Is Long Term Care Insurance Worth the Investment?

February 27, 2017

Getting older is an expensive proposition. With each decade, the risk of living with a chronic disease, some form of dementia, or other disabling condition, increases. Chances are that most of us will need some kind of assistance with daily care in the future, and many will need to pay privately for that help because their assets exceed the threshold for subsidized care.

Those expenses can add up quickly. According to the Massachusetts Executive Office of Health and Human Services, the average private pay cost of a nursing home in the Commonwealth was $354 per day in July 2016. Forbes pegs the hourly rate of an agency home health aide at $20 per hour; in Central Massachusetts, the average hourly rate is closer to $24.

For women, the cumulative costs are typical higher, simply because women tend to live longer than men in a supported care setting. According to the Forbes article, men will need 18 months of paid care, on average; women, three years.

Understand the Tradeoffs

For those without family members or friends who can be their at-home caregivers, Long Term Care (LTC) insurance presents one way to help cover future expenses. But LTC policies can be a pricey investment. Premiums increase as you age; chronic pre-existing medical conditions can rule out coverage options. Basic policies may not even cover the full daily cost of a nursing home.

So, how do you know whether to buy a LTC policy, when to buy it, and what to look for? The answer depends in part on how much risk you want to take, what you expect will be your future assets, and what you can anticipate about your own health based on family history.

Don’t count on Medicare: those benefits cover only acute hospital stays and limited rehabilitation care. In Massachusetts, MassHealth pays for nursing home expenses, but only after other funds are exhausted. The extent to which the federal and state governments continue to subsidize health care expenses through Medicare and Medicaid is the focus of heated debate nationwide, with no clear answer in sight.

Know Before You Buy

If you suspect that the odds of chronic, debilitating illness are against you, and if there is a high likelihood you’ll need help with basic activities of daily living (dressing, bathing, eating), then a LTC policy might be the right investment. Here are some basic tips:

  1. Buy before you get sick. While there’s no way to know the future, you will have a better chance of getting an affordable LTC policy if you buy while you’re still in good health. Balance this against the number of years you will need to pay premiums before you might need the benefits. On average, it pays to investigate this form of insurance and buy a policy during your 50’s or early 60’s.
  2. Look for a policy with the shortest elimination period. Typically, LTC policies have some kind of a waiting period before benefits can be claimed. A 90-day elimination period is common. Be sure to understand the time frame for which you will still have to pay full price for care until the policy kicks in. Some policies offer a “no elimination” period for home care benefits, which can be very helpful for families
  3. Buy inflation protection. The cost of long-term care will continue to rise. Since you’ll probably be purchasing a policy several decades in advance, you want to be certain that you’re covered for future, not current costs.
  4. Look for portable, flexible coverage. Your benefits should follow you wherever you live, both at home and in a long-term care setting, as well as geographically. Ideally, you want a policy that also gives you flexibility to hire the care that you prefer, and not be bound to a home healthcare agency.
  5. Name a third party contact. For your own protection, identify a family member or trusted friend who can be notified in case of failure to pay a premium or policy cancellation. If memory becomes an issue, you want to be sure of back-up to maintain coverage.
  6. Work with a reputable agent. LTC insurance policies are complicated. You need someone you can trust to help you sort out all the options, including the relative advantages and disadvantages of group versus individual policies. You also want someone who will find you a policy with a company that has an excellent track record with customer service.
  7. Include LTC insurance as part of your estate plan. Be sure to consult with your financial adviser to develop an affordable plan this is right for you. You want to be certain that you can still afford LTC policy premiums even after you stop working. Some policies enable you to change coverage and benefits as your circumstances change.

President of Deborah Fins Associates, PC , since 1995, Deborah Liss Fins is a licensed independent clinical social worker and certified Aging Life Care™ manager. Drawing on more than 30 years of professional experience in aging life care management, DFA offers comprehensive assessments and planning, guidance in selecting appropriate care, help identifying resources for financial support and professional consulting. Please contact us to set up a complimentary initial telephone consultation.

For more on coping with aging, follow us on Twitter: @DeborahFinsALCM.

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Replenishing the Well: How to Set Personal Boundaries as an Aging Life Care Professional™

January 9, 2017

In the helping professions, it’s far too easy to stretch yourself thin. We all got into this work because we wanted to support those in need and to make the world a better place. There is abundant opportunity to make a difference—because there is no shortage of suffering, sadness, pain and loss. But no one can do this work for long before learning, sometimes the hard way (read “burnout”), that we all have physical and emotional limits that must be respected, or we can’t do our best for those we seek to serve.

Setting professional and personal boundaries as an Aging Life Care™ Manager does not mean shirking responsibilities or being insensitive to clients’ needs. It does mean recognizing the importance of self-care as the foundation of being fully present for others. This holds true for all caregivers, whether a family member, friend or career professional.

Setting Realistic Boundaries Is Essential to Well-Being

Given that the overwhelming majority of professionals in this field (and caregivers, in general) are women—and that women are socialized in our culture to put the needs of others before our own—learning to set realistic boundaries can be difficult. It may even feel physically uncomfortable to say no when the default is to say yes to a plea for help.

But boundaries are essential to maintaining personal wellbeing and integrity. Especially when we find ourselves overwhelmed by a rash of client crises, severe illnesses or deaths, we need to be vigilant in finding ways to replenish emotional resources. The alternative is physical and mental exhaustion that can lead to poor judgment, sickness, accidents or worse.

Here are five ways to set realistic professional boundaries and foster your personal wellbeing:

  1. Manage client expectations about your availability. Be clear about your professional hours and availability in your contract and conversations. Consider whether you can realistically offer 24/7 response, especially if you are a one-person practice. Sleep matters. So does your emotional well-being.
  2. Give yourself permission to not answer the phone during off hours. There are many ways to screen calls, from voice mail to professional answering services. Pick the method that suits your personal style and budget, and hold to it. The vast majority of those calls can wait until morning. The ones that can’t, you’ll undoubtedly be able to anticipate.
  3. Think carefully about how big a caseload you really need to maintain. As the Baby Boom generation ages, there is plenty of work to go around. The real question we all need to ask ourselves is how much we can actually take on. Financial goals provide part of the answer. Professional career goals need to be accounted for, as well. Ultimately, however, it comes down to how to balance the ability to provide quality service with maintaining physical and mental health, as well as fostering quality relationships with our own loved ones.
  4. Carve out time for activities that replenish you—and stick to it. Exercise, walks in the woods, films with a friend, date night with your significant other, a good novel, even that trashy TV show you love watching—whatever healthful activity works for you, discover it, claim it and do it. Regularly. The time you spend feeding your soul will not only give you a much needed break; it will recharge your batteries and enable you to be all the more effective in your personal and professional relationships.
  5. Seek joy and laughter. Even in the midst of struggle and hardship, there is much to celebrate in life. Our clients teach us these lessons every day. Stay open to the possibilities.

President of Deborah Fins Associates, PC , since 1995, Deborah Liss Fins is a licensed independent clinical social worker and certified Aging Life Care™ manager. Drawing on more than 30 years of professional experience in aging life care management, DFA offers comprehensive assessments and planning, guidance in selecting appropriate care, help identifying resources for financial support and professional consulting. Please contact us to set up a complimentary initial telephone consultation.

For more on coping with aging, follow us on Twitter: @DeborahFinsALCM.

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Post-Traumatic Growth: How to Cultivate Resilience

November 18, 2016

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Caring for an aging loved one can wear you down. Worry about pain and suffering, power struggles, physical strain, emotional stress, financial fears, anxiety over what the future holds—the list goes on. In troubled times, when you are pulled in multiple directions by all of your responsibilities, the effort to keep your head above water can seem herculean.

But traumatic times can also trigger emotional growth. The ability to cultivate resilience is an essential skill for wellbeing, especially when the future seems dark.

According to Maria Sirois, PsyD , resilience is a choice. As the keynote speaker at the Aging Life Care™ Association—New England Chapter biannual conference, Sirois emphasized that resilience involves “behaviors, thoughts and actions that can be learned and developed in anyone.”

Recognize Common Stressors

The most common stressors that challenge our resilience are familiar to anyone involved in caregiving. Sirois identifies the following:

  • Presence of chronic suffering;
  • Lack of time;
  • Lack of power;
  • Not enough support, a sense of isolation;
  • Stressful patients; stressful family members;
  • Confusing or shifting rules, power structures and relationships.

Seek Opportunities for Growth

But stress and uncertainty also bring opportunities for creative problem solving and new approaches. Sirois describes these as the “Five Domains of Post-Traumatic Growth”:

  • The opening of new possibilities not present before;
  • A change (deepening) in relationships with others;
  • An increased sense of one’s own personal strength;
  • A greater appreciation for life in general;
  • A deepening or significant change in ones’ spirituality.

Practice Healthful Ways to Adapt to Chan ge

People who practice resilience have learned healthful ways to adapt to change while under stress. Close, dependable relationships provide key emotional support. Knowing your limitations, when and how to ask for help—and receive it—is also essential. Savoring the moment, practicing gratitude, leading from your strengths and perseverance are all qualities to cultivate.

Easier said than done when you’re under pressure. We all stumble and get stuck. Remember that this is a mindful mindset that takes constant practice. Sirois cites Karen Reivich, author of The Resilience Factor , who offers four questions to ask yourself on the path to “grounded optimism.” Next time you find yourself sinking under stress, complete these sentences:

  1. A more accurate way of seeing this is . . .
  2. One possible other explanation is . . .
  3. My thoughts aren’t necessarily true because (list evidence) . . .
  4. A more likely outcome is . . .

Your answers may well surprise you. Opening up to new possibilities takes a willingness to question and consider alternative ways of seeing the world. Each new step you take will undoubtedly stir up fear and anxiety that accompany any change. But clarity of vision and positive action also generate new energy and strength.

Stay mindful, celebrate your successes and give yourself room to falter. Cultivating resilience, like cultivating a garden, takes time, persistence, patience, a willingness to get your hands dirty and the reward of a creating a space of beauty, peace and renewal.

President of Deborah Fins Associates, PC , since 1995, Deborah Liss Fins is a licensed independent clinical social worker and certified Aging Life Care™ manager. Drawing on more than 30 years of professional experience in aging life care management, DFA offers comprehensive assessments and planning, guidance in selecting appropriate care, help identifying resources for financial support and professional consulting. Please contact us to set up a complimentary initial telephone consultation.

For more on coping with aging, follow us on Twitter: @DeborahFinsALCM.

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How to Help Your Loved One Survive a Hospital Stay

September 19, 2016

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Your 85-year-old father has Parkinson’s and loses his balance, falling and breaking his hip. Or your 79-year-old mother has congestive heart disease and is hospitalized for shortness of breath. Fill in the blank for the precipitating event: when your aging loved one lands in the hospital for an extended stay, he or she will need help.

The Long Road to Recovery

For all the wonders of modern medicine, getting appropriate care in a hospital is not guaranteed. Even in the best hospitals, many factors contribute to elderly patients’ risk of decline during their stay. Uncomfortable diagnostic testing, repeated blood draws and vital signs checks, noise, light, a rotating cast of health care professionals visiting at times that are convenient to their schedules, rather than the patient’s—not to mention the persistent risk of infection and complications following surgery or other medical procedures—all add up to sleep deprivation, confusion and stress when the patient is already in pain or a weakened state.

Delirium—the rapid onset of confusion and reduced awareness of physical environment—caused by illness, medication side effects, disorientation from lack of sleep, and unfamiliar surroundings, poses a significant risk for patients over 65, Another risk is malnutrition in patients who refuse to eat while in the hospital. The rush to discharge patients as soon as possible, prompted by Medicare and private insurance reimbursement rules, can result in complications from inadequate follow-up care. Even with a solid discharge plan, elderly patients take longer to recover from hospitalization—about one week for every day spent in the hospital.

Improving Chances of a Good Outcome

Here are some ways to help your loved one have a better chance of a successful outcome from a hospital stay:

  • Whenever possible, make sure that a responsible family member or friend is with your loved one. The doctor’s arrival is never predictable, and it’s essential that someone who can understand the medical issues and treatment options is present, both to advocate for your loved one and to help him make any decisions. An Aging Life Care Manager™ can be a key member of this team effort.
  • Understand that your loved one’s primary care doctor is usually not in charge. Even if the physician has hospital privileges, there is a special team of hospitalists who oversee patient care on the floors. When you or your loved one has questions, ask for the doctor managing the case and request to speak to her personally. Nothing will replace the trust established in a long-term doctor-patient relationship, but quality communication with the hospitalist is essential for informed decision-making.
  • To protect your loved one’s privacy, conduct any conversations about her in a private space —not the hallway or in front of a roommate’s family or other visitors.
  • Keep a notebook by the bed, with names and pager numbers of all essential members of your loved one’s medical team. Take notes when the doctor visits. Keep track of test results.
  • Bring your loved one’s advanced planning documents and have them scanned into his record. There is no need to fill out new forms if this work has been done in advance and represents your loved one’s current wishes.
  • Collaborate with your loved one’s hospital case manager and/or social worker to provide accurate, timely information that will enable them to create a realistic, workable discharge plan. Include your Aging Life Care Manager™ in the discussion.
  • If your loved one is able to return home, recognize that she has a new baseline. Make sure she is comfortable and has necessary support during the day during her transition back to health. If she is confused, have a family member or reliable help stay overnight until the confusion clears.

President of Deborah Fins Associates, PC , since 1995, Deborah Liss Fins is a licensed independent clinical social worker and certified Aging Life Care™ manager. Drawing on more than 30 years of professional experience in aging life care management, DFA offers comprehensive assessments and planning, guidance in selecting appropriate care, help identifying resources for financial support and professional consulting. Please contact us to set up a complimentary initial telephone consultation.

For more on coping with aging, follow us on Twitter: @DeborahFinsALCM.

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When Elders Keep Guns at Home: Assessing Safety Risks

August 12, 2016

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Gun ownership is not only one of the most politically sensitive topics this election season. It’s also a question that is frequently asked when Aging Life Care Managers™ conduct an assessment of a new client. Unsecured firearms, sometimes combined with a variety of diagnoses, are a safety concern of many professionals.

This past July, the Aging Life Care Association™ (ALCA) surveyed members to find out how many include questions about firearms when interviewing prospective clients, and, if so, how that affected their providing services in the home.

ALCA does not take a position on guns or gun ownership. As a professional society, their purpose is to provide education, networking and professional development to their members.

Firearms Ownership an Important Factor in Home Assessments

Fully 50 percent of those surveyed (141 of 282) said they include a question in their assessment regarding the presence of firearms. Some respondents said it was their employer’s requirement to ask this question; others said knowledge of firearms in the home was as important as knowing about the client’s driving ability, medications, alcohol or tobacco use, or potential sources of elder abuse. Many commented that they have not asked the question in the past, but will in the future. In addition,

  • 52 percent require that firearms are securely locked up;
  • 10 percent require that firearms be removed;
  • 1 percent decline to provide services if firearms are present.

Safety Risks Depend on Individual Circumstances

Further findings show:

  • The majority of Aging Life Care Professionals™ found the frequency of guns in the house “Very Rarely” (31.2 percent) or “Sometimes” (27.2 percent).
  • The biggest threats to firearm safety in the home included diagnoses of dementia, depression, PTSD or mental illness of any kind.
  • Most respondents said if there are firearms in the house, they require that guns are securely locked up (52 percent).
  • A very few (less than 1 percent) felt it was not appropriate to ask clients about gun ownership.

Overwhelmingly, respondents said they had to evaluate the safety implications of guns in the house on a case-by-case basis, citing cognitive functioning, medications, diagnoses, family dynamics, etc.

Certain Diagnoses May Increase Suicide Risks If Firearms Are Present

Several respondents recounted stories of suicides by clients that took place while professional caregivers were in the home. Said one, “I had a client commit suicide after the family said all firearms were removed from the house. He had one hidden. He was terminal with brain cancer with metastasis.” A similar circumstance was described by another care manager as “one of the worst days of my life.”

Conversations about gun ownership can also open new doors in a client-care manager relationship. Said one care manager, “Discussing firearms, hunting stories and war stories involving the use of firearms is a great way to bond with your client.”

As the survey found, certain diagnoses can result in a dangerous environment both for the client and those working in the home. And even with professional supervision, mistakes can be made. One respondent described this case:

“Client 92, former military. Family felt guns were out of the house. Professional guardian (former military herself) conducted detailed search of the home after appointed and assured me that there were no weapons in home. The client threatened to shoot the night caregiver but never produced a gun. However, while filling medication boxes and securing extra meds in a lockbox in a spare room, I found a handgun. Now I always assume there could be a weapon even if I am told there is not one.”

President of Deborah Fins Associates, PC , since 1995, Deborah Liss Fins is a licensed independent clinical social worker and certified Aging Life Care™ manager. Drawing on more than 30 years of professional experience in aging life care management, DFA offers comprehensive assessments and planning, guidance in selecting appropriate care, help identifying resources for financial support and professional consulting. Please contact us to set up a complimentary initial telephone consultation.

For more on coping with aging, follow us on Twitter: @DeborahFinsALCM.

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