When you visit a doctor, dentist, hospital, lab, or other health care provider, you are often asked to sign a form stating that you have received the provider’s Privacy Statement. The form will also usually include an Authorization section that gives the provider permission to share your medical information with other health care providers.

Patient privacy has become very important in our society, but its rules can be very frustrating. For example, if your loved one has a medical emergency, you usually won’t be able to get any information about him or her, even if your loved one is your spouse. When you ask, “Why not?,” you’ll hear that you can’t be told because of HIPAA. That’s the federal law that governs patient privacy. In our opinion, HIPAA’s patient protection rules are a good example of the best of intentions gone bad.

HIPAA works very well when it prevents unauthorized people from learning about your private medical information. For example, a drug company cannot get information about any illness you have so they can try to sell you their latest “miracle” cure. And, telemarketers can’t get your personal medical information so they can sell you an herbal concoction that’s guaranteed to cure everything from warts to hair loss to flat feet – and more.

Where HIPAA doesn’t work is that your spouse and other members of your family are automatically excluded from your list of authorized people. Very few Privacy Authorization forms have a space where you can indicate which family members do have your permission to share your medical information. In each case, you need to ask how you can give permission to share your information with the people of your choice.

As just one example of the difficulties caused by HIPAA, we know a doctor in Florida whose husband was hospitalized in California. The hospital would not tell her anything by phone even though he was temporarily unconscious and could not give the hospital permission to talk to his wife.

While a few health care professionals may sometimes bend the rules slightly for family members with the same last name as their patient, you can’t count on it. Married daughters with different last names can face an impossible hurdle.

Is there a solution? YES! In fact, there are two.

First, don’t wait until you are faced with a medical emergency. Every time you visit a doctor, hospital, medical lab, etc., ask them for whatever form you have to sign to give them permission to talk with your spouse and/or other family members about your medical affairs. Important note: Each form you sign applies only to that particular health care provider; if you have several health care providers, you will need to sign a permission form for each one of them.

Second, if you have any of these documents,

• Durable Power of Attorney for Health Care
• Health Care Proxy
• Living Will
• Trust(s)

have it (them) reviewed at the earliest possible date by an attorney who specializes in elder law to be certain the necessary HIPAA language has been included. If it isn’t there when it becomes necessary to utilize the document, doctors and lawyers won’t be able to communicate with each other, and it is very likely that your instructions in those documents will not be followed.

Speak with an attorney who specializes in elder law. Check the yellow pages in your local telephone directory. Or, go to the National Academy of Elder Law Attorneys‘ website and click on the Locate an Elder Law Attorney button in the middle of the page.

Not every picture is of spectacular heavenly objects; some are of equally facinating terrestrial subjects. However, the astronomical pictures include tons of NASA’s best from the Hubble as well as earth-bound telescopes. And, the archives go back to June 16, 1995.

Which retirement planning calculator tells you how much money you’ll really need for retirement? Which retirement calculator contains a fatal financial flaw that affects every senior and could cause you to outlive your income? Or, is every retirement calculator flawed?

Even the best retirement calculator  will ask you to guess the age when you might die – in other words, your life expectancy. (Because so many seniors live past 100, the insurance industry now estimates that our maximum life expectancy is 120 years.)

Often, a retirement calculator for seniors will also ask you to guess the future rate of inflation – without giving you a clue as to what might be reasonable. Or, the retirement calculator will use a built-in financial assumption for inflation that it does not bother to tell you about.

If your financial planning is wrong with either number, you may live like a king – during the first few years of retirement – until you run out of money and have to go on welfare, living the rest of your retirement in poverty. But, if your financial planning is right, you can enjoy a solid, sustainable lifestyle throughout your retirement, with money left over for your heirs.

The future rate of inflation will be … ? ? ?
No one has a crystal ball. So, we have to base our projection on historical data. Since 1950, inflation has averaged 3.9% annually, ranging from a low of -0.5% in 1954 to a high of 13.3% in 1979. (If 1950 is too far back for you, inflation has averaged 4.4% annually since 1960, 4.8% since 1970, and 3.3% since 1982.)

Will you outlive your retirement income?
You can make a huge financial mistake if you use your remaining life expectancy to estimate how long your income should last. By definition, life expectancy is an average for ALL people – half of us will live longer. In other words, life expectancy has only a 50% probability of being correct.

The reality? 11% of today’s 65-year-old men and 19% of today’s 65-year-old women will reach age 95. For every four 65-year-old couples alive today, one person will live to age 95.

When doing your financial planning, you want to be as certain as possible, without overdoing it, that you won’t outlive your retirement income. To accomplish that, we recommend that you base your plans on a 90% probability that your income will last for the rest of your life. Simply select the age at which you plan to retire, or your current age if you’re already retired.

Source: Average life expectancies and anticipated lengths of retirement derived from United States Life Tables, 2000, National Vital Statistics Reports, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Volume 51, Number 3, December 19, 2002.

Are interactions between prescription drugs a problem for your loved one? Two-thirds of seniors take one or more prescription drugs every day; one-fourth take 4 or more. Because they see specialists in addition to their own doctor, seniors are often given new prescription drugs without thoroughly assessing their other medications. Dangerous interactions, side effects and even disastrous consequences can be the result. Professionals estimate that 1 in 4 hospital admissions of seniors are a direct result of medication problems, including prescription drug interactions.

Prescription drug side effects and interactions between medications (this includes prescription drugs, over-the-counter drugs such as aspirin, herbal remedies, nutritional supplements – even daily multi-vitamins) can produce symptoms that include mood changes, loss of energy, difficulty walking, confusion and other memory problems, even incontinence. Unfortunately, these symptoms are often overlooked, ignored, or chalked up to old age. Or, they can lead to incorrect diagnoses of senility or Alzheimer’s disease, or other serious conditions, with totally inappropriate care being prescribed.

Older adults tend to be more sensitive to prescription drugs than younger adults due to slower metabolisms and organ functions. This affects how a drug is absorbed into the bloodstream, how it reacts in the organs, and how quickly it is eliminated. But dosage amounts are usually determined based on the faster metabolic rate of younger people. Consequently, many drugs tend to build up over time to far higher levels than desired for older patients. This can produce allergic reactions or worsen already troublesome side effects. Be especially alert for dizziness, blurred vision, constipation, incontinence, diarrhea, nausea, sleep changes, mood changes or a rash.

Over-medication of the elderly has become a major medical problem. This happens far more frequently than most people realize. (According to Consumer Reports on Health, “Any new health problem in an older person should be considered drug induced until proven otherwise.”)

Remember, loss of sight, hearing loss, confusion, memory loss, depression and incontinence are not normal aspects of aging. Left untreated, your loved one could face a life of despair in a nursing home.

If you suspect that medications may be causing problems for your loved one, consult with a doctor who specializes in geriatric medicine (elder care), not just one with a lot of older patients. To find a geriatric specialist, visit the American Medical Association’s Online Doctor Finder. And, you’ll find an excellent drug interaction checker at myOptumHealth.com.

Because research has begun to identify the causes for Alzheimer’s disease, we can reduce our odds. To learn how, click on causes for Alzheimers or Alzheimers.org.)

“How can that be? I’ve heard that half of all 85 year olds have Alzheimer’s.”

According to the Government Accounting Office (GAO) (Congress calls them when they want accurate information), half of all people 95 years old or older – not 85 – have some form of Alzheimer’s. But, for about 1 in 4 Alzheimer’s patients, it doesn’t interfere with most of their normal activities of daily living. Most of these patients usually need someone’s help only to remind them to take their medicine and do other personal care activities.

While about half of the 95+ year olds are affected, almost everyone dies of other causes before they develop Alzheimer’s. For example, of everyone age 65 or older in 1975, only 4% had developed any form of the disease 20 years later in 1995.

Based on a recent report prepared by the Government Accounting Office and sent to Congress, and the National Vital Statistics Reports, prepared by the National Center for Health Statistics, we estimate the following lifetime risks for the average person from age 50 through 90.

We also suggest that you take a look at the Johns Hopkins Memory Bulletin – Health Alerts. For people with Alzheimer’s and other forms of dementia, and the people caring for them, it can be crucial to get the most current, reliable information on treatment options. Where better for them to turn for cutting-edge advances in Alzheimer’s disease and dementia than Johns Hopkins University School of Medicine, ranked #1 of America’s Best Hospitals for 16 years.

Finally, the National Institues of Health offers 4 very informative videos. Each one is 4 minutes or less.

What is long-term care?
It is primarily personal care for people whose health has declined to the point where they need someone to help them with one or more normal activities of daily living (dressing, bathing, preparing meals, eating, taking medication, toileting, transferring – that’s getting into or out of a bed or chair, etc.). Their need for assistance arises because of frailty (loss of strength and flexibility), or cognitive impairment resulting from Alzheimers disease or senility. Their nursing care plans may also include various types of therapy that can help older people adjust to or overcome many of the limitations that often come with aging.

Why should I be concerned about long-term care?
Older Americans are living longer and healthier than ever before. But, as we grow older, our health will decline. Even as events begin to unfold, and the reality of the situation becomes apparent to others, most of us will still look the other way, hoping things will take care of themselves. Ignoring the inevitable will only leave you unprepared for a crisis – whether it arises suddenly with no warning because of a heart attack or stroke – or creeps up on you until you can no longer fully care for yourself.

Planning for these scenarios won’t make them come true, and refusing to think about them won’t make them go away. But, planning ahead now will make it easier for your loved ones when the crisis finally arrives. And, it will for most of us. In spite of our wish – to die quietly in our sleep before we become frail – more than half of us will eventually need help with our normal activities of daily living.

Where does someone receive long-term care?
It can be provided in many different settings: at home, in adult day care facilities, and in residential care facilities such as nursing homes and assisted living housing facilities that are often part of continuing care retirement communities. However, where it will actually be provided depends on a number of factors, including your financial situation. Aside the matter of finances that we’ll discuss later, most frail elderly people have the following options:

• If your spouse is still living, and you need only moderate assistance, you could probably remain in your own home.
• If you live alone and have friends or family members nearby, and you need only moderate assistance, you could probably remain in your own home, or move in with a relative.
• If you live alone and don’t have friends or family members living nearby, and you need only moderate assistance, you may be able to remain in your own home if you hire a home health agency, or you could move into an assisted living facility.
• If you need extensive assistance and/or require full-time nursing care, a nursing home would probably be most appropriate for you. The good news is that most of us will never reach the point where we need to move into nursing homes. Instead, assisted living facilities are now the preferred choice.

People with moderate to advanced Alzheimers disease or dementia have fewer choices – special Alzheimers/dementia units in assisted living facilities, other facilities that specialize in care for Alzheimers/dementia patients, or nursing homes.

What does it cost?
The cost of long-term care varies widely depending on your nursing care plans, how extensive that care must be, and the setting where it is provided (at home or in a residential facility). Costs also vary widely depending on where you live (your state and whether you live in a rural community or a large city). On average, however, assisted living is less expensive than a comparable amount of care at home or in nursing homes.

In 2008, the average cost of assisted living ranged from $2,033 to $4,802 a month for a one-bedroom unit; the average cost of nursing home care ranged from $3,163 to $9,338 a month for a semi-private room. (These amounts do not include Alaska or Hawaii because of their much higher than average costs.)

For in-home care, the average cost across the country in 2007 for a Home Health Aide was $25/hour, and a homemaker/companion was $18/hour; most agencies require a 4-hour minimum stay per visit. Care in an Adult Day Health Care Center averaged $61/day nationally in 2007.

Who pays for it?
Unfortunately, Medicare pays nothing for long-term care, regardless of where it is provided. Instead, virtually all long-term care expenses must be paid out-of-pocket by residents and/or their families, unless they rely on Medicaid.

What about Medicaid?
Medicaid reduces your options to just one – living in poverty in a Medicaid nursing home with at least one roommate (no privacy); Medicaid rarely pays for care in your home, in a community setting, or in an assisted living facility. If local nursing homes are full, you have to go wherever a bed is available, even if it is hours away from your family and friends.

While no one really knows how this affects people with advanced Alzheimers or senility, it can be devastating for an elderly person who is very frail but still mentally alert. So, if you’re thinking about spending down your assets to qualify for Medicaid, our advice is very simple – don’t do it.

How can I afford to pay for long-term care – preferably in an assisted living facility?
The good news is so many new options are available – the most popular being assisted living – that traditional nursing homes are becoming a thing of the past – if you plan ahead before it’s too late.

Look over your finances with the goal of stretching your available funds to last as long as possible. That may mean you won’t be able to afford to live in the most luxurious facility. But, assisted living is not as expensive as it seems at first. Instead, to an extent that varies from one person to another, it simply involves a shift of expenses from one living arrangement into another.

If your capabilities have declined to the point where you need to move into an assisted living facility, the move is almost always permanent. When your former home is sold, or its lease terminated, most of the expenses you had been paying for it can then be used to help pay your assisted living expenses. And, the money resulting from the sale of your home can be used, for example, to purchase a CD or annuity that pays monthly interest.

Also, since assisted living usually includes all meals, you will no longer have to buy groceries, thereby freeing up even more money. To help you evaluate your financial situation, we’ve included a retirement planning calculator worksheet, Finding the Funds for Assisted Living.

The worksheet assumes that no assets are being spent down; in other words, they will remain intact with only the interest/dividend income they produce being used to supplement your income. But, if you find that you’ll be short of the funds you need for assisted living, some or all of your assets may have to be spent down. That is, the principal value of an asset will have to be converted into a stream of monthly income payments.

What about long term care insurance – can it help?
Yes, in many cases – IF you use the benefits to help pay for your care in a nursing home. But, the assisted living benefit in most long term care insurance policies is a sham – most people will never receive any insurance benefits when they are in an assisted living facility.

How is this possible? Most long term care insurance policies sold today are “tax-qualified” plans. To receive benefits under those policies, you must:

• be unable to perform at least 2 of 6 defined activities of daily living (ADLs) for at least 90 days without the substantial assistance of another person (this fact must be certified in writing by a qualified health care professional), OR
• require substantial supervision due to severe cognitive impairment.

According to the Government Accounting Office (the federal government’s financial watchdog), most assisted living facilities will not admit you if you have severe cognitive impairment. Thus, the assisted living benefit in your long term care insurance policy could be worthless.

Also, most assisted living residents can perform at least 5 and perhaps all 6 of the defined ADLs (eating, toileting, transferring – once again, that’s getting into or out of a bed or chair, etc. – bathing, dressing, and continence). So, even though they need to live in an assisted living facility because, for example, they can no longer safely prepare their own meals or manage their prescription medications – both of which are critical to their continued well-being – they would not qualify for benefits under their tax-qualified long term care insurance policy.

Finally, it doesn’t make any difference if the long term care insurance benefits are provided by the policy we described above, or by benefits paid out under a life insurance or annuity policy. If they provide tax-qualified benefits, they all have to conform with the same very restrictive federal law. And, if an insurance agent tells you otherwise, walk away – he or she is either uninformed or not being honest with you.

Glossary – Elder care has its own unique language. Here’s a glossary of terms related to retirement, estate planning and elder care – all in words you can understand.

The bottom line …
If you want to have the option of assisted living in the future, you must prepare to pay for it out of your own pocket. That takes some advance planning – like you’re doing today – and setting aside sufficient funds for savings and/or investment.

“Across the country, nursing homes are forcing out frail and ill residents. While federal law permits nursing-home evictions in some circumstances, state officials and patient advocates say facilities often go too far, seeking to evict those who are merely inconvenient or too costly. Residents with dementia or demanding families are among the most vulnerable, particularly if … they depend on Medicaid to pay their bills … .”

“Residents may not know they can appeal or may be too ill to do so or fear retribution.”

- How Can I Keep That From Happening to My Parent? -

If your loved one is in an assisted living facility when his or her money runs out, they (and your family) will have two options: (1) you can pay the monthly assisted living bills from your own funds; or (2) your loved one will have to move to a nursing home that accepts Medicaid patients. Medicare never pays, and Medicaid only rarely pays, for assisted living.

On the other hand, if your loved one already lives in a nursing home when he or she runs out of money, the nursing home cannot throw them out – in most cases.

Most (if not all) nursing homes have the legal right to discharge a patient for a variety of non-financial reasons, including being a threat to the safety of other patients and/or the nursing home’s staff. But, that usually doesn’t happen. Instead, depending on the laws of the state where your loved one lives, the nursing home may restrain them chemically (with sedative drugs) or with physical restraints. To learn if and under what conditions your loved one can be discharged or restrained, read the contract you (or they) signed when they was admitted into the nursing home, together with any amendments that you (or they) may have signed later.

The contract will also spell out what assistance, if any, the current nursing home will provide in finding another nursing home if they (his or her current nursing home) discharge them. In most cases, you will receive no help; you’ll have to find a new nursing home on your own. However, most nursing home contracts state that they must give your loved one (or you) at least 30 days notice in writing in advance of the date when they want to discharge them.

Regarding the financial aspects of your loved one’s situation: If someone already lives in a nursing home when they run out of money, the nursing home cannot throw them out – in most cases. However, when he does run out of money, the nursing home may require them (or you on his behalf) to apply for Medicaid to avoid being discharged. (Medicaid is the federal/state program that pays about half of all nursing home expenses.) Once again, this will be spelled out of the contract signed with the nursing home when your loved one was admitted.

(Another reason for applying for Medicaid when their money runs out: It will pay for the medical care they receivs outside the nursing home, including office visits with medical specialists, lab tests and exams, hospital stays, etc. If that type of care is now being paid for by Medicare, their Medicare coverage will stop when they runs out of money if they have not applied for and been accepted by Medicaid.)

In 1999, Congress passed Public Law 106-4, “Nursing Home Resident Protection Amendments of 1999.” In summary, the federal law says:

1. If a private-pay or Medicare patient lives in a nursing home while the nursing home is a Medicaid provider (most are), he or she cannot be discharged for financial reasons, even if the nursing home later withdraws from the Medicaid program, but continues to provide nursing home care to other types of patients. HOWEVER, nothing prevents the nursing home from moving the patient, without his or her permission, into a lower-cost room, including a ward-type room for several patients, or a special Medicaid section of the facility. But, the nursing home cannot transfer the patient to another nursing home without his or her specific permission.
2. A Medicare or private-pay patient who enters a nursing home when the nursing home is not in the Medicaid program can be discharged [evicted] when he or she is no longer able to pay the charges of the facility, even if the patient then qualifies for Medicaid. But for this type of discharge to be allowed, the nursing home must have informed the patient of this discharge [eviction] policy in writing, and received the patient’s written acknowledgment, when the patient began residence in the facility.

As you can see, there are several “ifs” involved, including whether or how soon your loved one (or you on their behalf) should apply for Medicaid. We recommend that you discuss it at your earliest opportunity with an attorney who specializes in elder law. Check the yellow pages in your local telephone directory, or go to the National Academy of Elder Law Attorneys‘ website. On their home page, click the “Locate an Elder Law Attorney” button in the middle of the page.

A final word of advice: While you and other members of your family may be able to help your loved one financially, be very careful about accidentally becoming a co-signer for any of their debts, or signing any other type of document where you agree to become financially responsible for them. If you were to become a co-signer or become financially responsible, you would be legally obligated to use your own money to pay their bills.

If you do have to sign something for your loved one as their Power of Attorney, make sure that you include POA after your name AND that you also sign their name after yours. That isn’t forgery as long as you do have a valid Power of Attorney. And, acting as their Power of Attorney does not obligate you to use your personal funds to pay their expenses.

Other treatable conditions that can produce false symptoms of dementia are:

• The combined effect of weight loss/gain and medications
• Falls and concussions
• Depression
• Alcohol use

In other words, symptoms that some people (including many doctors) often dismiss as a “normal part of aging” – really aren’t. If these symptoms are left untreated, your loved one could face a life of despair in a nursing home. But, if the symptoms are treated early enough, your loved one can very often regain a full and normal life.

If your loved one has one or more of the symptoms described below, take him or her to a doctor as soon as possible. Determining the cause usually involves a team of medical specialists under the guidance of a patient’s primary care doctor. For patients who are 65 or older, the tests and doctor charges are usually covered by Medicare.

The tests may involve some or all of the following, many of which are designed to rule out other possible causes for your loved one’s problems:

• An evaluation of memory and mental skills.
• A physical exam, including a review of family medical history, to detect other medical problems, including possible interactions between prescription drugs, over-the-counter medications, herbal supplements, vitamins and/or mineral supplements. Many foods can also cause unexpected interactions with prescription medications.
• A nutritional evaluation to determine if dietary problems or improper eating habits may be causing the problem.
• Blood tests, including tests for vitamin B12 and folic acid deficiencies, thyroid hormone imbalances, anemia, etc.
• EEG (electroencephalogram).
• A neurological exam to rule out other disorders of the brain such as Parkinson’s disease, hydrocephalus (fluid accumulation in the brain), prior strokes and mini-strokes, brain tumors, etc.
• Brain Scan (CT or MRI).

Important Note: Even if a doctor has a lot of older patients, that doesn’t make the doctor an expert in the special problems of the elderly. If a doctor dismisses your loved one’s memory problems as “just a part of growing older” or decides that he or she has Alzheimer’s or senility without testing for other possible problems like those we’ve described, we recommend that you get a second opinion from another doctor.

– Symptoms of Alzheimer’s disease and Other Dementias –

In addition to memory loss, Alzheimer’s disease and other types of dementia cause a host of problems and challenges for both patients and their families. The most common symptoms are listed below. But, it is important to remember that not everyone with dementia has all of the symptoms.

Recent memory loss. Everyone forgets things for awhile, but remembers them later. But, dementia patients forget things, and never remember them. For example, they might ask the same question repeatedly, forgetting that you already answered it.

Difficulty performing familiar tasks. Patients might cook a meal but forget to serve it.

Problems with language. Dementia patients may forget simple words or use the wrong words, making it hard to understand what they want, causing an outburst of anger directed at the person they’re talking to.

Time and place disorientation. Patients may get lost on their own street, forgetting how they got to a certain place and how to get back home.

Poor judgment. Anyone might get distracted and forget to watch a child closely for a short time. Dementia patients might forget about the child and just leave the house for the day.

Problems with abstract thinking. Anyone might have trouble balancing a checkbook from time to time; dementia patients can forget what numbers are and how to use them.

Misplacing things. Patients may put things in the wrong places – an iron in the freezer or a wristwatch in the sugar bowl. Then they can’t find them later.

Changes in mood. Everyone is moody occasionally, but patients may have fast mood swings, going from calm to tears to anger in just minutes.

Personality changes. Patients may have drastic changes in personality, often becoming irritable, suspicious or fearful.

Loss of initiative. Patients may become passive, not wanting to go places or see other people.

Important Note: Even if your loved one has some of these problems, they may not have Alzheimers.

You might also wish to visit DementiaGuide. It offers helpful information about all forms of dementia, its symptoms and effects. More importantly, you’ll find the convenient online service, SymptomGuide™, a practical tool for recording, tracking and measuring the effects of dementia, including Alzheimer’s disease.

To help determine the cause of your loved one’s problems, the U.S. Administration on Aging has prepared a brief guide, “Questions to Ask the Doctor.” To see it, click here. Fill in the information about your loved one’s medications and take it with you for your loved one’s next doctor’s appointment.

If your loved one has already been diagnosed as having Alzheimer’s disease or another form of dementia, ElderCarelink can help you find the right local eldercare services for him or her. ElderCarelink has established a nationwide network of carefully screened eldercare providers and facilities, and provides their referral service free of charge.

Within minutes of completing their brief Needs Survey, you will receive a detailed email report listing care providers in your area who match your specific requirements. Last year, over 100,000 families utilized this service in their search for high-quality senior care. Click here to use the ElderCarelink service.

– Information Resources –

The information about the common symptoms for Alzheimer’s and other age related dementia was found on the MEDLINEplus Web site. For more information, click on Alzheimers symptoms.

MEDLINEplus is a gold mine of up-to-date, quality health care information assembled by the Library of Medicine at the U.S. National Institutes of Health. To go to MEDLINEplus, click here.

To help you better understand how Alzheimer’s disease progresses, the Alzheimer’s Association has prepared an excellent article, Stages of Alzheimer’s.