Quarterly Newsletter

Happy Holidays, and welcome to our Winter 2011 issue.

A visit by a caregiver is often the simplest thing that can make the difference in a senior’s day…going for a walk, having someone read to them, helping to cook a favorite recipe, or just asking the senior about their life experiences. Even if they’re experiencing health problems that limit their activity, a caregiver can help immensely, because more than anything else, seniors want to be listened to. Our caregivers have a passion for helping with all these “little things” that mean so much and we are truly grateful for both their passion and compassion.

2012 Medicare Premium Hike Lower Than Predicted

On the heels of the announcement of a 3.6 percent increase in Social Security benefits in 2012, comes news that Medicare's monthly premium will be much lower than expected next year—and will actually drop for millions of beneficiaries. Administration officials said the new health reform law was partially responsible for keeping costs down.

The basic premium for Medicare Part B will be $99.90 a month, only a $3.50 increase over the $96.40 a month that most beneficiaries have been paying since 2008. This increase is $7 a month less than what was being projected as recently as last May and means that most seniors will be able to keep the lion's share of their Social Security benefit increase. In addition, higher-income earners and others who have not benefited from the recent premium freeze will see a significant drop in their premiums.

Most Medicare recipients have not experienced a rise in their Medicare Part B premium—which pays for doctor visits and other outpatient costs—because of a provision in the Medicare law prohibiting premiums from climbing more than that year's cost-of-living increase in Social Security benefits. Since there has been no Social Security increase in the last couple of years, most beneficiaries—nearly three-quarters—have continued to pay Part B premiums of $96.40 per month.

But this protection has not applied to the other one-quarter of beneficiaries who either:

• Do not have their Part B premiums withheld from their Social Security checks, or

• Pay a higher Part B premium surcharge based on high income (see below), or

• Are newly enrolled in Part B.

These beneficiaries who did not benefit from the premium freeze will see their premiums reduced from $115.40 a month to the new $99.90 premium.  In addition, the Part B deductible will fall $22 to $140.

Donald Berwick, MD, administrator of the federal Centers for Medicare and Medicaid Services, said one big reason for the lower-than-expected premium hike was historically low rates of health care utilization, which he attributed in part to the health reform law's focus on preventive services. In addition, the unexpected Social Security benefit increase meant that rising Medicare costs could be spread among many more beneficiaries, with each one paying a smaller share.

"Between reduced Part B premiums and increased Social Security payments, the average Social Security recipient will have a net cost-of-living increase of $40 per month in 2012," said the Center Medicare Advocacy.  

Following are all the new Medicare figures for 2012:

• Basic Part B premium: $99.90/month

• Part B deductible: $140 (was $162)

• Part A deductible: $1,156 (was $1,132)

• Co-payment for hospital stay days 61-90: $289/day (was $283)

• Co-payment for hospital stay days 91 and beyond: $578/day (was $566)

• Skilled nursing facility co-payment, days 21-100: $144.50/day (was $141.50)

As directed by the 2003 Medicare law, higher-income beneficiaries will pay higher Part B premiums.

The Social Security Administration uses the income reported two years ago to determine a Part B beneficiary's premiums. So the income reported on a beneficiary's 2010 tax return is used to determine whether the beneficiary must pay a higher monthly Part B premium in 2012. Income is calculated by taking a beneficiary's adjusted gross income and adding back in some normally excluded income, such as tax-exempt interest, U.S. savings bond interest used to pay tuition, and certain income from foreign sources. This is called modified adjusted gross income (MAGI). If a beneficiary’s MAGI decreased significantly in the past two years, she may request that information from more recent years be used to calculate the premium.

Those who enroll in Medicare Advantage plans may have different cost-sharing arrangements. On average Medicare Advantage premiums will be 4 percent lower in 2012 than in 2011. 

http://www.elderlawanswers.com/resources/article.asp?id=9516&Section=4&state=

Holiday Blues and the Elderly

The holiday season—Thanksgiving through New Year’s Day—is usually a time of joy and celebration, but for the elderly it can also be a time of great sadness and depression.

While the rest of the world is busy planning family gatherings, and attending festivities, the elderly can be easily overlooked. The National Institute of Mental Health considers depression in people 65 and older to be a major health problem, with some six million seniors suffering from late-life depression, which is often magnified during the holidays.

Depression in the elderly can be triggered by a number of factors, including physical limitations, declining health, retirement, isolation from family and friends, a change in living arrangements, and financial constraints. All of these factors are heightened during the holidays when the feeling of isolation becomes more apparent. Older adults may have to relinquish their role as head of the family as they become guests rather than hosts of family gatherings. They may feel alone and left out while everyone around them is occupied with holiday planning. Geographical distance between family members can also be more difficult to cope with during the holidays. Perhaps most importantly, the holiday season can trigger a mourning period for those who have lost a spouse or other loved one.

Family caregivers and other helping professionals need to be able to recognize and manage depression in the elderly before it escalates. Left untreated, depression can lead to major declines in health, including a higher risk of heart problems, loss of independence, and greater need for daily caregiving assistance. Depression can also lead to suicide.

Some signs of depression in elderly people include:

• Loss of interest in life; questioning the value of their life

• Showing little interest in themselves or those around them

• Unwilling to get out of bed or get dressed in the morning

• Loss of appetite; changes in sleeping patterns

• Persistent sadness that lasts more than a month

• Withdrawal from social activities

• Excessive worry

• Inability to concentrate, slowed responses

If any of these signs are present, the person’s family physician should be contacted as soon as possible for diagnosis and treatment.

Preventing depression in the elderly during the holiday season may be as simple as making sure that they feel needed and included in family activities. Call upon their expertise and wisdom when making decisions about family matters and enlist their help with holiday traditions. Keep them informed about what is going on in the family and in the news. Keep in contact with phone calls and visits, and plan outings whenever possible.

Be sure to acknowledge the loss of loved ones during family gatherings with a toast in their honor, a visit to the cemetery, or simply by talking about the people who are no longer with us.

Since alcohol can also contribute to depression, family members should ensure that the elderly person does not over imbibe. Maintaining good eating habits, getting enough sleep, and remaining physically active will also help prevent depression.

Time is always in short supply during the holidays, and most of us tend to overextend ourselves, leading to added stress and anxiety. It is too easy to overlook elderly family members and friends at this time of year, and they may not always be able to verbalize why they are feeling sad or depressed. Keeping them actively involved during the holiday season will remind them that they are important and vital members of the family.

By Robert Brooks

http://www.thehomecaredirectory.com

/home_health_care/related_articles/holiday_blues_and_the_elderly/55/

Multigenerational Families on the Rise

American families are finding that the recent housing crisis, a struggling economy and an aging population are causing them to join forces across generations. According to a recent AARP study, the number of multi-generational households has jumped from 6.2 million to 7.1 million in only the last two years—a growth rate that exceeds the previous eight years combined.

Whether for economic or health reasons, making such a move requires planning and flexibility to make the transition comfortable for all concerned. Experts suggest that contingency planning for this eventuality be put in place before it is needed.

“Keep in mind that even if your parents are highly functioning now, anything can happen,” said Amy Goyer, AARP’s family expert and a specialist in multigenerational issues.

“That can change overnight.”

Your parents’ needs

Assess what your parents’ needs really are.

“Get a good idea of where your parent is functioning now,” Goyer said. “What kind of needs do they have, at what level are they functioning? A lot of times, the adult children don’t really have a clear picture of what their parents’ needs are.”

You can get an accurate picture by hiring a geriatric care manager to conduct an assessment. A geriatric care manager can tell you what your parents’ needs are and if you will need to modify your home to make it physically safer for your elderly parents.

Involve the family

It’s critical that all family members be included in the discussion, and it’s one of the biggest hurdles a family must overcome. All siblings should be in agreement on the decisions and choices made, since everyone may need to help out in some way at some point.

If other family members are unable or unwilling to help, you may need to hire someone to help you, such as with cooking and cleaning, or caregiving tasks. If possible, start putting aside money for this eventuality before the need arises.

Who pays for what?

Figure out whether mom and dad will contribute financially to the household and, if so, how much. Become familiar with what their health insurance will cover. Most insurance, including Medicare, does not cover non-medical in-home care services. Consider long-term care insurance (which can cover such services) if your parents qualify and it makes financial sense.

Prepare yourself

Be prepared for the impact this move will have on your lifestyle. Moving a parent in with you changes the family dynamic and requires planning ahead and honest communication about ground rules, boundaries and the new responsibilities of all family members.

A common issue to be resolved is how taking in your parents would affect the personal space of everyone in the household.

Don’t lose perspective

It may be tough to reconcile this with your desire to help your parents, but keep things in perspective and don’t jeopardize your own retirement.  Consider creating a new budget that takes into account any additional costs that may be incurred by the addition of your parents to the household.  Consulting a financial planner to create a strategy for your new financial situation may be helpful. You may even consider a family law attorney to prepare a written agreement, especially if money is involved.

While there are pitfalls to consider, such a move can bring rewards as well as stresses. Besides saving money and keeping an aging loved one safe, multi-generational living can forge closer ties between parents, children and grandchildren. 

By Caren Parnes,  for The Senior’s Choice

How to Be An Astute Caregiver

Know the Six Signs of Decline

Is it inevitable that aging must bring disease, debilitation and dementia? Jack Lalanne, the exercise guru, continued his two-hour daily workouts into his nineties. Clint Eastwood, at the age of eighty, continues to produce, direct, and star in major motion pictures.

Sure, our parents are aging. But while chronic illness and increased frailty take their toll on many, some are maintaining their independence, vitality, and mental acuity well into their eighties. Yet we still worry when these seemingly healthy parents forget their phone number or lose their car keys. So how can we differentiate the normative aspects of aging from disease?

My father was in his early seventies when he began showing signs of dementia. Though keenly intelligent, he had always been absent-minded— misplacing things, mixing up the names of his children, and growing agitated when events did not go as planned.

So it was no cause for alarm when he began to seem increasingly forgetful and disorganized: the emotionally wrenching search-and-rescue missions for his lost glasses were just business as usual. It was not until my father became disoriented on a short bike ride to the local grocer and was forced to call my mother to pick him up that we recognized something significant had changed. It was then that we made the decision to have my father undergo a medical evaluation for dementia.

For those of us caring for aging parents, we must balance concern for our parent's welfare with respect for their autonomy and independence. In addition, we may live a distance from our loved ones and view changes through a magnifying lens.

How do you know if what you're seeing is a true decline, versus a natural state of old age? These 6 warning signs will help you determine whether your parent is facing a medical problem or simply following the usual path of aging:

1.  Physical Changes: Are there gait changes, extreme weight fluctuations, or a decline in personal hygiene?

2.  Household Changes: Is there no food, old food or expired food in the fridge? Are there scratches or dents on the car?

3.  Mood Changes: Does your parent show signs of anxiety or depression? Depression is NOT a normal part of aging —and it can be treated!

4.  Forgetfulness—out of the ordinary: Like my Dad, losing glasses was expected. A repeated pattern of forgetting pertinent events, however, may be cause for concern.

5.  Misuse of prescribed medications: Are there expired prescriptions? Can your parent remember what medication he or she is taking and when to take it? 

6.  Mishandling Finances: Are there unpaid bills, problems keeping track of expenses, signs of carelessness with money?

Once you recognize, like my family and I did, that the changes you are observing may be signs of dementia, a chronic illness, or increased frailty and dependence; it is time to communicate your concerns in a compassionate and clear manner. You can then take proactive steps to plan for the type of care that will give your parents the independence and well-being they deserve, while maintaining their safety and your peace of mind.

By Jody Gastfriend, LICSW

http://www.care.com/senior-care-how-to-be-an-astute-caregiver-p1017-q6940206.html