By Sue Collins, RN Courtesy of

What do you do when you and your loved one have been punched in the gut with a terminal diagnosis? Or mom’s dementia seems to have suddenly worsened overnight? Or a family member faces a slow recovery from a serious accident? Few people are prepared. Most don’t know where to begin or what questions to ask. This can lead to feeling trapped. I’ve been there, as have many of my friends. It helps if you’ve got a practical to-do list to guide you while dealing with the emotional ups and downs of this new reality. A proactive approach will leave you feeling less trapped and in more in control.

Here are ten tips to get you started.

1. Sign Documents
There is so much in life we really can’t control, but you can take care of the necessary paperwork that will help in getting information and making timely decisions. For example, find out if a will exists; if not, get one in place while the person is still cognitive.  Without a will, the state takes over and decides what happens to a person’s property when they are gone.

2. Power of Attorney (POA)
The POA authorizes the designated person (or people) to act on behalf of the loved one in financial and legal matters. This means the POA designee may sign checks, pay bills, do banking and other business on behalf of the person. Make sure you remember to get access to online accounts and passwords.

3. Living Will
Is there Advanced Directive or Five Wishes? A crisis can be a scary thing and decisions may not be well thought out when you are overwhelmed or in a state of disbelief or trying to second guess what your loved one may want. For more information see:

4. Medical Power of Attorney
The Medical Power of Attorney designates a Health Care Agent, who then has the authority to make health care decisions.

5. Identify the Primary Caregiver
Explore which family members or friends can help, and make a plan based on both ability and need. Those who cannot be part of the long haul may be able to participate as pinch hitters, which takes some of the burden off the primary caregiver.

6. Who Can Help You Weekly, Biweekly or Monthly?
Rally the troops and make a schedule. Having something in writing helps create a routine for all involved. Don’t forget to explore co-workers, members of religious organizations, clubs or community networks. When people offer to help, don’t be afraid to take them up on it.

7.  How Can Out of Town Family Participate?
An out of town family member can set up a Facebook page, text or email thread to keep all family members and friends up to date with changes, which also helps to relieve the primary caregiver from repeating the same information over and over. Out of town family members can call and make doctor or treatment appointments as well as establish a group to provide meals, or have meals delivered.

8. Who Can Run Errands or Provide Transportation?
Having someone help with transportation to appointments or treatments gives the 24/7 caregiver a little break from the day-to day tasks. One group in my community set up a phone chain for the transportation of a neighbor who had bi-weekly chemo an hour’s drive away. Volunteers signed up for a one-time trip or even a once-a-week drive for the duration of the chemo. In one case, a retired executive who didn’t know the patient, Beth, drove her to a weekly appointment during which he got to know her, a pleasure for both of them.

9. Who Can Provide Caregiver Respite?
Scheduling respite from the daily caregiving responsibilities is critical in alleviating caregiver stress and burnout. Many caregivers put their own life on hold. It’s not selfish for the primary caregiver to take care of him or herself. It’s practical. Without it, there will be two people needing caregivers. Maintaining hobbies and club activities is important for caregiver wellbeing. Seeing a respite break on the calendar gives you something to look forward to.

10. Breathe
When feeling stressed STOP! Take three deeps breaths, inhale for the count of four, hold for the count of four, exhale for the count of four and hold for the count of four. You will feel the tension you are holding in your body soften.

Caregivers are being asked to perform more complicated tasks than ever before, and the responsibility of managing many kinds of medications can be daunting. Some caregivers are required to provide some medical and nursing tasks. Helping loved ones bathe, dress, shop, cook and manage household chores although fundamental, may fell intrusive. Checking with the local Department of Aging, Health Department or Easter Seals can be resources for services provided in your area.

What Matters Most? Developing a plan, even a temporary short term plan. It can help alleviate stress, anxiety and perhaps thwart some family disputes. Recognizing that disease progression is constantly changing will help caregivers realize that plans will need adjustments along the way to accommodate these changes. And finally, realizing that you can’t ‘fix’ everything — especially when a crisis situation appears. Just doing your best is what matters most.

Sue Collins has been a nurse for 40 years and a hospice nurse for 28 years.  She is co-author with Nancy Taylor Robson of OK Now What? A Caregiver’s Guide to What Matters (Head to Wind Publishing).

Read Sue’s book -a Today’s Caregiver Friendly Award Winner

For more information contact my office at 561.267.2207.

LKG Law, P.A.’s  is an Elder Law & Special Needs Firm with a focus on:   Trust & Estate Planning, Long Term Care,  Medicaid,  Veterans Administration Benefits (VA),  Alzheimer’s Planning, Guardianships, and Probate.  We are located in West Palm Beach, Florida and serve South Florida in Palm Beach, Broward, Dade, Martin and St. Lucie Counties.

Article courtesy of Katherine O’Brien, Katherine O’Brien is a freelance content writer and editor from Toronto who specializes in health, senior care and aging. She helps educate and inform seniors and their families about ways to make the aging process as smooth, painless and enjoyable as possible.

We’ve all had difficult patients, but sometimes it’s not the patients, but the families who will give you grief.

Handling Difficult Families

6 Tips for Handling Difficult Families

Before you lose your cool with the argumentative daughter, opinionated son or the partner who regularly makes a scene, have a glance at our six tips for dealing with challenging family members.

1. Work on Your Perspective

First off, when dealing with unpleasant family members, don’t waste energy trying to change their behavior; instead, strive to change something that is in your control, namely, your own attitude. Look past a caregiver’s demands and confrontational manner so that you can muster up some empathy. (Imagine how you would feel if your mother and father were incapacitated or in pain.) And try to view adult children as allies, rather than adversaries; after all, you do both want the best for their parent.

2. Practice Your Soft Skills

When a caregiver is upset rather than attacking it pays to take the time to actively listen to their concerns. Sometimes they just need to vent, and your hearing them out might relieve some of their anxiety. Even if that’s not the case, if you can, stop what you are doing so that you can be fully present, listening to what they are saying, instead of thinking about how to respond. You should also reflect back what you heard them say in your own words, then ask gentle, probing questions to clarify their concerns and get to the root of their problem. Sometimes, you’ll discover that the issue they appear to be upset by (Dad being dressed in sweats instead of “regular” pants) is not their real concern. They might be feeling helpless over their father’s situation or feel that that the residence is not relaying information in a timely manner.

3. Be Professional

If a family member is attacking rather than upset, know that their tantrum might have little to do with anything you have done and a lot to do with their fear or anger. So, instead of defending yourself or engaging in an argument, try to emotionally detach, stating your points firmly and calmly, while maintaining open body language (don’t cross your arms when facing them, for instance). If you are too emotionally triggered to do this, take some deep breaths, which can aid in calming you down. It’s better to leave the room, at least momentarily, than to fight back. In some cases, it might help defuse the situation if a colleague steps in and takes over.

4. Set Boundaries

Remember that listening to verbal abuse is not in anyone’s job description. If a relative yells at you, for example, ask them to stop, letting them know that you will leave the room if their behavior does not change. (Don’t forget to report and document this behavior.)

5. Don’t Get Hooked

Also, along the lines of setting boundaries, avoid getting into long, unproductive conversations with someone who is argumentative. Instead, keep the communication brief and to the point, letting the caregiver know the amount of time you have available to talk. If they are pelleting you with questions at a time when you have a lot on the go, ask them to write their questions down so that you can answer them in one shot when you’re available.

6. Keep Families Involved

It’s not always easy to coordinate care plan conferences with family members who live out of town or who work in the daytime, but don’t let this be an excuse for carrying on without their participation. Instead, find a time that works for them and ask them to join the meeting via phone or secure video chat. On top of this, make sure that they are always kept in the loop about any changes in their parent’s condition or in the treatment plan. Remember, good communication can go a long way.

LKG Law, P.A.’s  is an Elder Law & Special Needs Firm with a focus on:   Trust & Estate Planning, Long Term Care,  Medicaid,  Veterans Administration Benefits (VA),  Alzheimer’s Planning, Guardianships, and Probate.  We are located in West Palm Beach, Florida and serve South Florida in Palm Beach, Broward, Dade, Martin and St. Lucie Counties.

A move to senior housing may be one of the best decisions a family can make for an aging relative’s health, safety and happiness, particularly when a loved one needs more care than we can provide on our own, or is suffering from social isolation.

Yet lots of families delay this all-important decision, feeling helpless as their loved one’s care needs escalate and their own caregiving stress increases. Learn more about the top reasons families delay moving to assisted living.

Making a decision about senior housing is not easy or straightforward, and there are a variety of reasons why families and seniors may try to avoid discussion of this difficult topic.

We surveyed A Place for Mom’s readers to pinpoint your most pressing concerns, and the results might surprise you. Here are five of the most common reasons families might delay a much-needed move to senior living, along with some possible solutions for tackling each obstacle:

  1. “I Still Want to Do More Research.”

Of the readers we surveyed, the greatest number (27%) said that their top reason for putting off the move to senior housing was in order to do more research and information gathering – from looking at websites to driving by the property to calling communities directly. Families worry about the ratings of the community, and about what they offer residents.

Possible Solutions: Researching senior care can seem daunting, but there are numerous reliable resources out there for families to utilize in evaluating specific communities as well as different types of care. Those worried about ratings and quality of care should visit websites like and A Place for Mom’s State Guide to Assisted Living Records and Reports. Consulting with one of our own Senior Living Advisors can also provide you with invaluable advice on senior housing in your community. The key is taking that first step toward seeking out help.

  1. “I Still Need to Talk with My Loved Ones About Senior Care.”

Fully 22% of those surveyed said they delayed the move to senior housing because of needing to talk to family or friends first. We may put off the decision because it is difficult to coordinate with other family members, or because we want to talk with experienced or trusted friends before figuring out what to do. Of course, it is painful to think about an aging loved one’s declining physical or mental health, which makes it easy to delay having those tough conversations. But doing nothing about it may put our loved one’s health at greater risk, so it is important to discuss issues such as scheduling, health, and logistics before they become real concerns.

Possible Solutions: First, be honest with yourself about your own feelings and why the delay is occurring. Are you afraid of acknowledging your loved one’s frailty? Are you worried about losing control of their care? Think realistically about what will happen if you do nothing about their situation versus what will happen if they move into senior housing. Don’t be afraid to seek help from a counselor, a support group, a spiritual adviser, or a trusted friend, and don’t forget to involve your loved ones when it’s time to make a decision – but don’t put it off forever. If it’s pre-existing family conflicts getting in the way, remember that the focus should be on the welfare of your loved one, and set a good example by trying your best to rise above sibling rivalries and making sure everyone’s viewpoints are heard.

  1. “I’m Concerned About the Cost of Senior Living.”

With the median monthly cost of assisted living rising to almost $3,600 this year, according to the Senior Living Price Index by A Place for Mom, it’s no surprise that sticker shock is one of the reasons many families and seniors delay the move into assisted living – 13% of those we surveyed cited budget uncertainties or high expenses as a delaying factor.

Possible Solution: First, one important fact to remember is to check what is included in the monthly cost of senior housing: the sticker price may cover amenities such as meals and housekeeping – or it may not. The key is understanding what the costs mean and what you get for your money, so make sure to do your research about each facility, consulting with your Senior Living Advisor if you need additional help.

  1. “I Live Too Far Away to Make a Decision.”

Of our survey respondents, 12% cited reasons of geographic distance for delaying the search for senior housing – living in another state from their loved one, living at a distance from the family members doing the decision making, and so forth. This reflects the data collected in a 2004 study conducted by the National Alliance for Caregiving and AARP, who found that 15% of family caregivers live one or more hours away from their care recipient. Living at a distance poses extra challenges to those searching for senior housing, making logistics and timing difficult and adding stress.

Possible Solution: Even if you are looking at the very real possibility of managing your loved one’s care at a distance, you are not alone. To make the process easier, schedule family meetings with other involved loved ones to discuss decisions ahead of time. Make sure to organize all the important documents and paperwork you might need, so everything is in place in case your loved one’s health situation changes unexpectedly. Seek help from online and offline resources and referral services in order to determine what will fit your loved one’s needs and your family’s budget. And this bears repeating – don’t be afraid to seek help from family, friends, or even concerned neighbors.

  1. “My Senior Loved One Is Not Ready to Leave Home.”

There are a number of specific reasons why a loved one might be reluctant or even afraid to move into senior living – they may worry about losing their independence, they may fear that others won’t care for them properly, or they may worry about being bored. They may not feel they need to be in a “nursing home,” or they may be attached to their current home or pets and be understandably reluctant to consider the idea of parting with treasured possessions and memories in order to move into a smaller space.

Possible Solution: If your loved one is throwing up roadblocks to the discussion of senior housing, get informed about the most common fears associated with assisted living and other retirement housing options, and learn what you can do to openly acknowledge and discuss these fears rather than letting them derail the conversation. Once your loved one can articulate his or her worries and feel like they are being heard, you can take steps to assuage their fears. Then you can work together to discuss senior living options that value residents’ independence, privacy, and dignity. Talking to a loved one about downsizing their possessions can be difficult, but once the conversation is open, you can encourage them to enlist trusted family and friends to help, or even a professional move manager.

While these aren’t the only reasons families delay a move into senior housing, they are some of the most common – but being prepared and having realistic expectations will help you avoid potential roadblocks.

Have you or your family experienced roadblocks in the process of moving a loved one to senior care? Here at LKG LAW P.A. we work with community professionals to help transition your loved one smoothly. Please contact us at 561.267.2207 for more information.


Courtesy of Mcknights, By: Emily Morgan

With the number of states adopting managed long-term services and supports programs rising, providers hoping to benefit must make their thoughts and concerns known to managed care stakeholders, experts stressed Monday.

Providers must stay engaged as Medicaid managed care becomes more prevalent, said Julie Weinberg, director of Medicaid policy at UnitedHealthcare Community and State, speaking during a session at LeadingAge’s 2016 Annual Meeting & Expo.

“You as providers, your voices are really important,” Weinberg said. “You need to show up, or have someone show up to every stakeholder meeting. If the health plans aren’t successful, no one is successful. That is why the states and plans need your voices here.”

Providers also will benefit in a managed care world by facilitating care transitions from hospitals to post-acute care facilities, and facilities into the community. Currently, 41% of older adults requiring long-term supports are served in the community settings, up from 22% in 2002. But despite the push toward “less restrictive” home- and community-based settings, institutional long-term care providers should view Medicaid managed LTSS as an opportunity.

“There’s always going to be a need for nursing facilities — you guys have bricks and mortar,” Weinberg said. “Even with a focus on getting people into the community, there are opportunities for facilities to be a partner for care.”

Other highlights from Monday’s educational sessions at the convention included:

  • In the Housing Policy Forum update, Linda Couch, Director, Housing Policy & Priorities at LeadingAge, addressed the 2017 political scene, including relief on sequester caps and the low-income housing tax credit program. Hillary Clinton has talked frequently about the latter, plus a need to establish a larger infrastructure base and expand home ownership opportunities, Couch said. Donald Trump has not delved into affordable housing specifics but also discussed infrastructure and tax cuts to benefit citizens.

If the Senate flips to Democratic control, Sen. Chuck Schumer (D-NY) has said he’d tackle an infrastructure bill in the first 100 days, Couch noted.

Next year “I think we are going to see greater emphasis on human needs,” Couch told McKnight’s. “Patty Murray, Amy Klobuchar and other women in the Senate have shown a commitment to affordable housing.”

  • In a session on reducing unnecessary medications, Denise Hyde, Community Builder, The Eden Alternative, and Frances Holliday of the Brookshire House Rehabilitation and Care in Denver, shared strategies for success. At the facility, psychotropic use dropped from 79% to 10% in less than a year. It is now 6%, Holliday shared.

Residents often benefit from being taken outdoors, she said. Other ways to engage residents and reduce agitation include hand massage with aromatherapy, pet therapy, playing music and giving a resident shower shoes or other amenities during bathing.

“Decreasing medication is not a scary thing and can be done easily,” Holliday told McKnight’s.

    • Meanwhile, during a session about contending with “The Infusion of Millennials into the Workforce,” Linda Shell noted that in five years, 50% of the workforce will be millennials. That means new staffing strategies must be devised because the generation born roughly in the 1983-1997 range has attitudes and expectations of their bosses that will force seismic shifts unlike any before it.

They want fair and direct managers who are highly engaged in their personal development,” Shell said. More than previous generations, millennials will value their “purpose” over just their paycheck; their development over satisfaction; and having a coach over having a boss, she added.

“They’re looking for mentors,” noted co-speaker Wayne Olson, senior vice president of Volunteers of America Health Services, “and not just to help them in their job but to help them get their NEXT job.”

Fir more information contact my office at 561.267.2207.

LKG Law, P.A.’s  is an Elder Law & Special Needs Firm with a focus on:   Trust & Estate Planning, Long Term Care,  Medicaid,  Veterans Administration Benefits (VA),  Alzheimer’s Planning, Guardianships, and Probate.  We are located in West Palm Beach, Florida and serve South Florida in Palm Beach, Broward, Dade, Martin and St. Lucie Counties.

What is a reverse mortgage? We’ve all seen the commercials and heard the celebrity spokespeople… But what is it? Many believe that it’s that new product out there where you give your house away to the lender or the government and your kids get nothing. That’s simply not the case. A federally insured reverse mortgage is called a Home Equity Conversion Mortgage or HECM for short. They have been around since the late 80’s. A HECM enables a homeowner who is 62 years of age or older the ability to tap into the equity in their home (primary residence). That equity is first used to pay off any existing mortgages or liens attached to the home. If one owns free and clear, that means that there is more money available as there is not a mortgage to pay off. This instantly increases ones monthly cash flow. Depending on the amount of equity available, there are very often additional loan proceeds that can be received in various ways: one can receive a monthly payment from the lender for as long as they live in the home (tenure) or for a set period of time (term), they can receive a lump sum, put the money in a line of credit (to be used as needed) or they can do a combination. The great part is that it can be structured to best suit the homeowner’s needs. It’s up to you. While there are NO monthly repayments to be made, the homeowner is responsible for paying and keeping current their property taxes, homeowners insurance, HOA (if applicable) and keeping their home in good repair. The money received is considered loan proceeds, not income, therefore it is considered tax free. You can consult your tax advisor for more information about that. Reverse mortgages are for your primary residence – single family home, townhomes, FHA approved condos, manufactured homes that meet HUD guidelines, modular homes or 2-4 unit properties where the borrower lives in one of the units.

What about my kids??? The house can still be left to one’s kids/heirs. The reverse mortgage is a lien against the property; just like one’s current mortgage. A borrower or their heirs can never owe more than the value of the home. Usually, the heirs will sell the house, pay off the reverse and then the balance can be kept as an inheritance. If they want to keep the home, they can take out a loan to pay off the lower of the balance of the reverse mortgage or 93% of the home value at the time of repayment. The heirs are protected as this is a federally insured loan. It is called a non-recourse loan. This means that only the house secures the loan.

Living on a fixed income can be challenging. A reverse mortgage can take the pressure off of a senior homeowner as well as their kids who may be supporting them. The money received can be used for any purpose. They are no longer seen as or considered the loan of last resort. They are very often used as part of a financial or retirement plan. Many people are putting off collecting social security so that they can receive more later, preserving their investments and supplementing their retirement income. Between eliminating a mortgage payment and receiving loan proceeds, people now have the ability to retire. They now have the money to pay for daily living expenses, insurance (health/life/homeowners/car), medications, property taxes, payoff credit cards, eliminate debt, payoff car loan, afford in-home care, update home or home modification, relieve the burden on family members supporting senior, pay for a grandchild’s education, cash reserve for emergencies, early inheritance, buy 2nd home, become a snowbird, travel, enjoy life! No limitations…

I hear they are not safe. The truth is that they are safer than ever. With the recent changes, such as the addition of financial assessment, we are taking care to make sure that the reverse mortgage is a good fit. It should not be a quick fix or a Band-Aid. Is it for everyone, of course not, however, once one is educated and the loan is property structured, it can be life changing.

I hear it every day – it’s too good to be true or what’s the catch?  Contact me with questions or concerns. I love questions! It’s all about making smart decisions.

 Brian R. Cooper

Reverse Mortgage Specialist

NMLS# 176555

Office: 561.287.8243, Ext. 2697

Fax: 855.895.7713

Cell: 410.258.2667


Article by Kimberly Brannon, Technical-Legal & Software Trainer – Lawyers With Purpose

As many of us are aware, the federal guidelines allow Medicaid applicants to transfer their home to a child caregiver without suffering a Medicaid penalty for the transfer. It is a transfer often attempted by families in the Medicaid application process. It is also a transfer that often fails to meet the requirements necessary for the Medicaid agency to acknowledge the transfer under the child caregiver exemption.
ID-100347162The federal guidelines for the transfer remain somewhat vague, declaring that each state must develop “reasonable standards … for determining eligibility for and the extent of medical assistance,” and that the individual must “fulfill the criteria established by the State in which he lives.” 42 USCA 1396a(a)(17)(A), 453 US 34. This makes it of critical importance that we look to our individual state laws for the specific guidelines necessary. It is also crucial that our clients provide the documentation necessary to prove they acted properly as a caregiver for the parent for at least two consecutive years prior to the transfer.

Generally, individual states require that the child caregiver has resided in the parent’s home for at least two consecutive years immediately preceding the institutionalization of the parent AND provided full-time care for the parent who would otherwise have required institutional care for that entire time period. This is a very specific burden to meet. Just last month, the Superior Court of New Jersey held that a transfer made to a child caregiver who had taken care of her parent for five years prior to institutionalization and met all other requirements of the rule was not valid because the parent had left the nursing home and resided with her son for five months prior to moving back to the nursing home and making the transfer to the daughter. MK v. Dep’t of Human Services, Superior Ct of NJ, Docket No. A-0790-14T3.

So, what must we ensure that our clients have in order to make the transfer? First, we as attorneys must have a clear understanding of the Medicaid guidelines in our own states. Then we need to be sure our clients obtain, and we review, the required documentation. The Medicaid Child Caregiver Exemption generally requires the following documentation.

1.  Doctor’s letter

I immediately require that my clients bring me the letter from the doctor as soon as they indicate they may qualify for the exemption. I encourage them to have the doctor state all conditions that the parent suffers from, the time period the parent has suffered from those conditions, and that BUT FOR THE CARE OF THE CHILD, the period of time the parent would have required institutional care. Medicaid may, after reviewing the doctor’s letter, request medical records; however, they do not generally need to be provided without Medicaid requesting them.

2.  Proof of child’s address

To qualify for the exemption, the child is required to have lived in the parent’s home for the two years IMMEDIATELY preceding the institutionalization. The fact that the child owns a home and spent part of the time there may pose an issue. Any break in living together in the parent’s home may pose issues as it did in the New Jersey case.

3.  Proof of relationship

If the child has a different last name than the parent, he or she needs to be prepared to present a birth certificate in order to prove relationship. Step-children generally do not qualify for the child caregiver exemption.

4.  Proof the child provided full-time care

Medicaid may also ask for the past two years of tax returns. Clients may run into an issue here if they worked during the past two years. Generally, the exemption disallows any occupation other than acting as caregiver for the parent. However, in some states, part-time work outside the home is allowed when another child was providing services, or a caregiver was hired, during that time period.

Again, the first step in successfully transferring a home under the child caregiver exemption is knowing the rules of your jurisdiction. Second, we must make sure our clients can actually provide us with the proof required to meet Medicaid’s standards. Often, it is the second prong where we run into trouble. Medicaid rules are often not malleable, and documentation must prove that each prong of the state standard is met.

Kimberly Brannon, Technical-Legal & Software Trainer – Lawyers With Purpose

Article courtesy of Lisa A. Bowers, Senior Editor McKnight’s Senior Living.

Argentum also pointed out to the GAO that many assisted living providers serve older adults who pay with private funds as well as older adults who are Medicaid beneficiaries, whereas some communities that serve younger, disabled or developmentally disabled people rely completely on Medicaid for payment, Bersani said. “If you’re only getting $37 reimbursement a day, it’s pretty darn hard to provide quality care,” she said. “And maybe that will come out in the study, and that will be absolutely a positive thing.”

Stephen Maag, director of residential communities for LeadingAge, said he hopes the effort will highlight “a major weakness in the use of Medicaid funds in assisted living,” which is that the home- and community-based services waiver program used by many states to cover assisted living care and services does not cover room and board.

Argentum also pointed out to the GAO that many assisted living providers serve older adults who pay with private funds as well as older adults who are Medicaid beneficiaries, whereas some communities that serve younger, disabled or developmentally disabled people rely completely on Medicaid for payment, Bersani said. “If you’re only getting $37 reimbursement a day, it’s pretty darn hard to provide quality care,” she said. “And maybe that will come out in the study, and that will be absolutely a positive thing.”

Stephen Maag, director of residential communities for LeadingAge, said he hopes the effort will highlight “a major weakness in the use of Medicaid funds in assisted living,” which is that the home- and community-based services waiver program used by many states to cover assisted living care and services does not cover room and board.


LKG Law, P.A.’s is an Elder Law & Special Needs Firm with a focus on:   Trust & Estate Planning, Long Term Care, Medicaid, Veterans Administration Benefits (VA), Alzheimer’s Planning, Guardianships, and Probate.   We are located in West Palm Beach, Florida and serve South Florida in Palm Beach, Broward, Dade, Martin and St. Lucie Counties.

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If you’re like the majority of seniors, you probably want to live at home for as long as possible. You like your feeling of independence. The thought of paying for an assisted living facility makes your heart flutter.

But there are some activities of daily living (ADLs) like dressing, bathing driving or grocery shopping that can become difficult for some seniors.

In-home care provides seniors with home health care, non-medical care and even companionship. You keep your independence and your house. In-home care professionals come to you.

And with 78 million baby boomers starting to retire at a rate of 8,000 a day, the demand for in-home care will only increase, meaning more competition, better service and lower prices.

Why In-Home Care?
One survey shows that 90% of seniors want to stay in their homes as long as possible. Your home is where you’re comfortable. It’s what is familiar. It provides comfort. If you move out to an assisted living community or nursing home, you’re starting over. You may have to room with a stranger.

With in-home care, you’re able to remain as independent as you can be. Independence is a psychological boon, especially when the effects of aging are taking place.

For example, you have hip replacement surgery. And instead of heading to a nursing home for care, you go back home, where a physical therapist helps your recovery. And a home health aide tends to your home until you can. The surroundings are yours. You sleep in your bed. All of this familiarity can help with your recovery.

One study found that those who received in-home care visited the doctor 25% fewer times than those that didn’t receive in-home care. Clients with Alzheimer’s or other dementia diseases, made almost 50% less trips to the doctor.

Types of In-Home Care
Not all in-home care is the same. There is service for any kind of need. For example, a man shows signs ofAlzheimer’s but is otherwise physically healthy. He may just need help with paying his bills, getting to appointments, etc. He won’t necessarily need medical help yet.

Licensed medical professionals can include physicians, physician’s assistants (PA), nurses, physical and occupational therapists, and some specialty home health aides who work under the direction of a physician.

A recent survey by Home Instead Senior Care of over 1,600 caregivers showed the following services used by clients:

  • 60% used home-health nurses
  • 59% used physical therapists
  • 32% used occupational therapists
  • 37% had at least one in-home visit from a PA or nurse practitioner
  • 17% had an in-home visit from a physician

Non-medical paraprofessionals include as home health aides, personal care attendants, homemakers and companions. Home health aides provide hands-on care and assistance to with ADLs (see below). They can also help with cooking, shopping and laundry.

Homemakers or companions provide services such as light housekeeping, transportation, and companionship. These activities are known as instrumental ADLs (see below). People with Alzheimer’s will often use a companion to assist them.

Activities of Daily Living (ADLs)

  • Bathing
  • Dressing
  • Feeding
  • Toileting
  • Grooming
  • Oral Care
  • Walking or using a wheelchair

Instrumental ADLs

  • Housekeeping
  • Laundry
  • Change linens
  • General shopping
  • Transportation
  • Meal preparations
  • Managing money
  • Medication management

Who Receives In-Home Care?
According to Home Instead Senior Care’s survey of home care professionals, their clients fell into the following categories:

  • 61% had mobility issues
  • 48% were frail (muscle weakness, slow walking, exhaustion)
  • 43% had some type of dementia
  • 29% had Alzheimer’s disease
  • 22% were dealing with the after-effects of stroke

Costs of In-Home Care vs. Continuing Care
If you’re weighing the pros and cons of in-home care and continuing care (assisted living, nursing home, etc.), here are some numbers to think about. According to The 2012 Genworth Financial Cost of Care Survey, these are the national averages for senior care:

  • Nursing Homes average $222 a day for a private room; $200 for a semi-private room.
  • Assisted living facilities (“typically include at least two meals per day, housekeeping, and personal care assistance, were obtained for one-bedroom apartments or private rooms with private baths in assisted living communities.”) average $3,300 a month.
  • In-Home Care averages $19 an hour for health aides; $18 an hour for homemaker/companion. Additionally, 82% of home health care agencies provide Alzheimer’s training to their employees and 99% don’t charge an additional fee for patients with Alzheimer’s. Most home care services require a minimum of 4 hours so the minimum cost  is $76 /day.

In-home care can certainly be a lower cost solution to assisted living depending on the kind of care you need, and how many daily hours you need this care.

For many seniors, in-home care is an alternative to assisted living that allows them to maintain their independence for as long as possible. Most providers are even trained to care for Alzheimer’s clients.

If you or a loved one are considering in-home care services, search’s database for care providers in your neighborhood.


Ongoing stress is blamed for contributing to an array of health problems – from depression to high blood pressure. Now researchers say it’s also linked with a type of memory decline that’s often a prelude to Alzheimer’s disease.

In the new study of older adults, feeling stressed out increased the likelihood that people would go on to develop a form of mild cognitive impairment (MCI), according to scientists at Albert Einstein College of Medicine and Montefiore Health System. People with MCI face a greater risk of eventually developing Alzheimer’s.

The researchers analyzed data from an ongoing study of adults age 70 and over from Bronx County, New York. All were dementia-free at the start of the study.

The participants were followed for an average of 3.6 years, and over the course of the study, 71 of the 507 were diagnosed with amnesiac mild cognitive impairment (aMCI), the most common form of the condition.

The greater a participant’s stress level – which was measured using standardized stress tests – the greater their risk for developing cognitive impairment, the researchers reported. An MCI diagnosis was based on standardized clinical criteria including the results of memory recall tests and reports of forgetfulness from the participants or others.

High levels of stress were associated with a 30 percent greater risk of cognitive impairment, the authors reported in Alzheimer Disease & Associated Disorders.

“Our study provides strong evidence that perceived stress increases the likelihood that an older person will develop aMCI,” said Dr. Richard Lipton, senior author of the study and vice chair of neurology at Einstein and Montefiore, in a press statement.

Keith Fargo, the Director of Scientific Programs and Outreach at the Alzheimer’s Association, said it’s important to note that the study did not look at Alzheimer’s disease dementia.

“Instead, the authors measured new cases of amnestic mild cognitive impairment (aMCI), a condition characterized by a decline in memory that is measurable and noticeable but not severe enough to disrupt basic activities of daily living. In many people, aMCI appears to lead up to dementia, but in other people aMCI remains stable or even reverts to normal cognition,” Fargo said.

A few other studies have measured stress and risk for aMCI and found results that are similar to this new research, Fargo said.

“According to the scientific literature, there appears to be some kind of connection between high levels of stress and later developing dementia due to Alzheimer’s disease,” said Fargo. But he explained that it is not yet clear whether the stress causes Alzheimer’s, whether the decline into Alzheimer’s disease is what causes the high levels of stress, or if both issues are involved.

Fargo said, “This observational study can only tell us whether there is an association between stress and later being diagnosed with aMCI. It cannot tell us whether stress or perceived stress cause aMCI.”

Because stress is treatable, the authors said the results suggest that detecting and treating stress in older people might help delay or even prevent the onset of MCI and perhaps Alzheimer’s.

“Fortunately, perceived stress is a modifiable risk factor for cognitive impairment, making it a potential target for treatment,” Lipton said. “Stress management techniques … could include physical activity, meditation, yoga.”

Fargo said more research is needed to determine whether interventions aimed at modifying stress can delay or potentially even prevent cognitive decline. But because high stress can lead to a host of health problems, it’s important people learn to manage it.

“In people with Alzheimer’s dementia and their caregivers, symptoms such as anxiety and depression can be particularly debilitating, so stress management may be even more important for them and their caregivers,” Fargo said.

He noted that there is strong evidence showing regular physical activity and management of cardiovascular risk factors – especially diabetes, obesity, smoking and high blood pressure – can reduce the risk of cognitive decline as people age and may also reduce the risk of dementia.

“Given that physical activity can have beneficial effects on stress levels and also helps control cardiovascular risk factors, keeping an eye on stress levels is likely to be beneficial to our cognitive health as we age,” Fargo said.

With the Thanksgiving Holiday right around the corner, many elderly and their loved ones will be traveling to visit family or relocating south for the winter. In a great article written by Kristine Dwyer staff writer at Todays Caregiver Magazine, she explains how to travel with your loved one as a caregiver.

This time of year, many senior “snowbirds” are packing their bags, closing up northern residences and migrating toward senior communities to escape the winter’s fury. This yearly tradition is eagerly anticipated, yet amidst the glamour of senior living in the southern states and the usual pastimes of golfing, fishing, card playing, and senior recreation, the “reality” factor of caregiving still remains.

Caregivers and their spouses who head south to travel to winter residences and warmer climates, face additional challenges as they leave behind the familiarity of home, local services and support systems. Providing daily care to a loved one, while preparing to temporarily relocate, demands a great deal of planning and organization before the departure and in the months to follow.

Here are some important strategies to consider prior to embarking on the “snowbird” journey and when arriving at the winter destination:

Caregivers need to assess their own health status as well as the current health and safety needs of the care receiver and decide whether traveling and residing out of state is in their best interests. Yearly consultations are recommended with medical professionals and family members for advice in order to make this important decision.

Check health insurance guidelines and medical coverage, especially emergency clauses, as they pertain to out-of-state medical care. Discuss the need for medical information and prescriptions to be copied or forwarded to the clinic near your winter residence. See your physician and have prescriptions filled prior to leaving.

Consider the importance of pre-planning for health care directives (and funerals). Make copies of pre-plans for yourself, your family and the medical center you will be using in case there is a health crisis or death while you and your loved one are living out of state.

Prepare a travel route including departure and arrival information, maps, rest stops, and planned overnight stays. Provide vehicle identification information and a copy of the travel itinerary to family members.

Carry emergency information in the glove box including health care information (especially for Alzheimer’s disease, diabetes, allergies, epilepsy and Parkinson’s disease), medication lists, health insurance and emergency contact numbers.

Plan to carry a cell phone with you at all times in case of an emergency and to stay in touch with others while traveling.

Consider purchasing an ID or Medic Alert bracelet for yourself and for your loved one if there are health issues, safety concerns or memory loss problems. These can be lifesavers in case of a sudden health problem or if a loved one wanders away in unfamiliar surroundings.

Prior to moving, gather information through the Internet or library on the medical and social services available to you near your winter home. These may include home health agencies, caregiver support programs, adult day programs, respite care services, meal programs, or disease-specific organizations. Many of these organizations can be accessed nationwide through toll-free numbers or through the Internet (for example, the Alzheimer’s Association, American Cancer Society or the National Parkinson’s Disease Association.)

Plan to build up a “care team of support” at the senior community or RV Park. This team may consist of neighbors, friends, senior park staff, church members and local professionals who can be called upon to assist you with your caregiving or respite care needs during your stay.

Finally, if necessary, seek alternatives such as having a family member travel along, especially if you and your loved one have any medical needs, or consider a shortened stay if the stress of caregiving overrides the enjoyment of being a snowbird. Also, coordinate supportive visits from family members during the winter months.

Spending winters free of snow and cold temperatures is a welcome relief for retirees and caregivers alike. Careful preparations will ensure safer traveling, allow for better management of health care needs, and reduce the chance of a crisis developing away from home. Planning ahead can also enhance the snowbird experience and put your mind at ease as well as the minds of family members left up north.

For more information on helping caregivers plan for their loved ones, please contact my office at 561.267.2207.