I was reminded that we all have a lot to be thankful for. Great family and friends are at the top of the list. You don’t really know what you’ve got or how good you have it until you come close to losing something dear to you. This is a picture of my 8 month old labrador Lacy on the day my wife, daughter and I brought her home from the breeder.
We had a huge scare over the weekend. She was completely fine Thursday night and started vomiting Friday morning. The vet thought it may be the flu or even the Parvo virus. She tested negative for Parvo and he sent her home with antibiotics. I stayed up almost all night watching her. She just was not getting better. Luckily, we rushed her back to the vet Saturday morning. An xray confirmed an obstruction in her stomach. The little bugger had swallowed something…but what?
It turns out it was alot more serious than we thought. She somehow swallowed nearly a foot of a piece of towel or blanket that had wrapped around her stomach. The vet said had we waited only a few more hours she would not have made it. But this was not any ordinary vet. Dr. Huritz went out of his way to save our puppy. By Sunday morning she was 75% back to normal. Today when I picked her up she’s back to her old self–literally prancing like a horse, which baby labs do.
So remember to be thankful to those around you who do their best everyday to help your friends, loved ones, and yes…even your beloved pets!
A major component of your loved one’s ability to remain at home as long as possible is interaction with others. Mind stimulating activities and frequent contact with other people facing similar circumstances is key. Adult day care is a great way to make sure your loved one receives this level of interaction, and can give you as a caregiver a much needed break.
It can also be a very cost-effective option when you compare it with the cost of nursing home care, assisted living facilities etc. Adult day care facilities can be for profit or run by non-profits and are set up to improve your loved one’s quality of life. There are more than 3,500 adult day care facilities in the United States. Many have registered nurses on-site. On average it costs anywhere from $40-60 per day and some facilities allow payment by the hour or half day.
This is a great option for families who want thier loved one with Alzheimer’s to stay at home as long as possible, but need a break a few times a week to run errands or get other things taken care of.
Medicare has introduced a new 5 star rating system for nursing homes based on three main categories: nursing home staff, quality measures and health inspections.
A Geriatric Care Manager can be a very useful professional that your family can hire to help with long-term care arrangements. So what is a Geriatric Care Manager (GCM)?
These are licensed or certified professionals, often with a master’s degree in gerontology, nursing, counseling or social work. They can help your family develop a care plan for your loved one with Alzheimer’s and then monitor compliance with that plan.
In your journey through this disease, it will quickly become apparent to you that you will receive ALOT of conflicting advice: from nurses, doctors, social workers, hospital discharge planners etc. So it’s often a good idea to hire a GCM to provide your family with an independent evaluation of your loved one.
A good GCM is skilled at working with the family, who may have conflicting views of how their parent or other loved one with Alzheimer’s should be cared for. The GCM can provide you with a different viewpoint, explore alternatives, and even mediate among family members who disagree.
You may be aware, but there are levels of care or a “continuum of care” you will be faced with as your loved one’s Alzheimer’s progresses. When your family member is still able to substantially care for themselves, they may live first in an indpendent living facility. Many times health services are provided and some have emergency systems built in.
However it is also very common for a family member to live with the person with Alzheimer’s. In many cases this is the adult child who is providing care as an in-home caregiver. It’s often necessary to supplement this care with at-home health care. This can be a great way to balance your life as a family caregiver but still bring in additional help. As we have discussed, it can be quite expensive and it may be difficult for many families to pay this cost over time.
Next comes assisted living facilities. There are excellent assisted living facilities out there that can provide your family member with assistance with activities of daily living. Many facilities will even have Alzheimer’s units that are set up to handle the toughest of situations. As Alzheimer’s Disease progresses, it’s often neccesary to explore nursing care in a nursing facility. Nursing homes are set up for round the clock care.
We will talk more about how to choose a good facility.
I often tell my clients that at the first sign of any form of dementia (and hopefully much sooner), they must put in place a properly drafted power of attorney. It is critical that a trusted family member or friend is given the authority to help make decisions on behalf of the person with Alzheimer’s. As the disease develops, there will be good days and bad days where your loved one may or may not have the capacity to sign legal documents. Often an attorney will run through a series of questions with your loved one to determine capacity, or may rely on a doctor’s findings.
Power of attorney documents are important because they can help eliminate the need for a legal guardianship or conservatorship. I highly recommend avoiding guardianship/conservatorship proceedings at all costs and use them only as a last resort. They are time consuming, expensive and draining.
In general, you can use a variety of methods to have assets under an acceptable level for VA qualification. Use of a trust is just one method commonly used. For VA qualification you have to look at two things: 1) Income-your income must be under what they call the Maximum Annual Pension Rate. So if for example, your husband is in need of “Regular Aid and Attendance,” then you are potentially entitled to the Maximum Annual Pension Rate of $1,842 per month (the maximum in the category of Aid and Attendance-note there are 2 other categories.)
But in order to qualify, your income must be less than $1,842 per month. However, it’s important to remember that the VA allows you to subtract all Unreimbursed Medical Expenses from your gross income. Typically, a family facing Alzheimer’s has very high expenses and can easily qualify on the income side once they subtract Unreimbursed Medical Expenses. 2) Assets-Assets for a married couple must be about $80,000 or less not including a home. That’s where planning and use of trusts and other documents can come into play.
It’s very important to note that while the VA does not have strict rules about how, where or to whom you transfer income or assets to qualify for VA, Medicaid has very strict rules. Many people facing Alzheimer’s will go on to need Medicaid paid nursing home care. The main message is: if you are going to try and qualify for a VA Pension, you must do so in a way that does not prevent you from receiving Medicaid down the line.
We’ve talked before about countable vs. non-countable assets, but one thing that must be considered as well is that Medicaid also looks at transfers of property, money etc that have occurred. In general, if your loved one with Alzheimer’s needs to apply for Medicaid, they will look back at all transfers that took place over the last 5 years (depends on your state) to see if they were proper or improper.
If Medcaid believes an improper transfer took place, they can apply a penalty period for a transfer. So if for example your mom needs to go into a nursing home and apply for Medicaid, but 2 years ago she gave you $40,000, this may be viewed as an improper transfer subject to a penalty (it was within 5 years of the date she is in the nursing home and applied).
The penalty means that your mom would have to wait out a “penalty period” until she is eligible for Medicaid to help pay. It’s not just gifts of cash that can subject your family member with Alzheimer’s to a penalty, so it’s very important to at least have a good understanding of how the rules work, so that you can plan accordingly.
Here is the video I promised about Alzheimer’s and VA Benefits. Watch to find out how a VA benefit can really help pay for keeping your loved one with Alzheimer’s at home longer with at-home health care or at an assisted living facility.
Paying For Alzheimer's Care-A Blog About Helping Families Face Alzheimer's Head On and Do So Without Going Broke 