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Underlying Conditions Most Dangerous for COVID-19?

AARP’s recent article “Three Most Dangerous Underlying Conditions for COVID-19” reports that it is well-established that risk increases with age. The CDC lists nearly two dozen health conditions that could put you at higher risk of becoming seriously ill or dying of COVID-19. AARP did some research with doctors, who said three conditions worried them the most: diabetes, high blood pressure/underlying heart disease and obesity.

This corresponds with the results of one of the largest studies so far on COVID-19 mortality, published in the journal Clinical Infectious Diseases in December 2020. It looked at data from nearly 67,000 hospitalized coronavirus patients and found that these health conditions are associated with a higher risk of death:

  • Obesity,
  • Diabetes (with complications such as organ damage), and
  • High blood pressure (with complications, such as heart damage or kidney disease).

Each is an inflammatory disease that is prevalent among American adults, and experts say they are closely linked.

Obesity is a risk factor for diabetes and high blood pressure, and diabetes can contribute to high blood pressure. Moreover, diabetes and high blood pressure both can trigger kidney disease and lung disease—two other conditions that make COVID-19 riskier, says the CDC.

Some of the other dangerous conditions mentioned by the physicians include dementia, chronic kidney disease and chronic obstructive pulmonary disease (COPD). Immunocompromised patients, those who smoke and those with organ transplants also are a concern.

Lets’ look at those three health conditions that are associated with a higher risk of death:

High-risk condition: Obesity. Obese people diagnosed with COVID-19 are more than twice as likely to be hospitalized and about 50% more apt to die compared to patients who are a healthy weight. If you test positive for the coronavirus, ask your doctor if you are a good candidate for monoclonal antibodies. It is a life-saving treatment that can reduce hospitalizations among high-risk patients by as much as 70%.

Obesity is frequently associated with other health problems, but doctors note how hard COVID-19 impacts even those obese patients who have no other underlying conditions.

Obesity can make it difficult for a person’s lungs to expand, impairing breathing and oxygenation. Obesity is also believed to increase your risk of blood clots.

High-risk condition: High blood pressure. Researchers reviewed 22 studies from eight countries in 2020 and found that high blood pressure was present in 42% of hospitalized COVID-19 patients. That makes it the most prevalent health condition by a big margin. Even more surprising is the fact that those patients had twice the risk of death compared with patients without high blood pressure, said Vikramaditya Samala Venkata, M.D., one of the study’s authors and a hospital medicine physician at Cheshire Medical Center in Keene, N.H.

However, the Clinical Infectious Diseases study on COVID-19 mortality found that hypertension on its own raised the death rate only for those under age 40. For those age 40+, mortality risk increased only if their high blood pressure had caused a complication, such as heart damage or chronic kidney disease.

Experts think that the coronavirus damages the cells that line blood vessels, causing clots and making it more difficult for them to carry oxygen. Therefore, it is important to keep your blood pressure under control. Studies show that patients with unregulated high blood pressure are at greater risk from COVID-19 compared with patients who take medication to control it.

High-risk condition: Diabetes. Research of the medical records of 61 million people in England published in The Lancet Diabetes & Endocrinology found that the risk of dying from COVID-19 was almost three times higher for people with Type 1 diabetes and almost twice as high for people with Type 2 diabetes, compared with those with neither. High blood sugar weakens the immune systems, which makes it harder for the body to fight off infections. Diabetes puts you at risk for both cardiovascular complications and infectious complications. Both of those are common with COVID.

So, watch your blood sugar levels because patients with well-controlled diabetes have a COVID-19 death rate of about 1%, according to a study published in Cell Metabolism. What about those with poorly controlled disease? Their rate is closer to 11%.

Reference: AARP (Feb. 3, 2021) “Three Most Dangerous Underlying Conditions for COVID-19”

Am I a Senior Citizen?

Here are some milestones that could signal that you have become a senior citizen, according to US News and World Report’s recent article entitled “When Do You Become a Senior Citizen?”

Eligibility for Senior Benefits. There are exact ages when you qualify for a host of retirement benefits. In some ways, society makes it very clear when we become senior citizens. For example, we know that at age 65, we qualify for Medicare. Social Security benefits can begin as early as age 62 or as late as age 70. And senior discounts begin at some retailers and restaurants for those who are 55 or older.

If you’re 50 or older, you’re eligible to become an AARP member.

Spending Retirement Savings. Retirement accounts are developed to motivate workers to save for their retirement. Thus, accounts like a 401(k) plan or IRA usually impose a penalty for early withdrawals. If you take money out before age 59½, you’ll typically be hit with a 10% penalty. You may consider yourself a senior citizen when you no longer have to concern yourself with that 10% penalty for early withdrawals from your IRA or 401(k).

However, when you hit a certain age, you will need to take required minimum distributions from retirement accounts. Also called “RMDs,” these withdraws from traditional IRAs and 401(k) plans must be taken each year after age 72. Once you reach 72, you may think of yourself as a senior citizen because you have to start taking your RMDs from your retirement account.

Retirement. After you retire from working every day, your family and friends may consider you to have attained senior citizen status. The transition might bring on a feeling of meaning and purpose. Once you reach a certain age, you look back and go through self-reflection.

As you stop going to the office every day, you might feel a sense of gratitude for the years you were able to work and pursue a passion.

Health Issues. Medical conditions like arthritis, hypertension, or hearing loss may cause you to feel like you have reached senior citizen land. A person that is battling several age-related medical issues can feel olde,r just by the number and type of medications or medical devices they use.

It’s not easy to feel young when you are being fitted with a walker or hearing aid, and you’re lining up pill bottles every morning and evening. Feeling fatigued or ready for bed by 9 p.m. might be signals that you are getting older.

Reference: US News and World Report (Jan. 27, 2021) “When Do You Become a Senior Citizen?”

Do You Know These Social Security Surprises?

If you don’t understand how Social Security works, you may get caught off guard by some of Social Security’s rules and nuances, says Motley Fool’s recent article entitled “Don’t Let These 3 Social Security Surprises Ruin Your Retirement.” Here are some things to keep in mind:

  1. Taxes on benefits. Many assume that Social Security is not taxed, but it may be, depending on your provisional income. Your provisional income is calculated by taking your non-Social Security income plus 50% of your annual benefit payments. If that total is between $25,000 and $34,000 for a single or between $32,000 and $44,000 for a married couple filing jointly, you could be taxed on up to 50% of your benefits. Moreover, if your provisional income is more than $34,000 as a single tax filer, or $44,000 as a joint filer, you may be subject to taxes on up to 85% of your benefits. Typically, if Social Security is your sole retirement income source, you will avoid having your benefits taxed at the federal level. However, there are 13 states that tax Social Security.
  2. Withheld benefits when you still get a paycheck. When you hit your full retirement age (FRA), which is when you are entitled to collect your monthly Social Security benefit in full, you can earn as much money as you would like from a job, without having that income impact your benefit payments. However, if you work and collect benefits at the same time before reaching FRA, you may have some of your benefits withheld if you exceed the annual earnings test limit.

You can earn up to $18,960 in 2021 without losing any benefits. Above that threshold, you will have $1 in Social Security withheld for every $2 you earn. If you will be attaining FRA this year, the earnings test limit is higher, $50,520, and after that you will have $1 in Social Security withheld for every $3 you earn.

These withheld benefits are not lost permanently. They are added onto your monthly benefit once you reach FRA. However, claiming Social Security before FRA will also reduce your monthly benefit for life. Bear that in mind, if you are planning to continue working.

  1. Ultra-low cost-of-living adjustments. Social Security benefits are subject to a cost-of-living adjustment (COLA), which is designed to help seniors keep up with inflation. However, in recent years, it has not. From 2002 to 2011, COLAs averaged 2.43%, but between 2012 and 2021, they averaged only 1.65%. As a result, many seniors on Social Security have had trouble paying their bills. COLAs are tied to fluctuations in the cost of goods and services, but this does not necessarily relate to seniors. Because of this, some lawmakers have been advocating for a better way of calculating them.

If you are planning to depend primarily on Social Security in retirement, be certain that you know the details of the program.

Reference: Motley Fool (Feb. 1, 2021) “Don’t Let These 3 Social Security Surprises Ruin Your Retirement”

How to Be an Effective Advocate for Elderly Parents

Family caregivers must also understand their loved one’s wishes for care and quality of life. They must also be sure those wishes are respected. Further, it means helping them manage financial and legal matters, and making sure they receive appropriate services and treatments when they need them.

AARP’s recent article entitled “How to Be an Effective Advocate for Aging Parents” says if the thought of being an advocate for others seems overwhelming, take it easy. You probably already have the skills you need to be effective. You may just need to develop and apply them in new ways. AARP gives us the five most important attributes.

  1. Observation. Caregivers can be too busy or tired, to see small changes, but even slightest shifts in a person’s abilities, health, moods, safety needs, or wants may be a sign of a much more serious medical or mental health issue. You should also monitor the services your family member is getting. You can take notes on your observations about your loved one to track any changes over time.
  2. Organization. It’s hard to keep track of every aspect of a caregiving plan, but as an advocate, you must manage your loved one’s caregiving team. This includes creating task lists and organizing the paperwork associated with health, legal, and financial matters. You’ll need to have easy access to all legal documents, like powers of attorney for finances and health care. If needed, you might take an organizing course or work with a professional organizer. There are also many caregiving apps. You should also, make digital copies of key documents, such as medication lists, medical history, powers of attorney and living wills, so you can access them from anywhere.
  3. Communication. This may be the most important attribute. You need communication for building relationships with other caregivers, family members, attorneys and healthcare professionals. Be prepared for meetings with lawyers, medical professionals and other providers.
  4. Probing. Caregivers need to gather information, so don’t be shy about it. Educate yourself about your loved one’s health conditions, finances and legal affairs. Create a list of questions for conversations with doctors and other professionals.
  5. Tenacity. Facing a dysfunctional and frustrating health care system can be discouraging. You must be tenacious. Here are a few suggestions on how to do that:
  • Set clear goals and focus on the end result you want.
  • Keep company with positive and encouraging people.
  • Heed the advice of experienced caregivers’ stories, so you understand the triumphs and the challenges.
  • Be positive and be resilient.

Reference: AARP (Sep. 24, 2020) “How to Be an Effective Advocate for Aging Parents”

The Difference between Power of Attorney and Guardianship for Elderly Parents

The primary difference between guardianship and power of attorney is in the level of decision-making power, although there are many intricacies specific to each appointment, explains Presswire’s recent article entitled “Power of Attorney and Guardianship of an Elderly Parent.”

The interactions with adult protective services, the probate court, elder law attorneys and healthcare providers can create a huge task for an agent under a power of attorney or court-appointed guardian. Children acting as agents or guardians are surprised about the degree of interference by family members who disagree with decisions.

Doctors and healthcare providers don’t always recognize the decision-making power of an agent or guardian. Guardians or agents may find themselves fighting the healthcare system because of the difference between legal capacity and medical or clinical capacity.

A family caregiver accepts a legal appointment to provide or oversee care. An agent under power of attorney isn’t appointed to do what he or she wishes. The agent must fulfill the wishes of the principal. In addition, court-appointed guardians are required to deliver regular reports to the court detailing the activities they have completed for elderly parents. Both roles must work in the best interest of the parent.

Some popular misperceptions about power of attorney and guardianship of a parent include:

  • An agent under power of attorney can make decisions that go against the wishes of the principal
  • An agent can’t be removed or fired by the principal for abuse
  • Adult protective services assumes control of family matters and gives power to the government; and
  • Guardians have a responsibility to save money for care, so family members can receive an inheritance.

Those who have a financial interest in inheritance can be upset when an agent under a power of attorney or a court-appointed guardian is appointed. Agents and guardians must make sure of the proper care for an elderly parent. A potential inheritance may be totally spent over time on care.

In truth, the objective isn’t to conserve money for family inheritances, if saving money means that a parent’s care will be in jeopardy.

Adult protective services workers will also look into cases to make certain that vulnerable elderly persons are protected—including being protected from irresponsible family members. In addition, a family member serving as an agent or family court-appointed guardian can be removed, if actions are harmful.

Agents under a medical power of attorney and court-appointed guardians have a duty to go beyond normal efforts in caring for an elderly parent or adult. They must understand the aspects of the health conditions and daily needs of the parent, as well as learning advocacy and other skills to ensure that the care provided is appropriate.

Ask an experienced elder law attorney about your family’s situation and your need for power of attorney documents with a provision for guardianship.

Reference: Presswire (Jan. 14, 2021) “Power of Attorney and Guardianship of an Elderly Parent”

What are the Issues with COVID Vaccinations Sign-ups for Seniors?

With states across the U.S. providing the COVID-19 vaccine to people 65 and older, seniors are trying to determine how to make an appointment to receive their shots. Many government agencies ask people to make appointments online. However, website errors, overwhelmed phone lines and a collection of changing rules are frustrating seniors who are frequently less tech-savvy, may live farther from vaccination sites and are less likely to have Internet access—especially minority populations and the poor.

ABC News’ recent article entitled “Online sign-ups complicate vaccine rollout for older people” reports that almost 9.5 million seniors (16.5% of Americans 65 and older) lack internet access, according to U.S. Census Bureau data. Moreover, the access is worse for minority seniors, with more than 25% of Black people, about 21% of Hispanic people and over 28% of Native Americans age 65 and older have no way to get online. Compare that with 15.5% of white seniors.

In the San Francisco Bay Area, Dr. Rebecca Parish has been saddened by the bureaucratic red tape and continued calls for help from seniors. An 83-year-old patient called her in tears, unable to navigate the online appointment system at her local drugstore. After several of these types of calls, Dr. Parish took action. She contacted Contra Costa County and acquired 500 doses to vaccinate people at a middle school in Lafayette, California. She’s also working with nonprofits to identify seniors who don’t live in nursing homes and risk falling through the cracks. All her appointments have been taken, but she’ll begin adding more when more doses are available.

Many health officials have been trying to find other solutions to ease the confusion and help senior citizens sign up, as the Trump administration asked states to make the nation’s 57.6 million seniors eligible for the COVID-19 vaccine.

Some spots have discovered that simple ideas can work. For example, in Morgantown, West Virginia, county health officials used a large road construction sign to list the phone number for seniors to call to make an appointment. Some are looking at working with community groups or setting up mobile clinics for more remote populations.

Some medical systems, like UCHealth in Colorado, are trying to partner with community groups to get vaccines to underserved populations, like seniors. Local doctors are volunteering at a clinic hosted by a church that brings in the vaccine and helps build trust between health care workers and residents.

For now, UCHealth schedules appointments online, but a COVID-19 hotline is in the works because of the volume of calls from seniors. Howwever, even a Colorado health provider setting up vaccine clinics for underserved communities, Salud Family Health Centers, said their phone lines aren’t equipped to handle the number of calls they’re getting and encouraged people to go online.

Reference: ABC News (Jan. 15, 2021) “Online sign-ups complicate vaccine rollout for older people”

States with Most Affordable Long-Term Care?

Seven in 10 people 65 and older will require some type of long-term care during their lifetime. This expense will vary based on the patient’s required level of care, care setting and geographic location, says Think Advisor’s recent article entitled “15 Cheapest States for Long-Term Care: 2020.”

A recent study by Genworth found that the cost for facility and in-home care services increased on average from 1.9% to 3.8% per year from 2004 to 2020. That amounts to $797 annually for home care and as much as $2,542 annually for a private room in a nursing home.

At the current rate, some care costs are more than the 1.8% U.S. inflation rate, Genworth said.

These findings were taken from 14,326 surveys completed this summer by long-term care providers at nursing homes, assisted living facilities, adult day health facilities and home care providers. The survey encompassed 435 regions based on the 384 U.S. Metropolitan Statistical Areas, as defined by the U.S. Office of Management and Budget.

In a follow-up study, Genworth also found that these factors are contributing to rate increases for long-term care:

  • Labor shortages
  • Personal protective equipment (PPE) costs
  • Regulatory changes, such as updated CDC guidelines
  • Employee recruitment and retention issues
  • Wages demands; and
  • Supply and demand.

Here are the 15 cheapest states for long-term care, according to Genworth with their average annual cost:

15. Utah: $59,704

14. Kansas: $57,766

13. Iowa: $57,735

12. Kentucky: $57,540

11. South Carolina: $57,413

10. Tennessee: $56,664

9. North Carolina: $56,512

8. Georgia: $53,708

7. Mississippi: $52,461

6. Arkansas: $50,835

5. Oklahoma: $50,641

4. Texas: $48,987

3. Missouri: $48,753

2. Alabama: $48,240

1. Louisiana: $44,811

Reference: Think Advisor (Dec. 14, 2020) “15 Cheapest States for Long-Term Care: 2020”

What Do I Need to Know as a Caregiver for the Elderly?

Not everyone is cut out for assisting older people because the job requires a unique skillset and, more importantly, empathy.

Big Easy’s recent article entitled “6 Things to Consider as a Caregiver for the Elderly” says it can be hard to understand that a senior has become dependent on others, and being assisted in everyday tasks may even lead to compromises in their privacy. This can put a senior in stressful conditions that lead to anxiety. In that case, hiring a professional caregiver for the elderly may be the best option.

However, no matter your training, caring for an older person can still be challenging. Consider these six things to develop the best possible relationship with the elderly and to provide the best care.

Compassion. Being compassionate helps develop a better connection to the elderly person. This can frequently solve many behavioral problems and can make for a pleasant caregiving environment. Most older people have some physical or mental disability that keeps them from being independent. In some situations, being abandoned by their loved ones creates even more emotional damage. To help, be empathetic and kind to them in these difficult times. This can significantly help to decrease the emotional pain that accompanies old age and illness. Being compassionate is one of the most effective ways of delivering the best care possible in these situations.

Communication. If you have the ability to have natural and comfortable conversations with elderly patients, you can develop a tighter emotional bond with them. Healthy communication and conversations also can distract a senior from things that may be troubling them, which will not only benefit the patient but will also help you carry out your tasks more easily. You may also be called upon to interact with other family members or doctors, so good communication skills are required.

Safety. Safety is vital for the elderly, and the slightest negligence can become a matter of life and death for them. The most common types of injuries for older people are attributed to falls. It is also even more dangerous because their bones are weak and don’t heal quickly. Use extreme care when assisting seniors in slippery areas, like the bathroom. Take precautions, such as de-cluttering the house and eliminating tripping hazards. Most importantly, keep them under constant observation, especially those with mental illnesses.

Hygiene. Maintaining quality hygiene can be a challenge, especially if people are shy or want their privacy. Take bathing as an example: it’s not surprising that the elderly are embarrassed, when caregivers have to bathe them. Even so, you are tasked with maintaining their hygiene. If you don’t, it can lead to more health-related issues.

Medications. Most seniors take medication, some of which produce side effects, such as nausea or dizziness. As a caregiver, you should make certain that they are taking their medicines on time and watch for side-effects in the case of an emergency. Review their medications and administer the prescribed dosage at the right times yourself. This will also help those who forget to take their medicines without prompting.

You may have several challenging times throughout your career as a caregiver for the elderly, but empathy and compassion will help you considerably. You will create a better job experience and help the elderly with a very difficult phase of their life.

Reference: Big Easy (Dec. 10, 2020) “6 Things to Consider as a Caregiver for the Elderly”

What Should I Know, If I Need to Take an Elderly Person to the Doctor?

First, know and understand the rules in the pandemic.

AARP’s August 17 article entitled “4 Things to Know When Taking a Loved One to the Doctor During COVID-19” provides four other things to consider as you plan doctors’ appointments.

Is there an urgent need for the appointment? A caregiver of a senior may be tempted to schedule some appointments. However, doctors are trying to return to normal, and even with precautions in place, they may not want to see your senior for a non-urgent visit. Right now, most doctors don’t advise patients to come into their office for routine follow-ups. See if the visit can be postponed or ask the medical office about a virtual visit on Zoom.

Do you know the office’s visitor policy? If the doctor asks you to bring your loved one to the doctor’s office, look at its visitor policy before you go. With COVID-19, most offices have very strict policies and may only permit scheduled patients in the office. Some will make exceptions for a senior’s caregiver if needed, but they may request that once the patient is checked in, the caregiver wait in the car.

What are the facility’s precautions against COVID-19? In most health care facilities, as well as in imaging centers, doctors’ offices, hospitals with outpatient services, ERs and labs, there’s intense facility cleaning and sanitizing, universal masking, physical distancing and hand sanitizing. Patients are typically met at the door with a thermometer and a COVID-19 questionnaire. Other precautions include removing magazines to protect against the risk of virus transmission and requiring all staff to wear surgical masks.

What preparation is needed for an in-person appointment? Both the caregiver and patient should wear masks and get there punctually. When you make the appointment and it is prep for a scheduled surgery or procedure, ask if the patient needs a COVID-19 test.

You should also bring a list of medications with dosages and frequencies (and the number of refills left.). It is also helpful to have on hand a medical history that includes symptoms, dates and durations. This can be valuable in completing the COVID-19 questionnaire and to get more from the appointment. You should also have a list of questions for the doctor.

When you leave the appointment, be certain: (i) all of the patient’s questions have been answered; (ii) review the instructions for home care provided in the treatment plan; and (iii) schedule the next appointment, if a follow-up is needed.

Reference: AARP (Aug. 17, 2020) “4 Things to Know When Taking a Loved One to the Doctor During COVID-19”

What Did the Supreme Court Say about Medicaid Work Requirements?

The Trump administration had asked the Supreme Court in July to reinstate its historic approvals of state work requirements waivers. It contends that these rules may assist certain beneficiaries in transitioning to private policies and may result in improved health and to help states conserve financial resources to provide coverage to others in need.

MSN’s article entitled “Supreme Court agrees to consider Medicaid work requirements” reports that lower courts have struck down the Department of Health and Human Services’ approvals, holding that Medicaid’s primary purpose is to provide health care coverage.

The National Health Law Program, one of the consumer advocacy groups that brought the original lawsuits, said it thinks it will win at the Supreme Court.

“HHS’s action was properly vacated because Secretary [Alex] Azar failed to account for the significant loss in health coverage that these approvals would produce,” said Jane Perkins, legal director at the National Health Law Program. “Tens of thousands of people would lose their Medicaid coverage and become uninsured.”

The Supreme Court’s decision to take up the cases follows a panel of federal appellate judges that struck down the Trump administration’s approval of work requirements in Arkansas in February. The unanimous decision, written by Judge David Sentelle, a Reagan appointee, affirmed a district court ruling that found the administration had failed to analyze whether these programs would “promote the primary objective of Medicaid — to furnish medical assistance.”

New Hampshire stopped its roll-out of work requirements last year after the same district judge, James Boasberg in DC, set aside the administration’s approval in that state.

In an unprecedented step two years ago, the Trump administration started granting state requests to mandate that certain Medicaid beneficiaries work to receive benefits. Republicans have long wanted to have that requirement with Medicaid, which insures more than 75 million low-income Americans.

There were 12 states that received waivers, although four were set aside in court, according to the Kaiser Family Foundation. Another seven state requests are awaiting federal approval. Work requirements are not in effect anywhere, after states stopped their efforts because of the legal rulings and the pandemic.

In Arkansas, more than 18,000 people lost coverage in 2018, before the court intervened. Judge Boasberg had also canceled Kentucky’s approval. That move blocked work requirements from being implemented in the state. However, Kentucky withdrew its waiver request after a Democratic governor won election in 2019 and dismissed its appeal.

The judge blocked work requirements in Michigan earlier this year.

Reference: MSN (Dec. 5, 2020) “Supreme Court agrees to consider Medicaid work requirements”