Eat well, drink lots of water, exercise and socialize for brain health

In my last column, I wrote about Brain Health Awareness month. The brain, the most complicated system in our bodies is often the most overlooked. When most of us think of health we may think of overall health or we may think of heart health but how often do we think in terms of brain health?

I would speculate that many of us change habits or behaviors based on the fear factor. We wait until there is a health crisis to take notice and adopt healthier patterns. For many of us it may be stepping on the scale that provides the impetus to eat better or healthier. Most of us don't think in terms of brain health unless we are fearful of developing Alzheimer's disease or one of the related dementias.

As a part of normal aging our brains change. Our brains begin the gradual process of decreasing in volume as we age. Short-term memory may decline, reaction time increases, cognitive processing time increases, cognitive inflexibility increases, and the filter between our thoughts and words can become less inhibited. While these may be normal effects of aging we can try to minimize the progression of the effects of normal aging and potentially ward off the effects of "abnormal" brain changes such as the effects of dementia.

According to brainhealth.gov, brain health refers to the ability to remember, learn, plan, concentrate and maintain a clear, active mind. How do we achieve brain health? Maintaining overall health is the best way to protect the brain and minimize the overall effects of normal aging.

Improving overall health, minimizing risk factors and following simple steps can keep the brain active and sharp. Following a heart healthy regime also contributes to a healthy brain. Nutrition and eating smart, exercise, staying social, managing stress and continuing to learn and discover new interests are important to maintaining a healthy brain.

Here are some interesting facts about the brain that may help keep things in perspective: The brain is made up of 77-78 percent water, 10-12 percent fats and 8 percent proteins.

So here is where we begin to keep our brains as healthy as possible — water! Most of us are walking around chronically dehydrated and it takes its toll on our brains. In fact, as we age, dehydration may in fact cause confusion and memory loss. In a person living with dementia the effects of dehydration can be devastating.

Diet contributes a huge part in keeping a healthy brain. Our brains need healthy fats to function. However, maintaining a balance is so important. If you consider what is good for the heart is ultimately good for the brain, then eat a diet high in antioxidants found in fruits and vegetables and moderate in lean proteins and carbohydrates. The brain needs fats so some fat in the diet is therapeutic.

There is an ongoing debate about the use of cholesterol lowering drugs and the effect on the brain. The conundrum is to that to protect the blood vessels from plaque build-up that causes heart disease there may be some adverse effect on the brain. People are living longer due to the control of heart disease — although it is still the No. 1 killer of both women and men — thus living to the age when Alzheimer's disease and related dementias typically become obvious. Keep in mind the greatest risk for Alzheimer's disease is age. Also keep in mind the biggest risk associated with vascular dementia is hypertension, stroke and heart disease. So I am not advocating for anyone to stop their cholesterol-lowering medications because who wants to weigh those odds of a heart attack at a younger age versus an unhealthy brain at an advanced age?

The bottom line is to eat well and in moderation! And here comes the bombshell … just adding 30 minutes of exercise (like taking a walk) to drinking plenty of water, and eating reasonably well can significantly contribute to overall brain health.

While eating well, drinking plenty of fluids and walking are hallmarks of good overall health, the effects of socialization on the brain are undeniable. Those who are socially isolated and have very little contact and stimulation through relationships are known to have an increase in cognitive decline. Laura Carstensen, professor and founding director of the Stanford Center on Longevity, reported in 2009 that our social arena "influences not only our happiness in everyday life but the ways in which our brains process information, the levels of hormones circulating in our bodies and our physiological responses to stress."

Stress, the other culprit adversely affecting brain health, leads to increased levels of cortisol, which essentially kills brain cells, decreases the production of new brain cells and can lead to shrinking of the brain, which leads to cognitive impairments. Controlling stress comes in the package with eating well (including foods high in antioxidants), exercising and socializing.

Finally, add something new and fun to your routine. Changing it up and learning something new has been found to be great for the brain. Try a new activity such as ladder ball, add knitting to your bucket list of things to learn or go buy a new, grown-up coloring book and don't worry about staying in the lines!

Eat well, drink your water, go take a walk with a friend, and come home to relax with a new activity and your brain will thank you! I'm on vacation and I'm going to the front porch to color!

Jill Rosner is a registered nurse, certified geriatric care manager and owner of Rosner Healthcare Navigation. She provides patient advocacy and care management services to clients with health and aging issues. Contact her at JillRosnerRN@aol.com.

Reprinted from: http://www.carrollcountytimes.com/columnists/ph-cc-nav-health-0717-20160716-story.html

How Many Pills Are Too Many?

By Austin Frakt
THE NEW HEALTH CARE APRIL 10, 2017

The point of prescription drugs is to help us get or feel well. Yet so many Americans take multiple medications that doctors are being encouraged to pause before prescribing and think about “deprescribing” as well.

The idea of dropping unnecessary medications started cropping up in the medical literature a decade ago. In recent years, evidence has mounted about the dangers of taking multiple, perhaps unnecessary, medications.

Deprescribing will work only if patients also get involved in the process. Only they can report adverse effects that they sense but that are not apparent to clinicians. And they need to be comfortable weaning from or dropping drugs that they are accustomed to and believe to be helpful.

Yet an increasing number of Americans — typically older ones with multiple chronic conditions — are taking drugs and supplements they don’t need, or so many of them that those substances are interacting with one another in harmful ways. Studies show that some patients can improve their health with fewer drugs.

Though many prescription drugs are highly valuable, taking them can also be dangerous, particularly taking a lot of them at once. The vast majority of higher-quality studies summarized in a systematic review on polypharmacy — the taking of multiple medications — found an association with a bad health event, like a fall, hospitalization or death.

About one-third of adverse events in hospitalizations include a drug-related harm, leading to longer hospital stays and greater expense. The Institute of Medicine estimated that there are 400,000 preventable adverse drug events in hospitals each year, costing $3.5 billion. One-fifth of patients discharged from the hospital have a drug-related complication after returning home, many of which are preventable.

Not every adverse drug event means a patient has been prescribed an unnecessary and harmful drug. But older patients are at greater risk because they tend to have more chronic conditions and take a multiplicity of medications for them. Two-thirds of Medicare beneficiaries have two or more chronic conditions, and almost half take five or more medications. Over a year, almost 20 percent take 10 or more drugs or supplements.

Some are unnecessary. At least one in five older patients are on an inappropriate medication — one that they can do without or that can be switched to a different, safer drug. One study found that 44 percent of frail, older patients were prescribed at least one drug unnecessarily. A study of over 200,000 older veterans with diabetes found that over half were candidates for dropping a blood pressure or blood sugar control medication. Some studies cite even higher numbers — 60 percent of older Americans may be on a drug they don’t need.

Though studies have found a correlation between the number of drugs a patient takes and the risk of an adverse event, the problem may not be the number of drugs, but the wrong ones. Some medications have been identified as more likely to contribute to adverse events, particularly for older patients.

For example, if you’re taking psychotropic agents, such as benzodiazepines or sleep-aid drugs, you may be at increased risk of falling and cognitive impairment. Diuretics and antihypertensives have also been identified as potentially problematic. (The Agency for Healthcare Research and Quality has published a longer list of drugs that are potentially inappropriate for older patients. Note that, even if they are problematic for some patients, they are appropriate for many.)

Relative to the mountain of evidence on the effects of taking prescription drugs, there are very few clinical trials on the effects of not taking them.

Among them is one randomized trial that found that careful evaluation and weekly management of medications taken by older patients reduced unnecessary or inappropriate drug use. Adverse drug reactions fell by 35 percent. Medication use was reduced, along with the risk of falls among a group of older, community-dwelling patients through a program that included a review of medications.

Several other studies also found that withdrawal of psychotropic medications reduced falls. A comprehensive review of deprescribing studies found that some approaches to it can reduce the risk of death. Another recent randomized trial found that frail and older people could drop an average of two drugs from a 10-drug regimen with no adverse effects.

So why isn’t deprescribing more widely considered? According to a systematic review of research on the question, some physicians are not aware that they’re prescribing inappropriately. Other doctors may have difficulty identifying which drugs are inappropriate, in part because of lack of evidence. In other cases, doctors believe that adverse effects of drug interactions are outweighed by benefits.

Physicians also report that some patients resist changing medications, fearing that alternatives — including lifestyle changes — will not be as effective. Other studies found that many doctors are concerned about liability if something should go wrong or worry they’ll fail to meet performance benchmarks — like the proportion of diabetic patients with adequate blood sugar control.

To reduce the chances of problems with medications, experts advocate that physicians more routinely review the medication regimens of their patients, particularly those with many prescriptions. At hospital discharge — when patients leave the hospital, often on more medications than when they entered it — is a particularly important time for such a review. Including nurses and pharmacists in the process can reduce the burden on physicians and the risks to patients.

Patients can play an important role as well. Walid Gellad, a physician in the Veterans Health Administration and at the University of Pittsburgh School of Medicine, advises that at every visit with a doctor, “patients should ask, ‘Are there any medications that I am on that I don’t need anymore, or that I could try going without?’ ”

Patients, of course, should not try weaning themselves off medication without consulting their doctors — but deprescribing is an idea for all parties to keep in mind.

Reprinted from: https://www.nytimes.com/2017/04/10/upshot/how-many-pills-are-too-many.html?smprod=nytcore-iphone&smid=nytcore-iphone-share&_r=0

5 Ways Caregivers Can Build a Support System

Posted On 19 Jul 2016
By : Sally Abrahms

When you’re caring for your parents or in-laws, you’re often in fly-by-the-seat-of-your-pants mode. There’s a crisis. You react. There’s infinite scrambling to find resources (i.e. adult day care, a senior center, transportation), and meanwhile, your own life is teeming with additional responsibilities.

It’s hard to catch your breath, let alone consider your own future. You probably have an “I’ll worry about me later” mindset… Not smart!

Ways Caregivers Can Build a Support System

Thinking ahead about who will be there for you when you need care, what you want for yourself, and where you want to live, among other things, is something to begin considering now. It means positioning yourself so that when you are older, you will have as much control of your life as possible.

“The reality is that adult children do not plan for their future, long-term needs the same way their parents haven’t planned for theirs.” — Rhonda Caudell

You don’t have to take action today, but you do need a game plan. “The reality is that adult children do not plan for their future, long-term needs the same way their parents haven’t planned for theirs,” says Rhonda Caudell, a former nurse and geriatric care manager from Atlanta, who teaches an online course: “Crucial Conversations with Aging Parents Before It’s Too Late.”

Caudell believes that adult kids — you! — must break that cycle and be prepared. “You’re giving your kids a gift,” she says. Power of attorney? Check. Living will? Check. End-of-life and housing preferences? Check. But is building a strong support system on that list?

Today, one out of three baby boomers is single. They may have kids who live hours away. Or, even if they’re nearby, they are likely busy with their own lives. You need to count on you.

Want to boost or build a support system? Here’s what the experts suggest:

         1. Figure out what you don’t want.

You may feel you live too far away from your daughter and grandkids, that you will become too dependent on a nearby son, or that you love you can’t live without your community or neighborhood. If you stay in your big old house, it may need ongoing repairs or, with too many stairs, be too hard to navigate later on.

2. Create the life you want for your next phase.

Think about where you want to be, not only geographically but personally in the next 10 years. If you’re considering a move, figure out if you can afford it and what you will need to do to sell your home or condo in the future. Perhaps you can begin to do the work. Also, decide if you’ll have what you need when you need it (alternative transportation, doctors, movie theatres, restaurants  nearby). You might be the type who prefers to surround herself with people or not. Perhaps you want to live quietly.

3. Look around.

If there are enough people in your building or neighborhood who are at a similar age and stage, you might want to get to know one another and/or share services (caregiving, food bought in bulk, housekeeping).

4. Assess your friend situation.

If you want more caring, interesting, sports-minded (fill in the blank) people in your life, you will have to make an effort. Get involved in community activities and join committees or a walking group. Become a mentor or volunteer. Find a book club. Learn bridge. Meetups are a good way to connect with people who have common interests.

There are organizations like The Transition Network (TTN) with chapters around the country for professional women age 50+ “whose changing life situations lead them to seek new connections, resources and opportunities.” Some of its chapters offer the Caring Collaborative, an initiative made up of TTN members who are “there for each other” when help or company is needed.

Barbara Stahura is active in the Collaborative’s New York City chapter. “When you meet women in a social setting, it’s easier to pick up the phone and ask for help. “If you know people in advance you have those personal connections.” A health care consultant who left her full-time job, Stahura, 62 [63 in August] has no children, no siblings who are alive and a husband with a chronic illness. While she’s healthy now, she knows an accident or something else could trip her up anytime. “I now have friends I’ve met through Caring Collaborative I can count on who’ve said, ‘don’t worry, let me know if you need help.’ It’s very reassuring,” says Stahura.

5. Know your housing options.

There are several ways to ensure you will not be isolated, lonely and alone. One friend in her sixties plans to sell her condo and buy a house with her sister. It’ll be company, she’s decided, and by splitting expenses, they can live someplace they wouldn’t have been able to afford alone. It goes without saying that they will take care of each other as they grow older.

Some older adults are opting for cohousing. You have your own place but share some meals and communal space. There’s daily interaction with neighbors who become like extended family.

Continuing Care Retirement Communities (CCRCs or Life Plan Communities) — many with assisted living and skilled nursing — can be appealing, too. Not only are your medical needs taken care of, should you have them, but there are activities, stimulation and caring residents and staff. University-based retirement communities (UBRC) that are on or near college campuses and focus on lifelong learning are one type. There are more than 100 around the country.

The Village movement is also popular. You stay in your home and, for an annual fee, join a neighborhood “Village.” Members get discounted vetted service referrals (i.e. think home repairs, dog walking, a babysitter for your grandchild, transportation), and social opportunities, from museum trips, yoga classes or a group meal out.

Reprinted from: http://www.aplaceformom.com/blog/7-19-16-ways-caregivers-can-build-a-support-system/

New Alzheimer’s Association Report Shows Growing Cost and Impact of Alzheimer’s Disease on Nation’s Families and Economy

– Total annual payments for Alzheimer’s care surpass a quarter of a trillion dollars

– Deaths from Alzheimer’s increase dramatically while deaths from other major causes decrease

– Strain of providing Alzheimer’s care harms caregivers’ mental and physical health

CHICAGO, March 7, 2017 – For the first time, total payments exceeded a quarter of a trillion dollars ($259 billion) for caring for individuals living with Alzheimer’s or other dementias, according to data reported in the 2017 Alzheimer’s Disease Facts and Figures report, released today by the Alzheimer’s Association.

The report also includes new research on the disease’s impact on caregivers, such as family members. “This report details the physical and mental damage many people experience when caring for someone with Alzheimer’s,” said Beth Kallmyer, MSW, Vice President of Constituent Services for the Alzheimer’s Association. “It also reveals how this burden disproportionately affects women, who tend to spend more time caregiving, take on more caregiving tasks and care for individuals with more cognitive, functional and behavioral problems.”

More than 15 million Americans provide unpaid care in the form of physical, emotional and financia support for the estimated 5.5 million Americans of all ages living with Alzheimer’s dementia. In 2016, Alzheimer’s caregivers provided an estimated 18.2 billion hours of unpaid care – a contribution to the nation valued at $230.1 billion.

The Facts and Figures report illustrates that the strain of caregiving produces serious physical and mental health consequences. For instance, more than one out of three (35 percent) caregivers for people with Alzheimer’s or another dementia report that their health has gotten worse due to care responsibilities,  compared with one out of five (19 percent) caregivers for older people without dementia. Also, depression and anxiety are more common among dementia caregivers than among people providing care for individuals with certain other conditions.

“As the number of people with Alzheimer’s continues to grow, so do the impact and cost of providing care,” said Kallmyer. “While we’ve seen recent increases in federal research funding and access to critical care planning and support services, there’s still an urgent need to support research that can bring us closer to effective treatment options and, ultimately, a cure.”

Caring for someone living with dementia often falls on women, who make up two-thirds of Alzheimer’s caregivers. New findings highlighted in the report show that of all dementia caregivers who provided care for more than 40 hours a week, 69 percent are women. Of those providing care to someone with dementia for more than five years, 63 percent are women.

Soaring Cost, Prevalence and Mortality

The report provides an in-depth look at the latest national statistics and information on Alzheimer’s prevalence, incidence, use and costs of care, caregiving and mortality.

The report shows that, for the first time, total annual payments for health care, long-term care and hospice care for people with Alzheimer’s and other dementias have surpassed a quarter of a trillion dollars ($259 billion). Additionally, despite support from Medicare, Medicaid and other sources of financial assistance, individuals with Alzheimer’s or other dementias still incur high out-of-pocket costs. The average per person out-of-pocket costs for seniors with Alzheimer’s and other dementias are almost five times higher than average per-person payments for seniors without these conditions ($10,315 versus $2,232).

Although deaths from other major causes have decreased, new data from the report shows that deaths from Alzheimer's have increased significantly. Between 2000 and 2014, deaths from heart disease decreased 14 percent, while deaths from Alzheimer’s increased 89 percent.

Prevalence, Incidence and Mortality

·         Of the estimated 5.5 million Americans with Alzheimer’s dementia in 2017, 5.3 million people are age 65 and older and approximately 200,000 are under age 65 (younger-onset Alzheimer’s).

·         Barring the development of medical breakthroughs, the number of people age 65 and older with Alzheimer’s dementia may nearly triple from 5.3 million to 13.8 million by 2050.

·         Every 66 seconds, someone in the U.S. develops Alzheimer’s dementia. By mid-century, someone in the U.S. will develop the disease every 33 seconds.

·         Approximately 480,000 people—almost half a million—age 65 or older will develop Alzheimer’s dementia in the U.S. in 2017.

·         Two-thirds of Americans over age 65 with Alzheimer’s dementia (3.3 million) are women.

·         Alzheimer’s is the sixth-leading cause of death in the U.S. and the fifth-leading cause of death for those ages 65 and older.

·         Alzheimer's remains the only disease among the top 10 causes of death in America that cannot be prevented, cured or even slowed.

Cost of Paid and Unpaid Care

•        Total national cost of caring for those with Alzheimer’s and other dementias is estimated at $259 billion (excludes unpaid caregiving), of which $175 billion is the cost to Medicare and Medicaid alone.

•        Total payments for health care, long-term care and hospice care for people with Alzheimer’s and other dementias are projected to increase to more than $1.1 trillion in 2050 (in 2017 dollars).

The 2017 Alzheimer’s Disease Facts and Figures special report, titled “Alzheimer’s Disease: The Next Frontier,” highlights advances in research that may allow for the diagnosis of Alzheimer’s disease before symptoms of Alzheimer’s begin. By using biomarkers, researchers and clinicians will be able to improve how we identify and diagnose Alzheimer’s disease. The Special Report appears in the April 2017 issue of Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association.

About 2017 Alzheimer’s Disease Facts and Figures

The Alzheimer's Association 2017 Alzheimer's Disease Facts and Figures report is a comprehensive compilation of national statistics and information on Alzheimer’s disease and related dementias. The report conveys the impact of Alzheimer’s on individuals, families, government and the nation’s health care system. Since its 2007 inaugural release, the report has become the preeminent source covering the broad spectrum of Alzheimer’s issues. The Facts and Figures report is an official publication of the Alzheimer’s Association.

About the Alzheimer’s Association

The Alzheimer’s Association is the leading voluntary health organization in Alzheimer's care, support and research. Our mission is to eliminate Alzheimer’s disease through the advancement of research, to provide and enhance care and support for all affected, and to reduce the risk of dementia through the promotion of brain health. Our vision is a world without Alzheimer’s. For more information, visit the Alzheimer’s Association at alz.org or call the 24/7 helpline at 800-272-3900.

Reprinted from: http://www.alz.org/documents_custom/facts-and-figures-2017-news-release.pdf

Making it Easier to Keep Aging Relatives in Their Homes

by Kevin Graham on August 26, 2016

When we were younger, there’s no doubt many of us thought of our parents as the equivalent of Superman and Wonder Woman. If we ever got into any difficulty or personal struggle, they were there to lend physical and emotional support.

When those who are important to us start to slow down, it’s natural to want to provide the best support we possibly can for those who have stepped up for us time and again over the years.

Nursing homes and assisted living facilities are certainly viable options, but you may find that you want to keep your parents in their home. If possible, why not keep them in the place where they feel most comfortable? This post is all about resources to let seniors age in place rather than leaving their home and community.

Determine the Type of Care They Need

Anne Sansevero is a gerontological nurse practitioner and aging life care professional with over 30 years’ experience in the field. She runs HealthSense, a company dedicated to helping people with eldercare management strategies She said the most important thing to do to get started is to determine what type of assistance is needed. The best person to answer that is someone specializing in aging life care.

“The doctor won’t always be able to tell you that,” she said. “Doctors know a lot about disease processes, they don’t necessarily know about the bigger picture of needs.”

An aging life care professional will be able to evaluate needs in the home and in the community based on the doctor’s diagnosis. It’s also key to have someone familiar with the programs in your area do the evaluation as they should have the best understanding of local resources. Depending on the situation, they may also do periodic reevaluation.

Sansevero gave an example based on someone with Alzheimer’s. In the beginning stages, there are short-term memory changes. A person who is still fairly functional with activities of daily living might only have trouble remembering to take their medication. There are fairly cheap technological solutions to this including reminder apps. In a couple of years, if an individual starts to wander and get lost, then you could look into more constant supervision at that time.

Making Home More Accessible

Before we go further into types of care resources that are available, we need to discuss some basic home modifications for seniors you may be able to do to make living a little easier as your loved ones age.

You can install items like grab bars and nonskid mats that help to reduce the risk of falls in the shower. Having a lower tub-shower threshold will also help because you don’t need to take as big of a step up in order to get in and out. You may also be able to secure a relatively inexpensive shower seat.

A big part of this includes removing barriers. Widening doorways for wheelchairs and walkers could become important as well as having everything on one level. The current home may not be set up for this and it could require more extensive modification. In some cases, you might have to find your loved ones a different home to accommodate their aging.

At this point, it obviously becomes a bit more of an expensive proposition. Let’s take a look at some ways to pay for this.

Financial Planning

Once you know what type of care is needed and you’ve done everything that can easily be done to remove barriers in the home, now it’s time to look at ways to pay for care.

First, let’s look at a couple of cold, hard facts to see what we’re up against.

Amanda Lambert is an aging life care professional who runs Mindful Aging, an eldercare resource website.

She said a good home care aide can cost as much is $20 – $30 per hour depending on where you live, and if you hire privately through an agency. If you have to hire a nurse, that cost might start at $50 and go up. A certified nursing assistant (CNA) might fit somewhere in the middle.

If you have family support, they may be able to help keep the cost down by providing some care themselves.

The type of aide that can perform the services may depend on the state you’re in. Some states allow personal care attendants to do more tasks than others. In certain states, for example, personal care attendants are allowed to administer medication in one state while another requires a CNA.

Save Where You Can

There’s a certain amount of expense to all of this care, but before you go paying top dollar for everything, it’s important to be able to take a look at economical or free resources in the community.

Sansevero said that she provides a list of resources for clients when the evaluation is done. Your aging life care professional should be able to help you. Besides that, you can take a look at your local Area Agency on Aging. There also may be nonprofits dedicated to helping seniors in your area as well as religious groups. Take a look at charities dedicated to the particular malady from which your relative is suffering.

Medicare may also pay for certain specific treatments after a hospital stay if they’re needed in the short term. For example, they might pay for three in-house visits per week from a physical therapist for a maximum of 90 days. Personal care activities such as bathing and dressing wouldn’t be covered if that was the only thing they needed help with.

If you’re a veteran or a surviving spouse, there may be resources available to you through the Veterans Affairs Administration.

In this area, Lambert said a long-term care policy might be helpful. They pay as long as a medical need exists. This is periodically reevaluated.

Medicaid may also cover some services that Medicare doesn’t, but there are strict income and asset limits. If you qualify for Medicaid, there may be additional resources on your local county level you can find.

Finding the Money

Fairly early on, you need to start thinking about a strategy to help pay for all of this. Unless you’re independently wealthy, it’s a fairly sizable investment for your relatives and possibly yourself.

Lambert said it’s important for people to get in touch with a financial planner or attorney that specializes in eldercare planning.

“If they’re looking to the possibility that they may need to qualify for Medicaid down the road, a good financial planner will do an estate plan that keeps that in mind and is able to protect some of those assets so that they won’t be counted against Medicaid,” she said.

One option you might take a look at if you don’t want to spend all of your resources to qualify for Medicaid is a reverse mortgage. If you have a ton of equity in your home or even own it free and clear, this can be an excellent option to allow you to get money based on the equity in your home and your age. You still own your home, so you can stay there, without having to make a mortgage payment.*

Reverse mortgages are also a nonrecourse loan, meaning your heirs only have to pay back what they can get from the sale of the property. They have the option of refinancing into a normal mortgage if they want to keep the house.

If you would like to take a look at reverse mortgage options, check out our friends at One Reverse Mortgage.

The best option for you will depend on both the medical and financial situation you’re dealing with. Carefully consider all avenues before making any decision.

Reprinted from:  https://www.quickenloans.com/blog/making-easier-keep-aging-relatives-homes

Assisted Living vs. Nursing Home Care

Monday, September 19th, 2016 by Cathy Cassata

As a family caregiver you may find yourself limited in the level of care you can offer your aging loved one. It’s not uncommon for caregivers to find at some point that they can no longer provide the emotional, physical or social support their loved one needs and deserves on a daily basis. But, deciding where the next best place for them to go is can be difficult. Here’s a few things to consider about assisted living facilities and nursing homes (also known as skilled nursing facilities).

Know What They Don’t Offer

While assisted living facilities are supervised communities that offer services such as meals, social activities, and assistance with activities of daily living (e.g. bathing and dressing), one focus at these communities is to provide a healthy social environment so that elders don’t become socially isolated.

“Assisted living by definition is a lesser level of care [than a nursing home] and typically a more home-like environment often looking like an apartment. It is for someone whose prior living arrangement is no longer adequate,” says Jan L. Welsh, an Aging Life Care Manager and owner of Special Care for Older Adults, in Cincinnati, Ohio.

Because assisted living communities are considered non-medical facilities and are not licensed by Medicare or Medicaid to provide skilled care, they are not required by law to have a licensed nurse on staff. Even if a nurse is employed by the assisted living facility, which is often the case, the nurse cannot give residents hands-on skilled nursing care, which is defined by the federal and state governments and includes dressing wounds, administering insulin and oxygen, and more.

Assisted living facilities do not have the same safety or administrative requirements as a skilled nursing facility, and they are prohibited from providing any types of care they are not licensed to give.

“Some assisted living programs offer enhanced services, so you can receive a similar level of care that a nursing home would offer, as long as the family can pay for the services in addition to the room and board,” says Nancy E. Avitabile, who, like Jan, is an Aging Life Care Manager and owner of Urban Eldercare, LLC​​​, a care management practice based in Manhattan. “With this option, as the person becomes more immobile and eventually bedbound he or she could continue living there.”

Is Skilled Care a Must?

Nursing homes are set up like hospitals and staffed with registered nurses, licensed practical nurses, and certified nursing assistants who are licensed to provide skilled care. Skilled nursing facilities are regulated by the Department of Health and can bill Medicare and Medicaid for skilled nursing care, so they must comply with many complex legal regulations and requirements. For elders who need round-the-clock supervision, or who may need that level of monitoring in the near future, a nursing home may be the best option.

“When a caretaker can no longer provide what’s needed for their loved one, for instance, if the person needs ongoing dialysis or is bed-bound or needs a ventilator, those are appropriate times to consider nursing home,” says Avitabile.

While a senior’s health will inevitably decline over time, knowing which type of care your loved one will need in the future is hard to predict, adds Avitabile.

One thought is that your loved one may choose an independent living community first, then assisted living and then move to a nursing home when more advanced care is needed.

“That order works well for some people, but some people don’t necessarily have to enter assisted living even if they’re chronically ill,” says Avitabile. “We get conditioned to think that ‘OK, now my parent is older and becoming more frail and they can’t fully take care of themselves so now let’s move to assisted living.’ That’s not always the next step. Sometimes it’s less expensive to have an elder stay in their home and provide services for them there.”

Welsh adds that sometimes a person’s health actually improves when they are placed into a facility because they are in a more stable or healthy environment and at other times it declines. If a person was missing medications or eating poorly, those things can be easily stabilized in a nursing (or assisted living) environment. On the other hand, if the facility care is less than the care the person was receiving at home, or the person has a difficult time adjusting, they can go downhill quickly, she notes.

Major Factors for Nursing Home Placement

Determining whether a loved one should move into a nursing home will be based on several factors unique to each individual. However, Welsh says the following are major indicators:

·         Increase in falls and wandering around dangerously

·         Medication management becomes complicated

·         Incontinence

·         Family fears the risks of being responsible for the aging loved one

·         When aging loved ones become victims of phone, mail or door-to-door scams

·         Sudden change in health (particularly diabetes, stroke, etc.) and independence of the aging person

·         Diagnosis of dementia or Alzheimer’s disease

The senior’s personal preferences, whether expressed in Healthcare Power of Attorney documents or based on prior life style

Think Long-Term

Before deciding on a long-term residence, think about the long run.

“Moving is stressful. Moving an older adult who then decides they don’t want to be there is incredibly stressful for them. If you’re interested in a place, after looking at several and meeting with staff, I’d suggest having your loved one stay for a weekend, or at the least a whole weekday to get a sense of how it is day to day,” notes Avitabile.

Besides the health and lifestyle care your loved one will need, Avitabile says consider the following before making a decision:

·         Cost

·         Flexibility

·         Proximity to family

·         How easily your loved one will acclimate in the environment

·         How easily your loved one connects with new faces and other people

No matter where your loved one lives, Avitabile says to keep the following in mind. “It’s very important that family finds ways to engage with the elder and arrange for visitors,” she says. “You can’t assume anything. Nursing homes have improved over the years, but the more present family members, aging care coordinator or caregivers are, the more the nursing home is aware that other people are looking out for your loved one.”

Reprinted from: https://www.seniorhomes.com/w/assisted-living-vs-nursing-home-care/

Who Will Care for the Caregivers?

By Dhruv Khullar  JAN. 19, 2017

I should have put his socks back on.

The thought kept nagging me as I finished my clinic notes, replaying the afternoon in my head. My final patient of the day — a man with dementia — was a late addition to the schedule, after his daughter, herself a patient of mine, called to report he hadn’t been himself lately. We scheduled him for the last appointment, so she could join after finishing work across town.

She recounted the subtle changes she’d noticed in her father. He’d been eating less, sleeping more. He was less steady on his feet and seemed uninterested in playing with his grandchildren — an activity that normally filled him with irrepressible joy.

From her purse, she pulled out no fewer than eight pill bottles — each with a dose, time and frequency meticulously labeled. She handed me a handwritten transcript of his other recent appointments: an ophthalmologist, a neurologist, a cardiologist. As I examined him, her phone rang.

“Grandpa isn’t feeling well, sweetie,” she said. “There’s macaroni in the fridge. We’ll be home soon.”

She hung up and apologized for the interruption. Then she leaned over to pull his socks over his bare feet — socks I’d removed moments before and left on the exam table.

I should have put his socks back on.

There are some 40 million Americans like my patient’s daughter. Every day, they help a parent, grandparent, relative or neighbor with basic needs: dressing, bathing, cooking, medications or transportation. Often, they do some or all of this while working, parenting, or both. And we — as doctors, employers, friends and extended family — aren’t doing enough to help them.

According to AARP and the National Alliance for Caregiving, the typical family caregiver is a 49-year-old woman caring for an older relative — but nearly a quarter of caregivers are now millennials and are equally likely to be male or female. About one-third of caregivers have a full-time job, and 25 percent work part time. A third provide more than 21 hours of care per week. Family caregivers are, of course, generally unpaid, but the economic value of their care is estimated at $470 billion a year — roughly the annual American spending on Medicaid.

A recent report from the National Academies of Sciences, Engineering and Medicine suggests that society’s reliance on this “work force” — largely taken for granted — is unsustainable. While the demand for caregivers is growing because of longer life expectancies and more complex medical care, the supply is shrinking, a result of declining marriage rates, smaller family sizes and greater geographic separation. In 2015, there were seven potential family caregivers for every person over 80. By 2030, this ratio is expected to be four-to-one, and by 2050, there will be fewer than three potential caregivers for every older American.

This volunteer army is put at great financial risk. Sixty percent of those caring for older family members report having to reduce the number of hours they work, take a leave of absence or make other career changes. Half say they’ve gotten into work late, or had to leave early. One in five report significant financial strain. Family caregivers over 50 who leave the work force lose, on average, more than $300,000 in wages and benefits over their lifetimes.

Even worse, perhaps, is the physical and emotional toll of extended caregiving. Family caregivers are more likely to experience negative health effects like anxiety, depression and chronic disease. One study found that those who experienced mental or emotional stress while caring for a disabled spouse were 63 percent more likely to die within four years than noncaregivers who were also tracked. Another study found that long-term caregivers have disrupted immune systems even three years after their caregiving roles have ended. And caregivers of patients with long I.C.U. stays have high levels of depressive symptoms that can last for more than a year.

As overworked and underappreciated as family caregivers are, health systems, under pressure to reduce costs, increasingly rely on them to manage illness at home.

There’s more we medical professionals can do to improve the way we engage, support and educate them. Family caregivers aren’t always clearly listed in the medical record, and even when they are, we often fail to include them in important decisions about a patient’s treatment plan — despite expecting them to carry out that plan at home. We assume they’re able to perform complex medical tasks — administering injections, changing catheters, dressing wounds, starting tube feeds — but fewer than half of family caregivers receive the training to perform them.

The Academies’ report highlights several measures that could help. First, simply identify caregivers, assess their abilities and anticipate challenges they’re likely to encounter. The United Hospital Fund has developed a tool to understand caregivers’ existing home or work duties, as well as what training they’ll need to perform new caregiving tasks and any concerns they have about the treatment plan.

Having counseling and support services available to caregivers, as well as respite programs to temporarily relieve them of their responsibilities, could also help. And clinicians could be trained in how best to educate family caregivers, and to better meet their emotional and physical needs. A nurse might demonstrate how to turn a patient in bed without risking back strain. Or the right way to deliver an insulin injection — how to pinch the skin, what angle to insert the needle — and what signs to look out for if blood sugar levels get too low.

Policy makers can help caregivers, too. More than 30 states have passed versions of the Caregiver Advise, Record, Enable (CARE) Act. The act requires hospitals to identify family caregivers, inform them when patients are being discharged, and provide them with basic education on the tasks they’ll be expected to perform. Other policy changes might strengthen financial support for caregivers by increasing the amount of available paid leave and encouraging employers to offer more flexible work hours.

Caregivers should also feel comfortable speaking up about their needs, and asking for information on services available in their area. Increasingly, there are support groups available to those caring for patients with Alzheimer’s disease, cancer and other serious illnesses. The government’s Eldercare Locator is an online tool that allows older people and their caregivers to identify community organizations that can help with meals, transportation, home care, peer support and caregiving education.

Similarly, local Area Agencies on Aging can help connect patients and caregivers to the services they need. Employers might consider “time-banking” programs to share leave among employees. And, of course, we can all call to check in on a caregiver, and volunteer our time to give them a break.

If it’s a certainty that all of us will experience illness, it’s a near-certainty that most of us will care for someone with an illness. But our current conception of patient and disease seems too narrow. It may help to recognize that while patients’ needs come first, illness is often a family affair.

For many, caring for a loved one provides tremendous purpose and fulfillment. It can deepen relationships and offer the time and space for connection where it otherwise might not exist. It seems that the goal, then, should not be to reduce family caregiving, but to reduce its burdens.

About the Author:  Dhruv Khullar, M.D., M.P.P., is a resident physician at Massachusetts General Hospital and Harvard Medical School. Follow him on Twitter at @DhruvKhullar.

Reprinted from: https://www.nytimes.com/2017/01/19/upshot/who-will-care-for-the-caregivers.html?smid=nytcore-ipad-share&smprod=nytcore-ipad&_r=0