When Medicine Becomes a Menace

Seniors are increasingly reliant upon their medications. It’s a fact of life – Literally!

However, with so many different kinds of medications to do so many different things, at times the medications or their combinations can cause as much harm as good. According to a recent study from the Center for Disease Control, as reported here, two-thirds of drug-related emergency hospitalizations result from just four types of medications.

These four types of medicine are sadly, also very common. They are listed below in order, from the greatest to the least percentage of adverse instances per drug, whether taken together or separately:

1. A blood-thinning medication called warfarin (Coumadin, Jantoven)
2. Insulin
3. Antiplatelet drugs used to prevent blood clots such as aspirin and clopidogrel (Plavix)
4. Oral hypoglycemic agents – a diabetes medicine

The most important fact, however, is that nearly two-thirds of all such cases were not just the drugs themselves; they were the result of unintentional overdoses.

It’s scary to see such common medicines listed, and if you or loved ones use them there is cause to take notice, but the real lesson is awareness and care. There are real consequences when care is not received properly or when an elderly person is not able to accurately gauge their medications. There are many solutions involving a variety of levels of caregiving as well as many ways to fund that care. At Idaho Estate Planning we have a network of resources to help you care for yourself and/or your loved ones. Let’s work together and initiate a plan that works for your individual circumstances. Remember, good planning is no accident.

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Are You Ready for the “Holiday Reality Check”?

The Holidays bring families together, which is a great thing, especially for those family members separated by geography. But since the holidays also mean spending time with your parents and elderly loved ones, it can be a shock. The New Old Age Blog at the New York Times recently referred to this shock as the “Holiday Reality Check”.

All those months of checking in over the phone or getting reports from a sibling might have led you to believe that all was well with your elderly loved ones. Now, when you actually see them face to face, all is not well on the home front.

It hits in greater and lesser degrees: Finding a loved one to be fairly forgetful, much more than before. Perhaps it’s finding stacks of unpaid bills and old food filling the fridge, or discovering that the nursing home selected was the wrong choice. No doubt many readers already have encountered their own Reality Check during a Thanksgiving visit, but the important thing is that the holidays aren’t over yet. No, they are just ramping up.

As we venture deeper into the holiday season, you may seize the opportunity to pay more attention and begin to right some wrongs sooner rather than later. For many, this might mean an up-front and realistic discussion about what needs to happen, whether that be planning for the estate, writing advanced directives, or pursuing care.

However, there also are more gentle steps that can be taken and some pragmatic ones as well. Fixes that you can offer from afar might mean hiring helpers or even professional geriatric care managers to work in your stead.

The important thing is what the holidays mean about and for your family. Consider this a clarion call to be proactive while there still is time to plan, rather to be reactive when time to plan is past.

At Idaho Estate Planning, we can help you find the resources you need to put your estate plan together. We have the experience and expertise to help you maintain your options and protect yourself as well as your loved ones now and into the future. Remember, good planning is no accident!

Idaho Estate Planning is part of the Senior Resource Network of Idaho, a non-profit network of elder care professionals available to provide information on what we discussed above and much more. Let us know your concerns and we will help you find the resources you need.

In addition to caring for your parents or other family members, it is also important to consider your own concerns for the future. How will you maintain your independence as you grow older? What effect would a costly health issue have on your quality of life? The more planning you do now the less difficulty there will be later. Remember, good planning is no accident.

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Medicare and Medicaid Dodge the Budget Bullet (For Now)

Have you heard the news? It seems the grand experiment failed. The Congressional supercommittee, charged with doing what the Congress at large could not do, has run out of time. And, by running out of time, failed in its mission to come up with budget cuts.

What does that mean for Medicare and Medicaid beneficiaries?

As Reuters reports, in the event the supercommittee should fail, as it has, then automatic and sweeping cuts go into effect. For Medicare, that means a two percent cut across the board, or about $123 billion over the next decade. However, it might have been $500 billion to $700 billion in cuts, if various supercommittee arguments had prevailed.

Nevertheless, as it stands, there definitely will be a little pain, but not quite as much for individual beneficiaries. No, likely it will hit hospitals and doctors the hardest. Why? In the aggregate, that’s where the money tends to end up.

Of course, we’re not yet out of the woods. Just as it became clear last summer that we’d have to wait until the winter for some kind of budget solution from Congress, it now seems that we’ll have to wait for the upcoming election season. In turn, expect things to intensify even further and for budget discussions to become all the more drastic.

Trying to keep up to date on Medicaid, Medicare or any other issues faced by America’s Elderly can be a daunting task. At Idaho Estate Planning, we understand these challenges. We have the experience and expertise to help you maintain your options and protect yourself as well as your loved ones now and into the future. Remember, good planning is no accident!

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Hospital–Induced Delirium

When the elderly visit the hospital it’s simply not the same as when they were younger. No, everything is more dangerous.

The New Old Age Blog at the New York Times recently discussed a danger that is all too common, but still under the radar screens of medical and the everyday worlds alike. It’s the problem of elderly delirium.

Usually, when we talk about an elderly person no longer being themselves, we think of dementia. Nevertheless, another dramatic neurological problem is delirium and it is often, ironically, brought on by hospital visits. Here’s what happens: When the elderly are put under such heavy medication it can generate a neurological imbalance that results in dramatic disorientation, sudden confusion, and loss of attention. The list of medications that can have this affect is fairly long, including sedatives, sleeping pills, narcotic painkillers and some allergy, blood pressure and incontinence drugs. As a result, it’s not a surprise that delirium is common.

Each year 20 percent of the 11.8 million elderly patients in hospitals develop delirium. This includes some 60 percent to 85 percent of those in intensive care on ventilation and more than half of postoperative surgical patients.

The problem is that delirium also can have long-term effects, according to recent research. In the end, many hospitals may be doing long-term damage to their patients. For more information and a stirring example, read the original story here. Be sure to take a look at the checklist to help determine the difference between dementia and delirium.

If you are elderly do yourself a favor and forward this message on to those who would be your support should you end up in the hospital. The members or your Disability Panel are a good place to start. If you don’t have a Disability Panel call 208-939-7658 and we’ll help you set up your estate plan to include this critical option. Remember, good planning is no accident.

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Old Age Costs Rising

Are you planning for your old age or perhaps the old age of a loved one? If yes, then you know that such planning is all about getting a handle on healthcare. Unfortunately, the most recent study from MetLife indicates that the costs for long-term care and assisted living are rising at an even faster rate than in previous years despite the weak economy.

According to the MetLife study:

• The national average daily rate for a private room in a nursing home rose 4.4% from $229 in 2010 to $239 in 2011.
• The national average monthly base rate in an assisted living community rose 5.6% from $3,293 in 2010 to $3,477 in 2011.
• The national average daily rate for adult day services rose 4.5% from $67 in 2010 to $70 in 2011.
• The national average hourly rates for home health aides ($21) and homemakers ($19) were unchanged from 2010.

Businessweek offers some coverage of the development, along with the words of the director of the MetLife Mature Market Institute, Sandra Timmermann. According to Timmermann, “The state of the economy, combined with rising health-care and energy costs, are having a significant impact on long-term care rates.”

Indeed, even though MetLife is the largest life insurer in the U.S., it also has discontinued its long-term care insurance policies for these very reasons. Likewise, the CLASS Act (the first public-option long-term care insurance) recently shut down. In the end, this is rather grim news for those planning for their old age or an elder loved one.

At Idaho Estate Planning, we can help you find the resources you need to put your estate plan together. We have the experience and expertise to help you maintain your options and protect yourself as well as your loved ones now and into the future. Remember, good planning is no accident!

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Housing Slump Effects Senior Care Options

After four years or so the housing market is still idling at terribly low levels, but even if we’re all feeling it, it’s our nation’s seniors that seem to be uniquely hurt. The problem has been growing over those years, but the Kaiser Health News recently put out an article taking stock of the situation and new reactions from assisted-living and nursing home facilities.

With housing prices and market demand so low, seniors simply can’t get up and enter into a facility, even if they need it. For many seniors, the plan had always been to use the equity in their home as the investment to keep them afloat in retirement but the value in those homes simply dropped in 2008. Even if you can forget how much the house was worth in 2007, before the crash, it’s simply not easy to sell a house these days and they tend to just sit on the market for years, or fetch too little money to make the sale possible. It’s causing seniors to wait that much longer before they can enter into a facility, and that’s time on top of however long it took them to finally make the decision to give up the home in the first place. It isn’t good for finances, and it is especially bad for health.

The facilities themselves aren’t happy with the trend and some are working to help ease the transition. In certain facilities across the parts of the country that were hit hardest by the housing bubble the occupancy rate has dropped as much as 10%, with nursing homes and continuing care facilities hit the hardest and assisted-living only slightly better.

For you or a loved one it means that there are a number of possibilities to plan for. Those that can’t quite get out of their homes might consider bringing the care to them through in-home care services or perhaps living with loved ones. Still, if a facility is necessary then there may be options out there, it might be possible to work with the administration; chances are you’re not the only one with the problem and they may offer a solution.

At Idaho Estate Planning, we can help you find the resources you need to put a long-term care plan together. We have the experience and expertise to help you maintain your options and protect yourself as well as your loved ones now and into the future. Remember, good planning is no accident!

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Uncovering Alzheimer’s Cover-Ups

Dementia and Alzheimer’s are becoming increasingly common, but even if we are beginning to become more and more aware of how to spot them, it doesn’t make it any easier. Many a reader will be familiar with the terrible uncertainty and concern over their elderly parent’s thinking. Fortunately, Carolyn Rosenblatt of Forbes has more advice to give in her recent article.

Among the many dangers to keep in mind when an elderly loved one starts “slipping” it that they may begin “hiding” it. For one thing, it is not something with which any senior looks forward to acknowledging, even if they are aware of some telltale symptoms. It is human nature.

We all compensate or distract when there is something to hide, both from ourselves and from others. But when something like Alzheimer’s is at stake, it can be all the more difficult to get past and harmful to hide. Indeed, since there is no actual test for dementia or Alzheimer’s, it is possible that a doctor will be unable to diagnose those conditions.

It is important, therefore, to observe how your loved one functions. Keep a keen eye on them and know what you are seeing, for their own sake. The original article has more advice and anecdotes to offer, but Ms. Rosenblatt sums up the steps in four points. As soon as you begin to worry you must, first, persuade your loved one to visit a doctor, and a specialist if possible, to detect it early. Second, you must secure their estate planning documents while they have legal capacity to know and understand what they are doing. Third, you must secure proper care for them. Fourth and last, you have to discuss the circumstances openly with all family members, so all may be aware of the circumstances and can work together to protect your loved one.

Last year we published two blogs, Aging Parents: Warning Signs of Failing Health, and Recognizing Symptoms of Dementia. You may also find these articles useful if you are concerned that a loved one may be showing signs of dementia or other health issues related to aging.

Timing is critical in these situations. The best time to begin addressing your concerns is now. At Idaho Estate Planning, we can help you find the resources you need to protect yourself and your family. We have the experience and expertise to help you maintain your options and protect yourself as well as your loved ones now and into the future. Remember, good planning is no accident!

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Alzheimer’s & Estate Planning

A diagnosis of Alzheimer’s disease can be devastating for everyone involved, including the patient and all of their family members. Should you be facing this diagnosis, there are probably a million thoughts racing through your mind, from keeping your loved one safe to caring for them as the disease progresses. One thing you might not think about is the need for estate planning. As a recent article by Reuter’s explains, if you or someone you love has a family history of dementia, is showing symptoms of Alzheimer’s or is concerned about later-life planning, it’s time to get to work.

You’ll want to assemble a team that specializes in long-term planning and elder care issues. A good place to start is the National Care Planning Council (NCPC). The NCPC and their website www.longtermcarelink.net are a very comprehensive resource for Eldercare (Senior Care) and Long Term Care Planning. Idaho Estate Planning is a founding member of the Idaho Care Planning Council and the Treasure Valley Care Planning Council. Both are a part of the NCPC network.

At Idaho Estate Planning we can help you navigate the elective transfer of decision-making authority through a power of attorney or trust and can help you qualify for needs-based programs like Medicaid and Veterans Pension Benefits if necessary. We set up a legal framework through which the client and his or her family can transfer assets and decision-making responsibilities.

Alzheimer’s is the sixth leading cause of death in the U.S., with 5.4 million Americans suffering from the disease. So, health care proxies will be another important aspect of your legal plan.

You may want to read 2 previously posted blogs titled Maintaining Control of Your Healthcare Options and Recognizing the Signs of Dementia. When dealing with Alzheimer’s and other forms of dementia it is critical to start NOW. At Idaho Estate Planning, we can help you find the resources you need to put your long-term care plan together. We have the experience and expertise to help you maintain your options and protect yourself as well as your loved ones now and into the future. Remember, good planning is no accident!

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Medicaid Eligibility

Here’s another important reminder on how much of a stickler Medicare and Medicaid can be when it comes to denying benefits: the Matter of Komanoff Ctr. for Geriatric & Rehabilitative Medicine v Daines (N.Y. Sup. Ct., App. Div., 2nd Dept., No. 2010-05776, June 28, 2011) (here summarized on ElderLawAnswers.com.)

It’s the case of Bernadette Jordan and how she entered a nursing home and filed for Medicaid only to find that the State ruled her ineligible for a period of 14.31 months. Apparently, Mrs. Jordan had transferred funds from a revocable trust to her daughter, to repay expenses that her daughter had shouldered in getting her to the nursing home. States are skeptical of such transfers, and often examine them carefully. In this case they found that the transfers were made at less than fair market value for purposes of Medicaid eligibility, and so denied Mrs. Jordan Medicaid benefits.

On Mrs. Jordan’s behalf, her nursing home called a hearing and later appealed. After all, the expenses the daughter paid were documented and done with the assumption that they would be repaid with assets from the trust. The State still denied benefits. The problem was that there was no written document at the time of the expenditure that specified the agreement to repay the daughter’s expenditures.

The moral of the story is documentation. By documenting your interactions and intentions you can provide hard proof and avoid getting caught on a technicality. In Mrs. Jordan’s case, 14.31 months is a long time to wait for nursing home benefits.

At Idaho Estate Planning, we have the skill and resources to help you put your long-term care plan together, including preparing for the possibility of Medicaid. We have the experience and expertise to help you maintain your options and protect yourself as well as your loved ones now and into the future. Remember, good planning is no accident!

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Get Out of Bed & Get Better

As we and our loved ones age, we put a lot of effort (and resources) into making sure a hospital bed is available when needed. New research shows that while that hospital bed may sometimes be necessary, getting up and out of it as quickly as possible is key to recovery. As it turns out, the hospital bed is a huge contributor to old-age infirmity, as studies prove that bed-rest and immobility slow healing and stunt recuperation.

A recent New York Times column, “The New Old Age” covered the results of a study conducted by University of Texas physician, Dr. Steve Fisher. Using a step activity monitor (a fancy pedometer), the Texas team found that just an extra 600 steps a day, or about 12 total minutes of slow walking, could significantly shorten hospital stays. Although Dr. Fisher calls for further study, he still offered his optimism, “It’s encouraging to think that small changes can be of broad benefit.”

Though physicians may have advised nursing staff to help the patient ambulate, nurses and aides frequently have little time for these tasks and the patient may not get up and walk enough. Dr. Fisher recommends that family members take the initiative and ask about getting a physical therapist involved early on and about whether the family is permitted to help the patient walk.

One obstacle to an aggressive mobility plan is the risk of falls. Not only are they a valid concern for you and your loved one, but also for the hospital. Since 2008, a fall is grounds for Medicare to refuse to reimburse a hospital for a patient’s care. So, it’s understandable that the hospital might be overly cautious about families helping elderly patients walk. Nonetheless, Dr. Fisher still encourages families to look for safe ways to help elderly patients get up and walk. While falls can indeed be dangerous, the consequences of prolonged immobility may be worse.

Put together a detailed plan for your future long-term care by calling Idaho Estate Planning today. Remember, good planning is no accident.