Is your loved one crying? Depressed? Wanting to be alone? Wanting to stay in bed?

We all have a right to our blue days, and at times, the person with this disease just feels deeply sad. They sense the changes in their lives, and they feel their losses. Put your arms around them and say it’s okay to cry, it’s okay to feel sad. Bit by bit, you may coax them up and about. Try old, familiar stories or old familiar prayers. If they refuse still to get up, come back in a little while and try again, or have a different person try. Music can make an extraordinary difference. Play music they once loved; it will help them to reconnect to life.

In this case, you will be involved in a lot of physical care. Use touch. Stroking and rubbing of hands and feet (unless medically not advised for some other reason) will help keep the person “in touch,” and help with circulation to prevent skin breakdown. Your loved one will also need to be turned from side to back to the other side at regular intervals to prevent skin breakdown, commonly called bedsores.

Is your loved one bedfast (i.e. unable to get out of bed at all, or only with great effort)

Even if the person cannot move on their own, they can be repositioned — such as moved to an upright chair, or a recliner if available. They can therefore be involved in the social activity going on around them and can be a part of it, too. Don’t forget pet therapy or music.

A home health nurse can give instructions on how to do exercises that are appropriate for your loved one.

• Offer snacks or liquids. A person with Alzheimer’s may have missed a meal or forgotten they had one.
• Suggest that your loved one help with simple and repetitive tasks, like folding and unfolding laundry. Bring out the familiar pieces of games they once enjoyed, such as Monopoly, Parcheesi, or other board games. Also try giving them playing cards or crossword puzzles. It doesn’t matter if they do any of it well, or even at all. The object is to keep them occupied with familiar items and tasks.
• Restless and wandering patients need a safe place to wander and pace. They may just move around, or they may need a purpose, like carrying the newspaper from one part of the house to another, or going through old mail. Pet therapy can also work wonders. Be sure the animal is a calm breed, such a golden retriever. Or a smaller, lap dog may work better for others.

Is your loved one tense? Refusing to move? Irritable? Worried? Afraid?

• Always first ask or observe if your loved one is in pain. If not, remember these behaviors are often about feeling unsafe. Recall that persons with Alzheimer’s have lucid times that come and go. Try to imagine how frightening they must feel. Do comforting things. One is always to approach the person from the front. Hold their hand if they will let you, or just touch a shoulder and tell them they are in a safe place. Reduce any noises from a radio or television that may be creating confusion or anxiety for them. Try calming music from years ago. Tell them they are in a safe place. If they will allow you, hugs can do wonders!

Care Program Provides Friends and Fun - Kansas City Star

When someone is faced with the overwhelming job of finding a nursing home for a loved one in Kansas or Missouri, the question often asked is, “Where do I begin?” Although this is a job that no one wants to do, it can be done with forethought and confidence that the best decision was made for everyone involved.

When nursing home placement in Kansas City or surrounding areas is necessary, it is crucial that the family and/or potential resident decide what’s most important to them in looking for a facility. It is important that the resident’s needs and wants be included in the evaluation. Things such as location of the facility, if a special care unit is necessary and type of payer source should be considered when beginning this process.

The next step is to identify the facilities in your area which meet the criteria you established above. Beyond this guide, listings of facilities in the Kansas City Metropolitan area can be obtained from:

• Missouri Long Term Care Ombudsman, (816) 474-4240
• Kansas Area Agency on Aging, (913) 894-8811
• Alzheimer’s Association, (913) 831-3888
• Kansas and Missouri Alzheimer’s Resource Center of the Elder & Disabilty Law Firm, (913) 338-0959

If placement is “down the road” and you have time, call the nursing facilities and ask them to send you their information packet including an activity calendar and a menu.

Get ready to tour the facilities you have chosen. Don’t schedule your tours. Just show up during regular business hours. You will be able to meet with the administrative staff who will answer all your questions. Next, you will want to tour a second time in the evening or on the weekend just to see if there is a drastic difference in the atmosphere of the facility or the care being provided. It is important to tour at least two facilities so you can see the difference in the physical plant and the staff.

When you are touring, pay attention to your gut feeling. Ask yourself the following questions… Did I feel welcome? How long did I have to wait to meet with someone? Did the admission director find out my family member’s wants and needs? Was the facility clean?

Were there any strong odors? Was the staff friendly? Did they seem to genuinely care for the resident? Did the staff seem to get along with each other? Listen and observe. You can learn so much just by watching and paying attention. When touring a facility, ask any questions that come to mind. There are no “dumb” questions. Here are a few examples of questions you will want to ask to make sure that the administration of the facility is giving proactive care instead of reacting to crisis.

• How do you ensure that call lights are answered promptly regardless of your staffing?
• If someone is not able to move or turn him or herself, how do you ensure that they are turned and do not develop bedsores?
• How do you make sure that someone is assisted with the activities of daily living like dressing, toileting and transferring?
• Can residents bring in their own supplies?
• Can residents use any pharmacy?
• How many direct care staff members do you have on each shift? Does this number exceed the minimal number that state regulations say you have to have or do you just meet the minimum standard?
• What payer sources do you accept?
• How long has the medical director been with your facility?
• How were your last state survey results? (Ask to see a copy)
• How did you correct these deficiencies and what process did you put in place to make sure you do not make these mistakes again?
• Has the state of Kansas or Missouri prohibited this facility from accepting new residents at any time during the last 2 years?
• What is your policy on family care planning conferences? Will you adjust your schedule to make sure that I can attend the meeting?
• Do you have references I can talk with?
• Can my loved one come in for a meal to see if he/she fits in and likes the facility?

Once a facility has been chosen, there are some definite steps you can take to make the process less traumatic on the resident. First, plan the admission carefully. If you know the resident becomes very difficult to deal with in the late afternoon, plan the admission for midmorning.

Next, complete the admission paperwork before your loved one actually moves into the facility. This will allow you to spend the first few hours that they are there with them getting them settled and making them feel secure in their new living environment.

Some practical things you want to be sure to do … mark every piece of clothing with a permanent laundry marker. When a facility is washing the clothes for 120 people, it is common for things to occasionally end up in the wrong room; however, you can help ensure getting the item back if it is properly marked. If you are going to do your loved one’s laundry, post a sign on the closet door to notify staff and provide a laundry bag where dirty clothes can be placed.

Also, bring in familiar things for the resident so that there is a feeling of home. However, realize that space is limited, especially in a semi-private room.

A very important thing for you to remember is that the staff of the facility is just meeting your loved one for the first time. They do not know his or her likes or dislikes, or those little nuances that make providing care go smoother. The best way you can help your loved one is to tell the staff, in writing, as much information as possible about your loved one … his/her likes and dislikes, typical daily schedule, pet peeves, and so on.

It is important that you get to know the people who are caring for your loved one. Most importantly, stay involved. Let everyone know how much you care and how committed you are to your loved one’s care. Also understand you will not help your loved one by becoming anxious or emotional. Assure them that although this is not an ideal situation, you will be there to assist them in making it as pleasurable as possible.

Although it is a national program, it is administered by each state. The rules and regulations are constantly changing and can vary widely from state to state. So, it’s no wonder there are many myths and inaccuracies surrounding the program.

Today, we are taking a look at the common misconceptions we hear frequently about Kansas and Missouri Medicaid.

“My mother heard about someone who…”

All too often, we meet people who have heard horror stories about Medicaid from well-meaning friends or family members. These stories are often filled with inaccuracies and half-truths that frighten people into spending every last dime on nursing home care for themselves or a loved one before turning to Kansas or Missouri Medicaid for help.

Similar stories have also prompted people to assume that what worked for a friend will work for them as well. So, they may give their house or all of their assets to a child in hopes that impoverishing themselves will immediately qualify them for benefits. Unfortunately, they soon find out that these transfers mean they are unable to receive benefits for several months or even years after the money is gone.

That’s why it is important to contact an attorney who concentrates his or her practice in elder law. With a clear picture of your specific situation, an elder law attorney can explain those laws that should allow an individual or married couple to preserve their house and enough of their assets to live comfortably for the rest of their lives.

“My father is already in the nursing home so there’s nothing we can do now.”

It’s true that a family can wait longer than they should to contact an elder law attorney, but it’s rarely ever too late to establish a good plan. A good rule of thumb is that the earlier a plan is put in place, the more assets can be preserved. So, when is the right time to call an elder law attorney?

You should pick up the phone right now if you or a loved one does not have a Power of Attorney in place for financial and health care decisions. It’s important these documents are put in place before a gradual or sudden decline in mental competency occurs. It’s also important to make sure the financial Power of Attorney contains the right language so Medicaid planning is possible.

You should also call right now if you think that nursing home care will be needed by a loved one. This may be due to a diagnosis of a terminal or debilitating illness, such as Alzheimer’s, Parkinson’s or ALS. It may also be that your loved one is being discharged from the hospital and told he or she will be unable to care for themselves at home. All of these situations should be reviewed by an elder law attorney to determine what type of planning can be done.

“The Kansas or Missouri Medicaid office can just give me the paperwork.”

Those who work in the Medicaid office cannot offer you legal advice. You may not learn about laws that may allow you to receive Medicaid and still keep part or all of your spouse’s income as well as your own. Nor can they represent you or give you advice on the laws that, depending on your specific situation, may allow you to keep all of your assets without spending down a single penny. Medicaid has rules and regulations in place to ensure families don’t lose everything to nursing home costs. An elder law attorney can explain how those laws may benefit you and your family.

Medicare is the federally-funded health insurance program designed to provide health care services primarily to individuals over the age of 65. Recent changes to the program have expanded benefits through Medicare managed plans. However, long-term custodial nursing home benefits have never been part of either managed care or traditional Medicare plans.

For example, suppose that your loved one is enrolled in traditional Medicare. What is available? In most cases, Medicare will cover the first 20 days in a skilled nursing facility. In some circumstances, Medicare may cover the next 80 days of nursing home care, but with a deductible that is over $114/day. If your loved one is enrolled in a managed Medicare plan, days 21-100 are covered without a deductible, but only if your loved one meets strict qualification criteria.

We strongly recommend a complete review of your health benefits so that you can be prepared and understand the qualifying factors to receive services. If your loved one receives treatment and recovers, he or she may again be eligible for additional Medicare skilled nursing benefits.

It is difficult to predict how many days of skilled nursing care Medicare will cover. From our experience, we have found that our Alzheimer’s clients rarely receive benefits that extend to the 100-day maximum. But even if you do receive the full 100 days, what happens when Medicare discontinues coverage and your loved one still requires around-the-clock care? As stated above, the options available are either: long-term care insurance, payment from one’s own limited assets, or possibly coverage through the Medicaid program or through certain programs available through the Veteran’s Administration.

There are Health Maintenance Organizations (HMOs) that offer a Medicare +Choice program instead of traditional Medicare. These insurance companies use the Medicare reimbursement to provide additional services over what traditional Medicare provides. These are voluntary and are chosen by the Medicare recipient. There are strict enrollment rules. If a Medicare +Choice program is covering your family member with a condition that requires long-term care, it is very important to know the benefits offered and what the qualifiers are for the services. These programs are required to follow Medicare regulations, but can offer more services. Remember that the Medicare +Choice programs are the “gatekeepers” instead of the physicians and, therefore, dictate when, where, and if services are authorized.

Placing a loved one in a long-term care facility is one of the most difficult decisions a family can make. Along with the often overwhelming sense of guilt, there are often an overwhelming number of choices. So, how do you find the best facility for your loved one?

It’s important to have a list of questions before you visit care facilities. But the best information you can gather is usually what you observe while you are being taken on a tour and/or making an unannounced visit.

Privacy: Federal mandates give every resident the right to privacy in a care facility. Yet, very few facilities actually enforce this policy. All staff should knock on a resident’s door before entering a room, then wait to be invited inside. Staff should never discuss resident’s personal health information in the hallways or where others can overhear.

Security: You will want to ask how the facility protects its residents. You will also want to note how easy it is for you to wander into the facility or residents to wander out. Are you asked to sign in and out or asked for identification?

Staffing: Ask the ratio of nurses and certified nursing assistants per resident. The facility should be able to tell you the average amount of time each resident is given direct care by a CNA and nurse. As you narrow down your choices, go back for a second visit — at a different time and on a different day of the week. The staff changes with each shift and it’s possible that the level of care changes too. For example, try to gauge the amount of time it takes for a resident to get assistance from a staff member. Most importantly, do the residents seem happy and talk freely with the staff?

Mealtimes: This is often the most chaotic time for facilities and the best time to determine how the staff and residents interact. Notice if the staff remains friendly and happy. Do they assist residents with opening containers, using silverware, and eating? Is the food appetizing and served at the correct temperature? Do residents sit for long periods of time after they are done eating, waiting for staff to take them back to their room or afternoon activities?

State Inspections: The state is required to inspect each care facility to make sure they meet health and safety standards. Those reports can be viewed online at www.medicare.gov. It is important to research any facility you plan to visit. If you have questions or concerns regarding the inspections, address them with the facility’s Administrator.

If you need assistance in finding the best care for your loved one, there are local companies and geriatric care managers available to assist you.

For a complete list of all of the care facilities in the Kansas City metropolitan area, visit our web site for instant FREE access to the Kansas and Missouri Nursing Home and Assisted Living Guide. It provides additional information about getting good care and discusses ways to pay for the cost of care.

Why Choose Hospice?

A patient with a life-limiting illness may reach a point where he or she no longer responds to treatments aimed at curing the disease. At that time, the physician may recommend a shift in focus from curing the disease to making the patient as comfortable as possible. This shift toward palliative care is “comfort-oriented” rather than “cure-oriented.” It is medical treatment that seeks to control symptoms and manage pain.

When the physician’s estimation of the patient’s life expectancy is six months or less, hospice care often is the best option. Although some hospice care is administered in assisted living facilities, nursing homes, hospice centers, and inpatient settings, approximately 80 to 90 percent of hospice services occur in the patient’s own home. That’s partly because advances in technology have made it possible to operate much medical equipment in a home setting. It’s also because hospice team members and volunteers are available to provide services, as needed, including

• Pain and symptom management
• Assistance with the emotional, psychological, social and spiritual needs
• Drugs, medical supplies and equipment
• Training for family caregivers
• Speech, physical and occupational therapy
• Arrangements for respite care
• Bereavement counseling for surviving family members and friends
• Help with day-to-day chores and activities of daily living
• Experienced counsel for end-of-life decisions
• 24-hour on-call availability

Click here to get your FREE copy of The Consumer’s Guide to Hospice Care, an invaluable resource for families looking to get quality care for their loved one while legally protecting their assets.

You may know the general rule for a residence - so long as the applicant intends to return home, the value(up to $500K) is exempt. But, did you know:

• In Kansas, if your house is titled to a trust it is a countable asset?
• In Missouri, if you do not go directly from your home to the hospital or a nursing home prior to applying for benefits, your home loses its exempt status after 2 years?
• You can transfer your residence to a child, penalty free, if that child has been living with you in your residence for 2 years prior to applying for Medicaid benefits so long as you can prove the care that child provided prevented you from entering the nursing home during that 2 year period (referred to as the “caretaker child exemption”)?
• A Medicaid applicant can transfer their home, without incurring penalty, to: their spouse, their minor child (under 21); their blind or permanently disabled child; or their sibling with an equity interest who has resided there for one year immediately prior to the applicant’s institutionalization?

Most everyone knows that Medicaid considers your residence and one vehicle per family exempt, but did you know:

• In Kansas, the value of your IRA is exempt?
• In Kansas, rental properties are exempt?
• In Missouri, a working farm is exempt? Caveat: to be considered working, the farm must be in use directly by the applicant and/or spouse in the course of his/her business or employment (ex. collecting CRP income would not constitute “working” the farm).
  Transfers for less than fair market value incur Medicaid penalties for an applicant during which time they cannot qualify for benefits (one month for every $3,000 in Kansas and one month for every $2,943 in Missouri).

Did you know:

• Transfers made to disabled children do not cause any penalty?
• Prior to the implementation of the Deficit Reduction Act (“DRA”) last year, the penalty used to start on the date the gift was made, now the penalty does not start until an application for benefits is made… so, the gift of $10,000 you made 3 years ago will affect your application today!?
• Prior to the DRA, only transfers made to or from a trust were subject to a five year look-back period. Now all transfers made are subject to a five year look-back.

The Medicaid laws are very complicated and very case specific. Before selling, transferring or spending down your assets (or advising your clients on the same) it is important you consult someone who knows how to protect your assets and still qualify for benefits.

What is a Power of Attorney?

A power of attorney is a legal document where one person (the principal) authorizes another (the agent) to act on their behalf. There are financial powers of attorney which allow your agent to make decisions regarding your property and healthcare powers of attorney which allow your agent to make decisions regarding your health care needs.

Your power of attorney can be broad in scope, giving your agent the ability to make any and all financial and personal decisions for you (a General Power of Attorney) or you can limit your agents authority by specifying the types of decisions you would like them to make on your behalf (a Limited Power of Attorney).

You also have a choice whether you would like your agent to have the ability to make decisions both now and if you become incompetent (a Durable Power of Attorney) or your agent can be limited to make decisions only when you become incompetent (a Springing Power of Attorney).

What is a Guardianship?

Guardianship is a legal relationship whereby the Probate Court gives a person (the guardian) the power to make personal* decisions for another (the ward). A family member or friend initiates the proceedings by filing a petition in the Circuit Court in the county where the individual resides. A medical examination by a licensed physician is necessary to establish the condition of the individual. A Court of law then determines the individual is unable to meet the essential requirements for his or her health and safety and appoints a guardian to make personal decisions for the individual. Unless limited by the court, the guardian has the same rights, powers and duties over his ward as parents have over their minor children. The guardian is required to report to the court on an annual basis.

*A Conservatorship is a legal relationship whereby the Probate Court gives a person (the conservator) the power to make financial decisions for another (the protectee). The Court proceedings are very similar to those of a Guardianship except the Court of law determines an individual lacks the capacity to manage his or her financial affairs and appoints a conservator to
make financial decisions for the individual. Often the court appoints the same person to act as both guardian and conservator for the individual. Like the guardian, the conservator is require to report to the court on an annual basis.

The Differences

A power of attorney is a relatively low cost and private way to decide which family member or trusted friend will have the legal authority to carry out your wishes if you can no longer speak or act for yourself. If you do not have a power or attorney or if your power of attorney is not drafted properly, and something happens that results in your inability to make decisions, your family/friends may later face court proceedings and court supervised Guardianship and/or Conservatorship. A court proceeding is not only costly, but the person appointed as you Guardian/Conservator may not be the person whom you would have chosen yourself. And, as stated above, not having a properly drafted power of attorney could significantly limit financial and/or Medicaid planning that could be done on behalf of the principal.