A Caregiving Forum

1. A Caregiving Forum Presents: Doris Kraemer, RN COO HireFamily, Inc. Mary Lou McGuinness, RN, CLTC, CSA Senior Long Term Care Specialist Long Term Care Partners, LLC www.LTCFEDS.com

2. Mary Lou McGuinness draws on her extensive nursing background to integrate concern for the welfare of our customers with business sensibility. Since joining LTCP in 2002, she has provided invaluable leadership in developing and implementing our care coordination and claims processes within the FLTCIP while meeting the challenges of managing an ever-growing claim volume. For more than 20 years, Mary Lou has served as a nursing leader in long term care, including two terms (six years) as a governor appointee to the New Hampshire Board of Nursing, representing the long term care nursing specialty. Today’s presenters Mary Lou McGuinness As COO of HireFamily, Doris Kraemer brings extensive leadership and operations experience to the long term care industry. HireFamily offers payroll and verification services for independent care providers and the families they serve. Doris is a compassionate leader who has led the development of several innovative services supporting America’s aging population including the nation’s first national database of long term care providers with quality ratings, a national discount provider network, and a care coordination company. Doris Kraemer Tom Bebbington is a Senior Account Manager at Long Term Care Partners, LLC, which administers the Federal Long Term Care Insurance Program (FLTCIP). At Long Term Care Partners, Mr. Bebbington also serves in a PR role, assisting congressional outreach efforts, writing and coordinating press releases and supporting Long Term Care Partners' CEO, Paul Forte on press-related issues. Tom Bebbington

3. Housekeeping • Check your computer speakers for audio: • If you are having trouble hearing via computer speakers, you can call in to today’s webinar • Just exit the webinar and return to the “lobby” page where you can access a participant phone number and access code • Questions can be typed in at any time • Today’s webinar will be archived; it will be available online five days from today

4. What is an Adult Caregiver? • An adult who provides assistance to anyone who is physically or cognitively impaired • Actually providing care or coordinating it • Formal vs. informal/family caregiving

5. Agenda • Family caregiving • Understanding the Senior’s world • Normal aging vs. signs to be concerned with • Dealing with issues of aging • Long Term Care (LTC) home care, housing options and services • Where to get more information Questions Welcome!

6. What’s the Big Deal? • Didn’t we always take care of Grandma? • Baby Boomers are aging (In huge numbers!) • Their parents are living longer (Sandwich generation) • More women (the traditional caregivers) now in the workforce so are less available to give care • Scattered and blended families • 50% divorce rate • Fewer children = fewer caregivers

7. Family Caregiving… • The majority of care that is provided at home - about 80%- is provided by unpaid caregivers • The average length of this caregiving is 4.3 years “…it began to dawn on me that… I had a new role: ‘family caregiver.’ It’s a job nobody applies for. You don’t expect it. You won’t be prepared.” “Why We Must Help Caregivers” Gail Sheehy, Parade, September 9, 2007.

8. Getting Started • You suspect care is needed, then what? • Assess the Situation: • know what is normal • observe the elder in their environment (Proxy) • ask questions to promote self determination

9. “Welcome to My World” • Understand the Senior’s world: • living longer but not necessarily better • access to friends and family may diminish • transportation issues decrease access • physical disabilities or limitations • depression, alcoholism, loneliness common • sense of loss or isolation (control, loved ones, home)

10. Understanding the Senior • Physical Changes: • sensory (hearing, smell, taste, vision) • cardio-respiratory • muscular-skeletal • Cognitive Changes: (Normal vs. Abnormal) • processing speed, retrieval and storage of new information, reaction time…Just Wait! • short-term memory vs. long term • “Senior Moment”

11. Understandingthe Senior • Social structures: • outliving your friends • isolation from friends and family • where is Home? • blended families or Fewer children • control issues with caregivers/adult child • Financial concerns: • who is going to pay?

12. Understanding the Senior • Loss: • changes in physical functioning • social status and new roles • death of peers and impending demise • Resiliency: • too much loss + too much change = too little resiliency

13. Changing Needs–Warning Signs • Appearance:neglect of personal care/hygiene • Living environment:unsafe due to clutter • Nutrition neglected:cupboards empty • Withdrawal:social interactions change • Signs of forgetfulness:mail/newspapers • Mismanaging finances: not paying bills • Role of denial in identifying the warning signs Typical scenarios that mark the beginning of a long term care situation PHYSICAL IMPAIRMENT (falls) IMPACT OF CHRONIC ILLNESS COGNITIVE IMPAIRMENT

14. Warning Signs…Now What? • Ask Questions of your loved one: • what do they think they need? • what will they accept? • * Write down “warning signs,” concerns, desired services for reference later

15. Now What? • After observing and asking questions: • IS CAREGIVING NECESSARY? If so…Navigate the LTC Maze! • what care is necessary? • what type of provider? • where will care be provided? • who pays for it?

16. How Families Decide • Simple steps to making caregiving decisions: • family meeting/conference call (include Senior) • discuss assessment of needs • discuss available local community resources • long distance caregiving considerations • come to a “consensus” on plan of care

17. Stress and Caregiving • Most stressful aspects: bathing, incontinence, dementia • Alzheimer’s caregivers experience 3x more stress symptoms • A stress factor: whether the caregiver had a choice in the decision to become a caregiver • LTC tears at families due to responsibilities not being shared equally • Tips to avoid caregiver burnout

18. Important Incapacity Planning Documents • Effects of HIPAA on “family rights” • Power of Attorney: - durable or springing - for legal/financial decisions (DPOA) - for health care decisions (DPOAH) • Living Will / Advanced Medical Directive • Do Not Resuscitate Order (DNR) Content not intended to be legal advice. State laws may differ. Please consult a Professional in your/your parent’s state.

19. Assistance with Daily Tasks Activities may include: • Help with transportation • Accompaniment to medical appointments • Running errands & grocery shopping • Household chores, laundry, yard work • Reading mail & paying bills • Preparing meals • Reminders to take medication

20. Assistance with Physical Needs Personal Care assistance may include: • Getting out of bed • Getting to the bathroom or managing incontinence • Getting dressed • Helping with bathing, brushing teeth and hair shaving • Feeding

21. Assistance with Chronic Illnesses • Approx. 120 million Americans have one or more chronic illnesses, accounting for 70 - 80% of health care costs. • 25% of Medicare recipients have 4 or more chronic conditions. • Chronic illnesses are one of the major factors impacting long term care

22. Assistance with Chronic Illnesses • Self Management - Patients with chronic conditions make day-to-day decisions about their illnesses • Know their condition and various treatment options • Monitor and manage the signs and symptoms • Manage the impact of the condition on physical functioning, emotions and interpersonal relationships • Maintain optimal quality of life and healthy lifestyle behaviors • Reductions in unplanned health service utilization

23. Assistance with Chronic Illness - Cognitive Impairment • Cognitive problems may be considered a chronic illness and tend to become worse over time • Managing day to day needs while trying to maintain highest functioning possible • Maintaining Safety • Recognizing changes and communicating with health care professionals

24. What are the early signs of Alzheimer’s?

25. What are the early signs of Alzheimer’s?

26. Home Care and Services • Care managers (fees) • - counseling and referrals • - monitoring and coordination of care • - local help for long-distance caregivers • In-Home Services (skilled/custodial) • - Activities of Daily Living (ADLs) • - Instrumental Activities of Daily Living (IADLs) • - community resources (ADC, senior centers, MOW, EAP benefits) • - safety checks • Technological Services • - Personal Emergency Response Systems (PERS) • - “Smart Homes”

27. Hiring Paid Home Help • Important questions to ask: • If unavailable, e.g., due to illness, what alternate arrangements can be made? • How are social security, federal and state taxes, and unemployment insurance paid? • Is there verification that paid care caregiver can legally work in the U.S.? • If the hired caregiver is injured, who is responsible? • Are background and prior work reference checks complete? • Is there bonding and insurance in place to cover injury to client, or theft? • Will there be documentation that substantiates the completion of services? Source: “Show Me Guide – 2007”

28. Where to Get More Information • Caregiving resources list (attached) • “Since You Care” Guides (link referenced, attached); topics include: • Choosing an Assisted Living Facility • Making the Nursing Home Choice • Understanding Home Care Agency Options • Becoming an Effective Advocate for Care • Legal Matters • Long Distance Caregiving • FLTCIP enrollees can work with Care Coordinators

29. Online Resources Your Employee Assistance Program (EAP) Medicare & Medicaid Information – www.CMS.HHS.gov Eldercare Locator – (800-677-1116); www.eldercare.gov( National Association of Professional Geriatric Care Managers – (520-881-8008); www.caremanager.org Administration on Aging • – www.aoa.gov National Council on Aging • – www.ncoa.org

30. Online Resources Benefits Checkup • – www.benefitscheckup.org National Clearinghouse for Long Term Care Information • – www.longtermcare.gov • National Family Caregivers Association • –1- 800-896-3650 • Alzheimer’s Association • – www.alz.org National Academy of Elder Law Attorneys – www.naela.org All resources listed for educational purposes only. No endorsement implied.

31. Sources • “Conversations with Seniors,” Certified Senior Advisors, www.society-csa.com, accessed May, 2010. • “Show Me Guide – 2007,” SecureHorizons by UnitedHealthcare, 2006. • “Working with Seniors: Health, Financial, and Social Issues.” Society of Certified Senior Advisors, 2005. • “Medicare & You 2013 Handbook,” www.medicare.gov • “Since You Care” Guides - www.metlife.com - type “since you care guides” in the Search field. Topics include: Adult Day Centers, Alzheimer's Disease: Caregiving Challenges, Becoming An Effective Advocate for Care, Choosing an Assisted Living Facility, Community Services, Falls and Fall Prevention, Family Caregiving, Legal Matters, Long Distance Caregiving, Making the Nursing Home Choice, Medications and the Older Adult, Preventing Elder Abuse, Resources for Caregivers, Reaching for Tomorrow, Understanding Home Care Agency Options.

32. Caregiving in America • There are only four kinds of people in the world: • - those who have been caregivers • - those who currently are caregivers • - those who will be caregivers, and • - those who will need caregivers • Rosalyn Carter

33. LTC: Plan Before an LTC Issue • Agency retirement seminars • FLTCIP website www.LTCFEDS.com • online & cost of care calculators • Online Consultant Tool • premium calculator • Webinar series www.LTCFEDS.com/webinar • Personal consultations • 1-800-LTC-FEDS • appointments@LTCPartners.com • Apply anytime online • Eligibility: employees and spouses/eligible same sex domestic partners, parents, parents-in-law • qualified relatives can apply even if you do not

34. Q & A 1-800-LTC-FEDS (1-800-582-3337) TTY 1-800-843-3557 www.LTCFEDS.com The Federal Long Term Care Insurance Program issponsored by the U.S. Office of Personnel Management,offered by John Hancock Life & Health Insurance Company, and administered by Long Term Care Partners, LLC.