Subscriber seeks information about respite care

By Cynthia Wilson

Recently a subscriber named Charlene contacted me to ask the following questions.

“What exactly is respite care? What are the qualifications to obtain it? How often and how long the stay per visit? Does a care-giver’s mental breakdown qualify? (humor intended)!

Dear Charlene,  First let me say that I’m glad that you still have a sense of humor.

Respite care   is short-term care provided by another caregiver.  It typically is offered  to caregivers of hospice patients, but may also be provided for caregivers who live with disabled and elderly people in need of help with daily living activities such and eating and bathing.

Home Care & Hospice Services

Home Care & Hospice Services (Photo credit: Beedle Um Bum)

Anyone who is a caregiver needs, and definitely deserves respite care and in my opinion that is enough to qualify.  In my book, “Who Will Take Care of Mom? A Guide for Family-Managed Care,” the chapter entitled “Harmony Breaks” addresses the importance of respite care and how to make sure that the primary care given gets time off.

However, if you’re asking how to qualify for aid to pay for respite care, then it depends on your situation. Medicare won’t pay for respite care for the caregiver unless the patient is in hospice.  Long-term care insurance may  cover some of the cost of respite care, but you will need to check the policy to be sure.

If your parent or relative receives Medicaid assistance, then the state may pay for respite care because it wants to successfully keep disabled and terminally ill residents living in community-based programs instead of state-run facilities.  In-home care and adult day care programs are examples of respite care.  Contact your parent’s social worker what respite care services are available.

If you’re looking for respite care that will allow you to take a vacation or attend a family function, then I’d ask the social worker how many days will be provided and how far in advance you have to put in your request.  That’s because 24-hour respite care typically is provided in a facility, such as a nursing home. Your social worker will need time to make the arrangements.

If you’d rather not send your parent to a facility for respite care, then you may consider hiring a home care aid.  If that doesn’t appeal to you because you will be away, or you can’t afford it, then I’d suggest you enlist the help of family and friends.

If your parent is able to travel, ask a sibling, relative or close family friend who is retired or not working to let your relative visit for a few days.  At least once a year, my mother goes to visit my brother or another close friend. To lighten the work load for the them while my mother is there, other relatives and friends come to visit or will take my mom to their home for a night or two.  Of course this requires planning and  coordination so that visit occurs when my brother or friend has time off, but it is worth the effort.

You could also ask a sibling or an aunt or cousin you grew up with to volunteer a day, or evening so that you can take some time off.  If they cannot spend the entire day with your relative,  then considering hiring a reputable home care agency for a few hours and ask a relative or friend to stay overnight with your parent to keep costs down.

Don’t assume that a friend will not help. I’ve been fortunate enough to have a  family friend or even a church member I trust agree to stay overnight with my mother when I’ve had to travel unexpectedly. I just had to have the courage to ask.

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A first hand account of private Medicare plans on middle class children of aging parents

By Cynthia Wilson

I recently shared in an interview with,  a personal experience of how my household was affected by privatized Medicare.  

The online business publication reports news and follows trends that affects health care finance. So its readers may find my book “Who Will Take Care of Mom?  an interesting read.

Like myself, health care finance professionals recognize that adult children caring for elderly parents is a growing trend.   So is the trend of states making adult children responsible for their indigent parents health care debt.

Although I was not legally responsible for my mother’s debt, I’m grateful that I was able to pay the hospital and nursing home bills she accumulated during her stay after a serious accident several years ago. However, many families, would  not have been able to do so. And many, including myself, will not be able to take on that kind of financial responsibility  in the future given other family and financial obligations.

Read more of the review from insidePatientFinance

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Ryan’s Medicare reform plus filial responsibility laws equal more debt for middle-class

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Posted in Caregiver tips, Medical care, Medicare and Medicaid reform Tagged with: , , , ,

Who Will Take Care of Mom? A book launch

I spent the summer writing a book  about what it has been like taking care of my mother.

It’s been 13 years and counting since I moved mom into my home. Many of my friends and family have recently begun or are about to embark on a similar journey and have sought my advice. For that reason, I felt that it was time to write something more substantial.  Thankfully, God provided me with the words and resources  to write a book I believe will get people thinking about their own future elder care needs, care giving experiences, and how to prepare for it.

“Who Will Take Care of Mom? A Guide for Family-Managed Senior Care,”  aims to help families understand the political and economic climate that will affect how we pay for long term care and how that  will affect their senior care options. Notice that I said options, not plans.

That’s because the care we want may not be what we can afford or expect from future government senior care programs. So I advocate for something I call “Family-Managed Senior Care.”

In “Who Will Take Care of Mom? I explain why I believe that family-managed care is the best senior care option for most families. I also provide detailed information on how to plan and implement a family-managed care plan.

I believe that my solutions will provide your parents and you (when you get older) with the safe, loving care you want, without forfeiting your family’s wealth.

I hope you will read the book. More importantly, I hope it provides you with the information you need to care for your parents at home. God willing, it will also give you incentive to plan your own long-term care so that your children will know what you want in your senior years and how to provide it.

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Ryan’s Medicare reform plus filial responsibility laws equal more debt for middle-class

By Cynthia Wilson
Have you heard of filial responsibility laws?  If you haven’t rest assured you will if vice presidential candidate Paul Ryan’s Medicare reform proposals become a reality.

WASHINGTON, DC - MAY 25:  House of Representat...

Congressman Paul Ryan, Mitt Romney’s V.P. running mate.  (Getty Images via @daylife)

Currently 29 states and Puerto Rico have filial responsibility laws that require children to pay the health care debts of indigent parents?  That means if a court declares you responsible for your parent’s unpaid debts you could face a fine, which may be the least of your worries.  Some states allow criminal charges and jail time for not paying the bills.

I agree with Ryan that we must cut Medicare spending to sustain the program that is a safety-net for most Americans. But I don’t agree with Ryan’s plan to fix the problem with spending cuts alone. And I don’t support privatizing the system.

Ryan says he doesn’t want to raise taxes. However, the middle-class will adversely feel the economic effects of his solution for Medicare reform because more adult children will become directly responsible for their parent’s health care debts because of filial responsibility laws, which a federal appeals court has upheld based on a case out of Pennsylvania.

I go into more detail about filial responsibility laws in my new book “Who Will Take Care of Mom? A Guide for Family-Managed Senior Care,” and how it will affect the middle-class.  The book also shares time-tested solutions that will help many families mitigate the effects of filial responsibility laws.

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Voting is more important than ever for seniors

By Cynthia Wilson

I took mom to vote yesterday.

This cherished act is something a lot of seniors didn’t get to do this primarily election season for reasons ranging from an illness or disability to new voter identification laws that now require photo identification to cast a ballot.

voting day in a small town

Voting day in a small town (Photo credit: Muffet)

Sure seniors still have the option of casting an absentee ballot. But that’s easier said than done for many people like my mom, who is blind.  Without me here to assist her, she likely wouldn’t have made it to the polls or gotten the eligible photo ID that is now required to vote in our state.

Voting by mail would have been difficult too if she lived alone, because she doesn’t read braille. Mom relies on me to keep her informed about the candidates.  And no, we don’t always agree.

But the thought that she might not vote because of her disability upsets me because mom cherishes this right. She listens to the news all the time and while there are some things she doesn’t immediately understand, she knows that some proposals being touted as solutions for seniors and long-term care will lead to cuts to her benefits.

She recently learned from a friend she attends adult day care with that he is getting $100 less in one of his monthly benefit checks. Her 80-year old friend doesn’t know why his benefits were cut.  Regardless of the reason, that’s a lot of money to a senior on a fixed income. And it will have a major impact on his ability pay his rent and meet co-pay requirements for the medical and long-term care services he receives.

Now more than ever, it’s important for senior citizens to vote if they can in local and national elections.  Medicare and Medicaid will be front and center issues before and after the November 2012 elections. If those issues are not they should be because the programs are paying out more money than they are taking in.

The Patient Protection and Affordable Care Act, referred to by many people as Obamacare, imposes payment cuts on select provider services and new Medicare taxes on investment income to help fund preventative care services and coverage mandates for Americans. Nonetheless under current laws, the program still is expected to pay out more money than it takes primarily because millions of Baby Boomers will retire over the next 20 years.

The people who win state and federal seats will decide how to fix that.

Spending cuts are on the table for both the Democrats and Republicans, but Republicans want to privatize Medicare, something that I am against.  I think privatization is just another way of saying “guaranteed profit”.  In other words, some insurer will be guaranteed a profit to give Americans back the money that we are required to have deducted from our paychecks or pay taxes on from other earnings income.

I don’t think that anyone should be guaranteed the right to make a profit from the savings Americans were forced to set aside.  Why? Because seniors will ultimately lose something to make that profit possible when they are at their most vulnerable.

There’s a lot at stake in the November election for seniors and elder care.  Help them find a way to get to the polls or get their absentee ballots casts.

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A Mother’s Day tribute to my hero

By Cynthia Wilson

Why does your mother live with you?

I get that question a lot.  I usually tell folks it’s because she’s blind and has some other health issues. Here are  some other reasons I never mention.

I owe everything I have to God and her.

She didn’t tell me baby’s come from the stork.

When I was 14 and asked her if she loved me, she said.  “Don’t be stupid.  I’m your mother.  Of course I love you.”  Then after some thought, she apologized and said that’s not a good enough answer.  “A lot of mother’s don’t love their children,” she said. “Yes, I love you.”

After all the conversations we had about why it’s not good for a girl to date an older guy, she calmly listened when I was 16-years old and afraid to tell her that I wanted to date a 22-year old man. She cautioned me against the relationship, but confessed that she liked an older man when she was 16  and envisioned marrying him.  Within a week I was over the crush, but I learned to trust that I could tell her things she might not want to hear and survive.

She had three children but no obvious favorite.  Mom let each of her kids know at one time or another that we got on her nerves.

I couldn’t see myself living more comfortably than her knowing that she, with faith in God, was the reason I could live comfortably.

When I told her I was quitting my job, selling my house (an accomplishment many folks we knew hadn’t been able to) and going back to school, she didn’t weigh me down with her own anxiety.  After listening to my plan she simply said, “Okay.” There was no second-guessing, no further discussion.

She never told me that I couldn’t do what I wanted or that it would be too hard it achieve.

She was the aunt all the cousins wanted to have at their graduation because she understood the value of education and would appreciate their accomplishment.

She never said you need a man to take care of you.

She never said or implied, “You disappoint me.”

Her mother died when she was less than a week old, but she figured out how to be a good mother and shares her wisdom with me.

She taught me to develop my own style, not the latest trends.

I love her.

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Ryan’s traditional option in Medicare reform no different than Obama’s public option

By Cynthia Wilson

Do you remember when President Obama and the Democrats wanted to include a public option in the Affordable Care Act alongside insurance plans offered by private insurers?

WASHINGTON, DC - MARCH 22:  House Budget Chair...

 U.S. Rep. Paul Ryan (R-WI) (Image credit: Getty Images via @daylife)

Republicans said doing so would undermine health care reform, enticing employers to drop employee coverage and force most American’s into a government-run health care system that would put private insurers out of business and gobble up taxpayer dollars. So how is Rep. Paul Ryan’s (R-Wis.) newest proposal to offer a traditional Medicare plan alongside private insurers in his Medicare reform proposal any different than what Obama and the Democrats proposed?

Ryan’s proposal is supposed to be a concession for his initial proposal to completely privatize Medicare and give the program’s elderly and disabled beneficiaries a voucher to help pay for insurance bought through a Medicare insurance exchange.   In Ryan’s 2012 proposal all insurance plans would include a minimum set of benefits equal to the value of those in the traditional program. However, “benefits equal in value” does not mean that all plans will offer the same benefits. If Medicare beneficiaries believe that the traditional Medicare plan offers better coverage than the plans offered by private insurers and the government pays the premium, why would they buy a private insurer’s plan?

Let’s imagine that some Medicare beneficiaries do opt for the private plans.  Will the healthier participants pay a lower premium? It’s very likely. Will the sicker, older Medicare beneficiaries with costlier ailments be steered towards traditional Medicare, costing taxpayers even more money that could lead to the system’s collapse? I think so.

So where’s the reform? It will come from fewer benefits to Medicare recipients because Ryan’s Medicare reform imposes a hard spending cap that forces automatic cuts to providers and beneficiaries if the Medicare budget exceeds targets. That a real possibility with Medicare spending growth capped at 0.5 percent above the gross domestic product.

Ryan included a “public option” in his Medicare reform proposal because some Republicans think it will make his Medicare reform proposal more acceptable to the public.  But I still want to know how this “public option” offering is different from what President Obama and the Democrats proposed when they were crafting the Affordable Care Act. Why don’t Republicans seem worried that a “public option” will hurt private insurers?

Because Medicare Advantage plans prove  that private insurance cost more   than traditional Medicare. Also the hard cap on Medicare spending that Ryan is proposing will eventually force more people into private insurance when traditional Medicare becomes insolvent because it is shouldering the lion share of the financial costs to treat sick and older people.

Before it’s all said and done, Medicare’s elderly and disabled beneficiaries may have to pay more of their health care bills in retirement. But don’t be fooled by the “public option” Ryan is offering to appease Medicare beneficiaries worried that they will benefits.  And don’t mistake Ryan’s intentions as anything other than a plan to privatize Medicare at the expense of senior citizens.

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The other economic costs to cutting funds for elder care and disability services

Another state is taking the ax too much needed elder care services.  The reported today that Massachusetts has slashed funding for a   senior care service program that helps keep elderly people out of nursing homes. The decision will increase the wait list for seniors who receive basic help such as home-delivered meals, personal care and housecleaning so they can continue to live independently.

Portrait of old woman sitting by a window.

Photo courtesy of Wikipedia

Like most other states, Massachusetts’ elderly population has grown in recent years.  The state says its highest priority is to keep services for its most vulnerable seniors with urgent care needs. It’s trying to do that by maintaining level funding.

That’s understandable but also short-sighted.  Leaving seniors who have little or no one available to help them with basic needs will result in more nursing home admissions, which will cost the state much more than home health services.

If you think it doesn’t or won’t affect you because neither you nor a family member uses elder care services, or because you don’t live in Massachusetts, think again.  Other states are trying to contain Medicaid expenses, so funds to services that might benefit your family are vulnerable.  Kansas Governor Sam Brownback’s is rushing to privatize Medicaid in January despite urgent pleas from advocacy groups and lawmakers from both political parties to slow the pace of his reforms.

Medicare and Medicaid expenses do need to be addressed, but the problem can’t be fixed long-term if the primarily solution is to cut services to elderly and disabled people who have no other options. Agree or not, higher taxes will have to be part of the solution if our workforce is to remain productive.

Why? Most senior citizens are someone’s parent, aunt, uncle or other close relative.  When elderly and disabled people don’t get the meals, medicine and other critical home care services they need they require more attention which often causes a relative to miss work, leave early, or not focus on the job they should be doing.  If you are the co-worker, it may mean you have to do the work your colleague was expected to. If you are the employer, overall productivity  suffers.

Yes, the worker might be replaced, but doing so costs the employer time and talent, which equates to lost money.   According to The MetLife Study of Care giving Costs to Working Caregivers, nearly 10 million people over the age of 50 care for a parent.  Couple that with the fact that about 6 million Americans are over the age of 85, employers should expect that a higher percentage of their workforce will be caregivers.

When I began taking care of my mother nearly 13 years ago I was single and about to enter my peak earning years.  If my mother didn’t go to an adult day care program and have transportation services  to take her to and from the center,  I would never have been able to successfully oversee her care, make it to work on time or concentrate on what I was doing when I was there.

Still, there were missed opportunities and every career decision that I’ve made since my mother came to live with me has been influenced by concerns for her safety and medical needs. My last employment relocation literally hinged on having available home and adult day services, as well as reliable door-to-door transportation services as opposed to just curbside service.

I think families should help aging relatives and not leave it all to the taxpayers.  But our taxes should support effective elder care services too because doing so is as much as an investment in our future as any tax dollars invested in business and infrastructure.  To siphon funds from services that elderly people and their families count on is not just wrong it is dangerous to our nation’s economic prosperity.

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Computer time and exercise may be good for what ails memory loss

PET scan of a human brain with Alzheimer's disease

PET scan of a human brain with Alzheimer's disease (Photo credit: Wikipedia)

Okay, so granddad and grandmother may not be ready for an online game of Modern Warfare or a 30 minute spinning class, but some computer time and exercise may do them some good.

A new study published in the May issue of Mayo Clinic Proceedings, says that moderate exercise and mental stimulation through computer  use may help reduce the risk of age-related memory loss.  While other studies have found that one or the other helps lower the risk of memory loss, this study encourages both activities.

The recommendations are based on the activities of more than 920 senior citizens in Olmsted County, Minn., between the ages of 70 to 93 who answered questionnaires about their computer use and exercise over the prior year.  Researchers found signs of mild cognitive impairment in nearly 38 percent of the elderly participants who didn’t exercise or use a computer.  That compares with just over 18 percent of those who did some moderate exercises and also used a computer.

In case you’re wondering if there is a difference between memory loss and mild cognitive impairment apparently there is. Mild cognitive impairment is the stage between normal age-related memory loss and early dementia or Alzheimer’s disease.

The study’s researchers singled out computer use as a mentally stimulating activity due to its popularity, but it’s not the only or maybe even the best way to promote mental stimulation among seniors. Research has shown that reading, playing games, listening to music and taking part in artistic activities help mental simulation.  I suspect that talking on the phone for hours with friends has helped keep my mother’s mind sharp.  She is blind and talking on the phone allows her to stay connected with people and gives her something to do.  (Thank goodness for unlimited long distance calling plans). Her memory is so good she recently reminded me, in detail, of an incident that happened more than 10 years ago.

My mother also exercises regularly on the treadmill at her adult day center and sometimes walks holding onto a shopping cart when we shop.  She’s also gotten some exercise by holding onto the inside of our kitchen sink and doing a few sets of side, front, and back leg raises and swats. More active seniors may prefer brisk walks, hikes, strength training, swimming, and yoga.

It’s important to note that although the study found an association between moderate exercise and computer use and better memory function, it didn’t claim to prove a cause-and-effect relationship so there’s no guarantee that more computer time and exercise will help prevent elderly people from getting dementia or Alzheimer’s disease.

But given the impact of these diseases on the lives of senior citizens and their families, isn’t it worth a try?

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Some help for people who suffer from incontinence



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