Tuesday, August 8, 2017

Powers of Attorney: Frequently Asked Questions

Attorney in Fact.  Do you have that title for a loved one?  Bradley J. Frigon, Member of the National Academy of Elder Law Attorneys, gave a recent presentation on this subject to the Certified Senior Advisors.

Powers of Attorney are specific documents that give authority to an agent to act in the best interests of a principal.  Often the agent is a child, a spouse or other relative.  Perhaps you fill that role.

1.  Why is the word "durable" so important in a Power of Attorney document?  That word gives
the Power of Attorney continued effectiveness after the principal loses capacity. The document endures.

2.  What are the two categories of Powers of Attorney?  Financial Power of Attorney and Medical (Health Care) Power of Attorney.  Their spheres of responsibility are different, but the main role is the same:  to act in the best interests of the principal, whether managing finances or making decisions about health care.

3.  Are Power of Attorney documents standard throughout the country?   Not entirely.  However,  since 2010, well over 30 states have signed the Uniform Power of Attorney Act. in an effort toward standardization.  Most states have variations on their individual documents, and notarizing requirements so Frigon advises that when someone moves to a different state, they take the current documents to a lawyer to make any needed changes.

4.  What are Springing and Standing Powers of Attorney?  These refer to when the documents take effect.  A Springing Power of Attorney takes effect after a certain event, often when a licensed physician or physicians determine that the principal is incapacitated.  A Standing Power of Attorney takes effect as soon as it is signed by the principal.  It gives the agent immediate authority.

5.  Who can be the agent?  This is the most important role.  He or she must be 21 years old and someone whom the principal trusts.  The principal must ask permission of the person he or she wants to fill the agent role.  It's important to name a successor.  Frigon advises to limit the number of agents to avoid confusion and conflict.

6.  Anything new in this field?  We are used to agents managing financial portfolios, real estate, etc.  But what about Facebook and LinkedIn accounts, emails and photographs electronically generated?  Some states have provisions in their Power of Attorney documents which include this information.


Saturday, July 29, 2017

Your Aging Parent's Legacy, Pt. 3: A Sample Legacy Letter

 My mother-in-law will soon celebrate her 90th birthday.  Our family has discussed possible ways to remember this special day.  We know what she DOESN'T want.  No big parties or lavish gifts.  She'd prefer a family-only get together at her favorite restaurant.

Perhaps you're thinking through how you will help your aging loved one celebrate his or her big day.  You might consider a Legacy Letter, a type of tribute to the wonderful contributions he or she has made to you, your family and to the broader community. A Legacy Letter can stand alone or be part of a celebration, big or small. 

The previous two posts discuss the four parts of a Legacy Letter in more detail. 

1.  The Why:  Think about what you want to say and how you want the receiver to feel after reading the letter.  Focus on the values he or she has imparted to others.

2.  The Story:  Include things that highlight your main idea.  These are the concrete things that make your letter ring true.  Thinks like taking hikes together, doing crossword puzzles, attending football games,  proofreading college term papers.

3.  The Reflection:  Phrases such as "You have taught me..." and "You helped me understand..." show your gratitude to them for the impact on your life.

4.  The Love:  Tell the person how much you love them.  Show how grateful you are that they are an important part of your life and the lives of others.

A Legacy Letter will be part of my mother-in-law's celebration.  We're working on a draft
right now.


Dear Mom,

If I had to choose a word to describe you, both on your 90th birthday and throughout your life, that word would be "Giver."  You have showed generosity to every member of our family and to countless others whom we don't know.

For example, you hosted family dinners well into your 80s, and were generous in baking pies, cookies and other desserts.  We certainly knew that when we left your home, we would be "stuffed to the gills," with yummy food and good memories.  At Christmas, you gave the children special personalized treats which they didn't receive at home.   And when your great-grandchildren began arriving, their parents could count on a baby afghan, hand-made by you--blue, pink or white.

Your church family and retirement community also received your gifts of time and talent.  People could count on you to attend services and other functions and to do what you were able to do to help others.  You worked at the senior community annual bazaar for years, making sure the pies were cut just right and the coffee replenished.

You have helped me understand the meaning of hospitality and the importance of doing my part to help others.  Our whole family would echo this sentiment:  you are a giver, and we thank you for it.

Our children are blessed to have a generous Grandma and Great-Grandma for their children.

Love,

Alice

We have some time to revise the letter, and I'm sure we will think of more to say about this woman's legacy.

Good luck on your own legacy letter!

Wednesday, June 28, 2017

Your Aging Parent's Legacy, Pt. 2: Writing a Legacy Letter

It's a big occasion:  birthday, anniversary, holiday.  Your aging parent or loved one deserves something special. But what do you give to the person who has everything? 

Health Advocate Melanie Vetter of Wellfleet Circle as a ready response:  legacy letters.  She explained the concept in a presentation for the Certified Senior Advisors called "Legacy Letters:  Valuable Tools for You and Your Client." 

Legacy letters are a bit like eulogies, except the receiver is alive.  Generally written in second person, they address the person directly rather than speaking about the person in the style of a business recommendation. The letter highlights the person's positive key value, such as generosity, moral strength, humor, leadership.  True stories and memories follow to illustrate the impact of the person's life.

A bonus of a legacy letter is that it can be read over and over again. It can be read in front of a group, or to the recipient alone.   Either way, the person is honored and recognized for the legacy he or she leaves the world.

Vetter offers these tips for writing a legacy letter, whether it's to an elderly loved one or other family member or friend.  You can also write a legacy letter to a younger person, perhaps at graduation or marriage.

1.  The Why:  Think about what you want to say and how you want the receiver to feel when he or she reads the letter.  Focus on the values, traditions and wisdom he or she has imparted to others.

2.  The Story:  Include things that highlight your main idea.  These are the concrete things that make your letter ring true.  Thinks like taking hikes together, doing crossword puzzles, attending football games,  proofreading college term papers.  Your list will be as personal as the relationship between you and the recipient.  How have these memories shaped the person and illuminated their values?

3.  The Reflection:  Phrases such as "You have taught me..." and "You helped me understand..." show your gratitude to them for the impact on your life.

4.  The Love:  Tell the person how much you love them.  Show how grateful you are that they are an important part of your life and the lives of others.

Do you have experience writing a legacy letter?  Would you like to write one?




Your Aging Parent's Legacy, Pt. 1: Defining and Honoring It

Two words: Inheritance and legacy.  Are they the same?  And how do they impact you and your aging parent, and perhaps your children as well?

According to Psychologist James Dobson among others,  "inheritance" refers to tangible assets, the "stuff" we can see and touch: money, stocks and bonds, real estate, etc. "Legacy", on the other hand,  often has financial implications, but it is broader:  it speaks to the values a person has and gives to others, especially to subsequent generations.  A legacy could include such values as generosity, kindness, self-discipline, humor.

My father, for example, was a pastor in a small denomination in the Midwest.  By the time he died, he was on Medicaid.  A small life insurance policy, split three ways between my siblings and me, gave me enough money to buy a laptop.  Not a huge inheritance.

His legacy, though was larger.   I remember his kindness to parishioners given in big and small ways.  Every summer for 15 years he drove a carload of giggly kids some 650 miles to church camp along winding mountain switchback-laden roads.  I also remember him listening periodically on the phone as an alcoholic sputtered out his story at 2 am.  And there were the countless funerals in which Daddy gave himself unconditionally to the grieving families.  I value his example:  his legacy. 

How do we speak about legacy with our parents and with others?

First:  We honor the legacy we see in our parent's lives, now, and over the course of their lives.  If your parent has always been a giver, talk about that generosity with your family.  Stories are a wonderful way to do that.  In our family, we receive jams and jellies from my mother-in-law and little gifts of special cookies, crackers, and more.  Sometimes the stories illustrating
generosity are humorous, like the time our sons wanted Grandma to teach them how to make a pie crust.  A master baker, she tried, but both boys had all thumbs, and the session ended in laughter.

Second:  We think hard about our own legacy, and work to make it happen.  I'm not gifted in many ways,  but I can express my thoughts reasonably well in writing.  Hopefully my legacy will include memories of my notes, emails and other pieces of writing.  I also enjoy teaching my grandchildren how to bake and sew.  Small things, but they become part of a legacy.

Third:  We can write legacy letters to our loved ones , including our aging parents.  These letters highlight important aspects of a person's life and are illustrated with stories.  The next post will give more detail on writing these letters.  Health Advocate Melanie Vetter, of Wellfleet Circle, contributed much of the content on legacy letter writing.

Do you have any experience with celebrating a loved one's legacy? 

Thursday, June 8, 2017

Your Senior Center: One-stop shopping for help and fun

 North Shore Senior Center is in Chicago.  Northshore Senior Center, similarly named, is in Bothell, WA.  These two are the largest and second largest senior centers in the nation:  Bothell has grown to 6400 members since it began in 1972.  Like similar centers across the country, these offer one-stop shopping for help, information, services and fun.

If you have an elderly loved one in your life, or you want to be prepared for the future, I'd advise you to check out your local center.

I live close to the Northshore Senior Center.  Four-plus years ago I began attending the monthly Greater Bothell Chamber of Commerce meetings held there. Both groups are not-for-profit and give back to the greater community in many ways.  After our meetings, I was able to see community at work.  Volunteer receptionists, mostly seniors, greeted visitors and answered questions, other volunteers checked in to begin their work and still others occupied a corner with coffee mugs in hand, chatting away.

Volunteerism, it seems, is the hallmark of this center which has branches in Mill Creek, Kenmore and Bothell.  Five hundred-plus volunteers, some seniors and others younger, perform unpaid work that augments the work of the 14 paid staffers, allowing the center to help more people.  "One lady has volunteered for more than 14 years, "says Garreth Jeffrey, Program Manager for the Kenmore branch.  "She's a receptionist, and is a great greeter."

Others give of their time in serving in the dining room, keeping the coffee shop running smoothly and working in the Thrift Shop.  Then there's the Pie Man.  He bakes pies to order once a week.  Many of his friends enjoy their favorites: apple and berry pie.  The price is reasonable.  And all proceeds go to defray the costs of the center.

What about outings?  I checked out the senior center's field trips in the catalogue and was pretty tempted.  Have you heard of the Meowtropolitan Cat Café?  It's Seattle's first Japanese style cat café.  Last year the group enjoyed it so much they're going again!  Each person gets to spend 50 minutes interaction time with the resident kitties.  Another field trip is a progressive lunch, with three stops for appetizer, main dish and dessert.  Back at the center's campuses, you'll find classes that include watercolor painting, quilting, woodworking and journaling.

On a more serious note, Northshore Senior Center has a social worker, and offers workshops on
Medicare, legal and financial issues, caregiving and more.

As I return to Northshore Senior Center from time to time, I discover new items, new classes, new services.  I'd like to hear about the programs at your particular local senior center.  Any thoughts?

Thursday, May 18, 2017

Adult Family Home Owners: Do They Spend Wisely?

Adult family home owners, all in all, are a hardworking lot.  They provide care for the frail elderly in Washington, Oregon and elsewhere, at a lower price than nursing homes charge.

The following conversation between Tina, an adult family home provider, and a state social worker, caught me off guard.

"You're  making so much money you ought to share with the neighbors," the social worker said. 

Tina knew from his tone of voice he wasn't kidding.  Did he really want her to give away much of the money she made to people who hadn't worked for it?

The social worker was talking about the money .the state paid Tina for one resident's care.  It was $3000 a month.  From that amount Tina covers taxes, insurance, food, employee wages, home maintenance and more.

"I went to college for eight years,"  the social worker said.  "How about you?"

 Tina hadn't gone to  college. But she had learned the business from the school of hard knocks.  She sleeps with her cell phone by her bed, in case of emergency. Her home isn't extravagant, but it is clean, comfortable and light-filled. Her private pay rates are lower than many charge. She pays her caregivers more than the minimum, and she does things that money can't buy. 

"Rose, one of my residents, no longer recognizes her son.  But she knows me, and the caregivers.  We are Rose's family.  The money we make here is only part of the story.  At the end of the day we try to make the residents and families we serve have a better life."

Does she need to share her money with those who didn't work for it?  I don't think so. 





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Tuesday, May 16, 2017

Low Income Senior Housing: How it Works, Where to Go

If your parent needs low-income housing, you need to know the rules.  What determines whether your parent qualifies?   Various communities have different income limits, but they're generally based on a percentage of the average income in the area.  For example in King County, where Seattle is located, the average income is $90,300.  Low-income senior housing apartments will have an income limit of not more than $37,980.  Some communities have a much lower income cap.

How it works: What determines your parent's annual income?  It's the total of the monthly Social Security, pensions and other benefits.  Assets need to be factored in, as well, as anticipated income.  For years, HUD has had a formula for figuring the income an asset could bring if it were liquidated.  That number is 2 percent.

For example, if your parent has an asset worth $200,000, the anticipated income off of that asset would be 4 percent or $8,000.  You would add $8,000 to your parent's other income.  The total must fall below the community's income cap.

Where to go: 

Your senior center is a good place to start.  Most low income senior apartments also have a website.
 
When you call individual communities, ask their income limit (including 2 percent of assets), their approximate waiting list length and of course, pricing. 

I would encourage you to join multiple lists, even if they seem long.  When an opening occurs, the manager calls down the waiting list until someone is ready to move in.  Often people high on the waiting list aren't ready to move yet.

Sunday, April 30, 2017

One Family's Story: Heading West With Mom

I love telling stories.  True stories of families finding wonderful new homes for their loved ones.

Our company, Silver Age Housing & Care Referrals, matches seniors and their families with the best of retirement communities, assisted living communities or adult family homes.  Our service is free to families; we're paid by the communities on move-in.

For me, the best part of my job is the stories of heroic families wanting the very best for their loved ones, even if it means traveling across the country. 

Take Jane, 85.  Until a few months ago she lived in rural New York with little support except her younger brother.  One day, "Bam," he fell out of an apple tree, breaking his hip and ending his caregiver days. Jane's children were soon called into service.  They discovered her home was unsanitary and no longer safe.  They took her to their home in Washington State.  But this wasn't a long-term solution.

That's where Silver Age (and I) came in.  Jane didn't want to live in assisted living,  So we talked about what she did enjoy.  She loved baking wedding cakes and sewing wedding dresses.  She enjoyed playing the piano and listening to music.  And of course, there were the grandchildren, all here in Washington.

I also talked with her children separately about the Veterans Aid and Attendance which she likely would qualify for later as the widow of a veteran of World War II.

Jane's son and daughter-in-law visited a couple of assisted living communities and decided on one of them.  After several days of discussion and visits, Jane decided to move.

Several weeks later, Jane is doing well in her new home, minutes away from her family.  She is starting to make friends.  It's a great story; and I got to be a part of it!













Saturday, April 22, 2017

Touring Assisted Living? A set of questions can make it easier.

Are you global? Do you look at the overall picture, and rely on intuition and your senses to know what's right?  Or are you analytical, wanting to check every box, so you ask question after question until you're finally satisfied?

Many of us are some of both.  Whatever your decision making style, the search for housing and/or care for a loved one or for yourself can be daunting. 

Before you tour assisted living communities and/or adult family homes, consider formulating a list of questions that will keep you on track.  Silver Age Housing & Care Referrals, where I work, has created a list for clients that zeros in on key categories such as results of annual state surveys, staffing levels,  levels of care, cost and price increases, plus the more intangibles like average tenure of staff and management and resident satisfaction.

Many of my clients really get into the interview process.  They ask the same questions to each provider and stay focused on the search, rather than looking around and hunting for something to say.  When they choose "the winner," they feel good about the process and their final selection.

There are others, however, who may look at the questions ahead of time, but on touring day, they go with their gut, in a global sort of way. 

I happen to be one of those globals, but even so, preformulated questions help me tremendously. Our website's resource page contains a list of questions for touring which our clients have found helpful.  Look for the questions near the bottom of the Resource Page. Happy touring1


Silver Age Resource Page

Tuesday, March 28, 2017

Eldercare Professionals: 'What ME, a minister?'

"Alice, your work is a ministry."  A friend said this to me at church when I explained what I do. I help families find housing and care for their elderly loved ones.  But how does that make me a minister?

I don't wear a clerical collar or a black habit.  Occasionally a cross hangs around my neck.  I haven't been to seminary unless Sunday School counts. 

I've been mulling over what it means to be a minister.  I had a head start on many folks, as my father was a pastor.  Living in a parsonage in rural Indiana, I attended more funerals that most people attend in their whole lives.  Mother sang solos; Daddy preached.  I don't remember their words; I do remember their kindness to those who grieved.

If faith is a big part of your life, and you work with seniors and their families, your work may be seen as a ministry. Faith, if it's real, oozes out of our lives, but especially to those who are hurting.  It's not about Bible thumping, however.

I worked for 12-plus years at Warm Beach Senior Community, a not-for-profit Christian retirement community in Washington State.  One man who was interested in moving in said, "I don't believe in God.  Will people preach at me?"

What could I say?  I knew the residents and staff understood NO meant NO when it came to religious activities.  But I wondered if he'd been pressured before to come to faith. Or if he had been hurt by religious people.

I looked him straight in the eye.  "Of course, we won't preach at you."  I paused and added.  "However, if God speaks to you, we won't stop him."  He and I both smiled.

Faith is often expressed in more subtle ways:  a nursing assistant buying a Mariner's baseball cap with her own money for a resident without family.  An activities director procuring a live pony for a resident's 100th birthday.  A group of nursing home employees planning a wedding for a couple who both were nursing home residents.  These employees hosted a bridal shower, helped the couple buy rings on line, and organized the wedding itself, with the Chaplain officiating.

Most of the time this faith stuff just happens.  More than a decade ago I met a volunteer named Elinor who served many years as a Eucharistic minister to our Catholic nursing residents.  At life's end, she chose our nursing home.  One day, I asked the Director of Nursing Services, "How is Elinor doing?"  Elinor was actively dying.

A holy hush filled her room as I walked in.  "Elinor, this is Alice.  I've worked with you over the years.  I can't give you last rites, because I'm not a priest.  But I can pray with you, if you'd like."

She squeezed my hand.  I prayed the Lord's prayer.  She mouthed the words.

What a blessing to me!  I realize that many of you who work with seniors and their families have similar stories.  God uses us, weak though we are, to bless these wonderful people. It goes without saying that they bless us.

If you work with seniors and their families, do you have stories of faith you can tell?

Tuesday, March 21, 2017

Eldercare Q-A: What is Long-term Care?

Good question.  A client asked me that a couple of days ago.  Her mother had been in poor health for years, but somehow had managed to remain fairly independent in a retirement community.  Until now, when things started going south.

"She's in rehab now.  And therapists say she can't go back to where she lives.  They keep using the phrase, 'Long-term care.'"

Long-term care is precisely that:  hands-on care and supervision for the long haul.  It can mean a home care agency coming into a person's home to help with bathing, dressing, medication management and more.  Long-term care can also happen in an assisted living community, a nursing home or in many states, an adult family home.

Long-term care is NOT funded by Medicare.  People pay privately, perhaps with long-term care insurance.  Or if they run out of money, there's Medicaid.

That's the skinny on long-term care.  At least the very short version. 

Tuesday, January 31, 2017

Medicare 101: Five Myths about rehab

Medicare rules about rehab coverage can be tricky. Pay attention to the following myths:

1.  After a hospitalization, rehab coverage under Medicare A is pretty much guaranteed.

Not always.  Rehab in a skilled nursing facility requires three overnights in the hospital.  In addition, the person must need skilled services, such as Physical Therapy, Occuptional Therapy or extensive nursing care. An attending physician must write orders for these services and must justify them according to the rules of Medicare.

2.  People can stay 100 days in a rehab center under Medicare A. 

It's rare for someone to actually qualify to stay the full 100 days.  The length of stay is determined by the person's diagnosis and his or her progress.  Rehab staff chart the progress and report weekly. When a person "plateaus,' or stops improving, the rehab staff gives written notice, informing the person of the last covered day under Medicare A.

3.  Medicare A services in a rehab center are covered in full by the Medicare program.

Medicare A covers the first 20 days: room and board, therapies and most supplies.  At Day 21, there is a copay of $134 or higher, depending on a person's income.  Copays are often paid by a person's health insurance.

4.  After a person leaves a rehab center, he or she can no longer receive therapies.

 Therapies can continue, providing the physician writes the orders that these will benefit the patient and comply with Medicare guidelines.  These therapies are performed less often, and can be done in an out-patient center or in a person's home.  They're covered under Medicare B. There is a copay.

5.  Medicare gives you a lot of choices for rehab centers after hospitalization. 

If you or a loved one have traditional Medicare coverage, you can choose virtually nursing home in your area for rehab.  If you have a managed care insurance, such as a Medicare Complete Plan or Tricare for military families, you may be restricted in your choices of rehab centers.





Monday, January 9, 2017

What's a Geriatrician? And whom do they best serve?


Saturday mornings, I listen to two radio programs about senior care:  Leading Edge Medicine, hosted by Jerry Mixon, MD, and AgingOptions, hosted by Rajiv Nagaich. Each has its own distinctives.  Mixon's show emphasizes keeping healthy no matter one's age.  Nagaich's program focuses on the legal, financial and medical aspects of aging.

Last Saturday Aging Options featured Chad Boldt, MD, a renowned geriatrician.  Geriatricians specialize in treating older people, especially those with multiple chronic diseases. 

Could your parent or loved one benefit from a geriatrician? Here's a test.

1.  Does your loved one suffer from four or more chronic diseases?  An example would be someone who has diabetes, congestive heart failure, depression and chronic pain.  In 2010 37% of people on Medicare fit that description. Often these patients are 85 or older and have dementia,

2.  Does your loved one take lots of medications?  "Nobody should take 20 or more medications," says Dr. Boldt. More certainly doesn't mean better, since medications can interact negatively with each other.

3.  Does your loved one get confused when multiple specialists give instructions?  As people become more frail, they may not be able to understand and comply with instructions by several physicians.

A geriatrician specializes in the elderly, especially who are medically complex. This specialty requires extra training beyond that of a medical doctor.  And unfortunately, says Dr. Boldt, fewer doctors are entering this field than in the past.

So what questions do you ask a prospective geriatrician?  Nagaich suggest these:

1.  Are you a Certified Board Physician in Geriatrics?  There may not be a geriatrician in your area, however.  Many primary care physicians have experience in geriatrics.

2.  Are you accepting new patients?

3.  Will you take my insurance?

Nagaich also suggests that if possible, people look for doctor who has good experience but who is in his or her 50s.

Another way to provide specialized care to older, frail adults is through a team approach.  A physician with expertise in geriatrics oversees the care of patients who receive direct care from a specially trained Registered Nurse, plus other staff.  Dr. Boldt participates in a program called Guided Care, in which one doctor and one specially trained nurse work together to manage medications and give directions to patients and families.

Is your loved one a candidate for a geriatrician?



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