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• Eldercare Articles, Studies and Reports
Options For Elder Care will post articles here that we have found to be helpful about home care services, in-home care assistance, referrals to geriatric health care providers, assistance with relocation or placement in a nursing home or assisted living facility, or help with other age-related issues. Options For Elder Care can coordinate a full range of services, helping families make the best decisions and able to deal with anything from an immediate crisis to advance planning for the long-term care for a loved one. We now have a new separate section for Articles & Information About Hospice Care. You can also check out our Frequently Asked Questions (FAQs) page.
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Some Useful ElderCare Articles, Studies and Reports:
How Can I Help My Aging Parent Live Independently?
Article by Barbara (Bobbi) Kolonay, RN, BSN, MHRM, CCM
....Your mother is becoming increasingly frail and having a difficult time managing her daily basic needs. You are spending more and more time at her home, cleaning, doing laundry, bathing, paying the bills, and meal preparation. You are concerned about leaving her alone and are spending less of your time with your husband and children. You are overwhelmed with the many directions you are being pulled, and are wondering where you can turn for help....In my practice as a geriatric care manager, this is the number one concern of children caring for their aging relative. While many older people live out their lives in the comfort of their own home, other change living situations as they age. At some point, you may want to evaluate if the older adult just needs additional support or a change in management of care.
There are numerous services available in the Pittsburgh area to help older persons and their families manage their care. This article describes many of these services and offers the guidance of a geriatric care manager to decide which may be most appropriate for your family situation.
- Home Care or Home Health Services:
This service offers skilled nursing, occupational and physical therapy, speech therapy, social services, and home health aides. These services may be covered under Medicare provided specific requirements are met. Depending on the need and income level, they could qualify for these services under the county Area on Aging programs.- Homemaker or Caretaker Services:
Homemaker services help with the daily activities of living such as bathing, cooking, cleaning, and other household activities. There are numerous government-funded agencies that provide these services at little or no cost to older persons who meet eligibility requirements. Private companies also supply these services to customers who are able to pay.- Emergency Response Systems:
These systems allow an elder person to call for assistance in the event of an emergency or fall when they can't get to the phone. The older person usually wears a radio-transmitting device around their neck or on their wrist.- Transportation Services:
The local counties surrounding the Pittsburgh area offer discounted transportation services to bring older people to doctor appointments, social events and sometimes to shopping areas. There are also escort services to accompany older disabled people to doctor's offices.- Home Delivered Meals:
This service delivers two meals once a day to older people who cannot prepare their own food. Not only do these programs assure that your relative is getting nutritional food, but offer a daily check to see that your relative is able to get to the door for delivery.- Financial Assistance:
There are numerous entitlement programs available to seniors such as: Pharmaceutical Assistance Contract for the Elderly, Low-Income Home Energy Assistance Program, Property tax assistance programs, Rental Rebate, property tax deferral loans, home maintenance and repair programs, fuel assistance programs and home equity conversion plans.- Veterans Benefits:
A supplemental pension benefit program titled "Aid and Assistance program" is available to aging veterans or their widowed spouse to cover out of pocket expenses for personal care.Options For Elder Care can help coordinate all aspects of an older relatives support. We are able to assist adult children who live close or far away from their aging parent with all aspects of care. The owner, Barbara (Bobbi) Kolonay, is a registered nurse certified case manager with over twenty years of experience assessing older person's social, physical and emotional needs. She can help make the necessary contacts and arrangements, screen providers and oversee the plan. For more information please visit
The Baby Boomer Dilemma
Article by Barbara (Bobbi) Kolonay, RN, BSN, MHRM, CCM
We are spouses. We are parents. We are siblings. We are the adult children of aging parents. How can we possibly fill all of these roles? If you are struggling with theses concerns, you are not alone. Allegheny County has the second largest population of persons over the age of sixty-five in the United States, second only to Dade County, Florida.Due to the abundance of excellent health care available in Pittsburgh and the surrounding suburbs, we are living longer than ever anticipated. But as seniors age, some may need help if they want to continue to live independently. More often than not, it is the already overscheduled children of the baby boomer generation that are called upon to assist their parents to age with dignity.
On a recent visit to your parent's home you notice the mail is three days old in the mailbox, medication is scattered haphazardly over the kitchen table, the refrigerator is empty and neither parent has apparently bathed since your last visit. Your parents are adamant that "everything is fine".
How do you identify when your loved one needs help and how do you help without taking away their autonomy? The following may be helpful in your conversation and observation of your parents:
- Be Honest. If you are concerned about their needs, say so. State this in an "I" message. Example, "I am concerned about your diet, you seem to be loosing weight." Or "I noticed that you call me often and forget we have just talked, are you concerned about your memory?". "I am ...".
- When parents call you frequently and complain about vague symptoms, sometimes they are telling you that they are scared or lonely. Try to get to what the underlying issue is and don't focus so much on the vague symptoms. All medical complaints need evaluated by a health care professional.
- Tell your parent(s) that you respect their autonomy. Wanting them to be independent and to support their independence, you need to know a few important items to help them when and if an emergency presents itself:
- What kind of legal planning have they done? If they become disabled could you or another party take over without going to the court system? This means they have a Durable Power of Attorneys for both Health and Finances in place.
- Talk about their finances. What is their monthly income? Where does the income come from? What are their assets? Get a list of bank accounts and brokerage accounts. Is the income sufficient to meet their needs? They could be entitled to some governmental programs if they are low or even middle income.
- What is their medical insurance and what numbers are associated with those policies. What is their social security number? Do they have life insurance policies or long term care policies? If they have this insurance get the names and phone numbers of these companies.
- Have they pre-paid for funeral and/or burial expenses? Where have they done this? What are the phone numbers of the mortuary and/or cemetery?
- Who are their doctors? What medications are they currently taking? List all the medications and determine what they are taking them for. Ask them if they take any over the counter medications or vitamins or herbs.
- How often do they see friends? Do you have the names and phone numbers of their friends? Ditto for their religious community.
- Are they drinking alcohol? If yes, how much?
- Are they driving safely? Do they have convenient transportation?
Identifying when your loved one needs help is not difficult when a medical emergency of accident occurs. However, the slow progression of dementia or depression might not be apparent through telephone calls or short visits. If both of your parents are alive, the well spouse often compensates for the other's failing and may deny anything is wrong. It is a good idea to think proactively when caring for aging parents. Below is a list of "Red Flags" to watch for when visiting your aging family member:
- Change in weight
- Change in short term memory
- Change in usual routine
- Change in speech and/or ambulation
- Bills not being paid
- Entering contests
- Refusing to go with friends on outings or going to church
- Refusing suggestions as well as agreeing with everything without giving consideration to consequences
- Mood swings, getting angry quickly
- Refusing to see medical providers
- Inability to take care of activities of daily living: cooking, dressing, bathing, housekeeping to name a few.
Once you have decided to become proactive in helping your aging parents, your next step is where do you go for help?
If you are in a crisis mode, or do not have the luxury of time to gather this information Options for Elder Care is available to work closely with your siblings, other relatives and parents to design the most cost and care effective plan.
Ease Your Parents' Move to a Home
Article by Melinda Fulmer
....To find the right living situation for an elder, you've got to ask the right questions -- about extra fees, services, comforts and conveniences....Elizabeth Sturdevant thought she was prepared for everything when she helped her 82-year-old mother, Janet, move into a new assisted-living community. The 46-year-old Los Angeles paralegal had been through the process once before and thought she had asked all the right questions of the new managers.
Then she found out her mother had been stranded outside her doctor's office all day, with none of her phone numbers and no way home.
"She was calling dial-a-ride from a pay phone, but she had no idea where she was." Ultimately, a stranger helped her disoriented mother arrange for a cab ride back to her assisted-living community.
Since then, Sturdevant has had to make sure her mother arranges doctor appointments on days when the assisted-living facility's van can take her. She also has planted her phone numbers, and those of her sisters, in her mother's medicine bag, so she always has someone to call.
Planning for a parent's move into assisted living is more time-consuming and complicated than most people bank on. While many facilities seem like a dormitory with prepared meals, there's a lot more to consider than when you ship your kids off to college.
Memories count, and so do conveniences
Transportation is just one of the issues, Sturdevant found. The others? How and what to pack and how to arrange for care were just a couple. Moreover, she had to figure out how to transfer as much as possible of her mother's old life to her new home.
While Sturdevant drew the line at driving her mother more than 60 miles each week to get her hair done by her old hairdresser, she did arrange for her old newspaper from Lancaster to be mailed to her new community, for an additional fee.
"She was trying to get it delivered to her old home and have people bring it out here," Sturdevant said.
Helping your parents keep as much of their old lifestyle and mementos as possible helps to ease the transition to assisted living, geriatric care experts say.
"One of the most common mistakes that people make is they make their (facility) choice based on their values, rather than the values of their parent," said Linda Fodrini-Johnson, founder of Walnut Creek, Calif.-based Eldercare Services and board member of the National Association of Geriatric Care Managers.
If you can keep whatever it is in their life that gives it value, then you can minimize a lot of the depression that accompanies a move to assisted living, Johnson said.
Since most places only allow the furniture, appliances and belongings that can fit into their room or apartment, you have to sit down with a parent and choose these items carefully.
Johnson recommends talking about what items have the most memories associated with them. It may surprise you, she said. Rather than a beautiful dresser, your mother may be more sentimental about an antique treadle sewing machine that she used with her own mother.
An experienced eye helps
Likewise, children need to consider a parent's hobbies and lifestyle.
Can Mom take her pet? Many facilities now accept animals under certain conditions, and that can help ease the transition to a new place. Does she have a space to garden or window onto a garden? Is it near her church, trusted doctor or community center she attends? Can she do her own laundry?
"Some adult children come in kind of bossy and parental," Johnson said. "It's better to come in as more of a peer and a friend." Talk to parents about what's important and give them a couple of options, she said.
Moreover, consumer advocates say, it's often better to get a second, professional opinion on your choice.
Geriatric care managers, which can be found through the government elder-care locator number, (800) 677-1116, or at CareManager.org, can assess a parent to determine their needs and recommend facilities in your area that might be a good fit.
"They can also help when a family member feels a placement is necessary, but the older person may not," Johnson said. For a few hours of paid time, these specialists -- typically social workers or registered nurses -- can save you headaches down the road, experts say.
"They can say this facility gives good care, this one has had problems," said Washington D.C.-based estate-planning and elder-law attorney William Fralin. "A lot of the facilities have figured out how to decorate nicely ... but the care manager knows which ones are well run."
There is no federal oversight of assisted-living facilities and only limited state oversight, so this information can be especially helpful, as can advice from an ombudsman affiliated with your area's council on aging.
How much care is enough?
A few years before, Sturdevant's mother had entered an assisted-living facility for which she wasn't capable enough, only to be ejected when she couldn't take care of her apartment. After bouncing from relative to relative, she's back in a facility with greater oversight.
"My mother needs to have a schedule and see other people," she said. In this new community, Sturdevant said, "if she doesn't come down for dinner, they will be calling and checking up on her."
Drop in unannounced to a community, experts say, to see how residents are being treated. Taste the food and see how the place looks and smells. How friendly are people? Do activities happen as planned?
Another thing that Fralin and other care managers recommend is looking at the different levels of care offered by a community. Does it offer several options from independent living to skilled nursing? Does it have a special Alzheimer's unit? While your parent may operate just fine with an apartment and prepared meals today, he or she might not be as capable a year from now.
Being in a community with a continuum of care also is a good insurance policy should your parent's money run out. Most assisted-living facilities give priority for their Medicaid-funded beds to current residents.
Finding another attractive facility that accepts Medicaid, rather than private pay, can be difficult.
"If it does have Medicaid beds, it's probably not as desirable," Fralin said.
Plan for the extra costs
Most facilities are private pay, which means that a house must be sold or pensions used to pay the $3,000 to $6,000 a month that most places charge.
And these facilities often also charge an extra up-front "community fee," says Kathleen Cameron, chair of the Consumer Consortium on Assisted Living, which typically amounts to one month's board.
Cameron said it's important for consumers to know that these fees are negotiable.
Assisted-living centers charge many additional fees, and it's best for people to be familiar with them and plan for them up-front, so they don't come as a surprise with that first bill.
Will your parent need extra nursing, equipment or rehabilitation services? These are often billed separately. There may also be charges for housekeeping or hairdressing. If residents need a meal delivered to their room or apartment, that can cost extra, too.
Likewise, transportation can impose an additional cost. Since most assisted-living residents don't drive, a van is usually provided at least one day a week to take them to a doctor appointment or bank in the surrounding area.
If your parents' doctor isn't in the surrounding area or they have several weekly appointments, you might need to line up other transportation, such as a paid account with a local cab company.
In many cases, prescriptions must also be transferred to a pharmacy that the facility uses, which dispenses the drugs in separately packaged doses, so there is less room for caregiver error. While this is usually more convenient, it's often more expensive, care mangers say. Ask the facility what arrangements they have with a pharmacy and what medication management they offer.
To handle day-to-day expenses, most facilities allow residents to have a small account for petty cash, so they can withdraw money to buy a toy for the grandchild, or buy their favorite cookies or tea at the local grocery store.
"Many communities will keep a certain amount of cash for people, maybe $100, so they don't have to keep going to the bank all the time," said Marybeth Bersani, senior vice president of public policy for the Assisted Living Federation of America.
However, Bersani cautions that residents should leave the expensive jewelry and important documents with a relative, or in a safe-deposit box at the bank. "Although the doors do lock and people have a key to their own room, there's a lot of people coming and going," she said.
Choose comforts carefully
Residents of assisted-living facilities can usually take a television and other appliances, such as a microwave or small dormitory fridge. Some facilities also allow residents to bring in their own bed. And more and more people, she said, are taking a computer along, so they can keep in touch with relatives and friends or entertain themselves.
"Now, they are putting extra phone lines in some rooms," Bersani said.
To save space, many experts suggest taking only a season's worth of your parent's clothes at a time, leaving the rest at your house or in storage. Give Mom and Dad a floor plan to the space and let them show you where they want things to go. Measure the space. If a bed or other furniture won't fit, help them shop for new furniture.
Once it's time for the move, experts say, it's best to get it done quickly. Many caregivers recommend taking your parent out to lunch or to see relatives, then having her room set up with her furniture and other items when she's out.
"Sometimes it's less traumatic," when they don't see movers taking away their belongings, Johnson said.
If your parent is very vocal about wanting to be involved on moving day, let her. Some movers that specialize in seniors will allow residents to show them where to hook up the television and arrange other furniture and dÈcor.
Ease their transition -- and yours
To help her mother stay in touch, Sturdevant programmed her phone number, those of her four siblings and other important numbers into her mother's phone, so she wouldn't lose them. And she takes her mother on regular trips to the local grocery store she likes, and where she knows the layout.
"It's a very big change," said Bersani. "Many people have lived in their home for 50 years."
Don't deny your relative their grief, experts say.
But, at the same time, show them the pluses of living in a community, with greater care, such as not having to bother with preparing meals, or being closer to you and your children, so you can visit more often.
If your parent is moving out of their area, help them find new hair dressers, doctors, churches and other places that they like.
"It's a reason to get out and have a different set of relationships," Johnson said.
And lastly, caregivers say, don't neglect your own needs. Putting a parent in assisted living can bring tremendous grief and guilt to the adult children moving their parents.
"I would recommend a support group," said Gloria Schultz, a systems manager from Philadelphia who moved her mother, Rose, into an assisted-living facility a month ago.
"The first two weeks I went to visit her, I had to walk out of the room crying," she said. "It really stirs up a lot of emotional distress."
Health Costs: Help for Seniors at Home
Article by Andrea Petersen, Staff Reporter of The Wall Street Journal
During this recent holiday season and its many family gatherings, some adult children have gleaned a bit of unwelcome information: Mom and Dad need help if they want to continue living independently.The search for someone to care for seniors in their homes can be confusing. A dizzying array of agencies, companies and independent workers provide far-flung services from elaborate medical care to companionship. Medicare and long-term care policies do cover some services, but many families end up paying out-of-pocket.
Interest in home care is surging, partly because the cost of a private room in a nursing home has hit $74,095 a year, according to a recent survey by MetLife. Many grown children live far away from parents and can't handle the caregiving themselves. Also, there's a growing acknowledgement among people who work with seniors that many do better physically and emotionally if they can stay at home.
To find a caregiver, families first need to decide what level of care is needed. Registered nurses provide hands-on medical care. Certified nursing assistants and home health aides, who get several months of training and are licensed by many states, can help seniors with bathing and dressing. If Mom just needs someone to help her run errands or cook or remind her to take her medication, a "companion" provider might do.
Generally, the hourly cost rises with the level of training. The services of a companion, home-health aide or nursing assistant can run $12 to $30 an hour. A nurse or social worker can cost up to $150 an hour. Experts recommend that families make sure the caregiver has undergone a criminal background check and that his or her agency pays worker's compensation and Social Security levies. Families can also hire independent contractors, who may be cheaper, but then have to do background checks and pay taxes themselves.
Stumped? Geriatric-care managers can help families wade through the many home-care options; check out the National Association of Professional Geriatric Care Managers (GCM). They generally charge between $80 and $150 an hour.
Retired nurse Bettie Fisher has a caregiver come six hours a day, five days a week to the Walnut Creek, Calif., home she shares with her husband, Carl, a retired physician who has Alzheimer's disease. The caregiver drives the couple (she is 89; he is 90) to doctor's appointments, takes them shopping and does laundry. "I knew the time had to come when it would be very helpful," Mrs. Fisher says. "We want to stay here."
Medicare offers some home-care coverage, but its requirements are stringent. Still, it always makes sense to check Medicare before paying out of pocket: Seniors hospitalized and then discharged to recover at home may well qualify. To to be eligible, recipients must need nursing services, physical therapy or speech therapy. Patients also must be deemed "home-bound," which means they can leave the house only for limited reasons, including doctor visits and church services. Recipients must get care from a Medicare-certified agency or association. (Check out the U.S. Government List of Medicare-Certified Home Health Agencies | Home Health Compare for a list of providers.)
Most, but not all, long-term care insurance covers home care: It usually is sold bundled along with nursing-home coverage. To use the benefit, recipients usually must be diagnosed either as having some cognitive impairment or as needing help with at least two activities of daily living (such as bathing, dressing and eating) for at least 90 days. Most policies cover a set dollar amount per day. Many require use of licensed professionals but some will pay for "informal" caregivers, which could include a family member or friend.
by Andrea Petersen,
Staff Reporter of The Wall Street Journal
15 January 2006
© 2006 Dow Jones & Company, Inc.
If you need assistance with caring for an elderly loved one, are new to elder care or uncomfortable with elder care decision-making, are faced with having to make a sudden decision or major change such as a health crisis or change of residence, or simply want some advice about any aspect of elder care, please don't hesitate to contact us at any time.
Barbara Kolonay, RN, BSN, MHRM, CCM
Options for Elder Care
Gibsonia, Pennsylvania
412-443-1365
• About the National Association of Professional Geriatric Care Managers (GCM)
GCM was formed in 1984 to advance dignified care for seniors and their families in the United States. The association currently boasts a membership of 1,900 care managers. Geriatric care managers are professionals who have extensive training and experience working with older people and families who need assistance with care giving issues. GCMs help families cope with the growing challenges of aging, and assist families in the search for a suitable nursing home placement or extended care if the need occurs. The practice of geriatric care management and the role of care providers have captured a national spotlight, as generations of Baby Boomers age in the United States and abroad. For more information please visit www.caremanager.org or call 520-881-8008.
