Elder Law Alabama

Social Security factoid:

The first monthly payment was issued on January 31, 1940 to Ida May Fuller of Ludlow, Vermont. In 1937, 1938 and 1939 she paid a total of $24.75 into the Social Security System. Her first check was for $22.54. After her second check, Fuller already had received more than she contributed over the three-year period. She lived to be 100 and collected a total of $22,888.92.

Medicaid- You think you might qualify?

THE BASIC RULES OF NURSING HOME MEDICAID ELIGIBILITY

For all practical purposes, in the United States the only "insurance" plan for long-term institutional care is Medicaid. Medicare only pays for approximately 7 percent of skilled nursing care in the United States. Private insurance pays for even less. The result is that most people pay out of their own pockets for long term care until they become eligible for Medicaid. While Medicare is an entitlement program, Medicaid is a form of welfare—or at least that's how it began. So to be eligible, you must become "impoverished" under the program's guidelines.

Despite the costs, there are advantages to paying privately for nursing home care. The foremost is that by paying privately an individual is more likely to gain entrance to a better quality facility. The obvious disadvantage is the expense; in Alabama, nursing home fees average $5,000 a month. Without proper planning nursing home residents can lose the bulk of their savings.

For most individuals, the object of long-term care planning is to protect savings (by avoiding paying them to a nursing home) while simultaneously qualifying for nursing home Medicaid benefits. This can be done within the following rules of Medicaid eligibility.

In Alabama, Medicaid is administered by the Alabama Medicaid Agency (the  "Agency" ). However, in order to qualify for federal reimbursement, the state program must comply with applicable federal statutes and regulations. So the following explanation includes both Alabama and federal law as applicable.

THE ASSET RULES

The basic rule of nursing home Medicaid eligibility is that an applicant, whether single or married, may have no more than $2,000 in "countable" assets in his or her name. "Countable" assets generally include all belongings except for (1) personal possessions, such as clothing, furniture, and jewelry, (2) one motor vehicle, (3) the applicant's principal residence, and (4) assets that are considered inaccessible for one reason or another.

The Home

The home will not be considered a countable asset and, therefore, will not be counted against the asset limits for Medicaid eligibility purposes as long as the nursing home resident intends to return home or his or her spouse or other dependent relatives live there. It does not matter if it does not appear likely that the nursing home resident will ever be able to return home; the intent to return home by itself preserves the property's character as the person's principal place of residence and thus as a noncountable resource. As a result, for all practical purposes nursing home residents do not have to sell their homes in order to qualify for Medicaid.

THE TRANSFER PENALTY

The other major rule of Medicaid eligibility is the penalty for transferring assets. If an applicant (or his or her spouse) transfers assets, he or she will be ineligible for Medicaid for a period of time based on the amount of the transfer. The actual number of months of ineligibility is determined by dividing the amount transferred by $ 4,600. For instance, if an applicant made gifts totaling $ 46,000, he or she would be ineligible for Medicaid for 10 months ($ 46,000÷$ 4,600= 10). Another way to look at this is that for every $ 4,600 transferred, an applicant will be ineligible for nursing home Medicaid benefits for one month.

The catch with the transfer penalty is that under the Deficit Reduction Act of 2005, the penalty period does not begin until the person making the transfer (1) moves to a nursing home and (2) spends down his or her countable assets to the Medicaid asset limit. For instance, an individual who transfers assets causing a 10-month penalty period on June 1, 2006, who moves to a nursing home on June 1, 2007, and spends down his other savings by June 1, 2008, will be ineligible for Medicaid coverage until April 1, 2009. This is because the 10-month penalty period for the transfer will not begin until June 1, 2008.

Exceptions to the Transfer Penalty

Transferring assets to certain recipients will not trigger a period of Medicaid ineligibility. These exempt recipients include:

(1) A spouse (or anyone else for the spouse's benefit);

(2) A blind or disabled child;

(3) A trust for the benefit of a blind or disabled child; or

(4) A trust for the benefit of a disabled individual under age 65 (even for the benefit of the applicant under certain circumstances).

Special rules apply with respect to the transfer of a home. In addition to being able to make the transfers without penalty to one's spouse or blind or disabled child, or into trust for other disabled beneficiaries, the applicant may freely transfer his or her home to:

(1) A child under age 21;

(2) A sibling who has lived in the home during the year preceding the applicant's institutionalization and who already holds an equity interest in the home; or

(3) A "caretaker child," who is defined as a child of the applicant who lived in the house for at least two years prior to the applicant's institutionalization and who during that period provided such care that the applicant did not need to move to a nursing home.

A transfer can be cured by the return of the transferred asset in its entirety. And in some instances the applicant for benefits may be eligible for a "hardship" waiver.

LIENS AND ESTATE RECOVERY

The state has the right to recover whatever benefits it paid for the care of the Medicaid recipient from his or her probate estate. Given the rules for Medicaid eligibility, the only property of substantial value that a Medicaid recipient is likely to own at death is his or her home. Under current law, the state may make a claim against the decedent's home only if it is in his or her probate estate. Property that is jointly owned, in a life estate, or in a trust, is not included in the probate estate and thus escapes estate recovery. Congress has recently given the states the right to seek estate recovery against such nonprobate property; so far, Alabama has not acted on this new provision.

In addition, Alabama does not seek recovery against the estates of those decedents who owned long-term care insurance when they entered the nursing home, provided the policy was an individual policy approved by the Division of Insurance and (in contrast with the advice given all other Medicaid applicants) the Medicaid beneficiary states that he or she has no intent to return home. The law also provides exceptions to estate recovery when hardship can be proven and will delay estate recovery if a surviving spouse or other dependent relative is living in the house.

While estate recovery occurs only at death, during life the "Agency" will place a lien on the home of a Medicaid beneficiary living in a nursing home unless certain relatives are living there. These include a spouse, a child under age 21, a blind or disabled child, and a sibling who lived in the house for at least a year before the owner moved to a nursing home. If a lien is placed on the house and the house is sold during the Medicaid beneficiary's life, then the Agency will have a claim against the proceeds of the sale up to the amount it has already paid forthe beneficiary's care. In addition, since the balance of the proceeds will constitute a countable asset, they will render the owner ineligible for Medicaid until such funds are spent down.

TREATMENT OF INCOME

When a nursing home resident becomes eligible for Medicaid, all of his orher income, less certain deductions, must be paid to the nursing home. The deductions include a $30-a-month personal needs allowance, a deduction for any uncovered medical costs (including medical insurance premiums), and, in the case of a married applicant, an allowance he or she must pay to the spouse that continues to live at home.

SPOUSAL PROTECTIONS

Assets

Medicaid law provides for special protections for the spouse of a nursing home resident, known in the law as the "community" spouse. Under the general rule, the spouse of a married applicant is permitted to keep one-half of the couple's combined assets (as of the date of institutionalization) up to $109560 (in 2009). In addition, there is a minimum resource allowance for the community spouse of $25,000 (in 2009).

The determination of the level of the couple's assets is made as of the date of institutionalization of the nursing home spouse. That date is the day on which he or she enters either a hospital or a long-term care facility in which he or she then stays for at least 30 days. It is advantageous for the couple to try to have as much money as possible in their names on that date so that the amount the community spouse is allowed to keep will be as high as possible.

Income

In all circumstances, the income of the community spouse will continue undisturbed; he or she will not have to use his or her income to support the nursing home spouse receiving Medicaid benefits. In some cases, the community spouse is also entitled to share in all or a portion of the monthly income of the nursing home spouse. The Agency determines an income floor for the community spouse, known as the minimum monthly maintenance needs allowance, or MMMNA, which, under a complicated formula, is calculated for each community spouse based on his or her housing costs. (Where the community spouse can show hardship, the Agency may award a larger MMMNA, but only after an appeal to fair hearing.)

Increased Resource Allowance

Those community spouses whose own income is less than their MMMNA have an alternative to receiving the shortfall from the nursing home spouse. Instead, they may petition the Agency for an increase in the standard resource allowance so that these additional funds may be invested in order to generate income to make up the shortfall. Given current low rates of return, this often can permit the community spouse to retain a substantial level of savings. In some instances, even with the award of the higher resource allowance the community spouse will need to draw on the nursing home spouse's income to some extent. Unfortunately, the Agency may not award an increased resource allowance upon application. The intake worker must award the standard allowance described above and the applicant must appeal the determination to a fair hearing.

THE MEDICAID APPLICATION

Applying for Medicaid is cumbersome and tedious. Every fact asserted in the application must be verified by documentation. The application process can drag on for several months as the Agency demands more and more verifications regarding such issues as the amount of assets and dates of transfers. If the applicant does not comply with these requests and deadlines on a timely basis, the Agency will deny the application. In addition, after Medicaid eligibility is achieved, it must be redetermined every year.

Are you a Veteran or married (or widowed from) a Veteran?

WHAT IF 33% OF ALL SENIORS IN THIS COUNTRY could receive up to $1,949 a month in additional income from the government to help cover their elder care costs? THEY CAN!

Under the right circumstances, a little-known federal program will pay additional income to cover long term care costs for at least 1/3 of all US senior households -- that's how many war veterans or their surviving spouses there are in this country. But the provisions of this program are such a well-kept secret that only 4.7% of US seniors are actually receiving the benefit. The great news about this program is the Department of Veterans Affairs will pay you to hire your family, friends or just about anyone to take care of you (Caregiving spouses can't be paid under this program). The program is called "Veterans Pension."

Most people who have heard about it know that it will cover the costs of assisted living and, in some cases, cover nursing home costs as well. But the majority of those receiving long term care in this country are in their homes. Estimates are that approximately 70% to 80% of all long term care is being provided in the home. All of the information available about Pension overlooks the fact that this benefit can also be used to pay for home care.

It also comes as a surprise to most people that the Department of Veterans Affairs will allow veterans' households to include the annual cost of paying any person such as family members, friends or hired help for care when calculating the Pension benefit. This annual cost is deducted from household income and used to calculate a lower "countable income" which in turn enables families to receive this disability income from VA. Even though VA claims the benefit is for low income families, because of the special provision in the regulations -- allowing for deduction for care costs -- households earning between $3,000 to $6,000 a month or more can still qualify for Pension under the right conditions.

This extra income can be a welcome benefit for families struggling to provide eldercare for loved ones at home. Under the right circumstances, this annualized medical expense for the cost of family members, friends or any other person providing care, could create an additional household income of up to $1,056 a month for a single surviving spouse of a veteran, up to $1,644 a month for a single veteran or up to $1,949 a month for a couple.

William G. Nolan is the founder of Nolan Elder Law and Estate Planning, a law office providing a wide range of assistance to the elderly, Veterans, the disabled, and their families. He is a board member of the Jefferson County Council on Aging, a member of the National Academy of Elder Law Attorneys and charter member of the State Bar’s Elder law section. He can be reached at 205/823-8916.

Can the Home be saved if Medicaid/Nursing Home is in the future?

Yes it can. Medicaid has a little-known exception to the transfer penalty imposed on virtually every other transfer prior to nursing home care. It is called the Dependent Child exception and it applies if a child moves in with a person to provide care for them and does so for at least two years prior to Medicaid application.

Careful documentation of facts and circumstances is recommended if transfer to a child is contemplated and if the transfer is to avoid any penalty period on the basis of the care provided--over at least a two

-

year period--to the parent in the home. In developing this documentation, consider including all or most of the following:

[ ] A log or journal prepared by the child/recipient. While such care is given, the child should maintain a log or diary that sets forth specific incidents or events that, but for the child's care, might have resulted in the parent's institutionalization. Such events might include gas burners not being shut off, water left running in the tub, the parent's wandering, or medically dangerous actions. If the person is already institutionalized and such a transfer is contemplated, the child should prepare this log or diary without delay.

[ ] Statements or declarations of other family members and neighbors. Other family members, neighbors, and service providers may have witnessed events and circumstances that reinforce the position of the adult child who will be or has been the transferee of the residence. Such documentation by third parties is inherently reliable and trustworthy.

[ ] Statement by the parent/transferor. Such a statement should be substantive and, ideally, avoid language that is conclusory. While a conclusion that the child's care "kept me out of a nursing home for at least two years" is a good idea, specific examples of such care are preferred.

[ ] Statements by physician and other medical care providers. Physicians, visiting nurses, home health care providers, and other medical professionals may have sufficient knowledge of the circumstances to prepare statements that explain the medical circumstances and condition of the parent/transferor. Such statements are certain to be given great weight.

If any of this applies to you, chances are you should consult a qualified elder law attorney well in advance of need so you don't make an expensive mistake.

From a Professional resource:

Helping Your Older Parents Stay Happy and Healthy

by Robert Stall MD, Geriatrician

If you're fortunate enough to have one or both parents still living, you may have noticed a role reversal taking place in your relationship. Remember the days when Mom shuttled you to the doctor whenever you were sick? Now, it may be you who's driving her to her medical appointments. Perhaps you've become even more involved in managing her healthcare needs – serving as her healthcare proxy, moving her into your home to care for her, or even having to select a nursing home for her to live in.

Whatever the case, it's natural to feel challenged – and, yes, intimidated – in the role you've undertaken. But if you stay positive and proactive, you'll be in a great position to advocate for your parents' optimal care. And, really, what better way is there to say "Thank You" for all they've done for you over the years?

The following six recommendations will help you understand what may be happening to your parents as they age – and what you can do to help.

1. Stay vigilant to sudden changes.

Typically, sudden changes arise from sudden problems. Your elderly father who becomes confused one week but was alert and oriented the week before, or becomes unsteady walking and starts falling, is likely experiencing an acute problem – an infection, medication side effect, or perhaps, a heart attack or stroke.

If you pay attention to your parent's baseline health and behavior, you'll be alert to sudden, and subtle, fluctuations. Being attuned to what's "normal" for your parent is critical in advocating for his care. By informing his physician of these changes, you help ensure that he receives a proper diagnosis and timely treatment – especially important in acute conditions.

2. Investigate the source of gradual decline.

Several years ago, I met an elderly woman living in a nursing home. Her family, assuming she had dementia, had moved her there after she had gradually stopped speaking.

After performing a brief procedure on her, I asked how she was doing. "I'm OK," she replied.

A miracle? Not exactly. I'd removed bullet-sized pieces of wax from her ears. She'd stopped speaking because her ears were too plugged to hear.

A host of conditions can cause gradual decline. Before jumping to the conclusion – as many people do – that Alzheimer's disease is the culprit, recognize that your parent may be experiencing an altogether different problem: a vitamin B12 deficiency, an underactive thyroid, Parkinson's disease or depression, to name a few.

When discussing your parent's decline with her physician, make sure the two of you consider all the possibilities. To prepare for the appointment, make notes detailing how her decline has manifested itself – loss of appetite, a failing short-term memory and so forth – and how long you've noticed these changes. That way, you won't leave anything out. To help you, I've created a free checklist that either you or your parent can complete at seniorselfassessment.com – make sure you print or email the "Test Result Details" at the bottom of the page to analyze your responses and give you advice based on your answers.

3. Know thy parent's medicine cabinet.

Familiarize yourself with the medications your parent takes: what each one is for and how often he takes them. Make sure you notify each doctor your parent visits of all the medicine he takes, including over-the-counter products. Ask what side effects you might observe from each medication and whether it's potentially dangerous if your parent takes them together. You also want to tell the doctor whether your parent drinks alcohol or caffeinated drinks and whether he smokes, as these substances can affect some medications' efficacy and safety. To recognize which medications might cause the symptoms your parent experiences, check out drugscanmakeyousick.com .

4. Discourage ageist attitudes.

Simply put, ageism is prejudice against the elderly. It exists in many forms but can be particularly damaging to an older person's self-esteem when it assumes that all of her woes are age-related. Here are a couple of ways of expressing ageism to an elderly parent:

"What do you expect at your age?"

"You're not getting any younger."

If you're ever tempted to utter something similar, remind yourself that by chalking up everything that ails her to her age, you sell your parent short. If she's depressed, it may have nothing to do with the fact that she's 80 and everything to do with a biological predisposition to depression. And remember that right-knee pain in a 90 year-old can't be just from age if there's no problem with her left knee. (More about Dr. Stall and a more in-depth article on the attitude of society towards medical care for the elderly can be found at http://www.longtermcarelink.net/eldercare/medical_care_issues.htm )

5. Address not just symptoms—but emotions, too.

There is disease and then there is "dis-ease" – that is, a lack of ease, security or well-being. "Dis-ease" can manifest itself as myriad emotions in an elderly person: fear, grief, boredom, embarrassment and sadness among them. The fact is, these emotions can be every bit as debilitating as disease.

Take the case of a parent who's incontinent. Too embarrassed to socialize, she cuts herself off from friends. Without companionship, she becomes lonely. Instead of allowing her to become a hermit, discuss with her doctor how to address the incontinence. Together, you can consider different solutions that will ease her embarrassment and reinvigorate her social life.

6. Strive to maximize your parent's quality of life.

No matter our age, we all want to enjoy life to the fullest and have the capability to do the things we want to. Improving the enjoyment of life and a patient's functional ability are the cardinal goals of geriatric care. But you don't need a medical diploma on your wall to help your parent achieve either of those goals.

Being there to solve a problem or provide company are tremendously worthwhile services you can provide – no expertise required. Remember, as your parent gets older, his quality of life becomes more important to him than how much longer he lives. And he doesn't necessarily need medications or surgery to ensure that he's living the latter part of his life to the fullest.

If he enjoys books but has difficulty reading regular-sized type, check out sight-saving titles at the library. If he's grieving the loss of his best buddy, introduce him to new acquaintances at the senior center. If he's living in a nursing home, bring your kids there to share a meal with him.

Sometimes, it's the small gestures that have the most profound impact. As the child of an elderly parent, you are uniquely positioned to deliver these life-changing gifts.

Dr. Robert Stall is a geriatrician practicing in Tonawanda, New York and a clinical associate professor at the University of Buffalo's School of Medicine and Biomedical Sciences. He serves as medical director and attending physician at Beechwood Homes in Getzville and Blocher Homes in Williamsville. To learn more about senior care issues, visit his website at stallgeriatrics.com or call 716-213-4345. For information on a new program offering balance assessment and fall prevention tips, call 716-213-0772.

Quick Post

I met with a woman today who is in her late 60s and getting remarried after being a divorcee for many years. The man she is marrying is in his 70s and also a divorce'. They each have adult children from their previous marriages. To keep matters clean, they decided to execute a prenuptial agreement. This is an excellent idea at their ages since it is SO easy for one set of children to end up inheriting everything and thereby disinheriting the other set of kids.

If your mom or dad is considering remarrying, ask him or her about a prenup. It isn't about divorce at their age. It is about proper estate planning.

Non-Medical Senior Care- What it is and How we provide it

At Home Instead Senior Care, we know that caring for a senior isn’t always easy.

Every day, all across the country, people juggle the demands of their busy lives. Jobs, children, and dozens of other activities all compete for time. And then mom or dad gets sick or otherwise needs in-home help.

These seniors’ adult children – the ones who typically end up as their caregivers – are referred to as the "sandwich generation," caught between providing for their own young families and assisting their aging parents. They’re already stretched to the limit, and the strain shows no sign of easing. That’s largely because of numbers; by the year 2030, 70 million Americans – 20 percent of the population – will be over the age of 65.

Now, at this point, you might be asking, "What exactly is non-medical care, and how are these services delivered?" That’s a good question, because admittedly, it’s a bit unusual to define a product or service by what it isn’t.

Consider this, though. When many of us think of home care for seniors, we typically think of a home-health nurse giving a patient an insulin shot, or perhaps a pharmacist or similar licensed medical professional assembling a senior’s pillbox for the week.

But that’s not what Home Instead Senior Care does. Instead, the non-medical services we provide are grouped into two basic categories:

* Companionship – These include companionship and conversation; meal preparation; medication reminders (but not administration); plant care; playing games and watching videos; and doing crafts and activities; and,

* Home Helper – For instance, light housekeeping; helping with laundry and ironing; taking out garbage; assisting with pet care; escorting to appointments and events; and even Alzheimer’s care.

Home Instead Senior Care requires that its CAREGivers be the most skilled and trusted in the business. This starts with a careful evaluation and screening process that includes each applicant providing six references. Those selected are insured and bonded. Then, they undergo the best training in the industry: an ongoing, multi-phased program that turns compassionate individuals into extraordinary CAREGivers.

And, what’s more, these non-medical services are provided wherever seniors call home – be it a private residence, senior apartment community or assisted living facility (ALF). Indeed, Home Instead Senior Care frequently can help slow down a client’s progression along the care continuum that typically sees a senior moving from home or apartment to ALF, and ultimately, to a nursing home.

It’s also worth noting that Home Instead Senior Care can be a tremendous help to those who are providing informal care to seniors. Typically, this role is occupied by family members, who, logically enough, are called "family caregivers."

Full-time caregivers, or those heavily involved in the caregiving process, must guard against burnout and stress. In fact, according to a recent Home Instead Senior Care survey, 31% of family caregivers would like assistance, and 25% resent family members who don’t help more.

In addition, the basic stresses of family caregiving can be exacerbated when a caregiver has other responsibilities such as a job; children; a busy social life; some distance to travel to provide care for an aging parent or relative; and so on. Moreover, caregiving can be particularly hard for a spouse, especially when the care recipient requires around-the-clock assistance.

So, it’s not surprising to find that most family caregivers struggle to balance the task of caring for an aging parent or relative with other major life responsibilities. This often means that these caregivers have little time left to care for themselves – which can result in their experiencing high stress levels and resultant health problems. In fact, according to this same survey, 55 percent of family caregivers appear to have average or significant levels of stress.

So, you see that our brand of non-medical care can have significant positive effects on health, safety, and quality life for seniors, and in many cases, their loved ones, as well. For instance, a recent study led by Purdue University researchers indicated that for older adults living on their own, receiving just a few hours of help a day with basic activities of daily living can markedly reduce their likelihood of being admitted to a hospital or nursing home. Now, this is the kind of positive outcome that benefits not only our clients, but also their families and friends.

If you or someone you know can benefit from our non-medical services please call us, Home Instead Senior Care at 822.1915.

Starlet Rosser

Community Service Representative

Home Instead Senior Care

2059 Columbiana Road

Suite 105

Birmingham , AL 35216

Referrals: 205.822.1915

Direct: 205.824.2677

Cell: 205.585.1199

Fax: 205.263.1915

starlet.rosser@homeinstead.com

www.homeinstead.com/bham

www.4070talk.com

Keeping Mom and Dad Safe at Home

Generally, elderly parents want to remain living in their own home. However, remaining in the home becomes a concern when children see their parents slowing down, perhaps even having trouble with handling stairs and doing general daily activities. Yet, with parents' mental and physical health currently not creating problems, there seems to be no imminent need to search out support services or other accommodations for aging parents.

This is now the time to evaluate the home to make it safe and secure for your loved ones -- now and in the near future -- in anticipation of aging disabilities that may occur. Help and support are available. The nation as a whole is more aware of elderly needs and services and products are becoming available at an outstanding pace.

The Bureau of Labor Statistics states,

"Employment of personal and home care aides is projected to grow by 51 percent between 2006 and 2016, which is much faster than the average for all occupations. The expected growth is due, in large part, to the projected rise in the number of elderly people, an age group that often has mounting health problems and that needs some assistance with daily activities." Bureau of labor Statistics-Occupational Outlook Handbook, 2008-09 Edition

This growing need for aides and services also encompasses

* home remodeling services -- making a home more serviceable to the elderly;

* safety alert systems and technology;

* motion sensors to monitor movement;

* telehealth services -- using home-based computer systems for the doctors office or a nurse to monitor vital signs and

* even a pill dispenser that notifies when it is time to take medication.

Where do you begin to make sure your elderly family member is safe and managing well in his or her home?

Visit often and at different times of the day and night. Make note of daily activities that appear challenging and where changes might be made to add safety and convenience. Remove rugs that slide -- causing a fall -- and move furniture with sharp edges. Set the water heater at a lower temperature. This will protect their older sensitive skin from scalds and burns. Be sure smoke detectors and carbon monoxide detectors are in place.

Bathrooms are a hazard area for the elderly. Grab bars by the toilet and shower are a must to help prevent falls. There are easy to install bars at your local hardware store if you want to do the work yourself. Another item that is good to have is a shower stool or chair.

If you are not sure of what needs to be done, consider hiring a professional. There are companies that specialize in home remodeling and accommodation for seniors. Michelle Graham of Accessible Design by Studio G4 says about senior home remodel projects,

"The main thing we incorporate in all of our projects is a careful study of needs and potential needs that may develop throughout a client's lifespan."

Keep in mind what future home adjustments might be needed for your parents to "age in place" in their home.

Home safety or medical alert companies provide GPS-based bracelets or pendants to track the elderly at home who tend to wander. Or the companies may provide alarm devices such as pendants or bracelets which allow the elderly to alert someone if there has been a fall or a sudden health-related attack. In the event an alarm has been triggered, a 24 hour monitoring service will alert the family or medical emergency services or call a neighbor depending on previous instructions. In addition there are companies that will install motion sensors in the home to monitor the elderly on a 24 hour basis.

Don't forget your parents' community as a valuable resource for helping them stay in their home. Take Margaret Muller as an example. At 82 years of age, Margaret lives alone in her small home. She manages very well with the help of her local Senior Center. The Center's "Senior Companion" program sees that Margaret is taken to the store for groceries and other needs and checks in with her often to see how she is doing. Once a day, the Senior Center delivers a hot healthy meal to her door. Having these services and visits gives Margaret the help she needs and peace of mind that she is not alone.

Neighbors, local church groups, senior centers and city centers are some places to look for assistance. Most of the time there is little or no cost for these services.

Your state aging services unit is a valuable community resource. The National Area on Aging website www.aoa.gov states:

"AoA, through the Older Americans Act and other legislation, supports programs that help older adults maintain their independence and dignity in their homes and communities. In addition AoA provides funding for a range of supports to family caregivers."

Some of the programs the site lists are:

"Supportive Services and Senior Centers

Nutrition Services

National Family Caregiver Support Program

Grants for Native Americans

Nursing Home Diversion Grants

Aging & Disability Resource Centers

Evidence-Based Disease Prevention

Long-Term Care Planning

Alzheimer's Disease Grants

Naturally Occurring Retirement Communities"

A few thoughts on hiring home care aides or live-in care givers.

The classifieds are filled with people looking for work as aides to the elderly. Many of these aides are well-qualified, honest people who will do a good job; but, of course, there will be some not so reputable. If you are looking to hire someone, be sure you interview and check references and qualifications. You will be responsible for scheduling that person and doing payroll and taxes as well. Be very sure you hire someone trustworthy, as the elderly seem to trust these helpers more than they should and therefore can easily be taken advantage of.

A professional home care service will eliminate your employment concerns. Professionally-provided aides are usually bonded and service is guaranteed. Home care companies take care of the scheduling and payment of their employees. Home care companies cater to the elderly in their homes by offering a variety of services. The National Care Planning Council lists many of these companies throughout the country on its website www.longtermcarelink.net .

These providers represent a rapidly growing trend to allow people needing help with long term care to remain in their home or in the community instead of going to a care facility. The services offered may include:

* companionship

* grooming and dressing

* recreational activities

* incontinent care

* handyman services

* teeth brushing

* medication reminders

* bathing or showering

* light housekeeping

* meal preparation

* respite for family caregivers

* errands and shopping

* reading email or letters

* overseeing home deliveries

* dealing with vendors

* transportation services

* changing linens

* laundry and ironing

* organizing closets

* care of house plants

* 24-hour emergency response

* family counseling

* phone call checks

* and much more.

Thomas Day, Director of the National Care Planning Council states,

"Care in the home provided by a spouse or a child is the most common form of long-term care in this country. About 73% of all long term care is provided in the home environment typically by family caregivers."

As their caregiver, you can make the difference in the quality of life for your aging parents and if staying in their home is a possibility, you have the resources to make it happen.

Private Duty Home Care for Seniors

Loss of Independence or the Last Step to Maintain Independence?

By John Graham, BrightStar Healthcare

President, 205-868-2996

Having a private duty caregiver come into the home to assist a senior can be a great way to delay or eliminate the need for the eventual move to an assisted living facility or nursing home. This option allows the senior to stay in their homes longer and continue to maintain a more independent lifestyle with personalized help from a caregiver.

Seniors want to stay at home as long as possible. This option provides the opportunity to extend the amount of time someone has at home with family and friends, near their life’s possessions, enjoying hobbies in a familiar and safe environment.

It is important to note the difference between "Home Health" and "Private Duty Home Care". Home Health is a term typically associated with a Medicare benefit following hospitalization in which an agency provides temporary, limited visits in the home during recovery. Private Duty Home Care is a permanent service provided to anyone, anywhere on a private-pay basis, and can be either "Medical and Non-Medical" or only "Non-Medical".

Companies offering "Non-Medical" care include help in companionship, light housekeeping, meal preparation and transportation. Other companies offer more "Medical" care such as assistance with activities of daily living (bathing, dressing, toileting, ambulation, and eating). For seniors who have more advanced care needs, the "Medical" option of having skilled nursing in the home is also available. All levels of care are available to fit your schedule 24/7. Brightstar Healthcare is one of the few Birmingham companies that offers both "Medical and Non-Medical" In Home Care.

Essentially, private duty home care allows seniors to continue to live and age in place in their own home. Delaying or eliminating the need to move into a facility keeps them happier and will save money for future medical or long term care costs. Private duty home care is not the right answer in every situation but it should be a consideration as an option with very positive benefits.

Can Taxes Make Us Happy?

SANTA MONICA, Calif. (MarketWatch) -- Northern Europeans are the happiest people on the planet, according to a new survey.

The Organization for Economic Cooperation and Development says people in Denmark, Finland and the Netherlands are the most content with their lives. The three ranked first, second and third, respectively, in the OECD's rankings of "life satisfaction," or happiness.

There are myriad reasons, of course, for happiness: health, welfare, prosperity, leisure time, strong family, social connections and so on. But there is another common denominator among this group of happy people: taxes.

Northern Europeans pay some of the highest taxes in the world. Danes pay about two-thirds of their income in taxes. Why be so happy about that? It all comes down to what you get in return.

The Encyclopedia of the Nations notes that Denmark was one of the first countries in the world to establish efficient social services with the introduction of relief for the sick, unemployed and aged.

It says social welfare programs include health insurance, health and hospital services, insurance for occupational injuries, unemployment insurance and employment exchange services. There's also old age and disability pensions, rehabilitation and nursing homes, family welfare subsidies, general public welfare and payments for military accidents. Moreover, maternity benefits are payable up to 52 weeks.

Simply, you pay for what you get. Taxes in the U.S. have taken on a pejorative association because, well, we are never really quite sure of what we get in return for paying them, other than the world's biggest military.

Healthcare and other such social services aren't built into our system. That means we have to worry more about paying for things ourselves. Worrying doesn't equate to happiness.

The U.S. ranked 11th on the OECD list

. In addition to the top three, we were beat out by Sweden, Belgium, Canada, Australia, New Zealand, Switzerland and Norway. To be sure, we were ahead of France, Great Britain, Japan and China, among many others. But we can do better.

With the highest gross domestic product in the world, we are the richest country. On a per capita basis, though, we don't even make the top 10. The U.S. ranks 15th in this category, according to the International Monetary Fund.

Denmark -- maybe because they are happy -- ranked fifth. Other, more "satisfied" countries also earn more on an individual income basis. Oh yes, and the average workweek in Scandinavian countries is less than the U.S.'s

We need to take better care of ourselves.

It may not just be taxes, of course, that lead to happiness. There are other factors to consider. But better social services and less worry about having to pay for things such as medical bills, retirement and education do help with the happiness factor.

Yet, we are so dead set against paying more taxes that it's even spawning nationwide protests. Tea party, anyone?

Maybe it's time that we looked at taxes differently. We have to pay them anyway. So they might as well make us happy. If Northern Europe is any benchmark, the more we'd pay the happier we just may be.

Thomas M. Kostigen is the author of "You Are Here: Exposing the Vital Ink Between What We Do and What That Does to Our Planet" www.readyouarehere.com