Seniorization of Your Home – Caregivers Make Home Safe for Aging

Our population is aging quickly!

According to The Federal Interagency Forum on Aging-Related Statistics, the older population in 2030 is projected to grow from 35 million to 74 million and represent 21% of the total U.S. population.

Today’s seniors are healthier than ever in our history. Aging, however, presents our robust seniors with challenges to remaining independent in their homes as they age. Home safety is a major concern for family caregivers.

Many people want to stay in their homes as long as possible as they age, whether for financial reasons or because they simply love their current home and neighborhood.

Going to live in any type of congregate living situation such as a retirement home, assisted living facility or nursing home is not a dream for most seniors. Most of the time, transitioning to a care facility occurs because seniors and their family caregivers are unable to overcome the physical or medical challenges of aging.

Until that time comes, remaining at home is the goal for most who are currently aging in place.

Staying Safe Aging in Place

Aging in place especially when the home is older can present safety concerns for seniors and their family caregivers.

Unfortunately, the same homes that seniors have enjoyed and in which they have found comfort for years may not be suited to the needs of a senior adult. These homes are not always maintained in the safest condition for those whose need to reach for objects or have diminished movement and balance from aging. Functional decline may require home modifications, whether small or large, to improve home safety for seniors once again.

Family caregivers need to intervene for their seniors to be sure that every part of their living situation is as safe as can be for them. Overcoming and adapting to changes brought on by aging can be done to make their home as safe and livable as possible.

But what can family caregivers do?

On what areas of the house should you focus and where do you start?

Starting now even before you see gaps that need filling will make your senior loved one’s aging in place journey more successful.

Home Seniorization Checklist

Senior Care Corner has created a checklist to help you “seniorize” your loved one’s home.

It will help you consider small and large changes in the home environment that can be done by you and/or home repair and renovation experts before the need for modifications becomes a crisis.

You can download this valuable tool here.

Being proactive to improve aspects of home safety is important for family caregivers to keep seniors safe and living in the home of their dreams as long as possible.

Medicare’s Coverage of Respite Care in 2019

Danielle Kunkle Roberts authored this article as a guest of Senior Care Corner®. She is the co-owner of Boomer Benefits and a Forbes.com Contributor. Her licensed insurance agency specializes in Medicare-insurance related products, helping tens of thousands of clients across 47 states.

The number of unpaid caregivers in the United States has reached over 40 million, according to the Bureau of Labor Statistics. Often, a caregiving role falls upon a family member whether or not they are prepared to take on the difficult job.

The need for caregivers to have a break by way of respite care is well known amongst senior advocacy groups. Congress heard the plead for respite coverage and acted by passing the Bipartisan Budget Act of 2018. One of the bill’s many additions to Medicare Advantage plans is respite care.

Medicare’s coverage of respite care will depend greatly upon what kind of Medicare plan a patient has. Let’s look at how both Original Medicare and Medicare Advantage plans will cover respite care in 2019.

Original Medicare and Respite Care

Original Medicare’s coverage of respite care was not changed by the 2018 legislation from Congress. Medicare strictly states that it will cover respite care if the patient has a terminal illness with 6 months or less to live. Meaning, a patient must be receiving hospice benefits to get their respite care covered.

Hospice Respite Care

Original Medicare will cover short-term respite care for up to 5 consecutive days. According to Medicare.gov, they will cover additional stays in the case they are not too frequent.

To be covered, the respite care will need to be provided in a Medicare-approved facility such as a hospice facility, hospital, or a nursing home.

Additionally, the care will generally be provided under the following circumstances:

  • The caregiver is facing physical or emotional fatigue
  • The caregiver has an appointment, obligation, or event to attend to
  • The caregiver is ill and can no longer take care of the patient on their own

Cost with Original Medicare

Fortunately, if the patient meets Medicare’s criteria, Part A will foot most of the respite care bill.  Typically, the patient will only be responsible for covering 5% of the Medicare-approved amount.

To break down an example of this, if Medicare approves $100 per day for inpatient respite care, this would leave only $5 per day for the patient to pay while Medicare picked up the rest.

Beneficiaries enrolled in Medigap plans may find that their plan covers the 5% coinsurance for them.

Medicare Advantage and Respite Care

Notably, Medicare Advantage (MA) plans have seen the biggest change from the Bipartisan Budget Act of 2018. Respite care is one of the additions now allowed. If a carrier decides to include some of these new supplemental benefits to its plan design, it will usually allocate a set dollar amount and/or credit a certain number of hours of respite care that will be covered.

The respite care options that can be covered by some Medicare Advantage plans include:

Short-term residential facilities

Many assisted living facilities, nursing homes, and hospice centers offer short-term respite care as a service. There are typically rooms in these facilities that are specifically designed for temporary stays by their respite patients.

In-home respite care

In-home respite care is a great option for caregivers that need a temporary break but are in a situation where the patient cannot leave the home.

Adult day care

Caregivers can schedule respite care through an adult day care on occasion or a set schedule. This is a great change of pace and scenery for the patient while giving the caregiver a temporary break.

It is important to stress that not every MA plan will offer respite care coverage. There are still many plans that have yet to offer this coverage. With 2019 being the first year that plans can offer this coverage, analysts believe many more plans will offer the benefit in the future.

Summary

Respite care is a practical and necessary break for caregivers. This unpaid role can feel daunting to the caregiver at times and even cause stress on the patient. The newly available coverage of respite care through Medicare Advantage plans will be a welcome benefit to many beneficiaries and their family members.

When Assisted Living is Right for Your Senior – Choosing the Right Assisted Living Facility

Independent living in their own home is the preference stated by most seniors.

Is your senior loved one ready for more care than they can receive in their home? Despite our attempts to keep them at home as long as possible, at some point family caregivers may need to help find a new housing arrangement to meet the needs of their senior loved ones.

Assisted living is a solution that gives care in an apartment setting. The Assisted Living Federation of America defines an assisted living facility (ALF) as “a housing and health-care option that combines independence and personal care in a residential setting.”

Seniors remain independent but receive more support such as meals, medication administration, bathing, dressing, transportation, activities, and socialization.

There are approximately three quarters of a million older adults living in assisted living facilities, 40% of whom received three or more activities of daily of living assistance from the facility.

It is the fastest growing option for long-term care for independent seniors who still need some assistance or supervision.

Is assisted living on the list of options your senior would consider for their future?

Should it be?

Would an assisted living facility be the right next home for your senior?

If this becomes an option for your senior, what should you look for in a facility, what will meet your senior’s needs, how can they afford an ALF, and how can your senior and family select the best facility?

Assisted Living Facility Features

An assisted living facility provides care for seniors who need more help with dressing, grooming, taking medications, preparing meals, doing housework, and other activities but does not usually offer skilled nursing services or medical care that a long term care facility (nursing home) would provide.

When activities of daily living become more than a person can safely complete in their home, the next step is often a move to assisted living.

Here are some of the features you can expect to find in an assisted living facility:

  • Provide a long term living situation to meet the individual needs of each senior
  • Depending on what is needed, these facilities can provide assistance with activities of daily living such as medication dispensing, bathing, grooming, household chores; congregate meals; activities to relieve boredom; socialization with peers; spiritual events; transportation; physical activities and social engagement; housekeeping and laundry
  • Most provide health monitoring
  • Involve families in the care and progress of their senior loved ones
  • Improve the independence of seniors as they transition from the home setting with increased assistance to improve their function
  • Provide transportation to nearby shopping, health professionals and community entertainment
  • Some provide memory care services for those requiring more safe spaces, one-on-one care and assistance
  • Provide home-like setting with comfort and style maintaining privacy combined with a variety of amenities
  • 24 hour assistance provided, which may include security around the clock
  • Cost will vary depending on the services your senior requires; the more they need-the more it will cost

Assisted Living Facility Selection Considerations

There are many factors to consider when looking for the right assisted facility for your senior’s new home.

  1. Is it located close to family and friends so that they can visit regularly?
  2. What are the available desired amenities and features, such as beauty shop, meals that meet your senior’s needs, caring staff, comfortable apartments, pleasing atmosphere, welcoming staff, cleanliness, free of odors, well maintained grounds and common areas, and how emergencies are handled.
  3. Does the facility desire to maintain dignity and respect as well as the highest level of quality of life for your senior? Is your senior involved with the plan of care?
  4. Will your senior’s privacy be maintained?
  5. Do they offer choices to your senior, including meals, activities, and desired amenities to maintain their independence? Read the activity calendar and see if the social events are of interest. Are there appropriate spiritual events for your loved one or you?
  6. Is the facility and its location safe?
  7. Do you understand and agree with the fees charged and facility policies? Ask what is included in the basic rate and what services will be extra (and how much).
  8. Are you fully aware of what might constitute unplanned discharge from the facility? What functional or behavioral changes will result in a discharge?
  9. Can seniors bring their own furniture and mementos?
  10. Are pets allowed? If so, what are the limitations? What costs are associated with pets?
  11. Does the dining program adjust for medical needs? Are between-meal snacks offered? Can they eat when hungry or are there set meal times or choices of meal offerings?
  12. What do you foresee your senior’s needs will be in the future and can this facility meet those needs?
  13. Can your senior stay there if he/she becomes cognitively impaired? (Alzheimer’s disease or dementia)
  14. Check with the Better Business Bureau to see if any complaints have been made, as well as simply searching the web using the facility’s name.

You can’t assume each facility offers the services your senior needs or will need in the future.

Planning for the Cost of Assisted Living

The cost of assisted living is usually paid by the elder or their family caregivers, but some long term care insurance policies will pay a portion of the cost. Sometimes financial assistance is available from the facility or, if your senior qualifies, Medicaid can help, though the facilities that accept Medicaid are limited.

You can expect to pay less for an assisted living facility than a nursing home, but it is still likely to be expensive.

You typically get what you pay for, so a cheaper fee may mean fewer services or even care below your standards.

In 2018, Genworth Financial completed a survey of the cost of assisted living and found that the fees have spiked up 6.7%. The cost has risen largely due to a national staffing shortage (which is likely only to become worse).

The average cost is now $4,000/month for a one-bedroom unit which is $48,000 per year. The costs vary slightly across the country, with a daily rate averaging $132.

Federal and state government programs generally do not cover the cost of assisted living. Therefore, sound financial planning is key. At the current time, only half of adults have a financial plan in place.

Caregivers may end up paying out of their own pockets (often out of their own retirement savings) to pay for the care of older adults who did not plan for the cost of long term support services (LTSS).

When seniors wait longer to enter an assisted living facility, they often have greater needs, which translate into a higher cost for that care. Therefore, be aware of the additional costs for care your senior may have when comparing different facilities.

Seniors who have dementia may be living longer with care needs. This should also be considered when financial planning is done as well as deciding on placement options.

Seniors Like the Change – Really!

We speak with many seniors who are very happy and enjoying themselves in assisted living facilities.

They are relieved of the burden of maintaining their home, cooking their own meals, or feeling lonely.

There are fun activities and new people to spend time with every day.

Although it is true that many of our seniors wish to age in place, there are also many who are struggling living alone and need more assistance to stay safely independent.

Whether you call it an assisted living facility, continuing care retirement facility, retirement home, residential care facility, congregate living facility, personal care home, or community residence, you may find that your senior will be happy to have made a change.

Careful investigation of facilities near you, visiting each center and speaking with staff and residents, and including your senior in the decision will make it a smoother transition for the entire family.

Assisted living facilities can offer you and your loved ones a safe, caring, friendly environment full of fun activities.

These facilities can bridge the gap between independent and dependent living situations when staying in the home is no longer the best option.

We wish you and your senior well as you plan home transitions!

 

 




Vanquishing UTIs — Family Caregiver Quick Tip

Getting a urinary tract infection (UTI) repeatedly seems to be common for many seniors. Some seem to overcome one only to get another infection quickly.

In most cases, with effective management they should be preventable.

Even older adults who are incontinent should be able to remain UTI-free, according to healthcare professionals.

What can family caregivers do to prevent UTIs from making their senior loved ones sick and at risk for falls or worse?

Prevalence and Causes of Recurrent UTIs

The number of older adults who are diagnosed with a urinary tract infection is staggering! Over 10% of women over 65 and 30% of women over 85 have reported a UTI in the past year.

Urinary tract infections, infections of the urinary system, are the most common infection in older adults. When the infection spreads to the kidneys, it can lead to sepsis and hospitalization for seniors.

Older adults with compromised immune responses, exposure to pathogens, and multiple chronic diseases have higher incidence of UTIs.

Taking greater than 6 medications can also increase the risk of developing a UTI especially certain drugs such as diuretics or sedatives.

Having a history of UTIs is a major factor in future development, as much as a four times greater risk than those without a history.

Urinary retention, high post-void residual, BPH diagnosis, and urinary stasis are also common causes for frequent UTI rates.

Urinary incontinence can lead to infections, but it is not inevitable. Bowel incontinence can lead to UTI if good pericare is not followed. Using good handwashing and cleaning techniques as well as other toileting procedures can help prevent frequent infections.

Unfortunately for seniors, when germs enter the body due to improper or infrequent handwashing or poor cleaning technique after urinating, frequent UTIs are the result.

Symptoms of a UTI

Your senior may exhibit one or more of these symptoms if they have, or are developing, a UTI. Contact their healthcare provider to discuss their symptoms because, if left untreated, it could lead to more severe illness or even hospitalization.

  • Dysuria – painful or difficulty urinating, burning sensation
  • Urinary frequency and urgency
  • Nocturia – nighttime urinary urgency
  • Cloudy or foul smelling urine
  • Fever
  • Pelvic tenderness
  • Pyuria – pus in urine
  • Hematuria – blood in urine
  • Altered mental status – confusion, dizziness, disorientation
  • Falling
  • Potentially lower back pain or constipation

Treatment and Prevention Tips for Caregivers

Many seniors who have been diagnosed with UTI will be given an antibiotic, which may clear the infection. Unfortunately, it may set them up for drug resistance in the future.

There are other preventive treatments that can help lower the risk of UTIs:

  1. Closely monitor your senior for any of the symptoms listed above. If the changes come quickly, contact their healthcare provider
  2. Encourage adequate hydration – fluid intake throughout the day, 30-35 ml of fluids/kg/day

For the average 150# older adult = 2045-2385 ml = 69-80 ounces a day (8 ½ – 10 cups)

  1. Observe for signs of dehydration, such as dry tongue, dry mouth, decreased urinary output, or drier than normal skin
  2. Encourage cranberry products in the diet or ask the doctor about cranberry tablets
  3. Remove any physical limitations inhibiting seniors from getting to bathroom, especially at night; install way finding lights to help them get to bathroom at night
  4. Learn and practice proper cleaning techniques to thoroughly clean entire area with warm water and cloth, rinse, pat dry; avoid back to front wiping after having a bowel movement to prevent spread of germs, especially E. Coli.
  5. Encourage them to toilet regularly, as often as every few hours, and to take the time to empty their bladder fully
  6. Discuss concerns with the doctor to ensure all evaluations and treatments have been done to prevent recurrence
  7. Change soiled undergarments or incontinence products promptly to avoid contact with infection-causing pathogens.

Getting the proper cleaning products and incontinence supplies is one important way family caregivers can help prevent recurrence of UTI symptoms. For your convenience, we have set up a department in The Shop at Senior Care Corner with some of the supplies your senior loved one may need, with online ordering and home delivery.

Becoming a victim of a UTI should not be considered a part of normal aging but something for which to be alert and take steps to prevent.

You can help vanquish them with these tips!

 

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What Seniors Consider to be Successful Aging In Place – The Latest Report

We all want to live the rest of our lives in the home of our dreams. In fact, 3 out of 4 adults want to age in place according to a recent AARP report, 2018 Home and Community Preferences. 

Unfortunately, many adults fear that this won’t be possible for them. Family caregivers worry about their senior loved ones ability to safely and financially age in place.

The AARP report found that “59% anticipate they will be able to stay in their community, either in their current home (46%) or a different home still within their community (13%). “

What are options for you and your senior loved one to remain in either their current home or community that would enable them to age in place as they wish?

Will your senior need accommodations to their current home, downsizing, or renovation? Will in-home care be possible in their current location or would they have availability of family caregivers to help? Can their needs be met in their current community (age-friendly, walkable, or accessible)?

The survey found options that are becoming more viable and desirable, some of which might surprise you.

Non-Traditional Options for Aging in Place

There are many strategies that can be put into place starting right now that will help enable your senior loved one to remain in place as they age.

The AARP report found that seniors are willing to explore these options, including some new ideas that are beginning to gain traction as viable solutions.

They found that adults were willing to try home sharing (32%), building an accessory dwelling unit (31%), and moving to villages that provide services that enable aging in place (56%).

We have heard about NORCs (Naturally Occurring Retirement Communities); granny pods that can sit on the property of family caregivers to give independence and family support; assisted living facilities which allow for extra care and no home maintenance; and, continuing care retirement communities (CCRC) that can give care transitions in one living location as traditional options for seniors who desire a more supportive community as they age.

However, home sharing is a new preference, one that is beginning to catch on, with agencies designed to help you and your senior either share their home or find a suitable home. The costs of living are shared, the space is shared at the same time companionship is gained.

There are older adults who wouldn’t consider home sharing (28%), as well as some who might consider it in the future if the need arose for help with transportation or other tasks (58%). Half would consider this option for the sole purpose of companionship.

We may see those numbers rise in the future, especially among those aging alone.

In the survey, many older adults expressed a desire to relocate and also downsize specifically because their home requires renovations or maintenance that they aren’t willing to do but would be necessary for aging in place.

What Do Seniors Desire to Age in Place?

The AARP survey also asked adults about the experience of aging in place. What do they need to feel successful and safe?

Some of the results are not surprising, as we have been hearing for some time the importance of some of these factors. The trick is finding what they desire as many cities are still struggling to be age-friendly.

Seniors want affordable housing as they age (60%) and transportation especially for those who are disabled, according to the survey results. Currently, 90% of seniors drive themselves, but they also want public transportation, walking areas, and the ability to be transported by others to get where they want to go. Having all options available as they age is important to consider.

Ride sharing services such as Uber and Lyft are another option, but only 29% of older respondents report using them, although 94% were familiar with them. Only 68% felt they would use them within the year due to perceived lack of need or safety and privacy concerns. In addition, 88% have heard of driverless cars but are not willing to use autonomous vehicles. We anticipate this statistic will change as the vehicles attain broad familiarity and acceptance.

They also want access to jobs and job training for seniors and people with disabilities.

Half (50%) also say that they would want volunteer opportunities with transportation to those sites.

Being in proximity to a hospital, healthcare professionals, and safe parks were also high on the list of desires.

They would like walkable cities with easy to read traffic signs and well-maintained streets and sidewalks.

33% of adults feel that they have a need for companionship as they age (3 in 10) and feel left out or isolated. Most adults surveyed (94%) reported having someone they knew to call in a time of need day or night.

Family Caregivers Help to Make Dreams a Reality

The wants of our seniors who wish to age in place are really no different from those of younger adults. We all want to live in our homes as long as possible, want access to transportation to remain independent, want accessibility in all things, and to remain socially engaged.

How can this be possible for our seniors? There are things caregivers can do now to help facilitate aging in place.

  1. Begin now to achieve universal design in the home. Thinking ahead about what makes a home livable now and in the future so that you can make changes that will be useful at any age can be done now. Changing to lever handle faucets, installing adequate lighting, maintaining the dwelling so that it isn’t a safety risk, putting the bedroom on the main floor, and other design traits will make the home easier to age in place.
  2. Educate seniors about the benefits of ride sharing and autonomous vehicles so that they will be ready to use these services if the time comes when they could benefit from them. Also discuss the possibility of home sharing if they need support with their finances, companionship or help with daily tasks. There are numerous benefits to home sharing beyond financial to consider.
  3. Connect them with technologies that will allow them to remain safe at home, engage with others to reduce the feeling of social isolation, and give you (the family caregivers) peace of mind through privacy-maintaining monitoring of their health and well-being when you are not present.
  4. Advocate for livable, age-friendly communities. What does their locale need for them to remain in their community as they age and how can you be proactive in helping to achieve that?
  5. Encourage them to stay healthy through physical activity, healthy eating, adopting preventive health habits, and disease management so that they can maintain the highest quality of life to stay independent.
  6. Help them manage their finances and plan for aging in place so that they can afford housing, pay for upkeep of their home, seek appropriate medical care and medications as needed, eat a healthy diet, purchase technology, and pay for home health care as needed.

Successful aging in place takes planning on both your senior’s part and yours as a family caregiver.

Learning about what your senior expects as they age in place so you can help them meet those expectations may be your first step towards helping them achieve their dreams.

 




 

Lifestyle Medicine for Prevention and Wellness – Family Caregiver Quick Tip

Lifestyle medicine — are you familiar with it?

Is this something new? Is it something helpful for older adults and therefore should family caregivers encourage this intervention?

According to the American College of Lifestyle Medicine, “Lifestyle medicine is an evidence-based approach to preventing, treating and even reversing diseases by replacing unhealthy behaviors with positive ones — such as eating healthfully, being physically active, managing stress, avoiding risky substance abuse, adequate sleep and having a strong support system.”

The goal of lifestyle medicine is to put the person in the driver’s seat to control their own health by addressing the cause of disease instead of just the symptoms.

Avoiding the side effects of chronic disease treatment by preventing the disease in the first place is what lifestyle medicine tries to achieve. Lifestyle medicine can begin healing the body toward health.

Prevention is key.

Prevention Leads to Wellness

Most would agree that prevention is the better option than diagnosis and treatment. Researchers have found that changing our lifestyle by smoking cessation, healthy eating, and becoming physically active could prevent 80% of chronic disease.

Lifestyle medicine, when properly used, is said to to improve purposefulness, increase energy, and give you a positive outlook on life, according to physician’s who prescribe these interventions.

Lifestyle medicine interventions can impact:

  • Heart disease
  • Cancer
  • Cognitive function
  • Stroke
  • Diabetes
  • Erectile dysfunction
  • Pain
  • Weight management
  • Telomeres

Recommendations from major scientific bodies, including the American Cancer Society, the Diabetes Prevention Program, the American Heart Association, and the national Cholesterol Education Program, focus on lifestyle improvements as a means for prevention.

Foundation of Lifestyle Medicine – Tips for Change

There are six key areas for improvements in our lifestyles that will improve our health at any age.

These are the areas caregivers and their senior loved ones should implement change for their health.

  1. Nutrition – eat a balance at each meal including fresh fruits and vegetables, whole grains, lean proteins, and dairy products. Meet the bodies’ need for nutrients by including a variety of foods, especially those the nutrients of concern, because they are often eaten in inadequate amounts such as fiber, magnesium, calcium, potassium, and vitamins A,D, E, and C
  2. Physical Activity – move it or lose it, 150 minutes of moderate activity a week, choose something you enjoy so you will keep doing it
  3. Sleep – repair and heal our bodies during sleep which needs adequate time and sleep quality
  4. Tobacco Cessation – large cause of death, time to stop
  5. Stress Management – managing and recovering from stress
  6. Healthy Relationships/Socialization – connections impact our health

Experts now agree that genetics are not as important as a healthy lifestyle when improving our health.

Lifestyle medicine is simply lifestyle as medicine. It should be the first line of treatment where you work with healthcare professionals who help you make changes.

Continuing an unhealthy lifestyle will rob you of the life in your (and your senior loved one’s) years!

 




House Sharing – Social and Financial Solution for Many Seniors on the Senior Care Corner® Podcast

Older adults who may be living alone as a result of being newly single when the kids leave the nest or losing a partner or those who never married or are recently divorced have realized that aging in place can be lonely without someone else around.

Solo aging can also be expensive for those accustomed to having two incomes to pay the bills.

What if seniors could have someone to share the experience of aging in place?

Many of us recall the popular 80’s TV series The Golden Girls, about four older women who shared a home.

Sharing the financial burden of housing, gaining companionship or a community, having help with the household chores including home maintenance, or taking care of a pet are some of the benefits that house sharing can provide for seniors who want to maintain their independence without shouldering the entire load.

Shared housing is another term for this fast-growing living situation many boomers are seeking either through online sites, workshops or personal connections.

Statistics show this trend is growing. The Joint Center for Housing Studies at Harvard University found that the number of older adults living with non-relatives went from about 400,000 in 2001 to about 900,000 in 2016.

The numbers also reflect growth in shared housing that is outpacing the overall growth in the senior population, so the trend is one that is becoming more popular.

Because of the growing interest among seniors in a topic not known well by most family caregivers, we decided to make it the subject of this episode of the Senior Care Corner® Podcast.

Click on the ▷ below to play the podcast (note: you can continue reading while you listen if you want)

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Benefits of Shared Housing

There are many benefits including having someone to talk with at the end of a busy day or someone who will keep an eye out in case of an emergency which is an advantage for family caregivers who can relax a little that their senior is safe and not home alone.

As we age, we tend to have a decreased need for material things and gravitate toward shared relationships. We seem to be, as one expert stated at the recent Aging in America conference, ‘wired’ to connect with others as we age. Connectivity in social relationships is a major benefit of shared housing especially for solo agers.

Having extra income for seniors on fixed incomes by leveraging the largest asset, their home, can relieve financial burdens with which many older adults find themselves struggling. It is estimated that 45% of solo agers are 90% dependent on Social Security benefits for their income.

However, benefits also come with challenges, too. It is important that a housemate is fully vetted in advance and signs a contract spelling out the rent, house rules, and options to cancel the agreement. Getting advice from an expert on financial agreements and other legal details is imperative and organizations who help match house sharers will assist with this step of the process.

Being aware that conflict is inevitable, even among the best of friends and compatible roommates, so planning for these possibilities ahead of time will save trouble.

It is important to set up rules for the house such as who cleans the bathroom, overnight visitors, the thermostat settings, who gets a house key, expense sharing, when payment should be made, and how conflict will be resolved before entering into this type of agreement. Another important point to clearly spell out is how can housemates exit the agreement if they are dissatisfied with the arrangement?

Conversation with Silvernest

We first met Silvernest, a service that helps baby boomers and empty nesters meet the challenges of successful home sharing, at Aging in America earlier this year.

One of the things we really like about them is that they built a roommate matching process from the ground up based on the needs of older adults, rather than simply using one initially developed for those who are younger.

Wendi Burkhardt

While researching Silvernest to learn more, we came across this self-description on BuiltInColorado.com, a hub for Colorado startups:

Silvernest boldly breaks the rules of aging so you can open your home on your own terms. We’re creating the next generation of roommates. A more modern kind. A well matched kind. A kind that’s just your style. Because around here, the details are totally up to you.

In 2015, nonprofit leader, author, and activist Robert Egger, when asked by CNN “what is the most most important company we’ve never heard of,” said it was Silvernest.

We are pleased Wendi Burkhardt, Silvernest Co-Founder and CEO, agreed to let us record a conversation so we — and you — could learn more and are pleased to share it with you in this episode of the Senior Care Corner Podcast.

Link Mentioned in This Episode

 

We hope you found this podcast informative and will check back with Senior Care Corner often for future podcasts and other articles.

 




 

Telehealth Guidelines from CMS May Bring it to a Senior Near You

Older adults who are receiving benefits under Medicare for their healthcare needs visit the physician at least six times per year while most people visit four times a year. That number increases when blood draws, specialists, and procedures are added.

People over 65 also visit the emergency room 19.6 million times in one year (15% of the total visits) according to the Centers for Disease Control and Prevention (CDC) data.

Even with chronic disease management efforts such as medications, diet, and lifestyle factors, our senior loved ones will spend a lot of time in the hospital. They represent 40% of the total number of people hospitalized, according to Agency for Healthcare Research and Quality (AHRQ).

What can family caregivers do to reduce the frequency of doctor office visits and crisis care for senior loved ones?

Have you tried telemedicine or encouraged your senior to use this technology?

Using Telemedicine

Senior Care Corner has long been an advocate for the beneficial use of technology for seniors and their family caregivers.

The list of available and affordable technology can fill gaps for aging in place seniors and the caregivers who provide ongoing care and support.

One way seniors can use technology to improve their health and well-being is to begin using telemedicine services.

Telemedicine is healthcare using a technology that links people to all types of healthcare providers remotely (that is, not in the same location). It is defined as the remote diagnosis and treatment of a person using telecommunications technology.

CMS Changes for 2019

The Centers for Medicare and Medicaid Services (CMS) is the government agency that administers the Medicare Program.

Each year they determine how much and for what services they will reimburse healthcare providers across the spectrum. They also determine which benefits seniors will receive, such as for wellness visits or Part D prescriptions.

In 2019 the Fee Schedule for Physicians and Quality Payment Program is supposed to help boost support for telemedicine, which could help seniors wishing to participate.

Their own remarks show how valuable they now believe telemedicine can be for seniors:

“We now recognize that advances in communication technology have changed patients’ and practitioners’ expectations regarding the quantity and quality of information that can be conveyed via communication technology. From the ubiquity of synchronous, audio/video applications to the increased use of patient-facing health portals, a broader range of services can be furnished by health care professionals via communication technology as compared to 20 years ago.”

By increasing the reimbursement rate for physicians, the theory is that more doctors will join in delivering telemedicine. The greater the participation by doctors, the greater the opportunity for seniors to access telemedicine.

Many doctors have been reluctant to offer telemedicine services to their patients because of several factors, including lack of tech knowledge, potential cost versus benefit of their time spent in electronic medicine, crossing state boundaries with licensure and credentialing issues, privacy concerns, and the inability to receive adequate reimbursement.

What Doctors Do Via Telemedicine

Doctors and healthcare providers of all types, including general medicine, mental health providers, nurse practitioners, specialists, and emergency providers can use telemedicine technology and many already are.

  1. Receiving vital signs via text message or smartphone apps, including blood pressure readings, daily weights, blood glucose levels, and respiratory oxygenation data, as well as other vital statistics that will help them manage chronic disease, adjust medication, and avert a crisis requiring emergency care.
  2. Communicating via text message to discuss concerns, symptoms, schedule appointments, pay bills, and refill prescriptions without needing an office visit.
  3. Reviewing records in the electronic medical record, especially test results or consultations (store-and-forward medical care).
  4. Completing virtual exams where symptoms or physical signs, such as rash or swelling, can be viewed electronically.
  5. Diagnosing and prescribing treatments, especially in emergency first aid situations, avoiding the need for ER visits. Many of these ‘virtual practices’ have been operational using smartphone apps for a number of years already.
  6. Providing education and health coaching to better manage chronic disease states.

What Are the 2019 Changes That Could be Game-Changers?

The new guidelines coming in 2019 which could signal more availability of telemedicine include:

  • Reducing the amount of time required to complete a “visit” remotely. In the past, healthcare providers had a minimum time that they must spend with each patient to qualify for reimbursement under Medicare. The current guideline of 30 minutes/month is reduced to 20 minutes/month. This time could be spent reviewing remote data, communicating with the patient or caregiver, or completing a virtual visit.
  • Reimbursing the provider for time spent setting up the equipment or teaching the patient or caregiver how to use it. The new guidelines establish payment for three individual steps — setting up equipment, on-boarding a new patient into their system, and then training the user on the technology. This is a big step forward in making telemedicine more accessible as it removes obstacles to initiation of the new technology for seniors and caregivers.
  • Clinical staff, not just the doctor and other qualified staff, will now be able to receive reimbursement for using telemedicine through the physician’s office. For example, if the receptionist uses telemedicine technology to schedule and bill, theoretically, this time could be added to the 20 minutes allotted per month to be billed. The medical assistant or nurse can review the vital signs sent daily and report critical values to the doctor for order changes without the doctor spending time reviewing data. This will free the doctor’s time for office visits while providing care and oversight for remote patients who won’t need to physically enter the office for routine monitoring. Even better, under the new guidelines, the doctor doesn’t have to be in the room (or building) where this monitoring occurs. Currently any billing for services provided using a qualified staff member under the supervision of a physician must have a doctor present in the same building at the time of services. This is a huge change and will likely encourage a new form of healthcare provision that will certainly benefit seniors.

The real time benefit for seniors and family caregivers could be game-changers.

Many experts believe that these new guidelines will encourage healthcare providers to get into the game and begin offering telemedicine. Some also believe this will signal new companies and start-ups who can leverage clinical staff to provide telehealth services under Medicare but have been unable to do so in the past.

Multitude of Benefits for Seniors and Caregivers

Just think about the many benefits that both seniors and caregivers can gain if they begin taking advantage of more telemedicine services.

Family caregivers won’t need to spend hours getting to and from routine appointments, making appointments, or getting seniors ready to go out, often for hours for a 15-minute appointment.

It may all but eliminate the need for fragile seniors to be transported to the doctor office for routine visits.

It can reduce the incidence of healthy seniors getting exposed to communicable diseases while they sit in the waiting room, not to mention a sick person spreading their illness to others. Imagine not needing a visit to be treated for flu symptoms.

This can mean less waiting time for those who need to physically visit the physician or healthcare provider if some things can be done remotely, such as blood pressure monitoring for medication adjustments and then prescription changes.

The ability to react quickly and get care remotely when a crisis is looming may prevent many emergency room visits and avoidable hospitalizations.

All of these benefits can help not only manage the health of our senior loved ones more effectively, but also reduce the cost of healthcare.

Telemedicine will not replace the need for seniors to visit a doctor in person at some point. In fact, the guidelines for telemedicine reimbursement often require that the senior be a current patient so that the initial visit will be made in person.

As the technology improves and the trust in the system increases, asynchronous healthcare via technology may not involve a face-to-face visit.

One thing is for sure, using telehealth will help seniors and caregivers when used now and in the future.




 

5 Geriatric Care Focus Areas — Family Caregiver Quick Tip

As we age, we are at risk for development of a variety of medical problems.

Our senior loved ones may already have multiple medical issues and could be at risk for more.

They want medical care that is thorough and consistent, seeking expert advice to prevent worsening medical issues.

Family caregivers hope that their senior’s medical team is taking the time needed to diagnose and manage disease.

5 Ms Of Geriatric Care

Your senior’s healthcare team members who are trained in geriatric medicine are focused on five areas.

They treat older adults with an individualized approach to meet their needs.

The five focus areas (source HealthinAging.org) are:

MIND

  • Maintaining mental activity
  • Helping manage dementia
  • Helping treat and prevent delirium
  • Working to evaluate and treat

MOBILITY

  • Maintaining the ability to walk and/or maintain balance
  • Preventing falls and other types of common injuries

MEDICATIONS

  • Reducing polypharmacy (the medical term for taking several medications)
  • De-prescribing (the opportunity to stop unnecessary medications)
  • Prescribing treatments exactly for an older person’s needs
  • Helping build awareness of harmful medication effects

MULTICOMPLEXITY

  • Helping older adults manage a variety of health conditions
  • Assessing living conditions when they are impacted by age, health conditions, and social concerns

MATTERS MOST

  • Coordinating advance care planning
  • Helping manage goals of care
  • Making sure that a person’s individual, personally meaningful health outcomes, goals, and care preferences are reflected in treatment plans

Getting Focused Healthcare for Your Senior

Doesn’t that plan look like it would be very beneficial for you and your senior loved one?

In reality, does your current healthcare team practice this type of geriatric care?

We hope everyone who treats a senior would look at them with these 5 areas of focus but likely not as many are trained in this type of care and treatment as we would like.

We know that there is a shortage of geriatricians who specialize in treating older adults. In fact, in 2013 there were estimates that 17,000 more were needed to meet the demands of aging adults.

Family caregivers can:

  1. Ask the healthcare team if they have been trained as geriatric practitioners and if they follow these 5 areas of focus when treating your senior loved one.
  2. Ask to what other members of the team they will refer you such as speech therapists for swallowing difficulties, registered dietitians for eating issues, psychologist for depression, care managers or social workers to help get services, pharmacists for concerns of polypharmacy, elder law attorneys to execute advance directives or end of life options, and others who can help fill gaps in care services. The doctor doesn’t have to do it all, but should be able to connect you with appropriate experts to help you.
  3. Have your questions ready, be prepared ahead of time so you get what you need during a visit without wasting valuable time. Doing a little homework ahead of time through observation and understanding your senior’s needs now and in the near future will help you get the help you need.
  4. Take notes during healthcare visits so you don’t have to back track to get information already provided and so that you can follow-up with all the team’s suggestions. Having notes will make it easier to share the information with other family caregivers or paid caregivers.
  5. Don’t give up! You know your senior loved one best and what would be best for them. Continue to seek the answers you need. Get information from other caregivers through support groups as well as learning all you can about whatever issues your senior has such as dementia or other disease processes.

As family caregivers, we want our senior loved ones to get the person-centered care they need from their healthcare team. With these actions, we can do our part to help them get that care.