Nursing Homes|Nursing Home Abuse|Assisted Living Facilities

As people age, they become more susceptible to a range of health and well-being risks. From the possibility of a heart attack or stroke to the risk of a serious fall or other injury, there are numerous concerns that may arise among seniors and their loved ones. Unfortunately, these concerns sometimes lead to undesirable choices such as moving seniors to assisted living facilities or requiring expensive and possibly intrusive round-the-clock caregiving. One of the most exciting and effective responses to these problems is the medical alert system for seniors. Providing the elderly with a way to get help in the event of an accident or injury even when they're home alone, this type of system may be a wise choice for some families. Medical alert systems aren't perfect, however, and considering some of the most prominent facts about the systems before purchase can make any decision more confident and ultimately successful.

An especially useful feature of modern medical alert systems for seniors is the ease of use they typically afford. Most systems consist simply of a base unit similar to an answering machine; this is plugged into an electrical outlet and a phone line. The only other piece of necessary equipment is the wearable remote that the user can employ to make contact with the base unit, thereby alerting the monitoring service to an emergency. These remotes are usually encased in a small plastic object that can be worn around the neck or wrist, and a button typically functions as the alert mechanism. While this basic system is highly effective if properly used, it's important to note that keeping the remote on at all times is essential; if the button is out of reach, the system won't work, effectively nullifying the system's purpose.

Keeping the remote button on at all times is central to the effective use of a senior medical alert system, but when a user is away from their residence, other safety measures will need to be considered and put into place. The range of a given base unit will vary from one system to the next. While some are limited to a fairly small area, others are intended to reach through every room in a house, as well as some or all of the surrounding grounds. Knowing how far a remote button wearer can venture from the base unit and still be covered is important for making a wise purchasing decision, as is keeping in mind that no system can protect a senior once they've left the service area.

The equipment used in a medical alert system is crucial in determining the system's overall ability to perform as desired. Quality equipment should always be used, and while it may not always be easy to discern which units are more or less proficient, checking whether the equipment meets general standards, including those from the Underwriters Laboratories (UL), can help identify worthwhile models. Just as critical to the success of an alert system, however, is the quality of service that's activated whenever the equipment is actually used.

Medical alert companies may perform the necessary services of an alert system in-house, or they might outsource the service to another company, often in an effort to save money. Buyers should always be aware of whether an offered service is conducted by the same company that sends out equipment and collects payments, as in-house service usually indicates a company is fully committed to providing a quality product. Great services should also offer a range of options to medical alert system users. Sometimes, these services merely route calls to local emergency personnel, which can result in legal problems or may even cause emergency departments to block known alert numbers. When seniors are able to first connect with an alert system operator, they can convey whether they're truly in need of emergency assistance, or would simply like their family member, neighbor, or other pre-arranged contact to be notified.

An especially important fact about medical alert systems is that they're as useful for peace of mind and emotional well-being as they are helpful when accidents actually happen. The stress and worry that seniors and their families may experience when little to no security measures are in place can be exhausting, and may even lead to actual physical symptoms. Choosing a medical alert system wisely and allowing it to take the mind off of possible injuries or other dangerous situations can help family's support independent living and its many benefits without feeling vulnerable or afraid.

Medical alert systems for seniors can be highly effective in providing safety and a sense of comfort to the elderly and their loved ones, but there are many things to know before making a purchase and signing a contract. With the right choices, this method of preserving independence can benefit entire families.

What Does a Pharmacy Technician Do?

I have been writing articles on why and how to become a pharmacy technician, but some recent feedback has made me realize I left out the obvious. What is it that pharmacy technicians do in a pharmacy? Most people figure they help the pharmacist enter prescriptions and count pills. This is true for an outpatient pharmacy, also called a retail pharmacy, but there are many roles for pharmacy technicians in healthcare. The rest of this article will list different types of pharmacy settings and the roles that pharmacy technicians have in these settings.

Community/Retail Pharmacy:

I have worked retail, and I prefer other settings; however, it is where a large percentage of pharmacy technician jobs are found. What a pharmacy technician can do is determined by the state they work via state laws and rules. In general, technicians cannot provide clinical information to patients or be the final check for prescriptions. In some states, technicians are allowed to provide information on over-the-counter (OTC) medication (ie, medications that do not require a prescription, such as, acetaminophen and ibuprofen). Pharmacy technician tasks include, but are not limited to:

• Collecting patient information (insurance and personal information as needed)
• Entering and processing prescriptions in the computer system
• Filling and selling prescriptions
• Requesting refills from doctor offices for patients
• Compounding medications that are not commercially available
• Ordering medications
• Restocking shelves
• Answering the phone
• Working with insurance companies on approving payment for certain medications
• Maintaining the cash register and conducting accounting functions

Hospital Pharmacy:

There are many different roles for pharmacy technicians in a hospital pharmacy. I know this type of pharmacy best since this is where most of my work has been. The most common are technicians who work in the central pharmacy. In addition we have decentralized techs, sterile compounding techs, billing techs, OR techs, narcotic techs, database techs, automation techs, team lead techs, and buyer techs. These technicians as a whole perform the following tasks, but not limited to:

• Filling new orders, this includes a variety of medications from oral medications to specially prepared sterile compound medications (including chemotherapy meds)
• Answering the phone
• Tubing medications (if the pharmacy has a pneumatic tube station)
• Preparing medications for delivery
• Delivering medications
• Assisting floor pharmacists with medication histories
• Assisting floor pharmacists with IV drip checks
• Handling missing dose calls
• Billing medications where nurse charting does not bill
• Maintaining the pharmacy database
• Restocking operating rooms and anesthesia trays with appropriate medication
• Dispensing and tracking all controlled substances throughout the hospital
• Maintaining automation equipment [automated dispensing cabinets that store medication on nursing units, automatic fill systems (typically called Robot-Rx)]
• Purchasing of all medication and supplies needed in the pharmacy
• Leading and managing the technician workforce, including upkeep of schedules

Long-Term Care Pharmacy:

I have worked at a couple of long-term care pharmacies, and I think it is a great place to be a technician. They typically employee a lot of techs because the work load lends itself to a lot of technician tasks. These pharmacies provide the medication needs for nursing homes, assisted living facilities, and psychiatric facilities. The typical pharmacy is located in a warehouse. It does not have an open pharmacy for people to come to; they receive orders by fax and deliver all medications via couriers or drivers to facilities. The oral medication is filled in blister packs (cards of 30 tabs that are used to provide a 1 month supply of medication), or some other mechanism that provide the facility with an extended amount of medication doses that can be safely and cleanly kept until doses are due. Pharmacy technician tasks include, but are not limited to:

• Filling new and refill orders (different from hospital because of the number of doses provided)
• Processing new order and refills coming through the fax machine
• Order entry of prescriptions and printing of labels for fill techs
• Sterile compounding of medications (although there aren't as many sterile compounded medications as a hospital, there are still enough that most long-term care pharmacies have a few techs specialize in sterile compounding
• Billing medications to homes
• Controlled substance dispensing and documentation
• Ordering medications and supplies
• Restocking medications that are returned that are still suitable for reuse.

Home Infusion Pharmacy:

These pharmacies primarily care for patients that require some form of IV or other non oral medication, and want to receive the therapy at home (hence the name home-infusion). I have also worked in a home-infusion pharmacy. As a tech I had a lot of experience in sterile compounding, and found my self in any position that needed a IV room tech. Pharmacy technician tasks include, but are not limited to:

• Compounding sterile preparations in the clean room
• Preparing supplies associated with sterile medication administration for delivery
• Billing medications delivered to patients home
• Coordinating deliveries of medications with patients
• Entering orders in the pharmacy order entry system

Nuclear Pharmacy:

No, I have not worked in a nuclear pharmacy (I am sure you were staring to think I got around quite a bit, but I have been in pharmacy for about 17 years). I have some friends who work in a nuclear pharmacy. The hours are interesting; they usually come in at about 3 AM and work until about noon. These types of pharmacies make radioactive compounds and they need to be made in a way that when they are delivered to the hospital or clinic administering them, that the dose has degraded to a specific amount. Without going into too much detail, these medications have short half-lives. So they have to time the compounding of the product with the time it takes to deliver the medication and the time the patient is to receive the dose. The job pays well, but as you can imagine, there are not a ton of these positions available. Pharmacy technician tasks include, but are not limited to:

• Preparing radioactive products
• Cleaning and preparing sterile compounding areas
• Entering orders into the pharmacy system
• Coordinating dose due times with deliveries and preparation
• Billing products to hospital or clinic

Health Plans/HMO Pharmacy Group:

I saved this one for last because it is a lot different. Most healthcare plans have a pharmacy department. They manage the pharmacy benefit of the health plan. I have worked with my companies health plan and have spent some time with the pharmacy department. Pharmacy technician tasks include, but are not limited to:

• Answering phone calls and providing support for patients on the pharmacy benefit
• Reviewing prior authorization requests
• Providing support to physicians and drug companies for information requests
• Supporting the pharmacists in the department with database and projects as needed

As you can see, pharmacy technician roles can be very diverse. The best advice I can give you is to figure out what setting you would most like to work in and obtain some experiential hours in that setting. I have found that the type of pharmacy you train in is typically the type of pharmacy you end up working in.

Owners of commercial property and/or leasehold improvements can now legally redirect their Federal and State tax dollars back to their business. The alternative is to give your money to Uncle Sam to be managed...YIKES!! This process, known as cost segregation (A.K.A. cost seg or accelerated depreciation), is available to commercial property owners with holdings over $200k.

Cost seg is an IRS approved tax strategy allowing owners of commercial property to increase their cash flow and decrease their tax liability. A comprehensive study frontloads depreciation deductions into the early years of ownership, thus capitalizing on the time value of money.

A deduction today is always going to be worth more than that same deduction five or ten years from now.

Cost seg is the process of identifying, separating, and reclassifying costs in a commercial building from 39 year (or 27.5 year) property to 5, 7 and 15 year property.

• For example: The carpeting in a commercial building can be reclassified from 39 year property to 5 year property using cost segregation.

In general, an engineer based study can yield a tax savings of 8%-12% of the cost of any given property. A one million dollar property could yield a tax benefit of $100,000 or more.

So why isn't every owner of commercial property utilizing this tax strategy?

Many property owners are simply unaware of this tax strategy. Every year, thousands of commercial property owners overpay their taxes. Oh, and chances are your accountant is NOT "already doing that for you". A proper cost seg study is comprised of tax law/knowledge and engineering principles (cost estimating, construction, and blueprint comprehension). Most accounting firms do not specialize in this area; however, a good cost segregation company will work hand in hand with the property owner's accounting firm to make the final application of the study a turn key solution. A completed cost segregation study does not replace the important role an accountant plays in preparing tax documentation or determining tax liability.

Who qualifies for a cost segregation study?

Any property owner who has:

• Purchased or constructed a commercial building or facility after 1986


• Renovated, remodeled, expanded or restored an existing facility


• Paid for office or facility leasehold improvements


• Purchased commercial residential property such as an apartment complex/building

Cost segregation can benefit owners of apartment complexes, assisted living facilities, auto dealerships, banks, casinos, car washes, fitness centers, gas stations, grocery stores, hospitals, hotels, medical facilities (doctors, dentists, etc.), office buildings, storage facilities, restaurants, retail centers and more.

Think of the benefits of cost segregation this way: If you were given a check for a million dollars and had to choose to either cash it now or in 39 years, what would you do? Well, most people would cash it now, because the time value of that money is worth more today than 39 years from now. This is the same idea with cost segregation.

By not doing a cost segregation study, commercial property owners are basically giving the IRS an interest free loan of money they could be using TODAY for their own benefit! They could pay down debt, purchase more property, invest it, or take a vacation. Educate yourself on this tax strategy.

In desperate situations, EMT's and Paramedics are usually dispatched by way of a 911 operator to the scene where they often work together with police and fire fighters. After they arrive, they rapidly assess the patient's condition while attempting to determine if the individual has any pre-existing medical ailments. Following protocols and guidelines, they offer emergency care and transport the sufferer with to a nearby hospital or medical facility.

EMT's and Paramedics use special equipment, such as backboards, to immobilize patients before placing them on stretchers and securing them inside the ambulance for transport to a hospital. This work is normally carried out in teams. During patient transport, one person drives while the other monitors the patient's vital signs and provides additional care. Some highly trained Paramedics are part of a helicopter's flight crew to quickly transport critically ill or injured patients to hospital trauma centers.

At the medical facility, EMT's and Paramedics help transfer patients towards the emergency department, report their observations and actions to emergency department staff, and may provide additional emergency treatment. After each run, the trip is documented, used supplies are replaced, and equipment is checked. If a transported patient has a contagious disease, the inside of the ambulance is decontaminated and cases are reported to the proper authorities.

EMT's and Paramedics also provide transportation for patients from one medical facility to another, particularly if they work under private ambulance services. Patients often have to be move to a hospital that specializes in treating their injury or illness in order to provide them with long-term care, such as assisted living facilities.

Beyond these general duties, specific responsibilities depend on the degree of qualification and training. The nation's Registry of Emergency Medical Technicians (NREMT) certifies emergency medical providers at four levels: EMT-Basic, EMT-Intermediate 1985, EMT-Intermediate 1999, and Paramedic. In most states, NREMT approved courses are available at community colleges and private training facilities to prepare for certification at all four levels.

Salaries vary with respect to the state and amount of training achieved. The national average salary, including EMT's of all levels, is $33,020 annually. Top earners on this profession earn typically $51,460 a year and up. Additionally, there is a great chance for overtime pay as demand for services is consistently increasing because of the growing and aging US population. No matter the salary, becoming an EMT or Paramedic is a superb way to start a career where you can help make an improvement inside your community and save lives!

Entering into a new environment create a cocktail of feelings. One might feel anxious, scared, or excited, especially when they do not know what to expect. It is no different with introducing one's self to an assisted living facility, even more so that their life would take a change to creating a new family outside of home. However, knowing what to expect would help ease some of that anxiety. Here are some of the things one can expect from an assisted living facility.

While each facility varies from one another in the package offered, there are some common things that each package should at least offer. For one, they should be provided three nutritious meals a day, and their room and laundry are maintained for them. There would be minimal amount of supervision on the elderly if they have able bodies, and they will be allowed to participate in the facility's social-recreational activities. The overall environment will be safe with the presence of 24-hour staff watching over the premises, while the bathrooms are designed and equipped for handicapped, ensuring that the bathrooms are ergonomic for the elderly.

Other services may also be provided, and would usually cost extra. For example, you could get assistance with the daily medications by a registered nurse to help the elderly be reminded or prepare the medication. Some elderly may also need assistance with bathing as they may not be able to do it on their own. Apart from that, there can be services to help with daily living tasks, such as dressing up, walking, using the toilet, and even eating for the elderly who have trouble doing them on their own. If there is a need to transport the elderly from the facility to the doctor's office, physiotherapy centre, or other places, this service is also provided.

Although the daily necessities are provided for the elderly, one should visit their elderly frequently as no one can replace the company of their own relatives and friends. No elderly person would want to feel left behind.

Veterans Aid and Attendance Pension Benefit -- Long Term Care Benefits for Veterans What Is the Aid and Attendance Benefit? The Veterans Benefits Administration offers a disability income available to veterans who served during a period of war or to their surviving spouses. This special benefit is officially called "pension" but is more popularly known as the "veterans aid and attendance pension benefit". For a pension benefit for veterans younger than 65, evidence of total of disability must be provided. Veterans 65 and older do not have to disabled.

The National Care Planning Council estimates that as much as 30% of the US population over the age of 65 would qualify for the aid and attendance pension benefit under the right circumstances. That's how many war veterans or surviving spouses of veterans there are. The benefit is such a well-kept secret that only a small fraction of these eligible veterans are actually receiving it. Death pension -- a benefit available to a surviving spouse-- is a lesser amount based on the same rules for applying for a living pension claim. In other words, the deceased veteran must have met the rules for pension -- with the exception of being totally disabled or over age 65 -- or have been receiving pension in order for his or her spouse to receive the lesser benefit. In addition, in order to be eligible or keep receiving the benefit, the surviving spouse must remain single.

Who can submit a claim? A claim is submitted by the veteran or by the veteran's single surviving spouse in the case of a death claim. A duly appointed service organization, an employee of the local regional VA office, or a VA approved agent may file a claim on behalf of the veteran or the spouse. A claim cannot be filed with a general or durable power of attorney. The application will be sent back requesting proper documentation for a VA power of attorney. The veteran must sign a document specifically authorizing a power of attorney for someone to submit an initial claim for him. Many chagrined children with a durable power of attorney have submitted claims on behalf of a parent only to have the claim rejected by VA.

What happens if the veteran is incompetent? If the veteran cannot submit the original application or sign a power of attorney for a surrogate to file an application, then a duly appointed guardian can complete the application. VA also allows the spouse, a parent or next of kin, or a friend to complete and submit an application on behalf of an incompetent veteran if that person submits the proper power of attorney request and indicates the applicant could be considered incompetent for financial affairs. Even though the veteran or surviving spouse may be incompetent for financial affairs, he or she should always sign the power of attorney request if he or she is competent to do so. VA may appoint a fiduciary to take over the claim and the affairs for the claimant if VA determines he or she is incompetent.

How does VA handle power of attorney? Employees of VA and veterans service organizations already have authorization for power of attorney to file an application on behalf of the veteran. They have forms for the veteran to sign to allow this to happen. An attorney representing the veteran in other affairs can also request a power of attorney in the proper format and on his or her letterhead. Any single individual may also submit a letter requesting power of attorney to submit an application if it is signed by the veteran and if the letter provides certain required information. There is also a VA form in the book support packet that can be submitted for power of attorney. All attorney requests submitted for power of attorney must state that the veteran is not paying a fee to file the application on his or her behalf.

What is an "aid and attendance" or "housebound" rating? A "rating" is granted by a veteran service representative where a condition exists that makes the disability more severe. Medical evidence is required unless someone is a patient in a nursing home, and then the requirement is waived. The rating allows VA to pay an additional monthly amount of pension or compensation to a veteran or a surviving spouse for additional costs associated with this disability.

How does one qualify for aid and attendance or housebound rating? The application form has a block allowing for a request for either rating. Submitting medical evidence in advance instead of waiting for a request from VA can help expedite the process of getting this rating. We have provided in the book support packet, a sample form that might be used for this purpose. This form is also designed around information that VA is looking for and may be a more effective presentation of the facts than typical medical records from the doctor.

What is the effective date? The effective date is generally the day VA receives an original application. If it takes three months for the process of approval or six months, it doesn't matter. The effective date still reverts to receipt of the original application.

When does payment begin? Generally, payments start on the first day of the month following the month of the effective date. This means that if it took six months to get approval, at least five months of benefit will be paid retroactively. VA requires automatic deposit of awards in a checking or savings account.

What happens if the veteran dies during the period of application? If the veteran dies during the period of application and the application was not approved prior to the death, there may be accrued benefits. If the regional office had all of the information in its possession that would have led to an approval, then there is an accrued benefit payable. Otherwise there is none. The full benefit is available for the month of death of the veteran and to a surviving spouse through an application on Form 21-534. This is the same form a surviving spouse uses for a death benefit claim for himself or herself. VA will award either an accrued benefit or death benefit to the surviving spouse whichever is larger. If there is no surviving spouse or dependent child, VA will pay the unreimbursed costs of last illness and burial to the person who paid those costs. A special claim must be submitted for these costs, not Form 21-534.

What is a veteran's federal fiduciary, and does that affect the application? For a veteran who is considered incompetent to handle his own financial affairs, VA will appoint a fiduciary to receive the money and pay the bills. A federal fiduciary is an individual appointed for this purpose, usually a spouse or a family member. In most cases -- except for the spouse living with the veteran -- there is an interview required and mounds of paperwork. This process can take a long time, and it is to the advantage of the person filing an original claim to request the appointment of himself or herself as a fiduciary or for some other appropriate person or organization to help expedite the process. VA always makes the final decision on whom it appoints as a fiduciary. In fact, the agency might well ignore court appointed fiduciaries. In general, the decision favors declaring the veteran competent and avoiding a fiduciary where at all possible.

What is the income test for pension? If the household income adjusted for unreimbursed medical expenses and a deductible is greater than the maximum allowable pension rate -- MAPR -- there is no benefit. In 2007, the maximum allowable rate for a couple with aid and attendance allowance is $21,615 a year. For a single it is $18,234 a year. Without aid and attendance or housebound allowance the maximum couple's rate is $14,313 a year and for a single it is $10,929 a year. Death pension rates are lower. People seeking a benefit with adjusted incomes greater than these levels will be denied.

Can a household with income above the maximum limit qualify for pension? A quirk in the way benefits are calculated can allow individuals and couples earning between $24,000 to $60,000 a year to still qualify for a benefit. It has to do with the treatment by VA of the very large recurring medical costs associated with home care, assisted living, or nursing home care.

What is the pension household asset test, and what can be done if the asset test is not met? As a general rule assets cannot exceed $80,000. A veteran or spouse occupied-house, a reasonable amount of land upon which it sits and a vehicle are exempt from the asset test. In reality there is no specific test in the regulations. Veterans service representatives are required to file paperwork justifying their decision if they allow assets greater than $80,000. Thus this amount has become a traditional ceiling. The service representative is encouraged to analyze the veteran's household needs for maintenance and weigh those needs against assets that can be readily converted to cash. In the end, the decision as to allowable assets is a subjective decision made by a service representative. In certain cases a benefit award could be denied even if assets are below $20,000 or $10,000 or even zero dollars. There are legal ways to get around the asset test if assets are too high. These are described in our book.

What proofs and documents are required with the pension claim? We have already discussed the requirements for power of attorney and fiduciary if they apply. In addition, an original copy of the discharge from service -- typically DD 214 or form WD -- is required and the discharge must have been honorable. If there is a question about the marriage relationship, a marriage certificate or other proof may be necessary. Birth certificates of dependent children are usually not required but may be necessary under certain conditions. A dependent child is a minor, a dependent student under age 23, or a totally dependent adult child. There are certain documents that need to be submitted to prove future recurring medical expenses and to prove need for aid and attendance or housebound allowances. VA does not furnish these documents nor provide any information that they are required. Sample documents that could be used for these purposes are included in our book.

Can someone charge to help fill out the form? Federal code and VA regulations prohibit an agent, advisor or attorney from charging a fee to fill out and file a claim for pension. Most practitioners or providers help their clients for free, sometimes in the context of solving other retirement issues or providing long term care services. Some practitioners offer application advice for a fee (which is legal) but will send their clients to a veterans' service organization to complete the application. Some assisted living facilities or home care providers also offer free advice or help and this seems to be an acceptable practice. An agent or attorney can also be paid by a disinterested third party under certain conditions to complete an application. However, a home care agency, assisted living facility or nursing home that pays an agent or attorney to complete an application on behalf of a resident or client does not meet the definition of a disinterested third party is in violation of the prohibition for charging a fee

How are assets, income and unreimbursed medical expenses determined? The applicant must submit details on the application of all income and all assets including retirement savings accounts such as IRAs. Almost any type of money received or anything received that can be converted into money is income. The only exclusions for assets are a personal residence (occupied by the veteran or spouse) and a reasonable amount of land it sits on as well as vehicles and other personal possessions. Personal possessions used as an investment such as a coin collection are counted as assets. Unreimbursed medical expenses can be almost any expense related to medical needs.

Are there any other reporting requirements? VA requires that any change in income or assets be reported immediately. The award is calculated for 12 months in advance, but at the beginning of each calendar year, a formal report called an EVR (Eligibility Verification Report) must be filed detailing all income, assets and unreimbursed medical expenses for the coming calendar year. For example if the award is granted in April for 12 months in advance, an EVR must be submitted in January of the next year that could affect the award amount for the remaining four months of the initial 12 month period. The EVR will be used for determining benefits for the calendar year on which it is based.

What is a veteran's federal fiduciary, and does that affect the application? VA can appoint a number of different types of fiduciaries to manage the funds on behalf of an incompetent veteran. A federal fiduciary is typically an individual such as the spouse or a child whom the VA is most likely to appoint. If VA is not notified with the application that the veteran may be incompetent and that a fiduciary appointment is requested, this could slow down the application and approval process.

Will the pension benefit pay a nonlicensed homecare provider? VA does not pay providers directly but provides extra income to make up for the cost of licensed medical care. Medical conditions or injuries or diseases that require a need for ongoing licensed homecare will allow the applicant to reduce household income by the cost of homecare making it possible to receive the additional income from a pension award. If the beneficiary has an aid and attendance or housebound allowance, VA will allow deductions for nonlicensed providers as well.

Will the pension benefit pay a member of the family to provide care at home? As explained above, VA will not pay providers directly but only indirectly through extra income. If the beneficiary receiving care in the home has received a rating for aid and attendance or housebound, VA will allow expenses paid to a family member for care to be counted as unreimbursed medical expenses to qualify for the benefit. The care arrangement must be legitimate and appropriate evidence must be provided.

Does the pension benefit pay the costs of a nursing home? The application form has provision for indicating residency in a nursing home and whether or not the applicant is eligible for Medicaid. VA will automatically apply the monthly cost of the nursing home in determining the pension benefit. If the applicant is single with no dependent children at home and is eligible for Medicaid, VA is required to stop any payment of full benefits and only provide the veteran with $90 a month.

Does the pension benefit pay the costs of assisted living? As explained above, VA will not pay providers directly but only indirectly through extra income. If the beneficiary receiving care in assisted living has received a rating for aid and attendance or housebound, VA will allow expenses paid to assisted living for aid and attendance or housebound ratings -- including room and board -- to be counted as unreimbursed medical expenses. The cost of assisted living being used as a retirement residence is not considered a medical expense. It does not warrant a rating and cannot be deducted.

What are the requirements to receive a death pension benefit? The applicant must be a surviving spouse or a dependent child of an eligible veteran. VA form 21-534 is used to apply for death pension, death compensation, accrued benefits, or dependency and indemnity compensation (DIC). The surviving spouse must be single. A surviving spouse of any age is eligible as long as the deceased veteran served at least 90 days during a period of war. They had to be married at least a year prior to death or have a child as a result of the marriage. There is no requirement for total disability for the surviving spouse nor for the deceased veteran to have been totally disabled or older than age 65.

How does one prove that unreimbursed medical expenses will recur every month? VA has specific rules for proving future recurring medical expenses. Information in our book outlines the type of paperwork that must be submitted for each type of long term care service. The book also contains appropriate forms for this purpose. Neither the claims form nor information from the regional office provides any guidance on the rules for proving future recurring medical expenses for home care or assisted living. One simply has to know how to do it. This one crucial step often makes the difference between a successful claim and a denial.

What if the veteran or spouse is currently receiving Medicaid? Our interpretation of the rules leads us to believe that VA will not consider Medicaid payments as income. However, Medicaid will consider the nonallowance portion of the pension to be income. This could affect Medicaid eligibility in income test states. There is evidence that some income test states count the entire pension benefit including the allowance as income. According to federal Medicaid rules this should not happen.

What happens when the veteran or spouse wants to receive pension & Medicaid together? Federal law requires that a single veteran receiving Medicaid with no spouse or dependent children can receive no more than $90 a month from VA. Veterans in state veterans homes are exempt from this requirement. The veteran with a spouse can receive the benefit to help defray the costs of a nursing home. As a general rule, the pension benefit would probably not work if Medicaid were paying the bill. But the benefit does work well for non-Medicaid nursing home beds and while the recipient is going through the Medicaid spend down.

This article is an excerpt from the book -- "VETERANS AID AND ATTENDANCE BENEFIT -- LONG TERM CARE BENEFITS FOR VETERANS" -- published by the National Care Planning Council and written and edited by Thomas Day, Council Director. This first-of-its-kind book is available in two editions -- the Standard Edition (209 pages) for the general public and the Professional Edition (443 pages) to be used as a handbook for advisors and care providers. Both books contain the necessary information and forms to complete an application for the benefit. The Professional Edition also includes citations from rules and regulations, hypothetical planning cases, asset reduction strategies and a software CD with benefit estimate software, all applicable forms and planning sheets. To review and purchase the book go to http://www.longtermcarelink.net/a16veterans_books.htm or type in your browser window www.veteranbook.com.

It's part of life. As people get older, they are forced to deal with a greater number of serious emotional losses. Do your nursing assistants have an understanding of the types of losses experienced by the elderly? Do your CNAs know how to help their elderly clients deal with those losses? Consider sharing the following information at your next CNA inservice meeting.

Emotional Losses of the Elderly

There's no way around it. Losses are painful and often sad. They represent an end to something-and this ending creates an emotional wound. This is especially true for the elderly who must endure a number of different emotional losses. For example:

• At age 65, Sarah Smith retires from her job. Even though this gives her more free time, she misses the daily contact with her former coworkers. A year later, Sarah's husband dies. His sudden death leaves her devastated...and in some financial trouble.


• During that same time, Sarah is diagnosed with both diabetes and hypertension. She also develops chronic back pain.


• On her 67th birthday, Sarah receives word that her sister has passed away. Three months later, Sarah's best friend dies from cancer.


• Six months later, her son decides that she should no longer live alone. He helps Sarah sell her house and moves her into an assisted living facility.


• To the staff at the facility, Sarah seems like a grumpy, forgetful woman who keeps to herself and seems impossible to please. No one is very fond of her. But look at things from Sarah's point of view. Within two short years, she has lost her work, her friends, her health, her husband and her home. Is it any wonder that she tends to be grumpy and withdrawn?

Just like physical injuries need time to heal...so do emotional wounds. People who spend time grieving are doing what they need to heal their emotional wounds. The only "cure" for grief is to go through the grieving process. People must do this in their own way and at their own pace.

Grieving is hard work and can leave people physically and emotionally exhausted. In the end, the process of grieving encourages people to take charge of their own lives and to move forward.

Keep reading to learn more about the losses people face as they age, the different ways these losses can affect people and what you can do to help.

The Loss of Youth

As people lose their youth, they may start to realize that their days on earth are growing short. Some people react to this by considering every day to be precious. They work hard to live each day to the fullest. Others react by becoming depressed and by giving up their youthful hopes and dreams.

What You Can Do to Help

• If you have negative feelings about getting older, don't let them show during your work with your clients.


• Help your clients focus on the things they are still able to do, rather than dwelling on the things they can't do anymore.


• Talk to your clients about current events, such as politics, music and movies. Keeping up with the times helps people stay "young at heart".

As people age, it's common for them to lose a number of loved ones. They must face the deaths of their parents, their siblings and their friends. However, it's not always death that takes away family and friends. Longtime friends may move away-to retirement homes or nursing facilities. Children and grandchildren may also move. But no matter what the cause, the result is the same: older people feel they have lost their loved ones.

People who have lost friends and/or family members may feel unloved and unappreciated. They are at risk for depression.

What You Can Do to Help

• Don't dismiss the grief that older people feel when they lose their parents. For example, if your 75-year-old client loses her 95-year-old mother, her grief may run very deep. Encourage her to talk about her feelings and reminisce about her childhood.


• Remember that social connections are important for seniors. You can help by encouraging them to talk or write to friends and family members on a regular basis. And remember...it's never too late to make new friends.

Some people look forward to retiring at age 65. Others keep on working well past retirement age. However, even people who are looking forward to retirement feel some grief over the loss of work. Older people may feel pain over losing their daily schedule. They miss having someplace to go every day.

Many people take pleasure in being productive. A large part of their identity comes from their work-whether they are paid for it or not. If they lose the ability to be productive, they may feel worthless. They may start to think, "I am no good to anybody...I'm just taking up space."

What You Can Do to Help

• Remember that the goal for most seniors is to fill their time in a rewarding way-rather than to have each day drag on with no purpose. So, help your clients find a variety of interesting and fun ways to pass their time.


• Help your clients feel valuable by recognizing the knowledge and wisdom they have gained through the years. For example, ask for their opinion on a current event or on an issue such as how to invest money or discipline a child.

Losing a spouse, especially after a long term marriage, can be especially devastating. With the death of a spouse, many people lose their best friend, their confidante and their sexual partner. Every area of life is affected.

As married couples age, they usually hope to grow old together, but death often interrupts these plans. Most people live out their final years alone-especially women. (Among senior citizens, over half the women are widows. Only 13% of men have lost their wives.)

What You Can Do to Help

• Encourage your client to share some special memories of their spouse with you.


• Avoid offering false comfort such as, "You'll get over it some day." or "It was for the best." It's better to say nothing at all than to use "clich矇s" like these.


• Ask your supervisor is there is a support group that might help your grieving client.

As people age, they can experience a loss of health in a number of different ways. It can be a gradual process...slowly losing eyesight, hearing, muscle strength or memory. Or the loss of health can be a dramatic process...a sudden heart attack, stroke or tumor.

Some people react to a loss of health by denying that they have any problems. They continue with unhealthy habits such as eating too much, drinking too much and smoking cigarettes. Their attitude is, "Well, I'm going to die anyway...might as well do what I want."

Other people react to a loss of health by getting angry. They feel betrayed by their bodies and "cheated" out of a healthy future. Still others react by focusing on every little ache and pain. Their reaction is based on fear. They anxiously wait for the next health problem to appear-and they look for death around every corner.

What You Can Do to Help

• Help your clients maintain their health as much as possible by eating a healthy diet, quitting smoking and avoiding too much alcohol.


• Because chronic pain can be a problem in the elderly, learn all you can about pain management.


• Be patient with elderly clients who are dealing with chronic illnesses. It may sound to you like they are constantly complaining about their health, but would you trade places with them...even for just one day?

Many elderly people can still function on their own-they just take longer! Others may only need help for certain tasks like shopping for groceries or balancing their checkbooks. And, some seniors need help with basic everyday activities, such as bathing, grooming and dressing. Losing the ability to perform their own personal care can make your clients feel like children again. This can be difficult for many people to accept.

People who feel as if they have no control over their own lives may lose self-esteem. They may also become depressed and uninterested in doing anything for themselves.

What You Can Do to Help

• Allow your elderly clients to make as many of their own decisions as possible. This allows them to feel "in control" and may keep them from becoming more and more dependent on you.


• Enhance your clients' sense of purpose by giving them a responsibility: caring for a potted plant, straightening their room or folding their laundry.


• Above all, treat your clients with respect and dignity!

As you work with elderly clients, do your best to maintain your patience and your sense of compassion. Your clients deserve it! Here's a little reminder, from a poem by Shel Silverstein.

Said the little boy, "Sometimes I drop my spoon."

Said the old man, "I do that too."

The little boy whispered, "I wet my pants."

"I do that too," laughed the old man.

Said the little boy, "I often cry."

The old man nodded, "So do I."

"But worst of all," said the boy, "it seems grown-ups don't pay attention to me."

And he felt the warmth of a wrinkled old hand.

"I know what you mean, " said the old man.

I'm here with Margie Veis, the Executive Director of Summerhill Villa, an assisted living facility in Santa Clarita, California.

KH: We hear stories about elder abuse and things like that. How can families insure that won't happen?

MV:: Truthfully, I think that fear is always going to be in the back of people's minds.

Same thing as when you drop your child off at preschool. You're trusting strangers to take care of your loved one, so I think you need to be in tune and pay attention to your parent. Obviously, if someone has dementia and they say things you have to take it at face value, but I don't ever poo poo anything. I hate to believe it would ever happen, but I also would never stick my head in the sand and say it never would.

I think, again, getting to know who are the caregivers, getting to know the administrator, getting to know the nurses. Not that you have to be best friends with them but you can really get a feeling. Also, look at your parent and see how they are interacting. If every time a certain care giver walks by your parent they flinch, or it just doesn't feel right, you need to say something.

I don't think anyone could ever tell me it would never happen here because you can never say never. There are bad people and we do everything that we can, not to have them in our building.

KH: The residents could cause the problem. It's not necessarily your own people.

MV: That is true. It could be a resident. It could be a family member, it could be a visitor. I have to be in tune to family members with their parents. There are family members that take advantage financially, and there are family members that are verbally abusive. That's elder abuse. It's not only hitting someone, it's taking their money, it's using their money to buy personal things for you. It's calling your parents stupid, it's threatening them with things like "You know mom if you don't do this I'm not going to pay your bill. You're going to end up out in the street." It's physical. It's emotional. It's neglect. It's isolating. It's a broad spectrum of issues, and we have to be in tune to things like that. We do abuse reporting and those types of things with our staff because we're mandatory reporters.

It is suggested that nearly 70% of people with Alzheimer's disease will wander away from home and get lost. Wandering is one of the biggest risks for individuals with Alzheimer's disease and is a common but dangerous symptom of the disease. A wanderer is someone with a disease such as Alzheimer's who has wandered away on their own free-will from their caregiver. The risk is evident in the 31,000 Alzheimer's patients who researcher Robert J. Koester estimates wanders per year. When someone with Alzheimer's disease wanders, he or she is disorientated and unable to judge potentially dangerous places and situations. People suffering from severe Alzheimer's disease are more at risk and the incidence of wandering increases.

Alzheimer's patients may suddenly walk off and become lost, frightened or confused. Generally if a patient is found within 24 hours they are returned safely, but after a longer time span the survival rate drops to nearly 50 percent, according to recent studies. It is evident that wandering behavior can be a life threatening incident.

Koester's research provides more insight into wandering in Alzheimer's patients. Those with Alzheimer's disease leave their own residence or nursing home and usually start to wander along roads. Eighty-nine percent of wandering patients are usually found within one mile from the point last seen. If the patient is not wandering along the road (14%), they are usually in a creek or drainage (28%), or caught in bushes or shrubberies (33%). But, the Alzheimer's patient is frequently found wandering a short distance from a road. Unfortunately there are some wanderers who eventually give in to the environment and develop hypothermia or dehydration (35%), or are found deceased (19%).

It is important for you to know that you can help prevent incidents of wandering even though you cannot always guarantee total prevention. If you are aware of the causes of wandering you can minimize the risks of someone with Alzheimer's disease becoming lost. Although wandering remains a risk, there are several things that you can do to help prevent wandering in an assisted living center, long term care facility or at home to ensure that the family's loved one remains safe.

1. Install locks on doors- That is the first place to prevent a wanderer from leaving. However, in the earlier stages of Alzheimer's disease it is more likely for a patient to wander because they usually still remember how to unlock the current locks. Placing hook and eye latches on the outside screen door is proven to be very effective, especially if placed either very high or low on the door. Another method is to place a double key lock on the inside door, but be aware that the patient may begin to panic if they cannot open the door from the inside.

2. Install locks on windows- In general, most people would not consider exiting a building though a window, but an Alzheimer's patient who feels the need to escape would consider. Even windows on the upper levels of a house or facility should be secured. If there are windows that open by sliding side to side, consider placing a piece of wood on the track to keep the window from fully opening. Windows that slide up and down can be protected by putting a nail or screw in the tack to prevent it from completely opening also. If the window uses a crank, consider removing the crank each time after using it to open or close the window, and then hide the crack in an undisclosed place.

3. Build fences and gates- A fence is not as restrictive and offers patients an alternative place to go in relative safety. Chain link fences should be avoided because elderly patients still have the capability of climbing them rather easily. Also, stay away from building a fence with brace beams facing into the secured area because the support beams can provide a foothold for climbing over the fence. In general, a farm fence with square openings too small to be used as footholds is a very good option. Don't forget that it is important that the fence is at least six feet tall so a patient will not try to physically pull themselves over it.

4. Use emergency IDs- Even with safeguards and precautions, patients still could break free. You can make sure that a label with the elderly patient's name and phone number is worn on their clothing at all times. This is important because you can never depend on the patient to carry their ID when they wander, but it is vital that the wanderer can be identified immediately and returned quickly if they go astray.

5. A Patient Wanderer Security System- Accutech's Wanderer Security System (www.Accutech-ICS.com) can provide an assisted living or long term care facility with the security solution needed to monitor and care for their Alzheimer's patients and to help prevent wandering. By use of a Cut Band system, a gentle band and tag is placed around the patient's wrist. Then staff is able to be notified if the band is tampered with or removed and if the patient leaves the room or facility. Such systems are a great way for facilities to help prevent an Alzheimer's patient from wandering.

6. Dress patients in bright colored clothing- It is known that bright and distinct clothing can be spotted from a distance. Dressing in clothing that is easily spotted in a crowd is helpful when taking a patient out of the home or facility and to a public area. It is very easy for an individual with Alzheimer's disease to become separated especially when there is a crowd. It can happen within seconds.

7. Keep all keys in an undisclosed place and out of reach- An individual with Alzheimer's disease may still be able to recognize a key and understand how it is used. A patient that gets a hold of a car key or is able to let themselves out of the home or facility can be gone for miles before being noticed. This does happen and it happens more often than thought.

8. Never leave an Alzheimer's patient alone in the car- According to several surveys each year the number of times an elderly patient is left in the car while the caregiver runs quickly into the store, bank, etc. has significantly increased. Even though you might only think you will be gone for only a few minutes, the Alzheimer's patient is often left in the car for more than15 minutes. You must remember that it only takes seconds for a frightened or panicked individual with Alzheimer's disease to get out of the car and quickly wander away.

9. Avoid leaving an Alzheimer's patient home alone- Determining when an individual with Alzheimer's disease is no longer to be left at home alone for short periods of time can be difficult. This makes it very challenging for someone who is the sole caregiver for a person with Alzheimer's disease. Still, there are several ways to find assistance. One, alert neighbors to keep an eye out for the wandering patient or have a neighbor visit when you are going to be gone for more than a few minutes. Two, use the idea of a babysitter and have a young adult stay with and care for the elderly patient while you are gone. Three, ask for help. Churches, high schools, Boy/Girl Scouts, community centers, senior citizen centers, local Alzheimer's Association chapters and any other group you can uncover could be willing to assist you in caring for someone with Alzheimer's disease.

10. Find other useful materials to help- You often have to be creative to keep an individual with Alzheimer's disease safe by using house hold items. For instance, baby monitors or motion detectors that turn on lamps or radios to alert if a patient is moving around or trying to leave are both items that are either easily found at home or at a store. Another idea is to look through a child safety center for more items to help keep track of an Alzheimer's patient. For example, the elastic bands mother's attach to their wrist and their child's wrist can be a great help when taking an elderly patient into a crowded area. Also, hanging bells on a door can also be a useful alarm.

The risk of wandering in individuals with Alzheimer's disease is very great. You can take precautions to keep patients safe, but even the best caregiver or nurse will have experiences with wandering patients. Take reasonable precautions, don't panic and enlist others to help you care for patients with Alzheimer's disease.

Adapted from New Research & Perspectives By Robert J. Koester M.S. Virginia Department of Emergency Management Appalachian Search & Rescue Conference,

Let's face it: growing older is a difficult process and a bit tough to cope with. Not only do the elderly experience varying levels of immobility as they age, they grow to be less able to doing a number of things on account of their deteriorating health and energy levels. For this reason it is very important be sure that the elderly be as comfortable as possible at all times. Recliner and lift chairs for the elderly can surely help.

A little bit of background would be useful before you begin shopping around, since there are such a lot of choices and features. Here are some essential considerations when choosing recliner chairs for the elderly.

Recliner chairs are motorized to rise slowly and tip slightly to enable the individual to stand. They provide independence and comfort to people who face difficulties in rising from a sitting position. Available in several sizes, styles and performance, they are vital and permanent fixtures in most elderly assisted living facilities. Many chairs can be reclined to various degrees for optimum comfort. They are good for people affected by arthritis, muscle ache, back or hip problems, and different associated conditions.

These special chairs are designed to carry almost anybody's weight and come in many fabrics and styles. They are inexpensive on almost any funds; when they're a requirement to offer comfort to the aged throughout the day, they're priceless. When deciding on the correct chair it's possible you'll think about necessary elements equivalent to the weight of the person who will use it, the height of the user and the amount of time the chair will probably be used every day. Recliner chairs for the elderly are expertly crafted with a quiet and smooth lift system that will not be intrusive or disturbing to anyone. The variety of reclining positions might be the most important factor in selecting the fitting chair. Here is an explanation of the three basic reclining options:

- Two Position Recliner Lift Chairs: Two position chairs are probably the most economical and are perfect for a user who won't be spending a considerable amount of time in the chair. It provides the basic sitting position, 45 degree reading position and lifted position to assist the user to get out of the chair safely and easily.

- Three Position Recliner Lift Chairs: The three position is often the most popular because it presents multiple positions such as normal seated, napping position and of course the lifted position to assist the user out of the chair.

- Infinite Position Lift Chairs: The infinite position is ideal for users who will spend most of their day in the chair. It offers probably the most variety and variations, all the standard positions of the three position, such as seated, napping, and lifted. Nevertheless, in addition it has the option for the fully flat bed position and trendelenburg position for individuals who need their legs raised higher than the rest of their body, perhaps with a view to scale back swelling and enhance circulation within the lower extremities. With their independent leg and back controls, the infinite position lift chairs provide the maximum positioning customization for the user.

In addition to the reclining options, there are a number of weight and seat size considerations too. For instance, heavy duty chairs are more massive than regular ones, and have sophisticated lifting and tilting features. They accommodate people standing over 6" tall. They have wider seats and can hold up to seven hundred lbs of weight. On the opposite end, petite reclining lift chairs are great for folks 5'3" or under who weigh under 250 lbs. Petite chairs with broader seats are also available.

Another sensible tip is to contemplate all the other specs that make these chairs even more appealing. Options like arms that flip open for storage, lumbar support, leg extensions, wall huggers, transfer arms, pillow back seat, heated seat/back, warmth and therapeutic massage, separate leg and back controls. These certainly present the last word in relaxation, therapy, and safety. Materials options include fabric, vinyl, fake suede, micro fiber, and blown fiber, bringing folks quite a lot of style choices.

A singular, innovative and sensible possibility is a battery backup, giving confidence to the chair's lift and reliability in the case of a power outage.

The bottom line is that reclining lift chairs are quality investments that assure security and help reduce the risk of injury. They are important to help senior folks lead a comfortable and independent way of life for as long as possible. Now you can make an educated decision about buying a recliner chair for your self or somebody close to you. Choose a custom chair that's designed only for you or a chair with standard options that's good the way it is. Most chairs are available online, so browse through all the pictures and specs and imagine how glad you or the one you love will be in the finest one of your choosing. Order one right this moment!

Another housing option for your elders is an "Assisted Living Facility." While these type of facilities have gained in popularity around the country, the term "assisted living" means a lot of different things to a lot of different people. While most states require a facility such as this to have a license, not all state require it.

Living spaces can be as simple as a shared room in a huge complex or as robust as a small apartment with a self contained kitchen in a small facility. A great thing about these type of facilities in general as that there are a number of additional services that can be provided for at an additional cost. Things such as meals, cleaning, helping with bathing and going to the bathroom, laundry can be a big help to many elderly folks. It's important to note that where ever you are located, assisted living facilities can't provide your elder with medical care. However, a staff member will normally be willing to help with medication reminders.

The term "Assisted Living" is more of a marketing term than it is a definitive term that describes the kind of facility it is. When looking at these type of facilities, always be sure to ask if the facility is licensed by the state and what level of support and supervision is provided. Knowing how many staff members are on duty during the various points of the day, if they provide assistance with taking medications, and if residents of the facility are checked on regularly are all things that will help you determine if the facility warrants further review by your and your family.

Your goal is likely to have your elder live as independently as possible, but in a place that is able to provide the additional services and supervision that he or she may need. Continue to ask questions so that your mind is put at ease with the facility you are considering.

Candidates for this type of living arrangement are those who require help and support with daily activities, but don't need any medical assistance or constant supervision.

As with any facility you are looking into for your elder, you will want to know about the pros and cons. In the case of assisted living facilities, there are two very big "pros". Fist, these facilities can extend your elder's independent living. Second, for those that are socially active, they generally find these facilities provide a great opportunity to mix with others

However, there can be some negatives. These negatives usually center around the staffing levels. In these cases, supervision and oversight may not be what it should be. This is why it's critical that you know about their staffing levels before making a final decision to move your elder into an assisted living facility, or any other facility for that matter.

Another negative is that Medicare doesn't chip in for assisted living. More than 90% of the tenants of these facilities pay out of pocket - or that of their family's pocket. Don't be fooled into thinking that just because you have a long term care insurance policy that you are all set. Many policies only pay a specific amount of money towards assisted living. After those funds are exhausted, there will be no money left for nursing home care. Certainly something to consider.

However, some states do indeed provide a limited Medicaid benefit for assisted living residents. But, most unfortunately, the states that do this, generally limit the number of folks who can access this benefit. So - you could very well find yourself in a situation where your elder qualifies for this assistance in their state, but ends up on a gigantic waiting list.

Another downside to assisted living is those who are in charge of the marketing departments at some of these facilities can be very, very aggressive and very light with details. You need to be persistent in getting an itemized cost breakdown for every potential service your elder may need. What's included in the base price? What do meals cost? How many meals are served? What about snacks? Is cleaning provided for apartments? If the rep can't or won't provide answers to these type of questions, go to their boss. If they won't help, go elsewhere.

An assisted living facility is very much like a nursing home, but it also provides special care to those who need it. What differentiates it from a nursing home is the very fact that it offers more freedom and independence the person receiving care. There is one more difference - where nursing homes provide their services only to the elderly people, these facilities welcome even the young ones if they are physically disabled and need special care. There are many companies who are specialized in providing special care and housing solutions for both the elderly people as well as those who are young but have serious accessibility problems. Still, in general, these facilities largely cater to senior citizens only.

How Does These Facilities Work?
Unlike what happens in nursing homes, an assisted living facility does not monitor their residents all the time. It provides private apartments for its clients where the staff members make periodical visits in order to provide assistance to those who need it. Some staff members just visit them in order to provide them companionship so that they do not feel lonely. However, meals are not provided to the clients at their separate apartments. The residents have to o to the communal dining halls for their meals. This way, if some of the residents who are disabled or have accessibility problems, they get a chance to go out in the public and interact with people (who are also suffering from similar problems) in a friendly environment. So, they don't feel self conscious anymore.

In most cases, the main objective of the assisted living facilities is to provide an opportunity and platform for the people with disabilities to become self dependent. That is the reason why many facilities also feature handrails, lower countertops and tables, and wheelchair-accessible showers.

How Can One Benefit From These Special Homes?
Assisted living homes make the best option for those who are otherwise self sufficient but need some special care and assistance because of their physical disabilities. These facilities provide them a good platform where they can learn how to live independently and without having any sense of inferiority. These facilities inculcate self confidence in their residents by having a busy schedule of events so that there's no time for worries or develop inferiority complex.

However, it is very important for you to understand that assisted living facilities are not meant for those who are mentally challenged or very frail. For them, nursing home is undoubtedly a much better option. These are the people who need assistance twenty four hours a day and seven days a week, which only a nursing home can provide.

Aging and illnesses that comes with the process are real. Numerous of you are already caring for old folks and you understand the difficulties involved. That is why most people end up choosing assisted living homes for their aging parents and relatives. These are alternatives for old people with no one to take care of them, including their busy children. If you are looking to take someone in these facilities, encourage everyone concerned to get involved.

It is always a good idea to gather around, as family members, to deliberate the long term care issue. What is more, the old, sickly father or mother should be part of the discussion. He or she can speak out his or her feelings and help everyone else know all the necessities. Usually, most senior people get emotional or feel as if their children want to desert them. This is often not the case and that is exactly the reason why these people need support and understanding.

It is imperative to focus on the senior person's medical history if known. If not known, then the next of kin should make an effort of taking the aged parent to the doctor for a proper check up. Generally, these people suffer stroke, diabetes, heart diseases, cancers, arthritis, and joint pains and so on. Getting a good scrutiny of their health condition is necessary.

It would help the immediate family to find an assisted living and transportation facility that would manage to fulfill the doctor's instructions. Pay attention to the kind of foods and drinks that a given organization provides as well as sanitation standards. Does it offer any recreational activities to help the old work out and relax? As far as this is concerned, many organizations are available and they have unique facilities and arrangement of services.

This means that some organizations would only provide fun and leisure activities for the old. Others would take care of their health and medical issues, as they have nurses and doctors. Additionally, some companies offer transportation services with their own shuttle buses. The long term care insurance as far as transportation is concerned is often not a burden for the seniors. In fact, some non-profit and government organizations offer insured free of charge services. Additionally, given companies have special autos for transporting old people, their wheel chairs and other tools.

A few go a step further to provide built-in entertainment gadgets in the autos, making them completely equipped and comfortable. If you choose an all round long term care home, then it means that you would give your aging mum, dad or relative a second residence. The only way to find and choose a good company is taking time to research. Visit the home and evaluate its facilities too.

One of the most important pieces of the recently enacted "Patient Protection and Affordable Care Act" is the "CLASS Act", which stands for the Community Living Assistance Services and Supports program. Authored by Senator Ted Kennedy and others, it creates -- for the very first time -- a long term care insurance plan to help those with functional impairments pay for necessary care at home or in their communities. While the daily benefit is limited, the CLASS Act will ultimately help many continue to live at home or in assisted living facilities, rather than be forced prematurely into a nursing home in order to qualify for government assistance. Some key features of the program are:

(1) enrollment is open to those who are employed and choose to make voluntary monthly contributions to the program, and there is no underwriting exclusion based on pre-existing conditions; enrollment will open January 1, 2011;

(2) eligibility kicks in only after the individual has been enrolled in the voluntary payroll deduction program for 5 years, but the payout will not begin until 2017;

(3) benefits will be a minimum of $50/day but be scaled up as high as $75/day, depending upon the degree of impairment, and there is no lifetime "cap" on payout;

(4) benefits will coordinate with government assistance from the Medi-Cal program (called "Medicaid" in many states), such that CLASS benefits will have no effect on eligibility for Medi-Cal, Medicare, Social Security Retirement or Disability benefits, nor SSI. In fact, persons in nursing homes who qualify for CLASS benefits will be able to retain 5% of their daily or weekly cash benefit without seeing a reduction in their Medi-Cal subsidy.

Unfortunately, because of the 5 year vesting requirement and the companion requirement that the individual be employed for at least 3 out of those 5 years, most currently retired seniors will not see any direct benefit from the program. However, seniors can, and should in our view, encourage their children and family members who are still employed to sign up. That encouragement can be a part of the parents' legacy to their own children, just as Senator Kennedy left his legacy to the nation.

The harsh, cold winters are terrible for the elderly. Many attribute their painful physical conditions to that. There is also the risk of falling on the ice and in snow. The fact is, arthritis not only affects elderly people, but it can affect anyone at any age. However, since seniors believe that arthritis is handled better in warmer climates, many move away from their children to live in Florida where the heat is soothing. However, there are days when Florida's hot and humid weather can also cause pain. Another option that seniors have looked to is the desert climate of Arizona, which is quite advantageous for people with arthritis. Nonetheless, wherever they decide to go, the decision to leave will not diminish the fears or anxieties that their child may have in regards to their parent's well-being, especially when they are an only child. There is always the concern that something can happen that might uproot everyone's lives.

For example, you may have a situation like this:

The telephone rings. You answer. It's the emergency room at the hospital. It's the call you were dreading. The nurse speaks with a concerned voice, "Mrs. J., your mom was crossing the street on foot and was hit by a car. I want to let you know the nature of her injuries. She has internal bleeding; broken vertebrae in her back, a shattered pelvis and her arm and leg are broken as well. It's a wonder she survived. She is in a terrible amount of pain. Your father is very anxious and doesn't make sense when he talks. I think he is in shock. The doctor is examining him now. Can you please come soon? It is extremely urgent. Your mother is asking for you. The seriousness of her injuries requires immediate surgery. Your mother has agreed to it if it would stop the horrendous pain. Even with the surgery, the doctor is not sure if she will ever walk again. I am letting you know that she will have to stay here after her surgery until she is moved into a rehabilitation center."

You sit stunned by the complicating issues in this sudden, unanticipated mess, trying to figure out how best to break the news to your husband and children. How will they react when they find out you have to leave immediately? Who will take care of the kids when you're gone, perhaps a week or more? Taking mental notes, you wonder about the power of attorney and the living will that wasn't made at the time your parents moved, as they were both in full capacity and robust at the time so dad didn't think it was necessary. However, recently, dad has had some health issues with his heart which are causing you great concern. You are worried that dad might have a heart attack with all this stress. You say to yourself, 'I hope there is a will, because this can complicate matters. I don't even know if they both have life insurance and if so, how much? I'll have to take care of that later when I arrive in Florida, as one of my "Must Do's." You suddenly remembered what the nurse said, that your mom was going to be moved to a nursing home or a rehabilitation center after she leaves the hospital, if she leaves the hospital.

Now you are apprehensive, after considering the big "What If," what if they don't have long-term care insurance? My God, between the nursing-home residency, of which Medicare only covers a small portion, and the cost of long-term care, a mind-boggling figure of anywhere between $50,000 to a $100,000 a year may result.. Who is going to pay for that? "I can't think about that now," you say to yourself. "All of this is making me nervous." As you rush and make calls the wheels of your mind are still in motion pondering on the "What Ifs." You are starting to feel queasy and angry at the same time. You stop for a moment and say, "they'll have to sell their home and perhaps move into an assisted living facility which will be costly as well. Come to think of it, the worst could happen, they might just end up moving into my home. If mom can't walk, who will take care of her? Dad can't. Will I have to give up my job? Oh no, this can't be happening. WHY ME, I DIDN'T ASK FOR THIS! I don't mind dad living with us. He is such a sweetheart, but what about mom? It would be sheer hell. We never got along. To make matters worse, Jimmie dislikes my mom and the feeling is mutual. I am almost sure that my home will end up being a battle zone. I don't know what to do, why did she have only one child?" Your hands are shaking. "I hope my mother-in-law will watch the kids while I'm gone. What will Jimmy say? Now this will give him a good reason to leave.

Relieved that you were able to get a flight for that evening, you begin to pack. You inform your employer that you had a serious family emergency and need to leave immediately. You ask him if you could use your vacation time for this. His approval comes as a big relief.

Between the cost of airline tickets and other additional expenses added to the credit card, a hefty bill is tallied, adding more debt to your finances. Plus you lose your vacation time, time that was intended to be used at a later date. Whatever the results, the reality of the situation at hand is adding weight to your already hectic schedule. By now you know what's in store for you; the cost of flying back and forth between New York and Florida will become exorbitant. On the other hand, you could move to where they live, but that would wreak havoc for all back home. Lastly as a dreaded alternative, you could have your parents move into your home. This way you would be able to keep an eye on them even though this arrangement will also wreak havoc for all concerned. You find yourself trapped by making the choice between: "what you would rather do" and "what is required for you to do." You have officially joined the privileged ranks of the "Sandwich Generation," sandwiched between responsibility for those that raised you and choices that define your own life.

Whether the aging parent becomes confined to a nursing home, a rehabilitation center or an assisted living facility, the demands on the Sandwich Generation still exist. These caregiver's nerves are strained to the utmost. They suffer from depression, anxiety and even some may develop heart problems from all the stress. As it is, the wife-mother-daughter generally is a multi-tasked person holding down multiple jobs and responsibilities all at once.

Now let's take a look at another example. Mrs. B. is a sixty year old stay-at-home grandmother who never had to work because her husband always made decent money. Both of her children have married and maintain successful careers. Her daughter, Sue, finally was able to have two children after several unsuccessful attempts. With so much spare time on her hands, Mrs. B. can do all the things she wants to. Travel, play Mahjong with friends every other week, go to Broadway shows and participate in community activities. Since Mrs. B is a stay-at-home wife, she comes to be the lucky candidate who assumes the babysitter role at a moment's notice for her daughter. How can she refuse to take care of her sweet, innocent darlings once in a while? Happy and doing well, she feels her life is blessed. However, add to this context an aging mom with advanced dementia, the situation changes and becomes overwhelming, piling on additional responsibilities. Now Mrs. B's daughter has just received a promotion and has to put in more hours at her job. Sue is so excited, since it will raise her salary $30,000 a year. She's hoping that mom can take care of the kids full-time.

"Don't get nervous, it's only temporary until I get the hang of it, then I will put them in daycare," she says. At age sixty, Mrs. B. is not looking forward to spending 40 + hours a week taking care of a baby and a two-year-old toddler. She also has the responsibility of an aging mom with dementia. Since her father passed away over three years ago, Mrs. B. has been noticing changes in her mother's personality. Apparently she has been suffering from clinical depression with mood swings, wherein she would become enraged, unresponsive or withdrawn. She also watched her mom slowly fade into the never-ending fog of memory loss, repeating herself over and over again. Mrs. B.'s mom would become increasingly bewildered and confused, even in familiar surroundings. Lately, her appetite has been poor, and to make matters worse, she has developed a foul odor. She has been neglecting her personal hygiene as she does not realize that she has to bathe and change her clothes. Since Mrs. B. is the oldest of three sisters and as she lives the closest to mom, and supposedly had more free time on her hands than the others, she has become the designated primary caregiver, against her wishes. So as a result, Mrs. B.'s mom moves in with her daughter. Both situations have disrupted Mrs. B.'s comfort zone. It also has interfered with the quiet life that she built with her husband since the kids got married and moved out of the house.

The full-time baby-sitting issue in regards to her grandchildren is becoming a serious problem for her, going on for several months now. She cannot understand why it's taking her daughter so long to put them in daycare. Mrs. B. is too tired. She is wound tighter than a rubber band. The baby is teething and crying constantly and the toddler still in diapers is hungry, tugging at her pants. Suddenly the door bell rings. It's her next door neighbor asking if she could pick up her mail for the next four days since she won't be home. Smiling, Mrs. B. agrees and closes the door. She starts to fume, feeling envious of her neighbor, who has the freedom to take off when she wants to while Mrs. B. is trapped at home with two grandchildren, constantly changing diapers and doing the laundry.

She says, "What does she think I am, her errand girl? With all that I am doing, she has the nerve to ask!" Not even the girls at Mahjong call her anymore. They have been avoiding her like the plague. She calls her daughter constantly, complaining about the kids and her mom. The daughter, avoiding the issue, puts her on voice mail. Mrs. B. screams at her mom. She calls her sisters and vents on them for not helping out. She vents to the mailman, the supermarket cashier, whoever might lend an ear. She can't wait to vent on her husband when he comes home. There is no way for him to avoid the sound of her shrilly voice, her expression revealing her anger. He is deeply concerned that she may be having a nervous breakdown. The peaceful life of Mr. and Mrs. B. is long gone.

Meanwhile, Mrs. B. can hear her aging mom fussing because she has a terrible case of the runs, soiling her underwear and nightgown, she needs to be washed and changed just like the grandchildren she routinely babysits. Mrs. B. has found herself in a situation that is not easily solvable. She starts to freak out. She is extremely tired and cranky. She needs sleep in a desperate way. The horrible consciousness and sandwiched existence cause tears to stream from her eyes. "I can't stand it anymore. I hate what I'm doing. I don't want to do this any longer. I want it to go away," she cries. "I am only one person, how can I separate myself into so many pieces and satisfy everyone at the same time? Doesn't anyone care about me? I have needs too." She sits there stressed out, her body wracking with heart wrenching sobs. Frightened by grandma's emotional state, the baby starts to cry and her whole face turns red while the toddler starts to cry as well. Finally, she screams at the top of her lungs and says, "WHY ME? I DIDN'T ASK FOR THIS!"

Do these examples sound familiar? If so, you are not alone. Caring for aging parents is not an easy task. It saps your energy and robs you of your peace of mind. Very few people are emotionally ready to undertake this role. The comfort zone which you have created for yourself, including the freedom to come and go as you please, career fulfillment, and an active social life with your friends becomes completely disrupted. With care-giving, you feel captive to the needs of whoever you are caring for. Also, it puts you in the awkward position of parenting your own parents.

In the final part of this 3 part series, I'll address ways I have had to deal with being a member of the Sandwich Generation, and ways to help cope with the stress involved with being a caregiver.

My siblings and I were not use to making decisions involving our parents. My mother always knew what to do and when to do it. However, here we were, my mother was ill and not able to make decisions anymore and now we were responsible for taking care of my mother and father. This role reversal was a rude awakening.

Here are suggestions to assist you if you are in the position of being your parent's caregiver:

Signing over their health decisions
My brother and I spoke about the importance of getting our parents to sign agreements to let us make the health decisions in their lives. This means we would be responsible for "pulling the plug", putting them in a hospital or assisted living facility or rehabilitation center, etc. The enormity of these decisions for us was overwhelming.

Fortunately, my brother is a tax and estate planning attorney and created the documents we needed. It is very important that anyone who is put in the position of taking care of their elderly parents hire an attorney that they trust and that can explain the ramifications of what they are having their parents sign.

Taking care of their monetary affairs
It was decided that I would take care of paying my parents bills and keep up their bank accounts. It is essential for you and your siblings to agree that one person should take care of your parents' money. It just makes things simpler if one person does it. I kept my brother and sister apprised of the monetary affairs and felt trusted.

If you are an only child and are not comfortable with taking care of your parents' bank accounts and bills, find a friend or bookkeeper you can trust.

Taking care of their nutritional needs
I never thought that I would have to decide what my parents would eat. I would go to the grocery store every Saturday and shop for their foodstuffs. Sometimes my brother and sister-in-law would take meals over to my parents' home. Sometimes I would take them out to eat.

The time I spent in either taking them out to eat or in choosing what foods they would eat is special to me. I took great care in choosing the exact foods that I knew my mother would approve of. And of course going to restaurants reminded me of when they use to take me and my siblings to restaurants every Sunday while we were growing up.

Spending quality time with your parents while they are alive will help your pain after they have passed.

Caregivers
Luckily, we found caregivers who were very caring toward my parents. If you hire people to take care of your parents, you must be careful. There are people who take advantage of the elderly, whether they steal their money or mistreat them. Take your time in interviewing caregivers and get as many references as you can.

Choosing an Assisted Living Facility
The time came when we had to choose other living arrangements for my father. His dementia was getting worse. Caregivers could not handle his moods and strange reactions to things. One of the hardest days for my brother and I was moving him to an assisted living facility. The move wasn't difficult for him, but very difficult for us. He had dementia so it didn't really matter where he lived.

In choosing a facility, make certain that the aides and nurses are of the caliber you desire, that the food is cooked to your liking, that the beds are changed daily, that your parent's personal hygiene is attended to and that you can visit unannounced.

My parents took such good care of me and my siblings. They deserved the very best at this time in their lives. Perhaps you think that your parents would not have made the same choices you made for them, but never, never second guess yourself. You make the best decisions you can with the information you have at hand.

Let's face it. When you're the primary caregiver for an Alzheimer's patient, no one else in the family will ever truly understand what you're going through. Nor is it likely they'll understand just how demented the loved one is unless they spend a lot of time with that person - and they usually don't.

Having a loved one with Alzheimer's disease can create a tremendous amount of stress in families, although sometimes the diagnosis brings family members closer as they work toward the common goal of caring for the patient.

In families where there is generally good will, conflicts can typically be worked through for the common good. Advice given by the Mayo Clinic includes strategies such as sharing responsibilities among family members, meeting regularly to discuss care issues, being honest in discussions, not being critical of each other, and, if needed, joining a support group for Alzheimer's caregivers or even seeking family counseling.

However, in families where people didn't get along well before the diagnosis, it can create nightmares, especially for the primary caregiver. The situation can be even worse when the primary caregiver is not a direct family member, such as, for example, when the patient has remarried and the caregiving spouse is not a blood relative of the children.

The situation can become worse still if some of the family members live out of town and only see the loved one for short, infrequent visits. They just don't have the opportunity to witness the severity and frequency of demented behaviors you have to deal with every day.

You may find you're being criticized unfairly for the care you're providing even though you're doing a heroic job and making major sacrifices in your personal life to do so. This can lead to bitterness and create extreme disharmony in the family.

It can be endlessly frustrating to have others make caregiving suggestions that are unreasonable because they're based on a complete lack of understanding of the patient's condition and abilities.

For example if a parent living alone is no longer able to do laundry, a child might recommend using a laundry service. What the child might not know, however, is that the parent wouldn't even be capable of opening the door and giving the laundry to the service person when they arrive for the pickup.

Another example is that a well-meaning sibling might advocate for placing a parent in an assisted living facility when the parent couldn't even find his or her way to the dining room and back. Siblings who haven't been around their parent very often might not be aware of that basic fact.

Although you can probably never convey the full extent of the patient's impairment or the burden the caretaking is placing on you, there are some things you can do to try to reduce friction within the family:

1. Be Patient and Understand Where They're Coming from: Try to put yourself in the other person's shoes and understand why they lack knowledge of the situation. If you can stay calm you'll have a better chance of decreasing stressful interactions.


2. Educate Others about the Patient's Condition: It can help if you make very detailed lists of the patient's dementia behaviors and share them with other family members. Remember, they've never seen the patient do many things you see on a daily or even hourly basis, so put down even the smallest details. Update these lists frequently and share them with everyone on a regular basis.


3. Have Other Family Members Care for the Patient for Awhile: The best way to let other family members get a better understanding of the loved one's condition is to have them take care of the patient for a while. Ideally, this would be for a week or two while you go on vacation, not just for an afternoon while you're at a movie or go shopping. Almost anyone can deal with a demented patient for a few hours. Let them take care of the person for a couple of weeks and you may find you're being criticized less and appreciated more.

Physical distinctions

Skilled nursing facility

A skilled nursing facility will always be located in one building. The reason for this arrangement is to ensure that patients (as opposed to residents) can receive 24-hour care, quickly, in one location. Some skilled nursing facilities will have doors locked and on an alarm system. Many patients are free to leave their room, but the facility is completely responsible for the patients' safety and requires that they stay in an environment designed with their safety in mind. Hallway handrails are provided for patients who are not ready for a wheelchair, but are less steady on their feet. A nurses' station is usually visible from the main entry, and is typically located at the intersection of two wings.

Assisted living

Assisted living, on the other hand (particularly the up-scale facilities), offer a range of living quarters from a single detached home, duplex, four-plex, group living, and ultimately one large assisted living facility that offers suites, double, and single occupancy rooms. The assisted living facilities' occupants are considered to be "residents" and free to leave and return. Some residents are physically incapable of leaving on their own, or cannot drive and instead, will use the van service. Assisted living facilities or living quarters do not require nurses' stations, although some facilities will include "aid" stations.

Services

Skilled Nursing Facility

A nursing home will have a 24-hour, full-time skilled nursing staff. The facility is required to have a registered nurse as its director. Licensed practical nurses may be employed, but a registered nurse must supervise the medical oversight of patients. There are nurses' aides, a kitchen staff, activities and a janitorial staff employed. Skilled nursing is the main emphasis of the facility and all residents are patients who are recovering from a long-term illness, completing rehabilitation or perhaps may never leave the facility due to a degenerative condition. All patients will be attended several times a day for any number of reasons. Those who are able will dress and go to the social areas and can have their meals in the dining room. Others, less ambulatory will have meals brought to their rooms.

Assisted Living

Usually less expensive, along with a variety of living quarters, the same applies to services. Assisted living facilities/communities offer tiered services. The resident may require the assistance of care staff. Typical services include the assistance or supervision of bathing, dressing, grooming, toileting, continence management, medication, meals. Most residents eat in a dining room setting or room service is available for those who are not feeling well. Housekeeping, maintenance and laundry services are provided. They may be there temporarily, which is often referred to as a respite stay, or wish to stay as a permanent resident.

Delaware has many industries such as chemical, paper, plastic, rubber, and food processing units. Chicken farming, banks, pharmaceuticals, and auto manufactures are a part of its economy despite the fact that it is the second smallest state in the U.S.

Starting an assisted living facility in Delaware can be a good business idea if you have an aptitude as well as genuine intent to care for the aged who need assistance.

Tips for Starting an Assisted Living Facility:
The number of senior citizens who live alone but in need of assistance is ever increasing. It could be a drain on their finances to hire qualified full-time help to assist them with their daily chores, and the option of moving in with their children does not appeal to many of them because they prefer to be independent and not be considered a burden. This is why the demand for an assisted living facility is ever increasing.

It is recommended to carefully analyze the demographics and verify if there is a market for your services. Research in detail the kinds of facilities operating in your area, the rates they charge and services offered and the demand for their services; and estimate if there is a niche you could specialize in, such as a disease-specific assisted living facility.

Once you are sure about the demand, select an ideal location to start your facility. It can be built as per your requirements, or you can lease a suitable facility. Ensure that it is located in a predominantly residential area and that it has proximity to health care facilities and is within easy reach of physicians. Supermarkets, pharmacies, and shopping malls near the facility could be an added advantage. Make sure the rooms are not too many or too few in number and that you charge as per your services after comparing rates of your competitors. The rate has to be in proportion to the service charged and at the same time not be over-priced, intimidating potential residents.

Carefully consider the services you offer, your residents, and their needs; and hire the appropriate, experienced, and qualified staff. They have to be service-oriented with a caring attitude and must be patient with the residents, making sure they are happy in your facility. Monitor them frequently to see that they are not the cause of discomfort of the residents. A geriatrics care manager, cooks, aides, nurses, and cleaning staff have to be hired.

Have a good method of selecting candidates, making sure that those admitted are in need of the services you offer and not in need of extra care. It would be unwise to admit those folks, as the service will exceed the money paid by them as well as be a burden on your staff. Ensure that all residents' health is carefully monitored and evaluated.

Advertise your services regularly and use the products available in plenty to help you run a better establishment. It could not only be a profitable business but also leave you feeling satisfied that you have helped the community in some way.

As soon as you are about to care for an elder with Alzheimer's you need to review your loved one's durable power of attorney for finances and their advanced health care directives. Unfortunately, if that person is not of sound mind or body (especially if they are in middle to late Alzheimer's), then it is too late for them to prepare these important legal documents. However, if you go to court and ask the judge to name you the guardian (either full or financial conservatorship), then you will be held responsible for your elder's legal and financial decisions.

Durable Power Of Attorney

A durable power of attorney names you as the person to pay the elder person's bills, collect and deposit their income and take care of any other financial matters. You will need to find your elder's legal and financial documents and feel comfortable with their assets, income and expenses.

Here is a list of documents you should gather:

o Wills
o Bank and brokerage accounts
o Deeds, loans and ownership statements
o Pension and retirement benefits
o Social security information
o Insurance policies

As someone who is charged with caring for an Alzheimer's patient, you need to know that Alzheimer's is a progressive disease and that level of care may grow and change over time. You'll need to consider the cost of long-term care, prescription drugs, and in-home caregiving services. There are several ways you may be able to cover the costs of long term care that includes looking at your elder's employer's insurance plan (group and retiree coverage), disability insurance, Medicare and Medigap, and long-term care insurance. Your elder might also qualify for social security disability and/or Medicaid. And you should not forget about community programs to help with meals, respite care and transportation.

Advanced Health Care Directives

Advanced health care directives ensure that your elder person's health care requests are communicated to the health care providers and that you as the guardian act on your elder's behalf. Advanced health care directives also include a living will which tells health care providers what your elder prefers should become incapacitated. The living will gives preferences for life-prolonging treatments such as using a respirator, CPR, dialysis, surgery and antibiotic drugs. The elder and guardian can choose to receive all life-prolonging treatments, a few or none at all. The living will should also state whether your elder wants artificially administered food and water when they are close to death.

Here is a checklist of other advanced health care directives:

o Appointing your durable power of attorney for heath care who will consent or refuse consent (who would usually be the guardian). He or she can also fire and hire medical personnel, gain access to medical records and get court authorization
o Naming the doctor to supervise care
o Identifying and specifying treatments given or withheld (stated above in living will)
o Stating feeling about care-does the elder want full does of pain medications every time?
o Providing instructions for organ donation

After all of the papers have been signed and notarized, be sure to make plenty of copies and keep the originals in a safe, with other copies readily available at a moment's notice. Handing the details for your loved one with Alzheimer's is a great deal of work, but you will be saving yourself so much time and agony if the financial, legal and healthcare matters are well-planned before your loved one moves into an assisted living facility or if additional home service care is needed.

Resources: Alzheimer's Association 225 N. Michigan Ave. Fl. 17 Chicago, IL 60601-7633 1-800-272-3900

Alzheimer's Disease Education and Referral Center P.O. Box 8250 Silver Spring, MD 20907-8250 1-800-438-4380