Question:  I am 75 years old and have a modest amount of savings, a home without a mortgage and a small retirement pension plus my monthly social security check.  I am in relatively good health, and quite candidly hope to live for another 10-15 years.  I have one child who is in her 50s but can’t seem to keep a job or a marriage.  She is again without a job and is now divorced for the 3rd time.  My question is whether I should start gifting her my money and perhaps gift her my home as well in anticipation of my needing nursing home care in the future.  What would you recommend I do from a financial planning perspective, factoring in the fact that elder care cost so much in California?”

Answer:  It is great to hear that you are in good health, but your finances may not be as healthy as you are.

The good news is that your estate is under the current $5 million limit, so there are no estate tax issues.

The bad news is that, based on your information, you have very limited liquidity, and liquidity is the secret of financial survival.  In my opinion, you need to have $1 million in liquidity, that is cash, stocks, or a pension plan, so that you are financially secure during retirement.

Also, there is a real concern about Medicare.  Will it be around in 10 years and will it pay the lion's share of your medical expenses in the future, and if not, will you be able to afford these medical expenses? 

Another concern that you should have is that California is bankrupt.  What affect will this have on its ability to provide California residents with Medi-Cal benefits?

If you have not done so already, I would suggest that you do the following:

1. Meet with a financial planner to develop a financial "road map".
2. Meet with an attorney to have the following legal documents prepared:  Power of Attorney for Health, Power of Attorney for Finances, and a Living Trust (which can help your estate avoid the high cost of Probate)  

Finally, regarding your daughter.  I would suggest that at 50 years of age that she assume responsibility for herself–that she find a job, and perhaps start thinking about taking care of you and your elder care needs.

Hope this helps.

Orlando J. Antonini, CPA/PFS, CFP, QFP, RIA, NCG
Antonini CPAs LLP
San Francisco, California
Member of the national ElderCare Matters Alliance, California chapter

Question:  If you have the Power of Attorney for a person what sort of paperwork do you need to keep, and are you authorized to make decisions re: the care of that person in an assisted living facility or nursing home if the person is still in his/her right mind?

Answer:  Once the durable Power of Attorney for health care or finance is in place, the designated person who holds the Power of Attorney should keep as much documentation about the person as possible, including a list of their medications, physician's report including diagnosis, allergies, etc., advanced healthcare directive, POLST (physician's orders for life sustaining treatment), DNR (do not resuscitate) , family history, medical history, copy of the Will, bank information, mortuary information, etc. The Power of Attorney is authorized to make decisions re: the care of that person in an assisted living facility or nursing home even if the person is still in his/her right mind.

My answer to your question is based on my many years of being a long term care Administrator.  If you need more specific information about these legal documents, I would suggest you contact an Elder Care Attorney in California, which can be found on ElderCareMatters.com.

Daniela Berindei, Administrator
Elite Elder Care
El Dorado Hills, California
916-267-1346
Member of the national ElderCare Matters Alliance, California chapter

Question:  I am caring for my mother in my home in California.  It is a full time job.  Will the state provide any kind of assistance to pay for this elder care?

Answer:  The state of California offers a program called In-Home Supportive Services (IHSS), which is paid for by Medicaid funds (MediCal, in California).  The program, administered by each county, does provide a certain number of home care hours, based upon an assessment by a county social worker.   

The care may be provided by a family member, who is paid by IHSS, if the recipient qualifies for MediCal and the caregiver is acceptable to IHSS.   

There is a Website with links to each of the counties’ offices: http://www.cdss.ca.gov/agedblinddisabled/pg1785.htm 

If your mother does not qualify for MediCal, you can talk to a reputable employer-based home care agency about the possibility of working for that company.  The care will not be free to your mother, of course, and you would have to pass the agency’s background screening, but you would be legally employed.

Bert Cave, President
Support For Home
Sacramento, California
916-482-8484
Member of the national ElderCare Matters Alliance, California chapter

Answer:  If you are a professional who helps families plan for or deal with ANY of their elder care matters, then you owe it to yourself to be listed on America's #1 online source for "Elder Care Experts"….

ElderCareMatters.com

ElderCareMatters.com is where you will find more than 2,000 competent, caring elder care experts located across America, including:

• Elder Law Attorneys
• Estate Planning Advisors
• Financial Planners
• Investment Advisors
• Geriatric Care Managers
• Insurance Professionals
• Life Care Planners
• Professional Organizers
• Reverse Mortgage Lenders
• Senior Move Managers
• Senior Real Estate Professionals
•  Tax Advisors
• Aging in Place Professionals
• Daily Money Managers
• And other elder care experts with long and successful careers working with seniors and their families

This is also where you will find some of America's best:

• Assisted Living Communities
• Alzheimer's / Memory Care Communities
• Continuing Care Retirement Communities
• Home Care Agencies

Together, we provide families across America with:

• Unparalleled professional expertise
• Up-to-date elder care information & answers to your elder care questions
• Competent, caring assistance with a wide range of elder care services

So if you are a competent, caring elder care professional who helps families with ANY of their elder care matters, then request today an Application for Membership in the national ElderCare Matters Alliance and get listed on ElderCareMatters.com - America's #1 source for "Elder Care Experts" plus information and answers about a wide range of elder care matters.

Phillip G. Sanders, MBA, MSHA, CPA
Founder & CEO
ElderCare Matters, LLC
ElderCareMatters.com

Answer:  It is my pleasure to provide you with the following list of the 87 different elder care services that are currently provided by the members of the national ElderCare Matters Alliance on ElderCareMatters.com:

1. Accounting Services
2. Adult Day Care
3. Advance Medical Directives
4. Aging in Place Services
5. Alzheimer's / Memory Care Communities
6. Annuities
7. Arbitration
8. Asset Protection Planning
9. Assisted Living Communities
10. Assisted Living Referral Services
11. Bankruptcy
12. Bill Paying
13. Budgeting
14. Caregiving Education
15. Companion Care
16. Conservatorship
17. Consumer Law
18. Continuing Care Retirement Communities
19. Cremation Services
20. Crisis Intervention
21. Daily Money Management
22. Dementia Care
23. Disability Income Insurance
24. Disability Planning
25. Elder Abuse Litigation Services
26. Elder Law
27. ElderCare Planning
28. Estate Administration
29. Estate Liquidation
30. Estate Planning
31. Family Law
32. Financial Planning
33. Funeral Services
34. Geriatric Care Management
35. Guardianship
36. Health Insurance
37. Hoarding Clean Up and Coaching Services
38. Home Care
39. Home Downsizing Services
40. Home Health Care
41. Home Modifications
42. Hospice Care
43. Independent Living Communities
44. Investment Services
45. Life Care Planning
46. Life Insurance
47. Litigation
48. Long Term Care Insurance
49. Long Term Care Planning
50. Medicaid Planning
51. Medical Services
52. Medical Alert Systems
53. Medical Claims Processing
54. Medical Equipment & Supplies
55. Medical Malpractice Litigation
56. Medicare Consulting
57. Medicare Supplemental Insurance
58. Medication Management Services
59. Moving Services
60. Nursing Homes
61. Personal Finance
62. Powers of Attorney
63. Probate
64. Professional Organizing
65. Public / Non-Profit Resources
66. Real Estate Services
67. Rehabilitation Services
68. Residential Psychiatric Care
69. Respite Care
70. Retirement Planning
71. Reverse Mortgages
72. Securities Arbitration & Litigation Services
73. Senior Housing
74. Senior Move Management
75. Senior Move Planning
76. Senior Relocation Services
77. Social Security Disability Services
78. Special Needs Planning
79. Tax Law
80. Tax Planning
81. Tax Preparation
82. Transportation Services
83. Trustee / Fiduciary Services
84. Trusts
85. VA Benefits
86. Wills
87. Wound Care

The goal of ElderCareMatters.com is to provide families across America with the help they need to plan for and deal with their elder care matters.  Let us know if there are other elder care services that you would like to have us list on ElderCareMatters.com – America's #1 source for Elder Care Experts plus information & answers about a wide range of elder care matters.

Phillip G. Sanders, MBA, MSHA, CPA
Founder & CEO, ElderCare Matters, LLC
ElderCareMatters.com
1-877-379-4500

Answer:  ElderCareMatters.com is an elder care resource to help families across America plan for and deal with their elder care matters.  With this goal in mind, we will continue to add more elder care-related services to ElderCareMatters.com in order to make this online elder care resource invaluable for families looking for help in planning for and/or dealing with their elder care matters.

Below are the 72 different elder care services currently listed on ElderCareMatters.com (with more services soon to be added): 

1. Adult Day Care
2. Advance Medical Directives
3. Aging in Place Services
4. Alzheimer's / Memory Care Communities
5. Annuities
6. Arbitration
7. Asset Protection Planning
8. Assisted Living Communities
9. Assisted Living Referral Services
10. Bankruptcy
11. Caregiving Education
12. Consumer Law
13. Continuing Care Retirement Communities
14. Crisis Intervention
15. Daily Money Management / Bill Paying
16. Dementia Care
17. Disability Income Insurance
18. Elder Abuse Litigation Services
19. Elder Law
20. ElderCare Planning / Long-Term Care Planning
21. Estate Administration
22. Estate Liquidation
23. Estate Planning
24. Financial Planning
25. Funeral Services
26. Geriatric Care Management
27. Guardianship / Conservatorship
28. Health Insurance
29. Hoarding Clean Up and Coaching Services
30. Home Care
31. Home Downsizing Services
32. Home Health Care
33. Home Modifications
34. Hospice Care
35. Independent Living Communities
36. Investment Services
37. Life Care Planning
38. Life Insurance
39. Litigation
40. Long-Term Care Insurance
41. Medicaid / Disability Planning
42. Medical / Healthcare
43. Medical Alert Systems
44. Medical Claims Processing
45. Medical Equipment & Supplies
46. Medicare Consulting
47. Medicare Supplemental Insurance
48. Medication Management Services
49. Moving / Relocation Services
50. Personal Finance / Accounting / Tax Preparation
51. Powers of Attorney
52. Probate
53. Professional Organizing
54. Public / Non-Profit Resources
55. Real Estate Services
56. Rehabilitation Services
57. Residential Psychiatric Care
58. Respite Care
59. Retirement Planning
60. Reverse Mortgages
61. Securities Arbitration & Litigation Services
62. Senior Move Management
63. Senior Move Planning
64. Social Security Disability Services
65. Special Needs Planning
66. Tax Law
67. Tax Planning
68. Transportation Services
69. Trustee / Fiduciary Services
70. Trusts
71. VA Benefits
72. Wills

If you need help with your family's elder care matters, you can count on ElderCareMatters.com to provide you with the experts, information & answers you need to plan for and deal with your elder care matters.

Phillip G. Sanders, MBA, MSHA, CPA
Founder & CEO of ElderCareMatters.com
1-877-379-4500

Answer:  Medication Therapy Management (MTM) is a process that reviews and evaluates how each senior is responding to their unique group of medications—prescription, non-prescriptions, over the counter and natural medications, supplements, vitamins, minerals…any item that is in use to improve health.  It also evaluates food intake, how the medications are taken or used.   

Families, caregivers and other loved ones also share their insights about how the senior is responding to the “medications”, as many of them are with the senior at various time of the day.  An action plan is developed to address these issues or concerns.  There are many things that the senior and/or their family can do to improve the benefits of the “medications” in use and to minimize the side effects or other problems.  Prescribers are also contacted for changes in medications orders, provided with information about the use of multiple medications and changes made in medication dosage, and frequency of dose. 

Having one person organize such reviews and provide information to other members of the healthcare team can be very successful in avoiding the “close calls” that cause seniors end up in the emergency room, admitted to the hospital or even subsequently moved to the nursing facility. 

Medication Therapy Management may also be known by another name…Comprehensive Medication Review (CMR) which is defined as a systematic process of collecting patient-specific information, assessing medication therapies to identify medication-related problems, developing a prioritized list of medication-related problems, and creating a plan to resolve them with the patient, caregiver and/or prescriber. A CMR is an interactive person-to-person consultation conducted between the patient and/or caregiver and the pharmacist and is designed to improve patients’ knowledge of their prescription, over-the-counter (OTC) medications, herbal therapies and dietary supplements, identify and address problems or concerns that patients may have, and empower patients to self-manage their medications and their health condition(s).  

I hope this helps…

To find other competent, caring elder care professionals across America who are located near You and can help you with your elder care matters, go to: www.ElderCareMatters.com - A FREE online resource to find elder care experts plus elder care information & answers to your elder care questions.

Lynn Harrelson, R.Ph., FASCP, Senior Care Pharmacist
8302 Cheshire Way
Louisville, Kentucky  40222
502-425-8642
Member of the national ElderCare Matters Alliance, Kentucky chapter 

Answer:  Make a list of all the medications that she uses, prescriptions, non-prescriptions, over the counters, supplements, and nutritionals. 

Keep the list updated, make copies and share with other caregivers.  Take the up-to-date list to all healthcare appointments and share with all healthcare providers.

I encourage you to go to my web site and download the Health ICE (In Case of Emergency).  This form provides an area to list this information and much more. 

Copies of this should be placed in 2 envelops, marked “Health ICE” and with your mother’s name. Place one on the refrigerator and one in the car. Emergency personnel are trained to look for such lists on the refrigerator and in the glove compartment of the car.

To find other competent, caring elder care professionals across America who are located near You and can help you with your elder care matters, go to: www.ElderCareMatters.com - A FREE online resource to find elder care experts plus elder care information & answers to your elder care questions.

Lynn Harrelson, R.Ph., FASCP, Senior Care Pharmacist
8302 Cheshire Way
Louisville, Kentucky  40222
502-425-8642
Member of the national ElderCare Matters Alliance, Kentucky chapter

Answer:  How fortunate for your friend that she had you to provide care for her when she needed it. I have seen many situations like this and I find them so sad. I am not an attorney, so please know that my advice to you comes from experience only and not a license to help with legal issues. My general advice to you is to seek an attorney who would be willing to communicate with the family for you. I work with attorneys certified in elder law and would start there. If this is the wrong area of law, these attorneys can point you in the right direction. 

If there was anything in writing from her to you, this would help your cause. If there were any witnesses to your conversations or to your working relationships, this would also help you. If she is aware and alert, you might consider having another conversation with her. If she has any friends that knew the two of you maybe one of them would advocate for you. 

I hope this helps, good luck and many blessings to you for reaching out to help an elder.

Amy Cameron O'Rourke, MPH, CMC
The Cameron Group
Orlando, Florida  32803
1-888-896-2010
Member of the ElderCare Matters Alliance, Florida chapter

Answer:  No, the ability to stay in Assisted Living in Florida has not been abolished. If an elder wants to die in their home (Assisted Living is classified as home) they have the right to stay in Assisted Living. As her need for care increases (i.e. she becomes dependent or “bed bound”) she can remain in Assisted Living; however, she must pay privately for the extra care she needs. 

Assisted Living facilities are licensed to provide assistance with care. When an elder needs total care Assisted Living facilities are required to discharge the elder to a more appropriate setting, usually a nursing home; the only exception to this rule is when the elder is on hospice. When an elder is on hospice and needs total care they are allowed to stay in the facility but must pay extra for the care needed. Assisted Living facilities are not licensed or staffed to provide total care.

I hope this answers your question!

Amy Cameron O'Rourke, MPH, CMC
The Cameron Group
Orlando, Florida  32803
1-888-896-2010
Member of the ElderCare Matters Alliance, Florida chapter

Answer:  Keeping an elder out of the hospital while dealing with their multiple pathologies and can be challenging. Elders are frequently admitted to the hospital for the following preventable reason:  falls, undiagnosed infection, dehydration, and non-compliance with medicine. 

Once an elder is hospitalized, a rapid decline in health can occur. The old adage, “an ounce of prevention is worth a pound of cure” is so true in the too-often occurring syndrome of frequent hospitalization and rehabilitation stays for an elder. With careful monitoring of fluid and food intake, daily exercise and a closely supervised medication regime, hospitalizations can be prevented. 

These interventions can be implemented daily or every other day, depending on the elder’s need, by family members, professional staff, or a combination of both.  Adult children of an elder might say “My Mom or Dad won’t accept help.”  This is a natural response for a frail elder faced with losing some independence. We would advise bringing in an objective third party (professional care manager) to assist in these discussions and the implementation of care to achieve the desired outcome which, for most elders, is to stay at home and out of the hospital for their remaining days.

To locate competent geriatric care managers who are located near YOU and can help you with these types of elder care matters, go to: www.ElderCareMatters.com - A FREE online source to find elder care experts plus information & answers about a wide range of elder care matters.

Amy Cameron O'Rourke, MPH, CMC
The Cameron Group
Orlando, Florida  32803
1-888-896-2010
Member of the ElderCare Matters Alliance, Florida chapter

Answer:  Your family is in a very difficult situation and it appears that you have been unable to find anyone who can help you locate a suitable home for  your step-father.

If you are not able to get help from a state agency as to where he might be cared for, one other thing you can try is to to locate a geriatric care manager in your state who has a specialty in psychiatric  assessments. This person should be able to give you more specific information on the housing options that are available for your step-father.

To locate some outstanding geriatric care managers in your state who may be able to help you with this elder care matter, go to: www.ElderCareMatters.com/statechapters.htm

Dagmar M. Pollex, Attorney at Law
The Law Offices of Dagmar M. Pollex, P.C.
Braintree, Massachusetts  02184
781-535-6490

Member of the national ElderCare Matters Alliance, Massachusetts chapter

Answer:  There are a number of different solutions, depending on her medication routine, what is causing the difficulties, etc.  When we do a geriatric care assessment, this is often one of the areas explored and it is not unusual to find problems, which as you well know can be very adverse.  We tailor recommendations to the solutions that fit for the individual.

A couple of resources I can share that might work.  First, you’re probably aware of simple pill boxes, where medications are laid out as to when to be taken.  A family member or a R.N. from a home care company can do this.  If your Mom can handle taking the medications from the pillboxes correctly, this can work.  Some clients need additional reminders, and maybe it is feasible for someone in the family to call and help with this.  Some pharmacies and services also package pills in easy-to-use dosages (one of our local pharmacies delivers them right to the client, packed in easy to tear off packets with all the pills for a specified time).

For other clients, especially with cognitive deficits, a more extensive solution may be needed.  There are some wonderful technologies, such as electronic pill dispensers that are pre-loaded and dispense the meds. at the scheduled time.  They typically sound a reminder and have different settings to help avoid missed dosages turning in to overdoses.  Additionally, some of the emergency response systems (fall buttons) have options for medication reminders.  Some clients may need more hands-on, personal assistance.  A home care aide trained in medication assistance can be there to serve as a personal reminder.  You may want to talk to a home care agency about your Mom’s specific needs and see if a reasonable plan can be worked out…with 10 prescriptions, timing may be tough so it may require some creativity or a combination of options.

I always like to go back to the basics too.  I would suggest bringing this up with your Mom’s doctor (or doctors?) and asking if there are any ways to streamline the medication routine.  When pills are prescribed over time (and sometimes by different specialists), the doctor doesn’t have a really good picture of how complex this can be, and obviously at this point there have been adverse effects which make this a priority.  Can any of the pills be eliminated?  Can some of them be taken at the same time, or a larger dosage be taken less frequently?  If a review hasn’t been done recently, it is probably a good idea anyway with such a large # of medications.  There are consultant pharmacists who specialize in medication reviews.

To locate experts in your state who can help you with this elder care matter, go to: www.ElderCareMatters.com/statechapters.htm

Shannon Martin, M.S.W., CMC
Aging Wisely, LLC
Clearwater, Florida  33756
727-447-5845

Member of the national ElderCare Matters Alliance, Florida chapter

Answer:  If you are an elder care professional and you would like to "get the word out to thousands of families across America in a cost effective way about how you can help them plan for and deal with their issues of aging", then you should join our 1,250 elder care experts as a lifetime member of the national ElderCare Matters Alliance.  And, now, if you are one of the next 250 members, you will receive a 25% discount off the regular lifetime membership price.

This 25% discount is available only to the next 250 elder care professionals who join the national ElderCare Matters Alliance.

So if you are a competent, caring elder care professional – take advantage of this special 25% discount offer and pay only $337.50 for a "lifetime membership" (and there are no annual membership dues, ever!) to the national ElderCare Matters Alliance.

To request an Application for Lifetime Membership, send an email directly to: psanders@eldercarematters.com

Phillip G. Sanders, MBA, MSHA, CPA
Founder & CEO
ElderCare Matters, LLC
1-877-379-4500
www.ElderCareMatters.com

If you are an elder care professional and you would like to "get the word out to thousands of families across America in a cost effective way about how you can help them plan for and deal with their issues of aging", then you should join our 1,250 elder care experts as a lifetime member of the national ElderCare Matters Alliance.  And, now, if you are one of the next 250 members, you will receive a 25% discount off the regular lifetime membership price.

This 25% discount is available only to the next 250 elder care professionals who join the national ElderCare Matters Alliance.

So if you are a competent, caring elder care professional – take advantage of this special 25% discount offer and pay only $337.50 for a "lifetime membership" (and there are no annual membership dues, ever!) to the national ElderCare Matters Alliance.

To request an Application for Lifetime Membership, send an email directly to: psanders@eldercarematters.com

Phillip G. Sanders, MBA, MSHA, CPA
Founder & CEO
ElderCare Matters, LLC
1-877-379-4500
www.ElderCareMatters.com

Answer:  The experts of the national ElderCare Matters Alliance.

ElderCareMatters.com is now offering a NEW Ask an Elder Care Expert service.

Each week one of our 1,200 experts will answer your family's important questions about elder care matters – from legal, financial, housing, health care, etc.

If you would like to ask one of our Elder Care Experts a question about his/her areas of expertise, just send a short email (a few sentences only please) to:  Questions@ElderCareMatters.com

Every day we will post one of your questions along with an answer provided by our Featured Elder Care Expert of the Week to the homepage of www.ElderCareMatters.com (which is currently visited by thousands of families each week).  Yours may be one of the questions posted.

So bookmark www.ElderCareMatters.com and visit us daily as questions about a wide range of elder care matters are answered by some of America's top elder care professionals with years of experience helping families plan for and deal with their issues of aging.

Phillip G. Sanders, MBA, MSHA, CPA
Founder & CEO
ElderCare Matters
1-877-379-4500
www.ElderCareMatters.com

The ElderCare Matters Alliance is a national organization of 1,200 elder care experts who help families across America plan for and deal with their issues of aging, including providing families with a host of elder care resources that can be found on www.ElderCareMatters.com

If you are a competent, caring elder care professional – you need to belong to the national ElderCare Matters Alliance.

To request a Lifetime Membership Application to the national ElderCare Matters Alliance, send an email to psanders@ElderCareMatters.com

www.ElderCareMatters.com – America's online source for elder care experts who help families plan for and deal with their issues of aging.

Phillip G. Sanders, MBA, MSHA, CPA
Founder & CEO
ElderCare Matters
www.ElderCareMatters.com

Answer:  Infrequent medical care visits are often due to physical or mental impairment that reduces the elder's ability to recognize health issues and seek treatment in a timely way. Sometimes, unable to drive any longer, it is difficult to get to the doctor. Once there, they are likely to give incomplete or wrong information. They might fear seeking help because they do not want to be a burden or worry that their privacy or independence will be taken away. In preparation for their doctor's visit, the RN Care Manager can make a priority list for discussion. Problems such as joint pain, incontinence, confusion and weakness should not be passed off as simply symptoms of aging. A home care giver can accompany the elder to the doctor, keeping his visit to the doctor on track. With the care giver's help, critical instructions about treatment can be written down and followed at home.

Mary E. Peters, MS, CMC, RG
Care For Life, Inc.
Charleston, South Carolina  29455
843-852-9090
Member of the national ElderCare Matters Alliance, South Carolina chapter