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As many of my clients know, when an elder needs help with their activities of daily living (ADLs) even the process of changing clothes, having meals, and moving around the home or facility becomes a task.  Resdient Essentials saw this challenge and has an entire catalog of clothing, supplies and even furniture to make things a bit easier for both the elder and their cargivers or family.  Browse their catalog and sign up for updates if you wish!

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Jane Gross

368 pages, Knopf, $26.95

By JERRY HARKAVY |The Associated Press
Published: May 22, 2011

Decades after screen star Bette Davis famously declared that "growing old is not for sissies," Estelle Gross expanded on the woes of the ailing aged with her lament that people live too long and die too slowly.

On the day after the Sept. 11 attacks, after helping cover that story for The New York Times, an exhausted Jane Gross was finally able to drop by the nursing home a few miles north of ground zero where her mother had just moved to what would be her final residence. In a furious maternal vent, she greeted her daughter by saying, "I wish those planes had hit this building."

Gross was a feisty octogenarian with a grab bag of chronic conditions that for nearly three years forced her to rely on others to carry out the simplest of daily activities. On the other hand, her cognitive abilities remained sharp until the end, a contrast to many others in her nursing home who endured the ravages of Alzheimer's disease and other types of dementia.

Gross' ordeal, and that of her daughter as principal caregiver, is one that is becoming more widespread as baby boomers are compelled to reverse the roles of their childhood and take on the challenging task of becoming their parents' parents.

In her book, "A Bittersweet Season: Caring for Our Aging Parents —and Ourselves," Gross, who went on to launch a blog called The New Old Age, recounts her own experiences in shepherding her mother through the intricacies and indignities of long-term care.

The narrative begins in 2000 with Estelle Gross' move from Florida to New York, a "reverse migration" that is becoming more common for parents who need chronic care. It ends in 2003, when she dies at 88 in a nursing home after a decline that left her paralyzed, incontinent, unable to speak and unable to eat on her own.

An incisive reporter with a fine eye for detail, Gross laces her account of her mother's decline and its impact on her own life with suggestions and warnings for other caregivers who find themselves in similar situations: Avoid the chaos of hospital emergency rooms, assume that costs associated with long-term care are not reimbursable by Medicare, find a family doctor, internist or — best of all — a geriatrician to manage the inevitable cascade of medical problems.

Gross recounts a succession of middle-of-the-night phone calls, emergency summonses from the workplace, financial costs that swiftly escalate and the need to play social engineer to ensure that nursing home staff members aren't slacking off when the need arises to change diapers or prevent bed sores.

"Once a parent has passed eighty-five, easy and affordable passings are few and far between. Believing you're going to get one is magical thinking," she writes.

The book is written from the perspective of the caregiver — more often a daughter than a son — whose relationship with the parent can be fraught with decades of resentment and other family baggage. In the author's case, however, the ordeal brought her closer to her mother.

The path isn't smooth, but rather an all-consuming and emotional roller coaster ride that Gross describes as "living in a soup of fear, guilt, heartbreak, resentment, loneliness, and exhaustion from bearing the weight of so much responsibility."

While Gross' memoir outlines the end-of-life decisions that often confront health-care providers, clergy and ethicists, her mother's ability to think rationally until the end gave her the control that others must often surrender. Instead, she exits on her own terms, without sentiment or self-pity.

"A Bittersweet Season" is sure to become required reading for anyone with an elderly parent who depends on long-term care. It's also a worthwhile read for anyone who is interested in America's health-care system as it braces for the demands posed by demographic changes that include a sharp rise in the group now termed the "old old."

Of course, the time to read the book is before the crises begin to mount, to be better prepared to make wise decisions and deal with whatever arises.

NOTE: I am reading this book now and am enjoying it very much.  I will post my review of it upon finishing the book.

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As we relax with family and friends on this Memorial Day 2011, I also think of the client's and their families that have lost loved one over the past year.  When you are an elder law attorney, no file is ever closed.  Aside from our clients, we become close to the spouses, children, grand children and other family members of the client.  While we help them prepare their estates, preserve their assets and prepare for incapacity, no one can be totally prepared for the loss of a loved one.  We honor out clients that have passed in the last year and offer their families our continued support and prayers. 

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As many elder law commentators predicted, the Social Security Administration has eliminated a loophole that had allowed Social Security recipients to start receiving benefits when they first became eligible without being permanently locked in to the lower benefit level.

Although you can collect Social Security benefits starting at age 62, if you do, your benefits will be significantly lower than if you wait until your full retirement age or even later. About half of Americans file at 62, but "in most cases it's a costly mistake," says retirement journalist Mark Miller.

A little-known provision of Social Security law had allowed beneficiaries to have their cake and eat it, too -- to apply for benefits when they first became eligible and later withdraw their application for early benefits and reapply and receive full retirement benefits. The catch was that the recipient had to pay Social Security back all the money they had pocketed so far. But no interest was due on the benefits received, so the money was in effect an interest-free loan. The policy was designed to provide an escape hatch for those who took early retirement and then went back to work.

Under the new rules, retirees may withdraw their Social Security applications only once and only within 12 months of first receiving benefits.

Due to the payback requirement, the "do-over" strategy was available only to more affluent recipients and was little used, although word had been spreading. In 2007, Social Security processed only about 500 withdrawal applications, but that number had more than doubled to 1,015 in 2009 and processing the new applications was becoming an administrative headache for the agency.

For a USA Today article on the rule change, click here.

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 The House, by a vote of 277-148, voted to pass the Senate’s amendment to H.R. 4853, “The Middle Class Tax Relief Act of 2010,” late Thursday night.  An attempt by several House Democrats to amend the language of the estate tax, from the Senate plan of a 35% tax on estates of $5 million or more, to a 45% tax on estates of $3.5 million or more, was defeated by a vote of 194-233.  Earlier, on Monday, the Senate voted 81-19 to pass the bill on to the House.  The President, who negotiated the tax framework with the Republican leadership in the Senate, signed the bill into law on December 17th:

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Nursing home and assisted living rates rose significantly from 2009 to 2010, according to the 2010 MetLife Market Survey of Long-Term Care Costs. Private room nursing home rates rose 4.6 percent to $83,585 a year or $229 a day, while assisted living facility costs climbed 5.2 percent on average to $39,516 a year or $3,293 a month.

The average cost of home health care aides and adult day care were unchanged, after having jumped about 5 percent the year before. Home care aides still average $21 per hour and adult day care services remain at an average $67 per day.

The survey also reports on the cost of a semi-private room in a nursing home, which increased 3.5 percent to $205 a day, or $74,825 a year. The cost of a semi-private room in an Alzheimer's wing actually dropped, from an average of $75,920 to an average of $75,190 annually.

Once again, the highest rates for a private nursing home room in 2010 were found in Alaska, where the cost is now $687 a day on average. The lowest rates were found in Louisiana (with the exception of Baton Rouge and the Shreveport area), at $138 a day.

The cost of assisted living was the highest in the Washington, D.C., area, at $5,231 a month and the lowest in Arkansas (except for Little Rock) at $2,073 a month. Average home health care aide services ranged from a high of $30 an hour in Rochester, Minnesota, to $14 and hour in the Shreveport area of Louisana. Adult day care services were highest in Vermont at an average of $140 a day and lowest in the Montgomery, Alabama, area, at $31 a day.

For the full 2010 report, including listings of average long-term care costs in selected cities, click here. (The report is available in PDF format. If you do not have the free PDF reader installed on your computer, download it here.)

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The most important advances in geriatric care, say gerontological nurse researchers and practitioners, are not new technologies and procedures but changes in thinking about older patients. These changes are based on new evidence that for the first time includes large numbers of the elderly.  Though many older adults are active and in good health, most have at least one chronic condition and use healthcare services more often than other segments of the population. Although evidence shows elderly people benefit from caregivers who understand the needs of their age group, less than 1% of nurses have training in geriatric care, according to the Institute of Medicine’s 2008 report “Retooling for an Aging America: Building the Health Care Workforce.”  “The biggest problem is the lack of providers who are prepared to care for this population,” says Tara A. Cortes, RN, PhD, FAAN, executive director of the Hartford Institute for Geriatric Nursing at the New York University College of Nursing. The Hartford Institute is working to ensure that all nurses have geriatric competence. It has developed assessment tools, core competencies, evidence-based protocols, advance practice curriculum, and programs such as NICHE (Nurses Improving Care to Healthsystem Elders).  “Nursing is positioned perfectly to be the driver of care for older adults,” Cortes says, noting that nurses already are experts at managing care, providing education, looking at patients holistically and working in interdisciplinary teams, all crucial components of geriatric care.

Source: (October 25, 2010)

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The following resources provide critical information on Part D enrollment for 2011.  Premiums are expected to increase by about 10% and many plans are making changes in coverage, so it is important that beneficiaries review the terms of their current plan to make sure it still represents their best available option.

CMS Medicare Part D Plan Finder

Center for Medicare Advocacy, Part D Choices:  It's That Time Again

Kaiser Family Foundation, The Medicare Prescription Drug Benefit - An Updated Fact Sheet

Kaiser Family Foundation, Medicare Part D Prescription Drug Plan (PDP) Availability in 2011

Q1 Medicare, What's the Part D Outlook for 2011

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Point:   A new analysis of government data by Avalere Health finds that premiums will go up an average of 10 percent among the top plans that have signed up some 70 percent of seniors. That's according to Avalere Health, a private research firm that crunched the numbers. Marketing for next year's drug plans gets under way Oct. 1, and seniors will see some of the biggest changes since the Medicare prescription benefit became available in 2006. More than 17 million are enrolled in private drug plans offered through Medicare." On the positive side, the program's benefits "will improve with a new 50 percent discount on brand-name drugs for those who land in the program's coverage gap, the dreaded 'doughnut hole.'" Avalere adds that three million seniors will see their plans discontinued.

Counterpoint:  On the other hand, Vice President Joe Biden, the U.S. Department of Health and Human Services and the Centers for Medicare & Medicaid Services (CMS) today announced that the nation’s pharmaceutical manufacturers will provide 50 percent discounts on the cost of covered brand-name prescription drugs for beneficiaries in the Medicare Part D coverage gap, or donut hole, starting in 2011.   Vice President Biden and Secretary Sebelius made the announcement on a grassroots conference call with seniors from across the country. On the call, the Vice President and the Secretary discussed the benefits of the Affordable Care Act for seniors including the prescription drug discounts and provisions in the law that help fight fraud and make certain preventive care and annual wellness exams, free for most Medicare beneficiaries.  Seniors and people with disabilities enrolled in Medicare drug plans will also find next year that through the use of the new tools provided by the Affordable Care Act, premiums are stable and the number of prescription drug plans that voluntarily help fill the donut hole has increased. In August, CMS reported that the average 2011 Medicare prescription drug plan premium will remain similar to rates beneficiaries are currently paying this year – an increase of $1.  “Most Medicare prescription drug plan premiums will remain stable next year and beneficiaries will find there are clearer plan options and many plans that can help them save even more – like those plans that are offering benefits that help fill the donut hole,” said CMS Administrator Donald Berwick, M.D. “They will find that the Affordable Care Act improves the value of drug coverage they get next year.”

Source 1:  Associated Press/Medical News Today (September 27, 2010)
Full story:

Source 2: (September 23, 2010)
Full story: 

As the saying goes, I report, you decide.  I guess only time will tell.

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The proportion of America's seniors living in poverty dropped last year to just under 9 percent, a hopeful statistic in an otherwise dismal report on poverty released Thursday by the U.S. Census Bureau.  Local senior advocates, however, say the numbers mask some of the financial struggles older residents face living in the Bay Area, where the cost of living is high.  "The seniors have it tougher than the regular people," said Richmond senior advocate and retired United Parcel Service worker Fred Jackson, 73. "I always thought that seniors were cheaper, but as you get older, you become more dependent on the services provided."  Some advocates are pushing for a new way of measuring who has the resources needed to make ends meet. The federal poverty line, which the government uses to determine poverty, is the same for everyone in the contiguous 48 states, no matter the local cost of living.  The poverty line is determined by income and family size -- for a single person, being poor means making about $11,000 or less a year. But that amount of money buys more in some states than it does in California, especially in the pricey Bay Area.  An "Elder Index" created by the UCLA Center for Health Policy Research finds that East Bay residents over age 65 would need more than $24,000 annually to make ends meet if they are a single renter, and more than that if they are paying a mortgage on their home. Even a single homeowner with the mortgage paid off would need almost $18,000 -- well over the poverty line -- to cover basic necessities while living in the region. And these figures all assume that a senior is in good health.  The problem with the federal poverty threshold is that it is rooted in the cost of food, and ignores the stark geographical and demographic differences in the costs of housing, medical care and transportation, argue researchers with the Oakland-based Insight Center for Community Economic Development, which is pushing for state officials to take the "Elder Index" into account.

Editor's note:  According to international measures, over 25% of U.S. seniors live in poverty.  

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A new study by the University of Michigan reveals that racial and ethnic differences play a role in the emotional attitudes of caregivers of Alzheimer's patients. These findings could help improve support services for caregivers.

The study, conducted by James McNally of the Inter-university Consortium for Political and Social Research, part of theUniversity of Michigan's Institute for Social Research, looked at more than 600 caregivers in three racial and ethnic groups: whites, blacks, and Hispanics. The study found differences in the way these groups accepted death, let go of loved ones, and expressed anger.

According to the study, whites and Hispanics are three to five times more likely as blacks to feel relief when the Alzheimer's sufferer dies. McNally explained that this is consistent with studies that show that blacks have more stressors in their lives than other groups, so they do not get a break after a loved one dies. In addition, the study showed that whites are twice as likely to report emotional acceptance at the death of a loved one as Hispanics and blacks.

The study showed the groups have big differences in feelings of anger toward the deceased. Black caregivers were twice as likely to express anger as Hispanics. Meanwhile, white caregivers were considerably more likely than both Hispanics and blacks to report feelings of anger.

McNally presented the study at the Alzheimer's Association's International Conference on Alzheimer's Disease in Honolulu. McNally believes these results can help provide support services to caregivers. For example, blacks may need to address the ongoing other stressors in their lives, but Hispanics could need to focus on separation issues with the deceased.


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