Caregiver Solutions 2019 by On-Line Publishers, Inc.

2019

CAREGIVER SOLUTIONS A Resource for Family Caregivers

Articles • Directory of Providers • Support Services • Books and Resources

Please, Join Us for These Events! 50plus EXPOs — 50plusExpoPa.com 50plus EXPOS are lively, one-day events that bring businesses and the community together on a more personal level. Look for 50plus EXPOS in Chester, Cumberland, Dauphin, Lancaster, and York counties.

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Veterans’ Expo & Job Fairs — VeteransExpo.com The Veterans’ Expo and Job Fair is intended for active military and veterans, men and women, from all branches of service and their families. Events in Dauphin, Lancaster, Lebanon, and Berks counties.

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caregiver solutions 2019 Publisher

Donna K. Anderson

Editorial

Vice President & Managing Editor Christianne Rupp Editor Megan Joyce Contributing Writers Lori L. Dierolf Jennifer Holcomb Beverly Bernstein Joie, MS, CMC Kim Klugh Jim Miller Lisa M. Petsche Carolyn Romano

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Production Coordinator Lauren Phillips Production Artist Renee McWilliams

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Business Manager Elizabeth Duvall Marketing Coordinator Kelsey Fishburn Account Service Coordinator Emily Polito

Dear Readers, Thank you to all of you who are caregivers. While some of you receive compensation for your services, it doesn’t take away from the fact that all of you put a lot of hard work, love, and care into this journey. Much of what you do may go unnoticed. Your lives are sometimes put on hold. Very often, your caregiving responsibilities are done in addition to everyday obligations to your family and work, which makes it hard to keep up with everything going in your life. All of this can be very stressful and demanding. You may find that you are not only missing work due to accompanying your loved one to appointments, but also because you haven’t taken care of your own health and have become ill. Inside this edition of Caregiver Solutions, you’ll read articles that will help you through this stage of your life. If you are an employer or work in human resources, you’ll read why it’s important to embrace a care culture within your company. Keeping good employees is just good business sense, but you must be willing to support caregivers as well. Discover “small” things you can do that will make a huge difference in the lives of caregivers … and the well-being of your company. Learn more about some changes in coverage for nonmedical homecare services in Medicare Advantage plans for the coming year. Find out how physical therapy eliminates or reduces arthritis symptoms. Check out the Frequently Asked Questions and Good Reads pages. And did you know there are Pennsylvania and federal Caregiver Support Programs? Find out if you qualify for some or all of the benefits offered. Remember to let others help you along the way. You’ll not only be better off mentally and physically, but your care receivers will also benefit because you’ll be less stressed.

Christianne Rupp Editor

Contents 4 Why Employers

Should Embrace a “Care Culture” for Nonmedical Home Care in 2020

On-Line Publishers, Inc. 3912 Abel Drive, Columbia, PA 17512 717.285.1350 • fax 717.285.1360

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24 Veterans Funeral and

16 Frequently Asked

26 Good Reads

Caregivers

6 Medicare Coverage

Copyright © 2019 On-Line Publishers, Inc. All rights reserved. All listings and advertisements have been accepted for publication on the assumption that the information contained in them is true and accurate and that all merchandise or services offered in the advertisements are available to the customer according to the conditions warranted therein. The appearance of advertisements or products or services does not constitute an endorsement of the particular product or service. On-Line Publishers, Inc. disclaims any and all responsibilities and liability which may be asserted or claimed resulting from or arising out of reliance upon the information and procedures presented in this guide.

14 Hiring In-Home

8 Communication,

Questions

18 Dementia Friendly America Initiative

19 Caregiver Support

Dementia, and the Changing Brain

Programs

10 Confront Arthritis with

20 Keep Spirits Up to

12 Simple Improvements

22 What You Should Know

Physical Therapy

Prevent Burning Out

Can Make Home Safer

Burial Benefits

28 Directory of Housing & Care Providers

30 Directory of Ancillary Services

31 Support and Information

About Your Aging Parents’ Finances

caregiver solutions 2019 BUSINESSWoman

Modern Caregiving: Why Employers Should Embrace a ‘Care Culture’ By CAROLYN ROMANO Millions of employees struggle to balance their professional responsibilities with demands at home. Many are your employees and are among the three out of four U.S. workers who serve as caregivers for an aging loved one, a child or spouse with a disability, or another friend or relative who needs help. Are you surprised to learn that according to the National Alliance for Caregiving, 66% of these caregivers are women? Ask your employees if they are “caregivers,” and most will not raise their hands enthusiastically. If they even identify themselves that way, the fear of being labeled as less invested in their jobs, or, worse, being “mommy tracked,” pushes caregiving responsibilities out of the light. Caregiving demands and worries do impact a company’s bottom line. Recent Gallup research showed that on any given day, 20% of employees are disengaged or physically absent due to family caregiving responsibilities. Why? Many employees must spend time out of the office to attend doctors’ appointments, school meetings, and nursing home care-plan discussions. While at work, they may have to coordinate care, hire a home health aide, advocate for educational services, or schedule medical appointments. These seemingly “small” things — a meeting, a phone call, an appointment — add up: Caregiving responsibilities contribute to an astonishing $38.2 billion annually in lost productivity costs to U.S. businesses. 4

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Understand What Modern Caregiving Really Means While caregiving has traditionally been defined as care for an aging loved one or a relative with a disease or diagnosis, modern caregiving encompasses a far wider range of issues: elder scams, cyberbullying, undiagnosed behavioral issues, and LGBTQ+ concerns. An employer’s understanding of modern caregiving and the company’s culture can make things better or worse. According to Torchlight’s recent caregiving study, today’s employees are caring for children, spouses, parents, and other loved ones. Their responsibilities and biggest stressors are often the daily planning, routine challenges, and unexpected complications that would never have been defined as caregiving in the past. They don’t just worry about their mother being admitted to the hospital. They also need to figure out how to set up home care, sort through insurance coverage and referrals, and find pet care during her hospital stay. Additional situations that are especially complicated include figuring out how (and when) to help your parent with Alzheimer’s “retire” from driving, identify a nursing home for a relative in another state, or advocate for a teen who is being viciously cyberbullied while worrying about a suicide attempt. The logistics can be overwhelming, distracting your employees from their jobs, disrupting their lives, and keeping them up at night. The extent to which your company understands the complexities of modern caregiving, and responds in ways that support employees, will also help your company manage the productivity and absenteeism challenges that caregiving creates. A ‘Care Culture’ Supports Both Employees and the Bottom Line In their recent caregiving report, Harvard Business School encouraged businesses to create a “care culture” to support employees and their families. By creating a care culture, employers can relieve some of their employees’ burdens, lowering stress and boosting productivity in the process. Building such a culture also helps remove the stigma around caregiving. So, how can employers better support employees in their daily caregiving roles? Start by creating a care culture at your company with these five steps:

3. Train your managers. Familiarize managers with compliance laws, including the Family Medical Leave Act (FMLA), as well as the risks associated with Family Responsibilities Discrimination (FRD). Your managers need to know how to talk with sensitivity about caregiving to their employees. Ideally, when managers learn that an employee is dealing with a caregiving issue, they should explain and encourage use of the caregiving benefits the company provides. They should also be involved in creative strategies to support the employee’s ability to perform their job tasks while caregiving. 4. Increase utilization of benefits. In many companies, there’s a stigma around using benefits like flex time or PTO. Employees may worry that they’ll look like “slackers” if they take time off from work, fear their colleagues (or managers) will judge them, or think they’ll be passed over for a promotion. Still other employees are not fully aware of what family caregiving benefits are available. Therefore, make sure your internal communications plan includes a robust outreach strategy that is implemented with fidelity. 5. Design flexible approaches to solve caregiving challenges. Many caregiving demands take place during the workday. That’s when Mom’s doctor finally calls, or Jason’s teacher reaches out to discuss challenging behaviors at school. When employees can’t easily address these demands, it increases their stress, decreases their ability to focus on work responsibilities, and often leads to more days off, requests for reduced hours, or job flight. Creative companies have dedicated office space for employees to use for private, time-sensitive phone calls; allow employees to donate paid time off to a co-worker caring for a spouse; and offer telecommuting options for an employee helping an ailing relative out of state.

1. Survey your employees. Ask employees about the issues they face and what benefits they feel are missing. Get a sense of what employees need (and want); then provide benefits and support accordingly.

Think imaginatively about what your company can do to support caregivers. Many of these approaches cost little to nothing, yet the payoff is immense. When it comes to caregiving, there’s no “one-size-fits-all” solution. Employers that understand and support their employees as they try to navigate caregiving and work responsibilities reap positive business outcomes. Higher retention rates, increased productivity, fewer absences, and increased employee morale and loyalty are just a few of the gains to be made. In today’s labor market, can your company afford to do less?

2. Review and revamp policies. Does your company offer flexible work-life policies? Can employees work from home as needed? These policies and attitudes should be embraced from the C-suite down through all levels of management. Make it clear that the company “gets it” and supports its employees and their families.

Carolyn Romano, J.D. (cromano@torchlight.care), is vice president of product at Torchlight. For over 25 years, she has advocated for and participated in systemic-change efforts that improve the lives of children, the elderly, and other populations at risk. For more information, visit www.torchlight.care.

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Medicare Advantage Providers Struggling to Incorporate Coverage for Nonmedical Home Care in 2020

By MEGAN JOYCE In April 2018, the Centers for Medicare & Medicaid Services announced it would begin allowing Medicare Advantage plans to include coverage for nonmedical home care services — but now, in 2019, Advantage beneficiaries are highly unlikely to find that coverage incorporated into their current plans. Part of the reason for that is timing: Medicare Advantage providers must submit their next year’s plans by June 1 to CMS, which must approve those products by Aug. 31. On Oct. 1, Advantage providers can make their offerings public, publishing them for the start of the annual open enrollment period. So by the time CMS revealed this regulatory change in 2018, Advantage providers were already deep into the process of finalizing their plans for 2019 to meet that June deadline. “It really won’t be until this year that they’ll be able to offer these benefits,” Michael Fiaschetti, with MediPlanConnect, said. “Whether or not they do is another issue.” With a large U.S. baby boomer population that continues to 6

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gray, the demand for home care is exploding. The Bureau of Labor Statistics predicts employment of home health and personal care aides will far outpace that of all other occupations, expected to grow by 41% between 2016 and 2026. This type of nonmedical home care does not include services such as medication administration, wound care, physical therapy, or monitoring of medical equipment, which fall under the purview of medical home care. Medicare Part A already covers medical home care (with limits) when patient requirements are met. But it’s the presence of nonmedical care, or assistance with activities of daily living — bathing, dressing, toileting, meal preparation, housework, etc. — that often means the difference between someone’s ability to remain at home and needing admittance to an assisted living or nursing facility. As founder, president, and CEO of MediPlanConnect, an insurance and advisory services firm based in Harrisburg, Fiaschetti said most of the Medicare Advantage providers he has been in contact with would like to include home health services in their plans for 2020. www.BusinessWomanPA.com

But to do so would mean either raising the cost of their premiums or cutting back on other existing benefits — both of which providers are loath to do. “I think that the plans do see value in trying to keep people at home, because if you can keep them at home and give them some home healthcare, often times they won’t end up in the emergency room or in the hospital, and that saves a lot of money,” Fiaschetti said. “So they see the value. I think what the plans are struggling with is how to offer some of this benefit — and some plans will — without significantly increasing the price of the product.” Home healthcare doesn’t come cheaply, ranging from $25-$50 an hour, Fiaschetti noted, making the cost quite prohibitive for someone requiring even just a few hours of care on a few days per week. Even with his more than 30 years in health insurance and managed care, Fiaschetti personally understands the importance of establishing more widespread coverage for nonmedical home health services. Fiaschetti’s family recently made the difficult decision to place his mother in a nursing facility, despite wanting to keep her in her home and mainly due to the cost of the nonmedical home care she would require. “We would’ve loved to have had good-quality home healthcare,” he said. “If some of that [expense] would’ve gotten covered, that would’ve been a good alternative for us.

“These services are valuable; they’re important,” Fiaschetti added. “And I think the home care industry needs to probably do better … and we need more coverage on the Medicare side. Now, again, it’s a cost issue for the plans, so I don’t blame the plans for what they’re going through too. I think sooner or later we’ll see more coverage for this.” Fiaschetti predicts that once Medicare Advantage coverage is on the table, the nonmedical home-care industry will need to establish more quality and training standards. He also expects Advantage insurance providers will contract with select nonmedical home-care agencies, who will be required to lower the price of their services in exchange for the added customer volume they will receive. On the patient side, Fiaschetti said he believes “people are going to have to meet certain criteria” to qualify for covered nonmedical home care, such as needing help with a particular number of activities of daily living. “Then, there will be a benefit limit of so many hours a week; [insurance] is not going to pay an unlimited benefit, of course.” Finally, Fiaschetti recognizes the needed relief that covered nonmedical respite care could bring caregivers. “If we keep people in the home longer, ultimately that will be less costly. It’s better for the patient, it’s better for the family,” he said. “And it really does help if a child or relative or friend is attending to that person — it’s a big help for the caregivers. They’re stressed out, and it takes a toll on them.”

Medicare Confusion Ends Today! MediPlanConnect offers one-on-one advising at no cost to you. Call 717-980-3201 to discover the best Medicare plan to fit your lifestyle.

6360 Flank Drive, Suite 1100, Harrisburg, PA 17112 www.MediPlanConnect.com

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C ommunication, Dementia, and the Changing Brain

By LORI L. DIEROLF

ourselves ill equipped to handle our reactions because we simply do not know any other way to communicate than how we have always done it! Dementia-related diseases are progressive, degenerative illnesses, the result of a shrinking, dying brain. When individuals behave strangely, it is not because they are choosing those actions; it is because they are doing the best they can do with the brains they have left. The fact is, the brain changes of dementia make it necessary to change some of the ways we communicate with and relate to the individual living with the disease. One way we do that is by understanding the changes going on in that person’s frontal lobe. The frontal lobe is what can be referred to as “the center of the train.” Every piece of information that has been collected by our senses eventually comes here for us to figure out what to do with it. Basically, it’s where we “think.” The frontal lobe is where we weigh options and make decisions based on received data.

For those caring for a loved one with a dementia-related disease, it’s a familiar tale. While walking through Walmart one afternoon, Mom blurts out, “Look how fat that one is!” in the direction of an overweight and unsuspecting shopper. Your first response is shock, followed by sheer embarrassment. As you attempt to remove Mom from the area, you might say something like, “Mom! That isn’t nice!” or think to yourself, “This is the Sunday school teacher who always told me, ‘If you can’t say something nice, don’t say anything at all!’” Since the day we were born, we have been practicing the art of communication. We learned what was socially appropriate from those who raised us, and while some of us are better at communicating than others, we all have a basic understanding of social etiquette. So, when things like “The Walmart Event” happen, we find

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Our frontal lobes enable us to weigh decisions, taking into account our feelings, desires, and goals, and decide on a course of action — and they do all of this thousands of times a day and at lightning speed! For example, I utilize my frontal lobe to decide what I will eat for lunch. I could choose to make a chicken stir fry, but that would require a number of steps — cutting vegetables, thawing chicken, frying — which will take time and effort. I could also make a sandwich with the turkey that is in my refrigerator. That would take less time but would likely not be as satisfying as a chicken stir fry. A third choice would be to pick up the phone and order Domino’s. It is the most expensive of the three options, but it requires minimum time and effort, so I can continue to sit on my couch watching Family Feud. When my frontal lobe is damaged due to the brain changes of dementia, though, this decision-making process becomes broken. (Think about the last time you tried to convince a person living with dementia to change his clothes or take his pills!) Trying to rationally explain, to provide reasons to support your opinion and suggestions, is a waste of time when that individual has damage to his or her frontal lobe. Yet, that is exactly what most people do, simply because that is what has always worked in the past. The frontal lobe is also responsible for a second and very important part of our social behavior: our impulse control. It allows us to have a thought without expressing it or acting upon it. My intact frontal lobe reminds me of what is safe and what is socially appropriate. It allows me to see a person with a face tattoo and not express my thoughts about it while on the elevator with that person. It keeps me from walking across a six-lane highway to see the pretty flowers on the other side of the road.

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There are plenty of examples of how people living with impaired frontal lobes act in “inappropriate” ways. Often, however, it is others’ reactions to these behaviors that escalate the situation to DEFCON 1! Attempts to reason, chastise, or shame people into what is considered “appropriate” behavior usually results in making the person feel angry, embarrassed, paranoid, or alone. Loved ones of those living with a dementia-related disease need to be prepared for the unpredictable behaviors that will occur. And, unless the individual is in physical danger, we need to respond as though whatever is happening is an everyday occurrence, with patience and understanding. How do we know without a doubt that a person living with dementia is not choosing to say negative, hurtful things about strangers in public places? Because before she had a dementiarelated disease, Mom was a Sunday school teacher, or a nurse, or a secretary, or a seamstress. She was a person who understood and conformed to socially appropriate behavior. All of this means that when we are caring for a person living with a dementia-related disease, we must expect some socially inappropriate behaviors, we need to understand that these behaviors are caused by the physical brain changes of a degenerative disease, and we must respond the way we would want others to respond if we were in their shoes: with the same grace and dignity that we show to others living with a lifealtering disease.

Lori L. Dierolf is the president of Open Door Training & Development. She holds several certifications as a dementia care educator and can be contacted through her website, www.opendoortraining.net.

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Confront Arthritis Naturally with Physical Therapy By KIM KLUGH According to the Arthritis Foundation, over 50 million Americans are living with arthritis, making it the “leading cause of disability among adults in the U.S.” Chances are, if you are helping to care for an aging loved one, arthritis may be part of the picture. Arthritis can be debilitating and often interferes with and compromises day-today activities. Pain from the condition

may keep some people homebound and isolated. Because it restricts motion and movement, arthritis can make it difficult to perform simple tasks, such as tying shoes, buttoning clothing, or opening containers. The good news is that in many cases, physical therapy can provide relief and restoration to the affected joints for certain types of arthritis, bringing with it renewed hope and joint health. Dr. Michael Gilbert, DPT, owner

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of Gilbert Physical Therapy in Mechanicsburg, stresses that physical therapy is the “all-natural” approach that can help a person regain lost strength and flexibility, which he says is “often what causes arthritis to become painful” to begin with. Our joints take a lot of wear and tear as we age, and unfortunately, arthritis is often a “natural part” of that process. He explains that the pain comes when “the articular cartilage of the joint” wears down

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to what is referred to as “bone on bone.” Gilbert says that we spend most of our lives in this bone-on-bone state without pain because “our joints are adequately supported by strong muscles and free range of motion.” However, once we lose physical strength and our range of motion diminishes, pain steps in. To rebuild what is lost, Gilbert says, “There is no other magic bullet to regain strength and range of motion” other than through PT. Even those who undergo surgery for joint replacement must regain their balance, coordination, strength, and range of motion with physical therapy. “These do not automatically come back due to the ‘resurfacing’ of the joint,” he says. Gilbert emphasizes that fewer joint replacements would be necessitated if people worked on their arthritic pain now and learned and carried out a course of care that would appropriately build strength for the long-term, thereby possibly negating the need for surgery. The exercises that encompass a physical therapy treatment geared toward arthritic pain include those that increase range of motion and strengthen muscles, and Gilbert says the program is tailored to meet the specific needs of the patient. “Particular interest,” he says, “is in building the quadriceps muscles on the front of the thigh and the hamstring muscle on the back of the thigh.” He adds that many people with knee arthritis make the mistake of “not adequately strengthening the hip, which can cause abnormal biomechanics at the knee.” The exercises introduced during physical therapy sessions are not designed to be a short-term solution. As a caregiver to someone who is undergoing a PT program, it is important to be mindful of the home exercise program developed by the therapist, so you can encourage and perhaps “coach” your loved one after they are released from outpatient therapy and continue building on the progress gained. Gilbert also recommends walking, swimming, and biking as ways to continue strength and range-of-motion www.BusinessWomanPA.com

restoration. Yoga may also be another option, depending on flexibility and the ability to kneel; however, before hitting the yoga mat, this activity should initially be discussed with a physical therapist. As a caregiver, how can you help someone protect their joints from further damage? Gilbert says the best way to do that is to encourage them “to remain active, flexible, strong, and generally healthy.” If you have questions regarding the strength, flexibility, or activity level that may influence the future success of the person you are caring for, Gilbert says that those diagnosed with arthritis can be screened by a physical therapist to help identify any red flags that may be exacerbating their condition. He adds it is also beneficial to maintain a proper weight, as carrying extra pounds is generally detrimental to the body’s joints. If meal planning and preparation fall under your responsibility as caregiver,

this is an area where you may be influential when it comes to suggesting more appropriate menu choices. Although injections and medication are often suggested for those enduring arthritic pain, Gilbert says these options only numb the symptoms for a condition that will only worsen with time, if not properly addressed. He suggests that pharmaceutical and surgical solutions are not necessarily inevitable if arthritic pain is addressed at the outset. There are many people using strengthening and range-of-motion exercises to eliminate their arthritic symptoms and whose stories of success, he says, “do not make the headlines.” “It does not matter if you are told you are bone on bone; it does not matter if you think you are too old and there is no hope; it does not matter if your doctor does not believe in your ability to get better either,” Gilbert advises. “Make the choice to get better naturally, and go for it.”

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Simple Improvements Can Make Home Safer By LISA M. PETSCHE Falls are the primary cause of injury and hospitalization for older adults, and half of those injured do not regain their former level of independence. Even more sobering, falls are the seventh leading cause of death in people aged 65 and over. The majority of falls by seniors takes place at home while they are carrying out everyday activities. Most often they occur in the bathroom, bedroom, or a stairwell. Health- and age-related changes that contribute to falls include arthritis, decreased sensation in the feet (known as peripheral neuropathy), loss of strength, visual impairment, balance problems, and the use of certain medications.

The other major cause of falls is hazardous conditions in the home environment. Fortunately, there are numerous ways to reduce these hazards for yourself or a loved one. Many of them involve little or no cost. In the Kitchen Keep regularly used pots, dishes, staple foods, and other supplies within easy reach. Ensure the heaviest items are stored in the lower cupboards. If your loved one must reach high places, make sure they have a stepstool that has a high handrail and rubber tips. They should never use a chair. In the Bedroom Situate a lamp within easy reach of their bed. Also keep a flashlight on hand in case there’s a power failure (don’t forget to regularly replace the batteries). Keep a phone at their bedside. If their bedroom doesn’t have a phone jack, get a cordless phone and keep the receiver with you at night. Many seniors are using cellphones, which are easy to take anywhere. (Remind them to place the portable phone back on the base in the morning to recharge and to keep the cellphone charged.) Ensure there’s a clear path from their bed to the bathroom. Stairwells Steps should be in good repair and have a nonskid surface. Have solid handrails installed on both sides of stairways — ideally these should project past both the top and bottom steps. Keep steps free of clutter. Ensure stairwells are well lit. If necessary, get battery-powered dome lights that easily attach to the wall. In the Bathroom Have grab bars installed by the toilet and in the bathtub or shower area. Ensure they are placed in the proper location and well anchored to the wall. Use a rubber mat (the kind with suction cups) in the tub or shower and a nonskid bathmat on the floor. Get a bathtub seat or a shower chair. Obtain a raised toilet seat if they have trouble getting on and off the toilet. Get a handheld showerhead so they can shower in a sitting position.

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plug-in, rechargeable flashlights that automatically come on when the power goes out. Spend some time browsing in medical supply stores or perusing their catalogs to discover the many items available — for example, reachers and electric-lift armchairs — that can increase household safety and make everyday activities easier. Consider a cane or walker if balance is an ongoing problem. Make sure they are fitted with the appropriate type of aid and receive instruction on proper usage. Arrange for a home assessment by an occupational therapist if you would like more information about identifying potential safety hazards and successfully addressing them. The therapist may point out areas of risk and make recommendations that would not have occurred to you or your family.

General Tips Your loved one should wear slippers or shoes that fit snugly, offer good support, and have a nonskid sole (avoid a sticky sole like crepe, though). Make sure throw rugs and scatter mats have a nonskid backing. Better yet, remove them, since they are one of the most common causes of falls. Keep walkways clear of electrical and telephone cords. Avoid clutter in rooms and hallways. Post emergency numbers by the telephone for easy access. If vision is a problem, get a phone with a large, lighted keypad. Sign on with a personal emergency response service, whereby your loved one wears a lightweight, waterproof pendant or bracelet that has a button to press if you run into a crisis and need help. (Studies have found that getting help quickly after a fall reduces the risk of hospitalization and death.) Use nightlights in the bedroom, hallways, and bathroom. Get the kind that have a built-in sensor that automatically turns the light on in dim conditions. Also consider getting one or more

Lisa M. Petsche is a social worker and a freelance writer specializing in boomer and senior health matters. She has personal experience with elder care.

Build your caregiver circle. Many times the “best” care comes from an expanded care network and a caregiver who feels recharged and supported. Create a strong caregiver circle that supports you and your loved one’s needs. Messiah Lifeways offers more options for caregivers and the ones they love. Talk to the Messiah Lifeways Coach to learn more.

“I’m doing it for mom”

MessiahLifeways.org/Coaching 717.510.1556 | coach@messiahlifeways.org

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What Every Caregiver Needs to Know about Hiring In-Home Caregivers

By BEVERLY BERNSTEIN JOIE, MS, CMC Living at home is a primary wish for most of us as we age. As caregivers, it is often our responsibility to help choose the appropriate in-home caregiver in a knowledgeable, thoughtful manner. This decision is pivotal in determining whether life at home will be successful and offer the best possible quality of life for the people we love. The following guidelines are the building blocks to a successful hiring experience. Hiring Guidelines for In-Home Caregivers 1. Hire caregivers from a reputable agency. 2. Caregivers should ideally be employees of the agency. 3. B e certain caregivers are licensed, bonded, and insured. 4. Be certain that caregivers are covered by workersâ&#x20AC;&#x2122; compensation insurance. 5. Caregivers should be supervised by a licensed professional who makes unannounced visits. 6. If hiring caregivers privately, consider their Social Security compensation, federal and state taxes, and workersâ&#x20AC;&#x2122; compensation insurance as a responsibility of the individual who is paying the caregiver. 14

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7. Review two to three references. 8. A recent criminal background check with the current year is essential. 9. Random drug tests, TB tests, and a recent physical exam should be provided. 10. If the position involves driving, a valid driver’s license and car insurance should be investigated to determine that it is current and valid. 11. Caregivers should have a minimum of two to three years of experience. 12. If caregivers hail from another country, make sure that they can be understood. 13. A ll foreign-born caregivers must have a green card and a Social Security number. 14. Interview the applicant to get a sense of how their personality will match your loved one. 15. Determine if the applicant has experience in the kind of care required. For example, are they comfortable and experienced dealing with dementia, Parkinson’s disease, diabetes, etc.? 16. Make sure the caregiver’s physical ability matches the job at hand. For example, if lifting is involved, they must have the strength and ability to transfer their client. 17. Be certain that you define and describe the duties and expectations inherent in the position before it starts. 18. Discuss the dos and don’ts of the position. For example, the caregiver cannot talk on her cellphone while on duty. The caregiver can never invite anyone to the client’s home. 19. Create your own contract with the caregiver. This contract consists of the job description and specifies those behaviors that are not acceptable. Have her sign and keep a record of it. 20. Geriatric care managers can be retained to objectively oversee the care of seniors in their home and to keep the family apprised of the care’s quality. They can also manage other aspects of life at home, such as the coordination of all healthcare services, while addressing quality-of-life issues. The need for home care often highlights a time of life when people are in decline. They are losing control of the life they knew, and we are feeling at a loss to help them. The hiring of effective home care assistance, though, gives us the opportunity to make a real difference in their lives. By following these guidelines and doing our “homework,” there is a chance for a new lease on life — a life that will keep them safe, cared for, and, most importantly, allow them their greatest wish: to remain in their own home. www.BusinessWomanPA.com

Bathing & Dressing Assistance Grooming • Assistance with Walking • Medication Reminders • Errands • Shopping Light Housekeeping • Meal Preparation • Friendly Companionship • Flexible Hourly Care • Respite Care for Families

Specializing in dementia care for adults and their families York

717.751.2488 1840 E. Market St York PA 17402

Lancaster

717.393.3450 2141 Oregon Pike, 2nd Floor Lancaster, PA 17601

Hanover

717.630.0067 104 Carlisle St Hanover, PA 17331

RN Owned and Operated Each Visiting Angels agency is independently owned and operated.

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Frequently Asked Questions What is the National Family Caregiver Support Program (NFCSP)? The National Family Caregiver Support Program is a federally funded program through the Older Americans Act. It helps states provide services to help family caregivers. These services include: • Information to caregivers about available services • Help to caregivers in gaining access to services • Individual counseling, organization of support groups, and caregiver training • Respite care • Supplemental services, on a limited basis, to complement the care provided by caregivers. www.womenshealth.gov How can I find out about caregiving resources in my community? There are resources with staff who can help you figure out whether and what kinds of assistance you and your care receiver may need. The local Area Agency on Aging is one of the first resources you should contact when help is needed caring for an older person. Almost every state has one or more AAAs, which serve local communities, older residents, and their families. In a few states, the State Unit or Office on Aging serves as the AAA. You can find your Area Agency on Aging in the Directory of Ancillary Services on page 30. If you care receiver lives in another community and you aren’t sure what county that is, you can also call the National Eldercare Locator, a toll-free service funded by the Administration for Community Living, at 800.677.1116. The Eldercare Locator can help you find their local or state AAA. Eldercare Locator operators are available Monday through Friday, 9 a.m. to 8 p.m., Eastern Time. When contacting the Locator, callers should have the address, zip code, and county of residence for the person needing assistance. 16

The Eldercare Locator is also available online at https://eldercare.acl.gov. If your family member has a limited income, he or she may be eligible for AAA services, including homemaker home health aide services, transportation, home-delivered meals, and chore and home repair, as well as legal assistance. These government-funded services are often targeted to those most in need. While there are no income criteria for many services, sometimes you may have more service options if you can pay for private help. AAAs can direct you to other sources of help for older persons with limited incomes, such as subsidized housing, food stamps, Supplemental Security Income, and Medicaid. Supportive services for the person needing care can include both in-home and community-based services, such as: • Transportation • Meals • Personal and in-home care services • Home healthcare • Cleaning and yardwork services • Home modification

state. In all states, Medicaid pays for basic home healthcare and medical equipment. Medicaid may pay for homemaker, personal care, and other services that are not paid for by Medicare. For more information about what Medicaid covers for home healthcare in your state, call your state medical assistance office. If you need the telephone number for your state, call 800.633.4227 www.womenshealth.gov What is the difference between a home care and home healthcare? Home care agencies (HCAs) and home care registries (HCRs) provide nonskilled services to individuals in their homes or other independent living environments. Home care services include: • Assistance with self-administered medications • Personal care (assistance with personal hygiene, dressing, and feeding) • Homemaking (housekeeping, shopping, meal planning and preparation, and transportation) • Respite care (assistance and support provided to the family)

• Senior centers

• Other nonskilled services

• Respite services including adult daycare

Home healthcare is a wide range of healthcare services that can be given in your home for an illness or injury. Home healthcare is usually less expensive, more convenient, and as effective as care you get in a hospital or skilled nursing facility. Examples of skilled home health services include:

If you are an employee covered under the federal Family and Medical Leave Act, and if you meet the eligibility requirements, you are entitled to take up to 12 weeks of unpaid leave during any one year to care for certain relatives. www.womenshealth.gov Will Medicaid help pay for home healthcare? Medicaid is a joint federal and state program that helps with medical costs for some people with low incomes and limited resources. To qualify for Medicaid, you must have a low income and few savings or other assets. Medicaid coverage differs from state to

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• Wound care for pressure sores or a surgical wound • Patient and caregiver education • Intravenous or nutrition therapy • Injections • Monitoring serious illness and unstable health status www.medicare.gov www.BusinessWomanPA.com

What is the difference between a nursing home and a personal care home? Nursing homes are licensed medical facilities that are inspected and licensed by the Pennsylvania Department of Health. They must meet both state and federal regulations. There is third-party reimbursement (Medicare and Medicaid) for those who qualify based on income. Personal care homes are residential facilities that offer personal care services, assistance, and supervision to four or more persons. They are inspected and licensed by the Pennsylvania Department of Human Services. A personal care home must have a license to operate in Pennsylvania. There are state licensing regulations that apply to personal care homes. These regulations are aimed at protecting the health, safety, and well-being of the residents. There are no federal regulations for personal care homes. There is no thirdparty reimbursement for personal care homes, but many accept residents of low income who receive Supplemental Security Income (SSI). — Pennsylvania Department of Human Services Is there someplace I can get help with drug bills for someone in my care? Many senior citizens with low incomes are eligible for assistance with payment for their prescribed medications through PACE/PACENET programs. Who is eligible for PACE? For a single person, your total income must be $14,500 or less. For a married couple, your combined total income must be $17,700 or less. Social Security Medicare Part B premiums are now excluded from income. Prescriptions: Co-pay for generic drugs is $6; co-pay for single-source brand is $9. Who is eligible for PACENET? To be eligible for PACENET, the qualifications are the same as PACE. However, the total income for a single person can be between $14,500 and $27,500. A couple’s combined total income can be between $17,700 and $35,500. Prescription: Co-pay for generics is $8; co-pay for single-source brand is $15. Call your local Area Agency on Aging www.BusinessWomanPA.com

office for forms or more information or go to https://pacecares.magellanhealth.com. Effective Jan. 1, 2019, PACENET cardholders not enrolled in a Part D plan will pay a $37.03 premium at the pharmacy each month. Income qualification is based on prior year’s income and includes taxable and nontaxable sources. Assets and resources are not counted as income. — Pennsylvania Department of Aging What is the Extra Help Program? If your monthly income is up to $1,581 for singles ($2,134 for couples) and your assets are below specified limits, you may be eligible for Extra Help, a federal program that helps you pay for some or most of the costs of Medicare prescription drug coverage. You can enroll through the Social Security Administration, using either the agency’s print or online application, or at your local Medicaid office. If you are enrolled in Medicaid, Supplemental Security Income, or a Medicare Savings Program, you automatically qualify for Extra Help. You do not have to apply for this extra assistance. If you become eligible, you will get a special enrollment period to enroll in a Medicare private drug plan. See www. medicare.gov for more information. What is the APPRISE Program and where can I get more information? The APPRISE Program is a free program operated by the Area Agencies on Aging to provide healthinsurance counseling and assistance to Pennsylvanians age 60 and over. They can help you understand Medicare benefits by explaining Medicare, Medicare Supplemental insurance, Medicaid, and long-term care insurance. They can explain the Medicare appeals process, help you select a Medigap insurance policy, explain the Medicare prescription Part D benefit, and explain financial assistance programs. Call 800.633.4227 or your local Area Agency on Aging for more information. What is the waiver program offered through the Pennsylvania Department of Aging? There are several waivers available through the Pennsylvania Department of Aging for people aged 60 and older who

meet the eligibility requirements and income limits. Each waiver has its own unique set of eligibility requirements and services. • Aging Waiver – Provides long-term care services to qualified older Pennsylvanians living in their homes and communities • Attendant Care / Act 150 – Information for mentally alert Pennsylvanians with physical disabilities • COMMCARE Waiver – Home and community-based program developed for individuals who experience a medically determinable diagnosis of traumatic brain injury • Consolidated Waiver for Individuals with Intellectual Disabilities – Provides services to eligible persons with intellectual disabilities so they can remain in the community • Independence Waiver – Provides services to persons with physical disabilities to allow them to live in the community and remain as independent as possible • LIFE (Living Independence for the Elderly) – Managed care program for frail, elderly recipients who have been determined to need “nursing facility level of care” but wish to remain in their home and community as long as possible (called PACE in other states) • OBRA Waiver – Provides services to persons with severe developmental physical disabilities, such as cerebral palsy, epilepsy, or similar conditions • Family Directed Support Waiver – Provides services to eligible persons with intellectual disabilities so they can remain in the community What services are available from Pennsylvania Area Agencies on Aging? Area Agencies on Aging, county- or multi-county-based agencies that partner with the Department of Aging, provide a wide range of services, such as assessment of need, care management, in-home services, transportation, protective services, adult daycare, and legal services. Services may vary from county to county, so it is wise to call your local Area Agency on Aging for particular services of programs.

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A Dementia Friendly America Initiative By JENNIFER HOLCOMB According to the Alzheimer’s Association, it is anticipated that by 2050, 14 million Americans will be living with some form of dementia. The cost of care is expected to rise from $290 billion in 2019 to $1.1 trillion in 2050. For this reason, Adams and York counties identified a need to support people living with dementia and their caregivers living in the community. In 2018, as the director of memory support at Cross Keys Village – The Brethren Home Community in New Oxford, I decided to collaborate with other community providers to be proactive in meeting the challenges of people living in the community with dementia symptoms. I partnered with local community businesses to form a steering committee and launched the local chapter of Dementia Friendly America. This chapter spans across Adams and York counties and is adopted from the national movement, which began in 2015 in Minnesota. Living well with dementia symptoms is impossible without the support of the community. The goal of DFA is to make local communities more aware and better prepared to care for family, friends, co-workers, and neighbors who live with dementia symptoms. This movement seeks to cultivate a community that is informed, safe, and respectful of individuals living with the disease as well as their caregivers. Every person plays a pivotal role and works together to create a dementia-friendly culture that eliminates stigma and promotes socialization and engagement. DFA in Adams and York counties partners with business sectors to provide supportive options that foster quality of life. For example, visualize living with dementia symptoms and wanting to visit the grocery store; however, you can no longer drive due to dementia. DFA in Adams and York counties works to solve that problem by partnering with local transportation to transport the person with dementia to the grocery store. By partnering with local grocers, DFA can promote independence by creating a dementia-friendly checkout or a personal shopper trained to assist when challenges with the disease arise. Imagine a person with dementia going to a financial advisor and that advisor is trained to identify warning signs and then notifies the family. Envision faith communities that create a dementia-friendly service that is familiar, easy to understand, and filled with symbols and music from the past. The first step taken in launching DFA in Adams and 18

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York counties was offering informational sessions to anyone interested in becoming a Dementia Friend. Dementia Friends is part of a global movement that is changing the way everyone thinks, acts, and talks about dementia. Anyone can become a Dementia Friend by learning what it is like to live with dementia and turning that understanding into action. As of today, there are 1,508 Dementia Friends in Pennsylvania. In March 2019, the Jewish Healthcare Foundation in Pittsburgh traveled to New Oxford to make 100 Dementia Friends and 50 Dementia Friends Champions. Of the 100 Dementia Friends, 30 businesses were represented, and they each committed to taking steps toward creating a dementiafriendly business. Since that time, 52 businesses have expressed a desire to move forward with their part in creating a Dementia Friendly America in Adams and York counties. The DFA initiative in Adams and York counties is excited to continue offering this level of support to the community. The steering committee—comprising representatives from the Alzheimer’s Association, Visiting Angels, UPMC Pinnacle Hanover, Mooney & Associates, Good News Consulting, York County Area Agency on Aging, and Adams County Office of Aging and community volunteers—are excited to engage new businesses. Everyone, from banks and grocery stores to the local corner shop and hair salon, shares responsibility for ensuring that people with dementia feel understood, valued, and like a contributor to the community they live in. If you are interested in partnering with the Adams and York County DFA initiative or if you have questions about launching your own initiative, please contact me directly at j.holcomb@crosskeysvillage.org or 717.624.5474. You may read more about the local initiative by visiting www.crosskeysvillage.org/blog/dfa1, the national initiative by visiting www.dfamerica.org, Dementia Friends by visiting www.dementiafriendsusa.org, and the Alzheimer’s Association by visiting www.alz.org. www.BusinessWomanPA.com

Caregiver Support Programs There are approximately 43.5 million people who provide unpaid caregiving to family members throughout the year. Americans are living longer, and as the population ages, the number of caregivers will also continue to rise in the coming years. Caregivers are an essential element in our healthcare system and, according to AARP, they account for about $470 billion worth of unpaid labor in the U.S. Caregiving already has become the new norm for many, as we find ourselves helping loved ones who are disabled, frail, or suffering from Alzheimer’s disease, Parkinson’s disease, and kidney and liver diseases, which have been on the rise.

Benefits & Services for Caregivers • Assessment of caregiver and care recipient needs • Respite care • Training in caregiving skills • Financial assistance to purchase caregiving-related supplies or services • Limited funding for assistive devices and home modifications • Benefits counseling on services available through local, state, and federal programs • Referrals to family support or disease-specific organizations, such as Children of Aging Parents or the Alzheimer’s Disease & Related Disorders Association • Assistance in completing benefits and insurance forms

Eligibility If you are age 18 or older and the primary caregiver* of a functionally dependent person who is age 60 or older, you may be eligible for assistance. If you are age 18 or older and the primary caregiver* of an individual who is age 18–59 with Alzheimer’s disease or other chronic dementia, or an individual who is under age 18 with chronic dementia, you may be eligible for assistance. If you are age 55 or older and the primary caregiver* of a relative who is under age 18 or a relative age 18–59 with a non-dementia-related disability who lives with you, you may be eligible for assistance. * A primary caregiver is the one identified adult family member or other responsible person who has primary responsibility for the provision of care — including coordination of care and services — needed to maintain the physical and/or mental health of the care receiver. The caregiver may not receive reimbursement for personally providing caregiving services to the care receiver and must be actively involved with various aspects of care on a regular — but not necessarily daily — basis. For specific program information, please contact your local Area Agency on Aging or visit the Pennsylvania Department of Aging’s website at www.aging.pa.gov. www.BusinessWomanPA.com

Some research has shown that men are increasingly stepping up in their caregiving responsibilities, but women are still more likely to provide basic care (e.g., help with dressing, feeding, and bathing), while sons are more likely to provide financial assistance. The major focus of the Caregiver Support Programs is to reinforce the care given to people over the age of 60 or adults with chronic dementia. To determine the needs of both the caregiver and receiver, the package of benefits begins with an assessment. You could also take advantage of other benefits available, such as counseling, education, and financial information.

Assessment Criteria (Federal and State)

State No**

Federal No**

Caregiver must be related to the care receiver.

No***

Household income of care receiver is used to determine eligibility.

Yes

Care receiver must require assistance with two or more activities of daily living (ADLs).

No (1) ADL needed

Yes****

Maximum amount of monthly reimbursement for caregiver expenses (depending on the caregiver’s reimbursement percentage) is:

$200*****

Maximum amount of reimbursement for home modification/assistive devices (depending on the caregiver’s reimbursement percentage and availability of funding) is:

$2,000

Caregiver must have primary responsibility for the provision of care and be actively involved with various aspects of the care receiver’s care on a regular — but not necessarily daily — basis.

Yes

Caregiver must reside in the same household as care receiver.

** Unless care receiver is 18–59 years of age with a non-dementia-related disability, or the caregiver is 55 years of age and older caring for a child under age 18. *** Must be related by blood, marriage, or adoption if the care receiver is 18–59 years of age with a non-dementia-related disability, or the caregiver is 55 years of age and older caring for a child under age 18. **** ADL requirement does not apply if the caregiver is 55 years of age and older caring for a child under age 18. (The caregiver cannot be the biological parent of the child.) ***** Up to $500 with documentation to justify need. caregiver solutions 2019 BUSINESSWoman

Keep Spirits Up to Prevent Burning Out By LISA M. PETSCHE Caring for a chronically ill, disabled, or medically frail relative can offer many rewards, but it also involves physical, psychological, emotional, and financial demands. Caregivers may experience a variety of distressing emotions along the way, including frustration, guilt, resentment, anxiety, and sadness. If you’re a caregiver, read on for suggestions on how to keep up your spirits, which can reduce the risk of wearing down (a.k.a., burnout). • Emphasize the positive. • Limit your exposure to the news. • Cultivate a healthy sense of humor. Read the comics, watch a TV sitcom, or rent funny movies. • Accept realities you can’t change, and concentrate on those you can influence. • Focus on your relative’s abilities rather than disabilities, and build on those strengths. • Recognize that when the going gets tough, you have a choice about how to respond. • Stay connected to people who care. Minimize contact with individuals who are critical. • Find an outlet for expressing your thoughts and feelings, such as talking with a friend or keeping a journal. 20

• Pick your battles; don’t make a major issue out of every concern. Let the little things go.

• Identify sources of stress in your life, and then eliminate as many as possible and learn to manage the rest.

• Don’t dwell on past mistakes, hurts, or other unpleasant events.

• Practice relaxation techniques, such as deep breathing or meditation.

• Look for the good in people. Give them the benefit of the doubt and practice forgiveness.

• Learn to be flexible about plans and expectations. Take things one day at a time so you don’t become overwhelmed.

• Do something you enjoy every day. Read or listen to music, for example.

• Set priorities and stick to them. And let go of the need for perfection.

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• Be receptive to learning new ways of doing things, and try new activities. • Be open to learning skills such as proper bathing techniques. Not only will this make caregiving safer and easier, but mastering these tasks will also boost your self-confidence. • Find out about community services that can help maximize your relative’s quality of life and assist you with necessary tasks. Potential sources of information include healthcare professionals, the internet, and the local office on aging. • Develop a partnership with involved healthcare professionals. Share relevant information about your relative’s needs, abilities, and preferences — anything that may help with care planning. Ask questions, seek advice, and offer opinions and suggestions as appropriate. You’re an important member of your relative’s care team. • Connect with other caregivers by joining a support group. • Don’t neglect your physical health: eat nutritious meals, get adequate rest, exercise, and get regular medical checkups. • Seek help from your primary physician or a counselor if you continually feel sad, angry, or overwhelmed. This may be indicative of clinical depression — a legitimate and treatable illness. • Set aside quiet time each day; it nurtures your spirituality and helps keep you grounded. • Schedule regular breaks from caregiving duties, and do something fun to recharge your batteries.

For Love of Family. Devotion. Compassion. Dignity. When your loved one needs help, join hands with Homeland. We are privileged to offer a continuum of care options and to be part of your caregiving team. To arrange a family meeting—at no cost or obligation—please call.

• Finally, learn to live in the moment, and enjoy life’s many simple pleasures.

Lisa M. Petsche is a medical social worker and a freelance writer specializing in boomer and senior health matters. She has personal experience with elder care.

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What You Should Know About Your Aging Parents’ Finances

By JIM MILLER Dear Savvy Senior, My siblings and I don’t know much about our elderly parents’ financial situation or their wishes if something happens to them. When Mom broke her hip last year, it got me thinking we need to be better prepared. What’s the best way to handle this, and what all should we know? – Tentative Daughter Dear Tentative, Many adult children don’t know much about their elderly parents’ financial situation or end-of-life plans, but they need to. Getting up to speed on their finances, insurance policies, longterm care plans, and other information is important because some day you might have to help them handle their financial affairs or care or execute their estate plan after they die. Without this information, your job becomes much more difficult. Here are some tips that can help. Have the Conversation If you’re uncomfortable talking to your parents about this topic, use this column as a prompt or start by talking about your own finances or estate plan as a way to ease into it. Also see The Conversation Project (https:// theconversationproject.org), which offers free kits that can help you kick start these discussions. It’s also a good idea to get your siblings involved too. This can help you head off possible hard feelings, plus, with others involved, your parents will know everyone is concerned. When you talk with your parents, you’ll need to collect some information, find out where they keep key documents, and address how they want certain things handled when they die or if they become incapacitated. Here’s a checklist of areas to focus on. 22

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Personal and Health Information Contacts: Make a list of names and phone numbers of their doctors, lawyer, accountant, broker, tax preparer, insurance agent, etc. Medical information: Make a copy of their medical history (any drug allergies, past surgeries, etc.) and a list of medications they take. Personal documents: Find out where they keep their Social Security card, marriage license, military discharge papers, etc. Secured places: Make a list of places they keep under lock and key or protected by password, such as online accounts, safedeposit boxes, safe combination, security alarms, etc. Pets: If they have a pet, what are their instructions for the animal’s care? End of life: What are their wishes for organ or body donation and their funeral instructions? If they’ve made prearrangements with a funeral home, get a copy of the agreement. Legal Documents Will: Do they have an updated will or trust, and where is it located? Power of attorney: Do they have a power of attorney document that names someone to handle their financial matters if they become incapacitated? Advance directives: Do they have a living will and a medical power of attorney that spells out their wishes regarding their end-of-life medical treatment? If they don’t have these documents prepared, now’s the time to make them. www.BusinessWomanPA.com

Financial Records Debts and liabilities: Make a list of any loans, leases, or debt they have — mortgages owed, car loans, medical bills, credit card debts. Also, make a list of all their credit and charge cards, including the card numbers and contact information. Financial accounts: Make a list of the banks and brokerage accounts they use (checking, savings, stocks, bonds, mutual funds, IRAs, etc.) and their contact information. Company benefits: Make a list of any retirement plans, pensions, or benefits from their former employers, including the contact information of the benefits administrator. Insurance: Make a list of the insurance policies they have (life, long-term care, home, auto, Medicare, etc.), including the policy numbers, agents, and phone numbers.

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Property: Make a list of the real estate, vehicles, or other properties they own, rent, or lease and where they keep the deeds, titles, and loan or lease agreements. Taxes: Find out where they keep copies of the past year’s tax returns. For more tips, see the Eldercare Locator publication Let’s Talk: Starting the Conversation about Health, Legal, Financial, and Endof-Life Issues at www.n4a.org/files/conversations.pdf.

Jim Miller is a contributor to the NBC Today show and author of The Savvy Senior book.

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How to Get Veterans’ Funeral and Burial Benefits By JIM MILLER

the National Cemetery Scheduling Office at (800) 535-1117.

Does the VA provide any special burial benefits to old veterans? My dad, who has late-stage Parkinson’s disease, served during the Vietnam War in the 1960s. – Only Child

Private Cemetery Benefits If your father is going to be buried in a private cemetery, the benefits available include a free government headstone or marker or a medallion that can be affixed to an existing, privately purchased headstone or marker; a burial flag; and a presidential memorial certificate. Funeral or cremation arrangements and costs are, again, the responsibility of the family (some burial allowances may be available), and there are no benefits offered to spouses and dependents who are buried in private cemeteries.

Dear Only, Most U.S. veterans are eligible for burial and memorial benefits through the Department of Veterans Affairs National Cemetery Administration. Veterans who were discharged under conditions other than dishonorable are eligible. To verify your dad’s discharge, you’ll need a copy of his DD Form 214, Certificate of Release or Discharge from Active Duty, which you can request online from the National Archives (www.archives.gov/veterans). Here’s a rundown of some of the different benefits that are available to veterans who die a nonservice-related death. National Cemetery Benefits If your dad is eligible and would like to be buried in one of the 136 national or 111 grant-funded state and tribal VA cemeteries (see the National Cemetery Administration at www. cem.va.gov/cem/cems/listcem.asp for a list), the VA provides a host of benefits at no cost to the family, including: • A gravesite • Opening and closing of the grave • Perpetual gravesite care • A government headstone or marker • A United States burial flag that can be used to drape the casket or accompany the urn (after the funeral service, the flag is given to the next-of-kin as a keepsake) • A presidential memorial certificate National cemetery burial benefits are also available to spouses and dependents of veterans. If your dad is cremated, his remains will be buried or inurned in the same manner as casketed remains. Funeral or cremation arrangements and costs are not, however, taken care of by the VA. They are the responsibility of the veteran’s family, but some veterans’ survivors are eligible for burial allowances, which are explained below. If you’re interested in this option, the National Cemetery Administration offers a pre-need burial-eligibility determination program at www.cem.va.gov/pre-need, or call 24

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Military Funeral Honors Another popular benefit available to all eligible veterans buried in either a national or private cemetery is a military funeral honors ceremony. This includes an honor guard detail of at least two uniformed military persons, folding and presenting the U.S. burial flag to the veteran’s survivors, and the playing of “Taps” by a bugler or an electronic recording. The funeral provider you choose will be able to assist you with all VA burial requests. Depending on what you want, certain forms may need to be completed, which are always better done in advance. For a complete rundown of burial and memorial benefits, eligibility details, and required forms, visit the National Cemetery Administration online (www.cem.va.gov) or call the VA at (800) 827-1000. Burial Allowances In addition to the burial benefits, some veterans’ survivors may also qualify for a $300 burial allowance (or $780 if hospitalized by VA at time of death) and $780 for a plot to those who choose to be buried in a private cemetery. To find out if your dad is eligible, see the Veterans Benefits Administration’s burial and plot interment allowance fact sheet at www.benefits. va.gov/benefits/factsheets/burials/burial.pdf. To apply for burial allowances, you’ll need to fill out VA Form 21P-530, Application for Burial Benefits. You need to attach a copy of your dad’s discharge document (DD 214 or equivalent), death certificate, and funeral and burial bills. They should show that you have paid them in full. You may download the form at www.va.gov/vaforms.

Jim Miller is a contributor to the NBC Today show and author of The Savvy Senior book.

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Good Reads Before I Forget: Love, Hope, Help, and Acceptance in Our Fight Against Alzheimer’s By B. Smith and Dan Gasby, with Michael Shnayerson Harmony Kindle, print Restaurateur, magazine publisher, celebrity chef, and nationally known lifestyle maven B. Smith is struggling at 66 with a tag she never expected to add to that string: Alzheimer’s patient. She’s not alone. Every 67 seconds someone newly develops it, and millions of lives are affected by its aftershocks. B. and her husband, Dan, working with Vanity Fair contributing editor Michael Shnayerson, unstintingly share their unfolding story. Crafted in short chapters that interweave their narrative with practical and helpful advice, readers learn about dealing with Alzheimer’s day-to-day challenges: the family realities and tensions, ways of coping, and coming research that may tip the scale, as well as lessons learned along the way. At its heart, Before I Forget is a love story: illuminating a love of family, life, and hope. Things I Wish I’d Known: Cancer Caregivers Speak Out By Deborah J. Cornwall Bardolf & Company Kindle, print Family caregivers are the unsung heroes of the lifesaving drama that’s triggered by a cancer diagnosis. Nearly three-quarters of American households will find themselves caring for a cancer patient at one point in their lives. This book is the first to capture their thoughts, feelings, and insights on a large scale. It is based on 101 formal interviews with non-professional caregivers (some of whom are cancer survivors themselves). Lessons drawn from caregivers’ experiences are intermingled with their own words to forge a compelling narrative intended to help 26

both patients and their family caregivers to understand and cope with the full range of issues they should anticipate as they fight the battle of their lives. Hope for the Caregiver: Encouraging Words to Strengthen Your Spirit By Peter Rosenberger Worthy Inspired Kindle, print A caregiver is someone who helps meet the special needs of others—without pay and often at great personal cost to their own career, finances, social life, and mental health. Hope for the Caregiver shares hard-won wisdom from a 30-year caregiver who reminds fellow caregivers of God’s presence, strength, and faithfulness in every circumstance. Plumbing his decades of experience, the author provides proven, practical tips on how caregivers can live a calmer, healthier, and even more joyful life. 7 Caregiver Landmines: And How You Can Avoid Them By Peter Rosenberger Morgan James Publishing Kindle, print A caregiver’s journey often contains beliefs and behaviors that act like emotional landmines and can cause serious damage. Avoiding these landmines, while finding a path to safety, requires caregivers to hear from someone with experience they can trust. Author and radio host Peter Rosenberger draws upon three decades of caring for his wife through a medical nightmare to discuss seven caregiver landmines that wreak havoc in a caregiver’s life. Helping them navigate to a place of safety, 7 Caregiver Landmines: And How You Can Avoid Them equips fellow caregivers to live a healthier, calmer, and even more joyful life—because “Healthy Caregivers Make Better Caregivers!”

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The Emotional Survival Guide for Caregivers: Looking After Yourself and Your Family While Helping an Aging Parent By Barry J. Jacobs The Guilford Press Kindle, print Caring for a parent whose health is in decline turns the world upside down. The emotional fallout can be devastating, but it doesn’t have to be that way. Empathic guidance from an expert who’s been there can help. Through an account of two sisters and their ailing mother — interwoven with no-nonsense advice — The Emotional Survival Guide for Caregivers helps family members navigate tough decisions and make the most of their time together as they care for an aging parent. The author urges readers to be honest about the level of commitment they’re able to make and emphasizes the need for clear communication within the family. While acknowledging their guilt, stress, and fatigue, he helps caregivers reaffirm emotional connections worn thin by the routine of daily care. This compassionate book will help families everywhere avoid burnout and preserve bonds during one of life’s most difficult passages. When Reasoning No Longer Works: A Practical Guide for Caregivers Dealing with Dementia & Alzheimer’s Care By Angel Smits Parker Hayden Media Kindle, print Nearly 5 million families deal with Alzheimer’s disease and other forms of dementia on a daily basis. They do this with little training, and often only their good intentions guide them. When Reasoning No Longer Works is the training manual these family caregivers have been searching for. Written by a gerontologist with more than 20 years of experience, this reference gives the reader an easy-to-understand view www.BusinessWomanPA.com

Coping With Your Difficult Older Parent: A Guide for Stressed-Out Children By Grace Lebow and Barbara Kane, with Irwin Lebow William Morrow Paperbacks Kindle, print

of what dementia does to the brain, how it is diagnosed, and most importantly, how to deal with its effects. Bulleted lists clearly explain: • How to avoid a catastrophic reaction • Specific approaches for aggressive behavior • How to deal with disruptive behaviors • Ways to diminish wandering • What to do when a wanderer is missing • When to look for outside help You’ll also follow the story of Lou and Rose, a couple who share their lives with Alzheimer’s disease. Together, they find the answers to questions caregivers and victims are sometimes afraid to ask.

Company Kindle, print

How to Care for Aging Parents, 3rd Edition: A One-Stop Resource for All Your Medical, Financial, Housing, and Emotional Issues By Virginia Morris Workman Publishing

How to Care for Aging Parents is an authoritative, clear, and comforting source of advice and support for the ever-growing number of Americans — now 42 million — who care for an elderly parent, relative, or friend. It includes a whole chapter on fraud; details on the latest “aging in place” technologies; more helpful online resources; and everything you need to know about laws and regulations. There are also fill-in worksheets for gathering specifics on medications; caregivers’ names, schedules, and contact info; doctors’ phone numbers and addresses; and other essential information in one handy place at the back of the book. From having that first difficult conversation to arranging a funeral and dealing with grief — and all of the other important issues in between — How to Care for Aging Parents is the essential guide. www.BusinessWomanPA.com

parent who:

Do you have an aging

• Blames you for everything that goes wrong? • Cannot tolerate being alone and/or wants you all the time? • Is obsessed with health problems, real or imagined? • Make unreasonable and/or irrational demands of you? • Is hostile, negative, and critical? Coping with these traits in parents is an endless, high-stress battle for their children. Though there’s no medical definition for “difficult” parents, you know when you have one. While it’s rare for adults to change their ways late in life, you can stop the vicious merry-go-round of anger, blame, guilt, and frustration. Filled with practical tips for handling contentious behaviors and sample dialogues for some of the most troubling situations, this book addresses many hard issues, including: • How to tell your parent he or she cannot live with you • How to avoid the cycle of nagging and recriminations • How to prevent your parent’s negativity from overwhelming you • How to deal with an impaired parent who refuses to stop driving • How to assess the risk factors in deciding whether a parent is still able to live alone Everything You Need to Know About Caregiving for Parkinson’s Disease By Lianna Marie Live Fully Publishing Kindle, print This comprehensive

guide answers your most important questions about caring for someone with Parkinson’s disease. Written in easy-tounderstand, everyday English, this book is the result of 25 years’ experience and research in living a life with Parkinson’s disease. Filled with information, tips, and helpful hints on a wide range of topics, Caregiving for Parkinson’s will help guide you through all the many stages of caregiving. The Five Invitations: Discovering What Death Can Teach Us About Living Fully By Frank Ostaseski Flatiron Books Kindle, print Death is not waiting for us at the end of a long road. Death is always with us, in the marrow of every passing moment. She is the secret teacher hiding in plain sight, helping us to discover what matters most. Life and death are a package deal. They cannot be pulled apart and we cannot truly live unless we are aware of death. The Five Invitations is an exhilarating meditation on the meaning of life and how maintaining an ever-present consciousness of death can bring us closer to our truest selves. As a renowned teacher of compassionate caregiving and the cofounder of the Zen Hospice Project, Frank Ostaseski has sat on the precipice of death with more than a thousand people. In The Five Invitations, he distills the lessons gleaned over the course of his career, offering an evocative and stirring guide that points to a radical path to transformation. The Five Invitations: • Don’t Wait •W elcome Everything •P ush Away Nothing •B ring Your Whole Self to the Experience •F ind a Place of Rest in the Middle of Things •C ultivate “Don’t-Know Mind”

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Directory of Housing & Care Providers Bethany Village 325 Wesley Drive Mechanicsburg, PA 17055

717.766.0279 bvmarketingdept@asbury.org www.bethanyvillage.org

Bethany Village is a not-for-profit retirement community. Numerous residential options are available as well as assisted living, memory support, and skilled nursing services. See ad on page 11

Homeland Center 1901 North Fifth Street Harrisburg, PA 17102

717.221.7900 bramper@homelandcenter.org www.HomelandCenter.org

Homeland Hospice, HomeHealth, 717.221.7890 and HomeCare info@homelandathome.org 2300 Vartan Way, Suite 270 www.HomelandatHome.org Harrisburg, PA 17110 Homeland at Home is a community outreach of Homeland Center, providing a continuum of At Home care servicesâ&#x20AC;&#x201D;from non-medical personal assistance to skilled nursing, as well as compassionate palliative and hospice care. See ad on page 21

Messiah Lifeways 100 Mount Allen Drive Mechanicsburg, PA 17055

717.591.7225 life@messiahlifeways.org www.messiahlifeways.org

Messiah Lifeways offers more options for caregivers and the ones they love, including: support groups, workshops, free coaching, our Adult Day and At Home services, and respite. See ad on page 13 Pleasant View Communities 544 North Penryn Road Manheim, PA 17545

717.665.2445 info@pleasantviewrc.org www.pleasantviewrc.org

As a nonprofit Life Plan Community, Pleasant View brings together the very best in faith-based living and modern health care with a full range of living options.

Senior LIFE Harrisburg 1910 Manada Street Harrisburg, PA 17104

717.234.5433 (TTY: 711) info@seniorlifepa.com www.seniorlifepa.com

Senior LIFE provides complete medical care and supportive services for seniors so that they can remain at home. No-cost services for those who qualify.

Color Key For Directory of Caregiving Providers Independent Residences Personal Care Home Assisted Living Residence Dementia Units Nursing Care Community Rehabilitation Facility Respite Care Adult Day Center Home Care Services Hospice Care Palliative Care BUSINESSWoman caregiver solutions 2019

717.975.9762 jzarker@cparc.org www.cparc.org

Providing daytime compassionate care and support to participants and their caregivers. Social and recreational activities, trained staff, and lunch provided.

Homeland Center, a continuing care retirement community, offers beautiful personal care suites, skilled nursing, rehabilitation, and dementia care. Our community outreach programs serve 14 counties throughout south-central Pennsylvania and include Hospice, HomeHealth, and HomeCare. See ad on page 21

Life Time Adult Day Care 3 Crossgate Drive Mechanicsburg, PA 17050

Senior LIFE York 1500 Memory Lane Ext. York, PA 17402

717.757.5433 (TTY: 711) info@seniorlifepa.com www.seniorlifepa.com

Senior LIFE provides complete medical care and supportive services for seniors so that they can remain at home. No-cost services for those who qualify.

SpiriTrust Lutheran 1050 Pennsylvania Avenue York, PA 17404

717.854.3971 mwilliams@spiritrustlutheran.org www.spiritrustlutheran.org

For 60 years, SpiriTrust Lutheran has been providing seniors throughout York, Adams, and Franklin counties with homes and services designed to meet their needs. See our ad and listings for locations and contact information. See ad on page 32

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Directory of Housing & Care Providers SpiriTrust Lutheran, The Village at Gettysburg 1075 Old Harrisburg Road Gettysburg, PA 17325 See ad on page 32

717.334.4443 jkeefer@spiritrustlutheran.org www.spiritrustlutheran.org

SpiriTrust Lutheran, The Village at Sprenkle Drive 1802 Folkemer Circle York, PA 17404 See ad on page 32

SpiriTrust Lutheran, The Village at Kelly Drive 750 Kelly Drive York, PA 17404 See ad on page 32

717.854.5010 jgochoco@spiritrustlutheran.org www.spiritrustlutheran.org

SpiriTrust Lutheran, The Village at Utz Terrace 2100 Utz Terrace Hanover, PA 17331 See ad on page 32

SpiriTrust Lutheran, The Village at Luther Ridge 2736 Luther Drive Chambersburg, PA 17202 See ad on page 32

SpiriTrust Lutheran, The Village at Shrewsbury 800 Bollinger Drive Shrewsbury, PA 17361 See ad on page 32

717.261.1251 edoub@spiritrustlutheran.org www.spiritrustlutheran.org

Visiting Angels 1840 East Market Street York, PA 17402

717.764.9994 hbair@spiritrustlutheran.org www.spiritrustlutheran.org

717.637.0633 lsterner@spiritrustlutheran.org www.spiritrustlutheran.org

717.751.2488 information@visitingangelsyork.com www.visitingangels.com

Providing in-home, non-medical care to older adults in York, Lancaster, and Hanover. Specializing in dementia care for adults and their families. See ad on page 15 717.235.5737 pmitchell@spiritrustlutheran.org www.spiritrustlutheran.org

Visiting Angels 4607 Locust Lane Harrisburg, PA 17109

717.652.8899 717.737.8899 visitingangelshbg@comcast.net www.visitingangels.com

Care Options Home Health Care may be provided in a residential setting or as ancillary services wherever you call home. May be medical home health or non-medical services, such as light housekeeping, transportation to doctor visits, shopping, respite, and more. Hospice Care is for families living and coping with a life-limiting illness. Hospice provides professional treatment of pain and symptom management with support and counseling. Assisted Living Residences (ALRS) are designed to provide housing and supportive services to allow residents to â&#x20AC;&#x153;age in place.â&#x20AC;? As of January 2011, licensure requirements for ALRs became effective.

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CCRCs are communities offering a variety of living options in addition to comprehensive medical and nursing services. Retirement Communities and 55+ Adult Communities are planned for active individuals who are able to care for their own basic needs but want to live with other 50+ mature adults. Nursing/Rehab Facilities offer skilled or intermediate levels of care. Intermediate Care Facilities are for individuals who can move around the facility on their own initiative, even in a wheelchair, and are not bed bound. Skilled Nursing Facilities are for patients who require 24-hour nursing supervision, many of whom are confined to bed for some portion of the day.

Personal Care Homes offer food, shelter, and personal assistance or supervision. They are ideal for people who do not require the services of a long-term care facility but need help with transferring in and out of a bed, toileting, personal hygiene, and other activities of daily living. Respite Care provides normal caregiving opportunities on a short-term basis. May range from personal to nursing care, at home or in a care community. Adult Day Centers offer programs in facilities or independent organizations for hourly or daily adult supervision.

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Directory of Ancillary Services Area Agencies on Aging Chester County Area Agency on Aging Cumberland County Aging and Community Services Dauphin County Area Agency on Aging Lancaster County Office of Aging Lebanon County Area Agency on Aging York County Area Agency on Aging See ad on this page

610.344.6350 717.240.6110 717.780.6130 717.299.7979 717.273.9262 717.771.9610 www.p4a.org

Complementary Assistance Cumberland County Aging and Community Services 1100 Claremont Road Carlisle, PA 17015

717.240.6110 aging@ccpa.net www.ccpa.net/119/AgingCommunity-Services

Provides service coordination for LTSS (Long-Term Services and Supports) Waiver Program participants in Cumberland, Perry, and Dauphin counties. Dauphin County Area Agency On Aging 717.780.6130 2 South Second Street info@dauphinc.org Harrisburg, PA 17101 www.dauphincounty.org Dauphin County Area Agency On Aging provides services to older adults who reside in Dauphin County and are age 60 or older.

Lancaster County Office of Aging Caregiver Support Program 150 North Queen Street, Suite 415 Lancaster, PA 17603

717.299.7979 800.801.3070 aging@co.lancaster.pa.us www.lancoaging.org

The Caregiver Support Program provides caregivers with benefits counseling and reimbursement for related expenses and home modifications.

Legal Nikolaus & Hohenadel, LLP Barbara Reist Dillon, Wanda S. Whare 212 North Queen Street Lancaster, PA 17603

717.299.3726 bdillon@n-hlaw.com wwhare@n-hlaw.com www.n-hlaw.com

Areas of expertise include: elder law, wills, powers of attorney, living wills, medical powers of attorney, and estate settlement. Offices in Lancaster, Columbia, Elizabethtown, and Strasburg.

Medicare MediPlanConnect 6360 Flank Drive, Suite 1100 Harrisburg, PA 17112

717.980.3201 www.mediplanconnect.com

MediPlanConnect is an insurance and advisory service company licensed to sell Medicare Advantage plans, Medicare Supplement plans, prescription drug plans, and other ancillary health and life products. See ad on page 7

Responding to the Needs of Americans 60 and Over

Advocacy. Action. Answers on Aging. www.p4a.org

Contact your local agency for assistance (See listings above). 30

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— Support and Information — AgingCare.com 239.594.3222 www.agingcare.com

Eldercare Locator 800.677.1116 www.eldercare.gov

All About Vision www.allaboutvision.org

Epilepsy Foundation of America 800.332.1000 www.epilepsy.com

American Cancer Society Response Line 800.227.2345 www.cancer.org

National Institute of Mental Health Information Line 866.615.6464 www.nimh.nih.gov National Library Service for the Blind & Physically Handicapped 888.657.7323 www.loc.gov/nls

EyeCare America 877.887.6327 www.eyecareamerica.org

National Parkinson Foundation, Inc. 800.473.4636 www.parkinson.org

American Diabetes Association 800.342.2383 www.diabetes.org

Family Caregiver Alliance 800.445.8106 www.caregiver.org

American Speech Language-Hearing Association 800.638.8255 www.asha.org

Guide Dog Foundation for the Blind 800.548.4337 www.guidedog.org

American Urological Association 410.689.3700 or 866.746.4282 www.auanet.org Arthritis Foundation Information 800.283.7800 www.arthritis.org

Medicare 800.633.4227 www.medicare.gov

Needy Meds 800.503.6897 www.needymeds.org Office of Minority Health Resource Center 800.444.6472 www.minorityhealth.hhs.gov PACE/PACENET 800.225.7223 www.aging.state.pa.us/aging

Medicare Rights 800.333.4114 www.medicarerights.org Medicare Telephone Hotline 800.633.4227 www.medicare.gov

Pennsylvania Department of Human Services 800.692.7462 www.dhs.pa.gov

CareCentral www.carecentral.com

National Alliance for Caregiving 301.718.8444 www.caregiving.org

Rural Information Center 800.633.7701 www.nal.usda.gov/ric

Caregiver Action Network 202.454.3970 www.caregiveraction.org

National Clearinghouse for Long-Term Care Information www.longtermcare.gov

RxAssist www.rxassist.org

Caregiver Media Group 800.829.2734 www.caregiver.com

National Council on Alcoholism & Drug Dependence, Inc. 212.269.7797 www.ncadd.org

BenefitsCheckUp 571.527.3900 www.benefitscheckup.org

Christopher & Dana Reeve Foundation 800.225.0292 www.christopherreeve.org Community Action Network www.caregiveraction.org Crohn’s and Colitis Foundation of America, Inc. 800.932.2423 www.ccfa.org www.BusinessWomanPA.com

National Health Information Center 240.453.8281 www.health.gov/nhic National Institute on Aging Information Center 800.222.2225 www.nia.nih.gov

Shriners Hospital for Children Referral Line 800.237.5055 www.shrinershospitalsforchildren.org Simon Foundation for Continence 800.237.4666 www.simonfoundation.org Veterans Administration 855.260.3274 www.caregiver.va.gov

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Six conveniently located communities with a continuum of care, a spirit of service and a legacy of trust…what more could a daughter or son wish for their parents!

If you worry about your parents maintaining their home as they age, living alone, their safety or even their health, a SpiriTrust Lutheran® senior living community can give you more time to enjoy family time and less time worrying about the “what-ifs” in their future. Our communities offer a continuum of care that includes: • Maintenance-free living in one of our residential communities, • Support with daily activities in one of our personal care or assisted living neighborhoods, • Specialized care in our new Assisted Living Memory Support neighborhood, • Short-term rehabilitation or nursing care in one of our skilled care centers. Our spirit of caring has enhanced the lives of seniors and earned the trust of thousands. Come discover the SpiriTrust Lutheran difference for yourself.

• The Village at Gettysburg, Gettysburg • The Village at Kelly Drive, York • The Village at Luther Ridge, Chambersburg

• The Village at Shrewsbury, Shrewsbury • The Village at Sprenkle Drive, York • The Village at Utz Terrace, Hanover

Call us to learn more or schedule a personal tour.

888-404-3500 • www.SpiriTrustLutheran.org

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