SENIOR SPIRIT
Living Longer & Loving It
YOU'RE NOT ALONE
Elder Rage author offers Alzheimer's caregiving advice
One out of every 10 people experiences some form of dementia by the age of 65. By age 85, one of two is affected. And for every needy elder, there is a caregiver who is crying out for support and guidance.
Elder Rage by Jacqueline Marcell chronicles her own caregiving journey. In a riveting and sometimes humorous style, she exposes both the horrific and the hopeful along with some very real strategies for today's caregivers. Senior Spirit recently visited with Marcell to tap her experience as a guide for seniors who find themselves in a caregiving role.
SS: What's the most important advice you would offer to Alzheimers caregivers?
JM: Get a diagnosis! Statistically, families wait four years, ignoring illogical or irrational behavior because they think it's a normal part of aging. In fact, these behaviors may signal the beginning of one of the many types of dementia, Alzeimer's disease (AD) being just one type.
SS: What king of illogical or irrational behavior?
JM: Intermittent mild forgetfulness. Trouble remembering recent events, activities or the names of familiar people or things. As the disease progresses, there is increased difficulty in performing simple tasks, confus8ion about time and place, and changes in mood or personality. Sometimes, they cannot think clearly and may make poor decisions. You can find the 10 warning signs of Alzheimer's disease in my book or by clicking on People with Alzheimer's at www.alz.org.
SS: Why is putting a label on the behavior so important?
JM: Without a diagnosis, you can't get drugs to balance the brain chemistry and slow down the progression of the disease. Look for the best geriatric dementia specialist in your area. These doctors understand the disease, and can effectively prescribe the newest drugs. Unfortunately, family doctors may tell you that nothing can be done. It's like asking a podiatrist to perform hears surgery! Find a specialist by contacting the Alzheimer's Association at 800-272-3900.
SS: Why is it important to use the new drugs?
JM: The early, more manageable stages of the disease can be prolonged with one of three drugs - Aricept, Excelon or Reminyl. These drugs may help preserve cognitive ability and may delay the need for expensive, full-time care.
SS: Are drugs the only answer?
JM: No, but that's the first step. Also try behavior modification techniques. Always regard cooperation with extra affection and attention - even extra dessert. Never regard bad behavior, such as lack of cooperation, aggression or bad language. Finally, get them into adult day care. They have to have something to do. These programs offer mental and physical stimulation that keeps them functioning at a higher level. It's worthwhile to spend money on day care; both of you will benefit!
Elder Rage includes 70 pages of self-help information along with a doctor's chapter on medications. Visit www.ElderRage.com for more information or to order your copy.
SENIOR MEDICAL BREAKTHROUGHS
Miracle Drugs? Cholesterol-busting effects and more!
Today, statin drugs are wisely prescribed by doctors to reduce "bad" cholesterol levels. You know these drugs by their brand names - "Zocor", "Pravachol", "Lipitor", "Lescol", "Baycol" and "Mevacor". Along with exercise and a diet low in fat, the statins offer protection from heart disease. In fact, the National Heart, Lung and Blood Institute recently issued new guidelines on cholesterol, urging doctors to prescribe statins earlier and ore aggressively to reduce cholesterol levels.
However, the real store is the unexpected health benefits from taking statins. Studies in 1999 showed that these drugs may contribute to stronger bones. Researchers found that patients with osteoporosis who were also taking statins had fewer hip fractures and greater bone density.
More recently, statins were discovered to decrease the incidence of deep-vein thrombosis (blood clots) in the elderly. And, in combination with aspirin, statins appear to shi8eld against risk of colon cancer, a disease that kills about 48,000 Americans each year. Even the risk of dementia and Alzheimer's disease is significantly reduced in those 50 and older taking one of the statins. Finally, California scientists found that heart transplant patients taking statins were less likely to suffer organ rejection.
Miracle Drugs? Perhaps. More extensive study is needed to verify these remarkable treatment benefits. But like another wonder drug, penicillin, these drugs may cause adverse reactions. Those taking statins should be familiar with and alter to any potential side effects. For more information, consult your doctor or pharmacist.
GRANDPARENT CENTRAL -
TUNE IN TO YOUR GRANDKIDS!
The 12 Rules of Grandparenting by child development specialist and grandma Susan Kettmann gives grandparents permission to break traditional roles - and rules! One breakable rule is: "Grandchildren should listen to their grandparents." Kettmann stresses that information, ideas and opinions must go both ways if you're to build a relationship that spans the generation gap. Try these suggestions.
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Pay attention. Screen out interruptions, avoid busy work and make direct eye contact.
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Try not to dominate. You may have the answers, but try listening at least half the time.
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Take conversational cues from them. Even if they chatter about things that don't interest you, do your best to get involved.
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Make time to talk when they want to. It's important to respond when they reach out, because it may never happen again at a convenient time.
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Schedule "do-nothing" time. Plan low-key activities. It's surprising how tongues loosen when you're doing something like taking or taking a walk.
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Ask older grandchildren for their opinions. Ask what they think about current events, politics, religion, drugs or whatever. Then help them process thoughts from start to finish by asking what consequences would result if those thoughts were put into action.
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Ask your grandchildren to teach you something. They know things that you don't, and it makes them feel useful and grown up to teach you something.
You can find Kettmann's book at your local bookstore or at www.bn.com
LONG TERM CARE STRATEGIES FOR SENIORS
If you're going to pay, you want some say
Exercise your LTC insurance options
Just as no single financial plan suits everyone, your neighbors choice of long-term care (LTC) insurance may not work for you. Senior Spirit talked to Peter Gelbwaks, president of Gelbwaks Insurance Services and past president of the National LTC Network, to find out what alternatives are available.
"People resist the cookie-cutter approach to long-term care," says Gelbwaks. "They either don't like having to utilize certain types of services to qualify for benefits, or they can't accept a lifetime of premiums, or they simply refuse to abdicate financial control." For those individuals, Gelbwaks recommends insurance products that conform to the traditional LTC model while offering unique options.
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Cash benefit riders pay the daily maximum benefit without the hassle of submitting receipts or bills to get payments. Once you qualify for benefits through cognitive loss or by requiring assistance with at least two activities of daily living (ADLs), you get a monthly check. Use the benefit to pay for care needs or for any other purpose. You can even pay family or friend s for caregiver services.
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Limited payment programs allow you to pay premiums once or limit the number of years to pay - five, 10 or 20 years. Once the premiums are paid up, the contract is non-cancelable; you won't have to worry about rate increases from that point forward.
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Return of premium at death riders offer the choice of full or partial (limited) return of premiums to your estate at the time of your death. Full return does just what it says; the limited option returns premiums less benefits received.
All of these options offer more control, a higher return on your investment, or both, but they also cost more. To learn more about these and other LTC insurance strategies, consult with a CSA who specializes in long-term care insurance.
CLOSE THE LAST LOOPHOLE
By Marilee Driscoll, CSA
Does your retirement plan include long-term care (LTC) insurance? One-fourth of today's 65 year olds are projected to spend at least one year in a nursing home. An even greater number will need care at home or in an assisted-living facility. With annual costs of $50,000 and up today, what will LTC cost when you need it? And how will you pay?
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Use existing savings. But that may exhaust your assets.
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Start an LTC savings account. But what if you have a debilitating health crisis before you have enough saved?
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Rely on government programs that require you to be poor and give you limited care choices.
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Buy LTC insurance. An average age premium of $1,500 per year transfers the risk of declining health and increasing costs to the insurance company.
For many, LTC insurance is the answer. It pays for care anywhere - your own home, adult day care, assisted living as well as a nursing home - preserving your income and assets for your healthy spouse or heirs.
Consider these tips before you buy:
- Policies and premiums vary significantly. Have your agent get you quotes from three leading insurance companies.
- A specific policy from a specific company will have the same premium, whether it's purchased from your agent, over the phone or on the Internet. Get help and free advice when you buy from your insurance agent.
- If you are under age 70 when you buy, inflation protection is critical. This protection increases your policy every year without increasing your premium .
The right time to buy is when you've taken care of your other insurance needs and are saving for retirement. To learn more, consult your CSA or an experienced LTC insurance agent.
LONG-TERM CARE QUESTIONS & ANSWERS
Q: Won't Medicare cover LTC costs?
A: Medicare pays for "skilled" care only. Most long-term care (LTC) does not involve skilled care. Therefore, most people who need LTC, including those with Alzheimer's, don't qualify for Medicare's nursing home or home health care benefit.
Q: What about Medicaid?
A: Medicaid, a welfare-assistance program, pays for LTC when your financial resources are exhausted. If you have more than $2,000 in assets, you cannot qualify for Medicaid in most states. Medicaid primarily pays for nursing home care; rarely does it pay for assisted-living or home care. And with Medicaid, your choices of placement are limited.
Q: What determines the cost of LTC insurance?
A: Age and health impact the cost. Other factors involve decisions you make with your agent as you customize your LTC policy, including the following:
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Benefit amount - how much will it pay per day?
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Waiting period - how long after care begins do benefits kick in?
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Benefit period - how long will it pay?
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Inflation - how will the policy keep pace with rising care costs?
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Care options - what type of care do you want to insure?
Q: What happens if I wait?
A: You'll pay more. Premiums are based on age at the time of purchase. By waiting, you also risk not having coverage when you need it. Once your medical history includes a potentially disabling illness - heart attack, stroke, cancer, cognitive problems, etc. - you may not be able to buy LTC insurance at any price.
PRACTICAL TALK ON RETIREMENT ISSUES
Does Medicare pay for ambulance service?
If you've received a bill for ambulance services that Medicare won't pay, you're not alone. Even if your doctor, other medical provider or a care facility ordered the ambulance, you may be responsible for the bill. And it's surprising how much a few miles can cost!
Medicare limits responsibility for ambulance services as follows:
- The service is reasonable and medically necessary because the patient's condition requires emergency care.
- Other means of transportation cannot be used because of your medical condition.
Emergency situations include severe pain, bleeding, shock, unconsciousness, accident, injury, stroke, heart attach, needing restraint or immobilization, or requiring oxygen. Otherwise, you must be "bed-confined" with a doctor's certification that ambulance transport is necessary.
Medicare will only pay for ambulance transportation - emergency or non-emergency - to the nearest local health facility that provides the necessary medical services. However, Medicare does not pay for the return trip home or to a care facility. If the patient could safely go to or from the health facility by private car, cab or wheelchair van. Medicare will deny the ambulance charge - even if these alternate forms of transportation are not available.
So take heed before you call - or allow someone else to call - an ambulance. A good rule of thumb is to ask this question: Is this trip by this mode of transportation to this destination necessary for this person's current condition? If not, consider less expensive transport methods.
CENTENARIAN SALUTE
Pauline Pritzker
By Lynn Peters Adler, JD
Manhattan may intimidate some, but not Pauline Pritzzker. She can't imagine living anywhere else. She came to New York City in 1920 to study singing. And while she never said professionally, Pauline performed in small productions, sang on a radio program and entertained at parties. It was Pauline's singing that attracted her future husband. "When he heard me sing, he was taken with me right away," she confides.
It was due to her husband's heart condition that she adopted a diet containing more fruits and vegetables, fewer meats and fats. "He lived 20 years longer than expected," says Pauline, "and I've been eating the same healthy diet ever since."
Pauline's life since retiring in 1965 from her secretarial job with the NYC schools has involved travel, playing bridge, visits with friends and family and, her passion , the performing arts. In her 90s, Pauline recovered from two serious falls. Ever resilient, she continues to live along with some outside assistance. But her world is now expanded via the Internet. Of her e-mail proficiency, she says, "My typing was a little rusty at first, but now I hardly ever make typos".
During a blackout this summer, a TV reported interviewed Pauline. "I told her that the blackout didn't bother me." She recounts. "I just moved to the window and continued reading the New York Times. Of her one minute of fame, Pauline says, "I hoped no one I knew saw it, because I didn't have a chance to fix myself up at all." According to this spunky centenarian, "I'm up for anything as long as I can put on my makeup."
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