Friday, September 03, 2010 "Frank Talk About Care at Life's End"
“Last week, over the objections of New York State’s medical society, Gov. David A. Paterson signed into law a bill – the New York Palliative Care Information Act – requiring physicians who treat patients with a terminal illness or condition to offer them or their representatives information about prognosis and options for end-of-life care, including aggressive pain management and hospice care as well as the possibilities for further life-sustaining treatment.”1
Similar legislation was proposed in the National Health Bill that was passed this year, but that language was removed in the final version.
There are difficult choices concerning “what to do?” when you or a loved one has an illness that is identified as terminal. Having complete information about all the options seems the optimal beginning point for figuring out what is best for each individual.
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1“Frank Talk About Care At Life’s End” by Jane E. Brody, The New York Times, page D1, August 24, 2010 Friday, August 27, 2010 HOW TO PAY FOR LONG-TERM CARE? - THE MEDICAID PROGRAM CONTINUED - What if you have excess non-exempt assets
To meet the asset test it is often necessary to “spend down” excess non-exempt assets before applying for Medicaid. How can a single or married person “spend down” or make the excess non-exempt assets go away? There are four methods: 1) pay the bills for the Medicaid applicant, and the applicant’s spouse, if they are married, 2) purchase exempt assets 3) gift and 4) list non-exempt assets for sale.
1. Pay the bills.
• Pay the regular bills for the Medicaid applicant (and their spouse.)
• Pay off the house mortgage or other loans.
• Enter into a written “service contract” that meets the Health and Welfare Regulation standards that allows the Medicaid Applicant (and their spouse) to pay designated family members at a market rate for their help.
The family member is paid after the services are provided.
The income is taxable to the family member.
If there is no written contract, then the payment is a gift.
• Go on a nice trip and pay for 1 child to go along if you need a traveling companion to travel safely.
2. Purchase exempt assets
• Buy a more expensive home
• Remodel the home. Make the home handicap accessible.
• Buy a more expensive car
• Buy stuff: TV, mink coat, dining room set, computer, chair, bed and other household items.
• Prepay the funeral with an irrevocable funeral fund
• Pay for dental and eye care and hearing aids
• Purchase an Annuity that is paid out in equal monthly installments over the life of the single person or the life of the healthy spouse. Purchase the annuity from an insurance company that pays all the funds out in a time period that is less than the actuarial lifetime of the owner.
For a single person, name the State of Idaho as the beneficiary to be reimbursed for the Medicaid benefits paid on behalf of the Medicaid applicant.
For a married, healthy spouse, name the spouse first as the beneficiary and the State of Idaho as the contingent beneficiary to be reimbursed for the Medicaid benefits paid on behalf of the Medicaid applicant.
To my knowledge the first such annuity was approved by Health and Welfare in February 2010.
3. Make Gifts of assets
Understand there is a five (5) year “look back” for gifts. That means if you apply for Medicaid, Health and Welfare will “look back” to see if any gifts have been made during the five (5) years prior to applying for Medicaid.
If a gift was made within this five-year period the applicant will be assessed a penalty period. A penalty period means that even though a person meets all other tests to qualify for Medicaid, they must wait out the penalty period before they can reapply and qualify for Medicaid. The penalty period is calculated by dividing the amount of the gifts made in that 5-year period by $200 for a daily calculation. For example, a $13,000 gift will result in a 65-day penalty period. This means that the applicant must wait an additional 65 days before they can reapply for Medicaid.
One solution is to give back the gifted funds, and there will be no penalty period.
Another solution is make large gifts, and put them in an irrevocable trust to protect the assets, and retain sufficient funds to pay the bills for a least five years.
There is no penalty period if a home is gifted to:
• A child who has resided in the home for two years prior to the first time the Medicaid applicant went into a facility for 30 continuous days or more. The child’s care is expected to keep the parent out of a care facility for part of this time.
• A sibling who lived in the home for one (1) year and also has an ownership interest in the home.
• A disabled child.
4. List a non-exempt, real property or other illiquid asset for sale.
If the Medicaid applicant owns real property that is not a primary residence, this property can be listed for sale and will no longer be counted as a non-exempt asset.
Procedure for applying for Medicaid
Once the “spend down” is accomplished and the asset and other test requirements are met, then it is possible apply for Medicaid the next month.
Get Help!
The Medicaid rules are complex and change often. The information provided in this article is general information and not intended as legal advice. If you want to investigate whether you or a loved one may benefit and qualify for the Medicaid program to help assist pay for the cost of long-term care in the home, in an assisted living facility or in a long term nursing home (skilled nursing care) facility, it is recommended that you seek the advice of a Certified Elder Law Attorney or other professional.
Monday, August 23, 2010 HOW TO PAY FOR LONG-TERM CARE?-THE MEDICAID PROGRAM CONTINUED-THE MEDICAID ASSET TEST
Last week we discussed what it takes to meet the Income Test to qualify for Medicaid. This week we will address what it takes to meet the Asset Tests to be able to obtain Medicaid benefits.
There are two types of assets: Exempt and Non-exempt assets. The Idaho Department of Health and Welfare refer to “assets” as “resources.”
Medicaid applicants, who are single, are treated differently than married persons.
What is the Asset Test for a Single Person who is applying for Medicaid?
First consider the exempt assets. What are they? A single person can have the following assets:
One residence and the contiguous land with a maximum value of $750,000. This can be a farm, so long as the land is contiguous. Frequently the valuation can be proved by providing the county tax assessment statement.
One vehicle of an unlimited value.
“Stuff” in the home.
Prepaid irrevocable funeral plan or $1500 in an account identified for a “burial fund.” If the burial/funeral plan is “irrevocable,” that means the day of the funeral the family cannot ask for a lower cost funeral and be reimbursed the excess funds that were prepaid.
Funeral plots for family members.
Retirement accounts, so long as the Medicaid applicant is taking the minimum distribution required. If the Medicaid Applicant is under age 70.5, there are different rules that apply.
Less than $2,000 of other non-exempt assets, such as cash in a checking account, a 2nd car, a vacation home, certificates of deposit and all other non-exempt assets.
There are a number of other assets that can be owned by a single person and that single person will still qualify for Medicaid. The information presented in this article is intended as general information. If you have specific questions about your circumstances, it is recommended you contact a professional for legal advice.
Once a single person has the allowed exempt assets and has less than $2,000 in non-exempt assets, they will meet the Medicaid Asset Test.
The list of non-exempt assets is everything that is not an exempt asset. This list can include, but is not limited to the following:
Real property that is not the primary residence
Bank accounts, certificates of deposit, investments, brokerage accounts, and retirement accounts that are not subject to minimum distribution rules
Cash surrender value of life insurance
Other cars and trucks after taking into account the primary vehicle, which is an exempt asset.
Boats, motorcycles and other expensive “toys.”
What is the Asset Test for a Married Person who is applying for Medicaid?
The exempt asset test is slightly different than the test for a single person applying for Medicaid. The healthy spouse of the married couple (often referred to as the “community spouse”) is entitled to keep the following assets:
One residence and the contiguous land with no limit for the value.
One vehicle of an unlimited value.
“Stuff” in the home.
Prepaid irrevocable funeral plan for both spouses or have a burial account of $1500 set aside for each spouse.
Funeral plots for family members
Retirement accounts for the Medicaid applicant so long as the applicant is taking the minimum annual distribution.
All the retirement accounts of the healthy spouse.
One half of the other non-exempt assets but
No more than $109,560 (+$2,000) = $111,560 and
No less than $21,912 (+$2,000) = $23,912.
The non-exempt assets include separate as well as community property owned by either spouse. These non-exempt assets include but are not limited to:
All assets, including a home, titled in the name of a revocable trust in which either spouse has an interest.
Real property that is not the primary residence of the parties.
Bank accounts, certificates of deposit, investments, brokerage accounts, and retirement accounts of the Medicaid applicant that are not subject to minimum distribution rules
Cash surrender value of life insurance
Vehicles other than the one vehicle claimed as an exempt asset.
Boats, motorcycles and other expensive “toys.”
So how do you calculate the total value for non-exempt assets for a married couple?
Start with the “snap shot” date. This is the first day the Medicaid applicant was continuously in a nursing home or assisted living facility for thirty (30) days, or is expected to be in for thirty (30) days or a Registered Nurse administers the Universal Assessment Instrument (UAI) to the individual and finds that the Medicaid applicant meets the required level of care to qualify for Medicaid.
First identify the fair market value of all the exempt and non-exempt assets on the “snap-shot” date. The assessment values assigned by each Idaho county for real estate tax purposed in Idaho can be used as the fair market value for the real property.
Next blog will be on how to meet the asset test if you have to many non-exempt assets.
Friday, August 13, 2010 HOW TO PAY FOR LONG-TERM CARE? - THE MEDICAID PROGRAM
Medicaid is a State of Idaho and Federal government program that helps people with long-term care costs. The laws and regulations in this area change often so this article will just cover the high points of what it takes to qualify for Medicaid to have the government program pay for long term nursing home care costs.
There are many tests that need to be passed before a person can qualify for Medicaid.
• The Medicaid applicant must be age 65 or older, or blind or deemed disabled according to the Social Security standards.
• the applicant usually must be a citizen.
• the applicant must have a medical need.
• the applicant must past the income test.
• the applicant (and their spouse, if any) must pass the asset test.
What are the benefits of receiving Medicaid?
Medicaid will pay 100% for residential nursing home care and all prescription drug costs in facilities that participate in the Medicaid program
Medicaid will pay 100% for residential care in assisted living, but will not pay for drugs. There are a few Assisted Living facilities that participate in Medicaid because the facilities are often reimbursed at below their break-even point.
Medicaid will pay $16/hour for a maximum of 8 hours per day for in home care by a certified caregiver.
Income Test
Single Person
If the applicant’s gross income is more than $2,022 per month, then the applicant fails the income test. If there income is less than $2,022 per month they will pass this test. Income is usually from social security and pensions, but there are other sources of income that can be considered.
Income for a Married Applicant’s Spouse.
If the income of the healthy spouse [called the “community spouse”] is less than $1,821.25, she can get additional funds from her husband’s social security and pension to bring her up to $1,821.25 and if she has excess shelter costs, she can have a maximum of $2,739 per month. If she needs even more monthly income, she can petition the court for a greater income. There is no limit on the income received by the healthy spouse, so she can have income from her social security, wages and pension of more than $1,821 and her husband may still qualify for Medicaid.
Solution to failing the income test.
If the Medicaid applicant fails the income test by having too much income, that person can set up an irrevocable “Income Qualifying Trust” which is often referred to as a “Miller Trust.”
How does this “Income Qualifying Trust” work? The Trust creator is the Medicaid applicant. The Trustee of the Trust is that person’s spouse, a child or some other trustworthy person. Often the entire amount of the Medicaid applicant’s social security and pension are automatically deposited in the old checking account. The Trustee then sets up a new checking account and every month transfers all the social security and pension to the new account. Then the Trustee makes monthly checks: one for $40 for personal needs, one for $25 for Trustee fees and the balance to the facility.
Next week we will address the Asset Test requirements to qualify for Medicaid.
Friday, July 23, 2010 HOW TO PAY FOR LONG-TERM CARE? - VETERANS BENEFITS CONTINUED: THE ASSET TEST
Last week, July 16, 2010, I wrote about some of the tests that must be met to qualify for a Veterans Administration “non-service connected pension” benefit that can help provide added funds to pay for care in your home or in a facility. These tests included 90 days of military service, one day of service during war time, having the right discharge papers, and having reoccurring monthly medical expenses that were more or somewhat less than your monthly income.
An important additional test to qualify for the VA benefit is the asset test. The Veteran (and their spouse) is allowed a number of assets that are not counted by the Veterans Administration. These include:
One house
One car
“Stuff” in the house.
The instructions for VA Form 21-526 define net worth as follows:
Net worth is the market value of all interest and rights in any kind of property, after
subtracting any mortgages and other claims against the property. List all assets
except the house in which you live, any reasonable area of land on which it sits,
and those items you use everyday, such as your vehicle, clothing and furniture.
Clearly indicate if you and your spouse jointly share assets (such as money in a
joint checking account). Report the value of farms or buildings that you or a
dependent owns as “real property.”
You must disclose all financial transactions that involve a transfer of assets, even
if the transaction occurred prior to the date of your application for VA pension. A
gift of property or a sale below the property’s value to a relative residing in the
same household does not reduce net worth. Likewise, a gift of property to someone
other than a relative residing in your household does not reduce any net worth
unless it is clear that you have relinquished all rights of ownership, including the
right to control the property
The “other assets” become the area of focus. Other assets include a second home, rental, cabin, bare lot, other cars, bank accounts, certificates of deposit, stocks, bonds brokerage accounts, Individual Retirement Account (IRAs), 401(k), other retirement accounts, cash value of life insurance, annuities, partnerships, and the list goes on.
The old rule used to be if the “other assets” were less than $80,000 they would be ignored, and the claimant (and their spouse, if any) could keep up to $80,000. That rule has changed. Now the total amount of the “other assets” that you can keep is dependent on the claimant’s life expectancy. If the “other assets” are over $50,000, it may be best to consult with a VA Accredited Attorney, VA Accredited Agent or the Idaho Veterans Service Office.
The value of the other assets is based on the current fair market value of the assets owned by the claimant (and their spouse). If an asset is owned by someone in addition to the claimant (and their spouse), then the value of the asset is considered proportional to the number of owners. For example if you have a single claimant, and a few years ago he put his three children’s names on his Certificate of Deposit valued at $100,000, the VA would treat his interest in the Certificate of Deposit as $25,000.
Unlike the Medicaid rule, the VA rules do not penalize a claimant if they have given assets away in the years before applying for the VA benefits. So, if a grandparent has helped a grandson by paying $10,000 for his school expenses and then the Veteran grandparent goes into an assisted living facility, there is no penalty for the gift. Under the new VA Form 21-526, it is necessary to disclose each gift, but there is no penalty imposed.
Watch out for irrevocable trusts. If the creator of the trust retains any “strings” of control, it is likely the VA will pull the asset back and treat it as if it belongs to the Veteran or the Veteran’s spouse.
What is a “string” of control? Examples include: Substitute assets, change trustees, change trust protector, change beneficiary, or income from the trust is distributed to the creator of the trust and a 1099 is issued in that person’s name.
Being able to receive the Veterans non-service connected pension is a great help to many so they can stay in their home or afford to pay for an assisted living facility.
One last great feature of the VA pension - there is no “Estate Recovery.” The VA is not a “loan” program. The VA does not want to be paid back after the death of the claimant. Friday, July 23, 2010 IMPORTANT NOTICE - THE IDAHO HUMANE SOCIETY REALLY NEEDS YOUR HELP
It will only take a minute or two of your time!
The IHS is competing with nineteen other animal shelters from around the country to win $50,000 from Purina and Kroger. Anyone with an internet connection and email address can vote once every day to support the animals of Idaho. It’s really simple.
Visit: http://petloversvote.com/Pages/Signup.aspx
Enter Your Email Address & Click Submit
Vote Idaho Humane Society
The IHS took an early lead thanks to our hugely supportive community. Unfortunately, as the end of the contest draws near other, much larger animal shelters in the competition are creeping closer to the Idaho Humane Society and we’re losing our lead! That’s where we need your help!
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Please vote every day: You can mark it on your calendar. It is only 8 more days until the end of the contest on July 31, 2010. If you’re already voting—thank you!
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Forward this email: Please consider resending this email to everyone in your contact list. Tell them why you’re passionate about making our community and all of Idaho a more humane place for animals.
Thank you for your continued support!
The Idaho Humane Society is the State’s oldest and largest animal protection organization and veterinary charity. The Idaho Humane Society’s mission is to advocate for the welfare and responsible care of animals, protect them from neglect and cruelty and promote human awareness and compassion. Friday, July 16, 2010 HOW TO PAY FOR LONG-TERM CARE? - VETERANS BENEFITS
In the last Blog we discussed Medicare as a first government program that can help with the costs of long-term care. Now we will discuss a second program, available through the Veterans Administration that can help certain Veterans with the costs of paying for care in their home, assisted living or skilled nursing homes,
VETERANS ADMINISTRATION (VA) BENEFITS
The Veterans rules are complex and do not always follow common sense guidelines. The information about the Veterans programs presented here are general in nature. If you are interested in pursuing Veterans benefits, you are encouraged to contact the Idaho State Division of Veterans Services to find the contact information for your local Veterans Service Office, 208-577-2300, or contact an Attorney or Agent Accredited with the Veterans Administration.
When to use this program?
It may be possible to use the VA “non-service connected disability income” (called “pension” by the VA) to help pay for care in the home, assisted living or skilled nursing home facilities. The VA benefit is sometimes referred to as “Aid and Attendance.”
The VA has a number of programs available to Veterans, but the only one addressed here will be the “non-service connected pension.” Veterans who are disabled as a result of their military service have other benefits available.
What does it take to qualify for the Veterans “pension” benefits? There are a series of tests to qualify for this benefit.
The simple tests are listed below:
• Are you a Veteran, Veteran's spouse, widow or widower of Veteran
• Was the Veteran in the military for 90 days
• Was one day of the military service during a defined Wartime. The war periods recognized by the VA1 are:
WWII December 7, 1941 through December 31, 1946;
Korean: June 27, 1950 through January 31, 1953;
Vietnam: February 28, 1961 through May 7, 1975 for Veterans who served in Vietnam during that period and August 5, 1964 through May 7, 1975 inclusive for all others;
Persian Gulf: August 2, 1990 through (no one knows since the war on Terror continues and is part of the Persian Gulf War)
• Other than dishonorably discharged
• Is the Veteran age 65 or older? There is no age limit for the Veteran's spouse.
The tests that can be more difficult to measure are concerned with the applicant’s income and assets.
Income Test
The income test compares the gross income of the veteran and the veteran's spouse to their repeating monthly medical expenses. Gross income is defined as the income from social security, pensions, dividends and interest and other sources of regular income, before any deductions are taken out for taxes, Medicare Part B premiums, other health insurance premiums, etc. Repeating monthly medical expenses include, but are not limited to Medicare Part B premiums, health insurance premiums, Medicare Part D premiums paid for prescription drug coverage, prescription drugs, the cost of care givers coming into the home, if the physician declares him or her housebound and in need of assistance from another individual, which may also include services offered in assisted living. If the physician states the applicant needs to live in a “protective environment” then 100% of the assisted living expenses may be deemed a reoccurring medical expense for VA purposes.
What does it really mean to be in “need of assistance from another?” These are some of the categories.
Blind
Living in a nursing home
Unable to
Dress/ undress or keep oneself clean and presentable
Attend the wants of nature without assistance
Have a physical or mental incapacity that requires assistance on a regular basis to protect the claimant from daily environmental hazards.
What is the maximum the VA pays in 2010 for Aid and Attendance Pension on a monthly basis?
For a single Veteran, $1,644
For a married Veteran $1,949
For a widowed spouse of a Veteran $1,056
For a Veteran married to a Veteran $2,540
Calculating the amount of the VA benefit.
Start with the gross Income before any deductions of a single person or both spouses.
Subtract from the gross income all repeating monthly medical expenses, such as insurance, prescriptions, attends, caregivers or assisted living or nursing home costs to come up with “net income”
If the difference is
Zero, the VA will pay the maximum benefit.
Less than zero, the VA will pay the maximum benefit.
More than zero, the VA will only pay the difference between the maximum benefit and the net income.
Here is an example of the calculation for a single vet:
Gross income from Social Security and Pension 3,150
Repeating monthly expenses for Medicare Part B, Medicare Part D premiums
health insurance premiums and the cost of caregivers coming into the home 2,150
Difference 1,000
VA maximum benefit 1,644
Subtract Difference 1,000
VA will pay 644
Next time we will discuss the other criteria needed to qualify for the VA non-service connected pension benefits.
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1Check the VA regulations for additional war time dates. Friday, July 02, 2010 How to Pay For Long-Term Care
There are two approaches to paying for care. Assume the responsibility yourself or rely on the State and Federal government to pay for the care.
If you choose to assume the responsibility to pay for your own care, you will use your own assets and income or purchase long-term care insurance to help pay for care in your home, in an assisted living facility or in a nursing home.
If you look to the government to pay for your care, there are three programs currently available to help. Be aware that our government is in the worst financial position ever, and its expenses exceed income, so these safety nets may be diminished in the future. The three government programs that help pay for long-term care are Medicare, Veterans’ non-service connected "pension” benefits and Medicaid. We will consider each of these three government programs. In this article we will discuss the first Government program, Medicare.
MEDICARE
Who is covered? This is a federal health insurance program for people age 65 and older.
What does Medicare pay for?
Part A = Hospital bills.
Part B = Doctor, outpatient, home health and preventative services ($96.40/month premium up to $353.60 for higher incomes)
Part C = Medicare Advantage program, really HMOs
Part D= Prescription drug plan
Does Medicare pay for residential, long-term care in your home, assisted living or a nursing home? No, but with one exception.
If you are admitted to a hospital for 3 days, then discharged to a rehabilitation facility and you are improving, Medicare will pay 100% of the cost for the first 20 days. If you continue to improve, then from day 21 to day 100 the patient will pay $137.50/day [or their supplemental insurance pays] and Medicare pays the rest. How is this safety net disappearing?
WARNING: If you are not “admitted” to the hospital, but there for “observation” Medicare will not pay a dime and your supplemental Medicare insurance will not pay either. Failure to get the first 20 days covered by the Medicare program can cost in excess of $6,000! This is an Idaho and a nation-wide problem.1
THE SOLUTION: Make certain you are “admitted” to the hospital before being discharged. If you cannot get this accomplished, talk to the hospital social worker, or an independent Care Manager.
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1 "Hospital Stays Under Observation," AARP Bulletin, January-February, 2010
HAVE A GREAT 4th OF JULY
Friday, June 25, 2010 The Conveyor Belt of Aging - As People Age They Usually Fall Apart
We all want to just die some day in the distant future. No one wants to be dependent and require caregivers for any extended period before we die. The reality is obvious - as we age we probably fall apart. Just like an older car, the tires get flat or bald, the fender rusts and falls off, the battery dies. What is the progression for people?
Hopefully you started on the conveyor belt of life for seniors as a healthy retired person. As the belt moves along have you found yourself;
• Taking medications
• Having health issues
• In the hospital for a crisis (pneumonia or a fall)
• Experiencing memory loss
• Less mobile
• Signing up for Medicare and supplemental insurance to help pay for all of this.
At this point care becomes an issue, care in the home is needed and a new concern becomes how to pay for that care. Is the care paid for “out of pocket," with long-term care insurance, Veterans Administration benefits, or Medicare? As the conveyor belt keeps moving, staying in the home may no longer be possible, so you move to an assisted living facility (where you can do a few things for yourself) or you become a fragile senior and need to be in a skilled nursing home. Again, the concern is what funds you will use to pay for that care – your own money, VA non-service connected pension benefits, Medicare, Medicaid or long-term care insurance.
What is the average length of care in facilities?
Assisted Living stays range from 2.5-3 years.1 To qualify to stay in an assisted living facility, the residents need some help with what are called “activities of daily living.” These six activities include: medications, bathing, dressing, toileting, transferring and eating.
Skilled Nursing Care (nursing home) stays average 2.4 years. Of course, the average is based on residents who stay for only a few days, and others who stay for a decade or more.
What does it cost for care in southwestern Idaho?
Assisted Living $2,000 to 5,000/month
Nursing Home $6,000 to $8,000/month
At Home $20/hr for a bath aide in the home to
$15,000/month for 24-hour care.
Once the conveyor belt has stopped, after death, are there care needs for the surviving spouse or dependent disabled children?
The issues become frightening when considering this progression. Start planning NOW.
1 Public Policy Institute, Assisted Living in the United States Fact Sheet, AARP, FS62R Friday, June 18, 2010 Elder Abuse - Do You Know What That Is?
We have clients who are doing their best to help elderly family members, but are inadvertently harming their loved ones by leaving them isolated and alone. There just are not enough hours in a week to do the shopping, preparing meals, visiting, cleaning and the other large and small endless chores required for fragile or demented elders. So many people just do the best they can. But that really may not be enough or right in the big picture. How do you know when there is “Elder Abuse”? This brief article by Dr. Mor highlights the subtle and overt forms of abuse. It is my hope that being aware of even unintentional forms of abuse will help prevent this from happening and move caregivers to seek help in providing care for our seniors.
PREVENTION OF ELDER ABUSE
Eva Mor PhD
Author of "Making the Golden Years Golden"
The numbers reflecting incidents of abuse in the senior population vary depending on the source that is reporting them. Definitions of what constitutes as "abuse" are also diverse: some sources define elder abuse as only physical abuse, while other sources include emotional abuse, sexual abuse and financial abuse. Accurate numbers are also extremely difficult to compile since many incidents of abuse go unreported. Many elderly are afraid or ashamed to report incidents of abuse, especially if the perpetrator is a family member. Seniors at times are emotionally or physically abused by a familiar person, and are often unable to recognize it as abuse or rationalize it.
What can be done to eliminate incidences of abuse? Society should shoulder the responsibility to protect the elderly, but it begins with the family of the senior. Many of the children and other relatives of the elderly feel that once they have a care giver to care for the elderly their work is done. Far from it, they need to remain vigilant in directing and overseeing that good care is in fact what is provided.
When visiting an elder loved one, you should be alert to the warning signs of abuse:
Emotional or Psychological Abuse:
Are there insults or threats directed at the elder? Are they living in social isolation? The elder may be extremely upset, withdrawn, unresponsive, or exhibiting other unusual behavior. He or she may have a vacant look in their eyes or exhibit fear; they may not always express those verbally, so look for signs in their face or behavior.
Physical and Sexual Abuse:
Look for suspicious bruises or other injuries. Look for signs of restraints, such as a rope burns. See if he or she shows sudden changes of behavior, such as unexplained anger, fear, withdrawal, or has become very quiet. Note if a worker or caregiver refuses to let you visit the elder, making all kind of excuses.
Neglect:
Look for signs of malnutrition, if there is noticeable weight loss, dehydration, bed sores, or if personal hygiene is noticeable neglected. Note if the elder is sitting in soiled clothing, unshaven, unkempt, without dentures, or with long or dirty nails, are they walking around at midday still wearing pajamas? Listen to complaints from the senior as to whether or not their aide is listening to them or following their wishes and follow up on them.
Financial Abuse:
Keep an eye out for unexplained bank withdrawals, unauthorized use of bank and credit cards, reports of stolen or missing checkbooks and bank cards, or if your parent or elder writes checks as a loan or gift to the aide. Be on the lookout for valuables suddenly disappearing. Monitor any sudden changes in the will or banking documents, and be alert if assets are suddenly transferred to a family member or to someone outside the family.
If you discover any of the above warning signals, you should correct them and/or notify the police. The above warning signs should be looked for not only in the home of the elderly, but also if they reside in a nursing home, assisted living facility or a residential care facility. If the elder does not have a family member to protect him or her, the responsibility falls on the society, all of us – doctors, social workers, friends, neighbors and local clergy. For more info: www.goldenyearsgolden.com |