Teddy Roosevelt once said, “Old age is like everything else. To make a success of it you’ve got to start young.” That is especially true if you plan to age alone, without the benefit of children or close family. I am most likely going to age alone and I am preplanning for that. You should too.
Today’s 80 is the new 70 and 70 the new 60. Most of us don’t plan on giving up work, volunteering or travel until we’re well into our 70s or 80s. I have friends who were volunteers at the Key Biscayne Tennis Tournament for over 20 years — the only reason they didn’t volunteer this year was because he became sick and couldn’t.
As we grow older those of us aging alone have to make plans while we’re fully functional. We have to discern what resources are available to us in whichever community we choose as our ‘last home’. With today’s service industry and technology there is a huge advantage . . . there are healthy meal services (both for profit and non-profit), ride share and in many neighborhoods free ride services. We also have medical care right here on the Island.
But, as I state over and over again, it’s about preplanning. You need to have a trusted friends or advisors who can be named as your Power of Attorney for Finance and Health. You need to decide now how to disperse your jewelry, money and tangible goods and write it down. You should also plan to stay out of probate court.
You also need to give your passwords for your bank, phone, computer and any other technological device you have, to trusted friends. Sometimes the best thing to do is find a disinterested third party, such as elder care lawyer, and give it all to him or her. Yes, you have to pay them but it’s a simple business transaction devoid of emotion. You should also think of who is going to manage your health care from an insurance point of view so you’re not selling your tangible goods to pay for unwanted or unneeded health care. You will need an advocate and that takes preplanning.
To review: If you live alone now or believe that you will age alone without the benefit of family, now is the time to decide where to live, who to trust, who to choose as your beneficiaries and who to have as your Power of Attorney. I strongly advise you consult with an elder care attorney for all the correct documentation and to have an advocate for you when you can no longer advocate for yourself.
As we all now know, after Hurricane Irma fourteen elderly souls died because the nursing home in which they resided did not have a electricity after the storm. As a consequence, they “overheated” and died. Well, there is good news – the Florida Legislature and Governor have placed $37.1 billion dollars in this year’s fiscal budget to be used across six health care and social service agencies.
Florida’s medicaid program is the largest recipient at $29.2 billion and Children & Family Services receive $1.7 billion. Those living in nursing homes will receive a 25% raise, from $105/m to $130/m. Nursing homes are now required to have generators with enough fuel to cool buildings during elongated power outages. The above monies are all coming from Florida taxpayers but my favorite part of the legislation is not tax based.
Starting this fiscal year, nursing homes (that receive medicaid dollars) will be paid on a set formula. These providers must meet certain “direct patient-care” requirements as well as “quality of care” requirements. In other words, if a nursing home only meets a minimum standard, they will be paid a minimum amount and given a set amount of time in which to bring the ‘home’ up to the formulaic standard. As the homes hire more qualified staff and add amenities to its building and programs – they will receive larger payments. As one law maker put it, they have to spend money, to make money.
As a senior’s advocate I’m thrilled that our state government realized how badly these “homes” were treating their patients. Yet, it took senseless deaths to have a focus placed on how our greatest generation and aging or ailing baby boomers are treated when they can no longer treat themselves. That is where we must be more vigilant.
As I write this, I cannot help but remember the 17 people who died very prematurely at Parkland High School. And, yes, because of the deaths and the student’s activism we’ve put in some stricter state gun regulations. Also many large gun sellers are now refusing to sell to anyone under 21. Still, much like our senior citizens, why must it takes death to examine our mores and ethics.
This is an editorial to the Miami Herald written by H. Frances Reaves, Esq., President of Parent Your Parents, in October of 2017. This was written after Hurricane Harvey and Irma and the mirror placed on Senior Services. As we suffer through a very cold winter these words are still prophetic.
IF YOU HAVEN’T SEEN the video of the residents of a nursing home in Houston, Texas sitting in waist high water simply search “video of seniors in waist high water” in your browser – the You Tube video comes right up. School children were evacuated, families were evacuated and who was left behind . . . seniors. Two weeks later, in the aftermath of Irma, 14 seniors die from overheating in a Broward County Nursing Home.
If these seniors had been children the outcry would have been much louder and punishment swifter. An excellent example is the most recent earthquake in Mexico. The school caved in on top of 24 children and four adults. The volunteer rescuers were there within minutes and the TV crews transmitted the entire search and rescue for more than three days. That would not be the case if this had been a senior citizens facility.
Fariola Santiago wrote in her September 24th column that “the elderly are like children, frail, unable to care for themselves, and vulnerable to abuse and negligence. Those who don’t have money or advocates and require round-the-clock care end up in places with deplorable conditions . . .” I agree with Ms. Santiago regarding the elderly but disagree that all nursing homes have deplorable conditions. We also need to remember that, with the exception of one “lonely soul,” everyone had a family . . . and the family did not take them from the ‘deplorable home’ even after they knew about the power failure.
Baby Boomers, Gen Xers and Millennials beware — you, too will be a senior! Seniors, are an older version of who we are today. We espouse the sentiment that, “I only want to live a long life if I have a quality of life” but legally we don’t have a choice once our mind collapses.
What we don’t discuss is that dementia does not take away your intellect, mental pain or physical pain. Dementia takes away the ability to communicate effectively. It also absconds with your memory – which allows we the children to believe that with memory loss there is a loss of all senses. That is not the case. The 14 elders who died felt pain and the first to die truly suffered because they did not have the benefit of hospice care.
No doubt, the staff at this nefarious nursing home was negligent, incompetent and uncaring and they were allowed to function as “caretakers” for years. It took a hurricane and power outage to bring it to light. Had this been a daycare center the negligence would not have been allowed to continue.
As the President of a company who advocates for seniors, finds resources, counsels families and assists in medicaid preparations, my experience shows that most of us face living in a medicaid facility. Unless you have a healthy pension or half a million dollars you will not have the money for dementia care in a private facility. Today that runs between six to seven thousand dollars a month. If you qualify for medicaid, nursing homes run about $700.00 and medicaid picking up the balance.
We must look in the mirror! let’s begin the process of treating our elderly loved ones as our children. Treat them as you treat those around you. Hold the Assisted Living Centers and Medicaid Facilities accountable and — START SAVING!!
What is Hospice? First, it is a type of care and philosophy that focuses on the palliation of a chronically ill, terminally ill or seriously ill patient’s pain and symptoms, as well as attending to their emotional and spiritual needs. OK – so what is palliation? Palliation is a service that makes you feel better even though it can’t cure you.
Hospice is a positive addition to our medicare system because the focus is the patient. The goal is to keep each patient as comfortable as possible. This means additional care over what your loved one is already receiving. Between nurses, social workers and priests, there is someone there two to three times a week to make certain there is no pain or discomfort.
The other side of this service is that it is run by medicare. That means that Hospice is free if you’re in Medicare as most of our seniors are. This also means not all Hospice providers are the same. There are thousands of Hospice providers and you have to be certain that they are doing their job (much like those Medicare doctors I’ve described in earlier articles).
I’ve had two different patients in different facilities with different providers and the difference was night and day. One provider is in a nursing home that accepts medicaid patients, we’ll call it A for purposes of this article. The other provider was for a client who lived in an assisted living facility – one that cost $4500/month. This Provider is called F.
A little background – once a patient has been admitted to Hospice, its doctors, nurses and aides “rule” the care. If the patient is a diabetic he or she will still stay on diabetes medicine but perhaps be taken off non-essential medication depending on the comfort level. Yes, the facility still feeds and provides a clean environment but Hospice is in charge of the patients comfort.
In most nursing homes the patients are in full blown dementia but not necessarily at the end of their life physically. Therefore, it is much more difficult to qualify for Hospice in a nursing home. However, once the patient is accepted the care for my nursing home client was beyond great. Her nurse was Mark and I could call anytime to check on her (once the children had given their permission)
The other client was in an Assisted Living Facility and qualified for Hospice before the children asked. They had no indication he was in his last days, weeks or months. Once their loved one become uncomfortable and disoriented they started receiving a “run around.” Parent Your Parents was asked to intervene. Here’s what we found, the Assisted Living Center blamed it on Hospice and Hospice blamed it on the Assisted Living Center. We started calling the Hospice office daily to ask for more help. Hospice told the children that babysitters were needed (at $20/hour). That is when we went into advocate mode. I reminded the Hospice company that their job was comfort and they had to start providing real comfort, not advice to the children and Assisted Living Center’s employees! Remember these companies make money and paying people to babysit takes away from their bottom line. The end result, this Hospice company did what they advertised and found a bed in an extremely lovely location where the client passed away comfortably and peacefully.
Bottom line – not all Hospice is created equal.
I am confident most of you heard the news about the eight seniors who died from overheating. They were all in a licensed “nursing home” in Hollywood Hills. ‘Nursing Home’ is a euphemism for a home for seniors who are at the poverty level and qualify for medicaid.
Nursing homes are like every other industry — they have to make money to survive. In the case of nursing homes they’re paid by the state medicaid fund and it’s per pa
tient. This fund is made up of state and federal dollars. Obama Care expanded medicaid in the states who took the federal dollars but Florida is not one of them.
Bottom line, these are not the luxurious environments for either staff or residents. In my parents case, Mom had been in a lovely residential facility where she was one of three or four people. Her Long Term Care Insurance paid for it. She outlived her two year policy and we had to place her in a Nursing Home. It was our only realistic option as Mom’s care in an Alzheimer’s facility would be close to $7000,00 a month. Mom and Dad couldn’t afford it and neither could the children.
In pursuit of the best we could find, I went to several nursing homes and learned more than I needed to know. All these homes are very austere and it’s a shock! Bare floors, usually
formica, and waiting rooms with plastic chairs. Almost all the receptionists were behind a barrier — some better designed than others.
The patient population is made up of mostly Alzheimers and Dementia sufferers. All the residents are in a wheel chair, a portable bed or never moved from their beds.
Another surprise, the aides often use pulleys attached to patients to change their clothes, move them to the shower or simply change their diapers. Depending on the home, these medical aides must change and clean about 19 patients each. Some work in tandem others work solo — it all depends on the chore.
Further, most patients are only bathed twice a week, maximum three times a week. During one of these showers their hair is washed. Bottom line, it’s not how we envision our last days, weeks, months or years of life.
On the good side, the ‘better nursing homes’ have excellent care. They hire a team of Geriatric Doctors that include Psychiatrists. These Geriatric groups come to the Nursing Home through a PPO and the doctors physically visit once a month. There is usually a Podiatrist group that also visits once a month (Medicare pays for podiatry services) and a dentist who comes once a quarter. The day to day care is with the Registered Nurses (RNs), Licensed Professional Nurses (LPNs), physical therapists and medical technicians. They also have a contracted Hospice service.
Here are some tips when you need to look for a nursing home:
What is the turn-over rate of its employees
Needless to say, the less turnover the better the place. If the staff is not leaving then something is going well — usually their paid above average wages
Is there a hair salon
If there is a hair salon then there’s a market for it. This means the residents take pride in how they look. People who take pride in themselves care about their environment.
Is it clean
As we all know, cleanliness is godliness
Is there a smell
Again, if it smells that means it’s really not clean – no matter how good it looks
Is there a smile on the faces of the staff
A smiling staff means a happy staff
Again, hopefully it doesn’t come to this but if it does, know how to choose the best one.
My nephew was getting married — everyone in our family was thrilled — we love his wife, love him and love that they found each other. The wedding was in Texas — Mom and Dad live in Atlanta. Mom is extremely ill and cannot travel. Dad had just gotten out of the hospital and we could not travel. Our big fear — what if one died the weekend of the wedding?
My brother and I called several funeral homes to discuss options. We also consulted friends and my brother’s priest. During the course of this journey we discovered that family owned, multi generational funeral homes tend to be more gentle and understanding. They listen to what you want and explain what you need. There are several here in Miami — the oldest is Van Orsdel who took care of Eddie Rickenbacher and Marjorie Stoneman Douglas.
Most of us hate the idea of ‘visiting the funeral home.’ The idea of death and its finality brings discomfort. In this particular case Mom and Dad are both alive and we were there for selfish reasons – not wanting a wedding interrupted by death. Yet, as I write this, it was the smartest decision we ever made (more on that later).
There is nothing INEXPENSIVE about the simplest of funerals. The entire “funeral experience” has changed. It used to be 30% of the deceased were cremated and 70% buried. Today it’s the opposite, The average cremation costs in Miami are $2000. Then you need an ash container (beginning at $100.). Caskets range from $3000 up and add to that the burial plot, the actual burial and the memorial service . . . bare bones cost is about $6000.00. And then there’s the celebration of life . . . shiva . . . wake . . . which, arguably is the most important part of this process.
The first decision is the manner of ‘the goodbye’ – cremation or a burial? This brings me to insurance policies for burials. There are policies that cost from $50.00 to $100.00 a month which will pay out enough to cover the cost of the funeral and burial. It’s all a question of how much you want to pay. I know many of us on Key Biscayne think we have the money to bury a loved one but do you really have $7,000 to $15,000 sitting around for a burial?
Once that decision is made, it’s time for the legalities. Each state is different but all require notarized signatures. An example – although I am my Mother’s Power of Attorney (POA) for everything, my father had to sign the document allowing her cremation. However, Dad is not the person who signs for his own cremation — that was my brother and me as mother is non compos mentis (not of right mind).
Lastly, the choice of the receptacle or casket – another big financial hit – or not, depending on what you choose. Today, many funeral homes offer rental caskets (a variety of pricing) for the memorial/viewing or church service of the family member who will be cremated. A new trend is “cremation viewing” . . . in other words you can watch your loved one enter the cremator.
My brother and I went through this entire experience together. My advice — do not do this alone — no matter how lovely the people at the home there is an emotional toll. Having another person with you is calming.
We now have everything in place so when “it” happens we will not be making decisions with heavy hearts or guilty minds. And, the icing on the cake – my Father asked me what arrangements we had made. I asked him if he wanted to hear what we had in mind and he said yes. I told him that he and Mom will be cremated and after both have died (and I used that word) we were flying their ashes to Ft. Worth, Texas (Dad’s a Texas boy). There we will do a memorial service at their church and a party at Riviera Country Club. Dad loved the idea! Rites and Rights – done!
It’s a good news/bad news scenario. The good news, you have enough money to have in-home care. The bad news, it’s implementation time — finding the right company or person. This is a slippery slope — especially in South Florida.
Most of us reading this article have never dealt with caregivers —for ourselves or other family members. Questions to keep in mind: Is there a license necessary for this type of work? What happens if the person harms my family member? Is there a background check for the caregiver?
These questions are easily answered if you use a reputable bonded company. A “bonded” company is one who has a “surety bond” and if anything happens to your loved one like theft, maltreatment, or injury, the company cannot hide behind bankruptcy — the bonding company is responsible for payment.
In south Florida many people hire caregivers because a friend recommended him or her or the person had worked for another friend’s family member or its someone just in from Latin America and they need a job. It’s less expensive but it’s dangerous. If there’s theft or maltreatment you have no recourse — these people do not have the means to compensate for their conduct. We’ve all heard stories of stealing, maltreatment of the patient and overall sloth behavior.
One very well known man in Key Biscayne had in-home care for him and his wife. She died and it was just him. The home care folks started taking advantage — eating his food, taking his “change,” purchasing his food (and theirs) and only tending to him when his out of town daughter called to say she was coming to visit. Luckily, his neighbor became suspicious when he found the man disoriented and walking the halls. He took him back to his condo only to find the “helper” watching television and eating — totally unaware the patient had left. He chastised the employee, called the daughter and put an end to the in-home care.
Bottom line – you do not want your family members in the care of people who don’t care. The safest thing anyone can do is call a reputable company and pay the extra $2.00 or $3.00 an hour that a bonded company would charge.
Parenting Your Parents partners with ComforCare — not only do they have well trained caregivers but, if you qualify, they can find you free in-home care! Contact us if you need us. firstname.lastname@example.org.
BORING BUT USEFUL:
MEDICARE – MEDICAID — THEY SOUND ALIKE BUT ARE VERY DIFFERENT
Many of us think if we’re eligible for Medicare then we’re also eligible for Medicaid — although very few of us understand the difference. I am going to attempt to explain that difference without putting you to sleep.
MEDICARE: Medicare is a federally funded insurance program for “seniors.” It is available to all US citizens and green card holders from the age of 65 and higher. There are two parts: Part A (Hospital Coverage) and Part B (Medical Insurance). If you choose a simple ‘medicare’ then you also have to choose doctors and hospitals that accept medicare. (Please see my article, “Choosing Good Care Within the Medicare System”). In 2017 the Part B premium average is $134 but if you have a higher income it can go as high as $600.00/month. If you live on or close to your social security income it’s $109.00 on average.
For hospital insurance you usually pay a deductible — this can go into the thousands which is why many people choose to have a “supplemental” plan. These plans are run by insurance companies and often are free — which is an HMO. As you know, we at Parenting Your Parents, recommend PPO plans which is an out of pocket cost.
MEDICAID: Medicaid is a state administered program with some funds coming from state taxes and other funds coming from federal Medicaid grants given to needy states. (In other words, the poorer the state the more federal funds.) The benefits are intended for low-income patients who cannot otherwise afford medical assistance. To be eligible for Medicaid, you must meet a mandatory list of standards that are partially enforced by the federal government.
Again you must be a US Citizen or Green Card holder to be eligible. For the purposes of seniors, they must be in a nursing home facility or receive “home or community-based care.” Bottom line, a senior cannot have assets or income over the poverty level if they want to qualify for medicaid.
Here is the kicker – qualifying for Medicaid triggers a five year look back to ascertain that you (the senior or the child) have not recently transferred a home, bank account, and/or other assets to avoid paying for nursing home care. And this is the tricky part — when do you begin the asset transfer to children, a trust, and/or a power of attorney. And that is where Parenting Your Parents is a resource.
This is a very tough subject. In our experience parents don’t want to give up control and the kids are the prime suspects, i.e. “they want to take our money away and use it for vacations!” For the kids the hardest part is that one parent is going to go into a nursing home and you have to be prepared (unless you have more that $10 million in assets).
Bottom line — ask yourself — do you want these homes to get your money or do you want the money used for the greater good — whatever that might be. Once that question is answered, you can move forward in either direction . . . protecting your assets now or letting fate take her course.
That dreaded phone call — the one where you don’t know the person at the other end of the line and he or she says, “we’re calling about your Mother.” In this case, Mother, suffering from dementia, had pulled the fire alarm and the locks on the “locked facility” had released. She walked out onto a busy street in Atlanta, GA and tried to flag down a car and escape. Luckily, a concerned motorist called the Police who called the facility. They walked two blocks and found my mother. Until that moment no one knew she was missing. That was a wake-up call.
Dementia does not mean stupid — it simply means that the mind is forgetting. Mother, a summa cum laude graduate of American University, wanted out! She took a look at her surroundings, saw the fire alarm and pulled the lever. The problem, as you can see, is that her “protectors” are not as smart. Needless to say, we moved her out and found another place for her to live. That was three years ago. Today, she has forgotten how to walk, cannot move her wheelchair and is no longer a flight risk.
If one of your family has dementia/alzhiemers it is incumbent upon you to visit the facility regularly — this alerts the staff and the person receives better care. It’s the old axiom — the squeaky wheel gets the oil. Mother is now in a Medicaid nursing home and we are more vigilant than ever. The stories we hear of horrible abuse might be rare and extreme but they’re true. I check her legs, arms, feet, cut her nails and toenails because no one else does. Mom always has new scratches and I ask about each and every one. She can barely communicate so she is at the mercy of those who attend her.
Inform the nursing home of any issues verbally and follow up with a written document. I always email what I stated verbally.
Dad is in an assisted living facility. He has his wits about him and can communicate his needs to the staff. Still, we’ve had to watch the little things — are they washing his clothes on time, changing his sheets weekly, doing the deep cleans in his room and treating him with respect. As Dad has aged he has also lost motor skills, he is a fall risk and weaker – hence the heightened vigilance. If your parents live together this becomes much easier. They watch out for each other. However, this is an exception, not the rule.
In conclusion, the workers at these facilities care about their residents but are human. It really becomes an issue of time. In a nursing home each attendant has 16 to19 patients a day to bathe, dress and feed. The private-pay locations are more vigilant than the Medicaid nursing homes BUT they also have more employees and better paid employees. I do my best to be “understanding” but, at the end of the day, it’s my Mother and Father and no one messes with them!
You walk into the lobby and take a deep breath. How did you get here? Why is this necessary? How did my very competent ‘elders’ all of a sudden need assistance living? Other questions pop into your head, will they be happy here? Will they be fed well? Will they like the people here? Whether you’re 40 years old or 80 years old — these are real moments. Change is coming and it seems to be screaming down the train track right at you. Do you jump or simply lie down? Before you decide ask:
- Do the elders want to live near family or friends? If both are in the same location the question is moot. Otherwise, this question comes first. It’s not about YOU as the child it’s about your parent’s quality of life. We all think Mom and Dad should be close to us, family, but that’s not necessarily what THEY want. If they have a life in a separate location and want to stay, keep them there. Today, with UBER and LYFT the ability to drive is not a necessity.
- What is your budget for a senior care center? Certainly this makes a small difference in the food or housing (food and maintenance are fairly comparable) but the big difference is location. You ask yourself — how long will it take to get them to their synagogue or church? How far is it to their favorite restaurant? What other bills will need to be paid?
- How much money is there? Can Mom and Dad afford this on their own or are will the kids have to assist financially? What other sources of monies can be tapped? Are there VA benefits? Widow/widower benefits? Can social security disability come into play?
- Can this facility be trusted? We’ve all heard those horror stories of badly treated seniors and none of us want that happening to our parents. There are many resources and most of them are online. You can look up assisted living centers and many will pop up — most with ratings right next to the name. There is also AARP ratings, YELP ratings and Facebook.
Bottom line: You will have to do some searching — online and in person Peace of mind is what you want in any location. As the children you want your parents well treated — as the residents you, too, want options in food, activities and people. The most important aspect of this is that you and your parents feel comfortable and secure.
Our company, Parenting Your Parents takes no fees from assisted living centers. Our concern is you and we want the option of defending you against them — which can sometimes happen.