Senior Living • Summer 2015

FRIDAY, JULY 17, 2015

A special supplement to the AUSTIN DAILY HERALD

Helping seniors Center’s new advocate enjoying ‘rewarding, yet challenging’ role

By Alex Smith

alex.smith@austindailyherald.com

A new face is helping seniors at the Mower County Senior Center.

Linnea Williamson, 29, began as the new senior advocate in mid-May and is already enjoying her work.

“Seniors need that voice because it’s not always heard.”

— Linnea Williamson Senior advocate “I love it,” she said. “It’s a very rewarding, yet challenging job.”

Williamson is an Austin native who graduated from Minnesota State University, Mankato with a degree in family life and child development.

She is one of two senior advocates at the center who assist and provide support and resources for seniors at the center.

“Seniors need that voice because it’s not always heard,” Williamson said.

Advocates can assist with money management, housing issues, medical assistance and many other tasks. “[The job] isn’t just one thing, but a broad range,” WIlliamson said.

Williamson also helps with a Caregiver

What does a senior advocate do?

Duties include but are not limited to: —Assisting with money management, check writing, interpreting bills, balancing checkbooks.

—Housing issues —Medicare and insurance billing —Assisting to set up Chore services —Medical Assistance guidelines information —Drug plan applications and information —Sorting mail —Tax information—referrals for income tax help —Completing Health Care Directives and Power of Attorney forms —Telephone reassurance: volunteers call to check on seniors 5 days per week —Caregiver Support Group Support Group, which is something she believes is very important. The group meets the third Thursday of each month at 10:30 a.m. at the senior center.

“It’s an escape to talk to other people dealing with the same issues,” she said.

In the future, Williamson hopes to help seniors live happy and healthy lives.

“I want to look down the road and know I made a difference,” she said.

Building bones: Program aims to prevent bone loss

By Alex Smith

alex.smith@austindailyherald.com

The Mower County Senior Center hopes to prevent bone loss with their new exercise program beginning soon.

Bone Builders is an osteoporosis prevention program led by volunteer trainers to lead participants through different strength exercises. The program incorporates strength training, balance train-

ing and stretching.

An open house was held and many seniors are excited for it to start. “We had a very well attended open house,” said Sara Schafer, senior center director.

Each session is one hour long and includes a discussion about various health, nutrition, and exercise topics.

Classes are set to begin in early August.

Housework services still going strong after 2 decades

By Alex Smith

alex.smith@austindailyherald.com

The Mower County Senior Center has lended a helping hand to seniors through their chore program for the past 24 years, and they aren’t looking to stop any time soon.

Seniors 60 years old and up can get help with housework and outdoor services, like laundry, window and floor washing, snow shoveling and lawn mowing.

“We’ve gotten lots of good feedback,” said Cristina Melchor, chore program coordinator. “They’re very apprecia-

tive and grateful.”

The senior center currently helps about 250 clients a month.

“It’s extremely important for some of our clients,” Melchor said.

The program’s goal is to keep seniors in their homes and to help them with tasks that may be hard for them.

“They can be fragile or at a point in their lives where heavier work can be difficult,” Melchor said.

Interested seniors can call Melchor at 507481-3333 and see if they qualify for funding.

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JULY 17, 2015

Senior Living

AUSTIN DAILY HERALD

Key knowledge can to help protect seniors from summer heat Brandpoint Content

Staying cool during summer heat isn’t just a question of comfort for senior citizens, it’s a matter of good health. High temperatures can lead to serious heat-related illnesses such as heat exhaustion and heat stroke, and older people are at greater risk, no matter where they live, health experts say.

“As we get older, it gets more difficult for our bodies to manage extreme heat,” says Dr. Kevin O’Neil, chief medical officer for Brookdale senior living. “A number of factors contribute to this problem, including physiological changes, increased use of medications — such as diuretics — that can contribute to dehydration, chronic health conditions, and dementia that may make it difficult for people to recognize thirst or to know how to properly protect themselves from sun and heat.”

Heat-related deaths occur more frequently among older people than yo u n g e r a g e g r o u p s, w i t h those older than 75 being s u b s t a n t i a l ly more at risk, according to A 2014 National Health Statistics Report by the Centers for Disease Control and Prevention.

In fact, heat-related illnesses claimed more than 3,300 lives b e t we e n 2 0 0 4 and 2010 – more than 1,200 fatalities occurred among people older than 64.

O’Neil, whose organization serves approximately 100,000 seniors in 1,147 communities throughout the United States, offers guidance on how seniors and their care-givers can act to prevent heat-related illnesses: •Learn the symptoms of heat exhaustion and heat stroke.

Heat exhaustion and heat stroke are the most serious forms of heat-related illness, and they can be fatal for older people. Symptoms of heat exhaustion include heavy sweating, nausea, weakness or fainting, and cold, clammy skin. Heat stroke symptoms include a body temperature higher than 103 degrees Fahrenheit, hot or red skin, a fast pulse and possible unconsciousness.

If you recognize any of these symptoms in yourself or a senior loved one, seek medical assistance immediately.

For heat stroke symptoms, call 911 for help. It’s critical to treat both conditions as quickly as possible.

•Fight dehydration.

“Seniors can be at particular risk of becoming dehydrated during the summer,” O’Neil says. “Normally, when we get hot, our bodies sweat to dissipate the heat, but if you’re dehydrated the volume of fluid in your body is already depleted. That can impact your vascular system, which can affect your blood pressure.”

Aging may make you less able to perceive thirst, too, so you may not realize you need fluid. “I tell people to drink more than you’re thirsty for, especially when exercising or in warmer weather. Eating

fruits and vegetables with a high water content, like watermelon, is also a good way to increase your fluid intake, especially if you have trouble remembering to drink more.”

Watch for signs of dehydration, including urine that’s a darker yellow, rather than pale or clear. Mild dehydration can lead to heat cramps, and you can combat mild dehydration by simply drinking more. Severe dehydration can lead to heat stroke and may require treatment with intravenous fluids.

•Be aware of medications’ effect on heat-related illnesses.

Most seniors are on at least one type of medication, and diuretics are a common treatment for multiple common disorders, including high blood pressure. Diuretics can contribute to dehydration, and other medications may lower your re s i s t a n c e t o the effects of extreme heat.

If you’re on a diuretic, increase your w a t e r i n t a ke during the summer. Be aware that alcoholic beverages may also affect your body’s ability to regulate temperature. Talk to your doctor about your medications and how they may affect you during times of extreme heat.

•Be aware of how your medical conditions might elevate your risks.

Certain medical conditions — such as neuromuscular disorders, cardiovascular disease and renal disease — can increase your risk of overheating, and make you more likely to suffer from heat-related illnesses. People with Alzheimer’s or other dementia may not know when they’re feeling thirsty or too hot, and may not be able to communicate how they’re feeling. Be aware that heat can also make medical conditions worse. Heat-related issues can elevate your risk of falling, and falls are a leading cause of hospitalization for seniors.

•Take steps to stay cool.

Avoid exercising during the heat of the day, especially outdoors, and monitor weather reports for temperature and air-quality forecasts. Choose exercises like swimming and water aerobics, and consider exercising indoors. Check and change the air-conditioning filters in your home to ensure your air conditioning is working at its best to keep you cool.

Choose lightweight, light-colored clothing to help your body stay cool.

•Protect your skin from sun damage.

Older skin is less efficient at producing melatonin, so it’s important to wear sunscreen to protect your skin from harmful UV rays. It’s also a good idea to talk with your doctor about taking a Vitamin D supplement because, as you age, your skin is less efficient at converting vitamin D into its active form on exposure to the sun.

And although sunblock is highly recommended to reduce your risk of sunburn and skin cancer, it can contribute to vitamin D deficiency.

A special supplement to the AUSTIN DAILY HERALD

Senior Living

Comcast gives St. Paul seniors runaround on cable discount

Stuck in the middle?

By Frederick Melo St. Paul Pioneer Press

ST. PAUL — Elderly and disabled St. Paul residents say they’ve been unable to access a long-standing discount offered by Comcast cable, which appears to exist solely on paper.

St. Paul’s new 10-year agreement with the cable giant guarantees seniors a 10 percent discount off all cable-related services, as did the old 10-year agreement.

After reading about the senior discount in Sunday’s Pioneer Press, Val Laugtug said she asked a customer service representative for help but was told to drop it: “The guy said, ‘Well, the newspaper is not correct, take it up with them.’ He said, ‘I’m the sales rep for that area.’ “ Daniel Jackson of St. Paul had a similar experience. “I spent an hour on the phone with them, and they don’t know anything about it,” he said. “They said it’s only good in California and Puerto Rico, or something to that effect.”

At least a dozen other area residents have told the Pioneer Press of similar experiences.

Dave Nyberg, a Comcast corporate affairs manager, said the company has looked into the issue and is addressing it.

“We apologize for the inconvenience some of our customers have experienced,” he said. “We have provided the senior citizen discount to qualified St. Paul customers for more than 15 years, and will continue to honor that commitment. We are communicating with all customer care representatives to make certain they are aware of the discount and the qualification process for St. Paul customers.”

Comcast would not say how many customers have gotten the discount.

Tarek Tomes, chief information officer with the city of St. Paul, said, “Comcast has been informed numerous times over the years to educate their customer reps about St. Paul’s senior discount.

“The city is more than glad to assist any subscriber who has trouble receiving it,” said Tomes, who adds that St. Paul is the only city in Minnesota that has negotiated the senior discount with Comcast.

The same 10 percent discount is supposed to be available to the disabled and “economically disadvantaged,” according to the 11th page of the cable franchise agreement and the city’s own website. Given St. Paul’s poverty rate, the discount could, at least in theory, apply to onefourth of the city.

The contract, signed by the St. Paul City Council in March, defines the economically disadvantaged as anyone in St. Paul who can provide evidence of receiving food stamps or general assistance, or of being enrolled in the Minnesota Telephone Assistance Plan (“TAP”) or the Minnesota Family Investment Program.

“Discounts for seniors and the disabled? I think I fall under two of those categories as a disabled veteran,” said Tim Cornell, a longtime Comcast customer. “I called the number and spoke to a customer service rep that actually is in Mexico. She had no knowledge of that at all.”

The city’s website -- stpaul.gov/cable -- devotes a page to the discount program, as well as a phone number residents can call to request the discount directly from Comcast customer service (651-222-3333).

For many seniors, dialing the number has been an exercise in futility. Callers have been told the discount does not exist; others say they were redirected to multiple customer service reps and 1-800 numbers, with little or nothing to show for it. Seniors represent about 9 percent of the city.

Judy Morneau of St. Paul said bewildered customer service reps struggled to figure out what she was talking about. After some research, they gave her an address in Oregon to write to for a discount they said would amount to $1.

“The guy put me on hold for a while, and then he gave me another number, and then he said you have to send a letter to Beaverton, Ore., and you get $1,” Morneau said. “It wasn’t what I was hoping, and I certainly don’t understand why you can’t do it over the phone. It should be automatic when you sign up. They should do it right away when you call.”

Laugtug tried multiple phone numbers for Comcast and received conflicting information from different customer service reps. “The new person I talked to ... had no idea about this discount, thought it was something new,” she said.

FRIDAY, JULY 17, 2015

Poll: Sandwich generation caring for elderly parents and their own kids are worried about their future long-term care Associated Press

WASHINGTON — Caught between kids and aging parents, the sandwich generation worries more than most Americans their age about how they’ll afford their own care as they grow older, a new poll shows.

But most aren’t doing much to get ready.

Nearly 1 in 10 people age 40 and over are “sandwiched” — they’re supporting a child while providing regular care for an older loved one, according to the poll by The Associated Press-NORC Center for Public Affairs Research.

Another 8 percent may join the ranks of double-caregivers in the next five years, citing declining health of an older relative or close friend.

Dueling responsibilities can make some days feel like a tug-of-war.

“If my mom needs something badly, I get pulled away from my kids a lot,” said Kamila Al-Najjar of Santa Rosa, California, a lawyer with two children and self-described health advocate for her mother. She visits her mother’s assisted living facility at least twice a week and checks in daily by phone, to oversee a list of illnesses.

“You’re dealing with someone who is aging, toward the end of their — life; then you have to deal with a teenager.

I hear from my mom and daughter that I’m a nag. There’s no winning in it,” she said.

Adding to the challenge, 40- and 50-somethings tend to be at the height of their careers — and need to hang onto their jobs despite difficulties of caregiving, said Susan Reinhard, who directs AARP’s Public Policy Institute. Employer flexibility is a top issue as the population ages, she said.

“It’s not just their own financial security, it’s the financial security for their children and for the future,” Reinhard said.

After age 65, government figures show nearly 7 in 10 Americans at some point will need long-term care — from a relative, home aide, assisted living or nursing home.

Yet the AP-NORC Center poll found overall, most Americans 40 and older — 54 percent — have done little or no planning to get ready for this often pricey reality. Only a third reports setting aside money for those needs. That’s even though Medicare doesn’t pay for the most common types of long-term care, and a nursing home can cost more than $90,000 a year.

Drill down to the 9 percent of this age group who make up the sandwich generation, and their experience leaves them far more concerned about their own senior years.

About half worry about being able to pay for their future care needs or having to move into a nursing home, compared with just over a third of other adults, the poll found. Also, 44 percent of sandwichers fear leaving debts to family, compared with 28 percent of others polled.

But the poll found the sandwich generation no more likely than other middle-aged adults to be planning and saving, possibly because of time or resources.

Al-Najjar is glad her mother “saved all her life ... so she didn’t have to stress out about stuff like that.”

Caring for her has changed how she spends and plans for the future.

“It’s like a wake-up call,” she said. There are “a lot of seniors in the United States that don’t have that money.”

The squeeze isn’t ending as children grow up.

Among currently sandwiched parents, 29 percent have adult children living at home, the poll found; others are providing adult children with financial assistance, meaning some are sandwiched even after their children leave the nest.

Another challenge: Finding services to help seniors live out their days at home.

AARP recently opened an online “livability index” to rank communities on such factors as accessible housand transit options.

Kamila Al-Najjar ingAnd the National Association for Area Agencies on Aging runs an Eldercare Locator — at www.eldercare.gov and 1-800-677-1116 — to help people find local resources. Last year, the locator averaged more than 22,000 requests for assistance a month. A recent report found the top needs: transportation, mostly to get to doctor appointments; in-home services, such as meals and personal care; and finding affordable housing or making age-friendly home modifications.

“People don’t generally make these calls until they’re in crisis,” said association CEO Sandy Markwood. “If mom and dad need this as they get older, you should prepare for that, too.”

Carroll Burnett of Whitesboro, Texas, cared for his 88-year-old father, who’d suffered a stroke, for a year before he died in March.

“I felt good that I could take care of him,” said Burnett, a retired tool and die maker who had help from his wife and one of his three grown children. But he’s saving up: “I don’t want any of my kids to go through what I did.”

The AP-NORC Center survey was conducted by telephone April 7 to May 15 among a random national sample of 1,735 adults age 40 or older, with funding from the SCAN Foundation. Results for the full survey have a margin of sampling error of plus or minus 3.2 percentage points.

“If my mom needs something badly, I get pulled away from my kids a lot.”

SUBMIT YOUR MILESTONES Do you have a birthday, anniversary, wedding, birth or engagement announcement? Submit them for the Austin Daily Herald’s Spotlight section each Sunday via e-mail, jenae.hackensmith@austindailyherald. com; fax, 507-437-8644; phone, 507-434-2236 Announcements are free. The deadline is 5 p.m.

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Senior Living

FRIDAY, JULY 17, 2015

A special supplement to the AUSTIN DAILY HERALD

Stricter qualifications New regulations would require modernizing nursing home care

By Susan Jaffe Kaiser Health News

After nearly 30 years, the Obama administration wants to modernize the rules nursing homes must follow to qualify for Medicare and Medicaid payments.

The hundreds of pages of proposed changes cover everything from meal times to use of antipsychotic drugs to staffing.

Some are required by the Affordable Care Act and other recent federal laws, as well as the president’s executive order directing agencies to simplify regulations and minimize the costs of compliance.

“Today’s measures set high standards for quality and safety in nursing homes and long-term care facilities,” said Health and Human Services Secretary Sylvia M. Burwell. “When a family makes the decision for a loved one to be placed in a nursing home or long-term care facility, they need to know that their loved one’s health and safety are priorities.”

Officials announced the update as the White House Conference on Aging convenes Monday. The oncea-decade conclave sets the agenda for meeting the diverse needs of older Americans, including long-term care options. This month also marks the 50th anniversary of the Medicare and Medicaid programs, which cover almost 125 million older, disabled or

low-income Americans.

Medicare and Medicaid beneficiaries make up the majority of residents in the country’s more than 15,000 long-term care facilities.

“The existing regulations don’t even conceive of electronic communications the way they exist today,” said Dr. Shari Ling, Medicare’s deputy chief medical officer. “Also there have been significant advances in the science and delivery of health care that just weren’t imagined at the time the rules were originally written. For example, the risks of anti-psychotic medications and overuse of antibiotics are now clearly known, when previously they were thought to be harmless.“ The proposed regulations include a section on electronic health records and measures to better ensure that patients or their families are involved in care planning and in the discharge process. The rules also would strengthen infection control, minimize the use of antibiotic and antipsychotic drugs and reduce hospital readmissions.

Revised rules would also promote more individualized care and help make nursing homes feel more like home. For example, facilities would be required to provide “suitable and nourishing alter native meals and snacks for residents who want to eat at

non-traditional times or outside of scheduled meal times.”

Residents should also be able to choose their roommates. “Nursing facilities not only provide medical care, but may also serve as a resident’s home,” the proposed rules say. “Our proposed provision would provide for a rooming arrangement that could include a same-sex couple, siblings, other relatives, long term friends or any other combination” as long as nursing home administrators “can reasonably accommodate the arrangement.”

Consumer advocates are likely to be disappointed that officials are not including recommendations to set a federal nurse-to-resident ratio.

However, the proposed changes would require that nurses be trained in dementia care and preventing elder abuse to better meet residents’ needs.

“We believe that the focus should be on the skill sets and specific competencies of assigned staff,” officials wrote in the proposed rules, “to provide the nursing care a resident needs rather than a static number of staff or hours of nursing care that does not consider resident characteristics.”

Nursing homes will be required to report staffing levels, which Medicare officials said they will review for adequacy.

“It’s a competency approach that goes beyond a game of numbers,” said Ling. “If residents appear agitated, figure out why, get at the cause of the problem,” she said, instead of resorting to drugs to sedate residents.

Advocates for nursing home residents argue that because of inadequate staffing, residents with dementia are often inappropriately given antipsychotic drugs, even though that can be dangerous for them. The new rules would help control the use of these drugs by requiring the facility’s pharmacist to monitor drugs that are prescribed for excessive periods of time or other irregularities and require the resident’s physician to address the problem or explain in the resident’s medical record why the medication is necessary.

“We don’t have enough nursing staff,” Toby Edelman, a senior policy attorney at the Center for MedicareAdvocacy, said before the rules were released.

Federal law requires only one registered nurse on the day shift for a 20-bed facility or a 500-bed facility, licensed practical nurses around the clock and sufficient staff to meet residents’ needs, she said.

“We don’t look at the specific staffing positions per se,” said Greg Crist, a spokesman for the American Health Care Associ-

Home health agencies get medicare’s star treatment

By Jordan Rau Kaiser Health News

The federal government released on Thursday a new five-star rating system for home health agencies, hoping to bring clarity to a fast-growing but fragmented corner of the medical industry where it’s often difficult to distinguish good from bad.

Medicare applied the new quality measure to more than 9,000 agencies based on how quickly visits began and how often patients improved while under their care. Nearly half received average scores, with the government sparingly doling out top and bottom ratings.

The star ratings come as home health agencies play an increasingly important role in caring for theelderly.

Last year 3.4 million Medicare beneficiaries received home health services, with nurses, aides, and physical and occupational therapists treating them in the home.

Medicare spends about $18 billion on the home health benefit, which provides skilled services that must be authorized by a doctor, not housekeeping care that some elderly pay for privately.

For both the government and patients, Medicare’s home health visits are one of the least expensive ways to provide care, and the system has been especially susceptible to fraud.

Assessing quality is often challenging for patients and their doctors, who must authorize the visits, often just as patients are leaving the hospital. The elderly tend to be less familiar with the reputation of home health agencies than they are with hospitals and other institutions. That makes evaluating quality difficult for family members and guardians.

“It’s not like a nursing home, where you can go and walk around,” said Dr. Cheryl Phillips, an executive at LeadingAge, an association of nonprofit groups focused on the elderly. “You can call the agencies and find out a little bit about them and their philosophy of care, but even for an informed consumer like me, you’re kind of stuck with whatever your physician has ordered.”

Experts said the ratings could have substantial financial impacts on agencies, even driving some

low-rated ones out of business. Hospitals, doctors and nursing homes may be reluctant to refer patients to agencies with fewer than three stars. A total of 2,628 agencies — 28 percent of those Medicare evaluated — received those below average ratings.

“It’s a very fragmented, competitive market in a lot of metropolitan areas,” said Lilly Hummel, a manager at Avalere, a health care consulting firm in Washington, D.C. “It could get difficult for home health agencies

that, for whatever reason, aren’t doing well on the star ratings.”

The ratings are based on agencies’ assessments of their own patients, which the agencies report to the gover nment, as well as Medicare billing records.

The data is adjusted to take into account how frail the patients are and other potential influences. Medicare intends to use the same or similar data sources when it eventually begins to pay bonuses and penalties to agencies based on

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performance, as it does for hospitals.

More than 12,000 home health agencies take Medicare, including local for-profit shops with just a few employees, nonprofit associations of nurses, hospital affiliates and subsidiaries of publicly traded corporations like Kindred Healthcare and Amedisys.

Medicare assigned stars to all but 2,902 agencies that did not have enough patients to evaluate, had only started business recently or did not provide enough data.

ation, which represents 11,000 skilled nursing facilities. “We look at the needs of the individuals when determining staff levels, and that is best addressed in the resident’s care plan.”

Although there are also no provisions addressing enforcement in the proposed rule, Ling said it “will permit detection of violations to enable enforcement by lessening the noise.”

“The biggest problem is that the rules we have now are not enforced,” said Edelman. “We have a very weak and timid enforcement system that does everything it can to cajole facilities into compliance instead of imposing penalties for noncompliance.”

A report by the Center for Medicare Advocacy last year found that some serious violations often were not penalized.

“Once the new rules are finalized, they will be added to the items nursing home inspectors check,” Ling said.

K a i s e r H e a l t h N ew s (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

This story was distributed by the Associated Press.

Probe: Bogus enrollees kept getting ‘Obamacare’ Associated Press

WA S H I N G T O N — Phony applicants that investigators signed up last year under President Barack Obama’s health care law got automatically re-enrolled for 2015. Some were rewarded with even bigger taxpayer subsidies for their insurance premiums, a congressional probe has found.

The nonpartisan Government Accountability Office says 11 counterfeit characters that its investigators created last year were automatically re-enrolled by HealthCare.gov, even though most had unresolved documentation issues.

In Obama’s terms, they got to keep the coverage they had.

Six of those later were flagged and sent termination notices. But GAO said it was able to get five of them reinstated by calling HealthCare.gov’s consumer service center.

That seemed to be a weak link in the system.

The five bogus beneficiaries who were reinstated even got their monthly subsidies bumped up a bit, although GAO did not ask for it. The case of the sixth fake enrollee who appealed was under review.