How to Handle Difficult Behaviors Won’t use walker or cane

Almost always, the device makes the person feel old or disabled and is therefore ignored.

What to do:

• Enlist peer pressure. It works at any age! The more your loved one sees others (especially those perceived as peers or younger) using assistive devices, the more normal they appear. Arrange chance “encounters” with a dapper, active, respected friend of roughly the same age who use a cane. Even watching movies set in locations when canes are commonplace (lots of foreign movies set in Europe, for example) can have a positive subliminal effect.
• Talk up the benefits. Canes and walkers are seen as symbols of disability. Remind your loved one that they actually promote movement, which will increase the odds of better mobility over time. They also reduce the odds of a fall — which can cause serious injury and further limit mobility.
• Look for noninstitutional models. Many men prefer a sturdy, stylish wooden cane to an aluminum model, for example. Walkers also come in a variety of types; search online forwalker or look at medical equipment companies.
• Try compromising. Maybe your loved one will use a walker in certain circumstances (shopping) but prefers to lean on a companion’s arm in others (church).
• Supply the device wordlessly. Rather than nagging (“Get your cane!”), just provide it.
• Consider having a third party, such as a physical therapist or doctor, lay out the costs of ignoring a cane or walker.
• See a physical therapist’s tips for encouraging someone who refuses to use their cane or walker

caring.com

Raleigh Geriatric Care Management:  www.rgcmgmt.com

Activities for People With Alzheimer’s Disease

It is universally recognized that elderly people with dementia lose their short term memory first and their long term memory last. For example, they often remember people and events from their earlier years, but have difficulty remembering what they ate for breakfast the day before. A short summary of some activities include the following:

1. Reminisce! Everything you do together lends itself to reminiscing. If the person can still speak fairly well, say, “Tell me about…” If his vocabulary is more limited, you may have to facilitate the story. “Do you remember when…” As you bake cookies together you can talk about residents’ favorite cookies, meals, etc.
2. Read aloud and use visual aids such as memory poems, family pictures, or stories about “the days gone by” stimulate reminiscences. Ideas include Chicken Soup for the Soul series and Yesterdays by NaDezan, and other short stories
3. Make music. Sing, hum, whistle, dance. Singing brings oxygen to the brain to help you think more clearly. Dancing exercises other parts of the body. Both increase your own sense of well-being as well as the well-being of the residents! Have music activities and entertainers visit. Choose the residents’ favorite cassettes.

4.  Sensory stimulation activities could include the following:

• Making lap quilts.
• Painting.
• Talking books.
• Scrap books.
• Walking!
• Flower arranging.
• Tutoring, or visiting with children.
• Baking.
• Happy hour with non-alcoholic drinks.
• Ice cream party.
• Brushing & fixing a resident’s hair.
• Manicures.
• Ladies luncheons.
• Building with wood (include sanding).

Although these activities are written for residents of a retirement community or a nursing home, they certainly could be utilized for private use as well. Keeping the mind and body active are important for everyone, but especially your loved one with dementia. Do something that is enjoyable for both of you, and it makes it that much easier. Raleigh Geriatric Care Management assists adult children of aging parents. caregiver.com

Is it time for Assisted Living?

by Paula Spencer Scott

The decision to help an aging adult move out of a current home is a complex one — both emotionally and practically. Above all, you want the person to be safe and well. How can you all feel more confident about whether circumstances suggest that your loved one should no longer be living alone?

1. Big-picture signs it might be time for assisted living

Keep the big red flags in mind. Certain situations make it more obvious that it’s wise to start thinking about alternate living arrangements.

Look for:

• Recent accidents or close calls. Did your loved one take a fall, have a medical scare, or get in a fender bender (or worse)? Who responded and how long did it take? Accidents do happen, but as people get older, the odds rise of them happening again.
• A slow recovery. How did the person you’re caring for weather the most recent illness (for example, a flu or bad cold)? Was he or she able and willing to seek medical care when needed, or did last winter’s cold develop into untreated bronchitis?
• A chronic health condition that’s worsening. Progressive problems such as COPD, dementia, and congestive heart failure can decline gradually or precipitously, but either way, their presence means your loved one will increasingly need help.
• Increasing difficulty managing the activities of daily living (ADLs) and instrumental activities of daily living (IADLs). ADLs and IADLs are the skills needed to live independently — dressing, shopping, cooking, doing laundry, managing medications, and so on. Doctors, social workers, and other geriatric experts evaluate them as part of a functional assessment, which is one way to get an expert’s view of the situation. Difficulties with ADLs and IADLs can sometimes be remedied by bringing in more in-home help.

2. Up-close signs it might be time for assisted living

Give your loved one a big hug. Clues aren’t always visible from a distance; especially when you don’t see the person every day, you might learn more through touch.

Look for:

• Noticeable weight loss. Does the person feel thinner? Are clothes loose, or has he added notches to his belt? Many conditions, from depression to cancer, can cause weight loss. A person who is having trouble getting out to shop or remembering how to cook (or to eat) can lose weight; check the fridge and watch meal-prep skills.
• Seeming more frail. Do you feel anything “different” about the person’s strength and stature when you hug? Can your loved one rise easily from a chair? Does she or he seem unsteady or unable to balance? Compare these observations to the last time you were together.
• Noticeable weight gain. Common causes include an injury slowing the person down,diabetes, and dementia (when someone doesn’t remember eating, he or she may indulge in meals and snacks all day long). Someone with money troubles may choose fewer fresh foods and more packaged goods or dried pasta and bread.
• Strange body odor. Unfortunately, a close hug can also reveal changes in personal hygiene habits. Causes range from memory trouble to depression to other physical ailments.
• Changes in appearance. Does the person’s hair and makeup look all right? Are clothes clean? Someone known for crisply ironed shirts who’s now in a stained sweatshirt may lack the dexterity for buttons or may have lost the strength for managing an ironing board and iron. A formerly clean-shaven man with an unkempt beard may be forgetting to shave (or forgetting how to shave).

3. Social signs it might be time for assisted living

Think realistically about the person’s social connections. Social circles tend to shrink with age, which can have health and safety implications.

Look for:

• Signs of active friendships. Does your loved one still get together for lunches or outings with friends or visits with neighbors, or participate in religious activities or other group events? Does he or she talk about others or keep a calendar of appointments? Lack of companionship is associated with depression and heart problems in older adults. If friends have died or moved away, moving to a place where other people are around could be lifesaving.
• Signs that your loved one has cut back on activities and interests. Is a hobby area abandoned? Has a club membership been given up? A library card gone unused? There are many reasons people cut back, but dropping out of everything and showing interest in almost nothing is a red flag for depression.
• Days spent without leaving the house. This sometimes happens because the person can no longer drive or is afraid to take public transportation alone and lacks a companion to come along. While many older adults fear being “locked away” in a retirement home, many such facilities offer regular outings that may keep them more mobile and active, not less.
• Someone who checks in on a regular basis. If not you or another family member, who does this? Is your loved one willing to consider a home-safety alarm system, a personal alarm system, or a daily calling service?
• A plan for a worst-case scenario. If there’s a fire, earthquake, flood, or other disaster, is someone on standby to assist? Does your loved one understand the plan?

4. Money signs it might be time for assisted living

Riffle through the mail. Your loved one’s mail can offer an often-overlooked clue to how he or she is managing money, a common early warning sign of cognitive trouble.

Look for:

• Snowdrifts of mail in various places. Finding lots of mail scattered around raises concern about how bills, insurance, and other matters are being managed. (Piles of mail are also a potential tripping hazard.)
• Unopened personal mail. Everybody skips junk mail, but few of us can ignore a good old-fashioned, hand-addressed letter.
• Unopened bills. This can indicate that your loved one is having difficulty managing finances — one of the most common first signs of dementia.
• Letters from banks, creditors, or insurers. Routine business letters aren’t worrisome. But it’s alarming if they’re referring to overdue payments, overdrawn balances, recent accidents, or other concerning events.
• Thank-you messages from charities. Older adults are often vulnerable to scammers. Even those who have always been fiscally prudent are vulnerable if they’re having trouble with thinking skills (a common sign of Alzheimer’s disease). Some charities hit up givers over and over, and your loved one may not remember having donating the first time.
• Lots of crisp, unread magazines. The person may unknowingly have repeat-renewal subscriptions he or she doesn’t need.

5. Driving signs it might be time for assisted living

Take a drive — with your loved one behind the wheel, if he or she is still driving. Living independently in our culture often depends on the ability to drive (or the arrangement of alternate transportation options).

Look for:

• Nicks or dents on the car. Notice the car body as you get in and out. Damage marks can be signs of careless driving.
• Whether the person promptly fastens his or her seatbelt. Even people with mild dementia usually follow the rote basics of driving. It’s worrisome if he or she is forgetting this step.
• • Tension, preoccupation, or being easily distracted. The person may turn off the radio, for example, or be unwilling to engage in conversation while driving. He or she may avoid certain routes, highway driving, or driving at night and in rain — a safe kind of self-policing but also signals of changing ability.
• Signs of dangerous driving. People whose driving ability is impaired are more likely to tailgate, drift from their lane, go below the speed limit, react slowly to lights or other cars, and mix up gas and brake pedals. See 8 ways to assess someone’s driving.
• Warning lights. Check out the dashboard as you ride along. Does the car have sufficient oil, gas, antifreeze, windshield-wiper fluid?

6. Kitchen signs it might be signs for assisted living

Go through the kitchen, from fridge to cupboards to oven. Because people spend so much time in this room, you can learn a lot.

Look for:

• Stale or expired foods. We all buy more than we need. Look for signs that food is not only old but that this is unnoticed — mold, sour milk that’s still used, or expiration dates well past due, for example.
• Multiples of the same item. Ten bottles of ketchup? More cereal than can be eaten in a year? Multiples often reveal that the shopper can’t remember from one store trip to the next what’s in stock at home.
• A freezer full of TV dinners. Your loved one may buy them for convenience sake, but frozen dinners tend not to make healthy diet. If there’s not much fresh food in the house (because it’s too hard to for the person to procure or cook), your loved one might be ready to have help with meal prep or delivery services.
• Broken appliances. Check them all: microwave, coffeemaker, toaster, washer, and dryer — any device you know your loved one uses (or used to use) routinely.
• Signs of fire. Are stove knobs charred? Pot bottoms singed badly (or thrown out)? Do any potholders have burned edges? Also look for a discharged fire extinguisher, smoke detectors that have been disassembled, or boxes of baking soda near the stove. Accidents happen; ask for the story behind what you see. Accidental fires are a common home danger for older adults.
• Increased use of takeout or simpler cooking. A change in physical or mental abilities might explain a downshift to simpler recipes or food choices.

7. Around-the-house signs it might be time for assisted living

Look around the living areas. Sometimes the most obvious sign is hard to see because we become so used to it.

Look for:

• Lots of clutter. An inability to throw anything away may be a sign of a neurological or physical issue. Obviously it’s more worrisome in a neatnik than in a chronic slob. Papers or pet toys all over the floor represent a tripping hazard.
• Signs of lax housekeeping. Spills that haven’t been cleaned up are a common sign of dementia — the person lacks the follow-through to tidy. Keep an eye out for cobwebs, bathroom mold, thick dust, or other signs of slackness. Physical limitations can mean your loved one needs housekeeping help or a living situation where this is taken care of for him or her.
• Bathroom grime and clutter. A common scenario: Your loved one makes an effort to tidy up living areas but overlooks the bathroom. Or the guest bath is clean, but not the one the person uses all the time (the one off a bedroom, for example). Here you may see a truer picture of how your loved one is keeping up.

8. Pet-care and plant-care signs it might be time for assisted living

Be sure to check out how the other living things are faring. An ability to take care of pets and plants goes along with self-care.

Look for:

• Plants that are dying, dead, or just gone. Most of us have seen plants go brown sometimes. Keep an eye out for chronic neglect, especially in a former plant-lover’s home.
• Animals that don’t seem well tended. Common problems: dogs with long nails, cat litter boxes that haven’t been changed lately, or dead fish in the fish tank. Poor grooming, overfeeding, and underfeeding are other red flags.

9. Home-maintenance signs it might be time for assisted living

Walk around the yard. Yard maintenance — or lack of it — can yield clues that your loved one isn’t faring as well at home alone anymore.

Look for:

• Signs of neglect. Look for discolored siding or ceilings that might indicate a leak, gutters choked with leaves, broken windows or fences, dirty windows.
• Newspapers in the bushes. Are papers being delivered but ignored? Sometimes people pick up those they can see on a driveway but not those that go off into the yard.
• Mail piled up in the mailbox. Go out and check — it’s an indication that your loved one doesn’t even retrieve it regularly.

10. Get help looking for signs it might be time for assisted living

Get the input of others who know your loved one in order to collect a fuller picture of reality. Gently probing about what others think isn’t nosy; you’re being loving, concerned, and proactive.

Look for:

• Input from those in your loved one’s circle. Talk to old friends and close relatives to get their sense of how the person is faring. Listen for stories that hint that the person doesn’t get out much (“She doesn’t come over anymore.” “She quit book club.”). Pay attention to comments that indicate ongoing concerns (“Has he had that heart test yet?” “We were worried the day the ambulance came.”).
• Medical insight. With appropriate permission, your loved one’s primary doctor may share your concerns about his or her patient’s safety at home — or may be able to alleviate those concerns or suggest where to get a home assessment.
• A second opinion. A social worker or professional geriatric care manager visits older adults’ homes and does informal evaluations. While your loved one may initially resist the notion of a “total stranger” checking on them, try pitching it as a professional (and neutral) second opinion, or ask the doctor to “prescribe” it. Some people wind up sharing doubts or vulnerabilities with a sympathetic, experienced stranger that they’re loathe to admit to their own children or family.

11. Caregivers’ signs it might be time for assisted living

Finally, realize that some of the information you collect is intangible — it has to do with feelings and emotions, and the stress levels of everyone involved.

Look for:

• How you’re doing. While this decision to remain in one’s home is not primarily about you — the son, daughter, grandchild, caregiver — your own exhaustion can be a good gauge of a decline in older adults’ ability to care for themselves. Keeping someone at home can require lots of hands-on support or care coordination, and this is time-consuming. If your loved one’s need for care is just plain wearing you out, or if a spouse or children are feeling the collective strain of your caregiving activities, these are major signs that it’s time to start looking at other options.
• Your loved one’s emotional state. Safety is crucial, of course, but so is emotional well-being. If someone living alone is riddled with anxieties or increasingly lonely, then that may tip the scales toward a move not solely based on health and safety reasons.

If your loved one has a full life, a close neighborhood and community connections, and seems to be thriving, it’s worth exploring as many in-home care options as possible before raising stress levels by pressing a move from a beloved home.

If, on the other hand, your loved one is showing signs that living alone is a strain, it may be time for a talk. Broach the subject of where to live in a neutral way and you may find that your loved one harbors the same fears for current and future safety and security that you do. Find out what your loved one fears most about moving and about staying before launching into your own worries and what you think ought to be done.

The Art of Multitasking and Still Remaining Focused

by Maggie Almeida

Caregiving itself is an art. Many today are part of the Sandwich Generation who find themselves caring for both young children and teenagers as well as aging parents. Caregivers need to be professional multi-taskers to address everyone’s needs and not neglect their own. So what should a good caregiver focus on? As many know, it’s a balancing act, but there’s an order to follow starting with the caregiver himself.

Step number one is to look out for number one; me, myself, I, the big cheese, the head beagle (just ask Snoopy). This may sound selfish, but it’s really the most unselfish place to start. After all, if number one is not well, you cannot take care of your other charges. If you have a good attitude, you can even overcome your own health issues with greater ease. Those you care for also notice because they naturally behave as they see you behaving. This is called mirroring. One wise caregiver told me that her husband with Alzheimer’s was manageable because she knew that when her demeanor was calm, so was his. If she raised her voice, so did he. You can see where this leads. The caregiver had total control of her life as long as she managed her own emotions.

Step number two would be to give your attention to the next most vulnerable person you’re caring for. If it’s a child, have the older generation help since they may be acting childlike now. They may be able to play simple games with a child that you don’t have time for. Age and ability specific jigsaw puzzles, puppets, lying down with a child to get them to take a nap, or any other play related activity.

If your children are older, and you need to focus on Mom or Dad or Aunt Sally, have the older children help you in caring for your aged loved one. Keep it small and simple, but their involvement can mean the world to the older relative. It esteems them and they feel useful, as if the child needs their guidance. Some children feel esteemed when they’re asked to help and it also builds their character to practice acts of kindness toward the elderly. If they want an example of the positive impact of a grandmother on a pop star they all know, look at Will Smith. Even while accepting an American Music Award he gave the credit to his grandmother. She must have been inspirational, but he also allowed himself to be inspired by spending time with her. Parents can make this happen and enhance the whole family dynamic as well as build its heritage.

In conclusion, look at multi-tasking as building blocks. Today many families are fragmented because a caregiver in the sandwich generation gets burnt out on both ends. As they focus on caregiving, there are levels of trust and affection that we build. When the stress gets too much, sometimes the “tower of family solidarity” gets knocked down. Someone yells or cries. This doesn’t mean that the tower is erased from memory. Go back and do something nice for yourself because you are the cornerstone of your tower. The other blocks will be added again and again. Focus on the big picture because your part in caregiving is a temporary role in a continuum. As soon as your duties end, you may be the one needing care.

 

How to Handle An Aging Crisis

Unfortunately, life isn’t a smooth, straight road as you grow older.

Your husband could break a hip without a second’s warning or your Mom might simply forget to eat one week. Events that throw you into crisis mode happen more and more frequently as you age. But by taking the proper steps and leveraging the best resources, you can prepare yourself to deal with crisis when it strikes and get your loved one’s life back on track.

Below we have compiled some of the more common crisis situations you might encounter and given you the best game plan to resolve these issues:

1) A neighbor found your mother a mile away from her home. She didn’t know where she was, how she got there or how to find her way back.

Now’s the time to get Mom evaluated for dementia. She may need the security of a dementia unit at a skilled nursing facility or a retirement community.

2) When you visit your 90-year-old aunt, who lives alone, you noticed that she hasn’t bathed and her clothes are dirty. The food in her refrigerator is going bad. She may even be forgetting to take her medication.

Home care or an assisted living facility could help your aunt take care of the important activities of daily living that she’s having trouble with on her own. This interaction could also provide socialization she may be missing.

3) Your husband fell and shattered his pelvis. After he’s released from the hospital, he needs regular physical and occupational therapy, but driving him every day will be a hardship for you as well as cause him undue pain.

With a two or three-week stay in a short-term rehabilitation facility, your husband can receive the concentrated therapy and specialized care he needs and return to his regular activities more quickly. This also gives you the time to prepare your home for his return.

4) You live with your Dad, but worry about whether he’s eating right or mobile enough when you have to go to work during the day.

While you’re away, home care can fill your shoes, if your Dad prefers to remain at home, or if he needs the socialization, adult day care may be the right fit.

5) Your children want to take you on a cruise, but your wife, who suffered a stroke, needs your round-the-clock care.

You can feel confident that a respite care facility will take good care of your wife during the 10 days you are gone and you can enjoy a much-needed vacation!

—

There are a variety of crises that seniors can encounter that will require your immediate and informed response. By checking out the local resources available to you and your loved ones, including geriatric care management (in Raleigh, NC,  Raleigh Geriatric Care Management  home care, skilled nursing facilities, assisted living, hospice, adult day care and respite care, you’ll have solutions—rather than anxiety—should a crisis be around the corner. ~Senior’s Guide

Caregiver Anger and Guilt

~Paula Spencer Scott

No, it’s not all sweetness and light taking care of an aging loved one. They can make us mad. Very mad. Very, very, very mad.

Take, for example, some things I’ve heard caregivers say (or, uh, said myself. . . though I won’t say which ones!):

• “I try to do something nice for her and she ignores it, or complains!”
• “She makes me so mad because she doesn’t trust me!”
• “I could throttle him when he launches into that same story again. . . .”
• “How can I help but lose my temper with my mom when she ticks off the aides I’ve so carefully hired?”
• “Why why WHY does he keep doing that? He should know better!”
• Fill in your own blank!

What follows when our loved ones make us angry is often worse than pure anger: It’s anger mingled with guilt. We feel guilty because often the person can’t help being the way he or she is (dementia, depression, difficult illness). We feel guilty when we keep the upset feelings bottled up and simmering inside. We feel guilty when we snap and say something rude or sharp to the person. We can’t win.

So here’s one guilt-soothing thing to remember about caregiver anger: It reveals something very important about you.

No, not that you’re short-tempered or foul-natured. Not that you lack self control. Not that you’re uncaring or mean. Not that you’re even doing anything terribly wrong, really.

Getting mad at your loved one when you’re a caregiver reveals this about you: You’re human.

You’re only human.

So stop beating yourself up for what are, let’s face it, often perfectly natural responses to extreme stress. Do work on reducing the causes of that stress. But don’t add to your misery with a needless layer of guilt.

If you neverevereverever get mad, hats off; you’re human, too, though with a much longer fuse than the rest of us. But if you’re like the rest of us, you’ve gotten mad before, and you’ll be mad again.

And it’s okay. Because it’s normal.

What are the benefits of hiring a geriatric care manager?

• Help meet goals of older adult and all involved.
• A care manager’s knowledge, education, training, and experience can objectively help set realistic expectations while addressing obstacles that might be present.
• Often families are overwhelmed with the many options presented. A care manager can efficiently streamline decision making.
• As a neutral third party with knowledge of issues of older adults, a care manager can often help resolve conflicts that a more emotionally involved party can’t.
• A care manager can often be a cost-effective alternative to families doing it themselves. Knowledge of entitlement programs, the elimination of often hours of research, reduction of time off from work and crisis-based travel can prove to not only provide positive outcomes but save time and valuable financial resources.
• Avoid problems. The proactive nature of care management can help avoid many of the unfortunate problems that face older adults. Supervising caregivers, home safety precautions, and safe financial management can be vital parts of a care manager’s role.
• Avoid family conflicts. Having a facilitator to assist with difficult decisions can maintain family stability. Difficult decisions including end of life, driving, and relocation can be addressed in a positive manner.

~~excerpt from caring.com, Brad Prescott

In Raleigh, NC, Contact: Raleigh Geriatric Care Management, http://www.rgcmgmt.com, lwatral@rgcmgmt.com

Tips and Techniques for Dealing with Stress

by Dr. Rita Gugel   Change is an expected part of our daily lives today. Dealing with it so that YOU control IT rather than vice versa is an important and positive force in controlling your life. Try a few of these tips. 1. Accept what you cannot change. Take a tip from AA. Change what you can, if it bothers you. But, if you cannot change it, learn to live with it. 2. Face up to your problems. Sort them out, and see which ones are real and which are simply imagined. Deal with them as they are, and not what you think they are. 3. Deal with one problem at a time. Sort out your priorities, and deal with them in the order of their importance to you. 4. Be flexible. Give in once and a while. If you do, others will too. 5. Don’t hold all of your worries inside yourself—talk it out. Frequently we swallow our unhappiness (along with candy, cake, ice cream, etc.) because we can’t let the problems out. Talk to someone. A burden shared is much less of a burden. 6. Work off Stress. Physical outlets for stress help your body to fight off many of the negative results of stress. 7. Get enough rest/relaxation/sleep. Give your body a chance to recover from day to day. Lack of sleep and rest will only make matters worse for you. 8. Avoid “self medication.” A “spoonful of sugar” may make the “medicine go down,” but it does your body no good. Sugar, alcohol, nicotine, and ice cream may all feel good going down, but they make matters worse—from the inside. They add to your body’s physical stresses, thus making dealing with external stresses much harder. 9. “Take time to smell the roses.” Have some fun. Relax. 10. Think about and do something for others. A little altruism never hurt. It even makes people feel better about themselves. 11. Be the “captain of your ship.” If you are not happy with your life, think about what’s wrong or missing, and then plan the necessary actions to change it to coincide with your needs and desires for your life. 12. Work on your relationships with those who share your life. Don’t hold back your feelings. Share them with your family and friends and co-workers. It can help to decrease tensions.

Five Myths About Medicaid’s Long-Term Care Coverage

While Medicare gets most of the news coverage, Medicaid still remains a bit of mystery to many people. The fact is that Medicaid is the largest source for funding nursing home care, but there are many myths about exactly who qualifies for it and what coverage it provides.  Here are five myths followed by the real story.

1. Medicare will cover my nursing home expenses. Medicare’s coverage of nursing home care is quite limited. Medicare covers only up to 100 days of “skilled nursing care” per illness. To qualify, you must enter a Medicare-approved “skilled nursing facility” or nursing home within 30 days of a hospital stay that lasted at least three days. The care in the nursing home must be for the same condition as the hospital stay.
   
2. You need to be broke to qualify for Medicaid. Medicaid helps needy individuals pay for long-term care, but you do not need to be completely destitute to qualify. While in general a Medicaid applicant can have no more than $2,000 in assets to in order to qualify, this figure is higher in some states and there are many assets that don’t count toward this limit. For example, the applicant’s home will not be considered a countable asset for eligibility purposes to the extent the equity in the home is less than $536,000, with the states having the option of raising this limit to $802,000 (in 2013). In all states, the house may be kept with no equity limit if the Medicaid applicant’s spouse or another dependent relative lives there. In addition the spouse of a nursing home resident may keep one half of the couple’s joint assets up to $115,920 (in 2013).
3. To qualify for Medicaid, you should transfer your money to your children. Medicaid law imposes a penalty on people who transfer assets without receiving fair value in return. This penalty is a period of time during which the person transferring the assets will be ineligible for Medicaid, and the length of the penalty period is determined, in part, by the amount of money transferred. The state will look at all transfers made within five years before the application for Medicaid. That doesn’t mean that you can’t transfer assets at all — there are exceptions (for example, applicants can transfer money to their spouses without incurring a penalty). However, before transferring any assets, you should talk to an elder law attorney. 
   
4. A prenuptial agreement will protect my assets from being counted if my spouse needs Medicaid. A prenuptial agreement only works to keep property separate in the event of death or divorce. It does not keep your property separate for purposes of Medicaid eligibility.
5. I can give away up to $14,000 a year under Medicaid rules. You can give away up to $14,000 a year without incurring a gift tax. Under Medicaid law, a gift of $14,000 or any other significant amount could trigger a penalty period if it was made within the five-year look-back period.

Elderlaw News, Mary Markovich

5 Benefits of Coffee (Who Knew!?!)

by Paula Spencer Scott

1. Coffee Slashes Your Risk of Developing Type 2 Diabetes

The health benefit: The more coffee you drink, the less likely it is you’ll develop type 2 diabetes, numerous studies have shown. For example, postmenopausal women who drink at least four cups of coffee a day are less than half as likely to develop type 2 diabetes as those who don’t drink coffee, according to a 2011 study of more than 700 women by the UCLA Schools of Public Health and Medicine.

In fact, every additional cup is thought to reduce the excess risk of type 2 diabetes by 7 percent, according to Australian researchers in a 2009 Archives of Internal Medicine meta-analysis of 18 different studies, which linked coffee drinking and diabetes prevention.

How it works:
Coffee is thought to improve the body’s tolerance to glucose by speeding metabolism and improving insulin tolerance.

The UCLA researchers discovered one possible molecular mechanism for this. Coffee consumption increases blood levels of a protein called sex hormone-binding globulin (SHBG), which seems to offer protection against type 2 diabetes in those who have a certain type of genetic mutation. (Decaf coffee didn’t show this effect, however.)

If you’re already showing signs of prediabetes, of course, you’ll want to refrain from dunking doughnuts in that joe.

2. Coffee Can Counter Cancerous Cell Damage

The health benefit:
Coffee was once believed to cause cancer — but that was before researchers factored in such related behaviors of frequent sippers as smoking and drinking alcohol. Today, there’s mounting evidence that coffee may be protective against certain cancers, possibly by enhancing DNA repair.

Some of the best evidence concerns liver damage and liver cancer, which strikes more than 18,000 Americans a year. Multiple studies have found an inverse relationship between coffee consumption and liver cancer risk, including a 2007 meta-analysis of nine different studies.

Cancer-prevention researchers are finding similar benefits of coffee drinking versus other forms of the disease. In 2011, for example, a Harvard team found that women who drink several cups of coffee a day (caffeinated or decaf) have a lower risk of endometrial cancer. Another 2011 Harvard study reported that for men who consumed six cups of coffee a day, their risk of lethal prostate cancer was fully 60 percent lower than lesser coffee drinkers, and their risk of any kind of prostate cancer was 20 percent lower.

Other studies have linked coffee drinking to a reduced risk of colon cancer, rectal cancer, oral cancer, and esophageal cancer.

How it works:
Coffee contains hundreds of chemical compounds — among them antioxidants and anti-inflammatory compounds that can decrease markers for the damaging process of inflammation. The highly active antioxidant compound methylpyridinium, for example, is found almost exclusively in coffee (both caffeinated and decaf types), due to the beans’ roasting process. Espresso has two to three times the amount of this anticancer compound as a medium-roast coffee, according to the German researchers who identified it in coffee.

3. Coffee May Lower Your Risk of Dementia

The health benefit:
Scientists still don’t fully understand what causes the brain changes associated with Alzheimer’s disease, but they’re learning more about risk factors for dementia – and a hearty coffee-drinking habit seems to lower the risk.

When researchers in Sweden and Finland tracked coffee consumption in a group of more than 1,400 middle-aged subjects for an average of 21 years, they found a clear connection. Those who quaffed three to five cups a day were 65 percent less likely to have developed dementia than the two-cups-or-fewer crowd. (Drinking five or more cups a day also seems to reduce the risk, although this group was too small to allow researchers to draw statistically significant results.)

How it works:
Researchers believe the antioxidant properties of coffee may work to reduce vascular forms of dementia. Drinking coffee is already known to be protective against type 2 diabetes, a chronic disease that raises the risk of dementia. (Having diabetes together with depression, for example, doubles dementia risk.)

Another theory: Animal studies indicate that the caffeine in coffee may improve the efficiency of the blood-brain barrier, thwarting the negative effects of high cholesterol on cognitive functioning. Caffeine added to rats’ water improves their cognitive functioning and reduces by half the amount of abnormal amyloid protein in their brains, which has been linked to Alzheimer’s disease.

It’s also possible that coffee drinkers simply have more energy and move more; researchers point out that exercise is protective against dementia, too.

4. Coffee Protects Against Parkinson’s Disease

The health benefit:
It seems pretty clear that coffee helps lower the odds of developing Parkinson’s disease. When researchers looked at almost 305,000 participants in the National Institutes of Health – AARP Diet and Health Study, they found that those who consumed the most caffeine had the lowest risk of Parkinson’s, echoing earlier studies.

They also ran a meta-analysis of previous studies and found that this held true for both men and women. (Some earlier research had claimed a gender difference, with more benefit to men, probably due to smaller numbers of people studied.)

Why it works:
Researchers aren’t sure what the protective mechanism at play is, or even whether it’s the caffeine or other protective compounds that are behind the benefit. Genetics may play a role: One 2011 study found that subjects who carried certain types of a gene called GRIN2A received more neuroprotective benefits against Parkinson’s from coffee (although coffee drinkers with all forms of the gene still had a lower risk of developing the disease).

5. Coffee May Buffer Depression

The health benefit:
Another large study links long-term coffee use with a reduced risk of depression. Researchers at the Harvard School of Public Health tracked 50,000 nurses in the Nurses’ Health Study for more than a quarter century. In 2011, they reported that those who drank four cups of coffee or more per day had a 20-percent lower risk of developing depression, compared with those who rarely or never drank it. Those who downed two to three cups a day had about a 15-percent lower risk.

A much smaller study in Finland linked coffee consumption to a decreased risk of suicide in men when 7 or less cups a day were consumed. (Then the risk went up after 8 cups a day. There’s also some evidence that coffee protects against depression, too.

How it works:
Nobody’s sure, but one theory is that coffee drinking causes a short-term boost to energy and mood. The caffeine in coffee is probably the substance causing this effect — the Harvard researchers saw a similar decrease in depression among those who drank caffeinated soft drinks and ate chocolate, both of which contain caffeine.

Brain receptors that respond to caffeine are found in the basal ganglia, the part of the brain where neurotransmitters critical to depression are concentrated. Repeated low-dose stimulation of these receptors may help protect against the development of depression.