What’s the Best Way to Find the Right Assisted Living Facility?

News 19 Alabama’s recent article entitled “How To Choose the Right Assisted Living Facility,” provides some valuable tips for researching assisted living facilities and finding the best option for you:

Get recommendations. Ask friends, family and your doctor about assisted living facilities in the area and if they would recommend them. If someone you know lives in an assisted living facility, ask them how they like it, as their experience can provide insight into what facilities have the best reputation in your local area.

Consider your needs. Residents in assisted living facilities typically need assistance with some basic activities of daily living. This includes bathing, dressing, eating, and getting around. Some assisted living communities specialize in caring for people with specific conditions, such as Alzheimer’s. The level of care assisted living facilities offer can vary greatly, so consider how much assistance you require.

Consider the cost. Remember that Medicare doesn’t cover assisted living costs, which is why most people pay with private funds even though it’s expensive.

Consider location. A facility near friends and families is often the best choice. This lets residents receive lots of visitors. Employees will also see that the resident’s visitors scrutinize their care.

Ask questions. Before calling assisted living facilities, consider these questions:

How many residents live at the facility?
Are pets allowed?
What amenities are available to residents?
Are there personalized care plans for each resident?
How are additional services billed?
Are there doctors, nurses, pharmacists, physical therapists, housekeepers, cooks, and activity directors on staff?
Does the facility run background checks on staff?
What happens if a resident’s health deteriorates and needs additional care or a hospital stay?
What safety features does each residential unit feature?
What is the staff-to-resident ratio during the day and at night?
What are the meals the facility serves?
Are all utilities included in the overall cost of a unit?

Take note when you visit. When you tour a facility, look at the cleanliness, activities, safety features, available common areas, the friendliness of the staff and how healthy and happy the residents appear.

Compare several facilities before you decide. Don’t just choose the first facility you visit. Instead, tour several facilities and compare them.

Carefully examine contracts. Read assisted living contracts from start to finish and look for unexpected fees or deposits. Yous should also pay attention to the rules regarding discharging or evicting a resident, late or missed payments and how the facility handles (or limits) your rights to file a lawsuit should there be an issue.

Reference: News 19 (May 14, 2023) “How To Choose the Right Assisted Living Facility”

What Should I Know About Advocating for a Loved One with Parkinson’s Disease?

Unfortunately, recent studies have shown that three out of every four hospitalized Parkinson’s Disease patients didn’t get their regular home medications on time or had doses entirely skipped.

Proper medication management is the most critical part of a successful hospitalization for someone with Parkinson’s Disease.

Antiparkinsonian medications (levodopa or amantadine, for example) must be given correctly, at the right time and in the correct dose.

If regular home medications aren’t provided in the hospital, Parkinson’s Disease patients can develop mental disturbances, increased muscle rigidity, tremors and difficulty communicating. As a caretaker, you have a vital role in helping the transition from home to the hospital run smoothly.

Next Avenue’s recent article, “How to Advocate for Your Hospitalized Loved One with Parkinson’s Disease,” has some ways you can do this.

Make sure you have an up-to-date list of medications your loved one takes. The list should include the name, dose, when it was last taken and what pharmacy is used for prescriptions. Be prepared to give this to the hospital staff when requested.

You should also list drug or food allergies, including reactions. For example, did a particular drug cause severe irritability or a rash in the past?

It is important to remain with your loved one when they arrive at the hospital until the first dose of their regular medication is administered. Note that a first dose can usually be delayed by several hours if the nurse needs to input the medication list into the chart immediately or if the hospital pharmacy is delayed in verifying the orders. However, after the first dose, future quantities will likely be on schedule.

Cooperate with nursing staff to make sure that your loved one is comfortable. Be direct, yet kind, in asking when the patient might need personal hygiene supplies, a quieter environment, or on-time medication.

As a caretaker, your education and experience regarding Parkinson’s Disease are powerful tools.

Some things might fall through the cracks in a busy hospital– and you know the patient best. So don’t be afraid to speak up and express your needs as you advocate for your loved one.

Reference: Next Avenue (December 22, 2023) “How to Advocate for Your Hospitalized Loved One with Parkinson’s Disease”

Will I Be Able to Afford Nursing Home Care?

About 60% of older adults — or 24 million households — wouldn’t have the resources to pay for in-home long-term care, despite the fact that they would prefer to “age in place,” per a National Council on Aging report.

Fox News’ recent article entitled, “Most seniors in America can’t afford nursing homes or assisted living, study finds,” says that the researchers looked at 2018 data from the Health and Retirement Study, which was a joint effort by the National Institute on Aging and the Social Security Administration that surveyed some 20,000 U.S. adults about their net wealth.

When the researchers started examining the data some years ago, they were initially surprised to see that so many older adults were at severe risk of financial insecurity, Dr. Jane Tavares, a lead researcher at the LTSS Center at UMass Boston, told Fox News Digital.

“There is a common misconception that older adults are asset-rich, but we have found in our research that this is not generally true,” she said.

Dr. Tavares also noted, “We expect that there will probably be some worsening, once we examine data for the period covering the COVID pandemic.”

The national average cost for assisted living is $4,500 per month. However, it can vary significantly depending on the location and level of care needed.

“As the population continues to age and demand for these services grows, it is likely that the cost will continue to rise,” said Dr. Steven Norris, a senior health and care expert who is also the medical director at Transitions Care in Chicago, Illinois.

The widespread shortage of qualified caretakers means facilities must pay more to secure the right people.

“For decades, there has been a lack of awareness of how expensive assisted living really is.” “Additionally, recent increases in minimum wage requirements and changes in overtime payment legislation are increasing assisted living costs,” he said.

The cost could range from $3,000 in rural areas to $7,000 to $9,000 in urban locations.

“For decades, there has been a lack of awareness of how expensive assisted living really is,” Kim told Fox News Digital.

“Some people thought health insurance would cover long-term care costs, while other people optimistically believed that they would live a healthy life forever.”

Assisted living companies had to raise prices to keep up with their costs continually. However, retirees did not see the same growth in savings or investments. Middle-aged and older adults are also now facing a very different financial landscape than the generations before them did. More than the increases in household income and assets have also been needed to keep up with rising living costs, health care and inflation. Even when older adults have assets, they are often tied up in property and need to be more readily available to help them cover costs.

The changing retirement model has also added to gaps in savings. Past generations had private, employer-sponsored pensions that provided predictable payments. Many Americans now rely on 401(K) accounts, leaving individuals responsible for saving enough money to cover their retirement years.

“With all of this combined, few older adults have any significant savings in retirement accounts — and most can’t afford long-term care insurance that would help cover the expensive costs of assisted living or nursing home care,” she explained.

“With private long-term care insurance being unaffordable for most older adults, it is key to begin considering combined public and private initiatives that can put the cost of coverage within reach and make it more appealing to consumers,” she said.

Reference: Fox News (April 26, 2023) “Most seniors in America can’t afford nursing homes or assisted living, study finds”

How Can I Prevent a Fall?

Less than 60% have considered the home modifications necessary to age in place safely, says Yahoo Finance’s recent article entitled, “Prevent 300,000 Fall-Related Hospitalizations with Simple Aging in Place Home Modifications According to Lisa M. Cini.”

America’s leading aging expert compiled a list of simple home modifications to prevent falling and maintain balance while they stay home. Consider these simple home modifications to prevent falls:

Keep Item Within Reach. This includes your telephone and anything on a high shelf, or on another floor you may need. That way, you won’t have to stretch or balance on step ladders to reach things you need daily, since it can lead to falls.
Use Smart Flooring to prevent falls. For example, invest in anti-slip tiles for bathrooms and kitchens to avoid sliding on water or polished surfaces, and ensure that all rugs have anti-slip mats underneath to prevent slipping across the floor.
Consider Motion Activated Lighting. Install lighting with sensors to turn on when movement is detected, especially on stairs and in bathrooms.
Make the Garden Safe. Clear moss and old leaves from the paths to minimize the risk of slippery spaces. Avoid too many pots and ornaments as they are easy to trip over. Install lighting, so you can see your way along paths in the dark.
Get Rid of Clutter. Clearing clutter from steps and floors helps you to avoid slips and trips. Don’t leave things on the floor where they can cause a hazard.
Try Posture Exercises. Pilates and yoga will help you avoid falling by maintaining good balance, core strength and posture techniques. Some exercises are chair-based. However, most are gentle and set at a pace that the group can follow.
Install Handrails to Keep You Steady. Get handrails in all high-risk places, such as the shower or stairs, to prevent falls.
Make Your Bathroom Safe and Functional: Falls often occur in the bathroom. Today’s bathroom can include the Assisto bathtub, which features an easily accessible and ergonomic design that reduces the risk of injury and falls.
Voice-Controlled Assistance Devices: Play music, make calls, set music alarms and timers, ask questions and control smart home devices.

Reference: Yahoo Finance (May 8, 2023) “Prevent 300,000 Fall-Related Hospitalizations with Simple Aging in Place Home Modifications According to Lisa M. Cini”

More CPAP Benefits for Early Birds?

A study recently showed that patients with the morning chronotype used their CPAP machines for 32 more minutes per night compared with their intermediate chronotype counterparts over six months of use, according to Melissa Knauert, MD, PhD, of Yale University School of Medicine in New Haven, CT, and colleagues. Their research has been published in Annals of the American Thoracic Society.

“Understanding that chronotype can influence adherence to CPAP is another tool in the kit for sleep doctors to predict who might have trouble using CPAP and focus on patients at higher risk of not using their CPAP,” she told MedPage Today. “Ultimately, as we study and improve our understanding of the relationship between chronotype and CPAP use, we can develop specific therapies targeted at patients with non-morning chronotypes.”

MedPage Today’s recent article, “’Early Birds’ With Sleep Apnea May Get More CPAP Benefits,” explains that chronotype was defined by the Morningness-Eveningness Questionnaire (ME, which measures when a person’s circadian rhythm produces peak alertness. The researchers found that patients in the morning group were less likely to report feeling unrested during the day compared with the intermediate and evening groups. Here’s the breakdown:

Morning (MEQ 59 or above): 17.4%
Intermediate (MEQ 42-58): 28.3%
Evening (MEQ 41 or lower): 41.0%

The primary analysis of APPLES (Apnea Positive Pressure Long-term Efficacy Study), first reported in 2012, showed that treating sleep apnea with CPAP devices improved subjective and objective measures of sleepiness, especially among patients with severe OSA, versus a sham device. In addition, Sleepiness and functional status improve with each hour of CPAP use. Nevertheless, Dr. Knauert explained that sleep apnea is often hard to treat because many patients cannot use CPAP effectively.

Even within clinical trials, only 39-42% of patients use the device for more than four hours a night, and many patients stop CPAP use altogether. In the U.S., only 40-60% of the estimated 30 million patients with OSA remain adherent long-term.

“Anything and everything that we do to understand and improve CPAP use will have tremendous health benefits,” she said. “Understanding the mechanisms by which circadian biology impacts health is a large, untapped area for future research.”

Overall, 65% were men, and most had severe OSA and obesity, with an average body mass index (BMI) of 32, researchers said. Patients in the evening group were younger and less likely to be married. However, no significant differences in sleep apnea characteristics were noted between groups. There were also no differences in insomnia or sleepiness. Anxiety was highest among participants with an intermediate chronotype.

On average, patients slept about seven hours per night. However, on the weekends, morning chronotype patients reported slightly shorter sleep duration than the intermediate and evening groups (7.3 vs. 7.6 and 7.9 hours per night).

Reference: MedPage Today (April 1, 2023) “’Early Birds’ With Sleep Apnea May Get More CPAP Benefits”

How are Strokes Diagnosed?

The CDC says that a stroke happens when something blocks the blood supply to part of the brain or when a blood vessel in the brain bursts. In either case, parts of the brain become damaged or die. A stroke can cause lasting brain damage, long-term disability, or even death.

Verywell Health’s recent article entitled “Everything You Should Know About Stroke” explains that diagnostic tests for stroke include the following:

Brain imaging: A brain computed tomography (CT) scan frequently will spot the blood of a hemorrhagic stroke within the first hours of bleeding. Brain magnetic resonance imaging (MRI) can identify an ischemic stroke’s early, subtle changes.
Angiogram: This angiogram test looks at the blood vessels. Angiograms of the cerebral vessels can include computed tomography angiogram (CTA) or magnetic resonance angiogram (MRA). These tests can pinpoint structural irregularities or blood clots in the brain’s blood vessels.
Blood tests: while a stroke isn’t diagnosed with a blood test, it can identify stroke risk factors, like high cholesterol or diabetes.
Electrocardiogram (EKG/ECG): This is a fast, noninvasive test that examines heart rhythm. It can identify abnormalities associated with an irregular heart rhythm, heart attack, or heart failure.
Echocardiogram: This test is noninvasive and looks at the structure and movement of the heart. It can detect heart problems that increase the risk of stroke.
Carotid ultrasound: This noninvasive test examines the neck arteries leading to the brain. Narrowing or disease of these arteries can cause a stroke.

Sometimes brain imaging tests also detect previous asymptomatic (without symptoms) strokes.

Effective stroke care begins with a prompt assessment to determine the type of stroke, followed by rapid treatment.

Medical stabilization is needed for all types of strokes and includes maintaining optimal blood pressure, blood sugar and fluids.

Verywell Health (Feb. 27, 2023) “Everything You Should Know About Stroke”

What’s the Latest on VA’s Coverage of New Alzheimer’s Drug?

The VA has announced that it will cover Leqembi, a monoclonal antibody therapy made by pharmaceutical companies Eisai and Biogen, for veterans in the disease’s early stages. This makes the VA the first and largest health program in the country to endorse the treatment, reports’ military.com in its recent article entitled, “VA to Cover New Drug for Early Stage Alzheimer’s Disease.”

In January, the FDA granted accelerated approval for Leqembi, also known as lecanemab, when research showed that the medication slowed the physical and mental decline in some patients with early Alzheimer’s by as much as 27%. Although research is ongoing on the treatment’s effectiveness, the drug is among the first to show that it reduces beta amyloid — the toxic protein that contributes to the development of Alzheimer’s — in the brain.

“This treatment option is the latest therapy to target and affect the underlying disease process of Alzheimer’s instead of only treating the symptoms of the disease,” said Dr. Billy Dunn, director of the Office of Neuroscience in the FDA’s Center for Drug Evaluation and Research, during the accelerated approval announcement.

The VA treats about 168,000 veterans with Alzheimer’s, some of whom are in the early stages. Leqembi has an estimated cost of $26,500 a year, and a two-milliliter dose at the VA will cost the department $194.63. A five-milliliter dose will cost $486.57, according to the department’s National Acquisition Center Contract Catalog.

According to VA Press Secretary Terrence Hayes, the drug will be available only at the request of a provider to vets who “most closely align with” patients who meet the selection criteria for clinical trials. This means that the VA patients must meet the same demographic and health history standards as those studied by the manufacturers.

“Each dose of the medication administered for each patient will be tracked and monitored for safety and appropriateness of use, in real-time, by VA’s Center for Medication Safety,” Hayes said in an email to Military.com. “VA will continue to monitor the clinical evidence and safety data for this agent and adjust the criteria for use as appropriate. VA also has capabilities and safeguards in place that are very different from the private sector, such as the ability to conduct real-time medication-use evaluations that will allow for continued safe use of the medication.”

Leqembi is approved for use only in patients with early Alzheimer’s with a “confirmed presence,” via a brain scan, of beta amyloid.

Reference: military.com (March 14, 2023) “VA to Cover New Drug for Early Stage Alzheimer’s Disease”

Use Estate Planning to Prepare for Cognitive Decline

Since 2000, the national median age in the U.S. has increased by 3.4 years, with the largest single year gain of 0.3 years in 2021, when the median age reached 38.8 years. This may seem young compared to the life expectancies of older Americans. However, the median age in 1960 was significantly lower, at 29.5 years, according to the article “Don’t Let Cognitive Decline Derail Well-Laid Financial Plans” from Think Advisor.

An aging population brings many challenges to estate planning attorneys, who are mindful of the challenges of aging, both mental, physical and financial. Experienced estate planning attorneys are in the best position to help clients prepare for these challenges by taking concrete steps to protect themselves.

Individuals with cognitive decline become more vulnerable to potentially negative influences at the same time their network of trusted friends and family members begins to shrink. As people become older, they are often more isolated, making them increasingly susceptible to scams. The current scam-rich environment is yet another reason to use estate planning.

When a person is diagnosed with Alzheimer’s or any other form of dementia, an estate plan must be put into place as soon as possible, as long as the person is still able express their wishes. A diagnosis can lead to profound distress. However, there is no time to delay.

While typically, the person may state they wish their spouse to be entrusted with everything, this has to be properly documented and is only part of the solution. This is especially the case if the couple is close in age. A secondary and even tertiary agent needs to be made part of the plan for incapacity.

The documents needed to protect the individual and the family are a will, financial power of attorney, durable power of attorney and health care documentation. In addition, for families with more sophisticated finances and legacy goals, trusts and other estate and tax planning strategies are needed.

A common challenge occurs when parents cannot entrust their children to be named as their primary or secondary agents. For example, suppose no immediate family members can be trusted to manage their affairs. In that case, it may be necessary to appoint a family friend or the child of a family friend known to be responsible and trustworthy.

The creation of power of attorney documents by an estate planning attorney is critical. This is because if no one is named, the court will need to step in and name a professional guardian. This person won’t know the person or their family dynamics and may not put their ward’s best interests first, even though they are legally bound to do so. There have been many reports of financial and emotional abuse by court-appointed guardians, so this is something to avoid if possible.

Reference: Think Advisor (April 21, 2023) “Don’t Let Cognitive Decline Derail Well-Laid Financial Plans”

Is Low Bone Mineral Density Linked to Dementia?

In a study of community-dwelling older adults, every standard deviation lower BMD at the femoral neck was linked with a 12% higher risk for developing all-cause dementia, says Mohammad Arfan Ikram, MD, PhD, of Erasmus University Medical Center in Rotterdam, The Netherlands, and colleagues.

MedPage Today’s recent article entitled, “Osteoporosis: Another Dementia Predictor?” says that each standard deviation lower for femoral neck BMD was also linked with a 14% higher risk for Alzheimer’s disease during the 11-year follow-up, the group wrote in Neurology.

When the researchers looked at only the first decade of follow-up, older adults falling into the lowest group of BMD in the femoral neck had a twofold higher risk for dementia than those in the highest tertile. In the first 10 years, those in the lowest tertile for trabecular bone score and total body BMD also saw a significantly higher risk for developing all-cause dementia. However, when expanding to the entire follow-up period, only low femoral neck BMD was still significantly connected with dementia onset.

“Low bone density and dementia are two conditions that commonly affect older people simultaneously, especially as bone loss often increases due to physical inactivity and poor nutrition during dementia,” noted Ikram. “However, little is known about bone loss that occurs in the period leading up to dementia. Our study found that bone loss indeed already occurs before dementia and thus is linked to a higher risk of dementia.”

“Previous research has found factors like diet and exercise may impact bones differently as well as the risk of dementia,” Ikram added. “Our research has found a link between bone loss and dementia, but further studies are needed to better understand this connection between bone density and memory loss.”

“It’s possible that bone loss may occur already in the earliest phases of dementia, years before any clinical symptoms manifest themselves,” he explained. “If that were the case, bone loss could be an indicator of risk for dementia and people with bone loss could be targeted for screening and improved care.”

The researchers also noted that prior data suggested a link between low femoral neck BMD with structural brain changes, which may be a major driver of elevated dementia risk. These changes include declined white matter volume, increased white matter hyperintensity volume, the occurrence of silent brain infarction and progression of parenchymal atrophy.

In addition, it’s possible that these individuals experienced some loss of cognition that subsequently lead to poorer dietary nutrition and lifestyle habits.

Reference: MedPage Today (March 22, 2023) “Osteoporosis: Another Dementia Predictor?”

Protect Your Elderly Parents from Scammers

Thinking on a very practical level, if you were a thief and had to choose a target, it would likely be someone who has wealth and is vulnerable—the picture of an elderly person, especially one who is likely to be isolated and may have cognitive issues. According to the Federal Trade Commission, consumers aged 60 and older filed 467,340 fraud reports in 2021, reporting total losses of more than $1 billion.

A recent article from cbsnews.com, “How to protect elderly parents from financial scams,” says that consumers age 60 and older are less likely to report losing money to fraud than those aged 18—59. Still, when they do report a loss, it tends to be for more money, especially among those 80 and older. They have the highest median loss of all groups.

Older adults are likelier to lose money on scams involving tech support, prizes, sweepstakes, lotteries and friends and family impersonations. What can you do?

Talk about it. Scams target everyone. Therefore, it is an easy topic to bring up. First, start the conversation with your experiences or a trending news story. Next, explain specific scams, like someone reaching out through social media saying they want to be friends, followed by an urgent request for money or fake text messages from a grandchild who needs bail money. People informed about scams’ specifics are less likely to respond.

Use anti-fraud tools. Spam-blocking apps on cell phones can send unknown numbers to voicemail immediately. A credit freeze can secure credit information and is easily temporarily unlocked for legitimate access. Setting strict privacy tools on social media can also limit the number of scammers who can get through.

Signing up for financial account monitoring or receiving alerts for transactions is easily enough put into place. However, in some instances, it would be wise to allow adult children to monitor these accounts, depending upon the parent’s comfort level with sharing this information.

Put legal tools into place. A durable power of attorney, revocable trust, or, if appropriate, guardianship, can be among the most effective ways to keep an older adult’s assets safe from scammers. If a revocable trust is created, an adult child can quickly step in before too much damage is done, whether it’s a fake charity or a “kidnapped grandchild” scammer.

Know the warning signs. An older adult who is suddenly reluctant to talk about their finances had said they are having trouble paying bills when they never had a problem before or is receiving a high number of text messages or phone calls and insists on being alone when they respond may have become a victim of fraud.

Scammers are especially good at creating a sense of urgency, saying their victims must send money or gift cards immediately, or the IRS or police will arrive at their door. The latest wrinkle is the use of artificial intelligence to mimic a loved one’s voice, and the technology is so good that even experts are fooled.

Avoid shaming loved ones. The embarrassment of being the victim of elder financial abuse worsens a bad situation. Don’t scold an elderly person for being fooled; they certainly will be angry enough at themselves for being taken. Reassuring words are more likely to allow the victim to keep some of their dignity, while encouraging them to call you if, and more likely when, they are confronted with another scammer.

Reference: cbsnews.com (April 10, 2023) “How to protect elderly parents from financial scams”

Estate Planning Blog Articles

Estate & Business Planning Law Firm Serving the Providence & Cranston, RI Areas

What’s the Best Way to Find the Right Assisted Living Facility?

What Should I Know About Advocating for a Loved One with Parkinson’s Disease?