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Thank you for picking up Caregiver Solutions magazine. We endeavor to bring you relevant information for your caregiving journey.

Caregiving — it can bring loved ones closer together. But it can also bring challenges along the way. There are many things to consider, from health and financial concerns to keeping your loved one as active as their mobility will allow.

You may be helping out on a limited basis now, but juggling your day-to-day activities with your new responsibilities can become hectic. Over time, additional obligations may make you feel overwhelmed.

The articles included in this magazine offer help, whether you’re a novice or a veteran caregiver.

Did you know that a common condition in many seniors, hearing loss, may be disastrous for more than just hearing? It can lead to becoming unbalanced, which leads to falls, often ending in a broken bone. Read how a hearing aid and other strategies may help prevent detrimental falls.

Many caregivers haven’t thought ahead about what will happen after their loved one has been hospitalized. Check out the article on options the discharged patient will have. As a caregiver, now is a good time to look into personal care/assisted living communities, nursing/rehabilitation facilities, and home health, home care, and hospice agencies so you’re somewhat familiar with what each offers.

Did you know there are Pennsylvania and federal Caregiver Support Programs? Find out if you qualify for some or all of the benefits offered.

And what happens after your loved one has passed away? You’ll find some guidance for handling Social Security as well as for learning how to live alone.

You will also find books that can offer insight others have gained through their expertise or experience, in addition to support organizations you may want to connect with.

Your local Office of Aging is ready to assist in a plethora of ways through their programs and services. Don’t forget that they are just a call away.

When it Comes to Dementia, ‘Living in the Moment’ Can Help

By TERRI SCHLICHENMEYER

Dad used to pride himself on being handy.

He could make anything, imagine anything, fix anything. He was handy, from tools to toys and kitchens to kids. But last week, Dad got lost on his way home from the grocery store, a trip he’s made once a week for 30 years, and it scared you both.

You might imagine what’s coming; find Living in the Moment by Elizabeth Landsverk, M.D., with Heather Millar, and be prepared for it.

So you noticed some memory or cognitive issues, and Dad’s not himself lately. How do you know if this new behavior is eccentricity or early dementia? Is this a normal sign of aging, or is it outside of normal?

What kind of dementia might he suffer from, and to what degree? You’ll want to get an official diagnosis, so you know what to do in the future, and why.

The first thing to know about what Dad’s going through is that dementia doesn’t mean “it’s all over.” There’s still plenty of life ahead for you both, perhaps for many years to come.

Next, remember that your loved one isn’t “trying to be difficult.” Their wild, out-of-the-ordinary behavior can’t be helped, and the disease is “so uncertain, so uneven.”

There are many possible ways to deal with forgetfulness, frustration, anger, and acting out, and there are things to avoid. Says Landsverk, solutions can sometimes

be pleasant, even delightful.

Because Alzheimer’s and dementia cannot be cured, have a plan in place for your loved one’s care, but review it often. Things will change as time and the disease progress, so be willing to look at the bigger picture. That includes thinking about endof-life issues, power of attorney papers, and legal and financial protections for the long term.

Watch for scams; there are too many people who prey on our vulnerable seniors. Encourage physical activity, a good diet, and as much autonomy as currently possible. Learn how to craft a workaround for the easier-to-deal-with issues. And remember that “it takes a village to care for an elder with dementia” and “you are not alone.”

The sand is not your friend.

It’s certainly not where you want to stick your head when a loved one shows signs of dementia, because that life’s not a beach. No, it’s manageable, and Living in the Moment can help.

Though it’s perhaps not as thorough or comprehensible as you may want later, author Landsverk (with author Millar) says in her introduction that she wanted this book to be easy to use.

She succeeded, with a broad overview of the basics, things to know now, medicines that will and won’t work, problems to watch out for, and what to ready yourself for in the future. The case studies inside this book are strong and are scary enough to spur quick action, and they’re balanced

with quiet paragraphs of comfort. This book is great for caregivers, but it’s also an essential read for anyone who’s any way related to a dementia patient. Find Living in the Moment and keep it handy.

Terri Schlichenmeyer has been reading since she was 3 years old, and she never goes anywhere without a book. She lives on a hill in Wisconsin with two dogs and 14,000 books. Read other book reviews in 50plus Life, a monthly publication for boomer and seniors. Check it out at 50plusLifePA.com.

Do Word Choices Matter?

Teepa Snow and Positive Approach to Care believe

the words we choose are incredibly important and have made several shifts …

By POLLY LOGAN, PAC TEAM M EMBER

At Positive Approach to Care, we believe that the specific words we choose to use are incredibly important.

Over the years, we have had several shifts in the words and terminology that we use surrounding the topic of brain change.

We spoke with two individuals, Don Kent and Mel Sebastiani, to hear their opinions on this topic. Don is a retired attorney who lives in Texas, and Mel is a retired television producer and writer, currently living as a photographer and artist, who resides in Delaware. Both also live with Lewy body dementia.

One of the phrases we avoid using at Positive Approach to Care is “suffering from dementia.”

We feel that those of us who are living with healthy brains do not have the right to decide whether or not someone living with brain change is “suffering.”

When asked how he feels about the phrase, Don says he strongly dislikes it. He explains that he certainly does have challenges related to his condition but definitely would not describe his dayto-day existence as “suffering.”

Just a few months ago, Don accomplished the amazing feat of climbing the 8,751 feet of Guadalupe Peak, the highest mountain in Texas! To train for this adventure, he reported that he walked more than 1,100 miles and lost 90 pounds in the process. Don feels that he is living the best life he can with Lewy body.

Mel agrees that the phrase “suffering from dementia” is one she despises. She feels it implies that the individual is self-pitying and has a bit of a victim mentality. She thinks it also suggests the person has no quality of life. Like Don, Mel lives as well as possible with her condition and enjoys spending time taking photographs of the beautiful beach near her home.

Both Mel and Don state that the term “dementia” is one they strongly dislike as well. They feel the term carries a wide assortment of negative connotations, stigmas, and stereotypes. When people hear the word, they often associate it with someone who is in a very late state of dementia and don’t realize that people with the condition are capable of living well and having productive lives.

Don mentions that he feels the term “dementia” causes many people to discount or look down on those who are living with it. He shares a story of a meeting with his financial advisor, with whom he had had a relationship for 30 years. When he informed the individual that he had been diagnosed with Lewy body dementia, the financial advisor turned from Don and immediately started only speaking to Don’s wife.

Mel adds that, for many people, the term conjures up very negative images of “drooling fools who cannot be trusted and whose opinions don’t matter.” She says if she tells most people that she has dementia, she can instantly see a variety of negative emotions pass over their faces, such as horror, pity, disgust, and fear.

Instead of “dementia,” both Don and Mel prefer the phrase “living with brain change.”

They state that the old term should be abandoned altogether at this point, the way the use of negative terminology once used to describe those living with developmental disabilities has largely been discontinued. They also do not care for dementia to be called a “disease” and prefer the term “condition” instead.

Another language shift PAC has recently made is using the terms “typical and atypical” instead of “normal and abnormal” to explain different brains. Don feels that “normal/abnormal” doesn’t bother him as much as some other words. However, Mel says she does prefer the terms “typical/atypical” because she feels it is a better way of quantifying brain changes on a spectrum.

Both Don and Mel strive to change societal perceptions by showing that people living with brain change can set goals, work toward them, and live well.

Don points out that many people who have a diagnosis of brain change choose to keep it a secret, so people you know may or may not be living with such a condition. They both agree that the words and terminology used can make an incredible difference in either perpetuating negative stereotypes or helping to challenge them.

The way we talk about dementia and people living with the condition matters.

Help those affected by dementia by choosing to use terminology that is respectful and dignified clarifies they are people first.

We thank Don Kent and Mel Sebastiani for their contributions to this article.

Go to teepasnow.com/positive-approach-to-care-language for key phrases and ways of talking about dementia and care.

Positive Approach to Care® (PAC), founded by renowned dementia care educator Teepa Snow, is a dementia-care education company specializing in improving lives by empowering caregivers with highly effective, handson care skills and techniques. To learn more, please visit teepasnow.com or contact info@teepasnow.com

Copyright © 2023 Positive Approach, LLC. All rights reserved.

To Transfer or Not to Transfer: Deed Transfers as a Tool of the Estate Planning Process

By CHRISTOPHER R. GRAB, ESQUIRE

As someone who frequently meets with clients aged 65 and up regarding the estate planning and administration processes in Pennsylvania, one of the most common questions I am asked is: “Should I add my child’s name to my deed now, as opposed to leaving my child the real estate in my will?”

The answer — as with many things in life — is: It’s a bit complicated.

Many times clients, for one reason or another, believe that adding a child’s name to a deed is best practice because it “avoids probate.” This is true; generally speaking, only assets owned solely by a decedent are required to pass to beneficiaries through the probate process (i.e., the opening and administering of an estate).

However, while the creation of joint ownership in real estate may avoid the probate process, there are still several important considerations to bear in mind prior to proceeding with an inter vivos (lifetime) deed transfer to a child.

1. The Avoidance of Probate vs. Inheritance Tax

Many people assume that “avoiding probate” is synonymous with avoiding Pennsylvania inheritance tax.

For context: Pennsylvania imposes inheritance tax on the

date of death value of almost any property (real or personal) passing to beneficiaries as a result of the death of a decedent. In Pennsylvania, the rate of the inheritance tax is determined based upon the marital or blood relationship between the person receiving the property and the decedent. The inheritance tax rate is 4.5% for transfers of property from a decedent to a “lineal descendent” (e.g., a child or grandchild).

Pennsylvania has one of the most robust inheritance tax regimes in the country. Nearly all property inherited as a result of the decedent’s passing will be subject to inheritance tax. In Pennsylvania, even property jointly owned by a decedent and another person (for example, a child) will be subject to inheritance tax.

Thus, I always note to clients that attempting to avoid probate by jointly titling property does not equate to avoiding inheritance tax. Adding a child’s name to a deed may reduce the amount of inheritance tax owed, but it will not avoid inheritance tax entirely.

2. Capital Gains Tax Consideration

Another important consideration of an inter vivos deed

transfer made as part the estate planning process involves federal capital gains tax and the concept of “basis.”

The term “basis” is used in various contexts in the Internal Revenue Code. Broadly speaking, it represents the price actually paid by an individual for an asset.

A capital gains tax is generally calculated by taking the fair market value of an asset at the time of its sale by an owner, minus the owner’s basis in the asset.

For example: If you purchased an asset in 1980 for $100,000 and sell the asset in 2024 for $300,000, you would (generally speaking) have a capital gain of $200,000, subject to tax. This gain will be taxable at federal capital gains rates — some of the highest tax rates currently enacted under the federal tax structure.

Importantly, the Internal Revenue Code exempts certain asset sales from being subject to capital gains tax. Most importantly for our purposes, the sale of a primary residence is not subject to capital gains tax (with certain value limitations). Conversely, the sale of real property other than a primary residence is (potentially) subject to capital gains tax.

Consider the following hypothetical scenario: As part of Parent’s estate plan, Child is added to Parent’s deed as a joint owner with right of survivorship. Parent then dies, so Child becomes the sole owner of the real property. Child, however, has his or her own separate residential real estate and has not used Parent’s property as Child’s primary residence.

When Child sells Parent’s real estate, Child (because the real estate is not the primary residence of Child) may be subject to a capital gains tax. Furthermore, Child will be forced to use Parent’s basis in the property to compute the appropriate amount of the capital gains tax.

Continuing the same hypothetical, if Parent paid $30,000 for the property, this represents Parent’s basis. If Child sells the property for $100,000, this creates a theoretical gain of $70,000 that could be fully taxable at capital gains rates to Child.

One benefit of having real property transfer to a beneficiary upon the passing of a decedent (as opposed to a lifetime inter vivos gift) is that the recipient of the real property may utilize what is known as “stepped-up basis.” In essence, “stepped-up basis” means that, for capital gains tax purposes, the basis in the real property is modified or “stepped up” from the original purchase price of the real estate to its fair market value at the time of the decedent’s death.

Consider the following hypothetical: Parent purchased real property in 1980 for $30,000. Parent dies in 2024, and Parent’s last will and testament provides that Child shall receive the real property. Assume that at the time of Parent’s passing in 2024, the real property has a fair market value of $90,000.

If, after Parent’s passing, Child were to sell the property for $100,000 — again, assuming the property is not Child’s primary residence — Child is only responsible for $10,000 of capital gains tax.

This is because when real property passes as a result of Decedent’s death (as opposed to a lifetime, inter vivos gift), Child receives the benefit of a stepped-up basis — the value of the asset at the time of Parent’s death. Using the figures from the preceding hypothetical, Child’s basis becomes $90,000 as opposed to the Parent’s original basis of $10,000.

3. Medicaid

Many clients want to add an adult child’s name to their deed during their lifetime in an attempt to shield the asset from longterm care (nursing home) expenses. Many of the clients I meet with ask whether “the nursing home can take my house to pay for my care if my child is on the deed?”

Again — as with all lifetime gifts — the answer is complicated and often fact-specific. Medicaid regulations are ever-evolving and require careful analysis; accordingly, the following information is intended only as a very generalized overview. If you are in need of specific advice, you should always seek counsel from a qualified elder law or long-term care planning attorney.

Medicaid is a combination federal/state program that may be available to qualified individuals to help cover costs of certain long-term and/or nursing home care. An important consideration before applying for Medicaid is what is commonly known as the “five-year look-back period.”

When an individual applies for Medicaid long-term care benefits, the Pennsylvania Department of Human Services reviews the applicant’s financial records going back five years from the date of application to determine whether any assets owned by the applicant were transferred or given away for less than fair market value (i.e., a gift).

Such gift transfers can include conveyances of interests in whole, or in part, of real estate owned by the applicant. If a gift of more than $500 occurred within the five-year look-back period, a “transfer penalty” may be imposed by Medicaid. A transfer penalty is a period of ineligibility for Medicaid long-term care benefits (meaning that the applicant, as opposed to Medicaid, must bear the responsibility of payment for care services during the ineligibility period).

Consequently, if an individual has transferred part of their ownership interest in real property for nominal consideration (as is typically the case with interfamily deed transfers) during the five-year look-back period, the individual has likely violated the Medicaid rule against such transfers.

While a nursing home or care facility cannot “take” your home in a strictly legal sense, it may nonetheless become necessary to sell the home to pay for the cost of care in the event a transfer penalty is imposed.

4. In Closing

As indicated above, adding a child’s name to a deed as part of an estate plan can be fraught with potential risk and pitfalls for the unwary. There are important inheritance tax, capital gains tax, and Medicaid consequences to consider prior to transferring any ownership interest in real property to a child.

Anyone contemplating such a transfer would be well advised to speak with an experienced estate planning or elder law attorney.

Christopher R. Grab, Esquire, Wanda S. Ware, Partner, and Barbara Reist Dillon, Partner, are attorneys with Nikolaus & Hohenadel, LLP. Nikolaus & Hohenadel, LLP has a practice with a focus in elder law/ estate planning. See our information in the Directory of Ancillary Services – Legal, pg. 29.

Getting Paid as a Family Caregiver

By JIM MILLER

Dear Savvy Senior,

I have been taking care of my elderly father for over a year, and it’s taking a toll on my finances because I can only work part-time. Are there any resources you know about that can help family caregivers get paid?

– Seeking Support

Dear Seeking,

Caring for an elder parent can be challenging in many ways, but it can be especially difficult financially if you have to miss work to provide care.

Fortunately, there are a number of government programs and other tips that may be able to help you monetarily while you care for your dad. Here are some options to explore.

Medicaid Assistance

All 50 states and the District of

Columbia offer self-directed Medicaid services for long-term care. These programs let states grant waivers that allow income-qualified individuals to manage their own long-term home-care services. In some states, that can include hiring a family member to provide care.

Benefits, coverage, eligibility, and rules differ from state to state. Program names also vary. What’s called “consumerdirected care” in one state may be called “participant-directed services,” “inhome supportive services,” or “cash and counseling” in another.

Medicaid in Pennsylvania participates in Personal Assistant Services (PAS). This program provides services to family members and pays them to assist with the services related to care for activities of daily living (ADL) and instrumental activities of daily living (IADL).

Veterans Benefits

If your dad is a military veteran, there are several different VA programs he may be eligible for that provide financial assistance to family caregivers, including:

Veteran-Directed Care: Available in most states, this program provides a needsbased monthly budget for long-term care services (va.gov/geriatrics/pages/veterandirected_care.asp).

Aid & Attendance or Housebound benefits: These programs provide a monthly payment to veterans and survivors who receive a VA pension and who either need assistance with activities of daily living (e.g., bathing, dressing, going to the bathroom) or are housebound (va.gov/pension/aid-attendancehousebound).

Program of Comprehensive Assistance for Family Caregivers: This provides a monthly stipend to family members who serve as caregivers for veterans who need assistance with daily living activities because of an injury or illness sustained in the line of duty (caregiver.va.gov/support/support_benefits. asp).

Other Options

If your dad has some savings or other assets, discuss the possibility of him paying you for the care you provide, or talk to your siblings to see if they can chip in.

If they agree, consider drafting a shortwritten contract that details the terms of your work and payment arrangements, so everyone involved knows what to expect. A contract will also help avoid potential problems should your dad ever need to apply for Medicaid for nursing home care.

Also, check to see if your dad has any long-term care insurance that covers inhome care. If he does, in some cases those benefits may be used to pay you.

Tax Breaks

There are also tax credits and deductions you may be eligible for as your dad’s caregiver that can help.

For example, if your dad lives with you and you’re paying at least half of his living expenses, and his gross income was less than $5,500 (in 2024) not counting his Social Security, you can claim him as a dependent on your taxes and get a tax credit.

If you can’t claim him as a dependent, you may still be able to get a tax deduction if you’re paying more than half his living expenses, including medical and long-term care costs, and they exceed 7.5% of your adjusted gross income. You can include your own medical expenses in calculating the total. To see which medical expenses you can deduct, see IRS Publication 502 at irs.gov/pub/irs-pdf/p502.pd f.

Or, if you’re paying for in-home care or adult daycare for your dad so you can work, you might qualify for the Dependent Care Tax Credit, which can be worth as much as $1,050. To claim this credit, you’ll need to fill out IRS Form 2441 (irs.gov/pub/irs-pdf/ f2441.pd f ) when you file your federal return.

Jim Miller is a contributor

By JIM MILLER

How Medicare Covers Physical Therapy Services

Dear Savvy Senior,

Does Medicare cover physical therapy, and if so, how much coverage do they provide? My 66-year-old husband was recently diagnosed with Parkinson’s disease and will need ongoing physical therapy to help keep him moving.

– Worried Wife

Dear Worried,

Yes, Medicare does indeed pay for physical therapy along with occupational and speech therapy too, if he needs it, as long as it’s prescribed by his doctor. You’ll also be happy to know that Medicare has no limits on how much it will pay for therapy services, but there is an annual coverage threshold you should be aware of.

Here’s what you should know.

Outpatient Therapy

To get Medicare Part B — which covers outpatient care — to help cover your husband’s physical therapy, it must be considered medically necessary and will need to be ordered by his doctor. The same holds true for occupational and speech therapy.

He can get these services as an outpatient at a number of places, like a doctor or therapist office; in a hospital outpatient department; at an outpatient rehabilitation facility; at skilled nursing facilities if he is being treated as an outpatient; and at home through a therapist connected with a home health agency when he is ineligible for Medicare’s home health benefit.

For outpatient therapy, Medicare will pay 80% of the Medicareapproved amount after you meet your Part B deductible ($240 in 2024). You will be responsible for the remaining 20% unless you have supplemental insurance.

But be aware that if his therapy costs reach $2,330 in a calendar

year (2024), Medicare will require his provider to confirm that his therapy is still medically necessary. Medicare used to set annual limits on what it would pay for outpatient therapeutic services, but the cap was eliminated a few years back.

You also need to know that treatment recommended by a physical therapy provider but not ordered by a doctor is not covered. In this situation, the therapist is required to give your husband a written notice, called an Advance Beneficiary Notice of Noncoverage, or ABN, that Medicare may not pay for the service. If he chooses to proceed with the therapy, he is agreeing to pay in full.

Inpatient Therapy

If your husband happens to need physical therapy at an inpatient rehabilitation facility, like at a skilled nursing facility or at your home after a hospitalization lasting at least three days, Medicare Part A — which provides hospital coverage — will pick up the tab.

To be eligible, his doctor will need to certify he has a medical condition that requires rehabilitation, continued medical supervision, and coordinated care that comes from his doctors and therapists working together.

Whether you incur out-of-pocket costs such as deductibles and coinsurance, and how much they are, will depend on the setting for the treatment and how long it lasts. For more information on inpatient therapy out-of-pocket costs, see medicare. gov/coverage/inpatient-rehabilitation-care.

Medicare Advantage Coverage

If your husband is enrolled in a Medicare Advantage plan (like an HMO or PPO), these plans must cover everything that’s included in original Medicare Part A

and Part B coverage.

However, some Advantage plans may require a person to use services from physical therapy practices within an agreed network. If he has an Advantage plan, you’ll need to contact his specific plan before selecting a physical therapy provider to confirm they’re within the network.

More Questions?

If you have other questions about coverage and costs for therapeutic services,

call Medicare at 800.633.4227 or contact your State Health Insurance Assistance Program (SHIP), which provides free Medicare counseling. Visit shiphelp.org or call 877.839.2675 to connect with a local SHIP counselor.

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

Hearing Loss and Falls: Why They’re Connected

New study finds hearing aids are linked to a lower fall risk in older adults

By TEMMA EHRENFELD

A growing body of research suggests that hearing loss contributes to falls, but hearing aids can be a useful preventative tool.

For older people, falls are a big fear. As we age, our hearing and balance naturally decline. More than 1 in 4 Americans age 65 or older falls every year, the Centers for Disease Control and Prevention (CDC) reports

Even if the person is not hurt, a tumble is frightening. People tend to retreat to their chairs, which sets off a bad cycle: You move less, you become weaker, and are more likely to fall again.

Here’s a simple test of your risk: Stand on one leg. In a small study of women in their 70s, the chance of a hip fracture dropped by 5% for every second they could stand on one leg with their eyes open.

Hearing and Balance: How They’re Connected

How does hearing fit in? In the ear, balance and hearing are directly connected, sharing a common nerve pathway to the brain. What you hear (and don’t hear) directly affects your balance, according to a research overview led by Anat Lubetzk y, Ph.D., assistant professor in the Physical Therapy Department at New York University, with a team at New York Eye and Ear Infirmary.

This is especially important if your balance isn’t the best.

“Most of us in the field believe that people with poor balance benefit a lot from auditory cues,” says Timothy Hulla r, M.D., a professor of otolaryngology at Oregon Health and Science University.

Why Hearing Loss Matters

A 25-decibel hearing loss — equivalent to going from normal to mild hearing loss — triples your chance of falling, according to a study of people aged 40-69. That’s when hearing loss often first develops, and you’re less likely to guard against falls.

Another study, from a team at the University of Michigan, analyzed data on nearly 115,000 seniors newly diagnosed with hearing loss (but otherwise healthy). It found that 13% had an injury in a fall within three years, compared to 7.5% of the general population their age.

Reasons Hearing Loss May Increase Risk of Falling

Hearing taps your brain reserves. If you’re concentrating harder to interpret sound, you may have less mental resource available for balance.

“Gait and balance are things most people take for granted, but they are actually very cognitively demanding,” says otologist Frank Lin, M.D., Ph.D., from the Johns Hopkins School of Medicine.

Aging affects both hearing and balance. Age-related hearing loss may be linked to declines in the vestibular sense, a set of receptors in your inner ear, which comes into play whenever you move your head. It’s also activated by the downward force of gravity, giving you a sense of where you are: your grounding. If you’ve ever had an infection of the inner ear, you’ll recall you were dizz y

However, you don’t need to be dizzy to have vestibular issues. Some evidence suggests the vestibular sense may begin to decline at about the age of 40. More than a third of all Americans older than 40 are unable to pass a balance test — standing on foam with their eyes closed — that is linked to a higher risk of falling.

Loud low-frequency sounds (think pounding drums) may damage the inner ea r, over time affecting our balance (and hearing).

To be clear, age-related hearing loss and inner ear problems are not the same thing and don’t always occur simultaneously.

“Many people with vestibular disorders have excellent hearing, and not all people with hearing loss will have vestibular weakness,” Lubetzky told me.

Sounds help us balance. If you try to balance on one leg in a yoga class, for example, your teacher will tell you to stare at one spot. Stable sounds may work the same way, Lubetzky explained, as a kind of “auditory anchor.” But you have to hear them.

This process may be especially important if you have hearing loss. For example, when people with hearing loss hear stable background sounds, their posture improves.

Balance arises from the contributions of several senses: vision, the coordination between our head and our eyes, our muscle and joint coordination — and, possibly, what we hear.

Hearing loss is linked to mood. People may be less alert when caught up in a fog of misery or anxiety. Hearing loss increases the risk of depression. Depression is linked to more falls, and those falls tend to deepen depression in another classic bad cycle.

Do Hearing Aids Help Prevent Falls?

Most likely. A 2023 study shows that consistent use of hearing aids is associated with a lower risk of experiencing a fall in older adults with hearing loss. The research was conducted by University of Colorado-Anschutz Medical Campus.

The University of Michigan study found that a first-time hearing aid cut the risk of a fall-related injury by 13 percentage points in the next three years.

It’s possible that treating “hearing loss (with hearing aids or other implants) serves as a type of ‘balance aid’ like a cane,” says otolaryngologist Maura Cosetti, M.D., co-author of the New York Eye and Ear Infirmary study. The bottom line: If you’re concerned about your balance and you have hearing loss, hearing better may make a difference.

How to Prevent Falls

Keep moving. Walking, balance exercises, and resistance exercises to strengthen muscles can keep seniors on their feet. You can build strength and improve your balance in as little as two 15- to 20-minute sessions a week, Finnish researchers repor t Tai chi classes, an ancient Chinese practice, are popular among older people. An hour of tai chi from one to three times a week can cut the risk of a bad fall by half, according to a review of 10 randomized controlled trials.

The National Council on Aging recommends a program called “Tai Chi for Arthritis” for older people. You may feel more comfortable in a tai chi class (or any kind of class) if you can easily hear the teacher and converse with other students. Or consider a water aerobics class.

If you do fall, strength-training will make you less likely to break a bone. Working out with resistance bands or weights or doing resistance exercises makes your bones denser and therefore stronger, which is important since hearing loss is also linked to osteoporosis. Squats, for example, built bone mass in a group of postmenopausal women with deteriorating bones in one study Keep in mind it’s a great idea to wear your hearing aids when exercising, too.

When did you have your last eye checkup? Tint-changing lenses and bifocals are less appropriate for older people, and you may need to change prescriptions.

Another reason to keep up to date on vision loss? Studies indicate hearing and vision loss — known as dual sensory impairment — equals “substantial” risk for dementia.

Consider physical therapy, if you or your older loved one has trouble walking or getting up from a chair.

Last and perhaps most important, fall-proof the home. Have you done a walk-through, making sure the bottom and top of all stairs are well lit and the carpeting and railing secure? Secure any loose carpeting, especially in hallways. Install grab bars near the toilet and bath or shower. The CDC offers a home assessment checklist.

Temma Ehrenfeld is an award-winning journalist who covers psychology and health. You can read more of her work at temmaehrenfeld.contently.com r

How to Handle Social Security Benefits When a Loved One Dies

By JIM MILLER

Dear Savvy Senior,

How are Social Security benefits handled when someone dies? After a long illness, my 68-year-old father has only weeks left to live. I am helping my mom figure out her financial situation going forward, including what to do about my dad’s Social Security after he passes away, but I could use some help.

– Only Son

Dear Only,

I’m very sorry about the impending loss of your father. To help you and your mom understand what Social Security provides and what needs to be done when a family member dies, here are some key points you should know.

Your first order of business will be to make sure the Social Security Administration is notified when your father dies, so his monthly benefits will be stopped.

In most cases, the funeral home providing his burial or cremation services will do it. You’ll need to provide your dad’s

Social Security number to the funeral director so they can make the report. But, if they don’t offer that service or you’re not using a funeral home, you’ll need to do it yourself by calling Social Security at 800.772.1213.

When Benefits Stop

There are a couple of things to be aware of regarding your dad’s Social Security benefits. For starters, you need to know that a person is due no Social Security benefits in the month of their death.

With Social Security, each payment received represents the previous month’s benefits. So, if your dad were to pass away in August, the check for that month — which would be paid in September — would need to be returned if received. If the payment is made by direct deposit, you would need to contact the bank or other financial institution and ask them to return any benefits sent after your dad’s death.

Survivor Benefits

When your father passes away, your mother may be eligible for survivor benefits on his record if she’s at least age 60 (50 if disabled). Here’s how that works depending on her situation.

If your mom is currently receiving Social Security benefits based on your father’s work record, her spousal benefit will automatically convert to survivor benefits when the government gets notice of your dad’s death. She cannot receive both spousal and survivor benefits at the same time.

Widows are due between 71% (at age 60) and 100% (at full retirement age) of what the husband was getting before he died.

If, however, your mom is eligible for retirement benefits (but hasn’t applied yet), she can apply for retirement or survivor benefits when her husband passes away and switch to the other (higher) benefit later. Or, if your mom is already receiving her retirement benefits on her own work record, she could switch to survivor benefits if it offers a higher payment. She cannot, however, receive both benefits.

To apply for survivor benefits, your mom will need to call Social Security at 800.772.1213 and schedule an appointment. She can’t do it online.

You should also know that survivor benefits are available to former spouses and dependents who meet SSA qualifications — see ssa.gov/benefits/survivors

Also note that if your mom collects a survivor benefit while working and she’s under full retirement age, her benefits may be reduced depending on her earnings. See ssa.gov/pubs/en-05-10069.pd f for details.

Death Benefit

In addition to survivor benefits, Social Security will also pay a one-time payment of $255 to your mom (the surviving spouse) if she was living with your dad at the time of his death. If they were living apart, she may still receive this one-time payment if she’s collecting spousal benefits on his work record.

In the absence of a surviving spouse, the lump-sum payment can go to a son or daughter who is eligible for benefits on the deceased’s work record.

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

Frequently Asked Questions

Is there someplace I can get help with drug bills for someone in my care? Who is eligible for PACE?

• You must be 65 years of age or older.

• You must be a Pennsylvania resident for at least 90 days prior to the date of application.

• You cannot be enrolled in the Department of Human Services’ Medicaid prescription benefit.

For a single person, total income must be $14,500 or less. For a married couple, combined income must be $17,700 or less.

Prescriptions: Copay for generic drugs is $6; copay for single-source brand is $9.

Who is eligible for PACENET?

• You must be 65 years of age or older.

• You must be a Pennsylvania resident for at least 90 days prior to the date of application.

• You cannot be enrolled in the Department of Human Services’ Medicaid prescription benefit.

PACENET income limits are slightly higher than those for PACE. For a single person, total income can be between $14,500 and $33,500. For a married couple, combined total income can be between $17,700 and $41,500.

Prescriptions: Copay for generic drugs is $8; copay for single-source brand is $15.

Call your local Area Agency on Aging office for forms or for more information or go to https://pacecares.magellanhealth.com.

Effective Jan. 1, 2024, people with Medicare Part D are no longer responsible for 5% prescription cost-sharing in the “catastrophic phase” of coverage.

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 Medicare Savings Programs (MSP)?

The Medicare Savings Program helps

pay for Medicare premiums. In some cases, the Medicare Savings Program may pay Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) deductibles, coinsurance, and copayments if a beneficiary meets certain conditions. QMB, SLMB, and QI are part of the program.

Qualified Medicare Beneficiary (QMB):

The income limit is $1,275 a month if single and $1,724 a month if married. QMB helps pay for Part A premiums, Part B premiums, deductables, coinsurance, and co payments (for services and items Medicare covers).

Specified Low-Income Medicare Beneficiary (SLMB): The income limit is from QMB levels up to $1,526 a month if single and $2,064 a month if married. SLMB pay helps for Part B premiums.

Qualified Individuals (QI): The income limit is from SLMB levels up to $1,715 a month if single and $2,320 a month if married. QI pays for Part B premiums. Provides financial assistance with Medicare Part D prescription drug coverage (monthly premiums, deductibles, and drug costs).

MSP asset limits: The asset limits for QMB, SLMB, and QI are $9,430 if single and $14,130 if married.

For information, call 800.692.7462.

– Medicare.gov

What is the Medicaid spend-down program for regular Medicaid for the aged, blind, and disabled benefits and LTSS?

Individuals with incomes too high to qualify for Medicaid for the aged, blind, and disabled can enroll in Pennsylvania’s Medicaid spend-down. This program allows applicants to qualify for Medicaid by subtracting medical and long-term care expenses.

When an applicant enrolls in the Medicaid spend-down, the state determines the amount of their income that is above the income limit; this is known as “excess income.” Enrollees activate their coverage by submitting medical bills equal to this amount.

Pennsylvania usually approves spend-

down benefits in six-month increments, with additional coverage requiring new medical expenses be submitted.

In Pennsylvania, the Medicaid spenddown program covers long-term services and supports.

Income eligibility: The income limit is $425 a month if single and $442 a month if married.

Asset limits: The asset limit is $2,400 if single and $3,200 if married.

For information, call 866.550.4355.

– American Council On Aging

What are Medicare Preventive Services?

Early detection and treatment of health conditions can help reduce medical costs and maintain health. Many preventive care services are covered at a low or no cost. Talk to your doctor about preventive services available to you through Medicare.

What is the Extra Help Program?

Extra Help is a federal program that helps pay for prescription costs, premiums, deductibles, and coinsurance of Medicare prescription drug coverage for qualified beneficiaries. It is also known as the Part D Low-Income Subsidy (LIS). Persons may become eligible if certain requirements are met:

• You have Medicare Part A (hospital insurance) and/or Medicare Part B (medical insurance).

• You live in one of the 50 states or the District of Columbia.

• Your resources (excluding your primary residence) are not worth more than $34,360 if you are married and living with your spouse or $17,220 if you are not currently married or not living with your spouse. (Do not count your home, vehicles, personal possessions, life insurance, burial plots, irrevocable burial contracts, or back payments from Social Security or SSI.) If you have more than those amounts, you may not qualify for Extra Help. However, you can still enroll in an approved Medicare prescription drug plan for coverage.

Annual income limit is $22,590 for a person or $30,660 for a married couple. You’ll pay up to $1.55 or $4.60 for generic drugs and up to $4.50 or $11.20 for brand-name drugs or $0 for each covered prescription you fill at one of your Medicare drug plans’ participating pharmacies.

If you have Medicare and Supplemental Security Income (SSI) or Medicare and Medicaid, you do not have to apply for this extra assistance because you will automatically get Extra Help.

If your loved one becomes eligible, you can call 800.633.4227, TTY 877.486.2048, or visit medicare.gov for more information.

What is PA MEDI (formerly APPRISE) and where can I get more information?

The PA MEDI Program is a free program operated by the Area Agencies on Aging to provide health-insurance 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.

Program counselors 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 800.783.7067 or your local Area Agency on Aging for more information.

What is the difference between 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)

• Other nonskilled services

Home healthcare is a wide range of healthcare services that can be given in your home for an illness or injury.

Examples of skilled home health services include:

• 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

– Medicare.gov

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).

What is the difference between a personal care home and an assisted living community in Pennsylvania?

Many people frequently confuse the two to mean the same thing, which was pretty true until 2011. Personal care homes are for individuals who want to remain independent yet have supervision and help with daily living activities.

An assisted living community allows its residents to age in place longer, often making it unnecessary for them to move to a nursing facility. They are required to offer living units with kitchettes and private bathrooms.

Specializing in dementia care for adults and their families

Life after a Hospital Stay Discharge options following hospitalization

By LISA M. PETSCHE

There’s a good chance that sooner or later your parent, or another aging relative close to you, will require hospitalization, especially if they have chronic health problems.

Once their condition is stable, hospital staff will work with them and the family to formulate a discharge plan.

When a patient makes a good recovery, planning may be simple and straightforward. Other times, varying degrees of assessment and problem solving are required.

time to regain their strength before they can adequately manage at home.

Selected retirement homes and nursing facilities have short-stay programs that, in addition to providing meals and housekeeping service, offer medical monitoring, treatment (such as surgical wound care), personal care, and perhaps also some degree of physical therapy during this recuperation period.

A good discharge plan involves communication and collaboration among the patient, family members, and healthcare providers. It addresses issues around medical management, activities of daily living (self-care and home management skills), mobility, safety, and finances, as well as psychosocial needs.

The goal is to determine the most appropriate setting to meet the patient’s needs and facilitate a smooth transition.

The hospital discharge planner — usually a social worker — serves as the coordinator. An expert on community resources, they can assist with decision making and provide information and referral to community support services as needed. They may also arrange a discharge conference that includes key members of the healthcare team.

Read on for an overview of typical settings to which a hospital patient may be discharged.

Home

Many people are able to return directly to their home, especially if they have good family support. Some may require specialized equipment and/or support services on a transitional or long-term basis.

It’s important during the planning stage to be open and honest with your relative and the healthcare team about the type and amount of assistance you’re prepared to provide. If your relative is receptive to outside help, community or private-pay agencies may be able to fill in any gaps.

Prior to discharge, clarify your relative’s medication needs and ensure necessary prescriptions are provided. Obtain details about any home healthcare services being arranged. Also, inquire about follow-up medical appointments and tests, including who is responsible for arranging them.

Convalescent Care

Some patients, especially if they live alone, need additional

Rehabilitation

If your relative has been hospitalized due to a stroke, hip fracture, prolonged acute illness, or other type of major health crisis, an inpatient rehabilitation program may be recommended. Reactivation may occur on site or at an acute rehabilitation facility or skilled nursing home.

The goal is to help patients regain their strength and endurance through participation in various kinds of therapy.

Long-Term Care

Some patients don’t make a good recovery and require a setting where 24-hour supervision or assistance is available. Even if they are able to perform self-care activities, they may have difficulty with one or more instrumental tasks that are necessary for independent living, such as medication management, meal preparation, laundry, and housekeeping.

Several levels of long-term care are available, depending on the type and extent of services required.

Hospice/Palliative Care

For patients in the end stage of a life-limiting illness, inpatient hospice or palliative care may be recommended. The focus is on maximizing comfort and quality of life. Patients receive medical care to alleviate pain and other distressing physical symptoms and interventions that address psychological and spiritual concerns.

This type of program is not limited to patients with a cancer diagnosis. People with advanced heart, lung, or liver disease and neurological diseases such as Parkinson’s disease are among those who may benefit from specialized end-of-life care.

Lisa M. Petsche is a social worker and freelance writer specializing in boomer and senior health matters.

Caregiver Support Programs

There are approximately 53 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 over $600 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.

Some research has shown that men are increasingly stepping up in the caregiving responsibilities, but women are still more

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

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 Pennsylvania Department of Aging’s Caregiver Support Program is to reinforce the care given to adults aged 60 and older with functional deficits, individuals with Alzheimer’s disease, or other related disorders, as well as grandparents and other relatives aged 55 and older who are raising grandchildren or caring for related adults with disabilities.

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.

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 of any age with Alzheimer’s disease or a related disorder, 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 aging.pa.gov.

Caring for Your Aging Parent and Ways to Cope

By CHERYL M AGUIRE

When Lisa, age 57, first noticed that her mother seemed confused, she assumed it was typical behavior from an 80-year-old. She continued to take it in stride when her mother tried to make a phone call using the TV remote.

Lisa became somewhat concerned when her mother started sautéing onions in a pan and then walked outside to get the mail, forgetting the stove was on.

When her mother began seeing her long-dead mother in bed with her, Lisa realized there was more to the picture

than normal aging. She knew her mother required full-time care.

How Many People Provide Care for Their Parents?

Lisa is not a rarity. There are 53 million unpaid caregivers of adults ages 65 and older in the United States, and over 75% of these caregivers are women.

More families in the coming decades will be faced with what is referred to as being the “sandwich generation,” meaning that adults will provide care for both

their parents and their children, says Dr. Lisa Hollis-Sawyer, gerontology program coordinator at Northeastern Illinois University.

How Does it Feel Being a Caregiver for Your Parent?

Hollis-Sawyer says, “Families rarely anticipate that their parent will need care.”

This lack of planning can result in a breakdown of communication, leading to stress and frustration among family

members. She recommends discussing a “care plan” with your parents before it becomes necessary.

Hollis-Sawyer researched daughters who provided care for their mothers. She found their previous relationship influenced how the daughter felt about her role as a caregiver.

If the daughter had a positive relationship with their mother, often she felt happy to be a caregiver since she thought she was reciprocating care their mother provided for her as a child. On the other hand, if the daughter had a negative relationship with her mother when growing up, then she felt resentful about her caregiver role.

Hollis-Sawyer found that the care recipient felt guilty or a burden on her child regardless of her previous relationship. Even though it is no fault of her own that she required care, the care recipient felt as if she failed at being a parent.

How Can You Cope with Caring for Your Parent?

Your role as a caregiver can be less stressful if you have open communication with other family members and with the care recipient.

Hollis-Sawyer stresses the importance of asking for help when needed and expressing your feelings about the situation. She also suggests talking to the care recipient about their feelings or what they need assistance doing and ways they can be independent.

“It is important not to assume the care recipient is unable to do anything,” says Hollis-Sawyer.

Allowing the care recipient to complete everyday tasks within their capability may help them to feel independent. The caregiver and recipient should figure out together what the care recipient is capable of achieving.

Self-care is an important aspect when you are caring for others. HollisSawyer recommends the key to self-care is understanding yourself by writing in a journal or diary on a daily basis. This will help you recognize when you need a break or when to ask for help to prevent burnout.

It is also important to find social support for both the caregiver and recipient. There are many different forms

of social supports, such as counseling, community resources, senior centers, friends, or other family members.

“These social supports can help the pair identify both frustrations and triumphs, which can optimize coping strategies,” says Hollis-Sawyer.

Staying Positive about Your New Role as Caregiver

Through her research, Hollis-Sawyer

witnessed many positive effects of daughters caring for their mothers.

“Daughters learned about their own aging process, which helped them understand how to prepare for it,” says Hollis-Sawyer.

She also noticed that the grandchildren benefited from seeing a role model of a good care experience.

The caregiver and recipient often develop a stronger bond that was not there prior to their new roles.

“There is much to be gained through increased self-awareness and learning for all involved,” says Hollis-Sawyer.

Originally published in Grown and Flown.

Maguire holds a Master of Counseling Psychology degree. She is married and the mother of twins and a daughter. Her writing has been published in Parents magazine, Chicken Soup for the Soul: Count Your Blessings, and Twins Magazine. You can find her on X @CherylMaguire05.

What are Adult Day Services Centers?

Adult day services centers, also known as adult day centers and adult daily living centers, are designed to meet the physical, social and emotional needs of adults in need of supervised care. Adult day centers offer a community-based alternative that allow individuals to remain in their home or in the home of a caregiver.

Centers provide or arrange a coordinated program of services for part of a 24-hour day, including health maintenance services, social interaction, and respite. Adult day centers are licensed and inspected by the Pennsylvania Department of Aging on an annual basis.

All adult day centers in Pennsylvania offer personal care, nursing services, social services, therapeutic activities, nutritional meals, and emergency care. Additional services may include but are not limited to: physical therapy, podiatry, and cosmetology. Services are provided, as appropriate for each participant, through an individualized plan of care.

Additionally, respite is provided for caregivers, enabling them to take a break from 24-hour caregiving, thus preventing caregiver burnout.

Who is Eligible?

To be eligible to attend an adult day center, an individual must be a resident of Pennsylvania who is:

• 60 years of age or older

• 18 years of age or older and has post-stroke dementia, Parkinsonism, or a dementia-related condition such as Alzheimer’s disease or other organic brain syndrome

• In need of assistance to meet personal needs and perform basic daily activities

• Capable of being transported to and from the center

Eligibility is based on your need for the service, not on financial criteria.

All adult day centers in Pennsylvania offer personal care, nursing services, social services, therapeutic activities, nutritional meals, and emergency care.

“ ”

How Do Centers Manage and Help with Health and Care Planning?

Services are designed to:

• Maintain or improve a participant’s level of functioning

• Promote socialization and peer support

• Provide respite and support for caregivers, thereby contributing to a participant’s ability to remain in the community

Quality care:

• Retains the services of a registered nurse (RN) or practical nurse (LPN) — nursing services vary by center

• Utilizes qualified staff to administer medications and maintain a medication log for all clients who take medications at the center

• Creates and maintains individual care plans

How Do I Find the Right Adult Day Center?

When choosing an adult day center, it is recommended that you call or visit several centers before making a decision. It is often best to call ahead to schedule an appointment to tour the facility, as staff may not be readily available to meet with you if you arrive unannounced.

Use this guide to compare centers, and ask each center for a brochure or a written description of services provided and eligibility criteria.

How Can I Locate Centers?

Contact your local senior center or call 800.677.1116 for the Area Agency on Aging (AAA) in your area. A directory of adult day centers can be found at: aging.state.pa.us

Helpful

Tips to

Consider When Selecting an Adult Day Services Center

Use this helpful checklist when visiting or calling adult day services centers:

• Does the center accept persons with the condition(s) of the individual for whom you provide care? (Such as: limited mobility, incontinence, memory loss, etc.)

• Do the activities available at this center match your loved one’s interests?

• What are the center’s hours and days of operation?

• Does the center provide the specific services necessary for the individual for whom you provide care? (Such as: assistance with bathing, toileting, medications, diabetic care, monitoring of blood pressure, etc.)

• Does the center offer or assist with transportation?

• What is the daily cost to attend?

• Does the menu offer dietary balance, and is food appealing?

• Is an emergency evacuation plan posted in a public place?

• Are there any late pickup or cancellation fees?

• Are there potential funding sources? (e.g., waiver, VA, etc.)

• Did you feel welcomed?

• Did the center present information about staffing, program procedures, and what they expect of caregivers?

• Does the center have an inclement weather policy?

• Does the center have a designated first aid area?

• Is the center close enough to your home or office for your comfort?

• Is there a list of client’s rights posted?

• Is there contact information for the local ombudsman posted?

• Is their Pennsylvania license current and posted for public review?

• Did the facility appear clean and free of odor?

• Is the furniture clean and well maintained?

Source: Pennsylvania Department of Aging – aging.pa.gov

Learning to Live Alone: A Challenge and an Opportunity

By LISA PETSCHE

When the loved one you have been caring for moves into a care facility or dies, many caregivers face the challenge of learning to live alone. Loneliness may be profound and especially difficult to overcome if heavy caregiving demands have led to social isolation. If you find yourself in this situation, here is some advice that can help:

• Give yourself permission to feel all emotions that surface. Recognize there will be good days and bad days, and be extra good to yourself on the bad ones.

• Prepare a list of things to do on the bad days. Include small indulgences to give you a lift as well as tasks or projects that will give you a sense of satisfaction (for example, decluttering various areas of your home).

• Look after your physical health. Eat nutritious meals, get adequate rest, and exercise regularly. These measures can also help ward off depression.

• Take things one day at a time. Plan your days so you don’t have too much free time on your hands.

• If you don’t like coming home to silence, leave the television or radio on when you go out.

• Write down your thoughts, feelings, and experiences in a journal, chronicling your journey of self-discovery and growth.

• Nurture your spirit by doing things that bring inner peace, such as meditating, praying, practicing yoga, reading, listening to music, or spending time in nature.

• Get a pet. Cats and dogs provide companionship and affection and give you a sense of purpose. A dog also offers a measure of security and ensures you’ll get out of the house. And while walking the dog, you might make new friends.

Get Busy

• Get out of the house every day. To combat isolation, join a dinner club, fitness center, or walking group.

• Sign up for an adult education course or lessons that interest you — for example, gourmet cooking, pottery, pickleball, or guitar playing. Research available programs at the local senior center or recreation center as well as those offered by educational institutions. Learning something new is energizing and boosts your self-confidence. And you might make new friends in the process.

• Get involved in your community. Volunteer for a neighborhood association, charitable or environmental cause, animal shelter, or political campaign.

• Cultivate some solitary pastimes. Take up crossword puzzles, woodworking, gardening, writing, or sketching. Learn to enjoy your own company — recognize that it’s possible to be alone without feeling lonely.

Reach Out

• Take the initiative in calling friends and relatives to talk or get together. Instead of waiting for invitations, extend them.

• Do nice things for others, especially those who are going through a difficult time. This takes your mind off your own situation, boosts your self-esteem, and strengthens relationships.

• Find at least one person you can talk to openly who will listen and understand, such as a friend or mental health worker.

• Join a bereavement support group. Internet groups are another option if it’s hard to get out or you prefer anonymity.

• If feelings of isolation persist, you might take in a boarder, share accommodations with a relative or friend, relocate to a condo or apartment in a senior living community, or move into a retirement home. Don’t make such a major decision hastily, though — give yourself plenty of time.

If you were a caregiver through your loved one’s illness and put your personal life on hold, now is the time to reinvest in yourself by resuming former interests or pursuing new ones. Don’t forget to nurture neglected relationships in addition to expanding your social network.

While the reality of being on your own may at first seem overwhelming and perhaps frightening, with time, patience, and trust in your resilience, you will successfully adapt to your new circumstances. You may also end up growing in ways you could not have imagined.

Lisa M. Petsche is a social worker and freelance writer specializing in health and elder care.

Since 1995, On-Line Publishers, Inc., a multi-title, niche-publishing, and event-production company, has effectively reached boomers, seniors, caregivers, and elder care professionals with award-winning publications and events.

50plus Life, formerly 50plus Senior News, is a monthly newsprint magazine for and about the 50+ community. Editions in Chester, Cumberland, Dauphin, Lancaster, Lebanon, and York counties.

caregiver solutions

caregiver solutions is distributed throughout south-central PA and is available at our expos. It offers invaluable information to the person managing the care of a loved one and includes a directory of housing, care, and service providers.

All publications are available online, in print, and on mobile/tablet devices.

50plus Living is an annual guide to residences and care options available to boomers and seniors in the Susquehanna and Delaware valleys.

50 plus Living is a source for information about local products, services, and support for the community. Now included as “yellow pages” in 50plus Life

Serving the mind, heart, and spirit of the 50+ community since 1995.

Good Reads

Putting Things in Order … to help my loved ones when I’m gone

Product Concept Mfg., Inc.

Print

This organizer contains sections for the following information:

• Personal message to loved ones, location of personal papers, websites/ online records, important contacts, insurance policies, family health history, information on medical directives and other legal documents, wishes about personal property, overview of assets, overview of debts, banking information, investments and real estate, vehicles, benefits you can expect, burial/cremation choices, and things to do at the time of my passing

• Softcover spiral-bound 10x8 with 24 pages; includes two pockets for important papers

• Note where important financial and legal papers are kept, list doctors and important contacts, and guide them in what to do at the time of your passing

Give yourself, and your loved ones, peace of mind with the original Putting Things in Order.

The Conscious Caregiver: A Mindful Approach to Caring for Your Loved One without Losing Yourself

By Linda Abbit Print; eBook

Linda Abbit, founder of Tender Loving Eldercare and a veteran of the caregiving industry, shares her advice on taking care of an older parent or loved one and how to handle everything that goes along with this dramatic life change.

Being a caregiver can be a difficult role. It requires patience, tenderness,

selflessness, and hard work. Providing care for someone, whether it’s a parent, a loved one, or as a professional, requires a high level of self-love and self-care. But while it may be a rewarding experience to care for a loved one, the emotional and physical stress of caregiving can lead to burnout and exhaustion — causing caregivers to put themselves and their own well-being in the background.

How can you fulfill your role as a caregiver without losing yourself? Conscious Caregiver teaches you how to navigate caring for your loved one, whether it’s full-time, in-house caregiving or hiring support from outside services. With information on how to talk to your loved ones about the situation, handle the emotional stress, stay financially secure, and take the time to care for yourself, this guide can help you care for your loved one and yourself at the same time.

Living in the Moment: Overcoming Challenges and Finding Moments of Joy in Alzheimer’s Disease and other Dementias

By Elizabeth Landsverk, M.D.

Print;

eBook, Audio

Living in the Moment offers a comprehensive, easy-to-follow guide to understanding Alzheimer’s and other brain diseases and what to do next. For caregivers and patients alike, renowned geriatrician Dr. Elizabeth Landsverk offers a path for patients to live a healthy and full life with dementia.

A loved one’s dementia diagnosis can leave you feeling scared and overwhelmed. Landsverk, founder of ElderConsult Geriatric Medicine, has led thousands of patients through a brain disease diagnosis, equipping them with knowledge, tools, and support to help them live happy and engaged lives. She shares her expertise in this practical reference that offers helpful explanations, advice, and guidance through an often confusing and challenging new landscape.

Living in the Moment promises a plan

that will minimize medication, treat pain, and relieve agitation, without falling back on standard medical approaches. You’ll learn:

• How to recognize the earliest dementia changes

• How to create a plan of action for today — and tomorrow — that will help to manage this new normal

• Innovative new activities and holistic interventions that can slow the progression of dementia

• Comprehensive information on both prescription and OTC medications that can help or hurt dementia patients

• Dealing with day-to-day challenges, from staying mobile to overcoming agitation and aggression without resorting to sedation

• A guide to understanding powerful medications that are often prescribed and do not work

• How to relieve pain and calm agitation — without sedation or drugs

• How to keep your vulnerable loved one safe and secure — both physically and financially

• How and where to get help, including online support groups, home healthcare agencies, care managers, neuropsychologists, communities and day programs for people with dementia, and government agencies

• Tips on keeping your loved one at home versus placement

Who Cares: The Hidden Crisis of Caregiving, and How We Solve It

By Emily Kenway Print; eBook

An intimate and deeply researched account of the experiences of unpaid caregivers, this “beautiful book”

(Rob Delaney) calls for us all to put care at the center of our lives.

When Emily Kenway became the primary caregiver for her terminally ill mother, her life was changed forever. Although she was lonely, she was far from alone: Millions of caregivers all around the world are silently suffering from poverty, isolation, and burnout. Saving their nations’ economies billions by providing nonprofessional care, these people — primarily women — remain largely ignored by politicians, in part because the demands of care itself keep them from effectively advocating for their needs.

In Who Cares, Kenway brings the caregiving crisis into the light. Blending expert research with insights from her own experience, Kenway shows us that building a world that cares for its caregivers requires us to fundamentally reimagine the role of care in our society, bringing it from the margins to the center of our collective life.

Powerful and deeply reported, Who Cares is an essential read for anyone who has ever cared for, or will receive care from, another person — which is to say, for everyone.

Dying at Home: A Family Guide for Caregiving

By Andrea Sankar with Caitlin Cassady Print; eBook

Many people seek the comfort and dignity of dying at home. Advances in pharmacology and hospice care allow the dying to remain at home relatively free of pain and symptoms, but navigating professional services, insurance coverage, and family dynamics often compound the complexity of this process.

Sankar’s Dying at Home: A Family Guide for Caregiving provides essential information that caregivers and dying persons need to navigate this journey.

Featuring contributions by professionals and personal stories from indepth case studies of family caregivers, this guide discusses the challenges, resources, benefits, and barriers to care at home.

With updates on advance care planning, developments in palliative care medicine, and the availability of legally assisted dying, this edition discusses how to:

• Arrange medical care, nursing, and ancillary therapies

• Understand costs, sources of financial support, and insurance coverage

• Collaborate with health professionals in the home

• Assist in implementing painmanagement techniques

• Find social and spiritual support, as well as self-care for caregivers

• Handle family dynamics and legal matters

• Collaborate to make complex care and treatment decisions

• Navigate the process of dying and caring for the body after death

Nursing Medical Terms Simplified

By Charles Edwin Print; eBook

Designed with clarity in mind, this book promotes health literacy by making some of the nursing terminology accessible to everyone. It’s an excellent resource for caregivers, patients, and anyone passionate about understanding the language of healthcare. It unravels some of the complexities of nursing terminology, rendering it accessible and comprehensible for readers of all backgrounds.

Edwin’s diligent research and collaboration with healthcare experts guarantee the precision and dependability of each definition. Nursing Medical Terms Simplified is a vital reference for nursing students, professionals, and anyone eager to grasp the intricacies of healthcare, enhancing your ability to communicate within the healthcare environment.

Dear Caregiver, It’s Your Life Too

By Katie Duncan Print; eBook; Audio

Are you totally stressed out, overwhelmed, or completely burnt out caring for a loved one? Are you feeling alone and isolated or wish you had more help? Are you feeling resentful or guilty?

While there are rewards to caring for those we love, there is no denying being a caregiver is a stressful job.

It’s physically demanding, mentally exhausting, and emotionally draining.

Katie Duncan, a nurse practitioner, death coach, and former family caregiver, reveals the secrets she learned throughout her own caregiving experiences and the shared wisdom of other caregivers she’s encountered along her path.

It takes a very special person to be a caregiver, and you are one of them. You deserve to find your peace, your joy, and yourself again.

And there’s hope.

In Dear Caregiver, It’s Your Life Too, you’ll discover …

• Simple and easy-to-do tricks to help lower your daily stress and avoid burnout

• Key resources you can utilize to get you the help you need to relieve several caregiving burdens

• Solutions you can use to create more freedom and personal space to allow you to reset

• A blueprint to mastering and protecting the sleep you desire and deserve

• Encouraging techniques to drop the guilt, stop negative self-talk spirals, and keep you going

• Inspiring practices to help improve your mood and boost your energy

• Empowering strategies to help you build resilience, reestablish your self-identity, and strengthen your connection with others

Bethany Village

DIRECTORY OF HOUSING & CARE PROVIDERS

717.766.0279

325 Wesley Drive bvmarketingdept@asbury.org

Mechanicsburg, PA 17055 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

Chapel Pointe at Carlisle

717.249.1363

770 South Hanover Street info@chapelpointe.org

Carlisle, PA 17013 www.chapelpointe.org

Homeland Center

717.221.7900

1901 North Fifth Street info@homelandcenter.org

Harrisburg, PA 17102 HomelandCenter.org

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

See ad on page 9

Homeland Hospice, HomeHealth,

717.857.7400 and HomeCare info@homelandathome.org 2300 Vartan Way, Suite 270 HomelandatHome.org

Harrisburg, PA 17110

Homeland at Home, a community outreach of Homeland Center, provides a continuum of At Home care services—from nonmedical personal assistance to wound care, teleheath monitoring, and physical and occupational therapy, as well as compassionate hospice care.

See ad on page 9

Life Time Adult Day Care

717.975.9762

27 Miller Street jzarker@cparc.org

Lemoyne, PA 17043 www.cparc.org

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

Messiah Lifeways

717.667.8997

100 Mount Allen Drive life@messiahlifeways.org Mechanicsburg, PA 17055 www.messiahlifeways.org

Messiah Lifeways, located in Mechanicsburg, PA, provides a network of retirement living, enrichment, and community-based services for adults 55+.

See ad on page 21

717.520.0330 info@Prov-Place.com www.providence-place.com

Our age-in-place communities offer independent living, assisted living, and memory care (early or late-stage) in a scenic setting. See ad on page 15

StoneRidge Retirement Living Communities

717.866.3167

Kristine Tobias, Director of Independent Living & Sales 440 East Lincoln Avenue kristine.tobias@stoneridgeretirement.com

Myerstown, PA 17067 www.stoneridgeretirement.com

Mission driven, full-service continuing care retirement community with a history of almost a century of exemplary care.

See ad on back page

Visiting Angels

717.751.2488 1840 East Market Street information@visitingangelsyork.com York, PA 17402 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 17

Visiting Angels

4607 Locust Lane

717.652.8899

nsaia@visitingangels.net

Harrisburg, PA 17109 www.visitingangels.com

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 “age in place.” As of January 2011, licensure requirements for ALRs became effective.

CARE OPTIONS

Adult Day Centers offer programs in facilities or independent organizations for hourly or daily adult supervision.

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.

CCRCs are communities offering a variety of living options in addition to comprehensive medical and nursing services.

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.

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.

DIRECTORY OF ANCILLARY SERVICES

AREA AGENCIES ON AGING

York County Area Agency on Aging 717.771.9610

See ad on page 30 www.p4a.org

COMPLEMENTARY ASSISTANCE

Cumberland County Aging

717.240.6110 and Community Services aging@ccpa.net 1100 Claremont Road www.ccpa.net/119/AgingCarlisle, PA 17015 Community-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.

150 North Queen Street, Suite 415 aging@co.lancaster.pa.us Lancaster, PA 17603 www.lancoaging.org

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

LEGAL

717.528.2823

Meg Motter, Client Care Advocate, LCSW, CDP 1755 Oregon Pike, Suite 101 info@bellomoassociates.com Lancaster, PA 17601 www.bellomoassociates.com

We understand the sensitive nature of estate planning and elder law. No matter what situation, we provide peace of mind, and we are here to offer legal advice and have your best interests at heart.

Nikolaus & Hohenadel, LLP

717.299.3726

Barbara Reist Dillon bdillon@n-hlaw.com

Wanda S. Whare wwhare@n-hlaw.com

Christopher S. Grab cgrab@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 Quarryville. Please see article on page 6

— Support and Information —

All About Vision

www.allaboutvision.org

Alzheimer’s Association

800.272.3900 www.alz.org

American Cancer Society

800.227.2345 www.cancer.org

American Diabetes Association

800.342.2383 www.diabetes.org

American Speech Language-Hearing Association

800.638.8255 www.asha.org

American Urological Association

410.689.3700 or 800.828.7866 www.auanet.org

Area Agency on Aging

717.783.1550 www.aging-pa.gov

Arthritis Foundation

800.283.7800 www.arthritis.org

BenefitsCheckUp

800.794.6559 www.benefitscheckup.org

Caregiver Action Network

202.454.3970

www.caregiveraction.org

Centers for Medicare & Medicaid Services

877.267.2323 www.cms.gov

Christopher & Dana Reeve Foundation

800.225.0292

www.christopherreeve.org

Crohn’s and Colitis Foundation of America, Inc.

800.932.2423

www.crohnscolitisfoundation.org

Epilepsy Foundation

800.332.1000

www.epilepsy.com

EyeCare America

877.887.6327

www.aao.org/eyecare-america

Family Caregiver Alliance

800.445.8106

www.caregiver.org

Guide Dog Foundation for the Blind

800.548.4337

www.guidedog.org

Medicare Rights Center

800.333.4114

www.medicarerights.org

Medicare Telephone Hotline

800.633.4227 www.medicare.gov

Mid Penn Legal Services

800.326.9177

www.midpenn.org

National Alliance for Caregiving

202.918.1013 www.caregiving.org

National Council on Aging www.ncoa.org

National Council on Alcoholism & Drug Dependence, Inc.

410.625.6482 www.ncadd.org

National Institute on Aging Information Center

800.222.2225 www.nia.nih.gov

National Institutes of Mental Health 866.615.6464 www.nimh.nih.gov

National Library Service for the Blind & Physically Handicapped, Library of Congress 888.657.7323 www.loc.gov/nls

National Resource Directory

800.827.1000 www.nrd.gov

Office of Minority Health Resource Center

800.444.6472

www.minorityhealth.hhs.gov

PACE/PACENET

800.225.7223

www.aging.state.pa.us/aging

Parkinson Foundation, Inc.

800.473.4636 www.parkinson.org

Pennsylvania Department of Human Services

800.692.7462 www.dhs.pa.gov

Pennsylvania Department of Military and Veterans Affairs Cumberland – 717.240.6179 Dauphin – 717.780.6356 Lancaster – 717.299.7920 Lebanon – 717.228.4422 York – 717.771.9218 www.dmva.pa.gov

RxAssist www.rxassist.org

Senior Law Center 215.988.1244 www.seniorlawcenter.org

The Simon Foundation for Continence 847.864.3913 www.simonfoundation.org

Veterans Administration

800.698.2411 www.va.gov

Veterans Administration Caregiver Support Program

855.260.3274 www.caregiver.va.gov