From the Blog
How to Use Long-Term Care Insurance for Assisted Living
Long-term care insurance is a tricky topic—do just a little delving and you’ll find well-meaning advice from both wary LTCI opponents and staunch advocates of such policies. Whether you’re for it or against it, it’s out there, and plenty of older Americans have chosen to hedge their bets and buy long-term care insurance in case they find themselves in need. The problem is, not all LTCI policies are alike; they have specific stipulations about what they cover and don’t cover, when benefits are paid out, and how long they will pay for care. And if you’re not fully versed in what a policy covers, you might find yourself caught out when it comes to paying for care.
What Types of Long Term Care Insurance can be used for Assisted living and Memory Care?
Researching long term care insurance is important as you don’t want an LTCI company telling you they won’t cover assisted living and you’ll have to pay out of pocket—even after decades of paying for a costly insurance policy. Yet this is the unfortunate case for many individuals who purchased their insurance in the late 1980s and early 1990s, before the idea of assisted living became widespread, and before insurance policies became more comprehensive in their coverage of different types of long-term care.
Now that many of those same people are claiming their LTCI benefits, they are finding that their coverage doesn’t meet their needs. Their claims might only be partly covered or even denied, says California Health Advocates, “because older policies contain out of date requirements for claiming benefits, and don’t reflect changes in long-term care services and providers.” Here are just a few of the coverage dilemmas described by California Health Advocates in a 2008 report:
- Home care benefits not paid because the person did not meet the additional policy requirements: a subsequent three-day hospital stay and, within 30 days of that hospital stay, at least 14 days of skilled nursing in a nursing home.
- Refusal to pay for assisted living care because it does not meet the insurer’s requirements for design, staffing, or services—some policies, for instance, stipulate that nursing care must be on site for 24 hours, or that a facility have a minimum number of beds.
- Refusal to pay for some types of long-term care even for newer plans with an “alternative plan of care” clause, because enforcement of this clause is at the discretion of the insurance company.
It is important to make sure that your policy is up to date. According to Allison Kern, Business Office Manager for Aegis of Issaquah, “When most of our residents purchased their LTC policies, assisted living communities were not as prevalent as they are today. Many were written for nursing homes, so I find that it is easier to approve someone for memory care than assisted living because of the services offered. Many have to meet a certain care requirement before they will be approved. You can also appeal the decision. I have done so twice and won both times. It does take time, effort and follow up from the Business Office Manager, however.”
What to Look for in a Long-Term Care Insurance Policy
So how can you make sure that your loved one is able to afford long-term care when the time comes? If he or she already has an LTCI policy, look carefully at the benefits covered. What are the restrictions to coverage and payouts? It might be helpful to consult with an expert—you financial planner, an insurance professional, or a member of the American Association for Long-Term Care Insurance. That goes for those shopping for a new policy, too. If you or a loved one is considering buying one, make sure to do your homework. Do some comparison shopping, and ask important questions about what the policy covers:
- Is the cost of the premium worth the investment, and does the policy have a loophole that allows for rate hikes? According to Nolo.com, “Consumer and financial experts generally agree that LTC insurance is a bad investment unless the monthly premium is 5% or less of your monthly income.”
- What is the initial daily benefit, and what is the maximum benefit period? Does the benefit amount increase with inflation, and will that affect your premium?
- How long is the elimination period before benefits are available, and what is the benefit trigger? The National Clearinghouse for Long-Term Care Information notes that “most policies pay benefits when you need help with two or more of six Activities of Daily Living or when you have a cognitive impairment.” Meanwhile, the elimination period is defined as “the amount of time that must pass after a benefit trigger occurs but before you start receiving payment for services”—usually between 0 and 180 days. If you choose a shorter elimination period, it will mean a higher premium.
- What is covered and what is excluded? What percentage is covered for services like home care, hospice, assisted living, memory care, or housekeeping assistance? Can you even use your long-term care insurance for assisted living?
- Does the policy reimburse for actual expenses only, or does it provide cash for you to use at your discretion?
- How does the policy interact with Medicaid coverage?
- What are the future benefits? The AALTCI recommends checking whether the policy has an inflation growth option, and whether that option will cost more in future years. They also advise researching what the benefit level will be in 10, 15 or 20 years.
Most experts seem to agree on two things: long-term care insurance is not necessarily suitable for everyone’s budget or care needs, but at the same time, if you do your research and select a policy that fits, LTCI can potentially be an enormous help when it comes time to pay for senior care. For more detailed information on what to look for, visit these websites.
10 New and Exciting Alzheimer’s Disease Findings
Imagine if you could prevent Alzheimer’s just by drinking more green tea, or if you could find out years in advance whether you’ve got a risk of the disease. From the discovery of new ways to predict the disease to the testing of newdementia medications, the recent research landscape has provided a range of exciting—and hopeful—news for Alzheimer’s disease sufferers and their loved ones. Read on to find out about 10 recent scientific discoveries that have shed new light on our growing knowledge of Alzheimer’s.
1. Brain Fluid Biomarkers Can Predict Alzheimer’s Years in Advance
A 2012 study in Sweden provided one of the biggest Alzheimer’s findings to date: biomarkers in cerebrospinal fluid—namely beta-amyloid and tau proteins—undergo characteristic changes five to ten years before the onset of Alzheimer’s, a discovery that has promising implications both for prediction and treatment of the disease.
2. Disruption of Sleep May Be an Early Indicator of Alzheimer’s
According to an October 2012 research study at Dalhousie University in Halifax, Canada and a March 2013 report in JAMA Neurology, sleep problems such as poor sleep efficiency, daytime sleepiness, and frequent napping may be a useful early predictor of Alzheimer’s. However, scientists don’t yet know whether the sleep problems are a result of the brain changes caused by Alzheimer’s or a contributing factor to the disease.
3. Family History of Alzheimer’s is a Major Risk Factor for Cognitive Impairment
Researchers already know there’s a strong genetic component to Alzheimer’s disease. Earlier this year, a study reported in the journal PLOS ONE confirmed that people who have relatives with Alzheimer’s are more likely to show an earlier buildup of telltale cerebrospinal biomarkers—even those who appear healthy.
4. High Cholesterol Increases the Risk of Alzheimer’s
Scientists already know there is a link between the brains of people with Down syndrome and the brains of people with Alzheimer’s—both conditions result from disruptions on chromosome 21. This means that people with Down syndrome are valuable as a source of study for Alzheimer’s disease. In a study of Down Syndrome individuals reported in a 2013 issue of PLOS ONE, researchers found that high levels of cholesterol—particularly LDL—can cause disruptions to chromosome 21 that lead to Alzheimer’s disease.
5. Dietary Antioxidants Can Help Protect Against Alzheimer’s
In studies released earlier this year in the Proceedings of the National Academy of Sciences and the Journal of Cellular Biochemistry, green tea extract and cocoa polyphenols both provided a protective effect against the formation of beta-amyloid plaques in the brain.
6. Tau Proteins Identified as Another Key Alzheimer’s Mechanism
We’ve all heard of the beta-amyloid plaques that are characteristic of AD, but scientists have also found that excess tau proteins also contribute to cognitive degeneration and dementia in people with Alzheimer’s. A study published in the April 2013 issue of Neuron reported that tau protein levels are linked to four different genes, three of which are unrelated to amyloid levels. They say this may help explain why some individuals with high beta-amyloid do not end up developing AD.
7. Extra Virgin Olive Oil Protects Against Alzheimer’s Disease
Did you know that the prevalence of AD is lower in Mediterranean countries? A 2013 studyreported in ACS Chemical Neuroscience reveals that a substance called oleocanthal, found in extra virgin olive oil, helps boost the production of key proteins and enzymes that help remove beta-amyloids from the brain.
8. Controlling Hypertension May Help Ward Off Alzheimer’s
In individuals already possessing a genetic predisposition to Alzheimer’s, uncontrolled hypertensionmay lead to much higher amyloid levels, and thus a greater risk of developing Alzheimer’s disease, according to a 2013 study in Journal of the American Medical Association Neurology.
9. New Drug Improves Memory in People with Moderate Alzheimer’s Disease
Clinical trials have revealed that a drug called ORM-12741 may improve memory-related problems in patients already receiving drug treatment for AD, reports the American Academy of Neurology. After three months of treatment, patients receiving ORM-12741 scored slightly higher on memory tests than they had previous to treatment, while those receiving a placebo scored worse.
10. New Alzheimer’s Risk Gene Found
Thanks to new brain scanning techniques and DNA screening tests, researchers at UCLA have discovered a new genetic risk factor for AD: subjects with a variation on a gene called SPON1 had weaker brain connections that predisposed them to dementia risk. The study was reported in the 2013 Proceedings of the National Academy of Sciences.
How to Recognize Signs it’s Time for Assisted Living
More than 15 million Americans devote time and energy to caring for a loved one with Alzheimer’s disease or other dementia, according to the Alzheimer’s Association, but sometimes the cost of caregiving becomes too high. Caregivers find themselves unable to bear the burden of providing home health care without suffering from stress and illness themselves. At that point, it may be time to consider whether to move a loved one into senior care if their health needs become too much to handle at home.
Signs that Your Loved One May Need Assisted Living
Moving a family member into residential care is never an easy decision. However, there are some telltale signs that caregivers can look for in order to recognize when it’s time for assisted living:
- Wandering. In later stages of dementia, the risk posed by wandering becomes much greater, notes Rita Vasquez, M.A., an MFTI Clinician at Quail Lakes Counseling Center in Stockton, California. “They can wander even if you just take the time to go to the bathroom,” she says, and the probability of falls and injuries increases.
- Sundowning. “Sundowner syndrome“—very agitated behavior that becomes more pronounced later in the day—is a common characteristic of those with Alzheimer’s. Vasquez says that this can take a heavy toll on caregivers, and when it begins to severely disrupt family routines, this may be a sign that the caregiving burden is too hard to handle.
- Aggression. Verbal, physical, and even sexual aggression frequently happen in those with dementia, and caregivers and other family members may suffer or begin to feel resentful. “I tell people when they’re getting to that state, it’s time to start considering placement,” says Vasquez.
- Home safety issues. Ask yourself honest questions about your senior family member’s health and your own abilities to care for them. Is the person with dementia becoming unsafe in their current home?
- Escalating care needs. Is the health of the person with dementia or my health as a caregiver at risk? Are the person’s care needs beyond my physical abilities? If you’re answering yes to those questions, it might be time to have that tough family conversation.
- Caregiver stress. Stress and other caregiver symptoms can be just as telling a sign as the dementia behaviors described above.
Caregiver Stress May Indicate a Need for Help
A recent article in the New York Times discussed the psychological costs of caregiving and of making difficult care decisions, which some professionals are likening to the effects of post-traumatic stress disorder. Caregivers may experience symptoms like “intrusive thoughts, disabling anxiety, hyper-vigilance, avoidance behaviors,” and more.
Rita Vasquez attributes these symptoms not only to the pressures of caring for someone withdementia, but also to the disruptions to normal sleep and eating patterns that result when one is spending so much time on caregiving: “When the brain is always on alert, many things are going to happen—you’re not going to eat well, your nutrition is going to go down,” and physical health suffers.
The emotional, mental and physical toll of caregiving can be particularly pronounced for spouses of those who need care. In one of the families Vasquez works with, the wife and primary caregiver is 80 years old.
“She’s taking care of her 85-year-old husband and it’s draining her,” Vasquez says. “When he fell recently, she couldn’t pick him up and had to call the paramedics.”
In cases like this, it might be clear immediately when the demands of care become too great. In other cases, it might not be so obvious. However, if you are feeling isolated and alone, or if you begin to feel resentful of your loved one, it might be time to examine the source of those feelings, says Vasquez.
“Sleep deprivation, anger, resentment, all those things will become part of what happens to a caregiver,” she says. “And, of course, the guilt, when you think, ‘I’m not doing enough.’” When that happens, it’s important to recognize how much you’ve been giving to your loved one, and perhaps tell yourself, “Okay, I’m not living a life for myself anymore, I’m living for that person.”
My Loved One Needs More Help Than I Can Give—What Now?
Deciding between assisted living vs in-home care is never easy, and caregiver guilt and grief are common reactions to moving seniors out of their homes. As Rita Vasquez puts it, “We lose our family member twice: once to the disease, and again when they pass.” Caregivers may wonder if they could or should have done more; they may feel separation anxiety in moving their loved one to another location. If family dynamics are difficult—if, for instance, a caregiver caring for a parent had an unhappy childhood—that may further complicate the decision process.
This is why planning ahead is so important: “If you know your family member is in the early stages of [illness], first and foremost you want to get all your paperwork together,” Vasquez says. “It’s in our culture that we don’t want to talk about those things,” but before dementia begins to affect your loved one’s cognitive health, it’s important to have someone help them collect the right paperwork and make those critical decisions, whether it’s a friend, family member, or physician. Planning ahead, getting informed, and involving the appropriate persons in the decision will ultimately help ease the process when it’s time to move your loved one into care.
The best way to be there for them, Vasquez says, is to know that they are in the proper place for getting the care that they need. Visit communities before choosing one, and make sure they have activities and medical support appropriate to dementia patients. Ultimately, she says, try to remember that if you’ve done that research “They are going to thrive wherever you send them.”
Caring for the Caregiver
As a caregiver, it can be difficult enough to find time to care for your senior loved one, let alone yourself—even if your family member is in residential care. But staying healthy is one of the best things you can do to provide the support your loved one needs. Arranging a short stint in respite care is one way to get some time to rest and recuperate, especially if you are caring for someone at home.
Taking care of your mental health is also critical, and there are many benefits to seeking out a circle of support to bolster you when times are difficult. Counseling, therapy, and support groups all exist to help family members going through transitions relating to Alzheimer’s and dementia. Check with the facility that your loved one is moving to, suggests Vasquez, who has led caregiver support groups and coordinated family services at a local residential care facility. Many care homes, she says, offer support groups and other resources for families. These resources can help you come to terms with the idea that sometimes the best decision for the health and happiness of both parties is putting your loved one into care.
“We have to know that as a human being, we can only do so much without taxing our health,” says Vasquez.
Big List of Alzheimer’s Resources
We’ve started a list of Alzheimer’s and dementia resources to act as a guide for anyone who wants to get involved in the fight against Alzheimer’s, from fundraising for a cure, to learning about how to cope with difficult behaviors and raising awareness about the disease. This list includes our own articles as well as links to some of the best and most useful Alzheimer’s resources on the web. Please add other resources we might have missed in the comments below, we’ll continue to update this list.
- Trial Match Tool: The Alzheimer’s Association created this tool to help families find Alzheimer’s clinical studies and trials in their area
- Miami Jewish Health System Alzheimer’s and Dementia Trials
- Reasons to Participate in Clinical Trials: Why participating in trials benefits humanity and Alzheimer’s patients
Genetic Testing and Alzheimer’s
- Alzheimer’s Association Position Statement on Genetic Testing for Alzheimer’s
- 23andMe Genetic Testing: A private company that provides genetic testing to the general public that can inform those interested in whether they are genetically predisposed to Alzheimer’s
Alzheimer’s Fundraising and Awareness
- Walk to End Alzheimer’s: The nation’s largest fundraiser for Alzheimer’s awareness and funds for Alzheimer’s care, support and research
- Sign the Stop Alzheimer’s Petition
- Cure Alzheimer’s Fund: Fundraising for Alzheimer’s disease research
- Act to Action: National Alzheimer’s Plan: Details about the National Alzheimer’s Action Plan, a U.S. government initiative to cure Alzheimer’s
- Interview with President of the Alzheimer’s Initiative: Meryl Comer, President of the Geoffrey Beene Alzheimer’s Initiative on why we need to wage a war on Alzheimer’s, just as we did with cancer
- Senior Brain Donors Join Fight Against Dementia: How an unusual donation could make a big difference
- Alzheimer’s Advocate Network: A community of Alzheimer’s activists
- 13 Celebrities With Alzheimer’s Disease: Celebrities have been key to increasing public awareness about the illness and efforts to find a cure
- Top Alzheimer’s Myths
Diagnosing Dementia and Alzheimer’s
- 10 Early Warning Signs of Alzheimer’s: Top signs and symptoms of early stage dementia and Alzheimer’s
- National Memory Screening Program: A nationwide initiative to promote memory screening
- Early Detection Alzheimer’s Tests: What’s New: Cutting edge tests to diagnose Alzheimer’s and dementia
- How to Tell if it’s Alzheimer’s: Help determining whether your loved one’s forgetfulness is just a “senior moment”
- Medications and Dementia Misdiagnosis: Learn about the leading causes of misdiagnosed dementia
- What is Dementia?: Learn about the differences between Alzheimer’s and other types of dementia
- Dementia Treatment: Learn about dementia treatment options
- What is Alzheimer’s Memory Care?: Learn about Alzheimer’s care and memory care
Alzheimer’s Caregiving and Support
- Local Support Groups for Caregivers: Search for local caregiving support groups on the Alzheimer’s Association website
- Dementia Care Dos and Don’ts: What not to say or do when dealing with difficult dementia behavior problems
- 5 Common Behaviors of Alzheimer’s Patients : Identifying the most common and difficult behaviors of Alzheimer’s patients such as sundowning and verbal outbursts
- Caregiving Tips: Strategies for Success: Caregiving advice from the Alzheimer’s Foundation of America
- Dementia Stages: A Place for Mom’s guide to coping with the stages of dementia
- Alzheimer’s: Understand and Control Wandering: A guide from the Mayo clinic about how to address the challenging issue of wandering
- Sundowner’s Syndrome: Common triggers of Sundowner’s syndrome and ways to cope
- ALZConnected: Caregiver Support: Alzheimer’s caregiver message boards
- How to Communicate with a Loved One Who Has Dementia: Advice on how to communicate with a loved one who has dementia
- Signs of Memory Loss? How to Protect Your Aging Parent’s Retirement Savings: Seniors with mild cognitive impairment are at risk for making disastrous money management decisions
Alzheimer’s Research and Science
- Science Daily Alzheimer’s News: Daily news about Alzheimer’s
- Alzheimer’s Research Forum: News and discussions about Alzheimer’s disease
- University of Washington Alzheimer’s Disease Research Center
- Yale University Alzheimer’s Disease Research Unit
- Alzheimer’s Facts and Figures
- Alzheimer’s Drug Discovery Foundation
- Dementia Research Centre One of the UK’s leading centres for clinical research into dementia
- Recent Alzheimer’s Research Breakthroughs
- Ways to Reduce Your Dementia Risk: Practices linked to a lower probability of developing Alzheimer’s and other kinds of dementia
- The Science Behind Diet and Dementia: How diet may play a role in Alzheimer’s and dementia
- What Increases Your Odds of Dementia?: Learn the risk factors linked to dementia
- Dementia Fighting Vitamins and Minerals: How vitamins and minerals found in a well-rounded diet may promote brain health
- Dementia Causing Chemicals: Some ingredients in our food supply have been linked to Alzheimer’s
- Stress and Alzheimer’s: How researchers are exploring a possible link between stress and dementia
- Tips to Keep the Mind Sharp: Practical advice about keeping the brain healthy
Music Therapy for Dementia Patients
- Best Music for Dementia Patients: Tips on choosing music for a loved one who has Alzheimer’s disease
- Music Therapy: A detailed article from the Alzheimer’s Foundation about music therapy for Alzheimer’s patients
- Interview with Dan Cohen of Music and Memory: A discussion with president of a nonprofit foundation promoting music therapy for people with dementia
- Music Therapy and Dementia - An article about music therapy and dementia from a maker of sing-along DVDs for seniors
Alzheimer’s Online Videos
- Alanna Haikh – How I’m preparing to get Alzheimer’s
- Amy Harris - Relating to a Loved One with Dementia
- Warning Signs of Alzheimer’s – A video by the Alzheimer’s Association
- What is Memory Care? – A short video about memory care communities
Movies About Alzheimer’s
- The Alzheimer’s Project: A moving and informative documentary by HBO about Alzheimer’s
- The Savages: A dark comedy starting Phillip Seymour Hoffman about caring for a parent with Alzheimer’s
- Aurora Borealis: A well-received independent film where dementia plays an important role in the plot
- Iris: A Memoir of Iris Murdoch: The true story of the English writer Iris Murdoch’s battle with Alzheimer’s
- Away From Her: Julie Christie plays woman who is diagnosed with Alzheimer’s disease
Books About Alzheimer’s
- Nancy L. Mace & Peter V. Rabins - The 36 Hour Day: A Family Guide to Caring for Persons with Alzheimer’s or a Related Illness: The classic guide to caring for a loved one with Alzheimer’s
- Joanne Koenig Coste – Learning to Speak Alzheimer’s: A Groundbreaking Approach for Everyone Dealing with Disease : A guide for families coming to terms with an Alzheimer’s diagnosis
- Martha Stetinus - Inside the Dementia Epidemic: A Daughter’s Memoir: A daughter’s personal memoir of caregiving for a mother with dementia
- Patricia Callone – A Caregiver’s Guide to Alzheimer’s Disease: 300 Tips: A guidebook for caring for an family member Alzheimer’s
- Prudence Twigg & Sandy Burgener – A Personal Guide to Living with Progressive Memory Loss: Advice for people who are themselves living with a memory disorder
- Books for Helping Young People Understand Alzheimer’s: A list of books to help young people understand what’s happening when a loved one has Alzheimer’s
Personal Alzheimer’s Blogs
- Joseph Potocny – Living with Alzheimer’s – A patient’s perspective on Alzheimer’s
- Gevera Bert – “Had a Dad” Alzheimer’s Blog: Experiences as a caregiver and as an advocate in the fight against Alzheimer’s disease
- Bob DelMarco – Alzheimer’s Reading Room: Ongoing posts about the latest developments
- Carole Larkin – Alzheimer’s Speaks : By a caregiver and advocate
- Joan Gershman – The Alzheimer’s Spouse: About caring for a spouse with Alzheimer’s
- Ann Napoletan – Alzheimer’s Journey: The journey of a longtime Alzheimer’s caregiver
- The Art of Alzheimer’s - “How Mother forgot nearly everything and began to paint…”
Local Alzheimer’s Association Chapters
- Alzheimer’s Association of Western North Carolina – Charlotte and vicinity
- California Southland Chapter Los Angeles and greater Southern California
- Capital of Texas Chapter – Austin and vicinity
- Colorado Chapter – Denver and greater Colorado
- Delaware Valley Chapter – Philadelphia and the Delaware Valley
- Desert Southwest Chapter – Includes Phoenix, Scottsdale, and Tucson
- Georgia Chapter – Atlanta and great Georgia
- Greater Cincinnati Chapter – Cincinnati and the surrounding area
- Greater Illinois Chapter – Chicago and greater Illinois
- Greater Dallas Chapter – The Dallas – Fort Worth area
- Greater Indiana Chapter – Indianapolis and greater Indiana
- Greater Pennsylvania Chapter – Pittsburgh and greater Pennsylvania
- Houston and Southeast Texas Chapter – The Houston area
- Long Island Chapter – Long Island New York
- Mid South Chapter – Nashville, Tennessee and surrounding areas
- New York City Chapter – Staten Island, Brooklyn, Queens, Manhattan, Bronx
- Northern California & Northern Nevada Chapter – San Francisco, San Jose, Oakland, Fresno, Sacramento, Reno and surrounding areas
- Oregon Chapter – Portland and greater Oregon
- Southeastern Wisconsin Chapter – The Milwaukee area
- Utah Chapter – Salt Lake City and greater Utah
- San Antonio & South Texas Chapter – San Antonio and the surrounding area
- San Diego / Imperial Chapter – San Diego and the vicinity
- Western & Central Washington Chapter – Seattle, Tacoma, Bellevue and the greater Puget Sound area
- The Alzheimer’s Association: The nation’s foremost nonprofit for Alzheimer’s activism, support, and information
- Alzheimer’s Foundation: A nonprofit focused on promoting quality care for people with Alzheimer’s disease