Leave me home!!!   You better not put me in any nursing home!

Most people we speak to want to stay home.  Our concern is not just home, but home in a safe “senior friendly” environment.

You can make your home safer with a few simple steps; better lighting, trip hazards like worn or torn rugs, securing hand rails or banisters, etc.   Here are a few things you can do:

Quick fixes for creating a safer environment A good approach to begin creating a safer environment for seniors is to ask them what they have trouble with around the house, or watch them move within their home to determine what is causing them difficulty. The rooms in the home where the senior spends the most time, such as the family room, bathroom, kitchen, and bedroom, can be a good starting point. This room-by-room safety guide helps the senior, adult child, or caregiver focus on easy changes for a safer and more comfortable senior living space.

Overall Improvements:

• Cleanup clutter around the home to greatly lessen the chances of tripping. Look for any low-lying items that are on the floor, such as stacks of magazines or plants, which may be close to a walking path. Move electrical cords from lamps or in-home medical devices so that they are out-of-the-way.
• Inspect the condition of the floor in each room. Carpet shouldn’t be too shaggy or be wrinkling; feet catch easily on both. Tile or vinyl can be slippery, especially when wet. Secure throw rugs with anti-slip pads, tape them down, or remove them altogether. Stairs are particularly dangerous, so keep them clutter-free and install handrails on both sides.
• Ensure there is enough lighting outside leading into the home and inside the home, in all walkways, and in rooms that the senior uses the most. Keep flashlights in easy-to-see and reach locations.
• Replace doorknobs with easy, lever-style handles.

The Bathroom:

• Install grab bars around the tub, shower, and toilet.
• Elevate toilet seats.
• Consider a walk-in shower or bathtub with built-in seating, or put a shower seat in the bathing area.
• Use non-skid mats in front of the sink and toilet and outside the tub if you don’t put down low-pile carpeting.
• Cover the bottom of the tub with a suctioned safety mat or a permanent rough coating.
• Replace faucet knobs with lever handles to make it easy to turn water on and off.

The Kitchen:

• Make sure everything in the kitchen is within easy reach, so that a stepstool is not necessary.
• Post all important phone numbers,emergency contacts, and the senior’s doctors on the refrigerator.
• Post a list of all medications the senior is taking, any allergies, and any health conditions.
• Ensure lighting is sufficient.

The Bedroom:

• Use a bed only as high as necessary. An elevated bed can be a problem to get in and out of.
• Make sure the path to the bathroom is clear.
• Install night lights where necessary for middle-of-the-night bathroom trips.

SPECIAL QUESTION:  Are you, or do you know of a Wartime Veteran or their surviving spouse?  The Veterans Administration  has a program called  “Improved Pension, Aid and Attendance” that helps pay for helping the Veteran or surviving spouse with their activities of daily living while they remain in their home.   If you would like to know more, visit our web-site – www.wgalaw.com or email rick.messemer@wgalaw.com

Excerpt from “Senior Spirit” newletter from Raleigh Geriatric Care Management

Every new caregiver needs to be introduced to the Client by their manager. The “Caregiver Orientation” is

when the caregiver is introduced to the home environment (care plan, danger spots, Client preferences, daily

routine, the location of the supplies required to do their job). It is also when they are introduced to the Client.

Most companies do not do this “Caregiver Orientation.”

#7. THE CAREGIVER IS NOT SUPERVISED / FAMILY IS NOT INVOLVED

Regular supervision in the home and at the office by a qualified staff member (both announced and

unannounced) is required to maintain a safe and productive environment. Regular and frequent interaction

with the senior and their family will uncover issues before they have a chance to develop into problems.

#8. THERE IS NO CONTINUING EDUCATION OR UPDATING OF CAREGIVER SKILLS

Technologies, methods and procedures constantly change. Continuously updating caregiving skills through

teaching and testing, administered by an RN is important to keeping caregivers in top shape. For most

companies this is non-existent or “hit-or-miss”.

#9. THERE ARE NO DAILY PROGRESS NOTES/DOCUMENTATION OF ACTIVITY

Daily care activity and unusual occurrences need to be documented for everyone to review. Many companies do not require daily written documentation of activity in the home (Daily Progress Notes).

#10. THERE IS NO WRITTEN CARE PLAN

A written care plan needs to always be available in the home. The Care Plan should document the needs of the Client and the requirements of the caregiver and must be approved and signed by a medical professional.

Enjoy the peace of mind knowing you or your loved one is cared for properly by taking some basic precautions in the early stages of investigation.

REMEMBER:  If you are homebound, need the “aid and attendance” of another person to assist with your activities of daily living  and a veteran or surviving spouse of a veteran there may be financial assistance for your caregiver costs available.

Let me know your particular situation and see if there is help available.

rick.messemer@wgalaw.com

The baby boomer group is turning 65, on average,  at the rate of 10,000 individuals per day.  In many of the southeastern states like North Carolina, we have become a “destination” state for retirees, increasing the potential number of seniors looking for in-home care.

Kevin Corrigan of Caring Senior Service shared the top 10 things to look for when interviewing an in-home agency.  Here are the first five, look for the last five in a few days!

#1. YOU MIGHT GET AN INEXPERIENCED CAREGIVER

It is very dangerous to leave a senior with an inexperienced caregiver. Most companies do not require enough experience from their caregivers – usually only one year (because that is NC State law). Companies should

require at least 5 years of verifiable eldercare experience. Inexperienced Caregivers are dangerous.

#2. GETTING A LAZY OR INCOMPETENT CAREGIVER

It would be regrettable to leave a poor worker in the home. Most companies only require 3 work references

from an applicant. But it is important to interview both employers and friends. Checking too few references

will not let you get a good picture. Home Care companies should require 6 references (3 personal and 3 work).

#3. PUTTING A CRIMINAL IN THE HOME

It would be disastrous putting a criminal in the home. Most eldercare companies do not do thorough enough

criminal background checks – only checking on a local/statewide basis. And they only do that once at hiring

time. All criminal background checks need to be nationwide. And they need to be repeated frequently.

#4. CAREGIVERS ARE NOT PROPERLY INTERVIEWED AND ASSESSED

A Caregiver can look good on a resume and get by a casual hiring manager. Caregiver applicants need a

thorough face-to-face interview and skills assessment performed by a qualified professional.

#5. GETTING A DRUG USER FOR A CAREGIVER

Illegal drugs are widespread in our country and prescription medications are prevalent where seniors are

present. Initial urine drug testing at the time of hiring and then random follow-up drug testing is critical.

It is so important to choose the right care options, but don’t let your legal documents go uncheck either.  Make sure as you begin the care process with these updated documents:  your Health Care Power of Attorney, Advanced Directive, HIPAA Release form are in order.  Added to this, Wills should be updated, General Durable Powers of Attorney (GDPOA) and make sure all your insurance, retirement and annuity beneficiary designations are correct.

Please feel free to contact us if you have any questions regarding our post:             rick.messemer@wgalaw.com

We would all like to extend to you a warm Christmas greeting

Bill Alexander, Tovah McDonald, Rick, Tracy, Deb, Ann, Katherine, Elizabeth and Shelia

W. G. Alexander & Associates, Elder Law Attorneys, Raleigh, NC

If you are looking in Wake County, N.C.,  the Wake County Human Services (Senior and Adult Services) provides a listing of these facilities and reports provided by the Counties Adult Home Care Community Advisory Committee.  The link is:  http://services.wakegov.com/pmcweb/AdultCareListing.aspx?HomeType=AdultCare

Rick Messemer, Community Outreach and Education,      rick.messemer@wgalaw.com

1. GIVE A HUG

Look for:

• Obvious weight loss. Anything from depression to cancer to difficulty shopping and cooking can be behind a noticeable loss of weight.
• Increased frailty. If you can notice something “different” about a person’s strength and stature just in a hug, it’s noteworthy. Pay close attention to how your loved one walks (shuffles more?) and moves (rises easily from a chair? has trouble with balance?), comparing these benchmarks to the last time you were together.
• Obvious weight gain. Injury, diabetes and dementia (because the person doesn’t remember eating and has meals over and over) might be the cause. So can money troubles that lead to fewer fresh foods, more dried pasta and bread.
• Strange body odor. Sad to say, changes in personal grooming habits because of memory trouble or physical ailments might be noticeable on very close inspection. Look, too, for changes in makeup, hair, or the ability to wear clean clothes

2. RIFFLE THROUGH THE MAIL

Look for:

• Unopened personal mail. Everybody leaves junk mail alone, but few of us can ignore a good old-fashioned, hand-addressed letter.
• Unopened bills. This can be a sign that your loved one is having difficulty managing finances — one of the most common first signs of dementia.
• Letters from banks, creditors, or insurers. They may be routine business. But it’s alarming if they’re referring to overdue payments, overdrawn balances, recent accidents, or other worrisome events.
• Thank-you messages from charities. Older adults are often vulnerable to scammers, and even those who have always been fiscally prudent are vulnerable if they’re having trouble with thinking skills (a common sign of Alzheimer’s disease). Some charities hit up givers over and over, and your loved one may not remember having donating the first time.

3.   TAKE A DRIVE–WITH MOM OR DAD BEHIND THE WHEEL

Look for:

• Nicks or dents as you enter and exit the car. These can be signs of careless driving.
• Whether your loved one fastens his or her seatbelt. Rote basics are usually, but not always, remembered by someone with mild dementia.
• Signs of tension, preoccupation, or being easily distracted. Is your loved one no longer willing to drive at night? Or on highways? Is it hard for him or her to talk to you or listen to the radio and also pay close attention to the road?
• Signs of impaired driving. Tailgating, slow reaction time, going consistently below speed limit, confusing gas and brake pedals are signs to watch for. See 8 more ways to assess someone’s driving.
• Dashboard warning lights. Does the car have sufficient oil, gas, antifreeze, windshield-wiper fluid?

Look for:

• Perishables past their expiration dates. Your loved one might be buying more than he or she needs, as we all do — but you want to be sure there’s a reasonable ability to ditch the old stuff (rather than use it).
• Multiples of the same item. Ten bottles of ketchup or a dozen different vinegars might indicate he or she can’t remember from one shopping trip to the next what’s in the cupboards at home.
• Appliances that are broken and haven’t been repaired. Check the microwave, coffeemaker, toaster, washer, and dryer — any device you know your parent used to use routinely.
• Signs of past fire. Look for charred stove knobs or pot bottoms, potholders with burned edges, a discharged fire extinguisher, smoke detectors that have been disassembled. Accidents happen — but accidental fires are a common home danger for older adults.
• Increased takeout or simpler cooking. If someone who used to cook a lot no longer does or has downshifted to extremely simple recipes, the explanation could be a change in physical or mental ability.

Any single point does not signal a major problem, but several of these, especially if you seen an ongoing history, should cause some level of concern.  The first step might be increased phone or personal contact, having a neighbor “keep an eye out” for your loved one.  If the concern is food, look into Meals on Wheels, or a in-home care agency to supervise medications.

Important and most difficult, is making sure your loved ones legal and financial affairs are in order.  Medical and Financial Powers of Attorney are vital.  Possibly suggest opening a joint checking account sufficient for paying regular bills or to cover final expenses. 

If you have any questions regarding:

• Basic Documents
• Discuss levels of care
• Prepare for Long Term Care
• Or there is a crisis “right now”

Please feel free to contact our office:

Rick Messemer, Director of Community Education

W.G. Alexander & Associates,   Elder Law Attorneys

rick.messemer@wgalaw.com

In a recent survey, the median annual cost of a single occupant unit in an assisted living facility was listed as:

• North Carolina:  $33,600.00
• Georgia:  $28,800.00
• South Carolina:  $36,840.00
• Virginia:  $44,460.00
• Alabama:  $34,765.00
• Delaware:  $55,506.00
• Florida:  $31,950.00

The most expensive state was Alaska at $66,000.00.

Planning for costs such as these requires some planning now:

1. Do you have all core documents in order?  Wills, Powers of Attorney, etc.
2. Can you find important documents like Marriage Certificates and Military Discharge papers, needed to apply for assistance.
3. Protect your real property.  There are many programs available with the primary residence excluded from your assets
4. Have you checked all your beneficiary designations?  Will your 401K, insurance or annuity go the right place to protect it?  Keep in mind that these do not pass through your will.

Let us know if we can help with any of these questions.

Email:  Rick Messemer, Community Education Manager          rick.messemer@wgalaw.com

Counseling experts are already witnessing a 66% growth in calls this year from adult children seeking advice on complex medical, legal and financial issues involving aging parents, according to a report being released Wednesday by the ComPsych Corporation, an international provider of 13,000 employee-assistance programs. Add to that high volume the 18% increase during November and December, when families gather after long absences.

“A lot of the calls are financially driven and stress driven,” says Richard Chaifetz, chief executive officer for ComPsych. “People will call and say, ‘I think my father needs to go to a nursing home. Can you help us figure out our options and how to broach it with him?’ “

Chaifetz says it’s best to go home prepared to have a good time but to be aware of changes occurring in older parents. “A lot of people will decide not to say anything to parents when they’re visiting,” says Chaifetz, “but then they’ll go home and start to realize their parents might need help.” At times there might be a crisis, says Chaifetz, when adult children have to find alternative living arrangements for their parents.

During or after your visit, you may think about the following: 

•How do they look? If they were previously fashion divas or dapper Dans and their clothes are dirty or do not match, be sure to ask the next three questions.

•Is the home in good order? If the house and property were always photo-ready for Home and Garden and now are messy or have stacks of old newspapers and magazines scattered around, that could signify other problems.

•Are they eating well? If the refrigerator lacks healthy ingredients, they might not be meeting nutritional needs.

 •How are their cognitive skills? If there are unpaid bills or expired pill bottles, or if they get lost on routine trips, they might be suffering from depression or dementia.

When you are faced with making difficult decisions on behalf of your loved ones, always consider seeking professional help possibly in the form of a Geriatric Care Manager or experienced Elder Law Attorney.  Good advise early on can save the family from financial and emotional stress in the future.

If you have questions regarding general estate planning, the right documents and how to use them (Powers of Attorney, Wills, etc.), protecting assets, tax questions or financially providing for Long Term Care, please let us help.

Rick Messemer, Community Education,   rick.messemer@wgalaw.com

Based on an article by By Janice Lloyd, USA TODAY (off USAToday.com)

The 2012 Aid and Attendance Rates will increase per a recommendation made by the Congressional Budget Office.

The recommendation named S.894 Veterans’ Compensation Cost-of-Living Adjustment Act of 2011, was made in May of 2011.  The report and recommendation for the increase in the 2012 Aid and Attendance rates was ordered and reported by the Senate Committee on Veterans’ Affairs on June 29, 2011.

This is great news for veterans and widowed spouses of disabled veterans who depend on this non-service connected disability pension benefit with aid and attendance entitlement.

The aid and attendance rate increase will allow many of these wartime veterans or their widowed surviving spouse receive more care for their well-being and activities of everyday living commonly referred to as ADL.

2012 Aid and Attendance Rates

When Will These 2012 Aid and Attendance Rates Go Into Effect?

All VA benefit rate changes, including the 2012 Aid and Attendance Rates, go into effect on the first day of December of each year.

If you are in need of on-going long term care (in-home caregivers, assisted living or skilled nursing), find out how the Aid and Attendance benefit can help offset the cost of these services.

Monthly seminars on VA and Medicaid eligability.

Contact Rick Messemer at rick.messemer@wgalaw.com or call our office for seminar dates and times.

The strategies were divided into “Verbal” and “Nonverbal” communications.  There were some ideas we’d like to share. 

VERBAL COMMUNICATIONS:

• Use familiar words.  Newer slang and computer terms are very difficult to relate to.  Explain what you are trying to convey.
• Talk slowly
• Limit the number of conversation partners.  Everyone speaking at the same time is very difficult to follow.  One speaker at a time, same topic.
• Don’t have conversation with someone on the other side of the room. 
• Use simple, direct statements
• Be concrete.  Certain topics need special care; medical, financial, family matters should be thought through prior to presenting.
• Avoid arguing.  You may have issue with something that happened right now, they may be thinking of something 50 years ago.
• Provide additional information.  Be prepared to respond to questions, with solid, factual answers.
• Present material matter-of-factly”.  If you are stating your opinion, it is better to begin, “this is my opinion”.

Material was presented by Sandy Christos, M.S., CCC-SLP, Clinical Specialist, Master Clinitian-Dementia.

If you have questions or comments, contact Rick Messemer, rick.messemer@wgalaw.com