Showing posts with label caregivers. Show all posts
Showing posts with label caregivers. Show all posts

Wednesday, June 16, 2021

Home Health Care Worker Shortage Risks Lives- Impacts Aging in Place Planning


Aging in Place Planning should consider and account for all risks, including availability/unavailability of paid health care workers. The Michigan home health care worker shortage is discussed in an article here, and in a newscast video here.  

The reports suggest that Michigan home health care workers are paid only nine dollars per hour, and often call off.  Of course, there is a vast array of choices in health care agencies (public, private, for profit, and non-profit), and every agency deals with worker retention and availability differently.  

Our office is aware of only one private agency that will certify availability of an aide 24 hours a day; their workers agree that they cannot and will not leave until they are relieved, and the company assures availability by always having supervisory staff and periodic staff available to fill needs. 

Regardless, the challenge of caregiver availability is one that must be considered in making aging in place decisions.  Availability of temporary or respite services, workers, or sometimes, charitable hospice services, may provide relief when worker a home care worker shortage exists. Outside custodial care, respite care, or adult day care may relieve risk upon lack of availability, but transport and cost must be considered.       

Monday, April 6, 2020

COVID-19: Caregiver Action Network Tips for Family Caregivers

If you are an in-home caregiver the rapid spread of COVID-19 has and will continue to affect how you do your job. The Caregiver Action Network (CAN) has posted some Tips for Family Caregivers.  CAN continues to recommend following the guidance of the CDC.

Tips include:
  • Finding support through support groups, churches or community centers;
  • Refilling prescriptions and making sure you are fulling stocked on medical supplies;
  • Only going to the Emergency Room for emergencies;
  • Knowing your own risk factors – chronic conditions or immunosuppressed;
  • Being aware of any changes to visitation policies;
  • Calling ahead before going to any medical appointments; and
  • Preparing for possible quarantine.

CAN also offers several useful resources:

CAN is a leading family caregiver organization working to improve the quality of life for the more than 90 million Americans who care for loved ones with chronic conditions, disabilities, disease or the frailties of old age. It is a nonprofit organization providing education, peer support and resources to family caregivers across the country free of charge.

Wednesday, March 13, 2019

Care.com Rocked By WSJ Investigation - Conducts only Preliminary Screen of Caregivers


Care.com pledges to “help families make informed hiring decisions."  The company, however, undertakes only a "preliminary screening," of referred caregivers, leaving the heavy lifting up to the families themselves, sometimes with tragic consequences, according to Kirsten Grind, Gregory Zuckerman and Shane Shifflett writing in the WSJ.

The Journal found some nine instance in the last six years where caregivers on the site had police records, and later were accused of crimes while caring for customers' children or elderly relatives. The paper's probe also found hundreds of instances of day-care centers being improperly listed as state-licensed.

"Care.com is a marketplace platform," said CEO Sheila Marcelo."  The marketplace is designed for “shared responsibility overall," she adds.  Look for a greater effort by Care.com, but in the meantime, and nonetheless, family members should remain vigilant and conduct their own background checks.  Those who will take advantage of the most vulnerable will always seek others to confer upon them some imprimatur of integrity and responsibility.  Wisdom suggests caution in accepting referrals from any third party, especially where there is profit for the listing or referring service.

Tuesday, March 5, 2019

Respite for Family Caregivers

Respite is planned or emergency care provided to a child or adult with special needs in order to provide temporary relief to family caregivers who are caring for that child or adult. 

The ARCH National Respite Network and Resource Center provides useful resources on its website for family caregivers to navigate respite care. ARCH's Nine Steps to Respite for Family Caregivers, provides readers with facts sheets to guide caregivers to getting respite care. 

Each fact sheet is designed to be relevant to distinct caregiving situations, such as military caregivers and family caregivers of individuals with dementia.

Other resources on ARCH's website include the following:
The website also is where you can find Charting the LifeCourse Respite materials.  These materials include a Respite guide book, portfolio and other tools designed to help family caregivers caring for anyone of any age or disability and/or those who support them create a plan to access respite services within and outside the formal services system.

The materials provide:
  • information on the importance of respite for the well-being of the family caregiver and all family members;
  • tools for thinking about and planning for respite; and
  • additional resources for finding respite in the community. 
Missouri Family to Family, which is housed within Missouri’s University Center for Excellence in Developmental Disabilities Education, Research and Services (UCEDD) at the University of Missouri–Kansas City Institute for Human Development, in collaboration with the ARCH National Respite Network and Resource Center, developed Charting the LifeCourse Respite materials. 

Monday, November 19, 2018

Seniors with Dementia Abandoned by Family Caregivers at Hospitals and Homeless Shelters

Jeremy Jojola, investigative reporter for Denver KUSA/9NEWS, has published a heart-wrenching story uncovering a horrifying, but all-too-common, practice of family caregivers abandoning seniors suffering from dementia by abandoning, and stranding  seniors in public airports, malls, hotels, hospitals, homeless centers, and in at least one instance, a local McDonald's.  Jojola described the plight of 80-year- old Jerry Ellingsen, who suffers from Alzheimer's:
Within the bustle and organized chaos of Denver's massive airport, an 80-year-old man with Alzheimer's disease named Jerry Ellingsen was found wandering alone after traveling with his small dog from Fort Myers, Florida. 
Jerry didn’t know where he was or why he was in Denver.
A United Airlines supervisor found Jerry confused and alone, with only a small dog, near an exit door outside the ticket counter, and promptly called the police.  A police report indicated a flight attendant described Jerry as possibly suffering from Alzheimer’s.  One Denver police officer spoke with Jerry, and noted in his report:
“He was very confused about general details of his life to include where he was at, where he was coming from, who he was coming to visit and his family members’ names."
Police looked up the woman who checked him into his flight, and ended up talking to his daughter.  Police soon learned that Jerry's daughter, who was his agent under a Power of Attorney, put him on the one-way flight from Fort Myers, Florida.  She intended for Jerry to live with his estranged wife, but had texted the estranged wife only the day before with a simple notification that Jerry, and his dog "will arrive on a flight in Denver tomorrow afternoon."  The daughter made no other arrangements to transport her father, or communicate with her father's estranged wife, until sometime after he arrived, and then only texted the estranged wife, "[i]f you need to drop my dad at a homeless shelter, it’s fine. I just want him to have a roof over his head. Please." 

Jerry's family refused to rescue Jerry so police transported Jerry to University of Colorado Hospital. Laws require hospitals to admit and keep at-risk adults who’ve been abandoned until caseworkers can find safe placement for them, which can lead to extended stays for months and even years.

Jerry’s story sparked a 9Wants to Know investigation into at-risk adults who end up languishing in hospitals because they have no family to take care of them, or a facility willing to take them in due to a lack of space, finances, or appropriate scope of care.  The investigators conducted a point-in-time survey with the help of the Colorado Hospital Association because hospitals do not keep track of stays by people like Jerry.  Investigator Jojola described what the investigation discovered:
A three-month long 9Wants to Know investigation is uncovering a growing health care epidemic where hundreds of people like Jerry are abandoned every year at metro-area hospitals. The epidemic is costing hospitals and in some cases, taxpayers, millions of dollars a year.
Nineteen metro area hospitals participated in the survey, which revealed on a single day in September, 113 at-risk adults were stuck in the system, beyond medical necessity.  Of those patients, about 30 percent had mental health issues like Alzheimer's and dementia. Most of the stranded people were men over 40 years old.  The longest stay was 577 days!  

According to the article, Denver Health has a special wing called the "Oasis Unit" that houses around 30 at-risk adults on any given day. Denver Health reports it expected to spend $18 million on the Oasis Unit in 2018.  Anecdotally, Denver Health officials cited a case that resulted in a stay of eight years in the Oasis Unit.  Tax payers and consumers end up bearing the cost.  Hospitals in Colorado can cost up to $2,500 per day, per patient. 

A Knoxville television station also broadcast a report about Jerry's case.  Both reports indicated that charges were unlikely to be filed against and member of Jerry's family. The video broadcast identified the daughter's name, who, ironically worked for a health care agency specializing in providing health care for seniors.  

Instances of professional caregivers abandoning patients and residents are well-documented (see, for example, here, here, and, see here, what is hopefully an usual case in which professional caregivers abandoned a couple, who were then later abandoned by a privately paid professional caregiver who had worked for the first professional caregiver).  Family abandonment is less well understood and documented.

Given the stress and strain of caregiving, and the feelings of helplessness and abandonment that caregivers often feel, it is possible that caregivers simply surrender, leaving their vulnerable wards at risk.  Regardless, the only solution is advanced planning, including considerations of the demands and risks of caregiving, and the costs of same.  Greater education and support for caregivers from the community is also well past due.   

Saturday, August 5, 2017

Aging in Place- Male Family Caregivers are Breaking Stereotypes

There are 40 million family caregivers in the United States helping with everyday activities and personal tasks ranging from bathing, dressing, wound care and medication management to transportation and finance.  The “typical” family caregiver is a 49-year old woman who takes care of a relative.  Men are not traditionally seen as caregivers.

A recent AARP Public Policy Institute  report suggests the the tradition is changing; men are increasingly filling care giving roles.  The report, Caregiving in the U.S., found that men represent 40 percent of all family caregivers.  That means that 6 million males serve as family caregivers.

Jean Accius, a Ph.D. with the AARP Public Policy Institute has penned an article explaining the ramifications gleaned from the pertinent data:
"These husbands, brothers, sons, sons-in-law, partners, friends, and neighbors are joining—either by choice, obligation, or necessity—the army of family caregivers providing care across the country. Male family caregivers are performing medical and nursing tasks as well as a range of personal care activities." 
In many cases, male family caregivers are caring for a spouse or partner. The PPI report shows that spousal caregivers in general face unique challenges, in part because they may lack an adequate support network.

There were notable differences, however, between males caring for a spouse and those caring for a parent.  Male caregivers, according to the report, provide more hours of care, and are more likely to be primary caregivers with little to no support from other family members, compared to male family caregivers taking care of a parent or other relative.
Men caring for a spouse reported having been a caregiver for a longer period of time than other unpaid male family caregivers (5.1 years compared to 3.9).

Dr. Accius reported:
"...the study found that male family caregivers were more likely (66 percent) to be working compared with female caregivers (55 percent). The large majority of employed male caregivers were working 40 or more hours per week at the time of caregiving. 
Regardless of gender, caregiving responsibilities often require family caregivers to make workplace accommodations. The study found that nearly two-thirds (62 percent) of male family caregivers had to make changes in the workplace as a result of their caregiving responsibilities [reference omitted].  Moreover, their caregiving duties affected their work in other significant ways:
  • Nearly half (48 percent) of male family caregivers went in late, left early, or took time off to provide care.
  • About 15 percent of male family caregivers took a leave of absence or went from working full time to part time to provide care.
  • Less than 10 percent of male family caregivers turned down a promotion (8 percent), received a warning about their performance or attendance (7 percent), or retired early or gave up working entirely (6 percent).
  • Nearly two-thirds (62 percent) of male family caregivers indicated that their caregiving experience was moderately to very stressful.
  • Almost half (46 percent) of male family caregivers experienced moderate to severe physical strain due to caregiving responsibilities.
Qualitative studies indicated that younger men had more “difficulties” in the caregiving role and communicated particular “psychological stress” when having to choose between work responsibilities and caregiving responsibilities. [reference omitted].  More than one-third (37 percent) of male family caregivers did not inform their employers about their caregiving responsibilities. The percentage of male family caregivers who did not inform their supervisors was even higher for millennials (45 percent).
Despite this trend, though, considering the aging of the population, increases in life expectancy, and shrinking families, the supply of family caregivers is unlikely to keep pace with future demand.  Aging in place planning, therefore, is extremely important.  The planning shoul consider the unavailability of typical caregivers, and should consider the unavailability of family caregivers. 

Thursday, January 7, 2016

Filial Responsibility Laws Lead to Chaos

Filial responsibility laws often lead family chaos to spill-over into the legal system. A recent Pennsylvania case, involving a claim by one child against his brother and sister illustrates the ensuing chaos, and the case does not involve Medicaid!  

Joseph Eori is the attorney-in-fact for his mother, Dolly Eori, who requires 24-hour care.  Mr. Eori lives with his mother and provides management of her care and resources.  Mr. Eori testified that his mother's medical and caregiving expenses exceeded her income.  Although Ms. Eori had not filed for Medicaid, and apparently did not require Medicaid assistance, and was on no other form of public assistance, Mr. Eori filed a complaint on behalf of his mother seeking filial support from his brother, Joshua Ryan, and from his sister Paulette Rush.  The daughter entered into a consent order to pay her mother $400.00 per month in filial support before trial. 

Mr. Ryan, however, objected to paying anything on behalf of his mother on a number of grounds.  He lost at the trial court, and the Court entered an Order for Filial Support requiring Ryan to pay his mother Dolly Eori $400 per month in support.  Ryan appealed the judgment against him.  

Mr. Ryan first argued that his mother was not legally indigent because she did not have outstanding medical bills.  The court ruled against him, even though her medical and other bills were wholly satisfied.  The court, refusing to resort to receipts and detailed checking account statements as demanded by Mr. Ryan,  relied upon the testimony and documents submitted by the caregiving son.  The court recounted the testimony:
Plaintiff [the caregiving son] testified that his mother is diagnosed with cancer, dementia and Alzheimer's disease and requires twenty-four hour care. During the day, she goes to Senior Life adult day care. For the remaining hours, Plaintiff is responsible for ensuring that someone is available to care for his Mother. There are currently three individuals that provide that care, and he pays each of them in cash. He pays them a total of $1,722 per month for the care. According to Plaintiff's testimony, he has not been able to obtain care for his mother on weekends because she cannot afford it. Therefore, the total amount is not even reflective of the full care that Ms. Eori needs.
In addition to the caregiver costs, Plaintiff estimates that Ms. Eori spends an additional $1,000 per month on hygiene items, cleaning expenses, and diapers. The electric bill is an additional $250 per month and there is a deduction evidenced on her bank statements for Verizon at approximately $95 per month. These basic needs already total more than Ms. Eori's monthly income, and the bank statements submitted by Defendant evidence additional expenses for medical needs, such as a payment of $773 to Prime Medical Group in July 2012 and another $115 payment in September 2012. To further show the disparity between Ms. Eori's income and expenses, Plaintiff admitted a bank statement for January 2014 showing a deposit of $1789 and a withdrawal of $1779.67.
Based on the evidence and testimony presented, the Appellate Court determined that Ms. Eori did in fact satisfy the common law definition of "indigent." The appellate court agreed that "[a]lthough she is not extremely destitute, she has sought financial assistance in the past and does not have sufficient income to provide for her maintenance and support."  The appellate court continued:
...the definition of indigent does not state that outstanding debt is necessary for an individual to qualify as indigent. It just requires an inability to provide for ones [sic] own maintenance and support with the income received. The mere fact that Ms. Eori has been able to remain out of debt does not eliminate her from the definition of an indigent person. One does not have to be "helpless" or in "extreme want." Therefore, the Court did not err in finding Ms. Eori indigent merely because there was no evidence of unpaid or outstanding medical bills or other liabilities.
Ryan next argued that the Trial Court committed error in failing to consider the fact that Plaintiff, as power of attorney for Ms. Eori, claimed her as a dependent on his 2013 Federal Income Tax return. Federal law required the Plaintiff to be responsible for at least fifty percent of Ms. Eori's expenses in order to claim the deduction. The court held that while this may be true for federal income tax purposes, it failed to see how that impacted the determination that Ms. Eori is indigent. The court wrote: "[i]f her son has to provide at least fifty percent of her expenses to maintain her daily needs, then she, on her own, is clearly indigent."  The court failed to determine whether the son, in fact, contributed such sum, and failed to consider the benefit the son derived from the deduction, a fact that will later demonstrate why these matters are so poorly resolved by legal means. 


Ryan next argued that the Trial Court erred in failing to consider the amount Plaintiff contributes to Ms. Eori's support. The court agreed that from 2012 to 2014, Ms. Eori's bank account has never had a negative balance. However, the positive balance was not, according to the Plaintiff, the result of Ms. Eori's income. Plaintiff testified that he used his personal money to maintain a $2800 balance in case of an emergency,  and because there are no burial plans for his Mother.  The court did not, however, consider and recount the actual amounts contributed by the caregiving son, noting simply that his occasional need to support his mother evidenced her legal indigence.


Ryan finally argued that he had been estranged from his mother and that he had an abusive childhood.   Ryan was initially sued as Russell Eori. Although his birth name was Russell Eori, Russell Eori obtained a legal name change to Joshua Ryan.  The record was unclear whether the childhood abuse played any role in his name change.  Pennsylvania's filial responsibility law negates the support obligation if the parent abandoned the child for a 10-year period.  The court ruled that his testimony was legally insufficient to constitute a defense to his support obligation.  The court explained:
The term "abandoned" is not defined in the act itself. However, the Custody Act at 23 Pa. C.S.A. §5402 defines "abandoned" as "left without provision for reasonable and necessary care or supervision." Defendant testified that he did not have the greatest family growing up and he wanted to get away. (N.T. 6/5/14 pg. 66, lines 8-13). He testified that his grandmother cared for him more than his Mother; however, they were never far apart because he testified that his grandmother either lived with Mother or beside Mother. (N.T. 6/5/14 pg. 61, lines 21-25 and pg. 62, lines 1-7). Although he testified that Mother was abusive, left and caused them to move many times, and was either gone or fighting, he never established that she left for a ten year period. He did not provide details or time periods on any of the testimony presented. Therefore, it was not clear from his testimony that Mother ever left for a ten year period without provision for his reasonable and necessary care or supervision. Although it may not have been an ideal childhood, there was no evidence of abandonment to release Defendant from his obligation to support Mother.
The Pennsylvania Superior Court affirmed, holding that Mr. Ryan is required to provide support to his mother. The court agreed with the trial court's decision that the filial responsibility law doesn't require a showing of unpaid bills or liabilities to justify a claim. In addition, the court affirmed the trial court's ruling that while Mr. Ryan may not have had an ideal childhood, there was no evidence that his mother abandoned him.

There was no explanation regarding the $800.00 in ordered support, and whether that bore any equitable relationship to the occasional financial support provided by the caregiving son, or whether any financial support was even necessary under the statute since he performed non-monetary services.  The court did note that the caregiving son might also be responsible for financial support, but failed to address the issue since it was subject of the lawsuit.  The court did not explain whether the caregiving son would, in fact, need to sue himself before the court would consider such an argument, or whether refusing to consider the care giving son's potential liability left the other children responsible for their mom's care. In fact one might conclude, as did Ryan, that the son benefited financially from providing services to his mother (in that he received a tax deduction, a place to live, and meal and transportation opportunities) which benefits were not considered by the court.

One can expect more lawsuits under filial responsibility statutes and laws.  

For the full text of this decision, click here.  

Thursday, October 8, 2015

Good Care Is the Best Medicine for Alzheimer's

Lou-Ellen Barkan, President and CEO of the New York City Chapter of the Alzheimer’s Association, writing in the Huffington Post Blog, makes a very poignant observation: "in the absence of an effective therapy for [Alzheimer's Disease], effective care remains the best therapy."

She continues:
And providing quality care has never been more important. Today, Alzheimer's disease is the sixth leading cause of death in the United States and the only cause of death among the top 10 that cannot be prevented, cured, or even slowed. Right now, 5.3 million Americans have this deadly disease - more than a quarter of a million right here in New York City. By 2030, without treatments or a cure, nationwide, this number will skyrocket to 13.8 million.
Worldwide, top researchers, scientists, and medical professionals at renowned hospitals, universities, research centers, and pharmaceutical companies are working day-in and day-out to discover the causes, to develop effective treatments, and to find a cure for Alzheimer's and related dementias. Whether they are investigating beta-amyloid plaques, tau protein tangles, genetics, the effect of environment or lifestyle, their dedication is unparalleled. 


And while great strides have been made over the past decade in diagnostics - allowing us to get help earlier to those who need it most - Alzheimer's research remains poorly funded in comparison to other diseases with far fewer patients. For instance, total funding allocated by the National Institutes of Health (NIH) for HIV/AIDS research dwarfed the funding for Alzheimer's in 2014 (almost $2.978 billion vs. $562 million), yet almost five times as many Americans today are living with Alzheimer's than HIV (1.1 million). In the absence of an effective therapy, our focus MUST be on care. 
For more than 30 years the Alzheimer's Organization, nationally, and through Local Chapters like the one headed by Ms. Barkan, have provided compassionate care and life-saving support for hundreds of thousands of  with dementia and their caregivers.  Among these is the groundbreaking wanderer's safety program developed by the Mew York Chapter's own Jed Levine in the early 1990s, which became one of the prototypes for the nationwide MedicAlert® Foundation + Alzheimer's Association Safe Return® program.

Seniors, their families, and caregivers can support and implement these caregiving efforts through good financial and estate planning.   


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