Health Insurance

A level of frustration is inherent in Alzheimer’s and dementia , not just for the person who has it, but also for that person’s caregiver(s). Until recently, caregivers were advised to “correct” a dementia patient in regard to actions not considered “normal”. Today a gentler approach has superseded this wisdom. For example, a dementia care patient, forgetting that he is retired, may begin to dress for work. So nowadays, caregivers are always told to ” go along ” with the patient’s sake, help them pick out a tie or what-have-you, and then slowly move the discussion to other matters until the fact that he must go to work slips his mind. I have one friend who is a licensed CNA, and an in-home caregiver with over a decade’s worth of experience providing long-term care to dementia patients.

Rita’s voice appeals its rythmic Irish phrasing and accent, her laughter and graying red curls burst forth from her small frame in spurts of abundance. I had the chance to talk to her about her own personal care philosophy. When I mentioned the above situation, she responded, “You have to let them get dressed for work. You have to let me them go through their moments.” Her philosophy is definitively one of diversion, but she says she came across this naturally, and told me, “The man I look after now is a person. There are times when he’s going through something or having a moment, but he’s always a person.” She then stressed the importance of eye contact as she finds dementia patients are ” in their own world and they are clinging onto ideas, it is often hard to distract them from that so you need to make sure they really see you.” She went on to explain, ” It can be difficult because they are so strong-willed.” I asked how her patient was that evening. She said, ” He is absolutely wonderful. I’m holding hands with him right now,” and I could hear her mouth breaking into a smile even over the phone line. This vacillating between great joy and stress seems par for the course for many homecare aides. Caregiving is truly an interdisciplinary field where science, the mind and the heart have to combine for any real success to occur.

Rita’s patient is medicated and his aides overlap at different points in the day to help him with walking. One aide walks in front of his walker and the other on the back. Once during this exercise, a family member was talking about an issue in the family business, and although normally the man would be completely engulfed in the act of walking, he exclaimed in a jovial manner, ” Well, it’s my dough anyways! ” to everyone’s amusement. I also asked Rita how she deals with a job that can be rewarding, but can sometimes be quite tiresome, both physically and emotionally. She mentioned attending social events, in her opinion, nothing relieves stress as much as a good party with friends. She also made mention that even her patient was able to attend the odd family occasion, but big crowds stress him as do unfamiliar faces. I inquired as to whether he remembered her, after all, she works there five days a week. ” Oh now, I began working here too late. He doesn’t know my name, but, you know what, he is always happy to see me and calls me a nice lady. “

There are actually so many opinions about LTCI or long term care insurance which are mainly based on anecdotal evidence. Once a year, the American Association for Long-Term Care Insurance publishes a LTCI Sourcebook that cuts through the fog of opinion by helping to establish the facts. The 2009 version of this publication just became available and here are some of the results of the data gathered from a large sampling of the leading long-term care insurers for those who only have a single long-term care insurance policy:

The number of claimants and policyholders paid in claims: 8.25 million Americans currently have long-term care insurance and last year 8.5 billion dollars were paid in claims to 180,000 policyholders.

Age of claimants: Of the new claims opened during 2008, 61% of claimants were age eighty or older, 30% were between seventy and seventy-nine and only 9% were under the age of seventy.

Sales by issue age: It was found that 24% of long-term care insurance buyers were between the age of forty-five and fifty-four. 53% were between fifty-five and sixty-four. 15% were between the age of sixty-five and seventy-four.

Sales by daily benefit amount: Only 6% have bought policies with a daily benefit between $50 and $99, while 31.5% were between $100 and $149, 35% were between $150 and $199, and 27% bought more than $200.

Sales by elimination period: The overwhelming favorite elimination period chosen was ninety days, with almost 83% of buyers choosing it.

Sales with the use of benefit period: Benefit period choices by long-term care insurance consumers were as follows: 2 years, 7%; 3 years, 30%; 4 years, 15%; 5 years, 24%; 6–10 years, 11%; and Lifetime/Unlimited, 13%.

Sales by benefit increase mode: 40% chose 5% compound interest, 16% chose simple interest, 13% chose a Future Purchase Option, 7% chose CPI (consumer price index), 14% chose none, and 10% chose other forms of inflation protection benefits.

Care settings paid for: 42% of long-term care insurance claims paid were to policyholders receiving home care, 30.5% to those in a nursing home, and 27.5% to those in an assisted living facility.

There are still many other interesting facts that was revealed by this important gathering of data that I will include in the next articles. The information presented here should be helpful to anyone who is seriously considering the purchase of long-term care insurance.

On a clear Monday morning, the New York Times ran a good story about Medicare Advantage Plans. Medicare Advantage Plans are a type of home health care plan sold by private insurance companies. These plans are actually associated with Medicare. It seems that seniors across the country have been duped into signing away their Medicare benefits by enrolling in a Medicare Advantage Plan. In some cases, the seniors didn’t understand how the Medicare Advantage Plans worked, and in others, they didn’t even know that the insurance agents had signed them up for the plan. The insurance companies that sell these plans have been accused of several bad practices, including:

There are deceptive marketing strategies that do not make a clear distinction between Medicare and Medicare Advantage Targeting of uninformed seniors in low-income areas by pushy agents with hard-sell techniques, Outsourcing customer service to overseas call centers, whose employees have substandard knowledge of the complex Medicare system, Insurance agencies such as Medicare Advantage Plans undergo greater scrutiny than they have in the past;and it seems to be helping at least a little. Kerry N. Weems, the acting administrator of the Centers for Medicare and Medicaid Services, says, “There are substantially fewer violations, and those violations are of substantially lower severity than in previous marketing periods.”

It is true that Medicare Advantage programs can help some customers to finance their senior care, but these plans are not for everyone. There are factors to consider before signing up for any type of Medicare Advantage Plan. Here, a few of the most essential issues: Make sure your doctor(s) and local hospital are within the insurance company’s network of providers. Medigap policies become null and void once you are enrolled in a Medicare Advantage Plan. If you already have a Medigap policy, cancel it once coverage begins with a Medicare Advantage Plan to avoid paying twice.

Some Medicare Advantage plans vary greatly. You are giving up all rights to your existing Medicare policy, so pick a plan that will meet your future senior care needs as well as your current ones. Always read the fine print. This is an important decision, don’t rush it! We live in a society where the buyer must beware. Call your parents tonight! Make sure that they know about the issues concerning Medicare Advantage. That phone call could be the one thing that saves them from making, or worse yet, being pushed into a decision that isn’t right for them. You don’t even want to think about the alternative!

A close family friend recently phoned me to ask, “So I am thinking about long-term care insurance, what exactly should I be looking for and where do I start? ” And my answer was, ” Are you confused?” “Yes.” “Well, that’s how most people start.” We both laughed, but the point remains that picking a long-term care insurance plan can be very confusing. Some of the other postings on this particular subject I have covered the benefits of buying a policy especially in the early years of retirement. But what should you be looking at when you are shopping around for an LTCI policy? and how do the policies actually work?

1. Check out what will be covered. LTCI policies vary and may cover home health care, homecare, adult day care (and health care), assisted living, skilled nursing care, hospice care or some combination of these, but one must look closely and see what is being covered. Your best bet is to get a policy which covers most, if not all, of these possibilities.

2. How benefits will be paid out. Most of the policies pay by a daily benefit. Sometimes the daily benefit is calculated using a monthly average. This is an advantage when working with nurses, aides or homecare might work sporadic hours if, for example, a family caregiver is available. Secondly, benefits are paid on either an indemnity or reimbursement plan. So benefits are either a lump sum payment regardless of what the charge is OR (in the case of reimbursement) the insurance carrier will only pay the actual charges for care even if the charge is lower than the maximum daily. There are times when the unused funds are carried over.

3. When your coverage will begin. Many policies spell out how many activities of daily living (like dressing or bathing) you must need assistance with before your coverage begins. There is also a waiting period, which usually runs from 0-90 days, but sometimes is longer. So you need to consider what you can afford to cover before your benefits kick in.

4. How long will your benefits last. How long do your benefits need to last;a few years? 10 years? Although this is somewhat of an unknown, you need to take into consideration if you are predisposed to a chronic illness and what kind of funds you may have at your disposal.

5. What will your benefits be “worth” once they are paid out to you. Not only should you look at how they are paid out but what is exactly paid out in regard to inflation. Many policies offer some sort of inflation protection. Considering long-term health care costs only seem to be rising, this protection translates into having a financial cushion protecting your assets.

6. Which resources can help you make the best decision. There are three resources you need to use to make the best decision: ratings companies, a reliable agent and yourself. Always make sure that you select a company which has been in business and is highly rated by A.M. Best, Moody;s, Standard & Poor;s, or Weiss. Looking for professional assistance with long-term care insurance and which policy might meet your needs? Get a free long-term care insurance consultation and quote. Finding an agent is tricky. Many people are “referred” by carriers or internet searches. This is akin to mushroom-picking by memory, it is not in your best interest. Look for an agent that sells a variety of products, but specializes in LTCI.

Also, if the agent’s commission rates are standardized, then it is not financially gainful for him or her to up-sell you. And although most of these decisions can and should be aided by professionals, it is always your job to be vigilant. Use common sense along with the help of professionals. It can be hard to determine what your long term care needs are. A good place to start is by looking at what many consider the baseline;that is, what the federal government offers to its employees via the Federal Long-Term Care Insurance Program.

All of us have that relative who always has a checklist of what needs to be done in case of an accident or crisis. And although we might mock them, many are happy to know what needs to be done and how they can pitch in. In my previous articles, I have talked about how important it is for both the family and professional caregivers to make sure they are taking care of themselves. Also, a new product, which is Lotsa Helping Hands website, is streamlining the process for family caregivers by allowing 1 person to organize a circle of up to 100 loved ones who can look at a list of tasks and volunteer to do them. Many baby boomers are facing the prospect of how to do senior care for aging parents.

For people whose old parents need help with activities of daily living (e.g., buying groceries, preparing meals or maintaining the household) this website can be very useful in helping establish a network where everyone can volunteer for “assignments” so that, for example, the groceries are not bought two times in a day or so everyone doesn’t visit Granny on Sunday, leaving her alone the rest of the week. The family members of the senior might also find this helpful in getting someone to stop by and “check in” on their loved one. Has the senior dressed properly for the day? Does he or she need breakfast to be made for them? Scheduling tasks is also made easier with Lotsa Helping Hands, another person can pick up the dinner shift and help with bathing. This type of coordination can augment the service provided by homecare agencies, particularly if the aides are only on duty for a few hours every day.

Perhaps best of all, the service is free and the website is fairly intuitive. The process takes less time than a phone call on the volunteer side, but the administrator (e.g., you) has to be fairly on-task with what needs doing. A calendar shows whether help is needed or if all needs are met on a particular day. You can even scroll ahead and offer specific services. I think this is a brilliant concept, I mean, how many times have you wanted to help someone, but just were unsure of what to do? Also, most families have members with more free time than others.

We often don’t phone relatives for help as we figure they are probably “just too busy” and that someone else will take care of it. However, giving everyone a chance to know what is needed and what they can do is not just democratic, it is downright helpful, and as senior care caregivers isn’t that the point? As always I look forward to your comments and would love to know more if anyone has used the service and found other glowing points or even something that could be better in regard to this fantastic new resource

It’s always pleasing to highlight good news! Recently, the legislature in New Jersey recently passed a new law that will offer seniors on Medicaid more long-term care options. By 2008, senior citizens living in New Jersey will have a choice in the type of long-term care they receive through Medicaid, under a law by Governor Jon S. Corzine. The law provides “an extraordinary change in direction and policy in a way that makes sure our seniors have a choice,” said Corzine at a recent AARP summit on long-term care. Currently, New Jersey spends $1.68 billion of its Medicaid long-term care budget on nursing home care, which is compared with $162 million on community based care, like assisted living facilities, home health care and adult day care. That means a lot of money will be going to skilled nursing facilities. The law will now help bridge the gap between money going to nursing homes versus money going to people in the community. “Rather than requiring that nursing homes be the first stop, now nursing homes will be the appropriate stop, if necessary,” said Dr. Fred Jacobs, state health commissioner for New Jersey.

Skilled nursing facilities are the right choice for many seniors who require this type of specialized care, however, seniors should never be placed in a nursing home simply because there are no other options. On a personal level, the law provides for appropriate changes in a person’s home including the installation of bathroom handrails and other safety features. Home health aides and even respite care are now under the Medicaid umbrella of covered services. There are already so many choices to make regarding long-term care, and the passing of this law will give you better and smarter choices that will suit your needs! Most funding for adult day services comes from city government agencies, participant fees and charitable sources.

Try downloading the Private-hire Home Cargiver Application to help you outline work experience, education and references along with so much more. Employers can use this tool for assessing and comparing private-hire caregiver candidates.

As a family caregiver, short-term hospitalization of a loved one can be a difficult situation whether he or she is living in a long-term care facility or at home. As the family caregiver, this change can be challenging at some points, especially as hospitalization normally points to an unstable medical condition or an acute condition. Here are a few pointers for how to negotiate the situation. The most important issue at this point is that you have most of the information about your loved one’s previous condition, so make sure that you share it.

Let the hospital staff know about any cognitive or physical impairments even if the information is already too obvious. For example, let the senior care assistants know that your loved one is unable to use an emergency call button at times due to arthritis or that he or she has a hard time following directions due to cognitive impairment, or even if she or he should not be given a cup of coffee even if they ask for it in the afternoon as they have dementia-related Sundowner’s syndrome. Remember to tell the hospital staff in regards to a person’s dietary considerations or preferences. Small things can mean the world when placed in an unfamiliar hospital environment. A small favor such as asking to keep meals free from red meat for a person who doesn’t like beef is one easy way to make sure that your loved one has some creature comforts. Keep notes and pay attention. Hospitals are there to relieve acute medical problems and {as such may overlook smaller background issues~because of this, it may overlook some of the smaller background issues}. However, it is your job to speak up in the event you feel your loved one is receiving improper care. {Try to get as many visitors in to see your loved one as possible~Try getting as many visitors in to see your loved one as possible}. Even short visits can raise a person’s spirits’ and provide a nice change or shift in a person’s focus.

Several Internet-based sites host free personal webpages specifically designed for caregivers so that they can post information with ease about their loved one who currently is hospitalized or in need of help. These pages allow concerned family members and friends to schedule visits, monitor progress and sign-up to help with any needed tasks. This ensures that a person can have several visitors over the course of a day rather than a bunch all at once.

Discharge is Just the Beginning.

Keep notes on medications and dosages for your loved one. If new medications appear on the discharge plan, make certain you understand what they’re for, dosage amounts and possible side effects. Check with the pharmacist to ensure there are no contraindications, especially with drugs already prescribed. Make certain the discharge plan has all prescriptions listed on it. Do not assume previous prescriptions have been replaced or taken off unless you have been told so in absolute terms by a medical professional. If your loved one now needs to move out from his or her home, then a list of possible long-term care facilities that meet your financial and medical, dietary and social requirements needs to be found. Discharge planners might make referrals, but make certain they are aware of all your specific needs. (And, of course, Gilbert Guide offers information on how to find and assess the care options in your area.) If you have time, visit facilities and rank them according to your needs. Gilbert Guide offers an explanation and handy checklist of issues for both skilled nursing and assisted living.

Hospitalization may result in changes to your loved one’s life. Anything that can preserve some sense of continuity will help with the transition. If you have had a doctor prescribed home, health aides before the hospitalization and they were well liked and give proper care, then please ask to keep them. If the same holds true for your homecare aides you should also voice your opinion on retaining them, if they can provide the level of care necessary. Try to learn as much as you can about your loved one’s condition if it has changed. The Internet is a helpful resource, however should be tempered with information and recommendations from your loved one’s physician. Make sure you understand all the ways in which you can provide the utmost in care for this new situation. Let’s say that your loved one needs therapy, find out what the goals of the therapy are and if there are any exercises with which you can assist. Throughout the course of your loved one’s hospitalization, remember that you are their voice. Do not be afraid to speak up and ask questions, as they may be unable or unwilling to do so. If you run into any problems you feel you cannot solve, most hospitals have an on-staff patient advocate that will be able to provide help.

Alzheimer’s disease, aside from being the most common form of dementia, is a progressive degenerative disorder with the brain. Brain cells shrink or disappear, gradually destroying a person’s memory, ability to learn and make judgments. An estimated 4.5 million Americans have Alzheimer’s disease. By 2050 the number of those affected is projected to range from 11.3 million to 16 million. As the progress of Alzheimer’s disease advances, an individual’s capacity to carry out normal duties and his capacity to reason fades away. As the disease affects disparate areas of the brain, different functions and abilities are lost. Each people is uniquely affected, with widely different rates of acceleration. As a result, there is no single approach to caregiving.

When seeking Alzheimer’s care, it is very important to make certain that the patient in question have been accurately diagnosed. If any doubts exist, a second opinion should be sought and all resources should be exhausted. Doctors often confer with other health care professionals including neurologists, geriatricians, psychologists, home health care specialists, and psychiatrists. There is no single specific test to positively diagnose a patient with Alzheimer’s. Once Alzheimer’s is confirmed, there are a number of steps that can be taken to help ensure an understanding of the totality of the diagnosis. By examining and identifying behavior and behavioral changes, family members or caregivers can determine the most suitable care option for the patient’s individual situation. Alzheimer’s care is commonly categorized as follows: non-medical home care adult day care dedicated facilities that house and oversee Alzheimer’s patients

There is no cure for Alzheimer’s at this time and it is currently not possible to restore brain cells affected by the disease. However, there are treatments to help caregivers and patients cope with the challenges of the affliction. A patient with Alzheimer’s can still experience love, joy and sadness. Effective Alzheimer’s care combined with emotional support can improve the quality and richness of a patient’s life.

Board and care homes are residences for seniors usually having a resident capacity of no more than fourteen. Licensing requirements vary by state; some states require that board and care homes carry the same license as assisted living facilities.

If you happen to be under homecare and if you have to lie immobile for long periods of time, you should pay special attention to the health of your skin, to prevent skin breakdown. Proper skin care helps in preventing pressure sores (bedsores) and will help you feel generally refreshed. Weight loss and the side effects of radiation or chemotherapy can lower your resistance to infections, and since infections can be very difficult to treat, the best thing is to prevent them. Skin is your body’s first line of defense against infection, and once your skin gets broken through a rupture, it exposes you to infections. Germs can enter the body through a cut, an open bedsore, or raw, chafed skin. Bedsores are caused when an area of skin loses its blood supply for an extended period of time, e.g., when a bony area of the body lies against a surface like a mattress, and nutrients and oxygen are unable to reach the skin cells. The area begins to break down and the skin cells eventually die. Parts of your body which are particularly susceptible are the coccyx or tailbone, the hip bones, the spine, elbows, heels and ankles, and the shoulder blades. If redness doesn’t go away from these bony areas a short time after the pressure is removed, the skin is probably not receiving adequate blood flow. You may have to tell your senior care caregiver, if you happen to have one

You can prevent bedsores by changing your position frequently, at least every two hours. In addition, placing a cushion on the bony parts of your body is a good way to reduce pressure on the skin. An “egg crate” mattress, or a foam or sheepskin pad will cushion you, as well as providing better air circulation for the skin. You can also use pillows or any other props that can help reducing the pressure on those areas.

Heat and massage are additional means of increasing the blood supply to the skin. Whirlpool baths are ideal for this purpose. Although you can use heat lamps or heating pads, you must take care not to burn your skin, which is already tender. First check with your doctor or nurse to make sure a lamp or heating pad would be helpful to you; and if you do use a pad, keep it turned on “low,” and keep a protective pad or towel between it and your body to avoid skin burns. A warm pair of socks, an extra blanket at the foot of the bed, or fleece-lined booties are often more helpful than heating appliances. (See: Massage Therapy Techniques that will also increase blood flow to your skin.)

Chafed or irritated skin is caused by a combination of moisture, heat and friction. It occurs most often where the skin folds over itself as in under the breasts, in the groin area or in the abdominal area for heavier people. For chafed skin, you want to keep the area clean and dry. A small amount of talcum powder or cornstarch applied after bathing will help keep the area dry and free of bacteria. Exposing chafed skin to the air for a few minutes twice a day will also help keep it dry.

Good hygiene is the most important part of skin care. If you can, take a daily bath or shower. Even if you are not confined to bed, bathing may be a chore because of the difficulty of climbing in and out of tubs and showers. Try sponging your body at the sink while sitting in a chair. Aids such as bath seats, grab bars, and long-nozzled showerheads make tub or shower bathing much easier. Once you are confined to your bed, then take a daily sponge bath. Ask your family or you home health care nurses to assist you with the areas which you cannot reach by yourself. There is no one “right” way to give a bedbath. Common sense will dictate the most comfortable and thorough method for you. Don’t forget bath oils if your skin tends to dryness. Massaging body areas with a little lotion after a bath stimulates circulation and prevents skin breakdown.