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Wednesday, February 2, 2011

The Business of Elder Care in Santa Barbara (published in July of 2009 in the SB News Press)

In Santa Barbara, we have a significant percentage of elders.  They are our friends and neighbors, and our family members.  Regrettably, many do not plan ahead for the day when they will need help, but instead, usually wait until something bad happens before they seek assistance.  An array of elder care programs has sprung up over the last 20 years, funded by the Older Americans Act and distributed throughout all American communities. Unfortunately, these programs are not always highly visible or well coordinated, even though services are available in the Santa Barbara area.

According to Jessica Solomon, Elder Care Consultant with LivHOME (www.livhome.com), elders tend to wait until they are in crisis, whether that crisis is a fall or another health-related issue, the inability to perform required daily maintenance—feeding oneself, hygiene, home cleaning, etc.—or psychological, before they seek assistance.  Unfortunately, this can result in poor decisions regarding the choice of a caregiver, or whether or not to remain in the home.  As Solomon relates, this situation can be especially difficult for the family members and/or spouse of the elder in need. 

Companies like LivHOME, founded in Los Angeles in 1999 and the nation’s #1 professionally led at-home senior care company, provide a geriatric care specialist or care manager, who has an advanced education, usually in medical, nursing, psychology or social work, and experience with all facets of elder care.  This care manager designs a customized care plan for the elder, which can include medication monitoring and management.  As Solomon explains, the medication monitoring function must be managed by a specialist, and it is not simply, “…someone placing pills in daily medicine trays.” 

Another key function that the care manager performs is as liaison between the elder and family members, acting as an advocate for the client.  Elders may have difficulty articulating what they want or need to family members, and will typically find it much easier to work with the care manager.  Also, the care manager can help the family members understand the ins and outs of the care management plan, so that the stress of the transition from full independence to in-home assistance is accomplished smoothly for all involved.

An additional benefit of working with a large, in-home care company like LivHOME is that they are a national company and maintain a database and collaborative communication network among their professionals, so that, regardless of the issue the elder may be facing, there will very likely be a LivHOME caregiver somewhere in their system, with specific expertise that can be tapped to help resolve the problem and provide the needed care.  LivHOME provide virtually all in-home, non-medical care, such as:

·         Bathing
·         Dressing
·         Grooming
·         Toileting
·          Meal Preparation
  • Ambulation
  • Companionship / Socialization
  • Light Housekeeping
  • Errands and Transportation
  •  Medication Oversight
When elder care issues arise, you need to act as early as you can. You need to know what questions to ask, what kind of help is available and what is most appropriate. As a family member, how do you know when to step in? In a medical crisis, it's obvious, but if you're observant, sometimes an elder will send signals that intervention is needed before something more serious happens. For example, the elder may allow their home to become messy, forget to bath, or fail to shop for adequate groceries. 

Within the community, the single best place to begin is your county's Area Agency on Aging (AAA). Sometimes this office is called the Council or Commission on Aging or Elder Affairs. This federally-funded program, known as the National Network on Aging, offers free or low-cost services through public and private agencies. The wide range of services includes domestic help, home health care, transportation, information and referral, adult day care, and legal advice. The AAA's purpose is to keep elders in their homes and out of institutions, for as long as possible. The Area Agency on Aging may be reached at (805) 965-3288. You may also call 1-800-510-2020 for referral to senior services anywhere in the state of California. If you need help for a relative who lives farther away, call the ElderCare Locator, 1-800-677-1116, which can refer you to the nearest AAA office.

If you have an elder in need, and if you have the funds, but not the time or patience to do the care-giving yourself, consider hiring a private geriatric care manager, a licensed professional who will develop and administer a course of action, and monitor the care plan for you. This is especially valuable in long-distance care-giving. For a referral, contact the National Association of Professional Geriatric Care Managers, 1604 N. Country Club Road, Tucson, AZ 85716, 520-881-8008.

Regardless of your elder's health or financial state, there are four documents which he/she should sign right away, and these are things to consider completing yourself as well:

1.       An up-to-date will
2.      A durable power of attorney
3.      A health care proxy
4.      A living will

These documents are not expensive to execute and they will guard your family against sometimes lengthy legal proceedings and potentially bitter arguments. An estate planning attorney, such as Paul Graziano of Allen & Kimbell, can be a wealth of information and can advise on the drafting of the appropriate legal documents, including those above, and in addition, can help you with various trusts that your family may need, keeping in mind that the documents listed above are the bare minimum everyone should have. 

There are many other powers and documents available, such as the advanced health care directive, heath care proxy, and DNR (do not resuscitate), each with a specific purpose.  A good estate planning attorney, like Graziano, can walk you through each and help you decide which is most appropriate for your needs.
The cost of long-term care is a key issue most of us will inevitably face at some point, which is, how do we pay for care?  We hear all the time about long-term care insurance, but unless you are a specialist who sells this type of coverage, you probably don’t know as much as you should, in order to make a good decision.
Here is a link for a consumer guide to assist seniors and their families in buying a long-term care policy, avoiding fraud, and switching plans:


Many people will need long-term care at some point in their lives, and it is not just for senior citizens. Of the 13 million Americans receiving long-term care today, 40% are working age adults 18 to 64. As you age, your risk increases. Fully 60% of people age 65 and older can expect to need long-term care for some period of time.

Long-term care can be expensive. The cost depends on the amount and type of care you need and where you get it. Long-term care insurance costs depend on a large number of factors, including age, health, amount and type of coverage desired, length of coverage, etc, but all else being equal, the earlier you get it, the cheaper it will be.  Contact an insurance agent who specializes in long-term care insurance for more specific information. 

It is prudent to consider these issues and be proactive, planning for this inevitability, rather than waiting until you are faced with a family crisis to act.  I hope this information will assist you in taking your first steps toward lasting independence, for you and your family members.

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