Caregiving Guide

The Caregiver Sur-Thrival Guide Copyright 2013, Anthony Cirillo 1
The Caregiver Sur-Thrival Guide
Turning Caregiving from Burden to Opportunity
Anthony Cirillo, FACHE
877-278-8791 / anthonycirillojr@gmail.com

Table of Contents
Introduction pg. 3
Putting Things in Perspective pg. 4
8 Lessons on Leading a Quality Life pg. 5
5 Common Misconceptions About Aging pg. 8
How to Be a Caregiver and
Still Have Time to Make Love with Your Spouse! pg. 11
Another Reason To Take Care of Yourself.
There Will Be No One Left To Do It. pg. 14
Crossing the Precipice -
Stepping Into the Caregiver Role, Part 1 pg. 18
Crossing the Precipice -
Stepping Into the Caregiver Role, Part 2 pg. 21
Video Caregiving - All-Video Caregiving Site pg. 23
Alzheimer’s Resources from Assisted Living Today pg. 24
Guide For Male Caregivers pg. 25
Lotsa Helping Hands Can Do Lotsa Good pg. 27
Choosing Care
Choosing a Geriatric Care Manager pg. 28
Evaluate a Facility Before Touring It pg. 31
Taking a Tour pg. 33
Paying for Care
Overview pg. 39
Prepare for Higher Medical Costs During Retirement pg. 41
The Assurance Benefit pg. 44
Have a Flexible Retirement Plan pg. 46
Women Caregivers and Savings pg. 48
Caregiver Relief Fund pg. 49
Who Gets Grandma After the Divorce? pg. 50
Elder Abuse – Financial & Family Abuse pg. 51
After the Caregiving is Over pg. 54
Contact / Book Anthony pg. 55

Introduction
As a reader of my blog, you have benefited from great information pertaining to
quality aging. My platform is simple but profound. I call it Educated Aging. We
must prepare for aging sooner in life – physically, financially, emotionally – so
that we age with quality and not in crisis. Along the way I have also authored
important information on other platforms such as Assisted Living at about.com,
Caring.com and Answers for Elders. In this informative e-book, I bring you the
best of my writing as it pertains directly to your health and well being as a
caregiver. I hope you enjoy it.

A Horrible Way to Age – Putting This All in Perspective
From Ground Report
The Genworth 2013 Cost of Care Survey shows that the cost of receiving care in
a setting such as an assisted living facility or nursing home is dramatically
increasing, while the cost to receive care at home through homemaker services
or a home health aide is rising at a much more gradual pace.
Over the past 10 years of the study, the median annual nursing home costs have
gone up from $65,200 to $83,950, increasing at more than four percent a year.
The median annual cost for care in an assisted living facility is $41,400. This
represents an increase of 4.6 percent since 2012 and a 4.3 percent annual
increase over the past five years.
In all the debate over the Affordable Care Act, we are missing the bigger picture.
Obamacare is about providing insurance for hospitalization. Not sure about you
but I do not plan to grow old in a hospital. Most of us want to grow old in our
communities, not in a nursing home or an assisted living home. According to the
U.S. Department of Health and Human Services, at least 70% of people over age
65 will require some long term care services at some point; more than 40% will
need care in a nursing home.
My platform is educated aging, the notion that if you plan sooner in life for aging
– physically, financially and emotionally - you will age with a better quality of life. I
fell into a mission for elders partly because I am a healthcare professional but
mostly because one day I found myself singing and performing in nursing homes.
I contend that a lot of people in these homes got there not because age caught
up with them but because they did not keep up with themselves. But I have also
learned a lot about leading a quality of life from these very residents. I can point
you to a blind, wheel-chaired bound resident who has a better quality of life than
those on the “outside.” And it always has a lot to do with the person they were
before they ever arrived at the nursing home.
How we take care of ourselves when we are younger will affect how we age,
barring any uncontrollable factors. Most of the chronic conditions in this country
are a result of lifestyle and can be easily reversed. I will implore you to take
responsibility for your own health.
There are so many misconceptions about how long term care is paid for. Except
in a few circumstances, the sad reality is that many people will become destitute
in order to pay for care.
Emotional aging has more to do with what we can learn from our elders. So we
have lots to cover…

8 Lessons From Our Elders on Leading a Quality Life
from Caring.com
There is a Taco Bell Super Bowl commercial in which a bunch of elderly folks get
rowdy while the song "We Are Young" by a band called Fun plays in Spanish. It's
irreverent, but it is fun! The English lyrics read:
Tonight / We are young / So let's set the world on fire / We can burn brighter /
Than the sun.
On most days you probably don't feel like you can set the world on fire. But
caregiving doesn't have to be a bad experience. Caregiving is an opportunity to
give back and have a closer personal relationship with the person to whom you
provide care.
Over 20 years of performing for elders in nursing homes and assisted living
communities, I've learned a number of life lessons. One woman who was blind
and in a wheelchair had a better quality of life -- in a place we associate with
death -- than many I know on the "outside."
I have observed eight traits of elders living a quality life that can teach us all
something. In fact, I turned these lessons into a keynote presentation called "The
Meaning of Life," which I give for caregiving groups and long-term care
professionals.
1. Have purpose.
Ruth Anne, a resident in a Charlotte nursing home, was president of the
resident's council, delivered mail, and never kept still. When I interviewed
her for my book, Who Moved My Dentures?, she said she prayed to God
every day for her purpose. I mean, wow! Do you know your purpose in
life? If so, great -- but understand that it will evolve and change over time,
so watch out for the signs. You will not be a caregiver forever.

2. Stay active.
Why is my 92-year-old mom still getting around and driving my sister
crazy? She went dancing three times a week up until her mid-eighties. My
equally spry mother-in-law is in her early eighties, walks every day, and
takes no medications. Put time aside on your calendar for fitness.
3. Laugh every day.
The residents I have the most fun with are those who kid around with me,
like Esther, my designated heckler. Bring humor into your life and
workplace. Listen to comedy. Watch something humorous. Buy a book on
stand-up comedy. Open yourself up to fun.
4. Learn something new.
One of the groups I write about in my book calls itself The Raging
Grannies, a protest group of elders who use song parodies. They involve
other residents by having them help with costumes and songs. It keeps
them young because their minds are constantly stimulated. As Jim Rohn
said, "Formal education will get you a job. Self-education will get you rich."
5. Nurture friendships.
The strong friendships that develop in assisted living communities are
amazing. Seniors find that the social aspect of the community is life
sustaining. There are many studies on the value of friendship and
socialization. If you are shy and reserved, try to step out of your comfort
zone and talk to and meet new people. Be a good listener. Estranged from
someone? Life is too short. Make amends.
6. Have a great attitude.
My friend Jean, a CCRC resident who has long passed, when first
introduced to her new living arrangement saw it not with pain but with
possibilities. This shy, widowed housewife embraced community life and
came to all of my performances. The importance of a positive attitude has
been beaten to death. But know this: Your attitude reflects on you, and
you -- yes you -- have your own personal brand of attributes that others
will use to define you.
7. Be grateful and
8. Be loving.
We'll put the last two together. The seniors I hang out with have
unconditional love for people. But what really strikes me is how grateful
they are for everything. Try this: Every day, be grateful for three things in
your life. Keep a journal documenting one positive thing that has
happened to you that day. Miracles are everywhere. When you are
grateful, they show up.

Your health and well being are important. Don't sacrifice them as you care for a
loved one. Pay attention to what you can learn from all of this. Your caregiving is
a journey, and the rewards are the lessons you learn from paying attention to that
journey.

5 Common Misconceptions About Aging
from Caring.com
There is a tendency toward age bias in our society. Typical stereotypes are that
seniors are "slow" or have poor memory, for example. In addition, Princeton
University professors have uncovered prescriptive prejudice, which are beliefs
about how older adults should act. They found three key ideas:
 Succession, the idea that older adults should move aside from high-paying
jobs and prominent social roles to make way for younger people
 Identity, the idea that older people should not attempt to act younger than
they are
 Consumption, the idea that seniors should not consume so many scarce
resources, such as healthcare
Seems we're battling a lot. There are misperceptions and perhaps unrealistic
expectations among younger people about older people. Let's take a closer look
at five of the most common:
1. Misconception: When you're old, relationships are about companionship, not
romance.
Truth: Dating never changes. The dramas around finding romance when
you're older are the same as when you were young. Of course, with older
women typically outnumbering older men, the "cat fighting" might actually be
exacerbated in an aging society. A lot of women compete for a few lucky
guys!
My mom, soon to be 93, dated throughout her eighties. As with any romance,
for her it was about finding people who had similar interests, took care of
themselves, and could hold a conversation.
On the reality show Forever Young, on TV Land, one episode poignantly
depicted generational similarities, as the older house members helped the

younger ones prepare for a date -- and then vice versa. All of them were
nervous. All of them were looking for a connection. Some succeeded, some
did not.
2. Misconception: When you're old, sexual relations stop.
Truth: Not by a long shot. Many older Americans routinely engage in
intercourse, oral sex, and masturbation, according to a one study published
by the New England Journal of Medicine. The study included 3,005 men and
women. Among those aged 57 to 64, 73 percent said they continued to have
sex; 53 percent of those 65 to 74 and 26 percent of those 75 to 85 gave the
same answer.
A survey of 250 residents in 15 Texas nursing homes found that 8 percent of
them said they had had sexual intercourse in the preceding month, and 17
percent more wished they'd had.
In one New York nursing home, when the staff learns of coupling in the
works, they don't wait for residents to ask for a private room. They relocate
one of the partners to a private room if both are in shared rooms.
3. Misconception: You will become socially isolated.
Truth: It's your choice. While it is true that social isolation can become a
problem as you age, the capacity to pick meaningful friendships is actually
better. Mature adults tend to understand themselves well, and they also
understand other people. In a study published in the Journal of Gerontology,
older adults were especially good at solving interpersonal dilemmas. "As we
get older, our social intelligence keeps expanding," explains Dr. Margaret
Gatz, professor of psychology, gerontology, and preventive medicine at the
University of Southern California, speaking to O Magazine. "We get better at
sizing up people, at understanding how relationships work."
One bit of caution: In the book The Longevity Project, Howard S. Friedman
and Leslie R. Martin explain their 20-year study following subjects from
childhood to adulthood to discover why some thrived well into old age and
others did not. They found that friendly, outgoing people do not necessarily
live longer. They conclude that highly sociable people may tend more to
engage in the dangers of the moment and give in to the crowd.
4. Misconception: Your brain capacity decreases.
Truth: Your brain is a work in progress. Studies show your brain continues to
strengthen as long as you continue to challenge it. The brain is continually
reshaping itself in response to what it learns. In a study published in the
Journal of Neuroscience, German researcher Janina Boyke and her

colleagues taught 60-year-old adults how to juggle. Afterward, scans showed
growth in a gray-matter region that processes complex visual information. A
George Washington University study found that older adults who joined a
choir were in better health, used less medication, and had fewer falls after a
year than a similar group that didn't join. So keep your brain stimulated and
you will continue to grow.
5. Misconception: We grow up to be grumpy old men and women.
Truth: We get happier. At TEDxWomen, psychologist Laura Carstensen
shows research that demonstrates that as people get older they become
happier, more content, and have a more positive outlook on the world.
Researchers from Heidelberg, Germany, interviewed 40 centenarians and
found that, despite significant physical and mental problems, 71 percent said
they were happy, and more than half said they were as happy as they'd been
at younger ages.
According to a USA Today article, happy people have a 35 percent reduced risk
of dying compared with those who reported feeling least happy.
Romantic, sexual, social, smart, and happy elders -- sounds like a great way to
age and to live. That's something to emulate.

How to Be a Caregiver and Still Have Time to Make Love with Your Spouse!
from Answers for Elders
Ok. Got your attention. Good.
So much of aging has been turned into a negative, depressing state that is
constantly in a whirlpool of churning crisis after crisis. What if it didn’t have to be
that way? Let’s look at some ways of turning caregiving from crisis to opportunity
while enhancing your quality of life and that of your loved one. Oh and giving you
more time to do the things you love!
Mindset
Caregiving doesn't have to be a bad experience. Caregiving is an opportunity to
give back and have a closer personal relationship with the person to whom you
provide care. So first change your mindset from caregiving as a burden to
caregiving as an opportunity. And as you grow closer to the person you may also
want to pay attention to what you can learn. I have observed eight traits of elders
living a quality life that can teach us all something. In fact, I turned these lessons
into a keynote presentation called "The Meaning of Life," which I give for
caregiving groups and long-term care professionals. Here they are briefly. Read
more here.
 Have purpose.
 Stay active.
 Laugh every day.
 Learn something new.
 Nurture friendships.
 Have a great attitude.
 Be grateful and
 Be loving.
There’s An App for That
There are a handful of apps that can help you on your caregiver journey.
Elder 411
Over 500 pieces of expert advice are organized around 11 categories. There are
written tips, audio tips and video tips. You can search the app and also add your
own notes. Dr. Marion Somers, Ph.D., (Doctor Marion) is the face of the app.
She has provided care for more than 2,000 elderly clients while she owned and
operated a thriving Geriatric Care Management practice. She now shares her
approach to caregiving with others.

Involve Care
Involve Care helps you organize your caregiving activities and share them with
family and friends who want to help. Use the app to request assistance and
volunteer for activities to help everyone you care for live better. Add
appointments, post requests, involve others. Invite those people who you know
will help. Typically these are family and close friends. When they see all the
opportunities to help you and your loved one by accepting and completing the
requests, they will start pitching in.
Tonic
Winner of "Best Mobile Health Solution for Behavior Change" at the Mobile
Health 2011: What Really Works! conference held at Stanford University, Tonic
helps you remember and keep track of everything in your health regimen, making
it easier to take care of yourself and everyone else in your family. You set the
agenda—perhaps advised by your doctors, family and friends—while Tonic helps
you remember, track and organize.
Caregiver’s Touch
Touch is subscription-based app that keeps critical information at your fingertips
and allows you to safely and seamlessly share it with others. Use Caregiver's
Touch to enter, update and store a broad range of important data you need to
care for your loved one, such as a parent's insurance provider and medication
regimen. Then download the iPhone application to keep this information with you
wherever you are.
There’s a Community for That
There are communities of care popping up that can help and support you on your
journey.
Caregiver Relief Fund
The Caregiver Relief Fund provides vouchers for at-home respite care. Vouchers
for professional at-home care services are donated or purchased on behalf of the
Caregiver Relief Fund. They award these vouchers to caregivers, giving them
time to address their personal needs and financial resources to invest in their
own well being. They select individuals who have been in a caregiving role for a
chronically ill individual, elder or disabled person for 12 months or longer.
Applicants must not have an annual income that exceeds $80,000. Caregivers fill
out an application form, share their caregiving story and go through an interview.
They then select and match the available relief funds with the needs of the
caregiver.

Lotsa Helping Hands
Lotsa Helping Hands powers online caring communities that help restore health
and balance to caregivers’ lives. The service brings together caregivers and
volunteers through online communities that organize daily life during times of
medical crisis or caregiver exhaustion in neighborhoods and communities
worldwide. Caregivers benefit from the gifts of much needed help, emotional
support, and peace of mind, while volunteers find meaning in giving back to
those in need.
AnswersForElders.com
Voted in 2013 as the Best Caregiver Site - People’s Choice by
SeniorHomes.com, the resources are vast and a family caregiver just like you
created it! On AnswersForElders.com, you can find experts, be educated, and
seek out pretty much everything you need to know - complete with a checklist
and hiring guide, to make sure you are hiring the best professional along the
way!
These resources are just a start. Do you own research as well.

Another Reason To Take Care of Yourself.
There Will Be No One Left To Do It.
The AARP Public Policy Institute released a report called “The Aging of the Baby
Boom and the Growing Care Gap: A Look at Future Declines in the Availability of
Family Caregivers.”
We already know we have a country that is not like Asian cultures that have
traditions of caring for family members as they age (though even that is
changing). So adding to that fuel is the report’s conclusion.
Family members provide the majority of long-term services and supports.
But the supply of family caregivers is unlikely to keep pace with future
demand.
 In 2010, the caregiver support ratio was more than 7 potential caregivers
for every person in the high-risk years of 80-plus.
 By 2030, the ratio is projected to decline sharply to 4 to 1; and it is
expected to further fall to less than 3 to 1 in 2050.
 2050 – I will be in my 90’s hopefully. And my kids will be anywhere from
63 to 73 years old. So the care ain’t happening there! So with little unpaid
options, what’s an elderly bloke to do?
Pay for care. We have written about the cost of that a lot here. Or hey better yet,
do everything I can NOW to keep in the best health possible. Of course I use
health in the broad sense – physical health, emotional health and financial
health.
Even if we had enough family caregivers, we do not necessarily have a national
culture that embraces our elders so maybe we need to do some work there as
well.
The report notes that family caregivers are a key factor in the ability to remain in
one’s home and in the community when disability strikes. And it says more than
two-thirds (68 percent) of Americans believe that they will be able to rely on their
families to meet their LTSS needs when they require help. My fellow boomers
are in for a rude awakening.
That may not happen so another option here is start what have been called
NORC’s – Naturally Occurring Retirement Communities, where an elder
population congregates to live in residential areas and the services they need
start to spring up around them. Plus they have each other to lean on as well.
Of course, if you have to pay for care there is little assistance. And if family
caregivers go away, there is no way Medicaid can sustain this debacle.

The report notes that the most important predictor of having someone to count on
when an individual needs help is being married, because spouses and adult
children most often arrange, coordinate, and provide care and social support.
So my advice:
1. Follow this blogs advice. Age in quality not in crisis and tend to your health
– physical, financial, emotional.
2. Foster a dialogue about caring for elders with children and grandchildren. I
can already see that my wife and I will have FAR more grandchildren than
we had children. Some of that is only natural. Where we have
grandparents taking care of their children’s children in today’s society,
well, we need to reverse that.
3. Think of how you will age in place and in what place. As mentioned,
naturally occurring communities offer support.
4. Get married and stay married!

Prepared to Live to 100? -
You Can Be If You Prepare Financially and Legally
from About.com
Boomers following the advice given here at about.com and my sister blog Who
Moved My Dentures? might actually start thinking that they are feeling so good
mentally and physically that they could live to be 100! Well yes you can. But are
you prepared? Let’s look at some tips individuals can follow for their own well-
being.
When I say prepared, I mean financially and legally. Now is the time to get your
house in order while you have your faculties and safe in the knowledge that you
have laid out your choices. The information does not just apply to you the
boomer but also to mom and dad for whom you may be providing caregiving. As
you look to do some of these for yourself see if mom and dad have their house in
order as well.
1. For younger boomers and older ones too, save aggressively for
retirement. So if your employer offers a matching 401(k) plan, participate.
And if they don’t, open an IRA. No one has any idea where Social Security
will be!
2. Get your investment house in order. Consult a financial professional to
help you sort through your options. I don’t know about you but I have six
different 401(k) plans sitting around and know they should be rolled into
one and my investment strategy revised. This is the money that will get
you through retirement and maybe even let you retire early, so get on
track early.
3. Get the right insurance for your needs. One of the interview subjects in my
book, Who Moved My Dentures?, commented that you don’t need life
insurance, you need living insurance. It doesn’t take that much to bury you
but it sure can take a lot to keep you alive, especially if a spouse passes.
It’s important to know what your health insurance covers while you are
employed. And it is important to know how you are going to pay for health
insurance after you retire, especially if you retire before you are eligible to
receive Medicare benefits. What is the right amount of life insurance that
you need? And should you be looking at long-term care insurance? Find a
trusted insurance professional to handle your needs. Ask your friends
whom they use. And embrace technology. The Internet has a wealth of
information to help you in your research.
4. Make a will. Realize that others will have to suffer the consequences of
sorting out your estate and your kids bickering over it if you don’t.

5. Prepare a living will. A living will spells out your wishes for how you want
to be cared for should you become sick and unable to make decisions for
yourself. This is also referred to as an advanced directive. Check out Five
Wishes.
6. You can also appoint someone to make decisions on your behalf by giving
that person healthcare power of attorney. Durable power of attorney for
healthcare allows others to make medical decisions on your behalf or you
on your parents’ behalf. A living will stipulates only what kind of care you
want when recovery is not expected.
7. A touchy subject here but the last thing you want is to have to go to court
to possibly be declared incompetent or to have mom and dad declared the
same. Avoid court. Draw up a durable power of attorney for finances. This
authorizes you or your kids (at the appropriate time) to pay bills, manage
investments, collect government benefits, and file taxes.
8. For the powers above designate your spouse but have a backup as well
and review the plan every three years to see if your situation has changed.
You could be taking care of a loved one for longer than it took you to raise
your children.
9. I hold my breath as I write this next one but consider making your funeral
arrangements sooner than later. OK Anthony, you say, that is just morbid.
Maybe so and I have not done it yet but my brother-in-law and sister-in-
law, mid 50’s, have their plots picked out and the arrangements made. Of
course they are practical. It will save your beneficiaries money.
Above all, check with a good estate attorney, your financial planner and your
accountant as you embark on this journey.
Oh and I thought you might chuckle at this anonymous quote I found: “Be nice to
your kids. They will choose your nursing home.”

Crossing the Precipice - Stepping Into the Caregiver Role, Part 1
from About.com
Not to make light of a serious situation but usually the first time a son or daughter
becomes aware that mom or dad needs help is when they have a minor fender
bender or get lost while driving. Other signs follow. So what do you do? How do
you start to enter a caregiving role that you are probably not prepared to do?
Let’s ease into this.
1. First you need to start the discussion with your parents. Provide gentle
encouragement to let them actually start the discussion. Talk about
alternate living arrangements, about driving etc. Be respectful to their
independence. Have a family conference with your siblings.
As of this writing my in-laws, in their 80s, are living independently. Over
the last five years, we have started and advanced the discussion of what
they might do when they can no longer live alone. As an experiment, they
have been living with different children during the course of the year. They
come to see my wife and I in the Carolinas in the winter. They spend
some time with another daughter in Arizona. And also spend extended
time with a son in Pa. They are getting used to life being different. Of
course, a tragic fire in which they lost nearly everything in their 70s only
increased their resilience.
2. According to a Canada.com survey of Canadian boomers, 59 percent said
it did not matter which parent to talk to, as both were receptive; 32 percent
said it was easier to talk with mom; 9 percent said it was easier to talk to
dad. Sixty-seven percent believe it is a woman who communicates best

with the parent. The major roadblock in talking is that their parents still
treat them as children, particularly so in the U.S.
3. Set up an emergency fund for yourself to pay for last minute flights, etc.
4. Find out as much as you can about parent’s finances. Or at least know
where to find information in case of an emergency. Do they have an estate
plan, will, power of attorney? You need those as well!
The very fact that you are having the discussion means you are moving into a
caregiving role. Much has been written about this topic some of which bears
repeating.
There is an actual condition called Caregiver Syndrome. Dr. Jean Posner, a
neuropsychiatrist in Baltimore, M.D. describes it as “a debilitating condition
brought on by unrelieved, constant caring for a person with a chronic illness or
dementia.”
There is a 63 percent higher chance of death for caregivers than non-caregivers.
According to the American Alzheimer’s Foundation, 60 percent of family
caregivers die before the person they are caring for. Caregivers have chronic
conditions twice the rate of others and 91 percent suffer from depression.
34 million Americans are unpaid caregivers for other adults. Other estimates put
it at 44.5 million. Thirty-seven percent of people polled by USA Today and ABC
News expect to move into the role.
Forty-one percent of those with a living parent are now providing care; eight
percent have parents who have moved in. According to the National Alliance of
Caregiving and Evercare, a division of UnitedHealth Group, out of pocket
expenses for a caregiver can be anywhere from $5,500 to $8,728 a year. A
typical caregiver is a 46-year-old female working out of the home. Men represent
40 percent of caregivers.
And there is an expectation that family will take the caregiving role. A poll by the
Life and Health Insurance Foundation for Education indicates that those who
need care do not plan adequately. Thirty-nine percent of 1,000 polled said they
would turn to family and friends if in need; 18 percent to health insurance; 15
percent to long-term care insurance; 12 percent to the government.
Caring is a complicated problem. Husbands or wives so devoted to their
spouses’ care can lose all their other social connections. Husbands stop going to
meet their buddies at the American Legion or the wife stops meeting her friends
for breakfast after Sunday services because they feel guilty leaving their spouse
alone in a long term care setting. They promised ‘for better or for worse’ and they
will do it even at the loss of their own active lives and sometimes their health.

And when the spouse dies, the caregiver spouse is alone and doesn’t know how
to reconnect to their former lives.
With some preparation, this does not have to happen to you. And you may want
to look into the services of a professional geriatric care manager.

Crossing the Precipice - Stepping Into the Caregiver Role, Part 2
from About.com
In our first article in this two-part series we looked at how to ease into the
caregiver role. We listed things to do but particularly focused on the health of the
caregiver. Unless you reach out for help, caregiving can be wrought with
problems. Let’s examine some resources.
There is some relief at least financially. The following are examples only. Check
your own state and municipality for programs available for you.
1. The Cash & Counseling grant program has introduced participant-directed
programs into the Medicaid programs of 15 states. Cash & Counseling
gives people with disabilities, including older adults, the option to manage
a flexible budget and decide what mix of goods and services best meet
their personal care needs. Participants may use their budget to hire
personal care workers, purchase items and make home modifications that
help them live independently. Those participants who don't feel confident
making decisions on their own may appoint a representative to make
decisions with or for them.
2. Tax breaks may be possible. You could reduce your taxable income by a
certain amount but your parents can’t have income (other than Social
Security) that exceeds that amount so if they have pensions, 401K’s this
might make it less likely. You must also pay for more than half the cost of
their living expenses.
3. There is the possibility of taking a medical deduction. A parent doesn’t
have to meet the income test but you still have to be supplying more than
50 percent of the living expenses and the expenses must exceed 7.5% of
adjusted gross income. If paying for nursing or assisted living care, ask
the administrator to break out how much of that is for medical.
4. A Caregiver Contract is a binding employment contract that provides a
modest stipend that covers travel costs and other expenses. These are
also known as Personal Service or Personal Care Agreements. By legally
paying you, mom and dad can reduce their estate and become eligible for
Medicaid more quickly. Avoid family disputes though. Manage multiple
siblings and their responsibilities. Each should evaluate what they can
reasonably do. Put care plans and financial arrangements in writing. Don’t
second-guess the primary caregiver.
5. Keep in mind that you cannot be paid an inflated rate to accelerate money
out of estate. Establish the services you will provide and then call a home
care agency and get the equivalent market value. Decide how to be paid -
up front or weekly and whether the money will go into an escrow account.

Some long-term care policies may allow payment to family members as
well.
6. California has created comprehensive paid family leave insurance.
Employees can take up to six weeks off with 55 percent of pay. Check
with your state.
The Century Foundation in its report– Facing the Problems of Providing Long-
Term Care for the Oldest Old – recommended that businesses offer various
programs aimed at easing the caregiving problem for workers, which would aid in
retention, decrease absenteeism and improve the productivity of workers
carrying the burden. Some companies have initiated employee assistance
programs in this regard. Texas Instruments provides elder care referral sources,
online help, access to caregivers, home health aides, cleaning services, social
support and flexible work hours. IBM, Ernst and Young, Xerox and Johnson and
Johnson are among others.
More needs to be done to address the needs of employees who have insomnia,
physical and emotional fatigue, alcohol and drug abuse, unexplained crying and
irascibility. You may be able to take some time off under The Family and Medical
Leave Act. Find out if your employer is mandated. If it has 50 or more employees
you’re entitled to up to 12 weeks of unpaid time off. If companies do not come on
board they may find themselves being sued. This latest litigation is dubbed
“Family Responsibilities Discrimination.”
People 85 and older are the fastest growing segment of the population. They will
be two percent of the population by 2010; five percent by 2050. Twenty percent
of baby boomers have no children and 25 percent have one child. By 2020, 1.2
million people aged 65 or older will have no living children, siblings or spouse.
Who will take care of these people?
Some of my boomer friends who had kids when they were 50 might find those
kids at 30 having to take care of them. And add to that the fact that this
generation is having fewer children and the support system for the child left as
the caregiver could be huge.
So be aware and prepare.

Video Caregiving an Exclusive All-Video Caregiving Site
A website from Terra Nova Films, Video Caregiving, is dedicated to “streaming”
visual educational material to family caregivers. It has launched a Spanish edition
too. Both sites are unique is the almost exclusive use of video in focusing on the
challenges faced by the caregiver.
The videos are designed to be short, simple and direct, and are able to be
accessed easily by the user at any hour of the day or night. Many of the videos
follow a documentary format that uses real people and follows real situations.
Studies indicate that roughly one-third of Hispanic households have at least one
caregiver, many of those dealing with somebody who has Alzheimer’s. Over
40% of these caregivers said they’d been forced into making major changes in
their lives, from cutting back on their working hours, to changing jobs to taking a
leave of absence or stopping work altogether.
While Alzheimer’s presents its own set of problems in the general population, it
seems to be even more acute in the Latino culture. Studies suggest that many
Hispanics may have more risk factors for developing dementia than other groups.
And surveys indicate that Latinos, less likely to see doctors because of financial
and language barriers, more often mistake dementia symptoms for normal aging,
delaying diagnosis.
Among the goals of the sites are not only to help the caregivers better
understand and deal with their situation, but also to remind—and actually
SHOW—them they are neither isolated or alone in their struggle. The videos on
the website are original footage, documentary in style, focusing on real stories of
real people in real circumstances.
An advisory team of representatives from the leading caregiving organizations
and a production team of experts on caregiving and Alzheimer’s disease came
together to create this resource, which offers specific videos on Alzheimer’s
disease and general caregiving.

Alzheimer’s Resources from Assisted Living Today
To help raise awareness of the significant impacts Alzheimer’s disease has on
families and loved ones, Assisted Living Today put together the Alzheimer’s
Action Day Guide, a comprehensive resource covering the latest research,
treatments, fact and figures, as well as informative tips for caregivers.
The Guide contains:
The Caregiver’s Guide to Alzheimer’s Disease
They interviewed a panel of 20 leading memory care experts. Each expert
answered three pertinent questions related to caregiving for a loved one with
Alzheimer’s:
 Advice for Alzheimer’s Caregivers
 Techniques for Treating Alzheimer’s Patients
 Key Questions to Ask About Alzheimer’s
Other topics covered on the site include:
 Dementia vs. Alzheimer’s: Are They the Same Thing?
 5 Signs of Alzheimer’s Disease You May Not Be Aware Of
 10 Common Memory Loss Causes
 The Eye Test – Alzheimer’s Disease Detection at The Most Crucial Point
 Top 5 Dementia Medications for Seniors
 5 Non-Medical Alzheimer’s Treatments That Work
 Dementia with Lewy Bodies (DLBs) – how it differs from Traditional
Dementia in the Elderly
 Ideal Living Settings for Alzheimer’s Patients
 Memory Care

New Guide For Male Caregivers Available
A new book, Who Says Men Don’t Care? is written specifically for four
generations of male caregivers. The premise of the Guide is that men care
differently than women, and these differences present both opportunities and
potential problems in all male caregiving situations. Knowing better who you are
can make you a healthier and more balanced caregiver.
A step-by-step approach to strengthening areas that need attention while
acknowledging, encouraging and celebrating those areas of successful care
giving is enhanced with helpful checklists that assist with analysis of care
management. While exposing and debunking myths and stereotypes about male
caregivers, it gives an important examination of generational attributes that
impact upon care giving.
A “typical” male caregiver
 Is between the ages of 30 and 80 years old
 Represents every race, culture, economic class, and sexual preference in
the US
 Is married, living with a partner, or cares for a child or relative
 Provides care to someone fifty or older or 15 years and younger
 Feels unappreciated and isolated
 Manages a variety of medications
 Hasn’t recently taken a vacation and spends little time on leisure activities
 Manages caregiving while working full or part time
 Doesn’t or can’t afford outside help
 Has an income between $20,000 and $50,000 a year
 Spends approximately $6,200 a year out of pocket for the person he is
caring for
 Provides an average of 25 hours a week caregiving (many spend more
time)

 Costs industry billions in lost productivity because of lost time
 Saves this country billions of dollars in government tax supported services

Lotsa Helping Hands Can Do Lotsa Good
I talked about a community service web site called See, Click, Fix. Through their
platform, anyone can report and track non-emergency issues anywhere in the
world via the Internet. In the process this empowers citizens, community groups,
media organizations and governments to take care of and improve their
neighborhoods. They maintain that citizens who take the time to report even
minor issues and see them fixed are likely to get more engaged in their local
communities. I blogged that a service like this should be extended to the elderly.
In a limited way, Lotsa Helping Hands seems to do this. It was created to support
family caregivers by empowering their family, friends, neighbors, colleagues, and
church or synagogue members – what they call a family’s ‘circles of community’
– who are eager to help them as they manage the daily tasks that become a
challenge during times of family or medical crisis, caregiver exhaustion, or when
caring for an elderly parent.
During their own caregiving experience, the founders saw how earnestly friends
wanted to help, and juggling the difficulty of organizing their assistance, they
designed Lotsa Helping Hands.
You start by creating a community. Maybe it’s for my mom so I enter Friends
Who Want to Help Phil. I then invite people to join the community via email. I
start with people who have expressed interest in helping. Next I start posting
needs. This may include mom needs dinner on Monday, Wednesday, and Friday
nights; or rides to medical appointments on Tuesday mornings. Members are
notified by email when new needs are posted. The system sends reminders to
volunteers so no one forgets their commitments.
Organizers have designed this not just for the elderly. They suggest organizing
volunteers to help a military family during deployment, coordinating meals and
childcare for new parents; managing volunteers and events for a school or
religious group; or coordinating volunteer activities in your local neighborhood.
Check it out.

Choosing a Geriatric Care Manager
from About.com
When choosing care for mom or dad and eventually yourself, it is often hard to
know where to start and how to evaluate your care choices. Let’s start to sort
through this.
You might want to start with a Care Management Service. You pay these
agencies to advise you. A Geriatric Care Manager generally provides a home
assessment and then creates a senior care plan based on the interview.
Typically care managers evaluate a senior's situation with regard to health
needs, housing choices and financial needs. You are not obligated to implement
any portion of the care plan and of course, before you sign anything, have an
attorney who specializes in elder care review all contracts.
Seniors may be more forthcoming with a Case Manager regarding life issues
than with family members. During the assessment questions could cover a range
of issues relevant to the health and living situation, including everyday activities,
nutritional status, safety, memory, depression, finances, insurance, and can be
done with or without family members.
A Care Manager finds out what you can do yourself, what can be done by other
family members, matches this to the plan and the economic situation and
arranges for and monitors services.
In evaluating a care manager consider the following:
 Do they understand the issues?
 Do they stay have a reputation for staying on top of things?
 Do they work well with other care providers?
 Do they communicate well with you and with your loved one?
 Are they on top of issues before they become problems?
Geriatric Care Managers can serve the needs of their clients by providing:
 Personalized and compassionate service — focusing on the individual’s
wants and needs.
 Accessibility — care is typically available 24 hours a day, 7 days a week.
 Continuity of care management – communications are coordinated
between family members, doctors and other professionals, and service
providers.
 Cost containment — inappropriate placements, duplication of services,
and unnecessary hospitalizations are avoided.
 Quality control.

According to the National Association of Professional Geriatric Care Managers,
there are many different ways of charging fees and each Geriatric Care Manager
works differently. You will need to know how often s/he bills. Some Geriatric Care
Managers bill weekly, some bill monthly, some bill upon completion of work. Ask
about these matters at the initial conference and ask for them in writing, so there
will be no surprises. If you don’t understand, ask again. If you need clarification,
say so. It is very important that you feel comfortable regarding your financial
obligations.
In addition to fees, most Geriatric Care Managers will charge for out-of-pocket
expenses, which may include charges for mileage, caregiving supplies, long-
distance telephone calls, etc. Find out if there will be any other incidental costs.
There may also be additional fees if outside professionals are called into the
case. It is imperative that the Geriatric Care Manager receives approval to bring
others in before the situation arises, if at all possible. Be sure to discuss and
make sure you have all questions answered before proceeding with an
agreement for services. You should expect a written agreement including fees
before the commencement of services.
If possible seek a certified Geriatric Care Manager. They should have a
Baccalaureate, Master’s or Ph.D. with at least one degree held in a field related
to care management, i.e. counseling, nursing, mental health, social work,
psychology or gerontology.
They should be primarily engaged in the direct practice of services to the elderly
and their families; and have two years of supervised experience in the field of
gerontology following the completion of the degree.
Certified members may be non-degreed RNs and other individuals with a
Baccalaureate, Master’s or Ph.D. degree, who are primarily engaged in the direct
practice of services to the elderly and their families and have three years
supervised experience in the field of gerontology.
If the problems that you or your loved ones are facing are becoming larger and
more complex than you can comfortably manage and if other demands and
responsibilities are now so great that you are not able to provide the desired level
of supervision and attention to your loved one’s problems, you should consider a
professional care manager.
In addition to working with families directly, care managers often affiliate with
others in the senior field to help their clients. Client sources include: banks and
trust officers, physicians and allied health professionals, attorneys, hospitals,
social service providers, gerontology professionals, senior housing communities.
If you are having trouble locating a care manager consider those professionals
as sources of information. Choose wisely. Do your homework. Trust your gut.

Take your time. But do consider getting help, as the task of caregiving can be
overwhelming.

Evaluating a Care Facility Before Calling or Touring
from About.com
Whether or not you are considering employing the services of a geriatric care
manager, nonetheless, you will still want to do your own homework in choosing a
nursing home, assisted living or other provider of care. Before you ever step in
the door for a tour, consider the following steps.
1. “Google” the facility and see what you find online. Go to their web site as
well but take it with a grain of salt.
2. Go to blog portals such as www.technorati.com and www.blogpulse.com
and type “nursing home” into the search. (Or assisted living, whatever you
are searching for…) Find out what bloggers are saying.
3. Find out who the owners are. Is this a for-profit or not for profit
organization? Is it family owned or corporate run? Who are the investors?
What are their motives? Dig a little and find out. Do these people /
corporations have a history in long-term care? How long have they owned
the particular facility? Has often has the facility changed ownership
hands? Is it for sale currently? Has the firm divided into smaller
corporations insulating it from liability? That is a big red flag. Read this
excellent article in the New York Times and then make your own
decisions.
4. Look into the accreditation of the facility. For continuing care communities,
find out if they are accredited by the Continuing Care Accreditation
Commission of the American Association of Homes for the Aging. When
choosing a nursing home, find out if they are accredited by the Joint
Commission on the Accreditation of Healthcare Organizations (JCAHO).
5. Find and talk to the patient ombudsman for the facility. You can ask for
this contact information when you call your state’s health department.
Review public records kept by the ombudsman, social service agencies
and the state about the facility.
6. Go to Nursing Home Compare. And if you want a shock go here and see a
list of the worst of the worst. Scroll down to Special Focus Facility Initiative
and List.
7. Consumer Reports has evaluated nursing homes as well.
8. Talk to community professionals such as your doctor and clergy and to
hospital discharge planners. What are they hearing? Where are they
referring?

Nursing Home Inspect has a tool to compare nursing homes in a state based on
the deficiencies cited by regulators and the penalties imposed in the past three
years. You will find the number of deficiencies cited by regulators in the past
three inspection cycles (roughly three years); the number of serious deficiencies
per home (that is, deficiencies in which patients were put at immediate jeopardy
of harm); the amount of fines imposed; and how often the government has
suspended payments to the home for new patients, another type of penalty. A
mapping feature visually shows how states differ in average fines, serious
deficiencies per home and payment suspensions.
You can also search nearly 60,000 nursing home inspection reports to look for
trends or patterns. Nursing Home Inspect allows users to search through more
than 260,000 inspection reports by keywords – such as “choke” or “maggots” – to
look for issues you care about. These search results can be sorted by date, city,
and state or by severity of the deficiency.
Nursing homes are inspected on both a regular schedule and when there is a
complaint. Inspectors typically work for state agencies paid by Medicare. If they
find problems, known as deficiencies, they rank them on a scale of A to L, the
most severe. The vast majority is either labeled D or E.
Other Considerations
If a hospital informs you that your loved one must be discharged within 24 hours,
you have appeal rights under Medicare. This could allow you to extend your
relative’s stay by two additional days and give you more time to research nursing
homes. Ask the hospital for a copy of “An Important Message from Medicare,” or
call 1-800-MEDICARE.
If possible, choose a facility close to friends and family. Choose a facility that
meets your needs. You might find that some assisted living facilities have
residents that really should be in a nursing facility and independent living facilities
have residents that need assisted living or nursing level care. Sometimes this
happens in the interview stage and staff simply does not pick up on certain signs
that signal advanced care is needed. Sometimes though, facilities become
attached emotionally and financially to their residents and do not want to see
them go, so they may provide a level of care inappropriate for their facility.

Touring an Assisted Living or Nursing Home - Part 1
from About.com
After you have considered hiring a geriatric care manager and also done your
homework around a care provider you are considering, it’s time to take a tour of
the facility. We’ve broken this into two articles to make it manageable. Here are
some tips.
1. Visit a facility all hours of the day. Go at night and on weekends and see
what is going on, what is being offered. Visit often.
2. How diligent was security when you entered? Was their security? Is staff
wearing their identification badges?
3. We have been trained that nursing homes smell of urine. Well guess
what? In the typical parts of a tour you might take they probably will not
smell as the staff has thought out your tour in advance. So perhaps see if
you can stray off the beaten track and be curious about seeing other
areas.
4. See if the Director of Nursing is out in the halls. Is he/she walking by
everyone not making eye contact, not saying anything? That will tell you
something.
5. Same with the administrator. Is the administrator out there asking how you
are doing, how are you feeling? That interaction is important. Look for it.
Sit down with the administrator and ask about their views on long-term
care. Ask if the facility is participating in the American Health Care
Association’s “Quality First Initiative.”
6. Ask for a copy of a report known as Form 2567 or the state inspection
survey. This report will reveal the results of unannounced visits by state
surveyors who spoke with residents and checked on sanitary conditions
and care issues.
7. Observe the residents.
Do they look happy?
Are their clothes clean and in good repair?
Are they wearing footwear?
Are the men shaved?
Does their hair look cared for?
Do the women have appropriate hairstyles; i.e. not pigtails!
Do they still have bibs on from their last meal?
Does any one look cold and not have a sweater?
Do you see a number of residents that are wet or smell of urine or BM?
Do the hands look clean especially under the nails?

Do the wheel chairs look clean and cared for with no sharp edges or
tatters?
Do the residents in wheel chairs look comfortable?
Are residents in wheel chairs being pushed too fast or backwards?
Are residents that are being walked rushed or are they allowed to walk at
their own pace?
Is a resident yelling out the whole time you are there?
How many residents are still in bed who are not bed-ridden?
8. Ask to have a meal in the dining room. If there is more than one dining
area, ask to see it. If residents are dining observe them for a few
moments. Are they socializing, smiling? Are they having a difficult time
with the food? How many residents are eating in the dining room that are
capable?
9. If you are looking into CCRC’s or assisted living facilities there may be a
program that allows you to live there for a weekend to try it out.
10.Ask a lot of questions. Go in and talk to the staff and find out what it is like
there. How experienced are they in what they are doing? How do they like
working there?
11.Find out how the staff works together. Are there patient care meetings at
the start of the day? Is there a hand off when the shift changes so that the
next shift coming in knows exactly what each resident’s personal situation
is for that day? Does staff make rounds together?
12.Find out about staffing.
How many aides per patient are there?
How many LPN’s and RN’s per patient are there?
How long has staff been on board?
What is the turnover rate?
Are temporary people used?
Is management stable?
Is management experienced in long-term care?
Are there geriatric nurse specialists and others specially trained to care for
older adults?
Does a facility conduct criminal background checks?
What are the responsibilities of individual staff members?
Who supervises them?
What is the duration and frequency of services? Experts say to only
consider a home that is providing at least two hours of direct care to the
resident a day.
Find out how the staff is treated. Are they adequately trained? How are
they valued and recognized?

Facilities with staff that have been in place a long time are facilities that provide
better care because they have experience. The facility must be treating its
employees with respect if they stay.

Touring an Assisted Living or Nursing Home - Part 2
from About.com
In a previous article we started to give you hints and tips when touring a nursing
home or assisted living facility. Here are some others.
1. Observe how the staff interacts with residents.
2. Often a resident will need some type of therapy such as physical or
speech therapy.
How are the therapists interacting with the residents?
Are there residents in a therapy area alone?
Is privacy being respected?
Is it busy with activity or is no one there?
Do they have a full-time physical therapist and occupational therapist?
Do they have a part time speech-language pathologist?
3. Are safety precautions in place to prevent accidents? Are exercise and
rehabilitation sessions scheduled regularly?
4. Ask for references of families who have loved ones there. Find out if this is
the first facility that the family member has been in or if they have been
transferred from another and why.
5. It often amazes me how you can put two organizations side by side, each
funded exactly the same way with the same mix of patients, and find one
that can offer a myriad of services including putting time and money into
activities and others receive the same money but do not offer the same
level of service. Be forewarned that there are all kinds of accounting tricks
designed to suck money out of these facilities such as management fees
and the like. Reputation matters. Check with others. Ask around.
6. Ask to participate in an activity.
7. Take a nurse with you when you go to visit a place that you are thinking
about.
Is there a multidisciplinary approach to care, that is, is there a team
approach?
Is care individualized for each patient?
What kind of quality assurance program do they have in place?
How is their data handled?
Are medical records computerized?
Is there full documentation of what is taking place?
What are the checks and balances in place to assure that everything is
being done above board?
What emergency procedures are in place?

What hospital will a resident be taken to if care is needed?
How is a resident’s own physician brought into the care team?
8. Sit in on a family council meeting. Talk to family council members
privately. How are families involved in their loved ones life? How does the
facility interact with the community in general?
9. Sit in on a residents' council meeting and talk to residents privately as
well.
10.Look beyond the wallpaper. That is, looks are deceiving. Remember you
are paying for a level of care. That is primary. Whether it is run like a fancy
hotel is secondary.
11.Ask to see the outdoor areas for residents. Are they shaded from the sun?
Are the areas protected from the rain, snow, and wind? Do they have an
outdoor area for residents who smoke? Are there seating areas? Is it
visually appealing?
12.Request a copy of the contract that you would sign if you opted to stay
there. Review it with an attorney who specializes in elder care. Formulate
questions.
13.At the end of the tour, assess how the staff responded and took an
interest in you. That will be an indication of how they will respond if your
family member is in the nursing home.
After admission, keep a diary of every visit. Record the date and time and where
you spent time with your loved one. If you have a complaint, document it. Take
photographs. Ask the administrator for a conference. If you need to go above the
administrator, contact state or local authorities, social services, adult protective
services – whatever is appropriate to your needs.
The following apply more to continuing care and independent communities.
1. Find out specifically what services are provided in the monthly fee and
what services are optional and available for a cost.
2. How much advanced notice will be given of fee increases?
3. What is the history of fee increases in the facility?
4. What payment options are available?
5. Find out the type of medical care provided. Is their an on-site doctor,
nursing care, etc?

6. Where is the nearest hospital?
7. Find out what their policy is for bringing outside agencies such as home
care services or private duty nurses in to help you.
8. Check menus and ask how special diets are accommodated.
9. Find out how many meals are included daily.
10.Find out if there is assisted living type care available such as assistance
with bathing and dressing.
11.Find out the size and type of your living quarters, maintenance and
housekeeping responsibilities, furnishings, and whether utilities are
included.

Paying for Long-Term Care - What Consumers Need to Know
from About.com
The financing of long-term care can be confusing, expensive, and onerous. Let's
try to sort some things out for you.
Most adults do not believe that they will ever need long-term care of any kind.
Yet predictions show that 50-70 percent of people will need this care. According
to Penn State Professor Peter Kemper, Georgetown University Professor Harriet
Komisar and Lewin Group Consultant Lisa Alecxih, 69 percent of today's 65 year
olds eventually will need long-term care. Thirty seven percent will need nursing
home care or assisted living; eight percent will spend more than five years there;
11 percent men; 28 percent women.
People are going into facilities at an older age needing more acute care. Despite
alternatives to nursing homes the fact is that people are in such acute need that
a nursing home is the only stop unless community support services rise to a level
to be able to support people in this setting. Surprisingly residents tend to be
admitted more for the chronic diseases - like heart disease, COPD, diabetes -
than for slips and falls and hip problems. There are an increasing number of
patients being admitted more for depression than dementia.
Of course some of these diagnoses are preventable if we start taking better care
of ourselves.
There are five ways to pay for long-term care. People think that Medicare will
carry the day. It does for no more than eight percent of the population. Medicare
covers skilled nursing care only if you have been hospitalized for three
consecutive days and then only for 100 days, 80 days of which you pay a 20
percent co-pay. ($144.50 per day (2012 rates). Care must be received within 30
days of discharge.
Next, self pay. According to The Kaiser Commission on Medicaid and the
Uninsured, self pay accounts for how 20 percent of people now pay for nursing
home care. Remember that is out of your pocket and out of your savings. The
average nursing home stay is 2.8 years, so if you have $200,000 or so socked
away just for this, you should be OK.
Your third option is Medicaid, the primary payer accounting for 70 percent of
people in nursing homes. Essentially after you exhaust your own personal funds,
you might become eligible for Medicaid. There are stipulations that I will not spell
out here. Suffice it to say that it is not as easy as just going broke to qualify. And
many people never want to consider this or think that it can be an option, a bit of
stereotyping that Medicaid is a poor peoples' program. Consult a professional!
A fourth option is something called The Assurance Benefit. This benefit converts

the death benefit of an in-force life insurance policy into a long-term care benefit
plan. The Assurance Benefit is specifically designed to address immediate needs
to pay for long-term care services. Life insurance is an unqualified asset for
Medicaid eligibility. To qualify an applicant will often times need to lapse or
surrender the policy. Converting the policy to an Assurance Benefit that pays
directly every month towards the costs of long-term care is a Medicaid qualified
spend down of the policy and it preserves a portion of the death benefit over the
entire period.
Finally, the fifth option is purchasing long-term care insurance. Long-term care
insurance is not just for older people. We live in a culture where there is a sense
of urgency to discharge people from hospitals as quickly as possible and into
rehabilitation. The cost of paying for that recuperation is often left up to the
individual. So while nursing homes and seniors spring to mind, younger people
who become ill or who suffer serious accidents might find themselves in that
same situation needing convalescent care. For those without adequate health or
disability insurance, or no insurance, the burden falls on them to pay.
There are three components of a long-term care policy - a daily benefit amount, a
waiting period, and once the benefits begin, a benefit period.
Even long-term care insurance may becoming an extinct option. The exit or
retreat of five key firms from the market since 2010 leaves only one dominant
player. Consult a long-term care specialist. A good long-term care specialist has
to listen first, then advise and consult, giving all the options so people can build
their plan.
While having options sounds nice, the fact of the matter is that there has been so
much emphasis on hospital and physician care that long-term care has fallen
through the cracks. Even starting early to save for unplanned care may not be
enough. What could help is taking care of your physical and mental health
throughout your life so as to decrease the chances of potential long-term care
needs and increase the potential for quality aging.

Prepare for Higher Medical Costs During Senior and Retirement Years
From Expert Beacon
No matter what your politics, the Affordable Care Act will fundamentally change
how we buy and pay for healthcare. Whether you have Medicare or are in that
gray area between retirement and Medicare, one thing is certain. To be able to
afford your healthcare you will pay more out of pocket. Is there any way to
prepare so you can age with quality and not in crisis? Yes, but it takes some
planning and determination.
Do
 avoid the healthcare system at all costs by taking care of yourself
 seek the least costly care setting
 shop for insurance
 bulk up on your HSA
 consider Medicare Advantage
Don't
 forget about long-term care
 think retirement planning isn’t for the young
 think family will rescue you

 ignore valuable resources
 become dependent on the healthcare system
Do
Do avoid the healthcare system at all costs by taking care of yourself
This may sound obvious but the truth is that most of the healthcare costs in this
country are tied up in chronic disease management. We have become addicted
to the healthcare system and they like it that way. Guess what? Most of these
chronic conditions are preventable. It’s called self-responsibility. The
skyrocketing cost of treating these diseases ultimately impacts your health care
premium.
Do seek the least costly care setting
It says something when Wal-Mart starts to enter the primary care market and
when urgent care centers and CVS clinics become the choice of young people
for primary care. These setting are efficient, quick and the least expensive option
for care.
Do shop for insurance
The healthcare exchanges will offer multiple options for insurance. All will have
tradeoffs. The lower the premium, the higher the deductible, the lower the
choices. Figure out what you can afford and also make sure you are comfortable
with the providers available under the plan.
Do bulk up on your HSA
To offset the high deductible costs, sock money away in a Health Savings
Account (HSA) particularly when you are still working. That nest egg will serve
you well in the future.
Do consider Medicare Advantage
When you do roll around to become eligible for Medicare and assuming it is still
around, consider a Medicare Advantage plan. Typically these will be more
comprehensive, least costly and they will provide the type of medical
management you need to avoid what I wrote in #1!
Don't
Do not forget about long-term care
The elephant in the room of Obamacare is the financing of long-term care. Hint:
there is no financing mechanism save Medicaid. You have some choice
especially if you start younger. Consider a long-term care insurance policy or
converting a life insurance policy to a long-term care benefit. Consult your
financial advisor.

Do not think retirement planning isn’t for the young
The sandwich generation, that group that is caring for aging parents and still
raising or caring for children, is shifting. As the boomers’ parents pass on, so to is
the baton to Gen X’ers, who now are beginning to absorb the brunt of the
caregiving crisis. Ultimately this burden (or opportunity depending on your
viewpoint) has a cost, both financially and health wise. And keep in mind it will
impact how you prepare for retirement. So think about these issues sooner.
Do not think family will rescue you
Recent statistics show that the number of unpaid caregivers, typically family
members, will dwindle over the next 20 years. In 2010, the caregiver support
ratio was more than 7 potential caregivers for every person in the high-risk years
of 80-plus. By 2030, the ratio is projected to decline sharply to 4 to 1; and it is
expected to further fall to less than 3 to 1 in 2050. That means you will probably
have to pay for some home health care and custodial care.
Do not ignore valuable resources
There are cottage industries springing up that can advocate for your healthcare.
Geriatric care managers can help coordinate. Patient advocates can be your
champion when in a hospital. And there are companies that will scrutinize bills
and challenge providers on costs. They take a percentage of the recovered
money but could be well worth it.
Do not become dependent on the healthcare system
This gets back to our first “do” and that it exercise responsibility for your health.
People are becoming more and more dependent on the healthcare system
believing there will always be another pill, implant, procedure or prosthesis to
save them. This serves no one, jacks up costs and increases the likelihood of
your needing more acute care in the future.
Summary
Healthcare could bankrupt this country as it has millions of Americans. There is
still no real assurance that you can avoid a catastrophe if something unexpected
happens. But if you do the best to prepare, you can at least make decisions from
an educated viewpoint and not in a crisis mindset. The preparation you do before
to prepare for aging and the decisions you make with a rational mind when
something happens will not just save you money but could save your life.

The Assurance Benefit - An Option You Need to Know About
from About.com
Paying for long-term care services is a burden for many of your
residents/patients. And while options for payment are few, another option could
be available to them through the Assurance Benefit.
This benefit converts the death benefit of an in-force life insurance policy into a
long-term care benefit plan. The Assurance Benefit is specifically designed to
address immediate needs to pay for long-term care services.
Life insurance is an unqualified asset for Medicaid eligibility. To qualify an
applicant will often times need to lapse or surrender the policy. Converting the
policy to an Assurance Benefit that pays directly every month towards the costs
of long-term care is a Medicaid qualified spend down of the policy and it
preserves a portion of the death benefit over the entire period. After years of
premium payments, many policy owners will allow a policy to lapse or surrender
it for any remaining cash value. This is a big mistake.
A life insurance policy is legally recognized as an asset of the policy owner and it
counts against them when qualifying for Medicaid. If a policy has anything more
than a minimal amount of cash value (usually in the range of $2,000) it must be
liquidated and that money spent towards cost of care before the owner will
qualify for Medicaid.
All Medicaid applications specifically ask if the applicant owns life insurance and
full policy details. Medicaid recovery units have become much more forceful
about looking for life insurance policy death benefits (declared and undeclared)
that have paid out to families after the death of a Medicaid recipient. The
Assurance Benefit is a qualified spend down of the asset. A partial death benefit
is preserved over this spend down period and a final expense payment is also
preserved. Once the ABP benefit has been spent down, the enrollee would be
able to apply for Medicaid.
The Assurance Benefit Plan (ABP) is not a long-term care policy. The participant
enrolls in the program by converting their life insurance policy through an
ownership transfer. The client will be transferring all ownership and beneficiary
rights to the life insurance policy to the Benefits Administrator. The benefit is
administered by a third party administer on behalf of the insured and family with
the payments being made every month directly to the licensed provider of long-
term care services. SNF, AL, Home Health and Hospice all qualify.
From the moment the ABP is put into effect, the Benefits Administrator will begin
making monthly payments to the appropriate health care provider as well as all
future premium payments on the life insurance policy. Benefits can stop and start
or be adjusted to match changing needs. The Assurance Benefit can be used in

combination with a long-term care insurance policy, an annuity, a VA Aide &
Attendance recipient, or any other financial vehicle.
The client can customize the monthly payment arrangement to best meet their
needs. Generally, clients will try to average out the monthly payments to fully
exhaust the benefit over their life expectancy. Should the client pass away with
additional monies still due, the remaining benefit is paid directly to the client's
beneficiaries.
The total ABP payment amount is based on the face amount of the life insurance
policy, annual premium payments and most importantly, health status of the
client. The total payment amounts generally range from a low of 20% of the face
amount to a high of 50% of the face amount of the life insurance policy, however,
each case is individually underwritten.
To qualify:
 There must be a need for long term-care services (within 3 months).
 You must own an in-force life insurance policy.
To application steps include:
1. Application and Policy Review
2. Value Based Conversion of Policy
3. Benefit and Payment Administration
The following information is required:
1. Completed Life Care Funding application
2. Copy of the life insurance policy
3. Current policy illustration
4. Signed HIPPA authorization
5. Life Insurance Information Release Form
6. Last 2 years Medical Records
7. Proof of Power of Attorney (If Applicable)
To review, the key benefits of the program include:
 Simple application and review process
 No age or policy size minimum
 No premium payments
 All types of in-force life insurance qualify
 Fixed payments made directly to care provider/facility
 Preserves partial death benefit
Information for this article was provided by the Life Care Funding Group (LCFG).
They specialize in converting the death benefit of an in-force life insurance policy
into a long-term care benefit. For more information, contact 1-888-670-7773.
The Assurance Benefit is something you may want to become more educated
about and share with families, caregivers and community members.

Plan for the Unexpected – Have a Flexible Retirement Plan
The Met Life Mature Market Institute and the Scripps Gerontology Center
recently published a report, Best Case Strategies for a Flexible Retirement.
This study examined retirement-related thinking, experiences, and behaviors in
the face of the unexpected, combining two methods: 50 in-depth interviews with
individuals and couples (approximately half recently retired and half nearing
retirement) and a national survey of 1,007 individuals ages 50 to 70 (both retired
and pre-retired).
Personal retirement expectations vary from individual to individual, and
retirement planning is generally built on those individual expectations. However,
it is not generally built on the unexpected. The study reveals that the capacity to
withstand the unexpected is dependent upon the capacity of individuals to
imagine, anticipate, and prepare for circumstances that are sometimes well
beyond their control.
Key Findings – quoting from the study….
Retirement timing is not a simple equation of the “lure” of retirement vs. the “pull”
of work. There are multiple ways and complex influences through which
retirement timing can be thrown “off schedule.”
Declining or stagnant income or loss of job. Loss or erosion of pension.
Catastrophic illness or disability. Loss of health insurance, or escalation of health
care costs. Death of a spouse. Caregiving demands.
Only two in ten individuals report that they are “very confident” that they will have
enough money to live comfortably if they or their spouses/partners live to 85+
years of age, and another six in ten (58%) are only somewhat confident.
Confidence in retirement security is most strongly related to the presence or
sufficiency of a guaranteed stream of income (68%) and adequacy of savings
(51%). Alarms about retirement risks do not inevitably or immediately prompt
retirement planning. Several styles of thinking about the future suggest that
people are not easily awakened to retirement risks. Paradoxically, alarms may
produce inaction rather than action. The study characterized people as follows:
 Snoozers, who don’t think about future risks at all.
 Active Resisters, who “choose to snooze,” or choose to ignore information
about future risks.
 Immobilized Worriers, who understand future risks but whose worry
prevents them from acting.
 Oversleepers, who are late in their thinking and planning, and may regard
their decision or action windows as “come and gone.”

 Wood Knockers, who think about the unexpected but rely on hope; they
choose optimism. Somehow, things will “work out.”
 Plan B-ers, who hold on to a contingency plan, or the loose idea of one, as
a protection against trouble ahead. A Plan B may be a “plan” in name
only.
 Realists, who use the lessons of past experience to think about the future.
 Stewers and Brewers, who take a while to make decisions.
 Compromisers, who think about both today and tomorrow and balance
their current needs against future risks.
 Preemptive Planners, who strive to preempt future risks, or at least their
consequences.
Thinkers about the unexpected may not necessarily fall neatly into one of the
above types or another, and if they do, they may not stay there. Each individual
may have pieces of one type or another, or change from one time to another.
Tenuous health care coverage, long-term care costs, eroding defined-benefit
pensions, the vagaries of the stock market – these are on the minds of potential
retirees.
So where do you fit?
According to the researchers, there is no single road to retirement security. There
are too many variables to suggest a universal package, yet even a simple
contingency plan framework can be very helpful.

Women Caregivers and Savings
The Women’s Institute for a Secure Retirement has some good tips about saving
throughout the stages of your life. Here’s a snapshot but do check out their site
for more. And consult with your tax and accounting professional before making
any moves.
Saving in your 60’s, 70’s and beyond:
 continue to invest your retirement assets, living off a small percentage
each year, and consider annuitizing all or a portion of your retirement
assets, or a little bit of both.
Saving in your 40’s and 50’s:
 use a retirement calculator to see how much you should be saving at this
point in order to meet your future retirement goals.
 don’t be afraid to ask for help from a financial planning professional if you
feel you have fallen off course or need help getting more organized.
 caregiving can have serious financial consequences. It is important,
especially for women who tend to take the majority of caregiving
responsibilities, to understand the consequences and to take steps to
protect their retirement security.
Saving in your 20’s and 30’s:
 the savings habits you develop in your 20’s and 30’s can set a precedent
for how you will save throughout your life. Get into the habit of saving now.
 start by depositing about five percent of your salary into a savings account
each pay period.
 start an emergency savings fund in your 20’s and 30’s. You should have
about three to six months’ pay saved up in case you run into financial
surprises – a job loss or expensive car repairs, for example.
 sign up for your company’s 401(k) plan if they have one, and contribute at
least enough to get the full match if offered.

Caregiver Relief Fund
Limited time and chronic exhaustion are the two things that caregivers face in
their lives.
The Caregiver Relief Fund was established in 2009 to provide caregivers with
both respite and time needed to put a long-term plan in place for a loved one.
The Fund provides vouchers for at-home care and for recharge mini-getaways.
Vouchers for professional at-home care services are donated or purchased on
behalf of the Caregiver Relief Fund. They award these vouchers to caregivers,
giving them time to address their personal needs and financial resources to
invest in their own well being.
The Fund selects individuals who have been in a caregiving role for a chronically
ill individual, elder or disabled person for 12 months or longer. Caregiver
applicants also must have an individual income of $80,000 or less per year.
Caregivers fill out an application form, share their caregiving story and go
through an interview. The Fund then selects and matches the available relief
funds with the needs of the caregiver.
Check it out for yourself or a loved one.

Who Gets Custody of Grandma After the Divorce?
Who from my family will step up and care for me as I grow older? That is a
question a lot of baby boomers are asking themselves. Because the prospects
are scary.
In a study reported in Long-Term Care Magazine, divorce and remarriage is
changing the role of adult children in caring for aging parents and the quality of
family relationships is often trumping genetic ties argues a researcher from the
University of Missouri.
Lawrence Ganong, a professor and co-chair at the university’s Department of
Human Development and Family Studies, found that relationship quality, a
history of mutual help and resource availability influence decisions about who
cares for parents and stepparents.
Ganong said: “How close family members are to each other, how much they
have been helped by them in the past and what hardships caregiving might place
on family members are important factors when people consider caring for older
kin.”
Ganong and his research team presented study participants with hypothetical
caregiving scenarios involving an aging parent or stepparent and a child or
stepchild. Participants then responded to questions about their perceptions of
who should provide care.
The majority of participants said biological factors are relevant in caregiving
decisions, but they do not automatically require adult children to help older
relatives.
“Based on what happens before, during and after marital transitions, family
members may change what they think their responsibilities are regarding helping
and providing care to kin,” Ganong said. “As a society that relies on families to
provide much of the care for older adults, we need to better understand the
effects of changes in families due to divorce and remarriage.”
Ganong recommended that middle-aged adults have honest conversations with
parents and stepparents about expectations for caregiving and other types of
assistance before needs arise.
Ganong’s study, “Who Gets Custody of Grandma After the Divorce? How Marital
Transitions Affect Family Caregiving Responsibilities,” was funded by the
National Institute on Aging.
So now I am praying that my stepson, whose mom I am divorced from, will stay
married to my lovely daughter-in-law!

Tips to Prevent Elder Financial Abuse
The Met Life Mature Market Institute study Broken Trust: Elders, Family and
Finances takes a close look at elder financial abuse. Elder financial abuse is
more prevalent than you think and the perpetrators are often family members.
Today we look at tips Met Life offers to prevent elder abuse.
Stay Organized
Keep belongings neat; keep track of possessions; open and send your own mail;
direct deposit Social Security and other checks; complete and sign your own
checks whenever possible; use an answering machine to screen calls and do not
provide personal information over the telephone.
Stay Informed
Consult with an attorney about future plans, including a power of attorney;
consult with an attorney about caregiving arrangements; review your will; know
where to go if you suspect abuse; ask for help from police, from employees at a
bank, from Adult Protective Services, if needed.
Stay Alert
Do not leave items of value out in the open; do not sign any document unless
someone you trust reviews it; do not be left out of decisions about your finances.
Families, particularly those who find themselves in a caregiving role, also need to
be aware of situations that place their older loved ones at risk for financial abuse.
Family members should periodically inquire about their older family members’
financial resources and perceived limitations that may stem from their financial
situation.
Read the full report for more tips.

Elder Abuse – Families Often Responsible
We often think of abuse of our elders in terms of physical abuse and often
associate that with nursing homes. But abuse can also be verbal, financial
exploitation. And most abuse comes from family caregivers themselves. The
latest study in the British Medical Journal reports that more than half of family
members looking after people with dementia admit they have behaved abusively
toward their relative.
Actual physical abuse was rare among the 220 caretakers in the study. But 115
of those surveyed acknowledged some abusive behavior toward the relative
under care, with “significant” abusive behavior described by 33.6 percent of
caregivers.
The most common form of abuse was screaming or yelling at the person with
dementia. Insults or swearing accounted for 18 percent of reports, with threats of
sending the person to a nursing home happening in 4.4 percent of cases.
Comparable studies in the U.S. have not been done.
So a few suggestions:
· Create a plan for you and your loved one well before any signs of disease or
sickness appear.
· Work a plan with family members near and distant.
· Research care options and costs. Unless medically necessary many home
health options will not be covered by insurance.
· Draft a living will and durable medical power of attorney.
· Plan for how you will pay for care. Consider long-term care insurance.
· Reach out to your church and research support options.
· Once care is actually needed;; don’t be afraid to ask for help!
· Acknowledge your own feelings and behaviors and seek out a friend or pastor
to talk.
· Understand the motivations for your caregiving. Doing it for the wrong reasons
can lead to resentment, being overwhelmed, and feeling you have no options.
· If a loved one needs physician or hospital care, seek out a board certified
geriatrician and a hospital that has geriatric physicians on staff.

· Consider a geriatric care manager. Find one in your area at:
http://www.caremanager.org/ They can help you find available resources, paid
and non-paid, and help coordinate care.
· Consider your path as a caregiver as an opportunity to know your loved one
and yourself in a new and different way.
Consider some resources:
Take this stress test from the Alzheimer’s Association: www.alz.org/stresscheck
Use your local area agency on aging as a resource. Find one here.
Use the http://www.medicare.gov/nursinghomecompare if you need a skilled care
facility.

After the Caregiving
When the Journey is Done, Recover and Rejuvenate
Grieve your loss. Even adhere to some of the traditions you started with your
loved one, like daily rituals that will keep them in your heart and mind. A great
site is www.aftergiving.com. There are great resources to adjust to life after
caregiving ends including support as you grieve and miss and reminisce as well
as transition into the next stage of your life.
Give Back
Share your experiences with soon to be caregivers, new caregivers, and
experienced caregivers. Caring.com (www.caring.com) offers some great tips in
giving back. Gift your time or expertise. Arrange for a one-time housecleaning for
a caregiver maybe around the holidays. Prepare a meal for a caregiver and their
loved one. Think about gifts the person might not otherwise buy for himself or
herself.

About Anthony
Anthony Cirillo, FACHE, ABC is president of Fast Forward Consulting, an
international healthcare consulting firm. He works with healthcare companies to
help them strategically market to and create exceptional person-centered
experiences for the boomer and senior populations.
A professional speaker and performer, he also acts as a spokesperson for
companies looking to reach boomers and seniors.
He became passionate about aging issues when he walked into a nursing home
and started singing one day. He is the about.com expert in assisted living and a
thought leader in hospital patient experience. More here -
http://www.4wardfast.com/press-room/press-kit/platform-bio
IF YOU ARE A COMPANY WITH A PRODUCT OR SERVICE AND NEED TO
REACH PEOPLE IN THE HEALTHCARE INDUSTRY AND/OR CONSUMERS,
USE ME AS YOUR CONNECTOR AND GOODWILL AMBASSADOR. BECOME
A CORPORATE SPONSOR AND LET ME BE YOUR SPOKESPERSON.
IF YOU ARE A BUSINESS GROUP OR CAREGIVER GROUP THAT WANTS
AN ENTERTAINING AND EDUCATIONAL SPEAKER CONTACT ME.
THANKS!
Anthony Cirillo
877-278-8791

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