I held one of my Financial Forums, recently. A member of the audience raised his hand and asked me if the stock market is being influenced by Russia. My response was, “Which news story are you referring to?” He replied (and I paraphrase), “Well, President Trump, and his campaign’s involvement with …” Respectfully, I had to stop him and explain that I don’t talk politics at my Forums. Are politics important? Yes, of course! Here are my thoughts on the subject.
There is an unending bombardment of political “news” from the media, so you should carefully filter out the noise. Keep in mind that the media sells everyone’s ears and eyes to the advertisers that pay for their TV programs, radio shows, newspapers and magazines. When it comes to politics, in particular, there is just so much we don’t know. It’s kind of like an iceberg. Only 10% of the iceberg is above the water; it’s all we see; the other 90% is below the surface. We don’t have all the facts most of the time.
Let’s say the economy is doing well, the jobs report is good, companies are prospering, inflation is tame, but there’s some sort of political upheaval that concerns you. You get nervous and want to pull your money out of the market. You could be making a big mistake by reacting to the political “news of the day,” instead of using sound, well-thought-out decision-making about your money. I encourage my clients to look at the economic data. What is happening with interest rates? The Fed? The stock market? Small, mid-sized and large corporations? Read financial data, not headlines.
How does this translate to the adviser you choose? Ask yourself, are the political views of my adviser important to me? Is politics something I want to talk about with my adviser? Is it something he/she wants to discuss? You probably don’t want an adviser who is oblivious or apathetic to politics, right? But, on the other hand, do you want a zealot? Will current political news cloud the adviser’s judgement or logical thought processes? I’ll be happy to sit down with any of my clients to discuss my views on politics, if that is, indeed, something they want to know. I won’t, however, bring a divisive topic into a public discussion because it can quickly derail the subject at hand.
To sum up, take care when listening to the 24/7 news machine. Be aware of what the media is “selling.” Know that we, the public, are just seeing the top part of the iceberg, especially when it comes to politics. If you are strongly opinionated, you could choose an adviser whose views align with your own, but make sure he/she can remain clear-headed in his/her decision-making. And, finally, do your due diligence. Take some time to look at the economic data, yourself, so as not to base financial moves on political headlines. If you do that – you guessed it – you’ll plan stronger!
Many times, it’s the daughter who becomes responsible for the care of parents as they age. Over the years, I’ve seen this scenario play out with many clients, and with several of my employees, as well. Is the daughter’s fate sealed because women are considered more maternal and compassionate? Maybe, maybe not. According to a study by a gerontologist and sociologist (source: New York Times online), the child who will become the caregiver is a mixture of both gender and location. A daughter was more than twice as likely to become a caregiver, and, children who lived within a 2-hour drive were six times more likely to take on the role. Sorry, Mom and Dad, you are stuck with Jason and me (but we’re both local, and Jason is in the medical field, so you luck out after all)!
Caring for a parent, or parents, can be emotionally stressful, physically demanding, and many times, financially burdensome. Of course, the type and extent of assistance required will vary. A spouse is often the primary caregiver, but he/she might require substantial emotional support from a daughter. Or, if one parent has passed, all the care duties and decisions may fall on the daughter. These responsibilities may be less overwhelming for a child who is single, or not employed, but imagine the life of a daughter who works full-time, rushes home to cook and clean for her family, and then drives to her mother and father’s home for daily caregiving.
When a parent becomes physically dependent, a daughter’s chores may include preparing food, housecleaning, washing laundry, running errands (grocery shopping, picking up prescriptions, providing transportation to doctors’ appointments), dressing and personal hygiene needs. And, if the elder has a dog or cat, maintenance of the pet may also be relegated to the daughter. If the parent develops dementia, banking, bill-paying and dispensing of medication could also be added to the daughter’s long list of responsibilities.
For elders with enough savings, or for children with significant income, these tasks may be of little concern. There are many ways to provide assistance when resources are readily available. Aides can be hired to provide part-time or around-the-clock help in the home. Specialized communities are available for assisted living or for a continuum of care. But, for middle-class retirees, added longevity means the dollars they’ve saved need to stretch even farther.
So, what should parents do? First and foremost, talk to your kids! If a daughter lives close by, or is an only child, ask her if she is willing to provide support, if necessary. Or, if you have several children, could you rotate amongst them, living part of the year with each? If you choose to remain in your own home, how will you pay for assistance? Have you considered a reverse mortgage loan, or line of credit, to pay for services? How about Long-term Care insurance? These are just some of the questions that should be asked, and answered, before health care services are ever needed.
When I started to write this column, it was going to be about the ways relatives can be instrumental in protecting older family members from online financial abuse. But, the more I thought about it, the more I realized it was the responsibility of each one of us to help protect the elder members of our society from fraud, scams, financial manipulation and deception.
A story told to me by one of my employees comes to mind. Years ago, she worked with an older gentleman; we’ll call him “Vic.” Vic loved expensive things, but, to put it bluntly, he was extraordinarily frugal. A “newbie” to the world of computers, Vic discovered a popular Internet auction site full of potential “deals.” He spent hours combing through the listings, deciding, eventually, that he wanted to buy a luxury-brand watch. He found a merchant selling the timepiece he desired, but the seller would only discount the price if Vic were willing to circumvent the established payment system of the Internet auction site. A red flag should have gone up right then and there. For details on the deal, Vic called the merchant, who said he lived in an eastern European country and who spoke with a strong accent. My employee warned Vic that the transaction sounded “shady,” but her warning fell on deaf ears. Vic’s excitement over the perceived “bargain” made him vulnerable. He had conversed with the seller extensively by telephone, so he was convinced that “he was a really good guy.” (With one phone call, the scammer had earned Vic’s trust.) The smooth-talking stranger instructed Vic to wire him $1,400 cash, which he did. (Red flag! Red flag!) Vic then waited patiently, day after day, for a watch that never arrived. Eventually, he called the seller’s overseas phone number. No surprise. The line had been disconnected.
What’s the takeaway from this story? Speak up! Get involved! Even if you might not be successful, make an effort to save someone from what could be a huge financial misstep. You might encourage older friends and relatives to check with you, or another trusted person, before responding to any offer or entering personal information online. Warn them of the dangers, and tell them not to click on links embedded in emails, and not to open documents that are unsolicited or the least bit suspicious. An unfortunate click could even cause a personal computer to be locked and held for ransom! This can happen to anyone, of course, but the elderly tend to be more vulnerable because they can be less tech-savvy and more trusting. Lastly, if the person has a relationship with a financial adviser, encourage a quick call to him/her before executing any substantial financial transaction, especially those made online.
You may remember that a few weeks ago we talked about Continuing Care Retirement Communities (CCRCs). Since then, I’ve received some positive feedback, about the information shared, and this great question:
“I enjoyed your article about CCRCs in Hometown News this week. A question that immediately came to mind was how Long-term Care (LTC) insurance works with CCRCs . . . whether LTC insurance can be applied if you need to move to the assisted living or skilled nursing parts of the CCRC.” – M.D.
For this question, I defer to the website of my friend, Brad Breeding, who has appeared on my PlanStrongerTV™ show a couple of times. Brad is an expert on CCRCs and you can find good information on his site: mylifesite.net (tip: click on the tab “Resources” for helpful videos).
A contract, an “entry fee” and a monthly fee are generally required when moving into a CCRC. It’s very important that you read, and thoroughly understand, the contract. There are three different kinds: Type A, B and C. 1. Type C contract: When a resident moves from independent living to assisted living, or to the skilled nursing residence, his/her monthly fee will increase to reflect the current market rate. 2. Type A contract: The resident will pay a higher monthly fee for independent living from the start, but additional costs for assisted living or health care do not get added to the monthly fee when, and if, those services are required. 3. Modified Type B contract (sort of a hybrid of A and C): When Long-term Care assistance is needed, the costs are usually added to the monthly fee, but at a reduced rate. Alternatively, the resident may get an allotted number of days in the nursing center before having to pay extra fees.
LTC insurance can be quite compatible with a Type C contract, and might also be compatible with Type B. So, if a CCRC resident needs extra help, Long-term Care insurance can be there to offset the cost increase. But, and I stress this, talk to your insurance agent to see exactly what is required to qualify for a claim. Also, speak to someone in the finance department of the CCRC and ask how its residents have utilized Long-term Care insurance. Ask: “Is there a limit on the amount the community will submit to the insurance company to offset additional monthly costs?” If you sign a Type A contract, you might want to call your insurance company to see about scaling back your coverage so you’re not double-paying for the same service.
Holding on to Long-term Care insurance may be a good idea for a couple other reasons. If you choose to hire a caregiver while you are living independently, that expense may be paid partially, or totally, by LTC insurance under “home care” coverage. Also, though entering into a CCRC is supposed to be a final move, if you were to leave the CCRC, you’d want to continue to have your Long-term Care policy in place for care outside of the community.
There is an epidemic in our country. Maybe the citizens of Volusia and Flagler Counties haven’t experienced it to the same degree as other areas, but we are not immune. You may have heard President Donald Trump mention it during the State of the Union Address. Regrettably, I’m talking about the opioid crisis.
The following drugs are prescription opioids: oxycodone, hydrocodone, morphine and methadone. A synthetic opioid, fentanyl, is much more powerful than the others; it can be prescribed by a physician (often for cancer patients) or can be illegally produced. Heroin is an illegal opioid synthesized from morphine.
I first realized the severity of this problem when I heard the story of a local real estate agent. He had moved to our area from a midwestern, agricultural community. Farming was his life, but he sold all his animals and land. Why? In his town, the drug problem was totally out of control. He recalled trips to the department store where he would see customers plodding slowly through the aisles with glazed eyes – like zombies. Some had tremors or twitched uncontrollably. That sounds like a horror movie but, in that small farm town, it was “real life.”
You’ll be shocked by these statistics from CDC.gov: There were 42,249 opioid deaths in 2016. 42,249! That’s the approximate population of Salem, Massachusetts! 115 people die of overdoses every day (the number of deaths has increased 500% since 1999). The states with the highest rates of death include: West Virginia, Ohio, New Hampshire, Pennsylvania and Kentucky.
The amount of prescription opioids sold to pharmacies, hospitals and doctors’ office nearly quadrupled from 1999-2010. Many addicts aren’t “thugs” or criminals. They can be teachers, accountants, lawyers, and pastors – normal everyday people. They become addicted after being prescribed these drugs for chronic pain, or after injuries or surgeries. If not carefully administered and monitored, addiction can be one of an opioid’s worst side effects.
How does addiction tie in to your money? Consider what retirement looks like for parents who must pay tens of thousands of dollars for treatment and recovery programs for their children (or for themselves). For addicts, the drugs often rob them of their savings (not to mention, their families, friends, jobs, and homes). Some resort to crime to support their addiction. Our tax dollars funnel into government drug programs, and support the users and traffickers who now call jail their “home.”
If there is an addiction problem in your family, please tell your financial planner so he/she can help you take precautions to protect your assets. Obtaining a life insurance policy, for example, could be a smart move. Employing special language in trusts to mandate drug testing of heirs before inheritance distribution, or reserving monies for treatment and recovery, are other options. If you are not open and honest about these issues, however, a trusted adviser can’t be of assistance. There are no easy answers to this crisis, but we can “fight the good fight” with the tools and strategies we have at hand.
Family can provide a sense of belonging, as well as joy, comfort, and support . . . but not always.
Let’s take the case of two brothers, “Paul” and “Tony.” As kids, Tony was given “new” clothes, while Paul was forced to wear hand-me-downs. As young adults, Tony accepted “loans” from his parents on a regular basis. He launched a business and purchased a large home in an exclusive neighborhood. Tony was constantly praised by his parents for his entrepreneurship, picture-perfect family and community service – while Paul worked several jobs, simultaneously, “just to scrape by.” Years passed. When the men’s mother was moved to a nursing home, their father went to live with Paul. But, before relocating, the father entrusted Tony with money and valuables that were to be kept in a safe. When the parents died, and the safe was opened, many of the items had mysteriously “disappeared,” causing a feud between the two brothers that would span their lifetimes.
In another instance, “Janice” (a beloved daughter, sister, aunt and cousin), chose to cut ties with her entire family after her mother died. Without explanation, she simply ended all communication – would not attend family gatherings – stopped answering the telephone. Though many family members tried to reconnect with Janice, she refused all interaction.
Does either story sound familiar? Has something similar happened in your family?
Of course, there are dozens of reasons for estrangement amongst family members. A child might make a choice between a parent and a partner. There can be incompatibilities because of differences in religion, lifestyle or moral values. Shattered relationships can be the result of physical or mental abuse, or dependence on drugs or alcohol. Issues between the children of first and second marriages can cause tension and discord.
With such a prevalence of torn and segmented families, shouldn’t you decide the fate of your money and belongings? I can’t emphasize enough the importance of an estate plan. The death of a loved one is emotional enough, without the added stress of managing assets and liabilities, and dealing with attorneys, accountants, and realtors. Believe me, I’ve seen utter chaos when there has been no planning. In fact, it’s one of the reasons I started providing personal trustee services to my clients.
When you employ a professional to serve as your trustee and/or executor, you alleviate the burden of financial decision-making for your loved ones. Adult children have their own busy lives, and many times can’t handle the added responsibility of estate and trust administration. As we’ve illustrated, there can be conflict, or potential for conflict, within the family; so, putting certain individuals in charge may be a bad idea. With the proper legal documents, and careful selection of an independent trustee, you can reduce the risk of family in-fighting and help ensure your assets go to whom you choose, when you choose. Your advanced planning can make your wishes clear and help hold your family together during their time of grief. Let that be your legacy – not strife, fracturing and isolation.
Last week, we began a discussion on Continuing Care Retirement Communities (CCRCs), and I called on the father-in-law of one of my employees, Eldon, for his insight on this retirement lifestyle. He has lived in a CCRC in western Pennsylvania for several years. We touched on the three levels of care available – independent living, assisted living and skilled nursing care. Today, we’ll talk about the latter of the three, as well as some of the other “perks” of CCRC living.
At Eldon’s CCRC, the nursing facility is referred to as the “Health Care Center.” Residents who are recovering from a hospital stay, and/or who can’t manage the activities of daily living, can enter the Health Care Center and be cared for in a private or semi-private room. If Eldon were to need these services, he would pay an additional fee (provisions of which should be spelled out in the CCRC’s contract), but he would not lose his living quarters when a temporary Health Care Center stay was necessary.
Eldon, you may remember, had lived in his home alone and, after retirement, sorely missed social interaction. His wish was more than fulfilled with his choice to move to a Continuing Care Retirement Community. In fact, there are times he feels that there is too much interaction with other people! But, he always has a choice either to participate, or to retreat to the solitude of his apartment.
Eldon spends many hours each day in the community’s fully-equipped woodshop. He has even taught other people woodworking! The complex also has a large “art studio,” where residents can draw, paint and do crafts (their artwork adorns the hallways). For those who love to read, there is a library, as well as a game room and gym. Eldon says, “There’s always something going on.” People get together to play cards and, in the warmer months, bocce ball. In addition to woodworking and artistic pursuits, an outdoor gardening facility gives residents the opportunity to sow vegetable or flower seeds! Bus trips to museums, the theater, and sporting events are frequently scheduled.
I don’t know about you, but all this sounds great to me! Eldon even told me that the food prepared at the on-site restaurant is quite good! So, I asked him to list the “negatives” of CCRC living. He said that, in his opinion, “there really aren’t any.” Unfortunately, though, affordability is one downside which can’t be overlooked. The entry fee for CCRC living can be rather substantial and, typically, is only refundable for a short period of time. Also, the monthly fee(s) can easily be twice that of a regular apartment. For these reasons, the choice of a CCRC should be made very carefully and the contract should be meticulously reviewed.
Thank you, Eldon, for your input on the subject of CCRCs! Again, all Continuing Care Retirement Communities are not created equal. Contracts, monetary requirements, amenities and housing options vary widely. If you think a Continuing Care Retirement Community might be a good choice for you, meet with a financial planner to assess your situation and compare your options.
I thought that this week, and next, we’d take a closer look at Continuing Care Retirement Community (CCRC) living, from the perspective of someone who has resided in such a setting for several years. I called on the experience of Eldon, the father-in-law of one of my longtime employees, for his insight on this retirement lifestyle choice.
For those not familiar with the term CCRC, it is a housing community that provides three levels of care to its residents – independent living, assisted living and skilled nursing care. With these three stages along a “continuum of care,” residents can progress through the different levels as their health warrants. Within the community, there are usually a variety of housing options, depending on a person’s preference and budget. In most cases, this is a resident’s last housing choice. They enter the community living independently and stay within the community for life. Therefore, picking a well-run and financially stable community is imperative.
Before entering a CCRC, Eldon owned a home in western Pennsylvania. As he approached his 80s, the upkeep of his property became increasingly difficult. Outside help had to be hired for what used to be everyday chores, like, mowing the lawn, raking leaves and shoveling snow. But, even more concerning to Eldon than home maintenance, was the amount of time he spent alone. Though he was never a social person, even before retirement, living in total solitude was taking a toll. Eventually, he came to the conclusion that living in a community with people his own age, and with similar interests, would be his best option. Even though it wasn’t his primary reason for the move, Eldon also liked the idea that there was assistance, and facilities available, if he were to become ill or if his health were to decline.
Eldon researched a nearby CCRC which had been in existence for many years. It seemed to be well-run, well-maintained and financially sound. When he felt the time was right, Eldon signed the paperwork (CCRCs require a legal contract), paid an “entry fee,” and moved into a comfortable, 2-bedroom apartment. From that point on, a simple monthly payment would cover Eldon’s residence and its maintenance, one meal a day, and his utilities (note: Various meal plans are available. TV and internet services are extra).
Eldon now had at his disposal, what this particular CCRC calls, “Assistants in Living” – a group of CCRC employees who help with everyday chores or errands. A modest (additional) fee is charged for these services. For Eldon, still a very independent individual, the “Assistants” are only utilized once a week to clean his apartment. Other tasks they can perform include: delivering daily meals, shopping and running errands, washing and ironing laundry, transporting residents for doctors’ appointments, etc.
Keep in mind that all CCRCs are different, and this is just an example of one community. Join me next week when we’ll talk about some more of the “perks” you might find in a Continuing Care Retirement Community.
Disclaimer: No, no, I’m not a lawyer, and I don’t play one on TV (sorry, I know . . . it’s an old joke). But, I did have an interview with Daytona Beach attorney, Paul Rice, for PlanStrongerTV™, and, you guessed it; we talked about how to find and choose a good attorney. The financial and legal ramifications of choosing a bad lawyer can be enormous because, once a judgement is made on a case, it’s very hard to get a “do-over” – you can’t go back and “fix it” with another attorney. That’s why this topic is so important.
How Do You Find a Lawyer? Ask around! Question your friends, family, co-workers and members of your church. Ask financial advisers. We often work with attorneys on mutual clients. Compile a list of names from the responses you receive.
Next: Web-based Research. Use an Internet search engine to look up the recommendations you’ve accumulated. Read reviews, but remain skeptical. It is not unheard of for some firms to pay their employees’ friends for favorable reviews. Be cautious, and, just like everything posted on the Internet, take what you read with a grain of salt.
Be Careful of the Word “Free.” Though the best things in life are free, consultations with a seasoned lawyer usually aren’t. Paul Rice warns that if a lawyer is giving away his time, the demand for his services might be low. In many cases, top attorneys charge a consultation fee.
What’s Important? Consider education and credentials. Does the lawyer specialize in one area? Is he/she board certified in the specific discipline you need (example: Board Certified in Divorce and Family Law)? How long has the attorney been in practice?
What Comes Next? By now, you should have narrowed your list down to 2-3 top picks. It’s time for interviews! As mentioned above, this may be an out-of-pocket expense, but consider it an investment. When you arrive at the law firm, what is your impression? Is the office clean, orderly, and professional? Is the receptionist or assistant courteous and pleasant, or stressed and irritated? When the phone rings, how are the callers treated? When you sit down with the attorney, make sure you “like, trust and believe” in him/her. Do you have good “chemistry”? You will be working together as a team, so you need to be able to get along and communicate well. Once you have conducted two or three interviews, you will probably know which person to choose.
Coincidentally, several of the tips Paul shared on interviewing an attorney, can also be applied to choosing a financial adviser. In either case, you want to find a good “fit” for your personality, situation, needs, and goals. Please ask questions and be picky! Good luck!
Hello. I’m Steve Tacinelli, CPA and Vice President of Tax Services for Holland Financial. David asked me if I would share a few words with his PlanStronger™ readers regarding the federal income tax overhaul.
I’m sure you know by now that the Tax Cuts and Jobs Act of 2017 passed when it was signed into law by President Trump on December 22, 2017, drastically changing a big chunk of the tax code. I am not going to debate the pros and cons of these changes. Unless you’ve lived in a cave for the last few weeks, you’ve seen enough of that already! It seems, based on numerous reports from non-partisan think tanks (again, we are not here to debate), that the Act will benefit a large portion of the tax-paying public. Many Americans will see their tax bills decrease due to the passage of this law – at least for the foreseeable future.
However, it bears mentioning that one of the original and chief purposes of the push for tax reform was to simplify the tax code and eliminate the complexities encountered when preparing tax returns. In short, taxes were supposed to be easier to understand and complete. I’ve had more than a few clients ask me in the last year, “When are we going to start using postcards” (instead of lengthy and complicated tax forms)? No doubt, they saw politicians waving “tax return postcards” in front of the media’s cameras and shouting about the need for simplified taxes. Although the Tax Cuts and Jobs Act may lower your taxes, does the Act accomplish the goal of simpler taxes? In this respect, there can be no debate; it does not.
One of the more popular ideas to reduce complexity was to decrease the number of tax brackets. For individuals, the old system had seven tax brackets. The new system? Seven tax brackets. It must be noted that these new rates represent an almost across-the-board reduction, but they do not accomplish the goal of simplifying the tax code. Another major change is the doubling of the standard deduction and the elimination of the personal exemption. This exponentially increases the amount of people taking the standard deduction as opposed to tracking and reporting itemized deductions. Simple, right? Not based on the feedback I’ve gotten from my clients. They have questions about medical expenses, real estate taxes, mortgage interest and charitable contributions. The new law did not eliminate these deductions; it just changed the amounts allowed. That doesn’t simplify the process!
This is not an endorsement or condemnation of the new law, just an observation that, if you thought you would be able to file your taxes on a postcard, you might have to wait a little longer. Ironically, the Tax Cuts and Jobs Act of 2017 is not its official name. The law’s official title is The Act to Provide for Reconciliation Pursuant to Titles II and V of the Concurrent Resolution on the Budget for Fiscal Year 2018. The title, alone, would take up half the postcard!
In the previous two columns, we touched on topics like: what to bring to a nursing facility, the importance of listening and observing when you visit your relative, and how to communicate concerns. Today, we will focus on cleanliness, mealtime, staffing and volunteerism.
Next to Godliness. Cleanliness is of the utmost importance! When you enter a nursing home, there should be no unpleasant smells. If you detect an odor in your relative’s room, make a thorough check of his/her skin for any open areas or sores. An infection can cause a foul odor. Take special note of the pressure points on the body, including the heels, elbows and back. (There are special mattresses that can help alleviate the breakdown of skin. You can request that one be ordered.) Keep in mind that infections and viruses can happen in the cleanest of nursing homes. When there is an outbreak in the surrounding community, influenza can be transmitted to the home’s residents. Shingles, yeast infections, and pneumonia are just a few conditions that can also develop. If an outbreak occurs, ask the facility what they are doing to reduce the spread.
Mealtime and Staffing. If your loved one is on a special diet, ask to assist at mealtime. Generally, there is a flurry of activity during serving and feeding. This is a good time to observe the interaction between the staff and residents. Is there an adequate staff to feed everyone while the food is still hot, or are trays left sitting for long periods? Are the nursing assistants feeding two people at once? Do they speak to the residents with animated tones and have pleasant expressions, or are they quiet and simply going through the motions?
The attitudes of the staff can directly affect the well-being of your loved one! Do they appear to be committed, concerned and compassionate, or uninvolved, distant and uncaring? Nurses, and nursing assistants, undergo intense questioning and background checks before being hired, but, occasionally, an employee has to be dismissed because he/she is not qualified to provide loving care to long-term residents.
Volunteer. I mentioned the wonderful work done by volunteers in Part I of this series. If your schedule permits, volunteering is an excellent way to gather information about a nursing facility: Are medications being delivered in a timely manner? Does the maintenance staff respond to “clean-ups” quickly? You’ll be there, so you will know! If you can’t volunteer, or visit very often, remember, other visitors can be a great source of information on past and present quality of life, and care, at the nursing facility. Strike up a conversation!
Again, my thanks to Joanne Meshinsky for assisting with this series. Joanne spent three decades as an R.N. in long-term care, and assessed medical records for quality of care at nursing homes in Maryland. In the early 1990s, she authored the book, How to Choose a Nursing Home. She is now retired from medicine and resides in Scottsdale, Arizona with her husband, John.
Last week, we started the conversation about nursing homes, the costs, concerns and what you should, and shouldn’t, bring when you visit a resident. Today, we will discuss some of the things to look out for, and what to do, if you encounter a problem with the care your loved one is receiving.
Listen. When you talk to the nursing home resident, take special note of what is said about the nursing staff and their level of concern about any problems that arise. If the resident doesn’t feel that his/her physical needs are being met, don’t hesitate to direct your concerns to the nurse in charge.
Observe. Sometimes, a resident will experience symptoms unrelated to any medication. He/she may be having a physical problem (like constipation or urinary difficulty) and cannot tell you what is wrong. An increase in thirst, fidgety behavior, listlessness, jerky body movements, unsteady gait, or a change in facial features and expressions are all things to watch out for.
Pain. Do not accept that your loved one is not experiencing pain, even if you are told that by a staff member. Only the individual can relay such information, and sometimes he/she is unable. Pain has become a hot-button topic because of the abuse of opioid medications. Psychotropic drug usage in nursing homes has also declined in prevalence due to the side effects, which included falls. Nurses often know ways to reduce certain types of pain without medication. Discomfort can be caused by poor body alignment. Arthritis is also common amongst the elderly. Sometimes, pain issues can be corrected with neck braces, pressure-relieving mattresses, special pillows, massage or whirlpool therapy, or the use of electrical nerve stimulators. Keep in mind that if a resident is coherent, he/she has the right to accept or refuse any medication or treatment.
Speak Out. If there is a problem or concern, make sure to speak with a “charge nurse” or supervisor. When the need arises, many nursing homes employ agency nurses who may not be as familiar with your loved one’s particular requirements or condition. If a supervisor is not available, or doesn’t provide the assistance you seek, go directly to the facility administrator. If a problem is not urgent in nature, nursing homes usually have staff/family care planning meetings, and most issues can be addressed at that time. If you have made several attempts to communicate a problem, and your concern is still not being addressed, the ombudsman for your area can act as a liaison between the nursing home staff and family. If all else fails, the problem should be documented with your state’s Office on Aging and the Department of Licensing and Certification.
For our final installment, we will address meals, facility cleanliness and staffing. Once again, I want to thank Joanne Meshinsky for assisting me with this three-part series. Before her retirement, Joanne spent three decades as an R.N. in long-term care and assessed medical records for quality of care at nursing homes in the state of Maryland.
The decision to place a family member in a nursing home is a difficult one. The mental and physical demands of around-the-clock care for someone who needs help with the activities of daily living can be enormous. If circumstances make assistance from outside sources (like home or health care providers) impractical or impossible, placement of the individual in a skilled nursing facility becomes the only viable option.
The choice of a nursing home can be a daunting task, and the cost is exorbitant. According to Genworth’s 2015 Cost of Care Survey, the median cost for nursing home care in Florida is over $87,000 annually for a semi-private room. The cost for a private room can top $96,000! So, extensive research, site visits and financial planning are imperative before making this important decision.
Once your loved one is settled in to the new environment, you might think that your work is over. Your husband, wife, father, or mother is now being cared for by health care professionals, and it’s less likely he/she will cause harm to himself/herself, or wander away from home. However, even professionally managed establishments are not perfect, and you should stay vigilant to monitor the care your family member is receiving.
Visiting. When possible, try to place your loved one in a nursing home that is close to your residence, so you can visit frequently. The best time to assess conditions at a facility is during “off hours,” like weekends and evenings. If close proximity to the facility is not possible, take comfort in knowing that volunteers (oriented in providing for the physical and emotional needs of the residents) often visit rehab and nursing facilities. Volunteers can conduct drawing, painting, dancing or singing programs. They may organize choral groups during the holidays and can provide specialty services to individuals, like hair and nail care, which would be too time-consuming for the staff.
What to Bring. Many items can bring a smile to a resident. Everyone loves photos, both recent and long past. Videos of family, too, can be watched (and shared) over and over. Beloved items, like a special blanket or pillow, clothes and personal items are perfectly acceptable, as long as they cannot cause harm to the resident. All items should be marked for identity purposes. Avoid bringing perfumes or fragranced lotions. If your relative’s room is semi-private, ask the staff before sending flowers. It is not acceptable to bring in any type of drugs, even common over-the-counter medications. These could interact with your loved one’s current medications or otherwise interfere with his/her condition.
There’s so much more to talk about! Next time we’ll discuss the things to look out for, and be proactive about, when you visit your loved one. I want to thank Joanne Meshinsky for assisting me with this three-part series. Joanne spent three decades as an R.N. in long-term care, and assessed medical records for quality of care at nursing homes in Maryland. In the early 1990s, she authored the book, How to Choose a Nursing Home.
Just over a year ago, the restoration of water service in the aftermath of Hurricane Matthew caused thousands of dollars in damage to my home. My family and I had gone out to eat, and when we returned, several rooms of the house were flooded. What would we have done without insurance? When we bought our homeowners policy, my wife and I essentially transferred the risk (of major damage to our home) to the insurance company. And that same risk transference is what all of us rely on when we purchase automobile, disability, life, long-term care or similar insurance policies.
How are insurance companies able to bear all that risk? They are able to do so because large numbers of people (the insured) become members of one big pool. Actuaries figure out, through metrics and mathematics, the level of risk the insurance company is able to assume and at what cost. Let’s look at a fictitious example for life insurance. “Marty” had a 20-year term life insurance policy. In year 18, at age 68, Marty passed away, and the insurance company had to pay Marty’s beneficiaries $250,000. For every “Marty,” there may be thousands of “Dans,” “Bills” and “Sams” who pay into the same policy, but who don’t pass away during the 20-year term. Consequently, their beneficiaries don’t collect any money. Dan’s, Bill’s and Sam’s premium payments “fund” the payout for the policyholder who was not so lucky (“Marty”). It’s the job of the actuary to figure out, based on life expectancy projections and a host of other factors, the amount of risk the life insurance company can assume – the “risk” of that risk – and the appropriate premium costs. It’s a little like the Las Vegas casinos. The odds are all figured out ahead of time, so the “House” (the insurance company) always comes out on top. And that’s a good thing because, when you choose an insurance company, you want one that is financially stable and well-rated.
Aside from ratings, you should also consider: 1. the size of the insurance company; 2. how long it has been in business; and 3. how long it has been selling the product you are about to purchase. Don’t be shy about asking questions of your adviser or insurance agent: “If an incident occurs, will you be available to help me? If so, how will we engage with the insurance company? What steps will be taken? How does the insurance company pay out?” Shopping carefully, and knowing the answers to these questions ahead of time, will keep you from making an imprudent “bet” with your insurance premium dollars!
Several weeks ago, we talked about how using cash to purchase – just about anything – has become passé. It’s interesting to note that the process of spending, and even investing, money has also changed dramatically over the years. Of course, technology is the biggest contributor to that change. Who doesn’t have a cell phone, tablet, laptop or social media account? And, who hasn’t made a Black Friday or Cyber Monday purchase from the comfort of their home office?
Where’s the Cashier? Think about what you see when you go to some retail stores and grocers now. Instead of traditional check-out lines, there are stations where you can scan your items and put your money, or card, into machines for payment. These automated cashiers must be a boon to bottom-line profits because, as much as I hear other consumers complain, these self-checkout stations remain in place. On a similar note, I recently noticed that a local fast food restaurant tried to implement ordering by kiosks, exclusively. The process was confusing and took longer! Interestingly enough, the last time I dropped by the restaurant, people were standing in the lobby and ordering from a real person, once again.
Have We Become Lazy or Too Busy? Maybe it’s a little of both. Tell me, how many of us really need a round, plastic box to perform mundane, everyday tasks? Nevertheless, many people are buying these electronic, table-top “assistants.” We can now turn our lights on and off or order a pizza with nothing more than a voice command! Only time will tell whether this automation is simply a fad, or the wave of the future. There are now services that will select and deliver groceries (including pre-prepared or ready-to-prepare meals) and even mail clothing that can be worn, then returned, on a monthly subscription basis! Where’s the need for sales associates and brick-and-mortar stores?
I think the thing to remember is that no gadget, machine or computer can ever replace a human being. Take the financial services industry, for example. In the last few years, there has been a concerted effort to utilize what are known as “robo-advisers” to assist investors with their investment decision-making. The jury is out on whether this will be an accepted trend. But my opinion has always been that a machine cannot sit down with you, look into your eyes, and relate to your personal situation. Nor can it take into consideration your wants, needs, goals, and dreams. Turning on the lights is one thing, illuminating your financial future is quite another.