By Carol Marak, Carebuzz.com

Carol, one of SFL’s guest bloggers, helped care for her mom and dad and found few resources connecting her to other family members online. From that experience, Carebuzz.com was launched.

The Pew Internet American Life Project (2004) study shows that 22% of Americans 65 and older used the Internet in 2004. The number has grown 15% from 2000. The number increased again in 2006 to 34%. This study shows that “wired” seniors use the Internet in order to do various activities such as, health or medical information 66%; product research 66%, government Web sites 60%; online shopping 47 %; travel reservations 41%; and banking 20%.

Now that we’ve established the fact that seniors are online, what else are they doing there? How many seniors (50+) are on social media sites like Eons, ThirdAge and AARP? ThirdAge claims they have 1 million boomers in their database and 2 million boomers registered for their newsletter. That’s a large number, but it’s still only a small representation of sites where seniors gather.

Today, “boomers” is the leading group responsible for the care of an elder loved one. In my own experience of helping my aging parents, I found most “care information” like health, home care, and family caregiving topics on the Internet. Since I lived at a distance from my parents, I did not have easy access to their local phonebook so I went online to look for help. Most family members are doing the same, especially since distance is often a factor.

That was two years ago when I helped mom and dad. The landscape of the Web has since changed. More senior services like health Websites, support groups, geriatric care, home care agencies, home health, elder law, long-term care insurance, etc. are all popping up in cyber space. The options for family caregivers and aging seniors is now more plentiful than ever.

Now, in addition to finding the resources adult children need to find the best senior housing and senior care solutions for their loved ones, they are also flocking to community sites like Facebook, Twitter, and many others. They form relationships. They ask questions, get answers, and yes, even get referrals!

How are you using the Web to help in your senior housing decision-making?

Last month, the MetLife Mature Market Institute released their 2008 survey of nursing home and assisted living costs. As to be expected, rates increased since last year’s publication. The national average rate for an assisted living facility increased by 2.1% since 2007, bringing the monthly fees from $2,961 to $3,031 and the annual cost from $35,628 to $36,372.

A new feature of the 2008 report is the grouping of assisted living communities based on the number of services included in the base rate, which can vary greatly by community and thereby dramatically effect the overall cost of long-term care.

Most assisted living facilities are regulated at the state level; therefore, when crossing state lines, no two assisted living facilities operate equally. Even the basic definition of assisted living, a care setting that currently more than 900,000 Americans call home, varies greatly from state to state, which also contributes to the variances in costs. However, most assisted living communities advertise “a home-like setting” with assistance provided as needed, as opposed the 24-7 care provided in nursing homes.

Exactly how many standard services are included in the base rate also varies, and, as they age in place, many assisted living consumers will need several supplemental services. These additional services are often charged “a la carte” and can dramatically alter the grand total on the monthly bill.

There is yet another dimension to the already complicated base rate breakdown: charges for assistance with Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). ADLs (bathing, dressing, toileting) and IADLs (medication management) can also drastically alter a consumer’s monthly charge, and each community has their own formula for how they calculate these charges.

Finally, if your loved one needs the specialized services offered in an Alzheimer’s wing (provided by 52% of the assisted living facilities surveyed in the report), be prepared to pay. The average base rate for Alzheimer’s and dementia care is $4,267 monthly and $51,204 annually, according to the report’s findings.

Assisted living is an actively evolving market. Baby boomers are aging, state regulations are changing, communities are adapting to provide more specialized services — and we all know that the current economy is unstable, to say the least. All of these factors will impact the bottom line and therefore impact the consumer’s ability to afford this category of care both now and in the future.

Cost analysis aside, choosing the right long-term care setting for a loved one is not an easy task. Just as a prospective home buyer must weigh all the options, pros and cons (hidden costs, taxes, maintenance, etc.), prospective assisted living consumers must do the same. Ask yourself: What is most important to you? For some, aesthetics may be more important than the staff-to-resident ratio. For others who may have more complex care needs, the staff-to-resident ratio will likely be a higher priority than whether there are manicured lawns and walking paths.

Regardless of how you assess your priorities in choosing an assisted living facility to call home, you must choose wisely. Though the data fluctuates by state, the report clearly indicates that life in assisted living communities, regardless of where they are located and how many ancillary services they provide, is expensive.

Be a smart shopper: Weigh all the potential future care needs (the base rate plus the cost of a la carte services), tour many facilities, spend time talking to the staff, eat a meal in the dining room, visit the facility on a weekend or in the evening (most facilities are well-staffed during the day, but a good quality indicator is how well-staffed they are during off-peak hours), do the research, read all the fine print, and ask lots of questions. Your final decision will significantly impact your finances and your family member, and this decision must not be rushed or taken lightly.

Find out more about assisted living options.

- Michelle Seitzer

Hospice is a philosphy of care rather than a place (though there can be hospice residences) and that care can be provided in a variety of settings.

One place that isn’t commonly thought of for hospice care is in a nursing home.

Nursing homes usually have the image of skilled nursing care or rehabilitation rather than actively supporting the dying process. Though some people argue that it’s a duplication of services, nursing home patients can receive hospice care.

Nursing home staff can be stretched thin and since a hospice patient requires even more care than a typical nursing home patient. Though many nursing homes believe their staff can fill this role, it makes sense for a specially trained team to enhance and complement the nursing home to improve end of life care.

The hospice team is more than one trained person. The team includes doctors, nurses, social workers, spiritual counselors, home health aides, bereavement counselors and volunteers. They help patients live out their final days with dignity and with as much physical comfort as possible.

Hospice care in the nursing home also reduces end-of-life hospitalizations which can be both stressful and costly and negatively affect a person’s remaining quality of life.

Medicare has a hospice benefit for those eligible for Medicare Part A (Hospital Insurance), but it is important for beneficiaries to look closely at the benefits when someone is in a nursing home bed that is already covered by Medicare.

The decision to downsize and move, whether it is to a smaller residence, a nursing home or assisted living, is a big one and is significant for anyone, especially a senior. There are both physical and emotional aspects of this type of relocation and it’s more than just packing and calling a moving van.

Here are a few tips to help the move go smoothly:

Be tactful - What looks like junk to you may be important to someone else. Be gracious and gentle with suggestions about sorting possessions, ask permission before discarding anything.

Accept gifts and reassure the giver they’ll be cared for - Even if you aren’t in need of the item being offered, accept when possible. A senior may feel some relief knowing that a treasured possession is staying in the family. Be sure to find out about any history the item may have.

Begin the sorting process in room with less sentimental attachments - Sorting through possessions to downsize can be emotional. Beginning the process in a room that holds fewer memories such as the laundry room or storage closet.

Hire help - It can be helpful to have a neutral party involved to help make the sorting process easier. Many companies specialize in moving seniors, consult agencies listed in such directories as National Association of Senior Move Managers.

Take pictures - Photos of the new residence can help you gauge how much room there is for furniture and possessions and photos of how things were arranged in the old residence allow people to help set up the new place as well as provide a keepsake.

Be patient, allow the senior to say goodbye - Moving is hard for anyone. When you’ve lived in the same place for many years it’s harder and the process saying goodbye may take a while.

Allow adequate time for packing - It takes a lot of time to sort and move many years of possessions. Be realistic about how much time people can devote to the task. Consider a storage unit if there are things that the owner can’t bear to part with at the moment. It may be easier to sort some things after the emotions of moving wear off.

Involve the senior - What do they want their new place to look like? Do they want things the same or is a new look in order?

Moving day - If possible, arrange for someone to be on the receiving end of the move to begin setting things up in the new residence so there’s a comfortable place to sit and it won’t look stark and empty.

With a little planning, the transition might not be as stressful as everyone fears.

Assisted Living facilities are for those people who needs help with activities of daily living (ADLs) such as eating, bathing, dressing, laundry and housekeeping, but who wish to live as independently as possible for as long as possible. These facilities are somewhere in between independent living and nursing homes.

As with any important decision, there are several points to consider, including:

Facility location and appearance - Is the facility in a good location? Is the outside attractive and well cared for?

Welcome - Were you and the potential resident greeted promptly and courteously on your visit?

Visiting policy - What is the visiting policy? Are visits welcomed any time? Were you able to talk to the residents about how they like the facility?

Inside - Is the inside of the facility clean, attractive, free of odors, and the appropriate temperature? Are the rooms single or double? Can a resident bring their own furniture?

Needs assessment - What is the process for deciding what type of assistance a resident needs? Are needs reassessed periodically?

Contract terms - What are the terms of the contract? What does the contract include? Are there any additional charges if the resident’s needs change? What is grounds for termination of the contract?

Billing and payment - When appropriate, is the resident permitted to handle their own finances or is it the family’s responsibility? What are acceptable payment methods? When is payment due?

Insurance/personal property - What is covered by the facility’s insurance?

Medications/healthcare - How are medical needs handled? What is the emergency process? Are the staff members trained to handle, administer and document medications? Who coordinates home care visits?

Food services - What is the meal schedule? Is there a dietitian available? Are snacks available? Are special dietary needs accommodated?

Service hours and staffing - What services are provided? Is assistance with activities of daily living and other needs available 24 hours, 7 days a week? What is the staffing level mix (aides, licensed personnel)?

Find out more about assisted living to see if it’s the right choice for your loved one.

In its 2008 Long-Term Care Cost of Care research report, Prudential Financial found that assisted living facility costs have risen 13% over two years. Nursing home costs have risen 7% during this same period, and both are expected to continue to rise.

The report, which was based on data from 552 nursing homes, 533 assisted living facilities, and 528 home health care agencies, found that the average daily cost for an assisted-living facility is over $100, or about $3,241 per month. The average daily cost of a private room in a nursing home is now $217, or $79,205 annually. Costs were found to vary according to geographic location. Alaska, New York and Connecticut had the greatest costs, while Louisiana, Kansas and Missouri had the lowest costs.

Home health care experienced the smallest rate increase, rising just 5 percent over the past two years.

The long-term care cost study also found that while consumers understand the importance of saving financially for their future, there are misperceptions about the cost of long-term care and the insurance benefits related to long-term care. Most health insurance doesn’t pay for long term care, and Medicare usually only pays a fraction of the costs.

What’s most alarming is that the average cost of a two- to three-year nursing home stay could exhaust the assets of most Americans; approximately 5% spend at least five years in a nursing home.

The population is aging rapidly, yet people are living longer than before. Accordingly,  the demand for long term care services and the costs will only increase. How are you preparing yourself and your family for what’s ahead?

If you are caring for an elderly or disabled relative who needs help managing their monthly Social Security or SSI benefits, you can apply to be representative payee. More than seven million people who get monthly benefits need help managing their money.

After a careful investigation, the Social Security Administration will appoint a relative, friend or other interested party to serve as the “representative payee.” This means that, if you agree to be a representative payee, the government will pay you the person’s benefits to use on his or her behalf.

In agreeing to serve as a representative payee, you are taking on an important responsibility (one that can make a positive difference in both the beneficiary’s life and your life).

With certain exceptions, a payee may not collect a fee for services provided to the beneficiary. Unless Social Security authorizes you to collect a fee for providing services, or you are the legal guardian who has been authorized by a court to charge a guardian fee, you may not collect a fee from the beneficiary.

Social Security will conduct a careful investigation to determine if you meet the requirements.

You must know what your relative’s needs are so you can decide how benefits can best be used for his or her personal care and well-being. First, you must make sure that food and shelter are provided.

After you have provided for the beneficiary’s basic needs, you may spend the money to improve the beneficiary’s daily living conditions or for better medical care. You may decide to use the beneficiary’s funds for major health-related expenses, if they are not covered by the beneficiary’s health insurance. Examples of these expenses are reconstructive dental care, a motorized wheelchair, rehabilitation expenses or insurance premiums.

You could use the money to arrange for the beneficiary to go to school or get special training.

You also could spend some of the money on the beneficiary’s recreational activities, such as movies, concerts or magazine subscriptions.

Special purchases

You may want to make some of the following special purchases for the beneficiary.

A home—You can use funds as a down payment, and you can use some of the money to make payments on a house owned by the beneficiary.
Home improvements—You can pay for renovations that make the beneficiary’s home safer and more accessible; for example, installing a wheelchair ramp or widening doorways to accommodate a wheelchair.
Furniture—You can buy furniture for the beneficiary’s personal use, as well as items that may be shared with other members of the household, such as a television.
A car—You can use funds as a down payment, and you can use some of the money to make monthly car payments as long as the car is used for and owned by the beneficiary.

For more information about the representative payee program, read A Guide For Representative Payees (Publication No. 05-10076), from the Social Security Administration.

— Lori Woehrle

During one of my mother’s hospitalizations, it became apparent that she would be in no condition to go home, so my Dad and I were faced with deciding on a nursing home.

Unfortunately, we had to decide rather quickly as we got virtually no notice of her discharge.

We managed to visit nearly every nursing home in the area in a record amount of time, and the facilities we saw varied wildly.

One thing I did notice, however is that some of the nicer ones had more activities and amenities than I had access to at home. I was ready to move into a couple of them myself.

Apparently, these luxury hotel-like accommodations in senior living are a trend as seniors are ready to live the good life and be involved in the hustle and bustle of city life with support as their needs change:

Developments like the Bellettini and the Mirabella, which are open to those age 62 and older, are more like five-star hotels than traditional senior living complexes. They include such first class amenities as spas, swimming pools, gyms, personal trainers, room service, chauffeur service, brain fitness programs, travel services and concierge services. Residents who are the first to move in also have a say in the appliances, colors and decoration of their apartments.

People traditionally think of assisted living communities as staid, a bit depressing, and tucked away in the suburbs, but people are living longer and, while they may need assistance, they are still involved with society and enjoy being able to do the things they like to do.

For those that can afford it, these high-end facilities enable people to live the active lifestyles they are used to, with the help they need as they get older.

However, these luxury communities aren’t without criticism, as so many senior citizens live on Social Security alone and people are concerned about the current economy as well as being able to provide for their families after they are gone.

While they aren’t for everyone, people choosing these types of retirement communities are making their own decisions about how they live out their years and how they spend their money.

Read more about Lavish Retirement Living Options.

One of the hardest decisions an adult with aging parents has to face is, “When is it time for a parent to stop driving?”

While I’m not in favor of mandating that everyone cease driving after a certain age, the reality is that the changes that come with aging, rather than the age itself, can possibly impair driving skills, and it’s important to assure the safety of everyone involved.

Some of the physical changes that affect driving ability include slower reflexes and reaction time, night vision changes, limited physical mobility such as difficulty turning head or raising arms, fatigue, and, increased risk of medication side effects.

It’s a difficult subject for both the driver and the family, but, here’s a sample of the help available out there:

• Warning Signs - when to stop driving from AARP
• Driving Safely While Aging Gracefully - From the United States Government’s National Highway Traffic Safety Administration, this site addresses the aging driver directly
• When to Put the Brakes on Elderly Drivers - a checklist from Aging Parents and Eldercare
• Driving Us Crazy - a interesting Time article about elderly drivers
• Patient Resources for the Older Driver - from the American Medical Association
• AAA Self Rating for the OlderDriver
• In the United States, your local Area Agency On Aging - may have resources to help with older drivers issues and community transportation.
• Also, in the United States, your local unit of National Association of State Units on Aging may be able to help.
• United States Driver’s License Renewal Procedures for Older Drivers

The National Center on Senior Transportation addresses the transportation options for seniors and might be helpful as well.

Many people are aware of their limitations, and, voluntarily stop driving, I hope I will be one of them, someday. However, I can’t imagine what it would be like to have to give up your independence in this way.

Families, health care providers and communities are the most valuable resources for insuring the safety and satisfaction of everyone concerned, when it becomes time for driving retirement.

We often hear about how important it is to be familiar with your aging parents’ (or other family members’) finances, but it is often easier said than done to summarize and organize these matters.

It’s a tough thing to talk about because many people were raised to believe that money matters are an intensely personal and private matter. But, the fact is that any of us could be called upon at any time to be in charge of or assist with the finances of someone else. Remember, the 40/70 rule is a good indicator of when it’s time to talk about it, but the earlier the better when you can.

Always consult your legal or financial adviser, but some of the issues to consider:

• Assets – Make a list of checking and savings accounts and investments such as 401(k) accounts, stocks, certificates of deposit and life insurance polices. Also include other assets such as residential and commercial real estate.

• Income – How much money comes in to your parents and from where? Are there pensions or Social Security benefits?

• Other valuables and documents – Do your parents have safe deposit boxes? Where are they? Where are the keys? Whose names are on the signature cards? Where are their important documents stored? What about valuables such as jewelry, antiques and collectibles? Where are their birth certificates and their Social Security and driver’s license numbers?

• Insurance – How much and what types of medical, life and long-term care insurance do your parents have? What do their policies cover? Do they have supplemental insurance? How are the payments made – you need to know this to prevent coverage termination due to a payment lapse.

• Wills – Do your parents have wills? Who have your parents named as executors, trustees and powers of attorney, and do you know how to contact them? If your parents don’t have wills, urge them to work with an attorney and create them so they can avoid potentially huge tax consequences.

It’s also very important to contact each pertinent institution to find out what their requirements are for acting on someone else’s behalf should you be in a position to act as a power of attorney or other legal representative. With various privacy laws, you may not be able to get the information you need if there isn’t proper documentation.

Even if you can’t relate to needing this type of information about your parents because they are young and in good health, it’s still a good idea to broach the subject with them from a “what if there was an emergency?” approach.

Perhaps it is information they could prepare and store in a safe deposit box or with a lawyer if the discussion is deemed too awkward.

Additionally, do you have this type of information on hand for your own finances? In an emergency or under stress, this type of important information may be too difficult to remember.