For Boomers & Their Aging Parents
The problem of elder abuse is not going away. With millions of cases of elder abuse reported
each year, this has become a very serious issue. Maybe it’s a combination of more seniors
sharing homes with their families and the stresses most people live under
today. Certainly the struggle to care for an elderly adult who is sick or impaired, either
physically or mentally, along with the financial burden of caring for an elderly
individual, can cause stress on a caregiver and increase the
likelihood of abuse.
The victim is often
female, over the age of 75, dependent on the abuser, isolated and frequently impaired. The abusers are frequently financially dependent,
isolated, inexperienced, unrealistic and impatient caregivers. And while abusers can be spouses,
children, hired caregivers, or any other adults with whom elderly individuals
have contact, the greatest risk for the victim comes from those
with whom they live. Family dynamics are
a major contributing factor to adult abuse; it is known that in 90% of all reported elder abuse cases, the abuser
is a family member. Researchers have estimated that anywhere from five to
twenty-three percent of all caregivers are physically abusive.
What are the indications that someone is not being treated
with proper care? Each state might differ slightly in its definition, but the following comes from Florida’s Department of Elder Affairs:
Physical Abuse is the infliction or the threat to inflict physical pain or injury
on an elderly person. This
striking, slapping, kicking, pinching, restraining, shaking, beating burning,
hitting, shoving or other acts that can cause harm to an individual.
Emotional or Psychological Abuse is the infliction of mental stress, pain,
or anguish through non-verbal or verbal actions including verbal
berating, harassment, intimidation, threats of punishment of deprivation,
criticism, demeaning comments, coercive behavior, isolation from family and
Financial Exploitation involves improper use of the victim’s
funds, property or assets, cashing checks without permission, forging
signatures, coercing or deceiving an older person into signing a document, using
an ATM card without permission.
Sexual Abuse is non-consensual sexual contact of any kind
including assault or battery, rape, sodomy, coerced nudity or sexually explicit
Neglect is indicated with unexpected or unexplained
deterioration of health, personal care, or
living situation, inadequate food, clothing and/or shelter.
We all need to become educated about what elder abuse is and
how it can be prevented. In the event
that you know an elderly individual who is the victim of abuse, there are many
resources from public authorities to legal professionals, you can contact. Bottom line -- if you
believe someone you know is the victim of elder abuse, seek help. You
can call the toll free hotline: 1-800-96-abuse. All calls are confidential.
THE RED CARPET WILL ROLL OUT MARCH 16, IN BOCA RATON, FL., FOR PEOPLE WITH DISABILITIES
The nation’s Largest Free Event for Kids & Adults with Special Needs Invites America to Attend 5th Annual Day-Long Party in BOCA RATON, FL
The nation’s largest, annual, free-event for people with physical and/or intellectual challenges, the Boating & Beach Bash for People with Disabilities, will take place Saturday, March 16, 2013, from 10:00 AM – 3:00 PM, in Spanish River Park, State Road A1A, Boca Raton, FL.
The event encourages families with a child or adult member with disabilities, to spend a long weekend in Florida during the nicest time of year, early spring. “We annually roll out the red carpet to welcome people from all across the United States,” says Bash director Jay Van Vechten. “Florida residents and visitors alike have discovered the Bash is the one national event that celebrates diversity by offering a safe, accessible, atmosphere for all ages, with any type of physical and/or intellectual disability, their caregivers and families.
Last year, 4496 guests registered at the gates, while 501 volunteers lined up to assist with hospitality and helping attendees have the best possible time. Five thousand guests are expected this year. Everything for the day is free to all participants.
See you there!
Periodically I like to check out the new and/or updated technologies
for aging in place that are being brought to market. Here are a few I found interesting:
Microsoft, in an effort to improve its technology for
people challenged by limited motor skills or for those visually or
hearing disabled, has made changes to its new operating system, Windows 8, to
significantly enhance accessibility.
Both Microsoft Magnifier and Microsoft Narrator have been improved with
touch capabilities making them much simpler to use and maneuver. To make these features easier to find,
greater emphasis has been put on the Windows Ease of Access Center which will
be clearly visible on the systems home page.
The Ease of Access Center poses questions that are designed to direct
the user to the features they need to be using.
For example, “Do you have difficulty reading the screen?” will prompt
someone to open the Magnifier function. And
while not there yet, Microsoft’s journey is towards broader accessibility. Eventually users will be able to interact
with their computer or tablet using the method they’re most comfortable with --
keyboard, voice recognition or even gestures –
virtually eliminating any visual, auditory, or dexterity impediments they might
Care Technology Systems and
Qualcomm Life have partnered to create is a cloud based system that enables
provider and users to capture data for any wireless medical device and deliver
it in a secure and reliable system. Information can be easily retrieved by
physicians, caregivers, or other critical audiences, for use in healthcare
decisions. The company provides fall
detection monitoring, activity monitoring, and biometric monitoring (pulse oximeter,
glucometer, weight scale, and blood pressure cuff) which is FDA approved and HIPAA
compliant. Read more at www.caretechsys.com
is committed to helping people who are computer novices connect with family,
friends and the world. Telikin
makes the easy to use, all-in-one, touchscreen computer that integrates features such as video chat with integrated Skype, photo sharing with an
integrated facebook application, email, contacts, weather, news, full web
browser, word processing, built in video help and more in a virus free
system. With the large monitor, intuitive interface, easy menu of popular
features, and extensive customer support, Telikin helps people stay connected
to their families, friends and the world. Find out more at www.telikin.com
With an estimated 36 million American facing age-related
hearing loss and the hearing aid market estimated at $6 billion dollars globally,
the race is on to apply current technology -- such as that used in noise
cancellation and miniaturization -- to an inexpensive, user friendly hearing
device. Personal Sound Amplification Products (PSAP) are being marketed as less expensive alternative to a traditional hearing aid. PSAPs are classified as electronics and
not as medical devices by the Food and Drug Administration, consequently they are
not regulated and do not require a prescription. While these personal sound amplifiers may help people hear things that are at low volume or at a distance, the Food and Drug Administration (FDA) wants to ensure that consumers don't mistake them—or use them as substitutes—for approved hearing aids. "Hearing aids and personal sound amplification products (PSAPS) can both improve our ability to hear sound," says Eric Mann, M.D., Ph.D, clinical deputy director of FDA's Division of Ophthalmic, Neurological, And Ear, Nose, and Throat Devices. "They are both wearable, and some of their technology and function is similar."
There are a number of companies making PSAPs which range from well under $100 to around $1,000, unlike a typical pair of hearing aids which cost $3000-$4000. Able Planet, a $140 million consumer electronics company, offers a
tiny, in-ear device, called Personal Sound, which has won numerous product
awards. To read more see www.ableplanet.com/products/hearing-health
Susan Luxenberg, President
While there are many people who would benefit from
home modifications, finding the money to pay for them can be difficult. Unless one has private funds, is entitled to VA
benefits, has a long term care policy that pays for accessibility modifications,
or can draw equity out of their home, there is little else that pays for adapting a home for safety and accessibility. Local
governments used to be a source of funding for these projects through Community
Development Block Grants (CDBG funds) but today most of that money has dried
The challenge then is finding resources to help
families that need these type of modifications but cannot afford to pay for this work
Rebuilding Together is the nation’s leading nonprofit organization providing critical home
repairs, modifications and improvements for America’s low-income homeowners. Their “Safe at Home” program
addresses home repair and maintenance issues that may otherwise present a
safety risk or that limit access to or within the home.
Safe at Home covers a variety of strategies,
public awareness and build coalitions around the need for home safety and
training and technical assistance on fall prevention methods and home
our affiliate network’s core competency in the delivery of home safety
as an information and referral resource on fall prevention and home safety
for the needs and of low-income homeowners particularly older
adults, people living with disabilities and multi-generational families
Safe at Home modifications cover fall prevention, fire safety and general
grab bars throughout the home, widening doorways for greater access,
repairing stairways, handrails, and wheelchair ramps inside and outside
safety: installing fire alarms and
carbon monoxide detectors, eliminating electrical hazards, and repairing structural defects
- General safety: general safety upgrades and
rehabilitative practices to ensure the absolute safety and health of the
Rebuilding Together and their affiliates can’t
do it all on their own so collaborating with national and local organizations
is a critical factor in a holistic approach to service delivery. Community
partners include but are not limited to:
Occupational Therapy Association (AOTA)
Agencies on Aging and National Association of Area Agencies on Aging (n4a)
Council on Aging (NCOA)
Home Builders – Certified Aging-in-Place Specialist program (NAHB)
Safety Council (HSC)
Society on Aging (ASOA)
- Local city and county Health and Elderly Service Agencies
Housing Act is a federal law that prohibits all housing providers from
discriminating against persons with a disability. The Fair Housing Act covers most housing – single
family houses, apartment complexes, mobile home parts, condominiums, retirement
communities, cooperatives, time shares, senior housing, boarding houses,
residential hotels, group homes, and assisted living facilities. In
some circumstances, the Act exempts owner-occupied buildings with no more than
four units, single-family housing sold or rented without the use of a broker,
and housing operated by organizations and private clubs that limit occupancy to
this Act, a disability is defined as “a physical or mental impairment which
substantially limits one or more major life activities.” Examples of impairments include mobility and cognitive
impairments, vision, hearing, AIDS or HIV infection, mental illness, learning
disabilities, head injury, asthma, chronic fatigue, or history of alcoholism or
drug addiction. Disability does not
include current use of or addiction to illegal drugs.
Housing Act protects all housing applicants, buyers, and tenants with
disabilities as well as anyone associated with them, such as family members. It requires housing providers to make reasonable accommodations and allow reasonable modifications so that people
with disabilities can use and enjoy housing on an equal basis. A housing provider does have the right to request proof of the disability (a doctor’s note should suffice) and how the requested accommodation or modification would increase that individual's safety and comfort.
are those changes to policies, rules, or practices that persons with
disabilities may need in order to have an equal opportunity to use and enjoy
their home. For example, waiving a no
pet rule for a guide dog, or creating a reserved parking space near the
building entrance for someone who is mobility impaired.
A reasonable modification is any physical change to a rental unit, condo, co-op, or common space that is needed for an individual’s full enjoyment of his/her home. Generally
speaking, a modification is considered reasonable when it is practical and
realistic and linked to a particular disability. Here are
some examples of reasonable modifications:
Installing grab bars in the bathroom
Installing a ramp at
the building’s entrance or front door
Installing lever doorknobs and
Converting a tub to a curb-less
Lowering shelves or kitchen
It is each person’s responsibility to
pay and arrange for whatever modifications they are requesting. A housing provider can require a deposit to be
used to restore the unit back to its original condition when it’s time to be
rented or sold. They can also require architectural
drawings showing that the work complies with all state and local building codes.
If you think your rights have been violated, the Housing Discrimination Complaint Form is available for you to download,
complete and return, or complete online and submit, or you may write HUD a
letter, or telephone the HUD Office nearest you. You have one year after an
alleged violation to file a complaint with HUD, but you should file as soon
What to Tell HUD:
name and address
name and address of the person your complaint is against
address or other identification to the housing involved
short description to the alleged violation (the event that caused you to
believe your rights were violated)
date(s) to the alleged violation
Susan Luxenberg President
much new technology in the marketplace aimed at the aging in place market that’s
it’s difficult to keep up. Every few months though, I spend time researching some of
the newest software and gadgets that
have recently made their debut - specifically those designed to help seniors living on their
own and their remote caregivers keep in touch.
surprisingly there has been a growing number of applications available for use
with smartphones and tablets. Here are a
SwannView is a video monitoring solution that works on virtually any Smartphone or Tablet without the need for a computer or webcam. The Swann Security kit (cost: $449) includes
four color cameras and a digital video recorder to record up to 30 days of
video from all four cameras simultaneously.
SwannView works over wi-fi or cellular connectivity on an Android,
iPhone, BlackBerry or any Windows device so you can remotely log in to see a
live, real time view. The cameras are
easily mountable and have an infrared LED night vision feature that allows you
to see up to 65 feet in the dark. You
can set this kit up to send you an email if the cameras detect motion. The iCam app
for iPhone, iPad or iPod touch (cost: $4.99) allows you to monitor multiple
live video and audio feeds over Wi-Fi or cellular connectivity. With a computer and a webcam, you can
visually check- in to make sure all is well.
You can also set up the app to notify you when motion is detected.
Many seniors who live
independently often use a medical alert system to get help in an emergency such
as falling. The problem is that in the past, the majority of these systems
only worked within range of a home based receiving system. When a person was out of their home, they no
longer had on-the-go access to emergency assistance.
Today’s fall detection devices include fall detection
that works away from home and allows other family members to monitor the
whereabouts of the wearer using GPS tracking. ActiveCare’s Personal Assistance Link (PAL) is
a handset offering a range of features to assist people who want to continue
living independently. The device, which
connects via a cellular network, includes a one-click help button to call for
24/7 assistance, a built in fall detector that’s monitored remotely, and GPS. The PAL offers one touch communication to
Care Specialists from anywhere at anytime.
It looks like a cell phone but is
easier to operate with large buttons and quick one-touch access to
family and the 24/7 Care Center. (Cost:$180 activation fee, $60/month service
charge) The Alzheimer’s
Foundation of American along with
Breadcrumb LLC recently announced a state of the art locater device and
caregiver-friendly monitoring system. This innovative new tracking device – BC
300 GPS Device – is designed specifically for the dementia population and aimed
at immediately and precisely pinpointing a person’s whereabouts. .The
BC300 system works by setting up a virtual fence around a person’s residence
and/or other locations, such as a relative’s home or an adult day care center,
and sends an alert when the wearer leaves that zone. As one of the smallest, most lightweight tracking
devices on the market, the BC300 is strapped around a person’s ankle with a
heavy duty band. Designed with the symptoms of dementia in mind, including
memory loss, confusion and other cognitive loss, the device is not dependent on
the user’s activation. Caregivers can access the wearer’s real time location
24/7 on a Google map via computer or smartphone. In the event the person
wearing the locating device leaves a designated safety zone, an alert is sent
to the Breadcrumb Customer Care Center--as well as up to five caregivers and if
necessary, the proper authorities are contacted . (Cost: $190, $38/mo service charge)
As more and more families are caring for older relatives, the need for better ways to share sensitive health information has become obvious. There's many types of information to track, for eg. emergency contacts, details about care-related services or treatments, legal and financial documents, all of which family members in multiple locations may need access to.
This past week, CareZone, launched it's new site offering a way to share and manage information associated with caring for another individual. You set up a profile about the person receiving care, list their current medications, sketch out to do lists, add any relevant contacts, share notes and upload files. As the creator of a profile you can give others access which you can also revoke at any time. You might give access to family members who share caregiving responsibilities, professional caregivers or medical staff. The company plans to charge $5/month or $48/yr for each person for whom care is provided. As an introductory offer you can sign up for free until March 15th. Susan Luxenberg
Many of us
are facing the similar issue of getting our aging parent(s) to acknowledge that
they need some help in their home. More
often than not it’s a frustrating “locking of horns” as we try to persuade our
parent that it is no longer safe or feasible for them to live without
assistance, whether it’s help with cleaning and cooking, bill paying, driving,
or any of the normal activities of daily living.
difficulty starts in even knowing how to approach the subject, let alone meeting all their ready objections. Denial and control are the key elements here, so the objections are multiple and range from “I’m don’t need any help” to “I
don’t want to spend the money.” I’ve had seniors who have been hospitalized
for falling, tell me that they know
for certain they will not fall again and therefore do not need non-slip
flooring or grab bars. They simply will
be more careful.
spoke with a daughter, who lives in California, about installing some
additional safety aides for her father, a 99 yr old living in Florida. Her dad had been hospitalized three or four
times in the past year for falling and yet refused to use a walker or allow
grab bars to be installed in his home. As
she explained to me, “If there was nothing to help him, that’s one thing. But I’m starting to resent having to drop
everything to jump on a plane and fly cross country to the hospital when there
are options that would help prevent his falls.”
My sister, brother, and I have had numerous conversations about the best way to broach the topic
with our own parents. We’ve debated whether,
out of respect we should only gently press an issue or, out of concern we
should push forward to do what needs to be done. I’ve had similar discussions with the adult
kids of my clients. At some point or
another, everyone struggles with how long to beat around the bush before taking
control and forcing a solution.
to case managers, clinical social workers, psychologists and gerontologists for
some expert guidance in this matter. Their compounded wisdom suggests we consider
the following when trying to help our aging parents:
barge in and dictate that which you think needs to be done. Find a
quiet time to talk with your parent and explain why you are concerned. Encourage
their response, stay open minded, and listen carefully.
Make the conversation positive and emphasize
that if they are proactive and act before there is a crisis, they stand a
better chance of retaining control and independence.
Find out how
you can help them by understanding what options they might be considering and
what their objectives are.
Do not push
them to accept your assessment but rather give them sufficient time to form
their own conclusions.
to prioritize and negotiate the changes you believe need to be made.
advisers or other family members for support.
Sometimes it just takes the right person or personality to allow for a dialogue
without emotionality or defensiveness.
state the problem – help them find solutions. Do some research in advance so that you know
what resources and agencies are available in their community. Obtain
contact information, brochures, financial costs, etc. so that your conversation
with your parents can be realistic.
there’s more than one way to handle any given situation. Your parents may be far more ready to listen
if you can present a variety of choices to them, allowing them to make the
decision for their own well being.
I think most people would agree that making a
home safe and comfortable can allow an individual to remain at home and retain
independence as they age and their abilities change. Even the smallest renovation can change the
life of someone with a disability and mean the difference between comfort and
discomfort in one’s own home. Grab bars, stairway railings, lever door handles, non-slip coatings to
flooring, and threshold ramps are low cost modifications that greatly improve
safety. More extensive modifications may
include widening doorways, installing elevators, stair and porch lifts,
replacing tubs with walk-in showers, lowering counters and cabinets, and
someone independent, however, often extends beyond making physical changes to a
home. It's not uncommon that additional resources are required both in services and equipment. Assistive Technology devices are a
group of products that improve a person’s ability to live and function
independently. These products can be as
simple as a cane or a weekly pill organizer, or as sophisticated as a
voice-activated computer system or sensor.
In fact, the area of assistive technology has grown so quickly and there are so many products and devices available to meet every need, that it can be very confusing to the uninitiated.
Categories of Assistive Technology Devices:
Living Aids. These products help people perform activities
of daily living, such as bathing, dressing, and preparing meals. They include everything from reaching tools
and jar openers, to shower seats, bed rails, night lights and easy to
read alarm clocks, low vision aids and low hearing aids, neck pillows, back pillows, bluetooth devices -- the list is endless.
Aids. Pill organizers (from the simplest to the
most high tech), timers and pill crushers.
Aids. Canes, walkers, scooters and wheelchairs, both
manual and electric. Walkers improve
stability and should be tested to ensure they are sturdy, lightweight, at the
correct height for the individual, and can be moved easily. Manual wheelchairs
require some arm strength or leg strength and skill to move the chair while
electric wheelchairs are useful for those who can move around on their own but
lack the strength to wheel themselves. Scooters are useful for those who can
walk very short distances and get around by themselves.
Advances in computer and phone technology have greatly helped seniors to
live independently while maintaining connection to family, friends and support
services. There are modified phones with
large buttons, headsets, speakerphone capabilities or visual displays. Updated computer technology includes voice
recognition software and modified keyboards.
There is also simplified equipment that allows for email, photos and
other documents without having to use a computer.
Monitoring. Personal emergency response systems (PERS)
call the appropriate contacts and emergency services when a monitor center is
alerted via an emergency button worn as a pendant, bracelet or belt. Occupancy monitors use pressure sensitive
pads that activate when someone moves to get up. Webcams and other sophisticated computerized systems allow for long distance monitoring for distant family members.
these products are available at drug stores or medical supply stores and
you also can easily browse online for products. And
while some assistive devices are paid for by Medicaire, ie walkers, wheelchairs
and scooters if prescribed by a physician when determined to be medically necessary,
most are not. If you are looking for
funding you’ll need to check Medicaid waiver programs, health insurance, the
Department of Veteran Affairs and some public service organization like United
Way and Easter Seals.
If you are uncertain exactly what products or equipment
to choose, there are a few agencies which keep a complete list of assistive technology devices and can help you determine which is right for your
particular circumstance. In addition to
the national programs, every state has a State technology assistance project
that has information about assistive technology, financial assistance to purchase
equipment, and loan programs. ABLEDATA can connect you with someone in your state.
For more information, you can contact:
frequently comes up as to how to pay for accessibility modifications, especially
more major ones like a fully adapted bathroom or kitchen. Unfortunately, other than long term care
insurance and personal savings there’s little out there today to help defray the
cost of renovating a home in order to create a barrier free environment.
however, money available for Veterans. Veterans or
service members who have specific service-connected disabilities may be
entitled to a grant from the Department of Veterans Affairs (VA) for the
purpose of constructing a barrier free home or modifying an existing home to meet
their special needs.
Adapted Housing Grant (SAH), or a 2010(a) grant, is intended for disabled
veterans. The goal of the SAH Program is
to provide a living environment that affords the veterans or
service members a level of independent living he or she may not normally enjoy.
The grant is
meant to offset the cost of specially adapted housing and offers up to half of
the cost of the purchase, construction, or renovation of the house to a maximum
amount of $50,000. If the maximum grant
is not used all at once, a second grant can be obtained for future adaptive
modifications. For example, if the total
cost of adapting a home is $80,000, the maximum grant would be for 50% of the
$80,000 or $40,000. The veteran could,
at a later date, claim another grant of $10,000 for the repair of the
adaptations done originally, or for the installation of additional adaptations,
or towards the purchase, construction, or adaptation of another home.
According to VA requirements, those eligible
for the grant are those entitled to or currently receiving VA compensation for
what the Department of Veteran Affairs defines as permanent and total service
connected disability. Eligibility must
first be determined before an application for the Grant can be made. Some of the requirements in determining
1. It must be medically feasible for the
veteran or service member to reside in the
2. The house must be adapted to be
suitable to the veteran’s needs for living purposes.
3. It must be financially feasible for
the veteran to acquire the house with the
assistance provided by the Grant.
The types of
adaptations covered include ramps, lifts, widened doorways and hallways,
expanding garages and carports to allow for wheelchair maneuverability,
accessible bathrooms, adjusting placement of wall switches and electrical
outlets, windows that are operable from a wheelchair, automatically operated
entry and garage doors, kitchen adaptations, modifying exterior walkways and
The following are pictures of projects completed under the SAH grant program.
Modified Kitchen with new cabinets,
counters, flooring and window
Fully adapted bathroom
The Special Housing Adaptations (SHA) program, or
2101(b) grant, provides the actual cost to the veteran of certain adaptations
and/or equipment, not to exceed a maximum grant of $10,000. The home to be
adapted must be owned by the veteran or by a member of the veteran's family,
and the veteran must intend to continue residing there.
Types of renovations covered depend on the
specific disability and include special lighting, sliding doors, handrails,
grab bars, smoke detectors, security systems, exterior doors and locks,
concrete or asphalt walkways, fencing,
porches, awnings, additional electrical, lever faucets, lowered
cabinets, rocker light switches and other adaptations with the approval of the
Here are a couple of pictures of projects completed under the SHA program.
Bermed walkway and front porch
Enlarged doorway and pocket door
The Temporary Residence Adaptations (TRA) program
provides adaptation assistance to veterans who are residing, but do not intend
to permanently reside, in the a residence owned by a family member. If a
veteran is otherwise eligible for SAH, the assistance is limited to $14,000. If
a veteran is otherwise eligible for SHA, the assistance is limited to $2,000.
SAH and SHA grants may be used up to three times,
as long as the aggregate grant amount does not exceed the statutory dollar
limitation. TRA grants may only be used once (and count as a grant usage for
purposes of the limit of three), and the amount of assistance provided will be
subtracted from the veteran's available statutory maximum.
Aging Baby Boomers themselves may be a bit young for the services of a Geriatric Care Manager, but there are many Boomers who are arranging care for an elderly parent or
relative. If you've ever been in the position of searching for information about resources in a community for the elderly, you already know that the task can be overwhelming and difficult - especially from out of town.
Care Managers are educated listeners who can provide an individualized road map
for dealing with all the issues associated with aging. As
per the National Association of Professional Geriatric Care Managers (NAPGCM), a professional Geriatric Care Manager (GCM) is
a health and human services specialist who helps families who are caring for
older relatives. The GCM is trained and experienced in any of several fields
related to care management, including nursing, gerontology, social work, or
psychology and has
extensive knowledge about the cost, quality
and availability of elder services in the community.
GCM's are experts in helping families determine what kind of help an older adult
needs and can assist in planning and coordinating whatever help is required. The
services they provide include:
1. Conducting a thorough assessment of a client’s physical,
medical, mental and financial status so as to identify problems and provide both
short and long term plans for care.
2. Providing crisis intervention
3. Acting as a liaison to families at a distance,
overseeing care, and quickly alerting families to problems – especially
important when families are engaged in long distance care giving
4. Screening, arranging, and monitoring in-home
help or other services, including assistance in hiring a qualified caregiver for in home care.
5. Reviewing financial, legal, or medical issues
and offering qualified referrals to geriatric specialists.
6. Assisting with moving an older person to or
from a retirement complex, assisted care home, or nursing home.
7. Providing consumer education and advocacy.
care managers often bridge the gap between ongoing independent living and more
full-time care such as home health aides or assisted living. Their role is essential when there are
numerous decisions to be made, the person is in the midst of a crisis or at a
crossroads such as a hospitalization. GCM’s
also serve to buffer some of the emotional stress that occurs in a crisis and
help a family work towards a unified solution.
is yet another case where Medicare or Medicaid does not pay for the service,
and long-term care coverage varies widely. Most agencies charge an hourly rate of between
$60 to $300 per hour depending on the part of the country. And while these fees
can be pricey, sometimes a single consultation,
where the family can become educated about their options, is all that’s
You can find Geriatric Care Managers through the Area Agency on Aging in a community, hospitals, senior centers, geriatric assessment centers, or non-profit agencies serving families. You can also call the National Association of Professional Geriatric Care Mangers at 520-881-8008
In a previous blog I wrote about available funding sources for
home modifications. At the time, I avoided a discussion about
reverse mortgages given the loss of equity many people experienced during the
market meltdown. I do believe, however, that reverse mortgages are a
viable product for older homeowners who want to use some of the equity in their
homes for aging-in-place style renovations . The caveat being that you must first do your
homework, consider all your options, and realistically assess your short and
long term financial needs so as to understand the financial consequences of this
type mortgage loan.
Reverse mortgages are administered by the U.S. Department of
Housing and Urban Development (HUD) and the program is called the Home Equity
Conversion Mortgage (HECM). Before obtaining a reverse mortgage, it is required
that you receive consumer information from an approved HECM counselor.
So how does a reverse
mortgage work? Reverse mortgages allow you to borrow on the
equity in your home. Your home is used as collateral
to get cash and instead of you making payments to the lender, the lender makes payments to you. Payments can be made as a lump sum, monthly
for as long as you live in your home, set up as advances when needed through a line of
credit, or any combination of the above. The loan plus interest is paid
off whenever the property is sold - even
if the sale price is less than the amount owed the lender. By law,
lenders cannot go after a homeowner’s other assets or his/her estate if the home sells for less than the
reverse mortgage amount. Instead HUD
backs up these mortgages and pays back the difference.
Who qualifies for a
reverse mortgage? To qualify you must be 62 or older, own the
property, live in the home as a primary residence, and make the reverse
mortgage the first mortgage, meaning any existing mortgages will be
paid off by the proceeds of the reverse mortgage. You must also keep current on taxes,
insurance and maintenance. The borrower’s
credit history is irrelevant and FICO scores do not come into consideration.
What are the
advantages of a reverse mortgage? 1)
It will pay off the current debt on your home.
2) You take cash from your home’s equity without having to pay anything
monthly. 3) The loan proceeds can be
used for any purpose. 4) Money not
withdrawn immediately can be drawn via several different payment options. 5) Lenders cannot force you to sell the property
to pay back the loan so reverse mortgages guarantee that you can remain in your
home for as long as you live, even if the mortgage loan and interest exceed the
What are the
disadvantages of a reverse mortgage?
1) The fees for this type of mortgage are higher than fees for a conventional
2) Since a reverse mortgage enables you to use a portion of your
home's equity, future equity is reduced. 3) Substantial equity is
usually required in order to qualify for a reverse mortgage.
Unfortunately, there seem
to be many misperceptions about reverse mortgages. If you have some reason for
considering this type mortgage, the smartest approach is to
investigate it for yourself and then decide. Reverse
mortgages potentially provide valuable income, cash reserves, or debt
relief. The money received from a
reverse mortgage might be the only way you could afford to modify your home in
order to age in place. Research reverse mortgage options carefully and get sound, professional advice from your legal or financial advisors. Understanding the truth about reverse
mortgages will enable you to make a rational, well-informed decision about
whether or not the program is right for you and your circumstances.
An Aging in Place specialist is someone who is trained and certified in helping people remain in their homes
beyond retirement. These professionals have developed skills to assess the needs of seniors and evaluate their home environments for
potential modifications designed specifically for changing
Aging in Place professionals are trained to listen carefully
to clients and their caregivers, and to observe the physical conditions of a
home. They have the knowledge and
experience to provide practical, individualized solutions to a problem. They do not bring a generic approach to home
modifications but rather select from any number of relevant options. Aging
in Place professionals are not only trained in the physical issues of aging but
also in those products on the market designed to aid in those issues.
Aging in Place professionals have been taught the techniques
and strategies for designing barrier-free living environments. Their goal is to
modify or remove any architectural feature in a home that would interfere with safety,
comfort or independence while at the same time maintaining an attractive
environment suited to their client’s lifestyle.
Sometimes it is a combination of structural renovations along with
specialized equipment that alters the home environment sufficiently so as to
allow an individual to age in place.
While an Aging in Place specialist may be a contractor, not all contractors are Aging-in-Place
professionals. You might call in a
contractor to install a grab bar, but the question of which shape/sized grab
bar is best, where it should be located for your specific ailment, or whether a
grab bar is even the correct solution is not something a contractor is trained
So what special training does an aging-in-place professional
get? There are actually a number of certification
programs throughout the country geared specifically towards training
professionals in the field of aging-in-place. People come from a number of different
professions and perspectives – occupational therapists, remodelers and builders,
geriatric care managers, architects, nurses, interior designers, and medical equipment suppliers to name a few.
The programs vary widely in scope and duration. I’m familiar with two of the programs as I,
myself, have completed both the University of Southern California’s Home
Modification Certification and the National Association of Home Builders’
CAPS program. Please note that I am not suggesting that the
three programs listed below are the only programs available – they are just the
ones I am aware of.
University of Southern California offers an Executive Certificate in Home Modification
through its National Resource Center on Supportive Housing and Home
program is designed for professionals who work directly or indirectly in the
field of supportive home environments. This is a five month course that
includes home modification research, product and design
layouts, common modification issues, case studies, funding strategies, ethics, and
Georgia Tech offers a Certificate
in Workplace Accommodations and Home Modifications. Coursework is geared to applying assistive
technology and accommodation strategies in home, work, educational, and public
settings and to identifying needed assistive technology and environmental
accommodations for individuals with disabilities. The Program consists of eight
courses ranging from fundamental strategies for workplace and home
modifications to universal and accessible design for public spaces .
CAPS (Certified Aging in
Place Specialist) is accreditation earned through the National Association
of Home Builders. In three days of coursework, the CAPS curriculum
incorporates a variety of information tailored to aging-in-place home
modifications, including: background on the older adult population;
communication techniques; common aging-in-place remodeling projects; marketing
to the aging-in-place market; common barriers and solutions; codes and
standards; product ideas and resources; and business management.
If aging-in-place is something you’re
determined to do, it’s important to plan ahead so as to incorporate appropriate modifications that will meet your changing
needs as you age. If you take the time
to plan home modifications before you need them, you can ensure they are
designed properly and add value to your home. Aging
in Place Specialists are available to help.
America is aging at a tremendous rate. 10,000 people in the U.S. turn 65 every day, a rate that will continue for 20 years. By 2050, over 20% of Americans will be over the age of 65. Unfortunately, elder abuse is a growing problem.
Elder mistreatment is defined as intentional actions that cause harm or create a serious risk of harm (whether or not harm is intended) to a vulnerable elder by a caregiver or other person who stands in a trust relationship to the elder. This includes failure by a caregiver to satisfy the elder’s basic needs or to protect the elder from harm. The specificity of laws varies from state to state, but broadly defined, abuse may be:
- Physical - Inflicting, or threatening to inflict, physical pain or injury on a vulnerable elder, or depriving them of a basic need.
Emotional - Inflicting mental pain, anguish, or distress on an elder person through verbal or nonverbal acts.
Sexual - Non-consensual sexual contact of any kind.
Exploitation - Illegal taking, misuse, or concealment of funds, property, or assets of a vulnerable elder.
Neglect - Refusal or failure by those responsible to provide food, shelter, health care or protection for a vulnerable elder.
Abandonment - The desertion of a vulnerable elder by anyone who has assumed the responsibility for care or custody of that person.
Elder abuse can affect people of all ethnic backgrounds and social status and can affect both men and women. Victims of elder abuse are known to experience depression, anxiety and other mental health issues. Elders who experienced mistreatment, even modest mistreatment, had a 300% higher risk of death when compared to those who had not been mistreated.
Sadly, it is known that in 90% of all reported elder abuse cases the abuser is a family member. Researchers have estimated that anywhere from five to twenty-three percent of all caregivers are physically abusive. Most agree that abuse is related to the stresses associated with providing care.
While we don't know all of the details about why abuse occurs or how to stop its spread, we do know that help is available for victims. Know the warning signs of a possible problem so that you can make a call for help if an elder is in need of assistance.
While a single sign does not necessarily indicate abuse, some tell-tale signs that there could be a problem are:
- Bruises, pressure marks, broken bones, abrasions, and burns may be an indication of physical abuse, neglect, or mistreatment.
- Unexplained withdrawal from normal activities, a sudden change in alertness, and unusual depression may be indicators of emotional abuse.
- Bruises around the breasts or genital area can occur from sexual abuse.
- Sudden changes in financial situations may be the result of exploitation.
- Bedsores, unattended medical needs, poor hygiene, and unusual weight loss are indicators of possible neglect.
- Behavior such as belittling, threats, and other uses of power and control by spouses are indicators of verbal or emotional abuse.
- Strained or tense relationships, frequent arguments between the caregiver and elderly person
If you think someone is in danger,contact the Eldercare Locator for state specific information at 1-800-677-1116.
Rising costs and lack of public subsidies have made assisted living facilities expensive. According to the Genworth 2010 Cost of Care Survey, the national median monthly cost of an assisted living facility (one bedroom, single occupancy) is $3,185 per month. In general, 75% of this cost is paid by residents out of personal funds or family assistance. The national median daily rate for nursing home care is $185 for a semi-private room, $206 for a private room or approximately $70,000 per year. About 1/3 of all nursing home residents pay from their own funds.
Contrast that to the cost of renovating your home. A small ramp will cost under $500. Bathroom remodeling, including replacing the tub with a walk-in shower, should run approximately $15,000. For those who might need a stairlift, they can be found for under $2,000 on up depending on the configuration of your stairs. Bottom line - for well under $20,000 you can prepare your own home for your future needs.
So the big question is how to pay for home modifications. In today's market most people are experiencing a loss of equity in their homes which makes a line of credit or a reverse mortgage not feasible. Medicare does not pay for any home renovations - not grab bars, comfort height toilets, non-slip floor coatings, wider doorways or accessible vanities. Instead, Medicare will pay for medically necessary durable medical equipment as prescribed by a doctor. Translated this means that wheelchairs, toilet commodes and shower benches are covered but none of these items are particularly attractive or add any value to your home.
There are, however, some resources that might help defray the costs of accessibility modifications.
1. Long Term Care Insurance. While traditional health insurance does not provide for home modifications, many long term care policies include some coverage. If you are a senior and had the foresight to have purchased long term care insurance, check out your policy. If you are a baby boomer, make a note to yourself to investigate the benefits of a long term care policy. Given the increasing cost of health care and the age to which we now live, long term care insurance might be something you want to carefully consider.
2. Department of Veteran Affairs. The VA has four types of home modification programs depending on the level of disability. For more information on these VA grant programs or to obtain grant application forms, you can contact the VA at 800-827-1000 or visit the VA's website at www.va.gov
3. Community Development Block Grants (CDBG). The Community Development Block Grant program enables local governments to undertake a wide range of activities intended to create suitable living environments, provide decent affordable housing and create economic opportunities, primarily for persons of low and moderate income. Contact your local county or city government to find out the status of money available for accessibility modifications.
4. Tax Savings. Tax deductions are allowed for certain modifications such as the installation of ramps, widening doorways, modifying kitchen cabinets, installing bath fixtures, etc. To do so, the cost of the modifications must be treated as a medical deduction and be certified by a physician as being required for health reasons. The renovations also can't add to the property's overall value. Check with your accountant for details.
5. State Assistive Technology Projects. Several states have initiated home modification programs through their statewide Assistive Technology program. These programs can provide trial equipment as well as low-interest loans for the purchase of assistive technology or home modifications for individuals with disabilities.
6. The U.S. Department of Agriculture (USDA). The USDA has created the Rural Development Home Repair Loan and Grant Programs (aka Section 504 programs) to provide assistance to those who live in areas with a population less than 10,000. This program offers low-interest loans to homeowners of all ages and grants to those aged 62+ who meet certain income criteria, in order to help with home repairs or modifications for disabilities. Check out www.rurdev.usda.gov
7. Area Agencies on Aging (AAA). Some Area Agencies on Aging have funds to modify homes. Contact your local AAA to find out if programs are available in your area.
8. Centers for Independent Living. The term "center for independent living" means a consumer-controlled, cross-disability, non-residential private non-profit agency that is designed and operated within a local community by individuals with disabilities and provides an array of independent living services. These centers provide information and referrals on how to get funding in your area. To locate a center near you, visit www.ilru.org/html/publications/directory/index.html
We're frequently asked to help locate funding for clients residing outside of Florida. If you know about other funding sources for home modifications that are particular to your locale or state, we'd all love to hear about it.
We frequently get calls from out of state family looking for assistance for older family members who live here in Florida. In most cases the parents want to stay in their homes while their adult kids think it might be time to bring them back to live with them or move them into assisted living. We're initially asked to go into the parents' home to evaluate the physical layout for safety, but in time the conversation turns to the need for additional resources. Assistance might be needed for anything ranging from help with simple tasks like shopping, driving, and cooking to those involving personal hygiene and companionship.
Enter the home health agencies who offer a range of services designed to meet the needs of those who are aging or dealing with chronic illness. In South Florida alone, there are over 1,000 private home health agencies licensed to provide private duty home health care to people in need. That number is staggering. How do you decide which to use for care? How do you begin to compare the level of services offered and evaluate the quality of those services? What questions should be asked before bringing a stranger into your home?
I asked Scott Greenberg, Statewide Board Member of the Florida State Guardian Association and Vice President of the local chapter, Member of the Legislative Committee of the PBC Partnership for Aging, and President of Comforcare Home Care, a private home health company, for help in answering these questions.
"There really are differences in agencies and finding the right agency for you can be daunting but taking the time to make an informed choice is very important," says Scott. He suggests beginning with the following questions when interviewing potential providers:
- How long has your agency been in business? Is this your primary business or one of many types of services you provide?
- Do you provide an assessment of a client's needs by a nurse or other licensed professional? If so, is there a fee?
- How do you screen your caregivers? How do you match them to a client?
- How are your caregivers trained and do they receive any specialized training beyond the state requirements?
- Are your caregivers bonded? Are they covered by workers compensation? Do they have liability insurance?
- What procedures do you have in place if a caregiver is late or calls in sick?
- What funding sources does your agency accept? Do you require a deposit? Will you accept assignment from my Long Term Care Insurance or will I have to pay you and wait for reimbursement from my insurance company?
- What are your rates and are there differentials for nights, holidays and weekends? (more questions..)
I then asked Scott to explain how his own agency is an example of quality service so as to better understand what to look for when evaluating other companies.
"All our caregivers are our employees and covered by workers comp, bonded and covered by both supplemental auto and liability insurance. We provide references on request and can even arrange an interview with a caregiver if desired prior to providing service. We conduct specialized training in areas such as Jewish Cultural Traditions as well as keeping kosher for those to whom that is important. We contracted with the Alzheimer's Association to conduct a higher level of training for our caregivers than the state requires. 20 years of combined experience, advocating for senior causes, and being an active volunteer in the community is a differentiator for us and you should look for help from people with that same level of commitment to excellence."
Let's remember that aging in place is an achievable lifestyle choice that might require some additional help where necessary. Combining a safe and comfortable home environment with appropriate home health care will allow most seniors to stay in their homes rather than having to move into a facility.