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ElderCare Solutions of MI

Archive for 'End of Life'

There are so many conversations we’d rather avoid than have…conversations about finances or about someone’s inability to drive to name just a few.  But by far the most universally avoided topic has got to be end of life wishes.  On the surface this seems like such a silly problem.  I mean, most of us do truly know that someday we will die.  But do our children know our wishes?  Do they know the specific interventions we do and don’t want?  Have we given anyone the legal power to make medical decisions for us if we are unable to do so ourselves?

Clearly not, because statistics show that 70% of people wish to live out their lives and die at home, yet 70% of all deaths occur in hospitals.  The good news, however, is that there are tools available to help us navigate this potentially difficult topic.  There is a website, that has a free downloadable starter kit to help you start thinking about what is important to you regarding end of life care.  Unpleasant topic? Perhaps, but at least it’s free!

Downloading as we speak,


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If we were compiling a Top Ten list of things we put off, discussing our wishes for end of life care would probably be number one on the list.  Whether it is the expense involved with having legal documents drawn up or our own sincere desire to believe we have no need to think about it yet, too many of us have not put our wishes in writing.  That leaves our loved ones in the unenviable position of having to decide what types of treatment they think we would want.

However, the 5 Wishes program takes some of the sting out of this most important topic.  According to the Aging with Dignity website, the 5 Wishes program lets you notify your doctor and hospital:

  • Who you empower to make health care decisions for you if you are unable to do so yourself
  • What kinds of medical treatment you do or don’t want
  • What comfort measures you want
  • What information you want shared with your loved ones

The form is free, can be completed online and then printed out, or a soft-bound version can be ordered.  It is currently recognized as a legal document in 42 states including Michigan, and is written in plain, easy to understand language. 

For more information visit

 Downloading as we speak,


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I said good-bye to my beloved grandmother, Nannie, as I called her, in late November 2008. Alzheimer’s disease had ravaged her brain and taken away the grandmother I knew as a child. She was diagnosed in 2001 and steadily began to decline. Gone was the vibrant, eccentric gourmet cook, artist, and world-traveler, among other talents. She no longer helped me make cookies, sent me hand-drawn cards, or went on safari in Africa. She now needed to be reminded who I was, what food she was eating, how to get dressed.

She moved in with us and I watched as my mother had to essentially care for a second child. It must have been difficult, having one child going off to college and not getting an empty nest as she had been expecting. It was challenging for all four of us (My parents, my grandmother, and I) as we all had our roles constantly redefined, changed, and renamed. I was no longer granddaughter, I was big sister. My mother was no longer a daughter; she was a mother to her mother. My father was just a visitor. Even the dog played along: he was now the cat.

Within these roles, our responsibilities and expectations also changed. We no longer ventured far from home. I would have to “baby-sit” my grandmother and make sure she didn’t try and walk down the stairs for fear of a fall. My grandmother would set the table; someone else would reset it with the proper dishes and silverware for each setting. We all learned patience and creativity as we tried to keep her occupied and happy. We repeated ourselves often. The dog learned that he would have to go outside to do his business every 15 minutes because Nannie would forget she had already let him out.

As her disease progressed, it became obvious that she was no longer safe in our home. My parents woke up in the middle of the night to find her outside in her nightgown in December waiting for the bus to “go home.” With much pain and regret, my mother made the decision to place her into an assisted living unit. Faithfully, she visited my grandmother nearly every day. For over three years, my grandmother was in this facility before she went into hospice.

A few days before she was moved to hospice, she was having a particularly good day. I had taken a leave of absence from work so that I could be with my family and spend time with my grandmother, so I was sitting with her in the common room when she had a completely lucid moment, looked right at me and said, “I love you, Jennie.”

I think about this moment often. It is something I hold onto, for in all those grey, dark days where Alzheimer’s had taken over, this is a memory that shines like sunlight. It chases away all those negative thoughts and is how I like to remember Nannie in those last few weeks leading up to her death.

Jennifer Simms-Coffey

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A good friend of mine passed away this week.  It was incredibly sad and very unexpected.  But how can I possibly feel that way?  She had been seriously, chronically ill for several years, so how could I think that her death was unexpected?

Unfortunately my experience is not uncommon.  We rarely seem to be prepared for a loved one’s death, no matter how precarious someone’s physical condition may be.  I think it’s just too hard to live day to day with the awareness that our time is truly limited, and that something so final is outside of our control.

So I hope this blog serves as a reminder to us all that life really is a roller coaster ride. We have no control over when it begins, we celebrate the ups, survive the downs, and often feel that the ride ends much too soon. 

So take this time to enjoy the ones you love, make a moment to remember, and if you need help towards the end of the ride, remember that we are here to help you Plan Well, Age Well and Live Well.


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Do you have arthritis pain?  If so, is it in your hands or your knees?  Is it in your hip or your back?  What do you do on those days when the pain goes from bothersome to really bad?  Is Tylenol or Motrin your drug of choice, or do you need something stronger? 

If you’re like most people, annoying aches and pains become an accepted part of life as we get older.  But what would you do if you were unable to get your own pain medicine, and didn’t have the words to tell anyone that it hurt?  Unfortunately this is often the case for people living with advanced Alzheimer’s disease or other dementias.  Those lifelong aches and pains don’t go away when dementia sets in.  In fact, the nerves in our brains that sense pain are among the last to be effected by progressing dementia.

Pain can actually be mistaken as behavioral issues for people with advanced Alzheimer’s.  Carol Waarala, LMSW from Odyssey Hospice shared the following story during a recent presentation:

Imagine that you’re a resident in a skilled nursing facility.  During the night you rolled into the wall, banging your thin arm pretty hard.  It’s very painful when you wake up in the morning, but nobody saw it happen and you can’t find the words to explain.  So, when the caregiver comes into your room to help you get dressed, she tries to raise your arm, but it hurts, so you reflexively jerk it back.  She tries again, not understanding that you are in pain, and once again you pull your arm back.  As she continues to try to dress you, you push her away in an attempt to stop the pain.  From the outside, it looks as though you’re becoming uncooperative, or are displaying some sort of behavioral issue.

It’s important that all of us, geriatric care managers, nurses, physicians, aids, and family members be on the look out for indicators that someone is in pain.  Facial grimaces and repeated vocalizations are often signs. Hospice agencies have a wealth of knowledge about observable signs of pain, and can be a resource if you need more information.

Ever vigilant,



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This week I’ve spoken to sisters who have lost their brothers, sons who lost their mothers and husbands who have lost their wives.  Regardless of the relationship, the loss can be devastating.

Whether an older adult’s death was expected, came out of the blue, or was viewed as a blessing freeing someone from suffering, death of a loved one can be equally devastating for those left behind. 

Sometimes in their grief people place unrealistic expectations on themselves, setting time frames for what they’ll feel and when.  And while it may help us to feel we’re in control of our grief, sadly we’re not.  Most of the time people are unprepared for how overwhelming the loss can feel, and how long the grieving process can last. 

If someone you love is living with the recent loss of a loved one, it’s important not to have any expectations about how long it will take for them to “be themselves again”.  Instead, offer reassurance that grief is a process that takes time and comes in waves, and that it’s ok if they’re not bouncing back as quickly as they might have expected.

Of course, if anyone ever feels they cannot manage on their own, help is always available from clergy, therapists, and even hospice programs, if their loved one was receiving hospice services. 

Until next time,


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End of life documentation…not a very catchy topic!  But it’s hard to find many documents that are more vital.  Each week I speak with families who have not yet gotten their legal affairs in order.  And I understand why not.

The emotional difficulty of confronting your own mortality, or that of a loved one, coupled with the expense involved with drawing up wills, trusts, Powers of Attorney etc., can cause families to delay their paper work until, sadly it is too late. 

 An Elder Law attorney is the best source of information and can tailor legal documents to your family’s individual needs.  They are also aware of the intricacies involved in eldercare issues and can help families locate resources they may qualify for. However, if you haven’t yet taken that step, Five Wishes may be of value.

Five Wishes is a living will that is honored in Michigan as well as 41 other states.  At a price of $5 each, this is an affordable option for people who don’t have an attorney.  It is a very easy to use booklet, written in everyday language that helps an individual address the following issues in writing:

  1. Who you want making health care decisions for you when you are unable to make them yourself
  2. What kind of medical treatment you want, or don’t want
  3. How comfortable you want to be
  4. How you want people to treat you
  5. What you want your loved ones to know

 The document needs to be signed, witnessed, and then there’s just one more step before it is valid.  Michigan requires the person you choose to make health care decisions for you, also known as your Health Care Agent, to sign a Patient Advocate Acceptance Form.   For more information visit

Absolutely nothing can replace consulting with an Elder Law attorney, foradvice  about estate planning, Medicare, Medicaid, Veterans Benefits etc., as well as  customized legal documents for you and your family.  But if you’re not quite ready to take that step, Five Wished can be a place to start.


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When older adults start to need help it can be very expensive.  Many of the families I speak with are confused about what Medicare does and does not pay for.  The number of supplemental and prescription plans available add to the confusion.  But when an older adult needs help, questions usually fall into 2 areas.

 1. Will Medicare pay for short-term rehab in a skilled nursing facility?

Usually, as long as the older adult:

  • Has a minimum 3 day hospital stay
  • Has a physician order for inpatient rehabilitation
  • Meets Medicare guidelines based on acuity level and potential rehabilitation

If so, Medicare reimbursement is as follows:

  • Day 1-20: 100% covered (max is $400/day)
  • Day 21-100: covered with patient co-pay. Typical 2011 co-pay is $141.50/day
  • Day 101 and beyond: out of pocket charges from $175-$300/day

 2. Will Medicare pay for home care?

That depends.  There are two types of in-home care available, skilled and private duty.  Skilled home care refers to a nurse, physical therapist, occupational therapist or speech therapist that comes to provide treatment at home.  Those services are usually initially covered by Medicare as long as you have a prescription from your doctor, qualify for homebound status, and meet acuity and rehabilitation guidelines.  Qualifying for homebound status doesn’t mean that someone never leaves the house, but that it requires taxing effort and the assistance of someone else for them to do so.  Re-certification is needed to continue to receive services after the initial number of authorized visits are up. While someone is receiving skilled home care, they may also receive services from an aid that can come once or twice a week to assist with bathing, but these visits are short, usually lasting no more than an hour. 

Private duty homecare is not covered by Medicare.  Often called companion services, private duty caregivers help with bathing, dressing, cooking, shopping, running errands and companionship.  Private duty homecare companies usually charge anywhere from $18-$24/hour.   Most private long-term care insurance policies do pay for private duty care.  It’s a vital service that really makes a difference in someone’s quality of life, but the costs do add up.

Looking into long-term care insurance,


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I had so many questions this week about long-term care insurance that I thought I would re-post this blog.  Hope it helps…

More and more often these days I hear people talking about Long-Term Care Insurance…or should I say sharing their confusion about Long-Term Care Insurance!  There’s little doubt that having a plan for long term care is a smart idea, but it is important to be sure that the policy you choose will meet your needs.

Just like homeowners or car insurance, different plans come with different covered benefits, and, of course, different price tags. Here are a few things to keep in mind when choosing a long term care policy:

When will you be eligible for reimbursement?   

Coverage usually begins when someone needs assistance with at least 2 activities of daily living (ADLs).  ADLs include everyday activities like bathing, feeding, toileting, transferring, and dressing.  People with cognitive diagnoses, like Alzheimer’s, may also qualify, depending on the policy. Plans can have a daily or monthly payout.  For example, if you had a daily payout plan that covered $150 per day and you had $200 in services for the week, all incurred on a single day, you would only be reimbursed your daily maximum rate of $150.  Because monthly payout plans don’t limit the amount of service you pay for in a day, they will reimburse you up to your monthly maximum regardless of the amount spent per day.

What is the policy’s elimination or waiting period?

You can usually choose a 30, 60 or 90 day waiting period, but be sure to find out if the policy has a “service day” or “calendar day” elimination period.  Calendar day elimination means that benefits would be covered based solely on the number of calendar days since a diagnosis was made.  Service day elimination refers to the number of days you must receive and pay for services before they are covered.  For example, if you have a 90 service day elimination plan, and you receive services once a week, it would take you 90 weeks to fulfill your 90 service day elimination period before benefits would be covered.   

Should I consider an optional inflation rider?                      

Most plans offer an inflation rider as an option.  The same level of care that currently costs $150/day might cost double that amount by the time you file a claim.

Should I check out exclusions?                                                                                          

This is the equivalent of reading the fine print.  Most policies have broad coverage, but with a few specific exclusions.

Should I ask to have policies quoted from more than one company?

Yes and be sure you’re comparing apples to apples.

 Happy Shopping,


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It can be so stressful to be a family caregiver.  Very few people are actually prepared when a crisis thrusts them into this new role.  But, over the next several years, as the baby boomers age, more and more of us will find ourselves in exactly this position.

I had the opportunity to hear Peter Ostrow, Director of the Brown Adult Day Care Center speak about the emotional aspects of caregiving.  Here are 15 tips for how to succeed as a caregiver:

 Plan Ahead

  • Discuss with parents their needs, plans and wishes including end-of-life care, advance directives, hospice, funeral arrangements
  • Obtain Durable Power of Attorney documents
  • Gather telephone numbers for  doctors, lawyers, financial advisors
  • Find out location of crucial documents: wills, insurance policies, tax returns, investments, bank accounts, medical records etc.

Take Care of Yourself

  • Make a list of doable tasks
  • Identify your own personal and family needs
  • Maintain your health so you have energy to help your parents
  • Set aside time to pursue your own interests and goals
  • Be aware of making promises you can’t keep

Succeed as a Caregiver

  • Move from guilt to responsibility
  • Accept limits…decide what is doable
  • Learn that perfection isn’t possible
  • Transition to a new role with your parents, not a role reversal
  • Join the caregiving community
  • Get help…there’s no need to go it alone

I can’t emphasize enough how important it is to take care of yourself.  It’s the same concept as when the flight attendant on an airplane tells you that in the event of an emergency, put on your own oxygen mask before helping others.  We’re just no good to anyone if we’re running on empty.

Breathing deeply,


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ElderCare Solutions of Michigan is a division of Jewish Family Service of Metropolitan Detroit, a non-sectarian not-for-profit organization that has served the metro Detroit area for more than 80 years.