Once the decision has been made to move into assisted living or retirement center, the first consideration may be geography. Once a location has been chosen there are a whole host of questions and factors to consider. Today, though. I will be taking what I think is  a common sense approach look at  location.

*Nearness of Family & Friends - Do children or other family members live nearby or are they far away, perhaps even out of state?

*Area -  Do you like the area of town you’re in now?

*Knowledge of the Facility – Are you already familiar with a specific facility?

*Affordability - A retirement center can cost as much as $5000 per month. If Medicare or Long Term Care Insurance does not completely cover it, do you have the cash or other assets to make up the difference?

The above list is definitely not exhaustive, merely factors to initially consider once you decide to enter a retirement center. My next article will cover the considerations you may want to consider once a facility has been chosen.  This will include staff, services and amenities, cost (again) and fees, and other factors.

I don’t know what the outcome was, but it does beg the question, “when is it time to send a family member or friend to assisted living“? I went online to research this and found several thousand articles. Below is my condensed list to when you might consider easing a family member or friend into assisted living. This list is definitely not all-inclusive. I’m positive there are other signs to look for. These are merely a few of the most obvious and intended only to make you more observant and aware of what signs you may want to be on the lookout for.

* Safety Issues –Falling down often, leaving the stove on, are examples.

* Performance of Daily Tasks – It’s a given that most everything becomes harder as we grow older. But if your friend or loved one is having problems with simple things like getting groceries, showering, getting dressed or using the toilet then it may be time to look into assisted living.

* Taking Medication Properly – Examples include not taking medication as it is prescribed,  forgetting to refill prescriptions, or having expired medication around the house.

* Other Signs – These might include significant weight loss, mood swings, or memory loss. Any of these could be indicative of larger, more serious problems.

The issues outlined above are certainly not all the issues an elderly person encounters. These are merely a few and it is my intent to make you think about these and be on the lookout for others. Next week I will follow up with what to look for in an assisted living environment. Have a blessed week.

My research on this topic uncovered several scams. It is not my intent to list each and every one, but rather list a few that may be better known than others . Afterward, I will list a few simple ways to protect against scam artists.

BEWARE of THESE:

• Relative in Distress;
• Repair and Contracting Scams;
• Telemarketing, Charity, Prize and Sweepstake Scams;
• Nigerian Letter or “419” Fraud;
• Identity Theft

Simple Protection:

• Know your relative’s friends;
• Don’t give out private information over the phone;
• Shred all mail and junk mail before throwing it away,
• If it’s too good to be true, it is.

Closing Notes:

The best prevention is plain ol’ common sense. Don’t give money to people you don’t know, give out personal information over the phone, or succumb to fraudulent letters asking for help. Most all my clients receive letters from different groups asking for help.  One or two of these may be legitimate, but most are looking only to separate the Senior from their money. If you have an elderly friend or relative don’t be afraid to ask if they need help looking over their mail or if they’ve received phone calls soliciting money for different causes.

There are hundreds of scams and we all need to be on the lookout for those that are not legitimate. Just follow a few simple common sense rules and listen to your gut. If you think something is too good to be true, then listen to that small voice and hang up!

When I began researching this topic, I  initially came across several hundred thousand online articles espousing the pros and cons of long term care insurance (LTC). There were an equal number of sites giving quotes on LTC policies. If I had no other starting point, it would be fair to say that this is a hot topic for almost every adult.

I suppose the first question to ask is if LTC  insurance is a good investment or not. The answer to that  is equal to the number of companies selling LTC and the myriad differences between policies. Age, health, marital status, gender and location  are other factors that must also be considered. Essentially, LTC covers expenses not paid for by traditional insurance, Health Maintenance Organizations, or Medicare.

When you look at the escalating  costs of health care, especially as you grow older, it’s easy to see how one’s hard earned savings can be depleted in a very short time. Insurance companies have been quick to capitalize on that fear.  LTC insurance, also known as nursing home insurance, is usually very expensive and the benefits are limited.

The odds of a senior living in a retirement or nursing facility for a protracted length of time are very small.

• Two-thirds of all men, and one-third of all women, age 65 and older will never spend a day in a nursing facility.
• Most nursing facility stays are brief — only about 10% of men and 25% of women age 65 and older spend more than a year in a nursing facility.
• Only 10% of all nursing facility residents will stay longer than three years.
• More than half of all nursing facility stays last six months or less. The average stay of those who enter a custodial care facility is about 18 to 20 months.

Add to that the protections afforded by existing Medicaid laws, and it is improbable a senior would be thrown out into the street. Still, one may argue that LTC insurance provides coverage where Medicaid does not.

I stated above that the odds of a senior spending three or more years in a long term care facility are usually quite slim. Hence, the LTC care payout can be much less than what was stated when the policy was initially sold.  In recent years, though, LTC insurance has become vastly improved.  These improvements include clearer terms and conditions, which give consumers a better idea what to expect for their money. Many policies now offer extended coverage to include some types of assisted living residences in addition to regular nursing facilities. A number of policies permit seniors to use a pool of benefit funds for either home care or residential long-term care, rather than only for one or the other.

Requirements to qualify for benefits have also been loosened, and policies now routinely permit the policy holder to “step down” to lower levels of coverage, for a lower premium, if continuing to pay for the higher benefits becomes too financially burdensome.   As a rule of thumb, most financial advisors recommend spending 5% or less of your monthly income on LTC insurance. Keep in mind that as you age your premiums are likely to increase as your income declines.

If you are considering LTC insurance, be a very careful consumer. Comparison shop among several policies, checking each for exclusions and limitations. Don’t base your decision solely on advice from an insurance agent or broker who is trying to sell you a policy. Check the latest analysis of LTC policies by Consumer Reports or other reliable  source.

Remember that you may never need long-term care at all, or you might not need enough care to collect much in the way of insurance benefits. Before you make a final decision, ask an accountant or other financial advisor whether there might be more profitable ways of investing the money you would otherwise put into insurance premiums. Those investments may provide better protection and liquidity for your money than a long-term care insurance policy, and you’ll have to spend that money on care only if you need it.

This again is NOT a slam dunk. There are a myriad of costs and risks that must be factored into the decision of buying or not buying LTC. The monthly premium,  the likelihood of  needing this  care, are there other ways of funding this, and a myriad other concerns.  Before I embark on this series, let me state, categorically, that I am NOT a financial wizard, so I will speak only in broad general terms. Furthermore, I will not endorse one group or policy over another.

There can also be benefits to this type of insurance and I plan to give an overview of what these could be. Of course, every situation is different, be it financial or other, and the pros and cons must carefully be weighed.

My goal in this brief series is not be the expert in a very complex topic. Rather my goal is to  educate us all, helping everyone explore options that best fit their particular goals and needs. Join me next week when I kick this series off by exploring the COSTS and RISKS of LTC.

This week I wish to address the issue of should the Senior remain at home or move into an independent or assisted living situation. There is no carte blanche threshold holding true for every Senior and every situation. This is another minefield with multiple facts to take into consideration.

Me, I’m a fence sitter and want to have all the facts in hand before a decision is made. I looked at several sites online and had trouble finding information on what signs to look for. Instead, I found literally thousands of sites from assisted and independent living centers touting the unique benefits of their facility.

I guess the signs are so numerous and obvious that it’s not worthy of a short article. That may be a bit harsh and tongue in cheek, but I found very little on this topic. The signs I have listed are more a compilation of common sense and things I touched upon in earlier articles. It is certainly not all inclusive.

• Limited mobility -  Using a cane, walker, or wheelchair and no longer drives;
• Failing or worsening eyesight – Problem reading labels on food items or distinguishing items;
• Impaired memory- Short term memory problems like forgetting to turn off the stove.
• Problems with the little things- This could be a wide range of things, inability to open a jar of peanut butter, unable to easily use a vacuum cleaner or screw in a light bulb.

This list is certainly not exhaustive, but you get the idea. Let me also state that things like forgetting to turn off the stove is not a one time occurrence. I’m talking about patterns of behavior, where the Senior’s ability to independently function becomes more and more compromised and additional help may be needed.

At Time 4 Seniors we are big on making sure each client is honored by NEVER depriving them of THEIR right to choose. We believe  this is fundamental to one’s independence. To do otherwise strips them of the respect and dignity they have earned and deserve.

The flip side of the argument is the Senior and their needs, wants, and desires. First, let me say that not all Seniors are incapable of independent living. Some choose to move. They have accepted their limitations and often just want to scale back into something smaller and more manageable.

Other Seniors refuse to believe they are incapable of living alone. I have a few clients who could greatly benefit from assisted living, or at the very least, a live-in caretaker. I can’t blame them though for wanting to stay home  in familiar surroundings.

Listed below are a few of the things a Senior may feel  if they move into assisted living. Again, this is not an all inclusive list.

• Independence – Losing the right to make decisions or have options;
• Unfamiliar community – New people and new surroundings;
• Security Issues – Fear of physical harm or personal items being stolen:
• Just Giving Up – “If I move into assisted living, it’s just to die”.

As you can see, this is not an easy decision for either the Senior or the family. There’s a lot to be considered.  I don’t necessarily believe that moving into a Senior Community means giving up. There are many communities where the Seniors thrive and are cared for. Sadly, there are some bad ones too.  That said, it’s always best to have as much information as possible before making a decision of this magnitude.

If you are a Senior, have a friend trying to decide if this is the right thing or have an aging parent, be sure to do your homework. Evaluate not only physical needs, but do an exhaustive search of  Senior communities and what each one offers. Also, don’t neglect your own resources and what you can afford.

This series on the abuse of Seniors has not been easy. I have cringed at the horror stories my research has dug up.  The abuse heaped upon our senior citizens is shameful  and unconscionable. Abandonment is, thankfully, the last installment in this series. I may touch on it again, but definitely not anytime soon.

I have looked and looked again, trying to find a justifiable reason for ever abandoning a elderly person. Morally, I can’t seem to find one. Perhaps, though, if one has been abandoned physically or emotionally by their family, there may be cause to not help aging parents. Even so, I think it would still be hard to turn one’s back.

Abandonment is often defined in conjunction with abuse or neglect, but it does stand alone as an abuse and is defined as the desertion of an elderly person by an individual who has assumed responsibility for providing care for an elder, or by a person with physical custody of an elder.

Signs and symptoms of abandonment include but are not limited to:

• The desertion of an elder at a hospital, a nursing facility, or other similar institution;
• The desertion of an elder at a shopping center or other public location;
• An elder’s own report of being abandoned

I don’t have all the answers for stopping abuse of the elderly. I only know that it’s wrong.  When I think of each of my clients, I can’t help but smile as they have shared their life’s stories with me.  Each client is endearing in their own unique way. I know that I can only gain from their knowledge and wisdom.

Therefore, in closing, it is, I feel, an atrocity to turn  a blind eye or deaf ear on a Senior in need. I hope you agree and when you learn of an abusive situation will at the very least contact the appropriate family member or public authority.

This is the fifth  article I have written on elderly abuse. The previous articles and next week’s on abandonment are all about willful acts against a Senior. Neglect, though, can go two ways. If we’re talking about a Senior who is neglectful about their grooming, eating,  house cleaning or other daily habit, it could be pointing to other more serious problems. Neglect may also come from a caregiver  giving inadequate or improper care to the Senior.

Warning signs of neglect, by the Senior or others, include:

• Unusual weight loss, malnutrition, dehydration;
• Untreated physical problems, such as bed sores;
• Unsanitary living conditions: dirt, bugs, soiled bedding and clothes;
• Being left dirty or not bathed;
• Unsuitable clothing or covering for the weather;
• Unsafe living conditions (no heat or running water, faulty electrical wiring, other fire hazards);
• Desertion of the elder at a public place

Obviously, these are not all the the warning signs. More could be added. These are just the most common and easiest to detect. In my first article, I spoke of the little things many Seniors can no longer accomplish without help. If a Senior living alone is losing weight, not caring for themselves properly or has significant memory lapses, there may be more significant problems needing to be addressed by a physician. If the Senior does have caregivers and these  signs are evident, there could be an abusive situation.

If you know of a Senior in either situation, where a Senior living alone is no longer able to do simple daily tasks, or where the caregiver is giving substandard care, be sure a family member or  proper authority becomes aware of the situation.

The financial exploitation of Seniors is not an uncommon problem. It’s probably as old as the minting of the first gold coin, perhaps older. The Seniors I work with all grew up during The Depression and truly know the value of a dollar. More than any other generation, they value their savings and know what it means to “stretch a dollar”.

When they entrust others with their financial affairs they deserve to be cared for with respect and dignity. After all it was their sweat and money that bought us that first car and put us through school. The least we can do is not rob them of the fruits of their labors.

The improper use of an elder’s funds, property or assets constitutes financial exploitation or abuse. An exploiter can be an individual, an institution, or even someone who has power of attorney for the elder. Often the abuser is someone close to the Senior, like a family member.

Obvious examples of financial exploitation include cashing an elderly person’s checks without authorization; forging an older person’s signature; or misusing or stealing an older person’s money or possessions. Another example is deceiving an older person into signing any contract, will, or other document.

Signs of fiscal abuse may take the following forms:

• sudden bank account changes, especially an unexplained withdrawal of large sums of money when accompanied by another;
• additional unexplained names on an elder’s bank signature card;
• disappearance of funds or valuable possessions;
• the provision of substandard care despite adequate finances;
• sudden transfer of assets or changes in a will;
• an elder’s report of financial exploitation.

I often gather the mail for my clients. When doing so, I am on the lookout for “predatory junk mail“, those scam artists who prey upon Seniors and are looking only to separate them from their money.  Just to be sure, though,  I always ask my client if it’s a ministry or cause they are truly supporting.  If not, I make sure it is properly filed in their “circular file folder”.

The  inability to write a check is or can be a painful reality. A few of my clients have horrible arthritis, and with their permission, I will  write out their check and afterward let them review and sign it. I don’t want them believing they can’t handle their affairs, only that they may may need a firmer guiding hand, like we all once needed.

That firm gentle hand must always provide respect and dignity. If you know or suspect that a Senior is being exploited or abused financially be sure to report it to the proper authorities.

Any abuse of seniors is heinous and sexual abuse even more so. I suppose most everyone can guess what forms sexual abuse can take, but I’ll briefly outline them here just so we’re clear. It includes any non consensual contact, including physical sex acts,  activities where the elder is shown pornographic material,  is forced to watch sex acts or forced to undress.

The Bureau of Justice Statistics estimates that there are approximately 2.1 million reported cases of elder abuse. Sexual abuse of Seniors  accounts for .04%. The highest is neglect 58%, physical abuse 15.7%, followed by emotional abuse at 7.3%, and all other is 5.1%. The Bureau  also states that for every reported act of abuse, there are five that go unreported.  It’s easy to see that the above estimates are rather low.  You might say, “well’  sexual abuse is only +/- 2%. Yes, but that’s 2% too much.

According to The Help Guide, some of the many red flags or warnings signs of elder abuse include unexplained accidents, frequent bruising, scarring, sudden “dementia-like” behavior (mumbling, silence, rocking or forgetfulness), sudden self-neglect, depression, the caregiver’s refusal of private visits, broken glasses, bloody underclothing, bruises on the genitalia and weight loss, to name a few. An easy one to see may be (severe) withdrawal, unexplained mood swings, and perhaps an unwillingness to be around or engage  others.

I certainly don’t have all the answers, but if you do suspect an elder is being abused call the proper authorities and let them act on your suspicion.