With the Baby Boom generation entering its "golden years," it would seem that we need more nursing homes, not fewer. But the numbers show a troubling trend.
Nursing home closures eliminated about 5% of available beds between 1998 and 2008, according to a report posted online and scheduled for print publication in the May 9 print issue of Archives of Internal Medicine.
Not only that, the report shows that closures were concentrated in minority and poor communities, leaving elderly residents of those areas with fewer options.
"Regulatory oversight, reinforced by market forces and an increased focus on transparency and public reporting, is designed to eliminate poorly performing nursing homes," the authors write as background information in the article. "A small fraction of US nursing homes closes each year (not more than 2%). Perhaps this is a desired outcome, since closure is the ultimate indicator of performance failure.”
Zhanlian Feng, Ph.D, of Brown University in Providence, Rhode Island, and colleagues analyzed information from a national database of Medicare/Medicaid-certified nursing homes in the United States from 1999 through 2008. The database contained a total of 18,259 unique nursing homes from all 50 states and the District of Columbia in this time period.
The researchers used 2000 US census data to define geographic boundaries and map nursing home closures by state, metropolitan statistical area and zip code. They then matched closures to zip code-level population data on poverty and racial and ethnic composition.
Between 1999 and 2008, a total of 2,902 nursing homes closed, or almost 16% of all Medicare/Medicaid certified facilities. This included 1,776 freestanding nursing homes (11% of all such facilities) and 1,126 hospital-based facilities, for a net loss of more than 5% of beds.
Among freestanding facilities, the relative risk of closure was about 38% higher in the one-fourth of zip codes with the highest percentage of blacks than it was in the one-fourth of zip codes with the lowest percentage of blacks. Similarly, closure rates were 37% higher in the one-fourth of zip codes with the highest percentage of Hispanics vs. those with the lowest percentage of Hispanics.
Also, the risk of closure in zip codes with the highest level of poverty was more than double that of those in zip codes with the lowest poverty rate. Similar trends were observed among hospital-based facilities.
"Since most failed nursing homes experience a downward spiral in financial and quality performance before their eventual closure, one might argue that the demise of such facilities is not necessarily a concern," the authors write. "However, in the broader context of structural and socioeconomic disparities and persistent racial residential segregation, the clustering of nursing home closures in poor and minority-concentrated urban neighborhoods is troubling. This phenomenon, arguably, resembles similar dynamics of inequalities in public schools, housing, environmental decline and other sectors."
The cumulative loss of nursing facility beds in the aftermath of closures, combined with the lack of alternative long-term care services in these disadvantaged communities and increasing use of nursing homes among minority elderly people, suggests that disparities in access will increase in the future, they conclude.
When we think of caregivers, the first thing that pops into our heads is that a loved one lives with a family member. However, there are many instances where caregivers live miles away, whether in another city, state, province, or country. They may not be considered a primary caregiver because primary caregivers generally provide round the clock care. Long distance caregivers help out their loved ones with financial planning, organizing in-home care, and offering helpful tips when needed.
A family member such as a parent may also live in a nursing facility in their home state, while their children live in another city or state. That child is often contacted by the facilities should a problem occur. In addition, a parent may live with one sibling, while the other sibling(s) lives some distance away. The key to quality care is to offer as much as possible. As long as the caregivers, whether long distance or not, is willing to help, then quality care is being given.
Long distance caregiving can be quite stressful as you are not there to observe your loved ones needs. That is why it is crucial for you to visit as much as possible and recognize any changes, big or small, that occurs with your loved one. This may be especially difficult if you are living in another state. Below, are some questions that you may want to ask yourself when you become a long distance caregiver:
1. Is your loved one willing to move to your city? If your loved one is willing to move, look into all the options, such as living with you, another family member, or a separate housing situation. Also, ask your loved one what he/she would like. Try to come up with a plan that is helpful to you both.
2. How independent is your loved one? If your loved one is still living out of reach from you, you may need to make some phone calls and arrange help when needed, such as bathing, feeding, and cleaning. However, if your loved one needs assistance with the activities of daily living, it may be that he/she needs more care than initially thought. When you visit, take notice in how well your loved one does things for himself.
3. Is anyone else caring for your loved one? Keep in contact with other family members or facilities concerning your loved one. Offer as much help as you can. It may just be writing more letters or making more phone calls to keep your loved one happy.
4. How is your loved one being treated? This may be a problem if your loved one is being cared for by another family member that cannot handle the caregiving role. Speak to the family member and find out if he/she is coping. You can also have your loved one visit you for a few weeks to give the other family member a break.
A growing number of seniors today face the difficulty of sleep disorders, commonly referred to as insomnia. Up to 30% of the elderly experience infrequent sleep patterns, apnea (the stoppage of breath), and waking up too early.
Insomnia results in depression, constant fatigue, and even a decline in health in some people. The causes of sleep disorder are many and varied, including chronic pain and previous illness, high doses of medication, lifestyle changes, and anxiety and depression. All can play a part in triggering sleep loss and unless changed can damage your loved ones sleep cycle permanently. Caregivers usually must face a change in their own life when dealing with insomnia, and while it can be controlled, it often takes time. If your loved one has already begun sleeping less and waking up at odd hours, you may need to seek assistance from health care professionals who can assist you in the best treatment. Consider the following:
Check their medication to see if the side effects include difficulty falling asleep. You can discuss this with their doctor. Often it can be as simple as discontinuing one medication for another that does not have the same effect.
Restrict eating and drinking before they go to bed, so they do not wake up needlessly throughout the night to use the bathroom.
Make sure they get up around the same time every day so they can set a pattern to follow.
Make sure they do not drink colas or coffees that have caffeine and can keep them up at night.
Try to limit smoking to a minimum, as the effects can hamper breathing at nighttime in bed.
Take them for walks and regular exercise outings.
Instead of watching television, if they are able, you may advise them to read a book or newspaper to relax their mind.
Make sure their phone is off and their room is as dark to provide no distraction to sleep.
Remain calm and supportive if they struggle with getting up at night, and try to keep them composed.
Reduce stress levels as much as possible before they go to bed so they can have a clear mind and little to no anxiety.
Be willing to work with them and encourage them to try other methods to correct their sleeping problems.
Resist the temptation to use over the counter sleeping aids that are intended only for short-term sleeping problems and if used for any length of time, the body will build a resistance to them, causing further problems.
Where a senior resides, the organizations a senior belongs to, and the activities he or she participates in can determine whether they are socially isolated or enjoys an active social life.
Consider these social options:
- Retirement communities -- Seniors who live in retirement communities can participate in a wide range of organized activities that help them interact and minimize isolation.
- Apartment buildings with gyms -- Seniors who live in buildings that have their own gyms can exercise regularly and get to know neighbors while doing so.
- Health clubs -- Joining a health club can enable people who live in single family homes or apartments without gyms to take classes, work out, and socialize.
- Golf, tennis or racket ball clubs -- Some seniors belong to sports clubs that provide them with both a social network and the opportunity to exercise.
- Learning-in-retirement groups -- Classes for retirees that are sponsored by local colleges can offer both mental stimulation and a network of friends
- Groups based on common interests -- Some seniors enjoy regularly meeting with others who share common interests, such as gardening, discussing books or films, hiking (the Appalachian Mountain Club has special sections of local chapters for seniors), knitting, sewing, discussing foreign policy, bowling, writing, etc.
Want social connections but don't know where to start? Here are more suggestions:
- The local senior center, which probably offers lectures, classes, and meals.
- The local library, many of which have book discussion groups for seniors, as well as lectures and concerts.
- Your community's adult education classes.
- Your local college or university's classes, lectures and concerts. Some have special classes or activities for seniors while others encourage seniors to take regular classes at a discounted rate.
- Your local YMCA or JCC, many of which have movement classes for seniors.
- Health clubs, many of which have exercise, tai chi, dancercise or yoga classes for seniors.
- Civic, political, medical, educational or arts organizations looking for volunteers.
- Affinity groups, such as organizations or clubs for guitar players, singers, memoirists, walkers, hikers, environmentalists, amateur theatre actors, etc.
- Support groups.
- Churches, synagogues, mosques, or religious organizations that offer adult education, social action groups, and are always seeking volunteers.
- Alumni groups.
- Professional organizations, such as of lawyers, doctors, public relations specialists, etc.
- For women, The Red Hat Society.
- Widowed or divorced seniors who want companionship could consider online dating, which has connected more than one happy older couple. But don't always believe what you read in a profile. And it is helpful to follow your instincts -- if something about the person doesn't feel right, don't pursue it.
- Create your own affinity group on a topic of interest. You can go to Meetup.com and create a group on any topic, such as Lovers of Musical Theatre or Foreign Films. You will have to pay a monthly fee of $25 (the fees go down if you contract for more than one month at a time) to advertise there, but you can then ask the group members to share the cost with you. You can also create your own group and advertise at no cost on Craigslist.com. Or you can consider starting a group at your local church or through your local adult education organization. Be creative! By basing a group on your own interests, hopefully you will encounter people with similar passions.
It's never too late to get connected socially, which then helps with physical health as well. People with social connections tend to stay healthier.
We hope we'll never need the information, but if there is an emergency with your elderly parent or relative, having this checklist readily available will make your life easier.
Health emergencies with our elders can often become complicated by the sheer number of medications, doctors, insurance coverage and degree of chronic or acute illness(es) involved. Below is a comprehensive list of information and documents to keep on hand, so you'll be prepared.
Senior Care Emergency Checklist
- Doctors' names, their specialties and phone numbers.
- List of all medications being taken and what the prescriptions are for (be sure to keep the information updated -- as the medications may change frequently).
- Medical insurance and prescription plans and identification numbers.
- Social security number -- many insurance companies won't talk to anyone without the patient's social security number.
- Durable power of attorney -- a legal document that gives someone the authority to handle legal and financial issues if your parent or elderly relative becomes incapacitated.
- Health care proxy -- a legal document that gives someone the authority to make medical decisions for your parent or elderly relative.
- Specification of your elderly parent's or relative's wishes about resuscitation orders. Do you know their wishes? Knowing this information before a crisis can be crucial to the way in which you handle the crisis.
- Basic financial records -- a list of assets, account numbers, names and contact information for financial advisors or bank representative.
- Names and addresses of people to notify in case of an emergency -- such as children, grandchildren, close friends and neighbors who might be able to help out.
- Names and contact information for local clergy, if your parent or elderly relative has a preferred religious affiliation.
This information should be placed in the home in an easy-to-find location, such as near the phone in the kitchen, or in another commonly used area, as well as given to another family member or friend who agrees to keep a copy of the information for you.
Dr. Beverly Jones always dispenses this advice to the Alzheimer's caregivers who come through his office: You will never win an argument with an Alzheimer's patient.
"Family members simply cannot recognize how severe the memory loss is," he said. "They see the same person on the outside and just can't comprehend how different they are on the inside."
Winston-Salem doctors specializing in geriatrics and other seniors advocates shared their tips on living day to day with an Alzheimer's patient.
•Set up a no-argue zone. "If you argue with a person with dementia, both people just end up upset, and nothing is accomplished," said Dr. Kaycee Sink, director of the Kulynych Memory Assessment Clinic at Wake Forest University Baptist Medical Center. "With dementia, logic and reasoning are failing, and the person with dementia truly believes that the way they think is correct. If it's a minor issue, just concede. Put on your turtle shell and just let it slide off your back."
•Keep communication short and direct. "If a certain attempt is not working, come back to it later, maybe another way," Jones said. "You must pick your battles, and you must be flexible as a caregiver."
•Don't correct everything, especially if it's inconsequential. "If you try to make a point, it doesn't matter, because two minutes down the road, she won't remember it anyway," said Scott Trotter of Winston-Salem, who takes care of his mother. (See story on previous page .)
But what if the things the Alzheimer's patient says really are untrue and are harmful? One Alzheimer's patient, for example, told everyone she met that her daughter was spreading lies about her.
"You may never be able to convince her of the truth," Sink said. "In this case, for example, the daughter might have to make phone calls privately to the people her mother has spoken to and say, 'This really didn't happen.' But mostly, the people already know that the mother has problems."
•Don't take away what the Alzheimer's patient can do. Pick an activity that is appropriate to the person's level. If she can't cook an entire meal, perhaps she can slice the tomato for the salad.
"Allow them to do as much as possible, even if it's not up to standard," Sink said.
•Do things on a schedule as much as possible, Trotter said. This usually means less hassle.
•Always sit and listen, no matter what the loved one is talking about. Don't say you don't understand what they are saying. "The few times I caught myself saying 'I don't understand,' that would just frustrate her more or make her angry," Trotter said.
•Don't let the person see you get upset. Hide it and vent later with a friend or loved one, Trotter said.
•Don't treat the person like a child, even if some behaviors are childlike.
•Don't push someone to do things he cannot, such as a crossword puzzle that is too difficult.
•If a person with dementia is upset, try to get at the underlying emotion, Sink said.
For example, one man with Alzheimer's routinely worried that his money was going to run out and that he would be left poor. His daughter kept his bank statements nearby, showing them to him again and again. "Look Daddy, here's your money, safe and sound," she would say, and each time he would relax a bit.
Sometimes it almost takes stumbling upon the right words to calm an Alzheimer's patient. Sink told the story of one woman with dementia who worried constantly about her parents, who had long since died. She shouted out again and again, "Where's my mother and father?"
Various people told her, "They are coming for you," but then the woman became worried that her parents were lost.
Finally, someone told her: "Well, I don't know where they are, but they know where you are. And they love you very much." This satisfied and relaxed the woman, at least for a while, Sink said.
•Perhaps most important: Caregivers must give themselves a break.
"Build in some support for yourself, in terms of people who can help," Jones said.
The community offers adult day programs; take advantage of them, he said.
"The biggest problem I see is that caregivers work themselves to death," Jones said. "Literally. I have seen some caregivers who died before the Alzheimer's patient did. Lower your expectations and take it day by day."
Before you send your tax returns to the IRS, make sure you get the tax-savings you deserve. As a caregiver for a loved one with dementia, you may qualify for tax deductions and credits.
The cost of Alzheimer care is high. Because caregivers pay for most care expenses out of pocket, they may be eligible for some tax deductions.
Deductible caregiving costs may include:
- Medical care, including nursing care
- Transportation essential to medical care
- In-home care, such as physical therapy
- Personal care items, such as disposable briefs and special foods
- Nursing home care
- Assisted living or other residential care
- Home modifications such as grab bars or wheel chair ramps
A caregiver can take federal income tax deductions only if the person with dementia has been certified as chronically ill. This certification must have been made by a licensed health care practitioner within the last 12 months.
Long-term care services must be given under a prescribed plan of care. Be sure to keep records about your payment for services, and save certifications and plans of care. For more details on deducting caregiving costs, see IRS Publication 502, Medical and Dental Expenses.
If you paid someone to care for a child or a dependent so you could work or look for work, you may be able to reduce your tax by claiming the “Child and Dependent Care Credit” on your federal income tax return.
The credit is a percentage of the amount of work-related child and dependent care expenses you paid to a care provider. The credit can be up to 35 percent of your qualifying expenses, depending on your income. There are eligibility requirements to receive this credit. For more details, see IRS Publication 503, Child and Dependent Care Expenses.
Certain states have additional tax deductions or tax credits to provide financial relief to caregivers. These tax programs build on the federal tax credit, which reduces the amount of income taxes a family owes. Each state program differs by name and eligibility requirements. Consult the table on our Tax Deductions and Credits fact sheet to see if your state offers this type of credit or deduction.
Charity check-off boxes on state income tax forms
When filing your state tax form, you may be able to help fund Alzheimer’s disease research by making a donation with your return. Some state forms provide check-off boxes to contribute to charities involved in medical research.
- IRS Web site: http://www.irs.gov/
- IRS Tax Helpline: 1.800.829.1040
- Tax Counseling for the Elderly (TCE)
Helps people age 60 and older. Trained volunteers from non-profit organizations provide free tax counseling and basic income tax return preparation for senior citizens. Many of the volunteer counselors come from AARP’s Tax-Aide program. To find one near you, call AARP at 1.888.227.7669 or visit AARP’s Web site.
This information does not constitute financial, legal or tax advice. The determination of how the tax laws affect a taxpayer is dependent on the taxpayer's particular situation. Taxpayers should seek help from a competent tax professional for advice about the proper application of the law to their situation.