Phone rings.

Grandma- “Hello?”

Caller- “Hi Grandma, how are you feeling?”

Grandma- “Oh, I’m feeling ok.  I was pretty sick last week, but I’m doing better now.  How are you?”

Caller- “I’m not good Grandma, I’m in trouble.”

Grandma- “Is this Tom?”

Caller- “Yes, it’s Tom.  Do you remember my friend Steve?”

Grandma- “No”

Caller- “Well we went to school together, and he got married this weekend in Canada.  I’m in Canada right now, but we have run into a bit of trouble.”

Grandma- “Uh-oh, what kind of trouble?”

Caller- “Well, we were out at a party that got busted and now we are all in jail because someone had some cocaine in the car.  So now we are all in jail and my wallet and passport is in the hotel.  I need to borrow some money to get out of jail so I can come home.”

Grandma- (now, this is just classic) “Well, why are you calling ME for money?  You know I don’t have any money!  Did you call your dad?”

Silence, then dial tone.

We are lucky.  My grandma doesn’t take guff from anyone, including her grandkids.  But how many seniors have fallen for this scam?  Who wouldn’t want to help a grandchild in a bad situation in another country?  Questions later, just send the money now.  My grandmother has been called three different times with this scam.  She tells her neighbors and family about it, hopefully that has prevented someone else from being taken advantage of.

Talk to your loved one about these types of scams.  Remind them to never, ever give out their bank information over the phone.  The call will be urgent, and the callers are very convincing.  When this particular incident was reported to the local police, they responded that there was nothing they could do.  Often, the calls come from international numbers and impossible to prosecute.  It’s our responsibility as a community, family members, and professionals to educate seniors and their families about these scams.  Sadly, con-artists are coming up with new schemes every day.  Here are a few resources to protect yourself and your family.

Federal Bureau of Investigation

Consumer Affairs Scam Alerts

Oregon Department of Justice- sign up for scam alerts in your area

Better Business Bureau- Top 10 Scams of 2011

As for my Grandmother?  She’s doing great.  And determined never to let anyone get the best of her, even her grandchildren.

What to bring:

• Bed- Generally, beds are not furnished (the exception would be an adult care home), unless your insurance is paying for a hospital bed.  Depending on the size of the bedroom, a twin, double, or full-sized mattress is best.  You want to make sure there is plenty of room around the sides of the bed to maneuver safely, especially if other furniture is in the room.  A foot-board and headboard may be desired, depending on the space.
• Chairs and Sofa
• Shower curtain and rings- Most communities supply the rod.
• Towels- Several (2-3)complete sets of towels.  If housekeeping is done weekly, this should be plenty.
• Sheets- At least two sets, unless the bed is changed frequently, most housekeeping is weekly that includes laundering sheets.
• Bedspread, blankets, and pillows
• Laundry Basket
• Garbage cans- In a retirement or assisted living setting, a small garbage in the bathroom(s) and kitchen area are handy.
• Clothes Hangers
• Personal Items & Toiletries- toothpaste, toothbrush, denture products, comb/brush, soap, shampoo, shaving products, incontinence supplies*, glasses, hearing aids.
• Clock, personal photos, and decorative items- familiar items in your new home, like curtains, artwork, and houseplants can make a world of difference to make your new accommodations feel more like home.
• Telephone (optional)
• TV/ Radio
• Dresser/ Nightstand
• Clothing- Garments that are washable- commercial washing machines can be very harsh on clothing, I would limit dry clean items, and comfortable for everyday use.  Perhaps a few dressy items for special events.

*Some communities will assist in ordering incontinence supplies as they may be able to purchase in bulk at reduced prices.

What not to bring?

• Large Furniture- dining room tables, coffee tables, TV units, and King sized poster beds can all be left behind.  Not only are they difficult to move, but they will eat up considerable living space.  If these items are meaningful treasures, this may be the time to hand them down to family, place in storage, sell, or consider donating.
• Kitchen Items- you will no longer need the crock pot, dutch oven, and countless pots and pans that have accumulated over the years.  Yes, a few dishes, silverware, cups, and Tupperware are appropriate, but anything else will go unused and take up valuable cupboard space that can be used for other necessities.
• Cleaning Supplies- If housekeeping is included (and most of the time it is), you will not need to bring chemicals, mops, or the vacuum.  Perhaps a small broom for quick clean-ups, but that’s it.

Most of us have a lot of stuff- I recommend working with a professional organizer when the time comes to consider a move.  These wonderful folks will help you with organizing your belongings and performing the tedious task of deciding what to keep, what to pass on, what to donate, and what to simply throw away.

NW Organizing Solutions- 503-709-0791
Organizers Northwest- 503-245-3564
Roger Hall Associates- 503-803-5106

Remember, there’s a lot to get to know before purchasing a mobility scooter, and this should only be used as an initial list of questions to consider.  Scooters aren’t for everybody, and some of them can be downright dangerous (even the simplest to operate).   In a subsequent article, we’ll showcase many of the more popular scooter models available today, and the features/benefits of each.

The Top 10 Questions to Ask When Evaluating Scooters for Seniors

10.  Will the mobility scooter be used primarily indoors, outdoors or both? There is a lot to this question, and understanding where the user needs mobility-assistance will determine many factors about the models to consider.  For example, a scooter for (primarily) indoor use doesn’t need to be as durable as many of the outdoor models.  Most of the indoor models can get away with 3 wheels (one leading and two trailing).  A single leading wheel makes the scooter easier to steer, and lighter too.  Outdoor scooters are usually heavier, more sturdy, have more “range” under the hood (ok in the box), and can be a bit more expensive.

9.  Are you paying cash for the mobility scooter, or are you hoping Medicare will pick up the cost? Many manufacturers and marketers tout that mobility scooters for seniors can be paid for by Medicare (if you qualify for Medicare).  There are stipulations to this strategy however.  In most cases, your physician will need to “prescribe” and/or recommend a mobility aid/scooter for you with appropriate documentations.

8.  Do you require a new model OR would a used (reconditioned) scooter do the job? There are great discounts to be had on used and/or reconditioned mobility scooters.  A scan of “mobility scooters” in Craigs List showed over 20 scooters for sale in the Portland, Oregon area in the first 2 weeks of January alone!  Scooters are usually well maintained by their owner/operators, which makes buying a used scooter a wise choice if you’re spending your own money.

7.  Do you (or someone you know) have the means to transport your scooter if you intend on using it outside the home? The larger grocery chains usually have mobility scooters available for people that need assistance, but some do not.  If you plan on taking your scooter with you, you need ample space in your vehicle (like a mini-van) AND someone to muscle it in and out for you.  Van lifts are obviously the best alternative, but you need to think about transport as it relates to using a scooter away from home.

6.  How much do you plan on spending on your mobility scooter? For reasons mentioned above, there is a wide range in prices for mobility scooters for seniors.  Pricing for a new mobility scooter ranges from $750 on the low end up to $4,500 on the high end.  Features, durability, and quality raise the price points considerably.

5.  Have you found any ratings and reviews for mobility scooters? Here at The Senior List we plan on showcasing many of the popular models, so that our users can provide feedback on senior-friendly-scooters.  Until then, you can check out Amazon.com on many popular models today.  You can also check with the manufacturers, or the sales outlet (but you might not be getting unbiased feedback.  Just keep that in mind.) 

4. Is the scooter comfortable to sit in? Now this may seem obvious, but if you plan on purchasing online, make sure you find that model locally and take it for a spin.  Mobility Scooters are designed to be comfortable, but I can tell you from experience that people come in all sorts of shapes and sizes!  Leg room is a big consideration when evaluating the comfort of a mobility scooter.  Another consideration is that we all sit a bit differently!  My posture isn’t perfect so I may sit differently than the next person.  Test drive your mobility scooter… you’ll be glad you did.

3. What is the maximum load weight? Load weight refers to all of the weight-bearing-stress being placed on (or in) the scooter and any one time.  Individuals that are overweight, or need to carry heavy objects with them need to understand and answer these questions when evaluating mobility options.

2.  What safety features and/or accessories come standard with my purchase? You don’t want to spend $2,000 on a new scooter only to find out you need to purchase arm rests as accessories… (enough said).

1.  What kind of warranty comes with my purchase? Make sure you understand the warranty inside and out.  Service can be expensive on mobility devices (not to mention a pain in the posterior).  Know your rights upfront.

Chris Clark, Co-Founder The Senior List.com

Insurance: If your loved one has Medicare or a HMO that manages medicare benefits, the hospital stay is mostly covered. Medicare recipients will pay a $1132 deductible for 2011 for hospital stays of 1-60 days. If a HMO is involved, check with the benefits administrator for specific deductibles or co-pays.

Legal Documents: If you haven’t done it already, now would be a great time to have legal documents prepared for health care decisions. The most widely used form is called the Advance Directive for Health Care. This form allows your loved one to appoint someone to make decisions about health care if they are unable to do so, as well, this form also addresses end-of-life decision making. While you are helping your loved one with this document, fill one out for yourself!

Your mom has been in the hospital for two days now, and the discharge planner is telling you that she needs to leave the hospital in two days! To top if off, you have been presented with a list of in-patient rehab centers for discharge and you are expected to pick one!

Skilled Nursing Facilities (SNF): Medicare and HMO’s will cover rehab centers- with a catch. Medicare recipients must have a three night hospital stay and receive a doctor’s order to receive ‘skilled’ care in order to qualify for admission to rehab. The doctor will make a decision based on several aspects of a patient’s rehab potential. HMO benefits vary greatly, check with the benefits administrator for specific requirements. .

Medicare has a great website for users to compare rehab centers based on their yearly state inspection results and other quality indicators, www.medicare.gov/NHcompare. You will also find helpful checklists to assist in your search. Select a few; go for a tour. Talk to health care professionals who can share their experiences with these facilities.

The 100-day myth: Many families leave the hospital believing their loved one will be able to stay in the rehab center for a full 100 days. It is a rare case that a resident uses their full 100 days of Medicare during a rehab stay. Medicare does not cover long-term care, it is simply an insurance benefit. Medicare will cover a rehab center (skilled coverage) as long as your loved one continues to benefit from the skilled services they are receiving.   Medicare does not have representatives that make this decision, instead, the decision to continue with rehab on a day-to-day basis is decided by the interdisciplinary team at the rehab center working with your loved one.

Medicare recipients will be covered 100% for the first 20 days of their stay in a rehab facility.  For days 21-100, the co-pay is $141.50 per day in 2011.  If you have a supplement, this copay is generally covered.

In the case of HMO recipients, the HMO does employ case managers who keep in close contact with the rehab centers and decide when a resident is no longer eligible for skilled benefits. In either case, once it has been determined that your loved one no longer qualifies for skilled benefits, you will be presented with a Notice of Medicare Provider Non-Coverage (aka, a denial letter). By law, Medicare beneficiaries must have 72 hours notice of non coverage; HMO’s vary between 48-72 hours depending on the HMO.

Appeals: Once your loved one has been presented with a denial letter, several options are available. If you do not agree with the non-coverage decision, you can appeal it. You will find appeal information within the Non-Coverage letter, specific to the Medicare Insurance provider. If you do agree with the non-coverage decision, it is time to make decisions about the next move for your loved one. Hopefully, you and your loved one have been discussing the plans to return home after the rehab stay. The rehab social worker can help you arrange for equipment and services to ease the transition of returning home. If returning home is not an option for your loved one, you now face a myriad of options for community based care.

Amie Clark, Owner, The Senior Resource Network
Co-Founder, The Senior List

• “Forest Grove man gets 5 years probation for elder fraud”
• “Forest Grove police seek suspect in elder abuse case”
• “Family friend accused of stealing $83,000 from elderly Milwaukie man”
• “Portland man accused of pocketing his elderly mother’s assets and fraudulently applying for Medicaid”
• “Portland man accused of tapping 99-year-old grandmother’s ATM for more than $40,000″

And the list goes on… here’s a link to these elder abuse headlines (if you want to read on and raise your blood pressure).  Keep in mind, I only searched one “tag” in our local community here in the Portland, Oregon area.  It also goes without saying (although I’m saying it) that elder abuse is highly under reported, (as are all other forms of abuse).  Only 1 in 14 incidents come to the attention of authorities according to survey results published in The Gerontologist, (1998 28:51-57).  Does this scare you as much as it scares me?

The National Center on Elder Abuse cites a Wash. DC National Research Council Panel study that estimates “between 1 and 2 million Americans age 65 or older have been injured, exploited, or otherwise mistreated by someone on whom they depended for care or protection.  Definitions of “Elder Abuse” vary, but I found one I agree with on Medline Plus.  Medline Plus is the National Institutes of Health’s website for patients, families and friends. They define Elder Abuse as follows:

“Elder abuse is doing something or failing to do something that results in harm to an elderly person  or puts a helpless older person at risk of harm.  This includes:

• -Physical, sexual and emotional abuse
• -Neglecting or deserting an older person you are responsible for
• -Taking or misusing an elderly person’s money or property”

So what can you do to make sure you’re loved one isn’t taken advantage of, or worse yet, abused?

1. Make sure that there are multiple layers of trusted individuals communicating, and checking-in with your loved one often (family, friends, neighbors, and elderare professionals).
2. Make sure caregivers have UP TO DATE criminal background checks documented, and ask to speak to references
3. Make sure there are at least 2 trusted sources tracking “the money”.  There must be “checks and balances” with regard to finances for anyone… this is especially true for elderly individuals.  A conservator/guardian may be able to help manage the finances.

You’ll find a host of resources and links at Medline Plus. So I encourage you to bookmark the site (especially if you’re a caregiver, family member or eldercare professional).  Another great resource, as mentioned above, is the National Center on Elder Abuse (Administration on Aging).

Chris Clark, Co-Founder, The Senior List.com

Some agencies will simply supply you a list of “recommended” facilities based on a short telephone interview or an on-line screening.  Others may want to visit with you and any involved family, and of course, the soon-to-be resident to discuss needs, wants, and preferences and then hand-hold you through the entire process of searching for mom or dad’s next home.  For some families, it depends on time-frame.  For others, it depends on personality or experience of the agent.  Following is a list of questions to consider when selecting a referral agent- after all, this is one of the most important decisions of all time.

1. *How much experience does the agent and/or agency have? How long have they been in business?  What kinds of resources are available to them to make sure they are exploring only the best options for your loved one (office staff, database)?
2. *Is the agency paid by facilities? If so, how many do they work with?  Will certain facilities be excluded from your search because they are not contracted with the referral agency?
3. *Does the referral agency check the public disclosure files of all the housing options in your area (complaints, survey results)?  If so, how often?  If not, can they provide you with the information to view the data yourself?
4. *Does the agency preview all homes and facilities that it recommends to you?
5. *What criteria does the agency use to make referrals to you?  Do they perform an assessment?  Who do they gather this information from?  Are physicians, social workers, home care agencies, therapists, or other caregivers involved in the information gathering process?
6. *Do they work with all budgets? Do they work with Medicaid clients?
7. *Do they belong to any professional organizations?
8. *How quickly can they provide you with the information you need?
9. *Can they provide professional and past client references?

If you have only recently started your search for a referral agency, but don’t know where to turn, call your local Aging Services office, hospital, or rehab facility and ask for recommendations.  Social workers and case managers work with referral agents frequently, they will have the inside scoop and good recommendations.

Amie Clark, Owner, The Senior Resource Network
Co-Founder, The Senior List

There are certainly situations, however, that family or friends providing care is not appropriate, or does not appeal to everyone, including the family and friends. If professional support needs to be hired, here are a few considerations and questions to ask the agencies you are interviewing.

1. Most In-Home Care agencies have hourly minimums, usually 2-4 hrs. If a shift does not meet these minimums, the client may still have to pay for the full shift.
2. Make sure the agency you are considering is licensed, and caregivers are bonded and insured.
3. What kind of training and orientation do the staff participate in?
4. Is there a nurse to oversee caregivers and provide training?
5. What is the process if a caregiver is sick or does not show up for a shift?
6. What are the fees? Do you pay less for longer shifts? Does the agency bill monthly or weekly? Do they provide transportation to doctor appointments, grocery store, etc…?
7. Does the agency have access to other resources in the community should you need them?
8. Check inspection results at medicare.gov.
9. Ask to see references and customer testimonials. You can review online eldercare ratings and reviews right here on The Senior List.com.

What is the advantage of hiring my own private caregiver?

• generally less expensive than working with an agency
• caregiver is your employee, they work for you.
• may be able to exchange care services for room and board, this works well for students

What is the advantage of hiring an agency?

• agency pays taxes, insurance, etc… No liability on your part, less risk
• shift will always be covered
• agencies are regulated and must pass inspections to operate

What type of Assistance can a caregiver provide?

• Bathing/ Grooming
• Light Cleaning
• Shopping
• Laundry
• Meal Preparation
• Toileting
• Dressing
• Mobility
• Night care

How Much Does In-Home Care Cost?
I have seen quite a range for costs, anywhere from $12-$22 per hour, depending on geography and duties of the caregiver. If the caregiver is a CNA, the cost will typically increase due to training that the individual has received.

Who Pays for In-Home Care?

• Private Pay (you)
• Long Term Care Insurance- check your policy for restrictions and make sure agency is able to accept payment from Insurance provider
• Some Health Insurances- check your policy
• Medicaid- offers limited in-home care programs for those who qualify

Amie Clark, Owner, The Senior Resource Network
Co-Founder, The Senior List

The number of residents per home ranges from 1-6, depending on the state licensing requirements. Care services at this level can vary, but typically fit a higher level of care than can be provided in assisted living communities, but don’t require full 24 hour nursing care. The advantages of this level of care are consistent care givers, home-cooked food, high staff to resident staffing ratios, and a home-like environment. Typically the costs are less than other levels of care that provide the same services.

While these homes are a great option for many residents, there are some disadvantages. Due to the small number of residents, it is difficult for providers to maintain a full activities program for the residents. The care home may not provide the same social aspect as an assisted living or residential care community. They may not be able to provide transportation, hair-care services, or visiting podiatrists.  Care homes are operated by individuals, not corporations who have specific policies and procedures for staff to follow. Many care homes are not able to provide night-time care, as the caregivers are sleeping during the night as well. This is not to say that care homes can’t assist toileting at night or be available for emergencies, but consistent, extended night-time care is difficult to maintain. Care homes may also have great difficulty with a resident who is actively exit-seeking.

You have most likely just navigated some very important decisions regarding the care of your loved one. You now have several additional decisions to make about their new home and lifestyle changes. This following suggestions are designed to help you “organize” your thoughts and help you plan for the next steps.

A guardian is person who is appointed by a court to make health care and placement decisions for another person. We start the guardianship process by filing a court petition, explaining the circumstances to the court, and asking the court to appoint a legal guardian. We send out notices to interested persons, including close family members and people serving as trustee, power of attorney, and health care representative. A copy of the legal notice is personally delivered to the person in need of a guardianship (called a “respondent”). The respondent and interested parties have 15 days to object to the appointment of a legal guardian.

During the 15-day waiting period, a trained psychologist or nurse, known as the “court visitor,” is appointed by the Judge to interview the respondent and all persons who are knowledgeable about the respondent’s circumstances. The court visitor reports his or her findings to the Judge, including the visitor’s opinion about whether a guardian should be appointed.

From our first contact, it normally takes 20 to 25 days to obtain a guardianship. Sometimes there is an emergency situation requiring immediate action. The most common example is a respondent with a behavioral disturbance requiring immediate psychiatric treatment. In these situations, we can request a temporary emergency guardianship, which we can normally obtain within 5 or 6 days.

Sometimes the decision to file for guardianship is easy- the respondent’s behavior is creating an immediate and serious risk of harm. Other times it is more difficult. For example, we often meet with adult children of aging parents concerned about the parent’s ability to live independently, but the parent has “not yet” done anything risky or suffered harm. Filing for guardianship can create real animosity between adult children and aging parents. It is not a decision to be taken lightly. Sometimes the best decision is not to file for guardianship. An experienced elder law attorney can be of tremendous help in weighing the pros and cons, and the timing, of a guardianship petition.

Geoff Bernhardt is an elder law attorney in Portland, Oregon. For more information on
his firm and on guardianships, please visit his website at www.elderlawpdx.com.