Advocate For Senior Citizens - Protecting Against Abuse and Fraud

Ruth is 87 years old this year and has been living alone since 1997. She is in good health, however the daily chores around the home became increasingly difficult. Ruth turned to her church bulletin and found a ‘Home Care Company’ advertised.

Ruth is not unique in the fact that she is widowed and lives alone. According to the ‘2002 A Profile of Older Americans’ published by the Administration on Aging ([http://www.aoa.gov/aoa/stats/profile/4.html]) 41% of women age 65 and over, are widowed and live alone.

“The ad was in the church bulletin, I assumed this was a good company,” her voice cracking from the pain and embarrassment this home care service eventually caused her.

Unfortunately, Ruth is also not alone in the fact that she became victim to fraud. According to U.S. Senator Larry Craig, past ranking member of the U.S. Senate Special Committee on Aging, ‘Vulnerable elders are being abused, neglected and exploited within their own homes and communities at an a alarming rate.’

“The lady they sent to me was well groomed, she was polite, and I had no reason to distrust her. You could tell she was from a good family …” Ruth went on to justify how quickly she was robbed of $4,200.

Barbara Mascio, founder of Senior Approved Services, states “Ruth’s story was just one of many incidences of abuse that I learned of while employed with a national home care company. The stories of abuse and fraud against this precious generation became the driving force behind the creation of Senior Approved Services.”

Senior Approved Services actively assists in protecting seniors by helping to connect them with businesses that have a verified history of providing excellent care. “We remain actively involved, a link between the senior receiving care and the business providing the care.”

“We are building a nationwide network of services, resources and products that seniors and their family caregivers can feel safe in contracting with. We are inviting all those concerned with the right of all seniors to receive excellent and safe care to help.”

Assisted Living Costs

The average monthly base cost of assisted living increased 15% this year, to $2,905. That works out to $34,860 a year The annual survey was conducted by LifePlans, Inc., a risk management and consulting firm that provides data analysis and information to the long term care insurance industry.

Rates ranged considerably by region. The most expensive city was Boston, where people in assisted living facilities spent an average of $4,629 per month. The lowest cost was Jackson, Miss., where the average was just $1,642.

Assisted living is a form of housing for older Americans that is growing in popularity. This is in response to the aging of the population and the preference to age in a home-like setting. The monthly private pay base rates, which are defined as room and board and typically include at least two meals, housekeeping and personal care assistance, were obtained for private rooms with private baths in assisted living facilities. Quarters can range from a small house to a large apartment-style complex.

For the most part, base rates include 24 hour supervision, two to three meals per day, assistance with the activities of daily living (bathing, dressing, eating, toileting, transferring and continence), social activities, medication management, laundry, housekeeping and maintenance and recreational and spiritual activities. Most residents pay privately or through long-term care insurance policies.

The average assisted living costs in Georgia are $2,795 for Alpharetta and $2,643 for Atlanta. This is slightly below the national average. Do you have a plan in place to pay for this type of care when you need it? If you have a plan, have you reviewed it recently? Contact us for an evaluation of your plan to pay for assisted living costs.

Senior Citizen Abuse

News headlines report of senior citizen abuse, most everyday. Long gone are the values and moralities of our grandparent's generation. Time was when a handshake, or your word was all that was necessary to honor commitments. Gone are the days on an unlocked house, open windows, or sitting out back alone.

The elderly in today's society can, unfortunately, encounter many traumatic events for no cause of their own. Predators watch and learn learn an old person's schedule, like, when they leave their homes and when they are likely to return, what times they get up or go to bed, and if they are handicapped or ill by the comings and goings of a visiting nurse.

Many in the society of today appear to have lost all respect for other people's property. It seems these people are without limits, with nothing more important than self-serving tactics. Who cares if an old person is lonely, in pain, or needs assistance?

Many times, the media tells us about a kid that brutally beat elderly parents, grandparents, or elderly strangers. Without any motivation, other than pursuing what they want, senior citizens can become their prey. And, if they want something you have in your home, you could be their next victim.

But, not all attackers are strangers, and the elderly person might not be beaten, robbed, or brutally murdered by the hands of an unknown person. Sometimes, the attacker is a family member, relative, or friend.

When elderly people are attacked or threatened, how are they to protect themselves? Many don't possess the strength or agility to fight back or run. They can fall down stairs, against door jams, or be trapped in a wheelchair. Many times they do not understand what or why this is happening to them, because the person doing them harm is someone they trusted.

Perhaps a friend or relative lives in the senior citizen's home to provide assistance and/or companionship. This person might get angry because they don't want the responsibility of caring for an older person. Perhaps they feel as if their freedom has been taken from them. If the elderly person has adequate finances, the one that is supposed to be looking out for the well-being of the senior begins to feel that they should be compensated or rewarded excessively.

An elderly person who refuses to give money or sign over their property, risks being violently attacked by a family member or friend. It could be an adult son or daughter, grandson or granddaughter, or a friend. Most elderly people hesitate to report abuse from a relative or friend. Many are in failing health, and don't know who to turn to for help. Or, perhaps, they fear the attacker will retaliate and things will get much worse, if they report the abuse.

Aging can be a lonely and painful experience. Some senior citizens were attacked and left alone to endure the pain and shame. Many could not get to their phone to call for help. But, if they would have had an emergency alarm, the help they needed could have been summoned.

A small device, disguised as a pendant or wristwatch can save lives, literally. There is no need to get to a phone. Help and assistance is no further away than the end of the finger. As easy as pushing a button on the device calls an emergency operator, and help can be on the way.

Many times, long-term injuries or death can be the result of not being able to get the care when it is needed. A personal security device can provide peace of mind, and is a true friend in need. Senior citizens can live independently knowing they have the ability to get help whenever they need.

Differences Between Nursing Homes, Assisted Living & Continuing Care Retirement Communities

Benjamin Franklin said it best - “nothing in life is certain except death and taxes” but with daily advancements in science, technology and health care, Americans are living longer than ever before*. This blessing however, has created a unique dilemma for modern American families: How to plan for and prepare for one's retirement years.

Have you taken a road-trip lately? Almost every highway is graced with large bill-boards providing the locations of new planned communities where couples can spend their retirement years dedicated to recreational pursuits. I doubt you will find a local newspaper that doesn’t have at least one ad promoting the amenities found at a local assisted living facility. Try to search for “nursing homes in Virginia” on the Internet and thousands of web pages will appear. Each and every day new facilities offering different programs are being built and marketed across the state.

Is such a facility right for you and your family? If so, which facility? We often hear the terms “retirement community,” “nursing home,” and “assisted living facility” but rarely consider what these terms actually mean. The differences however, are striking and it is imperative to understand these differences when making choices for yourself or your loved ones.

NURSING HOMES

In Virginia, a nursing home means any facility with the primary function of providing long-term nursing care, nursing services and health-related services on a continuing basis, for the treatment and inpatient care of two or more non-related individuals**. Put simply, a nursing home is a facility designed for someone who needs less care than a hospital, but requires daily health care assistance.

The Virginia Department of Health licenses such facilities and has established guidelines regulating various aspects of their operations, programs, and staffing needs, etc***. For example, a nursing home must: (a) have written policies and procedures regarding the treatment of residents and the management of resident care which are available to residents and their families (12VAC5-360-20); (b) provide emergency medical services within 15 minutes, under normal conditions (12VAC5-360-50); (c) be subject to unannounced on-site inspections of the nursing facility by State employees (12VAC5-371-60); (d) have a written agreement with one or more physicians licensed by the Virginia Board of Medicine to serve as medical director (12VAC5-371-230); and (e) each resident shall be under the care of a physician licensed by the Virginia Board of Medicine (12VAC5-371-240).

In addition, residents of nursing homes are also given certain rights as defined by Virginia Code §32.1-138. See http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+32.1-138. Nursing homes are the most regulated and structured residential options for our Seniors requiring some level of daily health care. If the facility provides care through Medicare and Medicaid programs, it is deemed a "Certified nursing facility" (Virginia Code §32.1-123; Virginia Code §32.1-127) and must be in compliance with both federal and state laws.

Of course, the more rules and regulations that define and control the daily operations of a nursing home, the greater the responsibility of the staff. These are the people who will be charged with the daily task of caring for your loved one, and making sure they are in compliance with state and federal laws. No matter how nice and or attractive the facility might be, the staff will make the difference between your loved one being cared for and encouraged, or not.

A nursing home is best suited for someone:

• Who requires daily health care – such as assistance getting in and out of bed; taking medicine; or using the restroom.


• Who may have dementia or Alzheimer’s and as a result, is unable to eat and or bathe daily without reminder or assistance;


• Who is recovering from a fall or accident and is therefore unable to walk, dress and or eat without assistance

ASSISTED LIVING FACILITY

“Assisted living facility” means an adult care residence which has been licensed by the Virginia Department of Social Services to provide a level of service for adults who may have physical or mental impairments and require at least moderate assistance with the activities of daily living. Within assisted living, there are two types: regular assisted living for those seniors (typically) who need assistance with one or more daily activity; and intensive assisted living for someone who may be incapable of performing activities due to mental and/or severe physical impairment (12VAC30-120-450).

The Virginia Department of Social Services licenses assisted living facilities but does not regulate in the way the Department of Health regulates nursing homes. While there are Virginia guidelines regulating aspects of assisted living facilities, they are limited: An assisted living facility must: (a) provide or coordinate personal and health care services; and (b) provide 24-hour supervision.

As reflected in the table below, assisted living facilities have no obligation to provide health care and/or have health care staff available to assist your loved one. In addition, with no obligation to provide such services, there is the question as to whether or not they owe a duty to warn or treat residents with illnesses or diseases that could be transmitted from other residents.

While a nursing home will have many nurses on staff and doctors hired to monitor the residents, assisted living is more analogous to an apartment building or college dorm where laundry and food services are provided and residents are on their own for the rest of the day.

An assisted living Facility is best suited for someone:

• Who is basically independent but may not be able or willing to prepare their own food or drive to doctors’ appointments;


• Someone who wants to scale back and anticipates needing assistance with laundry, cooking, etc. in the near future.


• A couple where one spouse is independent but may need assistance in feeding and or providing for needs of other spouse.

CONTINUING CARE RETIREMENT COMMUNITY

In Virginia you may also see advertisements for a retirement community. They are popping up all around our favorite College Towns and Tourist destinations.

A Continuing Care Retirement Community provides care depending on your current needs. Like an insurance policy, the resident pays an entrance fee and periodic adjustable payments, which in turn gives the resident a package of residential and healthcare services that the CCRC is obligated to provide at the time these residential and health care services are required. For example, if upon entering, all you want is help with your meals, that is the only service which will be provided. If you require intensive physical therapy or God forbid, daily assistance for a Dementia patient, the CCRC has assisted living services or nursing home services available under your contract. Continuing care contracts are regulated by the Virginia Bureau of Insurance of the Virginia State Corporation Commission.

Many CCRCs can have nursing home services available either on-site, or at licensed facilities off-site (12VAC5-360-10). While you may be entering the Retirement Community as a very healthy independent and capable resident, as your needs change, so will your contract with the Community and in turn, the facility’s obligations to you.

A Continuing Care Retirement Community Facility is best suited for someone:

• Who is basically independent but anticipates the need for daily health care for themselves or a spouse in the near future;


• Someone who is physically disabled and would be unable to care for themselves or a spouse if the disability grew worse.

With at least three very different choices, it is very important to do your research:

To research assisted living facilities in Virginia, go to Department of Social Services website: http://www.dss.state.va.us/facility/search/alf.cgi.

To research nursing homes, go to Medicare’s website: http://www.medicare.gov

AND LAST BUT NOT LEAST

It is always best to speak to a family member of a current resident and spend time getting to know the staff, no matter what type of facility you are looking into. If looking and researching is not enough, then consider the chart below – a comparison of the legal duties of a nursing home compared to the legal duties of an assisted living facility in Virginia.

DUTY or REQUIREMENT

NURSING HOME

ASSISTED LIVING

Duty to provide nursing care and or monitor resident’s health?

YES

NO

Doctor required to supervise residents?

YES

NO

Each resident shall be under the care of a physician licensed by the Virginia Board of Medicine?

YES

NO

Must have nurses on staff?

YES

NO

Must offer rehabilitative services?

YES

NO

Must have ongoing consultation from a registered dietitian or dietitian on staff?

YES

NO

24 Hour Supervision required?

YES

YES

Must develop a written plan upon admission of resident?

YES

YES

Staff must undergo criminal background check?

YES

YES

Monitored by Virginia Center for Quality Health Care Services and Consumer Protection

YES

NO

Monitored by Department of Social Services

NO

YES

*Life expectancy increased dramatically during the past century, from 47 years for Americans born in 1900 to 77 years for those born in 2001. These same factors—improved medical care and prevention efforts— that are partly responsible for the dramatic increases in life expectancy have also produced a major shift in the leading causes of death in the United States in the past century, from infectious diseases and acute illnesses to chronic diseases and degenerative illnesses.” The State of Aging and Health in America 2004, published by the Center for Disease Control, available at http://www.cdc.gov/aging/pdf/State_of_Aging_and_Health_in_America_2004.pdf.

**See generally, Virginia Code §32.1-123, as amended and Virginia Administrative Code § 12VAC5-360-10.

***It is a Felony under Virginia law to operate a nursing facility without a license. See generally, 12VAC5-371-30.

Why You Should Start an Adult Day Care Center

Starting an adult day care center is a business which gives senior citizens an advantage over other types of retirement options because it allows them to stay at home longer. When the new health care laws come into effect it will cut $500 Billion in Medicare benefits. The costs of an adult day care center are supported by medicaid and private pay clients. Senior care centers offers people an option to live at home and still be a vital part of their family. Starting an adult day care center allows people from the ages of 18 and up who have trouble with everyday activities such as bathing, toileting, dressing or are socially isolated to have a place to come to everyday which helps them live a life with independence as well as with the necessary aid they might require due to age or an accident.

A part of the adult population which has been overlooked are the mentally challenged who now have aging parents taking care of them. The parents need a break and their children could benefit by the socialization and the physical and psychological care given to them by professionals. This population can be taken by an adult day care center but mostly states require a training program for these individuals to be working members of the community and learn a trade. However, if they are severely mentally or physically impaired an adult day care center would be a place where they could receive the attention and activity they need, provided they are private pay clients or are receiving medicaid benefits.

Starting and owning this type of business is also an advantage to a person looking to be in the health care field with regular hours. Many centers start at 7am and clients board vans and buses by 4:30pm for home. Its rewarding to be able to take care of clients psychological and physical needs, socialize with each other, and be an asset to the community. As owners run good businesses, word of mouth takes over and people come to your center. The advertising is very easy once you begin your center. the clients tell their friends and the families tell each other and soon its a thriving center full of life.

In conclusion, starting and owning an adult day care is a good business investment with government funding, is good for them community and provides an option to assisted living, nursing homes and other health related institutions. For additional information and the necessary requirements for starting a senior care center contact Adult Day Care Group at www.adultdaycaregroup.com

Avoiding Medication Errors in the Elderly

What is a medication error?
The National Coordinating Council for Medication Error Reporting and Prevention officially describes a medication error as a "preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer. Such events may be related to professional practice, health care products, procedures, and systems, including prescribing, order communication, product labeling, packaging & nomenclature, compounding, dispensing, distribution, administration, education, monitoring, and use."

Simply put, a medication error occurs when a patient is given the wrong medication. It may or may not cause lasting harm to the patient but it is a situation that could have been avoided.

Medication errors fall into a number of categories:

1. Incorrect or improper administration of a medication (i.e., dosage mistakes)
2. Administering the wrong medication for a disease or condition
3. Administering drugs that are out-of-date
4. Administering drugs at the wrong time or interval
5. Administering drugs without considering adverse effects due to drug combinations

An FDA study found that the most common medication error was improper dosage. Something as simple as the amount of medicine a patient should have has caused 41% of medication error fatalities. The next most common errors are patients being given the wrong drug or using the wrong route of administration.

Why do they occur?
There are a wide range of causes. Doctors or pharmacists may become confused with similar or generic drug names or have difficulty reading handwritten orders. Iodine, for example, can be easily mistaken for Lodine, which is used to treat inflammation. The prescribing physician may not be aware of potential side effects of a drug or may be unaware of other medications a patient is taking. A nurse may not understand the proper way for a patient to take the drug and patients may use the wrong dosage or take the drug too often - or too infrequently.

Are seniors at higher risk?
Yes. Because of general declining health, weaker immune systems and other possible medical conditions, the risk to seniors is higher. And with a rapidly-expanding senior population and the explosion of drugs targeting a variety of conditions, the risks won't decline anytime soon...especially since seniors as a whole tend to take more medications. More than one-third of all medication errors occur with patients over the age of 65, and over 20% of those could have been prevented. Of the medication errors that resulted in a patient's death, nearly half occurred in individuals aged sixty and higher.

How can seniors avoid medication errors?
Seniors or their family members can take the following steps to help reduce the likelihood of a problem:

1. Understand the name (and generic name), use, dosage, route of administration and frequency of each drug, including special instructions such as handling or storage.
2. Ask and learn about potential side effects and whether the drug will interact with other prescription drugs, over-the-counter medications or supplements.
3. Question the pharmacist if the bottle looks strange or contains names and dosages that seem different from what you've been told.
4. Ask doctors and nurses in medical facilities which drugs are being administered, and what they are designed to treat.

The key to reducing medication errors is to ask questions when something isn't clear or doesn't seem right.

Diabetes and Alcohol Abuse

DIABETES

Diabetes is so wide spread in the world that there are hardly any person who does not know what diabetes is. But to recap, there are predominantly two types of diabetes; Type 1 and Type2. Some general information on these types of diabetes is given below.

In Type 1 diabetes the pancreas in the body is not able to produce insulin (the only hormone that reduces the content of sugar in the blood stream) and is common in children but not restricted to them. This type of diabetes is insulin dependent.

Type 2 diabetes is more common and it is estimated that some 95% of all diabetic patients belong to this type. In this case, the body does produce insulin, but either in insufficient quantities or the insulin produced is inefficient. This condition is also known as "Diabetes Mellitus". This type of diabetes is non-insulin dependent.

Another variety of Type 2 diabetes is "Diabetes Insipidus" where there is excessive excretion of highly diluted urine. Reduction in the amount of fluid intake does not have any effect on this condition. There are also different varieties of Diabetes Insipidus, the most common being "Neurogenic Diabetes Insipidus" and the other is "Nephrogenic Diabetes Insipidus".

There is another type of diabetes that occurs in pregnant women and is known as "Gestational Diabetes" and occurs in women with no history of diabetes but develop such symptoms during pregnancy.

SYMPTOMS OF DIABETES

The symptoms of diabetes varies from person to person and depends on the following factors:

i. Type of diabetes,
ii. The stage of advancement of the disease,
iii. The age of the patient,
iv. The progress of the disease - slow or gradual
v. The history of diabetes in the family of the patient,
vi. The dietary and lifestyle of the patient, and
vii. The presence of other complications.

Based on the above factors the symptoms vary though there is some similarity. Some of the more obvious symptoms are described below:

i. The foremost symptom would be excessive urination, in excess of the quantity of fluid intake; the urine being thin and pale in color.
ii. Excessive thirst.
iii. Significant increase in appetite but no significant weight gain.
iv. General body weakness.
v. Skin problems such as itching, more predominantly in the genital areas.
vi. Slow healing of wounds, a serious condition.
vii. Pain in many parts of the body, especially in the lower back and the limbs.
viii. A sort of side effect would be loss of vision with patients becoming myopic.
ix. Impotence in men.
x. Both the blood and the urine show a marked content of sugar.

Diabetes currently has no known cure and can only be controlled through medication, diet control and regular exercise preferably walking for a minimum of twenty minutes a day; the distance covered does not matter it is the duration of the walking that counts.

COMPLICATIONS

Know that we know, more or less, the details of diabetes and its symptoms we shall move on to the complications of the disease. The most common complications include the following:

i. Kidney function complications. The earliest to occur. More so if the diet contains too much of fat. Narrowness of the arteries leading to the kidney occur and the toxins in the system are not flushed out completely leading to a complication known as "Uremia".

ii. Cardio-Vascular problems leading to hypertension and heart disease.
iii. Damage to the retina of the eye and resultant blindness.
iv. Nervous damage causing loss or destruction of the senses of the patient. In severe cases may cause paralysis.
v. The most appalling complication is undoubtedly gangrene especially in the toes leading to its amputation.

As such it essential that a specialist in Diabetology is consulted if there is a suspicion that a person is diabetic and find out exactly what type of diabetes he/she is suffering from and follow scrupulously the physician's advice in the control of the disease.

DIABETES AND ALCOHOL

The adverse effects of the abuse of alcohol is too well known and really does not really require elaboration.

A drink of alcohol in normally associated with 12 oz. (350 ml.) of beer, 5 oz. (145 ml.) of wine or 1.50oz. (45 ml.) of hard liquor. Each of these is equal to some 15 gms. of alcohol. What is the quantity of alcohol that is considered "light or moderate" and what is considered as excessive? Drinking 15 to 30 gms. of alcohol a day is considered as light or moderate and any excess of this quantity is "excessive" drinking. There are some people who should not drink at all. They include:

i. Pregnant women and those who are trying to become pregnant,
ii. Alcoholics who are recovering,
iii. Individuals who are planning to drive or engage in other activities that need skill or concentration,
iv. Individuals taking certain medicines such as antihistamines, antidepressants and anticonvulsants and
v. Individuals with certain medical conditions such a advanced neuropathy alcohol abuse, pancreatitis and hyper-triglyceridemia.

In respect of individuals with diabetes who have not been drinking it is better not to start.

WHEN IS DRINKING HARMFUL?

Drinking is considered to be harmful for diabetics if they have the following conditions:

i. Damage of the nerves in the arms or legs,
ii. Diabetic related eye disease,
iii. High levels of triglycerides and
iv. High blood pressure.

Alcohol normally damages nerve cells, even light drinking. For those diabetic patients with nerve damage there will be an increase in pain, numbness and burning or tingling sensations.

For those with symptoms of eye disease, drinking can worsen the condition, leading to blindness.

Levels of triglycerides and blood pressure increase with the consumption of drinks, in whatever quantities. Diabetic patients with a high level of triglycerides should not drink at all.

Does this mean that a diagnosis of diabetes is the end to drinking? Well, yes and no. Traditional medical practice advocates the complete cessation of the intake of alcohol. Modern thought differs. Taking a drink is not advised but allowed, but there are some considerations.

- Alcohol can metabolize to produce energy and has dietary consequences.
- Alcohol supports the intake of blood glucose into the liver.
- Many alcoholic drinks contain sugar, especially mixed ones.
- The symptoms of hypoglycemia (drop in blood sugar) and drunkenness are similar and as such alcohol is liable to mask the symptoms of hypoglycemia.
- Excess consumption of alcohol increases the level of triglycerides.
- Diabetics with drinking habits must remain sober enough to take care of themselves.

What is acceptable in moderation are:

- Red wines,
- Dry sherries,
- Spirits with "diet" mixers,
- Dry light beers (light ales with low residual sugars and lagers) and
- Dry or medium dry white wines.

What can be used with extreme caution because of their high content of sugar include:

- Sherries or sweet wines,
- Ports,
- Wine coolers,
- Liqueurs,
- Cocktails,
- Spirits with normal mixers and
- Stout, Porters etc. that have a high residual sugar content.

What can be used with extreme caution because of their high concentration of alcohol are neat, undiluted spirits

The above are not meant as a substitute for proper advice from a physician. As the complications of consumption of alcohol by diabetic patients are more and severe than the detrimental effects of drinkers without diabetes, proper competent advice is advised.