A Continuing Care Retirement Community

CCRCs provide a combination of living arrangements and services, typically all on one campus and can include: Independent living cottages or apartments; Supported
or assisted living apartments; In-home support services; Specialized dementia care; Rehabilitative and/or long-term nursing care; Hospice care.

Because CCRCs offer many services within the same campus, a resident can receive the level of support he or she needs while remaining in a familiar community and near friends and loved ones. Typically, the resident moves to the CCRC while still fairly independent, and the expectation is that he or she will transition to other levels of care when additional support services are needed.

Most CCRCs require payment of a one- time fee at the time of move-in; typically called an entrance fee. Entrance fees are often partially or fully refundable. Additionally, CCRCs may charge a monthly fee for services, such as maintenance and grounds keeping, transportation, and wellness, recreational and social activities.

Primary Contract Types: 
Type A (Extensive) Agreement: Includes housing, residential services, amenities and unlimited, specific health-related services with little or no substantial increase in monthly payments, except to cover normal operating costs and inflation adjustments.

Type B (Modified) Agreement: Includes housing, residential services,
and amenities and a specific amount of healthcare with no substantial increase in monthly payments, except to cover normal operating costs and inflation adjustments. After the specified amount of healthcare is used, persons served pay either a discounted rate or the full daily rates for required healthcare services.

Type C (Fee-for-Service) Agreement: Includes housing, residential services, and amenities for the fees stated in the resident agreement. Access to healthcare services
is guaranteed, but it may be required at established fee-for-service rates.

Accreditation by the CARF-CCAC (Commission on Accreditation of Rehabilitation Facilities, Continuing Care Accreditation Commission) assures that a CCRC meets or exceeds certain standards of operational excellence. The CCAC is the only accrediting body for continuing care retirement facilities. Participation
in the accreditation process is voluntary, although facilities in 38 states are also subject to certain state and federal health care regulations.

For more information about CCRCs, please see the “Consumer Guide to Understanding Financial Performance and Reporting in Continuing Care Retirement Communities,” or the brochure, “How to Choose Services for You and Your Loved Ones.” Both are available in the Resources section of www.carf.org.

Article provided by
Whitney Olsen,
Mennonite Village
(541) 704-4247

Checklist For Selecting A Care Community

Obtain a list of facilities in your desired location; many are included in this guide. Call the facilities you are interested in first; be prepared to briefly describe the care requirements of the person in need of placement, including such challenging behaviors as wandering, aggressiveness or specific health concerns.

• Read the most recent state survey regarding the facility; this report provides results from the annual licensing inspection conducted by the state’s Department of Health.

• Make an appointment to visit the facility. If you are interested in it, make a second unannounced visit, preferably on a weekend or evening.

• During your appointment ask questions concerning services, costs and special needs you might have.

• Ask to tour the home. Is the environment homelike and pleasing to you?

• Observe the interaction between residents and staff. Does staff respond quickly to calls for assistance?

• Are staff members wearing identification badges?

• Talk with residents and visitors. Is the setting conveniently located to encourage family visits and involvement in care?

Some nursing homes offer additional services, such as outpatient rehabilitation services; temporary, short-term recovery assistance; respite care; assisted living; specialized care units; and hospice services. When considering your options, keep in mind that the most important factors in making a decision are; location, services available and quality of care.

Article provided by
The Case Management Department, Salem Hospital
www.salemhealth.org
503-561-5200

Veterans: Are You Getting What You Deserve?

Question: My dad is in a nursing home and needs help paying for care but he has too much money to get onto Medicaid. He is retired from the military, and I heard that the VA may be able to offer him some help. Is this true?

Answer: Yes. The Department of Veterans Affairs has maintained a Pension program for many years to help certain categories of veterans with special needs. Although not everyone is eligible, these Pension benefits can be of significant value and, your dad may be eligible.

One such benefit, “Aid and Attendance” is available to a veteran or widow(er) of a veteran, providing that the veteran served at least 90 days of active military service (at least one day being during wartime) and was not dishonorably discharged.

In addition to the service requirement, the person applying for benefits (“the Claimant”) must meet one of the following conditions: (1) Claimant is blind; (2) Claimant is living in a nursing home;
OR (3) Claimant is unable to: (a) dress/ undress, take care of personal hygiene, or toileting; OR (c) Claimant’s mental capacity declines to the level of endangering the Claimant if unaided.

When a Claimant fits those standards, the VA goes on to examine the Claimant’s finances. The Claimant’s countable family income, less annual medical expenses, must be below a yearly limit set by law. The Claimant’s savings and other assets are also considered. Unlike Medicaid, which sets a strict limit on “countable resources” at $2000, the Aid and Attendance benefit may be granted even if the veteran has money in the bank. A rule of thumb, the Claimant should have no more than $80,000 in savings to be accepted into the Aid & Attendance program.

Applying for VA benefits is often complicated and may take some time. Although you can apply for benefits on your own, you are better off seeking assistance from an attorney who has been accredited by the VA. An accredited VA attorney, like the attorneys at McGinty & Belcher, can evaluate your income and assets, and potential conflicts with Medicaid and provide information on the best strategies to maximize a Pension award.

Article provided by
McGinty & Belcher
503-371-9636

When news of the attack on Pearl Harbor was broadcast on radio Sunday, some of the first fears for Oregonians were for the Willamette University football team and fans in Honolulu. They had traveled to Hawaii for a series of post season games known as the Shrine Bowl against the University of Hawaii and San Jose State. The first game was played Dec. 6th before a crowd of 24,000. Although the Bearcats had suffered a 20-6 defeat, many of the Oregonians were looking forward to several days of post-game festivities.

The Willamette team and fans from Salem were waiting outside the Moana Hotel for a bus tour to take them on a sightseeing tour of the island and a picnic. They were planning to see Pearl Harbor. As black oily smoke filled the air the team and their supporters realized they were witnesses to a momentous event.

In the aftermath of the devastating attack the football team was enlisted by the Army to fend off a possible Japanese invasion by water. Their first set of orders was to string barbed wire on Waikiki beach at low tide. The players were issued bolt-action Springfield M1903 rifles from World War I and given some brief training. They were told to be prepared to defend the beach. Shortly thereafter they were assigned to Punahou High School in the hills above Honolulu. Authorities feared that water towers and storage tanks nearby might become targets of sabotage. The players moved into the dormitories and class rooms and went on sentry rotation.

Uppermost in everyone’s mind was how and when they would get home. They finally left Hawaii on December 19th aboard the SS President Coolidge. A luxury ocean liner, the Coolidge had arrived in Hawaii with evacuees from the Philippines. Now it was commandeered to transport gravely wounded servicemen. Willamette coach, Roy “Spec” Keene and Douglas McKay persuaded the captain to take the team and their followers back to the mainland in exchange for assisting with the wounded. There were approximately 1,200 people on board the ship that was designed to carry 800. The normal four day trip took seven days because of the zigzagging route required to avoid Japanese submarines. On Christmas Day the Willamette football party returned safely to San Francisco. It was the last time they would all be together.

Virtually everyone from that year’s football team enlisted in the service. All but one, Bill Reder, survived the war. They went on to careers as teachers, business people, and lawyers. One became a federal judge. The team was inducted into Willamette’s Athletic Hall of Fame. The honor acknowledges the team’s football exploits–an 8-2 record with six shutouts, the second leading scoring team in the country–and its extra service in a time of chaos and disbelief.

Article Provided by: Oregon Paralyzed Veterans

Checklist for Selecting a Care Community

Where to start: Obtain a list of facilities in your desired location; many are included in the Retirement Connection Guide. Call the facilities you are interested in first; don’t wear yourself out visiting facilities that do not have openings. Be prepared to briefly describe the care requirements of the person in need of placement, including such challenging behaviors as wandering, aggressiveness or specific health concerns.

• Make an appointment to visit the facility. If you are interested in it, make a second unannounced visit, preferably on a weekend or evening.
• Read the most recent state survey regarding the facility; this report provides results from the annual licensing inspection conducted by the state’s Department of Health.
• If the prospective resident will be paying personally, ask to see an itemized list of the daily charges and clarify the billing procedures for additional items. For example, many facilities include personal care items.
• It is important to know you have the right to purchase medications at the pharmacy of your choice, but you are then responsible for either delivering the medication yourself or ensuring that the pharmacy will deliver the medications in a timely manner.
• Ask about the facility’s billing procedures and get the name and telephone number of the staff person to speak with if you have questions.
• Ask how money for the resident’s personal needs is handled.
• Medicare will pay for a limited amount of time in a nursing home depending on the rehabilitative needs of the resident. If the resident continues to stay in a facility and requires Medicaid assistance, it is important to choose a facility that accepts both forms of payment (Medicare and Medicaid) and can ensure a Medicaid bed will be available; otherwise the resident will be required to move to another facility that accepts Medicaid.
• Find out the name of the management company that operates the facility. Ask what other facilities this company operates in the region. You may want to review the health department surveys for these facilities to see if the company consistently provides good care.
• Meet the administrator, and supporting management staff. Ask how long they have worked at the facility. Be alert to frequent administrative changes. These are the people who will ultimately be responsible for correcting any concerns or complaints that you or the resident may have.
• Ask how complaints are addressed and how problems are resolved. Find out which staff person has been designated as the person to handle grievances.
• Is the facility clean? Are odors pervasive throughout the facility or in isolated areas? Are the odors temporary?
• Look at the residents’ rooms and bathrooms (with resident permission). Are they clean, comfortable and home-like?
• Is the bathroom clean and organized? Are the toiletries and personal items stored appropriately? Are towels and washcloths available?
• Do residents have easy access to a private telephone in a quiet place? Is the telephone equipped with a hearing-enhancement device?
• Can you easily find posted instructions on how to contact the ombudsman, the county health department, the adult protection division of the county department of social services and the county Medicaid office?
• Are pleasant areas available for private dining and family visits?
• Are the residents clean, well groomed and positioned comfortably?
• Are the residents up and active during the day? Are they engaged in activities or interacting with people in common areas?
• Visit with the residents. Ask them how they like the food, if they feel well cared for and if they have enough to do. Tell them that you are thinking about bringing someone to live there. Ask them if they like living there and would they recommend it to others.
• Look in the dining area during a meal. Are residents who need help being assisted in eating? Are adaptive devices, such as special utensils and dishes, used when appropriate?
• Are people served their meals promptly?
• Do the menus posted reflect what the residents are eating?
• Observe the interaction between the residents and the staff. How do staff members address the residents? It is usually not appropriate to address adults as “honey” or “sweetie.” Some residents like to be called by their first name; others prefer the formality of Mr. or Mrs.
• Do staff members respect the resident’s privacy? Do they knock at the resident’s door and wait for a response before entering? Are privacy curtains pulled and/or doors closed when personal care is provided?
• Are call lights within residents’ reach and are they answered within a few minutes?
• Are staff members wearing identification badges?
• Ask about staff training. What training requirements does the residence have? How much training do they receive? Who does the training?
• Do staff members acknowledge your presence? If you are visiting without a tour guide, someone should tactfully inquire about your presence at the facility.
• Do staff members look calm, well organized and attentive to the residents?

When you are considering a care community for yourself or a loved one, you want to find one that is a bright, comfortable, inviting place to live. You want a home that provides a variety of stimulating activities and has a history of providing good care to residents. It should be a place where family members are invited to participate in activities and meals. Some nursing homes offer additional services, such as outpatient rehabilitation services; temporary, short-term recovery assistance; respite care; assisted living; specialized care units; and hospice services.  These criteria will help you choose a nursing home that will meet your needs.

Top 10 Estate Planning Issues

As an Elder Law attorney, I am often asked “What is the biggest estate planning problem?”.  My answer, “Failing to start”.  The following is a list of issues to think about when preparing your estate plans.  Almost all issues can be taken care of with a little thoughtful consideration, but the same issue can also create major problems if not dealt with in advance.

1. Probate – Court supervised administration of your estate is never a pleasant journey. Despite the helpful court personnel, there are still filing fees, lack of privacy issues, and long waiting periods before distribution. And that’s if all goes well.

2. Asset Protection – Many people do not take advantage of the asset protection opportunities that can be achieved with relatively basic estate planning. Creating trusts for spouses and children with the right provisions means your assets can be protected from claims of creditors and predators for years to come. While we hope that our children would not fall victim to divorce, this is one asset protection conversation that must be planned for.

3. Tax Planning – This is never an easy issue as the various tax systems don’t always line up with each other. Consider the tension between gift planning, (giving away some of your assets) to shelter appreciation by moving them outside of your estate, and loss of basis for capital gains purposes. While not easy, this issue can really cost you money if not properly handled.

4. Family Disharmony – Estate planning is a way for you to say you care about your loved ones. But selection of your personal representative or trustee can also stir the pot and create issue issues for those not chosen. Sometimes it is best to name a non-family member to be in charge of your estate. Giving thought to how to help resolve these conflicts or at least, not make them worse, can help to avoid family conflicts.

5. Attorney’s Fees – The best way to control legal fees is to incur them while you are alive and able to oversee the planning process. Failure to plan is likely to increase the total amount of fees paid. Especially if family members decide that fighting is the best way to resolve disputes after you’re gone.

6. Successor Fiduciaries – Make sure that you name back up personal representatives and trustees, or provide the beneficiaries with a way to fill a vacant role, so that a court proceeding is not required.

7. Contingent Beneficiaries – Make plans for your estate in the event that your immediate family members die and are unable to inherit your estate. Pick a charity or a group of more distant relatives or close friends.

8. Updating Beneficiary Designations – Life insurance and retirement accounts are controlled by the beneficiary designations you make when you purchase the life insurance or open a retirement account. They are most notably the small boxes you checked at the end of your application. Make sure these stay updated. We have seen more than once a policy which still names a client’s first wife or husband many years after a divorce and remarriage.

9. Joint Accounts – Often used as a convenience during life and a will substitute at death. Because these accounts go to the survivor, make sure that this lines up with your overall plan of passing assets to your heirs. Leaving money in a joint account for one child with the idea that they will spread the wealth around after your death can be a recipe for disaster.

10. Failing to start – Procrastination is probably the leading cause of problems in estate planning. Once a disability or death occurs, planning becomes very difficult and lots more expensive, if possible at all.

For more information or answers to your estate planning and elder law needs, please call Kathy Belcher at 503-371-9636, or visit our website.

Article Provided by
McGinty & Belcher Attorneys
Address: 694 High St NE – Salem, OR 97309
Toll Free: (800) 542-4320

The Importance of Planning: Legally and Financially

The term “estate planning”, generally means making decisions now for times in the future when you may not be able to make decisions for yourself. Proper estate planning addresses both health care and financial decisions, during your lifetime and after your death. Having an estate plan in place can make a significant difference in how decisions are made for you in the future.

We all enjoy the right to make our own health care choices. However, it is important to have an Advance Directive for Health Care in place that would allow your designee to make decisions for you if you aren’t able to make them for yourself. You can also decide now whether you choose to have life support and tube feeding later on. It is up to you to decide what decisions will be made.

A Durable Power of Attorney is a document used to appoint someone to make financial decisions for you if you are unable to manage your affairs in the future. You may give your Agent broad powers or limited powers as you choose. You can modify the Power of Attorney at any time in the future, as long as you understand the changes you are making.

After you pass away, your Will specifies who will be your Personal Representative, and what will be done with your assets. After you pass away, the Probate Court empowers the Personal Representative to act, and oversees the administration of your estate. The Court ensures that your choices are carried out and that the beneficiaries of your estate are treated fairly.

A Revocable Living Trust is an alternative to a Will. A Trust creates a legal entity. Your assets are transferred into the trust, and are managed according to your instructions. In your trust, you can designate who will manage your assets, how they are managed, and who will receive them after you pass away. There is generally no court involvement with a trust.

There are many different combinations of estate planning tools that your attorney may recommend for your situation. Making these plans ahead of time may also help your loved ones with issues such as paying for long term care, later on. Proper estate planning ensures that your wishes will be carried out later on, when you may not be able to speak on your own behalf.

Article provided by:
Douglas, Conroyd, and Gibb
503-364-7000

Can You Protect Yourself Against Memory Loss

Besides age, there are eight factors that affect memory ability in older adulthood

1. Genetics (50%)
2. Cognitive stimulation
3. Other health conditions
4. Stress
5. Good sleep
6. Social support and engagement
7. Nutrition
8. Physical exercise

No one has control over genetics, but there is hope because we do have control over the other 7 factors listed above.

Brain exercise is essential in preserving memory. Research by Lachman H.M. (2010) found that older adults with more education are less likely to have memory problems. “Among individuals with low education, those who engaged in reading, writing, attending lectures, doing word games or puzzles once a week or more had memory scores similar to people with more education,” said Lachman.
Most people know about the physical benefits of staying healthy. Good health also affects memory ability. Depression, urinary tract infection, upper respiratory infections and even constipation are just a few things that can affect memory.

Stress inhibits the brain’s ability to learn new things and remember old ones, which is why when we stop thinking and relax, we suddenly remember a name or piece of trivia we were searching for.
Your mind is surprisingly busy while you snooze. During sleep you can strengthen memories or “practice” skills learned while you were awake (it’s a process called consolidation).
As people age, social connections often diminish, loss of social contact through work, death of friends, ill health or loss of transportation can all contribute to this. It is therefore doubly important to make the extra effort to seek out social stimulation.

Research has found a positive correlation between Omega-3 fatty acids levels (e.g., DHA) and cognitive functioning in older adults. Also, over time, our brain cells experience wear and tear from various oxidants known as free radicals (as well as cell division). Our bodies use antioxidants to combat the effects of free radicals. It is therefore important to eat foods high in antioxidants.
University of Illinois at Urbana-Champaign scanned the brains of 55 subjects, ages 55- 79, and measured their maximal oxygen uptake (a gauge of aerobic fitness) during walking and treadmill tests. Participants ranged from sedentary to those in peak-performance fitness. The results published in the February 2003 Journal of Gerontology showed that physically fit subjects had less age-related brain-tissue shrinkage than less active subjects.

Research is being conducted constantly and is often shared online.

Article Provided By:
Cathy Parkinson, CQSW
United Methodist Retirement Center 
503-585-6511

Faith Community Nurses Are Here To Help

Chances are that you have never heard of a Faith Community Nurse, but there are growing numbers of them in your community.

A Faith Community Nurse (FCN) is a registered nurse who works out of a faith community, such as a church, synagogue or mosque. There are more than 15,000 Faith Community Nurses (also called “Parish Nurses”) across the country, and in more than 2 dozen countries around the world. Each of these nurses brings years of experience working in healthcare before completing additional study to work in this specialty practice.

If you are involved with a congregation that already has a Faith Community Nurse, you may not know the variety of roles that a FNC has provide, such as health education, health counseling, resource referral, and healthcare navigation, just to name a few. Many of the health services offered through faith communities are open to all, such as health screenings, health fairs, and wellness classes, such as “Living Well with Chronic Illness.” Some congregations also offer free health clinics (such as the Salem Alliance Church).

Many people have found Faith Community Nurses extremely helpful with their own health and wellness concerns, while others have benefitted from their help with senior parents. One woman, who lived 1500 miles away from her father, wrote of the FCN in his congregation, “Ellen perceptively listened to Dad’s complaints, queried his doctors, and shared her observations about him with me on the phone and by e-mail. She was invaluable in sharing resources as I built a list of caregivers and services, and advised me well on navigating the insurance system….”

If you are part of a faith community, and would like to know more about getting a Faith Community Nurse program in your congregation, contact Northwest Parish Nurses Ministries at 503-413-4137, visit theirwebsite, or call a faith community near you to inquire about congregations with faith community nurses and programs in your area. We partner with many of the organizations listed in the Retirement Connection guide, and they would also be able to help you locate a congregation with a faith community nursing or health ministry program.

Article provided by:
Deborah L. Patterson
Northwest Parish Nurse Ministries 
503-413-4137

Comparison & Definitions Care At Home

There are so many choices for caregiving services at home. Which one is right for me, my loved one or my client? Let’s define each avenue, looking at the differences to help you determine the best fit.

Full Service In-Home Care:

• Licensed Agency; Services not limited with memory loss or dementia;
• Provides non-medical, skilled caregiving, case management & nursing services; Registered Nurse on staff;
• Required to screen, employ & supervise caregiver;
• Cost based on services provided; comparable at non-medical level;
• The most comprehensive package of services;

Non-Medical In-Home Care:

• Licensed Agency; Limited to non-medical services;
• Restricted: medication reminders or assistance to oriented client only;
• No skilled services provided; No Nurse on staff;
• Required to screen, employ & supervise caregiver;
• Cost comparable at non-medical level.

Caregiver Registry:

• Licensed Caregiver Registry Agency;
• Screens & verifies competency of caregivers;
• Does not employ or supervise caregiver, client takes on employer responsibilities & risks;
• No skilled care, case management or nursing services;
• Cost Registry Fee + Caregiver Cost; comparable-higher at non-medical level;

Case Management Company:

• Not Licensed to provide caregiving or nursing services;
• Does not employ caregivers, client takes on employer responsibilities & risks;
• Professional Case Manager’s & RN’s supervise, usually $70-110.00/hour;
• Cost Professional fee + Caregiver Cost; comparable-higher at non-medical level;

CEP (Client Employed Provider) Program:

• Not Licensed; Caregiver Registry; State of Oregon; Medicaid;
• Program does not screen, employ or supervise, client takes on employer responsibilities & risks;
• Screens with Criminal Background Check only;
• Operates much like an on-line listing service;

Knowledge is power. Find the best fit for the care of yourself, your loved one or your client.  Further assistance, visit our helpful guide “How to select the right In Home Care for your loved one”

Article Provided by:
Sharon Moore RN
Personal Home Care
503-371-1495