research is clear that 1 in 3 Americans over the age of 65 will suffer a fall and injury as the result of the fall. Although there seems to be a social assumption that falling is going to happen, there are many ways to prevent falling in the first place.

 

As you, your parent or a loved one are aging, this is certainly a topic to be discussed. There are other conditions that increase the likelihood of tripping, falling and sustaining an injury that are unrelated to aging such as neuropathy of the feet from diabetes or other neurological conditions. No matter what the risk factor, there are things that you can do to prevent a fall and possible lifelong injury.

 

Some of the possible injuries that can occur after a fall and have sustainable implications include broken bones, head concussions and bruising of the inner organs. Broken hips seem to be the injury that has not only a physical impact because of the treatment and rehabilitation needed after the hip is broken, but also has an emotional affect as well. The emotional impact on breaking a hip on an aging man or woman is the feeling of not being able to take care of themselves and do the normal activities they used to do easily.

 

To mitigate physical and emotional damage from accidents related to tripping, slipping or falling, here is a short checklist of three ways you can keep the possibility of falling, at bay.

  1. Have the discussion with your family member about exercise and maintaining good health. Discuss with them the ways in which increasing exercise or adding supplementation can boost the bodies effort to not only stay physically fit but to keep their brain sharp in paying attention to objects around them. Brain health is a critical piece when preventing dangerous falls so having these talks frequently with your loved one will keep it fresh in their mind for as long as possible. If it is you who may be a fall risk, you can simply start to pay attention to the surroundings you encounter to have a self-talk about falling.
  2. Inside of the home of your aging parent or loved one, talk to them about moving furniture around in such a way that the path is clear to walk straight through from furniture to doors and appliances. If they are using a walker, ensure that their walker leg will not hit furniture causing them to trip. At restaurants, ensure that a walker is placed away from the table to avoid tripping by your loved one or other guests in the restaurant. Have the talk about focusing on where the walker is going at all times and about having a visual of the next stopping point in the walk.
  3. Finally, a good way to ensure falls are reduced or eliminated is to spend time with your loved one and use the time to connect and bond, knowing that you are there to support them in their livelihood by helping them get from point A to point B with a reduced likelihood of falling. This also gives your loved one a blessing as they are going to the store, to the doctor or just on an outing. Not only does your love and time help them reduce their risk of a fall, but it provides long-lasting happiness and joy for you both.

 

Remember that falling and tripping is a leading cause of emotional distress and physical damage to an aging person. Having the talk about the impacts of tripping can help and taking these three practical steps can also assist in keeping your family member or loved one safe as long as possible.

 

Copyright 2017 –  Helen Justice GCM – Elder Care Navigator and Advocate – Advanced Wellness GCM, Inc

 

Known by many as “The Elder Care Navigator”, Helen Justice is a Certified Geriatric Care Manager trained to assist elders and their families with the process of aging with dignity and grace.  Her knowledge and experience insures elders obtain quality care and transitional preparation for their future.  More important than the financial aspect of aging is the social and emotional component that elder care places on the family.  Go to www.advancedwellnessgcm.com for information on no fee seminar. 

Maintaining Emotional and Intellectual Well-Being

Each human being is a combination of body, mind, and spirit; we should be aware of how these parts interact. For example, people may have powerful emotional responses while facing the many challenges which life presents. Thus, some may often appear cheerful and optimistic while others are anxious and unhappy. In later years, we usually continue our basic moods, but the ways we express our feelings often become more obvious. Maintaining

Depression: Signs and Causes

In the midst of losses, such as physical changes, death of friends or loved ones and reduction of income, older people may begin showing signs of depression. Some things to look for are:

  • inability to concentrate or make decisions,
  • lack of feelings of enjoyment, or enthusiasm even for doing those things that were favorites,
  • little interest in eating (causing weight loss) or changes in eating habits (overeating causing weight gain),
  • lack of interest in being with other people, or loss of sex drive (libido),
  • feeling unwanted and worthless, sometimes leading to the thought that life is not worth living,
  • sadness or crying spells for no apparent reason,
  • problems with sleeping (sleeplessness during the night or excessive sleep during most of the day),
  • feeling tired most of the time, regardless of adequate rest.

 

If older people brood about their unhappiness, much of their energy is focused on worry. Part of that worry may relate to the fear that they will become forgetful and unable to manage their affairs. This worry can lead down the path to more depression, which may cause physical problems.

 

In exploring the cause of depression, the following questions should be asked:

  • Is there a physical or medical problem causing the depression?
  • Have there been changes in hearing, seeing, moving, or other body functions?
  • What social contact does the care-receiver have?
  • What are the opportunities for usefulness?
  • What kind of personal losses (death of friends, relatives, or pets) have there been?
  • Is the older person getting proper nutrition?
  • What kind of mental stimulation is the person getting?
  • Has there been a difficult adjustment following retirement?
  • Is the focus entirely on the past or is there some enthusiasm about coming events?
  • Is there a possibility of reaction to medications?
  • Is there a dependency on alcohol or drugs?

 

Once these questions have been answered, steps can be taken to relieve the depression. It will take some work from both the caregiver and the care-receiver to change habits and routines. Prolonged depression causes biochemical changes in the brain, usually requiring treatment with medication. The doctor is a good person the contact to find help for treatment of depression. Other resources are County Mental Health Centers, psychologists, counselors or clergy.

Suicide Prevention

Suicide among the elderly is a significant and ever increasing problem. Statistics show that 27 percent of all suicides in San Diego county (1985-87) were committed by people 60 years of age and older. Nationally, elderly (65+ years) made up 12.3 percent of 1987 population and committed 21.0 percent of suicides. Elderly complete one suicide every 1 hour and 21 minutes, or each day 17.7 seniors committed suicide.

Unlike other segments of the population, the elderly do not often make threats or mention suicidal thoughts to others. Therefore, it is important that caregivers also know other warning signs:

  • Depression – feelings of sadness, hopelessness, a sense of loss and statements as “Life isn’t worth living” are common before a suicide.
  • Chronic or terminal illness.
  • Withdrawal and isolation – suicidal people may pull away from family, friends and others close to them.
  • Behavior changes – sudden changes such as irritability, aggressiveness or changes in eating and sleeping habits can signal problems.
  • Making final arrangements – a suicidal person may give away valued possessions, making out a will, make a plan for suicide, or write a suicidal note in preparation. They may purchase weapons or stockpile medications.

 

Suicide can be prevented. If the person you care for shows any of the warning signs, you can:

  • Ask – don’t be afraid to ask directly if the person is thinking about suicide. It is not a taboo subject. You will not be putting ideas into the person’s head. It can be a relief to the suicidal person to talk openly about their feelings.
  • Listen – let the person express his/her feelings and concerns. Don’t worry about saying the right things – just listen.
  • Show you care – tell the person you care and want to help. Take active steps to make sure the person is safe; remove weapons, pills, etc., and stay with him/her.
  • Get help – make sure the suicidal person gets in contact with a professional counselor or other helpful person who will know what to do. Or have the suicidal person call (suicide prevention/crisis intervention Hotline in your community. Telephone numbers for such local resources should be at the front of your telephone directory.) A crisis counselor can help figure out the best way to handle the situation and give referrals to other resources.

 

Death and Dying Interventions Elderly terminally ill encounter anxiety and fear regarding death:

  • fear of the process of dying; will there be pain?
  • fear of losing control; will I be at another’s mercy?
  • fear of letting go; I can not leave family and friends to an uncertain future.
  • fear of seeing how others will avoid me.
  • fear of losing my caregiver; will he/she be turned off emotionally to me?
  • fear of the unknown after death.
  • fear that my “life’s script” has been meaningless, unfulfilled, a waste.

 

You may wish to ease these fears through an open discussion of these fears and intervening:

Regarding the death process, a “faith system” may be of great help; if you can get the person involved in his/her religious faith, the subject of death is well covered.

Regarding fear of letting go and isolation, assist then person to get his/her “house in order.” This entails a will, funeral arrangements, burial plot, etc. Also attempt to have the person and family involved discuss the situation.

Regarding meaninglessness of one’s life, have the person do a “Life Script,” whereby he/she writes all the good things done for others, all accomplishments, etc. Then discuss with the person that had he/she not been there to do what he/she did at that time, no one else would have, and society would have been the worse for it. So he/she did make a difference. Truly, no person is an island!

Promoting Emotional Well-being

It is important to help the elderly remain involved in decision-making as long as possible. You must stress that needing help with everyday activities does not mean that they cannot make decisions for themselves. Also, granting others the right to decide does not mean you are ignoring or abandoning them. Caregivers need to be sensitive to the right combination of giving just the right amount of assistance and no more.

 

Ways to promote good mental health in the elderly:

  • encourage socializing with friends and relatives through visits, phone calls or letters.
  • arrange fun times such as parties or outings.
  • help start new hobbies or revive old ones.
  • listen, talk, and share feelings.
  • assure privacy.
  • treat with respect, not as little children unable to think for themselves.
  • encourage movement and exercise.
  • help find ways to be as useful as possible.
  • strive to keep the lines of communication open.

 

 

The Importance of Lifetime Learning

Research shows that reaction time may be slower in older people but they can still learn. Families and friends may need to be patient in waiting for responses. It is also important to remember that short-term memory may not be as good as it was.

The brain helps link people to the world. If we are able to process and understand what we see, hear and absorb from our senses, our experiences will become more meaningful.

Sometimes older people are incorrectly labeled as “senile”; the misconception is that they are no longer able to think for themselves. However, for the most part, older people continue to make good use of their creative powers, and as is true for all parts of the body, the brain usually will function better if it is used regularly.

Lifetime learning means exploring new ideas, whether this is from reading, listening to radio or television, trying a new hobby, or trying a new recipe. It can include lively conversation with friends and family. What it boils down to is a willingness to keep exploring the many adventures that life has to offer. The benefits of lifetime learning include more enthusiasm for life, less boredom and depression, increased feeling of self-esteem and self-respect, more interest in the surrounding world, and new ideas to share with family and friends.

Memory Problems

Memory loss can be one of the hardest problems for both the care-receiver and the caregiver. Some memory problems are treatable, some are not. Therefore, it is important for the doctor to determine the causes of memory loss in the individual. Forgetfulness, even inability to recognize familiar faces and places, might result from such treatable causes such as malnutrition related to improper eating habits, alcohol, side effects of medications, loneliness, isolation, few chances to socialize with others, sensory impairment (decreased vision, decreased hearing), surgery or accident resulting in injury to body, viral infections or other illness, or depression or other mental illness.

Sensory Problems

People who have losses in hearing and vision may have trouble understanding things consequently negatively affecting their emotional well-being. Basic aids to hear and see are vital. At times an older person may be cut off from the world because of wax in the ears or worn out hearing-aid batteries. Glasses may need to be adjusted or perhaps just cleaned. Good lighting, without glare, is important. Magnifying glasses or large print can make reading easier.

Confusion

For people who are confused, the following tips can be useful:

  • Make changes in routines gradually,
  • Be clear about reminders for appointments or meetings,
  • Write simple directions in large, clear print,
  • Use large labels (words or pictures) on drawers and shelves to identify contents,
  • have clocks and calendars clearly visible and mark off passing days,
  • Make certain that medicine is being taken regularly,
  • Confused or forgetful patients must have assistance with their medications,
  • Encourage consumption of nutritious foods,
  • Encourage movement and/or exercise as this will increase circulation of the blood and help improve bodily functions, including the ability to think.

 

Behavioral Problems

For people who are acting out, being disruptive, or have other undesirable behaviors, it is best to not antagonize or confront but to temporarily remove your presence from the person, giving the message that “I love/care for you but not this behavior.” Below are some suggestions to minimize undesirable behaviors:

  • Avoid confrontation. If the behavior deals with disrobing, offer brightly clothes which make the person feel good.
  • Don’t argue. If the person becomes too agitated, change the subject/object to something completely different.
  • Reduce stimulation. Lower lighting, reduce noise (radio, TV) to soothing music, minimize items in the area to a few possessions known to the person, and avoid clutter.
  • Promote familiar objects, pictures.
  • Walk slowly with the person to reduce anxiety and stress the muscle tension.

 

Mental Stimulation

Because many older people enjoy recalling events from past years, families and friends should encourage the sharing of stories. Activities which stimulate the brain (visiting with others) can contribute to the goal of continued lifetime learning.

Often, older people can become happier, more productive individuals when they are encouraged to perform fun, brain-stimulating activities. The following activities are especially good for homebound elderly:

  • sew or knit,
  • be a friendly telephone caller,
  • be a foster grandparent,
  • be a pen pal,
  • be a reader to children at an elementary school,
  • save stamps for collectors,
  • write favorite recipes on cards and share them with others,
  • read books, magazines, newspapers,
  • do puzzles (jigsaw, crossword),
  • try artwork (calligraphy, painting, drawing),
  • write or record memoirs, poetry, thoughts,
  • keep a joke book,
  • care for pets or plants,
  • listen to soothing music,
  • take correspondence courses,
  • play musical instruments,
  • start or re-arrange a family photo album,
  • volunteer, at libraries, hospitals, museums, schools, Retired Senior Volunteer Program (RSVP),
  • bake for self and others,
  • plan a potluck or brown-bag lunch at home,
  • tutor or visit with children and youth,
  • type for self and others,
  • participate in radio call-in shows,
  • learn to use a computer.
  • In addition, older people who are physically able should be encouraged to participate in swimming, bowling, gardening, dancing, miniature golf, nature walks, mall-walking, jogging, shuffleboard and other activities outside the home.
  • Drawing, writing, reading, crafts, taking classes, and other hobbies encourage creativity. Indoor games including chass, checkers, monopoly, cards, billiards and Parcheesi provide interesting relief from boredom as well.

 

Copyright 2017 –  Helen Justice GCM – Elder Care Navigator and Advocate – Advanced Wellness GCM, Inc

 

Known by many as “The Elder Care Navigator”, Helen Justice is a Certified Geriatric Care Manager trained to assist elders and their families with the process of aging with dignity and grace.  Her knowledge and experience insures elders obtain quality care and transitional preparation for their future.  More important than the financial aspect of aging is the social and emotional component that elder care places on the family.  Go to www.advancedwellnessgcm.com for information on no fee seminar. 

Legal and Financial Affairs

Older people continue to be concerned about management of their assets and property. However, they may be unable to participate because of illness, confusion or loss of memory. It is important to involve them whenever possible.

Compiling an Inventory

Develop an inventory which lists all assets and liabilities of the older person. The following items should be included: bank accounts, pass books, certificates of deposit, money market funds, stocks, bonds, precious metals, jewelry, real estate deeds, promissory notes, contracts, insurance policies, safety deposit boxes (including location of the key), and retirement or pension benefits. Location of the records for each asset and liability also should be included. Other important documents, such as birth and marriage certificates, social security numbers, divorce decrees and property settlements, income tax returns (state and federal), death certificate of spouse (if any), and wills (including the attorney’s name and executor) or trust agreements, should be listed and the locations designated. If able, the older person should compile the list. If unable, a family member, attorney, banker, accountant or certified financial planner can help compile the inventory which should be copied and kept in a safe, obvious place, possibly with a relative or friend. It is important that the document be updated every year.

Managing a Will and Financial Affairs

An objective of financial and estate planning for older people is to plan for the orderly distribution of the estate upon their death, according to their desires. Consequently, it is important for people to have a will drafted, which incorporates the above inventory and states how property is to be disposed of upon death. Everyone over the age of 18 should have a will or a similar legal document.

 

If a person does not have a will, an attorney should be consulted immediately. Proper planning is essential and powers of attorney or trust agreements should be executed while a person is still competent. Otherwise, transfer of responsibility for management of the person’s financial affairs to someone else must be completed through a court action, and costs spent in clearing up Probate problems come directly out of the person’s assets, diluting whatever estate is left after death.

 

Remember, as caregivers concerned about the financial affairs of a care-receiver, you should not get directly involved without legal authority. Acting without clear legal authority, even with the best intentions, can cause serious problems.

 

The legal mechanisms available for surrogate decision making are: durable power of attorney (DPA), probate conservatorship, durable power of attorney for health care (DPAHC), and ( California only — check to determine if your State has comparable laws).

Durable Power of Attorney

Durable Power of Attorney is a written legal document giving someone other that the Principal the authority to handle the Principal’s financial decisions. It must be signed by the Principal while the Principal is still legally competent. The DPA is valid without time limit until the Principal either revokes the DPA or dies, or the court revokes the DPA due to mismanagement. The preferences of the Principal regarding the management of assets can be specified. This power to manage assets can be transferred immediately or can be designated to go into effect when it is determined that the Principal has become mentally incapacitated. Financial decisions made by an individual given DPA by the Principal are binding on the Principal and his/her successors, so caregiver and care-receiver are urged to seek the advice of an attorney.

Probate Conservatorship or Conservatorship of Estate

Probate Conservatorship or Conservatorship of Estate allows for the management of the Principal’s money and other property when the Principal presently lacks the capacity to either decide or appoint another to decide financial decisions in his/her behalf. Court proceedings to designate a conservator are required. This is a difficult and extreme procedure but may be necessary if the care-receiver is already incapacitated to the extent that he/she is unable to manage personal financial affairs.

Durable Power of Attorney for Health Care (DPAHC)

is a written document which must be signed by the Principal while he/she still has the capacity to make decisions. The DPAHC gives someone other than the Principal authority to make medical treatment and health care decisions on behalf of the Principal for up to the maximum of seven years after the document is signed. It allows one to specify ahead of time how he/she wishes these decisions to be made. Wishes regarding extraordinary supportive care, including breathing machines and tube feeding, can be addressed in the Durable Power of Attorney. All adults should have a Durable Power of Attorney for Health Care.

Lantern-Petris-Short (LPS) Conservatorship

( California only — check for comparable laws in your State) or conservatorship of person is a court-ordered process which enables a person to get the psychiatric and/or medical care needed but by reason of mental illness is refused. The court determines if the Conservatee, in addition to receiving the necessary psychiatric treatment, may also retain or be denied the right to vote, possess a driver’s license, enter into contracts, or refuse non-psychiatric medical treatment. The Conservator may be a relative, friend or an appointee from the Conservator’s office. The Conservator may be given the right to require and authorize the conservatee to receive involuntary psychiatric and/or medical treatment and supervises and assists in making proper living arrangements, including placement in a Residential Care or a nursing home when indicated by the doctor. In order to start the process, one consults either with his/her attorney or calls the Office of the Counselor in Mental Health. An individual has to be adjudicated to be gravely disabled before being placed on an LPS conservatorship. Grave disability is defined as the inability to provide for one’s food, clothing, shelter and proper medical care due to a mental disorder.

Selecting an Attorney

It is important to select an attorney who is knowledgeable in the areas needed (estate planning, will drafting, probate or conservatorship). Ask friends or other professionals for recommendations, or contact a Lawyer Referral Service, County Bar Association, or Senior Citizens Legal Services. Before agreeing upon a particular attorney, ask if he/she has previously done what you require.

Liability of Caregiving

Anyone who accepts the responsibilities of a caregiver must also understand that there are a number of legal duties or liabilities that come with it. Many states including California have passed elderly abuse laws. Caregivers are bound by these laws in two ways: not to abuse the elder person (physically, mentally or monetarily) and report any incidents of abuse or suspected abuse to ( California residents only — the Adult Abuse Reporting line 476-6266 or 1-800-523-6444). (Residents of states other than California : Check you local telephone directory for the Adult Abuse Reporting telephone number or contact your county mental health services for guidance.)

 

As a caregiver, you must provide a clean and safe environment, nutritious meals, clean bedding, and clothes. At the same time, if you are in charge of the elderly person’s finances, you must use that money properly, purchasing necessary services for the benefit of the person to whom care is given. Failure to provide care, failure to get care, and failure to purchase care are all forms of abuse or neglect.

 

In addition, caregivers may not physically, sexually or psychologically abuse the person receiving the care. Yelling, screaming, withholding affection, etc., are as much an abuse of the person as is striking the person with the hand or with objects. Therefore, if you are contemplating becoming, or are now a caregiver, you must be ready to accept the physical, psychological and legal duties to provide the necessary care. If you are reaching a point where you are no longer able, physically or emotionally, to provide the proper care, we urge you to consider the alternatives to personal caregiving and to seek help with this decision from a counselor.

 

Copyright 2017 –  Helen Justice GCM – Elder Care Navigator and Advocate – Advanced Wellness GCM, Inc

 

Known by many as “The Elder Care Navigator”, Helen Justice is a Certified Geriatric Care Manager trained to assist elders and their families with the process of aging with dignity and grace.  Her knowledge and experience insures elders obtain quality care and transitional preparation for their future.  More important than the financial aspect of aging is the social and emotional component that elder care places on the family.  Go to www.advancedwellnessgcm.com for information on no fee seminar. 

Medical Aspects of Caregiving

Encouraging routine physical examination

As a caregiver, you are in a position to help your care-receiver along the road to good health care by encouraging routine physical examinations. You are valuable in helping the care-receiver talk to their doctors and other medical personnel. You can follow through with their medical treatment at home.

 

However, it is important to remember that the primary responsibility for medical treatment rests between the doctor and the patient. If there is any doubt about what you should or should not do, the doctor should be consulted. You can help your care-receiver to understand his/her medical treatment and encourage the care-receiver to be involved in making decisions. In medical treatment, it is often tempting to decide what is best for the patient, but it is best to recognize the care-receiver’s need to choose. We all need control of our lives, and this is especially true for a person who needs the help of others. If there are serious concerns about decisions being made, caregivers should discuss the matter openly with the doctor.

Keeping Records and Managing Medications

Caregivers can help older people maintain medical records for use by the doctor. Arrangements can be made through the doctor’s office to send for previous records that could be helpful in treatment. This may require getting Releases of Medical Information signed by the care-receiver. You also should keep a list of all medications (both prescribed and over-the-counter) being used. The same medications that are helpful in easing pain, stopping infection, controlling heart rate and keeping people healthy can also cause serious problems.

 

Because many older adults take several medications at one time, it is possible that these drugs can interact with one another and be a danger. If more than one doctor is prescribing medications, it is important to keep each doctor aware of the drugs that are being taken. You can keep them informed by taking all your drugs in a paper sack or a list of all your drugs to each doctor. Having one pharmacist that fills all of your prescriptions is a way to prevent taking drugs that interact and cause problems. Over-the-counter or non-prescription drugs also can cause problems. Talk with your pharmacist before using them.

 

If you find the medicine schedule confusing or difficult to follow, ask your pharmacist about preparing all medicines in blister packs.

 

Below is a sample of “current medication list” which includes the essentials: name of medication, sample of the medication taped beside its name, the reason for the medication, the dosage and the time the medication is taken:

Current Medications List

If your care-receiver is taking several medications at different times throughout the day, it may be helpful to develop a second list to assist you with daily medication set-ups; this list may be color coded, or may have the names of the medications grouped in the times to be taken each day. For medications taken several times a day, their names will appear several times on your list as in the example below:

Daily Medication Set-up

– Time of Day Medication is given, AM + PM

– List all Medications for Each Time

  • Morning
  • Noon
  • Evening
  • Bed Time

Choosing a Doctor

If you don’t have a doctor, choose one carefully. There are several referral sources you can utilize: 1) a friend who is satisfied with his/her physician for a referral; 2) your County Medical Society; 3) Physician Referral Service; 4) A neighborhood hospital (some offer a physician referral service.)

 

The doctor is a valuable resource. If you are having a difficult time managing your care-receiver at home, or an acute illness occurs, the doctor may assist with related health care concerns. Your care-receiver may have to be hospitalized. The doctor may assist by making a home health care referral. Once hospitalized, the doctor can assist in placement issues or home health care upon discharge. If he/she doesn’t offer it, you may request it.

 

If you are dissatisfied with your doctor, consider:

  • What do you want from your doctor?
  • Are these wants realistic (e.g., cure of an incurable disease)?
  • Have you discussed them with your doctor and/or staff?
  • Do you have a primary physician (usually internist or family practitioner) who oversees your overall medical care? (Often, sub-specialists such as cardiologists or orthopedists focus on one organ system, and do not try to coordinate the patient care.)
  • Do you keep your appointments?
  • Do you take medications as prescribed, contact the doctor if you change, and discuss your concerns with him/her?
  • Remember, physicians are human beings, with individual personalities, enormous responsibilities, and only 24 hours in one day. No doctor will be right for all patients. Find a doctor whose skills and style of practice suits your current needs. All patients should have one physician to coordinate their care. Frequently changing doctors is likely to result in poor quality care of chronic or complex problems.
  • Older individuals with multiple medical problems or difficulties with memory or intellectual functions may benefit from a comprehensive geriatric assessment program. (This guide identified one program in the San Diego area as the UCSD Seniors Only Care Program (SOCARE). Your physician or local Area Agency on Aging may have information on comparable programs in your community.)

 

Arranging the Doctor Appointment. Some questions to ask when you make a first appointment:

  • What are the office hours?
  • How are the bills handled?
  • Who will answer my questions if the doctor is unavailable?
  • How does the office handle emergencies?
  • How is co-payment handled?
  • What hospitals does he/she go to?
  • On the first visit to the doctor, the patient’s list of current medications (Table 4) and previous medical records should be given to the doctor. If the visit is for a specific problem, have the following information for the doctor:
  • the symptoms,
  • how long they have been present,
  • how often they happen, how bad they are.
  • Reviewing this information before the visit will help. And remember, it is important that the patient have a chance to visit with the doctor privately to discuss confidential information. Before leaving the doctor’s office, meet with the doctor or the nurse to find out how you can help with treatment and what your role as caregiver should be.

 

It is useful to look at the following three areas

  • What can be done now to help in the treatment of current medical problems,
  • How to recognize problems that may arise,
  • What to do in emergencies.

 

Planning For Emergencies

  • Having an emergency plan is important, especially when a substitute caregiver occasionally takes your place in the home. (Post phone numbers for the following agencies next to your telephone or a conspicuous place where they can easily be seen by anyone. This sentence modified for readers outside San Diego County .)
  • The 911 number for emergencies (Medical, Fire or Police),
  • The physician’s number (emergency and office number),
  • The name and number of the hospital the physician and the patient prefer,
  • The number of the home health agency, if one is currently making visits to the home,
  • The Poison Center phone number,
  • The 24-hour number of the medical or oxygen supplier, if one is being used,
  • The telephone number where you (caregiver) can be reached.
  • Remember, observe changes and signs of illness in the care-receiver. They can help detect a medical problem. But if any doubts about health arise, CALL THE DOCTOR FOR ADVICE; DO NOT PROCRASTINATE!

 

Copyright 2017 –  Helen Justice GCM – Elder Care Navigator and Advocate – Advanced Wellness GCM, Inc

 

Known by many as “The Elder Care Navigator”, Helen Justice is a Certified Geriatric Care Manager trained to assist elders and their families with the process of aging with dignity and grace.  Her knowledge and experience insures elders obtain quality care and transitional preparation for their future.  More important than the financial aspect of aging is the social and emotional component that elder care places on the family.  Go to www.advancedwellnessgcm.com for information on no fee seminar. 

Nutrition

Good nutrition is important in order that people live life to its fullest. Good nutrition is a balance of proteins, carbohydrates, fats, vitamins, minerals and water in the foods we eat. A healthy diet helps to provide energy; build, repair, and maintain body tissues and regulate body processes.

 

When meals are eaten in the company of others, people not only benefit from the nutritious foods, but also enjoy the chance to socialize. This encourages good eating habits and promotes good mental health.

Nutrients listed on food labels

The table that follows summarizes essential nutrients (which you may also finds listed on food labels) and their functions.

Adapting Meals for People with Dietary Restrictions

If an individual is on a special diet (low salt, diabetic or low saturated fat), the Basic Four Food Groups Guide (which follows) can still be used. However, because diets are prescribed to control a specific medical condition, certain foods may have to be eliminated, modified in the preparation, or limited in their intake. It is important that caregivers obtain specific instructions from a registered dietitian or their doctor on which foods are allowed, how much, and how they should be prepared.

 

Since some foods or medications may interact with other medications and/or foods in a harmful way, check with the pharmacist as to restrictions in any medications’ use before it is applied.

Nutrients on Food Labels and their Function

  • Protein: For preservation and repair of tissue; formation of antibodies to fight infection.
  • Carbohydrates: For energy; fiber to help prevent constipation.
  • Fat: For energy; healthy body and skin.
  • Vitamin A: For healthy eyes, skin, hair; resistance to infection.
  • Vitamin C: For healthy gums, skin; healing of wounds, bones; resisting infection.
  • Thiamin (B1): For digestion; healthy nervous system.
  • Riboflavin (2): For healthy eyes, skin, mouth; use of oxygen from air.
  • Niacin: For healthy digestive tract and nervous system.
  • Calcium: For preservation and repair of bones, teeth; muscle contractions; blood clotting.
  • Iron: For building red blood cells to carry oxygen to all parts of the body.
  • To simplify daily meal planning, foods are grouped according to the nutrients they supply. Plan your diet to include the recommended number of servings from each group.

 

The Four Basic Food Groups

Meat Group: Provides protein, niacin, iron, and Thiamin-B1. 2 servings daily. Dry beans and peas, soy extenders, and nuts combined with animal or grain protein can be substituted for a serving of meat. 2 ounces of cooked, lean meat, fish or poultry have the same amount of poultry as: 2 eggs; 1 cup cooked dry beans, peas, or lentils; 4 tablespoons peanut butter; 1/2 cup cottage cheese.

 

Grain Group: Provides carbohydrates, Thiamin-B1, iron, and niacin. 4 servings daily. Whole grain, fortified, or enriched grain products are recommended. 1 adult serving is: 1 slice bread; 1 cup ready-to-eat cereal; 1/2 cup cooked cereal, pasta, cornmeal, rice or grits; 1 small muffin or biscuit, 5 saltines, 2 graham crackers.

 

Milk Group: Provides calcium, riboflavin-B2, and protein. 2 servings daily: Foods made from milk contribute part of the nutrients supplied by a serving of milk. 1 cup milk has the same amount of calcium as 1 cup yogurt, 1 and 1/2 slices (ounces) cheddar-type cheese, 1 and 3/4 cups ice cream, 2 cups cottage cheese.

 

Fruit-Vegetable Group : Provides vitamins A and C. 4 servings daily: Dark green leafy or orange vegetable and fruit are recommended 3 or 4 times weekly for vitamin A. Citrus fruit is recommended daily for vitamin C. 1 adult serving is: 1 cup raw fruit or vegetable, 1/2 cup cooked fruit or vegetable, 1 medium fruit, such as an apple or banana, 1/2 cup juice.

Common Problems Interfering with Good Nutrition

Illness, disability and depression can affect an older person’s desire and ability to eat properly. The following suggestions deal with common problems that interfere with good nutrition.

 

When the care-receiver say the food tastes strange, it might help to:

  • Check teeth for tooth decay or gum infection,
  • Avoid alcohol,
  • Marinate meat, poultry and fish in sweet fruit juices, Italian dressing, or sweet or sour sauces,
  • Drink plenty of fluids or suck on candies to get rid of bad tastes,
  • Serve foods at room temperature or cold (Try milk-shakes or cheese),
  • Use stronger seasonings such as basil, oregano, rosemary, tarragon, lemon juice or mint when cooking,
  • Try new foods.
  • Cramps, Heartburn, Bloating:
  • Eat slowly,
  • Eat small meals frequently,
  • Avoid gas-forming foods, e.g., cabbage, onions, nuts, beer, cola drinks,
  • Avoid lounging immediately after eating; stand or sit upright for one hour after eating,
  • Avoid fried, greasy and heavily spiced foods,
  • Try bland, low-fat, easily digested foods,
  • Chilled antiacid may help, HOWEVER, check with your doctor regarding the brand of antiacid to use.
  • Constipation
  • Take high-fiber foods and plenty of liquids,
  • Exercise,
  • Add bran when cooking or baking (1 – 2 tablespoons of bran for each cup of flour),
  • Drink hot beverages which act as stimulants.
  • Diarrhea
  • Eat small meals frequently,
  • Drink clear liquids,
  • Avoid high fiber and greasy foods,
  • Replace fluid loss with liquids between meals.
  • Nausea, Vomiting
  • Avoid unpleasant odors,
  • Eat small meals frequently,
  • Chew slowly and thoroughly,
  • Sip cool, clear liquids between meals,
  • Rest after meals with head elevated,
  • Avoid hot, spicy, strong-smelling foods or fried, greasy foods,
  • Try foods which are cold or at room temperature, and low-fat food,
  • Eat dry or salty food,
  • Try fresh air and loose clothing.
  • Dry or Sore Mouth
  • Drink plenty of liquids,
  • Suck on ice chips,
  • Suck on popsicles made of milk or non-acid juices,
  • Dunk or soak foods in liquids,
  • Use extra gravies, sauces, salad dressing,
  • Rinse mouth frequently,
  • Suck hard candies or chew gum,
  • Eat sweet or tart foods if no sores in mouth,
  • Artificial saliva can be used.

General Tips for Helping the Older Person to Eat Well

  • Plan meals and snacks to include the person’s favorite foods.
  • Use a variety of foods from each of the four food groups,
  • Prepare foods that provide a variety of texture, color, and temperature,
  • Provide a pleasant setting, i.e., flowers, place mats, matching dishes, good lighting.

 

Copyright 2017 –  Helen Justice GCM – Elder Care Navigator and Advocate – Advanced Wellness GCM, Inc

 

Known by many as “The Elder Care Navigator”, Helen Justice is a Certified Geriatric Care Manager trained to assist elders and their families with the process of aging with dignity and grace.  Her knowledge and experience insures elders obtain quality care and transitional preparation for their future.  More important than the financial aspect of aging is the social and emotional component that elder care places on the family.  Go to www.advancedwellnessgcm.com for information on no fee seminar.