Frankly, the rules of paying for nursing care can get so complicated it makes your head spin! First let me tell you that many of my clients, about this time, decide they just want to know if I can save them money? If they are likely eligible for benefits?

They want to cut to the chase and find out now what their own personal bottom line is. If that’s you… if you want to know now how you might become eligible and how much you might save, then call my office at (913) 338-5713 and let’s explore whether or not you’re likely to qualify and what you might be able to protect.

You may have assets in lots of different places. You might have insurance policies, checking and savings accounts, IRA’s, 401k’s, CD’s, a car, a boat or RV, an annuity or a home. Let me show you how the Medicaid officials view your money and assets differently. They focus on dividing your financial assets into three different categories:

1. Available Assets

2. Exempt Assets

3. Unavailable Assets

Let’s look a little closer at each of those three types of assets:

Category number one, available assets, is made up of assets that you could cash in and use for your own nursing home care. Available assets are also referred to as “countable resources.” The Medicaid officials view your available assets as the ones you should send every month to the nursing home – at a whopping $5,000 to $8,000 a month.

The second category is referred to as Exempt Assets. The Medicaid Department allows you to keep these assets – even though you may qualify for Medicaid services. If an asset is exempt, you do not have to cash it in to pay for your nursing home bill.

The third category may sound a little bit strange, but it’s called Unavailable Assets. Those are assets which appear to have some value, yet for one reason or another, they are not available to be spent on long term care. One of the best examples of an unavailable asset is an irrevocable prepaid burial insurance policy. Prepaid burial insurance policies are a relatively straightforward insurance product in which a person spends money now for the future promise to pay for burial cost. Typically the burial insurance product is put together so that it is irrevocable and non-assignable (that just means that once it’s done, you can’t change it). It’s only available for one purpose – to pay a funeral home for your final expenses. After all, even Medicaid department doesn’t want to deal with all these buried bodies… so they’ve been generous enough to allow you to pre-pay for your funeral. Even if you paid $12,500 for that particular policy, it’s just plain unavailable to you for nursing home care.

If you’d like to learn more about how the Medicaid department views your money, give us a call at (913) 338-5713. Our experienced team of attorneys can show you how Medicaid “sees” your assets. Transform some of your “available” life savings into exempt or unavailable assets.

Many caregivers find it very difficult to visit their loved one in a care center. If that’s you, you may find you don’t know what to say or what to do. This causes some caregivers to avoid going to see their loved ones at all, which then makes them feel terribly guilty. Is there a way to make visits easier?

Yes! In fact, there are lots of ways to make visits more pleasant. Caregiving Absolute #7 tells us: ”Never Say “You can’t,” instead show what they can do – and your loved one may be able to do a lot!

First, don’t be so hard on yourself for the times you haven’t gone to see your loved one. You must recognize that you are suffering the loss of the role your loved one has played in your life. They can’t be the person they once were, the “one in charge” any longer, but they can be your beloved friend with whom you can share favorite things, smiles, hugs, laughter, and even tears.

Go on your visits intent on sharing something: bring their favorite ice cream, a magazine with pictures of things they like, a bouquet of wildflowers, a family photo album, a CD of music you both might enjoy, or anything else you can look at or do together. When you arrive, greet your loved one warmly, hug, and say something like “I am so happy to see you! Look what I brought.” Then spend time sharing your treat or looking at what you brought.

Make comments about it rather than asking questions, and watch and listen for her to show interest, react, or smile. You don’t have to stay long if you find it too difficult, but if you plan what you are going to do that day, you will see your visits improve and will find it easier to go. Your loved one will also be able to read your body language, so if you are smiling, hugging and joking, it will put you both at ease. That’s something we can all use a little more of.

How do you get the best care for your loved one at a facility? This is a question many caregivers pose to themselves. This tip will be addressed to both the family members of those with Alzheimer’s, and the staff at the care facility.

First to the families: When you first admit your loved one to a nursing home, get to know the staff. Express to the staff that you care about their well-being and that you would like an open relationship to discuss issues concerning your mother’s care. Let them know pertinent information about your loved one and her life—her likes, dislikes, rituals, moods, and how to approach her in different situations. The more they know about your loved one, her background and personality, the better they can care for her. Compliment the staff when you see them doing something you like. Be involved with the facility as much as possible. Attend social events and family council meetings if they are available. And bringing little treats like donuts and chocolates never hurt!

One man took a picture of his wife and the staff on her unit. He had the picture blown up to an 8 x 10 and put the name of each caregiver underneath their picture. He then placed the picture on her closet door. This serves two purposes, to help his wife recognize the people in the picture and to help the staff feel included. It made the staff feel important and that the family really cares about them. This small gesture bridged a lot of gaps.

To the staff: Don’t be intimidated by the families of the residents. Without you, there would be no care for their loved one. You are the front line worker. They have entrusted the care of their loved one into your hands. That is quite a compliment and an honor. Show an interest not only with the resident but also the family. Introduce yourself and tell them a little about you, your life, your interests. You may want to let them know how long you have been a caregiver and why you chose this line of work. When the family enters the unit, greet them and give them information concerning their loved one, both good and bad. If their loved one does something good during the day, call them and let them know. These are the little blessings.

Unfortunately, there is still a stigma concerning nursing home care and the people who work there. Everyone needs to work together to overcome these negatives so the residents will have a positive experience in their new home.

Many caregivers want to know, when their loved one must move to an assisted living facility or nursing home, how they can help their loved one make that transition as safely and easily as possible. There really is so much you can do to assist your loved one with this transition… but the best thing is having a caring, involved advocate like you to make the transition as smooth as possible.

First, don’t try to assume how your loved one is feeling or remind him of all the reasons he should make the transition. What he needs to know most of all is that his relationship with you will not change regardless of where he lives.

You may want to purchase a pull-out couch or chair for your loved one’s new place, so you can stay there with him sometimes. If he‘s moving closer to you, focus on how much more often you will get to see him… then make certain that you do see him more often.

If it is early enough in the disease process that he is making the decision to move himself, then he probably just needs muscle to help him sort and organize things, deliver items to family members or donate. You’ll also want to talk about what items from his old place you should keep at your home for safe keeping or to pass on through the family. You may want to offer to get the garage sale signs, set up for the sale and man the day of the sale.

If things are at the stage where he is not making the decision and changes his mind (or doesn’t even remember that he agreed to the decision) then don’t argue and don’t try to reason with him. In fact, you will do well to avoid the subject entirely, just make certain you spend as much time with him as possible and focus on the things you have always enjoyed doing together.

When all else fails, go and get ice cream. (Even if you are watching your weight or diabetic, you could have a small portion or look for sugar free alternatives.) Make sure you touch and hold your loved one… show your love and caring. If you hug, hug more, if you hold hands, do it more often. Tell him stories about all the wonderful things you have done together and tell him how much you love him and appreciate all he has done for you. These simple things can help any transition.

How often and when to visit? This question swirls the heads of caregivers with guilt, frustration, and exhaustion. When should you visit, and when do you need to take a break to take care of yourself?

When your loved one first moves in, the facility staff may ask you not to visit at all for the first few days, to allow time for your loved one to adjust to the new environment and routine and minimize confusion. This may seem like a harsh approach, but it is done in your loved one’s best interests.

In regards to your adjustment (because this a big one for you too), talk with your support system, other caregivers, a clergyman, or a counselor. Also keep in close contact with the staff on your loved one’s unit. Having a good rapport with the staff will make things much more pleasant. Don’t look at the staff as the enemy. Talk with them and get to know them. This will keep you in contact with your loved one in an indirect way. If it is a good facility, the staff will know how to handle this adjustment period for you and your loved one. If at any time you are uncomfortable with the situation, by all means, go to the facility. Stay involved with your loved one’s care at a level that won’t cause you stress.

After this adjustment period, it is not suggested that you visit every day. If you do, try not to stay for long periods of time. Remember “quality time vs. quantity time.” Develop a schedule that works for you and allows you time to do other things. Spending too much time at the facility can add to your stress, eventually affecting your health.

Some family members visit at mealtime so they can help with feeding. In most facilities, you may eat with your loved one if you make reservations in advance with the facility kitchen. Some facilities have separate rooms where family can eat together away from the other residents. Many facilities will help you celebrate birthdays, anniversaries, and other special occasions.

An individual plan of care is developed for each resident by a team of staff representatives from each department of the facility. The resident and family are invited to attend these care planning meetings. The meetings discuss the resident’s diagnosis, strengths, weaknesses, goals, and interventions. This is a good opportunity to be involved in your loved one’s care. You can make suggestions and express concerns in a neutral environment. These meetings are usually held every 30 to 90 days, depending on the level of care.

Many facilities have family council meetings, usually on a monthly basis. This is a time for families to come together with the staff and discuss upcoming events, any changes that will be affecting the facility, and other issues.

There are effective ways of being involved without physically being at the facility. If you want to be there more, that is your choice. Some family members enjoy “hanging out at the nursing home,” making friends with the residents.

You may also find the Caregiver’s Journal in my Alzheimer’s resource center helpful. Just go to http://AlzheimersResourceKit.com/hammond/pdf/caregiver-journal.pdf to print a copy… it’s one of the most sought-after portions of my Resource Center. You may even want to print out a copy for the staff at your loved one’s home – I know several facilities that use them to help improve their staff’s morale, as well.

A client of mine was recently trying to find resources for her husband with young-onset Alzheimer’s – that means he was diagnosed before age 65. In fact, he was diagnosed when he was just 52. His wife worked full time, and her husband was simply bored being home all the time during the day. He sometimes spent the day with his brother, but they spent the day cooped up there as well. She called looking for resources.

Unfortunately, in many parts of the country, there are not many resources for those with young-onset dementia… so caregivers have to get a little creative.

The first thing to do in this situation would be to look for a senior day center. Even though the people there are mostly older, the staff is usually well-trained in dementia care. They’ll know appropriate ways to interact with your loved one to maintain his dignity.

Very often, young-onset and recently diagnosed (less advanced) patients enroll in these centers as volunteers, and can actually assist with much of the programming. The center may need a lot of help moving things around, pushing wheelchairs, and setting up activities. Your loved one can be a huge help – which will make him feel needed, useful, and keep his morale and self-confidence up.

I know a young man (who was actually in his 40’s) who did just that. He was still young, strong and healthy, so the staff put him in charge of an exercise program. With a minimal amount of support he actually ran the exercise program for the other patients in the center! The center used a video of the exercises as he stood in front and lead the group. Everyone was much more engaged and able to participate when they had a live person showing them how. As time went on, and his disease progressed, going to the center was a comfortable and developed routine – and he just segued into the program.

Resources for early-onset patients are starting to be more common in some places, and even if there’s nothing in your area, you might be able to pique some interest based on your loved one’s needs by talking to some local nursing facilities. Give my office a call at (913) 338-5713 if you’d like… we can help recommend some that have day care or memory units that may fit your loved one’s needs.