Page 1

Generations Michigan

V.I.P.s Also in This Issue: ■ Ask the expert ■ Caregiving news & notes Published quarterly by Michigan’s Area Agencies on Aging

Spring 2008

TM


Welcome to Michigan Generations Michigan is divided into 16 AAAs, each serving a different part of the state.

11

They are:

         

10

Whether you are an older adult yourself, a caregiver or a friend concerned about the well-being of an older adult, Area Agencies on Aging (AAAs) are ready to help. AAAs in communities across the country serve as gateways to local resources, planning efforts, and services that help older adults remain independent. AAAs were established under the Older Americans Act in 1973 to respond to the needs of Americans aged 60 and over in every community. The services available through AAA agencies fall into five general categories: information and consultation, services available in the community, services in the home, housing, and elder rights. A wide range of programs is available within each category.

9

8

7 5

14

4

3A 3B

3C

6

4 Region IV Area Agency on Aging 5 Valley Area Agency on Aging 6 Tri-County Office on Aging 7 Region VII Area Agency on Aging 8 Area Agency on Aging of  Western Michigan   9 NEMCSA Region 9 Area Agency on Aging 10 Area Agency on Aging of Northwest Michigan 11 Upper Peninsula Area Agency on Aging 14 Senior Resources of West Michigan Visit the AAA’s state website at www.mi-seniors.net

  The services offered by   Michigan’s 16 AAAs cover a broad spectrum of needs, such   as information and referral, case management, in-home services, home-delivered meals, senior centers, transportation, and special outreach. To read more about each of Michigan’s AAAs and the services available, turn to page 8 of this issue.  MI

1A

1B

2

1C

Generations Michigan

SPRING 2008  Published quarterly through a cooperative effort of Michigan’s Area Agencies on Aging.

For information contact: Jenny Jarvis 248-262-9202 jjarvis@aaa1b.com

Editorial Project Development: JAM Communications, Atlanta, GA Design and Production: Wells-Smith Partners, Lilburn, GA Michigan Generations is a

On the Cover: Here are the Very Important Papers you or your loved ones need to assemble, in order to prepare for the future. This important process will save you untold money, time and, possibly, some legal headaches. Turn to the story beginning on page 4.

Spring 2008, Volume 5, #4 © 2008 by the Michigan Area Agencies on Aging. The information contained herein has been obtained from sources believed to be reliable. However, the Michigan Area Agencies on Aging and JAM Communications make no warranty to the accuracy or reliability of this information. No part of this publication may be reproduced or transmitted in any form or by any means without written permission. All rights reserved.

map photography courtesy travel michigan

AAAs —‑Gateways to Community Resources

1A Detroit Area Agency on Aging 1B Area Agency on Aging 1-B 1C The Senior Alliance   2 Region 2 Area Agency on Aging 3A Kalamazoo Co. Health & Community Services Dept. Region 3A 3B Burnham-Brook Region IIIB Area Agency on Aging 3C Branch-St. Joseph Area Agency on Aging IIIC


CAReGiVinGnews&notes How Alzheimer’s Affects

Selecting the right

mobility device

if  

you or a loved one is sidelined  because of a mobility problem,  a wheelchair or scooter can actually  give you the freedom to get out and  experience life again.  Scooter prices can range from  $500 to $3,600, while power wheelchairs start at $1,200 and can run  up to $3,500. Medicare may cover  80% of the cost with a letter of necessity  from your doctor.  Before you buy, spend plenty of time trying out the device. Sit in it and make sure that it feels  good, is easy to use and meets your needs. Keep your  physical therapist informed as you’re making your  selection. He or she will be able to offer guidance.

?

Did You Know…

D

iabetes runs up an economic tab of over $170 billion in the United States every year. Medical expenditures on care for people with diabetes has been estimated to be $116 billion — mostly for treatment and hospitalization due to diabetes-related complications. Other costs are associated with reduced productivity, unemployment and increased absenteeism. Source: International Council on Active Aging (ICAA) newsletter

Surfing the net

Each issue of Michigan Generations offers several websites of interest to older adults and their caregivers … right at your fingertips. www.rxassist.org provides a comprehensive directory of patient assistance programs that are run by pharmaceutical companies to provide free medications to people who cannot afford to buy their medicine. www.caregiver.org is the website for the Family Caregiver Alliance. It offers a wide range of caregiver information, education, guidance and resources. Look for more helpful websites in the next issue of Michigan Generations. Spring 2008

FINANCIAL COMPETENCE

I

f someone in your family  has been diagnosed with  Alzheimer’s disease, are they  still able to handle their  finances? A recent study  says no. A rapid decline in financial skills often accompanies  Alzheimer’s disease, the  study shows. The American Journal of Geriatric Psychiatry reports that researchers  evaluated the ability of 55  people with mild Alzheimer’s  disease to perform 18 financial tasks, including identifying currency, paying bills  and understanding a bank  statement. People with mild  Alzheimer’s disease showed  a 20% decline in overall 

Smarter M

financial ability compared to  a control group of 63 healthy  people. After one year, the  Alzheimer’s group dropped 

another 10%. Researchers  cautioned that people with  Alzheimer’s disease were less  able to detect mail or telephone fraud, which suggests  the importance of providing  oversight and transferring  financial responsibilities once  a diagnosis is made.

Shopping

ost grocery stores don’t make healthy shopping very easy. Products in the best locations — at eye level, ends of aisles and near cash registers — are usually the best sellers. Unfortunately, they are also most likely to be low in nutrition and high in sugar. Here are a few rules from nutritionist Marion Nestle to make your shopping experience smarter — and healthier: • Don’t buy anything with more than five ingredients. • If you can’t pronounce the ingredients on the package label, don’t buy it. • Don’t buy anything with a cartoon on it — it’s being directed toward your grandchildren. • If you don’t want your grandchildren eating junk food, then don’t have it in your house. • Don’t buy artificial anything — it’s just disguising bad taste. Also, look out for items that seem like health foods, but really aren’t. Just because candy comes covered with yogurt, for example, doesn’t make it good for you.

3


what you need to know about

V.I.P.s

Very Important Papers By Martha Nolan McKenzie

J

ohn was 85, active and living independently when he  disappeared. Four weeks later, friends finally tracked  down the Detroit man — in a nursing home. He was alert,  mobile and angry. “He said he felt like he had been put in  jail, and the only crime he had committed was getting old,”  says Jim Schuster, a certified elder law attorney. John had been driving home from church when he  suffered a mini-stroke, causing him to wreck the car and  sending him to the hospital. The hospital staff deemed  him unable to go back to his home, and since he lived  alone, had no in-state relatives and had not legally named  someone to act on his behalf if he became incapacitated,  they had the court appoint a professional guardian for  John. The guardian, in turn, put him in a nursing home. John’s friends notified his nephew, who came to  Detroit and hired Schuster. It took Schuster three  months to extricate John from the nursing home. “I  had to file a petition in probate court, and as part of  4

Michigan Generations


that I had to hire a care manager and put together a care plan,” says Schuster. “John was perfectly able to live independently — he just needed a little occasional help from a social worker and a health aide. I was finally able to get him released from the nursing home, but the probate court kept his assets under the guardian’s supervision. “The whole episode cost John thousands of dollars in legal fees and the loss of control over his assets,” continues Schuster. “And he could have avoided it all if he had had a simple durable power of attorney.” Cautionary tales such as John’s underscore the importance of planning for one’s potential disability. That planning needn’t be particularly expensive or laborious. It just involves assembling your V.I.P.s — Very Important Papers. Down the road, this process can save you and your loved ones untold money, time and headaches. “We all want to know that our wishes will be carried out in the event we are no longer able to make decisions ourselves, due to infirmity or death,” says Brad Geller, assistant state long-term care ombudsman in the Michigan Office of Services to the Aging in Ann Arbor. “Assembling the proper documents will help make sure that happens.” Here’s a look at Very Important Papers that everyone, regardless of age, should have.

Durable Powers of Attorney When the topic of estate planning comes up, the first thing people think of is a will. But experts say that the most critical documents are: •  a durable power of attorney and •  a durable power of attorney for health care These two documents allow someone you name to make financial and health care decisions on your behalf if you become unable to do so. If you do not have these in place, the state probate court will appoint a guardian, as it did for John. These documents are extremely important for people anywhere, but particularly so for residents of Michigan. That’s because Michigan residents have a higher likelihood of having a guardian appointed than residents in other states. “According to the American Bar Association’s Commission on Law and Aging, Michigan leads the nation in the number of adults who have guardianships,” says Geller. “That’s not a good place to be. Having a guardian appointed is timeconsuming, expensive and humiliating to the individual involved.” Durable powers of attorney prevent such court intervention. A durable power of attorney is a legal document that lets you designate someone (called an agent) to handle your financial affairs if you become unable to do so. It will allow your spouse or adult children, for example, to pay bills, deposit Social Security checks and file tax returns if you cannot. You can set it up so that it becomes effective immediately, or you can draft a “springing” power of attorney, which becomes effective if and when you become unable to make financial decisions for yourself. You should spell out exactly how your inability to make financial decisions will be determined — Spring 2008

typically it must be certified by a physician. You could require, however, that your agent get a second opinion. “Durable powers of attorney need to be drawn quite closely,” says Ronald Emerson, supervising attorney with Lakeshore Legal Aid in Caro. “You don’t want to give away too much power. For instance, you should require that your agent provide family members or another third party with regular accounting statements. And we encourage people not to authorize the sale of real estate or taking a mortgage on real estate.” People tend to think in terms of incapacity when dealing with powers of attorney, but it could just be a matter of convenience. “A very common situation is a parent in her mid-80s who has insurance questions but doesn’t want to deal with the telephone bureaucracy,” says Schuster. “She could give her son or daughter power of attorney so he or she could handle all the questions for her. Though she might still make the financial decisions herself, the woman might use a power of attorney to allow her children to do the leg work for her.” A durable power of attorney for health care allows you to name someone who can make medi-

cal and treatment decisions on your behalf if you are unable to do so. It only takes effect if two doctors or a doctor and a psychologist certify that you are unable to participate in treatment decisions. This document typically has two parts: (1) the first part designates a person to make decisions and (2) the second part contains medical directives, which allow you to say what kind of and how much treatment you want in various situations. “Michigan does not recognize living wills, so the advanced directives are our version of living wills,” says Steven H. Malach, a partner with Lipson Neilson law firm in Southfield. “The power of attorney for health care and the advanced directives are very important for caregivers as well as for seniors. While you want to know that your wishes will be carried out even if you are unable to express them,

Having your wishes in writing

relieves the caregiver of a big burden.

your caregiver or loved one needs to know that he is doing what you would have wanted. Having your wishes in writing relieves the caregiver of a big burden.” While the advanced directives deal with end-of-life issues, the durable power of attorney for health care isn’t necessarily confined to that. Just as with the general durable power of attorney, it could be used for convenience. “Let’s say an elderly person has some questions about why a doctor is recommending a procedure and wants to get more information,” says Schuster. “He might want his son or daughter to get that information for him, but because this is confidential medical information, the provider could not discuss it with the son or daughter unless they had a durable power of attorney for health care.”




It’s critical for everyone over the age of 18 to have a durable power of attorney for health care. And, experts add, don’t think that because you have a spouse, parents or adult children to care for you that you won’t need one. “Most states have a family consent statute that allows a family member to make health care decisions for a loved one if he or she cannot,” says Geller. “Michigan does not. So in this state, if your college-age daughter or your spouse becomes incapacitated, you need this document to be able to make medical decisions for them. Otherwise, the court will appoint a guardian to make those decisions.” And in Michigan, the State Bar Association offers the durable power of attorney for health care and advanced directive forms available online for free (see page 16). “In this case, people can certainly fill out the documents by themselves,” says Geller. “There is no need to pay an attorney to have these drafted.”

Wills and Trusts While virtually all attorneys agree on the need for durable powers of attorney, the case for wills and trusts is not so clear-cut. In fact, opinions differ on the need for wills. “Wills are passé,” says Malach. “Wills go to probate, trusts don’t.” “Everyone needs a will,” says Geller. “I’ve never seen a situation where it hurt an individual to have a will.” “For some people, it doesn’t make financial sense to have a will or a trust,” says Emerson. So which is the answer? It depends on your assets, any special situations you have and your wishes. Why have a will. Conventional wisdom has always been that everyone needs a will. Indeed, if you die without one, the court decides who gets your things, not you. A will details who will handle your estate and how your assets will be distributed. It does have to go through probate, which is a court-supervised process of transferring the property of a deceased person to his survivors. For an average estate, the probate process generally takes between 6 and 14 months and costs from $1,500 to $5,000. The State Bar Association offers a free, fill-in-the-blanks form for a will, available online (see page 16). “People can see if this meets their needs,” says Geller. “If not, it’s a very good idea to see a lawyer to have a will drafted to your particular circumstances.” The case for living trusts. A living trust is a document that, like a will, gives instructions about who will handle your estate and how the assets will be distributed. But while you are living, you transfer those assets out of your name and into the trust that you control. At your death, assets in the trust pass immediately to your survivors without going through probate. “People used to think trusts were only for the wealthy,” says Malach. “Nowadays, the middle class needs trusts even more, because it has become more expensive than ever to go through probate. Probate is charged by the hour, and if there are any problems, such as an asset being held in only one person’s name, that can slow down the process and drive up the costs.” 

With a trust, you can also set conditions for the distribution of the assets. “Say you want to leave money to your son, but he’s not terribly responsible with money,” says Emerson. “You could specify that the money be doled out at certain times to make sure he doesn’t blow through all the assets.” Anyone who has a minor child or a disabled adult dependent should have a trust set up so that money will be available but safely controlled in case of death or incapacity. While trusts make sound financial sense for many, they have also been exploited by some unscrupulous lawyers using scare tactics to sell trusts costing thousands of dollars. “They warn seniors that unless they put their assets in this trust, estate taxes will eat up most of their inheritance,” says Schuster. “However, the only people who need to worry about inheritance taxes are those with more than $2 million in net worth. They tell seniors that if they don’t have a trust, they will lose 40 percent of their estate to probate costs. Probate does incur some costs, but nothing like that.” And sometimes these lawyers are really only selling a trust kit. “Creating a trust is a lot of work,” says Emerson. “For instance, you have to put the property into the trust, so you have to create a new deed and file it with a court. Some lawyers are charging $2,000 and just selling the person a trust kit and leaving him to his own devices to make it effective.”

if you own your home…

you should

have a

will.

Emerson points out that low-income seniors may not need either a will or a trust. “If you just have a few household furnishings and no substantial assets, there’s no real point in having a will,” he says. If, for example, you have just a few certificates of deposit, you can designate one or more beneficiaries, and the CD will pass directly to them upon your death. “You don’t need a will for that, it won’t go through probate, and it doesn’t cost anything to do it,” says Emerson. If you own your home, however — even a modest one —   you should have a will. “While you can put someone else’s name on the deed so the house will pass directly to them, I generally advise against it,” says Emerson. “With a CD, if you have a falling-out, you can go and change it. But if a person is on your deed, they own the property with you. So they can keep you from selling the property or refinancing. It’s a much better idea to arrange to pass your house down through a will.”

Other Important Papers Though it is not a legal document, a comprehensive personal inventory is an excellent paper to have. It should list the name, address and phone number of your accountant, attorney, banker, stockbroker, all insurance agents and Michigan Generations


employee benefits administrator. The list  should include all accounts, policies and  assets with account numbers and contact  information. It should detail the whereabouts of the safe-deposit box and key,  and important documents such as birth  certificates, deeds, car titles and Social  Security cards. You can download a fill-inthe-blank personal records diary from the  State Bar of Michigan (see page 16).  Once you complete your personal  inventory, make sure you let your loved  ones know where it is. “It won’t do anyone a lot of good if they don’t know it  exists and don’t know where it is,” says  Geller.  If you have an adult child or other relative caring for you, you might also want  to draw up a caregiver contract. This  can specify what services will be compensated and at what rate. While such a  contract can seem like turning a parentchild relationship into a business one, it  can make a lot of sense. “I’ve talked to  children who have spent literally hundreds of hours helping a parent move out  of their home and into an assisted-living  facility, for example,” says Schuster. “Or  they’ve taken time off and rented a trailer  to move their parent from Florida back  up to Michigan — a move that would  have cost thousands of dollars if they had  hired a commercial mover. A caregiver  contract can help compensate that child  for time he invested and expenses he  incurred.” A caregiver contract can also allow a  parent to shift assets to a child without  being penalized by Medicaid. Under current rules, any transfer of money to a  child is considered a divestment unless  proven otherwise, and Medicaid imposes  a penalty period for divestment. So even if  a person is eligible for Medicaid because  he does not have money, Medicaid will  not pay for nursing home care for a time  equal to the amount of time the money  divested to a child would have paid for.  “Nursing home costs in Michigan are  about $6,000 a month,” says Schuster.  “So for every $6,000 a parent has given a  child for a certain period prior to entering a nursing home, Medicaid will not  pay for a month. With a caregiver contract, however, parents can move money  to children to compensate them for their  services without it being considered a  divestment.”  MI Spring 2008 Fall 2007

CONFRONTING THE TOUGH CONVERSATION

T

hough these documents are critical in making sure you or your loved one’s wishes are carried out, too many people don’t have these papers in place. Why? No one likes to think about their own or their loved one’s demise. Indeed, a recent AARP survey found that 70% of adult children have not talked with their parents about issues related to aging. Other times it’s the parents who don’t want to discuss the issues. Yet, as Baby Boomers age, more and more will find themselves facing a role reversal in which they must take responsibility for their parents’ finances and/or health care decisions. That day will be much easier to handle if the proper papers are drawn up and discussed in advance. Ideally, financial advisers recommend approaching parents and older loved ones when they are in their 60s — about the time they retire. It’s a natural time since they’ll be taking stock to plan for life after work. The older the parents get, the more difficult it might be to broach the subject. But no matter what age they are, it’s a talk that needs to happen. AARP offers adult children these tips to facilitate the discussion with their parents: Ñ Do it now. Don’t wait until a crisis to try to sort through these issues. Ñ Use your own planning or the recent illness or death of a loved one to start the discussion. You could share the story of someone who didn’t plan well and the mess that resulted. Ñ If your parents were unwilling to disclose a full list of their assets, perhaps they would be willing to write down account numbers without balances or make a list and tell you where the list is kept. Ñ Encourage your parents to seek expert advice. This assures them that you still consider them competent to make their own decisions and that you’re not trying to control the situation. You can offer to help them find a qualified elder law attorney. Ñ Make your parents — and their wishes — the main focus of the discussion. Find out what their concerns are. They may be worried they’ll outlive their resources, or that their kids will fight over their assets after they are gone. Ñ Acknowledge that you are discussing their assets and that your goal is to help them maintain control of them, not wrest it away. Ñ Be direct, honest and patient. This likely will be an ongoing dialogue, not a one-time conversation. Don’t be surprised if you meet with some resistance. “As we walk into incapacity, our instinct is to fight against it,” says Schuster. “Some people look at drafting these documents as losing the battle. If that’s the case, the adult children should say, ‘Mom, if something happens to you, this is the only way we’ll be able to help you and make sure what you want is done.’”

7 7


regionalNews In communities across the U.S.,

  6 Tri-County Office on Aging   7 Region VII Area Agency on Aging   8 Area Agency on Aging of Western Michigan   9 NEMCSA Region 9 Area Agency on Aging 10 Area Agency on  Aging of Northwest Reg 1-C / The Senior Alliance, Inc. Michigan 11 Upper Peninsula Area Agency on Aging 14 Senior Resources of West Michigan

11

Area Agencies on Aging (AAAs) serve as gateways to local resources, planning efforts and services that help older adults remain independent. Here are the programs and services offered by Michigan’s AAAs.

1A Detroit Area Agency on Aging 1B Area Agency on Aging 1-B 1C The Senior Alliance   2 Region 2 Area Agency on Aging 3A Kalamazoo Co. Health & Community Services Dept. Region 3A 3B Burnham-Brook Region IIIB 3C Branch-St. Joseph Area Agency on Aging IIIC   4 Region IV Area Agency on Aging   5 Valley Area Agency on Aging

9

10 Reg 1-A / Detroit AAA

Reg 1-B / AAA 1-B

7

8 5

14

Reg 2 / Reg 2

6 4

3A 3B

Reg 3-A / Kalamazoo Cty. Human Services Dept. (Region 3)

3C

2

1B

1C

1A

Reg 3-B / Burnham-Brook Reg IIIB

Reg 3-C / Branch-St. Joseph AAA (IIIC)

Reg 4 / Reg I

S potlight O n …

Region VII Area Agency on Aging Serving Bay, Clare, Gladwin, Gratiot, Huron, Isabella, Midland, Saginaw, Sanilac and Tuscola counties

A Learning Experience for Older Adults and Children

Reg 5 / Valley AAA

T

oday’s older adults and children have limited opportunities for meaningful interaction, but that is changing. The Human Development Commission, which serves Huron, Sanilac and Tuscola counties, opened the doors to an intergenerational day care facility in February 2007. Generations: The Mary Ann Vandemark Center is located at 430 Montague, Caro, MI, 989-672-2273, and provides high-quality care to meet the needs of two distinct service populations: older adults and children. The center provides an opportunity for socialization and stimulating activities — such as games, memory exercises 

Reg 9 / NEMSCA Reg 9 AAA

Generations: The Mary Ann Vandemark Center.

and sharing life experiences — in a safe environment for older adults

Reg 6 / Tri-County Office on Aging

Reg 7 / Reg VII AAA

who have functional limitations due to Alzheimer’s and related dementia disorders, while offering respite for caregivers as well. The facility also offers children before- and afterschool educational and enrichment experiences. Though these are two distinct services, the older adults and Reg 10 / AAA of Northwest Reg 11to / Upper Peninsula AAA children have aMIchance interact with each other through structured activities — like dancercise, reptile shows and charades — which fosters growth, caring and mutual respect. For more information about the intergenerational day care facility and additional services offered, contact HDC at 1-800-843-6394, 429 Montague, Caro, MI 48723. You can also contact the Region VII Area Agency on Aging at 1-800-858-1637 or www.region7aaa.org. Michigan Generations

Reg 8 / AAA

Reg 14 / Sen West Michiga


Detroit Area Agency on Aging Serving Detroit, Highland Park, Hamtramck, Harper Woods and the five Grosse Pointes in Wayne County

The Detroit Landscape and Long-Term Care

S

ome 40 percent of people over the age of 65 are expected to spend at least some time in a skilled nursing facility during their lifetime. If and when that time comes for Detroit area residents, the Detroit Area Agency on Aging (DAAA) wants to make sure that high-quality nursing homes are accessible to all consumers. By initiating Detroit’s Dying Before Their Time Task Force in 2003, DAAA brought attention to the significant long-term care needs of seniors in Detroit and the lack of services to meet those needs. In a national report released last year by The Commonwealth Fund, researchers found that poorer quality of care in nursing homes is linked to racial segregation. According to the 12 whites aren’t report, “Blacks and 10 getting different care in the same 8 nursing homes. They’re getting 6 different care because they live in 4 different nursing homes.” 2 With African Americans totaling Michigan Northern 83 percent of Detroit’sNational population, Average Average Region DAAA is in gear to address this issue and to reduce nursing facility disparities. DAAA is committed to ensuring that Detroit residents have access to quality long-term care facilities. Toward this end, DAAA commissioned a study to identify vulnerable facilities and create strategies to improve the overall quality of care in Detroit skilled nursing facilities.

In a nursing home, licensed nurses and certified nursing assistants work under the direction of a physician to provide 24-hour care. There are approximately 40 licensed skilled nursing facilities in Detroit. The nursing home study found that Detroit’s elderly population has unique needs relative to the average long-term care facility in Michigan. In

Reg 1-A / Detroit AAA

Reg 1-B / AAA

to other Michigan nursing homes, but that staff need additional training and education to increase their effectiveness and improve patient outcomes. WHAT CONTRIBUTES TO FINANCIAL SUCCESS? Having a high rate of

occupancy increases the likelihood of / Kalamazoo Cty. Human financial success forReg a 3-A nursing home Services Dept. (Region 3) operator. Many Detroit facilities have low occupancy, suggesting that there is excess capacity in some areas of Detroit Skilled Nursing Facilities the city. Average Number of Life Safety Citations Individuals who have a three-day $158 12 hospital stay prior to a nursing home $155 10 admission may have a portion of their $152 8 nursing home stay covered by the $149 6 5 / Valley AAA to nursMedicare program. Reg Payments $146 4 ing homes from Medicare are higher $143 2 than from Medicaid. However, many $140 National Michigan Northern Eastern Southern Western Eastern Southern Northern Western Michigan Average Average Region Region Region Region Regionfacilities Region are Region Region Average Detroit not certified to participate in 2005 Operating Expenses Per Patient Day Detroit nursing Medicare. $158 facilities, there The Med$155 is a higher numicaid program $152 ber of indigent reimburses $149 Reg 9 / NEMSCA Reg 9 AAA residents and a facilities using $146 higher incidence a complicated $143 of HIV/AIDS, formula that $140 Eastern Southernmental Western Eastern Southern Northern Western Michigan chronic does not proRegion Region Region Region Region Region Region Average health, substance vide incentives abuse and behavior issues. Often, the to owners to invest in improving the staffs in Detroit facilities are inadephysical plant of a building. quately trained to handle these special THE FUTURE? With the involveneeds. As a result, these residents ment of long-term care industry are often transferred to hospitals, leaders, advocacy groups, nursing home resulting in higher payments by both owners, residents and family members Medicaid and Medicare. throughout the state, Michigan can Detroit nursing facilities are cited explore and implement reforms that for health and safety citations at will stabilize the nursing home industry, WHAT ARE SKILLED NURSING higher rates than the average Michiprevent additional closures, and mainFACILITIES? These facilities are gan facility. These citations have a tain the quality of patient care. DAAA typically needed for long-term care; direct correlation to the age of the is committed to working with these however, nursing homes may also be buildings, accident prevention and stakeholders to improve the quality of used for brief periods of rehabilitasafety monitoring. facilities in Detroit. tion, or to give a family a break from The study noted that Detroit faciliFor more information, call the Detroit the demands of providing home care. ties are staffed at levels comparable Area Agency on Aging at 313-446-4444. Spring 2008



Reg 3-B / Burn

Reg 6 / Tri-Cou

Reg 10 / AAA


Area Agency on Aging 1-B Serving the counties of Livingston, Macomb, Monroe, Oakland, St. Clair and Washtenaw

Substance Abuse Rising Among Senior Population

T

oday, nearly one in five seniors misuses alcohol and prescription drugs. It’s an invisible, growing problem among older adults, and the dilemma is two-fold. Generally, after age 65, the body goes through subtle changes, processing substances like prescription drugs and alcohol less efficiently than it once did. These changes create an increased sensitivity to alcohol and drugs. Substances linger longer within an aging body, and this is why alcohol consumption and/or drug dosages can easily become harmful. Often, the signs of substance abuse are: •  Changes in personal hygiene; neglect of home or pets. •  Withdrawal from family, friends and neighbors. •  Sleeping during the day or other sleep issues; lack of energy; unable to concentrate. •  Request for refills beyond the

Living Well Series

L

isten to WWJ 950AM between Friday and Monday each week to hear the Area Agency on Aging 1-B Living Well Series. The Living Well Series provides seniors, adults with disabilities and family caregivers with short bits of information on interesting topics. Sponsors include Blue Cross Blue Shield of Michigan, Jim Schuster and the Medilodge Group.

10

illness the drug was taken to prevent. •  Falls, bruising, fractures or burns — especially when the person cannot remember how they got the injury. •  Self-medicating by taking more of a psychoactive drug whose effects have been weakened. •  Revolving activities around a drug dosage schedule and worrying about having enough medication. •  Irritability and unexplained

Reg 1-A / Detroit AAA

Reg 1-B / AAA 1-B

mood changes; emotionally out of touch. •  Loss of short-term memory; confusion. •  Sharing drugs. Reg 3-A Kalamazoo Cty. Human 3-B / Burnham-Brook Reg IIIB •  /Drinking in theReg morning. Services Dept. (Region 3) •  Heart irregularities. When you recognize a problem, often the difficult part is confronting your loved one with the issue. A good starting point is to have a conversation with their primary care physician. Another is to seek out a geriatric team that includes 5 / Valley AAA Reg 6 / Tri-County on Aging aReggeriatrician; a geriatric care Office manager who is also a nurse or social worker; a nutritionist; and a geropsychiatrist. Above all, don’t try to repair the situation on your own and don’t ignore it just because of their age. Studies show that recovery may be slower in older adults, but the rate of success is better. Reg 9Reprinted / NEMSCA Reg 9from AAA AAA Reg1-B 10 / AAA of Northwest MI ACCESS publication. By Rebecca Rabano.

Monroe County Caregiver Fair On Saturday, April 26, the Monroe Aging Consortium will host the 5th Annual Monroe County Caregiver Fair. Family caregivers of older adults and adults with disabilities can attend for FREE. Visit with over 40 providers of local services. Listen to presentations on topics including: •  Elder Law  •  Medicaid  •  Alzheimer’s Disease  •  Veterans’ Benefits and more. Monroe County Community College 1555 S. Raisinville Road, Monroe, 10:00 a.m. to 2:00 p.m. For more information, call 1-800-852-7795 or visit www.aaa1b.com. Michigan Generations

Reg 1-C / The

Reg 3-C / Bra (IIIC)

Reg 7 / Reg V

Reg 11 / Uppe


Program Provides Extended Break

F

or many families caring for an older loved one 24/7, planning a vacation, attending out-oftown functions or simply finding time to relax can be a challenge. The Area Agency on Aging 1-B’s Out of Home Respite program is designed to give families caring for an older loved one, or an aging parent caring for a disabled adult, the opportunity to place their loved one in an assisted-living facility for up to two weeks at a time, twice a year. Availability is on a firstcome, first-served basis. Caregivers using the program are asked to help cover program costs based on a sliding income scale. To learn more about this program, call us at 1-800-852-7795, or visit www.aaa1b.com, go under Programs & Services and click on Out of Home Care.

Help Is a Phone Call Away The Area Agency on Aging 1-B is the first resource for older adults, caregivers and persons with disabilities to call when looking to resolve problems or locate the resources they need to improve the quality of their life. When individuals call the toll-free Information and Assistance (I&A) service at 1-800-852-7795, they speak with a certified Infor­mation and Referral Specialist to determine what their needs are and the services and assistance available to address those needs. Once the needs are determined, the specialist accesses the I&A database of over 2,000 community agencies and mails the individual a complete listing of relevant services and providers in their local community. Call us. We can help.

1-800-852-7795

Region 2 Area Agency on Aging Serving Hillsdale, Jackson and Lenawee counties

Growing to Serve

P

erennial Park, also known as the Hillsdale County Senior Services Center (or the Center) is a private nonprofit organization that is “Growing to Serve” and functions as the Department on Aging for the county. The Center is a place where people meet to pursue mutual interests, receive services and take part in programs and services that will enhance their dignity, improve their health, support their independence and encourage their involvement in the community. The following list of services are available through the Center: lifelong learning classes and clubs, depression screenings, psychosocial evaluations, homemaking, personal care, respite, Spring 2008

volunteer transportation, meals on wheels, congregate lunch Reg 1-A / Detroit AAA Reg 1-B sites, / AAA 1-B kinship care, outreach, Medicare/Medicaid assistance, legal services, basic health care needs, volunteer opportunities, Tel-A-Tend (a free 24-hour telephone reassurance program), Legacy Club

The Center is a place where people meet to Reg 3-A / Kalamazoo Cty. Human Reg 3-B / Burnham-Brook Reg IIIB pursue mutual interests, Services Dept. (Region 3) receive services and take part in many programs and services. (adult day respite care), fitness center, flu/pneumonia vaccines, exercise classes and equipment loan library. The Center’s visionRegaddresses Reg 5 / Valley AAA 6 / Tri-County Office on Aging the needs of rural residents facing a high incidence of obesity, diabetes,

cardiovascular disease, illiteracy and limited Reg 1-C / The Senior Alliance, Inc. Reg 2 / Reg 2 AAA opportunities for lifelong learning. Over the 24 years the Center has been in existence, it has grown and expanded to adapt to the changing needs of older persons. A 15-member, demographically weighted volunteer board assists the Center in its operations and recently completed a strategic plan. For the next four years, the Reg 3-C / Branch-St. Joseph AAA Reg 4 / Reg IV AAA (IIIC) plan calls for future developments as aging baby boomers begin to retire. These plans include classrooms, a computer lab, an expanded 24-hour respite care program, affordable senior housing, a walking path, a woodshop, a pool and a gymnasium. For more information, please contact the Center at 517-437-2422 or Reg 7 / Reg VII AAA Reg 8 / AAA of Western Michigan 1-800-479-3348 or visit our website at www.hillsdaleseniorcenter.org. 11


Burnham Brook Region IIIB Serving Barry and Calhoun counties in Southwest Michigan

Change Is Tough, But Our Future Is Bright

S

ince opening as a full-service to the citizens of Barry and Calhoun senior center in 1996, the Burncounties. ham Brook Community Center has To achieve sustainability, the Burnhad its share of challenges. For the ham Brook Community Center has last two years, the board, staff, senior had to make some difficult decisions. center members As a result, ownership and community of the building has been leaders have looked transferred to a title holdfor innovative ing company, and the ways to achieve a Battle Creek Community sustainable model. Foundation will oversee In the meantime, senior center activities. the Region 3B Region 3B will remain Area Agency on at Burnham Brook as one Aging has operated of several tenants who quietly in the backwill share a senior service ground, bringing focus. With ownership of 1-A / Detroit AAA home and commuthe buildingRegtransferred, Executive Director Karla Fales. nity-based services Region 3B can re-focus its

energies to supporting the indepenReg 3-A health / Kalamazooand Cty. Human Reg 3-B / Burnham-Brook Reg IIIB Services Dept. (Region 3) dence of seniors and disabled adults in its service area. Leading this effort will be a familiar face — Karla Fales, who served as the AAA director of planning until July 2007. She returned to Region 3B as its executive director in February 2008. The process of change is often a painful experience. But for Region 3B, Reg 5 / Valley AAA Reg 6 / Tri-County Office on Aging it has only strengthened the capacity and resolve of the agency to serve seniors and disabled adults in Barry and Calhoun counties. Overall, the future is bright for the Region 3B Area Agency on Aging and for the Burnham Brook Community Center. For information, contact Executive Director Karla Fales, Region 3B Area Reg 9 / NEMSCA Reg 9 AAA Reg 10 / AAA of Northwest MI Reg 1-B / AAAon 1-B Aging, at 269-966-2450 Reg 1-C / The Senior Alliance, Agency or goInc. to www.region3b.org.

Reg 3-C / Bran (IIIC)

Reg 7 / Reg V

Reg 11 / Uppe Reg 2 / Reg 2

Branch–St. Joseph Area Agency on Aging IIIC Serving a two-county area surrounding Sturgis, Three Rivers, Coldwater and Quincy

Think Spring!

Reg 3-A / Kalamazoo Cty. Human Services Dept. (Region 3)

W

ith the weather changing from cold to warmer, many of us begin to think about spring cleaning and repairs. There are some resources available if you need assistance completing chores. Your local Commission on Aging provides Chore Services through their In-Home Services program. There may be a waiting list, so contact them today to schedule a date and time for them to help you. You must be over age 60 to be eligible for their services. The Community Action Agency and the USDA Rural Development Programs often have funding 12

completed. Eligibility may be based onReg 3-C / Branch-St. Joseph AAA income, so be sure (IIIC) to ask about each program’s requirements.

Reg 3-B / Burnham-Brook Reg IIIB

Reg 4 / Reg I

In Branch County: Commission on Aging 517-279-6565 Community Action Agency 517-279-8249 Reg 5 / Valley AAA

assistance available to help you complete major repairs to your home. Ask them about grantsRegand veryReglow9 / NEMSCA 9 AAA interest loans to help you get your roof repaired or other major projects

In St. Joseph County: Reg 7 / Reg VII AAA Commission on Aging 269-279-8083 Community Action Agency 269-467-4506

Reg 6 / Tri-County Office on Aging

Reg 8 / AAA

USDA Rural Development: (serves Branch and St. Joseph counties) Kaye Steiding 269-445-1607 Reg 10 / AAA of Northwest MI

Reg 11 / Upper Peninsula AAA

For information, call 517-278-2538 or toll-free 1-888-615-8009. Michigan Generations

Reg 14 / Sen West Michig


Region IV Area Agency on Aging Covering Michigan’s Great Southwest including Berrien, Cass and Van Buren counties

SeniorNet Takes Its Show on the Road Reg 3-A / Kalamazoo Cty. Human Services Dept. (Region 3)

M

ore people over the age of 50 in Southwest Michigan who want to learn how to use a computer for the first time, brush up on their

skills or learn new ways to use a computer can take classes closer to home through SeniorNet — thanks to new mobile equipment.

Reg 3-B / Burnham-Brook Reg IIIB

Thirteen laptop computers and a projector have been purchased through a grant from AT&T, and will allow more class offerings in more locations, using a model where volunteers serve as instructors and coaches. Classes are small — no more than 12 peopleReg per class — and Reg 5 / Valley AAA 6 / Tri-County Office on Aging the approach is low-key, allowing students to learn at their own pace. The new equipment will expand the location of class offerings, as it can be set up nearly anywhere — senior centers, churches or community centers. The wide offering of popular classes has included word processing, spread­sheets, email sending and Reg 9 / NEMSCA Reg 9 AAA Reg 10 / AAA of Northwest MI receiving, creating and printing greeting cards, photo editing and using the

Internet to look up information or 4 / Reg IV AAA Reghealth 3-C / Branch-St. Joseph AAA Reg (IIIC) genealogy — all in response to student requests. One student explained that he took classes because he wants to keep in touch with his six grand­ children, all grown or in their teens. “I’ve even had a few students who have gotten so involved in eBay that they make a little extra Reg 7 / Reg VII AAA Reg 8 / AAA of Western Michigan Reg 1-A / Detroit AAA 1-B / AAA 1-B money buying and Reg selling,” said Dennis Bowen, volunteer coordinator in St. Joseph. The AAA has sponsored the SeniorNet Learning Center since 2000. Since then, more than 1,800 students have taken classes. To learn about the SeniorNet Learning Center Southwest Michigan, contact Reg 11 / Upper in Peninsula AAA Reg 14 / Senior Resources of West Michigan Reg / Kalamazoo Cty. Human Reg 3-B / Burnham-Brook the3-AAAA’s chief information officer, Reg IIIB Services Dept. (Region 3) Richard Martin, at 1-800-442-2803.

Reg 1-C / The

Reg 3-C / Bra (IIIC)

Tri-County Office on Aging A consortium of Clinton, Eaton and Ingham counties and the cities of Lansing and East Lansing

Loan Program Helps Seniors and People with Disabilities

T

he United Cerebral Palsy of Michigan and the Option 1 Credit Union have joined together to offer an innovative program throughout the state of Michigan. The Michigan Assistive Technology Loan Fund (ATLF) enables seniors and people with disabilities to buy assistive technology equipment and devices. Allowable equipment includes, but is not limited to, hearing aids, power scooters and accessible home or vehicle modifications. In 2007 the Tri-County Office on Aging became an outreach site taking applications for ATLF. This program provides low-cost, fixed-rate loans to qualified applicants to finance the purchase of assistive technology Spring 2008

Sara uses a new ramp to her home.

devices and services. Any Michigan resident with disabilities — as well as their family members or guardian — is eligible to apply. The Loan Fund has no minimum limit, but the ATLF

has a maximum limit of $30,000. Reg 5 / Valley AAA Reg 6 / Tri-County Office on Aging Sara Grover, who has had a disability for the past four years, invested in a power scooter but was unable to bring it up the steps and into her home. With the help of the ATLF, she and her husband had a ramp built so that Sara could ride the scooter in and out of her home. “While I don’t currently need Reg 9 / NEMSCA Reg 9 AAAthe scooter Reg 10 / AAA full-time, of Northwest MI I will in the future,” she says. “Being prepared for that day means a tremendous amount to me.” If you live in Clinton, Eaton or Ingham counties and would like more information, call the Tri-County Office on Aging at 517-877-1440 or 1-800-405-9141. For other areas of Michigan, contact United Cerebral Palsy of Michigan at 1-800-8282714 or visit the Michigan Loan Funds website at www.michiganloanfunds.org. 13

Reg 7 / Reg V

Reg 11 / Uppe


NEMCSA Region 9 Area Agency on Aging Covering 12 counties of Northeast Michigan

Northeastern Michigan Commissions on Aging Offer Wellness Opportunities Reg 1-A / Detroit AAA

T

he Otsego County Commission on Aging (OCCOA) offers an Educational Breakfast Series program for Otsego County’s older adult population and their caregivers on the first or second Friday of every other month at the University Cen- Dr. Patrick McNamara of Image North in Gaylord ter in Gaylord speaks at a recent educational breakfast. from 8:00 a.m. to 10:00 a.m. The series is targeted toward older adults who are interested in short-

term education that they can apply to their own life situations. Each meeting is facilitated by an agency staff member and includes a guest speaker and a group of panelists who are know­ ledgeable about the program topic. A question-and-answer session is allotted at the end of eachRegprogram. 3-A / Kalamazoo Cty. Human Services Dept. (Region 3) There is a suggested donation of $5.00. Everyone is welcome to attend and have breakfast with us! For more information, please call OCCOA at 989-732-1122.

T

he Cheboygan County Council on Aging operates Sand Castles, an Adult Day Center in Reg 5 / Valley AAA Cheboygan. Their mission is to provide

participants with the highest levels of respect care Reg 9 /and NEMSCA Reg 9 by AAA Reg 1-B / AAA 1-B / The Senior Alliance, offering a wide rangeRegof1-Cactivities tai- Inc. lored to clients’ specific needs as well as encouraging socialization and interaction with others. The staff recognizes and understands the need for personalized service and develops a unique care plan for each individual client. The staff at Sand Castles has created a friendly and safe setting that provides a variety social Reg 3-B / Burnham-Brook Reg IIIB ofReghealth, 3-C / Branch-St. Joseph AAA (IIIC) and related support services for both the client and his/her caregiver. They strive to help their clients maintain a high level of both mental/physical functioning and independence while keeping the setting as pleasant and homelike as possible. For more information or to arrange an interview for services, please call Reg 6 / Tri-County Office on Aging Reg 7 / Reg VII AAA 231-597-8317.

Reg 10 / AAA Reg 2 / Reg

Reg 4 / Reg

Reg 8 / AAA

Upper Peninsula Area Agency on Aging Serving all 15 counties of Michigan’s Upper Peninsula

hands of the underserved populations that Reg 9 / NEMSCA Reg 9 AAA Reg 10 / AAA of Northwest MI theReg 11 / Upper Peninsula AAA nonprofits work with. “We are proud to be able to reach out to our community organizations cost of technology and take advanand help them help those in need,” tage of what it can offer. We are says Gail Torrethrilled that AT&T ano, president of has provided the AT&T Michigan. opportunity to “These organizabetter serve those tions will continue who need our to use technolhelp.” ogy that is funded The AT&T by this program Excelerator pro­ to empower the gram provides community and technology access AT&T Foundation presents a check to UPAAA. change the lives to organizations of the people whom they serve on a working to strengthen underserved day-to-day basis.” communities. Helping nonprofits inteFor more information, contact Sherry grate technology into their operations Whitman at 1-800-338-1119, or dial and community outreach, this grant 2-1-1 from anywhere in the U.P. also places technology tools in the

AT&T Foundation Supports the U.P.’s Senior Home-Delivered Meal Program

T

he AT&T Foundation has awarded nearly $30,000 to UPCAP’s U.P. Area Agency on Aging (UPAAA) through the AT&T Excelerator competitive technology grant program. This grant will allow the UPAAA to build a streamlined, computerized, user-friendly system that will be integrated with a national database to develop a home-delivered meal system for senior citizens. “This funding will allow U.P. homedelivered meal programs to better assist those in need of services, by helping them operate more efficiently and effectively,” says Jonathan Mead, director. “It can be challenging for nonprofit groups to keep up with the 14

Michigan Generations

Reg 14 / Sen West Michig


ASKtheExpert

Barbara Wolicki RN, BSN

Protect Yourself

Get Vaccinated

I am going to travel overseas. Are there any vaccines that I should be getting? start by making sure you are

up-to-date with all vaccines that are recommended for all adults living in the U.S. Make sure you have immunity to measles, mumps, rubella and varicella (chickenpox) and have had a tetanus/diphtheria shot in the last 10 years. Depending on your age or health risk conditions, you may also need hepatitis A, hepatitis B, influenza (flu), pneumococcal (pneumonia) or meningococcal vaccines. Additional vaccines (such as yellow fever or polio) may be needed depending on the area of the world you intend to visit and the reason you are visiting. For more information, contact your local health department or visit the Michigan Department of Community Health (MDCH) website www.michigan.gov/immunize or the Centers for Disease Control (CDC) travel website http://wwwn.cdc.gov/travel.

I already get the flu shot every year, but is there something else I can do to make sure I don’t get the flu? your chances of being exposed

to these viruses are decreased when a lot of the people around you have gotten the flu vaccine. If you are 50 years or older, have a chronic condition such

Do you have a caregiving question? Write or email your question to our “Expert” at: Jenny Jarvis, Area Agency on Aging 1-B, 29100 Northwestern Highway, Suite 400, Southfield, MI 48034; jjarvis@aaa1b.com. We will make every effort to answer your question in an upcoming issue of Michigan Generations. Spring 2008

as asthma or diabetes, or any problems with your heart, lungs, kidneys or immune system, you should encourage everyone living with you, or in frequent contact with you, to get vaccinated. This includes your health care provider and staff, friends, children, grandchildren and caregivers. Ask them if they have been vaccinated. Tell them to do it not just for their own good health, but for yours as well. Also, just like we were told as children, good hand washing and reminding people to cover their coughs helps!

I heard there is a new vaccine to prevent shingles. Is it covered by my Medicare plan? zoster vaccine has been licensed

and approved for persons 60 years and older who wish to decrease the chance of getting shingles. Ask your health care provider for more information. Insurance can be very confusing. Medicare has two parts that may cover vaccines. The first is Medicare Part B, which does cover participants for flu, pneumococcal, hepatitis B (if you are at increased risk for disease) and vaccines such as tetanus/diphtheria if you have an injury. The second is Medicare Part D, which may cover participants for zoster and other preventive vaccines, depending on the plan you choose. Currently, any vaccine covered by Medicare Part D has to be dispensed by a pharmacist (like your other prescriptions). So, your health care provider can write a prescription, you can take it to a local pharmacy (check first to see if they have it) and your pharmacist can administer the vaccine. Be aware that this vaccine should be given within 30 minutes of removing it from the freezer. Michigan pharmacists are licensed and often trained in giving shots, so getting the

zoster vaccine right at the pharmacy generally may be the best plan.

I read that whooping cough is back. Is there a way to protect myself from it? cdc estimates that there are

about 600,000 cases of pertussis (whooping cough) among adults each year. Pertussis can cause weeks of coughing, cracked ribs from harsh coughing spells and pneumonia. Adults with pertussis can transmit the infection to others, especially infants. Young infants have the highest risk for pertussis-related complications and death. In Michigan, two infants died from pertussis in 2006. There is now a vaccine for adults to protect against pertussis. Tdap (tetanus, diphtheria, pertussis) is available for adults up through age 64. If it has been 10 years or more since your last Td (tetanus, diphtheria) booster, you should get a Tdap vaccine now. If you are going to be in close contact with infants under the age of 12 months, don’t wait. If it has been 2 years (or less in some cases) since your last Td booster, you can get a Tdap vaccine today to protect yourself and these infants. Ask your provider to enter your immunizations into the Michigan Care Improvement Registry (MCIR). It’s a great way to keep track of your record! BARBAR A WOLICKI, RN, BSN, has been with the Michigan Department of Community Health , Division of Immunization, as a nurse educator for the past 9 years and serves as lead on adult immunization issues. Her prior experience includes over 20 years at Garden City Hospital. 15


SPonSoRS American House

J & B Medical Supply

Adult Communities with Services Unlike Any Other Stop by any of our 31 locations in Oakland, Wayne, Macomb, Washtenaw and Genesee counties or visit us online at www.americanhouse.com 

• Diabetes Supplies • Incontinence Supplies • Home Delivery & Quality You Can Trust We are your solution for all your medical supply needs. Call 1-800-737-0045 or visit our website www.jandbmedical.com

Chalgian & Tripp Law Offices PLLC

Presbyterian Villages of Michigan Senior Living Communities

• Elder Law • Estate Planning • Special Needs Planning Offices in East Lansing, Jackson and Ithaca. 1-888-956-9600

Serving seniors of all faiths since 1945. To find out more, visit our website, www.pvm.org, or call 248-281-2020 for a brochure describing the variety of housing and services Presbyterian Villages of Michigan offers. For more information on becoming a sponsor of Michigan Generations, please call Jenny Jarvis at 248-262-9202 .

How to

. Y . I . D LF) E S R U O Y T I O D (

! E N I L N O

The State Bar of Michigan offers a free downloadable booklet titled “Planning for Your Peace of Mind: A Guide to Medical and Legal Decisions.” Topics include: • Q&A sections • General information • Fill-in-the-blank forms for the Michigan Statutory Will, a Personal Records Diary, a Durable Power of Attorney for Health Care and Advanced Directives. FREE at www.legislature.mi.gov/documents/ publications/PeaceofMind.pdf. The State Bar has a downloadable fill-in-the-blank form for a Durable Power of Attorney for financial matters. FREE at www.michbar.org/elderlaw/pdfs/durable.pdf.

MIG08Wi PPrf All r1  

Michigan Also in This Issue: ■ Ask the expert ■ Caregiving news & notes Published quarterly by Michigan’s Area Agencies on Aging Spring...