What is a Reverse Mortgage?

A reverse mortgage is a special type of home equity loan that allows you to receive cash against the value of your home without selling it. You can choose to receive a lump-sum payment, a monthly payment, or a line of credit. You must use the funds you receive to pay off any existing mortgages or other debt against your home and to make required home repairs. There are no restrictions on how you use the remainder of the money.

As long as you spend the payments you receive in the month that you receive them, the money is not taxable and does not count towards income or affect Social Security or Medicare benefits. It also does not count as income for Medicaid eligibility.

When you take out a reverse mortgage, you continue to live in the home and you retain title and ownership of it. You are also still responsible for taxes, hazard insurance, and home repairs. However, you do not have to repay the loan as long as you continue to live in the home. Instead, the amount you owe, based on loan payouts and interest on the loan, becomes due when you or the last borrower, usually the last remaining spouse, dies, sells, or permanently moves out of the home.

Reverse mortgages are available to homeowners age 62 and older. Unlike traditional mortgages, you do not have to provide an income or credit history to get the loan.

Types of Reverse Mortgages

There are three types of reverse mortgages. These include:

• Home Equity Conversion Mortgage (HECM) 
  The Department of Housing and Urban Development (HUD) offers HECMs and the Federal Housing Administration (FHA) insures them. HECMs are the most popular reverse mortgages, representing about 90 percent of the market. The federal government regulates most upfront costs for HECM loans. There are limits on the total fees and interest rates that you must pay.
• Fannie Mae Home Keeper Loan
  The loan limits for Fannie Mae Home Keeper Loan is higher than for HECMs. Therefore, you may receive more cash from these loans than with a HECM.
• Financial Freedom Cash Account Loans
  Financial Freedom Cash Account Loans are designed for seniors who own expensive homes.

Most people get reverse mortgages through a mortgage lender. Some credit unions and banks, with state and local housing agencies, may offer these loans as well

Here is a comparison of conventional and reverse mortgages provided by Department of Health and Human Services.

Reverse vs. Conventional Mortgage

Things to think about:

• You continue to own the house and no entity can force you to leave as long as you maintain the home, and make property tax and hazard insurance payments.
• You must meet with a government-approved reverse mortgage counselor before your loan application is complete.
• You or your heirs will never owe more than the value of the home at the time you or your heirs sell the home or repay the loan.
• In order to avoid paying taxes on your reverse mortgage payments, you must spend the entire payment in the month you received it.

Photo: http://www.flickr.com/photos/patrick_q/213724154/sizes/m/in/photostream/

Many adults will eventually need some form of living assistance in their elder years. Considering the costs of services such as assisted living and nursing homes, as well as the fact people are living longer, the costs of financing long term care becomes important in financial planning.

New resources to help you plan

One option is to consider the new Community Living Assistance and Services Act  or hybrid long-term care insurance. According to the National Clearinghouse on Long Term Care Information, planning for long-term care is important because there is a good chance you will need some long-term care services if you live beyond the age of 65. About 70 percent of people over age 65 require some services. The older you get, the greater the chance that you will need long-term care.

Planning is also important because long-term care can be very expensive, and Medicare and other health insurance programs don’t cover many long-term care services. The cost of long-term care services is often more than what the average person can pay from personal income and savings. Planning ahead gives you the time to save for your long-term care needs or to find the payment options that work best for you if you need services.

Planning helps you understand:

• Services available from your family and in your community
• Special conditions (such as age or income) that may apply for receiving services
• Costs of services
• Public or private payment options available to you

This information helps you understand your options, and makes it more likely that you will be able to get and pay for the services you need and prefer.

Chances are good you will need some type of care

About 70 percent of people over age 65 will require some type of long-term care services during their lifetime. More than 40 percent will need care in a nursing home. Things that increase your risk or make it more likely that you’ll need long-term care include:

• Age: The older you get, the more likely it is that you’ll need help.
• Living alone: If you live alone, you’re more likely to need paid care than if you’re married or single and living with a partner.
• Gender: Women are more likely to need long-term care than men, primarily because women tend to live longer.
• Lifestyle: Poor diet and exercise habits increase the chance that you’ll need long-term care.
• Personal history: Health and family history can increase the chances you’ll need long-term care.

How Much Care Will You Need?

Service and support needs vary from person to person and often change over time.

• On average, someone who is 65 today will need some type of long-term care services and supports for three years.
• Women need care longer (on average 3.7 years) than men (on average 2.2 years), mostly because women usually live longer.
• While about one-third of today’s 65-year-olds may never need long-term care services and supports, 20 percent will need care for longer than 5 years.

If you need long-term care services and supports, you may receive or use one or more of the following:

• Assistance with personal care or other activities from an unpaid caregiver who may be a family member or friend
• Services in your home from a nurse, home health or home care aide, therapist, or homemaker
• Services in the community such as adult day services
• Care in any of a variety of long-term care facilities

The table below shows that, overall, more people use long-term care services at home than in facilities. Also, people use long-term care services longer at home than in facilities.

Distribution and duration of long-term care services

As you are making decisions on long term care, consider the information above on the number of people that will require a certain level of care and how long, on average, they require that care. Using this information you can readily obtain information on annual costs for the various types of care and then calculate possible costs for various levels of care.

This information will be helpful in making decisions on whether a long term care insurance plan is in your best interest, or if you are younger, if a medical savings account or larger contributions to an IRA or 401-K program may be a better investment for the future.

(photo: http://www.flickr.com/photos/seniors75287/5486023637/)

The Long Distance Caregiver

Monitoring the health and well-being of your parents from a distance can be a difficult and stressful experience. To address the growing need of children who are seprated from their parents at a considerable distance, the National Institute on Aging has provided valuable information on how you can more effectively manage long distance caregiving.

If you live an hour or more away from a person who needs care, you can think of yourself as a long-distance caregiver. This kind of care can take many forms—from helping with finances or money management to arranging for in-home care; from providing respite care for a primary caregiver to creating a plan in case of emergencies. Many long-distance caregivers act as information coordinators, helping aging parents understand the confusing maze of new needs, including home health aides, insurance benefits and claims, and durable medical equipment.

Caregiving, no matter where the caregiver lives, is often long-lasting and ever-expanding. For the long-distance caregiver, what may start out as an occasional social phone call to share family news can eventually turn into regular phone calls about managing household bills, getting medical information, and arranging for grocery deliveries. What begins as a monthly trip to check on Mom may become a larger project to move her to a new home or nursing facility closer to where you live.

If you are a long-distance caregiver, you are definitely not alone. There may be as many as 7 million people in your same situation in the United States. In the past, caregivers have been primarily working women in mid-life with other family responsibilities. That’s changing. More and more men are getting involved; in fact, surveys show that men now represent almost 40 percent of caregivers. Anyone, anywhere can be a long-distance caregiver. Gender, income, age, social status, employment—none of these prevent you from taking on at least some caregiving responsibilities and possibly feeling some of the satisfaction.

How Will I Know If Help is Needed?

Sometimes, your relative will ask for help. Or, the sudden start of a severe illness will make it clear that assistance is needed. But, when you live far away, some detective work might be in order to uncover possible signs that support or help is needed.

A phone call is not always the best way to tell whether or not an older person needs help handling daily activities. Often an elder adult will not want to inconveience relatives or they may fear losing their independence and cover up the true nature of their physical condition. As such, itis often better to actually visit the parent or contact someone you know such as a neighbor to see if you can determine your parents’ condition. If their is a sense that immediate attentino is needed, you may wish to contact a social worker or visiting nurse in the area to make an emergency visit.

What Can I Really Do From Far Away?

Many long-distance caregivers provide emotional support and occasional respite to a primary caregiver. Staying in contact with your parents by phone or email might also take some pressure off your sister. Long-distance caregivers can play a part in arranging for professional caregivers, hiring home health and nursing aides, or locating care in an assisted living facility or nursing home (also known as a skilled nursing facility). Some long-distance caregivers find they can be helpful by handling things online—for example, researching health problems or medicines, paying bills, or keeping family and friends updated. Some long-distance caregivers help a parent pay for care, while others step in to manage finances.

Caregiving is not easy for anyone, not for the caregiver and not for the care recipient. There are sacrifices and adjustments for everyone. When you don’t live where the care is needed, it may be especially hard to feel that what you are doing is enough and that what you are doing is important. It often is.

How Can My Family Decide Who Does What?

This is a question that many families have to work out. You could start by setting up a family meeting and, if your grandmother is capable, include her in the discussion. This is best done when there is not an emergency. A calm conversation about what kind of care is needed in the present and might be called for in the future can avoid a lot of confusion. Ask your grandmother what she wants. Use her wishes as the basis for a plan. Decide who will be responsible for which tasks. Many families find the best first step is to name a primary caregiver, even if one is not needed immediately. That way the primary caregiver can step in if there is a crisis.

Think about your schedules and how to adapt them to give respite to a primary caregiver or to coordinate holiday and vacation times. One family found that it worked to have the long-distance caregiver come to town while the primary caregiver was on a family vacation. Many families report that offering appreciation, reassurance, and positive feedback to the primary caregiver is an important, but sometimes forgotten contribution.

Know Your Strengths and Set Your Limits

If you decide to work as a family team, it makes sense to agree in advance how your efforts can complement one another. Ideally, each of you will be able to take on tasks best suited to your skills or interests. For example, who is available to help Mom get to the grocery store each week? Who can help Dad organize his move to an assisted living facility? After making these kinds of decisions, remember that over time responsibilities may need to be revised to reflect changes in the situation, your parent’s needs, and each family member’s abilities and limitations. Be realistic about how much you can do and what you are willing to do.

When thinking about your strengths, consider what you are particularly good at and how those skills might help in the current situation:

• Are you good at finding information, keeping people up-to-date on changing conditions, and offering cheer, whether on the phone or with a computer?
• Are you good at supervising and leading others?
• Are you comfortable speaking with medical staff and interpreting what they say to others?
• Is your strongest suit doing the numbers—paying bills, keeping track of bank statements, and reviewing insurance policies and reimbursement reports?
• Are you the one in the family who can fix anything, while no one else knows the difference between pliers and a wrench?

When reflecting on your limits, consider:

• How often, both mentally and financially, can you afford to travel?
• Are you emotionally prepared to take on what may feel like a reversal of roles between you and your parent—taking care of your parent instead of your parent taking care of you? Can you continue to respect your parent’s independence?
• Can you be both calm and assertive when communicating from a distance?
• How will your decision to take on caregiving responsibilities affect your work and home life?

 

What are Home Modifications?

There are a number of home modifications tat can help reduce falls, and there are modifications to adapt living spaces to meet the needs of people with physical limitations so that they can continue to live independently and safely. These modifications may include adding assistive technology or making structural changes to a home. Modifications can range from something as simple as replacing cabinet doorknobs with pull handles to full-scale construction projects that require installing wheelchair ramps and widening doorways.

Why Do Seniors Need Home Modifications?

The main benefit of making home modifications is that they promote independence and prevent accidents. According to a recent AARP housing survey, “83% of older Americans want to stay in their current homes for the rest of their lives,” but other studies show that most homes are not designed to accommodate the needs of people over age 65. Most older people live in homes that are more than 20 years old. As these buildings get older along with their residents, they may become harder to live in or maintain. A house that was perfectly suitable for a senior at age 55, for example, may have too many stairs or slippery surfaces for a person who is 70 or 80. According to the National Centers for Disease Control and Prevention, each year thousands of older Americans fall at home.

How Can I Tell What Home Modifications are Right for Me?

The best way to begin planning for home modifications is by defining the basic terms used and asking some simple questions. According to the Rehabilitation Engineering and Assistive Technology Society of North America (RESNA), home modifications should improve the following features of a home:

• Accessibility. Improving accessibility means making doorways wider, clearing spaces to make sure a wheelchair can pass through, lowering countertop heights for sinks and kitchen cabinets, installing grab bars, and placing light switches and electrical outlets at heights that can be reached easily. This remodeling must comply with the Fair Housing Amendments Act of 1988, the Americans with Disabilities Act accessibility guidelines, and American National Standards Institute regulations for accessibility. The work must also conform to state and local building codes.
• Adaptability. Adaptability features are changes that can be made quickly to accommodate the needs of seniors or disabled individuals without having to completely redesign the home or use different materials for essential fixtures. Examples include installing grab bars in bathroom walls and movable cabinets under the sink so that someone in a wheelchair can use the space.
• Universal Design. Universal design features are usually built into a home when the first blueprints or architectural plans are drawn. These features include appliances, fixtures, and floor plans that are easy for all people to use, flexible enough so that they can be adapted for special needs, sturdy and reliable, and functional with a minimum of effort and understanding of the mechanisms involved.

Where Do You Begin?

Before you make home modifications, you should evaluate your current and future needs by going through your home room by room and answering a series of questions to highlight where changes might be made. Several checklists are available to help you conduct this review. The National Resource Center on Supportive Housing and Home Modifications is a good place to start. Go to the center’s website at http://www.homemods.org  and click on the link to the “Safety Checklist and Assessment Instrument.”

In addition, Rebuilding Together, Inc. has an excellent home modification checklist athttp://www.rebuildingtogether.org/content/resource/detail/1192/ 

You can begin your survey by examining each area of your home and asking the following questions:

Appliances, Kitchen, Bathroom

• Are cabinet doorknobs easy to use?
• Are stove controls easy to use and clearly marked?
• Are faucets easy to use?
• Are there grab bars where needed?
• Are all appliances and utensils conveniently and safely located?
• Can the oven and refrigerator be opened easily?
• Can you sit down while working?
• Can you get into and out of the bathtub or shower easily?
• Is the kitchen counter height and depth comfortable for you?
• Is the water temperature regulated to prevent scalding or burning?
• Would you benefit from having convenience items, such as a handheld showerhead, a garbage disposal, or a trash compactor?

Closets, Storage Spaces

• Are your closets and storage areas conveniently located?
• Are your closet shelves too high?
• Can you reach items in the closet easily?
• Do you have enough storage space?
• Have you gotten the maximum use out of the storage space you have, including saving space with special closet shelf systems and other products?

Doors, Windows

• Are your doors and windows easy to open and close?
• Are your door locks sturdy and easy to operate?
• Are your doors wide enough to accommodate a walker or wheelchair?
• Do your doors have peepholes or viewing?

Driveway, Garage

• Does your garage door have an automatic opener?
• Is your parking space always available?
• Is your parking space close to the entrance of your home?

Electrical Outlets, Switches, Safety Devices

• Are light or power switches easy to turn on and off?
• Are electrical outlets easy to reach?
• Are the electrical outlets properly grounded to prevent shocks?
• Are your extension cords in good condition?
• Can you hear the doorbell in every part of the house?
• Do you have smoke detectors throughout your home?
• Do you have an alarm system?
• Is the telephone readily available for emergencies?
• Would you benefit from having an assistive device to make it easier to hear and talk on the telephone?

Floors

• Are all of the floors in your home on the same level?
• Are steps up and down marked in some way?
• Are all floor surfaces safe and covered with non-slip or non-skid materials?
• Do you have scatter rugs or doormats that could be hazardous?

Hallways, Steps, Stairways

• Are hallways and stairs in good condition?
• Do all of your hallways and stairs have smooth, safe surfaces?
• Do your stairs have steps that are big enough for your whole foot?
• Do you have handrails on both sides of the stairway?
• Are your stair rails wide enough for you to grasp them securely?
• Would you benefit from building a ramp to replace the stairs or steps inside or outside of your home?

Lighting, Ventilation

• Do you have night lights where they are needed?
• Is the lighting in each room sufficient for the use of the room?
• Is the lighting bright enough to ensure safety?
• Is each room well-ventilated with good air circulation?

Once you have explored all the areas of your home that could benefit from remodeling, you might make a list of potential problems and possible solutions.

Photo: http://www.flickr.com/photos/43102365@N04/4381931628/sizes/m/in/photostream/

Making the decision to hire a caretaker to help with an elder parent can be a a difficult process.

Once the decision has been made, however, finding and selecting a caretaker can be an even more difficult process.

With increasingly frequency, individuals are turning to Craigslist to hire a caretaker. If you go that route, here are some things to keep in mind.

Proceed with caution

Many people have had great luck finding services and goods on Craiglist. At the same time, many people have also had horrible experiences. Most people who regularly use Craiglist will tell you they have experienced both.

If you are trying Craiglist for the first time, don’t believe everything you read and please proceed with caution. Craigslist is filled with scams, dubious offers, and other not-so-nice things.

Of course, there are also legitimate people offering legitimate services. But if you keep your head on a swivel from the outset, you are more likely to spot a scam.

Meet at a neutral location and bring another family member

If you place an ad and have some applicants that perk your interest, consider meeting them at a neutral location (think coffee shop) to conduct an interview.

By meeting them at a neutral location, you take your elder parent out of the equation, at least at this point. This should also reduce the likelihood of a scam.

Bringing a family member is also incredibly helpful. Another set of eyes and ears is helpful to determine if the person is right for your parent and right for your family. No two minds think alike, and your family member may offer some valuable insights into the applicant and how they fit in.

Ask for references and call them

Almost every applicant should have some prior experience doing caretaker work. That means they should be able to provide references. If they are not willing to do so, that is a big red flag.

Once you get the references, call them. If all the references are family members, the applicant is probably not as qualified as they claim. Calling references does not guarantee you can weed out someone who is not an ideal candidate, but it is a helpful place to start.

Go with your instincts

If someone seems like a great fit, but something in the back of your mind tells you this is a bad idea, then it is probably a bad idea. Most of the time, your gut is right.

Making the decision to hire a caretaker can be a difficult transition. Don’t make matters worse by hiring the wrong person.

(photo:http://www.flickr.com/photos/jjay69/4050881930)

There are a variety of living options for elder adults depending on their health, age. Lifestyle, and income. At one end of the spectrum, individuals may wish to maintain their home residence and modify the home or acquire additional services as they age.

On the other end of the spectrum are retirement living communities that are privately run and offer housing options ranging from condominiums or patio homes to assisted living nursing homes care.

No doubt, the baby boomer generation will be seeking housing alternatives that are less traditional, offer more lifestyle options, and provide opportunities for continued recreational, social and educational opportunities. One option that originated, of all places, in Minnesota, is cooperative owned housing.

Essential elements of cooperative housing

Cooperative housing and the land it resides on is owned by a cooperative corporation. Residents of the coop buy stock in the coop that is proportional to the value of their individual unit. The stock can be sold and the unit can be liquidated. Some coops have restrictions on the appreciation of the property to insure that it remains affordable and can be readily liquidated.

Residents can reside in their individual unit as long as they make payments and are healthy enough to live independently. Monthly charges for units pay debt service on mortgages, real estate taxes, and operating expenses.  Real estate taxes, homesteading, and mortgage interest is generally tax deductible. Under the law, 80-% of the cooperative units must have at least one individual who is over the age of 55.

Overall expenses are generally considerably less than assisted living or continuing care communities. Individual units vary in construction and size but generally have a mix where 80% of the units are two-bedrooms and 20% one-bedrooms.

Cooperative housing has lots of upside

So why consider cooperative housing? Many residents select a coop as it provides a social framework that promotes self-reliance, interdependence among the residents and a cooperative living environment. To promote these characteristics, coops have a board of directors selected from the residents which establish and modify the by-laws of the community to meet the evolving needs of the residents. Many cooperative housing units are also located in neighborhoods with close proximity to where the residents grew up or previously owned a home allowing the residents to maintain social contacts, access to community services, and recreational facilities.

Cooperative housing amenities often include a van service, an exercise and community room with kitchen, heated underground parking, guest rooms, a craft workshop, whirlpool or sauna, and public restrooms.

For more information on cooperative housing:

“Growing Old Together: A new Kind of Commune” Article from the New York Times

Senior Cooperative Foundation

(photo: http://www.flickr.com/photos/maynard/50460651)

Reverse mortgages for individuals age 62 or greater allow a home owner the ability to draw upon their home’s equity. Funds obtained from these mortgages are often used by elder adults to pay for unanticipated medical expenses, to supplement Social Security, or for other financial necessities.

While in the past these loans have been rather expensive, new options are now available to draw upon smaller amounts of a home’s equity and the provision for a cheaper upfront mortgage insurance premium. Here are some of the highlights of the program.

Borrower Requirements

You must:

• Be 62 years of age or older
• Own the property outright or have a small mortgage balance
• Occupy the property as your principal residence
• Not be delinquent on any federal debt
• Participate in a consumer information session given by an approved HECM counselor

Mortgage Amount Based On

• Age of the youngest borrower
• Current interest rate
• Lesser of appraised value or the HECM FHA mortgage limit or the sales price
• Initial Mortgage Insurance Premium (MIP)–your choices are HECM Standard or HECM SAVER initial MIP

Financial Requirements

• No income or employment qualifications are required of the borrower
• No repayment as long as the property is your principal residence and the obligations of the mortgage are met
• Closing costs may be financed in the mortgage

Property Requirements

The following eligible property types must meet all FHA property standards and flood requirements:

• Single family home or 1-4 unit home with one unit occupied by the borrower
• HUD-approved condominium
• Manufactured home that meets FHA requirements

How the Program Works

If you are a homeowner age 62 or older and have paid off your mortgage or have only a small mortgage balance remaining, and are currently living in the home, you are eligible to participate in FHA’s reverse mortgage program. The program allows you to borrow against the equity in your home. You can select from five payment plans:

• Tenure – equal monthly payments as long as at least one borrower lives and continues to occupy the property as a principal residence.
• Term – equal monthly payments for a fixed period of months selected.
• Line of Credit – unscheduled payments or in installments, at times and in an amount of your choosing until the line of credit is exhausted.
• Modified Tenure – combination of line of credit plus scheduled monthly payments for as long as you remain in the home.
• Modified Term – combination of line of credit plus monthly payments for a fixed period of months selected by the borrower.

You can change your payment options for a fee of $20.

Unlike ordinary home equity loans, a FHA reverse mortgage HECM does not require repayment as long as the home is your principal residence and the obligations of the mortgage are met. Lenders recover their principal, plus interest, when the home is sold. The remaining value of the home goes to you or your heirs.

If the sales proceeds are insufficient to pay the amount owed, FHA will pay the lender the amount of the shortfall. FHA collects an insurance premium from all borrowers to provide this coverage.

The amount you can borrow depends on:

• Age of the youngest borrower
• Current interest rate
• Lesser of the appraised value of your home, the HECM FHA mortgage limit for your area or the sales price
• The initial Mortgage Insurance Premium (MIP) option you choose (2% HECM Standard option or .01% HECM Saver option).

For more information on reverse mortgages see HUD’s Reverse Mortgage site.

(photo: http://www.flickr.com/photos/jollyuk/1989719848)

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We have experienced tremendous growth over the past year—thanks to all our readers! We have a number of exciting additions planned for next year, so keep your eyes peeled!

In honor of this momentous year, we wanted to take a look back at some of the most popular posts from the last year. Without further delay, here are the five most popular posts from this past year!

1. Rights Under the Nursing Home Reform Act: Federal law provides nursing home residents with a number of substantive rights. A must read if you know someone in a nursing home.
2. WellAWARE Sensors Help Seniors Live at Home: Many elders are more comfortable modifying their current home instead of moving elsewhere. These sensors can allow seniors to stay at home while also making sure they are monitored.
3. Avoid Probate for Real Property in Minnesota: Options for avoiding probate, while still controlling assets until your death.
4. Make Computers Easy for Elders: Using computers can be daunting for elders. Fortunately, there are ways to make it easy for seniors to use them.
5. Using a Trust to Protect Assets: Having a trustee manage certain assets can provide security.

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Under the federal Omnibus Budget Reconciliation Act of 1987 (OBRA 1987) residents of nursing homes that receive federal assistance are required to provide residents with a number of rights.

These rights are provided under the nursing home reform act.

1. Respect: You have the right to be treated with dignity and respect. You have the right to make your own schedule, including when you go to bed, rise in the morning, and eat your meals. You have the right to choose the activities you want to go to. Also, the nursing home can’t interfere with, coerce, discriminate or retaliate against you in exercising your rights.

2. Freedom from Abuse and Neglect: You have the right to be free from verbal, sexual, physical, and mental abuse, corporal punishment, and involuntary seclusion by anyone. The nursing home must investigate and report to the proper authorities all alleged violations and any injuries of unknown origin within five working days of the incident.

3. Freedom from Restraints: A physical restraint is any manual method or physical or mechanical device, material, or equipment attached or next to the resident’s body that the resident can’t remove easily, which restricts freedom of movement or normal access to one’s own body. A chemical restraint is a drug that is used for discipline or convenience and not required to treat medical symptoms.

It is against the law for a nursing home to use physical or chemical restraints, unless they are necessary to treat your medical symptoms. Restraints may not be used for punishment, or for the convenience of the nursing home staff. You have the right to refuse restraint, except if you are at risk of harming yourself or others.

4. Information on Services and Fees: You must be informed in writing about all facility services (those that are charged and not charged to you) and fees before you move into the nursing home. The nursing home can’t require a minimum entrance fee as a condition of admission if your care is paid for by Medicare or Medicaid. Also, you must be informed when any services and fees change.

5. Privacy, Property, and Living Arrangements: You have the right to privacy and to keep and use your personal belongings and property as long as they don’t interfere with the rights, health, or safety of others. You have the right to send and receive mail and nursing home staff should never open your mail unless you allow it. You have the right to use a telephone and talk privately.

The nursing home must protect your property from theft. This may include a safe in the facility or cabinets with locked doors in resident rooms.

If you and your spouse live in the same nursing home, you are entitled to share a room (if you both agree to do so). You also have the right to reject a move to an inappropriate room. The nursing home has to notify you before your room or your roommate is changed.

You also have the right to review the nursing home’s health and fire safety inspection results.

6. Medical Care: You have the right to be fully informed in a language you understand about your total health status, including your medical condition and medications. You have the right to see your own doctor.

You have the right to take part in developing your care plan. You can also express any grievances you may have about your care and treatment. You also have the right to create an advance directive.

You have the right to self-administer medications unless the nursing home finds this unsafe. You also have the right to refuse medications and treatments (but this could be harmful to your health) and refuse to participate in experimental treatment.

You have the right to access all your records and reports, including clinical records (medical records and reports), within 24 hours. You also have the right to photocopy your records for a standard fee when you provide two days notice to the nursing home.

Finally, the nursing home must notify your physician and, if known, your legal representative or an interested family member when (1) you are involved in an accident that resulted in an injury or may require a physician’s intervention; (2) a deterioration of your health, mental, or psychosocial status in a life threatening condition or clinical complications; (3) your treatment needs to change significantly; (4) or when the nursing home decides to transfer or discharge you from the home.

7. Visitors: You have the right to spend private time with visitors. The nursing home must permit your family to visit you at any time, as long as you wish to see them. You don’t have to see any visitor you don’t wish to see.

8. Social Services: The nursing home must provide you with any needed social services, including counseling, help solving problems with other residents, help in contacting legal and financial professionals, and discharge planning. They also have to provide you with an appropriate activities program designed to meet the needs of you and its residents.

9. Leaving the Nursing Home: Living in a nursing home is your choice. You can choose to move to another place. However, the nursing home may have a policy that requires you to tell them before you plan to leave. If you don’t, you may have to pay them an extra fee.

10. Your Family and Friends: Family members and legal guardians may meet with the families of other residents and may participate in family councils. By law, nursing homes must develop a plan of care (care plan) for each resident. You have the right to take part in this process, and family members can help with your care plan with your permission. If your relative is your legal guardian, he or she has the right to look at all medical records about you and make important decisions on your behalf.

There are many other federal requirements for nursing homes. If you would like the examine these, click here.

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Health care underwent a massive reform earlier this year. As a result, Medicare, among other programs, will undergo some changes in the coming year.

There are rumors that if Republicans take control of Congress, Social Security reform will be a hot topic. Is change on the horizon?

Change is not always a good thing

For many elders and seniors, Social Security is their main source of income. The checks are consistent and elders usually know, down to the day, on what day their check will arrive. Given that elders usually have to do very little beyond applying for benefits, that income is low-stress and does not involve much management on the part of the individual. In a recent poll, elders noted that while they distrust the government, they have positive feelings for the Social Security Administration.

Under the plan proposed by Republicans, individuals would have the option of investing up to a third of their social security taxes in personal retirement accounts. As the recent market crash showed, that can be a very bad thing. Not only is it risky, but it would also require management by seniors, which can be very difficult for some individuals.

According to the Congressional Joint Economic Committee’s report on the possible privatization of social security, the Republican proposal would “erode the economic security and peace of mind that Social Security provides to millions of Americans.”

The report notes that even diverting a small portion of social security funds into private investment is a risky venture and could undercut the entire purpose of having Social Security.

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Locating practical and reliable books on addressing the issues of aging parents can be a challenging task. While there is an ever increasing need for information on this subject, there are relatively few books that can assist adult children who are attempting to assist their parents or grandparents.

Happiness is Growing Old at Home (2009) written by Maria Tadd provides a comprehensive discussion of the range of topics that one needs to address when caring for a parent and helping them live independently longer.

A good resource for learning to help elders live at home

Written in part from her experiences with her aging mother, Ms. Tadd provides information on assessing and monitoring a parent’s home for safety, tips for preventing falls and the use of technology to monitor those living independently. A section on staying healthy includes information on diet, benefits of exercise and meditation, and the use of herbs and supplements. The book’s coverage of alternatives for at home and home-like care is commendable. Readers will find information on the Beacon-Hill model, group homes, elder cottages, Medicare and Medicaid for financial support, and a practical and straightforward discussion on how to pay for parents’ care.

A chapter on how Ms. Tadd managed her own mother’s care is particularly helpful in gaining a clearer undrstanding of using home care agencies, selecting rehabilitation services, the importance of tracking medications, and dealing with problems that are often encountered with home services. A chapter on guidelines and questions to pose when selecting a home health agency, rehabilitation services, and hospice are, once again, clearly written, practical, and written from the perpective of a consumer and an advocate of the elderly.

Easy to read and a helpful resource

Happiness is Growing Old at Home is clearly written, practical in his approach to a wide range of issues, and would serve as a valuable resource for individuals who are preparing to assume the role of a caregiver or for elder adults who wish better prepare for living independently and improving the quality of their life.

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Continuing care retirement communities (CCRCs) provide provide a continuum of care for the elderly ranging from those who are able to live independently, those who require help in an assisted-living facility, and those who require more intensive care in a nursing home. These communities appeal to seniors because they can enjoy an independent lifestyle with the expectation that they will be able to stay in the same community, with their spouse, as their health deteriorates in their later years. There are currently 1,861 CCRCs in the United States,1 and the number of older adults living in CCRCs has more than doubled from 350,000 in 1997 to 745,000 in 2007.

Seniors today look forward to living independently longer than previous generations, but they also worry about whether their assets and retirement income will cover the cost of care they may require in their later years. CCRCs provide a growing population of America’s seniors with a convenient range of housing, supportive services, health care options and the ability to age in place. Many CCRCs require fairly large entrance fees (some can be in the five or six-figure range) and additional monthly payments. The fees cover housing costs and a range of care and services, including assisted living and skilled nursing. In addition, residents can purchase a meal plan, use a variety of on-site amenities and activities, and receive additional care which they can pay for out-of-pocket or have covered by insurance.

However, these arrangements are not without risks. The CCRC model is particularly vulnerable during economic downturns, as stagnant real estate markets drive down occupancy levels in independent living units, which serve as CCRCs’ primary source of profit. Financial difficulties for CCRC providers could place a consumer’s investment at risk and raise their monthly CCRC expenditures. In addition, according to the American Bankruptcy Institute Journal, “the CCRC industry is particularly vulnerable to insolvency, and several CCRCs have failed, primarily as a result of poor financial planning.  Several high profile bankruptcy filings over the past year have cast a spotlight on these risks.

A recent investiogation into the financial stability of CCRC providers was conducted by the U.S. Senate Special Committee on Aging (Committee) The providers were selected based on the size of their assets under their management and the extent to which they were involved in a federal or state enforcement action. The information collected may not be representative of the entire CCRC industry. The following types of contracts were examined:

Type A (extensive contract) – wherein a resident typically pays an upfront fee and ongoing monthly fee in exchange for the right to lifetime occupancy in the appropriate level of care without an increase in monthly fees as the resident moves between levels of care;

Type B (modified contract) – wherein residents often have lower monthly fees than a Type A contract though the same housing and residential services are included, however, only some health care services are included in the initial monthly fee; and

Type C (fee-for-service contract) – which typically requires an entrance fee, but does not include discounted health care services.

Conclusion

The U.S. Special Committee on Aging came to a number of conclusions. First, the committee noted that  unstable market conditions and poor financial planning have lead to financial difficulties or even insolvency among some CCRCs. In addition, choosing a CCRC can be extremely complex due to disparate state regulations, and variations in the type of contract that an individual can sign. Residents need to be aware of the risks that CCRCs pose and consider retaining independent counsel to review these complex agreements.

Some of the key areas that a consumer may want to explore include: the CCRC’s ownership and fee structures; financial performance and security measures; entrance fee refund policies; protections against involuntary transfers to different levels of care or to off-campus facilities; the extent to which residents are able to participate in management decisions; the methods available to residents to address their disputes and concerns with the CCRC; under what circumstances a resident can rescind or cancel his/her contract; and whether the CCRC is accredited.

Resources

The following resources can help potential CCRC residents determine information about CCRC policies, or assist CCRC providers who wish to strengthen their financial planning and management as well as disclosure and transparency practices:

•            American Association of Homes and Services for the Aging (AAHSA) (2010). Continuing Care Retirement Communities – Suggested Best Practices for CCRC Disclosure and Transparency.

•            American Seniors Housing Association (ASHA) (2010). Assisted Living and Continuing Care Retirement Community State Regulatory Handbook 2010.

•            Commission on Accreditation of Rehabilitation Facilities – Continuing Care Accreditation Commission (CARF-CCAC) (2009). Accreditation Standards Manual.

•            Commission on Accreditation of Rehabilitation Facilities – Continuing Care Accreditation Commission (CARF-CCAC) (2007). Consumer Guide to Understanding Financial Performance and Reporting in Continuing Care Retirement Communities.

•            National Senior Citizens Law Center. Questions to Consider When Evaluation Continuing Care Contracts.

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With the much-anticipated increase in older adults in our population, concerns have been raised about the capacity of nursing homes, senior living facilities, and long term care facilities to deal with the ever-increasing number of elderly. Because the majority of older adults would rather stay in their homes, more attention has been directed at home modifications in an effort to reduce potential hazards, and simplify the living situation without sacrificing an individual’s independence.

A number of modifications can be made in an effort to reduce falls, which are a serious public health problem. In the United States, one of every three persons over age 65 falls each year and two-thirds of those who fall do so again within six months. Among people age 65 and older, falls are the leading cause of injury deaths and serious injuries. About 9,600 older adults died in 1998 from fall-related injuries. Among seniors with osteoporosis, falls can cause devastating injuries such as hip fractures; 75%–80% of hip fractures are sustained by women. Half of all older adults hospitalized for hip fracture cannot return home or live independently after their injuries.

Easy modifications you can do yourself

• Remove all small area rugs, thick doormats, and bathroom rugs.

• In the bathroom install grab bars in the shower or bathtub area and on both sides of the toilet, place anti-slip rubber decals in the bathtub or shower, install a shower chair if the elderly individual is unsteady on their feet and a wand shower head so water can be brought down to their level. Consideration should be given to carpeting the bathroom to add warmth and provide a sense of security for the elderly individual.

• Stairs should be well lit (add lighting where necessary), and handrails should be installed on both sides of the stairs where possible. Stairs should always be free of any obstacles and the material that covers the stairs should not be slippery. Make certain switches for stair lighting are readily accessible at both the top and bottom of the stairs.

• Thresholds should be removed throughout the home.

• Hallways should be free of furniture or clutter, well lit, and be equipped with handrails.

• Kitchens should not have highly polished or waxed floors, and should be free of appliance cords that may get in the way. Make certain all items are within easy reach to avoid the possibility the elderly individual may have to stand on something to access an item.

• Living and dining areas should be free of electrical cords or telephone cords that could cause a fall. Make certain chairs and couches are easy to get in and out of, and remove casters wheels from furniture.

• Bedrooms should have a bedside light with a switch that is easy to turn on and off, a telephone that is readily accessible from the bed, a firm chair to use for dressing or to sit.

Consider assistive technology to help monitor the home

Another comprehensive option is to install sensor-technology, like WellAWARE, that will keep you apprised on what is going inside the house. While the sensors will not prevent falls, they will provide a level of security to the elder resident, and can also alert nurses and others monitoring the house in the event of a fall.

If you would like more information on falls among older adults, the Center for Disease Control and Prevention (CDC) has an excellent Web site that can be accessed at http://www.cdc.gov/homeandrecreationalsafety/falls/index.html

In 1985, there were about 5.5 million functionally disabled elderly living in the community and an additional 1.3 million in nursing homes. By the year 2020, each of these figures is projected to almost double to 10.1 million and 2.5 million.

The dramatic increase of the elder population, and the increasing fiscal burdens faced by states and federal governments to provide long term care has ben referred to as the silver tsunami.

The silver tsunami will create an overwhelming demand for nursing care

Long term care, particularly nursing home care, is expensive with average daily costs of approximately $200. In an era of large federal deficits, it consumes a large portion of Medicare and Medicaid expenditures. The elderly, whether functionally impaired or not, prefer to live independently in their own homes for as long as possible. The challenge is to find ways to control rising costs while enabling the elderly adults to live as independently as possible. Toward that end, a number of assistive technologies have emerged to monitor the elderly as they go about their daily living.

Home sensor technology lets elders stay at home

One promising solution provided by assistive technology is WellAWARE Systems, a home sensor technology initially developed at the Medical Automation Research Center, an affiliate of the University of Virginia.  Initial prototype designs and development studies were conducted with Volunteers of America and The Evangelical Lutheran Good Samaritan Society, two of the largest non-profit senior care providers. The system has three elements: the home data manager, a computer hosting center, and caregiver reporting.

The home data manager is a computer installed in the residence and connected to a telephone line. Data is received wirelessly from sensors placed throughout the residence. Sensors monitor movement, humidity levels in the bathroom, movement of the entrance door, impact (falls) and a bed sensor which monitors duration of sleep, arousals, and time when an individual goes to bed and arises from their sleep.

Daily household monitoring

The computer hosting center compiles the data for each residence on and on-going basis. If, for example, an extreme temperature is noted from the heat sensor, staff monitoring the system can place a telephone call to the occupant to determine the nature of the problem. If there is no response, contact can be made with 911. Data received by the computer hosting center allows calculation of baseline information for such things as how often the residence leaves their home and the duration of time they are gone.

Baseline data on sleep allows the caretaker the opportunity to note abnormalities in sleep patterns and if, for example, a residence repeatedly gets up during in which room they may move to and how long they stay in that room. If, for example, a resident’s data indicates repeated visits to the bathroom it may suggest discomfort, a urinary tract infection, GI bleeding, prostate issues, or the flu.

When data abnormalities are noted, caretakers, doctors, or family members can be notified and the appropriate steps can be taken to determine if a medical condition needs to be addressed.  Data obtained from the humidity sensor can determine if the resident is showering, and the duration of the shower.  Again, deviations from baseline behavior may indicate possible physical ailments.

Caregivers examine computerized reports of each resident on a daily basis. Changes in baseline behaviors are noted, and when appropriate, family members, residential staff, or home caregivers can be notified.

Family members can access via the internet

The WellAWARE System will soon be accessible to family members through an Internet interface thus allowing the family the ability to monitor their parents’ on a daily basis. Other enhancements will soon be available.

Cost of the system is $500 a month and includes installation, as many sensors required for a specific residence, and daily monitoring. Services are provided on a month-to month basis. There is no long-term contract. In addition, the monthly fee is fixed regardless of the number of the sensors installed in a home.

Home monitoring is a promising solution

The biggest upside to WellAWARE is that it can potentially allow elder individuals to live independently in their own home. The sensors should allow for peace of mind for both the individual and their family.

While at present, a nurse reviews each subscribers profile on a daily basis the ability for family members to have real-time data in the future should greatly enhance this service. Eventually as additional features are added to the WellAWARE product, we can anticipate more families and elderly individuals will subscribe to services of this nature and extend the period of time they can live safely and with a sense of security in their homes.

(photo: Magic Madzik)

Computers and the elderly can be a difficult combination. Most people have integrated computers into their daily lives for both work and personal reasons with relative ease. Elder individuals, however, are generally inexperienced with computers and can find frustrating and difficult to use. Fortunately, more and more software is being developed to make it easy for the elderly to use computers.

PointerWare makes computers easy to use

PointerWare is a new program that essentially displaces Windows as a computers operating system (it is not available for Mac OSX yet). PointerWare’s website also has a short video that shows how the program can be used.

Think of it as a very simplified version of Windows, that provides easy access to the programs most people use. It provides one-click access to: Internet, Photos, Games, and Mail.

Simplified programs

The Mail program, for example, uses large fonts, and can also read emails outloud. If someone sends photos in an email, there is a large button called “display photos.” Users can also easily respond to messages by either typing a response, or recording a voice response. Any attached website links are also translated into large buttons, making it easy for users to click on. While these features seem obvious to most computer users, they would be very helpful to a person who is not computer literate.

The other programs are similarly easy to use. Users can easily make web searches, play games, and look at photos.

Free trial for readers

You can try out the program through this link. As a bonus to our readers, if you enter ”ElderParentHelp” as the coupon code you will get 60 days, instead of 30 days, to try it out.

Older adults often are confronted with changes in their living options in an effort to have a different life style, as in the case of relocating to a retirement community, or as a matter of medical necessity such as moving into a convalescent center following major surgery.

While most older adults would prefer to stay in their homes this is not always possible as health conditions change and outside services are required for care.

More living options are available

Over the past decades the options for living arrangements have changed dramatically as more older adults make use of assisted living facilities, convalescent care, adult day care, and facilities offering living options that range from cluster housing to assisted living and nursing homes.

Making decisions to move from one’s family home can be a difficult and complex decision as one weighs the costs with personal and family needs. And locating a residential facility can be a daunting task.

Seniorhomes.com can help you find the best living option

I recently had a conversation with Chris Rodde, CEO of SeniorHomes.com, a web site that assists individuals and their families in locating a living option that is appropriate for their health condition, personal needs, and financial resources. Mr.Rodde noted that users of their site tend to fall into two classes of individuals: those who need assistance in selecting a residential option, and those who know the type of residential option they prefer, but need assistance in identifying the option in their community.

According to Rodde, most baby boomers who contact them prefer to live in age restricted living communities that provide leisure activities and social events. For older adults who need some type of skilled care, it is often family members that initiate inquiries and eventually select the appropriate living option. Interestingly, location of the facility is the most important criteria for families seeking a residence for their loved ones.

According to Rodde, families want to be close to their parents to provide support and assistance. To ease the process of locating a living facility, SeniorHomes.com provides a toll-free number where family members and elderly adults can discuss living options in their area, and costs of the facilities.

SeniorHomes.com then contacts the residential facility and information is mailed to the individual making inquiry. While costs are always a concern to families seeking a living facility, Medicaid will often cover many of the costs of a nursing home, and long-term care insurance will cover skilled nursing home care, assisted living, adult day care, convalescent care, and respite care.

Veteran’s assistance available

Rodde noted that many veterans could benefit from the Veterans Administration’s Aid and Attendance Pension Benefit program. This aid or assistance can be provided at home, in an assisted living facility, or a nursing home. A Veteran is eligible for up to $1,632 per month, while a surviving spouse is eligible for up to $1,055 per month. A couple is eligible for up to $1,949 per month. More information can be obtained at VeteranAid.org.

Photo by: allspice1

Many Americans are turning to long-term hospitals for recovering from intense surgeries or chronic conditions, but based on recent inspections, you should reconsider whether they are worth the money.

Long-term hospitals have sprung up because of the high cost to traditional hospitals to keep patients for long terms. Because of the way Medicare currently operates, traditional hospitals may actually lose money on patients who stay long term. This creates a reverse financial incentive to discharge patients earlier.

According to the Medicare Payment Advisory Commission, which was setup by a Congressional research agency, for-profit long term hospitals have profitable margins on Medicare patients, whereas traditional hospitals have unprofitable margins on Medicare patients.

Medicare inspection reports indicate one long-term provider, Select Medical Corporation, runs understaffed facilities with high levels of turnover. The reports also identified preventable injuries and even cases of preventable deaths.

The bottom line is to be sure to do in-depth research when choosing a care facility for yourself or an elder loved one.

Long-Term Care Hospitals Face Little Scrutiny | New York Times

(photo: andercismo)

According to a recent study, 20% of nursing homes received poor ratings for overall quality. The ratings are based on inspections, complaint investigations, and other data gathered by Medicare. With that in mind, here are some suggestions to picking the right living situation.

Prioritize your needs

Make a list of what is important to you before you begin your research. Are there certain accommodations you require? Do you want to live in a facility that allows residents to graduate from unassisted living to assisted living? Determine what is important to you and use that as a starting point.

Research before visiting

Medicare has a nursing home comparison tool. Using this resource before visiting homes can help narrow down the list of candidates. The ratings are fairly comprehensive, and you can narrow your search by various geographical and other concerns.

Visit the home

Brochures and online reviews can be misleading. There is no substitute for physically visiting the place. When you visit the facility, imagine whether you can envision living there (or picture your loved one living there). Was it clean? Did people seem happy? Intangibles can paint important clues about the facility.

(photo: Oldmaison)

There are lots of resources available to assist individuals in caring for their elder parents, but perhaps the best source is your siblings and immediate family. Getting siblings to help will help form a bond between you and them, and hopefully take some of the pressure off of you.

Siblings already have a relationship with the parent

One advantage is that your siblings already have a relationship with your parent(s). Good or bad, both parties should generally know that to expect. While some siblings do not always have the smoothest parental relationships, it is still more of a relationship than a stranger has. Especially as parents get older, dealing with people they know is usually an advantage. Your parent will undoubtedly appreciate the assistance you are providing.

It will strengthen your relationship with your sibling

Siblings who become the sole caretaker for parents can feel overwhelmed and isolated. Siblings who live far away do not always realize the burden the caretaker sibling is carrying. Even if your assistance consists of weekly phone calls to your sibling, those phone calls show support and can truly help the caretaking sibling.

Helping care for an aging parent is an opportunity to strengthen sibling bonds that may have weakened because of time or distance. When your parents are gone, your siblings will become that much more important to you.

For more discussion on the topic, click here for recent article in Time magazine.

(photo: TimothyJ)