Alzheimer’s Update: An Interview with the expert
Susan B. Geffen’s
THE ROAD AHEAD Your guide for navigating the challenges of caring for an elderly parent or spouse
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The Road Ahead
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THE ROAD AHEAD Publisher Joel B. Geffen Editor Susan B. Geffen Contributing Writers Susan B. Geffen Robert Santulli, MD Joanne Singleton, MS RD LD Graphic Design Corporate Imagination
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Susan B. Geffen is regarded as the Elder Care Guru throughout much of the country based on her education and career. After receiving her BS in Audiology and Speech, she attended law school at Loyola. Susan attended U.S.C. to receive her Master’s degree in Gerontology. She taught elder law at Loyola and has written several books on aging, including, “Take That Nursing Home And Shove It!” which has been read by thousands of Baby Boomers and seniors. Susan has offices throughout Los Angeles, Orange County and Ventura County, where she practices elder law and geriatric care management. Susan’s “Raising UP Your Parents” seminars have been attended by over 10,000 adult children, their elderly parents and caregivers. He monthly newsletter has over 7,000 subscribers, and her Facebook page, Elder Care Guru has over 12,000 subscribers. Initial Distribution: 5,000 homes of families who have attended Susan’s seminars. An additional 5,000 provided to corporations with large Baby Boomer populations (i.e. engineering firms) in Southern California.
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A message from the editor I want to welcome you to the first issue of The Road Ahead Magazine. I struggled with finding a name that would adequately convey the essence of this magazine. I wanted it convey the importance of planning ahead with the added promise of being interesting, informative and entertaining. I also want to provide you, the adult child, spouse caring for a spouse, or a caregiver, with all of the tools you need to make well informed decisions for yourself and for those you care for everyday so that “quality of life” is always addressed first and foremost. I firmly believe what I state in every one of my “Raising UP Your Parents“ seminar, “As long as you are alive, you have a future.” In each issue (quarterly for now) you will find informative articles by me and other experts in the field of aging which are most relevant to you, the people who are feeling the stresses and challenges of caring for an elderly person, so that your burden can be eased, even if it’s just a little bit at a time. Aging is a very complicated, so let me be your guide. I have over 25 years of experience in this field and chances are I have helped many families with similar circumstances to yours. Susan B. Geffen Editor editor@susanbgeffen.com
www. theroadaheadmagazine.com
Articles 6 Financial Insights Planning on Retiring? 10
18
Living Abroad
How to Find Affordable Places to Retire in France
14
Alzheimer’s Today
Alzheimer’s Disease - An Interview with Robert Santulli, MD
16
Nursing Home Rant
Many nursing home evictions are just another form of elder abuse
20
Ask the Dietitian 21 Know Your Elder Law
Know When To Seek Counsel
23 Watch Dog Report
Features 12 Choosing the right care options for your elderly parent or spouse
The ultimate betrayal
18 Everyone Needs Love
26
24 H earing loss speeds up brain shrinkage and could
Susan’s Funnies 28 On The Radar
State and Federal Laws
30
lead to dementia, researchers claim
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21
Calendar of Events 30
The Long Term Care Ombudsman
The Road Ahead
5
Financial Insights
Planning on Retiring? Y
ou’ll want to make sure one of the most important and expensive aspects of your golden years—your future health-care needs—is not overlooked. “You might start out just needing some help for a few hours a day, but that can progress to where your level of needed care increases significantly,” said certified financial planner Avani Ramnani. “It can add up quickly.” Blowing through hundreds of thousands of dollars for medical ex6
penses in retirement is a reality for many people. According to data from Fidelity Benefits Consulting, a 65-year-old couple retiring this year will need about $220,000 to cover medical expenses throughout retirement, not including the cost of long-term care. This is unchanged from last year, but down from a peak of $250,000 in 2010. “Our clients are watching parents in their 80s or 90s deal with health-care costs,” said Ramnani, director of finan-
cial planning and investment management for Francis Financial. “Because of that, they are getting more serious about health-care needs for themselves.” A Merrill Lynch study shows that Americans age 50 or older, regardless of wealth, peg medical costs in retirement as their biggest financial concern. Yet most of them have not factored those costs into retirement planning, and 70 percent of couples that age haven’t discussed how much they should save to fund those expenses. www. theroadaheadmagazine.com
Planning Ahead Eases Grief for Loved Ones
T
f
hough it’s not a topic most of us want to think about, planning for what happens after your death and understanding your options can reduce the stress on grieving loved ones. Making decisions now about what happens when you’re gone can help assure those left behind that your wishes are being honored. The death of a loved one is always stressful. Fortunately, preplanning is something you can do now to help your family. Often, family members and friends are unsure of the answers and worry about making poor choices. Preplanning can help your family make better choices and significantly reduces the number of difficult decisions that traditionally confront loved ones at a time of loss.
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Evaluate a decade in advance
While health care is a key part of any financial plan, regardless of age, Ramnani and other advisors say workers within 10 years of retirement should take a detailed look at their anticipated medical costs in retirement. Included in that evaluation: your anticipated coverage, whether you face a gap between employer-sponsored insurance and Medicare, your current medical expenditures and whether you need long-term care insurance. “The closer you are to retirement, the better an idea you have of your situation,” Ramnani said. One tricky period has been the gap between employer-based insurance and Medicare, which kicks in at age 65. In 1997, 28.9 percent of early retirees were offered medical coverage through their ex-employers, according to the Employee Benefit Research Institute. By 2010, that number had dropped to 17.7 percent and is expected to continue dropping. That gap is when the Affordable Care Act, aka Obamacare, can be a boon to some early retirees. Certified financial planner David Jackson has a client who wanted to retire early several years ago, but the estimated $600 monthly expense for medical insurance was prohibitive. The ACA made it possible for her to retire this year at age 61 because her monthly premium is about $150. As of this year, the ACA sets limits on how much insurers can charge older buyers, and insurers can no longer reject people due to preexisting conditions or charge them more because of one.
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Additionally, if your income is within 400 percent of the federal poverty level, you might qualify for a subsidy. Most people see their income drop when they retire, so this provision in the law can be helpful for early retirees. “The ACA might not help a high earner that much, but for ordinary people making $50,000 or $60,000 a year, it makes a huge difference,” said Jackson, an advisor with Waddell & Reed. Once Medicare kicks in at age 65, picking a plan differs little from choosing a plan at work or on an ACA health-care exchange. Different plans offer different coverage, but the Employee Benefit Research Institute says that in general, Medicare covers about 60 percent of the cost of heath-care services, not including long-term care. Ramnani said that to arrive at an accurate number, her firm estimates what kind of coverage might be chosen by clients and by what they pay out of pocket currently. “They might be using out-of-network providers or have specific health-care needs not being covered by insurance,” she said. “We assume those expenses will continue.” The biggest costs come from co-payments, deductibles and excluded benefits, along with out-of-pocket costs for prescription drugs and the cost of premiums for Medicare Part B (basic coverage) and Part D (prescription drug benefits). Premiums for Medicare are based on income; the higher your income, the more you’ll pay. Beyond basic coverage, there also are other options that come with additional costs. “It’s [typically] the end of life when you have the really bad stuff that costs a lot of money.”-Ray Benton, certified financial planner at Lincoln Financial Advisors On top of all that are long-term care needs that arise from chronic illness, disabilities or other conditions that require daily assistance. Medicare doesn’t pay for continuing care in nursing homes, assisted living or home-based aides. That’s where long-term-care insurance comes in. The cost is based on many factors, including your age when you purchase the policy and particular choices in coverage. Financial advisors recommend closely examining your options—especially because chances are that medical expenses will increase as you age. “It’s [typically] the end of life when you have the really bad stuff that costs a lot of money,” said Ray Benton, a certified financial planner with Lincoln Financial Advisors.
Nondiscretionary spending
That’s where powers of attorney and a living will can come into play. A medical power of attorney gives an appointed person the right to make decisions about your medical care if you cannot. A living will makes it clear what measures you are or are not okay with when it comes to keeping you alive. “You ultimately save money, but it’s really more helpful for family members because they know what your wishes are,” Benton said. “Without it, it’s an emotional thing and a very hard decision for family members.” The most important thing to remember, say advisors, is that medical care falls into the bucket of nondiscretionary spending. You can forego a vacation or a dinner out, but you can’t avoid paying for health care. “It’s just part of your cash-flow planning,” Bention said. “You should address it as you would any other necessary expense that will carry over into retirement.” n www. theroadaheadmagazine.com
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Living Abroad
How to Find Affordable Places to Retire in France
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n expat in the South of France offered a great overview of how to find affordable villages. He said, “further east = more expensive; further north (i.e. away from the coast) = cheaper; close to city commuters = more expensive. These days many small villages have no shops. A medium cost area would be between Montpellier & Nimes in a medium sized village. Within 2 hrs you would have access to airports in Lyon, Marseille, Nimes, Montpellier, Carcassonne, Perpignan, Girona (Spain) and access by TGV to Paris in 3 hrs.” Here are some top suggestions:
Living in Brittany, France
Saint Malo France “I would recommend Brittany. I find the people there warm and friendly. It is rainier than Dordogne, however, and again, there are a whole lot more English speakers in the latter, you may even be able to make it by without any French in some villages. Brittany has a culture of its own, the ocean is beautiful,” said one expat. Another said, “much of the area is rural with the countryside dotted with small villages and hamlets. Transport seems to be quite good with access to the TGV from major points. What I’ve read is that it is 2 hours to Paris. The nice thing about Brittany is that there is a huge British expat community, so English speakers are plentiful for those who are a bit tentative in the language department. Brittany is known for its seafood and is the place crepes hail from. Housing is fairly inexpensive for the most part; I have seen ads for 2 bed houses for rent for 500 euros. Brittany has lakes to fish, trails to hike and bike,
beaches to sit on and history to learn about. Most villages have a doctor, and hospitals are easily accessible, however Rennes is the largest city with good medical care. Bonus is that ferries regularly cross the Channel to England and there are ones that go to Ireland as well as Jersey.”
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Pezenas France “Dordogne is very French in it’s own way, the food is excellent, and the landscape beautiful. Basically, both areas are very nice and different from each other. Rural public transport is definitely a weak point here,” explained one expat. “This is south center France about equidistant from Atlantic to Mediterranean, Spain to Germany which means it’s not close to anything. But there are plenty of water sports and winter sports close by. Property prices are good and taxes and services not bad. There are many tourists here in Summer. There is not much diversity. Retired expats are mostly British. Anyone looking for an active nightlife would not be satisfied with what is available here and the closest larger cities where it might be offered, Tulle and Brive-la-Galliard are each about a 45 minute drive. If one is seeking a quite, rural friendly place, this is a good choice,” described one expat in Beaulieu-sur-Dordogne. www. theroadaheadmagazine.com
Retiring in Pezenas, France
Pezenas France “I love living amid Roman, Greek, and French history. I spent a year in an apartment while looking for a suitable house. Now I live in a small, 400 yr old village in a house down the street from a 12th century templar castle. Winters are mild, lasting 6 to 8 weeks around xmas. There are ski slopes 90 min away and the beaches are 25 min away from my house. We have a large expat, multi-national community since this is a popular retirement area. My income as a retiree is less than $35k and my lifestyle is simple. I travel as a retiree getting discounts where they are available. Often times travel agents will ask my age and then give me the discount without questions.” said one retiree in Pezenas.
Retiring in Uzes, France
Uzes France One expat said, “I’d like to suggest Uzes, a lovely medieval city near Avignon, Nimes, Montpellier and not far from sandy beaches. It’s in the Languedoc-Rousillon, which is cheaper than anything east of the Rhone River and only about 3 hours by TGV fast train to Paris. I’m thoroughly enjoying living there with lots of cultural and artistic events and many expats. Anybody can buy or rent and you have to have a residency permit from a French consulate in order to stay all year.” You don’t even need a car to live in Uzes explained one expat, “bus transportation is available and the TGV is an hour away
by bus in Avignon or 45 mins away by bus in Nimes. Bikes are available to rent. Uzes has the largest Saturday market in the area and lots of boutiques, cafes, etc. etc. Take a look at their Office de Tourism web site. My car sits in the garage begging to go somewhere!”
Retiring in Languedoc, France
Languedoc France An expat in Languedoc said, “as an American who has owned a second home in France and will be retiring there in about a year, let me put in my vote for the Languedoc. The climate approximates North Carolina’s Golden Triangle - moderate winters with no more than a dusting of snow once or twice that never lasts, the summers can be a bit hot, but the Mediterranean with its beautiful beaches is within reach. In the winter, the Pyrenees have wonderful ski runs. And the Haut Languedoc National Forest is a treasure for trail hikers. Yes, lakes and rivers and such can all be found in abundance. Housing is a bit more expensive than Brittany but that’s because of the climate. As is the case in most of France, there are plenty of English speakers, mostly Brits, and the doctors and such often have spent some time training in the States or England. There are international airports in several small cities and Barcelona is not too far away for all international n
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The Road Ahead
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Choosing the right care options for your elderly parent or spouse By Susan B. Geffen
C
aring for someone can be time-consuming and exhausting—for you and your bank account. Family and friends can step in to assist, of course, but there may come a point when your loved one needs professional care. Here are some basic options to consider.
Home sweet home
In-home health aides average $19 an hour, and hired companions who don’t provide health care are slightly less expensive. Do the math and you’ll see that for round-the-clock assistance, the tab can run as high as $170,000 a year, making home care a very costly option. “It’s so expensive because people are basically trying to recreate the nursing facility at home,” says Chris Cooper, a certified financial planner and social gerontologist in Toledo. Medicare and private insurance generally do not cover longterm in-home care. So unless you have a long-term-care insurance policy, the cost must be paid out-of-pocket, which may mean liquidating assets or applying for a reverse mortgage. Despite the expense, “most people try to do what they can to stay at home before placement in a facility,” says Nancy Wexler, a Los Angeles–based geriatric care manager and author of Mama Can’t Remember Anymore: Care Management of Aging Parents and Loved Ones. The good news is that many people don’t need 24-hour care, at least not right away. Someone with a chronic condition like heart disease, for instance, might only need help with specific tasks, like meal preparation or bathing. To find an in-home aide, ask others who have used one or consult a geriatric care manager. It might cost more to employ an aide through an agency, but if any sort of problem arises, the agency will furnish a replacement quickly. That beats spending stressful days trying to find aides and conducting background checks.
available. The level of medical care depends on the facility, but most cant offer the kind of round-the-clock professional medical attention that’s common in a nursing home. The average cost for assisted-living facilities in the United States is just under $3,000 per month (more than $35,000 per year), according to a 2007 market survey conducted by MetLife. In a growing number of states, at least some assisted-living services are covered under Medicaid, the government health-care program for low-income people, but most people pay for it themselves or through a long-term-care insurance policy. When researching assisted-living facilities, be sure to read the fine print. “As soon as you need something more than the basics, they raise the rate considerably,” cautions Wexler. Also, you can’t assume the facility will automatically up the level of care when your loved ones health situation changes, warns Matthews. You’ll need to monitor the situation to make sure he or she is getting the proper treatment. n
“most people try to do what they can to stay at home before placement in a facility,” says Susan B. Geffen
Assisted living
“Assisted living is not as institutional and depressing as many nursing homes,” says Joseph L. Matthews, the author of Long-Term Care: How to Plan & Pay for It. “It allows you to have your own living space, but it provides a level of monitoring that most can’t afford at home.” A key benefit of an assisted-living community is that, should your loved one’s health deteriorate, services are already in place to provide extra care in the same facility. He or she can start with a basic apartment and live independently, with services such as cleaning, meals, and transportation taken care of. If additional assistance is needed—with dressing, bathing, or walking, for example—that help is 12
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Alzheimer’s Today In this regular column, we begin with an interview with Dr. Robert Santulli, geriatric psychiatrist to establish a base for future articles about advancements in Alzheimer’s research and new therapies on the horizon.
Alzheimer's Disease An Interview with Robert Santulli, MD beginning of Alzheimer's or some other dementia. This is usually not the case. In fact, it's common for people as they age to have a little more trouble with their short-term memory. It's also normal to have less ability to recall names or think of words as quickly as they once could previously. While this can be annoying or frustrating, or embarrassing, it may simply be a phenomenon of normal aging. There are also many other medical conditions, both physical and psychiatric, that can cause some impairment in the ability to think and remember. The symptoms may not indicate a primary memory problem at all, but could be a result of a condition like depression or side effects from a medication. Once the cause of these symptoms is identified they can, in most cases, be successfully treated."
Q: WHAT IS ALZHEIMER'S DISEASE? “Alzheimer’s disease is a disorder of memory and other thinking problems, which is severe enough to affect life on a daily basis. It involves loss of short-term memory but also other things like the ability to express yourself with language, the ability to perform certain routine tasks like getting yourself dressed or operating a piece of equipment. It has a lot of emotional symptoms that can go along with it as well such as depression or anxiety, sleep disturbance, agitation, and so forth. Alzheimer’s disease is not an inevitable part of aging, it’s a disease process. And when people are concerned about how their memory is functioning or concerned about a loved one who seems to have trouble with their memory and their thinking, they shouldn’t just assume that it’s due to old age. They should go to their doctor and have an assessment done. That assessment may be reassuring to them or, it may indicate that a problem exists that needs further diagnosis and treatment. But it is important to get that assessment early on rather than to wait until things have progressed to a significant degree.” Q: WHAT ARE THE NORMAL SIGNS OF AGING AND WHAT'S CAUSE FOR CONCERN? "Many people worry that when they forget where they put their car keys or can't think of someone's name, this may mean the 14
Q: WHAT ARE SOME OF THE SIGNS AND SYMPTOMS OF ALZHEIMER'S DISEASE? "The most common symptom associated with Alzheimer's disease is loss of short-term memory. People may remember what they did decades ago but can't recall things that happened in the last five minutes or the last couple of days. Other changes that may develop include loss of interest in activities, general withdrawal, or apathy. Difficulties with language, such as not being able to speak clearly and convey ideas with words frequently occurs as well. People also may develop difficulties performing routine tasks such as driving a car, shopping, cooking and operating the TV remote control or other pieces of equipment. Eventually, as the disease progresses, more fundamental daily functions are affected such as being able to eat, get dressed, take a bath, walk, or use the bathroom." Q: WHAT KIND OF RESEARCH IS BEING DONE REGARDING THIS DISEASE? "Here at Dartmouth-Hitchcock Medical Center, we are doing some very exciting research looking at individuals who have mild cognitive impairment as well as early Alzheimer's disease. We're studying them using a wide variety of neuro-psychological tests, MRI scans of the brain, and a new technique called functional magnetic resonance imaging or functional MRI. We're observing people as they perform various memory and thinking tasks and we're able to observe what's going on in their brain at the time they're engaged in those activities. We can see differences in people with no cognitive impairment and those who have even very mild cognitive problems. This technique, although currently experimental, should help us be able to diagnose people very early on and to understand more about the function of the brain areas that are most involved in Alzheimer's disease. www. theroadaheadmagazine.com
Q: HOW IMPORTANT IS EARLY DIAGNOSIS? "It's very important for people who have a problem with their thinking and memory to get evaluated. If they are unfortunate enough to have the disease, it is important to get diagnosed and begin treatment as early as possible. We now have several medications to help control symptoms like memory loss and delay the progression of the disease." "Slowing the disease progression is very important because this is a disease that otherwise just gets worse over time. We found that the earlier we start treatment the more likely someone is able to maintain independence longer, participate in their own health care decision making and other life decisions, and generally function better for a longer period of time." Q: HOW FAR ARE WE FROM A CURE? "Currently, there is no cure for Alzheimer's disease, but there is a tremendous amount of research going on around the nation and around the world and one day I hope we will have a cure. We are beginning to understand more about some of the biochemical abnormalities that are occurring in the brain, which seem to be the starting point of the disease. However, we're not yet at a point where we can interrupt, reverse or cure these abnormalities or identify the people who are developing those abnormalities before showing any clinical signs." Q: WHAT SUPPORT GROUPS ARE AVAILABLE FOR CAREGIVERS, FAMILY MEMBERS AND PEOPLE DEALING WITH THE DISEASE? "Alzheimer's disease is an extremely trying condition, not only for the person who suffers from the disease but for the family as well. It really is a family illness. The primary caregiver, the spouse or adult child of someone who has Alzheimer's, really The Road Ahead
has a great deal on their hands. They are trying to provide care and support and maintain a relationship with someone whose memory and ability to function independently is fading. It's extremely stressful and we know that caregivers suffer a great deal of emotional distress themselves. There are support groups all over the nation, and right here in the Upper Valley there are a number of them. At Dartmouth-Hitchcock Medical Center, we have a support group where people affected by the disease get together, share stories and learn new ways of coping. Research has shown that people who attend support groups not only do better over time, but their loved one who has Alzheimer's disease also does better. It's very important for family members dealing with this disease to reach out for some help for themselves as well as for their loved one with the disease." Q: LAST THOUGHTS? While Alzheimer's disease isn't curable at this point, there's much that can be done to help manage the disease to help with symptoms, perhaps to slow it down or even improve some of the memory problems and other difficulties. And there's much that can be done for the caregiver stressed by this disease. A great deal of help is available both from the medical community as well as from the Alzheimer's Association and other resources. People should seek help if they are concerned they may have symptoms of Alzheimer's disease or if they are suffering from memory impairment, or have a loved one who is. Robert Santulli, MD is a geriatric psychiatrist at Dartmouth-Hitchcock Medical Center and the former President of the Alzheimer's Association of Vermont and New Hampshire. He specializes in the diagnosis and treatment of Alzheimer's disease. The following is an interview with Dr. Santulli about the disease and advances in research and treatment. n 15
Nursing Home Rant
By Susan B. Geffen
I
very recently had the displeasure of stopping a nursing home eviction dead in its tracks. Why would someone who wrote a book called “Take That Nursing Home and Shove It!” do something like that your ask? The answer is that nursing home residents who are transferred, “dumped” or evicted from long-term care facilities are victims of nursing home abuse. Whether I or you like it, in many cases this has become the individual’s home and/or it is all the in16
Many nursing home evictions are just another form of elder abuse dividual/family can afford. You should know your rights going in and then you will not have to hire someone like me to fight for you. Rather than have to hire me, I would rather see families who are struggling with a multitude of issues, including how they will pay for care, have the tools at their disposal; you can fight back. Most of my cases against nursing homes feature me representing a family because the nursing home has applied the wrong standard for Medicare reimbursement. Even though this ruling
came down in 2013, the “improvement standard” still seems to be the defacto policy in every facility. Why is this a recurring theme? The answer is easy. The facility is afraid of losing its coverage by keeping someone who does not qualify and then they are out of pocket or they smell a poor person and do not want them to go onto Medi-Cal whose reimbursement rates are ½ that of Medicare or private pay. And, once a person is in application status with Medi-Cal, they cannot be evicted. n www. theroadaheadmagazine.com
In Home Care Made Simple Choosing the Right Caregiver is the Most Important Decision You'll ever Make for Your Parents
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he realization that Mom or Dad isn’t an all-knowing superhero is something everyone discovers as they age out of childhood. That doesn’t make it any easier when the tables turn and the ones who cared for you now need care themselves. It’s hard to watch them struggle with daily tasks, and even harder when an illness like Alzheimer’s makes them slip away from us even further. Becoming a caretaker can overtake all aspects of your relationship, causing undue strain and robbing you of precious time with your loved ones. Right at Home is here to help. Allowing your loved one to stay in the comfort and familiarity of their own home is what we do. We know that choosing the right in-home caregiver is a big decision, that’s why we’ve put together some helpful Care Scenarios to give you a better idea of our differing levels of care. From basic Care Services to more complex Special Medical Care Situations, Right at Home Los Angeles South Bay takes the burden of caretaking off your shoulders and allows you to resume your relationship on your terms. Both you and your loved one should live a happy, fulfilled life - and we’re here to help make that happen.
310-694-5001 www.rightathome-wla-sfv.com
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lthough recognized as a fundamental driving force, human sexuality is frequently misunderstood and particularly in the elders, neglected. Human beings are actually never too old to enjoy a happy and healthy sex life. Despite this, many people, young and old alike, are astounded at the idea of people remaining sexually active in their sixties and beyond. It is frequently assumed that elder persons lose their sexual desires or that they are physically unable to perform. For the elders, the ability to remain sexually active is a major concern in their lives. Fear about the loss of sexual prowess in older males is common. Older women also express sexual desire, but may fear their interest is undignified and disgraceful. Some elder persons may even freely accept their interests in sex, but their children or grandchildren may disapprove, making them feel guilty. The elder often view sexuality as an expression of passion, affection, admiration, and loyalty, a renewal of romance, a general affirmation of life, especially the expression of joy and a continuing opportunity for growth and experience. In addition, sexual activity is a means for the elder to affirm physical functioning, to maintain a strong sense of identity and establish self-confidence, and to prevent anxiety. It remains a mode of pure physical pleasure as well. However, not all elder persons have positive attitudes about sexuality. Like all persons, elders may experience sexual dysfunction due to boredom, fear, fatigue, grief, or other factors (e.g., intrinsically low sexual desire, physical disability). Sexuality in the elder is particularly affected by problems that are common in this age group, for example, depression, medical disorders, or incapacitation or death of a partner. Aging is characterized by physiological, pathological, behavioral, and psychosocial changes that can all affect sexual functioning, and it is difficult to disentangle their individual effects. Clinicians tend to ignore this aspect of the lives of elders, who themselves can find sexual problems very difficult to talk about. In psychiatric interview of elders, sexual history and details are often omitted. Human sexuality and particularly sexuality in the elderly is an area that requires more attention in psychiatric training. A marked increase in life expectancy over the past century has meant that individuals over the age of 65 years form an increasingly large proportion of our population. Yet, very little attention has been paid until recently to the treatment of sexual dysfunction in older adults. Older individuals are generally erroneously viewed as asexual people who have lost both their interest in sex and their capacity for sexual behavior. n
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www.susanbgeffen.com
Our desire for intimacy doesn’t automatically disappear as we grow older
The Road Ahead
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Ask the Dietitian By Joanne Singleton, MS RD LD
Joanne Singleton is a registered dietician. Her advice gives caregivers healthy eating choices for the elderly. Q. I am having problems adjusting to cooking for just one person since my husband died last year. Sometimes, I just eat a bowl of cereal or open up a can of soup for dinner. Can you give me some suggestions? Your problem is becoming more common, not just among seniors, but also with our society in general. More people are choosing to live alone and spouse loss is also increasing with our longer life span. Prepackaged food in the store will usually serve four to six people. For one person, you would have too much food prepared and have to eat the same thing for several days in a row. If you have adequate freezer space, you could freeze the extra portions as homemade TV dinners. However, most single person dwellings are apartments with small refrigerator and freezer space. Try some of the following suggestions for shopping or cooking for one. Use your microwave for re-heating leftovers, heating frozen homemade TV dinners, as well as day to day cooking. They are a great time saver. If you can make the entree in one dish, the clean up will be shorter. If you do have the freezer space, buy the frozen bags of vegetables. You can open the bag and cook as much at a time as you choose. The rest can be tied and returned to the freezer for another meal. Larger quantities of pre-portioned meats like chicken and pork chops can be divided into smaller freezer bags when you get them home from the grocery store. Your favorite recipe can be cut in half to make fewer servings. Divide each ingredient by two and rewrite the halved recipe on a new card. Buy one or two pieces of fresh fruit or vegetables at a time. Look for a grocery store that offers non-packaged produce. Try buying salad ingredients at salad bars frequently found in stores. You could buy enough cleaned and cut lettuce for one or two meals. If the meat is pre-packaged, ask the butcher to package one pork chop or one chicken piece for you. Most will do this with no extra charge to the customer, especially seniors since they represent a large purchasing minority. 20
Buy food in the smaller size to suit your needs. Usually, the smaller package costs more per unit, but if you purchase the larger size, you may end up throwing out the rest anyway. Some examples could be a quart of milk instead of one-half gallon, four ounces of sliced cheese from the deli counter instead of eight ounces or three cookies from the bakery department instead of one dozen. Some grocery stores allow customers to split packages of margarine, eggs or frozen ice cream on a stick. Ask in your store. One stick of margarine or one-half dozen eggs may be enough for you for two weeks. Talk to your single neighbors. Someone may be interested in sharing the cooking of a dinner meal with you, once or several times a week. You could alternate nights each of you cooked or you could do a potluck dinner together. This would help you with the motivation to prepare a balanced meal and also provide you with some socialization at mealtime. Another choice for you to consider is the congregate meal program. Call your county Social Services for information about congregate meal dining. In most communities, seniors high rise, a church or a school provides the space for on-site dining. A donation is asked for at the door, but no one would be refused because of inability to pay. The meal is hot, nutritious and usually offered five days a week. You can choose to go as often as you like. Most dining programs do require a reservation a day ahead of time though. Meals are served to clients seated at family style tables. You can sit anywhere you like. Some programs may seat people with special diets together because they may not be offered the same foods as people on an unrestricted diet. Special diets that can be offered are usually diabetic and sodium nutrition therapy diets. The staff plans activities programs after the meal. The program occasionally includes a nutrition education topic of interest to seniors as well. Remember, each meal should have a meat or protein substitute like eggs or cheese, a starch, a vegetable, an optional salad, bread, margarine, milk and an optional dessert. Another consideration when planning meals is variety. Don’t eat the same thing day after day as you will be limiting the nutrients in your menu plan. n www. theroadaheadmagazine.com
Know When To Seek Counsel
By Susan Geffen
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any concerns and questions can arise as we grow older and approach the sunset years of life. Where will I live if I become too frail to take care of myself? Who will take care of me and help me make good decisions? How will I be able to pay for long-term care? How will I distribute my assets? In the last decade or so, a new category of law has emerged that specializes in helping people answer these questions and learn their rights. Elder law focuses on providing legal services to senior citizens and younger people with special needs, such as early onset Alzheimer’s or Crohn’s disease, who want to manage
their circumstances now and into the future. The client may also be a person helping a family member or friend in need. So whether you’re hoping to understand your personal rights in more detail, or just about to delve into the emotional and legal intricacies of end-of-life planning, it’s a good idea to seek sage council as early as possible. Planning for the future can be problematic without the correct information. Simple situations can rapidly turn into complicated and expensive conundrums without good advice. That’s where an elder law attorney can help.
Know Your Elder Law
Retaining counsel can help lead you through the pitfalls, roadblocks and hurdles associated with: • Evaluating the client’s needs relating to federal tax, social security, Medicare, Medi-Cal and property laws • Advocating the best way to move forward, consistent with these laws • Preparing trusts and wills • Figuring out the best way to pay for long-term health care • Helping the client make emotionally difficult decisions, such as those related to end-of-life Some areas of expertise might include: • Abuse of the elderly • Age discrimination • Asset protection • Disability • Estate planning • Guardianship • Long-term care • Medicare • Medi-Cal Planning and Asset Protection • Mental health issues • Power of attorney • Retirement and pensions • Social Security • Management of estates, trusts and wills Growing old comes with its challenges and you won’t always know how to deal with them on our own. Finding the right elder law advisor can be immensely helpful. n
Ask the Elder Care Guru Do you have questions for Susan B. Geffen? If you have a question(s) that you think others can also benefit from, we may publish them in one of the upcoming magazines. You may submit them by email to info@susanbgeffen.com Please limit each question to no more than 30 words.
The Road Ahead
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Watch Dog Report
Alerting you to the latest Scams, Elder Abuse, and things that just plaine WRONG!
The ultimate betrayal
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he New York Post called it the “swindle trial.” Jurors likened it to a “Shakespearean tragedy.” When New York socialite Anthony D. Marshall was convicted of defrauding and stealing from his elderly mother, philanthropist Brooke Astor, reports detailed how he conspired with lawyer Francis Morrissey to amend her will in his favor, took millions without her consent, and lifted paintings from her walls while she languished in her Park Avenue home. Elsie Brooks’s lifestyle was a world apart from Astor’s, but their stories are tragically similar. When she was 72 she sold her mobile home and moved in with her daughter and granddaughter in Monterey, Calif. She decided she didn’t want to deal with her finances any longer and let the two take control. But her daughter, Lisa Karen MacAdams, and granddaughter, Christi Schoenbachler, drained Brooks of jewelry, furniture, and an annuity worth almost $90,000, and abandoned her at a nursing facility, according to court documents. They were convicted of grand theft and financial elder abuse, both felonies, and two counts of misdemeanor elder abuse. Last summer, a California appeals court stayed one of Schoenbachler’s misdemeanor charges. Elder financial abuse is “the ultimate betrayal,” says Colleen Toy White, a superior court judge in Ventura County, Calif., who sees roughly 40 cases of such abuse each month. “It’s shocking to see how vulnerable the elder person is.” Such abuse can be financially and emotionally devastating. And experts say it’s likely to increase because of a stalled econom y and an aging population. Awareness is rising thanks to cases such as Astor’s. Yet because seniors might not recognize when it happens to them or are too ashamed to speak, the crime lurks largely out of sight. In a randomized New York telephone survey released in 2011, for instance, seniors mentioned being victims of financial exploitation more frequently than any other type of abuse. Yet the study estimated that only 1 in 44 incidents of financial elder abuse is officially documented. “Nearly every time I lecture on financial abuse, people will approach me with their personal stories,” says Elizabeth Loewy, a Manhattan assistant district attorney and lead prosecutor on the Marshall case. “They will talk to me about their grandmother, aunt, or neighbor, usually a senior with cognitive issues, who had ‘this problem.’ And it’s like a light will go on, and they’ll ask, ‘So this could be a crime?’ ” Law-enforcement and social-services professionals see exploitation rising sharply. Rhode Island Attorney General Peter Kilmartin’s office opened 128 financial-elder-abuse cases in 2011, a 40 percent rise from 2010. Paul Greenwood, a deputy district attorney in San Diego and head of the county’s elder-abuse protection unit, says the office will prosecute about 200 cases this year. “I’ve never been busier,” he says. Better reporting contributes to it's growth, Greenwood says. So does the flat economy. “As people become more desperate from the economy, they need that extra money,” says Sally Smith, adult protective services case manager supervisor at the Franklin County (Ohio) Office on Aging. n
Hearing loss speeds up brain shrinkage
and could lead to dementia, researchers claim
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ll people’s brains shrink with age but the rate of shrinkage is quicker in deaf people - they lose an extra cubic centimetre of brain a year Hearing loss is also associated with increased risk of dementia, falls, hospitalization and poor mental health. Elderly people who suffer hearing loss also experience a faster rate of brain shrinkage, new research suggests. People’s brains are known to become smaller with age but the rate of shrinkage is quicker in people who are deaf. Hearing loss in old age is also associated with an increased risk of dementia, falls, hospitalisations and poor mental health. Researchers at John Hopkins University, in Baltimore, U.S., and the National Institute on Ageing, looked at the on-going Baltimore Longitudinal Study
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of Ageing to compare the brains of elderly people with normal hearing and those with impaired hearing. The Baltimore Longitudinal Study of Ageing was started in 1958 by the National Institute on Ageing to track various health factors in thousands of men and women. Previous research from other studies linked hearing loss with marked differences in brain structure compared to those with normal hearing, both in humans and animals. In particular, structures that process information from sound tended to be smaller in size in people and animals with impaired hearing. Dr Frank Lin, an assistant professor at the Johns Hopkins University schools of medicine and public health, says it was
unknown, however, whether these brain structural differences occurred before or after hearing loss. As part of the Baltimore Longitudinal Study of Ageing, 126 participants underwent yearly MRI scans to track brain changes for up to 10 years. Each also had physical examinations at the time of the first MRI in 1994, including hearing tests. At the starting point, 75 had normal hearing, and 51 had impaired hearing, with at least a 25-decibel loss. After analysing their MRIs over the following years, Dr Lin and his colleagues found those participants whose hearing was already impaired at the start of the study had accelerated rates of brain deterioration compared to those with normal hearing. n www. theroadaheadmagazine.com
Understanding Government Insured Reverse Mortgages Home Equity Conversion Mortgages for Seniors
REVERSE MORTGAGES are increasing in popularity with seniors over age 62 who have equity in their homes and want to supplement their income, without the burden of monthly mortgage payments. The only reverse mortgage insured by the U.S. Federal Government is called a Home Equity Conversion Mortgage or HECM, and is only available through an FHA approved lender. As the same with a tradition mortgage, the homeowner always retains title and ownership of the home while the property is pledged to the lender as security for the loan. The bank does NOT take the home, as many incorrectly believe... Upon the death of THE LAST SURVIVING SPOUSE, house goes directly to the heirs or however the homeowner’s estate planning designates. Paying off the reverse mortgage is primarily triggered by any 3 events... death of last surviving spouse, homeowner choosing to move out of their home or homeowner voluntarily choosing to refinance their home at any time. There is NO fixed time frame or due date on the reverse mortgage and because there is NO prepayment penalty, a homeowner may pay down or pay off the reverse mortgage at any time. or pay off the reverse mortgage at any time.
For more information, contact Larry Berlfein at ( 818 ) 710-1024
Susan’s Funnies Don’t Skip this page!
Laughter is good for your health. Laughter relaxes the whole body. A good, hearty laugh relieves physical tension and stress, leaving your muscles relaxed for up to 45 minutes after. Laughter boosts the immune system. So go ahead and Laugh! If you have any good jokes you want to share with readers, send them to info@susanbgeffen.com
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www.susanbgeffen.com
Day... W
or Night
24 Hour Doctor
hether you’re at home, work, or a hotel, Dr. Farzam will travel to your location for same-day service and appointments, 24 hours a day, 7 days a week. As Los Angeles’ premier 24 hour on call doctor, Dr. Farzam is thorough in spending time understanding what your needs are, whether you simply need an annual physical to monitor you health, or you require urgent care to assess your symptoms and bring you relief.
Top Ranked Doctor for 24 Hour Urgent Care in Los Angeles
Do you feel your family doctor doesn’t give you the same bang for your buck that you’re paying for, and you dread going into the urgent care clinic or emergency room? Many patients feel that way, and seek out Dr. Farzm’s 24 hour doctor care.
As a top rated doctor in Los Angeles performing 24 hour urgent care, Dr. Farzam offers the following services to his patients which you may not find in the typical 24 hour health clinic: •Same-day appointments for house, hotel and work calls, even on weekends or holidays •Less than one hour for the typical wait time until the doctor reaches your locationExtended, unhurried appointments with no waiting room full of patients •Direct 24/7 access to physician through phone calls, texts and emails •Referrals to emergency room and hospital coordination, or referrals to specialists •Prompt follow up for tests, reports and other results House Call Doctor Los Angeles provides a revolutionary service that is a throwback to medical care the way it used to be: doctors making house calls. Should an urgent problem arise with your health, such as a sudden, acute problem like bronchitis, a flare up of a chronic condition such as lupus or a traumatic accident such as fractured bone, you want a doctor who is there quickly, even for after-hours care. Doctors that make house calls, such as Dr. Farzam, are able to give you the attention you need when you need it most.
Contact House Call Doctor Los Angeles Today
If you are interested in learning more about House Call Doctor Los Angeles, or to see a fee schedule of Dr. Farzam’s services, visit our website at www.housecalldoctorla.com for further information. Residents of Greater Los Angeles can call us at 310-849-7991 for 24/7 healthcare access.
On The Radar
State and Federal Laws
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ast month, an Assembly Budget Subcommittee placed AB474, state legislation designed to restore recession-era cuts made to the Supplemental Security Income/State Supplementary Payment program, on its suspense file. In 2007, the state legislature cut the State Supplementary Payment (SSP) portion of the program for both individuals and couples to the minimum levels allowed by federal law as a way to help close state budget shortfalls that emerged as a result of the Great Recession. In addition, it suspended the state cost-of-living adjustment (COLA) for Supplemental Security Income/State Supplementary Payment (SSI/SSP) program several times prior to 2010-11; and then, totally eliminated it. SSI/SSP helps 1.3 million low-income seniors and people with disabilities in California pay for housing, food, and other basic living expenses. It is funded with both federal (SSI) and state (SSP) dollars. SSI/SSP provides modest income support to the most impoverished seniors and disabled adults. This allows many to avoid total destitution and homelessness. As a result of the cuts, State spending for SSI/SSP dropped from $3.9 billion in 2007-08 to $2.5 billion and has not changed despite the fact that the recession ended several years ago. 47th Assembly District Representative Cheryl Brown who introduced the legislation defined AB 474 as, “the first step to restoring our moral responsibility to care for our most vulnerable citizens and prioritize our seniors and disabled constituents.” Another major concern expressed by many low income seniors is the lack of affordable housing. Affordable housing in the Inland Empire has declined and as a result, many elders are left with the option to either move in with their family members or become homeless. The Section 8 application process has created lengthy waiting periods of several years. “The waiting list for seniors can be as long as five to seven years,” Brown advised and added,
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“Representatives from housing projects in San Bernardino and Riverside counties have said that an apartment usually becomes available when either a tenant passes away or is placed in a long-term care facility.” Also, elderly who are capable of living independently in their own homes are receiving less in-home assistance from community service programs due to cuts or elimination of state and county programs. Many are receiving care from unpaid family or friends. Family support is a key driver in a senior’s ability to stay in his or her home and community. However, such family assistance too often comes at a substantial cost to the caregivers themselves; and can take a toll on their personal and professional lives.l Laws – what you need to know… In 2010, the caregiver support ratio in California was 7.7 potential caregivers for every person in the high-risk years of 80-plus. By 2030, the ratio is projected to decline sharply to 3.9 caregivers available to every one person who requires assistance with daily activities. Last week’s edition of Keeping it real highlighted recent Kaiser Family Research data that showed California seniors experience the highest poverty rate in the nation. It also revealed U. S. census data that identified the Inland Empire as first among the nation’s largest 25 metropolitan areas where poverty may be worsening. Many seniors in San Bernardino County, including a number in the mountain communities, are financially vulnerable and rely on a safety net of social programs that, despite the best efforts of local administrators to respond to all requests for assistance, are limited by the availability of inadequate resources. In light of these and other considerations affecting our aging neighbors you are encouraged to advocate on behalf of the elderly. Encourage legislators to take positive action on AB474. Write the Assembly Budget Committee at State Capitol, Room 6026, Sacramento. CA 95814. n
www. theroadaheadmagazine.com
Feel Safer with
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Calendar of Events Susan B. Geffen, the Elder Care Guru presents
Raising UP Your Parents
The most comprehensive elder care seminar ever offered for adult children and caregivers Over 10,000 adult children, their elderly parents, caregivers and professionals have attended Susan’s seminars since 2009. • The latest Alzheimer’s research • Protecting yourself and loved • How to Avoid • How to choose an assisted living ones from elder abuse Probate • How to afford services • Medi-Cal & Medicare • Home Modifications • Elder care options • When is a Conservatorship • Living Safely and Independently appropriate To make a reservation, go to www.susanbgeffen.com/events or call 1 (800) 301-1326.
All events are from 10 am to 1 pm
January 24, Long Beach, The Grand Banquet Center, 4101 E Willow St, Long Beach
June 13, Sherman Oaks, Marriott Courtyard Hotel, 15433 Ventura Blvd, Sherman Oaks
February 28, Manhattan Beach, The Belamar Hotel, 3501 N Sepulveda Blvd, Manhattan Beach
July 18, Torrance, Doubletree Hotel, 21333 Hawthorne Blvd, Torrance
March 21, Pasadena, Hilton Hotel, 168 S Los Robles Ave, Pasadena
August 15, Thousand Oaks, Palm Garden Hotel, 495 Ventu Park Road, Thousand Oaks
April 18, West Los Angeles, The Olympic Collection Banquet Center, 11301 Olympic Blvd #204, West Los Angeles
September 19, Culver City Doubletree Hotel, 6161 W Centinela Ave, Culver City
May 16, Garden Grove/Anaheim, Sheraton Hotel, 12221 Harbor Boulevard, Garden Grove
October 17, Newport Beach, Hyatt Regency Hotel, 1107 Jamboree Road, Newport Beach November 14, Los Verdes Country Club, 7000 Los Verdes Drive, Rancho Palos Verdes
The Long Term Care Ombudsman We often hear about residents in nursing homes being abused or neglected. Did you know that there are advocates for residents in nursing homes, assisted living and board and care homes? Ombudsmen (women are Ombudsmen too) provide information about how to find a facility and what to do to get quality care. They are trained to resolve problems. If you want, the
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ombudsman can assist you with complaints. However, unless you give the ombudsman permission to share your concerns, these matters are kept confidential. Under the federal Older Americans Act, every state is required to have an Ombudsman Program that addresses complaints and advocates for improvements in the long-term care system. The ombudsman program is administered by the Administration on Aging (AoA). The network has 8,813 volunteers certified to handle complaints and 1,167 paid staff. Most state ombudsman programs are housed in their State Unit on Aging. Nationally, in 2011 the ombudsman program investigated over 200,463 complaints on behalf of 131,078 individuals and provided information on long-term care to another 288,698 people.
What Concerns Does an Ombudsman Address? • Violation of residents’ rights or dignity • Physical, verbal or mental abuse, deprivation of services necessary to maintain residents’ physical and mental health, or unreasonable confinement • Poor quality of care, including inadequate personal hygiene and slow response to requests for assistance • Improper transfer or discharge of patient • Inappropriate use of chemical or physical restraints • Any resident concern about quality of care or quality of life
www. theroadaheadmagazine.com
No place like
Home k
Let VITAS bring hospice care to the place you most want to be: home
VITAS Healthcare serves people with serious illnesses. Our hospice care and palliative services provide comfort to patients and preserve dignity in the face of terminal illness.
Hospice care When medical treatments can no longer cure a disease, our interdisciplinary team of hospice care professionals still can do a great deal to control pain, reduce anxiety and offer needed spiritual and emotional support to patients and their families. We introduce gradual, non-crisis transitions from curative care to hospice care. There is time to talk, to try treatments and therapies, and to ensure comfort and dignity.
Hospice care at VITAS is focused on serving and comforting patients and families as the end of their lives. We offer a range of hospice care services, including music therapy and pet visits. To learn more, find your local VITAS hospice provider. Additionally, VITAS offers bereavement support & grief resources to support loved ones.
The Smarter Hearing Aid is Here Zounds was founded by Sam Thomasson, an Engineer and entrepreneur who has spent his career developing new technologies in the medical device and consumer electronics industries. Sam is also the father of a hearing-impaired daughter and has witnessed the problems associated with today’s hearing aids. Sam promised his daughter that he would develop a hearing aid to address the key problems com-
Zounds has brought the joy of hearing back into my life. To be able to hear many of the little things people take for granted, like the sound of the wind blowing or falling raindrops... Raymond o., aRizona
mon with other high-end hearing aids. Zounds’ breakthrough technology is the fulfillment of a father’s promise to his daughter and the solution for dissatisfied hearing aid users around the world. I have had hearing aids before, and they all ended up going into my dresser drawer. The feature I like about Zounds, is that it has a r echargeable battery. No more battery replacements... SaRgon a., KentucKy We sell Zounds hearing aids for so much less than other premium brands...
Call us at (480) 813-8400 http://www.zou