What Documents are Included in Advance Care Planning?

Starting discussions earlier helps ensure that a person with dementia stays involved and understands the planning process. In the same fashion, regular reviews of plans over time are beneficial for ensuring that their wishes are carried out.

Health News’ recent article entitled “Can Someone With Dementia Sign Legal Documents?” cautions that, when family members don’t know the preferences of their loved one, they have difficulties and stress in making decisions. Family members may also have feelings of guilt, self-doubt and stress while making advanced care decisions.

Laws in each state may differ. Working with an experienced elder law attorney can help seniors interpret state laws, plan how wishes should be carried out and understand financial options.

Geriatric care managers, trained social workers, or nurses can also offer support to those living with dementia, as well as their families.

While advance care planning, families and their loved ones with dementia should create a plan for long-term care and plan for funeral arrangements in advance.

Advance care planning documents commonly include the following:

A durable power of attorney for healthcare names someone to function as a proxy for the person with dementia, when he or she may be unable to make healthcare decisions for themselves.
A living will includes an individual’s wishes for end-of-life treatment. This can concern specific procedures such as dialysis, tubal feeding, or blood transfusion. If the person becomes permanently unconscious (coma), families can make treatment decisions based on wishes expressed in a living will.
A do-not-resuscitate order (DNR) is put with a patient’s chart when the patient doesn’t want to receive cardiopulmonary resuscitation (CPR) if their heart stops or breathing ceases. A doctor needs to sign these DNR orders before they can be placed in the patient’s charts.

Advance care planning can be a sensitive topic for families and those with dementia.

Getting medical and legal advice early is helpful in planning advance care. Involving the person with dementia in the planning process also helps families ensure that the wishes of the patient are respected.

Reference: Health News (Jan. 11, 2023) “Can Someone With Dementia Sign Legal Documents?”

How to Manage Aging Parent’s Finances

A day will come when age begins to catch up with your parents and they will need help with their finances. Even if your parents don’t want to feel dependent, when you think they need your assistance, you can approach the issue with sensitivity and extend your support for the management of their finances, says Real Daily’s recent article entitled “5 Tips to Manage an Aging Parent’s Finances.” Here are some tips:

Start the conversation early. Your parents may not need your help with the handling of their financial matters right away. However, it is smart to begin the conversation early. Approach the issue of who will manage the financial responsibilities when they’re no longer able to do it. Parents should select a trusted family member by providing their advance written consent. This will let you to talk about your parents’ financial issues with financial advisors, doctors and Medicare representatives and carry out timely financial planning.
Create a list of all pertinent legal and financial documents. Prepare a list of your parents’ important contacts, bank account details and locations of any stored documents, like wills, property deeds, insurance policies and birth certificates. Make certain all information and documentation is accurate and up to date. If information needs to be modified because of a change of circumstances, this is time to apprise them of it and help them do what’s needed.
Consider executing a power of attorney. A competent adult can sign a power of attorney to authorize another person to make decisions on their behalf. A power of attorney for a specific purpose may cover medical, financial, or other decisions, and it may be designed to give limited or more sweeping powers. When your parents sign a power of attorney with you named as their attorney in fact, it will legally empower you to make key decisions when they can’t. An elder law attorney can help you draft an appropriate power of attorney according to your situation.
Document your actions and keep others in the know. Transparent communication will help you avoid misunderstandings or controversy within your family. Keep your parents, siblings and any other loved ones involved with your family informed about your actions. No matter how noble your intentions may be, if others are kept in the dark, it can raise questions about your motives. Managing the finances of aging parents is a lot of work, and you can ask for the support of family members or at least keep the lines of communication open.
Don’ comingle your finances with your parents’ plans. While it may look to be a convenient or cost-effective thing to do, it’s never a good idea to combine your parents’ finances with your own. Keep them separate. Using your parents’ money for your purposes or your own money to help them out is usually a slippery slope that should be avoided. Don’t forget about your own financial goals and retirement savings while you focus on helping your parents.

Reference: Real Daily (Sep. 9, 2022) “5 Tips to Manage an Aging Parent’s Finances”

Wayward Senior Tracked by Bluetooth Technology

The Hernando County Sheriff’s Office recently received a report of a missing adult in the Hernando Beach area.

According to the agency, the elderly man, who suffers from dementia, was reported missing by his wife at about 7:30 in the morning.

Units were dispatched within minutes, reports WTSP.com, in the article entitled “’Technology is one of the best tools…’: Missing elderly man found through Bluetooth tracking device.”

The sheriff’s office said this wasn’t the first time the man has been reported missing.

This time, his wife was prepared: she attached a Bluetooth tracking device to her husband’s belt.

Bluetooth is a type of wireless technology that allows the exchange of data between different devices, such as two cellphones.

Because she planted the device, she was able to give deputies a location to where to find her husband.

Law enforcement was able to locate the man by 7:54 a.m.

He was returned safely home to his family.

“With the high heat index this time of year and the multiple access points to water in the area, we are thankful for this assistance of technology in order to locate this individual within 18 minutes,” the sheriff’s office wrote in a statement.

The sheriff’s office says tracking devices like the one used in this incident can give families peace of mind when caring for a senior with mental health issues, by being able to monitor their location.

“Whether it is a child with special needs or a senior who is forgetful, there are usually warning signs that a person is prone to wandering,” Sheriff Al Nienhuis said in a statement.

“Technology is one of the best tools family members can use to alert them when that individual has unexpectedly left the house.”

“It also provides invaluable tools to increase the likelihood the person will be returned safely. We strongly encourage families to research what technology is right for their situation.”

Reference: WTSP.com (August 8, 2022) “’Technology is one of the best tools…’: Missing elderly man found through Bluetooth tracking device”

Can Traveling Help Seniors’ Mental Health?

A study to be published in the October 2022 edition of Tourism Management presents the thoughts of a cross-disciplinary team of experts in both dementia and tourism. Medical News Today’s recent article entitled “’Travel therapy’ may offer treatment for dementia and benefit mental health” reports that the research hasn’t yet been peer-reviewed, but experts think there may be significant benefits of travel for people with dementia, particularly in the areas of mental health and well-being.

Dementia currently has no cure, but some medications and treatments may help control symptoms.

Care is often supportive, including helping those with dementia do as much as they can on their own and helping them have a better quality of life.

Researchers are still working on how to best help those with dementia. One area of interest is how traveling may benefit people with dementia.

The researchers say that the potential benefits of tourism in treating people with dementia are called “travel therapy.” One definition of tourism the researchers used was “visiting places outside one’s everyday environment for no longer than a full year.” They note that the experience of tourism has four main components to it:

Affective Experience: how it impacts feelings, emotions and mood
Cognitive Experience: how it affects thoughts and memories
Conative Experience: how it impacts behavior; and
Sensorial Experience: how it impacts the senses.

The authors concluded that tourism may have a potentially positive impact on well-being and quality of life through a variety of components. However, the literature supporting this in the treatment of dementia is limited.

The study authors also noted that focusing on components of positive psychology, such as what people can do, positive experiences, and well-being may also benefit people with dementia.

They proposed a few options to implement components of tourism to help people with dementia, such as group travel that promotes social interactions or traveling to locations that stimulate the senses.

Reference: Medical News Today (June 30, 2022) “’Travel therapy’ may offer treatment for dementia and benefit mental health”

Elderly Woman Thanks Firefighters for Ride to Visit Husband at Nursing Home

An senior in San Diego was so grateful for the help of local firefighters, she wanted to thank them in person with a big bag of sweets, reports NBC San Diego’s recent article entitled “Stranded La Jolla Woman, 87, Brings Treats to Firefighters Who Gave Her a Lift.”

“It was a long time I was waiting for that cab. If it wasn’t for you, I’d be there all night,” La Jolla resident Sandy Lightman recalled telling San Diego Fire-Rescue Department Captain Jordan Buller on May 10, the night of her “rescue.”

The article said that Mrs. Lightman may have needed a fire engine to haul the three dozen cookies and four cheesecakes to Captain Buller and the Station 35 crew.

The 87-year-old explained that she’d just ended one of her daily trips to a nursing facility, where she cares for her husband who’s living with dementia.

She started requesting a cab around 8:20 p.m., but it didn’t show. So, she kept calling.

Hours later at 11 p.m., while on another call to the facility, Captain Buller and his crew recognized Lightman’s distress.

“She was frantically trying to call family and call a cab and we could tell she was distraught,” he said.

“I can’t walk that well, and I was only two-and-a-half blocks from where I live but I was afraid to go on the street by myself. I didn’t know if I’d make it home,” she said.

Since the cab wasn’t coming, the San Diego fire firefighters loaded Lightman into the cab of their engine.

They strapped her into the jump seat—and even gave her headphones to wear for the trip.

“It felt so secure, it made me feel so good because they were helping me and I knew I was safe, because I was afraid,” said Mrs. Lightman.

Back home safely, the grateful woman says she’s thankful to the local news outlet that was able to help track down the station who treated her with such kindness, so she could spoil them with some sweet treats.

Lightman and her husband will celebrate 40 years of marriage next week.

Reference: NBC San Diego (May 24, 2022) “Stranded La Jolla Woman, 87, Brings Treats to Firefighters Who Gave Her a Lift”

Can I Help Parents Remember Online Passwords?

Hacked usernames and passwords are the most common causes of malicious online identity attacks, accounting for 61% of breaches.

Seniors Matter’s recent article entitled “Why your loved one needs a password manager” explains that keeping your loved one’s passwords safe is actually nearly as important as the security and complexity of the passwords themselves. This is why a password manager can help. It’s software that allows the user to generate, store and manage credentials in one central and secure location online.

A password manager can help make your loved one’s day-to-day interactions with technology easier and more secure for several reasons. For instance, older adults are vulnerable to scammers, more likely to forget their passwords or store them in unsafe locations. Online accounts should be included in estate planning, but many family members find themselves “locked out” of important accounts after their loved one passes, with no access to the credentials—especially if the death is unexpected.

A password manager puts all your loved one’s online account credentials and documents into one secure place, then they have just one password to remember. Many password managers let you share credentials with other people, so nothing’s ever lost forever. This way they can make certain that the right people will have the details they need to access the accounts necessary to settle the estate.

With many password managers, you can not only store, change and access passwords in these apps but also write notes about information like:

Financial account details
The location of valuables and important documents
Important contact info
Important logins or security codes that aren’t website logins; and
Instructions in case of death.

Research has shown that older adults who use password managers were satisfied with their experiences overall and even felt confident using multiple features, like the password generator and auto-fill.

After a senior gets over the hurdle of setting up and learning how to use the software, they love it and are quite adept at using it.

This is the reason for you as the caregiver to help your loved one get a password manager set up and help them get acquainted with using it properly.

Reference: Seniors Matter (March 6, 2022) “Why your loved one needs a password manager”

What Do I Need to ‘Age in Place’?

Home modification is the official term (from the Americans with Disabilities Act) for renovations and remodels aimed for use by the elderly or the impaired. It means physically changing your home, removing potential hazards and making it more accessible, so you can continue living in it independently.

Bankrate’s recent article entitled “The best home modifications for aging in place” reports that home modifications can be pricey—typically ranging from $3,000 to $15,000, with the average national spend being $9,500. However, it can be a worthwhile investment. You can save money by doing the right home modifications. That is because the longer you can safely live in your home, the less you will need to pay for assisted living care.

The best aging-in-place home modifications align with “universal design,” an architectural term for features that are easy for all to use and adaptable, as needs dictate. This includes additions and changes to the exterior and interior of a home. Some of the simplest home modifications include DIY jobs:

Adding easy-grip knobs and pulls, swapping knobs for levers
Installing adjustable handheld shower heads
Rearranging furniture for better movement
Removing trip hazards; and
Installing mats and non-slip floor coverings.

Next, are some more complex home modifications. These probably would need a professional contractor, especially if you want them up to code standards:

Installing handrails
Adding automatic outdoor lighting
Installing automatic push-button doors
Leveling flooring; and
Installing doorway ramps

There are also home modifications that can be done by room:

In the bathroom, installing grab bars and railing, a roll- or walk-in shower/tub, or a shower bench
In the kitchen: adding higher countertops, lever or touchless faucets and cabinet pull-out shelves
For the bedroom, use a less-high bed, non-slip floor, walk-in closets and motion-activated lights
Outside, you can add ramps, a porch or stair lifts, and automatic push button doors.

Finally, throughout the house, keep things well-lit and widen hallways and doorways; add a first-level master suite, elevators or chair lifts, “smart” window shades/thermostats/lighting and simpler windows.

Note that some home modifications may qualify as medical expenses. As a result, they are eligible for an itemized deduction on your income tax return. A home modification may be tax-deductible as a medical expense, if it has made to accommodate the disabilities (preferably documented by a physician or other health care provider) of someone who lives in the home, according to the IRS.

Reference: Bankrate (March 30, 2022) “The best home modifications for aging in place”

Can I Avoid the Economic Dangers of Caregiving?

AARP’s recent article entitled “5 Steps to Avoid Economic Pitfalls of Caregiving” reports that 20% of family caregivers have to take unpaid time off from work due to their caregiving responsibilities.

The average lifetime cost to caregivers in lost wages and reduced pension and Social Security benefits is $304,000 — that is $388,000 in today’s dollars. This does not count the more than $7,200 that most caregivers spend out of pocket each year, on average, on housing, health care and other needs for loved ones in their care, according to the AARP report.

Step 1: Calculate the gap. The average cost of a full-time home health aide is nearly $62,000 a year, and a semiprivate room in a nursing home runs about $95,000. Ask your parents about the size of their nest egg, how fast they are spending it, whether they have long-term care insurance and how much equity they have in their home. Compare your parents’ assets against their projected expenses to determine your gap.

Step 2: Fill the gap without going broke. Try to find free resources: Use the National Council on Aging’s BenefitsCheckUp tool to find federal, state and private benefit programs that apply to your situation. Then create a budget to determine what you can contribute, physically and in dollars, to closing the gap. In addition, ask your siblings if they can pitch in.

Step 3: If a gap remains, consider Medicaid. This program can cover long-term care. However, your parent or parents may need to spend down assets to qualify. Note that if just only one parent is in a nursing home, the other can generally keep half of the assets, up to a total of $137,400 (not including their house). However, the rules differ by state. As a result, this can get complicated. Speak with an elder-law attorney for help.

Step 4: No matter what the gap, try to get paid. If your parents have enough resources, you may discuss having them pay you for caregiving. However, you should speak with an attorney first about drawing up a contract. This should include issues like the number of hours a day you will spend on providing care and whether doing so will require you to quit your job. The caregiving agreement is written carefully, so that it does not violate Medicaid regulations about spending down assets.

Step 5: Protect your own earning ability. If you are mid-career, it is very difficult to leave a job for family responsibilities like caregiving and then go back into the workforce at the same salary. The Society for Human Resource Management says that it costs six to nine months’ salary to replace an employee, so many employers now see it is less expensive to make an accommodation.

Reference: AARP (Feb. 24, 2022) “5 Steps to Avoid Economic Pitfalls of Caregiving”

How Do I Hire a Caregiver from an Agency?

Part One of AARP’s recent article entitled “How to Hire a Caregiver” explains that when you have a list of promising agencies, you should schedule a consultation.

It doesn’t matter if your family member is eligible for Medicare, Medicare’s Home Health Compare can be a terrific tool for finding and researching home health agencies in your area.

It provides detailed information on what services they provide and how patients rate them.

Working with an agency has its pros and cons. The pluses include the following:

Background checks. Caregivers must pass a background check.
Experienced caregivers. Agencies are likely to have a number of caregivers who cared for other seniors with the illness or condition affecting your loved one.
Backup care. If the primary aide is sick or doesn’t work out, an agency typically can quickly find a replacement.
Liability protection in the event that a caregiver is injured while at the home.
No paperwork. The agency takes a fee, pays the aide and does the payroll and taxes.

Here are some of the corresponding minuses of working with an agency:

Greater expense. You’ll pay more for an agency-provided caregiver.
Little choice. The agency chooses the worker, and he or she may not fit well with you or your family member.
Negotiation is limited, and individuals are generally more flexible about duties, hours and overtime than agencies.
There are agencies that don’t permit a part-time schedule.

In addition, you can contact an experienced elder law attorney and ask for recommendations.

Reference: AARP (Sep. 27, 2021) “How to Hire a Caregiver”

What are Trends in Senior Health Care?

Feeling comfortable using virtual care technologies in the home, demanding more tech in independent living communities and becoming more engaged in their own health data are trends that show that seniors will be turning to technology more than ever to enhance their healthcare in the next year. Health Tech’s recent article entitled “3 Senior Care Tech Trends to Watch in 2022” gives us the top three trends in senior care for 2022:

Senior Care Will Continue to Adopt the Hospital-at-Home Model. Hospital-at-home is a growing trend in healthcare, as increased adoption of virtual care technologies permits the care of seniors with acute conditions to take place at home.

A 2018 AARP survey found that 76% of adults ages 50+ said they prefer to stay in their homes and communities, aging in place rather than moving to an independent living community. According to the American Hospital Association, the hospital-at-home care delivery model can reduce costs, improve outcomes and enhance the patient experience. However, traditional healthcare organizations have a part to play in this care delivery model with telehealth and remote patient monitoring that can extend care to the home setting.

Organizations Will Create Tech Concierge Roles to Help Seniors. Tech ownership, adoption, and use among older adults increased during the pandemic, with nearly half of those in an AARP saying that they used video chats more than before. With growing use of texting, email, smartphones and wearable devices, seniors are using more technology. As a result, the trend is likely to continue.
Consumerization Will Give Seniors More Control Over Their Health. Wearables and apps place health data in consumers’ hands. Healthcare organizations will not have to provide patients with all of their health information, which will create even more patient involvement in healthcare. This will give older adults more information and empower them to be active in decision-making about their health. Another impact of consumerization on senior care is that older adults are getting more comfortable with technology and are joining independent living communities’ selection committees to make decisions about which technologies the community will acquire.

As we go into 2022, consumerization and the desire for personalization are expected to impact the types of technology preferred by older adults and offered by independent living communities, as well as the ways seniors interact with digital health solutions.

Reference: Health Tech (Dec. 14, 2021) “3 Senior Care Tech Trends to Watch in 2022”

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