Can Fluffy Come to the Nursing Home with Me?

Several studies show the benefits of pets, and senior care communities are increasingly adopting pet-friendly policies.

IAdvance Senior Care’s recent post, “How Senior Care Community Design is Changing to Become More Pet-Friendly,” explains that pets can provide many valuable benefits in senior care settings, particularly because of their effects on mental and physical health. One study found that the presence of dogs was linked to less agitation and fewer behavioral issues for Alzheimer’s patients. In fact, according to News in Health, pets have been shown to help decrease the stress-related hormone, cortisol and lower blood pressure in residents who interact with our furry friends. Studies have also proven that pets can boost mood, reduce loneliness and help seniors feel they have social support.

In addition to health benefits, pets can also provide an important consistency for those who may be moving into a senior care setting. Many people see pets as family members, and a pet-friendly community that permits new arrivals to bring pets with them can avoid a painful separation.

More senior care communities are adopting pet-friendly policies, which can require design changes.

According to Natalie Ruiz, AIA, LEED, AP, NCARB, CDT, associate principal at CallisonRTKL, senior care communities that adopt a more pet-friendly approach see multiple benefits. “For residents, having a pet helps combat loneliness, increases social interaction and gives a sense of purpose,” she explains. “For communities, they see their residents thrive with increased mobility resulting from walking a dog or grooming a cat. There’s also a simple uptick in the job and happiness that comes with the residents having a sense of purpose.”

Ruiz says that in addition to designs and renovations that accommodate residents’ pets, some facilities also benefit from pet therapy programs that introduce community pets for residents to enjoy. In these instances, the facility’s residents still have access to animal companionship but don’t have the time or financial commitments of pet ownership. With the benefits of pets, care communities are increasingly requesting new pet-friendly elements. Ruiz said more and more senior care communities are working to include dog parks with dog washes and pet water fountains. Dog runs are also popular requests.

Ruiz says that while facilities can easily create dog-friendly spaces, they should also give some thought to creating a space for cat lovers. She also suggests that a care center trying to become pet-friendly should designate a pet coordinator who can help the residents with pet care.

Reference: iAdvance Senior Care (Nov. 30, 2021) “How Senior Care Community Design is Changing to Become More Pet-Friendly”

Does Lack of Clutter Help with Dementia?

Researchers in Great Britain looked at whether people with dementia were better able to carry out tasks, such as making a cup of tea, at home surrounded by their usual clutter or in a clutter-free environment. The researchers were surprised to find that participants with moderate dementia performed better when surrounded by their usual clutter.

News Medical Life Sciences’ recent article entitled “People with dementia may not benefit from a clutter-free environment” also noted that the different environments made no difference to those with mild and severe dementia. These patients were able to perform at the same level in both settings.

Professor Eneida Mioshi, from the University of East Anglia’s School of Health Sciences, said: “The majority of people with dementia live in their own home and usually want to remain living at home for as long as possible. So it’s really important to know how people with dementia can be best supported at home – one possible route would be by adapting the physical environment to best suit their needs.”

He also noted that as dementia progresses, seniors will gradually lose their ability to carry out daily tasks due to changes in their cognitive, perceptual and physical abilities. The professor went on to say that participation in daily tasks could then be improved, by adapting the individual’s environment.

“To this end, we wanted to investigate the role of clutter in activity participation, given the potential to use de-cluttering to support people with dementia to continue to be independent,” Professor Mioshi explained. “Environmental clutter has been defined as the presence of an excessive number of objects on a surface or the presence of items that are not required for a task.”

Mioshi also said it’s generally assumed that an individual suffering from dementia will be better-able to carry out daily tasks, when their home space is tidy and clutter free. However, he noted that there’s been very little research on this hypothesis.

Occupational therapist and PhD student Julieta Camino carried out the study with 65 participants who were grouped into those with mild, moderate and severe dementia. The participants were asked to carry out daily tasks, including making a cup of tea and making a simple meal, both at their own home and at UEA’s specially designed NEAT research bungalow – a fully furnished research facility that feels just like a domestic living space.

The researchers looked at their performance of activities in both settings, and also measured the amount of clutter in the participants’ homes. The NEAT home setting, however, was completely clutter free. They believed the complete absence of clutter in the research facility would play a beneficial role in helping people with dementia with daily living activities. However, we were wrong. Overall, those with moderate dementia, in particular, performed daily tasks better at home, despite the fact their homes were much more cluttered than the research bungalow.

Moreover, it didn’t seem to make any difference how cluttered the participant’s home was. The only factor that contributed to how well they could carry out tasks at home was their level of cognition – with those with severe dementia encountering the same difficulties to perform the tasks at home and in the research facility.

Sian Gregory, Research Information Manager at Alzheimer’s Society, said: “We can sometimes make assumptions about what might help someone with dementia who’s living at home, like de-cluttering so they can concentrate on tasks like making a cup of tea. But, as this study shows, our ideas might not always be right.

“Challenging assumptions is so important for careers to understand how to help someone with dementia to live well in their environment. That’s why the Alzheimer’s Society funds a variety of studies like this one to evaluate what actually works for people living with dementia today, as well as finding treatments for the future.”

Reference: News Medical Life Sciences (Nov. 26, 2021) “People with dementia may not benefit from a clutter-free environment”

Alexa, How Can You Help Seniors

Amazon’s new programs run through Alexa Smart Properties, which allows organizations to control a centralized Alexa system, according to MSN’s recent article “Amazon announces Alexa program for hospitals and senior care.”

“Early on in the pandemic, hospitals and senior living communities reached out to us and asked us to help them set up Alexa and voice in their communities,” Liron Torres, global leader for Alexa Smart Properties, said in an interview with The Verge.

“Hospitals wanted ways to interact with patients without using protective equipment, and senior living communities wanted to connect residents with family members and staff,” Torres says.

The program allows senior living facilities to employ Amazon Echo devices to send announcements or other messages to residents’ rooms. During the COVID-19 pandemic, many facilities relied on printed out sheets of paper slipped under resident doors to communicate changes in protocols, like around meals or quarantines. However, the Alexa program now lets them send messages immediately into patient rooms.

“Staff can be more available for other tasks,” Torres says.

Senior facility residents can also place calls through Alexa to family members or friends, without having to rely on a staff member. Approved contacts would also be able to call in through Alexa. The facility could enable calling for a list of contacts approved by the resident and family members when they arrive.

Two networks of senior living communities, Atria (which is nationwide) and Eskaton (based in California), are adding Alexa to some facilities, Amazon announced.

In hospitals, the Alexa Smart Properties program allows nurses to speak with patients through the calling and intercom-type drop-in features without having to enter patient rooms. Patients could ask questions, or nurses could see how a patient is feeling with this feature.

“This enables hospitals to increase productivity and be able to save on medical supplies,” Torres says.

Hospitals can also send information and announcements to patients through Alexa.

Reference: MSN (Oct. 25, 2021) “Amazon announces Alexa program for hospitals and senior care”

Talk to Parents about Estate Planning without Making It Awkward

If you don’t have this conversation with parents when they are able to share information and provide you with instructions, helping with their care if they become incapacitated or dealing with their estate after they pass will be far more difficult. None of this is easy, but there are some practical strategies shared in the article “How to Talk to Your Parents About Estate Planning” from The Balance.

Parents worry about children fighting over estates after they pass, but not having a “family meeting” to speak about estate planning increases the chance of this happening. In many cases, family conflicts lead to litigation, and everyone loses.

Start by including siblings. Including everyone creates an awareness of fairness because no one is being left out. A frank, open conversation including all of the heirs with parents can prevent or at least lessen the chances for arguments over what parents would have wanted. Distrust grows with secrets, so get everything out in the open.

When is the right time to have the conversation? There is no time like the present. Don’t wait for an emergency to occur—what most people do—but by then, it’s too late.

Estate planning includes preparing for issues of aging as well as property distribution after death. Health care power of attorney and financial power of attorney need to be prepared, so family members can be involved when a parent is incapacitated. An estate planning attorney will draft these documents as part of creating an estate plan.

The unpredictable events of 2020 and 2021 have made life’s fragile nature clear. Now is the time to sit down with family members and talk about the plans for the future. Do your parents have an estate plan? Are there plans for incapacity, including Long-Term Care insurance? If they needed to be moved to a long-term facility, how would the cost be covered?

Another reason to have this conversation with family now is your own retirement planning. The cost of caring for an ailing parent can derail even the best retirement plan in a matter of months.

Define roles among siblings. Who will serve as power of attorney and manage mom’s finances? Who will be the executor after death? Where are all of the necessary documents? If the last will and testament is locked in a safe deposit box and no one can gain access to it, how will the family manage to follow their parent’s wishes?

Find any old wills and see If trusts were established when children were young. If an estate plan was created years ago and the children are now adults, it’s likely all of the documents need to be revised. Review any trusts with an estate planning attorney. Those children who were protected by trusts so many years ago may now be ready to serve as executor, trustees, power of attorney or health care surrogate.

Usually, a complete understanding of the parent’s wishes and reasons behind their estate plan takes more than a single conversation. Some of the issues may require detailed discussion, or family members may need time to process the information. However, as long as the parents are living, the conversation should continue. Scheduling an annual family meeting, often with the family’s estate planning attorney present, can help everyone set long-term goals and foster healthy family relationships for multiple generations.

Reference: The Balance (Oct. 15, 2021) “How to Talk to Your Parents About Estate Planning”

What are Latest Trends in Senior Care Facility Design?

iAdvance Senior Care’s recent article entitled “The Newest Trends in Senior Care Facility Design” interviewed Christine Cook, NCARB, principal with the Dallas-based design boutique three. She explained that she’s seeing several new trends that are shaping the industry.

“Owners and operators are working to connect through lifestyle choices, in combination with a healthcare amenity, to reach the target pool of prospective residents. ‘Active aging’ and ‘purposeful lifestyles’ resonate favorably with both residents and their families. This shifts the perception away from residency as need-based or compelled to a feeling of joining the community by choice,” she remarked.

Other design trends include more tailored residential apartments and cottages. There is also an increased demand for amenities, both on-site and within walking distance.

“Also, it is foundational to ensure consistency of the design aesthetic and quality of materials across the continuum-of-care, from independent living to assisted living and memory care,” says Cook.

Cook also said that many existing communities are decreasing their skilled nursing offerings. They’re customizing assisted living and memory care environments, tailoring them to the residents’ needs. “Most new communities are not incorporating skilled nursing at all.”

The COVID-19 pandemic has also prompted an increased focus on cleanliness and practical material selection. “Escalating cleaning protocols are demanding increased attention to the selection of finishes,” says Cook.

“Materials must be durable and resilient, otherwise replacing them when they wear out will have to be cost-effective — think modular cabinetry or tile flooring. We have also had to address plans for processional arrival sequences at entryways, modifying and limiting them to ensure there will be no security breaches with respect to disease migration.”

She’s also seen an uptick in requests for no-touch access controls for resident and staff-only areas. Cook notes that there’s also a market preference for larger balconies and full-height windows to allow for more natural daylight. Designs that reinforce healthy connections to nature, like balconies doubling as outdoor great rooms, can prompt residents to be more inspired and engaged.

However, Cook says that owner-operators frequently describe two common challenges: Keeping occupancy rates high and attracting and retaining high-quality, mission-focused staff.

Cook thinks that several trends will continue to define the senior care market in the future. These include increased demand for pocket-park communities, which usually consist of 10 to 12 cottages that are organized around or near an activity center. These communities are often developed in association with a larger senior care community or health provider.

Reference: iAdvance Senior Care (Oct. 12, 2021) “The Newest Trends in Senior Care Facility Design”

How Does Medicaid Count Assets?

For seniors and their families, figuring out how Medicaid works usually happens when an emergency occurs, and things have to be done in a hurry. This is when expensive mistakes happen. Understanding how Medicaid counts assets, which determines eligibility, is better done in advance, says the article “It’s important to understand how Medicaid counts your resources” from The News-Enterprise.

Medicaid is available to people with limited income and assets and is used most commonly to pay for long-term care in nursing homes. This is different from Medicare, which pays for some rehabilitation services, but not for long-term care.

Eligibility is based on income and assets. If you are unable to pay for care in full, you will need to pay nearly all of your income towards care and only then will Medicaid cover the rest. Assets are counted to determine whether you have non-income sources to pay for care.

Married people are treated differently than individuals. A married couple’s assets are counted in total, regardless of whether the couple owns assets jointly or individually. The assets are then split, with each spouse considered to own half of the assets for counting purposes only. Married couples have some additional asset exemptions as well.

Not all resources are considered countable. Prepaid funeral expenses, a car used to transport the person in the care family and qualified retirement accounts may be exempt from Medicaid’s countable asset limits.

For married couples, their residence for a “Community Spouse”—the spouse still living at home, and a large sum of liquid assets, are also excluded. Many non-countable assets are very specific to the individual situation or current events. For example, stimulus checks were exempt assets, but only for a limited time.

Medicaid sets a “snapshot” date to determine asset balances because some assets change daily. For unmarried individuals, all asset protections and spend-downs must happen prior to submitting the application to Medicaid. A detailed explanation must be included, especially if any assets were transferred within five years of the application.

For married couples, a Resource Assessment Request should be submitted to Medicaid before any action is taken. This document details all resources Medicaid will count and specifies exactly how much of these resources must be “spent down” by the institutionalized spouse for eligibility.

In many cases, assets are preserved by turning the countable asset into a non-countable income stream to the spouse remaining at home.

Medicaid application is a complicated process and should be started as soon as it becomes clear that a person will need to enter a facility. Understanding options early in the process makes it more likely that property and assets can be preserved, especially for the spouse who remains at home.

Reference: The News-Enterprise (Oct. 5, 2021) “It’s important to understand how Medicaid counts your resources”

How Do I Hire an Elder Law Attorney?

Elder law attorneys are lawyers who assist the elderly and their family members, and caregivers with legal questions and planning related to aging.

These attorneys frequently are called upon to assist with tax planning, disability planning, probate and the administration of an estate, nursing home placement, as well as a host of other legal issues, says Forbes’ recent article entitled “Hiring An Elder Law Attorney.”

In addition, there are some elder law attorneys who have the designation of Certified Elder Law Attorney (CELA), a certification issued by the National Elder Law Foundation. A Certified Elder Law Attorney must meet licensing and other requirements, including specific experience in elder law matters and continuing education in elder law. However, note that an elder law attorney does not need to have the CELA certification to be an experienced elder law attorney.

There are many elder law attorneys who specialize in Medicaid planning to help protect a senior’s financial assets, if they suffer from dementia or another debilitating illness that may require long-term care. Elder law attorneys also prepare estate documents, such as a durable power of attorney for health and medical needs and a living will. As you age, the legal issues that you, your spouse, and/or your family caregivers must address can also change.

If you are a senior, then you should have durable powers of attorney for financial and health needs, in the event that you or your spouse becomes incapacitated. You might also need an elder law attorney to help you transfer assets if you or your spouse move into a nursing home to avoid spending your life savings on long-term care.

Healthy people over 65 are in the best spot to do more than having estate planning documents prepared. That’s because they have the opportunity to develop a holistic strategy beyond the legal documents. This can give assurances that the family members and professionals they’ve assembled understand the principle of supported decision-making and how it will be implemented.

For example, an elder law attorney may focus on finding the least restrictive residential environment and making other health care and financial choices. An elder law attorney can also protect seniors with diminished capacity, who are being victimized by personal and financial exploitation.

An initial consultation with an elder law attorney will help determine the types of legal services they can offer, and the fees associated with these services.

Reference: Forbes (Oct. 4, 2021) “Hiring an Elder Law Attorney”

Is a Cup of Joe Help Healthy for Seniors?

Nutrition experts and medical researchers are finding all kinds of reasons to recommend indulging in a cup of joe— most based on the fact that coffee is the single greatest contributor to total antioxidant intake, says AARP’s article entitled “Five Surprising Health Benefits of Coffee.”

“Coffee is abundant in bioactive compounds that promote health,” says Kristin Kirkpatrick, a registered dietitian at Cleveland Clinic. As she explains, research published in The New England Journal of Medicine shows that these compounds may improve the gut microbiome (made up of healthy bacteria that aid in digestion and boost immunity) and reduce what’s called oxidative stress, which occurs when free radicals outnumber antioxidants in a way that leads to disease-causing cellular damage in the body. “The beans also have a deep rich hue, and we know that the deeper the color of a plant, the more benefits we can expect for health.”

However, moderation is the key. Three to five eight-ounce cups of coffee — or up to 400 mg of caffeine — per day can be part of a healthy diet. That is plain black coffee, not cappuccinos, lattes and macchiatos. Those are high in calories, sugar and fat. Let’s look at five health benefits of coffee that give you even more reason to enjoy your next cup.

Lowers Your Risk of Type 2 Diabetes. A large review of studies published in Nutrition Reviews found that your risk of developing type 2 diabetes drops by 6% for each cup you drink per day. That’s because coffee is packed with phytochemicals that may act as antioxidants, anti-inflammatory compounds, insulin-sensitivity boosters and more. The same goes for decaffeinated brews. A study published in the Journal of Internal Medicine found that those who drank two to three cups of filtered coffee a day — as opposed to unfiltered coffee (made with a pod, an espresso machine, or a French press) had a 60% lower risk of developing type 2 diabetes than people who drank less than one cup of filtered coffee a day. Those drinking unfiltered coffee didn’t see such a reduction in risk.
Heart Protection. A review of three major studies published recently in Circulation: Heart Failure found that drinking one or more cups of plain caffeinated coffee a day may reduce your risk for heart failure. (Decaf didn’t yield the same benefits.) Among those without diagnosed heart disease, researchers found that drinking up to three cups of coffee a day was associated with a lower risk of stroke, death from cardiovascular disease and death from any cause.

If possible, though, drink filtered coffee because unfiltered coffee contains two compounds that raise LDL cholesterol in some people, and high levels of LDL cholesterol increase your risk for heart disease and stroke.

Boosts brain health. Some research suggests that regular caffeine consumption may offer brain health benefits. In one study of people ages 65 to 84, published in the Journal of Alzheimer’s Disease, those who drank a cup or two of coffee daily had a lower rate of mild cognitive impairment than those who never or rarely consumed coffee. Other studies suggest coffee may also protect against Parkinson’s disease. However, some research shows that having over five or six cups a day may have an adverse health impact on the brain.
Improves your mood. Drinking coffee may reduce your risk of depression by nearly one-third, according to research from Harvard Medical School. The effect may be related to coffee’s anti-inflammatory properties. Coffee also has phytochemicals that feed the good bacteria in our guts. The good bacteria may produce or enhance other compounds that act on the brain and have beneficial effects on mood.
Maximizes workouts. Downing a cup before exercise can make a difference in your workout because coffee improves circulation, endurance and muscular strength. It also may reduce pain, according to a review of research published in 2019 in Sports Medicine. However, it is important to recognize that coffee can also act as a diuretic.

Reference: AARP (Sep. 20, 2021) “Five Surprising Health Benefits of Coffee”

Can Exercise Prevent Dementia?

Market Watch’s recent article entitled “How exercise can help prevent dementia” points out that although there’s no cure for Alzheimer’s disease, and an estimated 3% of all cases are entirely genetic, recent research suggests that some lifestyle interventions could slow its progression.

Dr. Dean Sherzai, a clinical neurologist and co-director of the Brain Health and Alzheimer’s Prevention Program at Loma Linda University in California, has developed a five-component lifestyle intervention therapy he uses with patients.

“We have people coming to us with early signs, or so-called subjective impairment, and then we have people a little more advanced, classified as having mild cognitive impairment, or MCI,” Dr. Sherzai explained. “We give them interventions, give them advice on changes they can make to their lifestyle components and we look at what happens.”

Of the five components in Dr. Sherzai’s lifestyle intervention, exercise is the one he typically recommends starting first.

“Whenever we apply behavior change to a population, we’re looking to create sustainable habits with small successes people can see right away, and nothing is better than exercise. It’s easy to implement, measurable and precise, with a fast return,” Dr. Sherzai said.

After only a couple of weeks of regular exercise, Dr. Sherzai’s patients often feel better, get better sleep and their lipid and blood glucose profiles improve. He says that these are some of the indirect ways exercise reduces risk for Alzheimer’s, because each of those factors are associated with higher rates of the disease. The doctor also mentioned three direct links between exercise and improved brain health:

Exercise increases blood flow to the brain, which delivers more oxygen and nutrients;
Exercise simultaneously flushes inflammatory and oxidative elements out the brain faster; and
An increase in a chemical called brain-derived neurotrophic factor (BDNF) which Sherzai says, “is almost like growth hormones for neurons, but specifically for the connections between neurons.” Maintaining these neuronal connections is a key in preventing Alzheimer’s disease.

Brain scientists agree that exercise is good for preventing cognitive decline but they don’t yet know if any one type is better than another. It is something that scientists are starting to research. For now, a number of studies have shown that both aerobic and resistance training have major cognitive benefits.

Sherzai recommends exercises involving the legs, whether that’s walking, running, cycling or weightlifting he says that’s because, “your legs — not the heart — are the largest pump in the body.”

Reference: Market Watch (Sep. 28, 2021) “How exercise can help prevent dementia”

Will Vets Get a Cost-of-Living Boost?

The Veterans’ Compensation Cost-of-Living Adjustment Act passed unanimously in the House and without objection in the Senate earlier in the summer. By the time you read this, President Joe Biden is expected to sign it into law.

Military Times’ recent article entitled “Veterans benefits could see a big cost-of-living boost later this year” explains that the legislation links the cost-of-living boost for veterans benefits to the planned increase in Social Security benefits. Although the Social Security increase is automatic every year, lawmakers must approve the veterans benefits increase annually.

The amount of the increase for next year is still not certain. The Social Security Administration is expected to announce the COLA rate for 2022 in October, based on economic trends over the last few months. That increase will go into effect for benefits checks sent out starting this December.

The cost-of-living bump hasn’t been above 3.0% since 2011, and has averaged less than 1.3% over the last six years.

However, officials from the Senior Citizens League predicted that next year’s rise could top 6.2%, based on recent inflation and wage data released by federal economists. If so, it would be the largest increase since 1983 for Social Security and VA benefits recipients.

Lawmakers praised the bill passage as needed support for American veterans.

“The cost-of-living adjustment to veterans’ benefits is so much more than a rate adjustment tied to inflation,” said Rep. Mark Takano, D-Calif., in a statement. “It is a quality-of-life guarantee in the retirement years for veterans suffering with service-connected disabilities and ailments.”

VA officials will announce the plan soon, which includes a review of service records to see if individuals’ eligibility for benefits should be approved.

Committee ranking member Mike Bost, R-Ill., said the increase is critical for veterans and families who rely on disability benefits as a primary source of income.

“Many veterans rely on disability compensation payments to make ends meet; this was especially true during the pandemic,” he said in a statement. “For millions of veterans and their families, this adjustment is more important now than ever before.”

The VA COLA increase applies to payouts for disability compensation, clothing allowance, dependency and indemnity benefits and other VA assistance programs.

Reference: Military Times (Sep. 21, 2021) “Veterans benefits could see a big cost-of-living boost later this year”

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