Reverse Magazine May 2023

Critical Transitions Wealth Advisors has a proven process to bring clarity and reduce potential mismanagement. As an advisory fiduciary, we offer advice in your family’s best interest in areas such as consolidating assets, investment management, navigating Social Security & Medicare, your role as Power of Attorney & Personal Representative, and planning for a terminal illness or permanent care diagnosis. Together we can create a plan!

Stephanie Vokral,

5. 8.

CARE ENOUGH TO TAKE A BREAK

Take a deep breath

6.

KEEPING IN TOUCH

Easing the effects of isolation

AGING IN PLACE

Strategies for keeping seniors comfy and safe at home

10. 11. 12.

MANAGING MEDICATION FOR SENIORS ON MEDICARE

What you need to know about prescription drug plans

OUR MOTHER’S VOICE

An organization promoting advocacy for those without a voice

PUTTING IT IN REVERSE

Why self-care is critical for caregivers

Caregiving Shouldn’t Be So Hard

PUBLISHER AND MANAGING EDITOR

Anna Gelbman Edmonds

DESIGN AND PRODUCTION

Kristina Parella

ASSISTANT EDITOR

Amy Stokes

CONTRIBUTING WRITERS

Molly Aston

Karen Campbell

Carl Cease

Earl Gregorich

Emma Hynek

Jeanne Reynolds

Frances Shainwald

Melissa Sprouse Browne

Kinsley Turnipseed

Caroline Ward

(Volume 1, No. 2)

Reverse Magazine is a bi-monthly publication published by The F-Suite, LLC. Please email Anna@ reversemagazine.us for advertising rates and information regarding mail subscriptions and purchase of bulk copies.

Copyright ©2023 The F-Suite, LLC. All rights reserved. Reproduction in whole or in part without permission is prohibited. The publisher is not responsible for the opinions or comments of the authors or the subject matter of advertisers. We welcome your comments and questions by email at info@thefsuite.com or mail to The F-Suite, LLC, 317 Bradford Lane, Columbia, SC 29223. Tel. (803) 216-1902

I decided months ago to address a critical aspect of caregiving that typically goes unattended: the need for self-care. Only after my own caregiving days were over did I notice how much weight I’d gained, how much stress I was carrying in my shoulders and how much grayer my hair was. Now that I’m embedded in the caregiving community through this magazine, I hear firsthand accounts almost daily of just how little caregivers tend (or are able to tend) to their own needs.

Emma Hynek’s cover story includes a lot of hard-hitting statistics to which you as a caregiver should pay attention. The stress of your role is taking a toll on you that you may not realize until it’s too late. Self-care doesn’t have to entail pricey spa treatments, vacations in the sun or 18 holes of golf (though it can). Purposefully scheduling time to enjoy a hobby, a 20-minute brisk walk or a chat over a cup of coffee with a friend are good ways to relax that pay off in spades.

My mother was relatively easy to care for. She was a quiet and very gentle person who rarely asked me or the staff at her assisted living facility for anything. It was the senior care industry and government agencies that made caregiving so difficult. I’m referring to our mess of a healthcare system, Medicare, the cost of long-term care, inadequately trained employees, employee turnover, lack of information or access to information, profits over quality of care, low-budget institutional dietary menus, lack of oversight and monitoring ... need I go on? Nonetheless, during the years I cared for her, Mom and I had some wonderful experiences thanks to some very dedicated and helpful professionals we encountered along the way. But they also struggled against the system that often kept their hands tied and their patience short. Navigating all that often left me with very little energy to be at my best for Mom.

My original concept for the magazine was to use it as a platform to help make things easier for caregivers, not to help caregivers fight their way through the system. The daily struggles and bureaucracy seniors and caregivers face go largely unreported in the mainstream media. So, Reverse will begin looking into why the system makes caregiving so difficult. We’ll include articles that we hope will begin to answer the question “How can this be done better?” To that end, read about Our Mother’s Voice (page 11), an organization that empowers caregivers to advocate for their loved ones.

Finally, it’s gratifying to hear from so many people about how much they appreciate Reverse magazine and the Navigating in Reverse podcast. I’m very grateful to our current advertisers and subscribers for their support. Growing our subscription and advertising base is what will enable us to continue our mission. Email me for information on that or to share your thoughts on how we’re doing. I love hearing from our readers.

Take care,

Anna Gelbman Edmonds Publisher & Managing Editor Anna@reversemagazine.com

PROUD MEMBER OF THE GREATER IRMO CHAMBER

adjust your sails

Care Enough to Take a Break

You’re

equipped with a built-in weapon against stress

By Karen Campbell

Caregivers are known for being resourceful multitaskers. We manage the health needs, lives, families, finances and households of other people in addition to our own. We try to do this with success and composure. How well do we manage that? Sometimes, not well enough. Enter the power of breathing.

After pregnancy, I found physical reward in Pilates, and I learned that breathing, a big part of Pilates, relieves stress — stress I didn’t know I carried. Our bodies are always talking to us; we just need to listen. Within two years, I became certified to teach mindful breathing.

I worked with several sports teams at the University of South Carolina, women and men ages 18-22. Most were able-bodied but stressed out! I challenged them physically, but also encouraged them to employ good breathing during practices, on gamedays and in life situations: cramming for exams, making decisions, dealing with relationships and anxiety, interviewing, and improving sleep. I noticed that they especially anticipated the end of our sessions — the time we dedicated to recovery. Just like I had, they learned that focused breathing made them feel better. I found joy and humor in watching them twitch and fall asleep as they’d surrender to relaxation. I’d often catch a coach or an assistant slyly slinking

down to the floor to join us. No doubt, they also needed to destress.

Private and gym clients were generally more mature and focused. Despite their differences in age and status, they, like the athletes, longed for an escape, a form of permission perhaps, to relax.

My sons played high school sports. Occasionally I’d lead team flexibility sessions, and I realized adolescents can be oblivious to the breath-movement connection, yet instinctively crave the escape of deep relaxation.

The recurring theme is that all of us face daily demands that impact our mental and physical well-being. Adding in caregiving day in, day out and juggling multiple logistics and abrupt schedule changes means rising stress levels. Our bodies are talking to us!

In the grand scheme of all we handle, we need to give ourselves some grace and admit to being overwhelmed and unable control everything. The one thing we can control is how we take a breath. With focused breathing, we can help reduce stress, increase calm, detoxify the body, lower blood pressure, improve the function of the immune and digestion system, increase energy, relieve pain and tension, help support improved posture, and distract negative thinking. Controlled breathing also helps with mental clarity, focus and decision-making, all key components of being a caregiver.

Here is a simple “heat of the moment” way to take a breath wherever you are: Stop what you’re doing, close your eyes and inhale through your nose for four counts. Place your hands on each side of your rib cage, feeling it expand “east and west” as you do. Hold the breath and remain still for six counts. Then exhale for eight slow, steady counts as you feel the breath descend and “empty” from the body. Repeat 2-3 times.

Breathing may not be the getaway you long for, but it’s sure to provide a temporary escape to recovery and relaxation.

Keeping in Touch

Caregivers and the seniors they care for often suffer from isolation

By Frances Shainwald

During the COVID-19 lockdown, many people experienced loneliness due to their lack of physical and social connections. There was a lot of talk about touch deprivation or touch starvation affecting those who lived alone or had to isolate from family members because of compromised immunity. Even in a world free of COVID restrictions, giving and receiving physical affection can be challenging for older adults and caregivers. The loss of spouses, siblings and close friends or inability to socialize can cause both the elderly and, too often, caregivers to spend more time alone. Additionally, health issues can prevent participation in social activities.

With a vast amount of research showing the benefits of touch on overall health, it is clear that it is critical for seniors to maintain regular physical contact with others.

Many studies have been done on the effects of positive human touch. Since its inception in the early 1990s, the Touch Research In-

stitute in Miami has been researching the effects of massage on the human body. Their studies consistently show that massage therapy aids in a range of medical conditions including depression, anxiety, migraines, back pain and even multiple sclerosis. One study used mice that were engineered with a skin receptor that recognizes positive touch. The mice experienced a drop in heart rate and stress-related hormones when stroked compared to mice without the receptor.

Research related to the benefits of touch spans the human lifetime: The Stanford School of Medicine News Center reports that newborn babies who experience skinto-skin contact in the first hour of life cry less and experience better regulation of heart rate, temperature and breathing than babies without direct contact. In the 1990s, the discovery of severely neglected orphans in Romania led to multiple studies connecting a lack of touch in children to stunted growth and brain development, attachment issues and multiple developmental delays.

Why is touch so beneficial to human health? Acts of physical affection such as hugging cause the human brain to release oxytocin, a hormone nicknamed the “love drug.” Research shows it facilitates bonding between mothers and infants as well as between romantic partners. It is believed that oxytocin plays a role in prosocial behaviors such as cooperating with others and showing empathy. When we hug others, our brains release the feel-good hormones dopamine and serotonin — both of which positively affect mood and behavior. The brain’s level of cortisol, the stress-related hormone activated in fight-or-flight situations, is lowered when humans experience pleasant touch.

Not all touch generates pleasant sensations. Touching a hot stove, for example, does not release mood-boosting hormones. This is because our skin has a specific receptor for each type of sensation. Painful and pleasant touch each send unique signals to the brain, determining how we react to the different experiences.

An article from RUSH University Medical Center in Chicago explains that as we age, all our senses change. Older adults will often ask others to repeat words because of hearing loss. Multiple changes in our eyes

make it more difficult to focus on close-up objects and harder to see in dim light. Touch is no different. Our sensitivity to pain and temperature can be significantly lessened by reduced circulation as we grow older. Yet seniors still reap the health benefits of being touched. A study of 200 participants in a New York retirement home showed that those receiving more frequent physical contact reported better concentration, more satisfying sleep and increased energy. The diminished capacity to sense touch as we age makes it even more important to ensure seniors are experiencing regular physical contact. However, sufficient touch experiences for an aging loved one can be complicated by factors such as immune system concerns, limited mobility and a diminishing circle of available friends and family.

Providing positive touch can be just as beneficial, if not more, as receiving it. Notably, one Touch Research Institute study

examined how elderly volunteers giving infant massages compared with peers who received massages. Over a period of three weeks, the group administering massages reported more health benefits than the recipient group.

When excessive time alone is unavoidable, there are ways to reap the comforting benefits of touch without human contact. Taking a shower, using a weighted blanket and sleeping with a body pillow are all ways to experience touch stimulation when friends and loved ones are not available.

Some people prefer being touched more than others; don’t assume everyone enjoys a lot of physical contact. If you are unsure about how a person feels about touch, ask them. If they have a difficult time communicating, make sure you tell them what you are going to do before doing it, and pay attention to their body language. The last thing you want to do is to “rub someone the wrong way.”

Getting in Touch

Ways to ensure a senior in your care is experiencing adequate physical contact:

• Brush their hair

• Hold their hand

• Apply lotion to their hands and arms

• Bring a pet for them to touch

• Hug them when you arrive and before you leave

Caregivers and independent seniors can seek out pleasant touch by:

• Getting a massage

• Volunteering at an animal shelter

• Volunteering in a hospital or senior living facility

• Participating in social activities such as an exercise class or playing bingo can increase the chances of physical interaction

SARAH’S ROCKIN KITCHEN LLC

We’ve all heard the platitudes — “there’s no place like home,” “home is where the heart is,” “home sweet home” — touting the virtues of being at home. Idealized by many seniors, remaining at home for the last season of life is the ultimate goal. The question becomes what changes are important to make to achieve this very personal goal.

There’s one more phrase that’s becoming used to more perfectly describe what it means to stay at home: aging in place.

With a few modifications to your existing home, it may be possible to stay in place as your physical abilities and limitations change. Often, it can be the simple addition of stairway handrails or grab bars strategically placed in the bathroom that make the difference.

In older homes, and even in some modern construction, the hallways and doorways may be too narrow (often from 28 to 30 inches) to accommodate a wheelchair, but a good contractor can retrofit them to be wider. The standard width recommendation for best accessibility is 36 inches. Closet doors are another consideration, as some mid-century houses sport tiny widths of only 18 inches across.

Aging in Place

By Melissa Sprouse Browne

For the best outcome on home modifications, be sure to engage a licensed contractor. Anyone who claims licensure may be verified by checking with your state or local authorities. When paying someone for work on your home, always exercise extreme caution. A reputable business will expect payment upon completion; someone asking for full payment in advance is highly suspicious.

Reduced mobility may mean a ramp is a smart addition to your home. The home’s entrances need to be considered, and a wooden ramp can usually be built for a front or back door for a reasonable price. If a permanent solution isn’t desired, metal ramps are available from dealers for rent on

A few modifications may be all it takes to keep you comfortable and safe in your own home

a short- or long-term basis. If there are steps inside a garage leading to the house door, a small ramp could be created over them or, at the very least, additional handrails or grab bars may be added for increased stability.

A simple change to make your environment safer is the removal of throw rugs. While fashionable, they present a trip hazard. Look at your floors, and identify any changes in elevation, as even the smallest change could be dangerous. Prime locations to check include transitions from one room to another, particularly when the flooring type is different.

An often overlooked yet easy-to-make change for aging in place is home lighting. As we age, our need for more light can be critical for two important reasons. First, for those with cognitive decline, studies show that more light in the person’s environment can help with easing anxiety and promoting a natural wake/sleep routine to reduce the incidence of sundowning. This is a phenomenon common in dementia patients where

confusion increases as it gets later in the day, often beginning at dusk and continuing into the night. Fading light is thought to be part of the triggering mechanism for the behavioral change, so maintaining a steady light source could be beneficial.

Second, better lighting can help with reading. Whether it’s for enjoyment or important tasks such as reading a prescription bottle, task lighting and general lighting improvements will make it easier to see. LED bulbs are affordable and last for a range of 50,000 to 100,000 hours of light, giving around 14 years of service. New light fixtures can help you bring your home design into the future, but sometimes a great improvement is just a light bulb change away.

Pay attention to the lumens or wattage of any bulbs you’re considering: Higher numbers mean more light. An average desk lamp has a bulb around 450 lumens or 40 watts; but if you’d like to read for long periods of time without eye strain, a bulb of 800 lumens or better is your best bet.

One of the most recognized aging-inplace tactics is the walk-in bathtub. Many television commercials have shown the ease of converting your tub/shower combination into a walk-in bathtub. The surprise for this home modification is the price. On average, a walk-in bathtub can range anywhere from $2,500 for a basic model to upwards of $13,000 for a luxury tub conversion. Most of these walk-in tubs use the existing footprint of your tub or shower and take advantage of existing plumbing connections. The primary benefit is ease of access, with a swinging door that lets you simply step inside the tub and shut the door. Optional features include whirlpool jets, hand sprayers, and heated seats and backrests.

Remaining at home as long as possible may also mean engaging a nonmedical home care company for companionship and assistance with activities of daily living. With the aid of relevant home modifications and caregivers, aging in place can be a reality.

Managing Medication for Seniors on Medicare

Answers to commonly asked questions about prescription drug plans

By Caroline Ward

The cost of prescription drugs in the U.S. has skyrocketed in recent years. Often, seniors must choose between paying a utility bill or buying their medication. If you are helping loved ones on Medicare manage their medications, you probably have a lot of questions. Below are answers to a few of the most common concerns.

How are prescription drugs covered by Medicare?

If your loved one has Original Medicare or a Medicare Supplement Insurance (Medigap) policy, then they will need to add a prescription drug (Part D) policy. However, if they have a Medicare Advantage plan, the prescription drug coverage is included. This does NOT mean that the cost of drugs is included, only that you can purchase the drugs at the Medicare rate.

Can we choose between generic and brand drugs?

Yes, but generic drugs always costs less than brand.

Do we get discounts with Medicare?

Medicare has negotiated rates with pharmaceutical providers, but there is not a standard Medicare discount. Individual drugs vary in price with different plans.

Do we get to choose our pharmacy?

Yes, but you will save money by using a preferred pharmacy.

Are the costs the same with all Medicare plans?

No, the drug costs vary widely. It is important to compare drug costs when choosing a Medicare plan.

Is there a deductible before Medicare pays?

With the stand-alone Part D prescription drug plans there is almost always a deductible. In 2023, the deductible can be as high as $505. With most plans, however, the deductible only applies to drug tiers three and above.

Does Medicare pay for vitamins and supplements? No.

Is there an annual out-of-pocket maximum cost on prescription drugs?

Unfortunately, no. But there are lower catastrophic drug rates when a person has spent a

certain amount on prescription drugs in a calendar year.

Are discount programs available?

Yes, discounts are available based on income. You can check with Social Security (ssa.gov or 1-800-772-1213) to find out if your loved one qualifies for a Part D Low-Income Subsidy (also called “Extra Help”) to help pay for prescription drugs.

What is the “donut hole”?

The “donut hole” is the Part D coverage gap where there is a temporary limit on what a drug plan will pay. In 2023, when the total cost of an individual’s prescription drugs (copays plus what the insurance carrier pays) reaches $4,660, the person will go into the donut hole and will have to pay 25% of the retail price of each drug until reaching the donut hole limit of $7,400. At that point, the person enters the catastrophic phase and pays a minimum amount for drugs.

Do we have to use Medicare insurance to purchase prescription drugs?

No, you can shop for the lowest cost on drugs through pharmacy discount programs and online pharmacies. Just be careful that you are purchasing drugs from a credible source. You can verify your source through the FDA website (fda.gov) under “BeSafeRx.”

Caroline Ward is an independent senior insurance advisor. Learn more at AskCaroline.net.

Our Mother's Voice

Turning a mother’s story into an organization that promotes advocacy for those without a voice

By Kathy Bradley

In 2009, at age 76, my bright, accomplished, exuberant and loving mother suddenly declined into severe dementia. She could no longer speak or execute simple daily living or self-care tasks. This strong, independent woman resisted my father’s help and wouldn’t cooperate with in-home care. She needed the structure and assistance of a nursing home. My mother, a lifelong activist for social justice for groups in our society without a voice, became a member of a group without a voice: nursing home residents who cannot speak out when something isn’t right.

My first career consisted of providing long-term care for people with developmental disabilities, so I was quite familiar with the long-term care service arena and regulations. And I knew how to organize these complex services to meet people’s needs. I became my mother’s voice: I “listened” to what her behaviors were communicating, and I spoke up on her behalf to advocate for what she needed to have what she called “decent” treatment.

Unfortunately, the staff were trained to conform all residents to the facility’s schedule,

routine and way of doing things without regard for each resident’s personhood. My mother wanted to do what SHE enjoyed, what was meaningful to her — only she couldn’t on her own. She was labeled combative, resistant to care, noncompliant and agitated; the staff tried to medicate her into compliance. I refused consent to these medications and pushed for staff to learn my mother’s language: behaviors that were telling them what she needed and what wasn’t right.

All seven levels of organizational hierarchy rejected my pleas, so our family utilized our state’s regulatory agency to change the facility’s practices. Surveyors found that the practices were systemic and cited deficiencies. Change began to happen for my mother and all residents. The process was long; the results were amazing. My mother went from suffering from dehydration and urinary tract infections every six weeks to enjoying two years of good health. She received therapies that kept her as strong as possible and assisted with daily personal activities, enabling her to chew and swallow whole foods, not just ground-up globs. All the residents benefited from these changes.

My sister asked, “What do families do without someone who knows how to make the system listen?” Our Mother’s Voice was born. Established in 2010, we provide nocost information and resources to empower advocacy for those in long-term care, in any setting. Our website includes essential, practical information about what quality care looks like, how to recognize quality of life in daily routines, resident rights (and how families can exercise these rights for their loved ones), step-by-step tips for empowered advocacy, and scores of additional well-organized resources. We conduct online and in-person presentations on many topics and provide individualized information and resources for those needing more specific information for their situation. We do the research because we know what to look for and where.

For more information visit ourmothersvoice.org, or email us at contact@ourmothersvoice.org.

Putting It in Reverse

Why self-care is the most important aspect of caregiving

By Emma Hynek

While caregiving is an incredibly rewarding experience, it comes with a unique set of challenges. When wholly supporting the needs of loved ones, caregivers often put their own obligations on the back burner — and sometimes completely neglect them.

In South Carolina, caregivers provide approximately 610 million hours of unpaid care annually, valued at over $7.6 billion, according to the South Carolina Respite Coalition. A survey study by the Centers for Disease Control (CDC) reports that nearly

one fourth of adults nationwide aged 45 to 64 are caregivers, making caregivers a cornerstone of our public health system. So, what happens when the caregiver becomes the one in need of care?

For the necessary standard of care to be provided, it is vital for both the patient and the caregiver that the health of the caregiver is preserved. More than half of the caregivers in the CDC survey reported a decline in health that compromises their ability to provide care. Without proper wellness habits, caregivers risk their occupation taking a detrimental toll on their mental and physical health.

Mental Health

In the CDC survey, 14.5% of caregivers reported experiencing 14 or more mentally unhealthy days during the previous month. Furthermore, the Family Caregiver Alliance (FCA) reports that caregivers show higher levels of depression, stress and frustration than their noncaregiving peers.

“Some 16% of caregivers feel emotionally strained, and 26% say taking care of the care recipient is hard on them emotionally … Caregiving can also result in feeling a loss of self-identity, lower levels of self-esteem, constant worry or feelings of uncertainty. Caregivers have less self-acceptance and feel less effective and less in control of their lives than noncaregivers,” the FCA states. These negative mental health effects are found to be worse for female caregivers than for their male counterparts.

Physical Health

In the CDC survey, 17.6% of caregivers reported experiencing 14 or more physically unhealthy days during the previous month. Survey participants also had an increased risk for chronic disease and disability:

• 40.7% of caregivers reported having two or more chronic diseases.

• 53.4% of caregivers aged 65 years and older had two or more chronic diseases, compared to 34.8% of caregivers aged 45 to 64 years.

• 33.0% of caregivers reported having a disability.

• 35.5% of caregivers aged 65 years and older reported having a disability, compared to 31.9% of caregivers aged 45 to 64 years.

The FCA reports similar statistics:

• In a national survey, almost three quarters of caregivers reported that they had not gone to the doctor as often as they should, and more than half (55%) had missed medical appointments.

• Approximately six in 10 caregivers noted subpar eating (63%) and exercising (58%) habits compared to their time prior to caregiving.

• When comparing elderly spousal caregivers (aged 66-96) who reported stress from caregiving with their noncaregiver counterparts (aged 66-96), the study found that the caregivers had a 63% higher mortality rate.

Poor caregiver health can stem from a lack of preparation when taking on the caregiver role, the FCA says, as well as consistently neglecting self-wellness needs. The bottom line is you’re no good to anyone else if you don’t take care of yourself. Luckily, there are many practices and resources available to ensure you are happy, healthy and effective as a caregiver.

Preparing to Become a Caregiver

While many caregivers are put in the role with little to no advance notice, there are ways to prepare if you think you may become a caregiver at some point. There is a wide variety of educational literature available to caregivers who want to learn more about caregiver selfcare. (The Caregiver Resources tab on caregiver.org is a great starting place.)

The CDC suggests making a care plan detailing medical conditions, necessary medications, insurance and other personal information pertaining to the person being cared for. You can view an example of a care plan on the CDC website. Caregiver training is also available for those who would like to learn more before or during their caregiving experience.

MovingYou Where LifeTakesYou

Ask for Help

Asking for help is easier said than done. Like many things in life, caregiving can take a village. Taking on the mental, physical or emotional wellbeing of another person can feel like a huge individual burden, but it doesn’t have to be.

One option available to caregivers to help them bear their burden is respite care. Respite care provides short-term relief to caregivers. It can be anywhere from one day to several weeks in length and comes in many forms to best accommodate a variety of needs. According to the South Carolina Respite Coalition, just four hours a week of relief for a caregiver can make a positive impact.

Remember: You are not alone. There are resources for any situation you may find yourself in, and there are always people available to help. Caregiving is not easy, and it’s a learning process for everyone involved. Remind yourself that you’re doing the best you can and taking care of yourself in all capacities is just as important as taking good care of your loved one.

Caregiver Self-Care

As the saying goes, you can’t pour from an empty cup. Though it may be difficult, the best thing you can do as a caregiver is to first ensure that your own mental and physical needs are met.

• Get regular checkups from your medical provider. This serves as a preventative measure as well as a way to treat any ongoing medical issues, particularly those that could be worsened by your role as a caregiver.

• Ensure your necessary prescriptions are filled and picked up in a timely manner.

• Be intentional about making time for yourself. It can be tricky given the unexpected circumstances that often accompany caregiving, but allocating this time is important, allowing you the chance to rest, exercise, run errands or do whatever it is that helps you recharge.

• Eat a balanced diet and get regular exercise to help ward off chronic illnesses, keep you feeling healthy and lower stress levels.

• Talk to a therapist. For those short on time or funds, there are plenty of accessible options today. Check with your insurance about local providers in your area, or try out an online option like Better Help, Talkspace or Cerebral.

• FCA suggests ensuring you are communicating clearly and in a healthy manner, both with the person in your care and those around you. “Being able to communicate constructively is one of a caregiver's most important tools. When you communicate in ways that are clear, assertive and constructive, you will be heard and get the help and support you need.”

• Get back to the basics. What makes you feel your best? What are your favorite hobbies? Take a moment to answer these questions, and start to add time into your day for engaging in these activities. While new wellness trends seem to appear on the internet or social media every day, self-care truly doesn’t need to be complicated.

Paying for Long-Term Care

There’s more than one way to skin this expense

By Carl “Doo Dad” Cease

We’re all getting older. At some point you, or someone you know, will need help in the aging process. It may be a simple case of arranging house cleaning, medication administration and yard work or a more complex case where dementia is a factor. The two overriding questions are “Who can help us?” and “How are we going to pay for it?” The “who can help us” is a topic for one smarter than I, but the “how are we going to pay for it” we can tackle right now.

A month ago my phone rang, and it was a client in upstate South Carolina. I’ve known him for years — watched his business grow, his marriage suffer and dissolve and his children make their way through elementary school. The first words out of his mouth were “I need to talk to you about long-term care insurance.” After a few questions, I understood that his

problem was how to pay for long-term care (LTC) expenses for himself — at the least possible cost. And we solved his problem with a life insurance policy. “How does a life insurance policy help with long-term care expenses?” I hear you ask. “Very well” is my response. Here’s how it works.

Let’s pretend you’re 45 years old and want to avoid burdening your children as you age. You purchase a $250,000 whole life insurance policy that has an LTC access rider attached to it. And yes, I know there are talking heads that despise whole life insurance. Stay with me, and make your own informed decision.

The LTC access rider allows the policyholder to accelerate the payment of a portion of the death benefit to help pay for covered LTC expenses. It pays for both home and facility care on a reimbursement basis. Let’s put numbers to this for clarity. You purchase the policy at 45, and 30 years later you need help three days a week after you take a fall. The three days each week will cost $1,000 a month and allow you to stay in your home safely and securely. After 14 months, your strength and health are such that help is no longer needed.

• Initial death benefit purchased $250,000

• Funds used during 14-month period $14,000

• Remaining death benefit $236,000

If you need additional care, perhaps in a facility setting, the process is the same. If you don’t need the remaining $236,000 for care, that money passes to your beneficiary. Note that this is a very simple example and does not consider the cash value of the policy, any paid-up additions through dividends and a host of other considerations. Specific insurance companies structure their riders and the guidelines to access that money differently, so it pays to ask questions.

Next time we’ll talk about traditional long-term care insurance and how it may be — but probably isn’t — the best financing mechanism for care.

Now Hear This!

Shop with care when considering new lower-cost hearing aid options

By Jeanne Reynolds

Ellen* is 90 years old and wondering if she’s losing her hearing. She often has to ask people to repeat what they’ve said, has trouble following conversations on television or at the movies, and finds noisy restaurants uncomfortable. But she refuses to get her hearing checked, saying, “It’s not that bad, and besides, hearing aids are too expensive.”

She’s not alone. More than 37 million Americans over age 18 report some trouble hearing, according to the National Institute on Deafness and Other Communication Disorders. Not surprisingly, older adults bear most of this burden: Johns Hopkins University researchers report about half of all Americans older than 60, and two-thirds older than 70, have

some degree of hearing loss, and many are reluctant to admit they have a hearing problem.

But being able to hear properly is too important to ignore. A Johns Hopkins University study that tracked 639 adults for nearly 12 years found hearing loss is linked with walking problems, falls and even dementia. Hearing loss also can lead to socialization and isolation problems as communication with family and friends becomes more difficult.

Sounding out options

Ellen is right in at least part of her statement: Prescription hearing aids can make a deep dent in your wallet. The National Council on Aging pegs the average price at $4,600 a pair, and some models can cost thousands of dollars more.

But, following a recent ruling by the U.S. Food and Drug Administration, prescription hearing aids are no longer the only option for people with hearing loss. Adults with mild-to-moderate hearing loss can now buy (for half or less of the cost of prescription models) hearing aids at retail stores or online without a prescription, exam or audiologist fitting. And while that might sound like an ideal solution for seniors with limited incomes, some experts urge caution. They advise older adults and their caregivers to balance lower cost with downsides such as lack of testing, poor fit and absence of professional guidance in selection.

Testing

“It’s impossible to know if your hearing loss is ‘mild to moderate’ unless you’re tested,” says Dr. Meg Kalady, an audiologist in South Carolina with nearly four decades of experience. “You also need to know the ‘shape’ of your hearing loss to know what type of hearing aid will work best for you.”

Some people have trouble hearing highpitched or low-pitched sounds, others have hearing loss in only one ear, and yet others have different levels of loss in each ear. Testing will show, for example, whether an open-dome or closed-dome hearing aid will help most.

Testing also is essential to spot or rule out medical reasons for hearing loss, such as an infection, tumor or even just excessive ear wax. People with diabetes should be tested every year, Kalady advises, because the condition can affect blood flow to the cochlear system.

Fit

Nonprescription hearing aids aren’t custom-fit for the patient and may come with limited options. “If it’s uncomfortable to wear, you’ll quit using it,” Kalady says.

However, some audiologists, like Kalady, are willing to work with patients who’ve purchased hearing aids online or over the counter to help them fit and perform better.

Knowledge

Uninformed decision-making also can lead to poor choices when buying nonprescription hearing aids. Whether shopping online or in a local drug store, the choices, options and features can be overwhelming, with prices ranging from $200 to $3,000. Some retailers may add to the confusion by not clearly differentiating between hearing aids and simple sound amplifiers that only make sound louder.

“People often don’t know what questions to ask,” Kalady says. “You don’t know what you don’t know.”

Weighing the costs

Despite the publicity over lower costs, Kalady says the decision to buy prescription, online or over-the-counter hearing aids usually isn’t financial. “It rarely has to do with money. More likely they’re not ready or don’t think there is a problem.”

If cost is a concern, some practices offer financial support for prescription hearing aids, such as payment plans or discounts for low-income patients. Patients also may be able to lease prescription hearing aids on a monthly plan, then buy them or upgrade to newer technology at the end of the lease period.

“There are lots of different options,” Kalady says. “There’s no harm in finding out.”

Though over-the-counter and direct-to-consumer hearing aids do have at

least one upside, she points out.

“They may get people to start the process earlier. The average time from knowing you may have a hearing problem to doing something about it is seven years. Let’s get them into hearing aids sooner.”

*name changed to protect privacy

FIND YOUR

FIT

A side-by-side comparison of over-the-counter and prescription hearing aids

FEATURE

Hearing loss level covered

Average price

Where available

Prescription required

Fitting

Programming

OTC

Mild to moderate

$1,600 (est.)

Drug stores, discount stores, electronics retailers

No Self-fitting Self-programmed Many come with a smartphone app to adjust volume and settings

PRESCRIPTION

Mild, moderate, severe and profound

$4,600

Hearing clinics, audiologist practices

Yes

Custom fit by audiologist

Custom programmed by audiologist

Features

Post-purchase care

Warranty

Typically fewer

Some brands offer remote evaluations and adjustments by an audiologist

Usually shorter

Source: National Council on Aging

Typically more

In person by audiologist

Usually longer

Celebrating 60 Years

Helping Seniors Navigate Telehealth

What is telehealth, and why would seniors want to use it?

By Earl Gregorich

Healthcare, over the phone or on a computer!? How is that even possible? A doctor has to SEE and TOUCH you. You can’t possibly get a reliable checkup talking to someone on a gadget!

This is a common perspective of seniors who are unfamiliar with telehealth or patient portals. But a recent study by the Office of the National Coordinator for Health Information Technology found that 90% of hospitals offer online access to medical records, and 69% conduct regular telehealth appointments. The American Medical Association also shows a 40% increase in patient portal usage during the pandemic. So, let’s define telehealth and examine what makes it a viable option, while addressing the challenges to help make the transition a bit easier.

Telehealth is …

Telehealth, or telemedicine, and patient portals are convenient, especially for those with transportation challenges. Conducting appointments on a mobile device means you can contact a doctor no matter where you are. This is as useful for the homebound as it is for seniors who are living out retirement on the road. Plus, telehealth is normally available 24/7, so getting appointments is less stressful. Telehealth is also safer due to fewer germ-laden

doctor’s office visits. It may even enable a patient to go home for recovery and rehab faster instead of staying in a medical facility.

Telehealth is not …

As great as it may sound, telehealth is not for everyone. Technology can be a challenge, so it may actually complicate some situations. Usually, you must have a third-generation (3G) or newer device and a secure internet connection (through a VPN, virtual private connection) to use patient portals. Internet speeds and your loved one’s trust in and comfort with technology, as well as the medical situation, also dictate whether telehealth makes sense.

One clarification: The terms patient portal, telehealth and telemedicine get used interchangeably. The concept is the same for all three in that they describe remote and virtual healthcare. However, patient portals typically only allow access to patient information and the ability to do simple transactions without interaction with a medical professional. This typically means the ability to make appointments, pay bills and update records. Telehealth and telemedicine usually accommodate a remote, virtual interaction with health professionals. All virtual sessions require interactions conducted in accordance with Health Insurance Portability and Accountability Act (HIPAA) guidelines.

Understanding the health challenges of your loved one is important. The more you know about the health goals of your parent and their doctor, the easier it will be to assist in their telehealth journey. It will also help if you need to intervene and advocate for a face-to-face appointment or step in to clarify a point made on a call.

There are many advantages and disadvantages to telehealth. When approached properly, it can make caring for a loved one much less stressful. Following the tips in the sidebar and consulting some of the online resources listed below should help make your implementation of telehealth a success.

• TeleHealth.HHS.gov

• National Council on Aging: NCOA.org

• AARP.org

• AgingCare.com

Reap Telehealth Benefits, Minimize Its Challenges

Making telehealth a pleasant and effective experience may be a challenge you are facing with a loved one. These tips can help make telehealth a regular part of their medical routine.

 Be patient; this is new to everyone!

 Acquire and test the right technology. Practice logging in and using the microphone and camera. Consider creating a paper quick-reference guide with visual aids to help seniors navigate when they get frustrated. (See the Reverse March/April issue for additional technology pointers.)

 Consider internet quality. Remember, broadband access is not available in all rural and low-income areas. But if there are higher speed options, it may be time for an upgrade.

 Audio-only appointments may make more sense if poor internet speed is a problem. However, audio-only is recommended for more basic interactions like follow-ups, lab results and medication adjustments.

 Physical or cognitive challenges may limit the usefulness of patient portals and online appointments. You may need to be present during appointments in these cases.

 Ensure there is a private, quiet place for appointments.

 Pre-plan each call so your loved one is prepared and gets the information they need. Discussing likely questions and answers before the call can be helpful. Gather a list of all medications and notes on recent diagnoses.

 Try to make yourself available during and after the call, especially the first few times the technology is implemented.

 Accept that telemedicine is not for everyone. If it does not seem to be a good match for your loved one, be prepared to intervene with the medical professionals to find an alternative.

“Keep the Memories, Lose the Stuff: Declutter, Downsize, and Move Forward With Your Life”

by Matt Paxton

REVIEW BY KINSLEY TURNIPSEED

ut I don’t want grandmother’s china or Aunt Edna’s vase!” Such cries are common when family members sort through forty years of items in an older loved one’s home. Whether your family member is moving to a senior living community or has passed away, Matt Paxton’s “Keep the Memories, Lose the Stuff” is required reading.

Paxton, host of “Hoarders” and “The Legacy List with Matt Paxton” television series, offers a delicate walk through the senior move manager’s role. This how-to focuses on decluttering, downsizing and moving forward in life with your older loved ones, many of whom survived the Great Depression and have a hard time letting go of possessions. His practical advice encourages families to uncover the stories behind the items, establish a finish line, and take baby steps during this overwhelming season.

Chapters address practical solutions on sorting pictures, building a legacy list, donating, deciding where and what to sell, and cleaning up afterwards to sell the home and move on to the next great adventure.

Paxton acknowledges that “choosing what to hold on to and what to get rid of will probably be the hardest part.” He also defines a “legacy list,” explaining why making one is imperative: It enables us to focus on what we are keeping rather than what we are disposing of. That’s an important mindset shift when we downsize. Building your legacy list requires discerning between financially valuable items and items that hold sentimental value — which are not normally synonymous.

Paxton thoughtfully includes resources for researching charities, visiting senior living communities, shredding paperwork and much more. Easy to read, practical, often conversational and empathetically written, this book is a must-read when beginning the delicate conversation of what to do with your loved one’s stuff.

The Caregiver’s Training Program

Following My Mother’s Lead

By Molly Aston

A

The last time I saw my mother in her home, she stood peeking out from behind my brother-in-law, her pupils magnified by thick glasses and her back curved with age. I felt anxious, and sadness welled up in me as I turned to head home in another state.

by Melissa Sprouse Browne, founder of

This was several years after she was diagnosed in 2004 with Alzheimer’s disease, the most common form of dementia. At that appointment, the neurologist asked my mother to repeat back what she’d been told. Her response was disjointed as she searched for the right words. But she acknowledged that she understood she would lose her memory and ability to function normally. My gut wrenched in the awkward silence that followed.

We’d seen the signs: the repetition, the often-illogical conclusions, the comments from neighbors that she seemed disoriented. The behaviors her general practitioner dismissed as aspects of normal aging were now clearly not. We left the hospital and headed to a favorite restaurant for lunch. Before we had time to order, my mother announced: “I’m all right with that diagnosis. I have lived a good life. I love my home and my garden, my flowers. I’ll be fine.” My sister and I were dumbfounded. Thinking back, those few sentences formed my approach to my mother’s dementia diagnosis and her care: I also would do whatever I could to be all right with her diagnosis.

Fast forward to 2008: It was clear our mother would likely not be able to live out her life in her own home. People made unsolicited comments about needing to make hard decisions. We began exploring options. At the local senior center, I noticed a few straggly tomato plants planted by the residents in a raised box. My heart sank — our mother was a master gardener, growing luxurious vegetables and flowers even as her dementia progressed. As I spoke with the manager, Mom tugged at my sleeve. “I’m scared,” she said, and we left. In an abandoned high school renovated into senior living space, women wrapped tightly in blankets like mummies sat propped up in recliners facing the TV — no one moved, no one said a word. Last, and worst of all, was an actual nursing home. In the dementia ward, most of the 20+ residents stood in a ragged semi-circle round the edge of a large room. Some clung to one another with fear and bewilderment in their eyes. On the trip home, looking out over a pasture with grazing cows, we decided our mother would not be going to any of those places.

That was the easy decision. The hard decisions would follow. Then, in 2009, after some agonizing and often heated discussions, my mother arrived at my home on Christmas Day to stay. Over the next few days, a nor’easter dropped several feet of snow, and the electricity went out. Ironically, as I held my mother’s hand in the dark, I felt the greatest sense of relief. That peace was a gift, since I had no idea of what was to come.

practical guide and useful tactics for caregivers. Step-by-step instructions for what to do, who to call and how to find help when you need it.

MUSC HEALTH HOSPICE CARE

MUSC Health Hospice has been serving patients with life-limiting illnesses in our Midlands communities since 1978. We are committed to providing compassionate quality care to our patients and their families through dedicated professionals who are always there.

To find out if you or a loved one qualifies for MUSC Health Hospice services, or have questions, contact us as 803-425-1182.

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