Thursday, January 3, 2019

Medicare and Medicaid in Assisted Living

Today's seniors enjoy a life expectancy longer than any generation in history. An American who turned 65 in 1998 could expect to live nearly another 18 years beyond their 65th birthday. And while additional years are generally considered an blessing, it is also true that the older one grows, the more likely they will need health care services. Today's seniors, who often consider themselves among the best informed, would do well to learn about three crucial areas that pertain to their future health care needs: the potential that they may need long term care, the cost of long term care and the limited federal and state aid available.
According to a study by the Agency for Health Care Policy and Research, some 42 percent of Americans who reach the age of 70 can expect to utilize some type of long term care during the remainder of their lives. And with the number of people over age 65 expected to grow to 20 percent of the U.S. population by 2030, there is little doubt that demand for long term care services is poised to increase dramatically.
Long term care services have evolved dramatically over the past several years. Where the majority of long term care was once provided only in skilled nursing homes, long term care services today are provided in a wide range of settings, ranging from in-home care to community-based facilities such as adult day care and assisted care facilities to nursing homes. The cost of long term care can be significant, regardless of the setting in which it is provided. The average cost of a nursing home is approximately $60,000 a year, and home care costs can range from $50 to more than $250 a day.
Medicare and Medicaid provide only limited help for nursing home care. Medicare only pays for the first 20 days in a skilled nursing facility - and only after a hospital stay of three days or more. The patient or their family pays the first $99 per day from the 21st day through the 100th day, after which Medicare pays nothing. Medicaid rules vary from state to state, but as former U.S. Senator David Durenburger told the U.S. Senate Special Committee on Aging, Medicaid "dictates that people must effectively impoverish themselves in order to receive government assistance." Medicaid is essentially medical aide for those who have already spent down their assets.
Government won't help much with newer forms of long term care services, either. Though 38 states pay for some assisted living, the programs are miniscule, covering fewer than 100,000 poor people, so waiting lists are long. Medicare covers home care, but just 100 visits in the weeks following a hospital stay. So seniors increasingly are paying their long term care bills out of their own pockets.

Medicaid does not pay for assisted living services in most assisted living, typically they cover the costs of care in Nursing Homes for those who have exhausted their assets. The White House recently authorized Medicare coverage for the treatment of Alzheimer's disease. This means that Medicare beneficiaries can now receive reimbursement for mental health services that were formerly denied because the government rationalized that people with the disease did not respond to mental and physical therapy, this has since been proven incorrect, hence the reversal of their position. Medicare was never intended to cover the costs associated with custodial care, which is room and board, and activities of daily living, and these coverage changes still do not reimburse for this, further Medicare requires a three-day prequalifying hospital stay before they pay for care in a nursing home. Medicare covers certain care procedures, and some limited rehabilitation therapies. The physicians who visit assisted living are normally all Medicare certified providers, so the cost of their visits is often covered by Medicare, subject to the co-payment.

Friday, February 2, 2018

Learning how to read a food label can help you make good nutritional choices

The Food and Drug Administration (FDA) is responsible for assuring that foods sold in the United States are safe, wholesome, and properly labeled. This applies to foods produced domestically, as well as foods imported from foreign countries. The Nutrition Labeling and Education Act (NLEA), which amended the FD&C Act requires most foods to bear nutrition labeling and requires food labels that they are nutrient content claims and certain help messages to comply with specific requirements. It is the responsibility for the food industry to remain current with the legal requirements for food labeling.

The Nutrition Facts panel on any packaged item is the best way to understand exactly what is in the product you are buying.  The front of the package can be very misleading and tells you only what the manufacturer wants you to know about the health claims.  Terms used on packaging, such as “multigrain”, “reduced-fat”, “no additives” and even “natural” can be misleading, as these terms aren’t tightly regulated so manufacturers will use words that make you think you are buying healthy products. Knowing how to read the Nutrition Facts Panel will guide you to better choices for a healthy lifestyle. 

When deciding what is best to buy, compare nutrients and calories in one food to those in another. The information may surprise you. For your heart health, make sure you aren’t eating foods high in carbohydrates, saturated and trans fats, and sodium.

These steps may help simplify what can be a confusing Nutrition Fact label.

  1. Check Serving Size and Servings Per Container
This will tell you what is a standardized serving for this product and the nutritional information listed below relates only to this size serving.  It can surprise you to find out that a small package that seems like one serving can be labeled as two servings.  This would mean if you ate the entire container, you would have to double the calories, carbohydrates, fat, sodium and everything else on that label to get an accurate measurement of you are eating. 

  1. Carbohydrates count more than calories!

The Total Carbohydrates listed on the label will include sugar, starch, and fiber – all various forms of carbohydrates.  This number can be even more important than the calories, as limiting the carbohydrates you take in will naturally also limit the amount of calories, especially those ‘empty calories’ in the form of sugar and high fructose corn syrup that is commonly added when fat is removed.  For instance, you will be surprised to see that regular plain Greek yogurt will have approximately 8 carbohydrates per serving, while ‘low fat’ plain Greek yogurt will have approximately 12 carbohydrates! What?!?  Manufacturers know that when you take the fat out of a product, it doesn’t taste as good therefore ‘fat-free’ high calorie sugar is added to make it taste better! Even worse, when ‘fruit’ is added, it is generally a sugar-based fruit and the carbohydrate count jumps to 25+grams per serving!  Best to get regular plain yogurt, cottage cheese, etc. and add your own fresh or frozen berries or fruit.

Higher carbohydrate foods that should be limited include most white bread, pasta, rice, and potatoes.  Even the higher fiber breads and pastas, brown rice and sweet potatoes are only slightly better than the white form due to the additional fiber they contain.  They still have a higher amount of carbohydrates that should be limited daily.  The higher the fiber count, the better it is to eat.  Carbohydrates in food are digested and converted into glucose, or sugar, to provide the cells of the body with energy. Excess carbohydrates in your body can lead to weight gain and diabetes.

Mot fruits and vegetables are generally low in carbohydrates, with the exception of apples and bananas.  You would be astonished to know that one medium apple or one medium banana has approximately 25 grams of carbohydrates!  Best to eat fresh melons, berries, peaches, oranges, and pears, etc. and watch the canned fruit as there can be added syrups and juices that add sugary carbohydrates.  Limit the starchy vegetables like peas and corn (read the labels) but don’t hesitate to eat most other vegetables freely.  Did you know that one orange has only 8 grams carbohydrates, yet that small 4 oz. glass of orange juice has nearly 25 grams? Avoid most juices in general as they generally have significant amounts of added sugar (aka carbohydrates).  If you want juice, it would be best to use just a splash for flavor into a glass of water.

In general, when looking at the label and the carbohydrate content, if it has more than 20-30 grams of carbohydrates per serving, then use it in very limited quantities.  Moderation is always best.  As a guideline, keeping your total daily carbohydrate ‘count’ under 100 grams per day will result in controlling the amount of ‘empty’ sugar calories you take in.  Counting your daily carbohydrate intake is much easier than counting thousands of calories, and as long as you choose a variety of colorful fruits and vegetables to eat with your meals and snacks, you will get a well rounded and balanced intake of nutrients.

For those who wish to count the carbohydrates most effectively, you are able to reduce the number of carbs counted by whatever fiber count is shown on the label.  For instance, a label showing 10 grams carbohydrates that also has 3 grams fiber, you need to count only 7 carbs per serving (10-3=7).  Fiber is the only carbohydrate that is not changed by the body to sugar and is eliminated without affecting insulin levels.  Technically, fiber is considered a carbohydrate even though it is not digested and it provides no calories.  Fiber is important for heart health, and getting at least 25 grams of fiber daily is recommended. Most people, however, need a fiber supplement to get these recommended levels. 

  1. Look for Saturated and Trans fats

Look for products with the lowest amounts of saturated and trans fats per serving.   For the past years, consumers have been told ‘low fat’ was best and with the added carbohydrates in place of the fat in most products, people have been eating more sugar, more refined carbs and processed foods instead, which has made the world sicker and fatter. 

When reading labels, the amount of Total Fat, Saturated Fat, and Trans Fat is listed, as the law requires it.  No amount of trans fat in the diet is beneficial. Therefore, when a food label indicates "0 grams of trans fat," that's ideal. However, even then a product may still have some trans fat. Manufacturers are allowed to list "0 grams" of trans fat if the product has less than 0.5 grams of trans fat per serving. Some examples are tub margarines or peanut butter. Usually this isn't a problem if you eat one or two servings a day. However, if you were to eat many servings, this amount of trans fat may add up. 

In general, go for the ‘good’ fats, like olive and coconut oil, and don’t hesitate to use higher fat, yet healthy and nutritious foods on occasion, such as avocados, cheese, eggs, nuts, chia seeds and yogurt.  Again, moderation is key to healthy living.

  1. Watch your Sodium intake

Sodium (salt) regulates your body’s water levels, which is especially important for those with heart disease and high blood pressure.  Sodium is listed on the label in milligrams. When 1500 milligrams is the general limit for people with heart disease, sodium can add up quickly. That’s equal to little more than ½ teaspoon of salt!  A low-sodium food is defined by the Food and Drug Administration as 140 milligrams or less per serving.  This can be a helpful when deciding if and how a certain product can fit into your healthy eating plan. Most canned foods and highly processed food are high in sodium so best to buy frozen and or fresh produce and unprocessed or low-sodium meats.

5.    Review the Ingredient List

All food products have the ingredients list by weight in decreasing order.  This means the first items listed are the primary ingredients with the remainder of the list showing what is less within.  This can be very helpful in determining more information about the food product. 
  --If there are more preservatives and fillers than identifiable ingredients, this food is likely highly processed and therefore NOT healthy. 
  --If the list contains ‘partially hydrogenated oil’ then it still has trans fat despite a label that may say “0 grams” of trans fat.
  --If sugar or high-fructose corn syrup is listed before the healthy ingredients then likely the calories and carbohydrates are from sugar and low in other nutrients.  Other names for sugar include sucrose, fructose, glucose, maltose, dextrose, high-fructose corn syrup, corn syrup, concentrated fruit juice, honey and maple syrup.

What do I do if there is no Nutrition Facts label?

There are many fresh fruits, vegetables, and other grocery items that do not always come with nutritional labels.  A highly recommended online site that will give you nutritional breakdown of all foods is located at  If you do not use a computer, then seeking a good nutrition book at your local library or bookstore will help you understand which foods are the healthy choices.  As with most lifestyle changes, the more you read and understand the nutritional value of healthy foods, the easier it will become.

Sunday, December 17, 2017

Memory Care during the Holiday Season

Consider very carefully any inclination to take your loved one out of their familiar surroundings during the holidays.  While it is not always a problem, it can be.  Families are tempted to take their loved one home for a holiday party or dinner.  Others may want to take them to a holiday show or out to see the holiday lights.  Many times this change in their usual environment, away from the familiar surroundings and the people that they are comfortable with can cause great distress for them.  Rev. Bob Davis who is in the early stages of Alzheimer’s disease wrote in his book My Journey into Alzheimer’s Disease the following about different surroundings.   “Leaving the routine of being around my familiar home, having more people and excitement around than I am accustomed to, varying my ritual for taking care of my grooming and health care, being unable to lie down and nap at my usual times, all brought me to a place of not being able to make the most basic decisions for myself, not even how to relieve my discomfort.”  Rev. Davis’ insights are not uncommon.  You and your family may want to join in the community's holiday party instead of risking bringing your loved one into an unfamiliar environment.
Rev. Davis’ wife writes of her journey with her husband, “live every day to the glory of God.  Do every bit of good we can do for as long as we can do it.  We have prepared for the worst and we are going to live expecting the best.  If the worst comes we are ready for it.  If it doesn’t, we will not have wasted today worrying about it.”

Here are some great holiday gift ideas:
·       Easy to remove clothing
·       Old time musical tapes: Lawrence Welk, Big Bands, Kate Smith
·       Home video of family members
·       Videos of “I Love Lucy” or “The Honeymooners”
·       Photo Albums
·       Socks
·       Tote and handbags
·       Scarves
·       Magazine subscriptions: National Geographic, Life
·       Puzzles with large pieces
·       Memory Wallets: include copies of driver’s license, photos, union cards, library cards
·       Family photos in unbreakable frames.

You and your family may want to join in the Potomac Home’s holiday party instead of risking bringing your loved one into an unfamiliar environment.”

Alzheimer’s and the Holidays
The holidays are upon us, it should be a joyous wonderful time of the year for you, but without careful planning and consideration this potential blessing may become a catastrophe.  There is much that you can do to avoid the problems.  We have put together some suggestions to help you cope with Alzheimer’s and the Holidays.
First and most important, TAKE CARE OF YOURSELF!  If you don’t take care of yourself at this stressful time both you and your loved one with Alzheimer’s may suffer.  If you are tired, frustrated, without patience, become ill, who will be there for your loved one?  How do you take care of yourself during this incredibly busy time?

·       Join a support group.  These groups vary so you may want to try out different groups.  Some people like groups that are more educational and offer practical suggestions; others may want a group that encourages more emotion, venting and sharing.  You can find a group that will support you in the way that best fits your need or personality.

·       Ask for help.  Research shows that families of Alzheimer’s loved one’s are reluctant to ask for or help or use help, often using less help than professionals would recommend and using the help too late in the course of the illness to offer much help.  Even though you have placed your loved one in Potomac, you are still carrying a heavy burden.  Let people help.  Maybe they can pick up something on your shopping list.  Maybe they can sit with your loved one while you shop or get your hair done. Have them bring a meal.  Ask them to sit with your loved one so that you can miss a visit and tend to  some of the issues of the holidays and not feel guilty.

·       Adjust your expectations.  Remember that elaborate attempts to recreate past holiday traditions and have the same festive meaningful time as last year; is almost certainly not realistic.  Alzheimer’s Disease is progressive and it is likely that your loved one will remember less this year, will be less able to tolerate holiday excitement and stimulation and will appreciate less.  As time passes it becomes increasingly likely that the stimulation of holiday hustle and bustle, decorations, music and other holiday issues will cause anxiousness, withdrawal or even difficult behaviors.    People with Alzheimer’s disease need simplicity and routine.

·       Give yourself permission to do only what you can reasonably manage even though this may be significantly less than in other years.  Offer to make a dish for the holiday meal but not to host it. 

·       Remember that you don’t have to have long visits with your loved one.  We know that people with  Alzheimer’s disease have limited attention spans and difficulty focusing.  Often they cannot sustain a long visit.  Short and regular visits may be best for both you and your loved one.

·       Prepare visitors.  Many of your extended family and friends do not have your experience and insight into this disease and the current condition of your loved one.  Tell them how he or she has changed and what to expect when they visit.  Some families have even written letters to friends and  family to tell them how things have changed in the last year and give suggestions on how to visit successfully.