Caregiving and finances

As we begin the caregiving journey, we are mainly concerned about our aging parents’ well-being and safety. This can be a difficult time psychologically for adult children as they watch their parents, once vital and in charge, become frail and in need of help. In the rush to deal with day-to-day problems and scramble to figure out what to do if Mom or Dad is having difficulty at home or has a serious health crisis, the financial ramifications are often an afterthought.

However, sooner or later, finances will become a key part of the mix, whether we end up paying for incidentals, managing or coordinating parents’ finances, or paying outright for their care. It is not unusual for family caregivers to take on all three financial roles. A recent study finds that 92% of caregivers are “financial caregivers” along with more traditional caregiving responsibilities. Often people aren’t aware of what they are spending or how much time they devote to helping out with paperwork until they are deep into their caregiving responsibilities.

Paying out-of-pocket expenses
Whether aging parents or other loved ones are well off financially or not, family caregivers usually don’t think twice about picking up groceries, items from the drug store or medical supplies. And if they live in a different location from their parent, they are quick to get in their car or fly to a destination if a crisis occurs or simply to make sure things are okay.

Expenses for gas, airfare and all the incidentals can really add up. Caregivers spend an average of $6,954 yearly for out of pocket expenses, and for long-distance caregivers, the cost is nearly doubled. On average, those who care for someone who lives far away spends $11,923 per year. These expenses are generally unbudgeted and can take an unbudgeted bite into a family’s savings.

Coordinating and managing finances
It’s not unusual for someone who needs care or has a serious visual impairment to be overwhelmed by the paperwork generated from Medicare, insurance, utilities, and savings and checking accounts. Even if a parent has a financial professional, the day to day work involved of making sure bills are paid, taxes filed, accounts monitored, and insurance premiums and claims under control is part of this responsibility. Keeping track of legal documents such as powers of attorney, living wills and other safeguards also needs to be managed by someone. And that someone is usually a family caregiver.

Taking on this role has some pitfalls as parents are often reluctant to turn over anything related to money to their children. But it is an important role, because it enables the caregiver to make sure that the bills don’t stack up and that there are no suspicious expenditures. The annual loss to victims of financial elder fraud and abuse is estimated to be $3 billion a year; some estimate it could be as high as $36 Billion as four out of five incidents go unreported.

Whether fraud is an issue or not, financial caregivers find themselves spending many hours coordinating finances and making sure that their parent’s money is safe and secure.

Paying for care
As financial caregiving escalates and care needs increase, caregivers may need to confront a harsh reality. They may find that their parents don’t have enough money saved to afford paid care, whether at home, in an assisted living facility or nursing home, and do not have long-term care insurance protection. It’s also possible that assets have dwindled after one of their parents had to spend down savings to pay for the other spouses’ care.

The cost of care increases each year. The average rate for paid home care is now at $22 per hour and assisted living at $3.750 (base rate) per month. Studies indicate that about half of adult children feel an obligation to pay for their parents’ care should they need it. But families are often struggling with their own finances, worried about college tuition payments, mortgages, possible job loss and their need to save for their own retirement.

Transferring parents’ assets to a daughter or son, once considered a viable option, is risky and not always foolproof. Most states have look back periods, and thirty of them now have Filial Responsibility laws on the books requiring adult children to repay for the cost of care incurred by the government. While rarely enforced, a few lawsuits are currently pending. With state budgetary shortfalls in the news, it’s likely that these laws will have more teeth in the future.

Lost lifetime wealth
An alternative to paying for care directly is to ask a parent to move in, or as another option, to assume the caregiver role. For those who do the math, it may seem logical at first to leave the workforce altogether or step back to part time and become the primary caregiver. Paying for round-the-clock care is costly. Even if parents have money, the stress and emotions of providing care may drive a caregiver to stop working. Women, in particular, who take on intense caregiving roles, are more inclined to see this as an option and decide to cut ties with employment.

However, more sophisticated calculations show that a workforce departure or step-back can result in a significant blow to long-term retirement finances. For men, the loss of wages and benefits over a lifetime amounts to $284,000. It’s even worse for women at $324,000. People who do drop out often don’t think of the subtle ramifications in addition to the missed years of earnings and income growth. They forget about the 401 (k) match, the value of employee benefits, the career trajectory, and the roadblocks they might find when they try to get back into the workforce at the same salary level. Actually, continued employment might be the best thing to do, not only to maintain financial health but also for physical and mental health as well. Caregivers often say that work helps them take a break from the intensity and emotions of caregiving.

So what is a potential strategy?
Both the family and the financial professional can take the initiative and make a difference by confronting the issue of financing care early, before it is too late. A conversation with family members and with an advisor about care planning—who will provide care, where will care be delivered and how will it be paid for—is a very important step. It’s often forgotten or put off. Another topic of discussion with an advisor is what long term care protection options are available, not only to find out whether parents might be eligible but also as a planning tool for the adult children themselves. Financing the quality care that we all want and helping our families cope when they assume caregiving roles should be top of mind and incorporated into any discussion of long-term care.

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Music can improve mood and behavior for people with dementia

People with dementia showed positive changes in mood and behavior after listening to music, according to a study from researchers at George Mason University.

A documentary titled “Alive Inside” showed individuals with moderate to late stage dementia listening to personalized music with headphones. The listeners often sang along and became more talkative, showing a great improvement in mood, and decreased agitation.

The study involved 51 adults with dementia. An individualized playlist was developed for each participant. Study researchers recorded both within-person differences and between-group differences.

Behavioral observations showed increases in joy, eye contact and movement, communicating and talking. There was less restless moving, agitation, and sleeping. Participants smiled more, and were more alert and relaxed. Sometimes they recognized the music, sang, and followed the rhythm.

Music listening can be especially beneficial when the music is connected to positive memories for the listener. The music can be used in a variety of care situations, including at home. Music can be helpful to happily occupy a dementia sufferer when a caregiver needs to attend to other duties.

The study showed that music listening is a low cost, nonpharmacological intervention that can bring positive results for people with dementia.


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When Will We Have an Alzheimer’s Vaccine?

Scientists are working on a vaccine to delay or reduce Alzheimer’s disease. Researchers say they are close to testing the vaccine on humans.

In spite of all the research and money spent, no reliable Alzheimer’s treatments are available yet. But researchers believe they may be able to cut down the number of Alzheimer’s sufferers half.     

At the University of Texas Southwestern Medical Center, a team of scientists has developed an experimental vaccine that is designed to reduce two proteins in the brain, beta-amyloid and tau, that are associated with Alzheimer’s Disease. Buildup of these proteins prevents the brain from functioning normally. In mice, the vaccine reduces beta-amyloid protein by up to 40 percent and tau by up to 50 percent.

If the vaccine has the same effect on humans, it could delay the onset of Alzheimer’s by five years, or cut in half the number of people affected.

The main problem with animal studies is that human diseases and immune systems don’t always work the same way. Another problem is that proteins can build up in the brain for 20 years before a patient will have symptoms. So patients would have to agree to taking the vaccine long before they know if they are susceptible to the disease. At this time, tests that show who is at risk for Alzheimer’s are expensive.

The vaccine may be tested for safety on monkeys before trying it on humans, so it will probably be 10 years or more before it is available.

At this time, around 5 million Americans have Alzheimer’s disease. The Centers for Disease Control and Prevention estimate that by 2060 there will 14 million. The National Institute of Health will spend 2.3 billion on Alzheimer’s research this year.

Read more about Alzheimer’s and Dementia: Link

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Risk For Depression Higher If Using These Medications

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1 in 3 U.S. adults takes a medication that lists depression as a side effect.

The research shows that the prevalence of depression among participants rose as they took more medications that list depression as an adverse effect.

“I’m hoping this information will slow the process down a little bit, and that primary care doctors will also take a look at what medications the person is on and … consider that as a potential explanation for the patient’s depression.” – Dr. Mark Olfson

Read rest of story here.


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Caregivers At Risk.

It is not easy to talk about our parents or even ourselves getting older and some day needing help with very basic things. Here is information designed to educate the public about these issues.

Finding the words to begin a long term care conversation. (Genworth)

Beyond Dollars Infographic exposing the true costs of a long term care event. (pdf)

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LongTermCare.gov – Basic information about what is covered by Medicare and Medicaid.

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There are different ways to fund long term care: self-insure, long term care insurance*, life insurance or annuity with a long term care rider*, life insurance with a chronic illness rider*, Medicaid.
* Insurance is medical underwritten. Insuring locks in age and health.
27% of applicants ages 60-69 are declined because of health.

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A Solution for Caregiver Shortage: Robots

The government of Japan expects a shortage of 370,000 caregivers for the elderly by 2025, and is will look to robots to help provide care in institutions and at home.

Robots can transfer patients who are unable to move themselves from bed to a wheelchair, or to a bath, for example.

A new robot named Named RIBA (Robot for Interactive Body Assistance) has been developed by RIKEN and Tokai Rubber Industries (TRI). Using the latest sensor, control, information processing, mechanical and materials technology, it is the first of its kind in the world. So far, RIBA can safely lift and move a human patient of up to 61 kg (around 135 lb.).

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RIBA’s arms have high-precision tactile sensors and its human-like body has a soft exterior of urethane foam, for patient safety and comfort. Having robots do the lifting will ease the burden on staff, reduce injuries to health care workers, and help patients who want to live at home.

Another use of robot tech is a walking aid that can give a boost when the person is walking uphill and a braking action going down hills. The robot prevents falls and helps the user carry loads safely.

There are monitor systems that collect information aimed at improving nursing care services, and robots that can detect when a patient falls down or needs help. For example, robots are being developed that can predict when a person needs to go to the toilet and guide them there at the right time, helping them with removing clothing and other necessary motions.

In addition to their uses in nursing homes, robots can contribute to self-reliance for people who have some disabilities but want to remain at home.

The Japanese government wants patients to get used to robot helpers, hoping that by 2020, 80% of patients will accept having some of their care provided by robots. Several Japanese government agencies want to encourage businesses to develop care robots, and popularize them.

The RIKEN-TRI Collaborative Center for Human-Interactive Robot Research (RTC), where RIBA was developed, expects to bring care robots to market in the near future.

Priority Areas to Which Robot Technology is to be Introduced in Nursing Care – get information at METI.

For more information on long term care issues, see the Guide To Long Term Care,

 

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