Posts Categorized: Long Term Care

A Warning for Long-Term Care Patients: Monitor Your B12 Levels

too many meds macroToday’s entry is a little different from my usual blogs, and it’s written especially for my clients who are currently receiving some form of long-term care.

A brand-new study out of Canada, reported in U.S. News & World Report, finds that Vitamin B12 deficiency is surprisingly prevalent among long-term care patients, and it’s a real concern.

Vitamin B12 deficiency is linked with:

  • Amenia
  • Changes in skin pigmentation
  • Depression
  • Difficulty walking
  • Fatigue
  • Gastrointestinal upset
  • Heart palpitations
  • Lightheadedness
  • Nerve problems
  • Respiratory problems
  • Vision loss
  • Weakness

Many of those conditions can exacerbate problems already common among long-term care patients.

Most concerning, though, is the fact that several studies have shown a direct link between vitamin B12 deficiency and memory loss, including dementia. That’s startling when you consider that dementia is emerging as one of the primary factors in the rising need for long-term care in the first place.

While many people assume that the deficiency is caused by a lack of B12 in the diet, it often stems from medications and/or underlying medical conditions that interfere with the body’s ability to absorb the B12 already in your diet.

The good news is that most cases of B12 deficiency can be easily managed. Detection is the key. That’s why we’re sounding the alarm.

If you or someone you love is in long-term care, have a talk with your healthcare provider about vitamin B12 as soon as possible.

You Can’t Paint Long-Term Care Insurance with a Broad Brush

Forbes has an interesting new article that traces the history of long-term care insurance in America. It’s a topic I suspect many college history courses fail to touch upon, and not many more law school classes either.

Essentially, the summary looks like this: For a long time, long-term care insurance wasn’t very good. Then, in the 1990s, it became almost too good to be true, with great benefits at a surprisingly low price. Those untenable policy benefits eventually led to higher premiums, though, along with a reduction in benefits and a dramatic consolidation of the available plans.

Today, we’re somewhere in between. There are fewer long-term care insurance plans available, and those that exist range from modestly helpful to moderately helpful — and never entirely sufficient on their own.Long-term care insurance form and dollars.

There is a tendency among some Americans to take out a long-term care insurance policy and decide that they’ve done everything they need to take care of themselves in old age. That’s far from the truth, and those people may be in for a rude awakening.

On the other hand, though, there is an equally misguided tendency in the industry to write off long-term care insurance altogether.

For some people, long-term care insurance can make sense as one piece in a larger advance planning puzzle. It’s all a question of timing, premium, benefits, and your personal needs and financial standing.

In other words, long-term care insurance remains an option worth considering, but it’s a very fact-specific inquiry.

If you’d like to know whether long-term care insurance might play a role in your own plans for the future, I’d be happy to talk about it. Give me a call today.

Nursing Homes Replacing Hospitals for Primary Senior Care

We always hear about the rising number of Americans who turn to hospitals (particularly Emergency Rooms) as their primary source of healthcare. Likewise, we hear a lot about the constantly rising costs of nursing homes in America — especially here in Massachusetts and throughout New England.

I was struck, then, by a recent New York Times article that makes a surprising report: senior citizens are increasingly less reliant on hospitals for healthcare, as nursing homes are able to step up to the plate in their place.

Why the shift? Here are a few factors:

  • Healthcare Mobility — As the Times notes, many complex procedures like blood transfusions used to require several days spent in an outpatient hospital wing. These days, those same procedures can practically be done on the go. Nursing homes can give their residents a quick lift to a nearby medical center for a transfusion in a matter of hours. All of the follow-up care, including IV therapy, can be done back in the resident’s own room.
  • Risk of Injury and Infection— Despite popular belief, the hospital isn’t the safest place for the elderly. Falls, bedsores, depression, and hospital-acquired infections are all dangerous and increasingly common risks of any hospital stay. While those perils are present in nursing homes too, the rates of occurrence tend to be a little lower there.
  • Costs — Nursing homes are extremely expensive, but so are hospitals. Regularly relying on hospital clinics or Emergency Rooms can prove even more financially taxing than the monthly nursing home bill. That fact has insurance companies, Medicare, and Medicaid urging nursing homes to ramp up their roster of hospital-like services.

Of course, there’s still a lot of work to be done. Amazingly, many of today’s nursing homes still don’t staff registered nurses 24/7, and not all homes offer the same easy access to nearby outpatient clinics.

It is encouraging to know, though, that alternative approaches to senior care are developing quickly. Within the next few years, we may see seniors spend less and less time in hospitals, and that should hopefully translate to financial savings, fewer infections, and a lower rate of hospital-related injury.

Naturally, though, paying for nursing home care remains a real challenge, regardless of how much additional time gets spent in a hospital. Fortunately, proactive planning can make those costs much more manageable. To that end, my office can be of some help. Give me a call today to talk about setting up a plan that makes sense for you.

Who Takes Care of You If You Don’t Have Kids?

When it comes to growing older, there is one great insurance plan that you simply can’t buy from an agent: your children.

Family members provide the majority of senior care in this country. They do it with little training, no pay, and in spite of their own busy lives — all out of the goodness of their hearts. The situation isn’t ideal, but given the cost of senior care (especially for those suffering with illness), it’s often the only practical option.

But what happens if you don’t have kids to care for you?

A new study shows that a growing number of people in the U.K. are choosing not to have children there. That could mean major changes to their healthcare system in less than a generation’s time. A few years ago, The New York Times told us that a similar trend is happening here in the United States.

Potentially, an increase in childless seniors could spell catastrophe for the healthcare system. But so far, that hasn’t been the case.

Studies find that childless couples do not receive less care on average than those with kids. Nor do they score any lower on the happiness index. Very few express regret over the decision not to become parents, just as those who did have kids are happy to have done so. It seems most people are more or less happy with their lot in life by the time they reach the end of it.

Still, the Times notes, older Americans do worry about who’ll help them down the road. For many, “chosen family” networks — friends, volunteers, and support groups — fill the void.

Will that continue as a viable system-wide solution as the number of childless elders grows? Only time will tell.

In the meantime, one of the best steps you can take for yourself is to begin a long-term care plan as soon as possible. Making legal and financial arrangements today could spare you a lot of hardship and anxiety in later years.

There’s no reason for anyone to fear the future, regardless of the lives they’ve chosen for themselves. If you’d like to talk about your options, feel free to give me a call. We can put together a plan that will give you peace of mind.

Amy Grant’s Three Tips for Family Caregivers

Amy Grant has made a career out of inspirational storytelling in song, earning six Grammy awards and more than thirty million record sales along the way. She’s one of the best-selling female recording artists of all time, but now she also has a new job title on her résumé: long-term care provider.

Grant’s parents were each diagnosed with different but severe forms of dementia late last decade. Her mother passed away in 2011, an experience that informed most of the songwriting on Grant’s most recent album, released in 2013.

Her father, meanwhile, still suffers from dementia so profound that he has lost nearly all his ability to communicate.

Grant sat down with Guideposts magazine to share three insights she’s found throughout the heartbreaking journey she’s taken with both her parents. Her tips for family caregivers include:

  1. “Frame your experience in a way that gives meaning to what you’re going through.” Grant said that the key for them was finding a silver lining in an otherwise trying experience. “This is the last great lesson that we’ll learn from our dad,” she says.
  1. Spread the responsibility. Grant recommends making a list of all the people to whom this aging person matters. Rather than allowing an excessive burden to fall on just a few shoulders, encourage extended family and friends to realize that they’re a part of the puzzle too. She concedes, though, that relating to someone with dementia can be challenging for some family members, especially youngsters.
  1. Start preparing to fund long-term care as soon as possible. While Grant’s dad was a successful doctor and she herself has gone on to enjoy superstar fame, she recognizes that most families aren’t as fortunate. She stresses the need for parents and children alike to consider insurance and long-term care planning, even if everyone in the family is still in good health.

Her advice is well taken, and it is nice to see someone in the public eye shine a light on the need for long-term care planning, even as it comes in the midst of her personal sadness. For more of Grant’s eloquent and inspiring story, watch her Guideposts interview online.

Is the Green House the New Nursing Home?

Every so often, cultural institutions give way to paradigm shifts. That might be the case with the conventional nursing home, according to a new report from The New York Times.

In today’s society, when parents age and become less self-reliant, they generally have three options: live with children or other close family members, hire in-home care, or move into a nursing home.

It’s not always a choice between the three, though. Living with family requires relatives with sufficient time and space for providing attendant care. In-home assistance, meanwhile, is extremely expensive — especially if it has to be around the clock.

So without adequate resources, many elderly people resign to the nursing home by default.

That isn’t always a bad thing. Some nursing home experiences prove to be happy and effective ones for their residents. But, as the Times argues, many would rather live somewhere else if given the chance.

As I mentioned earlier, though, paradigms change. Increasingly, seniors aren’t resigned to just the three conventional choices anymore. A variety of innovative approaches to senior living are diversifying the elder care marketplace.

One promising example is the Green House Project, a new kind of living environment for older Americans, already available in more than half the country. (There are currently two locations in Massachusetts — Westwood and Chelsea).

Green House residents live in pleasant cottages with their own private rooms and baths. The idea is to create a community in which seniors help take care of themselves and each other.

For example, those who’re able can help prepare the Green House meals, which are served in an inviting dining room rather than a stifling cafeteria. Residents schedule their own mealtimes and generally enjoy greater autonomy than they might have in a nursing home.

The Times talks about the project as a potential catalyst for industry-wide change. That’s an inspiring thought, especially when you consider that a variety of other nursing home alternatives are flourishing throughout the country at the same time.

Things keep looking up for the future of senior care in America, and I can’t wait to see what comes next.

Not Your Grandmother’s Long-Term Care

I always love to see major media outlets shine a light on elder care. Not long ago, “The Today Show” aired a wonderful segment about long-term care, encouraging young people to take it seriously and start learning about it now.

Carol Levine, author of Planning for Long-Term Care for Dummies, joined the hosts to talk about the changing face of long-term care in the United States.

“The newer approach to long-term care is really not your grandmother’s long-term care,” Levine explained. Today’s approach differs from the previous generations in a few key respects. Generally speaking, she says, these include:

  • A wider range of options
  • Longer time periods, as people live longer
  • Care plans that are based on what people need, not on institutions’ needs.

But some things don’t change. Long-term care is still confusing and still very expensive. “Today” cited costs that span from $40,000 to $75,000 a year —sometimes higher. Often, it’s the families that end up paying for most or all of that.

Levine’s basic advice is golden. Do your homework, she says, and begin now.

She suggested starting small. Make your parents’ homes safer, more accessible, and more fall-proof. Falls often trigger an early need for elder care.

From there, you can start to put together a financial plan that might include savings accounts, trusts, long-term care insurance, retirement funds, health insurance, and more.

Like most things in life, long-term care is a mountain best scaled one stone at a time. Starting early is the key. If you’re feeling overwhelmed or have any questions whatsoever, don’t hesitate to pick up the phone and ask. I’m more than happy to help.

Don’t Give Away Money Until You Know You Won’t Need It

Many in their 50s and older are thinking about gifting money to their adult children. Many are unsure if they can afford to do so. That’s because the real question they are asking is whether they have saved enough for themselves in retirement.

(Photo credit: Wikipedia)

(Photo credit: Wikipedia)

An article I read on marketwatch.com really zones in on this thorny question and suggests that many people won’t really know the answer to well into older age.

About 17 percent of wealth transfers occur while the giver is still alive, the story says. People enjoy seeing how their gifts are used to improve their loved ones’ lives. They also realize that if they wait too long to give, their heirs will already be old and into retirement before they get a chance to see any money.

But the story says that givers must consider the costs of long-term care when they are doling out gifts. Seven in 10 people are going to need help one day. And Medicare isn’t going to cover long-term care costs in most cases.

If you have long-term care insurance, you are probably going to be more comfortable giving money away while you are still alive. If you don’t have it, you probably will want to be more conservative in your gifting.

Nursing home costs run at least $10,000 a month in most places and most people who need one are going to be there for a few years. Home health aides, if you plan to stay at home, can run $20 an hour.

Medicaid pays for many people’s nursing home stays but you can’t just give away your money to meet the rigorous low income requirements to be covered by that program. There is a five-year look back period.

As a result, the article recommends you having enough money in the bank to cover at least five years of nursing home care before starting to gift to others. That’s about $600,000.

And don’t give away money thinking your children will give it back in the event you need it, the story warns. There may be many reasons why they can’t or won’t give it back.

Some people get around this issue by giving away possessions, like a beloved family piano, for example, rather than cash.

But the bottom line, the story says, is that you don’t owe them anything once you’ve raised them and educated them.

Some Thoughts About The Purchase Of Long-Term Care Insurance

The United States Department of Health and Human Services estimates that approximately 70 percent of Americans over the age of 65 will need some type of long-term care. Contrary to what many people believe, Medicare does not cover long-term custodial care. Given the cost of such care, it makes sense to consider your options, in advance, about how to obtain the care you might very well need without exhausting your life savings to pay for it.

Dad at Diamond Ridge Healthcare Center (Novemb...

(Photo credit: cseeman)

One such option is long-term care insurance. I recently came across an article in the Los Angeles Times with valuable information about purchasing long-term care insurance that I would like to share with you. Here are the highlights.

Your age and health matter.
The younger you are when you purchase long-term care insurance, the less expensive it will be. Unfortunately, if you have conditions such as diabetes or heart disease, your application might be rejected.

It is better to have some coverage than none at all.
The very best plans, such as those that adjust for inflation or cover the widest range of services, may be prohibitively expensive. Experts advise that policies with the option to add services in the future may be a better approach.

Know exactly what services are provided by your policy, and just as importantly, what services are not covered.

Take note of when the coverage begins.
Most policies have what is known as a waiting period. During the waiting period, you will have to pay for services on your own before the policy kicks in. As you would expect, the shorter the policy’s waiting period, the more expensive the policy will be.

Finally, if you buy your policy through an agent, ask him or her these three questions:

  • How long have you been selling long-term care insurance?
  • How many policies have you sold? Fewer than 100 is not enough.
  • How many insurers do you work with? The minimum should be three or four.

To learn more about long-term care insurance, I invite you to click here to read the entire article. I can also help you decide whether long-term care insurance is right for you. Simply call my office for a consultation.

Cost of Long Term Care (Genworth Survey 2014) 

How Reverse Mortgages Can Lead To Problems For Your Children

According to a recent New York Times article, children of parents who took out reverse mortgages to cover the cost of long-term care are increasingly faced with a difficult choice—watching helplessly as the family home goes into foreclosure, or losing their inheritances to pay back the loan and protect the home.

Housing

(Photo credit: james.thompson)

While there is no specific data on the number of heirs facing foreclosure as a result of reverse mortgages, interviews with elder law advocates, housing counselors, and heirs suggest that the problem may already be impacting tens of thousands of people. And the problem could become worse. The combined debt of seniors between the ages of ages of 65 and 74 is rising faster than the debt of any other age group. Some will turn to reverse mortgages to pay their debts. Meanwhile, 13 percent of outstanding reverse mortgages are underwater, and create a financial crisis for the heirs forced to deal with the mortgages.

The problem for heirs of parents who have passed away with reverse mortgages seems to be twofold. The law requires that lenders offer heirs 30 days from when the loan is due to decide what they wish to do with the property. Furthermore, heirs are supposed to be given six months to arrange for financing if they want to keep the home. It would appear that many lenders are not informing the heirs of these options, and instead initiating foreclosure within a matter of weeks.

The other problem centers on what is known in the industry as the 95 percent rule. Heirs are permitted to pay 95 percent of the current fair market value of the property to buy out the reverse mortgage. But the housing crises from a few years ago has rendered today’s market value significantly below what the heirs’ parents paid for their reverse mortgage. The disparity between the current value of the home and the mortgage often forces heirs to opt for foreclosure rather than trying to keep the family home, or at least keep it long enough to sell it on their own.

If you are considering a reverse mortgage to pay for long-term care costs, I invite you to contact me for a consultation. I can show you other ways to pay for the care you need, and preserve your hard-earned assets for the enjoyment of your well spouse and your loved ones.