You may have heard of “improved pension”, “VA assisted living benefit”, or “veterans elder care benefits” that can be used to increase your pension. These are each names for the Aid and Attendance benefit that we discuss in detail in a separate article. In short, Aid and Attendance is a financial benefit that can help eligible veterans who have difficulty with routine daily activities, such as bathing, eating, dressing, and medication management. For eligible veterans, Aid and Attendance provides an additional financial benefit that is meant to help cover the financial cost of assistance with those routine daily activities.
There is also a benefit called the Housebound Pension, which is for veterans who are substantially confined to their home because of a permanent disability. The housebound pension would be added as an additional financial benefit to the veteran’s existing pension. However, a veteran cannot receive both the aid and attendance and the housebound benefit. Instead, it is one or the other.
If you have any questions or would like to explore your eligibility for these programs or any other Elder Care law issues,
call 856-281-3131. We’d be glad to help you form the plan that is right for you.
Aid and Attendance is also referred to as “improved pension”, “veterans elder care benefits”, and “VA assisted living benefit”. Each of these terms typically refers to the “Aid and Attendance benefit.”
Aid and Attendance is a government benefit for veterans and their spouses who require assistance from another person in order to perform routine daily activities. These activities may include eating, bathing, dressing, grooming, medication or assistance with adjusting prosthetics, among other things. Aid and Attendance is only available to those who are eligible for or who have a VA pension.
If you qualify, Aid and Attendance will provide monetary compensation in addition to your standard VA pension benefits. These benefits are meant to help cover the financial cost of having someone to assist with your routine daily living activities. The benefit may be used to help cover the costs of assistance in routine daily living activities for veterans who are in-home and those that may be in a facility.
To receive this nontaxable benefit, there are specific eligibility and financial requirements that must be met. If you think you may qualify, then talk to an elder law and VA attorney in order to explore your eligibility.
A life settlement, sometimes called a “senior settlement”, is the selling of one’s existing life insurance policy to a third party for a one time cash payment. In exchange for the one time cash payment, the third party becomes the owner and beneficiary of the policy.
What is a Viatical Settlement
“Viatical settlements” typically involve those with two years or less to live and the Viatical settlements are regulated and handled by the life insurance company itself. Life settlements, on the other hand, do not involve the insurance company. Instead, Life Settlements involve third party investors and brokers who buy the life insurance policy.
How do life settlements work?
Usually, the third party who purchases the life insurance policy is an experienced institutional investor. It’s worth emphasizing that after the sale is made, the investor who purchased the life insurance plan becomes the new beneficiary and owner of the policy. The investor who bought the policy hopes to make a profit by receiving the policy’s death benefit. Usually, the investor will purchase the policy for more than the face cash surrender value of the policy but for less than the net death benefit.
When do people usually consider a life settlement?
A life settlement is typically made by those who believe that they and their families will benefit more by taking cash now, instead of receiving the death benefit later. They also will not have to pay anymore premiums. A life settlement is also considered by those older folks who would otherwise have to surrender their policies or allow them to lapse due to financial constraints. The potential ramifications for a life settlement are huge. For example, if you receive Medicaid, then the life settlement could result in your disqualification.
Exercise caution:
Before you decide if you should take a life settlement, you should explore your options, compare rates, and speak with an elder law attorney or financial professional, such as a CPA or financial advisor. This professional should be someone who does not have a financial or other type of stake in the buying or selling of the policy involved in the life settlement. Because the ramifications of selling your life insurance policy are extreme, such as Medicaid eligibility and your listed beneficiary losing out on the net death benefit, you should proceed with caution. Speak with a professional who can clearly and exactly spell out your options.
As our loved ones age, there may come a time when they need to receive long-term care or move to a long-term care facility. Long-term care can be extremely expensive, and as a result, some choose to take out a long-term care insurance policy ahead of time.
Long-term care insurance is one method by which the costs of long-term care can be largely covered or reduced. However, long-term care (abbreviated as “LTC”) insurance policies can be very expensive and they need to be purchased before long-term care is actually required. Some LTC policies have limitations and loopholes that still leave significant long term care costs to the policy holder even if they bought it ahead of time. This is why it’s very important to know what the specific policies of your LTC insurance are.
For example, some long-term care insurance policies have a “waiting period” before the policy will kick in. This means that you will need to pay for long term care out of pocket at first, often for 30 days or more, until the policy will start covering the ongoing costs.
Some LTC insurance policies have maximum lifetime limits that cover the costs of care until that maximum dollar amount is reached. Once that maximum dollar amount is reached your loved one will be required to pay out of pocket for continued care. In selecting a LTC insurance plan, you need to do you research and choose the right plan for you or your loved one.
If you or your loved one has LTC insurance, and you need to go to a long-term care facility, you should contact the long-term care facility and make sure that your insurance will be accepted there. Not all long term care insurance is accepted at every facility. If it is accepted, you should verify with them exactly what items are covered and what expenses you may have to pay out of pocket. This will help you keep your budget in place without any surprised that could hurt your bottom line.
If you have any questions about your care options free to reach out to us at Scott Counsel. Our goal is to provide you with the best care planning services that meet your needs and circumstances. Our team would be glad to help you.
Medicaid is a joint federal and state program that provides health coverage for certain eligible persons who have low incomes and minimal assets. Medicaid is not to be confused with Medicare which is an entitlement program for those aged 65 or over, those on disability, or those with kidney failure, among other things. Medicare is something you become entitled to because you or a spouse paid for it through taxes by Social Security. Medicaid, on the other hand, is not an entitlement program, and instead you must meet exact eligibility guidelines.
Medicaid eligibility is different for each state so it’s important that you check with a professional that is familiar with the laws and regulations of your specific state. Specifically, eligibility for Medicaid is determined at the state level and it is mainly based on your income and the amount of assets you own. The income requirements for Medicaid are determined by the MAGI (Modified Adjusted Gross Income) and the exact income limit will be based on factors such as the size of your household.
In addition to income limits, there are also caps on the value of assets that someone may have to be eligible for Medicaid. While the specifics may vary from state to state, this countable asset cap is usually around $2,000. However, there are assets that may be exempt from being counted towards this cap. Assets that may be exempt could include your family home, your automobile, life insurance, among other things.
There are other specific provisions that may allow the spouse of a nursing home resident to retain about one half of the couple’s joint assets from being counted toward the asset limit for Medicaid. This situation typically arises when one spouse is applying for Medicaid and the other spouse is relatively healthy. This is called the “Community Spouse Resource Allowance” and there are very specific requirements that need to be met. As such, it’s important to discuss this possibility with a professional, such as a professional Medicaid Planner.
An important consideration to keep in mind when applying for Medicaid is that there is a “look back” period. In most states, except California, the look back period is five years. This means that Medicaid will “look back” five years from the date of your Medicaid application to make sure that you didn’t sell or give away assets for less than their fair market value. This “look back” period is meant to ensure that people don’t give away assets to their friends and relatives just to get under the Medicaid asset limits.
If you or someone you love needs assistance with Elder Care law issues, call 856-281-3131. Let us help ease your stress and give you a plan.
Planning for your passing or the passing of a loved one can be a very difficult process. It’s a process that many people may be inclined to avoid altogether. However, avoiding or ignoring end of life planning won’t solve your problems. In fact, by ignoring end of life planning, you may be putting very tough decisions and even guesswork onto the shoulders of those who love you most; and no one should have to guess what their loved one would or wouldn’t want regarding their end of life care.
Accordingly, it is very important that you discuss and plan with your close relationships and medical professionals the health care choices surrounding end of life care and the manner of your death. Before you begin, you may want to spend some time thinking about what you want your end of life care to look like. For example, do you want all potential medical treatments to be tried in order to save your life, regardless of the impact on your quality of life? Would you prefer to spend your final days with family and friends in the comfort of their home, or would you like to spend them in a supervised medical environment where loved ones can come and visit? To help make your wishes known and ensure they are followed, there are very specific legal and healthcare tools that you can use regarding end-of-life care and the manner of death.
Some common legal tools available for end of life planning:
End-of-life planning can include direction on where the patient wants to spend their final days, which treatments they wish to receive, and whether they want to pursue all life saving or resuscitation options.
An Advanced Directive or “Living Will” allows your wishes regarding medical treatment to be known in the event that a person is unable to communicate their health care decisions. The medical decisions in an advanced directive can include decisions about end-of-life care. Having a family discussion about your health care choices and advanced directive can help make sure that everyone in the family is on the same page and knows exactly what you want. A Living Will can include instructions on the use of breathing machines, resuscitation if the heartbeat or breathing stops, or whether the patient wants tube or intravenous feeding.
It’s important to keep in mind that a living will is not the tool you can use to leave property to your loved ones, name an executor, or name a guardian for any children. That document is called a traditional will or a last will and testament. In this case, we’re discussing a living will, which is also called a health care declaration. A living will is a document that you can use to describe the kind of health care you wish to get if you are incapacitated and cannot speak on your own.
Additionally, a “Do Not Resuscitate” or “DNR” request can also be signed by the patient. A “DNR” request instructs health care professionals that if your heart stops or you stop breathing, they should not make an attempt to resuscitate.
Other end of life planning can include signing a durable power of attorney that designates someone as your health care proxy or “agent” to make your medical decisions if you become unable to do so. If you do name a health care proxy, you should make sure that this person is comfortable with your choice and knows your wishes regarding end of life care. It may also be helpful to discuss these issues with your family when everyone is together so that everyone knows your wishes.
Planning end-of-life care can ensure that your wishes for the manner of your death are followed. In the event that you become unable to make health care decisions, it also alleviates the burden from your family members in having to guess what you may or may not want. If you or your loved one needs assistance with any of these topics or Elder Care law issues, call 856-281-3131. At Scott Counsel, we would be glad to answer your questions and help you craft the plan that works for you.
There often comes a point in the care of an elderly loved one where living at home is no longer a safe or appropriate option for them. When this is the case, it’s time to explore long-term care facilities. Choosing the right LTC (long-term care) facility for your loved one is a big decision and many caregivers often don’t know where to start. Among the common questions we get, two of the most common questions are
What type of facility is appropriate for my loved one and where can I find one? and
What level of care can we afford?
First, you’ll need to decide what type of long-term care facility is appropriate for your loved one. This includes choosing from Residential Care Facilities, Assisted Living Facilities, Skilled Nursing Facilities, Continuing Care Retirement Communities, among others. Each of these facilities is geared towards assisting the elderly who are within a certain spectrum of required care. For a brief overview, the following types of common LTC facilities include:
A residential care facility provides supervision, grooming care, meals, socialization, among other things, but it does not provide skilled nursing care.
An assisted living facility is for those who retain some independence but need daily help with their medication management, housekeeping tasks, and personal care. These facilities often have nurses on-site or on-call for your loved ones.
A skilled nursing facility or a “nursing home” provides 24/7 around the clock nursing services for those who require it. A nursing home is typically for those who need help with most or all of their self-care needs.
A Continuing Care Retirement Community, also called “Life Care,” provides independent living, assisted living, and skilled nursing facilities in a single location. This allows your loved one to stay at the same community, even if their health begins to deteriorate.
Once you’ve chosen the appropriate type of long-term care facility, you need to choose the right one for your loved one. To do this, you should research the facilities available to you by talking with family, friends, and health care professionals about the facilities in your area. If your loved one has a specific type of chronic or progressive health condition, you should search for a facility that offers specialized care to meet their specific needs.
Medicare actually provides a “nursing home compare” feature that has detailed information about every Medicare and Medicaid certified nursing home in the country. After you’ve selected a few options, you should prepare questions and schedule visits and tours with those facilities that seem like they could be a good fit. You should look at the living environment, meal times and the food, the kindness and competency of the staff, policies and safety features, and how the residents seem to like living at the facility.
As a caregiver, your role doesn’t end when your loved one moves into an LTC facility. While you may no longer be taking care of the hands-on tasks associated with care, your loved one will still need you to be their advocate. This job often entails paying bills, scheduling appointments, and ensuring appropriate follow-up care for your loved one. Help be the voice that your loved one needs. With an attentive caregiver and an LTC that is a good fit, you can make sure that your loved one is receiving the best possible care that they need.
Of course, even when you find the right place, there is still the question of affordability. The stark reality is that long-term care facilities are often very expensive. Most often, these facilities are paid for out of pocket. For private financing, common ways to pay for the care includes long-term care insurance, personal savings, reverse mortgages, annuities, and other options. For government programs, if you qualify, Medicaid may pay for some types of long-term care. There are also various other government programs available, if you qualify, that may help for some or most of the expenses of long-term facility care.
We hope this overview was helpful, and if you or someone you love needs assistance with Elder Care law issues, call 856-281-3131. We’re here to help ease your stress and give you a plan that meets the needs of you and your loved one.
When you’re caring for an older adult, caregiver stress is part of the job.
That’s why it helps to have a long list of ways to cope and get relief. You’ll always be able to find an option that works for the situation you’re in at the moment.
The Rising Spoon has a great article that shares over 30 helpful stress relief tips. From these, we selected the top 15 stress relief tips that are most useful and realistic for busy caregivers.
We’ve also added extra ideas and resources especially for caregivers to make it even easier to benefit from these stress relief strategies.
15 quick tips for managing caregiver stress
1. Take slow, deep breaths
One of the fastest ways to calm down and relieve anxiety is to breathe deeply and mindfully. Taking slow, deep breaths quickly shifts your body out of stress mode and allows you to relax.
Breathe in through your nose and out through your mouth. This gets more oxygen into your blood and gives you something concrete to focus on.
We recommend a free mobile app called Breathe2Relax that uses visual cues to help you breathe at a slow, steady rate.
2. Use aromatherapy Smells can instantly trigger significant memories and are a powerful way to affect the body’s nervous system.
For example, a research study showed that lavender essential oil can have a calming effect similar to anti-anxiety medications.
Place a drop of essential oil in your hands, rub your palms together, cup them to your face and inhale
Put drops of essential oil on a few cotton balls in a dish to diffuse the scent
3. Drink calming herbal tea Sipping a caffeine-free herbal tea is a wonderful way to take a break and rehydrate your body too. Some calming herbs like mint, lemon, or ginger can even do double duty as aromatherapy.
4. Meditate or pray Meditation is excellent because it’s free, can be done anywhere, and has been proven to reduce stress. If you’re religious, prayer works in a similar way.
Studies show that meditation reduces blood pressure, improves immune function, and increases the ability to concentrate. It’s also efficient – you can get the benefits in just a few minutes a day.
5. Release tension with exercise Exercise is an excellent way to relieve tension, boost mood, and improve both physical and mental health.
It helps you burn off nervous energy, do something that’s just for you, and focus on something positive. Regular exercise also helps you sleep better.
You don’t need to spend hours at the gym to get the benefits, even a 5 minute workout makes a real difference. We’ve even created a gentle, super-efficient 4 minute workoutthat’s perfect for caregivers.
6. Talk with a trusted friend Connecting with supportive people that you trust is another good way to reduce stress.
You’ll be able to vent your frustrations, know that you’re not alone in the world, and talk about something other than your older adult.
Meeting in person is ideal, but phone or video chat work well too. In a pinch, texting back and forth is still helpful.
7. Practice gratitude Thinking about the things you’re grateful for helps you notice the good things in your life, no matter how small or big they may be.
Getting into a habit of gratitude helps you look on the bright side more often and adds a new perspective. Instead of focusing on the negative aspects of life, it will be easier to balance things out with a dose of the positive.
8. Listen to music Music is an amazing way to improve your mood.
Whether you like to sing and dance to energetic tunes or relax with soothing classical or jazz, turning on some music is a sure way to help you de-stress.
9. Go outside Spending time outside, breathing fresh air, and looking at the natural scenery is a simple, but effective way to reduce caregiver stress.
Studies have shown that spending time in nature reduces the level of stress hormones, boosts the immune system, reduces anxiety and depression, and more.
10. Massage tired muscles Caregivers often hold stress in their neck and shoulders.
12. Do something creative Take a break from reality once in a while and focus on a creative project like painting, writing, photography, gardening, cooking, coloring, crafting, or knitting.
This takes your mind away from thoughts of caregiving and directs your energy toward something positive, fun, and productive.
13. Do a brain dump If your mind is spinning with to dos, worries, reminders, and errands, take a moment and write it all down.
Get everything that’s bouncing around your brain out onto paper so you won’t feel like you need to remember it all anymore. That definitely takes a load off your mind!
14. Watch or read something that makes you laugh Sometimes you just need a good laugh. Read a funny book, browse the cartoons in the paper, or watch an amusing video. We love funny animal videos like this one.
15. Take a spa-like bath or shower A hot bath or shower is a refreshing way to start the day and a soothing way to unwind at night.
Bathing with magnesium is said to soothe sore muscles, reduce stress, and improve circulation. This is easiest in the bath, but you might not have time to clean the tub and have a soak.
For a quick spa-like experience, run the shower with the drain stopped and let everything dissolve at your feet, creating a detox foot soak and scented steam (but make sure the shower floor isn’t slippery). Or, try using a magnesium spray like this oneor this simple DIY version.
While a cancer diagnosis is no longer tantamount to a sentence of death, in my Mother’s case, it was. In August of 2004 a five-inch malignant tumor was discovered in the liver of my otherwise healthy, vibrant and active 74-year-old Mom. The diagnosis was inoperable and untreatable liver cancer; therefore, I had no choice but to ultimately accept the fact that she had approximately six months to live. In the fall of 2004, I attended a seminar offered by a local hospice designed to educate those professionals who provide services to the elderly on the fundamentals of the hospice program. While the information presented proved to be helpful to me in counseling elder law clients, the main benefit that I derived was personal. I learned how this organization could assist my only surviving parent as well as family and friends in coping with the dying process on all levels.
This article addresses the following topics: history and structure of hospice, payment for services, services covered by Medicare. As suggested by the title of this article, one of the purposes in writing this piece is to share my individual perspective as a daughter and long distance caregiver. I therefore conclude the article with my own personal reflections.
The linguistic root of the word “hospice” is the Latin word “hospes” which refers either to a visitor or host who receives the visitor. The word “hospital”, “hospitality” and “hostel” share the same origin. Dame Cicely Saunders, an English physician, started into motion the chain of events that would evolve into the modern version of hospice care. The hospice concept was first introduced to the medical community in the United States in 1965 by Dame Saunders who subsequently founded St. Christopher’s Hospice in London in 1967. She lived out her final days in that facility where she passed away at age 87 on July 14, 2005.
Over the last half of a century, the hospice concept has evolved into a philosophy of care as opposed to a physical location. The current emphasis is on assisting patients to remain at home during their final days with medical professionals and volunteers offering in – home expert support to family and friends in caring for the dying person. Inpatient hospice units are available for those whose medical conditions cannot be safely or adequately addressed outside of an institutional context. Cindy Baptista, RNC, CHPN, Director of Hospice, Palliative and Oncology Care at Moorestown VNA & Hospice summed it up like this:”Hospice allows a patient to live their final days in comfort, and with dignity. It gives the family physical, emotional and spiritual support so they can share the precious time they have left with their loved one. Hospice is truly a gift we can give to our loved one and ourselves.”
According to the 2017 edition (rev. April 2018) of NHPCO Facts and Figures: Hospice Care in America” published by the National Hospice and Palliative Care Organization, approximately 1.43 million patients on Medicare received services from hospice in 2016. Furthermore, there were 4,382 Medicare certified hospice programs in operation in all 50 states, the District of Columbia, Puerto Rico, Guam and the U.S. Virgin Islands. (By comparison, there were approximately 3,300 operational hospice programs in the United States serving an estimated 950,000 patients in 2003.)
Currently, cancer patients account for 27.2% of hospice admissions. The top five primary non-cancer diagnoses (other than “debility unspecified” and “other”) included dementia, heart disease, lung disease and stroke or coma.
Hospice’s fundamental mission is to assist terminally ill individuals in living out their remaining days with dignity. The program is structured to provide palliative rather than
curative treatment. Thus, the emphasis is on managing pain, enhancing comfort and quality of life as well as providing spiritual and emotional support to the patient and the family. The tricky issue is when to seek hospice intervention. A requirement for enrollment is a medical diagnosis of a terminal illness which is generally measured by a prognosis of a life expectancy of six months or less. Statistics show that most do not take advantage of the program until death is imminent. Indeed, the length of service for 27.9% of patients in 2016 was less than 7 days.
The failure of so many to take advantage of the hospice benefit at an early date may be attributed to lack of education as well as reluctance to admit that someone is facing the end of their life. The prevailing attitude seems to be that life is over once hospice comes in. In addition, some individuals suffering from a serious illness choose to exhaust every available curative treatment no matter the agony that it may cause or the odds of success of the treatment, thus precluding the availability of hospice.
One of the most distinctive elements of hospice care is its focus on the family and other loved ones of the sick person. Assistance in the form of bereavement services is available after the patient’s death. In fact, regulations require completion of a bereavement assessment in order to determine whether family members are at serious physical or mental health risk after experiencing loss.
PAYMENT FOR SERVICES
Fortunately, most have no need to be concerned about how hospice care will be financed. Most private health insurers, health maintenance organizations (HMOs) and other managed care plans as well as the Department of Veterans Affairs provide coverage for hospice care. If a patient has limited financial resources and no insurance or is ineligible for governmental benefits, many hospices provide services without charge.
Until 1982, Medicare did not cover hospice services. Under legislation enacted in 1986, Congress established the permanency of the coverage. Finally, hospice was included as a nationally guaranteed benefit under President Clinton’s 1993 health care reform proposal.
Those seeking Medicare hospice benefits must satisfy the following criteria: (1) The patient must be eligible for Medicare Part A. To qualify for Part A an individual must fall within one of the following categories: age 65 or over, qualified for Social Security disability benefits for at least two years, suffer from amyotrophic lateral sclerosis (ALS), have had a kidney transplant, or need regular dialysis; (2) the patient’s physician and the hospice medical director must certify that the individual has less than six months to live if the disease runs its normal course. However, it should be noted that the hospice benefit consists of two 90-day certification periods and an unlimited number of subsequent 60-day periods. While the first 90-day certification must be issued by both the attending physician and the hospice medical director, all recertifications may be issued by either of them; (3) The patient (or legal representative) signs a statement choosing hospice care instead of other Medicare covered benefits to treat the terminal illness. However, Medicare will continue to pay for covered benefits for health issues not related to the terminal illness. The patient will be responsible for any co-pays or deductibles; and (4) The care is received from a Medicare approved hospice program. According to the NHPCO, approximately 90% of hospices are Medicare certified.
Services Covered By Medicare
The Medicare hospice benefit is provided under Medicare Part A (Hospital Insurance). In recognition of the diverse intensities of care required by hospice patients, four levels of care are offered: Routine Home Care, Continuous Home Care, Inpatient Respite Care, and General Inpatient Care. The classification determines the rate of reimbursement from Medicare. Not surprisingly, most of hospice care falls into the Routine Home Care category.
The following services are not covered: Treatment to cure terminal illness; charges for room and board for hospice care in home, a hospice facility nursing home or other long term care facility such as assisted living; any care, medications, equipment or transportation that is not authorized by hospice.
The services offered include providing educational material and classes to the survivors about the normal grieving process, ability to participate in support groups, periodic visits by a bereavement volunteer and referral to a mental health professional where appropriate. Terminally ill patients not yet in hospice are entitled to a one-time educational consult by a hospice physician. Many who have benefitted from the services ultimately choose to participate in the hospice volunteer program. Volunteers are able to offer an extraordinary depth of comfort and support as a result of the compassion and empathy that is developed through the experience of their own personal losses.
Federal law requires a hospice provider to maintain written policies and procedures regarding advance directives as set forth in Section 1866 (f) of the Social Security Act. The patients must be informed of their rights to refuse or consent to treatments, and how to legally execute an advance directive. However, the provider may not require execution of an advance directive as a condition of providing care and may not discriminate against an individual who refuses to sign the document. Likewise, a signed DNR order is not a prerequisite to acceptance to the hospice program.
PERSONAL REFLECTIONS
After my Mother’s cancer diagnosis, my family explored all treatment options and early on, she submitted to a mild form of chemotherapy which landed her in the hospital. She decided (after a great deal of soul searching and prayer) to forego curative treatment and let nature take its course. She wanted to live her remaining days to the fullest extent possible. The pain and nausea that she experienced during the initial five months after her diagnosis were by and large controlled through relatively low doses of the appropriate medication. I happily flew out to my hometown where she still lived eight to ten days each month. We shopped, we ate, attended religious services, visited with friends and family and had a lot of fun. However, at the beginning of the sixth month, both the pain and nausea began to escalate. Like many cancer patients, she refused to take the morphine until she was actually in pain. The reason that pain is often under treated is the unsubstantiated fear of addiction or side effects. Indeed, my mom wanted to retain her lucidity and also felt that taking regular doses of morphine was an admission that the disease was getting the best of her.
Based on my understanding that one of hospice’s major roles is pain management, I began to investigate the program. I knew that my mom was eligible since she met the life expectancy requirement, was no longer seeking a cure, her physician agreed that hospice was appropriate and she was living in a secure environment with my stepfather acting as primary caregiver with the assistance of friends, church members and me. The myriad of available services convinced me that the program was right for our family. Since there was only one hospice in her town, the choice was easy. For those who live in communities that support multiple hospices, it may be wise to conduct phone interviews to help in determining which program is right for the family. Consider the following suggested questions reproduced from the website of the Hospice Foundation:
Does the hospice serve the area in which the patient resides?
How long has the hospice been in operation?
Is the hospice certified by Medicare?
Does the hospice accept Medicaid?
What other insurance is accepted?
Is the hospice licensed by the State?
What services does the hospice provide? – Phone calls to the family? – Mailings on what to expect? – Support groups? – Retreats or activities for the family?
What, if any, hospice services does the hospice not provide?
Is participation in care by a family caregiver required for hospice enrollment?
What is expected from the family caregiver?
How can hospice supplement the family’s responsibilities?
To what degree are volunteer services available in the home?
What, if any, out-of-pocket charges can we anticipate? For what services?
How often does hospice staff make home visits? (E.g. once a day visits, every other day visits, or once a week visits? Note: This will change as the patient’s condition changes.)
Nurse ___________________________
Social WorkerSocial worker ______________ Home health Aide ______________________ Doctor ________________________________ Volunteer ______________________________ Pastor or chaplain ______________________
Who provides on-call coverage during nights and weekends? The staff of the hospice?
Is a home health aide on duty 24 hours a day if needed? 12 hours a day? Is on-call coverage contracted out to other persons?
Does the hospice have contracts with local long-term-care facilities? If so, which one(s)?
Does the hospice have an inpatient facility? Does the hospice contract for this? May I tour the facility?
Does the hospice provide funeral arrangement support?
What bereavement services are provided? Type: Individual ______ Group______ Duration of Sessions: ______ Extent of Support: month ______ 6 months ______ year ______
Are bereavement services performed: In person? a) Individual sessions? b) Group sessions? By phone? __________ (Some programs offer only bereavement follow-up phone calls)
Cynthia Sharp, Esquire is Advisor Emeritus at Scott Counsel, PC in Cherry Hill, NJ and can be reached directly at 609 923 1017. Check out www.scottcounsel.com if you are interested in additional information in the elder care area.
Chair yoga is a great way for older adults to get the wonderful health benefits of yoga. Staying seated means that even frail seniors or those who aren’t flexible can safely do the exercises.
Yoga is an excellent way for older adults to loosen and stretch painful muscles, reduce stress, and improve circulation.
It also reduces anxiety, helps lower blood pressure, protects joints, and builds strength and balance.
We found a fantastic 30 minute routine of gentle chair yoga for seniors that’s free to watch on YouTube. Instructor Sherry Zak Morris makes the class fun and lively and explains the benefits of the movements.
We share customization and safety tips and give an overview of the movements included in this 30 minute at-home chair yoga routine.
At-home workouts are customizable
The best part of an at-home yoga routine is that it’s easy to adapt to your older adult’s abilities.
They should skip any movements that cause pain or are too difficult. And if your older adult tires easily, do easier parts of the routine rather than the full half hour.
Safety and comfort is the top priority
The number one priority is to keep your older adult safe and comfortable.
None of these movements should hurt.
Make sure your older adult moves slowly and gently and pays attention to their body. It’s better to do a little less rather than risk injury.
Older adults should follow the instructor’s movements only as far as is comfortable.
Even if they only do a fraction of the range of motion or have to skip some movements, they’ll still benefit from the exercises.
Over time, their flexibility and strength will improve and they’ll be able to do more and more.
Chair yoga for seniors: a 30 minute routine
You might want to do this chair yoga routine along with your older adult so they can watch your movements. It’s a fun activity to do together and you’ll get the health benefits too!
The only equipment that’s needed is a sturdy chair that allows your older adult’s feet to touch the floor. An optional accessory is a belt or strap to aid in stretching.
In case you want to skip around, we’ve noted the time markers for each section of the routine.
Warm up poses for heat and circulation (30 seconds in video) This is a great way to warm up the body, improve flexibility, and reduce pain. This section lasts 10 minutes and could be a nice short routine in itself.
Standing poses for balance and strength (9:50 minutes in video) These yoga poses are done while holding on to the back of the chair. If your older adult isn’t strong or balanced enough to do this section safely, it might be best to skip it.
Lower body poses for flexibility (14:45 minutes in video) In this section, a belt or strap helps with stretching – any long belt, strap, or sturdy rope will do. Even if your older adult doesn’t use a belt, they can still benefit from the movements.
Shavasana (29:25 minutes in video) Shavasana is a restful pose usually done at the end of a yoga class. Just relax and focus on breathing slowly and deeply.
Closing (31:25 minutes in video) Instructor Sherry wraps up the class.
