Holiday Blues - Depression in the Elderly

The holiday season is quickly coming upon us. If you are a caregiver for an elderly loved one, you may notice a change in your loved one's mood as the holidays approach. Perhaps you are one of many, who visit elderly parents and family during the holidays who live a distance away. When you visit you may notice that loved ones are not as physically active, or they show symptoms of fatigue or sadness and have no interest in the holiday or in their surroundings.

According to the National Institutes of Health; of the 35 million Americans age 65 or older, about 2 million suffer from full-blown depression. Another 5 million suffer from less severe forms of the illness. This represents about 20% of the senior population -- a significant proportion.

Depression in the elderly is difficult to diagnose and is frequently untreated. The symptoms may be confused with a medical illness, dementia, or malnutrition due to a poor diet. Many older people will not accept the idea that they have depression and refuse to seek treatment.

What causes depression in the elderly?
It is not the actual holiday that causes depression, but the fact that holidays tend to bring memories of earlier, perhaps happier times. Additional contributing factors that bring on depression may be the loss of a spouse or close friend, or a move from a home to assisted living, or a change with an older person's routine.

Depression may also be a sign of a medical problem. Chronic pain or complications of an illness or memory loss can also cause depression. In addition, diet can also be a factor when proper nutrition and vitamins are lacking.

As an example, Selma’s husband passed away, a few months before Christmas. Her family lived close by and would call or drop in often to check on her. Selma seemed a little preoccupied and tired, but this was to be expected as she had been the caregiver for her husband for many years. It wasn’t until the family noticed that her holiday decorations were not out and her yearly routine of Christmas card writing was not happening that they began questioning her mental and physical well being.

A trip to her physician confirmed depression, caused by not only the loss of her spouse, but a vitamin B12 deficiency. There were both mental and physical reasons for her depression.

Symptoms to look for in depression might include:

• Depressed or irritable mood
• Feelings of worthlessness or sadness
• Expressions of helplessness
• Anxiety
• Loss of interest in daily activities
• Loss of appetite
• Weight loss
• Lack of attending to personal care and hygiene
• Fatigue
• Difficulty concentrating
• Irresponsible behavior
• Obsessive thoughts about death
• Talk about suicide

How do you know if it is depression or dementia?
Depression and dementia share similar symptoms. A recent article on Helpguide.org gives some specific differences:

In depression there is a rapid mental decline, but memory of time, date and awareness of the environment remains. Motor skills are slow, but normal in depression. Concern with concentrating and worry about impaired memory may occur.

On the other hand, dementia symptoms reveal a slow mental decline with confusion and loss of recognizing familiar locations. Writing, speaking and motor skills are impaired and memory loss is not acknowledged as a being problem by the person suffering dementia.

Whether it is depression or dementia, prompt treatment is recommended. A physical exam will help determine if there is a medical cause for depression. A geriatric medical practitioner is skilled in diagnosing depression and illnesses in the elderly. If you are a care taker of an elderly person it may be beneficial for you to seek out a geriatric health care specialist. For more information on senior health services go to http://www.longtermcarelink.net/about_senior_health_services.htm or visit our website at www.livefreehomehealthcare.com.

Treating depression in older people.
Once the cause of depression is identified, a treatment program can be implemented. Treatment may be as simple as relieving loneliness through visitations, outings and involvement in family activities. In more severe cases antidepressant drugs have been known to improve the quality of life in depressed elderly people. Cognitive therapy sessions with a counselor may also be effective.

As a care giver or family member of a depressed older person, make it your responsibility to get involved. The elder person generally denies any problems or may fear being mentally ill. You can make the difference in and remove the Holiday Blues from seniors suffering from depression.

The Geriatric Mental Health Foundation offers a “Depression Tool Kit.” To read more about the tool kit and depression in the elderly go tohttp://www.gmhfonline.org/gmhf/consumer/depression_toolkit.html

Communicating effectively with someone with Alzheimer’s

Caring for an individual with Alzheimer’s disease isn’t always a walk in the park; in fact, it can be downright stressful. Between memory loss, repetitive questions, false thinking or aggressive behaviors, each day often brings new challenges.

A person’s understanding of the disease as well as their attitude about the illness can have a large impact on the way day-to-day caregiving responsibilities are managed. Just because this illness has taken over someone close to you, it doesn’t have to conquer you as well.

So what do you do when your loved one blames you for something you didn’t do or becomes paranoid that you are plotting against him or her? How about when someone sees objects that aren’t there or says things that simply don’t make any sense?

If your first instinct is to try to orient the person back to reality, you are not alone. Many caregivers spend endless hours trying to prove who they are, where they are and what they are doing, but to no avail. They mistakenly believe that just by showing family photos or having other family members confirm information that the person with Alzheimer’s disease will catch on and it will become clear for them. Even though the caregiver’s heart is in the right place, these efforts most often do not succeed. Their loved ones may continue to press the issue, and even become angry or hostile at the “evidence” presented to them.

Fortunately, there are ways to manage daily challenges in order to minimize a caregiver’s stressful feelings and improve the odds that an individual with dementia will respond positively.

One of the best approaches to use with people with dementia is Validation - a technique that confirms their right to feel a certain way and express their emotions regardless of the situation. The validation theory, developed by Naomi Feil, suggests that an individual could be revisiting past events or trying to solve unfinished business. This helps explain why some people feel the need to go to work years after they retire or pay off a debt from decades ago. By validating their experience, you are meeting them where they are and sending a message that you still accept them no matter what.

Another powerful approach to utilize is redirection-a behavioral intervention that shifts the individual’s focus, by distracting the person or moving away from an undesired topic or behavior to something more pleasant. Here are some examples:

When your mother says, “I want to go home!” Instead of saying “This is your home! Don’t’ you remember? You’ve only lived here for30 years!” Try Saying “Of course you want to go home! Your house was the prettiest on the block. Why don’t you tell me about those tulips you planted in your front yard?” Why? Memory impairments and disorientation can cause people to forget where they are. When they want to go “home,” it really signals a desire for a sense of safety and familiarity. Bring mom “home” by reuniting her with her favorite memories of what home represents.

When your wife says, “Get away from me, you’re not my husband!” Instead of saying “But I am your husband! Look at our matching wedding rings. You know, you really upset me when you don’t remember who I am.” Try saying “You must love your husband very much. I can tell by the way you talk about him. Why don’t you tell me about your wedding day?” Why? Memory loss can cause individuals to forget even their closest loved ones. When your wife becomes agitated, respect her space, validate the love she feels for her spouse, and allow her to talk about “him” while you are sitting right beside her. Even though she may have forgotten you today, hearing her talk about you will demonstrate that you are still very close to her heart.

When during meals, your father refuses to eat and says, “You’re trying to poison me.” Instead of saying “That’s ridiculous! Why would I ever do such a thing? Eat your meal and stop making up crazy stories!” Try saying “Dad I understand you are feeling afraid, but I want you to know that I would never let anything bad happen to you. You are safe with me. By the way, this meatloaf is delicious. I am having a big plate of it myself. Let’s have some together and you can tell me all about the fishing trip.” Why? It is difficult, if not impossible to rationalize with people with dementia. Instead of trying to orient Dad back to reality, instill a sense of safety, and demonstrate it by eating the same meal as him or taking a bite from his plate. Once you’ve established trust, you can quickly refocus him by shifting the conversation to something more pleasant, such as a fun day he had by the docks.

When your sister says, “You stole my money! Give it back!” Instead of saying “I’m sick of you accusing me every time you hide your money. You stuffed it in your drawer five minutes ago. I saw you do it, so stop blaming me.” Try saying “Oh no, your money is missing? I can see why you’re upset. Well, don’t you worry because I am going to help you look for it.” Why? It is common for people with dementia to hide items and forget where they are moments later. Since it can be embarrassing to admit this, individuals sometimes accuse others to take the focus off themselves. Rather than trying to deflect blame, simply let your sister know that you understand how she feels and that you understand how she feels and that you want to help her resolve the situation. Then walk her over the drawer and ask her to open it. When your sister finds her money, allow her to take pride in finding it all by herself.

When your grandmother says, “I have to leave now. I need to pick up Jimmy from school.” Instead of saying “Grandma, Jimmy is a grown man. He’s 60 years old. You’re not going anywhere.” Try saying “Oh Grandma, you have always been such a loving mother to Jimmy. Why don’t you come with me to get a drink of water and tell me all about what you love to do with Jimmy after school?” Why? People with Alzheimer’s disease often live in the past by re-creating experiences that happened long ago. Despite the fact that Grandma hasn’t picked Jimmy up from school in decades, her maternal instinct is still very strong, and she feels an urgency to follow the same routine she did while he was growing up. Take this as an opportunity to reunite your grandmother with those happy memories: while you are distracting her from going to the front door, she will tell you all about those wonderful times she had with Jimmy and will forget about wanting to leave.

When your uncle believes he’s still at work. He treats you like an employee and tells you he needs the paperwork finished by the end of the hour. Instead of saying “Are you still starting with that nonsense again? You retired in 1985. How many times do I have to keep reminding you?” Try saying “You really run a tight ship around here! I guess that’s what makes you such a good boss. I’ll make sure to get the paperwork to you, but I could use a little help. Can you assist me with one of the documents?” Why? It’s not uncommon for people with Alzheimer’s disease to strongly affiliate with important roles they have taken on in the past. The fact that your uncle thinks he’s at work suggests that a job is still very meaningful to him. Use this moment to create an activity that can contribute to a sense of purpose. Bring him a phone bill or other document and allow him to “help” you interpret it. Support his efforts and remind him what a great boss he has always been.

Get Ready for Grooming

Most people take great pride in maintaining their appearance. For individuals with Alzheimer's disease or related dementias, grooming tasks that were once simple such as combining hair, shaving and brushing teeth can become extremely complex ordeals. They may look at a comb or razor and have no idea what to do with it; they may have lost their ability to sequence tasks; or they may be experiencing emotions like fear, resistance or anxiety that can sabotage their personal care efforts. These tips can help ease the process:

• Ensure a proper setting. An environment conducive to the activity at hand can help boost a person's concentration and cooperation. Make sure the area is a comfortable temperature, is free of distractions, and has plenty of light. Also remember that privacy counts.
• Adjust grooming tools. Making the switch to safer, more effective supplies can help prevent injuries and simplify the process. Options include using an electric shaver as opposed to a traditional razor. You can also purchase items like foam grips for toothbrushes and hair washing trays or try different products like dry shampoo.
• Develop a routine. Try to perform tasks in the same order and at the same time each day. Also, doing familiar activities can be comforting to someone with Alzheimer's disease. Also consider continuing past habits. If someone is accustomed to going to the barber or beauty shop every week, keep it up if possible.
• Keep it simple. The ability to multi-task is difficult for someone with Alzheimer's disease. So it is likely to be easier to accomplish a task by telling a person what to do one step at a time, using a quiet, calm tone and smiling.
• Demonstrate techniques. Visual cues can move the process along, especially when communication skills diminish. Illustrate what to do with a comb by combing your own hair, or with a toothbrush by brushing your own teeth. Then encourage the person to copy your behavior.
• Build on a person's strengths. Encourage the person to handle self-care that is still withing abilities and do not show discouragement or lose patience if the task cannot be performed. Teamwork may be helpful. Perhaps you need to apply the toothpaste, but then the person with dementia can carry out the brushing.
• Eliminate surprises. Explain what you are doing if you have to complete a task for the person with dementia. Say "I'm going to cut your nails."
• Select favorite items. Let the person select and apply preferred products, such as cologne, make-up or toothpaste. Giving an individual with dementia input adds an element of independence.
• Be creative. A technique that worked one day may backfire the next. This is due to the progressive nature of the disease. You have to be creative in your approach. For example, one study found it effective to use wet wash clothes or to pour water from a pitcher rather than use a spray to rinse a person's hair.
• Be patient. Understand that the activity may take a while so be sure to allow enough time. Rushing the process can stress both you and the person you are caring for.
• Set realistic standards. Recognize that perfection is not always possible. If shaving becomes to difficult, for example, it's okay to grow a beard. If necessary, skip the non-essential tasks in favor of concentrating on crucial grooming like oral hygiene.
• Prepare in advance. Have everything ready for grooming before hand. The right supplies can limit confusion, simplify grooming and reduce stress.

For more information on caring for a person with Alzheimer's disease or dementia visit our website at www.livefreehomehealthcare.com.

Long Term Care

(Plymouth – Oct 5, 2009) – Long-term care is a subject of growing importance in today’s aging society, since according to the American Society on Aging, after age 65, a full 70 percent of Americans will need some form of long-term care. Not only will long-term care solutions be a major issue for the parents of baby boomers who are now in their 70s and 80s, but baby boomers as well will need to plan for their own long-term care needs.

Live Free Home Health Care, LLC is raising awareness in the local community about long-term care needs and services because we understand the importance that education and planning make in positive outcomes. Too many individuals underestimate both the risk and costs related to long-term care options, or believe the government will cover their needs. Taking action now may enable an individual or couple to experience greater dignity, control and independence over how future care needs are met.

“I’m often asked if Medicare will cover all long-term care costs for seniors and the disabled,” said Jason Harvey, Co-Administrator of Live Free Home Health Care, LLC. “It’s amazing how many people think that, but the answer is, unfortunately, no.” Medicare, a federal health insurance program for disabled adults and adults age 65 and older, has specific rules that apply for payment of care, and the coverage is very limited in scope. “Most people don’t know that Medicare is not intended to cover long-term care,” added Harvey.

There are options available to finance long-term care, though, including:

- A private health insurance or retirement health plan specific to long-term care

- An individual’s own income, savings or sale of other assets

- The family home as collateral for a reverse mortgage

- Veterans; programs for eligible Veterans and spouses

- Care from children/relatives on an informal basis

- Medicaid, a public medical assistance program for people with low incomes and limited financial resources

- County/local resources aimed at keeping people out of nursing homes (where available)

It is very important to plan in advance when it comes to financing long-term care needs. To compare the costs of nursing home care, assisted living and home health care by state, a useful long-term care calculator is available at http://longtermcareinsurance.org/carecalculator.html.

Preparing a long-term care plan may seem daunting, but will help alleviate the burden if and when the time comes and it is necessary. Key areas to consider when developing a long-term care plan are as follows:

- Communication with family and friends

- Comparing and understanding long-term care insurance options

- Decisions on who can be counted on for help

- Establishing clear legal directions

- Focusing on available finances

- Learning what is offered in the community

- Making necessary home improvements

- Taking control of health and personal needs

In addition to providing in-home care services, Live Free Home Health Care, LLC also offers long-term care planning resources and help in coordinating community services outside of the usual home care setting. For more information about when home care is appropriate to help meet long-term care needs, please contact Live Free Home Health Care, LLC.

About Live Free Home Health Care, LLC

Serving Central New Hampshire and the Lakes Region, Live Free Home Health Care, LLC is dedicated to providing top quality care in the comfort of home as an alternative to assisted living facilities or nursing homes. Family owned and operated, Live Free Home Health Care offers a wide range of services, from companion care and assistance with activities of daily living to skilled nursing, and all care is supervised and updated by a registered nurse. Live Free Home Health Care also offers medical alert systems to provide extra peace of mind should an emergency care need arise. Whether the need is for short or long term care, Live Free Home Health Care’s compassionate staff promises to treat each client respectfully and like a cherished family member. For further information, contact (603) 217-0149 or visit www.LiveFreeHomeHealthCare.com.

Planning for Your Elder Years

If we were to ask an older person what his or her most important concerns for aging are, we would probably get a variety of different answers. According to surveys frequently conducted among the elderly, the most likely answers we would receive would include the following three principal concerns or life wishes:

1. Remaining independent in the home without intervention
from others

2. Maintaining good health and receiving adequate health care

3. Having enough money for everyday needs and not outliving
assets and income

To address these concerns or wishes and maintain the quality of life wanted in the elder years, it simply takes a little preplanning.

Few people do this kind of planning.

It is human nature not to worry about an event until it happens. We may prepare financially for unexpected financial disasters by covering our homes, automobiles and health with insurance policies.

However, no other life event can be as devastating to an elderly person’s lifestyle, finances and security as needing long term care. It drastically alters or completely eliminates the three principal lifestyle wishes listed above.

The majority of the American public does not plan for this crisis of needing eldercare. The lack of planning also has an adverse effect on the older person's family, with sacrifices made in time, money, and family lifestyles.

Because of changing demographics and potential changes in government funding, the current generation needs to plan for long term care before the elder years are upon them.

Let us look at some facts.

• The population of the "very old,"--older than age 85--is the
  fastest growing group in America. This population is at
  highest risk for needing care. (Statistical abstract of the United States,
  2008, population)
• Medical science is preventing early sudden deaths, which
  means living longer with impaired health and greater risk of
  needing long term care.
• The Alzheimer's Association estimates the risk of
  Alzheimer's or dementia beyond age 85 to be about 46% of
  that population.
• It is estimated that 6 out of 10 people will need long term
  care sometime during their lifetime.
• Children are moving far away from parents or parents move
  away during retirement making long distance care giving
  difficult or impossible.
• Government programs--already stretched thin for long term
  care services--will experience even greater stress on
  available funds in the future.

One of the important things for planning is how to maintain your lifestyle as you age. You may be healthy enough to stay in your own home with help provided for the following activities of daily living:

maintaining a home,
providing meals,
supervision,
companionship,
transportation and
shopping services.

This type of care at home is non-medical and must be provided free of charge by family, friends, or volunteers or the care must be paid for out-of-pocket by the family.

Government programs, in most cases, will not pay for this kind of care. It is estimated that 80% of all long term care is non-medical, with 90% of that care provided in the home. It is most likely that your long term care will begin with home care.

It is wise to plan now how you will pay for care when it is needed. In evaluating your future income you may find it necessary to add some resources such as long term care Insurance to pay for assisted living or nursing home costs. Long term care insurance must be purchased while you are younger and healthy. Failing health, stroke or other aging issues will not allow you to qualify for this insurance.

A reverse mortgage will also help pay for home care if staying in your home is an option.

Consider where you may want to live in your elder years. Many assisted living facilities offer complete care alternatives with a nursing home wing if needed. Senior retirement communities also offer many amenities with some including home care options.

Now is the time to do estate planning. A professional estate planner will give you direction on how best to protect your assets for future needs and for Medicaid planning.

Do your paper work. Now is the time to create your trusts, will, medical directives in a living will and any other documents you want noted for future use. Gather Insurance policies and bank records where they can be found by family members in case you are not able to get them yourself.

We don’t like to think of our elder years in terms of health problems, but a sudden stroke, heart failure or onset of dementia could make it impossible to carry out our own wishes if preparation was not made ahead of time.

The process of long term care planning involves the following four
principles:

1. Knowledge and preparation are the keys to success.
2. Having funds to pay for care expands the choices for care
settings and providers.
3. Using professional help relieves stress, reduces conflict, and
saves time and money.
4. Success is assured through a written plan accepted by all
parties involved.

(The above excerpt is quoted from "The 4 Steps of Long Term Care Planning," National Care Planning Council)

The National Care Planning Council' s website -- www.longtermcarelink.net -- provides over 700 pages of information for long term care planning and lists services of professional care providers in estate planning, long term care insurance, reverse mortgage, home care and many other important long term care services.

The National Care Planning Council' s book, “The 4 Steps of Long Term Care Planning,” provides information on what Medicaid and Medicare will cover as well as an overview of professional long term care service providers and how their services can help you create and execute your long term care plan. A check list of what to do to create a plan and forms for creating necessary paperwork are also included in the book.

You can also visit Live Free Home Health Care for more information.

Insure Your Retirment Funds

It might sound strange to be told to insure your retirement funds, but after working hard and diligently saving all that money, wouldn't you want to make sure that the funds will be there for you when you need them?

As you move into retirement, you are also moving towards age-related health problems. Events beyond your control, such as stroke, heart disease and cognitive impairment can change one's way of life.

Many people are under the impression that government programs such as Medicare or Medicaid will cover the costs of long term care. Medicare will cover some skilled nursing for a limited period. Medicaid will only cover long term care costs for impoverished individuals. Health insurance does not cover nursing home or other long term care costs except for short-term rehabilitation.

Out of pocket costs for needed long term care resulting from age-related health problems such as home care, nursing home or assisted living will quickly deplete retirement funds and leave the remaining healthy spouse impoverished.

Long term care insurance is the answer to insure your retirement funds and provide protection so that the money stays intact and at the same time insurance provides a way to pay for elder care services.

In his book “ The Total Money Makeover ,” Dave Ramsey says of long term care insurance, "If you are over sixty, buy long term care insurance to cover in-home care or nursing home care. The average nursing home stay costs $40,000 per year, which will crack and scramble a nest egg in a heartbeat. Dad in the nursing home can use up Mom's $250,000 savings in just a few short years.”

Long term care Insurance to insure your retirement makes sense. You insure your car against damage, your home against fire, and you purchase life insurance, so why not insure what can be the largest and most devastating risk to you and your family? And unlike the other risks you insure against, long term care is the most likely to happen. Long term care insurance will also help you keep your independence and dignity and allow you to make choices about where you want to spend your final years.

Here are some specific reasons for buying long term care insurance:

• If you are married and you have a need for long term care, your spouse will be able to pay for an outside caregiver and receive needed rest and recuperation.

• If your children promise to take care of you, then when the time comes that you need care, insurance will help them do that by paying for aides to help with tasks such as bathing and incontinence.

• If you are single and a need for long term care arises and you have no family who can help you, insurance can pay for and coordinate that care.

• If you have the desire to leave assets behind when you die, insurance will help preserve those assets from the cost of long term care.

"You should also consider buying long term care insurance at a younger age. There is an advantage for doing this. The premium is lower.

For example, a person, currently age 45, buying a typical policy with a spouse, could spend $21,146 in total premiums to age 78.

Suppose this same person chooses to wait to buy the equivalent coverage at age 65.

If that same policy were available in the future, the couple that waits could pay $52,566 in total premiums over their 13 remaining years to age 78. Because they waited, they would pay 2 ½ times more for the same policy.

In addition to the rates going up with age, the health qualifications will be stricter and development of health problems related to aging may even disqualify a person from obtaining a policy." “The 4 Steps of Long Term Care Planning,” National Care Planning Council

There are dozens of long term care insurance companies selling a multitude of different policy options. It can become very confusing. For each policy, there are literally thousands of benefit combinations for home care, assisted living, nursing home care, waiting periods, payment amounts, inflation riders, and the list goes on.

You can take the time to do your own research or find a competent long term care insurance agent.

Here is a checklist of some of the things you need to know before you purchase a policy.

LONG TERM CARE INSURANCE BUYING CHECKLIST

The more "yes" answers you get the better off you are.

1) Is the insurance company rated by A. M. Best (the rating company)

with a rating of at least A, A+ or A++?

2) Is it a large diversified company with deep pockets and selling more

than just long term care insurance?

3) Is the insurance representative an expert in long term care

insurance? (Because of its complexity, almost all LTCi experts only

sell LTCi; they seldom sell anything else.)

4) Does the representative have a degree and/or industry financial

designations?

5) Does the representative own a personal long term care insurance

policy for himself or herself?

6) Is the policy you like tax qualified, and if not, do you understand the

ramifications?

7) Are there at least 6 ADL's (Activities of Daily Living) allowed for

in the benefit certification?

8) Does it allow "standby assistance"?

9) Is it a "pool of money" as opposed to a "stated period"?

10) Is it "integrated" as opposed to "2-pool"? (2-pool is not allowed in

many states.)

11) Do you understand how the elimination period works? (This is

extremely important.)

12) Does it have prohibitive cost containment provisions?

13) Is there any "capping" or other future reduction of automatic benefit

increase riders?

14) Do you understand how the waiver of premium works?

15) Does the assisted living facility benefit pay the same as for nursing

home?

16) Are you buying adequate home care coverage?

17) Does the company have a history of premium rate stability without

periodic increases?

18) Does the policy pay for homemaker services?

19) Does the policy offer an alternative plan of care for services that

don't exist today?

Live Free Home Health Care celebrates 3rd Anniversary

Local Home Care Agency Celebrates 3^rd Anniversary

****

Live Free Home Health Care, LLC Expands Services to Elderly NH Residents

October 1, 2009 - Bristol, New Hampshire — After providing care for hundreds of clients, New Hampshire-based Live Free Home Health Care, LLC is celebrating its 3^rd year of operation.

“Over the last three years we have seen first-hand the freedom, joy and independence that come from helping our clients stay in their homes. We are so pleased to be able to offer home care solutions to our clients, spanning all types of care needs,” owner Jason Harvey said. “We are actively seeing our business grow as adult children of elderly parents continue to seek our care so their parents can remain safely in their own homes.”

Since its 2006 inception, Live Free Home Health Care has continued to grow and has expanded into larger offices in Bristol. In 2009, the company introduced two new services, the first being personal care providers/companion caregivers, which offers home care services such as meal planning, light housekeeping, companionship, errands, etc.

Seeing a need from three years of client cases, Live Free Home Health Care also added a personal emergency response system as well as monitored medication dispenses to assist those clients who have trouble remembering to take their medication. Medication non-compliance can be attributed to approximately 30% of hospitalizations for people over age 65.

Harvey continued, “Our new personal care providers/companion caregivers allow us to become a truly "full service agency" offering non-licensed companion home care all the way to licensed nursing services and skilled nursing. It is our vision to serve the families of central New Hampshire with all of their home care needs. For example, we might start off providing care with our non-licensed companion caregivers, and as our client ages or as additional needs arise, we can also provide more hands-on care with our skilled nursing services.”

“From the outset our goal was to stand apart from other agencies by spanning all possible care needs. We don’t want our clients to have to worry about continuity of care. We also give clients peace of mind because all of our care services are directed and supervised by a registered nurse. Whether skilled nursing or non-medical care is needed, a registered nurse works with the family, helps create the care plan and coordinates with the primary care physician. Our clients enjoy the benefits of a full service agency, but receive the care and feel of a family owned business,” concluded Harvey.

Fulfilling a longtime dream, owners Jason and Jennifer Harvey have found a perfect marriage for their unique talents with their agency - Jennifer, RN and BSN, as director of patient services, and Jason as business and finance manager. Perhaps more important than their professional experience is the passion and commitment they bring to the business. They are eager to make a difference not only in the lives of their patients but also in the lives of their staff.

About Live Free Home Health Care, LLC:

Live Free Home Health Care, LLC, is a home health care agency serving central New Hampshire and the Lakes Region. As a fully insured and licensed medical home care agency, Live Free Home Health Care offers a wide range of services from companion care and assistance with activities of daily living to skilled nursing services. All care is supervised and frequently updated by a registered nurse. For more information about the company please visit www.livefreehomehealthcare.com.

Planning for the Long Term

AMID ALL THE HEALTH CARE debates our nation has had this year, I’ve kept wondering: When are we going to talk about long-term care? Two-thirds of Americans age 65 and older are going to need long-term care—medical and nursing services that go beyond doctor visits or treatment for specific illnesses, and that can include help at home as well as stays in assisted-living facilities or nursing homes. This type of care is staggeringly expensive: The average rate for a private room in a nursing home was $212 a day last year, more than $77,000 a year, according to the MetLife Mature Market Institute. And when seniors require long-term care, they need it for an average of three years.

Our national system for delivering long-term care has problems that go beyond cost. For one thing, when a person over the age of 65 gets sick, Medicare covers lifesaving procedures and immediate treatment. But when she returns home, it will not cover ongoing services, such as rehabilitation therapy that lasts longer than 100 days. As Mary Brinkley, executive director of the Oklahoma Association of Homes and Services for Aging, says, “We’ve made a mistake in separating acute care from chronic care.” Medicaid covers long-term care, but seniors have to be severely impoverished, with less than $2,000 in assets in most states, to qualify. And Medicaid typically covers only institutional services, such as nursing-home stays, not care delivered at home.

While various members of Congress launched ideas to address these issues, each effort has stalled. For example, Sen. Tom Harkin (D–Iowa) and Rep. Danny Davis (D–Ill.) introduced the Community Choice Act, which would make home care the default option for seniors to get Medicaid. But that bill has languished in committee. The late Sen. Edward Kennedy (D–Mass.) sponsored the Community Living Assistance Services and Supports Act, which would create a national long-term-care insurance program, funded through a payroll deduction that would average $65 a month. By creating a gigantic long-term-care insurance pool, a national program could drastically increase coverage pretty cheaply. But that legislative provision is still mired in the overall Congressional healthcare debate.

The unfortunate upshot is that we cannot count on the Obama administration and Congress to act on long-term care. Which means it’s more important than ever to make long-term-care planning part of your overall retirement planning. In the past I have argued that you need long-term-care insurance, and that’s still true: The odds of needing care are high, the costs are huge, and most other kinds of insurance won’t cover its costs. But it’s also true that insurance companies have been boosting premiums. Suppose you’re 65 and willing to cut your long-term-care insurance costs by purchasing a policy that has a 90-day deductible and pays $150 a day in benefits (just 70 percent of the national average for nursing-home expenses) for three years. Your average cost will still be $3,042 a year, according to the American Association for Long-Term Care Insurance.

You or your parents may already be too old or too much of a health risk to get cheap long-term-care insurance; conversely, in order to get affordable premiums, you may have to jettison important chunks of your benefits. Fortunately, there are ways to supplement your long-term-care insurance and prepare for the costs of assisted-living or nursing care. Here are four.

* Partnership policies. Under this idea, if you buy a long-term-care policy approved by your state Medicaid agency, you can protect an amount of assets from Medicaid equal to the benefits that policy pays out. For instance, say your father’s policy pays $180 a day in benefits for three years. If he exhausts that care, he will then be able to keep $197,100 in assets ($180 times 365 days times 3 years) and still be eligible for Medicaid. Partnership policies can be a huge help in figuring out how much insurance to buy and in ensuring that running out of benefits won’t lead to destitution. Forty-three states now have or are implementing them.

* Long-term-care riders. For a small fee, many insurers will let you add a provision to your life insurance policy that will pay long-term-care benefits in exchange for reducing your death benefit. The good news is that because everyone dies but not everyone needs long-term care, you’ll get substantially more than you give up. The bad news, of course, is that your heirs will get less. Say you’re 55 and your death benefit is $250,000. With a rider, you could get $500,000 in long-term-care benefits and still have a residual $50,000 death benefit, says Craig Skeels, a fee-only planner at Apex Wealth Management Group in Oxnard, Calif. “In effect, it’s a way to turn your life insurance premiums into long-term-care prepayment.”

* Reverse mortgages. Since I wrote about them in April 2008, reverse mortgages have become better deals. With a reverse mortgage, your bank advances you part of the equity in your home, paying cash to you. This year Congress raised the limit on reverse-mortgage loans, to $625,500 through the end of 2009. It also capped origination fees, which had been a growing problem. Most important, for the first time it allowed seniors using reverse mortgages to put the money toward buying a new home.

* Aid for veterans. If you served in our nation’s military during wartime, you may be eligible for aid and attendance benefits. Aid and attendance is underpublicized but extremely valuable: The federal government will pay up to $1,950 a month for a veteran with spouse, in addition to a vet’s basic pension, to help cover in-home, assisted-living or nursing-home care. And this is a non-service-connected benefit, which means the reason you need help does not have to result from your military service. It’s terrific—but you need to apply. For more information, contact the Veterans Administration at (800) 827-1000.

The key with all these options is to expand your horizons about wealth you can tap to cover long-term-care expenses. Traditional insurance may be only a partial answer and may squeeze your monthly budget. But your home, your life insurance, federal coffers and states looking to ease their Medicaid burdens all may offer further resources. As long as we are stuck with the long-term-care system we’ve got, we have to build our own safety nets.

Medication Problems for the Elderly

At 83 years old, Martha still lived in her own home, and enjoyed working in her garden and canning peaches. It was becoming harder to motivate herself, to get up in the mornings and accomplish the day's tasks. She confided to her daughter that she felt anxious and tired. Her daughter, who was taking medication for her anxiety, took Martha to her own doctor, not Martha's and got her a prescription for Valium. In doing so, the daughter's doctor, who had never seen Martha and who did not have her medical history, was only aware of a few medications they told him she was taking.

Martha, in fact, was taking 9 different medications as well as herbal supplements.

The addition of Valium to her existing list of prescribed drugs sent her to the emergency room with respiratory distress. If she had gone to her own doctor, he would have found that a dosage adjustment of her current medications would have solved her anxiety.

Medication errors are common in the elderly. Many seniors take on average 6- 8 different prescriptions as well as over the counter drugs. Many times the elderly will not go back to their doctor to have their dosage evaluated and changed if necessary. Family members should be aware, that elderly parents may tend to take the family's advice over going to their own doctor. Even though children want to help increase the health and stamina of their parents, they may in fact be causing damage by misdirecting their loved ones.

Where a younger person can benefit from herbal supplements like Ginkgo Biloba, Saw Palmetto and others, in older people, these herbals may cause adverse reactions with their prescription medications.

In 2003, a panel of experts put together a list of potential medications that would not be appropriate to give to seniors. This is called the “ Beers List ” after one of the research professionals.

Dr. Donna M Fick, R.N. one of the panel members for updating the “Beers List,” states in her article on Seniorjournal.com:

"Just as our bodies physically slow down as we age, changes occur in the way that older bodies handle pharmaceuticals, and this has motivated experts to develop a list of drugs that may be harmful to elderly patients.

"With age, drugs tend to build up in the body, and the distribution and elimination of drugs from the body changes as well," says Dr. Donna M. Fick, R.N., associate professor of nursing at Penn State. "Many drugs, like diazepam (Valium) and other anti-anxiety drugs build up fast."

An on-line article on HealthSquare.com , Titled "Drugs and the Elderly," talks about physical symptoms and medications.

“ Among the first signs that a drug may not be working properly in an older person is a change in mood, energy, attitude, or memory. Too often, these alterations are overlooked, ignored, or chalked off to "old age" or senility. Older people may themselves feel that their blue mood is caused by something external such as the death of a friend or simply by boredom. Nothing could be farther from the truth. Virtually every heart medication, blood pressure drug, sleeping pill, and tranquilizer has been known to trigger depressive symptoms.

When a psychological symptom appears in an older person, examine his or her medication or drug use first. Consider, too, factors like alcohol intake, poor nutrition, and hormone imbalance. And never dismiss the possibility that a real psychological problem has developed and may itself require medication.”

There are many things family members can do to help monitor medications for their elderly parents.

• Make a list of medicines prescribed and all supplements being taken.
• Give this list to the doctor and pharmacist and have one on hand for emergencies.
• Use the same Pharmacy to fill all prescriptions. Pharmacies keep a record of your prescribed drugs and will verify your doctor's instructions. They will also tell you if foods or over the counter supplements will interact with a prescription.
• Dispense pills in a daily pill organizer box.
• Have a family member be responsible to call or physically monitor the taking of medication

Family members who live long distances from their elders have available to them

new technology in medication monitoring.

• Alarms for pill boxes, watch alarms, medical alarm bands and necklaces that ring a reminder.
• Computerized pill box dispensers that ring a designated number if the pills have not been taken.
• Home Telehealth -

“Technology has developed computer and computer cameras to help the elderly in their homes stay safe and healthy. Home telehealth-set up by medical professionals in the home--enables providers to monitor such things as medications and blood pressure and actually see the patient. Patient questions are answered and advice is given, while the monitoring nurse views through the video phone how his or her patient looks physically.” The 4 Steps of Long Term Care Planning, Pg 92

• Home Care Agencies – Home care companies offer a variety of service options in helping families care for and properly dispense medication to their elder parents.

Overmedication or taking medication incorrectly may lead to early mental confusion and decline in health in seniors. “If medication problems were ranked as a disease in cause of death it would be the 5th leading cause in the United States”. (from article on LongTermLiving)

Live Free Home Health Care offers several solutions to assist you or your loved one with medication compliance. Visit our website at www.livefreehomehealthcare.com or call us at 603-217-0149 to learn more.

Keeping Mom and Dad Safe at Home

Generally, elderly parents want to remain living in their own home. However, remaining in the home becomes a concern when children see their parents slowing down, perhaps even having trouble with handling stairs and doing general daily activities. Yet, with parents' mental and physical health currently not creating problems, there seems to be no imminent need to search out support services or other accommodations for aging parents.

This is now the time to evaluate the home to make it safe and secure for your loved ones -- now and in the near future -- in anticipation of aging disabilities that may occur. Help and support are available. The nation as a whole is more aware of elderly needs and services and products are becoming available at an outstanding pace.

The Bureau of Labor Statistics states,

“Employment of personal and home care aides is projected to grow by 51 percent between 2006 and 2016, which is much faster than the average for all occupations. The expected growth is due, in large part, to the projected rise in the number of elderly people, an age group that often has mounting health problems and that needs some assistance with daily activities.” Bureau of labor Statistics-Occupational Outlook Handbook, 2008-09 Edition

This growing need for aides and services also encompasses

• home remodeling services -- making a home more serviceable to the elderly;
• safety alert systems and technology;
• motion sensors to monitor movement;
• telehealth services -- using home-based computer systems for the doctors office or a nurse to monitor vital signs and
• even a pill dispenser that notifies when it is time to take medication.

Where do you begin to make sure your elderly family member is safe and managing well in his or her home?

Visit often and at different times of the day and night. Make note of daily activities that appear challenging and where changes might be made to add safety and convenience. Remove rugs that slide -- causing a fall -- and move furniture with sharp edges. Set the water heater at a lower temperature. This will protect their older sensitive skin from scalds and burns. Be sure smoke detectors and carbon monoxide detectors are in place.

Bathrooms are a hazard area for the elderly. Grab bars by the toilet and shower are a must to help prevent falls. There are easy to install bars at your local hardware store if you want to do the work yourself. Another item that is good to have is a shower stool or chair.

If you are not sure of what needs to be done, consider hiring a professional. There are companies that specialize in home remodeling and accommodation for seniors. Michelle Graham of Accessible Design by Studio G4 says about senior home remodel projects,

“The main thing we incorporate in all of our projects is a careful study of needs and potential needs that may develop throughout a client's lifespan.”

Keep in mind what future home adjustments might be needed for your parents to “age in place” in their home.

Home safety or medical alert companies provide GPS-based bracelets or pendants to track the elderly at home who tend to wander. Or the companies may provide alarm devices such as pendants or bracelets which allow the elderly to alert someone if there has been a fall or a sudden health-related attack. In the event an alarm has been triggered, a 24 hour monitoring service will alert the family or medical emergency services or call a neighbor depending on previous instructions. In addition there are companies that will install motion sensors in the home to monitor the elderly on a 24 hour basis.

Don't forget your parents' community as a valuable resource for helping them stay in their home. Take Margaret Muller as an example. At 82 years of age, Margaret lives alone in her small home. She manages very well with the help of her local Senior Center. The Center's “Senior Companion” program sees that Margaret is taken to the store for groceries and other needs and checks in with her often to see how she is doing. Once a day, the Senior Center delivers a hot healthy meal to her door. Having these services and visits gives Margaret the help she needs and peace of mind that she is not alone.

Neighbors, local church groups, senior centers and city centers are some places to look for assistance. Most of the time there is little or no cost for these services.

Your state aging services unit is a valuable community resource. The National Area on Aging website www.aoa.gov states:

“AoA, through the Older Americans Act and other legislation, supports programs that help older adults maintain their independence and dignity in their homes and communities. In addition AoA provides funding for a range of supports to family caregivers.”

Some of the programs the site lists are:

“Supportive Services and Senior Centers

Nutrition Services

National Family Caregiver Support Program

Grants for Native Americans

Nursing Home Diversion Grants

Aging & Disability Resource Centers

Evidence-Based Disease Prevention

Long-Term Care Planning

Alzheimer's Disease Grants

Naturally Occurring Retirement Communities”

A few thoughts on hiring home care aides or live-in care givers.

The classifieds are filled with people looking for work as aides to the elderly. Many of these aides are well-qualified, honest people who will do a good job; but, of course, there will be some not so reputable. If you are looking to hire someone, be sure you interview and check references and qualifications. You will be responsible for scheduling that person and doing payroll and taxes as well. Be very sure you hire someone trustworthy, as the elderly seem to trust these helpers more than they should and therefore can easily be taken advantage of.

A professional home care service will eliminate your employment concerns. Professionally-provided aides are usually bonded and service is guaranteed. Home care companies take care of the scheduling and payment of their employees. Home care companies cater to the elderly in their homes by offering a variety of services. The National Care Planning Council lists many of these companies throughout the country on its website www.longtermcarelink.net .

These providers represent a rapidly growing trend to allow people needing help with long term care to remain in their home or in the community instead of going to a care facility. The services offered may include:

• companionship
• grooming and dressing
• recreational activities
• incontinent care
• handyman services
• teeth brushing
• medication reminders
• bathing or showering
• light housekeeping
• meal preparation
• respite for family caregivers
• errands and shopping
• reading email or letters
• overseeing home deliveries
• dealing with vendors
• transportation services
• changing linens
• laundry and ironing
• organizing closets
• care of house plants
• 24-hour emergency response
• family counseling
• phone call checks
• and much more.

Thomas Day, Director of the National Care Planning Council states,

“Care in the home provided by a spouse or a child is the most common form of long-term care in this country. About 73% of all long term care is provided in the home environment typically by family caregivers.”

As their caregiver, you can make the difference in the quality of life for your aging parents and if staying in their home is a possibility, you have the resources to make it happen.

The caring, friendly staff at Live Free Home Health Care can help you or a loved one remain safe at home. Give us a call at 603-217-0149 or visit our website at www.livefreehomehealthcare.com.

Preventing Dementia

While you can’t control all factors that contribute to Alzheimer’s and other forms of dementia, such as genetics and age, there are many contributing factors that you can control.

An increase in physical activity is shown to decrease the probability of developing many types of dementia. Exercise promotes an increase of blood flow to vital organs including the heart and brain. At least 30 minutes of physical activity such as aerobics and brisk walking can help lower blood pressure. High blood pressure causes damage to blood vessels in the brain. Following the DASH diet (Dietary Approaches to Stop Hypertension) can also aid in lowering high blood pressure. Another advantage of exercise is weight control, which is a crucial instrument in preventing dementia. Being overweight can affect the way the body creates and destroys insulin that may cause brain inflammation.

Alcohol intake is a contributing factor in developing certain forms of dementia, specifically alcohol related dementia, which is one of the top five most common dementias diagnosed in elderly people. Excessive alcohol consumption also worsens psychiatric and intellectual symptoms of dementia. According to many professionals a person that regularly drinks more than one ounce a day should report that to their primary care provider. People with dementia should not drink at all.

It is also very important to continually challenge your mind. Sudoku and other puzzles books are great tools for keeping ones’ mind active. Learning new languages or taking art classes can helpful as well.

Keep in mind that preventative measures are continually emerging so be sure to discuss any lifestyle changes with your doctor.

The Hidden Secret of Elder Abuse

Many elderly people rely entirely on family or other trusted individuals to help them. Whether it is for physical needs or emotional needs, as people grow older they tend to need more and more help from others. This dependence on caregivers or family members makes an older person more vulnerable for abuse.

For example, an older person relying on her children to provide meals and transportation and help her with financial decisions finds it difficult to complain when one of her children takes advantage of her. If, for instance, the child takes her money, hits her or neglects her care, the parent may be threatened with loss of support from the child if the parent complains. The child may also use threats of violence to keep the parent in line.

It is estimated that 5% to 10% of elderly Americans are suffering abuse. According to the National Committee for the Prevention of Elder Abuse,

“Spiraling rates of elder mistreatment are reported by both practitioners and researchers. In a recent national study of Adult Protective Services (APS), typically the agency of first report concerning elder abuse, there were 253,421 reports of abuse of adults age 60+ or 832.6 reports for every 100,000 people over the age of 60 (Teaster, Dugar, Otto, Mendiondo, Abner, & Cecil, 2006). The National Elder Abuse Incidence Study (National Center on Elder Abuse, 1998) found that more than 500,000 persons aged 60+ were victims of domestic abuse and that an estimated 84% of incidents are not reported to authorities, denying victims the protection and support they need.”

Much attention has been focused on abuse in nursing homes but most of the elder abuse in this country is at the hands of family members or other caregivers in the home.

In 2004, Utah Adult Protective Services workers investigated approximately 2,400 allegations of abuse, neglect or exploitation of vulnerable adults. In Utah, a vulnerable adult is defined as an elder adult (65 years of age or older) or an adult (18 years of age or older) who has a mental or physical impairment, which substantially affects that person's ability to protect or provide for themselves. The majority of the victims were females between the ages of 60-89 and 60% of the perpetrators were family members/relatives, while 24% were non-related paid caregivers.

The protective needs identified were as follows:

• self-neglect 31%
• physical abuse 16%
• exploitation 19%
• caretaker neglect 12%
• emotional abuse 19%
• sexual abuse 3%

In conducting the investigations, it was not uncommon to find that adults who were self-neglecting were also being exploited or abused. As stated previously, these statistics are based on approximately 2,400 cases, thus, if only one in ten cases are ever reported, it is possible that there were actually 24,000 or more cases in Utah that year. We suspect 9 out of 10 is close to the actual ratio of unreported versus reported cases in Utah.

We also believe that Utah's lack of reporting elder abuse is not unlike other states in the country. We suspect all the states are experiencing close to the same ratios of underreporting as in Utah.

There are a number of reasons why incidents of abuse, neglect, or exploitation are not reported to Adult Protective Services or other authorities. One of the most common reasons is the victim's fear of losing support. Many of the perpetrators are family members and the victim fears that reporting the crime will result in removal of the caregiver, as the perpetrator may face incarceration or may discontinue relations with the victim once accused, charged, or convicted. Many of these victims fear that by reporting abuse they will be left alone and expected to care for themselves or they will be forced to live in a nursing home.

Many states have implemented mandatory reporting laws to assist in the prevention of abuse, neglect or exploitation of vulnerable adults. Utah is one of the many states to have a mandatory reporting law (U.C.A. § 76-5-111). Utah law states that any person who has reason to believe that a vulnerable adult has been the subject of abuse, neglect, or exploitation shall immediately notify Adult Protective Services or the nearest law enforcement agency. Anyone who makes the report in good faith is immune from civil liability in connection with the report; however, any person who willfully fails to report is guilty of a class B misdemeanor.

It is important to note that the anonymity of the person or persons making the initial report and any other persons involved in the subsequent investigation shall be preserved and may only be released in accordance with the rules of the division (U.C.A. § 62A-3-311). In addition, all investigation information is confidential.

The following is a list of indicators of abuse, neglect or exploitation. It is important to note that the following lists are merely indicators and may not always be violations.

Signs of Abuse:

• Unexplained bruises, welts, fractures, abrasions or lacerations
• Multiple bruises in various stages of healing
• Multiple/repeat injuries
• Low self-esteem or loss of self determination
• Withdrawn, passive
• Fearful
• Depressed, hopeless
• Soiled linen or clothing
• Social Isolation

Signs of Neglect/Self-Neglect:

• Dehydration
• Malnourishment
• Inappropriate or soiled clothing
• Odorous
• Over/under medicated
• Deserted, abandoned or unattended
• Lack of medical necessities or assistive devices
• Unclean environment
• Social Isolation

Signs of Exploitation:

• Missing/"disappearing" property
• Inadequate living environment
• Frequent/recent property title changes or will changes
• Excessive home repair bills
• Forced to sign over control of finances
• No/limited money for food, clothes and other amenities

Prevention can only occur if there is awareness, the statutes are adhered to, and any suspicions of abuse, neglect or exploitation of vulnerable adults are immediately reported to Adult Protective Services and/or law enforcement.

All states have agencies that receive complaints of abuse. In some states failure to report abuse of the elderly is a crime. To contact an abuse complaint department, call your local area agency on aging. To find an area agency on aging in your area go tohttp://www.longtermcarelink.net/eldercare/ref_state_aging_services.htm

ONE STOP SHOPPING FOR ELDERCARE SERVICES

A fast-growing generation of elderly people, needing care, is starting to put a great deal of pressure on caregiving family members. More and more we are seeing articles and books about the burden of long term care on families.

According to research By the National Care Planning Council, only about 16% of long-term care services are covered by the government. The other 84% are provided free of charge by family caregivers or provided by services paid out-of-pocket by families or from those receiving care. And the bulk of government care services are provided only after a care recipient has depleted all of his or her savings. The Council also estimates that at any given time approximately 22% of the population over age 65 is receiving some form of long term care support. About 44.4 million adult caregivers provide 21 hours a week of care with 4.3 years average time spent providing care.“National Care Planning Council”

Dilemma of Finding Eldercare Services
The need for care usually occurs without warning, when a stroke, heart failure or other medical condition or illness incident to age suddenly happens to an aging senior. Family members end up in panic mode trying to understand and educate themselves on what needs to be done and what resources are available. If they need to take time from work to handle the crisis then it becomes urgent to find answers and solve caregiving needs. The need to balance work with urgent caregiving responsibilities creates untold stress on employed family caregivers.

Most family caregivers simply don't know where to turn for help and advice.
Long term care services are complicated and provider contacts are fragmented throughout the community. For the majority of Americans, eldercare becomes a frustrating do-it-yourself process. How do you find out what government services are available and what they will pay for? What legal documents are necessary and how do you protect assets? What type of home care or facility care is needed? Should you quit your job to become the caregiver? Will the government or insurance pay you for caregiving to help replace your lost income?

The question often arises as to whether to use long term care professionals or go it alone in arranging care and services.

“Using care professionals is the most cost effective and efficient way to provide help for a loved one. Hiring professional advisers or providers to help with long term care is no different than using professionals to help with other complex issues such as car repairs, dealing with taxes, dealing with legal problems, or needing trained employees to help run a business. With their education and training, long term care professionals also bring experience that only comes from dealing with countless hands- on caregiving challenges”. “The 4 Steps of Long Term Care Planning”

One Central Source for Locating Help and Advice
The National Care Planning Council recognizes the need for family caregivers to educate themselves and find the needed resources and professional help quickly.

To fill the need for caregivers nationwide, the National Care Planning Council web site "Long Term Care Link", was developed as a comprehensive resource for long term care planning. There are hundreds of pages containing articles on long term care covering all aspects of caregiving and care services. Books are also available on how to plan for long term care and how to apply for your veterans benefits for long term care. NCPC books

If you are looking for government and community resources, there are lists with applicable website links. Some of those lists include National and State Area Agency on Aging Services, Senior Centers and Veterans Service Offices.

There are over 100 links to websites filled with reference materials. For example; the Gerontological Society of America, National Nursing Home Survey, Elder Law Answers, Senior Corps.

Find Eldercare Professional Service Providers in Your Area
The National Care Planning Council lists eldercare specialists and advisers who help families deal with the crisis and burden of long term care. These specialists can be found under the services category lists like the ones below, on the website. Each professional is listed under the State and area in the State that he or she services. A caregiver can go to the National Care Planning Council website and find someone in the area of need and read about the services of the listed company, individual or facility. Website visitors needing help can then call, email or fill in a request form to receive contact from a listed provider.

Listing categories on the website include the following specific services.

• Care Management, Guardianship, Conservatorship and Dispute Resolution
• Non-Medical Home Care
• Home Health Agency – Medicare-Covered Home Care and Hospice
• Home Maintenance, Deep Cleaning, Remodeling and Yard Work
• Veterans Benefits -- Consultant for the Aid and Attendance Pension Benefit
• Geriatric Health Care Practitioner or House Call Doctor
• Reverse Mortgage Specialist
• Elder Law Advice and Medicaid Advice
• Estate Planning, Tax Planning, Trust Management Services and End-Of-Life Planning
• Care Facility or New Home Search, Relocation, Downsizing and Real Estate Services
• Adult Day Care Services
• Insurance Products, Retirement Planning and Financial Advice
• Funeral & Burial Preplanning
  

THE NATIONAL CARE PLANNING COUNCIL INTRODUCES
ITS STATE CARE PLANNING COUNCIL WEBSITES

A state care planning council is an informal statewide alliance of eldercare specialists and advisers that helps families deal with the crisis and burden of long term care. When you go to your state care planning website, your search for help is right in your neighborhood.

Purpose of the State Care Planning Council

1. Educate the public on the need for care planning before a crisis occurs.
2. Provide, under one source, a list of providers representing most of the available
3. government and private services for eldercare.
4. Offer a trusted team of providers and advisers that the public will recognize in their area and can turn to for expert help in dealing with the challenges of long term care.

One Stop Shopping for Eldercare Services
State Care Planning Council websites offer a closer-to-home option for finding help and services to solve caregiving problems. Many of the local service providers work together as a team to help meet specific eldercare needs of the individual.

For example:
Tim and Debra, both in their late 80’s, were adamant about staying in their home. Both were taking medications and were mobile with walkers. Their daughter, Julie was concerned about their safety in the home, especially with avoiding hazardous falls, bathing and preparing meals. Tim insisted he could drive his car, even though he was a hazard on the road. Julie had taken the car keys and therefore faced an argument every time she went to their home.

Lately, Julie noticed that the required medications were not being taken. Tim was a diabetic and required monitoring with his insulin and diet. Julie ordered “Meals on Wheels” which her mother quickly canceled. Frustrated at having no cooperation from her parents, Julie realized she needed outside help.

Checking the internet for resources in her area, she found the name of a Professional Care Manager in her area listed on her State Care Planning Council website. Jackie -- the professional care manager and family dispute professional -- had worked many times with families like Julie and her parents.

A meeting was arranged where all parties to the caregiving were involved. Tim expressed that he did not want to give up his freedom driving to the store or other places he liked to go. Jackie suggested selling the car and using the money to pay a taxi or community transit. She arranged for Tim to see a geriatric physician to get his diet under control for his diabetes. Some in-home help with bathing, meal preparation and medication reminders was arranged by having a local non-medical home care company come in daily. Jackie gave Julie explicit instructions on how to organize the house to help prevent falls. To pay for the extra expense, Jackie introduced a reverse mortgage broker who explained how their home equity-- on a risk-free basis --could provide the money they needed for their care.

Every service provider or adviser Jackie brought in worked side-by-side with her on the state care planning council. Jackie knew they could provide the needed help with expertise and integrity.

Julie found that using professionals gave her peace of mind and confidence that her parents' care was in good hands.

The State Care Planning councils are just starting to grow and be populated with professional service providers throughout the Untied States. Like the National, the State websites are filled with resource material and articles for the public use.

Locate a State Care Planning Council at http://www.longtermcarelink.net/a15state_councils.htm

If you or a loved one would like more information or assistance in obtaining home care contact Live Free Home Health care at 603-217-0149 or visit our website at www.livefreehomehealthcare.com.

Advantages of Individual Help

Sometimes life goes more smoothly when you’ve got a companion. Not only does a home helper give you someone to talk to, a companion can help ease your burden, no matter what that burden is. Sometimes as we age we lose our companions and when that happens, life can seem lonely and even unbearable. But it doesn’t have to be that way because nowadays, a home companion is someone you can hire. Building a relationship There are many advantages of having someone you can count on provide in home care and building a relationship is one of them. As with any type of relationship, your first experiences may seem a bit awkward and perhaps uncomfortable. After all, you’re total strangers and you’ll need time to get to know one another. You’ve probably got a routine and the in-home carer needs to learn it. But soon enough you’ll hopefully be very comfortable with your home companion. And if you’re not, there’s a good chance you can talk with someone – a family member or the provider of your in home care – to see about finding another with whom you might get along better. After all, this person is coming in your home to help you so it’s important that you’re able to work together. With the same individual coming to your home regularly, you can’t help but develop a relationship with that person. It won’t take long before you’re friends, chatting about nothing, going out to eat or to the movies, and helping you to cope with whatever life delivers. Remain in familiar surroundings The fact that this person is coming into your home is perhaps one of the biggest advantages of in home care. Rather than being uprooted, you get to remain in your home, a familiar place that’s filled with your all your belongings and all your memories. That actually can help the relationship with your home companion grow. Your photographs, your decorating style, your pets and the like can tell a lot about the person you are. Knowing more about who you are is what’s going to help your home companion understand you better. By understanding you and your individual needs better, you’ll have someone on whom you can rely to give you the personal attention you need on a daily or regular basis. That personal attention might involve matters of personal hygiene, or housekeeping, or errand running, or help with daily tasks, or friendship or all of the above. The ability to pick and choose the type of assistance you need most and that you want is another of the advantages of individual in home care. There are other advantages, too. Family can relax knowing that you’re getting the care and attention that they aren’t able to provide, alleviating their guilt and their worry. In home care is also an affordable option and if you contract the services of a company that’s reputable, licensed and bonded, like Live Free Home Health Care, there’s little chance you or your home will be victimized in any way.

Putting Home Care In Perspective

The Evolution of Home CareIn the first century of our country's history there was no such thing as nursing homes or assisted living. Society was mostly rural and people lived in their own homes. Families cared for their loved ones at home till death took them. In the latter part of the 1800's because of an increasingly urban society, many urban families were often unable to care for loved ones because of lack of space or because all family members including children were employed six days a week for 12 hours a day. During this period many unfortunate people needing care were housed in County poor houses or in facilities for the mentally ill. Conditions were deplorable. In the early 1900's home visiting nurses started reversing this trend of institutionalizing and allowed many care recipients to remain in their homes. Nursing homes or so-called rest homes were also being built with public donations or government funds. With the advent of Social Security in 1936, a nursing home per diem stipend was included in the Social Security retirement income and this government subsidy spurred the construction of nursing homes all across the country.
By the end of the 1950s it was apparent that Social Security beneficiaries were living longer and that the nursing home subsidy could eventually bankrupt Social Security. But in order to protect the thousands and thousands of existing nursing homes Congress had to find a way to provide a subsidy but remove it as an entitlement under Social Security. In 1965 Medicare and Medicaid were created through an amendment to the Social Security Act. Under Medicare, nursing homes were only reimbursed on behalf of Social Security beneficiaries for short-term rehabilitation. Under Medicaid, nursing homes were reimbursed for impoverished disabled Americans and impoverished aged Americans over the age of 65. It has never been the intent of Congress to pay for nursing home care for all Americans. The nursing home entitlement for all aged Americans was now gone.
Over the last 40 years, there has been a gradual change away from the use of nursing homes for long-term care towards the use of home care and community living arrangements that also provide in-house care.
With Proper Planning People Could Remain in Their Homes for the Rest of Their Lives We are seeing a trend towards working conditions like those in urban America in the early 1900's where both husband and wife are working and putting in longer hours. We are also seeing a return of the trend in the early part of the 20th century where outside visitor caregivers are becoming available to replace working caregiver's and allow the elderly to receive long-term care in their homes. In addition there is a significant trend in the past few years for Medicaid and Medicare to pay for long-term care in the home instead of in nursing homes.
Given enough money for paid providers or government funding for the same, a person would never have to leave his home to receive long-term care. All services could be received in the home. Adequate long-term care planning or having substantial income can allow this to happen.
We only need to look at wealthy celebrities to recognize this fact. Christopher Reeve, the movie star, was totally disabled but he had enough money to buy care services and remain in his home. President Ronald Reagan suffered from Alzheimer's for many years but received care at his California ranch. He was also wealthy enough to pay for care when needed. Or what about Annette Funicello or Richard Pryor? Income from their movie careers allowed them to receive care with their multiple sclerosis at home. We will be willing to bet that Mohammed Ali, who is severely disabled with Parkinson's disease, will probably never see the inside of a care facility, unless he chooses to go there to die. With the proper planning and the money it provides, most of us could remain in our homes to receive long-term care and we would never have to go to an institution or a hospital.
The Popularity of Home Care Most of those receiving long-term care and most caregivers prefer a home environment. Out of an estimated 8 million older Americans receiving care, about 5.4 million or 67% are in their own home or the home of a family member or friend. Most older people prefer their home over the unfamiliar proposition of living in a care facility. Family or friends attempt to accommodate the wishes of loved ones even though caregiving needs might warrant a different environment. Those needing care feel comfortable and secure in familiar surroundings and a home is usually the best setting for that support.
Often the decision to stay in the home is dictated by funds available. It is much cheaper for a wife to care for her husband at home than to pay out $2,000 to $4,000 a month for care in a facility. Likewise, it's much less costly and more loving for a daughter to have her widowed mother move in to the daughter's home than to liquidate mom's assets and put her in a nursing home. Besides, taking care of our parents or spouses is an obligation most of us feel very strongly about.
For many long-term care recipients the home is an ideal environment. These people may be confined to the home but continue to lead active lives engaging in church service, entertaining grandchildren, writing histories, corresponding, pursuing hobbies or doing handwork activities. Their care needs might not be that demanding and might include occasional help with house cleaning and shopping as well as help with getting out of bed, dressing and bathing. Most of the time these people don't need the supervision of a 24/7 caregiver. There are, however, some care situations that make it difficult to provide long-term care in the home.
Please note from the first graph below that a great amount of home care revolves around providing help with activities of daily living. Note from the second graph below that the average care recipient has need for help with multiple activities of daily living. Finally, it should be noted from the second graph that well over half of home care recipients are cognitively impaired. This typically means they need supervision to make sure they are not a danger to themselves or to others. In many cases, this supervision may be required on a 24-hour basis. (Graphs were derived from the 1999 national caregivers survey, courtesy www.longtermcarelink.net.)


It is precisely the ongoing and escalating need for help with activities of daily living or the need for extended supervision that often makes it impossible for a caregiver to provide help in the home. Either the physical demands for help with activities of daily living or the time demand for supervision can overwhelm an informal caregiver. This untenable situation usually leads to finding another care setting for the loved one. On the other hand if there are funds to hire paid providers to come into the home, there would be no need for finding another care setting.
Problems That May Prevent Home Care from Being an Option Caregivers face many challenges providing care at home. A wife caring for her husband may risk injury trying to move him or help him bathe or use the toilet. Another situation may be the challenge of keeping constant surveillance on a spouse with advanced dementia. Or a son may live 500 miles from his disabled parents and find himself constantly traveling to and from his home, trying to manage a job and his own family as well taking care of the parents. Some caregivers simply don't have the time to watch over loved ones and those needing care are sometimes neglected.
The problems with maintaining home care are mainly due to the inadequacies or lack of resources with informal caregivers, but they may also be caused by incompetent formal caregivers. These problems center on five issues:
Inadequate care provided to a loved one
Lack of training for caregivers
Lack of social stimulation for care recipients
Informal caregivers unable to handle the challenge
Depression and physical ailments from caregiver burnout
In order to make sure home care is a feasible option and can be sustained for a period of time, caregivers must recognize these problems, deal with them and correct them. The responsibility for recognizing these problems and solving them is another function of the long-term care planning process and the team of specialists and advisers involved.
Adequate Funding Solves Most Problems Associated with Providing Home Care None of the problems discussed in this article would be an obstacle if there were enough money to pay for professional services in the home. These services would be used to overcome the problems discussed in the previous section. If someone desires to remain in the home the rest of his or her life, adequate preplanning could provide the solution.
This planning must occur prior to retirement. The most obvious way to provide sufficient funds for home care is to buy a long-term care insurance policy when someone is younger, healthy and able to afford the lower premiums. If insurance is not an option, then money must be put aside early in life to pay for care in the future. The only other option is to be rich.
Unfortunately, very few people address the issue of needing long-term care when they are older. This leads to a lack of planning and in turn leads to few options for elder care when the time comes. Lack of planning means most people do not have the luxury of remaining in their homes and must rely on Medicaid support in a nursing home to finish out the rest of their lives.

Family Reunion-A Good Time for Family Planning

Summertime brings a lot of family time. With family reunions, picnics, weddings and other events, long distant family members travel to gather together. It is also the perfect time to do some planning for the future. With parents aging and their health and lifestyles changing, children need to discuss some changes and decisions that will be needed in the near future. Parents should take the time to tell their children where important documents are kept and what their wishes are in the event of needing health care directives or experiencing long term care needs.

For those children who live away, the change they see in their parent's health and mental capacity may be alarming -- whereas siblings that have daily contact are working with these issues constantly. Here is the chance to compare notes and work together as a complete family in the long term care planning process.

For you parents who are well and active, this is a good time to hold a family meeting and share with your children your plan for long term care. Tell them where financial and legal documents are located. Review health care directives, living wills and long term care alternatives.

Experience has shown that even families that are close can quickly grow angry, jealous and hostile towards each other when an aging parent begins to need long term care. If a
sibling moves into the parent's home, others can easily be suspicious of ulterior motives and fear losing their inheritance. On the other hand, the child providing the elder care becomes bitter and feels there is no support or help from siblings. Pre-need meetings for the purpose of making a plan, before eldercare becomes imminent, avoids these types of conflicts.

In its book, “The 4 Steps of Long Term Care Planning,” the National Care Planning Council provides guidelines and checklists for family planning meetings. Here's an excerpt from the book:
“The first step to holding a meeting, and perhaps the most difficult
one, is to get all interested persons together in one place at one time.
If it's a family gathering, perhaps a birthday, an anniversary or
another special event could be used as a way to get all to meet. Or
maybe even a special dinner might be an incentive.

The person conducting the meeting can be a parent or one person of
a couple who are doing their planning, years before the need for care
arises. A meeting on behalf of someone already receiving care or
needing care in the immediate future could be conducted by that
person or by a member of the family, by an adviser or a friend.

The agenda could be formal or informal. If you want a formal
agenda, we suggest using our care planning checklist as the agenda.
Copies of the care plan should be prepared prior to the meeting and
presented to those attending. Discussion is encouraged and we
recommend that the person in charge not dictate but encourage input
from everyone.

After a thorough discussion of the issues and the presentation of the
solutions to the problems that will be encountered, there should be a
consensus of all attending to support the plan. If the plan needs to
be altered to meet everyone's expectations then by all means do so if
that can be done. But it is not always possible to please everyone so
there must sometimes be compromise.

The end of the meeting should consist of asking everyone present to
make his or her commitment to support the plan.

GET IT IN WRITING! All good intentions seem to be forgotten
with time. It may be years after this meeting before the long term
care plan begins. If there are vocal commitments to help with
transportation to doctors, give respite to the caregiver or other
commitments, write them down on the care agreement. You can
even have each person put a signature to his or her commitment if
you think that is important.”
“The 4 Steps of Long Term Care Planning ,” by The National Care Planning Council

The U.S Department of Health and Human Services states:
“No one wants to think about a time when they might need long-term care. So planning ahead for this possibility often gets put off. Most people first learn about long-term care when they or a loved one need care. Then their options are often limited by lack of information, the immediate need for services, and insufficient resources to pay for preferred services. Planning ahead allows you to have more control over your future”.
http://www.longtermcare.gov/

"Whether you plan a formal meeting with an agenda or informally gather for a discussion, when the family is together make it a point to start the long term care planning process.
There is a lot to learn and many decisions to make concerning finances, health issues and legal work. It may take research and a lot of time to put a plan together, but if everyone is involved it will work, and be worth it." National Care Planning Council, http://www.longtermcarelink.net/

Medication Management

Almost 30% of all hospital admissions for people over the age of 65 are directly attributable to medication non-adherence. 125,000 people die each year from non-adherence, twice the number killed in automobile accidents. Approximately 40% of people entering nursing homes do so because they are unable to self-medicate in their own homes. About 50% of the 1.8 billion prescriptions dispensed annually are not taken correctly, contributing to prolonged or additional illnesses.

Medication management is a growing problem for seniors and at-risk individuals in the United States. Live Free Home Health Care as an affordable, easy to use medication management system with seniors in mind. Clients using our medication dispensers are on average 90% compliant to their doctor's prescription regimen. Our systems work because they are easy-to-use and make remembering to take medications a breeze. The systems are pre-loaded by the caregiver or medical professional and set up to remind the client to take their medication. When the time comes for them to take their next dose an alarm will sound and the dose will rotate into position. The medication dispensers can also be set up so that they are monitored by the care center. Monitored devices are hooked up to the phone line and notify the Care Center if a medication dose is not taken within an allotted amount of time. When the Care Center receives notification of a missed dose they will try to contact either the client or a pre-designated contact person, such as a loved one, for the client to remind them to take their medication.

Staying Safe at Home

We are very excited to offer to a new service to our clients. With Live Free Home Health Care's medical alert systems seniors and at-risk individuals are able to stay safe, independent and at-home longer. Our medical alert systems are easy-to-use and feature the smallest medical alert help button in the industry. When you need help, simply push your button and one of the friendly Care Center Representatives will answer your call and get you to the help you need. Is there a stranger at the door? Do you need to step outside to get the mail in inclement weather? Our Care Call feature is available to you to help keep you safe. Simply press your button and one of the Care Center Representatives will listen as you answer the door or call to make sure you got in ok from your trip to the mail box. Care Center Representatives are there for you 24 hours a day, 7 days a week, 365 days a year.

Successfully Getting Over the 65+ Hill

Successfully Getting Over the 65+ Hill

Sixty-five is often considered a major turning point in ones life. It is also a time when Alzheimer’s becomes a concern. The number of people diagnosed with the brain disorder doubles every 5 years after the age of 65. But it is never too late to focus on aging successfully. Anyone can protect their bodies by integrating these 13 steps into their daily life.

1. Learn New Things-mental challenges keep the mind sharp.

2. Keep Social Contacts-friends stimulate not only the mind but also the soul.

3. Exercise Regularly- 30 minutes a day of walking is very beneficial.

4. Quit Smoking-it really is never too late.

5. Maintain a Healthy Weight-obesity may increase the risk of dementia.

6. Limit Alcohol Intake-drinking can cause falls or other injuries.

7. Eat a Balanced Diet-and take a multi-vitamin.

8. Watch Psychological Health-depression is a common but not normal part of aging.

9. If you feel depressed talk to your Doctor.
Trust Your Doctor-or find one you can trust.

10. Take Your Doctors Advice-you trust them for a reason.

11. Use 1 Pharmacy-doctors may not communicate with each other.
Pharmacists can help you understand medication interactions.

12. Plan for the Future-make your wishes known to your family.

13. And Above all Else-Enjoy your life!

Choosing the right Agency

Choosing the right Agency

You need to find a homecare agency. With a variety of home healthcare options available, how will you know which one is right for you? Where do you begin? Here is some basic information about the different types of home care agencies and the services they provide.

Nonmedical/Companion Agency:
These types of agencies provide services such as housekeeping, meal preparation, errands, and standby assistance for Activities of Daily Living (ADL's). Caregivers are not certified or licensed and have no medical training. The agency is usually not licensed or accredited and does not provide support by an RN. The agency is generally not available 24 hours a day/7 days a week.
Nursing or Employment Registry:
Registries work as a service to assist clients in finding caregivers to provide services in the home. The caregivers are not employed by the registry and the registries do not provide supervision once a caregiver has been placed.When a client hires a caregiver from a registry, they become the "employer" and are responsible for payroll taxes, work related injuries and in most cases verifying references and conducting background checks. There are many other factors to consider when hiring a caregiver from a registry, particularly, who will supervise the employee and protect the patient from abuse, neglect and exploitation.

Clinical Model Private Duty Agency:
A clinical model agency provides services for clients by certified or licensed individuals. Caregivers are able to provide simple companion services as well as care for individuals with more complex needs. Nurses provide supervision of the caregiver and develop a plan of care to meet the individual needs. Caregivers are employees of the agency and are provided with on going training and education. The agency is responsible for providing continuous care to the client. Agencies are usually required to be licensed by the area Department of Health or other accrediting body.Live Free Home Health Care is a clinical model agency that exceeds the minimum standards. If you are not sure if LFHHC is the right agency for you, give us a call. We will be happy to assist you in choosing the agency that best suits your needs. We understand the difficulties you are facing at this time and we want to assist you in making the right choices.

Tips for Diabetic Patients

Diabetes? Oh no! Nobody likes to hear that he or she has been diagnosed with diabetes, but the good news is that there are things you can do to prevent it from worsening too quickly and ways to stay on top of the disease. One of the most important things you can do is check your blood sugars. I know nobody likes to prick his or her finger, but it is the only way to know what your blood sugar is doing. And there are newer machines now that use just a small drop of blood and one that you can even get the sample from your forearm, which is less painful than your fingertips. Normal blood sugars range 70-125. So that would be the ideal level to have yours at. Blood sugar naturally elevates when we eat, so it is a good idea to check your blood sugar at different times of the day to see if it is going a lot higher after meals. Then after you check the blood sugar, write it down along with the time of day and if it is before or two hours after a meal. You can then take this logbook to your doctor so he can see if any adjustments need to be made to your medications.

Speaking of doctors, it is a good idea to visit yours every three months if you have diabetes. Then you can have your HgbA1c (hemoglobin A 1 c) checked. This level is taken from your blood and tells you what your blood sugars have been averaging over the previous three months. So there is no cheating with this one! People without diabetes typically have a HgbA1c of 5.0 or less. For diabetics, an average below 7.0 is ideal. A range from 7.0-8.0 demonstrates a need for improvement, and anything over 8.0, is considered poor control. If your HgbA1c is over 8.0, that is the time to take a closer look at your diet and see how much you are cheating, monitor your level of exercise, and possibly adjusting your medications. The doctor will also check the bottoms of your feet for neuropathy (loss of sensation) by using a monofilament, which is a very fine instrument that “tickles” your feet.

Because diabetics are more prone to neuropathies (or loss of sensations, typically starting in the feet), it is a good idea to check your feet everyday. Using a hand mirror, you can look at both feet from all angles to check for any sores or open areas. If you do notice one, call your doctor right away. An eye exam once per year is also important to check for any changes to your eyes, even if you haven’t noticed any changes to your vision.

Diabetes management is one of the services that our nurses have a lot of knowledge in. If you need help using your glucose monitor, understanding what your diabetic medications are all for, or some dietary counseling, we can help you with that. Or if you just have questions, we are a resource you can use. Good luck at staying in good control!
Jennifer L. Harvey RN, BSN
Live Free Home Health Care
New Hampton, NH
Jennifer Harvey is a registered nurse and owner of Live Free Home Health Care in Central New Hampshire. LFHHC specializes in eldercare and in home care for people seeking to remain in their own homes. For more information visit http://www.livefreehomehealthcare.com/ or call 603-346-4214.

Do not forget to take time for yourself

Doctor appointments that have to be scheduled; the constant physical and emotional care that mom or dad or your loved one needs; the endless errands to the grocery store, drug store, physical therapy sessions and, most of all, the need to know you are doing the “right thing” for that loved one you are providing care for are all taxing issues. Here at Live Free Home Health Care we understand the daily challenges you face as a family caregiver and that you most likely have little time for yourself.

But you do need time. Time to reflect, relax and recharge your batteries for at least a few hours each week. This “you time” is important to give you the strength to carry on. It is important to take that time. You deserve it and you should not feel guilty about it.

If you have questions regarding if the care you are providing for your loved one is appropriate, perhaps you should consider hiring a Nurse Care Manager. Live Free Home Health Care has Registered Nurses on staff that are available to meet with you in your home and discuss a care plan. If it is time to yourself you need, Live Free Home Health Care can provide Licensed Home Health Aides, who work under the supervision of a Registered Nurse, for as little as two hours a day to as much as round the clock care, all in the comfort of your or your loved ones home.

If you would like to discuss how we can possibly help give us a call at 603-346-4214.

In the meantime, here are three tips from CareGiver.Com:
Accept the help others offer. Suggest specific things they can do for you and your loved one. No one is a Super Hero. Do not feel like you’re the only one that can take dad to the doctor or your wife to her physical therapist. REACH OUT and ask another family member – or close family friend – to assist you occasionally so you have time yourself. Trust in their willingness to help. Many times, they do not know how to reach out and help unless you are able to communicate your needs. If you do not have anyone you can turn to for help, Live Free Home Health Care in Central New Hampshire in the heart of the Lakes Region can assist you with getting your loved one to appointments.

Ask for and accept favors such as, a friend staying with your loved one while you are able to get out of the house for a while, a dinner being cooked for you and your loved one once a week, an offer to go to the supermarket or drugstore in your place. Respite can be achieved on a daily basis with the smallest of kindnesses. Again, if you do not have anyone to provide you with Respite time Live Free Home Health Care has Licensed Nursing Assistants who can provide you with a much-deserved break.

Know your limits! If you wear yourself out caring for your loved one, who will step in to care for the both of you? Remember, caring for yourself is not selfish; it is the greatest gift you can give for your loved one.

Excellant Home Care Service

January 21, 2007

Hi Jennifer and Jason,
When I started thinking about how to bring my mother home, a lot of the information I received cautioned me to be careful. The private pay Agencies leave you hanging when the staff becomes ill, also Staff is late, poor weather conditions they just don't show and for these situations they have no back-ups. Another big concern was having strangers in my home for twelve hours per day. I work 40 hours per week and my job cannot be done from home so how could I make this happen and not loose all my quality of life with my family. Mom was very unhappy about being in a nursing home so I needed to make this happen.
Your Agency was the only one that offered to go to the nursing home, to meet my mother, assess what her needs would be, then meet with me to explain the process. I must tell you once I met with you Jen I felt I could trust you and that your staff would meet my expectations. You are a very caring, organized and business minded person.
My first impression was correct; you were there when we needed you. When we had some issues you addressed them, and I always felt I could call you at any time and you would be there to help. That is a wonderful feeling to have when you are taking care of a loved one, and will be leaving them with strangers for most of the day. You were very patient and so was all of your staff. We had a personality issue and it was handled immediately, and not once did I have to loose work due to staffing.
As you can tell I cannot say enough about your care and the way you manage your Agency. I have recommended it to many; and have spoken to quite a few people who wondered how I could have worked and taken care of Mom and I gave you most of the credit. I know your agency will succeed just because of how you manage it and put people's needs first and also how you address the needs of the family caregivers.
I want to thank you again for all you and your husband provided and your promptness in the management of a concern. Without your Agency this would not have been as good of an experience as it turned out to be and I am very thankful to have found you. Mom was able to come home and have a very peaceful death and for this I am so grateful. Thanks again you guys are great!!!!!!.
Sincerely,
Colombe and Jerome Lagace

Understanding Challenging Behavior

Understanding Challenging Behavior
By Sharon Roth Maguire MS, APRN-BC, GNP, APNP

While being a caregiver to unusual or so-called “difficult” behaviors, it is quite common for persons with dementia to display these types of behaviors and while many of these behaviors are predictable, like repetitive questioning, pacing, forgetting how to use common objects, etc., there are others that are more upsetting to both the caregiver and the individual with dementia. Agitation in the form of shouting, pushing, resisting care; spitting out food; urinating in inappropriate places, disrobing; wandering, etc., are the kinds of behaviors that are truly unsettling and should prompt investigation. Special note should be made of the fact that medication in the form of sedatives, tranquilizers, and other “behavior” medications like antipsychotics need not be the first step. Many of the medications given to help control these behaviors can cause more harm than good. It is true that in certain instances these types of medications are warranted, but far too often these medications are prescribed as a knee-jerk response when no or few other strategies have been attempted to reduce the problem or are continued for far too long without attempts to reduce the dosage or discontinue the drug.
Current thought on best practices with regard to understanding difficult behaviors in persons with dementia focuses on the concept of unmet need. As human beings, we all have certain, basic physical and emotional needs: air, food, water, sleep, comfort, love, safety, security, belonging, etc. Individuals with dementia continue to have these needs despite their disease; their disease, however, may make it more difficult for them to express or satisfy these needs. For example, if I no longer am capable of explaining an abstract concept like insecurity due to the cognitive impairment I have related to Alzheimer’s disease, yet I feel that way, how can I express it? If I have physical discomfort due to arthritis pain in my hips and lower back but cannot articulate the words to describe it due to the language impairment I have related to Alzheimer’s disease, how can I tell you that I am in pain when you try to get me out of my chair? I may “show” you by resisting, or withdrawing, shouting, striking out or any number of other ways that seem like difficult behavior. When in fact, I am trying to “tell” you that I have an unmet need: I am in pain; I need comfort.
As caregivers, you know your loved one well. You may be surprised when he or she does something out of character or behaves unusually. You may be tempted to respond abruptly or seek strong medication to curb the problem. Better strategies would include an analysis of the potential causes of the behavior focusing on unmet need. Some common themes related to physical need: Is your loved one in pain? Many older adults have chronic pain that research tells us is inadequately or even un-treated. The addition of a regularly scheduled mild analgesic may be of tremendous benefit. Could your loved one have an infection? The most common infections that we see in older adults with dementia are urinary tract infection, pneumonia, and skin infections from scratches or open wounds. This can be very uncomfortable for the individual and definitely contribute to exaggerated behaviors. You would need to see a physician for treatment of these. Could your loved one be dehydrated? As we get older, we have a diminished thirst response and coupled with common medications that older adults take, like diuretics (“water pills”) that further dehydrate them, you could see increased confusion. Is your loved one uncomfortable due to constipation? Again related to poor fluid intake and certain medications (add calcium supplements to the list), lack of exercise, and limited dietary fiber, older adults are at risk for constipation which can be very uncomfortable. Simple strategies like providing regular liquids throughout the day, adding fiber to the diet and a daily walk can help.
Some common themes related to emotional need: Is your loved one bored? Are they wandering or trying to leave your home to find something more interesting to do? Conversely, is the day too busy or too overwhelming and they are looking for more quiet time? The best days for persons with dementia are when they have balance between sensory stimulating and sensory calming activities. Is your loved one frightened of being left at home alone? Are they feeling sad or depressed? The research tells us that the rate of un or under-treated depression is quite high in older adults with dementia. Providing social times and opportunities for continued belonging are important; consider a pet, plant or an indoor garden to offer care responsibilities and purpose to the individual with dementia.
It may take some time before you are able to identify the potential causes of the challenging behavior, but understanding that it may be the result of an unmet need is an important first step. Unfortunately, there are behaviors that we may never be able to understand as they are part of the mystery of this challenging illness. Finally, it is very important to have a care team that accepts this approach to behaviors as well. Understanding challenging behaviors is key to meeting your needs as a caregiver!

If you need assistance in caring for a loved one with dementia or would like to consult with someone for more information or for suggestions feel free to contact Live Free Home Health Care in New Hampton, NH. Live Free Home Health Care provides medical in home elder care in Central New Hampshire. We have registered nurses and licensed nursing aides who are experienced in providing care to people with dementia. Call us today at 603-346-4214 or visit our website at http://www.livefreehomehealthcare.com/.

Should you use a Licensed Home Health Care Agency?

New Hampshire Home Health Care
The case for using an agency as opposed to hiring someone directly
www.livefreehomehealthcare.com

As anyone who has had to look for home care for a parent, child, or loved one may have discovered, home care rates can be less if you hire help (sometimes referred to as a “private duty nurse”) on your own rather than using an agency like Live Free Home Health Care. This is could be one of the most important decisions you make in regards to looking for in-home care, and if you are contemplating hiring on your own to save a few dollars, it’s important to know what your responsibilities will be. Here are some things you should ask yourself:
1. Are you prepared to place ads, screen responses, conduct interviews, check references, do criminal background checks, and drug screening? Also will you know whether a potential candidate has the right training and skills?
2. Have you calculated the cost of required taxes? You will be responsible for paying social security taxes, unemployment taxes, and workers’ compensation.
3. Do you want the responsibility of supervising workers and resolving misunderstandings when they (and they will) happen?
4. What are you going to do when your caregiver calls in sick? Are you always going to be available to provide back-up? If so, doesn’t that mean you will be on-call around the clock?
5. What about insurance? Does the person you are considering hiring have professional liability insurance?

A quality agency that directly employs its home care associates will assume each of these responsibilities for you. That’s what we do at Live Free Home Health Care. We have carefully screened our caregivers, done criminal background checks and drug screening. We have made sure they have the right training and licenses. We are responsible for paying our caregivers and making sure the appropriate payroll taxes are paid. If one of our caregivers has to miss work at the last minute, we are responsible for finding a replacement. Live Free Home Health Care has the appropriate insurance and we are licensed by the State of New Hampshire as a Home Health Care Provider.

You will have the comfort of knowing we have a Registered Nurse on-call 24 hours a day and are here to handle the unexpected for you. We will anticipate your needs and respond to changes before a potential problem may arise. Let us take the job of employer and care case manager from your shoulders so you can concentrate on relating with your parent, child, or loved one how it matters most: as family.

Jason M. Harvey
Owner, Business and Finance Manager
Live Free Home Health Care, LLC
603.346.4214

How To care for an aging parent without sibling rivalry

• Tips on how to help and stay on speaking terms with other family members

www.livefreehomehealthcare.com

As a New Hampshire based home health care agency, we know how difficult it can be to watch mom or dad’s health decline and not know what services are available to help them maintain independence and dignity and stay in the comfort of their own home. It can make it even more difficult when multiple siblings are trying to coordinate care; it’s hard enough when everyone concerned lives in close proximity. Imagine how difficult it is when mom and dad live towns or even states away. Here at Live Free Home Health Care, we have heard stories on more than one occasion of siblings squabbling over how best to help; this can make an already difficult situation a nightmare. Maybe one sibling isn’t doing his fair share of the hands-on work or there is another sibling who perhaps is better situated financially, yet hasn’t contributed a penny. This can cause hostility to build and create grudges that can last a lifetime, to develop. Everyone has mom and dad’s best interest at heart but without anyone to coordinate how best to help, it can not only place more stress on the siblings but also cause more stress for your aging loved one. Imagine how hard it is for them to see their kids bicker over them! Live Free Home Health Care can help; this is one of the many areas we excel. Coordinating care between family members and physicians, acting as the quarterback if you will. We can provide home health aides in the home to assist with daily living activities or a registered nurse to provide case management and to ensure everyone concerned is on the same page and understands what is going on. We can even accompany your parent or aging loved one to his or her doctor appointments to help relay what can be at times complicated information and act as a patient advocate. These are just some of the services we can provide, check out our website at http://www.livefreehomehealthcare.com/ to learn more or call us at 603-346-4214 to discuss your needs. Here are four tips to help ease the tension and get your parent or aging loved one the best possible help.
1. Understand the situation – conflicts often arise because of misunderstandings about your loved ones condition. After all, if your out-of-state sibling isn’t around to witness it, he may not know that dad sometimes forgets to turn off the stove or that mom has difficulty remembering to take her medication (medication management is another service Live Free Home Health Care offers). Fill siblings in so they’ll know why it is imperative to spend the money for in-home help. If they’re still in denial, ask the doctor to discuss your parent’s care needs with the whole clan (maybe a conference call) or hire a registered nurse to help everyone understand the situation.
2. Share the load – We all know the saying of why you should never assume anything. Just because one sibling lives closer to mom and dad doesn’t mean they will or can do most of the care giving. Have a family meeting to create a list of tasks and divide them fairly, says Linda Fodrini-Johnson of Eldercare Services. Ask for volunteers first, but make sure everyone has a suitable job. For instance the sibling that lives the furthest away may pay dad’s bills online, while one who lives closer takes on more of the day-to-day care.
3. Talk frankly about money – Money does strange things to people unfortunately. The best approach is just to be straightforward. Just because you suspect your sibling opposes a pricey nursing home or paying for in-home care because she wants an inheritance, she really could just be worried that mom will go broke by 85. If discussing the cost of care and how the family is going to pay for it is done openly, it can clear the air and prevent misunderstandings.
4. Seek out a middleman – still bickering? Get objective advice from a professional. If you have a tax problem, you call your CPA, if you have a legal problem, you call your attorney, and if your tooth hurts, you call your dentist (hopefully). The same should be true with something as important as helping your parents or loved one age with dignity while getting the care they need. If an agreement can’t be reached, perhaps you should seek out an impartial third party, like Live Free Home Health Care, to help with a care plan.

You can always count on Live Free Home Health Care to provide objective and caring advice to assist you with caring for an aging parent or loved one.

Jason Harvey
Owner, Business and Finance Manager

Jennifer L. Harvey RN BSN
Owner, Director of Patient Services

Home care is what we do; Dignity and Independence is what we provide.

Source: Money Magazine, Oct. 2006

Who Pays for Home Care Services?

Who Pays for Home Care Services?
www.livefreehomehealthcare.com

Home care services can be paid for directly by the patient and his or her family members or through a variety of public and private sources. Hospice care generally is provided regardless of the patient's and/or family's ability to pay. Public third-party payors include Medicare, Medicaid, the Older Americans Act, the Veterans Administration, and Social Services block grant programs. Some community organizations, such as local chapters of the American Cancer Society, the Alzheimer's Association, and the National Easter Seal Society, also provide funding to help pay for home care services. Private third-party payors include commercial health insurance companies, managed care organizations, CHAMPUS, and workers' compensation.
Self-pay:Home care services that fail to meet the criteria of third-party payors must be paid for "out of pocket" by the patient or other party. The patient and home care provider negotiate the fees.
Public Third-party Payors Medicare: Most Americans older than 65 are eligible for the federal Medicare program. If an individual is homebound, under a physician's care, and requires medically necessary skilled nursing or therapy services, he or she may be eligible for services provided by a Medicare-certified home health agency. Depending on the patient's condition, Medicare may pay for intermittent skilled nursing; physical, occupational, and speech therapies; medical social work; HCA services; and medical equipment and supplies. The referring physician must authorize and periodically review the patient's plan of care. With the exception of hospice care, the services the patient receives must be intermittent or part time and provided through a Medicare-certified home health agency for reimbursement.
Hospice services are available to individuals who are terminally ill and have a life expectancy of six months or less; there is no requirement for the patient to be homebound or in need of skilled nursing care. A physician's certification is required to qualify an individual for the Medicare Hospice Benefit. The physician also must re-certify the individual at the beginning of each six-month benefit period. In turn, the patient is required to sign a statement indicating that he or she understands the nature of the illness and of hospice care. By signing this statement, the patient surrenders his or her rights to other Medicare benefits related to terminal illness.
Medicaid: Administered by the states, Medicaid is a joint federal-state medical assistance program for low-income individuals. Each state has its own set of eligibility requirements; however, states are only mandated to provide home health services to individuals who receive federally assisted income maintenance payments, such as Social Security Income and Aid to Families with Dependent Children (AFDC), and individuals who are "categorically needy." Categorically needy recipients include certain aged, blind, and/or disabled individuals who have incomes that are too high to qualify for mandatory coverage but below federal poverty levels. Individuals younger than 21 who meet income and resources requirements for AFDC, yet otherwise are ineligible for AFDC, also qualify as categorically needy. Under federal Medicaid rules, coverage of home health services must include part-time nursing, HCA services, and medical supplies and equipment. At the state's option, Medicaid also may cover audiology; physical, occupational, and speech therapies; and medical social services. Hospice is a Medicaid-covered benefit in 38 states. The Medicaid hospice benefit covers the same range of services that Medicare does.
Older Americans Act (OAA): Enacted by Congress in 1965, the OAA provides federal funds for state and local social service programs that enable frail and disabled older individuals to remain independent in their communities. This funding covers HCA, personal care, chore, escort, meal delivery, and shopping services for individuals with the greatest social and financial need who are 60 years of age and older. Increasingly, individuals who can afford to pay for some of these services are being asked to contribute in proportion to their income. Individuals often request the services they need through an Area Agency on Aging, which will provide them directly or in cooperation with local organizations.
Veterans Administration: Veterans who are at least 50% disabled due to a service-related condition are eligible for home health care coverage provided by the Veterans Administration (VA). A physician must authorize these services, which must be delivered through the VA's network of hospital-based home care units. The VA does not cover nonmedical services provided by HCAs.
Social Services Block Grant Programs:Each year states receive federal social services block grants for state-identified service needs. The government allocates these funds on the basis of the state's population and within a federal limit. Portions of the funding often are directed into programs providing HCA and homemaker or chore worker services. Individuals should contact their state health departments and local offices on aging for additional information.
Community Organizations: Some community organizations, along with state and local governments, provide funds for home health and supportive care. Depending on an individual's eligibility and financial circumstances, these organizations may pay for all or a portion of the needed services. Hospital discharge planners, social workers, local offices on aging, and the United Way are excellent sources for information about community resources.
Private Third-party Payors Commercial Health Insurance Companies: Commercial health insurance policies typically cover some home care services for acute needs, but benefits for long-term services vary from plan to plan. Commercial insurers, including Blue Cross and Blue Shield and others, generally pay for skilled professional home care services with a cost-sharing provision. Such policies occasionally cover personal care services. Most commercial and private insurance plans will cover comprehensive hospice services, including nursing, social work, therapies, personal care, medications, and medical supplies and equipment. Cost-sharing varies with individual policies, but often is not required.
Individuals sometimes find it necessary to purchase Medigap insurance or long-term care insurance policies, for additional home care coverage.
Medigap insurance is designed to bridge some of the gaps in Medicare coverage. Some Medigap policies offer at-home recovery benefits, which pay for some personal care services when the policyholder is receiving Medicare-covered skilled home health services. The policyholder's physician must order this personal care in conjunction with the skilled services. Home care coverage in Medigap policies is not designed to cover extended long-term care. This type of coverage is most helpful to individuals recovering from acute illness, injuries, or surgery.
Long-term care insurance primarily was intended to protect individuals from the catastrophic expense of a lengthy stay in a nursing home. However, as the public need and preference for home care has grown, private long-term care insurance policies have expanded their coverage of personal care, companionship, and other in-home services. Considerable care should be taken in selecting a long-term care insurance policy, as home care benefits vary greatly among plans. Consumers should be aware of limitations on coverage, such as prior hospitalization requirements, and pre-existing condition exclusions. Some policies may only pay for services that are already covered by Medicare.
Managed Care Organizations: Managed care organizations (MCOs) and other group health plans sometimes include coverage for home care services. MCOs contracting with Medicare must provide the full range of Medicare-covered home health services available in a particular geographic area. Medicare beneficiaries who are enrolled with an MCO may elect their hospice benefit from the hospice of their choice. These organizations only pay for services that are pre-approved.
CHAMPUS: On a cost-shared basis the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) covers skilled nursing care and other professional medical home care services for dependents of active military personnel and military retirees and their dependents and survivors. CHAMPUS offers a comprehensive hospice benefit to its terminally ill beneficiaries, which covers nursing, social work and counseling services, therapies, personal care, medications, and medical supplies and equipment.
Workers' Compensation: Any individual requiring medically necessary home care services as a result of injury on the job is eligible to receive coverage through workers' compensation.

http://www.nahc.org/famcar_whopays.html

New Hampshire Home Health Care-Live Free Home Health Care

Record Enterprise

Live Free Home Health Care is all about living free with dignity
By KERRY L. NORLIN August 24, 2006
NEW HAMPTON - Live Free Home Health Care, LLC, is a newly established medical home health care agency serving the Bristol Lake and Pemi-Baker Valley Regions, Waterville Valley and parts of the Lakes Region. Jason and Jennifer Harvey, co-administrators and owners of Live Free Home Health Care, are passionate about their work and devoted to providing area residents a diversified and complete home care service that fosters independence and dignity.
"It started with an idea that quality of life and health is best served at home and folks from New Hampshire have a sense of independence ingrained in them," explained Jason. "We are a home health care agency, that is what we do; what we provide is independence and dignity to our patients."
As part of their humanitarian-based endeavor, Live Free Home Health Care and their team of skilled nurses, licensed nursing assistants and homemakers offer IV therapy, home health aides, homemaker services, medication and diabetes management, blood draws, private duty professional nursing, pediatric skilled home care, transportation and errands. They also provide respite care to serve family members and caregivers who need a break, which can be individualized using their half day, full day, bed & breakfast and vacation plans. A registered nurse is on call 24 hours a day, seven days a week.
Case management is another offering. This service arranges for a registered nurse to accompany patients to their doctor's visit to ensure their needs are being met and their questions answered. The RN will also review treatment plans with the patient as well as with family members and the patient's doctor.
Another important service is block staffing, nursing care provided in the home for as little as two hours per day up to 24 hour coverage. Medicare only covers diagnosis-related short term home health care and Medicaid covers block staffing only if a child requires such care, but Live Free Home Health Care is dedicated to providing block staffing, as they believe it as the single most important service that will allow patients to remain at home and out of nursing and assisted living facilities. Family member caregivers cannot always be there to care for their home-bound loved one, but are also unwilling to relinquish their loved one to a nursing home. Block staffing not only makes it possible for the patient to remain at home, but it also allows their caregivers to provide care when they can and still maintain a normal lifestyle. Furthermore, block staffing is a less expensive alternative to a nursing home.
Jennifer and Jason married in 1998 as students at Southern Illinois University. Jennifer graduated in 1999 with a B.S. in nursing and brings over eight years of nursing experience including working in the surgical and cardiac care unit of an Illinois hospital. Since their move to New Hampshire six years ago, she has worked in a physician's practice and most recently for a home care agency in Laconia. Despite completing his degree in political science, Jason pursued a growing interest in finance and investments. He has subsequently worked for Fidelity, Fleet and most recently as assistant vice president with the Global Wealth and Investment Management group at Bank of America, bringing over eight years of experience in business finance.
The pair found a perfect marriage for their unique talents with the new agency - Jennifer, RN and BSN, as director of patient services and Jason as business and finance manager. Perhaps more important than their professional experience is the vitality, enthusiasm and commitment they bring to the enterprise. They are eager to make a difference not only in the lives of their patients but also in the lives of their staff.
"We appreciate and respect our caregivers. Nursing can be a thankless job. We want our caregivers to truly feel they make a difference, because they do," said Jason.
"We are very careful who we hire. We conduct thorough background checks and everyone is required to participate in an orientation program and observation period to insure they have the competency and skill to work with patients in their homes," explained Jennifer. Reconfirming her husband's conviction, she said, "We want our staff to feel just as appreciated as our patients, and we want their ideas and their feedback."Live Free Home Health Care accepts private pay, select Medicaid plans, and will work with private insurance companies and long term care insurance policies for reimbursement. They are fully insured as a home health care agency and licensed by the N.H. Department of Health and Human Services. To find out more about their services or to discuss your needs, call 346-4214 or 888-346-4214 or e-mail at Jasonandjenniferharvey@livefreehomehealthcare.com. You can also visit their Web site at livefreehomehealthcare.com.

Taking care of an aging loved one -New Hampshire Home Health Care; Live Free Home HealthCare

I recently read an article in the July 2006 issue of Money magazine, written by Penelope Wang. It interested me because it combined two of my interests, financial planning and health care. As anyone who has had to help an ailing parent knows, it can be a difficult situation made more difficult if proper planning has not been done in advance. While never a pleasant topic to discuss, it is important. The article points out that 34 million Americans are caring for an aging loved one. Some warning signs that could tell you that your parents may need help range from a pile of unopened bills or the frequent complaints about the rising costs of gas, groceries, or medicines. Although loved ones may resist the helping hands of a family member, whether out of embarrassment or loss of independence, when there are clear indications that your parents are struggling, you owe it to your family to step in. Problems don’t solve themselves, and left alone they could jeopardize a lifetime of planning. Most people wait too long to take action. With proper planning, you can make the most of available resources. Here are some strategies that that can help:
Simplify things: little things like arranging for direct deposit of social security and pension and dividend payments go a long way. Also consider consolidating bank and investment accounts. Who really needs more than 1 checking, 1 savings, and 1 investment account? Diversity doesn’t mean having accounts all over the place, it means having different types of investments. You can accomplish this with 2 financial institutions at the most, and a lot of times, even just one. Having spent a few years as an investment advisor, I can’t tell you how many times I had to help children of ailing parents try to organize accounts that were spread among a dozen institutions; it can be a real nightmare.
Have your name added to accounts: If your parents are receptive, this can be a huge help. It allows you access to pay bills and get information on the account as well as access to the account if your parents become incapacitated. It is a good idea to check with your parents’ attorney first to make sure this does not conflict with any estate planning they have done, since you would inherit the account.
Hire Help if needed: If you live too far away or simply don’t have the time necessary to provide enough help, professionals trained to help with the elderly could be an option. You could bring in a money manager to help with budgeting, paperwork and bill paying. You can get referrals from the American Association of Daily Money Managers at www.aadmm.com. If your parent needs more generalized help with daily life tasks, like house keeping, personal care, or medical problems, consider hiring a geriatric-care manager; this is important especially if you live far away. They can help make sure everyone is on the same page, from you, to the parent, to your parents’ doctors. They can recommend specialists and monitor care. This is one of the services our company, Live Free Home Health Care, offers.
Get it in writing: No one likes to think about mom or dad becoming incapacitated by illness, and it’s an even worse crisis if it happens and you are unable to help, or had to fight for the right to do so because you did not have the legal authority to act on his or her behalf. It can’t be stressed enough how important it is to have a will and a power of attorney drawn up, and that you know where to locate these documents. You hope you never need these documents but there is peace of mind knowing that all the paperwork is in place and drawn up properly.

The Essential Paperwork: 4 documents you should make sure are drawn up
Financial checklist-list of assets with account numbers. Any debt should also be listed.
Durable power of attorney-This paper is authorizing someone your parents’ trust, to pay their bills and make financial decisions on their behalf if they are no longer able to do so.
Advance directives- A health-care proxy authorizes someone to make medical decisions on your parents’ behalf if the can’t do so and a living will makes it clear their wishes in the event that life-sustaining medical care is required.
Health-care privacy authorization- if you don’t have one of these, chances are your parents’ doctors’ will not discuss their medical status with you.

It is a good idea to consult with an attorney who specialized in estate planning to assist with these and other items.

Here are some links to other websites were you can get additional information:
http://www.aadmm.com/
http://www.findcaremanager.org/
http://www.benefitscheckup.com/ - screens for the eligibility for programs that help with property taxes, heating bills and other costs.
http://www.eldercare.gov/ - help with finding services for seniors near where your parents live.
http://www.caps4caregivers.org/


If you have any questions or would like to explore how we may be able to help please do not hesitate to call us at 603-346-4214.

Jason M. Harvey

Information for this article was obtained from Money Magazine, July 2006. Pp. 86 – 90, by Penelope Wang.

Avoid cold and flu's (New Hampshire Home Health Care, Live Free Home Health Care)

U.S. Consumers spent $3.6 Billion on over-the-counter cold, cough, and flu remedies in 2005

A few steps between the end of August and Mid Sept can help you avoid winter bugs – and the expense it takes to cure them

It’s almost that time of year again, flu and cold season. So it’s time to start building your defenses now. Your immune system needs more protection during winter months, and it takes a few months to boost that protection, says Elson Hass, M.D., author of Staying Healthy with Nutrition. What’s in it for you? Not only improving your odds of avoiding the misery of being sick but also the expense. In 2005 consumers spent over $3.6 billion on over-the-counter drugs, not to mention money lost in unpaid sick days, insurance co-pays, and prescription medications. All of us here at Live Free Home Health Care not only want to see you stay healthy and enjoy a joyous time of year (Thanksgiving, Christmas, New Years) but we want to see you hold onto more of your hard earned money! So here are some things you can do now to stay on your feet this winter season.

Gauge Your Risk
We have all heard this before: if your immune system is vulnerable, you have a greater chance of getting a pesky bug if you are exposed and it also takes you longer to get over that nagging cold or flu. To find out how at risk you are, answer these five questions:
1. Did you have more than two bouts of cold or flu last year?
2. Do you suffer from allergies? (Boy, I do, year round, drives me crazy!)
3. Do you often feel fatigued?
4. Do you get less than seven hours of sleep a night?
5. Do you notice that wounds take longer to heal than they should?

If you answered yes more than no, the more aggressive you should consider being in trying to build up your defenses. If you said yes to four or five of the questions, it is a good idea to schedule an appointment with your primary care physician for a pre-flu-season checkup, and ask whether you should have a complete blood count test, which shows how many of those wonderful disease-fighting white blood cells you have on guard. Typically your insurance will cover this check-up. If your levels are low your doctor can talk to you about a course of action.

Get Your Guard Up
Increase your chances of staying cold and flu free with this 60 day Rx:
· Get a good nights sleep – Ohio State University recently did a study showing that students who pulled all-nighters had depressed immunity, and this study is just one of many that link lack of sleep to greater chances of illness. If you add as little as 4 hours of sleep a week, it may help says Dr. Haas.
· Eat a Yogurt A Day – I personally love all the health benefits of yogurt. The biggest benefit of yogurt for warding off colds and the flu is a “friendly” bacterium, Lactobacillus acidophilus. It helps stymie the growth of bad germs. It’s found in most yogurts, just check the labels. My favorite is Yoplait, and it comes in many tasty flavors.
· Get Vaccinated – Did you know a flu shot is 90% effective against common strains? You should get a flu shot, especially if you are in a high-risk group such as kids and the elderly. Talk to you doctor or look for a flu clinic in your community, or call us at Live Free Home Health Care, and we will help you find a location for that flu shot, if we aren’t holding our own clinic. If, like me, you hate needles, you could discuss the new nasal vaccine, FluMist.
· Add Some Astragalus – This ancient Chinese herb may prevent colds by helping boost immunity. You can find it at health food stores but it’s good idea to talk to your doctor before using it.

Mount a Swift Defense
If you are struck with a cold or flu, you should act fast to fight it.
· For Colds: Take 1000 mg of Vitamin C and 8mg of zinc, this has been shown to decrease the length of the cold, when taken when symptoms first occur.
· For The Flu: Up to two days after symptoms begin (fever, fatigue, achiness, chills), talk to your doctor about the prescription medications Tamiflu or Relenza. These new antiviral drugs have been effective in shortening the course of the flu by a few days, and getting over the flu a little quicker sounds like a good deal to me!

A few other tips your friends here at Live Free Home Health Care recommend is eating a proper diet, getting plenty of exercise, washing your hands frequently, and even carrying around a small bottle of antibacterial hand lotion. Here’s wishing you a healthy and joyous winter!

Jennifer L. Harvey, RN, BSN
Owner, Director of Patient Services
Live Free Home Health Care
603-346-4214
www.LiveFreeHomeHealthCare.com
Jasonandjenniferharvey@livefreehomehealthcare.com

Jason Harvey
Owner, Business and Finance Manager
Live Free Home Health Care
603-346-4214
www.LiveFreeHomeHealthCare.com
Jasonandjenniferharvey@livefreehomehealthcare.com

Live Free Home Health Care is a family owned New Hampshire based Medical Home Health Care Company. We offer skilled nursing services in patient homes with the goal of helping them avoid nursing homes and longer term care facilities. We believe that people are most comfortable in their own homes and it promotes physical as well as mental well being. Home Health Care is what we do, Independence and Dignity is what we provide! Call us today or visit our website, www.livefreehomehealthcare.com to find out more about us.


Reference: Money Magazine, Sept. 2006, p.45. Curtis Pesmen.