What Percentage of Assisted Living Communities Don’t Provide Mental Health Services?

Assisted living communities and other residential care communities are more and more becoming the setting for care of older adults with Alzheimer’s disease and other dementias, according to a new report. More so, these communities struggle with suitable access to mental health services.

That report is based on data from the 2016 wave of the biennial National Study of Long-Term Care Providers.

McKnight’s Senior Living’s recent article entitled “More than 40 percent of assisted living communities do not provide mental health services: CDC” reports that in 2016, 41.9% of assisted living community residents had diagnosed dementia, according to the authors. A total of 30.9% of assisted living residents had depression.

Mental health services are not provided at nearly half of communities (49.4%) where more than 75% of residents have been diagnosed with dementia. In addition, in 42.6% of communities there are 25% to 75% of residents who have been diagnosed with dementia, and 44.5% of communities where less than 25% of residents have been diagnosed dementia, the authors said.

In a quarter of assisted living communities across the country, over 75% of residents had diagnosed Alzheimer’s disease or other dementias. Most of those communities (90.5%) were found in metro areas, compared with communities with lower percentages of residents with dementia.

Communities where more than 75% of residents had dementia were most likely to have four to 25 beds (77.5%) compared with 26 to 50 beds (11%) or more than 50 beds (11.6%).

Residents in communities where more than three-quarters of residents had dementia saw an average of 33 more minutes of aide time and 10 more minutes of activities staff time, compared with communities where fewer of the patients suffered from dementia.

However, assisted living communities with the highest prevalence of dementia also had the highest prevalence of depression (38.7%).

However, the rate of depression was 32.3% in communities where 25% to 75% of residents had dementia and was the lowest, 25.3%, in communities where dementia was diagnosed in less than 25% of residents.

A few of the organizational and staffing characteristics vary based upon the prevalence of residents with dementia, which may help give providers, policymakers, researchers and consumer advocates data concerning the differences among assisted living communities. Understanding these unfortunate realities may pave the way for improvements to be made.

Reference: McKnight’s Senior Living (Dec. 7, 2020) “More than 40 percent of assisted living communities do not provide mental health services: CDC”

Talk to a Parent Suffering from Dementia during the Pandemic

If you have a parent living in an assisted living facility or a nursing home, or they’re at home, caregivers need to know how to explain the current coronavirus pandemic in an appropriate and clear manner—and in a way that protects and cares for your own personal health. With the busy holiday season behind us, you may have noticed new struggles with your parents.

Long Island Weekly’s recent article entitled “Caregiving During The Coronavirus” explains that older adults often have more health complications, like heart disease, diabetes and hypertension. As a result, they’re more susceptible to the complications of the coronavirus. Review the recommendations of the Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) for protecting you and your family, especially your elder parents, from exposure.

And although some people suffering from Alzheimer’s or dementia may not fully understand the complexity and severity that the COVID-19 pandemic is having on our communities, they can sense what’s happening. They can read your personal energy and can sense your stress. This may cause them to show more symptoms of anxiety, agitation, cognitive decline and confusion. Communicate as best you can to your parent frequently and clearly about what’s happening. While they may not need to have all the details, let them know that there’s a virus spreading within the community and that we need to wash our hands thoroughly and stay indoors.

For those still being cared for at home, take the necessary precautions as you’d do for yourself. Modify your grocery shopping trips, since stores are adding special senior hours, reschedule unnecessary doctor visits, stock up on needed medications and talk to your doctors about any concerns.

For those in a facility, understand the visitation policies, because many have adjusted their policies to limit or prohibit personal visitation. Ask the administration about visitation and what your parent’s care facility is doing to ensure for proper care.

Although you might be frustrated that your parent’s facility is limiting or cancelling visitation, remember that the new rules are designed to protect the residents. You may be able to schedule a time to speak with your mother or father on the phone every few days, or you can deliver food or items, like photos albums or other gifts to stay connected. Try to be reasonable and understand that these facilities may be understaffed.

Here are a few key points that may be helpful to get through this crisis:

  • Have a talk with your parent and with the facilities in which they’re living, so they can understand the new policies.
  • Be careful yourself. Take reasonable precautions for yourself and your family member.
  • Avoid public spaces. This includes routine, or non-essential doctor visits, grocery shopping and other visits.
  • Stay upbeat. Know the latest news and guidelines but try to remain calm, because your parent may sense your stress and reflect that.

Be reasonable and understanding and try your best in these uncertain times—for yourself and your parents.

Reference: Long Island Weekly (April 12, 2020) “Caregiving During The Coronavirus”

Does a ‘Senior Moment’ Mean Alzheimer’s?

When your memory starts to waver, its easy to assume the worst, even Alzheimer’s disease. Considerable’s recent article entitled “What it means when you can’t remember a word” says on its own, sometimes forgetting a word is a completely normal part of life. Whew! Psychologists call this experience “tip of the tongue” state. When you forget a word, it hasn’t disappeared from memory. Actually, it is still there, but in the moment of speaking something is preventing it from being fully accessed.

What prevents the retrieval of a word? A word is a collection of features: it has a meaning and associated meanings and images. It has a form, which includes its pronunciation, a written representation and a syllable and stress pattern. Psychologists also say it leaves traces in neural connections of how frequently or recently it’s been used. Word retrieval might be disrupted by an issue in activating one or just a few of those features. Stress, fatigue and distraction can also all result in insufficient activation for retrieval.

More serious issues that damage or slow the necessary neural connections can also cause problems for word retrieval, most notable Alzheimer’s disease. The inability to find words can also signal brain injury or infection, strokes and degenerative diseases. However, in those cases, word-forgetting will be only one of many symptoms. By itself, forgetting a word once in a while is a completely normal part of life.

Forgetting a word can be annoying. However, the situation usually resolves itself quickly.

Word-forgetting can cause seniors a special kind of distress. That’s due to the fact that they worry more about what it means about the health of their memory.

Some memory functions do decline with age and are signals of Alzheimer’s or other problems. However, tip of the tongue states are independent of that type of cognitive decline.

In a study of age-related increases of tip-of-the-tongue states showed that “even though increased age is associated with lower levels of episodic memory and with more frequent TOTs [tip of the tongue states], which can be viewed as failures to access information from memory, the two phenomena seem to be largely independent of one another.”

In other words, your failure to remember a word isn’t a general memory problem in most cases. It is just a failure to remember a word.

Regardless whether your memory and mental state is in tact or wavering, prepare for whatever the future holds with careful estate planning and elder care considerations.

Reference: Considerable (July 13, 2020) “What it means when you can’t remember a word”

Estate Planning for a Second Marriage

It takes a certain kind of courage to embark on a second marriage, even when there are no children from prior marriages. Regardless of how many times you walk down the aisle, the recent article “Establishing assets, goals when planning for a second marriage” from the Times Herald-Record advises couples to take care of the business side of their lives before saying “I do” in a second marriage. Changing the dynamic of your family calls for changes to your estate plan.

Full disclosure of each other’s assets, overall estate planning goals and plans for protecting assets from the cost of long-term care should happen before a second marriage. The discussion may not be easy, but it’s necessary: are they leaving assets to each other, or to children from a prior marriage? What if one wants to leave a substantial portion of their wealth to a charitable organization?

The first step recommended with remarriage is a prenuptial or prenup, a contract that the couple signs before getting married, to clarify what happens if they should divorce and what happens on death. The prenup typically lists all of each spouses’ assets and often a “Waiver of the Right of Election,” meaning they willingly give up any inheritance rights.

If the couple does not wish to have a prenup, they can use a Postnuptial Agreement (postnup). This document has the same intent and provisions as a prenup but is signed after they are legally wed. Over time, spouses may decide to leave assets to each other through trusts, owning assets together or naming each other as beneficiaries on various assets, including life insurance or investment accounts.

Without a pre-or postnup, assets will go to the surviving spouse upon death, with little or possibly nothing going to the children.

The couple should also talk about long-term care costs, which can decimate a family’s finances. Plan A is to have long-term care insurance. If either of the spouses has not secured this insurance and cannot get a policy, an alternate is to have their estate planning attorney create a Medicaid Asset Protection Trust (MAPT). Once assets have been inside the trust for five years for nursing home costs and two-and-a-half years for home care paid by Medicaid, they are protected from long-term care costs.

When applying for Medicaid, the assets of both spouses are at risk, regardless of pre- or postnup documents.

Discuss the use of trusts with your estate planning attorney. A will conveys property, but assets must go through probate, which can be costly, time-consuming and leave your assets open to court battles between heirs. Trusts avoid probate, maintain privacy and deflect family squabbles.

Creating a trust and placing the joint home and any assets, including cash and investments, inside the trust is a common estate planning strategy. When the first spouse dies, a co-trustee who serves with the surviving spouse can prevent the surviving spouse from changing the trust and by doing so, protect the children’s inheritance. Let’s say one of the couple suffers from dementia, remarries or is influenced by others—a new will could leave the children of the deceased spouse with nothing.

Many things can very easily go wrong in second marriages. Prior planning with an experienced estate planning attorney can protect the couple and their children and provide peace of mind for all concerned.

Reference: Times Herald-Record (Sep. 21, 2020) “Establishing assets, goals when planning for a second marriage”

Can I Afford In-Home Elderly Care?

Staying in-home long-term isn’t always affordable, according to a recent US News and World Report article. The article, entitled “Can You Afford In-Home Elderly Care?”, says about 80% of seniors are concerned about being able to afford in-home health care costs, based on a 2019 SCAN Health Plan survey. Paying for personalized in-home elderly care can add up quickly and isn’t always easy on a senior’s tight income.

If you’re thinking about in-home elderly care, review these criteria to determine what costs to expect and the different payment options available for this type of care.

Find Out the Services Included in In-Home Care for the Elderly. In-home care can vary a lot, depending on your health conditions and needs. You might get helpers if you’re recovering at home from an illness or injury, and you could also have home care workers help you with daily activities, such as preparing meals and personal hygiene. Home care services often include rides to and from appointments, monitoring heart rate and blood pressure and in-home physical and cognitive therapy sessions.

Think about the Level of Care Needed. If you can do most daily activities on your own, but could use help with certain activities, such as cooking or cleaning, home care might be a wise option. In-home care is focused on the service, and it’s supposed to help those who are living on their own as long as possible. When more care is required, moving to a place with more health support may be necessary. Elderly persons who have significant needs may often look to assisted living as an alternative. Assisted living facilities offer more services, like 24-hour emergency care and ongoing supervision for seniors with Alzheimer’s, dementia, or other disabilities.

Check Out the Cost of In-Home Senior Care. Homemaker services cost about $22.50 per hour on average and include tasks to help a person with daily duties like laundry, grocery shopping and light housework. An in-home health aide charges an average of $23 per hour, and may help with administering medicine at scheduled times, supervising and monitoring chronic illnesses and helping with walking aids. Of course, the exact cost of these services depends on where you live and the amount of help you need. The monthly cost for in-home care ranges from $4,290 for homemaker services to $4,385 for home health aide care. This typically costs more than the monthly median cost for an assisted living facility—but less than the median cost per month for a room at a nursing home facility.

Know Your Insurance Coverage. If you’re on Medicare, you may be able to get coverage for some short-term home services. To do so, a doctor will need to indicate that skilled nursing care is needed for a short period of time. Medicare will cover speech therapy, occupational therapy, or physical therapy. You can also use it to help with the purchase of durable medical equipment and safety additions to your home. However, Medicare won’t typically cover long-term in-home care services.

Medicaid will cover some health services at home, like cleaning and meal preparation, rides to and from medical visits and personal care. The Programs of All-Inclusive Care for the Elderly (PACE) is available in some states, if you have Medicare or Medicaid. It provides some care and services in the home to elderly persons who need a nursing home level of care. If you have long-term care insurance, some in-home services may be covered by your policy.

Look at Other Payment Methods. If your insurance won’t cover in-home care, you might have to pay out-of-pocket. One way to lower costs, is by asking family members to help. If you need to hire more help over time, the cost for services will increase accordingly. If that doesn’t work, they may help pay for in-home elderly care. You can also look at a reverse mortgage, which lets you borrow against your home’s value.

Reference: US News and World Report (June 10, 2020) “Can You Afford In-Home Elderly Care?”