Caregiver Solutions Guide 2012

CAREGIVER SOLUTIONS 2012 PUBLISHER Donna K. Anderson EDITORIAL Managing Editor Christianne Rupp Editor Megan Joyce CONTRIBUTING WRITERS Neal Delisanti Mark A. Mateya, ESQ. Jessica A. Pavelko, CSA Lisa M. Petsche Dianne Stott, BA Mary Theresa Webb, Ph.D. ART DEPARTMENT Production Coordinator Renee McWilliams Production Artist Janys Cuffe SALES Account Executives Janet Gable Angie McComsey Ranee Shaub Miller Sue Rugh Sales Coordinator Eileen Culp ADMINISTRATION Business Manager Elizabeth Duvall Project Coordinator Loren Gochnauer

Copyright © 2012 On-Line Publishers, Inc. All rights reserved.

All listings and advertisements have been accepted for publication on the assumption that the information contained in them is true and accurate and that all merchandise or services offered in the advertisements are available to the customer according to the conditions warranted therein. The appearance of advertisements or products or services does not constitute an endorsement of the particular product or service. On-Line Publishers, Inc. disclaims any and all responsibilities and liability which may be asserted or claimed resulting from or arising out of reliance upon the information and procedures presented in this guide.

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Dear Readers, One of the most demanding and exhausting realities for many women is caregiving.

According to The American Journal of Public Health, women provide the majority of informal care to spouses, parents, parents-in-law, friends, and neighbors, and they play many roles while caregiving—hands-on health provider, care manager, friend, companion, surrogate decision-maker, and advocate. We are pleased to present Caregiver Solutions, a resource to help caregivers in their journey.

After talking with a number of caregivers, we have endeavored to include articles that discuss issues frequently on their minds, including special features laid out in questionand-answer format.

Everyone in business today leads a hectic life, meeting the demands of their personal and professional lives. Add caregiving to an already heavy schedule, and you could be looking at burnout. Find out what you can do to prevent this and manage your stress.

I can’t emphasize enough the importance of becoming familiar with federal and state caregiver programs. Check out the general eligibility requirements as well as funds available for expense reimbursements, home modifications, or assistive devices available through the Pennsylvania Caregiver Support Program and the National Caregiver Program. Your local office of aging will be able to assist you with this and offer guidance regarding a number of issues you may be dealing with.

Another important feature in this publication is the Directory of Providers and Services. It’s an excellent starting point, whether you’re looking for residences, care options, or other services that may aid in your care efforts.

For more than 15 years, On-Line Publishers, Inc. has been offering relevant information and support to our readers so they — and those in their lives — can live happy, healthy, and productive lives. If you have a question you would like us to address, please let us know so we can help make your caregiving experience rewarding.

Christianne Rupp, Editor

Contents 2012 4

Starting the Conversation with Your Parents

15

Pennsylvania Caregiver Support Program

6

Veteran & Survivor Benefits

16

The Dementia Tsunami

Take Steps to Prevent Burnout

20

Should Your Aging Parent Come to Live with You?

10 12 14

27

Preventive Services and Screenings

28

After a Loved One Has Had a Stroke

30

Resources

31

Directory of Housing & Care Providers

Types of Residences and Care Options

23

Simple Solutions

33

You Wanted to Know

24

Directory of Ancillary Services

Frequently Asked Questions by Caregivers

34

Support and Information

4 12

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Starting the Conversation with Your Parents …

By MARK A. MATEYA, ESQ. The phrase “having the talk” conjures up images of that awkward moment when we had to talk to our child about the birds and the bees.

But today, when baby boomers my age hear “having the talk,” most of us think about the talk with our parents. It’s the “so-which-retirement-home-are-youleaning-toward-Dad” talk. And this talk can make the first one seem tame.

Famous author and speaker Dave Ramsey has a phrase that I believe applies 4

here. He calls it the “powdered butt syndrome.” He says, “When someone has powdered your butt as a baby, it’s really hard for that person to take advice from you about money.”

The same may hold true about more than just money. But none of this negates the fact that many of us will have to address this issue, sooner or later, with our parents.

There are a multitude of options for aging citizens. These options depend upon

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many variables: finances, health (not only mobility, though mobility is a major contributing factor in deciding where to spend one’s golden years), family ties or lack of family ties, and proximity to healthcare providers, church, or synagogue are just a few of the factors that must be considered.

This article does not address the “where” of our loved ones spending their retirement years; it assumes that you have already begun to address this question.

This article addresses how to approach your aging parent or aunt or uncle about this touchy subject.

To prepare yourself for the talk with your parent, I want you to answer these questions about where you live today.

1. Where do you live, and why do you live there?

2. Who decided that you would live there?

3. How much was price a consideration in choosing where you are living?

4. Do you have sufficient space, including space for your collection of comic books (or Longaberger baskets, or whatever else you collect) where you live right now?

5. How important is it to you that you get to come and go as you please where you live right now? Is there a gate where you live? Is there a time limit to when guests may visit you where you live?

Consider these questions for yourself. I suggest you write out your answers so that you form complete thoughts about each of these five questions.

When you have the talk with your parent, be sure you understand and empathize with their concerns and their fears. Your loved one may be thinking, “Why should someone else get to choose where I am going to live? It’s my life!” or “I wanted to see the Grand Canyon before I die. Why should we spend all my money on some retirement home I don’t know anything about?”

Or they may be thinking, “I bet they found the cheapest place they could to dump me,” or “I do not want to live like a prisoner in my own house. Get me my driver’s license back and I’ll show you who is going to go where and when!”

Your parent is about to enter into a living arrangement and a lifestyle that they have not prepared for. It is your job to help ease them into this transition.

After you have answered these questions for yourself, try walking in your parents’ shoes and imagine how they feel, being asked to relocate into a place that may not be of their choosing, that may be

the top of the list due to price alone, or that bears no resemblance to the life they have lived up until this point.

They perceive that by addressing this question of entering into assisted living or nursing care, they are giving up the right to choose the answer to these and similar questions.

My advice is simple: • Be sure your parent is a part of the discussion as much as possible.

• Be clear with them that financial considerations are not the only parameters you are working with.

• Give them a voice to share their concerns about mobility, proximity to family (few seniors want to live in a Shangri-La that is 500 miles away from their grandchildren), and all of the other concerns addressed earlier.

• Be patient.

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And start early. Even if you think these issues are 10 years away, start the conversation today.

Ask: “Mom, have you and Dad decided where you would like to retire?” If she is like my mom, she’ll say, “Right here in my own house, of course.” And the conversation begins . . .

You can ask her how well prepared they are financially, what their thoughts are about in-home care, and so on. Even though this isn’t always comfortable, it is necessary. Start the conversation today.

You will be glad you did.

Attorney Mark Mateya is the managing partner of Mateya Law Firm, P.C., which focuses on estate planning, estate administration, and estate litigation. Follow Attorney Mateya at his two blogs: http://mateyalf.blogspot.com and http://mateyalfmom.blogspot.com.

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Veteran & Survivor Benefits Available for Vets and Their Spouses

By NEAL DELISANTI Benefits for veterans and their survivors are available to eligible individuals from the U.S. Department of Veterans Affairs (DVA), Pennsylvania, and its counties. Generally, benefits require activeduty service with a discharge characterization of other than dishonorable. Some benefits require a financial need.

The following are the most sought-after benefits from the DVA. Medical care is available for veterans with service-connected disabilities rated at 10 percent or higher and certain categories of veterans. Others may be eligible if they have a financial need.

Disability compensation is awarded to veterans who incurred a chronic disability as a result of active-duty service. The severity of the disability determines the rating percentage and the amount of compensation paid.

Pensions are awarded to veterans and widows of veterans who had active-duty service during a wartime period. These pensions are needs based and take into consideration the applicant’s age, income, and net worth.

Two related benefits are pension with aid and attendance and homebound benefits. The same eligibility criteria for pensions apply for pensions with aid and attendance or homebound benefits except that the applicant must be a resident in a care facility or be homebound.

Dependency and indemnity compensation (DIC) is a benefit available to survivors of veterans who died from service-connected disabilities.

All benefits paid by the DVA to veterans and their survivors are tax exempt; however, they may be 6

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countable for other benefits from the DVA or other agencies.

The Commonwealth of Pennsylvania also has many benefits available to veterans and survivors. The following are the most common: Real estate property tax exemption is a financial, needs-based benefit that requires that the veteran: be honorably discharged or released under honorable conditions from active-duty service during a wartime period; be a resident of the commonwealth; have a 100 percent permanent and total service-connected disability rating by the DVA; occupy the

real estate as a principal dwelling; and have household net worth below $750,000.

pension provides $150 per month to honorably discharged veterans who were Pennsylvania residents upon entering the military and suffered a service-related injury or incurred a disease that resulted in loss of vision.

Veterans emergency assistance provides financial aid for necessities of life in an emergency, on a temporary basis, to veterans and their survivors who reside in Pennsylvania. The veteran must be honorably discharged from active duty during a wartime period and have a loss of income through no fault within 180 days of the application.

Death and losses caused by natural disasters may also qualify. Blind veterans

Paralyzed veterans pension provides a pension of $150 per month to veterans who: served honorably during an established wartime period; were Pennsylvania residents upon entering the military; suffered an injury or disease resulting in loss or loss of use of two or more extremities; and are rated 100 percent disabled by the DVA.

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Spread the Word Aid and Attendance Service —

A Free Service This program provides financial benefits to qualified veterans and their spouses or their surviving spouses who are patients in nursing homes or assisted living facilities; who are in need of regular aid and attendance of another person; or who are permanently housebound. Eligibility is based upon need. Contact the VA for assistance.

Your local county has accredited service officers to assist veterans and their survivors in understanding what benefits are available and the eligibility requirements. They also assist in completing and submitting applications for all benefits.

In addition to this advocacy, a funeral allowance at the time of death is also available to honorably discharged veterans who served during a wartime period and their surviving spouses, as well as a headstone allowance to all honorably discharged veterans.

Veterans and their survivors should be cautioned that they are not required to pay for assistance in obtaining information about or applying for veteran benefits.

They are further cautioned to seek assistance from persons who have received accreditation from the DVA. Cumberland County Neal Delisanti or Sharon McLaughlin 888.697.0371, ext. 6178 ndelisanti@ccpa.net Dauphin County Administration Building (fourth floor) Tom Wasco 717.780.6356 twasco@dauphinc.org Lancaster County Daniel Tooth 717.299.7920 dtooth@co.lancaster.pa.us Lebanon VA Medical Center 1700 S. Lincoln Ave. Lebanon, PA 17042 800.409.8771 York County Veteran Affairs Philip Palandro 800.441.2025, ext. 9218 papalandro@york-county.org

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What if she falls when I’m not there?

Can we afford to keep her at home - safely and comfortably?

75% of caregivers do not know where to access the services they need.

We have answers.

Making choices for the care of loved ones is overwhelming. Researching available products and services is complex and time-consuming.

For over 40 years, UDS has helped individuals live safely and comfortably in their own home in the community despite physical limitations. Our services include: t mobility products, like wheelchairs, beds, scooters and lift chairs t BDDFTTJCMF IPNF NPEJmDBUJPOT MJLF UVC UP TIPXFS DPOWFSTJPOT BOE SBNQT t personal care like help bathing and dressing, medication reminders, meal preparation Our care managers can help you keep it all together.

Don’t know what you need or where to turn? Call our customer care representatives today. If XF EPO U IBWF XIBU ZPV BSF MPPLJOH GPS XF XJMM mOE JU GPS ZPV 8F XJMM XBML XJUI ZPV UISPVHI your journey and make sure your loved one gets what they need to stay home.

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Family Caregivers Should Take Steps to Prevent Burnout

By LISA M. PETSCHE Family members and other informal (unpaid) caregivers provide practical assistance and enhance the quality of life for ill, older adults who might otherwise require placement in a longterm care residence. Typically, they are spouses or offspring, many seniors themselves.

The help they provide ranges from chauffeuring, shopping, running errands, and paying bills to groundskeeping, housekeeping, preparing meals, managing medication, assisting with personal care (bathing, dressing, grooming, and toileting), and assisting with mobility (ambulation, transferring from one location to another, and changing position in bed). Needs usually multiply over time.

Other typical caregiver responsibilities include coordinating care and advocating for the ill person’s needs. If their relative is cognitively impaired, caregivers may also provide supervision to ensure safety. In addition, they provide companionship and emotional support.

Although it has its rewards, the caregiving role can be physically, psychologically, emotionally, and financially demanding.

This can be exacerbated by sometimes limited availability of community support services.

The caregiving journey is particularly challenging when it continues over a long period of time and when the elder has complex needs, a demanding personality, or mental impairment. A variety of emotions may be experienced along the way, including sadness, grief, frustration, anger, resentment, guilt, anxiety, and loneliness.

While a certain degree of stress is inevitable, when left unchecked it can lead to burnout, a serious matter. It’s important to watch for the following physical warning signs: chronic 10

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fatigue, sleep difficulties, significant weight loss or gain, frequent illness, and development of chronic health problems. Memory problems are also common, as is social isolation.

Emotional red flags include frequent crying, frequent irritation by small annoyances, difficulty controlling one’s temper, feeling overwhelmed, feeling inadequate, feeling alone, and feeling hopeless. In severe cases, burnout can lead to abuse of the care receiver; this signals the need for immediate help.

If you are a caregiver, consider the following strategies for keeping stress manageable and preventing burnout: • Accept the reality of your relative’s illness. There is nothing you can do to stop it.

• Learn as much as possible about the illness and its management, and educate family and friends to help them understand.

• Pick your battles; don’t make a major issue out of every concern.

• Use positive self-talk. Emphasize phrases such as “I can,” “I will,” and “I choose.”

• Nurture your spirit. Do things that bring inner peace, such as praying, reading something uplifting, writing in a journal, or listening to music.

• Create a relaxation room or corner in your home— a tranquil spot you can retreat to in order to rejuvenate.

• Develop a calming ritual to help you unwind at the end of the day. Avoid watching the news before going to bed.

• Look after your health: eat nutritious meals, get adequate rest, exercise, and see your primary physician regularly.

• Stay connected to your friends,

Create a relaxation room or corner in your home—a tranquil spot you can retreat to in order to rejuvenate.

parish, and other groups to which you belong. Minimize contact with negative people.

• Simplify your life. Set priorities and don’t waste time or energy on unimportant things. If finances permit, hire a housecleaning service or a personal support worker for your relative to free up some of your time and energy.

• Be flexible about plans and expectations. Recognize that there will be good days and bad days, and what you can give may vary from day to day. Take things one day at a time.

• Give yourself permission to feel all emotions that surface, including resentment and frustration. Remind yourself that you are doing your best and are only human.

• Don’t keep problems to yourself—seek support from a family member, friend, or counselor. Join a community caregiver support group (some offer concurrent care) or an Internet group if it’s hard to get out.

• Accept offers of help. Ask other family members to share the load. Be specific about the kind of help you need. Get information about community support services—including respite care options—and take full advantage of them.

Information can be obtained from your local office on aging.

• Don’t promise your relative you will never place him or her in a long-term care home, because you don’t know what the future holds.

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Types of Residences and Care Options We are fortunate in the Central Pennsylvania region to have a wide variety of options for residence and care, most offering superior service to their clients.

Terminology may vary from facility to facility, but we offer a broad overview below: Residential living is for individuals who are responsible for their own basic needs.

Nursing services are not available on site nor are residential communities affiliated with nursing care providers. No meal service or activity programs are offered.

Active Adult Communities are residential-type communities for mature adults only. Individuals are responsible for their own basic needs. Nursing services are generally not available on site.

CCRCs (Continuing Care Retirement Communities) are facilities offering a variety of residential living options in addition to comprehensive medical and nursing services. Many CCRCs are selfcontained communities offering educational and recreational activities, dining accommodations, banking facilities, transportation services, etc.

Residents move between independent living, personal care or assisted living, and nursing care based on changing needs.

Retirement Communities are planned for those who are able to care for their own basic needs (or almost so) and who choose to live in a community with other 12

seniors. Organized social programs, meal service, transportation, recreational activities, and access to health and shopping are typical amenities.

Nursing care is not usually provided.

Some do offer personal care designed for individuals who function on their own most of the time but may require assistance with medications, bathing, or dressing. Services offered are similar to those provided by personal care homes.

Retirement communities can be freestanding or affiliated with a complex offering nursing care services.

Personal Care Homes offer food, shelter, and personal assistance or supervision.

They are ideal for people who do not want to forfeit independence and do not require the services in or of a licensed long-term care facility but do require assistance or supervision in activities of daily living (ADL).

Some ADL services provided are transferring in and out of a bed or chair, toileting, bladder and bowel management, personal hygiene, securing healthcare, managing healthcare, self-administering medication, and proper turning and positioning in a bed or chair.

Assisted Living Residences (ALR) are designed to provide an environment that combines housing and supportive services to allow residents to “age in place� without having to move to a licensed long-term care facility when their care increases.

ALRs will have living units with kitchen

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capacity and private bathrooms and only one person per unit.

An ALR may provide services that otherwise would be provided in a longterm care facility (personal care homes may not). As of Jan. 18, 2011, the new regulations regarding licensure for assisted living communities became effective.

Nursing/Rehab Facilities provide nursing care and related medical or other personal health services 24 hours a day, seven days a week, to individuals who require full-time care or supervision but do not need more intensive, hospitalbased care.

Nursing/rehab facilities may be independent or part of another community. Individuals may be temporarily placed for rehabilitation following an illness, injury, or surgery or reside long term due to illness or aging.

Nursing facilities offer skilled medical care under the supervision of licensed nurses, and at least one registered nurse must be on duty during the day. Custodial care is also offered and includes services that assist in the activities of daily living, which include bathing, dressing, using the bathroom, or transferring from a bed to a chair. Nursing centers are licensed by the State Department of Health.

Acute Care Facilities are licensed as hospitals. They provide the highest level of care under a physician. Some of the services provided at an acute care facility

include emergency services, critical care, medical/surgical services, and maternal/childbirth services.

Dementia/Alzheimer’s services may be offered in either a nursing or residential care environment. Generally, staff are specially trained in memory care.

Adult Day Centers offer programs in facilities or function as independent organizations. The services may include but are not limited to personal care, assistance with eating or using the toilet, assistance with taking medication, and social assistance. Centers offer a protective, supervised setting and generally operate during normal business hours.

Respite Care provides caregiving opportunities on a short-term basis. Care may range from personal to nursing care.

Home Care Services may be provided in a residential setting or as ancillary services, such as in personal care and assisted living or a nursing care environment. Services include skilled nursing, therapies, and changing and reinforcing simple wound dressing, as well as non-medical services such as light housekeeping, transportation to doctor visits, shopping, respite, and more.

Hospice Care is for families living and coping with life-limiting illnesses. Hospice provides professional treatment of pain and symptom management with support and counseling. Includes medical, psychological, and spiritual support.

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You Wanted to Know . . .

As a caregiver, you have many questions. Some are common among caregivers, while others are unique to your own situation. The following are a few questions that seem to be on many caregivers’ minds.

What care services are available to my loved one at home?

Nonmedical and medical care is available, focusing on helping individuals with daily activities needed to remain safe and healthy at home.

Nonmedical in-home care provides personal assistance with instrumental activities of daily living (using the telephone, preparing food, shopping, and handling finances) and activities of daily living (eating, toileting, dressing, bathing, transferring, and continence).

Medical in-home care provides healthcare in one’s home by licensed medical professionals, for which an individual needs a prescription. While non-medical in-home care is most commonly a private-pay arrangement, medical in-home care is often covered by Medicare.

What does long-term care insurance pay for?

Long-term care insurance can pay for a number of services, all of which are specified in the individual’s policy. A policy may include daily benefit coverage for in-home care, personal care, skilled nursing, and/or additional services.

Some of the most important details to review include the benefit provisions, maximum daily benefit amount, lifetime maximum benefit amount, elimination period, and whether or not the policy has an inflation rider.

If an individual has questions or is interested in investing in a policy, consult with a local financial planner who specializes in long-term care insurance.

Jessica A. Pavelko, CSA Geriatric Consultant Pavelko Senior Consulting Services, LLC www.pavelko.org

. . . . . . . . . . . . . . . .

My father is a veteran. What caregiving benefits may he be eligible for?

The Aid and Attendance (A&A) Pension provides benefits for veterans and surviving spouses who require the regular attendance of another person to assist in eating, bathing, dressing and undressing, or taking care of the needs of nature.

To qualify for A&A it needs to be established by your physician that you require daily assistance by others to dress, undress, bathe, cook, eat, leave home, etc. You do not have to require assistance with all of these.

It’s especially helpful to contact your county veterans benefits coordinator, who can advise and offer assistance with the application.

Dianne Stott, BA Associate Care Manager/Consultant Transitions: SOS dcstott@verizon.net

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I am my sister’s main caregiver. She just got out of the hospital and needs home care. We’re in our 70s. Does Medicare pay for medical and nonmedical services?

Medicare has strict eligibility requirements for the post-hospital care they will cover.

Generally speaking, the care must be for the same ailment for which the patient was in the hospital and must follow a stay of no less than three days’ time.

Your hospital discharge planner/social worker is your best resource in this case.

They are paid by the hospital to coordinate your after care according to your physician’s orders and they can help you to understand what Medicare will and will not cover.

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The Pennsylvania Caregiver Support Program There were approximately 52 million Americans serving as caregivers of older adults in 2011. Americans are living longer, and as the population ages, the number of caregivers will also continue to rise in the coming years.

Caregivers are an essential element in our healthcare system, accounting for about $450 billion worth of unpaid labor in the U.S. in 2009.

Caregiving already has become the new norm for many, as we find ourselves helping loved ones who are disabled, frail, or suffering from Alzheimer’s disease, Parkinson’s disease, and kidney and liver diseases, which have been on the rise.

Benefits & Services for Caregivers

Daughters are more likely to provide basic care (i.e., help with dressing, feeding, and bathing), while sons are more likely to provide financial assistance. A number of studies have shown that women caregivers are more likely than men to suffer from high stress due to caregiving.

The major focus of the Pennsylvania Caregiver Support Program is to reinforce the care being given to persons over the age of 60 or adults with chronic dementia. To determine what your particular needs are, both the caregiver and receiver, the package of benefits begins with an assessment.

You could also take advantage of other benefits available such as counseling, education, and financial information.

Assessment Criteria (Federal and State)

• Assessment of caregiver and care recipient needs • Counseling on coping skills • Respite care

State No

Federal No

Caregiver must be related to the care receiver.

No

No

Household income of care receiver is used to determine eligibility.

Yes

Yes

Care receiver must require assistance with two or more ADLs.

No (1)

Yes (2)

Maximum amount of monthly reimbursement for caregiver expenses (depending on reimbursement rate chart) is:

$200

$300

Maximum amount of reimbursement for home modification/assistive devices (depending on reimbursement rate/cost-sharing chart and availability of funding) is:

$2,000

$2,000

Information to caregivers includes advice on how to access: individual counseling, locations of local support groups, and caregiver training to assist caregivers in making decisions to solve problems related to their caregiving role.

Yes

Yes

Caregiver must provide daily hands-on caregiving to care receiver.

Yes

Yes

Caregiver must reside in the same household as care receiver.

• Training in caregiving skills • Home chore caregiving skills • Financial assistance to purchase supplies or services • One-time grant for home adaptations • Benefits and counseling on services available through local, state, and federal programs • Referrals to family support or disease-specific organizations such as Children of Aging Parents or the Alzheimer’s Disease & Related Disorders Association • Assistance in completing benefits and insurance forms

Eligibility If you are age 18 or older and the primary caregiver* of a functionally dependent person who is age 60 or older, you may be eligible for assistance.

If you are age 18 or older and the primary caregiver* of a relative who is age 18 to 59 with dementia, you may be eligible for assistance.

If you are age 55 or older and the primary caregiver* of a relative who is age 18 or younger and lives with you, you may be eligible for assistance. *A primary caregiver is the “one identified adult family member or other individual who has assumed the primary responsibility for the provision of care needed to maintain the physical or mental health of a care receiver and who does not receive financial compensation for the care provided.”

For specific program information, please contact your local Area Agency on Aging.

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The Dementia Tsunami

By MARY THERESA WEBB, Ph.D. My cousins love to tell the story at family reunions about how my grandfather lost his glasses. Many of us have lost glasses or keys or have forgotten names or phone numbers at some time or other. My parents didn’t think my grandfather had dementia, just absentmindedness.

Today, an estimated 24 million people live with Alzheimer’s or another form of dementia, and others fear memory-loss symptoms. But not everyone who has memory-loss problems has a dementia disease.

Tiredness, stress, grief processes, mild depression, and even absentmindedness can cause temporary memory confusion. Wear and tear on our brains as we age causes the processing and recalling of information to slow down.

When seniors undergo surgery, especially heart surgery, anesthesia may cause temporary dementia symptoms called postoperative cognitive dysfunction (POCD). Because of the potential for POCD, anesthesiologists should only administer narcotics and sedative drugs during surgery in low doses.

According to the Cleveland Clinic Journal of Medicine, those who already have dementia symptoms may likely worsen postoperatively, complicating disease management. These symptoms may persist for many months.

Dementia Disease Determination In order to distinguish between normal, short-lived memory problems or those that define the onset of a dementia disease, trained medical professionals can administer a mental status exam, such as the Mini-Mental State Examination (MMSE) or the Cognitive Capacity Screening Examination (CCSE).

If the exam results indicate dementia, pathology referral should follow for a complete neuropsychological examination that includes a bio-psychosocial history and is designed to differentiate the areas of the brain affected. The results enable family members and their physician to plan the best course of treatment.

Dementia Classifications With advances in brain studies and dementia research, many different types of dementia disease can be identified and a best practices course of treatment specified.

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Alzheimer’s disease (AD) leads as the most researched and treated kind of dementia. AD begins with short-term memory loss and confusion similar to most of the other kinds of dementia, but, unlike the others, has a predictable progression.

Medical professionals can identify AD by finding plaques along with empty pockets through CT, MRI, or PET brain scans. Current Alzheimer’s research has confirmed that early-onset AD may be genetically transmitted.

Two other kinds of dementia, vascular dementia (VD) and Lewy body dementia (LBD), vie for second place to AD in prevalence.

VD occurs in more than 80 percent of those who have had a stroke or a series of small transient ischemic attacks or TIAs. Cognitive problems, such as disorientation in familiar locations, difficulty following directions, and problems handling money, may appear suddenly and worsen with each additional stroke and progress in a steplike fashion.

Frontotemporal dementia, or frontallobe dementia (FTD), has been difficult to distinguish from VD because in both VD and FTD, the impairment occurs in the frontal lobe part of the brain. The most common signs of FTD include changes in personality and behavior,

euphoria, apathy, decline in personal hygiene, and a lack of awareness concerning these symptoms. Frequent falls may also occur with FTD. Prevalence of movement disorders, behavioral problems, and visual hallucinations could lead to a diagnosis of either LBD or Parkinson’s disease.

Differentiation between the two becomes difficult since Lewy bodies in the brain (hence the name LBD) can only be seen during an autopsy. Physicians prefer to use a diagnosis such as mixed dementia.

Treatment, then, becomes more of an art than a science.

Continued on next page

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Treatment Issues Through continued neurological studies and pharmacological research, one day specific medicines may cure these varieties of dementia diseases. However, today no cure exists. Physicians and health facilities treating those affected can only seek to maintain mental functioning as long as possible and manage mood and behavior.

Nonmedical interventions have been proven to be the most effective in controlling moods and undesirable behaviors.

Socialization with other dementia patients and family members, along with music and arts and crafts therapy, help defuse anxiety and fear symptoms that lead to behavior problems.

Establishing a set routine, simplifying tasks, and eliminating unnecessary, noise-like TV programs filled with action and violence also aid in minimizing any behavioral problems.

Physicians who treat behavioral problems in dementia patients with prescribed drugs do so experimentally. Medicine that works for one dementia patient might not work for another. Some studies show that herbal supplements such as ginkgo biloba and salvia can be effective. A dietary supplement known as COP-choline may help improve brain function because it increases acetylcholine (a brain neurotransmitter).

On her website Elder Consult, Dr. Elizabeth Landverk writes that some commonly prescribed medications, such as antiinflammatories, anti-convulsants, benzodiazepines, and brand names of Lomotil, melatonin, and Selegiline, may have serious side effects with dementia patients. Common medicines that decrease acetylcholine—such as prednisone, amitriptyline, and Benadryl and those prescribed for bladder infections—are counter-indicated for dementia patients.

Physicians often prescribe the drug Namenda, an NMA receptor, to treat a dementia disease in its moderate to late stages 18

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to delay the degenerative progression. Along with Namenda, some physicians prescribe cholinesterase inhibitors, under brand names of Aricept (donepezil), Razadyne, or Exelon, to increase the availability of acetylcholine and improve mental acuity.

However, these pharmacological agents lose their effectiveness as the disease progresses and may not work in every case. Aricept’s effectiveness works in only about 10 to 30 percent of dementia patients and for only up to about nine months. In some instances, this drug may worsen dementia symptoms.

Geriatric physicians sometimes try to control a dementia patient’s behavioral changes with antidepressants, neuroleptics, or antipsychotic drugs.

According to a British governmentcommissioned study, of the 180,000 persons with a dementia disease who were prescribed antipsychotics, 144,000 were given them inappropriately.

Those treated with high doses of haloperidol had double the risk of death compared with some of the other drugs taken. However, the drug Celexa has been clinically proven to be a better choice than Ativan or lorazepam.

Although their potential to relieve behavioral symptoms and prolong brain deterioration is promising, most of these treatments cannot lessen the impact that the current dementia tsunami has on family members and caregivers.

Useful websites for further reading: www.alz.org www.webmd.com www.medicine.net

www.cdr.rfmh.org www.elderconsult.com

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Should Your Aging Parent Come to Live with You?

By LISA M. PETSCHE If you have a parent who lives alone, you may be concerned about his or her physical or emotional well-being—or both. Especially if he or she (the latter will be used from here on) does not live close by or is clearly not managing well, you may wonder whether you should invite her to move in with you.

Before making an offer, ask yourself the following questions and take time to honestly and thoroughly answer each one.

Interpersonal issues. What kind of relationship do the two of you have? How do others in your household get along with your parent? Any personality clashes 20

are sure to be magnified when you’re living under the same roof.

Your needs. Consider your physical and mental health. Would you be able to provide hands-on assistance if needed?

Could you cope with the ongoing stress involved in primary caregiving?

Your family’s needs. What do others in your household—spouse and any children—think of your parent moving in? It’s crucial to have their support in order for such an arrangement to work.

Would you still have enough time to devote to them?

Lifestyle issues. If you’re employed, how

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might the primary caregiver role impact your work? How would it affect your social life, vacation plans, and other pursuits? Decide what adjustments you’re prepared to make.

Your parent’s needs. Determine what kind of practical assistance your parent requires at present and how much time it involves on a daily or weekly basis. Can she be left alone? If she’s been diagnosed with a chronic illness such as Alzheimer’s disease, how are her needs likely to change in the future?

Available supports. If you have relatives in the area, what kind of regular support would they be able and willing to provide

to help make this work? Perhaps they could accompany your parent to appointments, regularly have her over for dinner, or periodically take her into their home for the weekend. Many creative arrangements are possible whereby caregiving responsibility is shared among family members, at least to some degree. This helps to prevent caregiver burnout.

What kinds of community support services are available in your area to assist you in meeting your parent’s needs, either now or in the future? Find out about accessible transportation services; seniors’ recreation centers; day programs,

home healthcare services that offer nursing, homemaking, and various types of therapy; and residential respite programs.

If you live in a different town, how easy would it be to link your parent with needed medical supports, such as a new primary physician?

Home setup. Is there sufficient space in your home to meet everyone’s needs for privacy? Would your parent have separate quarters or would it be a communal living arrangement?

Finances. Give thought to how household expenses would be shared.

Find out, too, whether your parent has savings or insurance that would cover the cost of any needed medical equipment or healthcare services. If not, are you able to pay for them yourself?

Consider, too, your home’s accessibility.

Would renovations need to be made, and if so, what is the estimated cost and who would pay it? (See page 15 for The Pennsylvania Caregiver Support Program.)

Your parent’s wishes and expectations.

Would your parent want to move in with Continued on next page

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Determine what kind of practical assistance your parent requires at present and how much time it involves on a daily or weekly basis.

you? If so, can you anticipate her expectations in terms of privacy, financial arrangements, and practical help?

Other options. Before making any decisions, explore alternatives: in-home services, adult day programs, live-in help, or an assisted living facility or nursing home. Determine whether any of these options are appropriate and affordable.

Consider the least disruptive ones first.

The decision. If, after careful thought, you conclude that moving your parent in with you is not feasible, don’t be swayed

by guilt. Instead, help her develop a workable plan—whether it be arranging in-home services or finding another place to live—and provide as much practical and emotional support as possible.

If you decide to move your parent in, allow plenty of time for everyone involved to adjust to the inevitable changes in family dynamics and household routines.

There are bound to be some difficulties, but these can usually be worked through if you are committed to making the arrangement work.

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The rewards can be great: a closer relationship with your parent; a feeling of fulfillment that you’re doing something worthwhile; the satisfaction of being able to give back to someone who has done much for you; and the peace of mind that comes from knowing your parent is well cared for.

No matter how positive you feel about the long-term viability of your plan, don’t promise your parent you will never pursue placement in a care facility, since you don’t know what the future holds.

Unexpected events can alter the bestmade plans, so flexibility is key.

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250-pound weight capacity.

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Aids in transfers between the wheelchair and the bed or toilet. Reduces back strain on both user and helper.

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Frequently Asked Questions by Caregivers What services are available from Pennsylvania Area Agencies on Aging?

Area Agencies on Aging, county- or multi-county-based agencies that partner with the Department of Aging, provide a wide range of services, such as assessment of need, care management, in-home services, transportation, protective services, adult daycare, legal services,

healthcare counseling, and senior centers.

Services may vary from county to county, so it is wise to call your local Office of Aging for particular services or programs.

Is there some place I can get help with drug bills for someone in my care?

Many senior citizens with low incomes are eligible for assistance with payment for their prescribed medications through PACE/PACENET programs.

Who is eligible for PACE? To be eligible for PACE, you must be 65 years of age or older and a Pennsylvania resident for at least 90 consecutive days prior to the date of application.

For a single person, your total income must be $14,500 or less. For a married couple, your combined total income must be $17,700 or less.

Prescriptions: co-pay generic – $6; co-pay single-source brand – $9.

Who is eligible for PACENET? To be eligible for PACENET, the qualifications are the same as PACE. However, the total income for a single person can be between $14,500 and $23,500. A couple’s combined total income can be between $17,700 and $31,500.

Prescriptions: co-pay generic – $8; co-pay

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single-source brand – $15. Monthly $40 deductible.

Call your local Area on Aging office for forms or more information.

What is PACE Plus Medicare?

Under PACE Plus Medicare, PACE/PACENET coverage is supplemented by federal Medicare Part D prescription coverage—offering older Pennsylvanians the best benefits of both programs. Older adults continue to receive the same prescription benefits while, in many cases, saving more money.

What is the APPRISE Program and where can I get more information?

The APPRISE Program is a free program operated by the Area Agencies on Aging to provide health insurance counseling and assistance to Pennsylvanians age 60 and over. They can help you understand Medicare benefits by explaining about Medicare, Medicare Supplemental Insurance, Medicaid, and long-term care insurance.

They can explain the Medicare appeals process, help you select a Medigap insurance policy, explain the Medicare prescription Part D benefit, and explain financial assistance programs. Contact 800.783.7067 or your local Area Agency on Aging for more information. The services are free of charge.

How can my mother get answers to some legal issues she has concerning her estate?

Older Pennsylvania residents age 60 years and older can receive free, confidential telephone legal advice and/or referrals for services to local participating lawyers by calling the Senior LAW Helpline.

Attorneys will advise callers on any civil legal matter, to the extent they are able. No client representation is available directly. Legal helpline clients needing representation are referred to their local

area legal services, title IIIB project, or the bar.

Call 877.727.7529 for more information.

What is the Pennsylvania Department of Aging Waiver?

The Aging 60+ Waiver provides homeand community-based services to eligible persons age 60 and older with the help they need to live independently in their own homes and communities: home health and personal care services, home support, attendant care, respite care, adult day care, transportation, home modifications, specialized medical equipment and supplies, counseling, extended state plan physician services, home-delivered meals, personal emergency response, and companions.

Care management and service coordination are provided by your local Area Agency on Aging.

To be eligible, the person must meet the following requirements: • Would benefit from nursing facility care • Can be served in the community by available health and social services • Meets the financial requirements, as determined by your local county assistance office

assisted living residence. Is that true?

Yes, that is correct. At the beginning of last year (2011), personal care and assisted living can no longer be interchangeable terms. Specific requirements must be met and communities (including retirement communities and CCRCs that offer those services) must be licensed as one or the other, although they can meet requirements and be licensed for both.

Do home care agencies need licenses too?

Yes, home care agencies (HCAs) and home care registries (HCRs) must now be licensed by the Department of Health to provide home care services, medical and nonmedical.

• Agrees to the requirements and responsibilities of the program I heard that communities must now be licensed as a personal care home or an

Continued on next page

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Are there caregiving tax breaks I can take advantage of?

You may be able to claim your loved one as a dependent on your tax return. To qualify for dependency, you must pay for more than 50 percent of your qualifying relative’s support costs for the year.

With changes occurring in the healthcare laws, it is advisable to check with your tax preparer to find out what you qualify for, such as medical deductions and a dependent-care credit.

What is the Pennsylvania Caregiver Support Program?

Previously called The Family Caregiver Support Program, the Pennsylvania Caregiver Support Program’s major focus is to reinforce the care being given to persons over the age of 60 or adults with chronic dementia.

The package of benefits begins with an assessment to determine what benefits best meet your needs and the needs of the person receiving care. Then you will choose an option from available supportive services. Other benefits could also include counseling, education, and financial information.

period for your loved one, allowing the person to become familiar with a community before the need actually arises.

Another option is a companion. Home companions can be contracted to come to your home for just about any length of time you wish.

What is respite care?

Respite care provides caregiving opportunities on a short-term basis. It may be provided as a day service (adult day services) or for a week or two in a community setting that meets your loved one’s needs.

These services allow you to have a temporary break from the tasks of caring for a loved one while knowing that person is being well cared for. Sometimes respite stays also provide a “get acquainted”

Are there any programs set up that can help resolve abuse allegations?

The Ombudsman Program is designed to support and empower consumers by resolving individual complaints involving long-term care service, while working to improve and enhance the long-term living system for the residents and their families.

Pennsylvania Ombudsmen champion the right of these consumers to achieve the highest quality of life and care wherever they reside. Pennsylvania Ombudsmen may be staff, volunteers, or PEER residents.

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Is there a transportation program for seniors?

Yes, there is. This program provides free transit service on local, established bus routes and trolley and rapid-transit lines. Individuals 65 and older may now ride free on fixed-route services at all regular operating times on weekdays, weekends, and holidays.

Persons must be 65 years of age or older. RRTA provides accessible vehicles on all bus routes and has space available for two wheelchair passengers per trip. A PA Department of Transportation senior citizen ID card is required and is available free of charge from participating local transit operators. An acceptable proof of age document must be shown to the transit operator to obtain the identification card.

Are there any other online sources for additional information?

Yes. Click on www.heretohelp.pa.gov.

There is an abundance of information to be found at Here to Help on the PA Government Portal.

Preventive Measures Could Make a World of Difference

More than likely, the adult person you are caring for is on Medicare, which provides them with a broad range of preventive services and screenings. If you knew they could delay, control, manage, or even prevent certain illnesses and diseases, wouldn’t you want your loved one to take advantage of them?

At your Medicare recipient’s next annual wellness visit, ask his or her Medicare-participating healthcare provider about the following preventive screening and services that are now available to them without paying the Medicare Part B deductible and 20 percent coinsurance (the list is not complete and may be subject to change): • Annual wellness visit • Bone mass (bone density) measurement • Cancer screenings > Breast cancer (mammography and clinical breast exam) > Cervical and vaginal cancer (Pap test and pelvic exam) > Colorectal cancer including fecal occult blood test, flexible sigmoidoscopy, colonoscopy, or barium enema

The annual wellness visit presents an excellent opportunity for you to speak with your loved one’s healthcare provider about preventive screenings that he or she may be able to take advantage of.

• Diabetes self-management training • Glaucoma screening • Human immunodeficiency virus (HIV) screening • Immunizations (seasonal influenza, pneumococcal, and Hepatitis B) • Initial preventive physical examination (IPPE) > Referral for an ultrasound screening for abdominal aortic aneurysm for eligible beneficiaries • Intensive behavioral therapy for cardiovascular disease • Intensive behavioral therapy for obesity • Medical nutrition therapy for beneficiaries with diabetes or renal disease • Prostate (PSA blood test and digital rectal exam) • Screening and behavioral counseling intervention in primary care to reduce alcohol misuse • Screening for depression in adults

• Cardiovascular disease screening

• Screening for sexually transmitted infections (STIs) and high-intensity behavioral counseling (HIBC) to prevent STIs

• Diabetes screening

• Tobacco-use cessation counseling

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15 Things Caregivers Should Know After a Loved One Has Had a

1 5 2 6 3 7 4 It’s better to find out than miss out. Be aware of the medications that have been prescribed to your loved one and their side effects. Ask if your home should be modified to meet the specific needs of the stroke survivor. Ask a doctor, nurse, or therapist to clarify any unanswered questions or to provide written information that explains what occurs after the stroke and during recovery or rehabilitation.

Reduce risks, or stroke may strike again.

Survivors who have had one stroke are at high risk of having another one if the treatment recommendations are not followed. Make sure your loved one eats a healthy diet, exercises, takes medications as prescribed, and has regular visits with their physician to help prevent a second stroke.

Many factors influence recovery.

Recovery depends on many different factors: where in the brain the stroke occurred, how much of the brain was affected, the patient’s motivation, caregiver support, the quantity and quality of rehabilitation, and how healthy the survivor was before the stroke. Because every stroke and stroke survivor is unique, avoid comparisons.

Gains can happen quickly or over time.

The most rapid recovery usually occurs during the first three to four months after a stroke, but some stroke survivors continue to recover well into the first and second year post-stroke.

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Some signs point to physical therapy.

Caregivers should consider seeking assistance from a physical or occupational therapist if their loved one has any of these complaints: dizziness; imbalance that results in falls, difficulty walking or moving around in daily life; inability to walk six minutes without stopping to rest; inability to do things that he/she enjoys like recreational activities or outings with family; or increased need for help to engage in daily activities.

Don’t ignore falls. Falls after a stroke are common. If a fall is serious and results in severe pain, bruising, or bleeding, go the emergency department for treatment. If a loved one experiences minor falls (with no injury) that occur more than two times within six months, see your physician or the physical therapist for treatment.

Measuring progress matters. How much acute rehabilitation therapy your loved one receives depends partly on his/her rate of improvement. Stroke survivors on an acute rehabilitation unit are expected to make measurable functional gains every week as measured by the Functional Independence Measure Score (FIMS). Functional improvements include activities of daily living skills, mobility skills, and communication skills. The typical rehabilitation expectation is improving 1 to 2 FIM points per day.

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Stroke

8 9 10 11

A change in abilities can trigger a change in services. Medicare coverage for rehabilitation therapies may be available if your loved one’s physical function has changed. It there appears to be improvement or a decline in motor skills, speech, or self-care since the last time the patient was in therapy, he/she may be eligible for more services.

Monitor changes in attitude and behavior. Evaluate whether your loved one is showing signs of emotional liability (when a person has difficulty controlling their emotions). Consult a physician to develop a plan of action.

Stop depression before it hinders recovery. Post-stroke depression is common, with as many as 30–50 percent of stroke survivors developing depression in the early or later phases post-stroke.

Post-stroke depression can significantly affect your loved one’s recovery and rehabilitation. Consult a physician to develop a plan of action.

Seek out support. Community resources, such as stroke survivor and caregiver support groups, are available for you and your loved one. Stay in touch with a case manager, social worker, or discharge planner who can help you find resources in your community.

12 13 15 14 Learn the ins and outs of insurance coverage. Be sure to consult with your loved one’s doctor, case manager, or social worker to find how much and how long insurance will pay for rehabilitation services. Rehabilitation services can vary substantially from one case to another.

Clarify what medical and rehabilitation services are available for hospital and outpatient care. Determine the length of coverage provided from your insurance (private or government supported) and what out-of-pocket expenses you can expect.

Know when to enlist help. If rehabilitation services are denied due to lack of “medical necessity,” ask your loved one’s physician to intervene on his or her behalf. Ask the physician to provide records to the insurance carrier and, if needed, follow up yourself by calling the insurance company.

Take care of you. Take a break from caregiving by asking another family member, friend, or neighbor to help while you take time for yourself. Keep balance in your life by eating right, exercising or walking daily, and getting adequate rest.

For more information on caring for a stroke patient, visit www.strokeassocation.org.

Know your rights. You have rights to access your loved one’s medical and rehabilitation records. You are entitled to copies of the medical records, including written notes and brain imaging films.

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Resources A Long Goodbye and Beyond: Coping with Alzheimer’s

By Dr. Linda Morrison Combs www.combsmusic.com/ALG.html

Grieving God’s Way: The Path to Lasting Hope and Healing

By Margaret Brownley www.thomasnelson.com

Alzheimer’s is indeed a disease that causes a loved one to fall apart, one piece at a time. When her mother was diagnosed with the disease, Combs left her important position in the U.S. Department of Treasury to care for her mother.

A Long Goodbye and Beyond is a resource for other parental caregivers who must assist a loved one as they pass through the stages of unlovely deterioration.

This book offers 90 days of practical and spiritual advice.

From the seemingly simple things like how to breathe, to the complex questions like, “Why did God allow this to happen?” Browley knows that grieving is a process with purpose. No matter the cause of grief, Grieving God’s Way will help readers see their sadness as a journey toward a hopeful future.

Dementia: The Journey Ahead

By Susan Kiser Scarff with Ann Kiser Zultner www.langdonstreetpress.com Dementia: The Journey Ahead is filled with practical advice for every stage of the disease’s progression, including information on support groups to help you prevent burnout, questionnaires designed to keep your loved one safe, and checklists to give you control in this time of unknowns. This book will help you help your loved one—every step of the way.

Finding Your Way: A Practical Guide for Family Caregivers — 250 Real Life Questions & Commonsense Answers

By Dr. Linda Rhodes www.lindarhodescaregiving.com Dr. Linda Rhodes is a former secretary of aging for the state of Pennsylvania and columnist for the PatriotNews. She is credited for initiating Pennsylvania’s Family Caregiver Support Program, which is often cited as a national model. From senior housing and assisted living to long-distance grandparenting, handling caregiver stress, and eldercare benefits, Finding Your Way offers insightful answers to all of your questions throughout 424 pages. Easy to read and formatted by specific subjects for easy access.

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The Invisible ConversationsTM with Your Aging Parents

By Shannon A. White www.shannonawhite.com Whether it’s discussing living arrangements, health issues, money, grief and loss, the ability to drive, or advance directives, The Invisible Conversations will help you start or continue the conversations you want and need have with your aging parents. White guides you through facing the toughest topics, so you can communicate clearly with dignity and respect.

Her practical tools will help you alleviate stress and nurture a deeper connection within your relationship together.

The Long Hello

By Cathie Borrie www.cathieborrie.com Memory, and the losing of it, serves as a powerful guide, and Borrie follows her mother’s eccentric and poetic lead into the past, transformed by the unexpected brilliance of the elder woman’s shifting dementia mind. The Long Hello cherishes the bond between mothers and daughters and creates a startling change in society’s perception of those journeying through Alzheimer’s.

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Treasures in the Darkness: Extending the Early Stage of Lewy Body Dementia, Alzheimer’s, and Parkinson’s Disease

By Pat Snyder www.facebook.com/Treasuresinthedarkness How do you cope when you hear the words Lewy Body disease, Alzheimer’s disease, and Parkinson’s disease? As a caregiver, there are things you can do for a person with degenerative cognitive disease to make your daily lives better. There may even be blessings you never thought could happen to you in this journey. If you are an early-stage caregiver, this story may help you. It has tips on how to make a difference.

You Might Be a Caregiver If ...You Give Yourself to Others and Wonder What Happened to YOU!

By Lon Kieffer www.defenderofcaregivers.com This book will help caregivers learn about themselves through increased awareness and acceptance of who and what they are, and more importantly, why they do what they do! Join Lon Kieffer, caregiver, and his alter-ego DOC, the “Defender of Caregivers,” as they take you through a personal journey of awareness and acceptance that will separate you from “caregiver distortions” that lead to wondering whatever happened to you?

Understanding Dementia and Caregiving for Your Aging Parents from A to Z

By Ellen Gerst www.lngerst.com This book is not an attempt to educate you on all the medical aspects of dementia, although they are touched on lightly.

Instead, it speaks to you from the heart and from a personal standpoint. It lets you know some of what to expect and the emotions and thoughts you might have in response to your loved one’s deteriorating condition, and it provides suggestions to help you cope.

DIRECTORY OF HOUSING & CARE PROVIDERS Angel’s Touch Personal Care Home 717.252.2223 5849 Lincoln Highway angelstouchpch@aol.com York, PA 17406 www.angelstouchpersonalcarehome.com

Homeland Center/Homeland Hospice 717.221.7902 1901 North Fifth Street homeland1@pa.net Harrisburg, PA 17102-1598 www.homelandcenter.org

Why live alone? Enjoy the good life in our restored Georgian mansion. Walking trail around horses and goats, Italian gazebo, and 24-hour love and care.

Homeland Center, a continuing care retirement community, offers exemplary care in 50 personal care suites and 92 skilled nursing care units, 21 of which are for dementia-related residents. Homeland Hospice provides exemplary, quality care to those at the end of life.

See ad page 5

CareMinders® Home Care 217 West Penn Avenue Cleona, PA 17042

717.454.0159 abeck@careminders.com www.careminders.com

While providing for their safety and security, we deliver compassionate, skilled, and non-medical care in the home.

See ad page 21

Cumberland Crossings 717.240.6013 A Diakon Lutheran Social Ministries 717.240.6021 Senior Living Community hazano@diakon.org 1 Longsdorf Way www.diakon.org/cumberlandcrossings Carlisle, PA 17015 Worried your aging parents may not be taking care of themselves? Cumberland Crossings’ personal care helps with grooming, medication management, and meals. Nursing and respite services also available.

See ad page 29

Garden Spot Village 433 South Kinzer Avenue New Holland, PA 17557

717.355.6000 info@gardenspotvillage.org www.gardenspotvillage.org

Experience a socially engaging community where people are empowered to live with purpose and significance at all stages of life! Offering award-winning healthcare.

See ad page 35

Hospice of Lancaster County 717.295.3900 685 Good Drive, P.O. Box 4125 info@hospiceoflancaster.org Lancaster, PA 17604-4125 www.hospiceoflancaster.org 24-hour support for the entire family. Palliative medicine, hospice care, and bereavement support. Special caregiver groups open to all. Lancaster County’s only nonprofit hospice.

JCAHO-accredited.

See ad page 27

Landis Homes 1001 East Oregon Road Lititz, PA 17543

717.569.3271 www.landishomes.org

Serving persons living in cottages, apartments, suites, personal care, and healthcare. Heritage memory support serves persons with memory loss. Also serving clients in adult day and home care services. New cottage and hybrid homes available now.

Life Time Adult Day Care 3401 Hartzdale Drive, Suite 132 Camp Hill, PA 17011

717.975.9762 jhutcheson@cparc.org www.cparc.org

Compassionate daytime care for older adults and support to their caregivers. Over 30 years of experience. Convenient locations in Camp Hill and Carlisle.

See ad page 11

Graysonview Harrisburg Personal Care & 717.558.7771 Adult Day Services Community www.graysonviewhbg.com 150 Kempton Avenue Harrisburg, PA 17111

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COLOR KEY FOR DIRECTORY OF CAREGIVING PROVIDERS INDEPENDENT RESIDENCES PERSONAL CARE HOME ASSISTED LIVING RESIDENCE DEMENTIA UNITS NURSING CARE COMMUNITY

REHABILITATION FACILITY RESPITE ADULT DAY CENTER HOME CARE SERVICES HOSPICE CARE

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DIRECTORY OF HOUSING & CARE PROVIDERS Lutheran Retirement Village at Utz Terrace 2100 Utz Terrace Hanover, PA 17331 See ad page 13

Lutheran Social Services South Central Pennsylvania 1050 Pennsylvania Avenue York, PA 17404

717.637.0633 lsterner@lutheranscp.org www.lutheranscp.org

717.854.3971 mwilliams@lutheranscp.org www.lutheranscp.org

For 60 years, Lutheran Social Services has been providing seniors throughout York, Adams, and Franklin counties with homes and services designed to meet their needs. See our ad and listings for locations and contact information.

See ad page 13

Luthercare 600 East Main Street Lititz, PA 17543

See ad for locations info@luthercare.org www.luthercare.org

Luthercare is committed to serving the needs of seniors in Lancaster and Lebanon counties with residences and assistance to encourage an active and dignified life.

See ad page 17

Messiah Lifeways 100 Mount Allen Drive Mechanicsburg, PA 17055

717.790.8201 life@messiahlifeways.org www.messiahlifeways.org

Messiah Lifeways (formerly Messiah Village) offers more options for caregivers and everyone 55+ including: coaching, enrichment, community support, and resident communities.

See ad page 19

Safe Haven Quality 717.582.9977 Care, LLC safehavenqualitycare@verizon.net 1566 New Bloomfield Road www.safehavenqualitycare.com New Bloomfield, PA 17068 A locally owned and operated business, we proudly and diligently serve clients in Dauphin, Cumberland, and Perry counties.

See ad page 22

SeniorLIFE York 1500 Memory Lane Ext. York, PA 17402

717.757.5433 smitrzyk@seniorlifeyork.com www.seniorlifeyork.com

SeniorLIFE is an all-inclusive care, non-residential program.

Services include transportation, physician and nursing services, and much more. Call for complete service listing and eligibility requirements.

See ad page 2

Shrewsbury Lutheran Retirement Village 717.227.3000 800 Bollinger Drive bjohns@lutheranscp.org Shrewsbury, PA 17361 www.lutheranscp.org See ad page 13

TLC Elder Care Services 540 Ichabod Court Mechanicsburg, PA 17050

717.737.8512

TLC Services, a home-based business, strives to make you or your loved ones as comfortable and relaxed as possible.

Caregivers are reliable, responsible, affordable, experienced, and very compassionate.

UDS Independent Living Resource Center 888.837.4235 1901 Olde Homestead Lane resourcecenter@udservices.org Lancaster, PA 17605 www.udservices.org Don’t know what your loved ones need? Call us. We provide personal care and a variety of home care products and services.

If we don’t offer what you need, we’ll find it for you.

See ad page 9

The Village at Kelly Drive 750 Kelly Drive York, PA 17404 See ad page 13

717.848.2585 hbair@lutheranscp.org www.lutheranscp.org

The Village at Sprenkle Drive 1802 Folkemer Circle York, PA 17404 See ad page 13

717.764.9994 hbair@lutheranscp.org www.lutheranscp.org

COLOR KEY FOR DIRECTORY OF CAREGIVING PROVIDERS INDEPENDENT RESIDENCES PERSONAL CARE HOME ASSISTED LIVING RESIDENCE DEMENTIA UNITS NURSING CARE COMMUNITY

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REHABILITATION FACILITY RESPITE ADULT DAY CENTER HOME CARE SERVICES HOSPICE CARE

HEALTH

DIRECTORY OF HOUSING & CARE PROVIDERS Visiting Angels Living Assistance Services Hanover 104 Carlisle Street, Suite 1 Hanover, PA 17331

717.630.0067 visitingangelshanv@comcast.net www.visitingangels.com

Lancaster 202 Butler Avenue, Suite 302 Lancaster, PA 17601 York 1840 East Market Street York, PA 17402

717.393.3450 angelsat156@aol.com www.visitingangels.com 717.751.2488 visitingangelsyk@comcast.net www.visitingangels.com

See ad page 26

VNA of Central PA/ Crossings Hospice of the VNA 3315 Derry Street Harrisburg, PA 17111

717.233.1035 www.vnacentralpa.com

Hanover Hospital Center for Acute Rehab Medicine 300 Highland Avenue Hanover, PA 17331 See ad page 8

717.637.3711 duffyl@hanoverhospital.org www.hanoverhospital.org

HOME MODIFICATIONS UDS Independent Living Resource Center 888.837.4235 1901 Olde Homestead Lane resourcecenter@udservices.org Lancaster, PA 17605 www.udservices.org Your one-stop source for accessible home modifications like bathtub-to-shower conversions, ramps, and stairglides. Don’t know what your loved ones need? Call us. If we can’t do it, we’ll refer you to someone who can.

See ad page 9

MEDICAL EQUIPMENT AREA AGENCIES ON AGING Area Agencies on Aging Cumberland County Aging and Community Services Dauphin County Area Agency on Aging Lancaster County Office of Aging Lebanon County Area Agency on Aging York County Area Agency on Aging

717.240.6110 717.780.6130 717.299.7979 717.273.9262 717.771.9610 www.p4a.org

Your local offices of aging act as advocates for Pennsylvania’s seniors—promoting their continued physical, social, and economic self-sufficiency.

COMPLEMENTARY ASSISTANCE ConnectCare3 147 West Airport Road Lancaster, PA 17543

877.223.2350 www.connectcare3.com

Healthcare navigation with RNs who will find you the best doctors and facilities; research the best and newest treatment options; and accompany you to physician appointments.

See ad page 7

UDS Independent Living Resource Center 888.837.4235 1901 Olde Homestead Lane resourcecenter@udservices.org Lancaster, PA 17605 www.udservices.org Your one-stop source for mobility equipment like power and manual wheelchairs, scooters, and patient lifts. Don’t know what your loved ones need? Call us. If we don’t have it, we’ll find it for you.

See ad page 9

MOVING & RELATED SERVICES Transition Solutions for Seniors, LLC 717.615.6507 1075 Hunters Path rochelle@supernet.com Lancaster, PA 17601 Move organizing and implementation: sorting, packing, disposal of unwanted items, unpacking, resettling, home staging, cleaning, and selling (through Prudential HSG), work with estates.

See ad back cover

PHARMACY Your Neighborhood Drugstore at Giant Various locations www.giantfoodstores.com We believe in providing pharmaceutical care the old-fashioned way — with personal and professional service. Visit giantfoodstores.com to find a location near you.

See ad page 25

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Support and Information All About Vision www.allaboutvision.org

Eldercare Locator 800.677.1116 www.eldercare.gov

National Library Service for the Blind & Physically Handicapped 800.424.8567 www.loc.gov/nls

Alzheimer’s Disease Education and Referral Center 800.438.4380 www.alzheimers.org

Epilepsy Foundation of America 800.332.1000 www.epilepsyfoundation.org

American Cancer Society Response Line 800.227.2345 www.cancer.org

EyeCare America 877.887.6327 www.eyecareamerica.com

Needy Meds www.needymeds.com

American Diabetes Association 800.254.9255 www.diabetes.org

Family Caregiver Alliance 800.445.8106 www.caregiver.org

Office of Minority Health Resource Center 800.444.6472 www.omhrc.gov

American Speech Language-Hearing Association 800.638.8255 www.asha.org

Guide Dog Foundation for the Blind 800.548.4337 www.guidedog.org

PACE/PACENET 800.225.7223 www.aging.state.pa.us/aging

Medicare Rights 800.333.4114 www.medicarerights.org

Pennsylvania Department of Public Welfare 800.692.7462 www.dpw.state.pa.us

Medicare Telephone Hotline 800.633.4227 www.medicare.gov

Rural Information Center Health Service 800.633.7701 www.nal.usda.gov/ric

National Alliance for Caregiving www.caregiving.org

RxAssist 401.729.3284 www.rxassist.org

American Urological Association 800.828.7866 www.auanet.org Arthritis Foundation Information 800.283.7800 www.arthritis.org BenefitsCheckUp www.benefitscheckup.org CareCentral www.carecentral.com Caregiver Media Group 800.829.2734 www.caregiver.com Centers for Medicare & Medicaid Services 800.633.4227 www.cms.hhs.gov Children of Aging Parents 800.227.7294 www.caps4caregivers.org Christopher Reeve Paralysis Foundation 800.225.0292 www.christopherreeve.org Crohn’s and Colitis Foundation of America, Inc. 800.932.2423 www.ccfa.org

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National Council on Alcoholism & Drug Dependence, Inc. 800.622.2255 www.ncadd.org

Shriners Hospital Referral Line 800.237.5055 www.shrinershq.org

National Family Caregivers Association 800.896.3650 www.thefamilycaregiver.org

Simon Foundation for Continence 800.237.4666 www.simonfoundation.org

National Health Information Center 800.336.4797 www.health.gov/nhic National Institute on Aging Information Center 800.222.2225 www.nia.nih.gov National Institute of Mental Health Information Line 800.647.2642 www.nimh.nih.gov National Insurance Institute Helpline 212.346.5500 www.cancerandcareers.org/resources

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National Parkinson Foundation, Inc. 800.327.4545 www.parkinson.org

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Over

27 Years of Experience!

Make Your Moving Process Easier, More Economical and Less Stressful!

Offering the Area’s Most Complete Menu of Services for Older Adults in Transition and their Families.

We Can: * Organize and Implement the Entire Move * Assist with the Sorting Process * Help with Packing * Dispose of Unwanted Items * Create a Floor Plan for Your New Residence * Stage/Prepare Your Property for Sale * Provide Professionals for Repairs, Cleaning, etc. * Sell Your House* * Help You Find Retirement Living Suitable to Your Needs and Budget * Work with Estates * Unpack, Arrange Your New Home & Remove Boxes * Arrange Intra-Community Transitions * Downsize in Place * Customize All Services to Your Specific Situation You Choose Only the Services You Need – Our Experienced, Caring and Friendly Professionals Do All the Work!

Rocky is available to speak at your group’s next meeting. Let her share 27 years of downsizing experience and expertise.

CALL Rocky for information or a FREE Brochure: (717) 615-6507

(717) 295-HOME (Office)

Rochelle “Rocky” Welkowitz,

(717) 615-6507 (Direct)

Founder

©2008. An independently owned and operated member of Prudential Real Estate Affiliates, Inc.

SRES, GRI

Prudential is a registered service mark of The Prudential Insurance Company of America. Equal Housing Opportunity.