Showing posts with label Seniors. Show all posts
Showing posts with label Seniors. Show all posts

Thursday, October 15, 2015

Taking a Bite Out of Senior Diet Myths

 


 

Taking a Bite Out of Senior Diet Myths


The varied health concerns of seniors can make it difficult for caregivers to know how to manage their elderly loved one's diet.  Is it normal for a senior to lose their appetite or weight for no obvious reason? What combination of vitamins and minerals does a senior really need? Are supplements safe?  Ruth Frechman, M.A., a registered dietician and spokeswoman for the Academy of Nutrition and Dietetics, debunks some common myths about senior nutrition and offers advice for caregivers:
  1. "A senior can eat whatever they want." Frechman feels that this misconception tops the list as one of the most common senior nutrition myths. "Proper nutrition is important at any age—how you eat affects how you age," she says. The key for seniors, according to the National Institutes of Health (NIH), is to look for foods that are low in calories, but high in nutrients. This includes: fruits, veggies, whole grains, lean sources of protein (fish, poultry beans, nuts)
  2. "A senior's nutritional needs don't change when they get older." Following this line of thought is a big mistake, according to Frechman. There are a few important tweaks older adults should make to their daily diets. The U.S. Department of Health and Human Services advises seniors to cut back on their daily sodium intake, consume a higher volume of whole grains, increase their daily potassium intake, and eat foods fortified with vitamins D and B12.
  3. "Dietary supplement pills are a safe way to make sure that a senior is getting all of their vitamins and minerals." Grocery stores often devote several shelves to vitamin and mineral supplements, but caregivers should be careful when considering giving these pills to their elderly loved ones. Seniors who eat a balanced diet should be able to get all of their nutritional needs met from the food they eat. Using supplement pills to make up for a deficit in an elderly person's diet may cause adverse reactions with prescription medications or cause them to overdose on a particular vitamin or mineral.
  4. "Eating out all the time is fine, as long as we don't get the same thing every day." Caregivers (and seniors who live alone) may find it difficult to find the time and energy to cook meals. This may cause them to turn to dinner options that require less effort and time to prepare, such as restaurant take-out or pre-packaged frozen meals. But, according to Frechman, these seemingly handy short-cuts come with a price: high amounts of fat and sodium. This can be particularly dangerous for seniors with heart problems or high blood pressure.
  5. "If a senior doesn't feel like eating a whole meal, a supplement shake is a fine substitute." Meal replacement and supplement shakes are not suitable alternatives to a balanced meal. When used too frequently, these shakes may cause a host of health problems, including: malnourishment, and diarrhea. A good rule of thumb to follow when it comes to these kinds of drinks is that they should be used periodically as a snack, not a substitute.
  6. "It's normal to lose your appetite as you get older—I shouldn't try to get my loved one to eat if they're not hungry." An older person may lose their appetite for a variety of reasons, none of which should be ignored or brushed off as a symptom of aging. Medication side effects, problems with chewing and digestion, loneliness, depression, and a reduction in the ability to taste and smell are all things that can contribute to a senior's reluctance to eat. Frechman says a lagging appetite can cause a senior to become malnourished. She advises caregivers to entice seniors to eat by making the meal look as appealing as possible; using fancy silverware, lighting candles, and arranging the food in a pleasant manner. It may also be helpful if the senior has an eating companion. Try to schedule in some time to sit down and eat with your elderly loved one when you can.
  7. "My loved one doesn't have diabetes, high blood pressure, or high cholesterol, so they don't need to see a nutritionist about their diet." Frechman feels that all seniors could benefit from consulting with a professional about their diet. She says that there is a great deal of conflicting and incorrect nutrition information out there, so it can be helpful to get advice from a knowledgeable source. Medicare Part B only covers dietary consultations if a senior has diabetes or renal disease. Some Medicare Part C Advantage programs will pay for a person to see a nutritionist, if their doctor deems it, "medically necessary." A senior's primary care doctor may also be a good source of information on proper diets for the elderly.


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Thursday, March 6, 2014

19 Free Services for Seniors or Their Caregivers

Most seniors these days are living on limited incomes from sources that may include Social Security, a small pension or maybe some other form of government assistance. With few resources at their disposal, finding services for free or discounted prices is vital.

There are likely many of these types of services available through your local Office for the Aging (the name of this government agency may be different in your local area, i.e. Division of Senior Services) or local charities such as Lions Club or Meals-on-Wheels, or on the Internet through sites like ElderCare.gov.

However, in my opinion, the most rewarding of these freebies for seniors and their caregivers – things like free hearing aids and free dentures – will be more difficult to come by. From my experiences as a caregiver, I have compiled a list of these types of services and provided a roadmap and examples for how to find them.

Free or Discounted Services for Seniors or Their Caregivers


1. Benefit Counseling
How many times have you, either as a senior or as a caregiver, wrestled with trying to figure out what type of help was available to you? There is free counseling available through your local Office for the Aging that can provide this type of assistance and point you in the right direction to receiving the help you need.

You can get answers regarding health insurance, food stamps and other services through these counselors.

2. Adult Day Care
Adult day care centers can be run by a government entity, or through a local charity or house of worship. The purpose of these senior centers is to provide a safe place to socialize and have a hot meal in a protected setting. These adult day care centers are ideal for seniors who cannot remain alone, but are not in need of the care that a nursing home provides.

If you go through your local Office for the Aging, they will probably be able to direct you to such a day care center, let you know if there is a charge for the facility and what the eligibility requirements are.

As for the fees associated with these facilities, if the facility does in fact charge a fee they are normally quite nominal and are just there to help the center cover its own costs for meals and operating costs like utilities.

As for the eligibility requirements, that will depend upon the capabilities of the staff at each individual facility. As an example, some adult day care centers will only accept those who are continent because they will not have the supplies to change adult diapers. Other facilities may require a certain amount of mobility for those attending (i.e. they are able to get out of a wheelchair on their own or with minor assistance). It is really 'hit or miss' because each facility will have their own requirements.

When initially contacting the Office for the Aging or the local charity, give them as much information upfront regarding both the fees (if you are only looking for a free facility) and the physical condition of the applicant. This way they can act as a filter to point you in the right direction.

3. Dentists That Accept Medicaid
Due to the problems of billing and getting paid by the government, there aren't many dentists that accept Medicaid, but a few do. This means that a senior with no dental insurance may still be able to get the dental care needed…you just might have to travel to get it.
To find a dentist in your state that accepts Medicaid, contact your state Department of Health, but keep in mind that you may have to travel out of your way to get these services. For example, in my home state of New York, the state Department of Health website lists about 40 dentists that accept Medicaid. That's not a great number for a state with a population of 19,500,000. On Long Island, where I live, there are only two.

4. Free Dentures
As incredible as it may seem, it is possible for low-income seniors to receive a free set of dentures. In addition to calling your Office for the Aging to see if they know of a source, here are two additional places to look into:

• Your State Dental Association: here you will be able to access free or low-cost dental programs. As an example, one of my customers contacted the Ohio Dental Association and was then directed to Dental Options (in Ohio). She discovered her mother was eligible and will soon be getting the help she needs. While these services will vary based on your location, the place to start is with your state dental association.
• Dental Colleges: while not free, if there is a local dental college in your area you could get a substantial discount on dental care.

5. Elderly Pharmaceutical Assistance Program (EPIC)
EPIC is the name of the State Pharmaceutical Assistance Program in New York. New York is one of the 23 states that have such a program (the other 27 canceled their programs after the Federal government instituted Medicare Part D). If you live in Colorado, Connecticut, Delaware, Idaho, Illinois, Indiana, Massachusetts, Maryland, Maine, Missouri, Montana, North Carolina, New Jersey, Nevada, New York, Pennsylvania, Rhode Island, Texas, the U.S. Virgin Islands, Virginia, Vermont, Washington State or Wisconsin, you have access to another means of assistance to obtain your prescription medications.

Income requirements vary from state to state, so you will have to check with your state administrators to determine your level of eligibility, but this can be a great way for seniors to save on their prescription drug costs.

6. Low Cost Prescription Drugs
Despite the advent of Medicare Part D, and certain state run assistance programs such as EPIC (outlined above), there are still many seniors that cannot afford their medications.

This is why most manufacturers of prescription drugs provide assistance for those who cannot afford their medications. A comprehensive list of these programs is provide by the Partnership for Prescription Assistance as well as the steps to follow to apply for assistance.

Another cost saving strategy is to make the switch to generic drugs.

As the Food and Drug Administration says: "Generic drugs are important options that allow greater access to health care for all Americans. They are copies of brand-name drugs and are the same as those brand name drugs in dosage form, safety, strength, route of administration, quality, performance characteristics and intended use."

Generic drugs cost about 50%-80% less than their brand name equivalents, so it makes all the sense in the world to speak with your doctor about making the switch.

7. Family Caregiver Support Programs
These programs are often offered through the government, or volunteer organizations. Either way, as a caregiver, you can be provided with respite care by volunteers, as well as counseling and support groups to ensure your physical and emotional wellbeing. These services are designed to supplement, not replace, the efforts of the family in caring for a loved one.

8. Free Cell Phones or Discounted Phone Service
LifeLine is a federal government program for qualifying low-income consumers designed "to ensure that all Americans have the opportunities and security that phone service brings, including being able to connect to jobs, family and emergency services."

LifeLine assistance provides one free or discounted phone (either landline or wireless cell phone) per household. To qualify, seniors will likely have to be on some form of government assistance, such as:
• Medicaid
• Food Stamps
• Supplemental Social Security
• Temporary Assistance for Needy Families
• Low Income Home Energy Assistance Program
Visit LifelineSupport.org to see if you qualify and to find participating companies in your state.
I was able to get my mother a free cell phone within five days of her being approved for Medicaid, after providing a picture of my mother's Medicaid award letter (yes, I know it is shocking for the government to move that quickly). The only drawback to the program is the type of phone that you are sent. My mother can use it but it has smaller buttons that can make it confusing. I would prefer for her to have a larger handset with larger buttons, but this is working for the moment.

9. Free Phone for Hearing Impaired
A new service that is (at least temporarily) being funded by the FCC, called CaptionCall, provides free phones to those with medically recognized hearing loss.
The way that this phone works is simple. A screen on the phone instantly takes the words being spoken and puts them onto a screen on the phone so that hearing impaired individuals can read what is being said.

You can learn more at CaptionCall.com/Caregiver (and click on Promotions) for more information.

10. Supplemental Nutritional Assistance Program (SNAP)
This used to be called Food Stamps, but is now known as the Supplemental Nutritional Assistance Program (SNAP). You can apply through your state Office for the Aging, or Elder Affairs Department.

Each state has slightly different requirements based upon income, but what I have found is that most states have a website (www.mybenefits.ny.gov in my home state of New York) where you can set up an online account and, based upon your age, zip code, income and residence status, you are then directed to all of the benefits that you are eligible for.
Once you are approved, the maximum monthly benefit depends upon the size of your family, from $200 all the way up to $1,500.

11. Other Free Food Services
In addition to programs such as SNAP, there are many nutrition programs, offered either by local charities or local governments that can provide seniors with a nutritious meal (typically lunch) and the opportunity to socialize.

Check with your local Office for the Aging to see what programs are available in your area. In my county, there are 33 such nutrition sites that seniors can attend and, in some cases, transportation is provided.

There are also websites that have listings of local food banks where qualifying individuals can receive free food. The best food bank search engine is at Feedingamerica.org. Simply plug in your state and a listing of locations and the types of services offered at each food bank will pop up.

12. Free Hearing Aids
Buying a new hearing aid can run into the thousands of dollars, so it's no wonder that seniors are hard pressed to pay for these devices. But I have found that there are a few ways to obtain free hearing aids. Some will be new, and others may be used, but they will all be free.
First, try your local Lion's Club. Most chapters either operate or know of a local hearing aid bank that can match needy seniors with recycled hearing aids.
Another approach is to seek out clinical trials of new hearing aids. Contact hearing aid manufacturers and see if you can volunteer for a trial. When the trial is over, you typically get to keep the hearing aid. I recently saw a commercial from one hearing aid manufacturer that was advertising for people to participate in trials, so they are open to this idea.

You will have to medically qualify for the trial and you may have to contact several manufacturers until you find one that works for you. You may also get put on a waiting list. Regardless, this can be a powerful way for very low income seniors to receive a free hearing aid.


13. Free Legal Help
When my mother had her heart attack and I started the Medicaid application process, I quickly realized that there would not be any money to pay our mounting bills. So I called my local Office for the Aging and they put me in touch with a local law school that operated a Senior Law Center for low income seniors like Mom.

They wrote a letter to the creditors on my behalf asking for the debts to be forgiven. With this letter I attached a letter from the nursing home detailing Mom's prognosis. That was 14 months ago, and I haven't heard from the creditors since, so I guess that ‘no news is good news.' I did receive one confirmation letter, from Wal-Mart, that the debts were forgiven. The others have not contacted me yet, so I am hopeful that they've written the debts off as bad debt.

These types of law centers won't represent you in a large scale, but they can be invaluable in drafting a simple will, certifying a POA or health care proxy, or drafting a letter to creditors.

If your Office for the Aging is unaware of a local resource for such help, another place to look would be the Lion's Club. Many of the members of the Lion's are attorneys and local business leaders who may be able to help you find a pro bono attorney to handle something like this.

14. Free Medical Alert System
We have all seen the television commercial with the elderly woman in the bathroom saying, "Help, I've fallen and I can't get up!" That's what a medic alert system is for. It is a waterproof pendant that is worn around the neck or wrist, that works in conjunction with a wireless phone attachment. In an emergency, the wearer presses the button to be connected with the monitoring service and speaks into the pendant.

The actual system is totally free, even the shipping. The monitoring service does have to be paid for, but that is normally around $30 a month.

One thing I would advise you to consider when choosing a medic alert company. Make sure that the company you choose does NOT outsource its central station monitoring service. When your loved one hits that button, you want a trained, competent professional who can calmly contact emergency services and stay on the line with your parent until help arrives.

There are many medical alert products out there, such as, LifeStation and Rescue Alert, that offer this type of service.

15. Free Walkers or Rollators
A walker will run you around $40 (rollators are a little more expensive). That can be a lot of money for a cash-strapped senior. If you are looking for a discounted or free walker, here are places you should start your search:

a) Thrift stores such as Goodwill, which operates outlet stores throughout the country and has very reasonable prices
b) Hospitals and nursing homes may periodically dispose of reliable, used equipment that may be ideal for you.

16. Home Energy Assistance Program (HEAP)
Through your local or state Office for the Aging, you can apply for assistance either in the form of weather upgrades to your residence - such as added insulation in the attic to improve the energy efficiency of your home (this is known as the Weatherization Assistance Program) – as well as direct cash assistance based upon your income level.

One not widely known fact about HEAP is that it is available to both homeowners and renters, making it more widely accessible for low-income seniors.

17. Ombudsman Services
For caregivers of nursing home patients, the state ombudsman's office is there to address issues with the care of their loved ones. You can think of the ombudsman as similar to a union rep. They will investigate complaints on your behalf to insure that nursing home residents are being treated fairly.
I previously wrote about my own experience with nursing home neglect against my mother and how I brought in the state ombudsman to investigate the issue.

If you feel there is an issue of neglect or abuse of a nursing home resident, getting the contact information is easy. This information must be prominently displayed in the lobby of all nursing homes, along with the website and phone number to call for help.

18. Residential Repair Services
Need some minor work done around the house, but can't afford the labor? Many Offices of the Aging run a residential repair service where seniors can have minor work done to their home or rental at no labor cost.

NOTE: You will have to pay for supplies, but the labor is free from the volunteers.

19. Silver Alert Program
Caregivers of seniors with dementia are often concerned about a loved one getting lost while wandering - especially if they are driving with dementia. There are many ways to combat this. One way is through a Silver Alert program, which (as defined on Wikipedia) "is a public notification system in the United States to broadcast information about missing persons – especially seniors with Alzheimer's Disease, dementia, or other mental disabilities – in order to aid in their return."
Silver Alert and similar programs vary greatly by state. The way the Silver Alert program works in my local area is as follows:

The caregiver will contact the local police department and fill out a form identifying the senior, giving a physical description, as well as any medical information you wish to disclose.
Your parent will then be issued a Silver Alert bracelet that will have a unique ID number and instructions for anyone who locates them to call a police non-emergency number. This way they can be safely returned home without compromising any personal information on the part of the senior or caregiver.

Check with your local Police Department for more information.
I have used many of these services to assist me in my role as a caregiver and hope that this list of free or discounted services is useful to you and your family as well.

Friday, July 19, 2013

Applying for Medicaid: A Caregiver’s Personal Experience

For those of us who have been through it as caregivers, applying for Medicaid is one of the most arduous tasks that you will ever face. It is a time-consuming, life-altering situation which can literally cause you to put your life on hold while you go through the process.

Having just dealt with this situation due to my mother's heart attack, the best way for me to explain the Medicaid application is for me to tell you my personal story of dealing with the government and the accompanying red tape that comes with applying for Medicaid.

It was a little over a year ago that mom had her heart attack. She pulled through but lost most of her motor skills as well as some cognitive function, so my family had to get her into a quality nursing home. Even more stressful than choosing the right nursing home was figuring out how to pay for it.
For lack of a better word, mom was broke and there was no way that my brother and I could possible pay for a nursing home. That meant that we had to apply for Medicaid. I have to say it was probably the single most difficult things I have ever had to do in my life.

To get mom approved for Medicaid, the government requires a five-year look back period into her personal finances. It is tough enough to accumulate this information under normal circumstances. I had the additional problem of not having a power of attorney to obtain the information. Plus the fact that mom could not be cooperative to help us given her condition made it even more difficult.
As a note to caregivers, it is imperative to sit down with your parents before this type of situation happens to you and make sure that you get a power of attorney ready before they get sick, as well as a health care proxy. I was extremely fortunate that Mom's condition started to clear up to the point where the social worker in the nursing home was willing to notarize a power of attorney so I could accumulate the information I am going to go over. If this didn't happen I would have needed to go for legal guardianship of my mother through the courts, costing me thousands of dollars.

The process for applying for Medicaid
Once I was legally able to begin obtaining the information, I received a list of the required information plus the Medicaid application from the social worker.
Here was the initial list of information that was required:

(Note: because Medicaid is a joint Federal/State program it is possible that the list below may be slightly different than the requirements in your area. Nonetheless, the information will approximate the necessary information required to get on Medicaid)
  • Social Security Card or Social Security award letter showing the amount of monthly benefits.
  • Marriage information. This can take the form of a divorce decree, separation papers or the death certificate of the ex-spouse.
  • For those born outside the USA, proof of legal residency.
  • Birth certificate.
  • Deed, mortgage and property tax statement if your parent owns his or her residence.
  • A copy of the rental agreement if the residence is rented. In either case of renting or owning, a legal address must be established for a period of 5 years.
  • All loans owed.
  • Child support and/or alimony statements, whether your parent is obligated to pay or is the beneficiary.
  • All unpaid medical bills (note: Medicaid will not approve a person unless he or she already has unpaid medical bills…one of the many things that I learned during this process.)
  • Health insurance premiums, paperwork and identity cards.
  • Military discharge paperwork if applicable.
  • Any type of savings and retirement information, including bank statements going back 5 years (Note: I do not know if this applies for all banks but when I requested this information from my mom's bank, they waived the standard $6 a month fee for bank statements due to the fact that it was a Medicaid request, saving me $360)
  • All life insurance policies and statements including any cash value accumulated within the policies.
  • Any cars owned.
  • Pay stubs for the last 6 weeks.
  • Any pensions being received.
  • Copies of tax returns of the applicant for the last 5 years.
And that's only the first part!

Because after all of that information is accumulated, you then have to submit the information and wait for Medicaid to ask for clarification on any or all of the information submitted.

In my mother's case, most of the clarifying information took the form of any cash deposits she made at the bank that were not part of her regular income, Social Security or alimony.

After I received the initial set of bank statements I sat down with the social worker and looked at every deposit into her account over those five years. Anything that did not fall into mom's regular check, Social Security check or alimony was going to be questioned.

I know that it may seem ridiculous to have to clarify a $38 deposit that was made four years ago, but this is the way it is. There were dozens of them and I had to request from the bank copies of all the deposit slips. These deposit slips are enough for Medicaid to approve these deposits as ‘valid'.
Now, I understand that if the government is going to pay out $14,000 a month for a nursing home (that is what mom's costs) they have the right to question the information and make sure that no fraud is being committed.

What infuriated me was that the U.S. government only gives caregivers a few days to gather this information or you have to start the application process over! Even more infuriating was that fact that most of the information had already been submitted the first time. It's just that the person handling the file couldn't read it right.

So you are going to have to be ready for these types of disruptions in your life. Fortunately, I was able to get all of the required information re-submitted but had to take two "vacation" days from work in order to do it.

The only good thing is that once you gather this second round of information it is normally smooth sailing and you are just waiting for the approval. My approval came for my mother in around 5 months.

Tips on applying for Medicaid
If I was to offer any tips, advice or suggestions to caregivers who may have to face this someday, here is what I would suggest:
  • Prepare now. It is imperative to sit down with your parents before a situation like mine happens. Get a power of attorney to manage your parents' finances in an emergency plus a health care proxy in place so you are able to make medical decisions on their behalf if they are not able to.
  • Speak to your parents and try and gather as much information as you can now, or at least understand what their filing system is so that you can access all of this information when the time comes. I have things set up much better to handle my father if anything happens. Everything is in one briefcase, all organized. I just need to take the briefcase and start the process again.
  • Have you spoken to your loved one about a specific nursing home they would want to go to? I know that can be tough but if you have the chance to take the tour beforehand. Using the Medicare Nursing Home Comparison tool can be a great benefit to you.
Now that I have experienced the extensive process of qualifying for Medicaid on my mother's behalf, I can say without a doubt that I was not ready to initially meet the challenges that awaited me. I hope that sharing my personal story will help other caregivers prepare now so that they will be ready in the future.

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Thursday, July 18, 2013

Spending Down to Medicaid Doesn’t Have to Impoverish Both Spouses

One of the biggest worries of a married couple where one spouse needs to go into a nursing home is that the spouse who is still at home will become impoverished in order to pay their partner’s bills.
While it is true that the nursing home spouse may not have more than $2,000 in countable assets in order to receive Medicaid benefits, federal law permits the so-called “Community Spouse” to retain up to $115,920 in countable assets (cash, stocks, bonds, real estate in addition to the home, etc.). (Discover which Assets You Can Have to Still Qualify for Medicaid.)
 
In most states the Community Spouse may only protect 50 percent of the total countable assets of both spouses, up to $115,920. In other words, all countable assets—no matter whether titled in the husband’s name, wife’s name, or jointly—are totaled up and then divided by two.
 
The Community Spouse is then permitted to keep one-half of the total, up to $115,920. The other half—minus the $2,000 exemption allowed the nursing home spouse—must be “spent down” or otherwise disposed of, or converted to something that is non-countable.
 
The ’50 percent rule’in action
For example, consider a couple with a house, car, personal property in and around the house, jewelry, cash in the bank, and maybe an IRA or 401(k).
 
First of all, the house will be exempt no matter its value, as long as the Community Spouse is living there. One car of any value is also exempt, as is all personal property and jewelry. However, the cash and retirement accounts are countable (although there are a few states that exempt an individual’s retirement accounts once they are paying out the minimum amount required under federal tax laws). If that cash and the retirement assets total, say, $200,000, then the Community Spouse can protect only $100,000 (50 percent). If it totaled $300,000, though, the Community Spouse can protect the full $115,920, even though that is less than 50 percent of $300,000.
 
Exceptions to the rule
For couples who have very few assets, the “50 percent rule” will allow the Community Spouse to protect the first $23,184, even if that’s more than 50 percent of the couple’s total assets.
 
Some states do not follow the above “50 percent rule.” These states simply allow the Community Spouse to retain the first $115,920, even if that is more than half of the total assets of the couple.
Currently, these states are AK, CA, CO, FL, GA, HI, IL, LA, ME, MA, MI, VT, and WY (SC reduces the maximum to $66,480).
 
Once the protected amount is determined, the real work begins: how can you protect the extra assets so they are not merely spent down on the monthly nursing home bill?
 
This is what is known today as “Medicaid planning,” and it can get quite complicated. There are many options to protect the excess assets, such as investing in exempt real estate, purchasing a “Medicaid annuity,” using Medicaid's "Cash and Counseling" program to hire a family member for caregiver services, transferring money to a disabled child, using specialized trusts, etc.
 
Be aware that spending down to Medicaid is tricky. You cannot simply give excess assets to a child (unless they are considered disabled under federal law) or another family member without incurring a penalty period of disqualification from Medicaid coverage: the greater the gift, the longer the penalty period. The exact calculation varies from state to state, but all gifts made within the five-year period before the date you apply for Medicaid will count against you.

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