Caring for Aging Parents - The New Old Age Blog

September 19, 2012, 6:42 am

A Little-Known Benefit for Aging Veterans

As veterans age, many are unfamiliar with a benefit that can help pay for care at home or in assisted living or a nursing home.

Ricardo Arduengo/Associated Press As veterans age, many are unfamiliar with a benefit that can help pay for care at home or in assisted living or a nursing home.

Here’s a riddle: When is a government benefit that pays for caregivers, assisted living and a nursing home not a benefit? When hardly any people know they’re entitled to it.

That seems to be the story with a Department of Veterans Affairs benefit called the Aid and Attendance and Housebound Improved Pension benefit, known as A&A, which can cover the costs of caregivers in the home (including sons and daughters who are paid to be caregivers, though not spouses) or be used for assisted living or a nursing home.

The benefit is not insignificant: up to $2,019 monthly for a veteran and spouse, and up to $1,094 for the widow of a veteran.

Surprised that you’ve never heard of it? You’re not alone.

September 17, 2012, 5:46 am

A Choice of Community Care, in Your Own Home

By JUDITH GRAHAM

For 51 years, Catherine Mack has lived in a four-bedroom house in Haddon Township, N.J. Even at age 96, she has no intention of leaving.

Joining other older adults at a nearby retirement community doesn’t appeal to her, although the facility is attractive and has a great reputation.

“I think in a place like that, life is restricted,” Ms. Mack explained. “You eat at a certain time, and you’re always around other people. I am more on the side that I like to do what I want to do when I want to do it.”

So this independent woman instead selected to get services at home from the retirement community’s “C.C.R.C. without walls” program.

Only a dozen continuing care retirement community — C.C.R.C. — programs like this exist across the country, mostly east of the Mississippi. But several more are under development, and experts believe the concept may be poised to expand more broadly in the years ahead.

How does it work?

In traditional continuing care communities, members pay a substantial entry fee ($250,000 and up) and monthly fees (typically $2,000 to $4,000 a month) for housing, with a lot of on-site amenities and a guarantee that assisted living and nursing home care will be available, if needed. The model is “come to us and you’ll get what you need — all in one place.”

In a continuing care program without walls, members also pay an entry fee ($20,000 to $70,000) and monthly fees ($250 to $800) and receive a similar guarantee of lifelong care, with a twist. The main focus of these programs is helping people stay healthy and independent in their homes for as long as possible. This model can be summed up as “let us bring what you need to you — or find a way to make it easy for you to get it.”

September 14, 2012, 3:39 pm

When Work Makes You Choose

By PAULA SPAN

4:50 p.m. | Updated Rachel Robinson was doing well at T-Mobile in Chattanooga, Tenn. The company hired her in 2006 as a customer service representative, promoted her twice in two years and honored her with an employee award that included a trip to Hawaii.

The trouble began in early 2008, when her mother developed a brain tumor. Ms. Robinson requested leave under the federal Family and Medical Leave Act, to which she was indisputably entitled, according to court filings related to her lawsuit. Her manager persuaded her to take intermittent leave, she said in court documents, and she agreed to work from home and in the hospital, “so that I could try to balance both and still do my work.”

After 18 days’ leave, T-Mobile granted her another 10 days to help her mother at home once she was discharged from intensive care. But thereafter, when Ms. Robinson tearfully told her manager that her mother was not improving and that, as her mother’s only caregiver, she would need additional leave, the manager’s previously friendly tone changed. “Rachel, you really need to decide between your personal and professional life,” he said, according to her court filing. “You’ve got to draw a line.”

Who can draw such a line? Most caregivers for the elderly also have jobs, and need to hold onto them.

Family Relationships September 13, 2012, 1:53 pm

Children of Aging Parents Are Often Nearby, Study Finds

By PAULA SPAN

Who moves?

For decades, demographers and gerontologists have investigated the senior migration. Researchers talked about “amenity moves” when healthy retirees head for places with gentler climates and lower costs of living, and “assistance moves” when those same people return, less healthy and more needy, to live near family. They published articles about the so-called J-shaped curve.

“It wasn’t until later that people began to ask, ‘What about the kids?’” said Michal Engelman, a University of Chicago gerontologist and an author of a new study that helps answer that question. “We had a hunch there was more to this story.”

Isn’t there always? Much of what we think we know about who lives where as people age — a key factor in this country, which plunks elder care responsibility so squarely on family shoulders — is simplistic or plain wrong.

How often, for instance, have you heard about our increasingly mobile society, often part of a lament about self-centered children abandoning the old folks at home? But mobility rates in the United States have declined among all age groups, in a nearly unbroken pattern, for 60 years.

“Although there may be good reasons to worry about the future of family care provided to elderly individuals, increased geographic mobility does not appear to be one of them,” the demographers Douglas Wolf and Charles Longino Jr. wrote in a much-noticed 2005 article in The Gerontologist.

Dr. Wolf examined more recent census data for me and pointed out that, post-recession, the decline has continued: The percentage of Americans who moved in the past year reached an all-time low (11.6 percent) in 2010. Ours is a decreasingly mobile society, geographically and otherwise.

September 11, 2012, 3:38 pm

The Caregiver

By JUDITH GRAHAM

I was driving through Kansas, taking the kids back to college, when my cellphone buzzed. It was my sister-in-law letting me know that Juanita Hawkins had died.

An aching sensation — grief — filled my chest and swelled into my throat.

Juanita was my mother’s caregiver for more than 35 years. She was at every Passover, every Thanksgiving, for as long as I could remember, sitting at the table, smiling at the jokes, partaking in the closeness of family.

They were an unlikely pair: my mother, raised in Chicago by Russian Jewish parents, her high school’s valedictorian and a gifted pianist before multiple sclerosis attacked in her early 20s.

And Juanita, a black woman, the second of 10 children from Pine Bluff, Ark. A modest woman who never went to college, married or had children. A committed churchgoer.

They had nothing in common, these two, except decades of living together and being bound inextricably by my mother’s illness and the rhythms of their daily life.

My brother, sister and I can’t remember when Juanita first arrived in Evanston, in the house we lived in at that time near Lake Michigan. Probably it was 1970 or 1971. My father walked out a few years later, leaving the caregiving to others.

Medical Issues September 10, 2012, 6:50 am

Coping With Mild Cognitive Impairment

By JUDITH GRAHAM

About 10 to 15 percent of adults age 65 and older are believed to have mild cognitive impairment — a condition commonly characterized by memory problems, well beyond those associated with normal aging.

Alarmingly, mild cognitive impairment, or M.C.I., can signal serious problems ahead: About half of people with this condition go on to a diagnosis of Alzheimer’s disease or another dementia within five years.

Yet when researchers from the University of Toronto searched worldwide for programs that educate people about M.C.I. and how to adapt to it, they found only five — three in Canada, one in Germany and one in Rochester, Minn., home to the Mayo Clinic, which first defined M.C.I. in 1999. Similarly, a North American search for support groups for people with M.C.I. turned up just a handful.

The University of Toronto researchers set out to rectify this lack of attention by writing “Living With Mild Cognitive Impairment,” published recently by Oxford University Press. One of its authors, Nicole Anderson, an associate professor of psychiatry at the University of Toronto, spoke with me at length, and our conversation has been edited for clarity and length.

There’s some confusion about mild cognitive impairment. Is it the earliest stage of dementia or something else?

Most often, it is the earliest, preclinical stage of dementia. That means symptoms are not severe enough to meet the criteria for dementia. But pathology is developing in the brain that will likely lead to dementia.

Sometimes, however, people have other health problems that lead to an M.C.I. diagnosis, and once these are treated their cognition improves.

What cognitive functions are affected by M.C.I.?

The most typical one is memory. Also common are subtle language difficulties and executive functioning deficits. This refers to an ability to multitask, switch back and forth between two tasks, or inhibit irrelevant information and stay focused on what’s important.

Finances & Legalities September 7, 2012, 11:44 am

Medicaid Changes Loom for the Elderly

By THE NEW YORK TIMES

The Times reports this morning on states’ efforts to rein in Medicaid costs with managed care programs and how these may affect the elderly in nursing homes.

Some health policy analysts doubt that managed care will save money, and advocates for the aging and disabled worry that the sickest and most vulnerable people may be hurt in the process.
“Managed care isn’t going to help — it’s just more money going off the top,” said Toby Edelman, senior policy attorney in the Washington office of the Center for Medicare Advocacy, who has written on the importance of Medicaid to Medicare beneficiaries and their middle class relatives. “The managed care company has to take its cut.”

Read the full article, “With Medicaid, Long-Term Care of Elderly Looms as a Rising Cost,” and please share your thoughts in the comments section.

September 7, 2012, 5:53 am

Court: You Can Appeal Medicare Decisions About Hospice Services

By JUDITH GRAHAM

When Emily Back lay dying and in excruciating pain, her hospice made a decision that her husband couldn’t accept.

Ignoring a doctor’s order, the organization said it wouldn’t supply Ms. Back, who was 81, with Actiq, a fast-acting, powerful narcotic that a patient sucks on, like a lollipop.

That outraged Howard Back, who then bought the medication on his own dime and filed a lawsuit after his wife died.

Now a California court decision has resulted in an important clarification, determining that Medicare beneficiaries and their survivors have a right to appeal the denial of services by a hospice provider.

“This wasn’t at all clear until this court’s decision,” said Gill Deford, director of litigation at the Center for Medicare Advocacy, which represented Mr. Back in the case.

Hospice care is one of the fastest growing services under Medicare; in 2009, about 1.1 million elderly and disabled beneficiaries received these end-of-life services at a cost of about $12 billion, according to the Medicare Payment Advisory Commission, an independent agency established by Congress.

With hospice, the government pays a flat daily rate that’s meant to cover all necessary comfort care for patients expected to live six months or less. Because hospice providers can’t bill separately for individual items, there is potentially a direct effect on a provider’s bottom line when expensive extra services are ordered.

September 6, 2012, 6:33 am

Shopping for a Nursing Home? There’s a Tool for That

By PAULA SPAN

In July, the Centers for Medicare and Medicaid Services, which surveys and certifies the nation’s roughly 15,000 nursing homes, finally took a step that reformers had been urging for years: It put online the full text of the reports that nursing home inspectors file for each facility.

Until now, consumers could obtain a raft of helpful information based on those inspections through Nursing Home Compare, Medicare’s online ranking. But the particulars often remained mysteriously vague: A reader could see how many deficiencies a facility was cited for, but wouldn’t know what problems or shortcomings triggered them.

If you wanted the fuller picture, you had to either file a Freedom of Information Act request — not a speedy process — or go to the nursing home and ask to see the report, which by federal law it is required to hand over. (Of course, you’d want to visit a facility anyway, multiple times, before placing a relative, and ask a bunch of questions — but that’s a different exercise.)

Now, when you look up a nursing home on Nursing Home Compare, you can obtain the full findings by selecting “Inspections and Complaints,” then clicking on “View Full Report.”

A view of Medicare.gov’s tool to help compare nursing homes.

But there’s an even speedier way to reach this information, thanks to a new interactive tool from ProPublica, the nonprofit investigative news organization. It’s called (a tad confusingly) Nursing Home Inspect.

Developed by the journalists Charles Ornstein and Lena Groeger, it will prove a big help to reporters probing problems in nursing homes — something, sadly, there’s no shortage of. Advocates and regulators will no doubt log in, too.

September 5, 2012, 6:12 am

Medicare Part D Premiums Holding Steady

By PAULA SPAN

A morsel of good news about Medicare drug coverage for the coming year: Selecting a Part D plan might drive you crazy, as Jane Gross, the founding New Old Age blogger, wrote earlier this summer, but at least the average 2013 premiums will remain basically level for the fourth year in a row.

As it has since 2010, the average monthly premium is projected to hover around $30, the federal Department of Health and Human Services has announced. Last year, the actual amount came in a few cents lower, at $29.67. And the dread doughnut hole, which this year suspends coverage once spending hits $2,930, will kick in a few dollars later, at $2,970.

More important is that the discounts applied to drug costs once a beneficiary hits this coverage gap will continue to rise, courtesy of the Affordable Care Act. This year, beneficiaries in the hole received a 50 percent discount on brand-name drugs and 14 percent for generics. Next year, those discounts climb a bit, to 52.5 percent and 21 percent. By 2020, the hole is scheduled to close completely.

The number of people taking advantage of these discounts has grown, too. Through July this year, 1.41 million beneficiaries had received savings averaging $629, compared with 1.28 million people at that point in 2011.

Unhappily, some people are likely to pay more for drugs, either because their Part D premiums rise more than this national average or because price increases for their prescriptions outpace the rising doughnut-hole discounts. That’s why this constitutes merely a morsel of good news, but we’ll take it.

The annual enrollment period begins Oct. 15.

Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”

September 4, 2012, 11:44 am

On Ageism and ‘Eastwooding’

By PAULA SPAN

Mark Wilson/Getty ImagesClint Eastwood speaks to an empty chair on the final day of the Republican National Convention in Tampa, Fla.

One advantage of age: I’m old enough to remember the Democratic convention in Atlanta in 1988, when then-Gov. Bill Clinton of Arkansas, deemed a rising young pol making his debut on the national stage, gave a much-anticipated but ultimately disastrous nominating speech for Michael Dukakis.

It ran 33 minutes, roughly twice the expected length. It bombed. The delegates got so restive as he droned on — the phrase commentators used — that they actually cheered at the words “in closing.” Pundits seriously debated whether Mr. Clinton’s long-windedness might end his career.

One thing nobody much mentioned, that I recall, was the speaker’s youth. Mr. Clinton got slagged for a bad speech, not for being wet behind the ears at not-quite-42.

Clint Eastwood: There’s another story. Much of the reaction to his empty-chair address in Tampa, Fla., a rare unscripted moment in contemporary political conventions, focused on his odd talk. It was “rambling” (The Guardian) or “a bizarre performance” (Mayor Rahm Emanuel of Chicago) or “a winding rant” (Politico). Fair enough.

But the accompanying age stereotypes — this guy is 82, so he hasn’t just blown a speech, he’s lost his mind — were hard to miss. I saw headlines praising or assailing “Dotty Harry.” I read words like “addled.” Someone posted a “satirical” public service announcement on YouTube, complete with sorrowful music, that began, “Do you know the signs of dementia?”

On Twitter, among many references to taking pills and to Medicare, the comedian Damon Wayans urged, “Please take the rambling old man offstage and change his diaper.” The hashtag “#eastwooding” sounds to me like a variation on “sundowning,” a reference to the agitated evening behavior of some dementia patients — at least, that was my interpretation.

Maybe I’m too sensitive to this sort of not-quite-joking. Fortunately, we have now have a way to determine whether age-related remarks and attitudes are offensive: a blog called “Yo Is This Ageist?”

August 31, 2012, 6:00 am

The Ex Factor

By PAULA SPAN

She had recently moved to beautiful San Francisco from the East Coast. He was an artist living in the old Victorian house she was sketching. He came outside, looked over her shoulder and pointed out that she hadn’t drawn the correct number of pillars.

They married in 1964 and divorced, without acrimony, 10 years later. “I was very unhappy and very irritable,” is the way Esther explained it.

She now attributes her restless discontent to serious depression, but at the time, “I thought if I found the right person, things would be O.K.,” she said. “I moved back East for a while. I moved to Santa Cruz. I had a lot of therapy. None of it ever worked.”

That is, until 1999, when Esther, who had tried one antidepressant after another, responded to Celexa. “Within a couple of months, the depression completely lifted,” she said. “It was miraculous.”

By then, Esther (I’m withholding her last name for privacy) had made enough money selling real estate to retire and buy a house with a garden in semirural Sonoma County. She’s had happy years there growing vegetables, walking her dogs on the beach and spending time with friends.

Then, a little over a year ago, her former husband unexpectedly walked up to her door.

August 29, 2012, 12:13 pm

Effects of Delirium Are Found to Linger

By PAULA SPAN

The more researchers learn about delirium, the clearer it is that attention must be paid. For years, people thought of it as a transient condition: Patients, especially older ones, grow confused and irrational and sometimes even violent during hospital stays — then in a few days, the delirium passes and people return to themselves.

That’s what happened to my colleague Susan Seliger’s mother, who was so agitated and disturbed after hip surgery that the hospital staff tied her hands to the bed. The fog lifted once doctors reduced her medication and physical therapists got her up and moving.

But the evidence increasingly shows that the mental effects of delirium linger. In particular, a study published in Archives of Internal Medicine indicates that it takes a terrible long-term toll on those who can least afford to lose cognitive ground: people with Alzheimer’s disease.

August 27, 2012, 1:19 pm

The Dirty Little Secret of Nursing Homes

By PAULA SPAN

This sounds like common sense: If you work in a nursing home, you wash your hands when you start your shift and again before you leave. You wash your hands (or, in some cases, use an alcohol-based antimicrobial) before and after any direct contact with residents. Before you help someone with tooth-brushing, bathing, eating or using the toilet. Before and after handling a catheter or taking a finger-stick blood sample or changing a dressing. Or handling used bed linens. Or blowing your own nose.

In fact, these are not only common-sensical habits; they’re prescribed by guidelines from the Centers for Medicare and Medicaid, part of the process by which the nation’s nursing homes are inspected and certified.

Yet the percentage of nursing homes cited for deficiencies in “hand hygiene” has been rising in recent years. Inspectors found such deficiencies in fewer than 7.4 percent of nursing homes from 2000 to 2002, but by 2009 found them in close to 12 percent. Some states did better: Hand hygiene citations in Pennsylvania in 2009 came from just 6 percent of facilities. Some fared much worse: Michigan that year was at 15 percent.

One reason cited by the University of Pittsburgh gerontologist Nicholas Castle, a veteran nursing home researcher whose team uncovered this trend, was the growing emphasis on infection control, which means that “surveyors are probably looking harder than they used to” — not a bad thing.

But the study, published in the Journal of Applied Gerontology, also indicated that understaffing and insufficient training played a part. “Most facilities understand the importance of hand washing,” Dr. Castle said in an interview. “It’s a question of having the staff and resources to implement what they know they should be doing.”

In an era when fierce infections like MRSA and Clostridium difficile haunt nursing homes and hospitals (patients in one often become patients in the other, and around again), this represents a dispiriting trend. Usually very elderly, and sick and frail almost by definition, nursing home residents are particularly vulnerable to infection. Infections picked up in health care settings represent their single greatest cause of sickness and death, the reason underlying a quarter of all hospitalizations from long-term care facilities.

August 23, 2012, 11:53 am

Drawbacks to Banking Accounts for Seniors

By PAULA SPAN

Caveat check writer.

The Pew Charitable Trust, as part of a project titled “Still Risky: An Update on the Safety and Transparency of Checking Accounts,” has looked into so-called senior checking accounts at four of the largest United States banks and one large credit union.

It determined that simple senior accounts, those most similar to the institutions’ basic checking accounts, don’t offer much advantage. They may waive certain service fees, but those tend to be ones people use only rarely anyway, like the cost of a cashier’s check. Senior accounts that offer lower monthly fees and lower minimum balances, on the other hand, may save you or your older relative a few bucks.

But beware those that could actually cost more than a standard account unless you maintain a high balance. The report describes a senior account that waives the monthly fee — but only with a $5,000 minimum balance. A basic account at the same bank waives the fee for a $1,500 minimum or a $250 direct deposit.

The upshot: Your parent may do better with an ordinary account than one labeled “senior.”