Figuring Out Long Term Care Costs

While most retirees say they plan on living out their years at home, a large percentage end up in assisted living or nursing homes. How much can you expect to pay for long-term care? A look at average costs and stays can provide a rough idea.

A lot of financial advisors warn that retirees aren’t financially prepared for a long future existing only on Social Security, that they haven’t saved enough, that medical costs will eat more out of their budget than they think and that they aren’t prepared for long-term care. Although most retirees say they plan to live out their remaining years at home, a large percentage end up in assisted living or nursing homes. In fact, according to the Centers for Medicare and Medicaid Services, a majority of people over age 65 will require some type of long-term-care services, and more than 40 percent will need a period of care in a nursing home.

Retirees or those about to retire who want to figure out what long-term care might cost them can make an educated guess, based, of course, on averages. The MetLife Mature Market Institute’s market survey for 2012 found that:

• The national average daily rate for a private room in a nursing home is $248, while a semiprivate room is $222, up from $239 and $214, respectively, in 2011. That’s about $81,000 annually for a semiprivate room.
  
• The national average monthly base rate in an assisted-living community rose from $3,477 in 2011 to $3,550 in 2012. That would equal $42,600 a year.
  
• The national average daily rate for adult day services remained unchanged from 2011 at $70.

However, costs can vary widely depending on the state and region of the country where you live (see sidebar, “Differences among States”). It’s also important to remember that different states require—and different facilities offer— varying baselines of level of care, so one place might offer nothing more than three meals a day plus activities, while another facility includes providing medicines, for example, in its base rate. This is especially important regarding assisted-living, which is not federally regulated.

 

Differences among States Average costs for long-term care vary widely by state and region of the country and by private versus semiprivate room. The MetLife Mature Market Institute’s market survey found the daily price of a semiprivate room could range from a low of $138 in Louisiana to a high of $678 in Alaska. In this sampling of state prices from around the country, it is important to remember that cities generally are more expensive than rural areas. While Illinois’ rate is low, for example, the Chicago area’s rate is much higher. Alabama $182 Arizona $182 California $235 Connecticut $362 Florida $223 Idaho $199 Illinois $175 Maine $257 Nebraska $163 New York $344 Oregon $228 Texas $139

Differences by Sex, Marital Status

Long-term costs for long-term care also vary by sex and marital status. For example, single women, on average, live the longest in nursing homes. Below is a comparison of the average length of stay in a nursing home (from Long-term Care Association's 2008 LTCi Sourcebook):

Female			2.6 years
Male			2.3 years
Married			1.6 years
Single/never married			3.8 years
Widowed			2.3 years
Divorced/separated	2.7 years

Average Stays for Long-term Care

The average nursing home stay is 28 months, according to the government's latest National Nursing Home Survey (“How to Pay For Nursing Home Costs,” U.S. News & World Report). The average stay for assisted-living residents is 27 months, according to Kiplinger.com

Other organizations break down the long-term care figures differently (Alzheimer’s care, continuum of care). The National Clearinghouse for Long-Term Care Information makes it simpler. On average, a 65-year-old today will need some form of long-term-care services for three years, according to Kiplinger.com.

Figuring Out the Total Costs

To determine the average amount a person would have to pay for long-term care, you can extrapolate from the data:

• Cost of semiprivate room in a nursing home for average 28-month stay: $186,480
  
• Cost of assisted living (base level) for average 27-month stay: $95,850 

If the average stay is three years for long-term care, your long-term care costs would be some combination of those two figures. Of course, if you need more assisted-living care than basic care, the cost goes up. If you’re a woman, you will probably pay more because you will live longer.

Another factor to throw into the mix is the average age of residents in long-term care. The median age of residents in nursing homes was 82.6 years; in assisted living, 86.4 years, according to MetLife.

If you’re wondering if you will live that long, the Social Security Administration provides calculations. For example, a man reaching age 65 today can expect to live, on average, until age 84.3, while a woman turning 65 today can expect to live, on average, until age 86.6.

Where Will Money Come From?

A recent Wall Street Journal article (“10 Things Retirees Won’t Tell You,” Sept. 21, 2014) said that nearly 60 percent of people over 55 who haven’t yet retired have saved less than $100,000 for retirement. So where will an individual find the approximately $200,000 needed for long-term care?

While Medicare does not pay for assisted living, it will help pay for nursing home care for up to 100 days if certain conditions are met (from Senior Home):

A senior is currently receiving Medicare Part A (Hospital insurance) benefits and is therefore 65 years or older or has been formally diagnosed with renal failure.

An in-patient hospital stay of three or more consecutive days (three midnights) has been made within the past 30 days.

A physician has determined that skilled care and/or rehabilitation is medically necessary due to a current health condition.

The skilled services required are provided in a facility that has been certified by Medicare.

Specifically, Medicare will provide 100 percent coverage for skilled nursing costs for the first 20 days of a nursing home stay. From day 21 through day 100 of the benefit period, the patient is responsible for paying approximately $130 per day. At any time, if the patient is no longer making progress, Medicare will stop paying, because this is considered a rehabilitation, not long-term care benefit.

Medicare also pays for care at home, involving skilled nursing care and therapy, although certain restrictions apply. Even paying for home care yourself is less expensive than nursing homes and assisted living.

Another option is long-term care insurance, which pays for assisted living, nursing homes and at-home care. However, only 10 percent of the elderly have a private long-term care insurance plan (National Bureau of Economic Research). Other sources for long-term care financial help are Medigap (supplemental policies for Medicare) policies and/or veteran’s benefits, but these policies only pay 20 percent of the charges that Medicare does not pay.

If people in need of long-term care don’t have the financial resources and/or don’t have a long-term care insurance plan, who will take care of them? It turns out that most (78 percent) who need some kind of care are being taken care of by family and friends.
According to the Caregiver Action Network, “The value of unpaid family caregivers will likely continue to be the largest source of long-term care services in the U.S., and the aging population 65+ will more than double between the years 2000 and 2030, increasing to 71.5 million from 35.1 million in 2000.”

For many older people, one strategy for long-term care might be to start investing in relationships with family and friends.

Figuring Out Long Term Care Costs was featured in the November 2014 Senior Spirit newsletter.

Blog posting provided by Society of Certified Senior Advisors www.csa.us.

Six Steps for Positive Conflict Resolution of Family Dynamics

Family dynamics are never easy, but they can be especially complicated when it comes to decisions that surround the process of aging.  In a perfect world, the family unit works together to provide their senior the best options and loving outcomes.  Remember, I said "in a perfect world."  Unfortunately, this isn't always the case.

Families with a senior struggle because of differing opinions on care, location, money, property, time constraints and more.  Even the strongest family groups can be torn apart during this stressful time.  While doing research on the issue of conflict resolution, I came across leadership expert Michael Hyatt and his thoughts on conflict resolution in the workplace. No, we're not dealing with bosses, and employees; however, these same basic steps with a little tweaking can be very useful when working through issues within the family. Communication is critical when seeking the best possible outcome, so before the threads of the family unravel, consider steps 1 and 2, then open the dialogue with steps 3-6.

1.  Give the other person the benefit of the doubt. Maybe they don't know all the facts involved in caring for your loved one or are unaware of the total amount of time you spend in care activities.  Are you making assumptions regarding their willingness to help? Stop - and keep an open mind and open heart.

2.  Always speak directly to the person with whom you are having an issue. How many times do we complain about someone's behavior but yet don't let them know our concerns?That hardly seems fair.  If you are upset with a family member, caregiver, or friend, talk specifically to them.  Don't share your feelings with others who can have no impact on the situation.

When you do decide to have a meaningful conversation to resolve your concerns:

3. Affirm the relationship. Let this person know that you love and value them, and are opening up because you care about your relationship. Let them know that you need to share something that is bothering you so that you can resolve it together. Confirm the fact that you have a common interest in what is best for your senior loved one.

4. Outline the issue objectively. This is often hard to do since these topics are emotionally charged but try to isolate exactly what is causing you pain.  For example, simply saying you feel "taken advantage of"  is not specific enough. Isolate what the circumstances are that cause you to feel this way.  "I am currently taking Mom to all of her doctor appointments."  "I am responsible for handling the expenses for Dad's care and he doesn't have the funds to cover it."  Write down your pain points so you don't get off track.

5. Be clear about what it will take to fix the problem. It is important to communicate and then listen. Be clear about what meaningful measurable steps can be taken to move forward.  "I need your help in taking Mom to her appointments.  If you can take her to run errands, I can take her to doctor appointments, but I can't continue to do both."  You also need to listen to understand the dynamic of how together you can reach positive resolution.

6. Discuss the outcome - positive and negative - and the consequences. The outcome you hoped for could be as simple as being upfront and open.  Congratulations! However, should you find that you can not resolve the problem at least you will know where you stand and can make decisions accordingly. Opening the lines of communication with your family member or caregiver helps to make things transparent.  If the resolution is not what you had in mind, then this is the time to indicate what the consequences will be. "If you can't find a way to help me with Dad's care, then I fear that the family and our relationship will suffer irreparable damage."  "You've stated that you can't  help take some of the responsibilities for Mom's care. That will mean we will have to hire some help.  I will need you to assist in covering the cost and interview caregivers."

Remember...

There is no guarantee that open communication will solve all the concerns of caring for seniors that we love, however, it is the best tool in our toolbelt.  If you are still struggling to work together, don't just throw in the towel. Patience, time, and prayer are powerful healers.


Blog posting courtesy of guest blogger, Cyndi C. Caldwell, CSA

As a CERTIFIED SENIOR ADVISOR* Cyndi is on a mission to advise Seniors and their family members on viable options in Senior Care and Dementia Care. Her broad media background of sales, marketing and management experience with Disney, ABC Broadcasting, and Cumulus Media has provided a strong platform for her success in the senior services industry. In her “Encore Career” Cyndi has received
extensive training in the areas of Assisted Living Care, Dementia Care and In Home Care having worked with the finest providers in the industry - Five Star Senior Care and Seniors Helping Seniors.   Currently Cyndi is a Certified Senior Advisor* with  Seniors Helping Seniors –a service providing care FOR SENIORS BY SENIORS – so that families can stay in their homes and age in place.

Cyndi is also a trained speaker for the Alzheimer’s Association – and a trained Support Group Facilitator for the Alzheimer’s Association.

  

You can find out more about Cyndi and her outreach at her blog:

www.seniorsoundingboard.com

Blog posting provided by Society of Certified Senior Advisors
www.csa.us

Tai Chi Gentle but With Strong Physical Benefits

Although this ancient Chinese martial art is now used as a form of exercise, you can think of tai chi as a way to fight back against the effects of aging: losing flexibility, balance and muscle strength. With minimal stress on the body, it’s especially good for older adults.

 

You may be acquainted with tai chai from seeing a group of people in a park doing slow movements with their arms and legs, looking more like a synchronized ballet or modern dance than any kind of exercise you are familiar with. Yet this ancient Chinese martial art has real physical benefits—and without the physical stress that other forms of exercise, even yoga, can have on aging bodies.

Its low-impact and gentle movements put minimal pressure on your muscles and joints, and the risk of injury is low. Instead of going to a gym, you can do it anywhere, and it doesn’t require any special clothing or props (a yoga mat, for example, or exercise machine).

In fact, tai chi (pronounced “tie chee”) may be a better exercise option for older adults than strength training, even though such exercises combat the wasting effects of aging. That's because strength training tends to stiffen arteries. A recent study in Europe compared the health of older adults who practiced tai chi and those who did not practice. Though the study did not directly test tai chi, it did find that tai chi practitioners’ large and small vessels were more flexible (“Why Tai Chi Makes Sense for the Elderly,” June 2012, Atlantic Monthly). And the more flexible the arteries the better one's overall cardiovascular health generally is. Poor arterial flexibility is an independent risk factor for cardiovascular disorders— diseases affecting the heart and blood vessels.

Although most people no longer use it as a martial art, you can think of tai chi as a way to fight back against the effects of aging: losing flexibility, balance and muscle strength.

What Is Tai Chi?

The centuries-old Chinese martial art is descended from qigong, an ancient Chinese discipline that has its roots in traditional Chinese medicine. It is based on the concept of qi — an energy force thought to flow through the body — and yin and yang — opposing elements thought to make up the universe and that need to be kept in harmony. Tai chi is said to unblock and encourage the proper flow of qi and to promote the yin-yang balance.

Both yoga and tai chi are said to have meditative benefits. But unlike yoga, another Eastern form of exercise in which you hold a pose, tai chi involves a series of slow, continuous and meditative body movements that incorporate a series of motions named for animal actions—for example, "white crane spreads its wings" — or martial arts moves, such as "box both ears." As you move, you breathe deeply and naturally, focusing your attention—as in some forms of meditation—on your bodily sensations.

Tai chi differs from other types of exercise in other respects. Its movements are usually circular and never forced, the muscles are relaxed rather than tensed, the joints are not fully extended or bent, and connective tissues are not stretched. Tai chi can be easily adapted for anyone, from the fittest athletes to people confined to wheelchairs.

Often described as "meditation in motion," tai chi, like yoga, demands concentration, so breathing and movement are coordinated. Many tai chi proponents say this promotes calm feelings and thus a reduction in stress. Others say tai chi interweaves the mind and body into one.

Benefits of Tai Chi

In China, it is believed that tai chi can delay aging and prolong life, increase flexibility, strengthen muscles and tendons, and aid in the treatment of heart disease, high blood pressure, arthritis, digestive disorders, skin diseases, depression, cancer and other illnesses. Unfortunately, there hasn't been a significant amount of scientific evidence to support all of these claims but several small studies show a positive connection between tai chi and many chronic diseases. Most of the studies offer tai chi as an intervention for a short duration, and long-term results or benefits of tai chi may vary by individual over time.

Balance and flexibility. Most of the research on the impacts of tai chi on older adults has studied balance and fall prevention. This is especially pertinent to older adults because fall-related injuries (see Exercise Best Cure for Hip Fracture Recovery, July 2014, Senior Spirit) are the leading cause of death from injury and disabilities among older adults, as well as the leading cause of loss of independence and need for long-term care. Because tai chi often involves shifting weight from one leg to the other, it can increase both balance and leg strength in older adults. One researcher says that tai chi strengthens weak muscles in legs and improves the ability of ankles to flex on uneven surfaces, and repeated movements improve reaction time. Tai chai also counteracts the loss of balance as we get older, because it improves the sense of one’s physical position in space (known as proprioception).

In one study, adults in their 60s and 70s who practiced tai chi three times a week improved, after six weeks, their balance, muscular strength, endurance and flexibility. Another study compared men age 65 and older who had more than 10 years of tai chi with similar-aged who were sedentary and found that the men who did tai chi performed better on tests of balance, flexibility and cardiovascular function. Another study involving people with mild balance disorders found that eight weeks of tai chi training significantly improved function on a standard balance test.

Even people with Parkinson’s disease found improved balance and function after 20 to 24 tai chi sessions, according to two studies.

To help older adults improve their balance, the National Institute on Aging includes tai chi in its Go4Life exercise program as a lower-body strength exercise.

Heart disease. In a study at Harvard Medical School, 12 weeks of tai chi reduced blood levels of B-type natriuretic protein, an indicator of heart failure, and improved participants' ability to walk and quality of life. Another study suggests that tai chi may improve quality of life, mood and exercise confidence in people with chronic heart failure.

Cancer. A 2008 study at the University of Rochester found that quality of life and functional capacity (including aerobic capacity, muscular strength and flexibility) improved in women with breast cancer who did 12 weeks of tai chi, while declining in a control group that received only supportive therapy.

“It does not cure cancer, but restores function, strength and energy, helps people deal with symptoms, and improves resiliency,” says Dr. Yang Yang, who works with cancer patients at the Integrative Medicine Center of the Memorial Sloan-Kettering Cancer Center (quoted in Senior Planet).

Cognitive aid. Studies show that among people with early dementia or mild cognitive impairment, exercises such as tai chi can have positive effects on cognitive performance and memory, says Dr. Peter Wayne, co-author of The Harvard Medical School Guide to Tai Chi: 12 Weeks to a Healthy Body, Strong Heart & Sharp Mind.

“Tai chi can not only reduce stress and depression, but also relieve pain, build strength, and improve cognitive function, perhaps even delaying dementia” says Wayne, who is director of research at the Osher Center for Integrative Medicine, jointly based at the Harvard Medical School and Brigham and Women’s Hospital in Boston (“Tai Chi for Older Newbies,” Senior Planet).

Walking. One study found that individuals who practiced tai chi walked significantly more steps than individuals who did not; this is good news for older adults whose walking speed decreases with age.

Aerobic capacity. After reviewing seven studies focusing on the effects of tai chi on aerobic capacity in older adults, researchers found that individuals who practiced tai chi for one year had higher aerobic capacity than sedentary individuals around the same age.

Muscle strength. Stanford University researchers tested women and men, average age 66, who had below-average fitness and at least one cardiovascular risk factor. After taking 36 tai chi classes in 12 weeks, they improved in both lower-body strength (measured by the number of times they could rise from a chair in 30 seconds) and upper-body strength (measured by their ability to do arm curls).

Arthritis. A Tufts University study found that an hour of tai chi twice a week for 12 weeks reduced pain and improved mood and physical functioning more than standard stretching exercises in people with severe knee osteoarthritis.

Low bone density. A review of six controlled studies by Dr. Wayne and other Harvard researchers indicates that tai chi may be a safe and effective way to maintain bone density in postmenopausal women.

Hypertension. A review of 26 studies in English or Chinese found that, in 85 percent of trials, tai chi could decrease blood pressure.

Sleep. In a University of California—Los Angeles study of healthy older adults with moderate sleep complaints, 16 weeks of tai chi improved the quality and duration of sleep significantly more than standard sleep education.

Stroke. A study conducted at the University of Illinois compared patients who had suffered a stroke at least six months earlier. In the 12th week of the tai chi program, participants demonstrated improved standing balance.

Sources

“How the Ancient Martial Art of T’ai Chi Is Prolonging Seniors’ Lives,” Fight Ageism

“Tai Chi for Older Newbies,” Senior Planet

“Introduction to tai chi,” Medicine Net

“Tai Chi Exercises Both Mind and Body,” Web MD

“The health benefits of tai chi,” Harvard Health Publications

“The 12 Benefits of Tai Chi for Seniors,” March 2010, Inside Elder Care


Tai Chi Gentle but With Strong Physical Benefits was featured in the October 2014 Senior Spirit newsletter.

Blog posting provided by Society of Certified Senior Advisors www.csa.us.

Lying in Wait: PTSD in the Older Population

Post-traumatic stress disorder is usually thought of as a condition related to the military. But research is finding that PTSD can be prevalent in older populations.

Post-traumatic Stress Disorder (PTSD) has become something of a buzzword in recent years, given the ongoing conflict in the Middle East and the impact of this war on the younger generation. While the increased attention to PTSD in the media has been beneficial in bringing this important issue to light, it has also resulted in a somewhat narrowed view of PTSD as only affecting a specific part of the population—young adults who have been to war. This is unfortunate, because PTSD is a global disorder that occurs across the lifespan.

What is PTSD?

It is currently estimated that 8 percent (roughly 25,112,000) of the U.S. population meets the criteria for PTSD (Center for the Treatment and Study of Anxiety n.d.). A wide range of traumatic incidents can lead to PTSD. Any event in which a person is exposed to "actual or threatened death, serious injury, or sexual violence” (APA 2013) can lead to PTSD. Examples include: combat exposure, sexual assault, car accidents, natural disasters, and mass shootings. This traumatic exposure is what is known as a Criterion A stressor, according to the diagnostic criteria for PTSD. Exposure to a Criterion A stressor does not guarantee the development of PTSD; development of PTSD comes when a Criterion A stressor sparks the onset of symptoms in four additional categories: intrusive symptoms (nightmares, memories, flashbacks), avoidance symptoms (isolation, withdrawal), cognitive symptoms (negative emotions, guilt), and arousal symptoms (being hypervigilant, easily startled, on edge) (APA 2013). The range of exposure to at least one traumatic event during their lifetimes is the highest in adults aged sixty-five and older, ranging from 70 percent to 90 percent (Creamer and Parslow 2008), making older adults one of the most vulnerable populations to the condition. PTSD is rarely a stand-alone diagnosis. It is most commonly diagnosed with “comorbid” conditions—those that are naturally related to the experience of PTSD, such as depression and substance abuse.

PTSD in Older Adults

Aging populations are uniquely vulnerable to PTSD for a broad range of reasons. The transition to older adulthood comes with a series of changes that can be significantly stressful. These include but are not limited to, reduction in income, changes in identity with retirement, decreased mobility and physical strength, widowhood, declining social support, and slowing or diminished cognition (Cook 2001; Kaiser et al. 2014). Where many of these stressors do not constitute a Criterion A stressor and therefore are not PTSD-inducing, many will exacerbate pre-existing trauma and bring symptoms of PTSD to the forefront for the first time in an older adult’s life. Older adults often have dormant traumatic symptoms that occasionally flare throughout their lifetimes, but usually did not overtly interfere with everyday life. 

The stressors inherent in the transition to older adulthood may serve as catalysts for the onset of PTSD in older adults. For those who have had PTSD for most of their lives, many are able to “manage” their symptoms independently without the assistance of medication or mental health providers through will power, avoidance (example: isolating themselves socially), or distraction (example: working excessive hours). When cognition slows, physical abilities weaken, distractions like work fade with retirement, and social support systems are lost or reduced, the symptoms of PTSD that older adults were once able to “manage” may become unmanageable. It is also important to note that many of our current older adult population experienced trauma prior to the advent of the diagnostic terminology for PTSD, developed in 1980. This has resulted in their PTSD going undetected or untreated for years due to lack of knowledge of the disorder at the time of trauma (Cook 2001). 

Symptoms

Much of the research done into PTSD in older adults demonstrates that the experience of trauma, as well as symptoms in response to this trauma, differ between younger and older adult populations (Kaiser et al. 2014). Symptoms tend to present in older adults as more physical in nature such as aches and pains, gastrointestinal problems, fatigue, and cognitive difficulties such as problems with focus, attention and memory (Hermann 2014). Older adults are more likely to describe their problems as related to stress or call them issues, rather than specific psychological or trauma-focused language, like saying, “I’m feeling anxious.” PTSD symptoms in older adults tend to be less persistent over time (Cook 2001)—they ebb and flow more. For example, having good and bad days, weeks, and months, rather than always feeling anxious. This is likely due to the impact of factors like the amount of time since the event, culture (example: believing hardship is inevitable and should be endured), and past traumatic experiences that may have served to offer perspective.

Research has shown that as many as forty-five years post trauma, older adults meet diagnostic criteria for PTSD (Falk 1994). Studies done on aging populations often demonstrate a curvilinear relationship. That is, symptoms are highest after exposure, decline for years, then increase later in life (Port, Engdahl, and Frazier 2001). Older adults with PTSD may begin to show symptoms the first time in older adulthood or have a recurrence of symptoms from long-ago traumas as a result of the impact of recent stressors.

Recognition, Treatment, and Support of Older Adults with PTSD

Recognition of PTSD in older adults begins with knowledge of the prevalence of lifetime exposure to trauma in the older adult population, awareness of the variable nature of symptoms, and the potential for late-life onset due to the unique stressors inherent in the transition to older adulthood. As symptoms of PTSD and its related diagnoses (depression, substance abuse) manifest in older adults, it is important for family members and people in supportive roles (CSAs, doctors) to notice them and aid in organizing treatment and support.

Treatments for PTSD come in the form of both medication and supportive therapies. Many of the drug trials that led to development of medications approved for PTSD did not include older adults, and therefore the medications can be unpredictable in older populations (Hermann 2014). Antidepressants known as selective serotonin reuptake inhibitors (SSRIs)—for example Zoloft, Paxil, Lexapro—have been shown to help with some of the symptoms of PTSD. However, evidence has consistently demonstrated that therapy is most effective in treating symptoms of PTSD (Hamblen 2010).

There are multiple evidence-based treatments (EBTs) that include cognitive processing therapy (CPT) (Resick, Monson, and Chard 2008), and prolonged exposure therapy (PE) (Hamblen 2010). The two techniques have significant overlap, with CPT attempting to change the thoughts associated with the trauma, and PE attempting to change the emotions and physiological reactions to the trauma. Both have been shown to be effective in treating more immediate trauma in younger populations. However, older adults are less likely to approach their trauma from a psychological perspective (the way they think and feel) and are more likely to relate their symptoms to outside events and stressors (loss of income, loss of a spouse). (Hermann 2014). Older adults may also have cardiac or respiratory problems that make intense trauma-based treatments dangerous.

Assessment of PTSD in older adults should include questions about symptoms, distant and recent trauma, as well as screeners for cognitive decline that may be contributing to or exacerbated by the symptoms. If trauma or PTSD is suspected, older adults should be referred to a therapist with knowledge of trauma, the unique problems of older adults, and necessary adaptation of interventions for working with older adults (APA 1998). Effective forms of treating trauma in older adults focus more on finding meaning, and helping patients organize and examine memories throughout their lifetimes. Patients may benefit from integration of their trauma history into this life examination with the aid of a therapist to help in processing memories and coping with changes resulting from
trauma (Cook 2001).

Many older adults have lived with their trauma for years. Over time, they learned methods of coping, both healthy (relying on social support) and unhealthy (drinking alcohol), over the course of their lifetimes. Good treatment of PTSD will incorporate existing strengths and healthy methods of coping, and aid them in supplementing the more maladaptive methods of coping or methods they have lost (example: engaging in local community groups for social support following the loss of a spouse).

Perhaps the most unique and important component in the treatment of PTSD in older adults is education, support, and methods of coping for the caregivers and family members who are a part of the person’s daily life, and will aid in the treatment and recovery. PTSD has a lasting social impact. Caregiver stress is particularly high in people who care for older adults with symptoms of PTSD, warranting additional support and education for them to be able to cope with the vicarious effects of supporting someone who has a trauma history. CSAs and other advisors are well positioned to advise and guide their clients to appropriate professionals for help. • CSA 

Carilyn Ellis is a Fellow at the Boise VA Medical Center, specializing in oncology, palliative care, and primary care psychology. She completed her doctorate in clinical psychology at George Fox University in Newberg, OR. She loves serving those who serve our country, and especially loves working with Veterans. She can be reached at cellisalaska@yahoo.com.

Lying in Wait: PTSD in the Older Population was recently published in the Summer 2014 edition of the CSA Journal.

Blog posting provided by Society of Certified Senior Advisors

www.csa.us

Supporting an Older Relative: A Surprising Tax Benefit

Many people may not be aware of a powerful tax benefit that exists within

their families. Those who financially support an older relative may be able to

claim them as dependents.

Our society is changing. Over the past ten years, older parents have begun moving

in with their adult children at increasing rates. In 2000, 4.1 percent or 2.3 million

aging parents were living with family. By 2007, the number had jumped to 6.5 percent or 3.6 million. Today, multigenerational households are burgeoning (AsYouAge 2013), and many who support these aging Americans are missing an important tax benefit.

It is called the Personal Exemption. The value varies from year to year. In 2013 the personal exemption was worth $3,900, and in 2014 it increases to $3,950. In many instances, those who support older adults financially are able to claim them as dependents or seniors can claim themselves. Taking advantage of this powerful tax benefit requires knowledge of the support received by the older adult and how much seniors support themselves. In this article, individuals will discover who can claim a senior as a dependent and under what circumstances.

For older adults who claim themselves as dependents, the value can be more than the personal exemption. In addition to claiming the personal exemption, those age sixty-five and older can claim an added $1,200, and an additional $1,200 if they are blind.

Blindness is the only physical impairment that allows the additional personal exemption amount. For married couples, this is a double real benefit. For example, Reg and Chickie are both over age sixty-five and Chickie is blind. Their personal exemption

for 2014 would be:

Only taxpayers who claim their own personal exemption—meaning they are not claimed as a dependent by someone else—can get the additional age and blindness exemptions.

But if you cared for an older parent, your parent may qualify as your dependent, resulting in additional tax benefits for you.

The first thing that often comes to mind when considering dependents is the parent/child relationship. Normally, parents claim their children as dependents until they become adults. It also works the other way around. If you cared for an older parent, your parent
may qualify as your dependent, resulting in additional tax benefits for you. Once you determine that both of you meet IRS criteria, you can claim your parent as a dependent on your tax return and claim their Personal Exemption on your tax return.

The First Test is the Income Limitation
A parent must first meet income requirements set by the Internal Revenue Service to be claimed as a dependent. To qualify as a dependent, the parent must not have earned or received more (income) than the personal exemption amount for the tax year. Again,
this amount is determined by the IRS and may change from year to year. The current exemption amounts can be found in IRS Publication 501. For 2014, the personal
exemption amount is $3,950. Generally, Social Security is not counted as income, but there are exceptions. If a parent has other income from interest or dividends, a portion of the Social Security may also be taxable. 

Example 1: My mother, Minnie. Minnie only has Social Security income and draws $18,000. Because this amount is under the threshold for taxing , Minnie does not need to file a tax return. Her taxable income is below the personal exemption amount of $3,950 for 2014, and she could be claimed on someone else’s tax return.

Example 2: My aunt, Millie. Aunt Millie came to live with me in January 2014 and I am her total support. Her health prohibited her from living alone However, she did not want to sell her home, always wishing and hoping she could return to it one day. She rented her home for $350 a month but the insurance, repairs, and yard maintenance exceed the income. Because her gross income is $4,200 ($350 x 12 months), I cannot claim Aunt Millie as a dependent. 

Her $4,200 of gross income from the rental of her former home exceeds the personal exemption amount of $3,950 for 2014.

Example 3: Gale and her grandchildren. Gale has custody of her two grandchildren, Julie and Brian. The assets of their deceased parents were placed in a simple trust where Julie and Brian are the beneficiaries. The terms of the simple trust dictate that all income
made by the trust assets is distributed to the beneficiaries.But if the income distributed by the trust exceeds $3,950 for Julie and/or Brian, Gale cannot claim them as dependents.

If Gale adopted Julie and Brian, the income would not be a factor and she could claim them as “qualifying children,” unless their income from the trust supported them greater than 50 percent.

The Second Test is the Support Requirement
Adult children must have provided more than half of their parent’s’ support during the tax year in order to claim them as dependents. When determining the monetary value of the amount of support they provide, they need to consider several factors. 

First, calculate the fair market value of the room the parents occupy. That is, how much rent could be charged for the space? 

Next, consider the cost of food provided. Do not forget to include utilities, medical bills, and general living expenses, as well as the cost of transportation for the parents. This includes transportation to doctor appointments, attendance at church or synagogue, as
well as for recreation. If structural improvements were made to a home to accommodate a disabled relative, such as a wheel-chair ramp or modifications to bathroom facilities among others, the costs may qualify as medical expenses, to the extent they do not improve the value of the home. Compare the value of support you provide with any income, including Social Security, that your parent receives to determine whether you meet the support requirement. The amount of support provided must exceed the parents’ income by at least one dollar and therefore be greater than 50 percent.

Relatives Who Do Not Have to Live with You All Year
The residency test. In most instances, the person claimed as a dependent must live in your home all year. A person related to you in any of the following ways does not have to live with you all year as a member of your household to meet this test.

• A child, stepchild, foster child, or a descendant of any of them. A grandchild would be an example.
• A brother, sister, half brother, half sister, stepbrother, or stepsister.
• A father, mother, grandparent, or other direct ancestor, but not a foster parent.
• A stepfather or stepmother.
• A son or daughter of your brother or sister.
• A son or daughter of your half brother or half sister.
• A brother or sister of your father or mother.
• Your son-in-law, daughter-in-law, father-in-law, mother-in-law, brother-in-law, or sister-in-law.

It should be noted that none of these relationships that are established by marriage are ended by death or divorce.

For example, Frank and Marie were the caregivers and supporters of Marie’s father, John. Marie died in 2013 but Frank continues to support and care for her father. Although John was Marie’s father, the relationship between Frank and John did not end with her death. If qualified, Frank can continue to claim John as a personal exemption on his tax return for 2014. 

What about temporary absences? A person is considered to live with you as a member of your household during periods of time when they are temporarily absent due to special circumstances such as: 

• Illness
• Education
• Business
• Vacation
• Military service

If the person is placed in a nursing home or care facility for an indefinite period of time to receive constant medical care, the absence may be considered temporary.

Death or Birth
A person who died during the year, but lived with you as a member of your household until death, will meet this test. A person doesn't need to be alive the entire year to be claimed as a full-year dependent. If a dependent died during the year and you otherwise
qualify to claim the personal exemption for the dependent, you can still claim the exemption.

Example: My mother, Minnie, died on January 15, 2014. She met the tests to be my qualifying relative. The other tests to claim an exemption for a dependent were also met, and I am able to claim the personal exemption for her on my tax return. The personal exemption is not prorated, but the full $3,950 is allowed although she did not live all year. 

Head of Household
A taxpayer using the Head of Household filing status is entitled to use the head of household tax rates, which feature wider tax brackets. Also, the taxpayer is entitled to a larger standard deduction ($9,100 for tax year 2014) than taxpayers using Single or Married Filing Separately ($6,200 for tax year 2014). Head of Household is a filing status for individual United States taxpayers. To use the head of household filing status, a taxpayer must:

• be unmarried or considered unmarried as of the last day of the tax year;
• have paid more than half the cost of keeping up a home for the tax year (either one’s own home or the home of a qualifying parent);
• in most cases have a qualifying person who lived with the head of household in the home for more than half of the tax year except if the qualifying person is a dependent parent.

Deducting Medical Expenses
If you paid for your parent’s medical care, the expenses may be deductible. They can be claimed as itemized deductions on Schedule A. Itemized deductions are beneficial when they exceed the amount of the standard allowable deduction. Total medical expenses,
including the cost of prescription drugs, equipment, hospital care, and doctor’s visits, must exceed 10 percent of adjusted gross income to be claimed. The IRS understands the heavy burden that medical expenses sometimes create, and has made an exception
for this deduction.

You can deduct your parent’s medical expenses even if they do not meet the income requirement to be claimed as your dependent, as long as you provide more that half of their support. 

Example: My mother, Minnie. Minnie makes too much money for me to claim her as a dependent. But if I support her greater than 50 percent, I can claim her medical expenses I paid on my Schedule A, Itemized Deductions on my tax return.

People sixty-five and older have an exclusion of 7.5 percent of income from the amount they can claim as medical. Taxpayers under age sixty-five have a 10 percent of income exclusion. This provision of the Affordable Health Care Act is in effect until 2017 when
all taxpayers fall under the 10 percent exclusion. However, if I claim Minnie’s medical expenses on my tax return, Schedule A, Medical, I am still subject to the 10 percent of adjusted gross income exclusion unless I, too, am sixty-five or older.

Dependent Care Credit. The child and dependent care credit is a non-refundable tax credit. It can be claimed by taxpayers who pay for the care of a qualifying individual and meet certain other requirements. If parents are physically or mentally unable to care for
themselves, they are qualifying individuals.

In order to qualify for the credit, you must meet certain requirements. You need to have earned income and work-related expenses to qualify. This means that the care must have been provided while you were either working or looking for work. In addition, you must be able to properly identify the care provider. This includes giving the provider’s name, address, and identifying number (either Social Security number or employer identification number to the IRS on your tax return). If you are married but file a separate return, you may not claim this credit.

The cost of home care, which enables the taxpayer to work elsewhere, can be applied towards a medical expense deduction or the Dependent Care Credit, but not to both. Usually, it is advantageous to apply these expenses up to the maximum amount ($3,000) toward a dependent care credit and the remainder as medical expense deductions. However, this may not always be the case. It is advisable to seek a tax professional to
determine which is more advantageous.

In 2013, twenty-eight states have some version of the Federal Child and Dependent Care Credit. These states allow tax filers to deduct a percentage of their federal tax credit from their state tax returns. If the dependent care tax credit in your state is 50 percent of the federal amount and your federal credit is $1,050, you can also deduct $525 for your state taxes. Many states apply a range of percentages based on the income of the person claiming the older adult as a dependent. Some states limit the credit for higher-income taxpayers, allowing only 35 percent of their federal credit. Your state’s website will be a good source of information about this potential credit.

Claiming a Dependency Exemption under a Multiple Support Agreement
Multiple Support Agreements are a little-known boon to taxpayers with older dependents. Many seniors who may qualify as dependents go unclaimed on federal income tax returns each and every year. Although there are no statistics on unclaimed individuals (neither the IRS or the U. S. Census Bureau have these numbers), many who financially support seniors may fail to claim their personal exemptions because they do not know about the Multiple Support Agreeement. 

Even if you do not provide more than half the support of another person, you may still qualify for a dependency exemption ($3,950 in 2014) if you have a multiple support agreement. This agreement applies if you contribute more than 10 percent of the person’s support and, together with others, contribute more than 50 percent of the person’s support. Then each of the other supporters who contribute more than 10 percent
must agree among themselves who will claim the exemption (it cannot be prorated among the supporters). Only one person can claim the exemption.

Example: You and your three sisters support your mother. You contribute 40 percent and the other sisters each contribute 15 percent, and your mother contributes 15 percent toward her own support. 

Since you and your sisters contribute more than half of your mother’s support (40 + 15 + 15 + 15 = 85 percent), a multiple support agreement can be used for one of you to claim your mother as a dependent and receive her personal exemption. 

Any one of you may claim your mother as a dependent, but only one of you each year, and this can be done on alternating years. IRS Form 2120 Multiple Support Agreement must be signed by all who contribute greater than 10 percent to the parent’s support. Contributing more than 10 percent is a requirement to claim the dependent.

A worksheet for determining support in order to claim an older adult as a dependent and receive a personal exemption can be found at www.irs.gov/pub/irs-pdf/p501.pdf. Once completed, the worksheet will determine who can claim the older adult. It should be
retained, with documentation to support the schedule, with the tax records of the individual making the claim. Taxpayers in the top tax brackets will experience the phase-out, a provision of the tax code that reduces itemized deductions and personal exemptions, sometimes to zero, simply because of the amount of their income.

A knowledgeable and trustworthy tax professional can be the most valuable asset in determining who can and should claim an older adult as a dependent. Financial advisors should be aware of these tax benefits and refer their clients to tax professionals
for assistance. •CSA

Beanna Whitlock is an Enrolled Agent in private practice as Whitlock Tax Service, LLC, in Reno, Nevada. She is an adjunct professor at Auburn University, and is a faculty member at the National Center for Professional Education. She has been honored by Accounting Today as one of the 100 Most Influential in Accounting for an unprecedented seven years. Contact her at Beanna@ whitlocktax.com, or see www.Whitlocktax.com.

Supporting an Older Relative: A Surprising Tax Benefit was recently published in the Summer 2014 edition of the CSA Journal.

Blog posting provided by Society of Certified Senior Advisors

www.csa.us

Home and Community Based Services: A Broader View

Navigating the myriad of resources available to older adults in need of special services can be daunting. This article covers them in detail.

Those who are new to the aging industry often find themselves confused by the world they have entered. Even experienced service providers have difficulty understanding how to weed through the labyrinth of the “continuum of care.” As a professional advisor, you know your clients wish to remain active, healthy, and independent but are unsure how to find resources to assist them with that goal. 

To make things more complicated, older adults have different needs based upon their stage of life. You may be working with older seniors (not boomers) who deal with issues such as: Should I still be living in my current home? If not, where should I be living? Am I safe in my environment? Should I be driving? How do I get to the doctor? Will I have enough money to survive through my final years? These same questions and others may be initiated from the family member or caregiver.

Boomers may be in a different phase of life, but still be unsure where to go to get help. They may be unemployed when it is difficult to find a job and are not old enough to qualify for Medicare.  Sometimes they find themselves members of the “sandwich generation” who are still supporting children while taking care of their older parents. Perhaps they are looking for a way of reinventing themselves by finding opportunities that allow them to apply their skills and talents in a new  environment. How do they deal with these challenges in meaningful ways? 

With the growing numbers of older adults, it is important for advisors to be aware of the resources available in their communities to help these individuals. These services are defined by the public sector as Home and Community-Based Services (HCBS). However, it is important that service providers understand there are many public and private resources available for their clients. To better serve older adults, providers should consider realigning their existing paradigms of what services are available and developing a broader knowledge of home and community-based services.

The Common Perception of Home and Services

HCBS allow people of all ages who have limitations to remain independent in the least restricted settings possible, and to be connected with their communities. Both of these defined goals are critical to an older person’s quality of life. They need to be independent and they need to feel connected to the community in order to have balance and meaning. 

Some people identify HCBS as publicly supported services serving the low-income, older adult population. Although there may be some services under publicly supported HCBS that are paid for with private-funding, the majority of publicly-funded services are paid for through publicly funded sources. These services are available to all older adults, but typically are provided based on the greatest need. 

The National Association of States United for Aging and Disabilities (NASUAD) defines HCBS as “services or other supports to help people with disabilities of all ages to live in the community.” Each state has a mix of public programs and funding sources. The Medicaid program pays for many of these public services in all states. There are also other federal, state, and local dollars that fund home and community-based services, including the Social Services Block Grant (SSBG), Older Americans Act (OAA), Education and Rehabilitation funds, and State General Funds (NASUAD Clearinghouse). 

In 1965, Congress passed three important pieces of legislation that, over time, would shape and define the nation’s approach to its growing older population: Medicare, Medicaid and the Older Americans Act (OAA) (Niles-Yokum and Wagner 2011).

Over the last forty-eight years, the OAA has been largely responsible for the development of the public aging network and services. These services are administered and overseen by fifty-six State Units on Aging and 629 Area Agencies on Aging (AAAs) across the nation. The Congressional authors viewed the role of AAAs to include identifying the priority service needs of the age sixty-plus population in their communities, developing plans of action to address those needs, and serving as visible advocates with and on behalf of older Americans. 

Each AAA has evolved in the context of a unique social, economic, and political environment. Further, AAAs are flexible and take advantage of emerging opportunities and “climates for success” to mount new initiatives or expand services that support the health and independence of those sixty and older, especially the most frail and vulnerable, and their caregivers. Consequently, no two AAAs are alike. Yet, the OAA provides the umbrella uniting them in a common mission with a common set of roles and responsibilities (National Association of Area Agencies on Aging 2011). Existing programs and services provided through the aging network have been categorized as follows (Niles-Yokum and Wagner 2011):

• Home-based and community-based long-term care
• Elder rights protection 
• Health, prevention, and wellness 
• Special projects

AAAs either provide these services directly or contract with providers to provide the services identified in Figure 1. AAAs often serve as the pass-through for Older Americans Act funds, contracting with local service providers to provide the actual services for older adults. Many of these services are provided through the network of senior centers across the country. The National Institute of Senior Centers states there are over eleven thousand senior centers nationally. These entities are either nonprofits or run through local governments, providing services that include meal programs, transportation to and from the centers, case management and assistance programs, as well as social and fitness activities.

The Broader Picture of HCBS

It is clear that the publicly provided HCBS are an important resource to assist older adults. However, a relatively small proportion of the older population receives services directly funded by the Older Americans Act (O’Shaughnessy 2011). Most older adults receive care from family, friends, public and/or private agencies. These existing networks provide services for older individuals in most communities around the country. Service providers, working in what is called the “continuum of care,” meet many people’s needs (Tenenbaum 2010).

In addition to publicly funded home and community-based services, many are paid for with private monies and service fees. Demand for services in the private sector have grown annually an average of 5.1 percent from 2009-2014 resulting in an industry revenue total of $14 billion (IBISWorld 2014). This trend supports the growth of the private service sector including services such as adult day care, non-medical home care or homemaker services, social activities, group support and companionship services. The U.S. Bureau of Labor Statistics states jobs for home-care workers (home-health aides and personal-care aides) are projected to increase 70 percent—1.3 million from 2010-2020, much faster than average. In fact, these are two of the projected fastest growing occupations in the United States (currently at 1.9 million nationally). 

Privately-funded services are typically found in senior resource directories under varying categories, but some can list up to fifty categories of senior resources. For example:

• Living Arrangements: adult day care, assisted living facilities, nursing homes, hospice care, independent living, continuing care retirement communities, active adult living, housing referral service, moving and relocation services.
• Estate Services: elder law, estate planners, financial planners, funeral services, reverse mortgages, insurance providers.
• Health, Prevention and Wellness: hospitals, physicians, non-medical home care, medical home health, geriatric care management, companion services, health clubs, fitness programs, chiropractors, personal trainers, nutritionists, dietitians, physiotherapists, occupational therapists.
• Medical Supplies: assistive devices, health products, foods & supplements, medical equipment.
• Home Maintenance and Delivery: home maintenance, home modification, house cleaning, grocery delivery, meal delivery.
• Transportation: medical and non-medical transport services.
• Employment: jobs for seniors, civic organizations, training organizations.
• Volunteering: senior volunteering programs, community volunteering organizations.
• Education: aging advocacy, education for seniors, lifelong learning programs.
• Information and Resource Referrals: resource centers, care managers, and others.

Why Understanding the Broader Picture is Important: Silos of HCBS Services

Though many services may be available, piecemeal development of HCBS over a long period of time largely explains why the services do not always work in coordination with each other. Additionally, programming and funding have emerged from an array of congressional appropriations, state programs, nonprofit grants, private enterprise, and community initiatives. The service providers’ inspirations and intentions, background, mission, and purpose are equallyvaried. Neither funding nor providers are developed for comprehensive care on an at-home basis (Tenenbaum 2010).

Public funding for home and community-based care comes from different departments, agencies, and levels of government, sometimes described as “silos” because operationally they are self-contained and vertical. Funding and services from non-profits and foundations are organized around missions, goals, and funding priorities. Private-pay providers organize their services around a skill set or resources they can manage well. This is fair because all of these provider organizations are meeting their purposes, charters, and goals to provide a program or service. However, none are mandated to consider or provide the whole continuum to match client needs, which is the optimal situation for a service consumer (Tenenbaum 2010). As a result, people are often unaware of available resources to help them address their needs.

Resources to Find HCBS

As an advisor to older adults, connecting your clients with resources to help them remain independent can be confusing. Questions you may need to ask yourself include: What specific services does my client need to remain independent? Does my client qualify for publicly-supported programs and services? If so, is there a waiting list for these services? How accessible are existing aging resources for my client? How affordable are privately-developed services for my client? You may not feel comfortable addressing these issues with your clients. If so, consider referring them to a geriatric care manager or a local AAA. Many AAAs have Aging and Disability Resource Centers (ADRC), which can help them find existing services.

Aging and Disability Resource Centers

Information and referral resources are available from multiple public and private organizations. As a result of the 2006 amendment called “Choices for Independence,” Aging and Disability Resource Centers (ADRCs) are growing across the nation. Tied to Area Agencies on Aging, ADRCs look to better coordinate services and assist consumers across the age spectrum to access them.

The ADRC program, a collaborative effort of the Administration for Community Living (ACL), formerly Administration on Aging or AoA, the Centers for Medicare and Medicaid Services (CMS), and now the Veterans Health Administration (VHA), supports state efforts to streamline access to long-term services and support (LTSS) options for older adults and those with disabilities. ADRCs simplify access to LTSS, and are a key component to long-term care systems reform (ACL 2013). ADRCs are known to be “No Wrong Door (NWD)” or “Single Entry Point (SEP)“and are designed to serve as highly visible and trusted places available in every community across the country where people of all ages, incomes, and disabilities go to get information and one-on-one counseling on the full range of LTSS options. Nationally, ADRC programs have taken important steps towards meeting AoA (now ACL) and CMS’s vision by:

• Creating a person-centered, community-based environment that promotes independence and dignity for all.
• Providing easy access to information and one-on-one counseling to assist consumers in exploring a full range of long-term support options.
• Providing resources and services that support the needs of family caregivers.

As a CSA, you should locate one of the 629 national Area Agencies on Aging in your region to ensure you are connecting your clients with available aging resources and services through the ADRC program. In addition, you should educate those connected with AAAs and ADRCs about your services. 

The HCBS resource chart lists home and community-based resources that will help you connect your clients and their family members with solutions. •CSA

Erika T. Walker, MBA, MSeD, CSA, is owner and CEO of SAGE WAVE Consulting, LLC, in Gainesville, Georgia. She conducts strategic planning with businesses and
communities across the country, helping them to prepare for the growing aging population. With over twenty-five years of experience, she has served as Director of the SAGE Institute and Director of Geriatrics at Greenville Hospital System. She may be contacted at 678-971-4778, etwalker2@charter.net, or at www.sagewave.net.

Home and Community Based Services: A Broader View was recently published in the Summer 2014 edition of the CSA Journal.

Blog posting provided by Society of Certified Senior Advisors

www.csa.us