BY:  Beverly Bernstein Joie, MS, CMC
President, Elder Connections

Tax Help for Your Aging Parents

It’s that time of year to start your tax planning.   Be certain to file for the allowable deductions for the personal care of a senior.  There are numerous deductions to explore that can provide you with significant tax benefit.

5 Categories of Deductible Senior Care Services

1. Qualified Long-Term Care Insurance – premiums are deductible based upon the age of the insured. 
2. Qualified Long-Term Care Services that are necessary, diagnostic, preventive, and  involve maintenance and personal care services. 
3. Maintenance and Personal Care Services.  These are considered those which provide for care of a chronically ill individual with needed assistance.
4. Medical services from licensed health care providers and medications that are prescribed.
5. Nursing Homes

Tax Resources to Help Seniors

Elder Connections advises you to consult with your tax preparer and investigate the IRS publications addressing this issue.  The rules need to be understood thoroughly before you proceed because there are many factors affecting the eligibility for deductions.   The IRS code is 7702B.

As we know, the cost of care for seniors is a challenge for most families.  Let’s protect our resources armed with the knowledge of a thorough planning strategy.  Better senior care relies upon a team of specialists who can provide you with this knowledge. 

When the time comes to help your aging parents with their care, seek the expertise of  Geriatric Care Managers – your partners in providing quality better senior care.

BY:  Beverly Bernstein Joie, MS, CMC
President Elder Connections

Medical Revolving Doors

It is often said that hospitals can be dangerous to our health!  Actually, according to The Institute of Medicine report, between 44,000 and 98,000 hospitalized Americans die each year as a result of preventable medical errors. Certainly, there are circumstances that demand hospitalization and a hospital visit can be a life saving and necessary event.  But, the problem of remaining at home after discharge has become a hot issue.  Many elderly people with chronic conditions find the move from home to hospital to rehab reminiscent of a revolving door.  Actually, avoidable hospital readmissions affect one in five patients and account for $17.4 billion of the current $102.6 billion Medicare budget.

Recently, Elder Connections was invited to provide an inservice training at the Montgomery Rehab Center to discuss this alarming statistic and share solutions with the staff.  On November 3, 2010, we will be presenting: Tips For Stopping The Revolving Door of Hospital (and Rehab) Readmittance.  Hospitals and Rehab centers are paying increasing attention to this phenomenon due to the Patient Protection and Affordable Care Act .  Starting in 2013, hospitals with “excess” readmissions will incur financial penalties based upon their rates of readmittance.  It’s no wonder that this problem is high on their list of concerns.

What can we do to keep ourselves and loved ones from being readmitted?

Tips To Avoid Rehospitalizations:

Maintain a Personal Health record.  This record is something all of us should maintain and take with us to all doctor’s appointments but especially relevant for hospital discharge purposes.  It should contain your personal information, primary physician information and directions about contacting caregivers and family members.  You should also place into this folder, all your recent hospitalization information, the reason for this hospitalization, copies of tests, medical records, and doctor’s notes.  Most importantly, record the “red flags” and those potential difficulties that will demand immediate doctor contact.  Also, record your concerns and questions in a clear concise way to have on hand when you meet with your doctor following the hospitalization

Discharge Preparation Checklist.  Speak to the doctors, nurses, and social workers about what is going to happen next and be clear about their expectations.  Find out who to call for problems with your transfer, and understand your medications.  Make sure your questions are answered before you leave, your family and/or caregivers are in place and understand your needs, and that a follow-up appointment is scheduled along with the transportation to that appointment.

Medication One of the most important factors to staying away from readmissions is how well you know and understand your new medication regimen.  Invariable medications change during a hospitalization.  Make sure you write them down and take this list with you to every appointment.  Update this list as it changes.  Share all questions and concerns about medications with your doctor. 

 Successful Hospital and Rehabilitation Discharges

 The new health care changes on the horizon has created a call to action.  Some hospitals such as The University of Pennsylvania have utilized a new breed of Physician-Administrator, called a Hospitalist, one of the fastest growing medical specialties.  This specialist is now following the care of patients through their hospitalization to discharge to address this need.  For those being discharged, the family’s participation is critical.  Luckily for families who do not live close by,  the services of a Geriatric Care Manager can be obtained to implement a success discharge plan and follow-through.

Charting the Conversation for Caregivers

Caregivers are faced with many challenges.  One of the most stressful for many families is the end-of-life care conversation.  Yet, without this conversation you invite vulnerability and lack of control when it’s needed most. 

Prepare Your Plan for Better Senior Care

There is no such thing as not having a plan.  The lack of planning kicks off a default series of events.  For example, a former client of ours refused to designate a power of attorney.  When her health shifted and she was unable to make her own decisions, the hospital became her guardian.   Imagine how horrible!  “What should we do?” is a common question asked by many families caring for aging parents.  Start with a plan and these helpful steps. 

Helpful Tips for End-of-Life Care Conversation

1. Best time to begin this conversation is when your senior’s health is stable and this is no emergency.
2. Use the events of other family members and friends as a stimulus to begin the conversation.  For example, Aunt Sally died without a will.  Talk about the ramifications of this choice as a means of inquiring as to how your parent feels about these and related decision.  Let them elaborate about what they think Aunt Sally should have done.
3. Suggest that wills be updated to best express the elders’ current wishes.
4. Designate a durable power of attorney for health decisions and finance.
5. Speak to an elder law attorney about estate planning issues.
6. Create advanced directives to stipulate the senior’s wishes.
7. Communicate and forward the power of attorney and advanced directives to the primary physician.  Put everything in writing.  Verbal communication is not enough.
8. Engage in a frank conversation about finances and how future care will be funded.  Learn about the costs of home care, assisted care, and nursing care.
9. Understand the difference between Medicare and Medicaid.
10. End-of-Life is not a subject to be avoided rather it is an opportunity for caring, intimacy, and understanding the wishes of someone you love.

Caregiver’s Gift for Peace of Mind

The subject of this conversation activates many confrontational feelings for most people – seniors and their families.  This is natural and can be acknowledged as such.  Do not expect that this is a one time conversation.  Rather, it’s a topic to be raised and discussed over time.  It is a process and a gift for peace of mind.

Turning for the Support and Trust You Need in Better Senior Care

If you need support, rely on trusted professionals to help you.  Geriatric Care Managers are excellent coaches to help you to discuss these issues and communicate effectively.  Allow your care and love to be present as a background to your words.  The goal is to begin the actions to protect, support and allow seniors to convey their wishes and have them followed.

BY  Beverly Bernstein Joie, MS, CMC
President Elder Connections  -  Solutions for Peace of Mind
Serving the Greater Philadelphia Region

By:   Beverly Bernstein Joie, MS, CMC
         President Elder Connections

The process of finding a suitable assisted-care community for yourself or a loved one can be overwhelming for anyone, and I should know. I have worked with hundreds of families to educate them about choosing eldercare communities.

It is possible to make the difficult process of choosing an assisted-care community successful—if you are willing to make an up-front investment of energy and time to understand the aspects of care and cost, and the lifestyle options, that are available.

Here are some initial factors to consider:

• Assisted care is an important component of the continuum of care for older adults. It offers a sense of apartment-like living, accompanied by meals, social activities, and the kind of care people require as they age. Many assisted-care communities also offer special care for those suffering from a form of dementia, such as Alzheimer’s disease.

• The biggest distinction between assisted care and nursing-home care is that assisted living provides help with the activities of daily living, such as bathing, dressing, toileting, and transferring from one place to another. It also helps with instrumental activities of daily living, such as food preparation, laundry, transportation, and housekeeping. These needs and services are considered “unskilled.” Instead, a nursing home provides “skilled” care.

The nursing home resident may have wound issues, brittle diabetes, complicated medical conditions, or be wheelchair bound, for example. Skilled needs require the care of licensed professionals; but in assisted care, licensed professionals are not mandatory.

• Compared to nursing homes, the government regulations and supervision of assisted-living communities is much looser and less stringent, although this is beginning to change. Assisted care is a relatively new phenomenon, and it takes time for the government to develop regulations to respond to changing trends in housing for older people.

Medicare does not pay for assisted living, and other sources of funding vary from state to state. But every state has governmental funding for residents without funds who require nursing-home placement. This is an important distinction. Often it is incumbent upon the resident to foot the bill for assisted living. Assisted care is often predicated upon the ability to pay for it, which shuts the door for many who simply cannot afford this option.

For people with the means to afford it—or for those who live in a state with adequate funding that they qualify to receive—assisted living is an excellent choice. It meets the needs of elders who are frail and require support, while it enhances their independence and autonomy.

Often, assisted living can free up the remaining time families have with one another to share memories and have quality visits. And most important, it allows residents to become part of a community that is their own, promoting their individual identities, dissolving social isolation, and allowing them to contribute and be cared for at the same time.

It is of the utmost importance that parents or loved ones and their families carefully research and explore assisted-care options. Being an informed consumer will help you reach the right decision

Download your free Elder Connections plan kit

  BY:  Beverly Bernstein Joie, MS, CMC
                                  President Elder Connections 

The Care Manager’s Diary

Care Giver Needs Help

The frantic call came from a nephew who was moving his aunt from the west coast to the Philadelphia area.   “What should I do?”  His Medicare Advantage Plan is not accepted in his new assisted care community.  Do we have to find a new place?

Consider This

Medicare Advantage Plans were developed by private insurance companies.  They capture the Medicare dollars allotted to every senior and provide their own unique plan.  The consumer no longer possesses Medicare per se, but now is insured by the selected company.  Health care providers can only provide care when they become preferred providers of the company.  Physical therapy centers and long term care communities for example, may or may not participate.

Better Senior Care for Aunt Alice

Since Aunt Alice was moving from out of state, she was able to secure a Medicare plan without waiting for the open enrollment period.  But, it was up to Elder Connections to advise her nephew about the best  possible choice for him.  In his case, and what we almost always advocate, is for seniors to choose a traditional Medicare Plan with a secondary insurance known as a Medigap Policy.  To date, this option assures that the recipient has the most control over their choice of physician and all auxiliary health care services.

Whether you are facing this decision or will some time in the future, it is essential to know the facts about Medicare.  I have been grateful that my own mother has access to the doctors, hospitals, physical therapy and services that her doctor and I choose for her.  You may have doubts about Obama’s Health Care Policy for various reasons, But, it’s really important to understand Medicare Advantage Programs actually work when care and services are required to meed changing needs.

Elder Connections Reminds You that Medicare’s Open Enrollment Period Begins November 15, 2009.

If you are interested in changing your Medicare coverage, the Open Enrollment Period for 2010 will begin on November 15, 2009 and close December 31, 2009.   All changes will go into effect January 1, 2010.  Not acting during this period means you will keep the coverage you have.

Obama’s Controversial Health Plan Addresses Medicare Options

• Trim subsidies for Medicare Advantage Plans
• Managed care companies receive about $17 billion a year from Medicare
• Private plans now cost the government 14% more per person than traditional plans.

A Better Plan

Obama’s Health Care Plan will be debated for some time to come.  But in the meantime, decisions for better senior care will not wait.  Call Elder Connections to help you with decisions for your own peace of mind.