Monday, March 31, 2014

Preventing Elder Abuse

Happy Monday!!!  Elder Abuse is a growing concern among the elderly and their families and so I want to address some of the issues we see and what you can do to be aware and protect yourself and your loved ones.

Before I start, just a quick note.  I am available to give presentations to groups on any of the topics you see posted on this blog.  Just give a call to our office to schedule (858-779-9254).

Now, on with the daily topic.  Fortunately I do believe that most older adults receiving in-home services or interacting with the community are safe and well cared for.  Unfortunately the occasional bad apple is the one that is highly publicized.  That said, there are scams and unscrupulous people out there but, with a little caution and common sense, you can navigate away from those people and situations that put you at risk.  Today I'm going to cover 4 primary topics.

1.  PHONE SCAMS:  I'm going to talk about two types of phone scams.  The first is an old scam but one that is continually effective.  An example is that you will get a call from someone claiming either to be a grandchild or the representative of a grandchild.  This grandchild is allegedly in trouble and they need you to wire money to them via Western Union to help get them out of trouble.  They will also say, not to tell mom and dad because they are very embarrassed about the situation.  They will make you swear not to tell anyone and to wire the money ASAP--frequently out of the country.

You may assume that this is always a scam.  If in doubt, call the grandchild's parents and ask if all is well.  Then call the police and give them the details of the scam.

The other type of phone scam is that someone will call alleging to be from a utility company and that they would like to come by and see if they can save you money on your utility bill.  The utility company will never call you unsolicited.  If in doubt, call them and verify.  This type of scam happened to my elderly cousin, and when the perpetrator arrived he pulled out a gun.  This type of scammer may also try to force the elderly adult to the bank with a gun or knife in the back.  If this happens, just let the teller know that the person with you is forcing you.

There are also people that will target older adults on the street and tell a sob story about how they've lost everything and please help.  The kindhearted person can easily get scammed out of a lot of money.  If someone approaches you with this kind of story, direct them to Father Joe's Village or some other charitable organization that can properly assist.  

2.  INTERNET SCAMS:  The internet is a great tool but it also creates a lot of vulnerability.  Email is the biggest culprit.  We see more and more emails coming out saying that you need to reset your password, verify your account information, or open a file to verify your mortgage documentation.  These emails are always virus carriers or tools for identify theft. The simple rule of thumb is to never open an attachment unless it is a pdf from a family member and you were expecting the file to be sent.  And never open a zip file or a link within a file as these are always related to computer viruses and identity theft.

If you have gone to a link and given your account or other personal information, immediately get in touch with a family member who can help you take the steps to protect yourself and secure your accounts.

3.  UNSCRUPULOUS SERVICE PROVIDERS:  Whenever you are contracting with a service provider (such as in-home services, fiduciaries, attorneys, etc), check them out on the Better Business Bureau (BBB) website.  If they are legitimate you will be able to read about them.  Although I personally always look for an accredited business to work with, there are a number of businesses are reliable and have a good rating on the BBB even though they are not accredited.

A client of ours got scammed out of $1,500 by an in-home health subscription service.  The service not legit and when I investigated, I found that the business had a D- BBB rating and the Attorneys General in two states was investigating them.  We were able to work with the client to get their money back but not without a great deal of effort and involvement by the police and Adult Protective Services.

There are also legitimate businesses that will oversell what a client needs because the elderly client may not understand everything that was presented.  One of our clients paid $1,600/person for a burial pre-need package that included many things they didn't want or need.  When you are making an investment in something, have a family member, fiduciary, or other trusted person present to make sure your best interests are always represented.

4.  ISOLATION:  There are many other types of elder abuse including financial abuse, physical abuse, and emotional abuse.  A lot of times these occur because a caregiver is isolating the older adult and the services are not being monitored.  If you are an older adult in this situation, immediately call the police.  There are very stringent laws that will protect you.

If you are the friend of an older adult and you are not able to get access to them due to isolating behaviors of a caregiver, call the police and or Adult Protective Services to report your concern. Don't assume that your friend or loved one is safe unless you are able to look them in the eye and verify that they are well cared for, safe, and their assets are in tact.

And, never give a caregiver power of attorney (POA) or control of bank accounts.  If the older adult is not able to manage their own accounts, have a fiduciary or family member with POA take care of that requirement. 

That's it for now.  Tomorrow is April Fools Day and I need to go and come up with some crazy antics to play on the ladies in the office.  I hope you all have a wonderful start to April.

Many blessings to you always.  Laura Barish

Saturday, March 29, 2014

Guest Blog from Michele Kole of Golden Equity Mortgage about maximizing your resources

Thank you to Michele Kole (Golden Equity Mortgage) for the following guest blog.  Michele brings us information on maximizing our resources...  Please click on the link above to reach Michele.

The #1 Fear in the United States is not the fear of death!
Why are so many of us approaching our retirement years with such trepidation? It’s pretty simple – the # 1 fear in the United States is the “fear of running out of money before we die”!  Recently replacing the “fear of death” – now #2. 
Who are they who fear entering their golden years most? The Baby Boomers who are turning 65 at the rate of 10,000/day and have experienced unprecedented losses in their retirement savings and decline in overall wealth due to the recent economic meltdown.  In fact many Boomers do not plan on retiring anytime soon – determined to acquire enough money to maintain the lifestyle to which they’ve grown accustomed. The especially fear running out of money before they die!  Does this mean we’ll be seeing 90 year old executives, salespeople or office workers?  Or is there another solution?
Although investment portfolios are depleted and replacing lost savings may require working a few more years there is a bright spot.  Recent homeownership statistics report a growing area of untapped wealth.  Home Equity is now increasing in homes across the nation as real estate regains its value and we call that “Housing Wealth.”  In fact “housing wealth” is now considered a resource by many financial planners that can be used to strengthen and preserve the longevity of assets.  Potentially making it possible for Baby Boomers to have the financial resources necessary to retire and enjoy their golden years!
In previous generations “Housing Wealth” was the family inheritance and was sacred. It was expected that parents would leave the home, free of any mortgage, to their children.  People routinely had sufficient assets for their retirement years – not only their home but also savings, a pension from the job they worked for 40 years; and passing those assets plus the family home to the next generation was what everybody did.
Attitudes are rapidly changing as the new wave of retirees cannot afford to follow in those footsteps.  For Baby Boomers who have lost their savings, did not work the same job for 40 years with a pension, and whose only asset may be their home, funding retirement requires a new approach.  Boomers are eyeing their housing wealth - the increased home equity - as their ticket to a decent retirement.
Baby Boomers are increasingly accepting the use of the Home Equity Conversion Mortgage (HECM) to tap into a portion of their housing wealth to fund retirement. Recent changes in the HECM (a federally insured reverse mortgage) have given it legitimacy with financial advisors as an important weapon in their financial arsenal.  When the homeowner has sufficient home equity the HECM is extremely versatile.  Financial advisors often recommend:
·       Using this source of tax free cash rather than draw down their portfolio in a bad market. Thereby preserving the longevity of their assets.
·       To postpone taking social security until a later date when the payout will be greater; and instead temporarily meet their cash flow needs with the HECM line of credit.
·       Using the HECM as a line of credit for funding future health care needs like in-home care, buying  long term care insurance and establishing an emergency fund  
The HECM is only for homeowners over the age of 62, who continue to live in their home as their primary residence.  There are no monthly principle and interest payments required until a repayment event occurs.  The loan balance, which includes the principle, accumulated interest and mortgage insurance, is due when the last borrower on title permanently moves out, or if the homeowner fails to pay the property taxes or hazard insurance or other property charges, or does not maintain the property to FHA standards.
Changes in the HECM occurring October 1, 2013, now preserve more home equity, reduce loan costs for most borrowers, and settle concerns about the payment of property taxes, hazard insurance and other property charges with set asides (similar to an escrow account).  On the horizon there will be financial assessment requirements to make sure the borrower will be able to meet all of their obligations after receiving the HECM. 
The stability and preservation of this valuable financial tool for generations to come is important to everyone who cares about the older generation – especially since in the future most of us will be joining them.  The Home Equity Conversion Mortgage (HECM) allows people to live out retirement in the home of their choice without monthly principle and interest payments,  in many cases providing added cash flow and strengthening the longevity of assets. It can be said that the HECM has helped to remove the fear of running out of money before one dies!
Michel Kole is a Home Equity Conversion Mortgage Specialist with Golden Equity Mortgage, the Reverse Mortgage Division of Land Home Financial Services.  With over 25 years as a lending professional. NMLS/CA-DBO#248631. 
Golden Equity Mortgage
7670 Opportunity Road, Suite 165
San Diego, CA 92111
Office:  858-256-7119
Cell: 858-34-5998

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Visit us at to learn more about AltaGolden and our services.  Have a great day! Laura

Incredible Generosity

Hi all.  I had an amazing experience that I want to share with you.  Today I went to a drum swap meet at Studio West in Rancho Bernardo.  My intention was to find some percussion instruments to use in the Memory Center Day Program. Our clients had requested that we get drums. 

At the first booth I found a tambourine. It was only $5 and, as I was about to pay for it, the seller (Jon Oren) donated it to the AltaGolden Memory Center. The next booth, iTAP Live, had small drums for sale and they ended up donating 5 drums!!! I am overwhelmed by the kindness of these incredible people. Just this last week our clients expressed that they wanted drums and our wonderful community has provided us with these beautiful instruments. I can't thank you enough for your tremendous generosity. I encourage all of you to visit Jon Oren on Facebook and visit iTAP Live ( - Nancy and Olivia). Nancy and Olivia do drumming and tap dancing. Please connect with all of these great folks.

And thank you to our wonderful community for the incredible generosity.  Our Adult Day Program continues to grow and be enhanced by all that you do.  Here is a pic of our beautiful new instruments.

Thursday, March 27, 2014

Follow Us

Just a quick note.  If you like what you've been readying, follow us on this blog as well as on LinkedIn and Twitter.  Our Twitter posts include daily photos from AltaGolden's adult day program as well as other helpful information.

Tomorrow's blog is going to discuss online elder abuse fraud and other scams and how to protect yourself.  TTFN  Laura

Navigating Health Insurance

Hi all.  Today's guest blog is from Rhonda Norton, President of Hughes-Norton Insurance Services Inc., License # 0C18588.  Hopefully this will clarify some of the confusion we face with health coverage enrollment.  To learn more about Rhonda and her company, visit her at
Spring has just begun. Sign-ups for the ACA Covered California will end March 31, 2014. Some say that means we are past the confusion. This is not true. Open enrollment is an option for change for Medicare Advantage plan members and prescription drug card members. Let’s add some more groups of people to this time frame.

During open enrollment the Covered California enrollees can change plans. The “off-exchange” members can change their plans as well. Before this the under 65 year old health insurance member typically changed their plan when the premium went up. They could do this a number of ways but it did not need an open enrollment window.  Now with Guaranteed Issue the rest of the population will have the same open enrollment options and decisions as the Medicare Advantage and Prescription drug card members.

The insurance industry also added another element of work for the health insurance industry. Many small companies moved their company’s open enrollment to the end of 2014. That means small companies that are changing their insurance plans will have the same open enrollment and deadlines as the rest of the population noted above. 

What does this mean for you? Study early, make your decision early and put your paperwork in as soon as you can under the open enrollment rules of October 15 to December 7.   If the change doesn’t matter very much, stay put. Look at your Advantage or PDP paperwork and make sure of the forms needed if you want to stay the same. You may not need to do anything. Be sure of it.

Have a happy summer.

Thanks to Rhonda for the great blog.  I've known Rhonda for a while and she's great people.  She's always my first stop for insurance questions and enrollment.

And for your your in-home services and Adult Day Program needs contact AltaGolden at 858-779-9254 or learn more about us at

Take care and have a wonderful rest of the day.  Laura

Using Hospice - Is it the right thing for you?

Hello on this blustery San Diego Day.  I always love it when the weatherman isn't bored and we have rain or clouds--a great change of pace.

Today's topic is about Hospice.  What does it mean to use hospice; what are the benefits; is it right for me and my family; how will I pay for it?

Hospice is a really wonderful program and, when dealing with end of life-type issues it is a godsend.  Let's start with the money question--how will I pay for it?  The good news is that Medicare will cover hospice costs. 

What does it mean to use hospice Hospice was designed to provide you the services and equipment needed for comfort care through end of like.  This includes visiting nurses, medical equipment, and comfort care medications such as pain meds and oxygen.  The interesting thing about hospice is that a person can go in and out of hospice depending upon their needs.  We had one client who had a severe medical incident, ended up in the hospital, and was transferred into a skilled nursing facility under hospice.  She was not expected to live more than a day or two.  Miraculously she survived but was in a severely compromised medical status for a couple of months.  Hospice supported her throughout this period and managed her pain, provided chaplain support to the client and family members, and coordinated all needs with the skilled nursing facility.  After two months the client had recovered enough and she wanted to receive physical therapy to regain her strength.  She signed herself off of hospice and recovered enough to move out of the SNF and into assisted living.  She has continued to get stronger and is now off her walker and using a cane.

There are other times that a doctor may recommend hospice to a patient even though they are not in imminent danger of passing on.  The reason they do this is that hospice will provide help in the home that is not otherwise covered by Medicare. Hospice will evaluate all of those things needed to keep the patient safe and comfortable and have them provided without the patient having to do anything. If a hospital bed is needed it will be brought in. If the O2 saturation level is low (this can cause agitation) oxygen will be delivered.  Medications will be managed to ensure the best possible level of comfort and pain control.  And, visiting nurses will monitor all care, coordinate with the doctor, and work with your own caregivers to ensure consistent care.

What are the benefits of hospice?  You may use hospice in a hospital, nursing home, your home, or a hospice hospital.  It is a very flexible program that operations 24/7, 365 days a year.  Yes, hospice works on holidays!  You can also sign in and out of hospice as your needs change.  A hospice order must come from a doctor but you use the program as you need it.

We had a client last year that came to us as a referral from a local hospital.  The client was discharged to family but the family was not told that she was dying.  We started working with this client 2 days before Thanksgiving.  The next day our caregiver called the office to express concerns about the client's status.  I went over to evaluate and then called in the family to let them know that if the client wanted to live she needed to be readmitted to the hospital.  She was taken by ambulance and admittance was refused by the hospital because they said there was nothing that could be done for her.  She was sent home again, but this time with an order for hospice.

Unfortunately the hospital coordinator did not think that hospice would respond on a holiday weekend and never forwarded the order.  The next day, Thanksgiving Day, the family called me to say that hospice never showed up.  I immediately called Elizabeth Hospice and gave them the details. They coordinated with the hospital to get a copy of the order and arranged a hospital bed, visiting nurse, and pain management to be in place that day. O2 levels dropped creating increased agitation and oxygen was added, which caused the client to relax and become very peaceful.  She passed away the next day in her own bedroom. Family and friends had time to come in, surround her with love, and say goodbye.

A few years ago my step-dad passed away in a hospice hospital.  He had fallen and incurred very severe injuries that could not be survived.  The hospice hospital provided wonderful support and ensured that he was kept comfortable through his last days.  The hospice social workers and chaplain coordinated with us daily to help us with the stress and grief of the loss.  This type of support is available to the family for a full year after the passing of the loved one and can be a great part of moving through the grief process.

So, what does hospice not provide?  While they do provide visiting nurses, the program does not pay for general caregiver support.  Caregivers can be a very important part of hospice support--especially in the last days when you want to make sure your loved one has all that is needed.  Some people think that they must do a 24-hour bedside vigil through those last days.  The problem is that this is exhausting and it is important to take care of yourself so that you may be there both physically and emotionally for your loved one and the rest of the family.  Caregivers will help you do that and will keep a close eye on status.  The hospice nurses will also keep you apprised of status.

Also, you cannot receive Medicare paid physical therapy if you are on hospice.  Physical therapy implies that you are getting better an gaining strength.  When you are strong enough to 

OK, now for my AltaGolden plug of the day.  AltaGolden has great experience in assisting clients with hospice support.  Planning ahead helps minimize stress when higher levels of support are needed.  You may not need help now but, if you'd like to sign up for our services, you may call us 24-hours a day when you do find you have a need.  Click HERE to visit us online.  You may also follow us on Facebook, Twitter and LinkedIn.

Tuesday, March 25, 2014

6 Reasons to Hire a Fiduciary

Greetings all.  I have a special surprise for you today--a guest blog from Frank Fiorito of  Exclusive Estate Administration.  You can learn more about him and his company at

Here are 6 great reasons why you may want to consider using a fiduciary.  Enjoy!  Laura

Have you ever wondered how you are going to secure your financial future? Are you prepared to protect your assets? Although these questions may seem overwhelming, we have a few crucial reasons why you should hire a fiduciary today!

Reason #1 – Experienced “Neutral Party Professional” = No conflict between beneficiaries.
Everyone has heard at least one story about family members fighting over their parents’ estate assets after they pass away. Sometimes these stories result in bitter lawsuits and ruined sibling relationships. Why spend thousands of dollars on legal fees, when there is a much more cost-effective alternative that may also save your family’s relationships.

When coping with a parent’s declining health or recent passing, emotions are at an all time high. When high emotions are combined with the stress of completing the very demanding and time-consuming estate administration process, it is fairly common to see arguments between siblings.
Before you list your child or a non-licensed fiduciary as your Power of Attorney, ensure that they have the knowledge and experience to do so. Licensed and bonded fiduciaries are a great resource for assisting the elderly with their daily finances and bill paying. Many cases of financial elder abuse can be avoided by hiring a licensed and bonded fiduciary.

It is your responsibility as a parent to ensure that your entire estate plan is precise and clear. Ambiguity in your Will or Trust oftentimes leads to disputes between beneficiaries. Don’t let this happen to your family! Let an experienced fiduciary take care of all your estate management needs, we will keep the beneficiaries updated every step of the way.

Reason #2 – Save TIME.
Being named as the executor in a Will (or trustee in a trust) can be extremely time consuming if you have little or no experience doing it.  Have a knowledgeable fiduciary guide you through the estate process. Our newest service EEA Estate Coach provides you with 1-on-1 accesses to a licensed fiduciary.  Have a question? Call today and speak with a fiduciary to get your estate questions answered at a reasonable price!

Reason #3 – Avoid probate.
Have our fiduciary work with you and an “EEA Preferred” estate-planning attorney to create a strategic estate plan that is customized to help you avoid probate. We have helped many of our clients save thousands of dollars by avoiding probate. We are happy to help you do the same!

Reason #4 – Peace of mind.
In knowing that the distribution of the estate will be done according to the exact wishes stated in the Will. Have the assurance that your estate will be distributed efficiently and properly so that your assets avoid going into probate (where they are taxed) and usually delegated contrary to your intended wishes.

Reason #5 – Save Money.
Many families who attempt to “save money” by designating an inexperienced sibling or beneficiary as the executor, end up losing far more due to assets going into probate and/or not having their assets held in appropriate trusts to avoid heavy estate taxes.

Reason #6 – Experienced Professional Oversight.
Whether it is overlooking a life insurance policy, 401k, investments, forgetting to claim entitled benefits, or failing to file required estate documents on time, there is no need to worry any more!  Our professionals will ensure that everything is accounted for and that you and your family are in the best position to deal with what is important.

EEA is a great company and Frank Fiorito is one of a very short list of fiduciaries I recommend to our clients.

Tomorrow we'll talk about what it means to use hospice and how it can be of benefit.  Have a great rest of the day and be well.  Laura follow me icon
Don't forget to visit us on Facebook, Twitter, and LinkedIn.  Every day I tweet fun things from the Memory Center Adult Day Program.  Today I tweeted a picture of maple pecans we made for Pecan Day along with how to make them.  TTFN  Hugs. Laura

Monday, March 24, 2014

Structure Your in-Home Services to Meet Your Needs and Budget

Hello friends and welcome to today's blog.  The topic of the day is how to structure your caregiving needs in a way that meets both your requirements and your budget.

The first thing to ask yourself is, "do I need a caregiver?"  Many adults need a little help but think that if they ask for that help they will lose control of managing their lives and/or the request for assistance means that they are no longer safe to continue living in their homes.  What we frequently see is that the older adult may not be as strong or as steady on their feet as they used to be so simple tasks like carrying laundry from the dryer, washing and putting away dishes, writing out checks to pay the bills, or driving safely to a doctor appointment may be problematic.  With just a little help, however, safety and stability is restored and maintained.

Driving is a key aspect of independence but, if the individual is recovering from an illness or the eye sight is failing, they may not be safe behind the wheel.  Many adults struggle with the idea of losing their independence if they can't drive and it is a very valid concern.  Many of our clients no longer drive but having a caregiver to take them out or to run errands allows them to stay in their homes and have all needs met.

Now, what is the best way to structure your caregiver support.  Hopefully you have selected an agency that is flexible in the options provided.  Let me give you some examples of what we do for our clients.  One of our newer clients lives in an independent living community.  They first started asking for 2 hours each morning to help with bathing and dressing and 1-2 hours in the evening to help get ready for bed.  After a week they realized they only needed the morning hours and the schedule was adjusted.  We touch base with them periodically to make sure their needs haven't changed.

Another client has us come in every morning from 8-10am and then again from 2-4pm.  We provide a combination of assistance with dressing and meal prep along with socialization, shopping, and helping with activities.

Other clients have us come in one or two days a week for a few hours; and others have us 7 days a week for 8 hours a day.  We even have one client that uses us once a month for two hours.  We also have clients needing 24-hour care, and we do that too.  The key is that each client is different and has different needs.

My recommendation is to come up with a list of the tasks and activities with which you need assistance, what time of day each task occurs, how long each takes, and on what days of the week each is performed.  This will tell you what your schedule needs to look like.  If you can make minor shifts in your ordinary routine to allow activities to be grouped so you can compress the support schedule this will help you save money.

One of our clients was surprised when I signed her up because she only wanted help on Monday and Friday but the agency she had previously been using insisted that their minimum support was 3 days a week.  Remember - you are the boss.  Don't let the agency dictate your needs.  A good agency will help you structure your support plan, not dictate the schedule to their convenience or bottom line.

Also, insist that you have consistency in the caregivers assigned.  You can't get good support if a different caregiver is sent over each day.  Your caregiver is your personal assistant and, like a good personal assistant in an office environment, they need to learn the duties of their job and you are the boss.

Well, that's it for today.  I'm arranging some guest blogs with great information to facilitate your safety and independence.  One of our guests this week will be a Fiduciary--hopefully that will be tomorrow's input.  In the meantime, have a fabulous day and don't forget to visit us online at or give us a call if you have any questions 858-779-9254.

Take care and be well.  Laura

Sunday, March 23, 2014

In-Home Care Services - Finding the right agency for you.

Good morning all and Happy Sunday!  So, is it the last day of the weekend or the first day of the week?  I've never gotten that straight.  Here is an interesting discussion on Wiki about that.

Today's blog topic is about in-home services and how to find the right agency for you.  When I go to speak with a potential new client for AltaGolden  it is not uncommon for the individual to tell me that they don't think they need much help--and that may be true.  What we usually find after speaking with them is that, in truth, some assistance would be beneficial.  The biggest challenge an older adult may experience in trying to work with an agency is the overselling of services.  An agency that is more concerned about the sale rather than what is best for the client may try to get them to buy more than what is wanted or needed.  Some agencies have daily and/or weekly minimums that force the client into something they don't want and drives up sales.  I've spoken with some agencies that have a 4 hour per day and 12 hour per week minimum required to use their services.  Many clients, however, don't want or need this much help.

So, what are the first steps in finding an agency.  A google search is always a good place to start to find out who is in your area.  Once you find the agencies you want to consider, check them out on the Better Business Bureau site.  The BBB will allow you to look at all of the information about the agency, how long they've been in business, have there been complaints, and are they accredited.  Click here to see AltaGolden's listing as an example.  When I am looking for any business to work with I go to the BBB and I am likely to pick an accredited business over one that is not accredited. I was recently furniture shopping and I looked up the store I visited on the BBB site.  They had a D rating and, needless to say, I will not be buying from them.

Unfortunately I have seen several agencies claim to be "accredited", implying BBB accreditation, but they were not--so always check them out.  There are a lot of great agencies out there but there are some disreputable ones as well.  There are also some scam agencies that claim to offer subscriptions but all they really do is take your money and give nothing in return.

Click here to go to our elder abuse prevention page and read about a real life example a client of ours experienced with a "subscription".

After you find an agency you feel comfortable working with, call them up and ask about their terms of service.  Here are the questions I would ask:
  • Is there a registration or a cancellation fee?
  • What is the cancellation policy?
  • What are the service minimums?
  • What are the hourly rates?
  • Are there discounts to the rates depending on the number of hours of support?
  • Will my caregiver speak my language? (whether you speak English, Spanish, or Tagalog, you want to know you can effectively communicate your desires)
  • Will I have the same caregiver each time? (employment law does come into play but you want to avoid the caregiver shuffle--a different caregiver each day)
  • How do you manage care planning?
  • Do you take long term care insurance? (if you have this type of insurance)
  • Are you insured, bonded, and accredited by the BBB?
You also want to make sure the agency is giving you a caregiver that is a good personality fit and has the skills, experience, and training/certifications appropriate to your needs.  Someone who is bedridden is going to need a CNA; while someone who needs help with shopping, meal prep, and light housekeeping really just needs a great companion.  You also want to make sure that your caregiver has had the training needed to keep you safe with your ambulation.

Regarding the "caregiver shuffle", consistency of support is important.  We have a client that recently switched to us because the other agency was overselling services and sending in a different caregiver each day. Effective support can only be given if the caregiver knows and understands the client; and this can't happen if a different caregiver is sent in each day.

Let me know if you have questions (you may post them here or call me at work); and don't forget to visit us at AltaGolden (either online or come on into the office).

Tomorrow we'll talk about structuring your in-home services to best meet your needs and budget.  Stay tuned later in the week for discussions on Hospice, Assisted Living, and supporting a loved one with dementia.

Have a great Sunday and a wonderful start to the week!  Be well.  Laura

Saturday, March 22, 2014

Contingencies Part 2 - Picking a SNF

Good morning and welcome. Laura here to continue yesterday's blog on contingency planning. I discussed how a fiduciary can benefit but not many people do advance planing in the event they need skilled nursing or caregiver services. Today we'll discuss what to look for in a skilled nursing facility (SNF).

You may ask, "Why should I worry about finding a SNF now?  I will probably never need one."

And my hope is that you are right--that you will never need to be in a SNF. But, in case you do need that service, what are some of the reasons that you might suddenly find yourself in a SNF?
  • You have a hip or knee replacement and need recovery and rehab support. 
  • You have surgery and need a higher level of support for a few days or more post-op.
  • You develop a urinary tract infection (UTI), become very weak, and are not steady enough at home until you recover and get your strength back.
  • You have been experiencing a lot of falls and, at least for now, are not safe living at home until you have physical therapy and get stronger. 
  • You have fallen and broken a hip or shoulder and need 24-hour care until you recover.
These are just a few examples but all are realistic.  Some of the issues that cause an admittance to the hospital or SNF are avoidable with a little vigilance and perhaps caregiver support if the older adult is in a weakened state.  The priority is to do whatever is needed to prevent hospitalizations and falls. This frequently involves family members monitoring their loved one's status and calling the doc or getting a caregiver in place as a preventive measure.  (Future blogs will include guest inputs from the medical community).

When admittance to a SNF becomes necessary it is good to have that advance planing in place. So, how do you select the best SNF for you.  There are many options so how do you choose?  The first thing I recommend is to create a list of what is important to you.  I gave a presentation this past Friday to a group of women from the AAUW and we were discussing some of the local facilities. For one of facilities I mentioned that the services were great but the food was not.  One of the women immediately chimed in that this facility would therefore not be an option for her. While everyone laughed at the comment, it was an important criteria to consider. Here are some of the items I think are important:
  • Food! Yes, I agree that quality of food is important.  You need to eat to regain strength and you want the quality of food to be healthy as well as tasty. 
  • Physical therapy department.  What is the PT department like, do they have adequate equipment and trained staff, what is their PT schedule? Do they have staff that will take you for extra walks outside of PT visits?
  • Response times.  What is their response time policy vs their actual documented response times? When you are ringing the buzzer for bathroom assistance you want to know they will respond within 3-5 minutes. As we al know, when nature calls she isn't always patient!
  • Smells. What does a facility smell like?  Does it smell fresh and clean or is there a smell of urine, chemicals, or mustiness?
  • People parking. When you walk down the halls, are people parked in wheelchairs in the hallway or are they engaged in activities?  An activities program isn't offered at all facilities but I feel it is important to engage someone socially and cognitively throughout recovery. 
  • Animal therapy. Is there an animal therapy program or 'Love on a Leash' visits?
  • Attractiveness and cleanliness. What does the facility look like?  Is it a place you don't mind being in?  No one wants to be in a SNF but, when it is a necessity, it should be a facility that you at least consider tolerable.
So, where do you start?  My recommendation is it start on the Medicare website. You can do a search of all SNFs in your area and see the ratings based on various criteria such as PT, quality of service, and quality of the facility. A good facility can make all thee difference.

A quick example and I'll close out for the day. A few years ago we had a client on MEDICAL come to us because she needed help writing checks to pay her bills and going shopping.  While she had her own apartment, she had been living for the prior 18 months in a SNF and she wanted to go home; but she had not been receiving any PT or OT at the facility that would allow her to get stronger and leave. I took her to visit a few other local facilities and she chose a nice quality facility with a good PT program. Within a few months she was able to go home and lived in her apartment until she passed.  She was 87 when I met her and she lived into her 90s.

That's it for today.  A bit of a lengthy discussion but hopefully valuable. Tomorrow I'll discuss in-home caregiver services, how to structure what you need, and, of course, brag about AltaGolden (that is, after all, my job!). 

Ta Ta for now (TTFN). Visit me at or call any time for assistance at 858-779-9254.  Have a wonderful, joyous day and be well!

Friday, March 21, 2014

Planning for contingencies - The value of a fiduciary

Good morning all. This is my first foray into blogging so let me start with introducing myself. My name is Laura Barish I work with a wonderful company called AltaGolden.  AltaGolden works with older adults to help them stay independent in their own homes – wherever that may be. We love what we do and we do think that we do it very well. We also have an Adult Day Program that works with people with any form of dementia. The day program is in our facility in Rancho Bernardo. What sets this apart from other programs is the activities we do to help people be as engaged as possible as long as possible.

But enough of that for the moment, let's get on to the topic of the day. I want to talk with you about what you can do to plan in advance when something unexpected happens. There are many aspects to the subject including everything from financial well-being to making sure your physical needs are met. From a basic standpoint, two of the primary issues are financial management and physical management. Let's first talk about financial management. If you are suddenly and unexpectedly unable to manage your bills and finances, what do you have in place to make sure that your needs will be managed appropriately?

If you don't have these plans in place and you haven't yet had this discussion with family, you may want to consider using a fiduciary. A licensed fiduciary will act as your agent to make sure that all of your needs and desires are met in the manner of the agreement that you have made with him or her. This can range from simple bill payment to making sure you are in a good hospital or skilled nursing facility; or, if you are at home, ensuring great caregiver services.

Even tho you may not need anything now, just a little bit of advanced planning can make all the difference in eliminating stress and ensuring that your desires are met.

If your family is your backup plan, have that discussion now. Don't wait until crisis mode to get plans in place. This will add stress to all involved and may result in you not having the level of services you want, need, and deserve.

Tomorrow I'll add my two cents on what to look for in a skilled nursing facility.  I would also like to invite you to post your comments and questions.

Come visit us at or give us at call at 858-779-9254.

Have a wonderful, healthy, and joyous day!  Laura